SIMPLE STEPS TO STAY WELL
WHILE we wait for the outcome of clinical trials, there could be lifestyle choices that may help us lower our risk of Alzheimer’s. These are particularly important if you have a family history.
A good night’s sleep may be a key preventative factor, suggests Dr Liz Coulthard, a dementia neurologist at North Bristol NHS Trust.
Sleep disorders such as sleep apnoea (where throat tissue collapses during sleep) raise blood pressure and cardiovascular risk — both linked to dementia.
But separately, in a stage of sleep known as non-REM, which occurs just after we drop off, amyloid and toxins are cleared from the brain. ‘With interrupted, bad sleep you don’t get into this [non-REM] stage so don’t go into this clearing process — raising the risk of amyloid build-up,’ says Dr Coulthard.
Other scientists are now investigating whether drugs for insomnia could help prevent dementia or treat early signs of disease.
‘It always makes sense to prevent rather than focus on treating conditions — but we must prioritise both equally,’ says Gill Livingston, a professor of psychiatry of older people at University College London. ‘Sadly much more money has gone into the so-called magic bullet than into prevention.’
The 2020 Lancet Commission on Dementia Prevention,
Intervention and Care concluded that 40 per cent of dementia cases could be prevented or delayed by tackling 12 modifiable risk factors, including losing excess weight, controlling blood pressure and diabetes, lowering alcohol intake and exercising regularly.
The significance of this is borne out by the fact that while the number of people with dementia is increasing — as we have an older population — the rate per 100,000 has decreased considerably, by 25 per cent in 20 years, says Professor Livingston. ‘This is due to improvements in education, smoking cessation and healthcare — which suggests preventative measures can have an impact.’
A study reported just this month found that a diet packed with vegetables, fruit, beans and tea and coffee seems to protect against dementia.
Researchers in Greece looked at intake of foods thought to reduce inflammation — a third of the 1,000 study volunteers (all aged over 70) who ate the least of these foods were three times more likely to develop dementia during the three-year study, compared with the third who ate the most.
The difficulty is that there is a lack of direct evidence from robust clinical trials for lifestyle interventions to prevent dementia, says Dr Sebastian Walsh, an academic clinical fellow at the University of Cambridge, but the emerging evidence is pointing clearly towards a benefit of maintaining a healthy lifestyle (e.g. exercising more, eating well, keeping your brain active), reducing dementia risk. ‘It’s definitely worth trying because this prevents other diseases too, and unlike taking drugs there are no side-effects,’ says Dr Walsh. The problem, he adds, is that while a treatment has been prioritised, investment towards improving prevention and care for patients has been lacking. ‘What we don’t need is drugs that don’t work lauded as magic bullets wasting millions — we have to spend money on things that will change people’s lives and be honest with people about where we are.’