Innovative Approaches to Prevent Dementia
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In today’s world, people tend to be more concerned than ever about staying healthy as they grow older. Perhaps thanks to social media, there is a lot more access to information on topics such as how to maintain a healthy heart or lose some extra pounds. However, there seems to be a need for education on how to take care of one aspect of our health: our cognition.
According to scientists, it is normal for older people to exhibit certain cognitive changes such as slower processing and having difficulties learning new things (Murman, 2015, p. 119). However, some people develop severe cognitive impairment, which greatly impacts their lives and their families.
This is called dementia, and it affects approximately 5.8 million Americans aged 65 and older today, with projections of 13.8 million by mid-century (“2020 Alzheimer’s Disease Facts and Figures,” 2020, p. 445).
Considering these numbers, it is important to inform ourselves about the different ways to lower our risk of developing dementia so that we can enjoy life to the fullest for the rest of our days.
What is Dementia?
According to the World Health Organization (2020), dementia is a syndrome characterized by the deterioration of several cognitive functions such as memory, thinking, and behavior that affects a person’s ability to perform their everyday activities.
It is relevant to point out that it is a syndrome because dementia is not homogeneous. There are many types of dementia, with different causes but with a similar clinical presentation.
Alzheimer’s Disease is the most common type of dementia, but others include vascular dementia and dementia with Lewy bodies.
Since it is the most common type of dementia, Alzheimer’s Disease is the subject of many studies. Unfortunately, most cases appear to have a sporadic origin, making it difficult to predict and prevent it.
However, recent studies have suggested that certain factors may have a role in its development by accelerating the course of the disease. (Edwards III et al., 2019, p. 1).
A special focus has been put on cerebrovascular disease (stroke) as a strong risk factor for dementia (Kuźma et al., 2018, p. 1424). The importance of this connection lies in the possibility of reducing the risk of dementia by targeting the modifiable risk factors for cerebrovascular disease.
Know Your Risk
Can You Prevent Dementia?
In 2020, the Lancet Commission on dementia prevention, intervention, and care published a list of 12 potentially modifiable risk factors that seemingly account for 40% of worldwide dementias.
These factors included less education, hearing loss, traumatic brain injury, hypertension, excessive alcohol consumption, obesity, smoking, depression, social isolation, physical inactivity, diabetes, and air pollution (Livingston et al., 2020, p. 431).
Almost half of these are also risk factors for cerebrovascular disease. However, other factors such as hyperlipidemia and diet should also be considered when discussing dementia prevention (Boehme et al., 2017, p. 492). As you can see, like with many other diseases, lifestyle changes are significant and can impact more than one modifiable risk factor.
Source: UW Medicine
The Importance of a Healthy Diet
Eating healthy is probably the most common recommendation for the prevention of most diseases. This does not come as a surprise since our nutrition influences all of the biochemical processes that occur in our bodies.
Hence, the importance of having a balanced diet that provides an adequate amount of nutrients.
Unfortunately, only 1.4% of Americans have an ideal diet, according to the American Heart Association’s dietary guidelines (Virani et al., 2020, p. 78). This reflects the importance of educating people on nutrition and helping them make wiser choices regarding their diets.
Starting a healthy diet can be a daunting task, considering the amount of information (and misinformation) found online. It isn’t easy to discern the best path to follow with so many different diets out there.
Therefore, it is vital to look for diet regimes that have been scientifically proven to provide real benefits, such as the Mediterranean diet.
This regime prioritizes the consumption of whole grains, fruits, vegetables, olive oil, and low-fat dairy while limiting the amount of processed meat and refined carbohydrates (D’Alessandro et al., 2019, p. 1296).
According to many studies, the Mediterranean diet has been linked with better cognitive function and a decreased risk of dementia.
Researchers believe this effect may be due to the increased consumption of polyphenols, antioxidants, flavonoids, and carotenes, among other micronutrients. Furthermore, this diet appears to reduce oxidative stress and inflammation, both related to neurodegenerative diseases like Alzheimer’s Disease (Petersson & Philippou, 2016, p. 895).
Considering that strokes significantly increase the risk of dementia, any interventions destined to decrease the risk of strokes will decrease the risk of dementia.
