• Self-confidence about memory at midlife can be enhanced by:
— learning more about how memory works, and developing realistic expectations of your memory
— paying attention to paying attention!
— using a variety of specific memory strategies to support your memory
— identifying and managing any aspects of your health and lifestyle that could be impacting on your memory.
• Midlife is an opportune time to take positive steps for your future brain health.
CHAPTER 5
What can we do to reduce the risk of developing dementia?
In Chapters 3 and 4, the focus was on how to get the most out of your memory as you are right now. In this chapter, the emphasis will be on your future memory and brain health, answering questions such as, ‘What can I do to minimise the impact of ageing on my memory?’ and, ‘Is there anything I can do to reduce my risk of developing dementia?’
In my clinical practice as a neuropsychologist I see people who are concerned about their memory. Some people have no detectable memory difficulties, others have mild inefficiency related to a variety of issues, and others have significant memory loss associated with memory illnesses, like dementia. When I ask people what they want to get out of the neuropsychological consultation, most will say, ‘I want to know what I can do to stop my memory from getting worse.’
Most of us don’t ask ourselves this question until we reach midlife, and experience a few memory lapses, or perhaps a friend or family member is diagnosed with dementia. We might start to have a few health issues and think more about our future health, including our brain health. Brain and memory function are sensitive to how we live our life and to other aspects of our physical and mental health. The earlier you begin to work on optimising your brain health, the better. Midlife is an opportune time because this is often when changes in our health occur that can begin to have a negative impact on the brain.
Risk factors for Alzheimer’s disease
While research into medical treatment for dementia continues, there is currently no drug available to prevent or cure Alzheimer’s disease. Some risks for dementia are genetic and are not currently modifiable. Whether you end up developing a brain disease like dementia comes down to a combination of your genes and other non-genetic factors. Decades of international dementia research studies suggest that there is the potential to modify negative non-genetic influences in order to reduce your chance of developing dementia, or at least delay the onset of the disease.1
Scientists examining these potential non-genetic influences have discovered relationships between particular health and lifestyle risk factors, the brain disease process, and subsequent development of dementia. Around one-third of all dementia cases are associated with a combination of these risk factors.2 Researchers suggest it is best to address as many of these risk factors as possible, aiming to enhance brain health and reduce the risk of developing dementia or delay its onset.3 We will discuss these specific risk factors in more detail later in the chapter.
The latest research into reducing dementia risk has focused on ways that we can build up ‘brain resilience’ in an effort to prevent or delay the onset of symptoms. When people have dementia, the changes that occur in the brain build up over a long period of time. Typically, people start showing symptoms of the illness, such as memory loss, decades after these changes begin.4 If we work on building up our ‘brain resilience’, then we may lessen the impact of disease processes on everyday functioning. If we can harness the brain’s ability to form new connections between nerve networks, then perhaps we can build up resilience to dementia. The methods for building up brain resilience identified by research will be covered later in this chapter.
While it feels good to be proactive and to work on a healthy ageing plan, it’s important to acknowledge that none of us have total control over our future health. We all know someone who has done all the ‘right’ things, but still develops an illness such as dementia. This person may have followed all the evidence-based suggestions for maintaining brain health, but ended up having dementia. It’s the same with other illnesses. We know so much now about reducing our risk for heart attack, for example, but it is not really possible to prevent a heart attack with certainty.5
Ultimately, there is a limit to the extent we can control our health. Addressing the health and lifestyle risk factors for dementia identified by research might only have the potential to delay or reduce the change of developing dementia in one-third of all cases of the disease.6 The condition is very complex, and we do not fully understand how it develops. It’s important not to blame yourself if you have dementia, and similarly important not to think that others who have dementia have brought it on themselves. Sometimes our genes win out against all the other non-genetic factors that we diligently work on.
We may not be able to stop ourselves from getting an illness like Alzheimer’s disease, and much more research needs to be done to help us understand more clearly what we can do to prevent dementia. In the meantime, we can do what the current research suggests, and hope that we may be able to delay the onset of the symptoms of dementia, so that even if we have the illness in the brain, it has less impact on our lives, and the lives of those closest to us.
Your personalised future brain health plan
Your memory and brain health are like any other aspect of your health: they can change with age. We all change as we get older. We can’t stop the ageing process totally—but we can be proactive about brain health. We can have regular check-ups and perform necessary adjustments to keep our brain as healthy as possible, just like we take our car to the mechanic for regular maintenance and care. We have routine health checks for various parts of our bodies as we get older, and it helps if we include memory and brain maintenance on our list of parts that need to be taken care of!
