Reducing the risk of dementia - keeping brain tissue healthy

By Muir Gray

There are three strategies to reduce the risk of dementia.

1. keep the brain tissue healthy 2. stay engaged and seek out challenges 3. keep the blood and oxygen flow to the brain healthy The factors that damage the brain tissue itself can be divided into two types - external and internal. But there are four risk factors that every individual can influence: 1. Reducing stress 2. Improving sleep 3. Know your medication & reduce alcohol 4. Get active 1. Reduce the impact of stress

Coping better with stress, and dealing with the causes of stress help you feel better immediately and reduce the risk of dementia.

Acute stress increases your heart rate, your lungs take in more oxygen, your blood flow increases, and parts of your immune system become temporarily suppressed, reducing your body’s inflammatory response to pathogens and other foreign invaders.

By managing acute stress, your body will not release stress hormones such as cortisol that prepare your body to either fight or flee the stressful event.

When stress becomes long term, your immune system becomes less sensitive to cortisol, and since inflammation is partly regulated by this hormone, this decreased sensitivity heightens the inflammatory response and allows inflammation to get out of control.

Long term inflammation, in turn, is a hallmark of most diseases, from diabetes to heart disease, cancer, and Alzheimer's.

You can reduce your stress through a variety of methods including physical activity and mindfulness-based stress reduction. Talk to friends and family can be helpful or look for counselling which includes cognitive training - which helps you learn patterns of thinking that are positive and which give you the feeling of control all of which can reduce stress. 2. Improving sleep

Sleep is a major factor that can improve cognitive abilities and reduce the risk of dementia.

Adequate sleep (over six and a half and less than nine hours) is important for everyday good health. Less or more sleep is associated with reductions in cognitive ability.

The two sleep disorders are:

- insomnia

- sleep disordered breathing (apnoea).

Ways to prevent or control insomnia include:

- getting regular exercise

- avoiding high calorie snacks, sugar or large amounts of caffeine

- avoiding extreme levels of activity late in the evening before going to bed.

- a quiet, cooler bedroom with little or no light

- a warm bath aids in having a restful sleep.

Sleep- disordered breathing (apnea) may impair cognitive ability in older adults. What is called a continuous positive airway pressure device is the treatment for this disorder. This device has the potential to improve cognitive ability at least in the short term as well as reducing risk for cardiovascular disease, an important cause of dementia.

If you have insomnia or sleep disordered breathing speak to your family physician and other primary care providers.

3. Protect your Brain from Over Medication and drugs

Modern medicine has had a wonderful impact in the last fifty years but all healthcare can do harm as well as good. Over medication is a preventable cause of dementia.

On average, people over the age of 65 are on six drugs a day. Often the physicians who prescribe the drugs do not talk to each other, so the patient gets one drug from the cardiologist, another one from the neurologist, a third from the psychiatrist, another from the endocrinologist.

There are 20 drugs that cause memory loss; the leading ones are sleeping pills and cholesterol-lowering medications.

You need to assess with the assistance of your friends and family and your health care practitioners the following:

- are the drugs you are taking incompatible when taken together?

- are you able to easily obtain your drugs in your community?

- are there reasons why you not taking the medications?

- are you keeping track of how you are doing while you are taking your medications?

Alcohol is the other drug commonly consumed and there is no doubt that alcoholism is a risk factor for dementia. However there is no clear agreement about what is the best advice about alcohol consumption. Here is a simple set of principles:

​- If you don't drink alcohol you don't need to start

- If you do drink alcohol don't drink more than a unit eg a glass of wine a day and in your sixties have at least one alcohol-free day a week, and every decade after that add on another alcohol free day

4. Get active

Maintaining and indeed increasing your levels of physical activity is a very effective way of reducing the risk of dementia.

Increasing physical activity has both direct and indirect effects on the brain. Brain tissue responds directly to physical activity.

The indirect effect is by keeping the oxygen rich blood supply flowing freely. There is strong evidence that increasing activity slows decline in brain function. We should all create opportunities for movement both at home and at our workplace.

Recommended course

Living Longer Better taught by Sir Muir Gray

Learn to live better longer, with former Chief Knowledge Officer of the NHS, who shares his secret elixir of life

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Muir Gray

Professor Sir Muir Gray, CBE, FRCPSGlas, FCLIP is a British physician, who has held some of the most senior positions in screening, public health, information management. and value in healthcare. Sir Muir has worked for the National Health Service in England since 1972, occupying a variety of senior positions during that time, including serving as the Director of Research and Development for Anglia and Oxford Regional Health Authority, and first establishing and then being the Director of the UK National Screening Committee. He founded the National Library for Health, and was the Director of Clinical Knowledge, Process, and Safety for the NHS (England) National Programme for IT, serving as the Director of the National Knowledge Service. Sir Muir is an internationally renowned authority on healthcare systems and has advised governments of several countries outside the UK including Australia, New Zealand, Italy, Spain and Germany.

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