We can delay onset of dementia

Here is a very thoughtful piece by the ever-helpful ANDRÉ PICARD in a recent Globe & Mail column. He notes from a study that in fact, we can delay the onset of dementia by taking some proactive steps for ourselves and our aging loved ones.

 

There are few things that aging baby boomers fear more than dementia, a condition that robs one of memory – and too often dignity – and leaves you dying little by little, piece by piece.
The numbers are frightful: An estimated 564,000 Canadians are currently living with dementia, and that figure is expected to rise to 937,000 within 15 years.


Globally, it is estimated that almost 50 million people are afflicted with dementia and that is forecast to rise to 131 million by 2050.


The data are grim – even without mentioning the impact on caregivers, the health system and the economy. Yet, there are little glimmers of hope – in particular, research showing that dementia is preventable, at least in part.


A study published in medical journal The Lancet shows one in three cases could be prevented or delayed if people took better care of their brains.


Based on a review of scientific literature and mathematical modelling, a panel of 24 global experts identified nine factors that increase the risk of dementia and how much those risks could be lowered if they were addressed:
Mid-life hearing loss: 9 per cent;
Failing to complete secondary (high-school and above) education: 8 per cent;
Smoking: 6 per cent;
Failing to seek early treatment for depression: 4 per cent; Physical inactivity: 3 per cent; Social isolation: 2 per cent; High blood pressure: 2 per cent; Obesity: 1 per cent;
Type 2 diabetes: 1 per cent. All told, the potential risk reduction adds up to 36 per cent – but, of course, health problems are easier to avoid in theory than in practice.


Still, some important lessons can be drawn from this list of modifiable risk factors. While things such as smoking and inactivity are commonly seen as lifestyle choices, they are largely symptoms of poor socioeconomic conditions.


That’s a reminder that, as Dr. Martin Prince of the Institute of Psychiatry, Psychology and Neuroscience at King’s College London writes in The Lancet: “Dementia selectively affects the old and frail, women and the socioeconomically and educationally disadvantaged.”
The research also drives home another key point: The brain changes at the root of dementia occur years before the onset of symptoms.


Dr. Antoine Hakim, emeritus professor of neurology at the University of Ottawa, stresses this point in his new book, Save Your Mind: Seven Rules To Avoid Dementia. While the script for dementia is written early, perhaps as early as our teenage years, he writes, the risk of dementia is modifiable – up to and including when symptoms of cognitive decline begin – because of the plasticity of the brain.


Dementia is caused by the death of brain cells. But Dr. Hakim notes that most cases are not Alzheimer’s – characterized by tangles and plaques in the brain – but caused by vascular problems such as high blood pressure and stroke. In other words, what’s good for the heart is good for the brain (and vice versa).


Of his seven golden rules for brain health and reducing dementia risk, Dr. Hakim’s No. 1 recommendation is to “save for a rainy day,” to grow the brain’s capacity and resiliency by exercising it like a muscle.


We can’t prevent dementia from killing people, but we can delay its onset. A one-year delay would translate into nine million fewer cases by 2050; a five-year delay would halve the prevalence of dementia globally in that same time period.


Want to stave off dementia? Read. Write. Play music. Be physically active. Be socially engaged. Eat healthy food. Maintain a healthy weight. Sleep well. Don’t sit mindlessly in front of the TV. Those simple counsels are the best tools we have in a world in which there are no drugs or treatments that prevent dementia.


There are 100 billion neurons, trillions of contact points known as synapses and 600 kilometres of blood vessels in the brain, and “everything we do – and don’t do – affects the health of these cells and their connections,” Dr. Hakim writes.


Dementia is not a natural consequence of aging. Risk depends, in part, on genetics, and on the lifestyle “choices” we make. (And we have to be careful with that word because major factors such as poverty and education are rarely a choice.)


As The Lancet notes, “dementia is the greatest global challenge for health and social care in the 21st century.” But it is not a runaway train. We have the ability prevent – or more realistically, delay – the disease. And keeping dementia at bay, even temporarily, can change a lot of lives.


We can save a lot of minds by using our heads.

Video: Dealing with Alzheimer’s and Dementia

Parenting Your Parents co-author Dr. Michael Gordon was a recent guest on the national Canadian network show, Canada AM.

