WAYS TO PRO­TECT

In many cases we can pre­vent our brains be­ing rav­aged by cog­ni­tive de­cline

Reader's Digest Asia Pacific - - Front Page - BY Anita Bartholome­w

Against De­men­tia

About 50 mil­lion peo­ple world­wide suf­fer from de­men­tia, and much has been writ­ten about how these num­bers will only in­crease as the pop­u­la­tion ages. With this in mind, it’s easy to as­sume that the over­all risk of get­ting de­men­tia is in­creas­ing, too, but the op­po­site is true: the rate of de­men­tia in the age 65 and older pop­u­la­tion is ac­tu­ally fall­ing. If sheer num­bers rise, it’s be­cause so many of us are liv­ing much longer than ear­lier gen­er­a­tions. And the older you get, the more sus­cep­ti­ble you are to age-re­lated ill­nesses.

WHAT IS DE­MEN­TIA? It’s a bun­dle of symp­toms as­so­ci­ated with pro­foundly im­paired think­ing, mem­ory and abil­ity to func­tion. Al­though most of­ten con­nected to Alzheimer’s, it can also be caused by other i l lnesses, ­i nclud­ing Parkin­son’s and car­dio­vas­cu­lar dis­ease. And a 2017 Lancet re­view of the re­cent re­search on de­men­tia found seven con­di­tions, in­clud­ing hy­per­ten­sion, ­obe­sity, ­un­treated de­pres­sion and un­treated hear­ing loss, in­creased the risks of de­men­tia.

The good news, ac­cord­ing to ­Pro­fes­sor Gill Liv­ingston, one of the au­thors of the Lancet re­view, is that if you im­prove those life­style fac­tors, you should elim­i­nate at least 35 per cent of ­de­men­tias at­trib­uted to them. But this may be much too con­ser­va­tive an es­ti­mate.

Stud­ies in the US, UK, Den­mark and else­where have shown that it is more pos­si­ble than ever to live a long life free from de­men­tia’s rav­ages. And this might be true even for ­peo­ple whose brains have al­ready un­der­gone some of the phys­i­o­log­i­cal changes ­as­so­ci­ated with de­men­tia. Such brain ­ab­nor­mal­i­ties some­times take decades to de­stroy the abil­ity to re­mem­ber, to com­mu­ni­cate and make sense of the world. But ­de­spite ex­ist­ing dam­age, some of us re­main re­mark­ably de­men­tia-re­sis­tant.

Here are five new find­ings that prove you can de­fend your brain against de­men­tia.

GENES AREN’T NEC­ES­SAR­ILY DES­TINY

So, what about genes? Don’t they make de­men­tia al­most in­evitable in some peo­ple? In the rare forms of early-on­set Alzheimer’s that strike peo­ple aged in their 30s through

to their 50s, genes do de­ter­mine ­dis­ease. But this is not the case in late-on­set ­de­men­tia.

“The com­mon gene that raises risk for Alzheimer’s in peo­ple 65 and over is called APOE-4,” says Pro­fes­sor ­Liv­ingston. But, she points out, not ev­ery­one who has the APOE-4 gene gets the dis­ease. And not ev­ery­one who gets de­men­tia has the APOE-4 gene. In fact, ac­cord­ing to Pro­fes­sor Liv­ingston, “It only ac­counts for about seven per cent of the de­men­tias.”

AN AC­TIVE BRAIN IS A HEALTH­IER BRAIN

On­go­ing re­search con­ducted at the Rush Alzheimer’s Dis­ease Cen­ter in Chicago since 1997 has shown that “Higher lev­els of cog­ni­tive ac­tiv­ity are as­so­ci­ated with bet­ter cog­ni­tion,” says Rush neu­rol­ogy Pro­fes­sor Aron Buch­man. He points to com­mon ­in­tel­lec­tual pur­suits such as read­ing books, writ­ing let­ters and reg­u­larly seek­ing and learn­ing new in­for­ma­tion such as an­other lan­guage. The Rush re­search found that the more such ac­tiv­i­ties were part of some­one’s life in their later years, the less men­tal de­cline a study par­tic­i­pant ex­hib­ited.

But an im­por­tant ques­tion ­re­mained: did these in­di­vid­u­als ­es­cape de­men­tia de­spite their brains show­ing phys­i­o­log­i­cal changes? ­Re­searchers got their an­swer when all the study par­tic­i­pants agreed to do­nate their brains for au­topsy upon death. The phys­i­cal con­di­tion of the do­nated brains was about what would be ex­pected of peo­ple in their 80s, 90s and be­yond, in­clud­ing brain ab­nor­mal­i­ties. But these ab­nor­mal­i­ties hadn’t caused the ­ex­pected ­i mpair­ment in those who had ­re­mained in­tel­lec­tu­ally ac­tive.

The pre­vail­ing the­ory is be­cause their brains had plenty of what sci­en­tists call cog­ni­tive or brain ‘re­serve’, a reser­voir of ac­tive grey mat­ter avail­able to com­pen­sate for age-re­lated changes.

But what if it isn’t just brain ­‘re­serve’? What if en­tirely new brain cells are form­ing and com­pen­sat­ing for dam­aged ones? Ac­cord­ing to a ­pa­per in the May 2019 is­sue of the jour­nal Cell, the do­nated brains of peo­ple who died be­tween ages 79 to 99 showed ev­i­dence that they

cont in­ued to grow new neu­rons their en­tire lives – even in their late 90s. And the bet­ter their cog­ni­tive func­tion at the end, re­gard­less of brain ab­nor­mal­i­ties, the more new neu­rons they had grown. Could life­style fac­tors af­fect that growth? More ­re­search is needed, but it’s an in­trigu­ing pos­si­bil­ity.

