Dementia Prevention and Intervention

Dementia numbers are increasing

But twelve factors can lessen the likelihood of Dementia – (Source: Lancet Report 2020):

• Education;

• High Blood Pressure;

• Hearing impairment;

• Smoking;

• Obesity;

• Depression;

• Physical activity;

• Diabetes;

• Social Contact;

• Excess Alcohol;

• Traumatic Brain Injury (e.g. boxers and footballers);

• Air Quality.

Other things that can be added to the list are …smell, shingles vaccine etc.

How Education can help prevent Dementia

The following interventions can help lessen the risk of Dementia:

• Early age learning is protective – so is pursuing school and university degrees;

• Keeping the mind active with for example crosswords and word games also lessens the risk of Dementia;

• Learning a language;

• Undertaking a University degree as an older, semi-retired or retired adult;

• Be and stay curious;

• Have fun;

• Stimulate your brain: use it or lose it!

High Blood Pressure and Dementia risk

• Get your blood pressure checked in the NHS health check –or see your pharmacist or GP surgery; 

• Aim for a blood pressure below 130/80;

• Lifestyle changes that you can make to help control your blood pressure – low salt diet, regular exercise, weight loss, low cholesterol;

• Treat high blood pressure effectively – this may require 3 or more tablets;

• Lower combinations of tablets give more benefits and fewer side effects (speak to your GP about this);

• Possible treatments include a potassium-sparing diuretic (spironolactone, amiloride).

hearing loss and Dementia risk

• Hearing loss is very common with increased age: 2/3’s of over 70’s struggle with hearing loss;

• However, only 10% get aids – and those that do encounter issues such as tubes getting blocked with wax, batteries running flat and requiring help with small and fiddly aids;

• Those that do not address hearing loss, the ones with mild hearing loss are twice as likely to get Dementia and we know use of aids stops the decline;

• This is the simplest modifiable factor that could make a significant impact, as 8% of Dementia cases are related to hearing loss!

Smoking and Dementia Risk

• Smoking is dangerous in lots of ways. Nicotine narrows blood vessels (and vaping is still bad, just less bad) and other chemicals make the blood vessels sticky to cholesterol and leaky to toxins involved in Alzheimer’s – like beta-amyloid;

• Stopping even once Dementia has started, slows the progress of the condition;

• And, of course, lessens the risk of heart disease and cancers as well.

Obesity and Dementia Risk

• Obesity (when you have a Body Mass Index (BMI) over 30) is associated with late–life Dementia;

• Weight loss of 2kg or more in people who are overweight (BMI over 25) is associated with significant improvements in memory and attention. Long-term results on the rate of Dementia however are unknown;

• Mounjaro (tirzepatide), and other weight loss drugs approved for use in type 2 diabetes, show a reduced chance of developing Dementia while also slowing the cognitive decline in patients with mild Dementia – this seems to be an anti-inflammatory effect rather than just the weight loss.

Traumatic Brain Injury and Dementia Risk

• Brain Damage after major head injury and more worryingly after repeated less severe brain traumas (such as in boxing and even heading a football) is associated with an increased risk of developing Dementia;

• Clearly, the best approach is to reduce the risk of injury;

• Cycle helmets should always be worn;

• Rugby, Boxing and heading in Football all need careful thought in terms of head protection;

• The social and fitness benefits also need to be considered!

Physical Activity and Dementia Risk

• Weekly exercise (enough to create mild sweating) sessions reduce the long term risk of developing Dementia;

• Walking seems to have particular benefits – the rhythmic stepping motion allows the brain to form theta waves which improve mood, memory and cognition. The varied smells of the walk can also help – pine oils lower inflammation, blood pressure and reduce stress hormones;

• ‘ADS’ run seated exercise classes designed for the client group of Carers and People with Dementia. The sessions aim to reduce the risk of developing Dementia for the Carer while helping slow the progression of the condition for People affected by the condition.

Diabetes and Dementia Risk

• The risks of Dementia increases with the duration and severity of diabetes;

• There is evidence that specific treatments help (eg Metformin) while other specific treatment regimes are weak;

• The key for getting your approach right is to reduce the chance of diabetes by controlling your diet and weight.

Excessive Alcohol and dementia risk

• Heavy drinking is associated with low mood and brain damage. Alcohol reduces the body’s ability to use Vitamin B and which can cause irreversible nerve damage;

• This is a particular cause of Young-Onset Dementia (Dementia in those younger than 65);

• Mild drinking (less than 14 units per week) may be protective;

• Drinking more than 14 units weekly is shown to cause some brain shrinkage.

