Good Health
We asked an expert to assess five very brave volunteers. His findings could make YOU reconsider your lifestyle — before it’s too late
OnCe it was cancer, but now surveys show that dementia is our most feared disease. While advances in surgery, screening and drug therapies have transformed the outlook for cancer patients, dementia has been left behind.
The best that drugs currently available for it can do is slow the progression of the disease or temporarily alleviate the symptoms.
However, there is some better news. Last month Dr Dennis Gillings, chair of the World Dementia Council, said he was ‘optimistic’ that treatments to halt or reverse dementia may be developed within five years.
Dementia refers to a set of symptoms, including loss of memory, confusion and difficulties with thinking, or language, caused by some sort of damage to the brain. Typically it starts after the age of 65 and the risk increases with age, with one in six 80-year-olds affected.
There are more than 100 forms of dementia, but the most common, affecting more than 520,000 people in Britain, is alzheimer’s disease, where abnormal proteins — amyloid and tau — build up in the brain, leading, it’s thought, to a loss of connections between cells.
a further 150,000 people in the Uk have vascular dementia, where brain cells die due to restriction in the brain’s blood supply as a result of a stroke or because the brain’s blood vessels have become diseased.
It’s common for people to have a combination of alzheimer’s and vascular dementia.
The causes vary. Genetics play a role particularly in alzheimer’s, but increasingly, studies are highlighting the importance of lifestyle.
Obesity, for example, is strongly linked to dementia — one theory is that excess fat releases harmful hormones that are damaging to brain cells. Being overweight also tends to be accompanied by high blood pressure, cholesterol and furring up of arteries, raising the risk of vascular dementia.
High-sugar diets are now thought to raise the risk of both alzheimer’s and vascular dementia, because they impair the normal action of insulin — a hormone that mops up sugar in the bloodstream, but that also seems to be important for brain signalling.
problems with insulin lead to excess sugar in the blood, damaging blood vessels, including those in the brain.
But just as poor diet and lifestyle may cause dementia, healthy living can protect against it.
‘Dementia is not inevitable,’ says Dr naji Tabet, a leading dementia specialist and senior lecturer at Brighton and Sussex Medical School.
‘We think that in a quarter of patients destined to develop the most common causes of dementia — including many of those with a family susceptibility — it can be stopped or significantly delayed. It’s never too early or too late to start thinking about what you could do to protect yourself.’
So what makes someone destined to get dementia? Here, Dr Tabet assesses five people for their risk, and explains what they — and all of us — could do to help protect our brains . . .
MY MOTHER AND GRAN HAD DEMENTIA
Clare Murphy, 39, who works for a charity, is married with three children aged nine, seven and three and lives in london. she is 5ft 4in and weighs 9st 7 lb. her Body Mass index — BMi — is 22.8, ‘healthy’. MY MUM, who’s 77, was diagnosed with alzheimer’s about three years ago and my grandma developed it around the same age.
Mum, a respected historian, was put on the drug donepezil [aricept] which definitely stopped the decline — in some ways she’s better than she was when first diagnosed, and suffers less with confusion.
The fact that both my mum and grandma developed alzheimer’s has made me think about what I’d do if this happened to me, and I’ve looked at my daughter and thought, ‘are you going to have to look after me in the same way?’
I am keen to do what I can to protect myself.
I do the 5:2 diet to keep my weight in check, but have read it could help overall health and longevity. I don’t smoke, but I do drink — probably about a bottle-and-a-half of wine a week.
I walk the kids to school every morning and then on to the railway station, so get about 30 minutes’ brisk walking every day. RISK: MODERATE
EXPERT COMMENT: a family history of alzheimer’s does mean you’re more at risk, particularly if you have a first degree relative — a parent or sibling — with it, which some studies suggest increases your overall risk by five or six-fold.
Other research suggests that a family history on your mother’s side raises your risk more than a history on your father’s side.
That might all sound scary, but many people who have parents with dementia don’t go on to develop it, and we see people in our clinic with dementia who have no family history.
