Understand dementia and take action to help prevent age-related cognitive decline
Perspectives surrounding health and wellness are shifting at a radical rate, with a newfound interest in the study of prevention, healthy aging, and longevity. As things continue to evolve rapidly in this field, some of the fears that accompany us as we grow older will remain unchanged, including the fear of losing the full capacity of our minds and our memories. While we see exciting new developments in diagnostic and therapeutic technologies for cancer, cardiovascular disease, and metabolic syndrome, dementia continues to be a challenging problem to solve, with a severe lack of therapeutic options. Although cognitive decline is a scary reality that will affect many of us or our loved ones, there are actions we can take to limit the risks and prevent age-related cognitive decline.
Dementia is known as a loss of cognitive functions such as memory, reasoning, and processing in a way that interferes with daily life. It can arise from several different causes related to aging, cardiovascular health, or even traumatic brain injury. There are many different types of dementia, such as Alzheimer’s dementia, Lewy Body dementia, frontotemporal dementia, and vascular dementia – the most common diagnosis being a mix of multiple types of dementia. Alzheimer’s, Lewy Body, and frontotemporal dementias all arise from the abnormal buildup of improperly folded or mutated proteins that disrupt neural pathways in the brain. On the other hand, vascular dementias likely result from a reduced supply of oxygen or nutrients to the brain that can be related to other cardiometabolic diseases such as hypertension, high cholesterol, or diabetes (1).
Dementia can display a broad range of symptoms. Some will notice a steady decline in cognition and working memory, whereas others have experienced a more confusing and sporadic variant of the disease, with some days being much better than others. Some people are completely cognisant of the changes in their cognitive health, while others remain completely unaware. It is especially important to understand the common symptoms and seek help when these symptoms are observed in yourself or someone close to you (1,2). The well-known symptoms of dementia include a decline in memory, ability to reason and process things in our surroundings, ability to express thoughts, and general confusion. If any of these signs are observed, it is essential that you see a doctor as soon as possible to undergo a proper diagnostic protocol.
How to Screen For Dementia – Precision Approaches to Dementia Screening and Management
Due to the wide range of factors associated with dementia and our poor understanding of the true causes of cognitive decline, a variety of diagnostic approaches are used to screen for underlying risks. A major predisposition for Alzheimer’s dementia, one that has been gaining traction in the media recently, is the APOE gene. Individuals with one or more copies of the APOE4 variant of the gene are shown to have an increased risk of developing Alzheimer’s disease (3). Fortunately, there are many preventative actions that can be taken to reduce the risk of developing Alzheimer’s, allowing many individuals with the APOE4 variant to continue living healthy lives, free of dementia.
Other diagnostic approaches are not as specific in the outcome, including standard blood work to screen for cardiovascular symptoms that can exacerbate the risks for dementia (ie., cholesterol, glucose, inflammation, etc.,) and the gold standard cognitive assessment/clinical interview that is required to confirm all dementia diagnoses. An exciting new technology for dementia screening is amyloid imaging, which has the capability of detecting and quantifying amyloid plaques in the brain that are commonly associated with Alzheimer’s (4). This approach still has some limitations, as many people show signs of Alzheimer’s before developing any plaques, and others with signs of plaque development may not have any symptoms of cognitive decline at all.
Dementia is not a disease that develops spontaneously. In fact, studies have shown thatsigns of dementia are detectable as early as age 55 – nearly 30 years before someone might start showing clinical symptoms. It is especially important to screen early and rigorously because early detection will provide the best chance of successful prevention and treatment (5).
Dementia Is Not A Fatal Diagnosis!
Things You Can Do To Affect The Trajectory of Dementia
While the threat of dementia continues to be highly prevalent, there are fortunately many things we can do to reduce the risks or even completely avoid the onset of cognitive decline and dementia. One of the most effective strategies to limit these risks is aerobic exercise. Several studies have shown that regular aerobic exercise can improve cognitive testing scores, even in patients that already have dementia (6). Aerobic exercise can also improve biomarkers associated with cardiovascular health, thus reducing the vascular risks for dementia.
Another behavioral factor that is strongly associated with cognitive health is sleep. Many studies have revealed that irregular sleep cycles early in life can substantially increase the risk of developing dementia late in life (7). Changes in sleep patterns are also one of the earliest signs of the onset of dementia, but it remains unclear whether these changes are causative of the disease or just early symptoms. Practicing behaviors associated with good sleep hygiene can improve sleep quality and may reduce the risks of developing dementia or other psychiatric diseases later in life.Dietary and supplementary approaches have also shown great promise in the prevention and management of dementia. Diets such as the Mediterranean diet have successfully helped many patients manage their symptoms of dementia. There is also a growing body of evidence supporting the protective effects of omega-3 fatty acids (specifically DHA) against Alzheimer’s disease and general cognitive decline (8). It is not yet clear whether these factors reduce risk by improving cardiovascular health, or whether they have a more direct mechanism of action. Still, these approaches show great promise as behavioral tools individuals can use to improve their chances of favorable health outcomes and limit their risk of age-related cognitive decline.
Dr. Rohan Bissoondath,
Medical Director