An older man is aided at home in Mamaroneck, N.Y. Dementia takes a huge toll on families and the health system. Maansi Srivastava/The New York Times

Dementia in US expected to surge

Yearly cases set to double to 1 million by 2060, data shows

BY PAM BELLUCK THE NEW YORK TIMES

The number of people in the United States who develop dementia each year will double over the next 35 years to about 1 million annually by 2060, a new study estimates, and the number of new cases per year among Black Americans will triple.

The increase will primarily be due to the growing aging population, as many Americans are living longer than previous generations. By 2060, some of the youngest baby boomers will be in their 90s and many millennials will be in their 70s. Older age is the biggest risk factor for dementia. The study found that the vast majority of dementia risk occurred after age 75, increasing further as people reached age 95.

The study, published Monday in Nature Medicine, found that adults older than 55 hada 42% lifetime risk of developing dementia. That is considerably higher than previous lifetime risk estimates, a result the authors attributed to updated information about Americans’ health and longevity and the fact that their study population was more diverse than that of previous studies, which have had primarily white participants.

Some experts said the new lifetime risk estimate and projected increase in yearly casescould be overly high, but they agreed that dementia cases would soar in the coming decades.

“Even if the rate is significantly lower than that, we’re still going to have a big increase in the number of people and the family and societal burden of dementia because of just the growth in the number of older people, both in the United States and around the world,” said Dr. Kenneth Langa, a professor of medicine at the Universityof Michigan, who has researched dementia risk and was not involved in the new study.

Dementia already takes an enormous toll on American families and the country’s health care system. More than 6 million Americans have dementia, nearly 10% ofpeople 65 and older, research has found. Experts say that each year in the United States, dementia causes more than 100,000 deaths and accounts for more than $600 billion in caregiving and other costs.

If the new projections are borne out, there will be about 12 million Americans with dementia in 2060, said Dr. Josef Coresh, director of the Optimal Aging Institute at NewYork University’s Grossman School of Medicine and a leader of the study, which involved about 100 researchers at 10 universities.

The study reinforces the urgency of trying to prevent or slow the onset of dementia, the authors and other experts said. Their major recommendations are to improve people’s cardiovascular health with medication and lifestyle changes; increase efforts to prevent and treat strokes, which can lead to dementia; and encourage people towear hearing aids, which appear to help forestall dementia by allowing people to be more social and cognitively engaged.

“One needs to see the huge magnitude of the issue,” said Alexa Beiser, a professor ofbiostatistics at Boston University School of Public Health, who was not involved in the new study but evaluated it as an independent reviewer for the journal. “It’s enormous,and it’s not equally distributed among people,”

Beiser added, noting that the study found disproportionate risk for Black Americans.

The researchers evaluated more than three decades of data from a long­ running study of the health of people in four communities – in Maryland, Mississippi, Minnesota and North Carolina. About 27% of the 15,000 participants were Black, primarily from Jackson, Mississippi, Coresh said. The analysis, which was funded by the National Institutes of Health, focused on Black and white participants because there were not many participants from other racial and ethnic groups, the authors said.

The study estimated that the number of new annual cases among Black people wouldsurge to about 180,000 in 2060 from about 60,000 in 2020. The main reason for the tripling of new cases in that population is that the percentage of Black Americans living to the oldest ages is growing faster than among white people, Coresh said.

In the study, Black participants also developed dementia at younger average ages than white participants and had higher lifetime risk.

“I don’t know that we fully understand it, but at least some of the contributing factors are that the vascular risk factors are more common,” Coresh said, noting thathypertension, diabetes and high cholesterol increase dementia risk.

Several studies in the United States and globally have found the percentage of dementia cases among older adults has declined in recent years, most likely because of better treatment for cardiovascular problems and a more educated population, since education can improve brain resilience and overall health.

That decrease doesn’t contradict the new study, experts and the authors said, because the study estimated the current level of cumulative dementia risk over people’s lifetimes and projected it forward.

It’s possible that positive changes – healthier behaviors and better treatment for conditions like diabetes and stroke, for example – could lower the rate of risk at any given age in future decades, but the number of new cases each year will still increase from the current number, 514,000, because of the growing population of older people, experts said.

At Heather Glen Senior Living, we strive to provide exceptional memory care services tailored to the unique needs of each resident, but our approach is not just about offering care, it’s also about creating an environment that fosters dignity, comfort and personal growth. Central to this mission is our innovative Memory Care Community, which has been an integral part of Heather Glen Senior Living since it opened in 2016. With our neighborhoods model and highly individualized programming, we are redefining what it means to provide care for individuals with dementia.