You’ve probably read those lists of tips for memory health in articles about ageing and dementia. These provide a helpful general guide for everyone. But you are not everyone—you are you! A strategy that suits one person may not suit another. To keep your brain as healthy as possible, and to work on the suggested methods for reducing the chance of memory illnesses, such as dementia, you need a personalised plan of attack! The best first step for this is to book a long appointment with your doctor.
Health factors found to be associated with risk of developing dementia include high blood pressure, high cholesterol, diabetes, obesity, smoking, excessive alcohol consumption, depression, anxiety and stress.7 Some of these factors can cause changes in your brain. If that occurs, you might not get optimum function from it as you get older and you could have less resilience to brain illnesses, such as dementia. It is important to identify these factors, so you can start to work on reducing any possible effect that they may have on your future brain health and your health in general.
Your doctor will check through your personal and medical history with you, and ask you questions about your normal daily and weekly routine. This check-up usually involves a physical examination. You might even end up doing some memory tests. You may be asked to have further medical investigations done to complete the information gathering stage. Your doctor might not have time to complete a comprehensive check-up, and you may be referred to a medical specialist who works in the field of ageing and dementia.
Based on the information you and your doctors compile, you can work together on a plan to modify any features of your health and lifestyle that can be altered, which will aim to enhance your brain health and boost your ‘brain resilience’ for the future. The research on brain health shows that individuals have the most success in working towards these goals when the plan is specific for them, and this customised approach targets several aspects of their health and lifestyle at once.8 Once you know the areas you need to work on, it may help if you see specialists in those fields to assist with making the recommended changes. For example, a psychiatrist or psychologist can assist with managing stress, or symp
toms of depression and anxiety.
Building up ‘brain resilience’
The next step is to consider what you can do in an effort to build up your brain’s resilience to disease. Scientists have proposed that we may be able to prevent or delay the onset of the symptoms of dementia, if we can build up ‘brain resilience’. The idea here is that a person may have changes in their brain that indicate dementia, such as Alzheimer’s disease, but the actual symptoms of the dementia developing, such as memory loss, may emerge later if a person has built up sufficient resilience to the disease over their lifetime.9
Let’s run through the aspects of daily life that numerous studies have shown to be important for building up such ‘brain resilience’. And remember, the research tells us that it is best to work on as many of these areas as possible, not to just focus on one or two.
Physical exercise
Regular physical exercise can boost general cardiovascular fitness, and in turn increase blood flow to the brain. Studies have suggested that exercise can increase levels of a protein in the brain called the ‘brain-derived neurotrophic factor’.10 This protein promotes growth and survival of brain cells and may strengthen the brain’s resilience to injury or disease.
Increasing the amount of physical exercise you do from midlife onwards is associated with a reduced risk of dementia, possibly because it can have a positive impact on some of the health issues associated with increased risk for dementia, such as obesity, insulin resistance, high blood pressure and high cholesterol.11
When it comes to maximising everyday memory performance in healthy older adults or people with dementia, there is still no clear consensus about the possible effect of physical exercise. Some studies describe improved performance on memory tests after older adults have taken part in several months of regular aerobic exercise, whereas others report that exercise alone does not improve memory performance. Nevertheless, regular physical exercise enhances general fitness and mood.12
Talk to your doctor about the best way for you to include daily exercise in your routine. Scientists have suggested that we include a combination of aerobic, strength and balance exercises.13 Exercising under the guidance of a physiotherapist or exercise physiologist will ensure that you do this safely, and in a way that suits your body and your routine.
Mental stimulation
Mental stimulation can come from a variety of activities, including taking part in new and varied pastimes, education courses, and attending programs that provide training on specific memory and thinking tasks. Mental stimulation over a lifetime has been associated with promoting resilience to brain illnesses, such as dementia, and delaying the onset of symptoms of the illness.14 These findings suggest that ‘brain resilience’ to dementia is something that continues to build up over your lifetime, from the years that you spent at school completing formal education, to the new learning activities that you do now to stimulate your brain.
Scientists have shown that when we challenge ourselves for months or years with new experiences that involve mental effort, changes occur in the brain to support the learning of the new skill.15 These changes can involve increases in the number of brain cells and supporting cells, and stronger connections between the brain cells. This type of brain plasticity is possible throughout life, and the brain changes that occur with prolonged mental activity could build up resilience to disease processes that cause dementia.
We are spoilt for choice when it comes to mentally stimulating activities that could build up ‘brain resilience’. We can read a challenging book, complete regular brain-teaser puzzles, or do mentally engaging cooking or craft activities. We can enrol in educational courses, or perhaps learn a new language or musical instrument. Volunteer work usually involves learning something new, as does travelling to somewhere you haven’t been before. It’s important to choose activities that work for you. If the challenge is too hard, you could end up feeling anxious, which might make learning something new even more difficult. Choose activities that interest you and keep introducing new challenges, aiming to do something different once a week. As one 90-year-old woman proclaimed during one of my community memory talks, ‘Stay curious!’
