But in a recent episode of his podcast Dr Karan Explores, surgeon Dr Karan Rajan spoke to doctors Dean and Ayesha Sherzai, neurologists and codirectors of the Brain Health and Alzheimer’s Prevention Programme at Loma Linda University Medical Centre, who shared that there may be other factors at play too.
Why might women have higher instances of dementia?
“We know that lipid metabolism and how women’s bodies respond to vascular risk factors, whether it’s an abnormal cholesterol panel or abnormal blood pressure, is different” than men’s, Dr Ayesha Sherzai said.
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Cleveland Clinic says that women “face unique risks, largely due to differences in anatomy and hormones,” such as narrower blood vessels and fewer red blood cells, when it comes to heart issues.
“We also know that in the perimenopausal period, the woman’s body goes through a lot of physiological and neurological changes, because oestrogen is a very important factor in memory creation and in brain health,” the doctor added.
The combination of increased effects of vascular issues and the decline in oestrogen as women age “may increase the risk factors” of dementia for women, the expert says.
Any other reasons for the gender gap?
Harvard Health says that aside from the age difference, women are way more likely to develop Alzheimer’s than men. But they are not more likely to develop other kinds of dementia when you adjust for age.
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Part of the reason for that may be that women are far more likely to experience autoimmune disorders than men.
That might be because women’s immune system is stronger, which may have the effect of creating more amyloid plaques in the body. These plaques have been linked to dementia.
The university’s site recommends taking aerobic exercise, like swimming, jogging, or dancing up for 30 minutes a day, at least five days a week, sleeping well, socialising, and eating well to mitigate the potential risks.
While you’re probably used to asking your doctor about new moles or a pesky cough, you might not be used to talking to them about your social connections or anxiety.
Turns out, there’s an array of topics you should be bringing up with your primary care doctor (or your neurologist, if you have one), according to a recent report in the journal Neurology.
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The report detailed 12 questions that patients should discuss with their physician that can help protect the brain from cognitive decline. And while it lists some obvious brain health inquiries, it also includes factors that you likely don’t connect to your cognitive health, like your social interactions and diet.
Sleep: Are you able to get sufficient sleep to feel rested?
Affect, mood and mental health: Do you have concerns about your mood, anxiety or stress?
Food, diet and supplements: Do you have concerns about getting enough or healthy enough food, or have any questions about supplements or vitamins?
Exercise: Do you find ways to fit physical exercise into your life?
Supportive social interactions: Do you have regular contact with close friends or family, and do you have enough support from people?
Trauma avoidance: Do you wear seatbelts and helmets, and use car seats for children?
Blood pressure: Have you had problems with high blood pressure at home or at doctor visits, or do you have any concerns about blood pressure treatment or getting a blood pressure cuff at home?
Risks, genetic and metabolic factors: Do you have trouble controlling blood sugar or cholesterol? Is there a neurological disease that runs in your family?
Affordability and adherence: Do you have any trouble with the cost of your medicines?
Infection: Are you up to date on vaccines, and do you have enough information about those vaccines?
Negative exposures: Do you smoke, drink more than one to two drinks per day or use nonprescription drugs? Do you drink well water or live in an area with known air or water pollution?
Social and structural determinants of health: Do you have concerns about keeping housing, having transportation, having access to care and medical insurance or being physically or emotionally safe from harm?
Experts say these questions align with previous research findings and a focus on prevention instead of treatment.
This study is backed up by a report from The Lancet, another medical journal, last year, as Dr. James Ellison, a psychiatrist at Jefferson Health in Philadelphia, pointed out. That report found that 45% of cases of cognitive decline or dementia could be delayed or even prevented by simple lifestyle interventions.
“I would say that the Neurology journal is keeping up with the current trend in health care, which is to try and emphasise wellness and prevention and not just response to disease,” Ellison said.
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Dr. Tanu Garg, a vascular neurologist at Houston Methodist Hospital who often treats stroke patients, added that many of her patients’ families ask what can they do so they don’t end up in the same situation as their loved ones — and these lifestyle interventions are the answer.