Alongside our own efforts, we are proud to support Dementia Friendly Lehigh Valley, a non-profit organization dedicated to educating the community and reducing the stigma associated with dementia. Through thispartnership, we provide both financial support and community-based initiatives that raise awareness about how to interact with and care for individuals living with dementia. Together, we aim to make a real difference for both our residents and their families.

A personal and community-centered approach

Memory Care at Heather Glen Senior Living is not a one-size-fits-all solution, and our team, led by our Memory CareDirector, Jackie Crespo, works tirelessly to ensure that every resident feels seen, understood and supported. A keyaspect of this approach is our commitment to creating a homelike atmosphere by organizing residents into smaller groups we call neighborhoods. Each neighborhood houses up to 10 residents and is designed to provide a moreintimate and quieter living experience. This setup fosters a sense of community and minimizes overstimulation, which can be a significant source of stress for those with dementia.

Unlike some other facilities, our entire staff is trained in dementia care. Every new employee, whether they work in housekeeping, dining services or personal care, completes six hours of dementia-specific training as part of their onboarding process. This training includes learning how to communicate effectively, manage behaviors and meet theunique needs of our residents.

This process is repeated annually to ensure our staff is equipped to handle the changing needs of those in our care.

“Our training is continuously evolving. Each year we go over all of the residents that we have and the behaviors that they’re having, and the training is guided per department,” Jackie explains. “If I’m meeting with the housekeepingteam, it’s going to be very housekeeping driven. We’re going to discuss how to enter their rooms, how to communicate with them, discuss any issues they might be having and put plans into place.”

Every detail in Heather Glen’s Memory Care Community is carefully considered, and every aspect is designed with our residents’ comfort and well-being in mind. Even the brightly colored dining plates—red, orange, and yellow—werespecifically chosen to stimulate appetite based on the psychology of color.

Family involvement and support

At Heather Glen Senior Living, we believe in fostering strong relationships between residents and their families, and Jackie emphasizes that family members are not only welcome but encouraged to stay involved in their loved one’s life each day.

“Oftentimes a family member in our Memory Care Community has my phone number and can reach me anytime, and I encourage my families to reach out to me whenever,” Jackie says. “Since we communicate frequently, our families feel more at ease. It’s also great when we’re doing activities, and I can just take a picture and send it right to their family,and that makes their day!”

For families caring for a loved one with dementia, the emotional toll can be significant, and many are thrust into the role of caregiver without adequate preparation. Jackie is trained as a Savvy Caregiver, so we also offer a six-week course, 2-3 times a year, that provides families with the tools they need to understand dementia and care for theirloved ones effectively. These sessions meet once weekly over a six week time frame and are designed to reduce caregiver burnout by equipping family members with knowledge about dementia progression, behaviors and self-care.

Person-centered programming and activities

Every resident at Heather Glen Senior Living has a life story, and it’s our job to ensure that story continues in a meaningful way within our community. From the moment a resident joins, we work with their family to understand theirinterests, hobbies and life experiences, and this allows us to create personalized activities that engage residents both cognitively and emotionally.

For instance, when a new resident who loved Scrabble moved in, we quickly organized a weekly Scrabble club, whichnow meets every Thursday. Activities like this, based on personal interests, help residents retain a sense of normalcyand connection to their past. Our team has also introduced unique projects, such as woodworking, air hockey andeven a basketball hoop to cater to some of our younger residents.

In addition to that, we also offer outings that cater to various levels of care, such as trips to the Allentown Art Museum for the Art Can program, visits to the fish hatchery, breakfast outings, rides for ice cream and even seeing the Lights in the Parkway Christmas event. We’ve recreated nostalgic games, like Hungry Hungry Hippos, by having residents in wheelchairs use brooms with baskets attached to collect the balls on the ground while our staff enthusiastically guidedthem around. For residents unable to join the carriage ride through the parkway lights at our Heather Glen holiday celebration, we brought the experience to them by setting up a makeshift sleigh over their wheelchairs and recreating the scene in our memory care garden.

One of the most beloved members of our community is Chewy, Jackie’s dog, who visits the Memory Care Communityregularly. Residents light up when Chewy arrives, and he has become an integral part of daily life, bringing comfort and joy, and even helps some residents reminisce about their own pets. Jackie and her team ensure that every resident, regardless of their stage in memory care, has the opportunity to engage in an activity that is safe and meaningful to them—making each day a new adventure.

“The part of my job that I absolutely love is being out with the residents and seeing them enjoying themselves,” Jackieexplains. “Yes, they’re changing, but a lot of times we focus on how much they’ve lost as opposed to how much they retain and can still do.”

