Seventy year old Mrs. Lansing drew a complete blank as I asked her if she could recall any of the five words I’d given her to remember some 4-5 minutes ago as part of her mental status exam. Inwardly I always wince at those moments. It feels like I’m unintentionally bullying a harassed person into looking the fearful specter of their approaching dementia directly in the eye. Her husband quickly came to her rescue with a small white lie, “That’s alright darlin’, I don’t remember any of them either,” and we all smiled with relief.
Dementia is the common term for a set of symptoms including memory loss, mood changes, and difficulty with communication and reasoning. Modern medicine is trying to replace the term with “major and minor neurocognitive disorder”. Yah, for now let’s stick with the term everyone knows, dementia. There are several types of dementia, with the most common two being Alzheimer’s disease (AD) and vascular dementia (due to atherosclerosis [plaque] on the blood vessels supplying the brain) coming in a close second.
AD currently affects about 5 million Americans. There are a handful of approved prescription medications to treat AD. They delay (but do not stop) the progression of the disease by about 6 to 12 months. This is useful, but far from a cure. Likewise various supplements and vitamin treatments have come and gone over the years. When subjected to careful scrutiny the results have generally been disappointing. The likelihood of AD dramatically increases with age, roughly doubling in likelihood every 5 years after age 65. If one lives to 85 years old the likelihood of having AD is almost 50%.
So can anything be done to prevent it? Of course certain risk factors cannot be altered, such as age, family history and genetics. But at the same time, there is a growing body of research showing that certain lifestyle choices have a substantial impact on whether AD or vascular dementia will indeed show up in your life. Certain treatable maladies contribute to a significant increase in dementia. For example, dementia is:
- 41% higher in smokers
- 39 % higher in people with high blood pressure
- 22% higher among whites who are obese
- 77% higher in diabetics
So obviously there is room for better lifestyle and aggressive treatment of these
conditions to help delay or prevent the onset of dementia. A recent article predicted that substantial improvement in lifestyle factors could reduce the risk for AD (and perhaps even more so vascular dementia) by 50%.
What lifestyle factors can substantially impact the likelihood and/or timing of you or me getting dementia?
- Being a regular exerciser could reduce AD by 21%. A recent study showed 5% greater brain mass retention in active folks vs. inactive. Five percent may not sound like a lot, but when it comes to the brain, it is substantial. A reasonable goal in terms of time and activity would be a 30 minute brisk (3-4 miles per hour) walk or the equivalent 5 days per week.
- Quit smoking
- Avoid excess alcohol. Anything beyond one drink a day in females or two daily in males is associated with increased risk of dementia.
- Stay socially connected and mentally active.
- A heart-healthy diet rich in nuts, seeds, whole fruits and vegetables, olive oil, fish and other low fat meats, and low in sugars and simple carbohydrates is beneficial in reducing vascular dementia.
- Finally, if you have diabetes, cholesterol issues, obesity, or high blood pressure, treating these well can impact the incidence of dementia.
In the end, there is no way to guarantee that you will avoid the scourge of dementia. At the same time, we want to avoid the fatalism that assumes that nothing we do will impact its likelihood or timing. Dementia is a grim enemy. While more weapons against it are sought, it’s worth using every one that is available to delay or prevent it.
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. He is contracted with some commercial insurance carriers and sees Direct Primary Care patients who do not have insurance, who belong to a cost sharing ministry, or who are on Medicare. He is accepting new patients. You may contact him at 982-0835