Dementia is not inevitable, and in some cases can be prevented. That's the main message of a report based on the latest studies of the disease published in The Lancet. While there is currently no known cure for dementia once onset is detected, we now know that approximately 40% of worldwide dementias can be prevented or delayed.
But teaching patients how to prevent dementia is only one half of the brain health equation. Scientifically-backed clinical assessment tools are becoming readily available for clinicians, such as computerized assessments and care planning, that can track and measure cognitive decline.
Unfortunately, dementia remains a serious health concern for approximately 6.7 million Americans over 65 years old. Not only is the disease debilitating, but it also leaves older patients vulnerable to more common illnesses. For example, the COVID-19 outbreak affected many nursing homes across the United States, and 72% of deaths caused by the virus were dementia patients. These impacts also echo out to caregivers, healthcare providers, and the healthcare system as a whole.
In this article, we'll cover 12 modifiable dementia risk factors and what physicians can do to help their patients prevent dementia and preserve their brain health as they age.
What Are 12 Modifiable Risk Factors For Dementia?
Physical Activity and Diet
1. Exercise
Aerobic exercise can help delay the onset of vascular dementia in older adults. Vascular dementia is the second most common type, with Alzheimer's disease being the most common type of dementia. A study looked at how aerobic exercise affected the progression of vascular dementia, scanning the brains of older adults and examining the areas associated with memory, decision-making, and attention. After six months of brisk walking for three hours a week, their executive function was better, memory loss was reduced, and their cognitive test results improved.
For dementia patients, as well as those who want to improve their cognition through exercise, physicians can support them with cognitive tests or assessments to track their progress. Cognitive tests can be used to monitor their cognitive performance over time, allowing accurate measurement of the long-term effects of exercise on their brain function.
Read more about an ongoing international study investigating the effect of physical activity on cognitive performance using Creyos. The Brain Body Study.
2. Weight Control and Obesity
Evidence suggests there's a correlation between obesity and dementia—but more research is needed to pinpoint the connection precisely. Midlife obesity seems to be a risk factor for later dementia. Generally, patients can reduce their risk of dementia with a healthy lifestyle and physical exercise to manage weight and stay sharp in old age. In other words, staying at a healthy weight and partaking in an active lifestyle supports their brain health and can reduce cognitive decline.
3. Alcohol Consumption
Heavy drinking has many known detriments, including neurodegeneration, cognitive impairment, and an increased risk of dementia. But how much alcohol is too much? Excessive consumption can lead to alcohol-related brain damage, and even moderate consumption may increase the risk of other diseases such as cancer, according to new WHO guidelines.
Treatment for alcohol-related disorders can be difficult, but administering a short and simple questionnaire can be a great place to start the conversation. The Alcohol Use Disorders Identification Test (AUDIT) is designed to assess alcohol consumption, drinking behaviors, and alcohol-related health problems in just two minutes. A quick AUDIT can capture behavioral data, while pairing it with cognitive assessments can collect a baseline that helps patients to better understand how heavy drinking is affecting their cognition.
4. Diabetes
When it comes to diabetes and dementia, patients should aim for prevention rather than treatment. Often, the recommendations for managing diabetes overlap with those for preventing dementia—healthy diet, regular exercise, and tackling related risk factors all contribute to lowering risk. If diagnosed with diabetes, patients can still benefit from taking the prescribed medication and health strategies intended for managing the condition, as they may also prevent a dementia diagnosis.
Respiratory and Cardiovascular Health
5. Smoking
Smokers are generally at a higher risk of developing dementia in their senior years than non-smokers. A longitudinal study on how smoking cessation affected the risk of dementia found that participants who never smoked or who had quit smoking for over four years had significantly reduced their dementia risk for the next eight years. On the other hand, those who continued smoking in late-life had an increased risk of developing dementia, Alzheimer's disease, and vascular dementia. Encouraging patients to stop smoking is the best action a clinician can take for risk reduction. Try working with them to create a quit plan tailored to their health and lifestyle.
6. Air Pollution
While air pollution is already associated with poor respiratory health, certain studies have begun testing how exposure affects cognitive function. A systematic review of air pollution and dementia found that exposure to fine ambient particulate matter, and nitrogen dioxide and carbon monoxide from traffic, were all associated with increased incident dementia risk.
Unfortunately, air pollution is a difficult risk factor to modify. Pollution varies from area to area, and is largely outside the control of the individual person. But there are ways for patients to minimize the pollutants they come into contact with. Strategies such as avoiding exercising near high traffic areas, wearing an N95 mask outside, and using an air filter while indoors, can help alleviate their exposure.
7. Hypertension
Also known as high blood pressure, not only does hypertension increase the risk of heart disease, but it's also associated with an increased risk of dementia in late-life. A cohort study on blood pressure and late-life brain structure found that participants with hypertension as young as 40 years old tended to have reduced brain volumes and increased white matter hyperintensity volumes later in life. To support patients, physicians can help them consistently keep track of their blood pressure and guide them to live a healthy lifestyle, so they can increase their chances of protecting their cognition and preventing dementia even in their later years.
Head and Hearing Protection
8. Traumatic Brain Injury
Traumatic brain injury (TBI) can either be moderate (such as a concussion) or severe (skull fracture, brain damage, and so on) with either kind of head injury increasing the risk of dementia. When it comes to older adults and their risk of dementia after a concussion, results from one study indicate that one in six of the 28,815 participants were diagnosed with dementia in the next three to nine years.