Partnership with Dementia Friendly Lehigh Valley

One of the cornerstones of our mission is giving back to the community, and our partnership with Dementia FriendlyLehigh Valley allows us to do just that. As a financial supporter and care partner of this non-profit organization, Heather Glen is committed to helping reduce the stigma surrounding dementia and providing education on how to support individuals living with this condition.

Last year, our team at Heather Glen Senior Living held a successful fundraising event for Dementia Friendly Lehigh Valley, where we matched every dollar raised. After quickly reaching our initial goal of $1,000, we continued ourfundraising efforts and doubled the match to $2,000. This November, we are excited to host another month-long fundraising event in collaboration with Dementia Friendly Lehigh Valley to continue our support for this important cause.

A future of compassionate care

At Heather Glen Senior Living, our focus is on what our residents can do, rather than what they have lost, and we arecontinually evolving to meet the changing needs of our residents, with the goal of providing the highest level of memory care possible. Whether it’s organizing personalized activities, fostering strong family relationships or partnering with organizations like Dementia Friendly Lehigh Valley, Heather Glen Senior Living remains committed to creating an environment where residents thrive.

Our team is always thinking outside the box, finding new ways to enhance the lives of those in our care, and as we look toward the future, our focus remains clear—providing a place where residents feel at home, families feel supported and memory care is delivered with compassion and expertise. For more information about Heather Glen Senior Living or to schedule a visit, give us a call at (610) 841-4478 or fill out our online form today. We’d love to showyou how our unique approach to memory care can make a difference in your loved one’s life.

Kelly O’Shea Carney, PhD, ABPP
Board Certified Geropsychologist
President, Dementia Friendly Lehigh Valley Steering Committee

Historically we have considered dementia to be a concern that pertains primarily to older adults. How often have we heard someone say, “I hope I don’t get dementia someday like my dad (or mom, or friend) did.” These comments convey a sense that dementia may come for us “someday,” but it is not something we need think about or act upon today. Yet, the research on brain health clearly demonstrates that it is never too early and never too late to begin actively supporting the health of your brain.

The reality is that what we do to foster brain health today is likely to have a significant impact on whether or not we develop dementia “someday.” In the most recent Lancet article (Livingston, et. al., 2024) summarizing the current state of brain healt

h research and insights, the number of risk factors for dementia has increased from 12 to 14 and the diminishment of overall risk that results from addressing all these risk factors is estimated to account for 45% of the total risk for dementia. As scientists identify the various lifestyle risk factors for developing dementia, this information provides each of us with the power to make different decisions TODAY that may reduce our risk for cognitive change tomorrow.

The two new risk factors that have been identified are high LDL cholesterol and vision loss. High LDL, or “bad” cholesterol, becomes a risk factor in mid-life and joins many of the other health related risk factors, such as obesity, smoking, drinking too much, lack of exercise, diabetes, and hypertension. Avoiding and/or effectively managing all these health conditions becomes critical to both heart health and brain health in midlife. Vision loss, on the other hand, becomes a factor in brain health later in life. Like hearing loss, vision loss results in diminished cognitive stimulation and can contribute to social isolation and depression, which are also risk factors for dementia.

The reality is that fostering brain health is actually a lifelong process. The opportunity to begin fostering a healthy brain starts when we are very young and engage in learning and education, wear a helmet during sports and activities, and lay the groundwork for healthy eating habits. The opportunity to enhance brain health continues through midlife into the final years of our lives when social isolation, air pollution, and visual acuity help to determine our brain health. In each stage of life, we have the opportunity to reduce risk factors for dementia, and if we fail to address those risk factors, we in fact increase our risk for developing dementia later in life. It is never too early and never too late to think about brain health and to engage in the healthy habits that serve to foster cognitive health and diminish the risk of dementia. The graphic below, which comes from the July 2024 Lancet article referenced above provides an illustration of the multitude of ways we can promote brain health across the lifespan.

Based on this understanding, we can all consider how we might promote an awareness of brain health in our homes and in our communities. We can encourage young family members to eat well, get exercise, and build a solid network of friends, knowing that as they do so they will enjoy better health and wellbeing today and lay the groundwork for a healthy future. We can also take comfort in knowing that if we have not always paid good attention to our health, put off getting those hearing aids or refused to see the eye doctor, it is never too late to change course on these important aspects of brain health. In fact, the research tells us that addressing the factors that diminish brain health can even enhance the function of those who are already living with dementia. For example, exercise, socialization, wearing one’s glasses or hearing aids, managing chronic health conditions, and providing sources of cognitive stimulation are all ways to keep our loved ones living with dementia healthier, happier, and functioning at their maximum potential.