Specific programs dedicated to encouraging mental stimulation have become increasingly available in recent years. Some of these programs involve regular attendance over several weeks for repeated group training on particular memory or thinking tasks. Other online ‘brain training’ programs involve completing games and puzzles on a variety of devices. These programs typically improve people’s performance on the trained tasks, although some researchers have questioned whether commercial brain training programs improve general, everyday memory function.16 Recent studies have shown that participating in memory training programs can improve some untrained aspects of memory and thinking in healthy older people, but there is no evidence to show that these programs can prevent dementia.17
Attending skills training programs and doing online brain training can provide a fun and convenient way to include regular mental stimulation in your routine. Furthermore, many people report feeling more confident about their memory after taking part in these activities. As we have discussed in other chapters of this book, if you feel more positive about your memory, then you are often more willing to try new things, which in turn may help with building up ‘brain resilience’.
Social engagement
Research examining risk factors for dementia has shown that being more socially isolated is associated with a greater likelihood of developing dementia.18 There are many possible explanations for this finding. It could be that it is more difficult to take part in social activities when you have dementia. On the other hand, if you are not socially connected, this could increase your risk of depression, and reduce your mental stimulation, and both these factors have been associated with the development of dementia. It is difficult to be absolutely clear about what these research results mean, but specialists in dementia research recommend that we stay as socially connected as possible since this may have the potential to delay or reduce the risk of developing dementia. So spend time with your family, workmates, friends and neighbours. Participate regularly in book clubs, sports clubs, Senior Citizen’s meetings or whatever appeals to you.
Diet
More and more research studies are examining the potential benefits of particular diets for maintaining brain health. Recent research on the ‘Mediterranean diet’ has shown that it is associated with better memory and thinking abilities in healthy older adults.19 This diet includes a high intake of vegetables, fruit and fish, a low intake of meat and dairy products, and 1–2 glasses of wine per day.
Researchers investigating risk factors for dementia have found no definitive evidence that any particular diet or dietary supplement can prevent dementia.20 However, it has become increasingly clear that obesity, diabetes, high blood pressure and high cholesterol are associated with the development of dementia, and what we eat is important for the management of these health issues. Emerging research has shown that people who follow a Mediterranean diet have fewer issues with diabetes and other health concerns that can cause damage to the blood vessels in the brain. It is important to review your eating habits with your doctor. If you would like to make changes to your diet, a dietitian can assist with a personalised nutrition plan.
Hearing
Dementia researchers have identified the management of hearing loss as an important factor when it comes to promoting ‘brain resilience’ to dementia,21 although the evidence doesn’t point towards a clear reason why hearing loss could decrease the brain’s resilience to brain illnesses such as dementia. Scientists have proposed that there may be an indirect effect as reduced hearing ability often leads to less social engagement, which could even impact negatively on mood. The main message from the research is to have your hearing checked regularly, and wear hearing aids if they are recommended.
Sleep
Researchers have begun to investigate links between sleep, b
rain health and dementia. Sleep has been shown to be important for the formation of new memories.22 In some studies, poor sleep quality was associated with reduced performance on memory and thinking tasks.23 While more research on the importance of sleep in maintaining brain health is required, it is important to discuss any sleep difficulties with your doctor. Referral to a psychologist or sleep physician can help with enhancing sleep.
It is possible that sleep disordered breathing, sometimes called sleep apnoea, can cause changes in the brain that reduce the brain’s resilience to dementia.24 When people have sleep apnoea, they have difficulty breathing when they are asleep, which may be related to obstructions to the airway. Some research has suggested that sleep apnoea can cause damage to the brain due to changes in both the levels of oxygen and the flow of blood to the brain. Sleep apnoea is often associated with snoring and can cause daytime sleepiness. Tell your doctor if you suspect that you may have sleep disordered breathing, as there is simple, effective treatment available for this condition.
Putting your future brain health plan into action
So now you have gathered plenty of information for designing your personalised future brain health plan. Perhaps you have been to your doctor, seen one or more medical specialists, and identified some areas of your health and lifestyle that you would like to work on, so that you can keep your brain as healthy as possible, and potentially reduce your chances of developing dementia.
Life is a constant balancing act. Most of us know a lot about what we need to do to keep our bodies and minds healthy. Some of us like to live in the now and not worry about the future and how our body will age. Others spend time thinking towards the future and are willing to make changes to how they live now in an attempt to be healthier in the future. Taking the time to read this chapter probably means you are the type of person who is willing to commit to a future brain health plan in the hope that it will make a difference for your health as you get older.
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