Age of reason – minimising the risk of dementia

There is a great deal of emphasis on information that tells us how we can promote a healthy body and extended life expectancy, but there is a comparative lack of information about what we can do to promote a healthy brain. ‘Living longer’ does not need to mean ‘living longer with mental impairment or chronic disease’, and any discussion about healthy ageing needs to consider lifestyle changes we can make to prevent cognitive decline, most typically experienced as dementia or Alzheimer’s disease (AD). While there is currently no cure for dementia or Alzheimer’s, there are many ways we can delay onset, halt progression or potentially avoid cognitive decline by developing some proactive lifestyle strategies.

The terms dementia and Alzheimer’s are often used interchangeably but they are different. Alzheimer’s disease is a brain disease that causes the loss of large numbers of brain cells and is the most common cause of senile dementia, accounting for about 50 percent of all cases. There is a normal decline in cognitive functioning associated with ageing typically referred to as normal forgetfulness, but dementia is not necessarily ageing related and is not a natural part of ageing. Dementias are caused by a marked deterioration of cognitive ability such as memory and recall, reasoning, judgement and the ability to learn new information. They can also be caused by exposure to toxins (alcohol, toxic medications and environmental toxins), brain trauma and infections (such as Lyme disease or AIDS). There are many kinds of dementia such as Lewy body, frontotemporal, vascular and sub-cortical degenerative, and progressive dementias are ultimately fatal as they are usually accompanied by a bodily shutdown. Dementia is usually more of a concern to family and friends than it is to the sufferer who may not have the cognitive capacity to realise something is wrong. Pharmacological medications can provide some symptom relief, but there are a great many adjuvant integrative therapies that can be embraced to improve prognosis and help with the symptoms experienced.

As world populations age, there is a corresponding increase in dementia incidence and it is estimated that by 2025 there will be over 50 million people worldwide experiencing the effects of cognitive decline. The prevalence of dementia in Australia is expected to increase fourfold by the year 2050. Family history and genetic factors play a part in increasing risk. Research has also found that dementia affects twice as many women as men overall and incidence increases in all people in successive age brackets. For example in Australia, the incidence of dementia in all people under 65 is one percent, between 70-79 years of age incidence for men is 5.6 percent and women six percent, and between 85-89 years the incidence rate for men is 12.8 percent and women, 20.2 percent. In Australia, approximately 10 people a day suffer from a brain injury as a result of an assault and injuries of this nature can be an additional risk factor. It is interesting to note that incidence rates for dementia vary cross-culturally, with higher rates in Western countries. This poses a very good rationale for the importance of diet and other lifestyle factors in the management of dementia onset.

The spectrum of symptoms in dementia Cognitive symptoms may include memory impairment (including prospective, remote, working and recent memory), word-finding deficit, executive dysfunction (the mental process that connects the past to the present), visuospatial problems (assessing objects and space), apraxia (difficulty with controlled, meaningful movement and communication), delirium and language impairment.

Physical and emotional symptoms may include personality change, aggression, depression and anxiety, agitation, paranoia and delusions, wandering, sleep disturbances and weight loss.

What increases cognitive decline? Loneliness – A lonely person has almost twice the risk of developing dementia compared to someone who is not lonely according to a recent study. Social isolation in old age is a significant problem in our population. Pets have been proven to decrease agitation and increase socialisation, and great success has been experienced when dogs have been introduced to aged residential care facilities.

Personality – High levels of neuroticism may be linked to dementia. Researchers found that positivity, easy-goingness, adaptability and a sense of spirituality helped lower the risk of cognitive decline.

Stress – Research has shown that stress can destroy memory cells in the hippocampal area of the brain. The likely mechanism is thought to be due to the increase in cortisol that stress creates.

Poor diets and sedentary lifestyles – A lack of fruit and vegetables, high saturated fat intake and the lack of regular exercise all increase the risk of dementia, and also contribute to all other chronic diseases. Foods with a high glycaemic index, such as sugar, are bad for the brain because they keep insulin levels high. (See Diabetes article in The Adelaide Review, June 2012).