Adopting the lifestyle factors that foster brain health is a lifelong pursuit. When we pay attention to adopting a healthy lifestyle, not only do we reduce our individual risk of developing dementia later in life, but also we contribute to bending the curve on the world-wide prevalence of dementia. Fewer people living with dementia in the years to come is a gift to each of us individually and collectively.

So, remember, it is never too early, and it is never too late to begin addressing the risk factors associated with dementia. We have greater influence on the outcome of our cognitive health than we realized in the past. Today we know that nearly half of the total risk for dementia can be influenced by the choices we make and how we live. Let’s embrace the opportunity to change our futures rather than just hoping for a better outcome “someday.”

Resources:

Livingston, Gill et al. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission, The Lancet, Volume 404, Issue 10452, 572 – 628. https://doi.org/10.1016/S0140-6736(24)01296-0

When Is It Time to Consider a Personal Care Community?

Deciding when it’s time to consider a personal care community for a loved one is never easy. For many families, it’s a decision filled with emotion, uncertainty, and concern. However, as people age and their needs evolve, there may come a time when the level of care they require surpasses what family members or home health aides can provide. Understanding the signs that suggest it’s time to consider a personal care community can help you make a more informed, compassionate decision.

1. Increasing Difficulty with Daily Activities

One of the clearest signs that it may be time to consider a personal care community is when your loved one struggles with activities of daily living (ADLs), such as:

• Dressing
• Bathing
• Eating
• Using the restroom
• Walking or moving around

If your loved one is finding it increasingly hard to perform these basic tasks independently, a personal care community can provide round-the-clock support to ensure they receive the care and assistance they need to maintain a comfortable quality of life.

2. Declining Health and Medical Needs

As people age, they often develop chronic medical conditions that require ongoing management. If your loved one’s health is declining and they have complex medical needs—such as frequent medication changes, specialized treatments, or the need for constant monitoring—a personal care community might be the best option. Personal Care communities provide professional medical staff who are trained to handle medical emergencies, administer medications, and monitor patients’ overall health. 

3. Frequent Falls or Safety Concerns

Safety is a critical factor in determining whether it’s time to consider a personal care community. Frequent falls, injuries, or increased difficulty navigating their home could put your loved one at serious risk. If they’re no longer able to live safely in their current environment, a personal care community offers a secure setting with staff available to assist in case of accidents, minimizing the risk of injury.

4. Caregiver Burnout

Caring for an elderly loved one can be physically and emotionally draining, especially if their needs become more demanding over time. If the primary caregiver—whether it’s you, another family member, or a home health aide—is experiencing caregiver burnout, it may be time to explore other care options. Burnout can lead to stress, exhaustion, and even resentment, which can impact both the caregiver and the individual receiving care. A personal care community can alleviate this pressure by ensuring that professional staff are available to provide care 24/7.

5. Worsening Dementia or Alzheimer’s Symptoms

For individuals with dementia or Alzheimer’s disease, memory loss and cognitive decline can become overwhelming. If your loved one is wandering, becoming easily disoriented, or forgetting essential tasks such as eating, taking medication, or turning off the stove, it may no longer be safe for them to live at home. Personal care communities with specialized memory care support are designed to provide a secure environment for individuals with cognitive impairments, ensuring their safety and well-being.

6. Social Isolation

Aging adults may experience increased loneliness and isolation, especially if they live alone or have limited social interaction. This isolation can lead to depression, anxiety, and a decline in mental health. Personal care communities offer a community-based setting where residents have access to social activities, group meals, and opportunities to interact with others. This sense of community can help improve their emotional well-being and provide a sense of belonging.

7. Inability to Manage Finances or Household Responsibilities

As we age, managing household responsibilities like paying bills, cleaning, grocery shopping, and maintaining the home can become overwhelming. If your loved one is struggling to keep up with these tasks or has lost track of their finances, it may be time to consider a personal care community where they can focus on their health and well-being rather than worry about managing a household.

8. Frequent Hospitalizations or Medical Emergencies

If your loved one has been hospitalized multiple times due to falls, infections, or other health concerns, it could indicate that they need a higher level of care than what can be provided at home. Personal care communities have medical staff on hand to address emergencies quickly and prevent hospital readmissions.

9. Family Conflict Over Care Decisions

When family members disagree on how best to care for a loved one, it can lead to conflict and tension. If family members are unable to agree on the type or amount of care needed, or if everyone is feeling overwhelmed by the situation, a personal care community might offer a solution. A personal care community can provide professional, impartial care, which can reduce the strain on family relationships.