Here is a clip of that segment, which includes two other prominent guests who are dealing with parents who have advancing Alzheimer's and dementia.

We think you'll find it interesting and informative.

Canada AM: Dealing with Alzheimer's and dementia

 

 

 

 

 

 

 

 

Some thoughts for Alzheimer’s Month: the scoop on dementia

Dementia Care Cost Is Projected to Double by 2040— the headline was very dramatic and from the trusted New York Times (April 3, 2013). Similar articles have appeared in Canada’s main newspapers as well.

The implications were potentially enormous in terms of costs to society and challenges to caregivers and family members.  

During the past few years there have been doom and gloom predictions have flooded the media about the negative impact of the increasingly aged population, and that would include vast numbers of those living with dementia. This is so much the case that when it comes to creating public policy, one often hears various government representatives and those in charge of health and finance portfolios prepare the population for drastic changes in funding because of the hysterically classified “tsunami of dementia”.

So it was with a sigh of great relief that The New York Times carried the following headline on July 16, 2013: Dementia Rate Is Found to Drop Sharply, as Forecast leading an article written by Gina Kolata. The essential message from the article was, “A new study has found that dementia rates among people 65 and older in England and Wales have plummeted by 25 percent over the past two decades, to 6.2 percent from 8.3 percent, a trend that researchers say is probably occurring across developed countries and that could have major social and economic implications for families and societies”.

So while the researchers are looking for pharmaceutical or dietary curative or preventive “magic bullets” and the pharmaceutical industry is supporting their efforts, with a focus on early diagnosis, everyone can already take the known steps to promote their own brain health by eliminating smoking, exercising, decreasing blood pressure levels and lipid levels, and eating as healthy a diet as reasonably possible and keep their brains as active as possible. That is all we can do while the saga of Alzheimer's and other forms of dementia unfold.

Open, honest communication is essential

If one is a geriatrician, a good part of one’s practice is focused on individuals either living with dementia or concerned about having symptoms that might be dementia. It is often a frightening prospect, at times more so for the family members than for the person with the symptoms, depending on their awareness of the problem and insight into the implications.

As I looked through the health record, I saw the neuropsychological report that supported my initial clinical diagnosis of likely dementia. The symptoms suggested it was probably a type of Alzheimer’s type. There was a note that my secretary handed to me from the patient’s spouse which reminded me of many requests I have received over the years from family members accompanying a loved one to such a medical visit. She did not want me to share an adverse diagnosis with her husband

Years ago, families and physicians sometimes conspired to withhold the true nature of a patient’s condition. As a result, patients and families were denied the opportunity to honestly express their important thoughts and feelings to each other before the patient died.

Gaining trust

What should I do about this latest request? I looked again at the wife’s note and asked the couple to come into my office. I knew that I would have to gain the couple’s trust to ensure our future relationship would be productive. After our initial greetings, I turned to the issue of the neuropsychological report. “So how did that go?” I asked the patient. “I think pretty well. What was the result?” he replied.

I responded that the reason I sent him for the examination was because his wife and I had concerns about his memory, and that I suspected dementia. I could see the patient tense up when I used the term dementia. I continued, “You know that we use the term dementia to mean something is not right with the way the brain and its ability to remember things works. There are many disorders that can cause dementia…”

Breaking the news

The patient concentrated on my every word. I continued, “Fortunately, we now have medications and other treatments that can treat these conditions, including Alzheimer’s disease.”

I want to try one with you and start it now at a low dose to give you the best chance of tolerating it until I see you in a few weeks for follow- up. Is this OK with you?” I could see his wife with a bit of trepidation waiting for his response. “Sure…are there any side effects?” he asked. I replied, “Most people tolerate the medication well but I always start with a small dose just to make sure.” 

As he got up to leave with his prescription, I said that I looked forward to seeing him. I did not tell him or his wife what to expect so that there would be no pre-conceived ideas of his treatment. As she left the room, the wife said, “Thank you, I did not believe we could do this and we did.” I’ve learned through many years that open and honest communication between doctor and patient (and their family) is more helpful than avoiding the truth. It has to be done with sensitivity and sometimes over time rather than in one meeting.