That's why it's important for doctors to educate patients and their caregivers on head safety practices, such as wearing a seatbelt while in a moving vehicle, wearing a helmet when engaging in contact sports, and performing exercises to improve balance and increase leg strength.
But even the most vigilant patients can still suffer from accidents. Concussion care is a delicate process, and while clinic appointments will be necessary, physicians can also offer to monitor their condition remotely in addition to regular check-ups. For example, the Rivermead Post-Concussion Symptoms Questionnaire is an online assessment which allows clinicians to track a patient's TBI recovery process while allowing them to rest and recuperate in the comfort of their own home.
9. Hearing Loss
While there needs to be more research to determine the exact mechanism by which hearing loss impairs cognition, studies show a clear link between the two. A cross-sectional study on subclinical hearing loss and cognitive performance found a decrease in cognition with every 10 dB reduction in hearing for adults over 50.
When it comes to noise-induced hearing loss, doctors can start by teaching patients how to reduce or eliminate loud noise. Simple actions like turning the volume down on the TV and headphones, taking breaks in silence, using quieter products (such as power tools and vacuum cleaners), and using earplugs or earmuffs when noise is unavoidable can help them preserve their hearing and minimize risk. For patients using hearing aids, instructing them to use those devices consistently and correctly can help them avoid strain and further damage their hearing.
Mental Health and Stimulation
10. Education
The connection between education and late-life cognition is largely positive, with dementia research showing that a high school level of education or higher in young adulthood decreases the risk of cognitive decline. But just because a person doesn't have a higher education level doesn't mean that they won't be able to maintain their cognitive function.
Older patients who regularly engage in mentally stimulating activities like travel, social outings, playing music, creating art, physical activity, reading, and speaking a second language can still have an increased chance of preserving their cognition in late-life. These lifestyle factors stand to benefit patients' cognitive reserve—the ability of the brain to build new networks or change strategy—making their cognition more resilient to decline.
11. Depression
While depression is a modifiable risk factor, like diabetes, starting treatment before it reaches its chronic stages is vital for decreasing the risk of dementia. A study found that depression was associated with a 51% higher risk of dementia regardless of treatment, while participants who were treated for less severe symptoms of depression were associated with at least 28% lower risk of dementia.
Before treatment can be considered, physicians need to determine if a patient is suffering from depression in the first place. One tool that can assist in diagnosis is the Patient Health Questionnaire (PHQ-9). Stress often has a strong correlation with depression. By capturing a patient's depression symptoms in a quick, simple test, physicians can use that data to reach a more accurate diagnosis.
12. Social Isolation
While isolation makes older patients more vulnerable to incident dementia, the good news is that encouraging them to be more socially active can prevent or delay dementia onset. A study on social relationships and incident dementia identified five points of social contact. Participants in late life who were married, received support from family members, maintained close friendships, participated in community groups, and engaged in paid work were less likely to have dementia at an earlier age.
Other Risk Factors
While the 12 risk factors we've discussed are all modifiable to some degree, there are other risk factors for dementia that are considered non-modifiable. They include:
Age
Mild decreases in certain cognitive abilities are a natural process of aging, but impairment that results in dementia is not a normal part of anyone's journey into old age. To counteract the cognitive vulnerabilities that come with age, it's important for patients to engage in healthy lifestyle habits and reduce modifiable risk factors in their early and mid-life to build a more robust cognitive reserve in the future.
Genetics
Genes will always play a part in determining a patient’s risk for health conditions later in life. Certain dementias like frontotemporal dementia and early onset Alzheimer's disease are more closely associated with genetic causes. However, even patients who have a strong family history of dementia can still reduce their chances of getting the disease by focusing on the other risk factors they can modify.
Access to Healthcare Services
Systemic and socio-economic inequalities are often what prevent marginalized peoples from seeking and receiving medical aid. When healthcare is hard to access, it becomes more difficult for people from minority communities to find the right support for debilitating conditions like dementia.
While making the healthcare system more accessible is a large but necessary task, smaller societal changes can start bringing positive benefits to these communities. Examples include creating environments that have physical activity as a norm, promoting brain health, raising awareness of healthy food choices, and decreasing excessive noise and air pollution exposure in residential areas.
Limits to Early Detection
Some screening tools, like the Montreal Cognitive Assessment (MoCA), can't catch the early signs of cognitive decline. Often, they lack the sensitivity to detect milder forms of dementia. Plus, they’re static and can be memorized by patients, leading to inaccurate results.
A better method to test, track, and monitor cognition over time is through cognitive assessments. Through quick, scheduled checkups and assessments that can be performed completely online, patients can get a better sense of the state of their cognitive health without the stress of traveling to multiple clinic appointments.
With a large amount of longitudinally-collected data, clinicians are able to make more informed conclusions regarding the state of a patient's cognition and catch early signs of cognitive decline. With this data, clinicians can also develop a cognitive care plan for patients with more advanced stages of dementia.
Final Thoughts
Dementia is a prevalent health problem throughout the world, and although it may not yet be curable, in some cases it can be preventable. By supporting patients as they address their modifiable risk factors and improve brain health overall, clinicians help patients build cognitive resilience later in life. When it comes to risk factors that can't be changed, early detection is key. Through routine tests carried out online and a cognitive care plan, healthcare providers can increase the chances of detecting dementia in a patient at its earlier—and more preventable—stages.