Importance of early diagnosis
My article last month described dementia, its causes and prevalence, and its tell-tale signs. There is no cure at present for the debilitating and progressive disease. However, its early diagnosis enables us to develop a care plan in coordination with specialists and experts, for a better prognosis and improved quality of life for patients, caregivers, and their loved ones.
Major risk factors for dementia
We don’t yet know how to keep cognitive decline at bay and prevent the onset of dementia-related illnesses – or how to cure them when diagnosed. Researchers have identified the major factors that increase the likelihood (risk) of developing one or more of the degenerative neurological illnesses that lead to dementia: a mix of age, genetics, family history, certain medical conditions, and some modifiable risk factors. Smoking and excessive alcohol use fall in this last category. They could trigger many chronic and severe illnesses, including dementia-related diseases. The impact of race and ethnicity is unclear – ethnicity could influence a racial or ethnic propensity for other illnesses such as metabolic or cardiovascular disease. Exposure to air pollution is known to increase risk, as are prolonged periods of depression.
The role of age and hormones
The greatest known risk factor is age; dementias take time to develop. Two percent of people aged 65 to 69 have dementia, compared to a third of those over 90. Age increases risk because older people likely have other health conditions that increase dementia risk, such as high blood pressure, atherosclerosis, diabetes, and metabolic deficiencies. Women are more likely than men to get dementia simply because they live longer. Some research indicates that levels of hormones during menopause could affect a woman’s risk of dementia, though there is no clear evidence. Clinical trials using hormone replacement therapy have not shown any effect.
Genetic factors
Genetic testing is used in research settings and clinical trials but is not routinely part of clinical protocols to diagnose or predict the risk of developing Alzheimer’s or related dementias. Both ‘familial’ and ‘risk’ genes could increase risk. Although very rare for most types of dementia, familial genes – when present – increase the chances of inheriting dementia to 1 in 2.
Most of the 20 or more risk genes identified increase risk only slightly. The most important risk gene is apolipoprotein E or APOE; it can increase the likelihood of Alzheimer’s – the most common dementia-related disease – by a factor of four. The APOE gene is involved in making a protein that helps carry cholesterol and other types of fat in the bloodstream. Problems in the protein-making process are thought to contribute to the development of Alzheimer’s.
Preventing cognitive decline
The quality of our lives depends on our physical, emotional, and cognitive health. As we age – or watch our loved ones aging – it is natural to ask: can I prevent cognitive decline? Stay healthy and stave off dementia? What can I do to reduce my risk?
“We have a playbook on what you need to do to reduce your dementia risk in terms of modifiable behavior,” says Dr. Peter Attia, a popular physician, bestselling author, podcast host, and expert on the applied science of longevity. He identifies four principal components. The effect of everything else, he says, is “in the noise.” The National Institute of Aging, major medical research centers, and the World Health Organization broadly agree.
Exercise
Exercise is the most powerful tool we have to preserve cognitive function and prevent cognitive decline. Dr. Attia asserts that it is far ahead of all other things we can do, in terms of the magnitude of its impact. It does not matter whether it’s strength training or cardio fitness; both are important, he says. Some studies have shown that engaging in a program of regular exercise improved cognitive function in people who already had memory problems. Regular physical activity also helps lower risk of other conditions such as heart disease or type 2 diabetes that in turn increase dementia risk. Exercise also helps relieve other risk enhancers like insomnia, anxiety, and depression.
Metabolic flexibility
To quote researchers at Stanford’s Van Haren Labs, life is a series of metabolic hurdles, and our health depends on our ability to surmount them. Operating on a strict budget, our metabolism provides all the energy we require. It needs to be flexible, constantly providing energy for essential body functions like breathing, digesting, growing and repairing cells, and regulating body temperature; adjusting to rising and falling energy demand, and the available fuel – the carbohydrates, lipids, and proteins in our food. When demand exceeds supply, the system fails.
An adult’s brain accounts for only ~2% of body weight. It consumes an astounding 20% of our total body energy, to perform daily cognitive tasks in discrete brain regions, and within the networks between anatomically remote brain regions that coordinate with each other by synchronizing their neural activities. Research has quantitatively linked the effectiveness of this functional connectivity to our body’s energy metabolism. Impaired functional connectivity leads to declined cognition and impaired memory.
Dr. Attia tells us that metabolic flexibility and exercise go hand in hand. Individuals with a well-functioning metabolism tend to maintain weight without excessive fluctuations. They have consistent energy levels throughout the day and experience minimal fatigue. Their digestion is efficient, leading to regular bowel movements and optimal nutrient absorption. Diseases like type 2 diabetes drastically increase metabolic inflexibility; the increase in risk for Alzheimer’s for a patient with type 2 diabetes is anywhere between 40 to 100%.
Sleep
The 3rd principal factor, sleep, is not a passive undertaking. It is “an active form of recovery for the brain,” says Dr. Attia. Professor Matt Walker, author of Why We Sleep examined the impact of sleep on human health and disease. “Sleep is a non-negotiable biological necessity,” he says, “It is your life support system.” During deep sleep, our memory systems undergo radical change, integrating new memories, and associating them with our past back catalog of autobiographical memories. Sleep impacts learning, memory and even our genetic codes. Lack of proper deep sleep has adverse impacts on brain function, overall health, and lifespan. Some research findings show that poor sleep may affect the body’s ability to clear the toxic amyloid protein from the brain, increasing the risk of Alzheimer’s disease.
Brain-body activity
Activities that combine brain and body function and involve the use of multiple senses are also among the most important instruments in your cognitive vitality toolkit. Dancing requires you to coordinate your movement with the music you hear as well as with the movement of others. Driving is another activity that needs coordinated brain-body functioning with inputs from multiple senses. Learning a new skill – pottery, painting, scuba diving, or playing a musical instrument falls in this category.
Yes, you can!
Taking care of our physical health, following nutritious heart- and brain-healthy diets, maintaining a healthy body weight, and keeping strong social connections are all important for our physical, mental, and emotional health, and overall well-being.
A research study attributed 41% of dementia cases to modifiable risk factors. Addressing these modifiable risk factors through lifestyle changes can reduce the prevalence of dementia.
Are you ready to act – to improve your cognitive reserve and forestall dementia?