Preventing dementia: the 12 risk factors

A team of dementia specialists say addressing what we already know about the disease could prevent or delay 40 per cent of it worldwide.

They comprise the Dementia Commission for The Lancet, a UK-based medical journal that’s been around since 1823.

This is their dozen priority areas (not in order).

1. Childhood education — and brain stimulation in later life

More education correlates with less risk of dementia. Women have more of the disease than men, and one theory is that women in the past have had less access to schooling.

The value of education seems to be that it lays down a strong foundation in our early years, with little benefit after about age 20.

There’s also evidence that working in a mentally stimulating job supports a healthy brain, and a few small studies show that social outings, travel, playing music, art, physical activity, reading, and speaking a second language help maintain cognitive function regardless of education.

The message for retirees is to build your life around engaging activities.

2. Systolic blood pressure

That’s the higher number in a blood pressure reading. The current recommendation is to keep it at 130 or less. Ideally, we want to do this with lifestyle, but if that doesn’t keep it down, we need medication.

The Lancet team argues that blood pressure medication is the only known effective preventive medication for dementia.

In general, whatever increases or decreases our risk of cardiovascular disease has the same effect on our dementia risk. For example, a diet that helps protect against cardiovascular risk factors (e.g. a Mediterranean-style diet) is thought to be beneficial for brain health too.

It’s worth noting though that statins don’t seem to help prevent cognitive decline or dementia.

3. Obesity

Obesity, but not being overweight, is linked with late-life dementia. If someone’s obese, losing just a couple of kilograms has been shown to improve memory and attention.

4. Diabetes

Type 2 diabetes is associated with increased dementia risk. A reminder that cardiovascular disease, diabetes and dementia are interwoven.

5. Depression

Depression is considered a risk factor, and since chronic stress can lead to depression, it’s important to get help if we’re dealing with major or ongoing mental or emotional strain.

A related issue could be severe lack of sleep. This results in inflammation and dementia is an inflammatory disease.

6. Physical activity

There’s good evidence that physical activity can help to prevent dementia. Recent studies show that when we exercise our brains produce a substance called brain-derived neurotrophic factor (BDNF for short). It’s like fertiliser for the brain, creating new cells and synapses and protecting our ability to think.

Physical activity provides plenty of bang for our buck given it also helps reduce other risk factors such as depression and high blood pressure.

7. Social isolation

Less social contact increases the risk of dementia. This could come about from life events such as the death of a partner, or an ongoing illness or injury that limits mobility.

8. Hearing aids

Hearing loss is associated with worse cognition, presumably because it can mean social withdrawal and loss of auditory stimulation. Hearing aids counter this. They can be difficult to use for a lot of older people, but it’s worth persevering.

9. Head Injury

This ranges from concussion through to the kind of trauma we’d sustain from a traffic accident, a fall from a horse, and so on. We’ve seen plenty of news stories about the long-term impact of head injury in ex-footballers and boxers.

     10. Smoking

Stopping smoking, even when we’re older, reduces the risk.

11. Alcohol

Heavy drinking is linked with brain changes, cognitive impairment and dementia. The Lancet Commission defines heavy drinking as more than 21 units of alcohol a week, or three drinks a day (in the UK a standard drink is 8 grams).

Drinking more than 14 units a week (the recommended upper limit in the UK) is linked with some atrophy of the hippocampus (the part of our brain responsible for memory, learning and spatial recognition).

Australia’s guidelines are slightly lower than the UK’s — the recommended limit here is 10 drink a week, a standard drink being 10 grams.

12. Air pollution

Pollution includes traffic exhaust, factories, smelters, and residential wood burning. This has shown up as a factor in cardiovascular disease, but it also has a degenerative effect on our brain and nervous system.

Governments have a key role to play in tackling this list, but as individuals these are the types of actions we can take in our everyday lives:

• Stay engaged in stimulating activities
• Keep blood pressure at a healthy level
• Try to lose even a small amount of weight if we’re obese
• Try to avoid diabetes or cardiovascular disease, but if we have them, manage them as well as we can
• Get help with depression, and the kind of stress that can lead to it
• Keep physically active
• Be mindful of staying in contact with others
• Use hearing aids if we need them
• Quit smoking
• Limit alcohol to recommended levels.

Dementia’s not going away but we can be proactive in preventing it.

Finally, quick question: which of the 12, if we eliminated it, do you think would bring about the biggest reduction in incidence of the disease? According to the Commission it’s hearing loss.

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