HEALTHY EAT­ING, HEALTH­IER BRAINS

A study pub­lished in 2006 found that by strictly ad­her­ing to the Mediter­ranean diet (higher con­sump­tion of whole grains, fruit, veg­eta­bles, olive oil and fish; low con­sump­tion of meats and sweets), you could lower your risk of Alzheimer’s by as much as 40 per cent.

To­day re­searchers have taken diet one step fur­ther and con­firmed the con­nec­tion be­tween it and de­men­tia, and have created what is re­ferred to as the MIND diet, a regime di­rectly tar­get­ing brain health. The MIND diet is a com­bi­na­tion of the Mediter­ranean and DASH di­ets (that re­stricts sweets, re­fined grains, fried and fast foods, red meat, but­ter and cheese). This com­bi­na­tion has now been proven to re­duce cog­ni­tive de­cline by about 50 per cent.

The most re­cent re­search, publ ished last year in the jour­nal ­Neu­rol­ogy, found that an over­all healthy diet is the key to re­duc­ing cog­ni­tive de­cline. Pauline Croll, lead au­thor of the re­search, be­lieves that fo­cus­ing too nar­rowly on any par­tic­u­lar foods might miss the big­ger pic­ture. “We did an ex­tra anal­y­sis where we could see whether one food item would drive the en­tire as­so­ci­a­tion of all diet qual­ity, and that was not the case. It’s the over­all di­etary pat­tern.”

Older peo­ple who ate the most health­fully, re­gard­less of whether the diet was closer to a MIND diet, a Mediter­ranean diet or other recog­nised health­ful eat­ing habits, had larger – and there­fore health­ier – brains. What the health­i­est di­ets have in com­mon is an em­pha­sis on plant-based foods, with fewer pro­cessed foods.

YOUR BEST DE­FENCE: GET MOV­ING

It has al­ready been es­tab­lished that peo­ple who fol­lowed the Mediter­ranean Diet and ex­er­cised rou­tinely had as much as a 67 per cent lower risk of de­men­tia. But more re­cent ­re­search on the ef­fect of ex­er­cise shows even more promise.

The Rush Alzheimer’s Dis­ease Cen­ter has been fol­low­ing a rolling (new peo­ple en­ter as older ones pass away) group of older peo­ple since 1994, try­ing to tease out the fac­tors that help some stay cog­ni­tively healthy while oth­ers de­cline. The av­er­age age of par­tic­i­pants as they en­ter the study is early 80s.

“In 2005, we be­gan us­ing a wrist de­vice that mea­sured phys­i­cal

ac­tiv­ity,” says Pro­fes­sor Buch­man. The de­vices mea­sured ev­ery­thing from sweep­ing the floor or gar­den­ing to more for­mal ex­er­cise like cy­cling. “We found that peo­ple who had higher ac­tiv­ity had a de­creased risk of de­vel­op­ing de­men­tia. They also had a slower rate of cog­ni­tive de­cline over time.” This re­search is on­go­ing.

As the par­tic­i­pants died and do­nated their brains to the study, the re­searchers dis­cov­ered that, just as with those who stayed in­tel­lec­tu­ally ac­tive, those who stayed phys­i­cally ac­tive off­set cog­ni­tive de­cline. “The ben­e­fits of higher ac­tiv­ity giv­ing you bet­ter cog­ni­tion held good re­gard­less of any ab­nor­mal­i­ties that we mea­sured in the brain,” says Pro­fes­sor Buch­man.

Be­cause the Rush re­search only mea­sures ac­tiv­ity start­ing when peo­ple are in their 80s, it didn’t tell us at what age ac­tiv­ity must be­gin to be of ben­e­fit. But it has now been shown that ac­tiv­ity at any age seems to help. Re­search pub­lished in Neu­rol­ogy last year found that, among older peo­ple with think­ing prob­lems that hadn’t pro­gressed to de­men­tia, those who took up and did aer­o­bic ex­er­cise for 35 min­utes, three times a week, for six months, were bet­ter able to pay at­ten­tion, plan and com­plete some cog­ni­tive tasks.

GOOD FOR THE HEART IS GOOD FOR THE BRAIN

Nu­mer­ous re­searchers have found a con­nec­tion be­tween de­men­tia and di­a­betes, obe­sity, high choles­terol, atrial fib­ril­la­tion and high blood pres­sure. High blood pres­sure, for ­ex­am­ple, has been linked to small brain le­sions that can af­fect cog­ni­tion.

“What is good for your heart is also good for your brain,” says Dr Sil­van Licher of Eras­mus Uni­ver­sity Med­i­cal Cen­tre. “I think that’s some­thing we should pro­mote more.” Heart-healthy rec­om­men­da­tions for diet and phys­i­cal ac­tiv­ity are much the same as brain-healthy ones.

“The im­por­tant mes­sage to­day is that peo­ple may be able to re­duce the risk of de­men­tia and main­tain brain health as they age,” says Pro­fes­sor Buch­man.

You, me, all of us – what­ever our ages – have the power to make small changes that in­crease our chances of liv­ing de­men­tia-free, for life.

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