“That’s why these questions are very important, because we are trying to prevent people from having difficulties in the future, whether it’s heart attack, strokes or just, in general, for brain health,” Garg explained.
How do these factors impact brain health?
While it’s clear how certain habits mentioned above could affect your cognitive health (like wearing a helmet, for example), other factors are a little more nuanced ― but are just as important to manage.
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For instance, socialisation is a true indicator of brain health. “We are social beings … and there are even changes in metabolic activity and brain activity that occur when we’re isolated that are harmful,” Ellison said.
With isolation comes loneliness, which can put you at higher risk of cognitive decline and stroke, Ellison added. “It’s very important to cultivate a social network,” he said.
Garg also noted that those with close family and friend connections can also get more support when recovering from health issues, which is important for well-being, too.
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The factors that seem to relate more to heart health, like blood pressure, are important, too. “Almost everything that’s good for the brain is actually also good for the heart,” Ellison said. “When the heart is functioning properly, it provides nutrients and oxygen, which fuel the brain and keep it healthy, and it helps remove toxic metabolites from the brain as well.”
“When the heart is not functioning properly, the circulation and oxygenation and metabolic care of the brain is compromised, and that can lead to cognitive changes,” Ellison continued. He added that one of the most common kinds of cognitive decline in older people is “vascular cognitive impairment, which is a direct result of compromised circulation in the brain.”
Garg said simple, small positive habits, like diet and exercise, can often bring the biggest health rewards. She recommends a Mediterranean diet and said you should talk to your doctor about the best exercise regimen for you, as it varies person to person. Additionally, if you smoke, you should talk to your doctor about quitting, to protect both your brain and your overall health, Garg said.
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It’s also important to manage your emotions, and you can talk to your doctor about how to best do that, too. “There are so many different ways to curb anxiety and stress, but people don’t realise how much of an impact it can make on your body and your brain,” Garg said. Research shows that anxiety is linked to higher rates of dementia.
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Exercise benefits your brain health and your heart health.
These are questions you should bring up throughout your life, not just once you reach a certain age.
While it’s never too late to think more holistically about your brain health, you should always pay attention to them — not just once you reach old age.
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Ellison said these questions focus “on prevention throughout the life cycle, not just in the elderly.”
While cognitive decline is often only associated with getting older, problems during mid-life, such as sleep disorders and unmanaged high blood pressure, can compound your risks for cognitive decline and dementia later on, he added.
It’s also important to talk to your doctor about any cognitive changes you notice, no matter your age.
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“If you go see a doctor sooner than later, then we can find things that are reversible to prevent further decline. But when you’re afraid or you’re not sure if it’s the right thing to do, then we may get to the point where you’re not able to fix things,” Garg said.
Garg always reminds her patients that it’s OK to ask your doctor questions, whether you think they’re the “right” ones or not.
Ellison added that not all cognitive changes are related to major health issues, either. Stress, anxiety, certain medications and certain health conditions can cause cognitive issues, too, making it crucial to talk to your primary care provider.
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Your doctor can also help you incorporate exercise, social connections, a nutritious diet and other healthy lifestyle habits into your life — because there’s real proof that these good habits work, Ellison said. The rate of dementia in older adults is decreasing. Specifically, dementia rates have fallen 13% per decade over the last 25 years, according to a 2020 study.
“The decrease in incidence has been attributed to population improvements in cardiac health, greater awareness of diet and exercise,” Ellison said.
While these habits may not seem big, they really can have a big impact on your brain health as you move through life.
Dementia is the loss of memory, language, problem-solving and other abilities that require thinking. It is often caused by Alzheimer’s disease, and mainly affects those 65 and older. Unfortunately, dementia can be severe enough that it interferes with daily life, and those who have dementia often require additional care.
“Dementia is a group of conditions characterised by impairment of at least two brain functions, such as judgment and memory loss,” explained Blair Steel, a psychologist at Carrara Treatment, Wellness & Spa. “Symptoms of dementia include forgetfulness, limited social skills and impairment in thinking that interferes with daily functioning.”
