Dementia is the condition I fear most of all the terrible illnesses and injuries I treat. And last week came the sad news that the number of people with dementia in England and Wales alone will double by 2040, according to a study published in The Lancet.
I have seen hundreds and hundreds of patients with this terrible condition, devastated by declining cognitive abilities, personality changes, and loss of independence, all of which effectively means that you die years before your body.
For your loved ones, it is also horrible.
One of the first dementia patients I saw was many years ago when I was a junior doctor: an elderly, incontinent and confused gentleman in his 70s, brought to A&E by his daughter after a fall.
To determine the severity of their dementia, I reviewed the questions we typically ask these patients, including the time, when they got it wrong. He clearly had advanced dementia.
Dementia is the condition I fear most of all the terrible illnesses and injuries I treat, writes Professor Rob Galloway.
Then his daughter told me, with tears in her eyes: ‘You know that a few years ago he could define how time really began. He was a professor of astrophysics. She proceeded to pull out of her bag one of her textbooks, which contained equations she couldn’t even begin to understand.
We chatted more and I explained what I had been taught in medical school; that dementia, and specifically the most common type, Alzheimer’s disease, was a case of bad luck, in which genes played an important role, leading to the accumulation of excess proteins (amyloid plaques) in the brain.
But 20 years later, I now question what I was taught about the disease. Yes, there is a subset of Alzheimer’s that is closely linked to specific genes and causes dementia at a very young age. However, this represents less than one percent of cases.
The biggest risk factor for dementia is advanced age. However, it is not a given that you will suffer from dementia as you age.
And in some ways this is good news, because it raises the question of whether dementia is really due to bad luck or whether we can influence our chances of developing it. And according to the latest research, the answer is yes, we can.
But why can’t you just rely on those amazing new drugs we’ve heard about, like aducanumab, that can remove amyloid plaques from the brain?
When you look at the details of the studies, the results have been disappointing, despite what drug companies would like us to think.
Yes, these drugs have been shown to remove amyloid plaques, but what we don’t know yet is whether they will actually make a difference in patients’ lives.
One of the first dementia patients I saw was many years ago when I was a junior doctor: an elderly, incontinent and confused gentleman in his 70s, brought to A&E by his daughter, after a fall (Archive image)
At the moment, the only thing we can say is that these drugs slow the deterioration in people with mild or moderate Alzheimer’s. They are also expensive and potentially have very serious side effects.
But perhaps we are aiming at the wrong target. What if the amyloid is the smoke, but the fire that is actually burning your house is something else? And that “something” is high blood pressure.
For years, we have known that high blood pressure was linked to an increased risk of dementia, but definitive evidence was lacking.
However, new research by the Center for Healthy Brain Aging in New South Wales, Australia, published last month in the respected JAMA Network Open, demonstrates the role of high blood pressure in dementia and challenges the traditional view. of the causes of the disease.
Researchers analyzed data from more than 34,000 people from a total of 17 studies and looked at the chances of developing dementia if you had high blood pressure that was being treated, untreated, or if you had normal blood pressure. This analysis found that there was a proven increase in the chance of getting dementia (a 42 percent increase) if you had high blood pressure or untreated hypertension.
However, if your hypertension was treated, your risk was the same as if you had normal blood pressure without any medication.
This is a surprising finding and, for me, finally put to rest the argument about the important role that hypertension plays in causing dementia and worsening symptoms once you have it.
But how does this explain the amyloid plaques seen in Alzheimer’s? One theory is that poor blood flow to brain tissue damages cells and leads to dementia, and it is this damage to cells that results in the formation of amyloid plaques, rather than the amyloid plaques themselves causing the problem.
This would explain why cheap drugs such as blood pressure pills such as ramipril reduce the risk of Alzheimer’s. This was demonstrated by the JAMA study, which also showed that treating high blood pressure reduced the risk of dementia by 26 percent.
It would also explain why expensive new drugs that remove amyloid plaques don’t actually improve Alzheimer’s symptoms.
Based on this knowledge, other things that improve blood flow to the brain would also reduce the risk of Alzheimer’s.
And that is precisely what a 2020 review, published in The Lancet, confirmed, which brought together all the studies that analyzed what increased the risk of dementia.
Lack of exercise increased dementia risks by 40 percent; smoking, obesity and diabetes independently increased the risk by 60 percent each; and air pollution increased the risk by 10 percent.
Prioritize regular exercise as it could help protect you and reduce chronic pain, say scientists in Norway.
They analyzed data from more than 10,000 adults who, over eight years, reported how much exercise they did and their pain tolerance (measured by how long they could submerge a hand in cold water). Those with more active lifestyles were more tolerant of pain, and the more they exercised, the more their ability to withstand pain grew over the study period, the journal Plos One reported.
Knowing this, I now run every day if possible (but at least five times a week), check my blood pressure every two months, and have lost some weight.
When it comes to alcohol, the accepted wisdom is that small amounts of alcohol are safe, as long as they are less than 14 units per week in total.
Data published in the BMJ in 2018 confirmed that for every seven units above 14 per week, the risk of dementia increases by 17 per cent.
Surveys show that people now fear dementia more than cancer. If that’s you, I think there’s a very positive message that you can significantly reduce your risk by doing a number of simple things: exercise regularly, eat healthy (to maintain a healthy weight), not smoke, reduce alcohol consumption, and control your blood pressure.
What’s more, these measures will also help slow decline in dementia patients, and just how effective is demonstrated in a study published this month in the Journal of Alzheimer’s Disease.
A group of 55 patients with early Alzheimer’s received standard care or standard care plus telephone counseling on lifestyle management.
This included cognitive brain training, dietary recommendations based on the MIND diet (a Mediterranean diet that has been shown to reduce the risk of dementia), physical activity, sleep advice (such as trying to sleep 7 to 8 hours a day), and stress management. (for example, breathing). exercises).
The study showed a significantly slower rate of memory decline in those who underwent this program compared to the control group. But since all of these interventions were offered at the same time, it is not possible to say which had the greatest impact.
Still, the results make scientific sense: Brain training would help build new brain cells to counteract some of the declining functions of Alzheimer’s, and lifestyle factors would improve blood flow and reduce inflammatory processes that cause brain damage. brain and the resulting symptoms.
Like so many things in medicine, dementia is more complicated than we first thought. We may one day get a cure, but until then, make your own luck and try to reduce your chances of needing that cure by decreasing your chances of getting dementia in the first place.