Abstract
It is now well known that conditions that compromise cognitive abilities will play an increasingly important role in individual and population health in the decades to come. Approximately thirty percent of individuals over the age of 80, residing in western countries will exhibit some degree of dementia. Whether it is Alzheimer’s disease, vascular dementia, a combination of both or the less common causes as those associated with Parkinson’s Disease, Fronto-Temporal dementia or Lewy Body Disease, the statistics are astounding. Approaches thus far have focused at great deal on medications to decrease the risk by attacking the neuro-transmitter mechanism or the development of TAU proteins. There is a growing body of evidence that strongly implicates life-style changes may be as important as pharmacologic interventions to turn the tide of the deluge of dementia across the world.
Key Words: dementia, lifestyle, Alzheimer’s disease, vascular dementia, fronto-temporal dementia, lewy body disease, pharmacologic interventions.

Case Study
Mr. CF was a 73-year-old president of a large and successful building corporation. He was referred by his family physician at the request of his wife because of increasing forgetfulness. He had several co-morbidities including hypertension and hyperlipidemia. He minimized his deficits with the commonly expressed, “everyone forgets something once in a while.” While taking his history it became evident that his “social drinking” was in fact approximately 15-16 drinks a week including wine at dinner, beer and wine on the weekends and a few shots of whisky on weekends if there were social engagements. His wife maintained that if for some reason he did not drink on the weekends he was somewhat clearer after the weekend. He dismissed that description.

His physical examination was normal including testing for cerebellar dysfunction. He scored 23 on the MOCA with problems in immediate and late recall and his clock was only a 2 out of 3 with misplacement of the hands. His MRI revealed some microangiopathy but no focal lesions. I explained to him that his score was worrying. I told him that normally I would either have to report him to the Ministry of Transport or do an on-road driving test. I also told him I would not consider anti-cholinesterase inhibitors (donepezil for example) at this point. After much prodding and support from his wife he agreed to the following regiment: Not drive until I see him again, discontinue alcohol altogether (even low-alcohol beer in the meanwhile) and increase his exercise even if only walking as he said he did virtually none at all.