Such is the case of the DASH (Dietary Approaches to Stop Hypertension) diet.
It was developed in 1997 by the US National Institute of Health to help treat hypertension. Its guidelines are similar to the Mediterranean diet, with high consumption of fruits, vegetables, low-fat dairy foods, whole grain, legumes, and nuts, accompanied by a low intake of sodium, red and processed meats, and sweetened beverages (Feng et al., 2018).
In 2015, researchers at Rush University Medical Center in Chicago, IL, and Harvard School of Public Health in Boston, MA, developed a diet regime that merged the Mediterranean and DASH diets and named it the MIND diet (Mediterranean-DASH Intervention for Neurodegenerative Delay).
These teams did this after some research pointed out the benefits certain foods had over neurocognitive deterioration.
The MIND diet promotes leafy green vegetables, nuts, berries, beans, whole grains, fish, poultry, and olive oil and recommends limiting the intake of red meat, butter, sweets, fast food, and other unhealthy foods. It has shown promise by slowing the progression of cognitive decline (Cremonini et al., 2019, p. 4).
Staying Active
As previously stated, physical inactivity is one of the 12 potentially modifiable risk factors for dementia, according to the Lancet Commission. Therefore, it does not come as a surprise that physical exercise is relevant for the prevention of dementia.
This protective effect is not only the result of improved cardiometabolic health but also due to the direct effects of exercise on our brains. Furthermore, these effects are not limited to youth.
A study on 55-to 80-year-old adults reported an increase in hippocampal size after a one-year trial where subjects walked 40 minutes three times a day (Erickson et al., 2011, p. 3021).
Studies have suggested that physical exercise can help prevent dementia due to an increase in neurogenesis, neuron connections, and blood vessel growth, as well as an increase in grey matter.
Furthermore, exercise can also improve mental health, decreasing the prevalence of depression and preventing social isolation, both on the Lancet Commission’s list of risk factors (Alty et al., 2020, p. 237).
Source: Vital Record
The Role of Cholesterol
High cholesterol has been associated with dementia in several ways. On the one hand, hyperlipidemia is a risk factor for cerebrovascular disease. It has already been discussed that strokes have a detrimental effect on cognitive function and increase the risk of dementia.
On the other hand, according to some researchers, high cholesterol increases the risk of dementia even in the absence of cerebrovascular disease, but these mechanisms have not been completely elucidated (Reitz, 2013, p. 1)
In any event, studies have shown a greater risk of dementia in individuals with high cholesterol in their midlife (Anstey et al., 2017, p. 221).
These findings make it even more important to measure plasma lipids in high-risk individuals. Generally, when patients have high cholesterol, the first level of therapeutic intervention consists of lifestyle changes like the ones indicated in the previous paragraphs.
However, in many cases, these changes are not enough to reach satisfactory cholesterol levels, and doctors must prescribe drugs.
For many years, statins have been used to decrease serum lipids with excellent results. There’s even data suggesting that taking statins decreases the risk of dementia in both men and women (Zhang et al., 2018).
However, some patients cannot control their cholesterol even after taking statins at their maximal doses. Thankfully, in recent years a new class of lipid-lowering drugs has been developed.
PCSK9 inhibitors work by destroying specific cholesterol receptors in the liver, and as a result, they can lower LDL-C levels 50-60% more than statins. Currently, there are two drugs of this class approved by the FDA: Alirocumab and Evolocumab.
They both have specific indications, such as the treatment of family hypercholesterolemia, which is incredibly resistant to conventional treatment (Chaudhary et al., 2017, p. 76). Such potent drugs may be the future of lipid-lowering therapy and may play a role in preventing dementia.
Unfortunately, many mechanisms in the pathogenesis of dementia are still unknown, so precise interventions for preventing dementia still seem far-fetched.
Nevertheless, researchers have identified multiple factors like those described in this article that increase the risk of dementia directly or by leading to cerebrovascular disease.
Currently, the prevention of this disease relies greatly on lifestyle modifications, which can be challenging but very effective and help prevent dementia and other debilitating illnesses such as cardiovascular disease and diabetes.
Healthcare professionals are responsible for teaching patients the importance and effectiveness these changes can have on their lives and futures.
Know Your Risk
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