Experts share tips for reducing dementia risk

Dementia and memory loss do not have to be part of aging. Good habits can help stave off damage to our brains, according to a new study from a risk reduction work group of nine clinicians and health researchers convened by UsAgainstAlzheimers, a national nonprofit that works to stop the devastation of Alzheimer's disease and related dementias.

"The ideal scenario is for us all to live into our 90s, physically fit and functioning, with our cognitive abilities intact," says Thomas M Holland, MD, MS, physician-researcher at the Rush Institute for Healthy Aging at Rush University Medical Center, one of the expert members of the group. "Hopefully, with these lifestyle modifications, we can start to see that happen much more regularly."

The study is aimed at primary care physicians and general neurologists, in hopes that they will translate its recommendations into toolkits for care teams to use with patients. However, there are valuable takeaways for individuals as well. As the population ages, dementia is on track to triple by 2060, Holland says, and as many as 40% of dementia cases may be associated with modifiable risk factors.

Focusing after age 45

Anyone, of any age, can and should follow these suggestions, but Holland says that his work group identified 45 as the age when people should begin in earnest to take steps to head off cognitive decline. Some strong risk factors for dementia, like hypertension, come to the fore in middle age, and Alzheimer's disease, for example, is a "silent" disease process that can begin decades before symptoms appear.

The new study concludes that more research is needed to "confirm and validate" the group's consensus recommendations, and research on many of these lifestyle interventions is underway, at Rush and elsewhere. Holland is study clinician, medical adviser and assistant trial director for the Chicago site, of which Rush is part, of the Alzheimer's Association United States Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (US POINTER), a two-year clinical trial to evaluate whether lifestyle interventions can protect older adults against dementia.

Holland's group looked at the most pertinent evidence from research, most of it gathered in the past five years, on risk factors for cognitive decline, as well as approaches that might slow it down. The group came to a consensus on 11 recommendations and strategies they would suggest across these six topics:

• Neurovascular risk management: Heart health and brain health "go hand in hand," according to the study. Specifically, making lifestyle changes to bring down high blood pressure (a systolic measure of more than 130), and blood sugar levels of more than 7% (which indicates diabetes), will help those at risk for hypertension-related dementia.
• Physical activity: Evidence abounds that increased physical activity can decrease the risk of cognitive decline. The eventual goal is a minimum of 30 minutes a day, five days a week, but everyone is starting from a different point. An individual plan for how to get more exercise, based on the needs and capabilities of each person, is a must.
• Sleep: Studies have shown an association between cognitive impairment and sleep disturbances—poor sleep quality (less than seven to eight hours in a 24-hour period), sleep apnea, excessive daytime napping. Holland's group noted that the importance of sleep, as well as some of its basic restorative benefits, have flown under health researchers' radar. Good sleep may help prevent a number of neurodegenerative diseases, including Alzheimer's disease and related dementias.
• Nutrition: A healthy diet may not only help build cognitive resilience, it also addresses heart-related risk factors for dementia, like hypertension and diabetes. Holland's group recommends specific diets—the Mediterranean, DASH (Dietary Approaches to Stop Hypertension), and especially the MIND (Mediterranean and DASH Intervention for Neurodegenerative Delay) diet, developed at Rush. Trials have been done, and others are underway on how well and how specifically the MIND diet counters cognitive decline.
• Social isolation: The inability to interact regularly with other people, which is social isolation, and loneliness, or unhappiness about being alone, are associated with impaired cognitive performance, cognitive decline, and an accelerated progression of Alzheimer's disease. They can also affect physical health and lead to depression. These situations and feelings need to be assessed and addressed by a physician.
• Cognitive stimulation: Limited evidence suggests that increased brainwork—education, curiosity and other challenging mental activity undertaken over a lifetime—may stimulate or enhance "cognitive reserve," the brain's ability to compensate for insults or cognitive decline. Holland's group suggests several activities, including reading or listening to news or other nonfiction material, playing strategy games, participating in visual or performance arts, and spending time in nature.

Dementia is something of an umbrella term, Holland notes. It takes in conditions caused by a number of pathological processes. Some of those may be heritable, at least to an extent; others may have environmental causes.

To fight the disease, Holland says, "Diet has long been thought to be a piece of the puzzle. All these lifestyle recommendations complete the puzzle, focusing on taking care of yourself and tracking your health and wellness with support from your physician."