There is a lot about dementia in the press these days. Headlines seem to tell us that there is a miracle cure coming, but when you read the small print it turns out that the study is at a very early stage. Or that it is just a good idea with no research to back it up.
The latest figures from the Alzheimer’s Society indicate that the number of people with dementia under the age of 65 is really small. The bigger problem for people in our age group is how to take care of our older relatives who are affected. By the time your parents are in their 80s they have almost a 20 per cent chance of having dementia, so you may be wondering how you will cope if that happens. You might also be wondering how to avoid it yourself.
To understand what helps prevention you need to know a bit of science. Dementia is just a symptom of some underlying diseases. In the most common form, Alzheimer’s disease, which affects more than half of the cases, the brain gradually shrinks and brain cells die.
The second most common is vascular dementia, where the blood supply to parts of the brain has been cut off, like a mini-stroke. After each blockage, a tiny bit of the brain stops working.
Research into how to avoid dementia is complex because it can be affected by genetics, lifestyle, accidents and sheer bad luck. There is a global race to find a medicine or vaccine that will prevent or cure it, but what do we do in the meantime, based on the evidence we have got?
What is good for your heart is good for your head: the fuel your brain needs is oxygen, and that is carried by blood. If you do things that will improve your circulation it will help your brain to function at its the best, even if it is already affected by Alzheimer’s type of damage. The rules that apply to heart health apply to this: exercise; keep your weight and blood pressure within the normal range; drink only in moderation. A glass of red wine or champagne a day is said to be good, but if you can’t stop at one, none is better. Alcohol-related brain damage is the only preventable form of dementia.
Even if you have waited until middle age to give up, the risk of dementia after 20 years of not smoking is the same as if you never smoked.
2 Get diabetes, high blood pressure and depression treated
People who have had poorly controlled clinical depression, hypertension or diabetes seem to be more susceptible to dementia than others. So get any problems seen to now, and stick to the doctor’s orders.
Exercise is like magic for avoiding most health problems. There is a link between obesity and dementia, so get moving in any way that you can, as the exercise will help with weight loss. As many as half the cases of vascular dementia occur in people with high blood pressure, and exercise reduces your blood pressure. Small studies have indicated that taking blood pressure tablets reduces the risk of dementia, even in Alzheimer’s disease.
Studies have shown that lower vitamin D concentrations in the blood are associated with poorer cognitive function and a higher risk of Alzheimer’s disease. You can get it from food, but even in our misty islands we get most of our vitamin D from exposure to sunlight. You’d have to eat a lot of oily fish or take a supplement to get the equivalent of ten minutes in the sunshine. You can also get vitamin D from eggs, and some fortified margarine-type spreads, and some breakfast cereals. But sunlight is best, particularly in the summer months, when the rays are the right wavelength.
A diet that is full of fresh fruit and vegetables is good for heart and brain health. Minimise the amount of red meat and dairy produce you eat, such as cream, cheese and butter, and snack on dried fruit and unsalted nuts. High fibre is good.
Hydration is crucial. If you don’t drink enough fluids, it increases the risk of urinary tract infections, and that can lead to hospital admission in older people. In addition, being dry can decrease your brain function.
I met an American lawyer in Washington recently whose family all have an inherited form of Alzheimer’s that usually starts at working age (under 65). Her brothers and sisters who had college educations started their symptoms around ten years later than the others. Her own daughter, who was a rebel and fell out of education altogether, started symptoms in her thirties. With a regime of careful exercise and social support the lawyer was doing fine most of the time.
This illustrates the point that education seems to help. It is like working out: the more strength you build, the more spare capacity you have if something goes wrong. It won’t prevent the disease, but it will keep the symptoms at bay for longer. Bilingual people seem to get this effect as well – so it is time learn that new language now!
People who are lonely are more likely to get dementia, and if you are looking after someone with dementia, socialising can reduce their symptoms and help them to stay independent. So get out and about as much as possible.
The University of Stirling Dementia Services Development Centre, where I work, works to get the information about delaying dementia or diminishing the symptoms to those who need it. Because many health and social care workers have had no education on this subject, it can be hard to get practical advice. My book Dementia: The One-Stop Guide is being published as part of our 25th anniversary project to find out what people need to know and make that information available as easily as possible.
Professor June Andrews is the author of Dementia: The One-Stop Guide, published by Profile Books, £9.99. She is the director of the Dementia Services Development Centre (DSDC) at the University of Stirling. She is a recognised leader in the worldwide movement to improve services for people with dementia and their carers. She set up and directed the Centre for Change and Innovation in the Scottish Executive Health Department, and is a former trade union leader, NHS manager and senior civil servant.