There’s a lot you can do to prevent dementia, start now
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Currently we do not have any drugs or treatments to modify AD (Alzheimer’s Dementia). The three main drugs in use, donepezil, rivastigmine and memantine are mainly symptomatic treatments. They slow down deterioration in memory for a period of time. For maximum benefit they should be started early and continued as long as there is benefit. Sudden withdrawal can cause the patients to get worse faster.
Even though we don’t have drugs to cure AD we do know of ways of protecting the healthy brain. The lifestyle strategies that help keep a brain healthy can be grouped under four categories. They are, exercise, mental stimulation, reducing stress and diet.
Exercise
Several studies have shown the benefits of exercise for a healthy brain. Any form of exercise whether it is gardening, housework or sports reduces the risk of AD. Aerobic exercises such as walking are the best. Just 20 minutes of aerobic exercises a day improves memory and the improvement is maintained a year later even if the person has not been regular with the exercise programme. Although stretching and toning are important components of a fitness programme it has no direct benefit for improving brain function. Strength training such as lifting weights can not only increase muscle mass and strength but it can increase brain function and mass as well.
Another bonus of physical exercise is to reduce depression, a condition that affects memory. A study done at Duke University found that exercise was as effective as the antidepressant sertraline in relieving depression. Exercise increases both endorphin and serotonin which are natural antidepressants in the brain.
Mental stimulation
The Nun study (referred to in our last issue) found that the better educated sisters had a lower risk of death at every age. The sisters with a college degree not only had a better chance of surviving to old age, they were also more likely to maintain their independence and were less dependent on nursing care. In this study most of the potential confounders such as poor housing and health care, and smoking were eliminated.
In an important study published in Neurology, by researchers at Rush University, Chicago cognitive tests were given to 294 people aged over 55 every six years until death. They were also asked about their reading and writing habits and other memory stimulation activities. The study found that in people with a record of participating in such activities the cognitive decline was 15 per cent slower than those who did not.
Don’t be discouraged if you don’t have high educational achievements. Researchers have found that some people with less educational achievements also performed well on cognitive tasks. These were the people who spent time in stimulating brain activity such as reading, writing, listening to lectures and doing crossword puzzles. Mental stimulation compensates for lack of formal education.
Reducing stress
Stress is a known causes of cognitive impairment. It leads to secretion of glucocorticoids which appears to damage neurons particularly the hippocampus, a part of the brain important for memory and learning.
At present there are no definitive studies which show that reducing stress reduces the risk of developing dementia. But early results are promising. Managing stress with psychotherapy or other stress reduction methods is good for your mental health. It may also reduce your risk of developing dementia.
Diet
Laboratory rats deprived of calories live significantly longer than obese rats. Living perpetually hungry however is not a pleasant way of living a long and healthy life. People might prefer to enjoy their food and live a shorter life.
Hypertension and diabetes are important risk factors for strokes which in turn increase the risk of dementia. A diet that helps control these factors would help in reducing dementia. Are there any special diets that have been found useful in reducing AD?
The Mediterranean diet is a food regime inspired by the dietary patterns of people living in Greece and Southern Italy. It consists of a high proportion of olive oil, legumes, unrefined cereals, fruits and vegetables, moderate to high proportion of fish, a moderate consumption of dairy products, mostly as cheese and yoghurt, moderate wine consumption and low consumption of meat and meat products. Olive oil is high in monounsaturated oils and fish in omega 3 fatty acids. They have been found to improve working memory and reduce the risk for mild cognitive impairment. Vegetables and fruits are rich in antioxidants known to improve cognition, and wine contains resveratrol a compound with anti-aging properties (at least in animals). It is now available as a nutritional supplement but its value in humans is yet to be proved.
What about other supplements that are supposedly good for your brain? The OPTIMA (Oxford Project to Investigate Memory and Aging) project was started in 1988 by Prof David Smith to study AD. The project studied both normal and cognitively impaired elderly persons until their death. One finding of this project was that three B vitamins, B1, B12, and folic acid given in high concentration slowed cognitive impairment.
The evidence for use of other supplements is not strong at present. Another interesting supplement that may help is cucurmin, an anti-inflammatory substance found in turmeric, which slows the formation of amyloid and tau in the brain. Regions of India where turmeric in curry is consumed in large quantities have lower rates of AD. Will increasing the amount of turmeric help prevent dementia? We do not have definite evidence yet. In the meantime enjoy your curry. It may be good for your brain.
At this moment we don’t have a cure for AD but there is a lot you can do to keep your brain healthy and reduce the risk of developing dementia. The earlier you start the better.