Alzheimer’s disease is a dreaded word that can evoke the same heart-gripping terror as the word cancer. Alzheimer’s disease is only one of many causes of dementia, albeit the most common. Other causes include strokes, Parkinson’s disease, HIV, and syphilis.
Many fear dementia as an inevitable consequence of aging, which it most definitely is not.
Dementia is a broad term that describes progressive, persistent impairment of intellectual capacity resulting from the loss of or damage to neurons (nerve cells) in the brain. It is a brain disease much like emphysema is a lung disease.
One in nine Americans over the age of 65 has Alzheimer’s dementia. That means eight out of nine don’t. Yes, our brains change with age, but age-related changes are not dementia.
In this column, I want to share the key findings of The Lancet Commission on Dementia Prevention, Intervention, and Care: Dementia prevention, intervention, and care: 2024 report of the Lancet Standing Commission - The Lancet
Published in July, this document presents research showing that up to half the cases of dementia worldwide may be preventable. By modifying (i.e. changing) the 14 risk factors they identified, you can protect your brain cells’ health.
Risk factors are not causes and as such should never be used to shame, blame or judge someone suffering from a disease. However, risk factors underlie the development of some diseases, and when modified, can decrease the risk of and possibly delay the onset of a disease.
Knowing there are modifiable risk factors for dementia is good news for individuals and societies. Death and disease are inevitable but delaying both is a cause worth pursuing.
This is particularly true for dementia. To date, drug treatment has had a disappointingly low impact on the disease, and the cost of care is tremendous. The costs are financial and emotional, incurred by the government, health insurers, families, and those with the disease. Most of us have been impacted directly or indirectly.
Population screening tools and interventions for vision, hearing, mental, and social health will be more cost-effective than the painful years of custodial care we see now for this disease.
An encouraging note is that risk modification works even for those with an increased genetic risk for dementia.
Attention all readers: this list applies to you, your children, parents, loved ones, and friends of any age! Here are the 14 modifiable risk factors in “relative” order or their ability to reduce risk:
1. Hearing loss
The more severe the hearing loss, the higher the risk of dementia. 20% of people worldwide suffer from hearing loss. Treatment of hearing loss, with hearing aids and other treatments, can make a big impact.
DO: If people close to you point out that you are not hearing them, instead of using defense and denial, get your hearing tested and treated if impaired. It will protect your brain as well as your relationships.
2. Elevated LDL cholesterol > 120 mg/l increases dementia risk, and more so if HDL is low. Higher HDL seems to be protective.
LDL = low density lipoprotein or “bad” cholesterol; HDL – high density or “good” cholesterol.
What to DO: that is not clear. It has not been proven that statins prevent dementia. Stay tuned for more science.
3. Education early in life and a long duration of education protect the brain from dementia and cognitive decline.
DO: use your mind, also known as cognitive activity. Okay, crossword puzzles count. Even with little education, using your mind makes a difference in midlife (ages 18-65).
Parents, send your kids to preschool and support them in finishing high school and pursuing higher education. It is good for their brains long term, unlike playing football…keep reading.
4. Social isolation or infrequent social contact in later life is a dementia risk. This is defined as living alone, seeing family or friends less than once a month, and not participating in group activities at least once a week.
DO: If someone you care about is socially isolated, encourage them to connect. Total independence is not healthy for our brains.
My 92-year-old mother is fortunate to live in a continuous care community in Colorado. Every visit, I observe the value of the abundant social connections that the residents have built into their living situation. Our local senior centers provide these services, too, and at little to no cost. Also, see related story.
5. Air pollution is a risk factor for dementia, and improved air quality is linked with improved cognition and reduction of dementia risk.
DO: Air pollution is a risk factor that would be difficult for an individual to modify. Improving air quality depends on public policy and regulation. Vote for your health!
6. Traumatic brain injury (TBI) from any cause poses a risk for dementia. TBI prevention at any age will reduce risk.
DO: Parents, think about the contact sports your kids are playing and how their coaches are reducing risk. Wear head protection when at risk (work environments, bicycling, and motorcycling). Avoid further injury immediately after TBI. An injured brain, like any other organ, needs time to heal before being ready to tolerate additional stress.
7. Depression is a bi-directional risk factor. This means depression can be a sign of evolving dementia, a reaction to dementia, or a cause.
DO: Treatment of depression (with any modality that helps) is important for both quality of life and reducing dementia risk.
8. Smoking especially in mid-life and starting smoking early in life (ages 33-44) increases dementia risk. Ex-smokers have a lower risk than current smokers.
DO: Quit! This is a risk reduction strategy for dementia, heart disease, stroke, and cancer. One, albeit difficult, behavior change reduces so much disease risk! Tobacco use is highly addictive. Keep trying to quit because eventually, you will succeed.
9. Hypertension = high blood pressure
DO: Maintain systolic (the top number) under 130 after age 40. Trust treatment with your doctor or advanced care practitioner who deals with this regularly. Lower your blood pressure, lower your risk.
10. Diabetes is a midlife risk
DO: improve control and/or lower your risk for developing diabetes, a topic too complex for this column.
11. Physical inactivity is an independent risk factor
DO: Get physically active, strong, and flexible, and your brain will do so, as well. Anything you do to move is better than nothing. Exercise at any age improves cognition.
12. Untreated visual loss is one of the newest risk factors discovered for dementia. A United States study showed that cataract surgery reduced dementia risk.
DO: Take care of your eyes and vision. Get them checked regularly and do what is needed to maintain your vision with corrective lenses, surgery, or medication.
13 Obesity in midlife is associated with dementia. Intentional weight loss of as little as five pounds has been shown to improve brain function. For more on this topic, please see my most recent column.
14. Excessive alcohol consumption (defined by >168 grams*/week of ethanol) increases the risk of dementia. Heavy use increases all-cause dementia risk and is associated with a reduction of grey matter (the thinking and processing cells of your brain).
*168 grams of alcohol calculates to 12 drinks per week. A drink is equivalent to 12 ounces of beer, 5 ounces of wine, or 1 shot of hard liquor.
Reducing your risk of dementia has the potential to give you more years with a healthy brain and body.
Risk reduction can make a difference at any age. It’s never too early or too late to start modifying any of these risk factors. The earlier and longer the better.
See you at the eye clinic, doctor’s office, walking in the park, playing at the lake, the Y, and more… but not at the bar!
Debra L. Glasser, M.D., is a retired internal medicine physician in Olympia. Got a question for her? Write drdebra@theJOLTnews.com
2 comments on this item Please log in to comment by clicking here
Grailking
Great information, thank you!
As elders we should do everything we can to keep ourselves functioning well and being self-reliant for as long as possible.
Tuesday, September 10, 2024 Report this
Snevets
Thank you Dr. Glasser once again for a good article. I will certainly share with my 2 adult children as well.
Thursday, September 12, 2024 Report this