The Battle Against Dementia
So I’ll be honest with you, dementia scares the shit out of me. Aging brings a lot of changes and not a few hardships. I can deal with the gray receding hair, wrinkles, and reading glasses but I can’t get comfortable with the potential of dementia. Recently my wife and I toured an assisted living facility looking for a place for my father in law. The tour hostess decided to cut through the ‘memory care” unit. All we did was walk through. It was clean and neat, but then I gazed at the local population and it quickly became very unsettling. I pondered my feelings after the event, and made a conscious decision to do everything in my power to not end up in such a place. As I began to research this piece it became clear to me that there are many interventions or hacks that significantly reduce the risk. Here are some tips for successful aging by limiting the risk of dementia.
According to the Centers for Disease Control dementia is the impaired ability to remember, think, or make decisions that interferes with doing everyday activities. Current estimates are that 7 million Americans have dementia symptoms. It is not a single disease but rather a grouping of diseases that affect the mind in a similar fashion. Alzheimer’s is the most common form, accounting for 60-80% of cases. There are vascular, mixed, and genetic causes among others. Interestingly genetic causes are very rare, amounting to less than 1% of cases. This means that for the vast majority of us with affected parents or family that our risk of genetically programmed disease is low. Put another way, just because our parents suffered dementia doesn’t mean that we will develop the disease. According to the Mayo Clinic the problems of dementia can be divided into cognitive and psychiatric buckets. Cognitive changes include:
Memory loss
Problems finding words
Visual/spatial problems -getting lost
Problems with reasoning or problem solving
Difficulty planning or organizing
Problems with coordinated movement
Confusion, Disorientation
Psychiatric changes include:
Personality changes
Depression
Anxiety
Agitation
Inappropriate Behavior
Suspicion, paranoia
Dementia has a profound effect on families and caregivers. The burden of care can be enormous in terms of time, emotions, and money. Now that we’ve defined the disease and its impact, we can move along to focus on prevention.
Neurocognitive resilience is the key to protection. Unfortunately, aging is the single biggest risk factor in the development of dementia. Fortunately there are many ways to build our defenses:
Excercise. Moving in any form is great prevention. Walking, swimming, pickle ball, strength training or whatever gets you off the couch. Three sessions per week reduces risk but the more the better.
Diet. Adopt a Mediterranean diet. Consider the MIND diet.This is so important that I’ll address it in detail below
Increase social activity. Interestingly social interactions stress our brains and improve its function more than most alleged “brain training” activities. Get out in the world with people
Reduce vascular risk. Treat or prevent diabetes and high blood pressure.
Stay mentally active. Try sudoku, crosswords, or wordle. It’s probably important to train the brain in multiple skills rather than only doing one activity repetitively.
Treat hearing problems. Get your hearing tested. Get a hearing aid if you need one. If you can’t hear conversations, that leads to social isolation.
Stop tobacco. Blood vessel damage is one of the key contributing causes to many cases of dementia. Tobacco is a leading preventable cause of blood vessel damage.
Stop drinking alcohol. Alcohol even in small doses kills neurons ( the cells that make up our brain). Significant alcohol use is a clear cause of many cases of dementia. It’s probably better if you don’t drink at all, but if you want to continue drinking try to limit your intake to just a few alcohol doses per week.
Lose weight. This works mainly by reducing vascular risk due to diabetes and hypertension. So many of these points are intertwined.
Sleep better. Sleeping well has been shown to reduce dementia risk by 30%. This is a big topic that I’ll address in more detail in future posts.
Avoid head injury. Severe or repetitive head injury is a known risk factor. Wear a helmet. Don’t spar with head contact.
Avoid air pollution. Difficult to accomplish in many areas of the world now. Poor air quality is linked to dementia risk. Consider moving, wearing a mask, or avoiding certain times of the day, or seasons when pollution levels are highest.
This is a big, encompassing list and it may seem daunting to follow all these suggestions. I invite you to personalize a few that may work for you. It only helps if you actually adopt and stick to the modifications.
Diet for dementia prevention is a relatively new idea. In 2015 Morris and Chan found a 53% reduction in Alzheimer’s risk for those individuals in a population study that followed the MIND diet. You read that right. Eating better cuts your risk in half! The positive food recommendations were:
3 servings per day of whole grains
1 serving per day of vegetables
6 servings per week of green leafy vegetables
5 servings per week of nuts
4 servings per week of beans
2 servings per week of berries
2 servings per week of poultry
1 serving per week of fish
Olive oil use ( over other oils)
Foods to avoid were:
Pastries and sweets
Red meats
Cheese
Fried foods
Butter
Diet modifications help us age successfully in so many ways. The importance of eating well cannot be overemphasized. As per my recommendations above, you may not want to, or you may not be able to follow all the MIND recommendations. I invite you to think about the list and your current food choices and adopt what works best for you.
There are treatable diseases that can mimic dementia. If you begin to experience some of the symptoms outlined above, a medical work up is important. Treatable causes to check for include depression, certain medication use (diphenhydramine, oxybutynin), thyroid abnormalities, vitamin deficiencies (D,B6,B12,folate) and alcohol abuse. Either an internist or neurologist can be helpful for these types of evaluation. Treatments for dementia exist, but most are limited to slowing disease progression rather than reversing damage. This is the reason prevention is so important! What’s lost is lost forever. It’s best to build a massive reserve of neurocognitive resilience in order to fight the battle.
So much of successful aging involves healthspan over lifespan. Most would prefer not to live a long time in a memory care facility. It’s better to live a healthy, vibrant life right up to the day we shuffle off this mortal coil. Avoiding dementia is a key piece toward this better path. I hope that you will take the time to think about this post, then adopt what personally fits your quest.