Recently, I spotted an ad for a Brain Health and Brain Disease conference at University College Dublin, organised by the Dementia and Neurodegeneration Network Ireland, directed at both healthcare professionals and the general population. I decided to go, as I’m a bit of a nerd when it comes to learning in medicine. I also have seen the full spectrum of how dementia can affect patients during my hospital training over the last three years, particularly during a three month rotation in Medicine for the Elderly/Geriatric Medicine.
September is World Alzheimer Month, and I can’t think of a better time to promote awareness and education about dementia, of all forms, not just Alzheimer’s (the most common type). We know that currently, there are approximately 55,000 people living with dementia in Ireland, and we cannot ignore the fact that this number is projected to increase to 113,000 by 2036. I wanted to write about my learning from the conference for two reasons. Number one – there is a huge amount of confusion and a degree of stigma in the general population about dementia – what it actually is, how it can affect the patient and also the family/carers, what the prognosis is, and importantly, what we can do to manage it when faced with a diagnosis. Number two – contrary to popular belief, dementia is NOT caused by, or a normal part of, the ageing process. Reflect on that for a minute, because I think many of us would have believed that it was. We know our Western world populations are living longer, and so the prevalence of dementia is only set to increase over the coming decades. So my second point is that we need to be aware of the simple changes we can make to our lifestyles to keep our brains healthy. Happily for us, much of these changes overlap with those that keep our bodies healthy – nutrition, exercise, sleep, and stress. I’m going to discuss some of these in brief in this post, to empower you to work on your brain health!
This isn’t going to be a very nitty gritty science-y article, but I will start by defining dementia for you guys. The American National Institute on Ageing defines dementia as ‘the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it interferes with a person’s daily life and activities.’ It gives examples of such functions – ‘memory, language skills, visual perception, problem solving, self-management, and the ability to focus and pay attention.‘ Importantly, many people not working in healthcare don’t know that there are a few different TYPES of dementia. It is not a one size fits all diagnosis, and another key thing to note is that NOT all dementia = Alzheimer’s dementia. Dementia is an umbrella term. Alzheimer’s dementia is a particularly type of dementia, but not the only one. The Alzheimer Society of Ireland helpfully has a page (linked for you guys here) which lists the most common types. Finally, we should all be aware that the degree to which dementia affects each individual person is a spectrum – like any disease, it will affect everyone in a unique way, while sharing some similarities. As you would expect, early on the deficits a person suffers might be very minimally noticeable or affecting their day to day functioning – but as the dementia progresses, the effect does of course become more pronounced and challenging to manage. Finally, dementia doesn’t just affect the elderly – it can affect people much younger than this in early-onset forms (usually in the 40s/50s), albeit far less commonly.
In terms of WHY this loss of cognitive functioning happens, it’s fairly multi-factorial, and I’ll discuss the risk factors below. Again, the cause is not a one-size fits all, and depending on the type of dementia, the main drivers for the deterioration in brain functioning will differ.
I now realise how much MORE we need to be talking about dementia, to reduce the stigma and confusion around the diagnosis, and empower people of all ages to keep their brains healthy throughout life. Most people now understand that type 2 diabetes mellitus is a disease which involves an excess of sugar in the bloodstream (hyperglycaemia) – and understanding something really does take a lot of fear away, both for the patient and their family. This shift in mindset is really important, because if we understand what causes an illness, we can understand how to manage it.
Which is what brings me to risk factors for dementia, and what we all can do to keep our brain healthy throughout life, to reduce our risk of developing it. Importantly, in the conference, there was a strong promotion of the fact that actually, there are few non-modifiable risk factors for dementia, and the modifiable ones outweigh them big-time. The non-modifiable risk factors discussed in the conference included:
- Age (a risk factor, the biggest one, but NOT a cause)
- Family History
- Trisomy 21/Having a diagnosis of ‘Down’s Syndrome’
Now let’s look at the modifiable risk factors presented at the conference:
- High Blood Pressure (Hypertension)
- High Cholesterol
- Coronary Heart Disease
- Cigarette Smoking
- Excessive Alcohol Intake
- Low levels of physical activity
These are nothing crazy. This list isn’t entirely exhaustive, but it is the most relevant, because as we know from our rising rates of chronic disease in Ireland, we are not getting the basics right as a population. Working on this list can have a MASSIVELY positive impact on the health of your brain. So here’s my list of solutions and tips for you to keep your brain healthy throughout your life, based on the modifiable risk factors above.
Cardiovascular and Metabolic Health
If you have a diagnosis of high blood pressure and/or cholesterol, make sure you are well-linked in with your GP. Controlling both of these things to the accepted normal range (via lifestyle modifications, medication, or a combination) has a really powerful impact, however intangible it may seem, on your risk of dementia. Similarly, with heart disease, it’s important to be well-linked in with your GP, and possibly a cardiologist depending on your history.
This point will be short, and to the point. I don’t need to quote any studies here to emphasise the risks posed by cigarette smoking, and inhalation of second hand cigarette smoke. There is no benefit from smoking for your health. At all. Seek help from your GP, and start to kick the habit, even if it’s ‘social smoking.’ We are not invincible, and smoking has so many more toxic effects on the body than just posing a significant risk of lung cancer – for example, it’s effect on your risk of dementia!