In fact, many other factors are also involved — and the biggest risk factor for dementia is age.
as we get older, the brain’s agility decreases and its connections become less strong.
There’s also more time for abnormal proteins to build up in the brain and for risk factors — such as hypertension and high cholesterol — to do their damage. So the older your relative is when they get dementia, the more it is likely to be a mix of nature and nurture.
Women are also slightly more likely to develop dementia. Recent studies suggest this may have something to do with the menopause and loss of the hormone oestrogen, which seems to be important for cognition.
Clare has a moderate risk because of her family history, so her lifestyle becomes really important. She is a healthy weight and does the 5:2 diet, restricting calories two days a week — animal studies have found that caloric restriction may help protect against dementia.
If Clare cuts down her alcohol intake a little, she could lower her risk more. Her current intake is just over the recommended limit of 14 units.
Some research shows that a small amount of alcohol, particularly red wine, can be beneficial for health. But I always advise moderation — i.e. stick to the recommendations and don’t binge.
I LEARN SPANISH TO KEEP MY MIND SHARP
Fiona Callister, 44, who works for the charity Wateraid, is married with two sons, age nine and seven, and lives in london. at 5 ft 8in and 10 st 4 lb, her BMi is 21.8, ‘healthy’. I Speak fluent French, having studied it at university, and recently decided to start Spanish lessons.
I used to work for a charity that helped older people and learned a lot there about alzheimer’s, including the fact that speaking a second language can have a protective effect. It isn’t the main reason I’m learning Spanish, but it’s definitely a big motivator.
My much- l oved gran developed alzheimer’s in her mid-80s and died in 2008 at the age of 91. Watching her decline was incredibly hard.
I understand that it’s pushing your brain that helps. I read a lot of nonfiction — at the moment I am reading a lot of science.
I go to the gym once a week and a couple of times a year will do something like a half marathon.
I don’t eat anything processed, and have oily fish once a week. I drink about four glasses of wine a week. RISK: LOW:
EXPERT COMMENT: Fiona is right that keeping your brain active protects against dementia, probably because it increases the quality of your cognitive reserve — the connections within the brain network.
as we age, our brain shrinks and the connections weaken, but the bigger your cognitive reserve is, the longer you should go without experiencing problems — it’s like the bigger the fuel tank is on your car, the further it will go.
Speaking two languages challenges the brain and this then maintains cognitive reserve.
You don’t have to l earn a new language — you can do yourself good by reading, doing puzzles and crosswords, and learning any new skill. The key thing is always to aim at a level just higher than you think you can do.
Fiona has a family history of dementia, but as she’s keeping her brain engaged, eating well, not drinking excessively, and taking exercise, I think her risk is low.
STRESS GIVES ME HIGH BLOOD PRESSURE
Chris Whelan, 43, a deputy headteacher of a special school, is married with two children and lives in Crosby, Merseyside. he is 6ft 1in and weighs 13st 7lb, giving a BMi of 24.9, ‘healthy’. WHEN I was 39 I had a pacemaker fitted because I had an irregular heartbeat. I had my blood pressure checked around that time, and it was found to be high.
It was a surprise as I’m pretty fit. I play football and regularly do events such as half-marathons and go cycling or running three times a week.
My doctors thought it might be stress; although I enjoy my job it can be quite intense.
My blood pressure crept up over the years, until 18 months ago it was 150/106 [the ideal is between 90/60 and 120/80]. So I was given blood pressure tablets. at the moment my reading is about 140/86.
It’s made me aware of stress and I now consciously take time to relax.
I’ve also cut back on the cheese and try to resist cake. RISK: LOW TO MODERATE EXPERT COMMENT: Hypertension, specifically in middle age, is a significant risk factor; it can cause a stroke and in turn vascular dementia, or lead to inflammation which may contribute to the build-up of amyloid plaques.
Taking blood pressure medication will have reduced Chris’s risk significantly. He should continue to eat well and exercise. His heart rate abnormality would also have raised his risk because of the risk of stroke and heart disease, but this has been stabilised with a pacemaker.