Sunshine deficiency – Low vitamin D is directly linked to dementia and difficulty in performing cognitive tasks. Anyone working indoors for long periods and especially the elderly, whose living circumstances may keep them confined indoors, will be vitamin D deficient.

Obesity – There is an association between middle-age obesity and the onset of dementia – a Body Mass Index (BMI) greater than 30 can increase dementia risk by as much as 74 percent.

Smoking – Both number of years smoked and number of cigarettes smoked have been found to be associated with a decline in cognitive functioning.

Heavy metal exposure and toxic environments – Exposure to mercury (in teeth amalgams and in large fish), aluminium (for example, in drinking water) or some metals such as copper and zinc have been linked to the accumulation of metal plaques in the brain – a typical cause of Alzheimer’s and dementia. What delays cognitive decline? Brain exercise – Brain training or ‘intensive plasticity-engaging training’ can result in an enhancement of cognitive function. Both participation in formal education and learning multiple languages are linked to delayed cognitive decline. Evidence of positive neurobiological changes suggests that engaging in mentally stimulating activities – a new course, puzzles/Sudoku and the like, can be effective in not only maintaining but also improving cognitive function. Keep learning, keep memorising and keep using your brain. People with a tertiary level education have a decreased risk.

Regular general exercise – Exercise more than three times a week and enjoy a significantly reduced incidence rate for dementia and effectively delay its onset. Tests have shown memory function is greater in those who exercise regularly. Long term Tai Chi exercise may be of particular benefit in delaying cognitive decline. Dancing, in addition to being great fun, can also enhance left and right brain communication.

Relax, sleep well and enjoy quality of life – Meditation has many health benefits and there is evidence that it helps slow age-related decline in specific cortical regions of the brain. Physical and emotional therapies that reduce stress and anxiety enhance quality of life and cognitive functioning. They can be highly useful for offsetting agitation in dementia sufferers, but should also be considered part of a healthy life design. Quality sleep is critical to good health generally and melatonin has shown promising results for those with cognitive decline, which often causes restless nights. Spend quality time with friends in quality activities and enjoy the health benefits.

Diet and nutrition – Foods such as fish, fresh fruit and vegetables (especially blueberries and cherries), wholegrains, tea, red wine as well as dark chocolate are beneficial. Recently the New England Journal of Medicine (the USA’s leading medical journal) reported a correlation between a country’s level of chocolate consumption and its total number of Nobel laureates per capita! Cognitive function is enhanced by vitamins and minerals such as the B Group vitamins (especially B6 and B12), folate, magnesium and Coenzyme Q10. Fish oil and olive oil are also proving to assist in cognitive functioning and diets rich in Essential Fatty Acids (EFAs) are desirable. The antioxidant vitamins C and E, which scavenge free radicals, are also being found to be helpful for cognitive functioning with a possible protective effect.

Enjoy a drink – Smaller amounts of alcohol in early adult life may be protective against developing dementia, but be cautious, larger amounts of alcohol are directly associated with cognitive decline and one of the major risk behaviours. (The same study found that abstinence from alcohol also increased the risk of dementia, so mild to moderate consumption is the key.)

Brainy herbs – Thousands of years of use have indicated some herbs can be beneficial in delaying cognitive decline and further research on such herbs is warranted. In India, where turmeric is regularly consumed, the incidence of dementia in men 70-79 years old is 4.4 times less than in the US. Gingko Biloba may be useful for those in mild/moderate states of decline and also has positive effects on mood and daily living. The anti-inflammatory and antioxidating effects of herbs such as brahmi, sage and ginseng may be useful as they can create optimal conditions in the body and support efficient brain functioning.

Cognitive decline need not be an inevitable nor reasonable part of ageing if we are proactive in other stages of our lifetime and do what we can to sustain a healthy brain. This can be achieved readily by doing more of what is good for the brain, and less of what is bad. Mental agility and life enjoyment can be increased along with our increase in life expectancy. The proof is readily available in the lifestyles of many traditional yet present day cultures, such as Okinawa in Japan, where living well, and to the age of 100 years and beyond is normal!

Professor Avni Sali is Founding Director of the National Institute of Integrative Medicine (NIIM) niim.com.au