The risk of dementia doubles every five years after the age of 65 in Australia. And whereas before little was known about this debilitating disease, we now have “some good ideas as to what may be the contributing mechanisms”, says Professor Perminder Sachdev, co-director of the Centre for Healthy Brain Ageing (CHeBA), UNSW.
While there’s no cure, there are preventive measures everyone can take right now, from this day onward, to help delay the onset of brain disease. In fact, rather than being purely genetic, Alzheimer’s may be equally induced by environmental factors – things we actually have the power to change. And if you’ve ever lived through the effects of dementia on a loved one, you will know you want to avoid it as much as humanly possible.
We all know we should exercise, but probably thought it was mostly for the physical aspects. But studies now show the positive effects exercise has on all of the organs, including the brain. Sachdev thinks regular exercise is one of the most important things we can do to keep our brains healthy.
“Exercise has many benefits for the body, including the heart, muscles, bones, and immune system,” Sachdev says, “and its effect on the brain is an important one. It has been found to increase blood flow, promote new cell formation in the brain and improve cognitive function. In a number of trials, it has been shown to slow the decline seen in the early stages of dementia. The minimum recommended is about 150 minutes per week [30 minutes, five days a week], but I tell my patients to achieve an average of 40 minutes per day. It is a good idea to combine aerobic exercise with resistance training, and it’s important to do something that you enjoy so that it can be sustained.”
It sounds like a lot of exercise, but once a rhythm it becomes normal, and if there’s a healthy brain to be had in your twilight years, that’s got to be worth it.
2. Regular GP checks
A regular check-up can help control factors which may contribute to dementia.
“Vascular risk factors increase the risk of heart disease, stroke and Alzheimer’s,” Sachdev says.
High blood pressure is the most important, and as it’s common, and can be effectively treated, everyone should begin annual GP check-ups in their 40s. A GP check will also pick up things like high cholesterol and high homocysteine levels – both of which are brain disease risk factors.
“Homocysteine is an essential amino acid which rises with age,” Sachdev says. “A high homocysteine level has been shown to have some bad effects on the brain and blood vessels, it increases the risk of heart disease and brain disease. If it’s high, you lower it with folic acid [a B vitamin].” So again, something that can be easily treated if diagnosed.
“Diabetes is another vascular risk factor and even blood glucose below the threshold for diabetes may be harmful for the body and brain,” Sachdev adds.
3. Alcohol and smoking
Smoking at any level is harmful to the body, and should be avoided at all ages, naturally, we’ve heard this one before. It will reduce the risks of vascular disease (see point 2).
“Alcohol has a complex relationship with the body and brain,” Sachdev says. “Small amounts of alcohol may be good, but large amounts are clearly bad. If you enjoy alcohol, make it occasional use, perhaps a glass of wine a few times a week with your meal. Do not average more than two drinks a day (less for women), and have one to two alcohol-free days.”
He also weighs into the red wine debate, saying, “There is some evidence that red wine, which contains polyphenols, may be offer some benefit, but only when used in moderate amounts.”
As usual, moderation is the clear winner here.
4. Good nutrition
With all of the stories being flung around about high fat, low sugar and the paleo diet, it’s hard to know what’s what in this area.Sachdev agrees: “There has been a lots of speculation, but a lot of it is not based on evidence. What we do know is that obesity is bad for you.”
5. Lower obesity
Midlife obesity (the most common) increases the risk of diabetes, heart disease and dementia. “It damages the heart and we think there is a direct link with brain health as well,” Sachdev says. “Weight reduction itself is good for you. Bringing your weight into a normal BMI is good for you. How you achieve that is a combination of two things: physical exercise which we’ve mentioned, and good nutrition.”
6. Reduce caloric intake
“We know that caloric restriction increases your lifespan from a number of studies in animals. This isn’t a new finding – the science goes back 70 or 80 years. But then you have to think about what kind of calories you are consuming,” Sachdev says.
Our everyday caloric intake comes from three kinds of foods: carbohydrates, proteins and fats. The general notion is that most diets have the majority of calories coming from carbohydrates which Sachdev says isn’t necessarily bad, but it’s about what kind of carbohydrates you are consuming.
7. Good carbs
“If you’re eating refined sugars, that stresses your endocrine system and predisposes you to diabetes. Eat complex carbohydrates like wholegrains instead of refined white flour, and also a mix of wholegrains,” he advises.
8. Good quality protein
We don’t need a lot of protein as we get older, but we do need good quality protein, Sachdev says. “Many diets actually push high protein, which do make for lean mass, but we don’t know if they are necessarily good for the heart and the brain,” he says. “Red meats may not be so good for you and the evidence comes from cancer, not necessarily in terms of brain health. Evidence shows that fish may be good for you and the brain, through Omega 3 fatty acids or generally the quality of the protein itself. So some of your protein should come from fish and much smaller amounts from red meats and poultry, and other sources of vegetarian proteins like legumes, because the quality of protein is not so good.”
9. Good fats
While there is a lot of talk about how we’ve overdone the “low fat” message, when we’re talking fats, doctors still don’t recommend a lot of saturated fat.
“There have been numerous studies on the Mediterranean diet which is focused around olive oil, and that should be your major source of fat,” Sachdev says.
10. Vitamins and Minerals
Vitamins and minerals which help the brain come from eating a large variety of vegetables. “Especially B vitamins and antioxidants. Coloured vegetables and leafy vegetables are what you really want to consume. You can’t go wrong there,” Sachdev says. Fruit is also a good source, but fruits have a lot of sugar so eat within reason. “The other thing is raw nuts which are also a great source of good fats.”
And should we be spending a small fortune on supplements? Will they increase our brain health and stave off brain disease?
“I tell people that if you have a generally good diet, then you don’t really need a supplement. There’s no science that suggests overdoing a vitamin is good for you. If you’re worried about your vitamin intake, take one multivitamin a day, that’s probably all you need, unless you have a deficiency in something,” he advises.
11. Stay mentally and socially active
There’s good evidence that staying mentally active preserves the brain and that people with high education often do better in relation to brain ageing.
“It’s never too late to start stimulating your brain with activities that challenge the mind – learning a new language, or instrument or dance or solving puzzles or doing brain training on a computer can all be helpful,” Sachdev says.
12. Loneliness is bad for you
There’s increasing evidence of social networks being good for you.
“They don’t have to be large, but if there’s a group of friends you see regularly and interact with, that’s good for you. There’s a benefit on your mood so you’re less likely to be depressed and also, it does force challenges to you in terms of your mental activity,” Sachdev explains.
13. Take a course
Some people have jobs that challenge their brain with problem solving, but others might have a more routine job, then come home and watch television, then go to sleep, which is not stimulating the brain.
“That’s really something we’re finding a lot of evidence of now, that these people are more vulnerable to decline later in life. And also when people retire, even if they had a challenging job previously, they go into a non-stimulating environment. People who do best later in life are the ones who are pretty engaged – they’re volunteering somewhere, they’re actively with people, they’re taking on new things, they do an evening course or something like that. That’s the kind of thing that generally keeps people much more stimulated and active.”
The idea, Sachdev explains, is to try to delay the onset of dementia and Alzheimer’s by five or 10 years. That might be all you need to get a better quality of life, for longer.
– Nedahl Stelio