Until last decade, dementia was regarded as a grim lottery.
asserted
dementia → regard → lottery
If you made it into your twilight years, you’d wait and see if it came for you.
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it → make → you
If you carried a gene linked to Alzheimer’s, it was your destiny.
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it → carry → Alzheimer
Medical science could offer no treatment and there was nothing you could do as an individual to lower your risk.
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you → offer → risk
This fatalism wasn’t borne of ignorance.
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fatalism → bear → ignorance
The world-leading National Institutes of Research laid out this dispiriting position at its Preventing Alzheimer’s Disease and Cognitive Decline conference in 2010.
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Institutes → lead → 2010
“There is currently no evidence considered to be of even moderate scientific quality supporting the association of any modifiable factor … with reduced risk of Alzheimer’s disease,” it said.
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it → be → disease
Today, it’s a very different story.
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it → ’ → ?
We’re no longer considered powerless hostages to neurodegeneration as we age: at least 45 per cent of dementia risk can be attributed to modifiable factors, according to latest World Health Organisation (WHO) guidelines.
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cent → consider → guidelines
In Australia, that figure rises to 50 per cent based on our health data, according to Professor Kaarin Anstey, the only Australian on the World Health Organisation’s dementia guidelines panel.
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figure → rise → panel
“I think it will increase because there are some risk factors that researchers are aware of that are not there yet,” she said.
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she → think → that
“The list will get longer.”
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list → get → ?
Senior Australian of the Year Professor Henry Brodaty, of the University of NSW’s Centre for Healthy Ageing, has helped drive enormous change in dementia awareness, from “half a page in textbooks” in the 1970s to the world’s largest dementia research conference, attended by more than 10,000 this year.
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Brodaty → drive → 10,000
“If you think there’s nothing you can do to prevent dementia, think again – because there’s plenty you can do,” he said.
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he → think → dementia
Many of the preventative measures are good advice for general health: eat well, don’t smoke, cut back on alcohol, and exercise regularly.
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Many → eat → alcohol
But others are less obvious and carry even more weight.
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others → carry → weight
Hearing loss and high cholesterol are the two biggest known modifiable factors in dementia, according to the Lancet Commission, each representing a potential 7 per cent drop in risk if addressed.
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each → know → risk
“Hearing loss contributes to a cascading effect of decreased social engagement, mental wellbeing and physical activity, which can increase the risk of cognitive decline and dementia,” said the WHO guidelines.
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guidelines → contribute → decline
When left untreated, it’s thought hearing loss may expose people to higher cognitive load and potential brain shrinkage.
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loss → leave → load
It’s a similar story for those with untreated vision loss, a newly recognised risk factor for dementia.
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It → ’ → dementia
But having high levels of low-density lipoprotein (LDL) cholesterol in your blood puts you at risk of vascular damage and an increase in amyloid and tau proteins in the brain.
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having → have → brain
Likewise, high blood pressure, stroke, diabetes and obesity can cause inflammation and cell damage, bumping up susceptibility to dementia.
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pressure → cause → dementia
The good news is all these conditions are treatable, with solutions ranging from lifestyle changes and medication to glasses and hearing aids.
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solutions → range → glasses
Associate Professor Dr Marita Long, a GP and honorary medical advisor at Dementia Australia, believes a dementia risk assessment should be incorporated into general practice for Australians at middle age.
“When patients come into my consulting room, they might ask for a skin check and wouldn’t be surprised to get their blood pressure or heart checked, but they wouldn’t really know about brain health,” said Long.
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Long → believe → health
“I’m not trying to drive fear about dementia, but if you talk to your doctor, there are a lot of things you can be doing.
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you → try → things
That includes considering medication for high and borderline high cholesterol and blood pressure in midlife, even if it’s not subsidised.
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it → include → midlife
“It’s about having shared decision-making with patients,” Long adds.
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Long → ’ → patients
At Neuroscience Research Australia (NeuRA), Anstey and her team developed a free and clinically validated 10-minute online risk assessment called CogDRisk, which gives users a dementia risk score based on their medical history, lifestyle, diet and sleep.
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which → develop → history
“I would like to see it much more widely used and ideally integrated into GP software,” she said.
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she → like → software
Midlife is the prime time to make changes, as this is when two-thirds of the risk factors for dementia come into focus.
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thirds → make → focus
Your brain is not insulated from the rest of your body when it comes to dementia risk, nor the world around you.
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it → insulate → you
And what you put into your body matters.
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put → put → body
A healthy and balanced diet is protective, as it may reduce inflammation and support brain function, as well as lowering the risk of chronic diseases.
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it → reduce → diseases
According to the WHO, the strongest evidence points to Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets or the hybrid Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet.
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evidence → accord → diet
That means plenty of fruit and vegetables, nuts and legumes, whole grains, and some fish, with limited consumption of red meat, saturated fat and sugary foods.
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That → mean → meat
This is the style of diet followed by all the experts the Herald spoke to for this feature.
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Herald → follow → feature
Anstey, who follows the MIND diet, which includes cooking with olive oil and having berries a few times a week, is also concerned about what we shouldn’t be eating.
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we → follow → what
“The impact of ultra-processed food on our health and brain health concerns me,” she said.
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she → concern → me
“I understand that people are so busy and don’t have time to cook, but we would see an improvement in health if we could reduce reliance on unhealthy fast foods.”
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we → understand → foods
There’s reason for concern: older people who ate the highest amount of ultra-processed foods, such as processed meats, soft drinks and snack foods, had a 58 per cent higher risk of dementia than those who ate the least in a large Harvard University study published in June.
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who → ’ → June
…and 87 more, not listed.
The Aporia
