Dealing with Dementia
Stay active and fit—‘healthy behaviour’ can help combat the early onset of dementia
A new case of dementia is diagnosed every 3 seconds, says the World Health Organization (WHO). It estimates the number of people living with this debilitating disorder worldwide currently at 47 million. This is projected to increase to 75 million by 2030. Cases are expected to reach 132 million by 2050.
In India, the number of people with dementia stood at 4.1 million in 2015, according to the “World Alzheimer Report”, 2015 led by King’s College London—lower than other countries. According to WHO’s revised 2015 estimates, East Asia is the region with the most people living with dementia (9.8 million), followed by Western Europe (7.4 million). South Asia, is close behind with 5.1 million, followed by North America with 4.8 million. Ten countries had over a million people with dementia in 2015: China (9.5 million), US (4.2 million), India (4.1 million), Japan (3.1 million), Brazil (1.6 million), Germany (1.6 million), Russia (1.3 million), Italy (1.2 million), Indonesia (1.2 million) and France (1.2 million).
Dementia is an umbrella term used to describe a group of diseases that may cause the brain to fail. It includes Alzheimer’s disease, Vascular dementia and others like Lewy body disease. Alzheimer’s makes up half of all cases.
The symptoms broadly include loss of memory, changes in behaviour, progressive loss of independence, and inability to perform everyday activities.
“It’s dreaded because this chronic and progressive-nature disorder affects personal, family and social life extensively, and reduces life span too,” says Bhushan Joshi, consultant neurologist, Columbia Asia Hospital, Pune.
According to a study published in July in the Lancet journal, dementia is not an inevitable consequence of ageing. In fact, one in three cases can be prevented if more people pay attention to their brain health throughout life. The study lists nine key factors contributing to a high risk of dementia. These are lack of education, hearing loss, obesity, depression, lack of education, social isolation, smoking, type 2 diabetes and physical inactivity. The researchers say these potentially modifiable factors can bring down the risk by about 35%.
“Although dementia is diagnosed in later life, mostly in the 60s, the brain changes associated with this disease usually begin to develop years before, sometimes as early as in the 30s, so acting now can help keep the disease away,” says Rahul Jain, consultant neurosurgeon, PSRI multi-speciality hospital, Delhi.
A 35-year study by Cardiff University, Wales, which looked at the impact of five lifestyle behaviours on dementia and cognitive decline, and was published in the journal PLOS One in 2013, found that those who achieved four out of five “healthy behaviours”—regular exercise, non-smoking, low weight, healthy diet and low alcohol intake—showed a 60% drop in dementia risk and an arrest in the decline in cognitive abilities, including memory, judgement, language and thinking skills.
Here are the 10 things you can do to lower the risk of dementia:
Watch your weight
“Both being overweight as well as underweight is linked to higher risk of dementia,” says Dr Jain. According to a 2011 Swedish study published in the journal Neurology, those with a body mass index (BMI, which measures weight relative to height) greater than 30, classified as obese, were 288% more likely to develop dementia. The figure was 71% for the clinically overweight, with a BMI of 25-30.
Being underweight doesn’t help either. A Lancet study of two million people in the UK found middle-aged people with a BMI lower than 20 had a 34% higher chance of dementia as they age than those with a healthy BMI of 20-25.
Diabetes can increase the risk of developing dementia by damaging small blood vessels in the brain, leading to a reduced blood flow to the brain,” says Praveen Gupta, director and head of department, neurology, at the Fortis Memorial Research Institute in Gurugram, adjacent to the Capital.
“So make sure you follow a lifestyle that can help keep diabetes at bay by ensuring regular physical exercise and eating a diet that is low in refined carbohydrates,” he adds.
It has been known for a while that exercise helps prevent dementia, but now we finally know why. A study by researchers at Goethe University Frankfurt, published in the July issue of the Translational Psychiatry journal, reported that regular physical exercise not only enhances fitness but also has a positive impact on brain metabolism by restricting an increase in choline, a metabolite that rises as the result of an increased loss of nerve cells (typically occurs in patients with brain disorders). Physical exercise can thus help protect brain cells.
Another study published in 2015 found that exercise actually increases the size of the hippocampus and improves memory.
Socialize (make friends)
Interaction with friends and family is healing. There’s a huge connection between stress and problems with the brain as we grow older, and socializing helps reduce dementia risk—our brain is designed for managing relationships. “If we don’t use our brains optimally, decay can set in,” says Dr Gupta.
Smoking increases the risk of a host of illnesses, including dementia. A 2015 analysis published in PLOS ONE evaluated the results of 37 studies that compared smokers with people who never smoked, or who had quit. The authors found that smokers were 30% more likely to develop some form of dementia than people who had never smoked. “Tobacco smoke damages arteries, which interferes with the free flow of blood to the brain. Depriving neurons, or brain cells, of the oxygen and nutrients in blood can cause them to die and lead to Vascular dementia,” explains Dr Joshi. Smoking also triggers a phenomenon known as oxidative stress, which harms the DNA in cells throughout the body, including the brain, thus upping the damage,” he adds.
Limit alcohol intake
“Alcohol-related dementia (ARD) is a form of dementia caused by long-term, excessive consumption of alcoholic beverages, resulting in neurological damage and impaired cognitive function,” says Dr Joshi. In fact, a study published in The BMJ in June reports that even moderate drinking is linked to pathological changes in the brain.
Individuals who continue to learn throughout life are likely to build additional brain reserves. “Crosswords, learning new skills, extensively, reading and keeping the brain challenged as we get older helps a lot,” says Dr Gupta. Pursuing creative passions and activities like painting, drawing or sculpting into old age could stave off dementia, according to a study published in 2015 in Neurology.
Blood pressure control
Research published in the journal Stroke last year shows that high blood pressure is associated with a 62% higher risk of dementia between the ages of 30-50. “High blood pressure, a known risk factor for heart disease, causes problems by damaging and narrowing the blood vessels in the brain too, and thus ups the risk of dementia,” explains Dr Gupta.
“Keeping depression away is an important factor in keeping dementia away, as research is now suggesting that depression can damage areas of the brain,” says Dr Jain. A paper, published in the journal Current Opinion In Psychiatry in 2015, looked specifically at neural circuits in the brain linked to fear and anxiety and reported that chronic stress and anxiety can damage areas of the brain involved in emotional responses, thinking and memory, leading to dementia. “The good news, though, is that this type of stress-induced damage to the brain is not completely irreversible and treatment with antidepressant drugs and physical activity helps boost regeneration,” adds Dr Jain.
“In India, the incidence of dementia has traditionally been low thanks to the kind of diet loaded with protective spices like turmeric that we consume, but that seems to be changing now due to the onslaught of processed foods, coupled with lack of physical activity,” adds Dr Jain. “We need to return to our traditional diets. Eating a diet rich in antioxidants and minerals like zinc, and eating the right fats like omega 3, also provides a protective benefit,” he adds.
If you want a healthy brain, think before you eat.
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