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Published on August 13, 2019

Minimize your dementia risk with these tips

Dementia Avoidance

The jury is still out on the exact causes of dementia, especially Alzheimer’s disease, but new research is starting to show more ways that you can minimize the risk.

A 2017 study of close to 16,000 people over 24 years old showed that poor vascular health in middle age was strongly associated with later in life cognitive decline. Researchers found that midlife hypertension, alone, is estimated to be responsible for 425,000 additional cases of Alzheimer’s disease in the United States each year.

The heart-brain health connection is well-documented, according to neurologist Sean Horrigan, DO, at Neurologists of Cape Cod in Hyannis. The bottom line is that brain health is dependent on overall cardiovascular health.

“The number one cause of dementia in the United States is Alzheimer’s disease,” he said. “The second most common cause of dementia is cerebrovascular disease, also called vascular dementia. Many individuals with Alzheimer’s disease also have evidence of cerebrovascular disease on brain imaging. This too can affect their overall cognitive performance.”

Just like plaque can build up in the arteries that supply blood to your heart and limbs, it can also build up in your brain. If the arteries are not open and flowing with oxygen and nutrient-rich blood on a second-to-second basis, over time, these associated organs don’t work as well as they should.

“Hypertension is one of the major risk factors for vascular disease,” Dr. Horrigan said. “We know for a fact that men and women with well managed blood pressure have a much lower risk of developing vascular disease and dementia.

“The current blood pressure guidelines state that normal blood pressure should be under 120/80, whereas in the past, normal was under 140/90.'

It’s About Lifestyle

Cholesterol is just as important to manage as blood pressure and, like blood pressure, those recommended numbers have come down in recent years. When Dr. Horrigan was in medical school, an acceptable goal for LDL, or bad cholesterol, was under 160. Now the American Heart and Stroke Associations are both in agreement that your total cholesterol (the combination of your LDL cholesterol level and your HDL, or ‘good’ cholesterol, plus 20 percent of your triglyceride level) should be under 160. Your LDL cholesterol should be less than 100 and ideally less than 70 if you have diabetes or have a higher risk for heart attack and stroke.

“If you have high cholesterol then you’re going to get that plaque buildup throughout your body. When it comes to your brain, your neurons are not going to work their best over time because they’re not getting good blood flow anymore,” he said. “The goal is not to be on blood pressure pills and cholesterol pills. The goal is to manage these risk factors, ideally with diet, exercise and watching your weight.”

For diet, he recommends the Mediterranean diet, which focuses on eating more vegetables, fruits and grains and discourages the use of too much dairy and animal products. When it comes to our diet, cholesterol comes exclusively from dairy and meat.

“It’s pretty hard to convince most people to go vegan or vegetarian, but the truth of the matter is that if you don’t eat dairy or meat, your cholesterol levels probably look great,” Dr. Horrigan said. “Individuals eating a vegetarian-based diet are also far less likely to have hypertension and diabetes.”

Dr. Horrigan recommends that people keep a food journal with a calorie count to share with their primary care doctor. If you drink alcohol, eliminating it is a great way to cut calories and decrease your risk of dementia at the same time because alcohol is another one of the risk factors.

“I have had people really get their blood pressure and cholesterol goals in check just by investing more money in their grocery store,” he said. “It may cost a little bit more upfront, but they’re not putting money in their pharmacy. That’s really satisfying for a lot of patients.”

Other Strategies

If you have tried your best with diet, exercise and weight and your numbers are still high, then Dr. Horrigan recommends talking to your primary care physician about your risk factors and whether medication is indicated.

Preventing diabetes or keeping your blood sugar under control, if you have the condition, is another way to prevent dementia along with not smoking.

Getting the proper amount of sleep is also an important lifestyle factor. Most studies show that the ideal window is seven to eight hours a night. People’s overall health declines with fewer hours than that. Other studies show that too much sleep isn’t good. It helps to go to bed and wake up at the same time every day.

If you have trouble sleeping, Dr. Horrigan recommends the following:

  • Avoid caffeine and alcohol, especially in the afternoon or evening.
  • Avoid drinking too many fluids of any kind in the evening.
  • Go to the bathroom several times before bed to minimize waking up in the night.
  • Don’t take naps during the day because that throws off your clock at night.
  • If you do need to nap, limit the time to 20 to 30 minutes.
  • Don’t rely on sleep aids because they can cause other cognitive problems in the long run.
  • Don’t use melatonin because supplements are not regulated and there is no way to know how much you are getting.
  • Ask your doctor about doing a sleep study to look for reversible, treatable problems.

Social interaction is another really important way to prevent dementia, Dr. Horrigan said. Being active and pursing activities you are passionate about are especially important after retirement. Keeping mentally sharp and socially engaged is one of the key ways to promote both longevity and quality of life as you get older.

“I take care of many people living well in their 80s and 90s. I find that the healthiest patients I care for are still living in their own house, paying their own bills, knowing how to use a smart phone, still driving their own car and are also really involved and quite active in their community,” Dr. Horrigan said. “They’re still exercising several days a week. They keep active with their family and friends. Their brains are constantly being stimulated because they always have something to do!”