10. Your Loved One Expresses a Desire for More Care

Sometimes, the individual needing care will express that they no longer feel comfortable living at home or want more assistance. If your loved one is voicing concerns about their ability to care for themselves or is open to the idea of moving into a personal care community, it’s important to listen to their wishes. Respecting their autonomy and understanding their needs can guide you in making the best decision for their care.

Deciding when it’s time to consider a personal care community is a deeply personal choice, and it’s not one to be made lightly. It’s important to evaluate your loved one’s physical, emotional, and social needs, as well as your own ability to provide care. While the decision can be challenging, personal care community provide a safe and supportive environment where your loved one can receive the attention, medical care, and social interaction they need to live a comfortable and fulfilling life.

Sensory Supported Aromatherapy for Individuals Living with Dementia at Lehigh Commons Senior Living, Macungie PA

Gradual decline across the five senses (visual, auditory, kinesthetic, olfactory, and gustatory) is often part of normal aging and can lead to loss of independence, social isolation, disorientation and confusion, safety risks, and other adverse outcomes. However, sensory change is also specific to cognitive impairment. Older persons living with dementia are particularly vulnerable to sensory deficits, which can reduce their capacity to interpret and manage the demands of their environment. Supportive sensory practices with basic care practices can help reduce confusion and enhance orientation.

The support across the five senses can be greatly essential for individuals living with dementia. There are a wide range of techniques available to correct sensory imbalances, increase alertness, reduce anxiety and agitation, and enhance quality of life. Aromatherapy has been noted to be one of those evaluated sensory techniques.

There has been a long history of using essential oils, plants and herbal therapy for its restorative properties for mind, body and spirit.

Some essential oils, such as chamomile, can help reduce stress, anxiety, and depression. Used for brain health, Rosemary essential oil may help protect the brain from chronic anticholinesterase diseases such as Alzheimer’s. The aroma of sweet orange has the ability to boost mood. The use of essential oils can be endless with homeopathic benefits.

To assist with promoting life enrichment programming and fostering well-being  utilizing the five senses, we have introduced Aromatherapy with the use of  warm towels. The administration of scented oils via heated towels to induce a calm and positive effect. Social and physical contact can be a key therapeutic element in aromatherapy practices that is well-accepted by recipients with no harmful effects.

The sense of scent combined with the sense of touch can reach the innermost parts of the person. When fear, agitation, restlessness or anxiety is elevated, the use of aromatherapy can often help to ease the effects of these common behavioral and psychological symptoms associated with dementia in a natural, harmless, holistic approach.

Aromas have the potential power to activate a number of physical and emotional responses. Certain aromas can set a childhood memory in motion, bringing back long forgotten thoughts, faces and feelings. Just like the smell of home-baked cookies wafting from our kitchens. Aromatherapy is a wonderful and pleasant way to reach our residents and to help caregivers cope with tasks of daily living.  Aromas and Fragrances are an essence of long- term memories to be brought back to life within the degenerative diseases of dementia. By continuing to support across the five senses, this fires up the brain cells to reminisce those past long forgotten thoughts, faces and feelings. We want to help foster strong connections with those pleasant memories for those residents in our community for as long as they have the ability to.

Caring for a loved one with memory challenges is both rewarding and demanding. Whether you’re a family caregiver, an elderly individual navigating your own path, or a healthcare professional seeking insights into dementia support, understanding memory care is crucial. This guide aims to provide comprehensive information on memory care, equipping you with the knowledge to make informed decisions.

Understanding Memory Care
Memory care refers to specialized care tailored to meet the needs of individuals with memory loss conditions like dementia and Alzheimer’s disease. Unlike traditional senior care, memory care focuses on creating a safe and structured environment that nurtures cognitive function, emotional well-being, and physical health.

Key Features of Memory Care

• Specialized Staff: Memory care facilities employ trained professionals who understand the intricacies of dementia and related conditions. Their expertise ensures that residents receive personalized care and attention.

• Structured Environment: Facilities are designed with safety in mind, featuring secure layouts to prevent wandering and confusion. Regular routines help residents maintain a sense of normalcy and reduce anxiety.

• Engaging Activities: Cognitive therapies and activities are integral to memory care, enhancing memory retention and improving quality of life. These activities can range from art therapy to music sessions and reminiscence therapy.

• Nutritional Support: Proper nutrition plays a vital role in managing dementia symptoms. Memory care facilities offer balanced meals tailored to the dietary needs of residents, ensuring they receive essential nutrients.

 The Importance of Memory Care
For family caregivers, entrusting a loved one to a memory care facility can be a daunting decision. However, the benefits often outweigh the initial apprehension. Memory care provides a supportive community where your loved one can thrive, offering peace of mind to families knowing their loved one is in capable hands.