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So what causes dementia? Your age, family history, race and ethnicity, heart health and history of a traumatic brain injury are all factors that increase your risk of developing the condition. But another big category is lifestyle habits. So while you can’t control your genetics, there are a few seemingly harmless behaviours you may be doing that can increase your risk. Read on to learn more about them below:
Not moving your body enough or sitting for too long
Exercising ― aerobic exercise, especially ― can help reduce cognitive impairment and dementia risk. Long-term, regular exercise can affect your brain and your overall health in a positive way, especially if you’re nearing 60. Getting your body moving daily is something you can do to decrease your risk of dementia.
Steel said “being inactive does a number on the brain.” Just like other muscles, a good thing to remember is, “If you don’t use it, you lose it.”
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Not socialising enough
Social health plays a role in the development of dementia; an active and socially integrated lifestyle can protect against the disease. Stimulating the brain with social interaction is important for everyone, especially as they age. Though, in the age of social media, socialising has become a broader term.
“We spend a lot of hours on social media, however this likely does not stimulate the brain’s experience of connection as much as socialising in person,” Steel explained.
Poor social health can overstimulate the body’s stress response through increased levels of the stress hormone cortisol, raise blood pressure and decrease blood flow to vital organs amongst other health issues.
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Getting inadequate sleep
Sleep disturbances and dementia are two common and significant health problems in older adults. (Let’s face it, sleep tends to be put on the back burner.) Whether due to family obligations, work or staying up late on your phone or watching TV, there’s always something in the way of adequate sleep.
“Avoid screens and light after a certain hour and try to not reach for your phone if your sleep is interrupted,” Steel suggested. Try unplugging at least 30 minutes before bed.
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Not getting enough sleep can have a huge impact on your brain health.
Being chronically stressed
According to the Alzheimer’s Society, stress is linked to dementia because when you’re stressed and cortisol is released, it can create problems with your memory. The negative effects of stress, particularly chronic stress, on the brain can lead to cognitive decline due to prolonged elevations of cortisol — which plays an important role in how your body responds to stress.
Working to reduce your stress through healthy habits can be key to mitigating this risk. Exercise, creative activities or hobbies, spending time with loved ones, meditation, watching a good show or reading a good book can all help you relax.
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Additionally, “try to be flexible with your reactions and avoid the ‘my way or the highway’ mentality, which can be common in older adults,” Steel said.
Consuming excessive amounts of alcohol
The Alzheimer’s Society also saysthere’s a specific type of alcohol-related dementia that is considered alcohol-related brain damage (ARBD). This is due to the damage of the brain caused by drinking too much alcohol on a regular basis, usually over many years.
Those with this type of dementia may have issues like cooking a meal, remembering things, thinking things through, and even struggle with more complex tasks like managing finances.
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Eating an unbalanced diet
Research shows a diet high in ultra-processed foods can increase dementia risk in adults. While no one’s diet is perfect, ensuring that the majority of the time you are sticking with well-balanced, healthy meals can be extremely beneficial.
Try eating leafy greens, berries, whole grains, beans, nuts, fish, and healthy fats like olive oil while limiting red meat, sweets, cheese, butter, and fast and fried food. These are healthy options that optimise your brain health.
You can lower your risk of dementia by altering the habits mentioned above, but you should also speak to a doctor if you’re struggling with your cognition.
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“If you or a loved one is experiencing signs of dementia, it is important to speak to a doctor and get an assessment,” Steel said. Your primary care physician will be able to assess you, and if needed, refer you to a specialist.
In his new book How To Prevent Dementia, Dr. Richard Restak (neurologist, neuropsychiatrist, author, and professor) shared that some signs of dementia can show up first in everyday tasks ― including brushing your teeth.
“Four impairments underlie the outer expressions and inner experiences of the Alzheimer patient,” the doctor shared in his book. He called these the “four As.”
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One sign is amnesia, he says ― simply forgetting things. Then, there’s aphasia, which involves not being able to understand, find, or use the right words.
“Neither amnesia nor aphasia in their milder forms is always abnormal,” Restak says. But “the third and fourth of the four A’s are always a sign something is amiss,” he adds.
One of these is agnosia, or “an impairment of correctly understanding information provided by the senses of seeing, hearing, touching, smelling, and tasting.” For instance, someone might not be able to recognise a beloved family member by sight.
