PROFESSOR ROB GALLOWAY: Like most people, my biggest fear is dementia, but there is a PROVEN way to prevent it

Dementia is the illness I fear most, especially the horrible illnesses and injuries I treat. And last week came the grim 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 who are affected by cognitive decline, personality changes and loss of independence, which basically means you die years before your body.

It is also terrible for their loved ones.

One of the first dementia patients I ever saw was as a resident many years ago: an elderly, incontinent and confused gentleman in his late 70s who was brought to the emergency room by his daughter after a fall.

To determine the severity of his dementia, I reviewed the questions we often ask such patients, including when he was to blame. He clearly had advanced dementia.

His daughter then told me with tears in her eyes: ‘You know that a few years ago he was able to define how time actually began.’ He was a professor of astrophysics.’ Then she took out one of his textbooks from her pocket which contained equations that I couldn’t even understand.

We continued to talk and I explained what I had learned in medical school; that dementia – and especially its most common form, Alzheimer’s disease – was an accident in which genes played an important role and led to the formation of excess protein (amyloid plaques) in the brain.

But twenty years later, I wonder what I was taught about the disease. Yes, there is a subset of Alzheimer’s that is strongly linked to certain genes – and causes dementia at a very young age. However, this affects less than one percent of cases.

The biggest risk factor for dementia is increasing age. However, it is not a given that you will develop dementia as you get older.

And that’s good news in a way, because it raises the question of whether dementia is really due to bad luck and whether we can influence our chances of developing it. And according to the latest research, the answer is: yes, it is possible.

But why can’t you just rely on those wonderful new drugs we’ve all heard about, like aducanumab, which can remove amyloid plaques from the brain?

If you look at the details of the studies, the results are disappointing, no matter what the pharmaceutical companies would have us believe.

Yes, these drugs have been shown to clear amyloid plaques, but we don’t yet know if they will actually make a difference in patients’ lives.

One of the first dementia patients I ever saw was as a resident many years ago – an elderly, incontinent and confused gentleman in his late 70s who was brought to the emergency room by his daughter after a fall (file photo)

At this point, we can only say that these drugs slow the decline in people with mild or moderate Alzheimer’s disease. They are also expensive and can have some very serious side effects.

But maybe we’re focusing on the wrong thing. What if amyloid is the smoke, but the fire that’s actually burning down your house is something else? And that “something” is high blood pressure.

We have known for years that high blood pressure is associated with an increased risk of dementia, but clear evidence is lacking.

However, new research from the Center for Healthy Brain Aging in New South Wales, Australia, published last month in the prestigious JAMA Network Open, supports the role of high blood pressure in dementia – and challenges the traditional view of the cause of the disease out.

Researchers analyzed data from more than 34,000 people from a total of 17 studies and looked at the risk of dementia if you had high blood pressure that was treated or not, or if you had normal blood pressure. This analysis found that untreated high blood pressure or high blood pressure increased the risk of dementia by 42 percent.

However, if the high blood pressure was treated, your risk was the same as if you had normal blood pressure without medication.

This is an astonishing finding, and for me it finally settled the debate about the important role that high blood pressure plays in both the development of dementia and the worsening of symptoms.

But how does this explain the amyloid plaques seen in Alzheimer’s disease? One theory is that poor blood flow to brain tissue damages cells and leads to dementia – and that it is this damage to the cells that leads to the formation of amyloid plaques, rather than the amyloid plaques themselves causing the problem.

This would explain why inexpensive drugs such as blood pressure tablets such as Ramipril reduce the risk of Alzheimer’s disease. This was proven by the JAMA study, which also found that treating high blood pressure reduced the risk of dementia by 26 percent.

It would also explain why expensive new drugs that clear amyloid plaques do not improve Alzheimer’s symptoms.

Based on this finding, other things that improve blood flow to the brain will also reduce the risk of Alzheimer’s disease.

And this is exactly what was confirmed by a 2020 report published in The Lancet, which summarized all the studies that looked at what increases the risk of dementia.

Lack of exercise increased the risk of dementia by 40 percent; Smoking, obesity and diabetes each increased the risk by 60 percent; and air pollution increased the risk by 10 percent.

Do it

Prioritize regular exercise as it can help prevent and relieve chronic pain, say Norwegian scientists.

They analyzed data from more than 10,000 adults who reported how much exercise they did and their pain tolerance (measured by the amount of time they could submerge a hand in cold water) over an eight-year period. Those with more active lifestyles were more pain tolerant, and the more people exercised, the more their ability to tolerate pain increased during the study period, the journal Plos One reported.

Knowing that, I now walk every day if possible (but at least five times a week), check my blood pressure every few months and have lost some weight.

When it comes to alcohol, the general consensus is that small amounts of alcohol are safe, provided they are less than 14 units per week.

Data published in the BMJ in 2018 confirmed that for every seven units more than 14 per week, your risk of dementia increases by 17 percent.

Research shows that people today fear dementia more than cancer. If this is you, I think there is a very positive message that you can significantly reduce your risk by doing a few simple things: exercise regularly, eat healthy (so you maintain a healthy weight), don’t smoke, drink less alcohol and control your blood pressure.

What’s more, these steps will also help slow dementia patients’ decline—and how effective they are is evident in a study published this month in the Journal of Alzheimer’s Disease.

A group of 55 patients with early Alzheimer’s disease received standard care or standard care plus telephone coaching on lifestyle management.

These include cognitive brain training, nutritional recommendations based on the MIND diet (a Mediterranean diet proven to reduce the risk of developing dementia), physical activity, advice on sleep (e.g. aim for 7-8 hours a day ) and for stress management (eg breathing exercises).

The study found that memory decline in participants in this program was significantly slower than in the control group. However, because all these interventions were offered simultaneously, it cannot be said which had the greatest impact.

In any case, the results make scientific sense: Brain training will help build new brain cells to counteract some of the declining function of Alzheimer’s disease, and lifestyle factors will improve blood flow and reduce inflammatory processes that damage the brain and cause subsequent symptoms.

Like many things in medicine, dementia is more complicated than we first thought. One day we may find a cure, but until then you have to make your own luck and try to reduce the likelihood of needing these medications by reducing your risk of developing dementia in the first place.

@drrobgalloway