Dementia Aware: what you need to know about reducing dementia risk factors
The world has experienced many epidemics in its history. Most were the result of infectious disease e.g. Spanish flu; they came and then went away. The dementia epidemic is not an infectious disease, and we cannot afford to sit by and wait for it to disappear, because it will not. We must fight it, and the only way to stop an epidemic is prevention (Korczyn & Vakhapova, 2007). To date, there is no cure for dementia, no one single cause of dementia, and no specific diagnostic test to determine who is at risk of dementia. Given this information, our goal is the prevention of dementia; however, a delay in the onset of dementia would also be an effective preventative strategy, since research has indicated that delaying the onset of dementia by just 5 years would half its prevalence.
Dementia Risk Factors
Non -Modifiable Risk Factors:
- Learning disabilities (Down’s Syndrome)
Potentially Modifiable Risk Factors:
- Alcohol: whilst low to moderate alcohol consumption is associated with lower risks of coronary artery disease and ischemic stroke; alcohol intake exceeding current recommended limits increases the risk of dementia e.g. Wernicke’s Korsakoff
- Head Injuries: there is increasing evidence of a link between brain injury and dementia. Recent studies show an increased incidence of dementia, notably Chronic Traumatic Encephalopathy (CTE) in people who sustained multiple concussions
- Physical Inactivity: lack of physical activity has clearly been shown to be a risk factor for cardiovascular disease, and a potential risk for high BP, obesity, and type 2 diabetes
- Smoking: is a risk factor for atherosclerosis and stroke both of which can result in vascular dementia
- Mid-life obesity: an elevated body mass index (BMI) in middle age appears to be an important risk factor for dementia, type 2 diabetes, stroke and heart disease. Therefore, the maintenance of a normal weight is a worthwhile intervention in the prevention of dementia (Gorospe & Dave, 2007)
- Depression: people with depression have two times the risk of dementia (Barnes & Yaff, 2011)
- Mid-life hypertension: hypertension is a well recognised risk factor for stroke and multi infarct dementia and is now a suspected risk factor in Alzheimer’s disease
- Diabetes: hyperglycemia can have a direct toxic effect on neurons causing oxidative stress and accumulation of advanced glycation end products which affect brain tissues. Diabetes may also lead to dementia through ischemic cerebrovascular disease, and can develop in a cluster of vascular risk factors which can constitute metabolic syndrome which is already known to be a predictor of stroke (Yaffe, 2004)
- Hypercholestrolemia: mid-life high cholesterol appears to be a risk factor for dementia, and atherosclerosis is believed to be involved in the development of dementia, notably vascular dementia and Alzheimer’s disease
- Cognitive inactivity: based on the concept of ‘use it’ or ‘lose it’!
The 1st World Health Organization Ministerial Conference on Global Action Against Dementia (2015), identified the following strategies that can potentially reduce the risk of developing dementia and/or delay the onset of dementia:
Risk Reduction Strategies:
- Keep physically activity: exercise for 30mins, 4-5 times per week.
- Lose weight: follow a healthy weight loss plan and exercise program as per your Doctor
- Stop smoking: hypnosis, acupuncture, smoking cessation patches
- Brain training: work out your brain every day: read, computer games, crossword puzzles, take a course, start a new activity. Several observational sturdies have indicated that people who do cognitive stimulation activities, may have a lower risk of cognitive decline and dementia. Furthermore, studies show that regular brain exercises can improve some aspects of memory and thinking particularly for middle age and older people
- Manage diabetes: follow diet plan, maintain weight, exercise, take medications/insulin as prescribed, blood tests as ordered, learn to recognize the early signs of low/high blood sugar, and most importantly, schedule regular follow up visits with your Doctor
- Management of midlife hypertension: limit salt intake, take prescribed medications, stress management techniques, healthy diet, exercise, regular BP checks
- Healthy eating pattern: reduce saturated fat, limit salt and sugar e.g. Mediterranean diet
- Management of cholesterol: take medications as prescribed, exercise, reduce fat intake
- Limit alcohol intake: as per Canadian guidelines, men should have a maximum of 15 drinks per week, whilst women should have a maximum of 10 drinks per week
- Keep socially engaged: meet with friends, go to social events, volunteer
- Protect your brain: wear protective helmets when playing contact sports or an activity that may cause a head injury e.g. cycling, skiing, and follow concussion protocol if injured
Given that all these risk factors are largely correlated, it may be that living a healthy, socially engaged life is the best way to prevent dementia, and that one single factor is insufficient to prevent dementia. Given that 1 in 3 babies born today will develop dementia in their lifetime (Lewis, 2015);
it is never too young to develop good habits, but mid-life (age 40-64) is a good time to start making healthy choices if you are not already doing so.