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The final one, apraxia, refers to an inability to perform “purposeful and highly practiced actions despite normal muscle strength and tone.”
Brushing your teeth is a good example of where apraxia may show up
It’s not necessarily about forgetting how to do the task, nor is it about not being strong enough to follow the steps, Restak says. Instead, the issue lies in tying all the actions and thoughts together correctly and in the right order.
“A person with apraxia may be able to recognise and even name a toothbrush and toothpaste but may be unable to carry out the act (praxis) of squeezing the toothpaste onto the toothbrush.”
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Or they could struggle to put the brush in their mouth and scrub their teeth. “All the muscle components are present but can’t be coordinated,” Restak shared.
Tooth decay has been linked to increased dementia risk, though Dr. Restak doesn’t suggest apraxia is the cause of this in his book.
Other forms of apraxia can cause people to fall, speak, and, for those in the later stages of Alzheimer’s, dress and bathe themselves, the neurologist says.
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“Many, if not all, expressions of Alzheimer’s can be explained by reference to the four A’s,” Restak stated in How To Prevent Dementia.
What if I suspect dementia?
If you think you or someone you love could have the condition, the NHS advises you to see a GP as soon as possible.
If you’re supporting a loved one, “You may like to suggest you go with your friend or relative to see a GP so you can support them. You’ll also be able to help them recall what has been discussed,” they say.
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“A diagnosis of dementia can also help people with these symptoms, and their families and friends, make plans so they’re prepared for the future,” they add.
You may already know that shuffling your feet while walking can be an early sign of dementia, affecting someone’s ability to, say, go up the stairs.
But scientists may have identified another possible early symptom that shows up in your stride.
A 2022 study, published in JAMA Network Open, didn’t look at walking on its own; they compared older people’s hiking styles to their memory.
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The changes in walking didn’t mean much without a decline in certain cognitive skills, they say.
But those who notice differences in their walk alongside cognitive changes, referred to by the study as “dual decliners,” had a higher risk of developing dementia than the rest of the participants.
They examined gait speed in two-year intervals across seven years, and again in the final year.
They also looked at cognitive changes (in memory, verbal fluency, mental processing speed, and “global” cognition) at years 0, 1, 3, 5, and at the close-out of the test.
“Association between domains, such as processing speed and verbal fluency, with gait have been explained by the crossover in the underlying networks or pathology,” the paper says.
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It continues, “Of domains examined, the combination of decline in gait speed with memory had the strongest association with dementia risk. These findings support the inclusion of gait speed in dementia risk screening assessments.”
Does this mean walking more slowly over time is a dementia sign?
No ― again, it was only relevant when paired with cognitive changes.
If you suspect dementia in yourself or a loved one, the NHS advises you to see a GP as soon as possible.
Bringing up the topic with a loved one can be hard, they say, so be sure you approach the topic gently, in a situation they’re familiar with, and without rushing.
“A diagnosis of dementia can also help people with these symptoms, and their families and friends, make plans so they’re prepared for the future,” they add.
According to the journal Frontiers In Neuroscience, around 80% of the world’s population is exposed to excessive or inappropriate use of artificial light outdoors, dubbed “light pollution”.
While the health risks of excessive light pollution can include sleep deprivation, fatigue, headaches, stress and anxiety, new research published in the journal has revealed that it could actually lead to Alzheimer’s Disease.
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In the study, researchers used satellite-acquired data to determine nighttime light intensity in states, and compared that data with Alzheimer’s Disease prevalence in the same places, finding that a positive correlation was found in areas with the most light pollution in every year studied.
The study also indicated that nighttime light pollution had a stronger correlation to Alzheimer’s Disease risk than alcohol abuse, chronic kidney disease,depression, heart failure and obesity, but less of a link to the conditions of atrial fibrillation, diabetes, hyperlipidemia, hypertension and stroke.
This was especially true for those under the age of 65.
Robin Voigt-Zuwala, PhD, lead investigator for the study said: “Certain genes can influence early-onset Alzheimer’s, and these same genes may cause increased vulnerability to the effects of nighttime light exposure.