Depression and Dementia Risk

• This is not simple as depression can be an early sign of Dementia – as damage to the emotions centres of the brain (hippocampus) can be an early part of the Dementia process;

• Depression in younger age does not seem to be associated with later Dementia;

• The use of SSRI drugs (a widely used type of anti-depressant), like citalopram,  reduces amyloid plaque formation in animal studies. Long term use of citalopram in people with Alzheimer’s and depression showed delayed progression of Dementia.

Air Pollutants and Dementia Risk

• Exposure to Particulate Matters (from traffic exhaust or wood burning), Nitrous Oxide (traffic) and carbon monoxide accelerate brain degenerative processes, including amyloid deposits;

• They are all associated with increased risk of Dementia;

• This particularly affected people in crowded deprived areas with slow traffic.

Social Isolation and Dementia Risk

• Social contact enhances cognitive reserve and encourages beneficial behaviours;

• High social contact is associated with better late-life cognition and lower risk of Dementia.

• Facilitated meetings and discussions groups are associated with improved global cognition and increased brain volume;

• ‘ADS’ runs singing, dancing, crafting and other services, aimed at creating a supportive welcoming and dementia-friendly community to help People affected by Dementia and their Carers feel valued and included. Maintaining social connection is associated with a slowing of the progression of Dementia.

Your Dietary choices and Dementia Risk

• The WHO guidelines recommend a ‘Mediterranean Diet’ to reduce the risks of cognitive decline and Dementia. This has been shown to improve global cognition;

• Other studies show that people with a high intake of green leafy vegetables have less cognitive decline;

• Multivitamin tablets have been shown to improve global cognition;

• Vitamin D has been shown to reduce DNA damage that is the cause of ageing, and may therefore lessen the risk of cancer and Dementia.

Smell and Dementia Risk

• Loss of smell is associated with cognitive decline and is even used as a screening tool for Dementia;

• Some of this is genetic – some of the genes associated with Alzheimer’s (APOE4) are also associated with olfactory nerve pathway damage;

• Some of it may be immune and inflammatory – bad smells stimulate an inflammatory response; while nice smells lessen inflammation;

• There is increasing evidence that suggests that smell training can slow or reverse some cognitive decline.

Tips

• If you have concerns – for yourself or others have a conversation with your GP, as some treatable conditions can give Dementia-like symptoms;

• Examples include Infection, side effects of medication, delirium; hearing and eyesight issues;

• To identify or exclude Dementia Blood tests are taken;

• Full Blood Count (FBC) and inflammation test (ESR, CRP) (Anaemia and vasculitis);

• Thyroid Function Tests (T4, TSH) ( as hypothyroidism can mimic Dementia);

• Calcium (as high or low calcium affects brain function);

• Kidney Function tests (U&Cr) (as renal failure affects brain function);

• Glucose (as diabetes, damages small blood vessels and affects brain glucose levels);

• Vitamins check - B12/folate (vitamin deficiency most frequently associated with Dementia) and possibly Vitamin D

• Clotting and LFT (indicating liver disease);

• Mild cognitive changes are common with age and most never progress further. Lifestyle changes can slow/ stop deterioration;

• Depression – can be difficult as . . . . .

  • Dementia can be depressing;

  • Depression causes memory loss, lack of concentration, poor sleep, social isolation – all of which can look like Dementia;

  • Treating depression can include talking therapies, support groups (‘ADS’) or medication;

  • Medication takes a while to work – but can have side effects straight away and can interfere with other medication;

  • Having said that, it can also be brilliant!

• It’s important to be prepared;

• Sort out your Power of Attorney, finances, health;

• Have a plan in place for housing, driving, cooking;

• End of Life: how would you like to be supported? Have conversations using frameworks (Advanced Directives, ReSPECT);

• ReSPECT (DNAR) – Recommended Summary Plan for Emergency Care and Treatment;

• The ReSPECT process creates personalised recommendations for a person’s clinical care and treatment in a future emergency in which they are unable to make or express choices;

• These recommendations are created through conversations between a person, their families, and their health and care professionals to understand what matters to them and what is realistic in terms of their care and treatment;

• Stay Involved!

• ‘ADS’ can provide support for Carers and People affected by Dementia that helps improve their lives through – exercise, singing, social connection (and expert and emotional one-to one support for Carers);

• Join ramblers, walking groups, dance groups – do your thing;

• And keep talking and connecting!

The two main sources for this article are:

The Lancet Commission on Dementia. Prevention, Intervention and Care. 2020

NICE Guidelines  NG 97. Dementia: assessment, management and support for People living with Dementia and their Carers. June 2018