Brain Longevity (Part 1 Of 5): Dementia Prevention

Up to 40% of dementia diagnoses are attributable to 12 modifiable risk factors. Awareness of these factors empowers us to improve our brain health and prevent debilitating disease. Over 50 million people and their care partners now live with dementia. Millions of future cases may be avoided. The four talks that follow this one will explore The Alzheimer’s Research & Prevention Foundation’s “4 Pillars of Prevention”: nutrition, exercise for mind and body, stress management and Spiritual Fitness.

Transcript

Welcome,

And thank you for joining me for the first part of this series of talks about brain health for dementia prevention.

I share these thoughts based on what I learned during brain longevity specialist training through the Alzheimer's Research and Prevention Foundation,

As well as the years I spent interacting with families at an adult day program that provided socialization for people diagnosed with dementia and hours of respite for their caregivers.

If you are uncertain or simply curious about what dementia is exactly,

Or whether it's the same as Alzheimer's disease,

I'll start by defining dementia as an umbrella term for a set of symptoms,

Such as memory loss and impairments in problem solving and language,

Which interfere with a person's ability to function independently in daily life.

The decline in cognitive abilities is caused by abnormal brain changes,

Which affect behavior,

Emotions,

And relationships.

Note that these brain changes are not a part of normal aging.

The most common cause of dementia is Alzheimer's disease,

Which is responsible for 60-80% of cases.

Cellular dementia,

Lewy body dementia,

And frontotemporal dementia are distinguished primarily based on which cells of the brain are involved.

It is also possible for a person to have mixed dementia when damage affects multiple areas in the brain.

There is currently no cure for any of these causes of dementia.

However,

Disease that is prevented needs no treatment.

We now know that most pathological processes that cause dementia begin decades before their outward expression as memory impairment or changes in behavior and personality.

Underlying damage to the brain that reveals itself years later than it could have is more likely to be met by an advanced care infrastructure,

Whether that is therapy for the patient or social support for affected families.

Before I begin,

I want to make it clear that even before prevention,

I advocate for the acceptance of,

And a restored sense of belonging for,

People who are currently living with dementia.

Not a resigned passive acceptance,

But having the courage to not look away from what we don't want to see.

Really engaging with and embracing your neighbors,

Friends,

And family who might be isolated in their struggle.

They're closer than you think,

And more numerous.

Around the world,

55 million people currently have dementia,

According to the World Health Organization,

And that figure is projected to almost triple in the next 30 years.

These figures obscure the true number of people actually living with dementia,

Which includes diagnosed and undiagnosed individuals,

But just as much their care partners.

A separate recording will address caregiver support specifically,

And you are also invited to access my talks in the At the Center series about the lessons learned from my beloved teachers at an adult day program.

For all the moments of joy and unexpected creativity I witnessed at the center,

Another part of the picture was the deep suffering of the family caregivers.

For all the cheerful chaos of color,

Music,

Laughter,

And strange languages in our room during the day,

There were poignant stories of what happened at home,

At night,

And on weekends.

The man with Parkinson's disease and Lewy body dementia,

Whose hallucinations and paranoia convinced him that his wife's lover,

Who didn't actually exist outside of his head,

Lived among them in their apartment.

The wife who asked her husband with Alzheimer's disease to take out the garbage,

Which she found two days later in the trunk of their car because he didn't remember that it belonged in the trash can instead.

The suffering caused by these changes to a person's cognition are real,

For the one whose brain is damaged,

And for everyone whose relationship with that person may change.

The costs are physical,

Emotional,

And financial for families and societies.

It is becoming more likely that we all have or will have some point of contact with dementia.

My intention with this series about brain longevity is to increase awareness that we are not powerless.

If more people knew what they could do throughout their life to improve their brain health and prevent debilitating disease,

That's the next best thing to the elusive cure.

It also empowers us to not wait for science or governments to meet the needs that already exist for a reduction in suffering for patients and their care partners.

In 2017,

The peer-reviewed medical journal The Lancet assembled a panel of experts to consolidate the available results of research across domains in order to make recommendations for how to address the worldwide crisis of rising cases of dementia.

The Commission reconvened in 2020 based on dramatic new projections about cases,

As well as new evidence about the conditions that cause dementia.

Their report,

Titled Dementia Prevention,

Intervention,

And Care,

Is freely available online by visiting the journal's website.

In the 2017 report,

The panel identified nine modifiable risk factors to help reduce the incidence of Alzheimer's and other causes of dementia.

The nine modifiable risk factors were obesity,

Smoking,

Diabetes,

Depression,

Hypertension,

Low social contact,

Physical inactivity,

Hearing impairment,

And low education.

In 2020,

The panel's report was updated and the list of modifiable risk factors expanded from 9 to 12,

Adding traumatic brain injury,

Exposure to air pollution,

And excessive alcohol consumption.

Together,

Those 12 factors account for 40% of worldwide cases of dementia.

And remember,

They are modifiable,

Which makes dementia preventable up to 40% of the time.

That points to the potential for millions of fewer diagnoses in the future.

Of course,

For each individual case,

There is a network of loved ones,

Neighbors,

Coworkers,

And even strangers whose lives are also affected.

I became aware of the Lancet Commission's report when the founder of the Alzheimer's Merchant Prevention Foundation,

Dr.