“Additionally, younger people are more likely to live in urban areas and have lifestyles that may increase exposure to light at night.”
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How to protect your health against light pollution
Need: Use light only where needed. Consider how the use of light will impact the area, including wildlife interactions and habitats. Rather than permanent lights, use reflective paint or self-luminous markers for signs, curbs, and steps. Outdoor lighting should not be used for aesthetic purposes.
Brightness: Use the least amount of light needed for the activity taking place. Be aware of surface conditions as some surfaces reflect a lot of light into the sky.
Colour: Minimise blue and violet spectral components, i.e. use warm-white, yellow, or amber light. This aids night vision by all animals, including people.
Shielding: Use shielding so that light does not spill beyond where it is needed. To reduce skyglow, do not use luminaires that project any light above the horizontal. Reduce glare by restricting beams to downward cones. This improves the ability of drivers and pedestrians to see into shadows.
Timing: Use light only when needed. Turn lights off after use, or use active controls such as timers and motion detectors so that lights are on only when needed.
Encourage neighbours to reduce their light pollution by observing these principles, especially to reduce glare and light trespass into your domain.
They tracked who got mild cognitive impairment (MCI) and dementia, and who didn’t.
What did they mean by “psychological well-being”?
The team measured “self-acceptance, autonomy, environmental mastery, purpose in life, positive relation with others, and personal growth,” the researchers said.
Every year, they measured participants’ scores in those six areas using Ryff’s Scales of Psychological Well-Being.
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They found that “Psychological well-being (specifically purpose in life and personal growth) became significantly lower before MCI diagnosis,” the study said.
Researchers found that the dip in psychological well-being usually happened six years before the diagnosis.
The 73 participants who developed dementia were more likely to have lower psychological well-being than those who didn’t.
The mean age of participants was 79.9 years old, and “most participants are white and female, which may limit the generalisability of our findings to other populations,” the scientists said.
So, will I definitely get dementia if my psychological well-being is low?
Absolutely not.
“Future studies with larger and more diverse samples are warranted to verify our findings,” the paper said ― even then, it only studied older, mostly white, mostly female people.
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They did not find that every person with decreased psychological wellbeing got MCI or dementia, nor did they find that every person with good psychological wellbeing was dementia or MCI-free.
“Compared with participants who were dementia-free, those who developed dementia were more likely to be older, female, APOE ε4 carriers, and to have a lower level of psychological well-being (p0.05 for all),” the paper said.
Dr Richard Oakley, associate director of research and innovation for Alzheimer’s Society, told The Guardian that it’s very likely taking care of your mental health and social life is a prevention factor.
But he added, “At this stage, it is not clear whether we can use these wellbeing factors as a predictor of MCI and we need research to demonstrate if tackling these factors might change the trajectory of a decline in memory and thinking skills.”
Speak to your GP ASAP if you suspect you or a loved one have dementia.
According to the NHS, research shows there are more than 944,000 people in the UK who have dementia, and this is only increasing as people are lving longer.
The NHS also state that in the early stages of dementia, sufferers may be able to live at home, continuing to enjoy doing the things they have always done and having an active social life.
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However, there are steps you or a carer can take at home to make the condition easier to manage and offset the more difficult days of dementia.
Now, Dementia UK have shared tips for making bathrooms more dementia-friendly
On their TikTok channel, a specialist dementia nursing charity have shared their tips for making bathrooms more dementia-friendly, and they’re really simple.
Most notably, the charity recommend using brightly-coloured towels which, as well as just making your bathroom a little more colourful, will stand out more on the towel rail and make spotting them easier.
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Additionally, the experts recommend that if you have a fabric bathmat, this should be rolled up when not in use to prevent trips and falls.
While this is probably just good practice in general, NHS Inform urge that dementia sufferers are at a higher risk, saying: “There are different personal risk factors that cause people to fall, however, people with dementia are at greater risk because they: are more likely to experience problems with mobility, balance and muscle weakness.”
