Dementia. Darn, it’s on the tip of my tongue

I am taking a break over the holidays. For the next four weeks, I will be republishing a few of my favourite blogs.

I’ve noticed an alarming thing lately, although I should not be surprised. My patients are growing older. Teenagers I was helping with their self-destructive behaviours two decades ago are now anxious mothers. Anxious mothers whom I met 20 years ago are now looking at retirement. It shouldn’t be surprising; I am getting older too. So is the rest of the world. Life expectancy has been steadily increasing worldwide over the last two decades. This is largely due to better infant survival in poorer countries and less cardiovascular and infectious events in richer countries. The world life expectancy is 71.8 years, with the USA at 78.8 years and SA at 60 years (all those years of AIDS denialism still means we have high AIDS mortality, bringing our stats down).

To grow old is hard; it is not for sissies. One of the most difficult things to face is that our brains degenerate as surely as our bodies do. One percent of us will have some type of dementia at 65 years of age; five percent of us in our 70’s; nearly a quarter of us in our 80’s; and should we be blessed to make it into our 90’s, 37.8% of us in that age group will be dementing. We all fear the fading and dependency that dementia brings. Medicine has not been helpful. Despite a great deal of research, we have been unable to cure or even halt Alzheimer’s dementia. (There are many types of dementia. In this article, I am mainly referring to Alzheimer’s dementia, although the principles I am addressing are for all dementias.)

Scientists now realise that someone is the endpoint of a long progressive illness when they reach the point of needing 24-hour care; when they cannot remember their loved ones and are even confused as to where they are. It starts with MCI (mild cognitive impairment), which is essentially forgetfulness. It may then progress to mild (early stage) dementia, moderate (middle stage) and finally severe (end stage) Alzheimer’s disease. Fortunately, not everybody who is forgetful gets Alzheimer’s disease. But everybody with Alzheimer’s Disease did start with MCI, even if it wasn’t formally diagnosed.

The recommendation now is to make changes early on to live a “brain healthy lifestyle”. Whilst no one can protect against genes or advancing age, two-thirds of the brain’s degeneration can be attributed to lifestyle factors.

Diet

Alzheimer’s dementia is known as the third type of diabetes. Staving off inflammation caused by sugars, trans fats and processed carbohydrates is essential. You can’t go wrong with a Mediterranean diet – lots of fish and fresh fruits and vegetables. While the Banting or Atkins diets go a long way to reduce carbohydrates and sugars, the emphasis on animal proteins is a problem.  Too much animal proteins, particularly red and processed meats, can raise cholesterol and be pro-inflammatory. In a bid to manage metabolic inflammation effectively, yearly blood sugar, blood pressure and cholesterol screens are essential. It is beneficial to stop smoking and to drink modest alcohol.

There are studies supporting the benefits of:

• Selenium (1 brazil nut a day should do it)
•  Anthocyanins, as found in a small cup of blueberries consumed regularly
• Curcumin (the spice found in turmeric. You can take it in supplement form)
• Folic acid, Vitamin D, Magnesium, Zinc (the super four of brain supplements)
• Omega 3’s and probiotics (I am yet to be convinced that most probiotics are better than fairy dust. But the probiotics found in fermented foods such as kimchi or yoghurt are fantastic)
• 2- 4 cups of tea daily (there is a reason why old people drink more and more – it’s neurostimulatory)
• Fasting. 10 hours at night should be enough to deplete your brain glycogen stores, which is what is needed to reap at least some of the benefits of intermittent fasting

Exercise

Human beings are made to move.  The current recommendations are for a minimum of 30 minutes of cardio a day, or 150 minutes a week. Start slow, go for walks. Exercise protects against Alzheimer’s disease, or further degeneration in existing Alzheimer’s disease, by stimulating the brain’s ability to maintain connections as well as make new ones. After 40 years of age, we start losing muscle mass. Moderate levels of resistance training (weights) not only helps you keep strong, you “pump up” your brain too.

Sleep

For a long time, it was thought that sleep problems are a symptom of dementia. Now it is thought that sleep problems are a precursor to dementia and a contributing risk factor to developing the illness. During sleep, the brain’s microglial cells act like little vacuum cleaners mopping up waste products. Without proper sleep, waste products build up and start to interfere with brain functioning. If you are not getting adequate sleep, prioritise sleep hygiene and speak to your doctor to help get it sorted.

Socialise and have fun

People who engage in social activities show less cognitive decline.  One reason is that social activities promote new connections between brain cells. People who laugh more are less stressed and have better immune systems. When you connect with friends, you are looking after your brain. Yet loneliness is a scourge of old age, especially with children working all over the world and perhaps the death of a spouse. It has proven benefits to reach out with Skype or join a social club. I know that croquet has had a resurgence of popularity in the Southern Suburbs, and not just with old folk!

When we socialise, we are forced to try to be nicer.  Nice people stay nice when they dement. Prickly, difficult people become more prickly and difficult as dementia progresses – adding to care-giver burden.

Use it or lose it

It is a fallacy that you get too old to learn. Learn a new instrument, language or hobby. You might not master it, but your neurons will keep firing and moulding. A great deal of research has gone into “brain train” games such as Lumosity or Elevate (available in app stores). It has disappointing results on restoring function in Alzheimer’s disease but does seem to have “brain rehab” benefits. That is, keeping those neurons going.

Medications

Once Alzheimer’s dementia is diagnosed, the use of Acetyl choline inhibitors ( Aricept) and memantine (Ebixa) can help stabilise symptoms for several years. The earlier they are initiated, the more good years can be benefited.  These are not a cure, though.

We are all getting older. A large percentage of us will dement to some degree or another. But we are not helpless victims in this progression. We can accept the challenge of caring for our brains.