Dharma Singh Khalsa,

Wrote a white paper in response to it,

Noting that many of the 12 modifiable risk factors listed in the Commission's report are directly addressed by the Foundation's four pillars of Alzheimer's disease prevention – diet and supplements,

Mental and physical exercise,

Stress management,

And spiritual fitness.

However,

The Lancet Commission's recommendations do not specifically address stress management or the emerging data about the value of meditation and yoga,

Which are encouraged as part of ARPF's brain longevity therapy.

It is a common misconception that people suddenly get Alzheimer's disease in the last decades of life.

The fact is that pathology likely begins decades before its manifestation as problems with memory and language.

Related to that,

Some people whose brains show pathology at autopsy never exhibited symptoms of dementia.

That matters for several reasons.

First,

Because the slow progression of the disease presents multiple opportunities throughout those decades to interfere with its expression.

Secondly,

It means that biology is not necessarily destiny.

Let's take one of the modifiable risk factors – low education.

Secondary education provides its advantage by increasing cognitive reserve.

The ability of the brain later in life to tap into alternative support networks when primary systems begin to fail.

The Lancet report showed that pursuing higher education later in life is not quite as beneficial for cognitive reserve as doing so before the age of 20.

Which is not to say that lifelong learning is not worthwhile,

But that the cognitive advantage appears to be greatest in earlier years.

Regarding that cognitive reserve,

I want to reiterate that the reserve serves as a protective mechanism even when there is cellular damage occurring in the brain.

So,

The outward expression of dementia might be delayed despite underlying disease.

I will talk more about tools for improving brain plasticity even later in life throughout this set of talks on brain longevity.

Other risk factors like smoking,

Hypertension,

Obesity,

Diabetes,

And physical inactivity can be addressed in midlife to slow or stop the neurodegenerative processes thought to lead to Alzheimer's and other diseases that cause dementia.

Generally speaking,

What you already know to be true about the things you can do and not do to avoid heart attacks and heart disease apply to the brain too.

I would like to highlight two of the lesser known modifiable risk factors for dementia that can only be addressed if people know they pose a threat to cognitive ability later in life.

Hearing loss and social isolation.

Midlife hearing impairment has been linked to a loss of volume in the brain's temporal lobe.

The temporal lobe is located just behind the ears and one of its main functions is the processing of auditory stimuli,

Including language.

But it is also important for emotional processing and for memory.

When brain mass is lost in this area because hearing is impaired for some reason,

That loss may be responsible for impaired memory as well.

The use of hearing aids when hearing loss is first detected may help preserve cognitive function.

I suspect the connection between hearing loss and dementia may be related to another surprising risk factor for dementia,

Social isolation.

And I will talk more about the value of social engagement in parts 3 and 4 of this series.

The four pillars of Alzheimer's prevention I learned during my brain longevity specialist training with the Alzheimer's Research and Prevention Foundation is a holistic approach that addresses most of the modifiable risk factors for Alzheimer's disease.

In the talks that follow this one,

I will share more about the roles of proper nutrition,

Exercise for the mind and body,

Stress management,

And spiritual fitness.

I hope you will listen to the complete series for the most comprehensive benefit.

Whether you are currently living with cognitive impairment or are more concerned about preventing it,

I share these teachings with love and as a witness to the renewed vitality that comes from compassionate connection.

Many future cases of dementia may be preventable,

But there are already millions of families who live with dementia today.

And we should also not forget those individuals who are isolated from their families due to physical or emotional distance or pandemic restrictions who also deserve to be seen,

Heard,

And supported.

Thank you for your willingness to not look away.

Reviews

Thank you so much for sharing this!
Dementia runs in my family, so far, at 78 , I have no signs of it yet. But now my husband has had dementia for 5 years and currently lives in a care home. This is at times very sad and stressful for me, so I do meditation, walking and Qigong. Thank you so much for sharing this!

Thank you for gently sharing this difficult information. It made me feel comforted and hopeful.

Thank you. That is a very helpful and informative guide. I shall continue to listen to your series. 🙏

Being a caregiver is a challenge I wish no one ever has to deal with. It is exhausting & depressing & many other adjectives i will not list for brevities sake especially when the person is mean, angry, volatile, & paranoid. Those adjectives I will list. Anyway, thank you & I look forward to listening to the full series.

Thank you for all your love and knowledge you share. And the most important reminder… to not look away; let all be seen, heard & supported! Embrace one another with acceptance!🥰 Look forward to listening to more of your series!

This was so informative and I look forward to listening to the whole series. Thank you.

This is very helpful, how do I locate the next parts of the series?
Thank you!
Donna

Under the age of 20 I didn't like education as I was bullied and had bad experiences at home with my parents. Interesting stuff though.

We, as a family, are starting out on the journey to understand dementia as it effects our loved one. Insights into this new world are welcome and appreciated .

Very informative! Looking forward to the rest of the series. Thank you

Thank you for sharing this.

Extremely interesting,I will certainly follow the next talk, thank you for sharing this with us.

Information was clear and well presented. Many thanks.

Thank you for this information. My 80 year old dad is struggling with dementia and our family is feeling the effects. We just try to enjoy and have fun with him. Good to have some information on prevention. 🙏🙏🙏💕☮️✝️

Eye opening ! Thank you

Thank you

Very informative, thank you. Hope to listen to rest of series.

I am very grateful for this series that you have offered with such compassion and understanding. Thank you.

I want to kiss the author hard

Very informative and helpful. Thank you. Where can I find the rest of the series ?