Again, this sounds like a basic point, but the key here is moderation, not necessarily deprivation. The guidelines we have in Ireland, which I’ve sourced from alcoholireland.ie, are as follows:
- For Men: 17 standard drinks, spread out over the course of the week, with at least 2-3 alcohol-free days
- For Women: 11 standard drinks, spread out over the course of the week, with at least 2-3 alcohol-free days
Now, special occasions aside, it’s fair to say that in Ireland, as a society we have a tendency to lean towards a ‘binge’ style consumption of alcohol, and in fact, it’s referenced as part of our culture by foreign visitors. While that is usually done in jest, and there’s nothing wrong with socialising around alcohol, there is something wrong with regularly exceeding the guidelines above. What’s mostly wrong about it is the vast negative effects this has on our long-term physical and mental health – and Alcohol Action Ireland has great links full of accessible information about the impact of alcohol, at both individual and societal levels. Most of us outside of the healthcare world know that excessive alcohol intake and chronic liver damage are connected, but what about the brain? The Irish website Ask About Alcohol lists quite nicely the main symptoms that can result from alcohol-related brain damage:
- Poor memory
- Coordination problems
- Problems with temperature control
- Mood changes
- Learning and concentration difficulties
- Mental health problems, like anxiety and depression
In addition to this, there are more serious alcohol-related brain syndromes, but that’s beyond the scope of this article. The take home is, as with so many aspects of our health, moderation, not deprivation.
I’m not going to delve deep into dietary advice here, because I’m a doctor, not a dietitian or nutritionist! Importantly, at the conference, there was a talk from a registered dietitian working in Neurology in a large tertiary Dublin hospital, and it was a great broad overview of healthy eating principles. A healthy lifestyle approach was emphasised – i.e. looking at our diet as part of that, one which includes physical activity, no smoking and not exceeding alcohol guidelines. The speaker did discuss certain diets such as the Mediterranean diet and the D.A.S.H. (Dietary Approaches To Stop Hypertension) diet from a positive point of view. Most importantly, she discussed challenges to adequate nutritional intake a person with dementia faces, such as poor memory, lack of appetite and smell, loss of interest in food, physical barriers to eating, and other factors such as agitation and medication interactions. It isn’t black and white. The take home I brought with me was two fold – first, to aim to eat a healthy balanced diet based on wholefoods throughout our lives, and second, to be very aware of the risk of malnutrition in a person with a diagnosis of dementia.
For further reading, here’s a great blog post on the Siel Bleu site – click here to read.
There are two things to emphasise under this heading – first, that physical INACTIVITY is a risk factor for dementia, and therefore physical ACTIVITY has a preventive role, and second, that it is 100% important (and okay!) to maintain a degree of physical activity WITH a diagnosis of dementia. We know that as a population (and this is true for the U.K. and USA too), we are simply not meeting our physical activity guidelines, which I’ve discussed multiple times on the blog in previous articles, but I’ll pop in again here:
- At least 30 minutes a day of moderate activity on 5 days a week (or 150 minutes per week), or vigorous activity 75 minutes per week (e.g. brisk walking, cycling, swimming)
- Engage in activity which increases muscular strength and balance on at least two days per week (e.g. weight training using handheld weights or bodyweight, or yoga and tai chi)
The above guidelines are for adults aged 18-64, (and those aged 65+). By just meeting even the minimum of those guidelines, we are taking valuable action to keep our brains healthy as we age. If we could wrap that promise up in a pill, we’d all take it without question.
But what about exercise for someone WITH a diagnosis of dementia?
Exercise for dementia is no different to exercise for a healthy individual except the instruction must be kept simple and clear. You would need to suit the activity to the level of dependency. For those who can’t comprehend instruction exercises that suit are passive/assisted movements to keep the joints mobile and prevent stiffness. Walking is a great form of exercise for dementia and can be done without having to give any verbal cues but instead just linking arms and walking at a slower pace. Using a piece of equipment as a stimulus which helps focus attention (The brighter the colour the better). Exercise to music is possibly the best as the brain tends to still recognise music even if a lot of other memory functions are impaired. Dancing while standing/seated can be done and as I mentioned earlier assisted movements like holding hands and swaying would work here. A person with early dementia can do a lot of exercise that a normal healthy individual can do and it all boils back to individual needs and ability. Exercise activities for dementia tend to be shorter in time too 45 minutes with regular breaks throughout. Personally I would rather split it into shorter bouts more often and aim for as much as possible within the persons limits.
For further reading, here’s a great blog post on the Siel Bleu site – click here to read.
Community & Engagement
I finish with this point because it’s not exactly a risk factor, but it’s really really important for a person with a diagnosis of dementia. They need support – physical, social and emotional, through family, friends and community. There are many many great resources, societies and events available to the patient and those around them, and it’s essential that this information be given to a person at diagnosis. For example, the Alzheimer’s Society of Ireland run the Alzheimer Cafe in various locations, and it’s a wonderful way for carers and patients to connect and share their experiences.
And that’s a wrap! I hope you guys enjoyed this post. Dementia is such an important health issue, and we need to promote awareness educate the population and reduce the fear and stigma that affects the individual and family faced with a diagnosis. As always, I would love to hear your thoughts – leave a comment here or on Instagram, send an email, DM me, your pick! I’m @theirishbalance on Instagram/Twitter/Facebook!
Ciara 🙂 x