Until recently, one of the biggest bummers of the Alzheimer’s journey was the complete lack of agency around it. You had no idea if you were going to get it, but once you did, it was a one-way trip down the Dementia Highway. No rest stops along the way and no cure in sight.
Little did I know at the time, but all that started to change in 2017. That’s when the Lancet medical journal came out with a message of hope based on findings from the Lancet’s commission on dementia prevention, intervention and care. The upshot: in many cases, Alzheimer’s and other dementias may be prevented or delayed by addressing modifiable risk factors at various stages of life. As a bonus, these same lifestyle changes can lower the risk of other big diseases we want to avoid, like heart disease, cancer, diabetes and chronic respiratory diseases.
Any shred of optimism when we were in the thick of Nina’s Alzheimer’s battle would have been welcome news, so I’m sharing it here to make sure it’s no secret. I actually love being told what to do, but only when the advice comes from a reliable source. So, before the list… a little background on the names and acronyms behind the various landmark studies.
It all started with the FINGER
The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) trial was, a: a mouthful and, b: the first randomized controlled trial showing it is possible to prevent cognitive decline among healthy older adults at increased risk of dementia. The results of the two-year study, released in 2014, showed that a combination of physical activity, nutritional guidance, cognitive training, social activities and management of heart-health risk factors could help prevent cognitive decline.
In 2017 the Lancet journal reported that their commission had wrangled and consolidated the FINGER results with other studies and emerging knowledge to determine that lifestyle interventions could prevent or delay up to 40 percent of Alzheimer’s and dementia cases.
Pretty soon, everyone else wanted to get on the bandwagon. WW-FINGERS (World Wide, baby) was established to support and collaborate on similar global dementia prevention trials.
The US got into the game with the POINTER, shorthand for The Alzheimer's Association U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk trial. The U.S. POINTER is a 2-year clinical trial enlisting approximately 2,000 cognitively normal adults across five sites, who are at increased risk for cognitive decline.
The end game of all the trials is to build on what the FINGER started and evaluate whether lifestyle interventions that simultaneously target many risk factors can protect cognitive function.
Here’s the list of risk factors: (updated to include Lancet report from July 31,2024)
Physical inactivity
Smoking
Excessive alcohol consumption
Air pollution
Head injury
Infrequent social contact
Less education
Obesity
Hypertension
Diabetes
Depression
Hearing impairment
Untreated vision loss
High LDL cholesterol
For the visually inclined, this infographic shows the modifiable risk factors and their life stages.
A little run-through on the list
Most are self-explanatory, but some merit a little further explanation
1.Physical inactivity: No surprise here. Regular cardiovascular exercise elevates your heart rate and increases blood flow to the brain and body, so get up and get moving. A good starting point recommendation is 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity each week.
2. Smoking: Enough said.
3. Excessive alcohol consumption: Again, no huge surprise, but it’s a tough one for a lot of people, myself included. You’ll be hard-pressed to find anyone touting the health benefits of alcohol, though some make the case for red wine. Officially, drinking 21 units (whatever those are) per week increases the risk of dementia. Many people say alcohol is poison and there is no safe level to consume. They are probably right, but it still makes me sad.
4. Air pollution: Here’s one that is kind of out of your control unless you can move.
5. Head injury: This can be from a traumatic accident or repetitive impact from sport. You can’t change your past but you can do your best to protect your noggin going forward. Wear a seat belt, use a helmet when playing contact sports or riding a bike, and take steps to prevent falls.
6. Infrequent social contact: This is a biggie. Staying socially engaged may support brain health and definitely supports mental health. Pursue social activities that are meaningful to you (volunteer, join an exercise group, do activities with family and friends, etc…) Keep yourself in the mix!
7. Less education: A low level of education in early life is one of the most significant risk factors for dementia. Again, there’s not much you can do about your past, but challenging your mind may have short and long-term benefits for your brain. Play games, complete jigsaw or word puzzles, build things, make art, solve problems, play a musical instrument.
8. Obesity: This is another one that puts you at high risk for a host of other diseases and conditions. Diet and exercise are the key to managing obesity. The adage that “You can’t outrun a bad diet,” underscores that diet is the most influential of the two. However, it’s tough to find any official specific diet recommendation because diet advice gets into very controversial territory. People in every camp—along the spectrum from plant-based, bean-loving Vegans to gluten-free, animal protein loving Paleos, and all the nutty, grainy Mediterranean stops in between—will go to the tape defending their particular diet. In a Venn diagram of all the “healthy” diets, kale, avocado and water may be the only things in the overlapping space. But there is consensus around some basic principles, such as: minimize sugar, processed foods and alcohol; and cram as many colorful vegetables down your gullet as you can.
9. Hypertension: High blood pressure at mid-life sets you up for all kinds of other issues and ailments down the road. Aim for 130 mm Hg or lower systolic blood pressure mid-life to delay or prevent dementia.
10. Diabetes Type 2: Like high blood pressure and obesity, diabetes is a risk factor connected to many other diseases and needs to be treated.
11. Depression: Here’s a chicken and egg scenario where depression is often an early sign of dementia, but it’s unclear whether it is cause, consequence or a bit of both.
12. Hearing impairment: If a person’s hearing worsens in mid-life, their risk of developing dementia when they are older increases. This surprised me at first but it makes sense considering social isolation/withdrawal is a risk factor for dementia. The good news is that people who use hearing aids are less likely to develop dementia and have fewer memory problems and thinking problems independent of dementia. Getting hearing aids…and USING THEM is key, and the earlier the better.
Untreated vision loss: The thinking here is that vision loss reduces cognitive stimulation. Get those eyes checked!
High LDL cholesterol: This is important to get on in midlife, because the duration matters. Researchers suggest the association may be due to excess cholesterol in the brain raising the likelihood of stroke, and the accumulation of plaques of beta-amyloid protein in the brain.
But wait, there’s more
One thing not mentioned in the above risk factors is the role of sleep. This is odd, because sleep makes the Alzheimer’s Association’s list of ten healthy habits for your brain. It turns out the Sandman is a darned good janitor too, because during sleep the brain clears out waste products and toxins (including the beta-amyloid associated with Alzheimer’s) that accumulate throughout the day. This article in Harvard Health sums up studies indicating that people who slept less than the “normal” seven hours per night in middle age are more likely to be diagnosed with dementia later in life.
As a good friend used to always remind us at around 11pm, “Sleep is cheap and it’s good for you.”
So there you have it—all kinds of ways to have some agency around Alzheimer’s and give yourself a fighting chance for a better outcome. As a bonus, many of these lifestyle modifications can address multiple risk factors at once. For example, when you go for a walk with a friend you’re potentially decreasing your risk factors related to inactivity, social connection, obesity, depression and hypertension. Such a bargain, and who doesn’t love one of those?
Up next:
We’re taking a little swerve and looking at one of my failed (but also kind of fun) attempts to bring some action into Nina’s life. It involves a program that may be available and accessible in a town near you.
In the meantime if you want to do a deeper dive on the advancements in Alzheimer’s research, diagnosis and treatment, check out this article in Scientific American, entitled “A Seismic Shift in Alzheimer’s”