It’s a bit churlish and flippant to title this post about dementia with a country song by Elvis when this insidious and heartbreaking condition is affecting so many people in Australia and worldwide. Each week, according to Alzheimer’s Australia, there are 1,700 new cases, or one person lapsing into a fog of cognitive impairment every six minutes. Currently, 321,600 Australians live with dementia and this number is expected to increase by one third to 400,00 in less than ten years. By 2050 that number is expected to expand to nearly 900,000. It is the third leading cause of death in Australia and at this stage there is no cure. Sufferers of Younger Onset Dementia number 24,400. This type shows up in those younger than 65 years of age and can appear in those as young as 30.
These figures are tragic. When you factor in that families notice sufferers show symptoms three years before diagnosis, that’s a lot of distress and dysfunction in our communities affecting the sufferers themselves and the 1.2 million carers who shoulder a lot of the burden.
Even those of noted intellect are not immune. Dementia has been in the news lately because of the death of British ex-Prime Minister Margaret Thatcher. Her ability to skewer politicians and journalists on their inability to match wits and figures with her was renowned but her daughter Carol finally confirmed the rumours of her mental decline into the malady in 2008. She said her mother used never to forget anything but her former “blotting paper mind” had been in decline for a decade and she even frequently forgot that her husband Denis had passed on from cancer in 2005.
Other issues have put dementia in the spotlight. Recent cases of violence perpetrated by dementia sufferers on others at home and in institutions have been in the media. In addition, Alzheimer’s Australia recently released the results of a comprehensive study that showed Aboriginal Australians suffer dementia at a rate 3 times higher than the general population.
I apologise for any churlishness or flippancy because this syndrome (it’s not classified as a disease) is so widespread it must affect so many of us. Let’s take a look at it and see what might be done to reduce the risk of contracting it as we age.
The word “dementia” comes from the Latin de – “without” and ment -from its root mens, or “mind”. Over the years mental illness has been lumped together and treated similarly but the modern approach sheds new light. Today, dementia is regarded as a loss of global cognitive ability in a previously unimpaired person beyond what is expected from normal ageing.
It takes several forms and may be static, resulting from brain injury, or progressive: characterized by long term decline. As mentioned, it is not regarded as a singular disease but as a syndrome that impairs memory, attention, language and problem solving.
To not know who you are, where you are, or the identity of those around you must be bewildering and terrifying, not just to oneself but to one’s family and friends.
Alzheimer’s Disease is the most common form. There is no cure, and it worsens with progression until inevitable death. Vascular dementia is the next most common form and often follows stroke(s). It is essentially a failure of blood supply to the brain. Frontotemporal dementia attacks our behavioural control centre and results in disinhibited and inappropriate behaviours as well as compulsive ones like overeating. Semantic dementia robs one of the meaning of words and dementia with Lewy bodies shows up abnormal protein aggregates in nerve cells.
Enough of gloomy statistics. There is hope of prevention. In the words of Alzheimer’s Australia: “what’s good for the heart is good for the brain”. Studies show that Alzheimer’s and other forms of dementia are closely linked to high blood pressure. Blood vessels are damaged by the narrowing that causes high blood pressure. When an artery hardens (as it inevitably does with ageing) the heart must pump harder to force blood through constricted vessels,and in the long term that is not good for the brain whose cells rely on nourishment from the blood supply like elsewhere in the body.
Reducing high blood pressure is a high priority for dementia prevention. I had an unusual experience last Christmas when I spent a delightful week with friends and their family at an idyllic beach hamlet next to the roaring surf on New South Wales’ south coast. We enjoyed daily swims, meals of local, fresh-caught fish and endless games of quoits and cards. I slept through the dawn rises to accompany a local professional fisherman on his boat way out through the pitching swell and beyond the horizon in search of snapper and kingfish but I was always there for the convivial seafood meals that included local friends.
One morning as a member of our party was checking his high blood pressure and taking his medication, his digtal blood pressure cuff was sent around the breakfast table so that everyone could take a reading. I was a bit nervous as it came around to my close friend and I as we had relaxed our normal healthy routine and attended numerous late-night Christmas celebrations where the cheer flowed. I could almost hear my heart pounding as my turn approached. I am a professional fitness trainer after all. Each member of our party over 50 took a reading and we all groaned along with them as the sphygmomamometer hit the high notes. I needn’t have worried as I’d spent most of the year painstakingly dropping eight kilos of body fat and had trained in the gym regularly. My friend had also lost quite a bit of weight and pumped iron as often as he could. Despite something of a hangover and a bit of exhaustion we both nailed perfectly low normal readings and felt pretty good about that as the others plunged into momentary despair. Even our local fisherman clocked dangerously high readings and the others urged him to see a doctor and get some treatment.
I guess the point here is that regular exercise and keeping our weight down had given two of us healthy readings. Blood pressure is largely in our own hands.
Dementia will probably always shadow humanity but we can reduce its risk with preventative behaviours.
Dementia risk shoots up with obesity. High alcohol use increases its risk but paradoxically, low alcohol use may reduce it. Some alcohol increases blood levels of “good” HDL cholesterol and weakens blood-clotting agents like fibrinogen. Some studies conclude that Omega-3 essential fatty acids have an uncertain effect on risk but all studies agree that meat high in saturated fat is a risk factor. Nuts have been studied and they do reduce dementia risk, possibly because of their high content of polyunsaturated fats.
Niacin (Vitamin B3) has been shown to be preventative as those with the highest levels circulating in their blood had the lowest risk of dementia and cognitive decline. This may be because of niacin’s role in DNA synthesis and repair, its role in neural cell signalling, or its known properties of boosting circulation.
I hope you are picking up that there is a close link between the state of your circulatory system and your risk of dementia. Currently, only vascular dementia risk is linked to poor circulatory function but I’m going to stick my neck out and say that most of dementia will be attributed to a failure of blood supply to the brain in future. After all, the brain is an organ using up to 20% of the the body’s metabolic energy and depends heavily on a rich blood supply.
Of course mental and physical activity are part of the picture. Research supports the idea that exercise can create new brain neurons (cells) and even release substances that protect them. Think of how great, how alive you feel after a brisk walk. Mental activity, from reading to cards and board games, playing a musical instrument, or participating in an engaging occupation or hobby are known to build up connections between brain neurons.
Even sleep has been looked at, and surprisingly, more than 9 total hours of cumulative sleep (including night sleep and daytime naps) is an increased risk factor.
So, substitute an activity for some sleep if you are overdoing it, cut down on alcohol, avoid smoking and do the other things you need to do to lower blood pressure, cholesterol, blood glucose levels and bodyweight to reduce your risk of dementia or manage it if onset has begun.
At Alzheimer’s Australia’s national conference Professor Michael Valenzuela told reporters that even dogs get it. 12% of dogs over the age of ten develop a similar type of dementia to their human owners. That may mean they are sharing the same lifestyle and could also benefit from improving their critical blood supply to their brains.