Dementia UK offer more tips for making bathrooms accessible
On their website, Dementia UK recommend the following steps for making bathrooms a safer place for dementia sufferers:
Stick a written sign or a picture of a toilet to the door to help the person identify the bathroom
Leave the bathroom light on at night to help the person find their way
Fit a toilet lid and seat in a different colour from the toilet itself to make it more visible
Use a free-standing toilet roll holder. These are easier to see than wall-mounted holders, and putting it right next to the toilet means the person does not have to stretch and potentially lose their balance – but if the person is prone to falls, be aware that they may be a trip hazard
Install rails or handles at useful points such as in the bath/shower and next to the toilet
Provide a bath or shower seat if the person has mobility or balance problems
Use flood and scald prevention plugs in the basin and bath
Which is all well and good ― but what about more fun ways to keep the condition at bay?
Well, in his book How To Prevent Dementia, neurologist Dr. Richard Restak shared that hobbies and “obsessive” interests can be really, really good for your brain health ― and that reading in particular can build up something called “cognitive reserve.”
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What’s my “cognitive reserve,” and why does it matter?
Dr. Restak compares people with a high “cognitive reserve” and those without to two people who have lost their homes in a hurricane.
One is a millionaire who barely notices the change, and the other is “wiped out” by the loss as all his assets are tied up in his house.
“As with wealth, cognitive reserves are built up over time,” the neurologist says.
“Cognitive reserve theory refers to the representation stored within the brain of the knowledge, experience, and life events that accumulate during the course of a person’s lifetime,” he adds.
The bigger your “cognitive reserve” is, the more ballast you may have against dementia, the theory suggests ― just as a high muscle mass may help to give you more defences against the side effects of chemotherapy.
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“A lifetime investment in building up cognitive reserve leads to healthy cognition and thinking later in life,” Dr. Restak wrote.
So, why reading in particular?
Thanks to the brain’s plasticity, “It is never too late to build your cognitive reserve” by learning something new, or more deeply, or experiencing different things, Dr. Restak says.
No matter what age you are, he says that the best way to build a decent cognitive reserve is to “Pick something that really interests you, grips you in a visceral sort of way, and then obsess (in a good way) about it.”
But that aside, “Reading for pleasure is perhaps the single most effective activity you can engage in for increasing cognitive reserve,” he says.
This is because reading “exerts its most powerful effect on memory,” both episodic and working.
He adds, “Fiction is more brain-challenging than non-fiction because it demands your full awareness of the narrative you are currently reading, while at the same time requiring you to hold in mind the situations and characters described earlier in the book.”
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The author referenced a study which found that being immersed in a book was the “magic juice” which improved participants’ cognitive ability over those who did word puzzles.
So before you dismiss your romance novel habit as trashy, remember ― you’re simply strengthening your cognitive reserve.
According to the Alzheimer’s Society, there are currently 900,000 people living with dementia in the UK and this is projected to rise to 1.6 million by 2040.
The NHS states that some of the early symptoms of dementia include memory loss, difficulty concentrating, confusion, and mood changes. However, one doctor speaking to The Express has highlighted that there is a hidden symptom that can be a sign of the syndrome.
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While there is no cure for dementia, early detection can ensure that the condition is managed and you can get the help you need.
The ‘hidden’ sign of dementia
Dr Rayaz Malik, professor of medicine at Weill Cornell Medicine in Qatar warned that taking naps throughout the day could be a sign of dementia saying, “Taking frequent daytime naps is also a notable behaviour associated with certain conditions, including dementia, and losing interest in friends and family is a sign that may indicate dementia.”
This is backed by Alzheimer’s Research UK. Dr Susan Mitchell, Head of Policy from Alzheimer’s Research UK said, “Unusual sleep patterns are common for people with dementia, but research suggests that sleep changes could be apparent long before any symptoms like memory loss start to show.”
According to research, this appears to only apply to older people. In something of a paradox, scientists in the US have suggested that those who nap more frequently when they get older are more likely to get dementia, but those who have dementia are more likely to nap.
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So, how long should we actually nap for?
A healthy nap is around 15-45 minutes, according to experts. However, the NHS urges that if you experience excessive daytime sleepiness, you should speak to your GP as it could be a sign of something more serious.