 Benefits for Family Caregivers

• Reduced Stress: Caring for someone with memory loss can be emotionally and physically taxing. Memory care offers respite, allowing caregivers to recharge and focus on their own well-being.

• Expert Oversight: With trained staff overseeing your loved one’s care, you can rest assured that they are receiving expert support tailored to their unique needs.

• Social Interaction: Memory care centers facilitate social engagement, reducing feelings of isolation for residents and helping them form meaningful connections.

 Navigating Memory Care Options
Finding the right memory care facility involves careful consideration of several factors. Here’s how you can begin the process:

1. Assess Needs: Identify the specific needs of your loved one. Consider their cognitive, physical, and emotional requirements to find a facility that aligns with these needs.

1. Research Facilities: Conduct thorough research on memory care facilities in your area. Look for reviews, visit potential centers, and speak with staff to understand their approach to care.

1. Evaluate Programs: Explore the programs and activities offered. Ensure they align with your loved one’s interests and contribute to their overall well-being.

1. Consider Location: Choose a facility that is easily accessible for family visits, fostering a connection between your loved one and their family support system.

 Memory care is an invaluable resource for those navigating the complexities of dementia and Alzheimer’s. By choosing the right care environment, you can enhance the quality of life for your loved one while also providing relief for yourself as a caregiver.

Remember, you’re not alone in this journey—resources and communities are available to guide you every step of the way. Call us today: 610-509-0445.

Your State Representative or State Senator can Help!

Did you know?

If you or your loved one is no longer driving due to medical reasons, you can trade in your PA driver’s license for a PA Photo ID, and there are resources to help you with the process! Here is a step-by-step guide:

• You can do this before the license expires or shortly afterward
• Complete a PennDOT form DL-54A and attach the driver’s license to surrender
• PennDOT will issue a FREE Photo ID and use the photo ON FILE for the first 4 years
• Should your Photo ID need to be renewed, at that time there will be a fee and you will have to go to a Photo Center for the picture

This easy process helps older adults who may have a difficult time getting to a photo center to have the picture taken and this “buys” at least four more years! If you cannot get to a photo center to renew in four years, there is a way that a request can be made to PennDOT to continue to use the photo on file (this isn’t guaranteed but is often approved!)

Lastly, to make it even easier and to expedite the process, residents can go through their State Representative or State Senator to do this.  Offices have the forms and can inform PennDOT that the driver’s license was surrendered to their office on what date, and office staff can work with PennDOT for processing on your behalf.

Kelly O’Shea Carney, PhD, ABPP
Board Certified Geropsychologist
President, Dementia Friendly Lehigh Valley Steering Committee

As the evidence grows that reducing risk factors for dementia by adopting healthy lifestyle choices can prevent and/or delay the onset of dementia, researchers are also advancing the tools and processes for diagnosing Alzheimer’s disease early in its development.  The goal of this early diagnosis is to provide more opportunity for early treatment and intervention, as well as to motivate the adoption of healthy lifestyle factors to slow progression and maintain function.

By way of example, consider how we now identify and treat heart disease.  By middle age, your doctor likely orders blood tests to identify cholesterol levels and blood sugar, while also taking your blood pressure and perhaps even offering an occasional EKG to monitor heart function.  All of these tests are used to look for the very earliest signs of heart disease, and if there is evidence that any of indicators are outside normal limits, your doctor will likely recommend changes in diet and exercise, perhaps send you to a specialist for further evaluation and/or recommend a medication that reduces risk for heart disease.

Until recently, the same options for identifying very early signs of Alzheimer’s disease and related disorders (ADRD) were not available.  As a result, most people have not typically received a diagnosis of dementia until symptoms were clearly evident and the disease was in the middle stages of progression.  However, researchers have been working tirelessly to develop the kinds of tests that will help to identify the earliest signs of Alzheimer’s and now there are blood tests, neuroimaging, and other tests that can identify increased levels of the building blocks for this disease.  These tests identify increased levels of amyloid and tau in blood streams, cerebral spinal fluid, and brain metabolism.  In addition, there are neuroimaging tests that can reveal early changes in brain structure and function that typically accompany the development of cognitive decline.  The signs of these early changes identified by the various tests a doctor can order are called “biomarkers,” and just as we identify an increased risk for heart disease using the biomarker of cholesterol, doctors can now look for biomarkers of Alzheimer’s disease by using these new diagnostic tools.

