Preventing dementia:

As I approach my midlife years I have become much more interested in things that afflict older people. While 5 years ago I never thought of dementia except something that happens to really old people, I have come to realize that those "very old" people are actually not that old after all. Yes we all have grandparents in their 90s that may not be as sharp as they used to be, but I also see plenty of patients who show signs of dementia as early as their 60 and 70s. And somehow, 60s does not sound so old anymore! I also know that I am not alone. Many of you in your 40-50s have asked me about your risk of dementia and how to prevent it. So, for you and me, here it is.

Common Causes of Dementia

Dementia is not a single disease, but an umbrella term for a range of medical conditions caused by abnormal brain changes. These changes lead to a decline in cognitive skills which can include memory, speech, reasoning and executive funcitoning. As we age it is normal to forget minor things like the name of the doctor you just met or what you had for dinner three nights ago. True dementia is a more pronounced loss of memory that gradually gets worse and starts to interfere with your daily life. In most cases, family members notice a dramatic change.

The most common causes include:

• Alzheimer’s Disease: Accountable for up to 80% of cases, it involves the buildup of plaques and tangles that damage brain cells.

  • Autosomal dominant familial Alzheimer's disease represents less than 1-5% of all cases and is caused by rare, highly penetrant mutations in three genes: APP, PSEN1, and PSEN2. These mutations virtually guarantee early-onset AD (typically before age 60-65), sometimes with onset as early as the 20s or 30s. If your parent has this gene, you have a 50% chance of getting in. This is a very rare form, and in my 15 years of practie I have actually never seen one.

    The remaining 95% of cases are sporadic late-onset AD. While twin studies demonstrate 58-79% heritability for late-onset disease, this does not mean the disease is "inherited" in the traditional sense. Instead, risk is determined by the combined effects of multiple common genetic variants, each contributing small individual effects, plus environmental and lifestyle factors. So, what this means is that although there are genetic components, but environmental factors also play a significant role. If your parnets or siblings have Alzhemers, you are more at risk, but you are not gauranteed to get it. Just like diabetes and heart disease. By making smart lifestyle choices you can reduce your over all risk by 50-70%.

    
    
  
  

• Vascular Dementia: Resulting from conditions that block or reduce blood flow to the brain, such as stroke or chronic high blood pressure. These can occur suddenly after a stroke or more gradually due to persistently elevated blood pressures.

Alzheimer's dementia presents with mostly memory and recall issues. The brain can not form new memory. The grandparent that keeps telling the same story over and over or does not remember recent events or encounters. Vascular dementia can present with various sympotms, dependinhg on the area of the brain affected. But the most common presneting symptom is word finding difficulties. Patients know the word, the memory is formed, but they have a hard time recalling it. Once prompted, they remember it.

There is also some evdidence suggesting that as we age, our brain may have a component of both vascular and alzheimer's demnetia.

Less common causes of dementia inlcude:

• Lewy Body Dementia: Caused by abnormal protein deposits called Lewy bodies that affect thinking, movement, and mood.

• Frontotemporal Dementia: Involves the loss of nerve cells in the frontal and temporal lobes, often affecting personality and behavior.

• Other medical conditions: some medical conditions can affect our mood and memory, but these are reversible and once the underlying condition is corrected, memory recovers. The most common conditions include:

  • Low thyroid

  • Depresison (very common among elderly patients)

  • Urinary Tract infections

  • Malnutrtition and vitamin deficincies, which are very rare in our communities.

How to Lower Your Risk in Midlife:

Research suggests that nearly 45% of dementia cases may be prevented or delayed by addressing "modifiable" risk factors. Your 40s and 50s are the most impactful years to make these changes. These modifiable risk factors are essentially the same things that we always address for overall better health with some additions.

• Manage Midlife Health Conditions: Probably one of the most important risk factor is persistently untreated high blood pressure. Unfortuanelty hypertension is usually a silent disease, so unless you see your doctor or monitor it at home, you may not be aware of your elevated pressures. I have seen many patients in their 60s who tell me they have no medical problems, but they also have not seen a doctor in 20 years. Unfortunatelly, some diseases like hypertension and diabetes may not have any clinical symptoms until it is too late.

• Protect Your Hearing and Vision: Untreated hearing loss can strain the brain and lead to social withdrawal. Using hearing aids if needed has been shown to reduce risk to the level of someone with normal hearing. Similarly, addressing vision loss protects cognitive function.

• Stay Physically Active: Aim for at least 150 minutes of moderate activity weekly, such as brisk walking, swimming, or cycling. Exercise improves blood flow to the brain and reduces chronic inflammation.

• Eat for Brain Health: Prioritize heart-healthy eating plans like the Mediterranean diet which emphasize whole grains, leafy greens, nuts, berries, and healthy fats while limiting red meat and sugar.

• Prioritize Mental and Social Engagement: Brain is like a muscle. You lose it if you dont use it. As long as you work, you are using your brain. But as more and more people live longer than before, they spend a good portion of their time in retirement. So, learn new skills, pick up a challenging hobby, and stay socially active with friends and community groups. Cognitive engagement through specific activities appears protective. Adult literacy activities/classes and active mental activities (games, puzzles, chess) show the strongest associations with reduced dementia risk, with 9-11% risk reductions per category increase in participation frequency. Your local library or communty college is a great source for various classes. Some of my patients have even picked up retirement part time jobs that correlate with their hobbies (working at HomeDepot or local hardware store for a retired handyman, volunteering as a mentor for the retired lawyer and business owner). Sadly reading books and watching TV does not count as mental activity. So, get off the couch.

• Improve Sleep Quality: Aim for 7–8 hours of uninterrupted rest. High-quality sleep is essential for brain health.

  
  

And since I know I will get some emails about which vitamins and supplements will help boost your brain health, let me bust your bubble right now: studies have faild to show any correlation or causation with one particular vitamin or suppplement for better memory. Unfortunately, as of today there are also no FDA approved pills that lower the risk of developing dementia or slow the progression once dementia starts. As with overall health, brain health is a hollistic approach that depends on various factors. So, ditch the pills and focus on:

• high quality food with lots of fruits and vegetables

• physical activity

• mental activity

• social engamenet

• high quality sleep