Chronic stress is another risk, because of raised levels of the hormone cortisol. There are cortisol receptors in the regions of the brain important for learning and memory — constantly high cortisol levels saturate these receptors, so the body keeps producing more. This can damage brain cells, causing these areas of the brain to shrink. So it’s important to manage stress. For information about blood pressure visit bloodpressureuk.org
I EAT HEALTHILY BUT HAVE DIABETES
Foster carer Pamela Mason, 68, lives in London. she has two children and 13 adopted children, aged from 13 to 45; her husband died four years ago. she is 5 ft 2in and weighs 10st. Her BMI is 25.6, putting her just into ‘overweight’. WHEN I was 60, I was diagnosed with type 2 diabetes. It was a shock, as I wouldn’t say I’m really overweight. I started following a low GI diet, but after two years the doctor said I needed to go onto metformin tablets. I also take medication for blood pressure and statins for cholesterol.
I continue to take care with what I eat — I always cooked from fresh, but now I avoid puddings. If I really want something sweet I’ll have a square of very dark chocolate. I’ve never smoked and drink occasionally.
I keep active, with all my children and grandchildren to look after — and I have a treadmill which I walk on a few times a week.
I also keep busy, volunteering at my local school where I was chair of governors for many years; I do online courses and read a lot to aid my professional development.
I’ve read up on diabetes and know it can raise your risk of problems such as dementia, so I really want to keep my blood sugar levels stable. My mother was diagnosed with dementia in her late 60s; my grandmother had it, too.
For advice about diabetes visit diabetes.co.uk
RISK: MODERATE TO HIGH EXPERT COMMENT: Type 2 diabetes raises the risk of dementia in several ways. High blood sugar damages the tiny blood vessels in the brain, which raises the risk of stroke and vascular dementia. It also causes inflammation, and may increase the deposits of a myloid plaques and tau. Pamela has a family history of dementia, and has high blood pressure, and diabetes. But she’s doing her best to mitigate all these with a healthy lifestyle and medication.
She’s also very sociable which is great, because a social network protects against depression, a risk factor for dementia.
I’M A FATTY AND LOVE JUNK FOOD
Dan MILLWARD, 28, a sales manager for a finance company, lives in stoke on trent with his wife and daughter, aged three. at 6ft 2in and 17st, his BMI is 30.5, ‘obese’. I WAS a semi-professional footballer when I was a teenager and signed with Stoke City, but when I was 18 I suffered a bad knee injury and that put a stop to that.
I hadn’t ever been a healthy eater, but playing football six times a week meant that I didn’t put weight on. When I stopped, I piled on the pounds — between the ages of 18 and 21 I gained 5 or 6 st.
My weakness is takeaways. When I’m on the road for work, I’ll grab fast food for lunch, then when I get home I don’t feel like cooking. Three years ago I did Slimming World and lost 3½st. I started playing squash and then my knee went again, and I put all the weight back on.
I am desperate to lose weight again. My grandma died, aged 76, from alzheimer’s and I do worry about my susceptibility.
RISK: HIGH
EXPERT COMMENT: Dan has four risk factors for dementia — he is overweight, has a poor diet, doesn’t exercise and has a family history (though not a first-degree relative).
Independently of being overweight, eating lots of junk food has been linked to dementia and some scientists have even called the disease ‘diabetes of the brain’.
exercise is vital, too: there are hundreds of studies to support this. It helps mood, which has a positive effect on cognition. It also increases blood supply to the brain, and it lowers the risk of heart disease and high blood pressure, factors for dementia.
Studies have also shown that exercise energises the antioxidant system in the brain, which may help stop the build-up of amyloid plaques. So there’s a direct and indirect effect.
Our team recently ran a study comparing retired people who undertook extensive exercise and people of the same age who just stayed active, regularly taking a brisk walk or jog, for example, or gardening.
We found no significant difference i n cognition between the two groups. So you don’t have to be running marathons.
The good news for Dan is his age. at 28, the damage hasn’t been done. If he changed his diet, exercised more and lost weight, he could get his risk down to low.
manvfat.com provides motivation and advice for men trying to lose weight.