Some of the biomarker tests are used exclusively in research settings, but a few have been approved for use in clinical settings.  As the use of biomarker tests for Alzheimer’s becomes more common, perhaps too the stigma and fear of dementia will diminish. Just as the identification of high cholesterol is now used as an early warning sign to encourage a patient to alter their lifestyle and pay attention to their heart health, so too identify the biomarkers for Alzheimer’s has the potential to serve as a motivation to adopt the healthy lifestyle changes that diminish risk for dementia.

The guidelines and metrics for using the new tests to identify biomarkers for Alzheimer’s disease are still being developed and both doctors and their patients are wrestling with the risks and benefits of early diagnosis of Alzheimer’s.  It is clear that the sooner the building blocks of dementia are identified in a patient, the more intentional the physician and patient can be about early interventions that may prevent, postpone, and/or slow the progression of the disease process.  Researchers are still working to create new therapies and determine how effective and long-lasting diminishing risk factors might be in altering the course of disease.

For the moment, however, these advances in research and clinical care provide us all with a few hopeful developments.  First, there is increasing evidence that up to 50% of all dementia cases can be delayed and/or prevented by adopting the lifestyle choices that address the identified risk factors for dementia (see the DFLV April 2024 newsletter for a review of those risk factors).  Second, we know that early intervention is far more effective at bending the curve on disease progression than later intervention.  Therefore, the ability to identify the biomarkers for Alzheimer’s before symptoms develop is a move in the right direction.  Finally, if the use of biomarkers to identify Alzheimer’s proves to be as effective as the identification of biomarkers for heart disease in promoting healthy behavior and altering the trajectory of disease, we may all enjoy a future in which dementia is far less common than it is today.

Resources: 

Livingston, Gill et al. (2024).  Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission, The Lancet, Volume 404, Issue 10452, 572 – 628.  https://doi.org/10.1016/S0140-6736(24)01296-0

Jack, C. R., Andrews, S. J., Beach, T. G., Buracchio, T., Dunn, B., Graf, A., Hansson, O., Ho, C., Jagust, W., McDade, E., Molinuevo, J. L., Okonkwo, O. C., Pani, L., Rafii, M. S., Scheltens, P., Siemers, E., Snyder, H. M., Sperling, R., Teunissen, C. E. & Carrillo, M. C. (2024). Revised criteria for the diagnosis and staging of Alzheimer’s disease. Nature Medicine, 30(8), 2121–2124. https://doi.org/10.1038/s41591-024-02988-7

Kelly O’Shea Carney, PhD, ABPP
Board Certified Geropsychologist
President, Dementia Friendly Lehigh Valley Steering Committee 

Benjamin Franklin is credited with saying “An ounce of prevention is worth a pound of cure.” When he first coined this phrase, he could not have had any idea about brain health and the insights we have today into the risk factors for dementia. But even so, his words could not be truer for those who care about such things. 

Research has identified 12 modifiable risk factors for dementia and seven of them are medical issues that your physician is likely to track during routine preventive care visits. In relation to brain health, this means that by seeing your physician for your annual physical and following the advice you are given, you can reduce your risk for dementia over the course of your lifetime. 

The seven modifiable risk factors that your physician can help you to monitor and address, and the percent of total risk for dementia contributed by each factor is listed here: 

• Hearing loss (8%)
• Elevated blood pressure (2%)
• Excess use of alcohol (1%)
• Obesity (1%)
• Smoking (5%)
• Depression (4%)
• Physical inactivity (2%)
• Diabetes (1%)

In other words, the research suggests that the risk of developing dementia could be reduced by 24% if each of us simply engaged in good preventive health practices and lifestyle choices that reduced the occurrence of these specific risk factors. Truly, a little bit of prevention can make a significant difference in brain health! 

When you look more closely at the issues listed above, it becomes clear that most of them relate to the healthy behaviors we all know we should be engaging in. Regular exercise, healthy eating to reduce problems with obesity, managing hypertension and diabetes, giving up smoking, and drinking only in moderation. These are the same things we know are good for our overall health and heart health. Now we also know these same issues are important for brain health. Moreover, your family physician can both monitor for these problems during annual physicals and can treat the issues if they arise. For example, treating issues with blood pressure, diabetes, and/or depression reduces the risk these conditions present to your brain health almost as well as not developing them in the first place. Similarly, remediating hearing loss, if it occurs, also serves to reduce the risk of the damage to the brain that develops as a result of the 

loss of the connection and cognitive stimulation that comes from not being able to hear. So even if you have a genetic predisposition to one of the conditions identified above, managing that health issue under the supervision of a physician can still help you to preserve the health of your brain. 

