For decades scientists have been searching for a treatment and cure for Alzheimer’s disease and related dementias (ADRD). This research has resulted in some positive outcomes related to understanding the disease processes underlying different forms of dementia, new tools and techniques to diagnose dementia, and the development of a few treatments that can help to maintain function for a time. But currently, we still do not have a cure for dementia, nor do we have treatments that truly hold disease progression at bay.
However, research has yielded very exciting results in the identification of factors that can help to reduce the risk of dementia and possibly slow disease progression. With an eye toward prevention, research in the area of brain health has identified 12 factors that can reduce individual risk for dementia. When proactively addressed over the course of the lifespan, there is a significant reduction in the risk of dementia for the individual. In the words of the Lancet Commission (2020, pg. 1) the group of dementia and brain health experts who have published the most recent findings in the area, “It is never too early and never too late in the life course for dementia prevention. Early-life (younger than 45 years) risks, such as less education, affect cognitive reserve; midlife (45-65 years), and later-life (older than 65 years) risk factors influence reserve and triggering of neuropathological developments. If the 12 identified risks to brain health were consistently addressed over the course of each person’s lifespan, 40% of dementias worldwide might be prevented or delayed.
The 12 brain health risk factors identified by the Lancet Commission take precedence at different times in the lifespan. Listed below are each of the brain health factors and the time of life when they play the greatest role in predicting brain health later in life. The percent reduction in worldwide prevalence of dementia that would be realized by eliminating this risk factor is noted for each factor in parenthesis. A graphic illustration of these risk factors is available here for reference.
Early Life:
Education (7%) – Education is used as a proxy for cognitive stimulation across the entire lifespan. Researchers have found that people who engage in lifelong learning and cognitive stimulation develop stronger neural networks that help to maintain brain health later in life.
Midlife:
Hearing loss (8%)- Minimizing exposure to factors that impair hearing and managing hearing loss if it occurs helps people to remain more socially and cognitively engaged, and in doing so improves brain health.
Traumatic Brain Injury (3%) – Head injuries, such as concussions, can have long term negative effects on brain health and function. Protecting your head by wearing a helmet and avoiding activities that can result in head injury will also help to protect minimize the risk of dementia later in life.
Hypertension (2%)- Heart health and brain health are closely linked. Managing the risk of hypertension and other cardiovascular health issues helps to maintain brain health by ensuring that the brain has the blood and oxygen supply it needs to function optimally. Untreated hypertension is also associated with disease in the small blood vessels of the brain, and this disease process has been demonstrated to be foundational to many forms of dementia.
Excessive alcohol use (1%)- Defined as more than 21 servings/week, routine consumption of too much alcohol damages the brain and sets the stage for various dementias. Alcohol directly affects the function of the brain any time it is consumed, and in excess it can lead to long term impairment of the
brain tissue and cognitive function. Less alcohol is always best, but if you do enjoy a drink now and then, remember that moderation is the key to brain health.
Obesity (1%) – Obesity is associated with higher levels of inflammation in the body and often also affects heart health. Maintaining a healthy weight and eating a healthy diet will help to keep inflammation at bay and ensure that your body has the nutrients needed for lifelong brain health. Scientists agree that the Mediterranean diet is an excellent choice for maintaining weight and brain health.
Late Adulthood:
Smoking (5%) – Smoking is detrimental to health in a variety of ways, and this includes the toll it takes on brain function and integrity. If you smoke, quit. If you have never smoked, don’t start. Staying away from secondhand smoke can also help you to keep your brain healthier.
Depression (4%) – Depression can be an early symptom of depression, and when untreated, may also contribute to developing dementia. Maintaining a positive mood, active lifestyle, and healthy social connections can all help to improve mental health. If you do experience clinical depression, be sure to seek treatment to enhance your well-being and quality of life. Doing so will also enhance long term brain health.
Social Isolation (4%) – Loneliness and social isolation are associated with a broad range of negative health consequences and dementia is one of them. For improvements in general health, mood, and cognitive function, be proactive in connecting with loved ones, participating in community, and being present to those you encounter each day.
Physical Inactivity (2%) – Exercise is good for your heart, good for your body, and good for your brain. The physical benefits of exercise ensure that a strong flow of blood, oxygen and nutrients is delivered to your brain and helps to minimize generalized inflammation. Moreover, exercise contributes to a positive mood and improvements in self-concept. In fact, simply walking everyday has been provide to enhance cognitive function and reduce symptoms of depression.
Air pollution (1%) – Air pollution is one of the newest brain health factors recognized by scientists. While this is not a factor that people have direct control over, it is worth noting that those who live in areas of higher air pollution are at a greater risk for dementia. This fact is one more good reason to advocate for clean air for all.
Diabetes (1%) – Like other heart health factors, diabetes takes a toll on brain health. In particular, diabetes that is poorly controlled can impair the integrity of the small vessels of the brain, impeding blood flow and diminishing the structural strength and function of the brain. Eating a healthy diet, treating diabetes if you are diagnosed with it, and staying physically active will minimize the potential impact of diabetes on your brain health.
The factors listed here account for 40% of the total risk for dementia. The remaining 60% of risk is associated with unknown factors. This may include individualized lifestyle factors, genetics, and/or other environmental toxins. While many people think genetic predisposition is the primary contributor to the risk of developing dementia, across the general population, genetic risk is thought to account for 25% of less than the total risk. Therefore, the 40% risk that we can control with our lifestyle choices may compensate for and/or even diminish the impact of any genetic risk that is beyond our control.
For those concerned about the impact of dementia on a personal and public level, brain health interventions are the key to turning the tide. Not only can the adoption of healthy lifestyle choices reduce personal risk for dementia, but when approached as a public health issue, reducing the factors that challenge brain health can dramatically decrease the global prevalence of dementia. In fact, if the overall risk associated with these 12 factors were reduced by just 10%, the prevalence of people living with dementia could be reduced by over 1 million cases worldwide.
For those already living with dementia, there is also scientific evidence suggesting that healthy lifestyle choices may help to slow progression and/or preserve function. Moreover, healthy lifestyle choices related to all the factors noted will also help to improve overall health and quality of life for those living with dementia.
Preventative, proactive efforts to adopt healthy lifestyle choices is our best hope right now for improving brain health and reducing the risk of developing dementia. As we continue to learn about the brain and the underlying causes of dementia, it is important that we draw upon the clear and exciting evidence pointing us toward reducing personal risk and worldwide prevalence of dementia. Doing so is good for each of us and all of us.
Information contained in this article is summarized from the following source:
Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, Brayne C, Burns A, Cohen- Mansfield J, Cooper C, Costafreda SG, Dias A, Fox N, Gitlin LN, Howard R, Kales HC, Kivimäki M, Larson EB, Ogunniyi A, Orgeta V, Ritchie K, Rockwood K, Sampson EL, Samus Q, Schneider LS, Selbæk G, Teri L, Mukadam N. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020 Aug 8;396(10248):413-446. doi: 10.1016/S0140-6736(20)30367-6.
For additional reading about Brain Health, consider this resource:
Center for Disease Control National Brain Health Initiative Road Map Series:
https://www.cdc.gov/aging/healthybrain/roadmap.htm
Written by:
Kelly O’Shea Carney, Phd, ABPP
Board Certified Geropsychologist
Chair of Dementia Friendly Lehigh Valley Steering Committee