Dementia is something many fear, knowing that the risk of this condition increases substantially with age. Thus, amongst those aged 70-74, about 3% suffer from it but, amongst those aged 90 or more, 40% have dementia.
We may not just worry about dementia being a leading cause of death.
There are many types of dementia including Alzheimer’s disease (the most common), vascular dementia and Lewy Body Disease.
Actually, when autopsies are performed, it turns out that many individuals have mixed dementia, that is more than one type.
Some may have a fatalistic attitude: whatever happens, happens. However, there is quite a lot we can do to reduce the risk of suffering from dementia or, at least to delay the onset.
Alzheimer’s Disease International has recently issued a call on governments ( World Alzheimer Report 2023) to reduce the burden of dementia by tackling twelve modifiable risk factors (see Table). This strategy could prevent or delay up to 40% of dementia cases.
In recent decades the proportion of those suffering from dementia in each age group has reduced in some countries, though the overall number of those with dementia is still increasing because more people live until advanced age. The age-specific dementia reduction is probably a consequence of partial interventions on the risk factors.
What reduces the risk of dementia?
Reaching old age without developing dementia may be possible because of what is known as “cognitive reserve”. Autopsy studies have shown that the brain changes typical of Alzheimer’s disease can be found in individuals who had no symptoms of dementia. It is thought that these individuals had enough cognitive reserve to protect them.
The question is, how do we increase the cognitive reserve? A high level of education would be a good starting point: as low education is an important contributing factor for dementia.
However, there is also evidence that a range of activities throughout life may reduce the risk of dementia: work complexity, mentally stimulating activities, playing games or musical instruments, speaking more than one language and social engagement. The aphorism “use it or lose it” applies to the brain as well.
We should try to reduce our exposure to the risk factors listed in the Table throughout our life. According to Alzheimer’s Disease International it is never too early, and never too late, to take actions that reduce the risk of dementia.
One of the risk factors most easily addressed is hearing loss: hearing aids reduce the risk of dementia.
Traumatic brain injury, caused by accidents or assaults, is another modifiable risk factor. Nowadays, we are increasingly aware of the risk of repetitive brain injuries in some sports, like boxing and rugby, leading to chronic traumatic encephalopathy and dementia. In football there is an increased risk of dementia associated with heading the ball.
It is difficult to address the risks arising from sport activities because sport associations and spectators may resist criticism and oppose changes to the sport rules. Sports, though, should be aimed at making us healthier, not the opposite. Football heading, so far, has been restricted only for primary school children.
Diet is not listed as one of the twelve modifiable risk factors, but there is increasing evidence that healthy diets, that reduce cardiovascular diseases, would also reduce dementia.
The concept of risk reduction applies also when there is a diagnosis of early dementia. June Andrews, in her recently published book (Dementia: The One-Stop Guide, 2020), argues that there are two possible dementia journeys: staying well as long as possible or going downhill faster than necessary. The same strategies that reduce the risk of dementia, and some additional ones, can increase the probability of staying well as long as possible.
Curtailing dementia is in part down to individual effort. However, many of the risk factors cannot be addressed satisfactorily by an individual, but only by governments. Sadly, successive Conservative governments, hindered by their hostility to the so-called “nanny state”, have been reluctant to promote public health.
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