Local geriatrician responds to WHO recommendations to limit risk of dementia
Recently, the World Health Organization released its first-ever guidelines for reducing risk for dementia and cognitive decline. Today, dementia is a global-health priority. The Centers for Disease Control and Prevention predict that the U.S. burden of Alzheimer’s disease and related dementias will double by 2060 to 13.9 million people.
The guidelines seek to help people limit their risk by increasing physical activity, reducing alcohol and tobacco use, and engaging in weight management.
We talked to Michael LaMantia, MD, MPH, geriatrician, about the WHO recommendations and what they mean.
Can we prevent dementia?
Dr. LaMantia: The biggest risk for developing dementia is aging. If we're lucky enough to age, we will all experience increased risk. But, there are steps that we can take to manage and decrease the risk for dementia. That's what the WHO guidelines speak to.
How does regular exercise decrease the risk for dementia?
Dr. LaMantia: When I think about brain health, I also think about heart health. Over the years, we've learned that the things that are good for your heart are frequently the same things that are good for your brain.
Just like the heart depends upon getting oxygen and blood flow, the brain depends upon that same oxygen and blood flow. Any type of activity that increases blood flow and oxygen flow into the brain is good for it.
When I talk with patients about how to apply this to their day-to-day lives, I recommend that they get at least 150 minutes a week of activity that increases their heart rate above resting. That could be walking around the neighborhood. That could be riding a bike. That could be chair exercises if your balance or mobility are affected. It needs to be personalized to the individual. Your brain is happier if you're doing exercise than if you're sitting around as a couch potato.
What is the connection between brain health and heart health?
Dr. LaMantia: Your vascular system. We know that high blood pressure and diabetes affect vascular health. They impact whether your blood vessels stay open to provide blood and oxygen to your heart. It's our thought that the same thing is going on in your brain, too. So, if you have uncontrolled blood pressure and you have uncontrolled diabetes and you smoke over many years, you're probably causing problems with the flow of blood through those pipes which bring oxygen to your brain.
How does smoking impact one's risk for dementia?
Dr. LaMantia: It may do so by different pathways. It may have a direct influence upon the flow of blood to the brain. It may also increase inflammation in the body, which may play a role in whether you develop problems with your vasculature. Stopping smoking is a good thing from the perspective of brain health.
What about alcohol consumption?
Dr. LaMantia: There is some evidence that the Mediterranean diet, which may include low amounts of red wine, is associated with decreased risk of vascular events and potentially even decreased risks of cognitive problems.
The difficulty is that the positive results are modest. I think that the results are modest enough that I don't recommend to people who are not drinking to start drinking as a way of decreasing their risk of dementia.
In fact, in many cases I see, people who once had a regular drinking habit when they were younger find that this same amount of alcohol affects them differently ---this is because as they age their body handles alcohol differently. They may find themselves experiencing more problems as a result of drinking because they haven't adjusted their drinking with their increased susceptibility to the negative effects of alcohol as they age.
I advise older adults to consider cutting back on alcohol as you age because the side effects may become more prominent. People who already have problems with mobility or with dizziness are likely to have even greater problems when you add one or two drinks to the picture.
The WHO does recommend the Mediterranean diet. What do you think about it?
Dr. LaMantia: The Mediterranean diet has been studied quite widely. The thinking on it is that this type of diet, which is high in vegetables, nuts and fruits, and low in the amount of red meat, benefits your vascular, heart, and brain health.
How do you advise your patients?
Dr. LaMantia: I essentially give them a prescription for what they should do to promote their brain health. While the evidence is certainly evolving, these are all things that I believe have little to no downside to them.
- Exercise your body at least five days a week for a half hour a day.
- Exercise your brain. Do at least 30 minutes a day of cognitively-stimulating activity. That could be reading the newspaper and talking about the articles with your partner or friends. It could be playing Scrabble, or doing Sudoku puzzles. Anything that is going to get your brain to connect and engage with new information is important to do.
- Get adequate sleep. Six to eight hours a night is usually adequate for people as they age. You don't want to sleep too much. You also don't want to sleep too little. If you're having problems with sleep, talk with your doctor.
- Eat a balanced diet. For many older adults this can be difficult. Some people have issues with food insecurity or don't have access to a variety of nutritious foods. They'll eat TV dinners, which can have high levels of salt.
- Manage your stress. Talk about your levels of stress and any mood changes with people who are part of your support system, including your doctor.
- Stay social. During a long Vermont winter, it can be tempting to stay in your own house and look at the same four walls. But, as humans we have a need for social contact, and this can be quite stimulating for our brains.
- See your doctor regularly and check in with them about your other medical conditions and stay on top of those.
What do you say to people who think dementia is an inevitable part of aging?
Dr. LaMantia: Aging in America does not mean that you have to develop dementia, that you have to develop other health problems, and that your 70s and 80s need to be years of inevitable decline. There are individuals in their 70s and 80s who are doing just as well as they were doing 10 or 20 years before. Genetics may play some role for some individuals as to whether they develop dementia, but there are steps that we’ve reviewed that may lower your risk.
Dr. LaMantia: Remember: "It's never too early to start and it's never too late to start." Those are words to live by when it comes to brain health.
Michael LaMantia, MD, MPH, is a geriatrician at the University of Vermont Medical Center.