In a 2020 article published in the Lancet naming the 12 modifiable risk factors for dementia, the researchers noted that the stage of life in which each risk factor comes into play is also relevant to preserving brain health (Livingston, et. al., 2020). That article included the graphic below that illustrates when each risk factors plays the greatest role in compromising brain health. This illustration makes clear that brain health and the prevention of the risk factors that compromise it is a life-long endeavor. While it is never too late to focus on a bit of prevention, it is better to be mindful and attentive to the prevention of health issues throughout the lifespan. Engaging in healthy behaviors, seeking preventive health care, and collaborating with your physician to monitor and treat any health issues that emerge is your best bet to reduce the modifiable risks for dementia later in life. That ounce of prevention is far better than experiencing the cognitive changes associated with dementia for which there is currently no cure. 

Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413–46. https://doi.org/10.1016/S01406736(20)30367-6. 

It has long been known that social isolation is bad for your health.  People who have limited relationships, social connections, and/or social support, as well as those who describe themselves are lonely, are at higher risk for a multitude of negative health outcomes.  These well documented negative health outcomes include hypertension, stroke, and premature death, as well as an increased likelihood of mental health disorders, such as depression and anxiety.  In addition to these findings, there is an expanding body of evidence confirming an increased risk of developing dementia among those who lack social connection and support.

 

In a 2023 report by the U.S. Surgeon General, the negative impact of loneliness and social isolation were examined and the increased risk for dementia among socially isolated older adults was estimated to be as high as 50%.  In other words, if you are someone who lacks social connection with family, friends, and neighbors, you are at substantially greater risk of developing cognitive decline than your same age peers who enjoy social connection and support.  Similarly, in a recent longitudinal study conducted at Johns Hopkins, researchers found a 59% higher risk of developing dementia among those with a poor social network and a 29% higher risk for dementia among those lacking social support.  Based on findings like these, the Lancet 2020 report on dementia prevention, intervention, and care noted that, assuming a causal relationship, up to 4% of all dementia diagnoses can be attributed to lack of social support in later life.

 

The range of negative health outcomes associated with loneliness and isolation, including the increased risk for dementia, are mediated by the stress response in our bodies.  Specifically, human beings are social animals, and we need the presence and support of other people in our lives to help us manage the demands of daily life and challenging life events.  Relationships serve as a protective factor in our response to stress as those around us provide comfort, encouragement, and assistance with the stressors in our lives.  Without social support as a buffer, chronic life stress has an increased impact on our minds and bodies creating greater wear and tear on body systems, widespread inflammation, and inhibition of our immune system.  These stress related outcomes also take a toll on the brain and help to set the stage for disease and dysfunction.

 

Sadly, we live in a culture that has become increasingly disconnected and loneliness is on the rise among all age groups. The Surgeon General’s report addresses these trends and suggests a variety of ways that social infrastructure can be enhanced in America to support the wellbeing of all and to reduce the negative health impacts of social isolation and loneliness.  It will take collective action government, businesses, social services, and faith communities to foster improvements in social infrastructure, such as neighbor to neighbor interactions, availability of social clubs, networks, and events, and enhanced access to faith communities, local services and events, and education about the impact of poor social support.

 

Each of us can also be mindful and intentional about seeking, engaging in, and maintaining our social networks.  Simple ideas for building a social network include reaching out to neighbors, maintaining relationships with friends and family – even if they live far away, joining a club, church, or local group, or volunteering.  Any one of these small acts can help to connect us with others and serves to expand and strengthen our web of connection with others.  Human beings evolved in community and have always benefitted from interdependence and connection with others.  Modern culture may challenge the ways we have stayed connected in the past, but it has also given us new ways to connect virtually and across barriers of time, space, and differences of background and experience.  We owe it to ourselves and to our communities to reach out and connect with others.  When we do so, we improve our own health and wellbeing and support the health and wellbeing of those around us.

 

Written By:

Kelly O’Shea Carney, PhD, ABPP

Board Certified Geropsychologist

 

Chair of Dementia Friendly Lehigh Valley Steering Committee

The content of this article was informed by the following scientific articles and reports, which can be consulted if you would like to learn more about the relationship between social connection and dementia.

US Surgeon General’s Report:  Our Epidemic of Loneliness and Social Isolation.  Available at:  https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf

Huang AR, Roth DL, Cidav T, et al. Social isolation and 9-year dementia risk in community-dwelling Medicare beneficiaries in the United States. Journal of the American Geriatrics Society. 2023; 71(3): 765-773. Available at:  https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.18140?utm_term=JGS&utm_campaign=WRH_1_9_23&utm_medium=email&utm_source=publicity

Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020 Aug 8;396(10248):413-446. Available at:  https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30367-6/fulltext