Preventing Dementia – What You Can Do

Many risk factors can lead to dementia. A healthy lifestyle can help prevent dementia. Learn all the important information in this article.

A dementia diagnosis can shake a person's entire being. The characteristic feature of dementia is the deterioration of cognitive abilities, eventually leading to their complete loss. In later stages, it negatively impacts language, orientation, attention, comprehension, and thinking skills. Consequently, dementia leads to a progressive loss of daily living skills, making it the most common cause of dependency in old age. In Switzerland, about 1.7 percent of the population is currently affected by dementia.

The causes of dementia are diverse. Alzheimer's disease, the most common form of dementia, results from a multifactorial origin, including genetic changes, environmental influences, and lifestyle. Vascular dementia, the second most common form, is caused by changes in the brain's blood supply.

The good news: You can reduce your risk of developing dementia. This article explains the risk factors and how you can prevent dementia or slow cognitive decline. Here’s a quick hint: What’s good for your heart is also good for your brain.

Key Facts

• Prevalence: About 1.7% of the Swiss population is affected by dementia.
• Avoidable Risk Factors: Low education, untreated hearing loss, brain injuries, high blood pressure, alcohol consumption, obesity, smoking, depression, social isolation, physical inactivity, air pollution, diabetes.
• Additional Risk Factors: Low blood pressure, high inflammatory markers (CRP), vitamin D deficiency, unfavorable blood lipid levels.
• Preventive Measures: Mental and physical activity, social integration, avoiding alcohol, smoking, and air pollution, healthy diet, regular medical check-ups.
• Unavoidable Risk Factors: Genetic predisposition, age, gender.

Is Dementia Preventable?

The risk of developing dementia increases with age. Currently, about one in three 90-year-olds is affected. However, up to 40 percent of dementia cases could be prevented or at least delayed, according to an international expert commission. This would require changes to 12 factors affecting dementia risk.

Preventable Risk Factors for Dementia

The Livingston Study identified 12 preventable risk factors for dementia in 2020. The percentages in parentheses indicate the potential risk reduction, totaling 40 percent:

1. Low education in early life (7 percent)
2. Untreated hearing loss (8 percent)
3. Brain injuries (3 percent)
4. Hypertension (2 percent)
5. Alcohol consumption (1 percent)
6. Obesity with a BMI over 30 (1 percent)
7. Smoking (5 percent)
8. Depression (4 percent)
9. Social isolation (4 percent)
10. Physical inactivity (2 percent)
11. Air pollution (2 percent)
12. Diabetes mellitus (1 percent)

Factors 2 to 6 should be addressed in mid-life according to the researchers. Factors 7 to 12 can contribute to risk reduction regardless of age. While you may not be able to completely avoid brain injuries, wearing a bike helmet can minimize your risk. Below, we provide more tips for dementia prevention.

Additional Preventable Risk Factors: Low Blood Pressure, High Inflammation, Vitamin D Deficiency, and Unfavorable Blood Lipids

In 2023, an international research team investigated modifiable risk factors and their interactions with genetic factors in dementia cases under 65 years old. Their study confirmed the risk factors identified in the Livingston Study and highlighted mental health as a crucial factor in dementia development.

The researchers added four more risk factors: vitamin D deficiency, orthostatic hypotension (a type of low blood pressure), high levels of C-reactive protein (CRP), a marker for acute inflammatory diseases, and unfavorable blood lipid levels. High CRP levels are a risk factor for arteriosclerosis, which can lead to cardiovascular diseases and vascular dementia. Such vascular changes can result in dementia caused by impaired blood flow to the brain, as seen in strokes.

Another significant risk factor is unfavorable blood lipid levels, particularly high LDL cholesterol and low HDL cholesterol. The ApoB level, the main protein bound to "bad" cholesterol in the body, is also a critical predictor of cardiovascular diseases. (Source: What is ApoB? Learn why it’s the future of heart disease prevention (aware.app)).

How Can I Prevent Dementia?

A healthy lifestyle positively impacts dementia prevention. Various measures often interconnect, and you can reduce your individual risk by considering the following points:

• Mental activity and education
• Physical activity
• Social engagement
• Avoidance of alcohol, smoking, and air pollution
• Regular medical check-ups

Mental Activity and Education

For cognitive fitness, studies show that actively using previously stored knowledge is crucial. This may play a more critical role in dementia prevention than passive leisure activities. Passive activities include reading, listening to music, or watching TV. Although these activities contribute to dementia prevention, their effect is smaller compared to creative hobbies like painting, knitting, or crafting. To maintain cognitive function, it is better to actively challenge brain cells, such as through:

• Card or chess games,
• Literary activities like writing letters or diaries, and
• Taking courses, for example, to learn a new language.

Physical Activity

Regular exercise is crucial if you want to prevent dementia. A study from the UK, which tracked the daily steps of adults over seven years, found that around 10,000 steps a day are associated with the lowest dementia risk. However, a protective effect was already noticeable at about 3,800 steps per day. You can achieve this effect with other forms of exercise as well. Dancing, for instance, is particularly interesting for dementia prevention because it challenges both the brain and the body.

Social Engagement

Unwanted loneliness is a significant risk factor for dementia. If you rarely engage in social contacts, your brain will not be sufficiently challenged in the long run, leading to cognitive decline. Conversations with others are a complex process involving:

• Listening and understanding the other person,
• Remembering previously said things,
• Perceiving the other person's tone and facial expressions.

(Source: Alzheimer’s Risk: Loneliness - Social Contacts Prevent Dementia | Alzheimer Research Initiative e.V. (AFI))

Loneliness can also trigger depression, which is linked to dementia development. Social activities positively impact your mental well-being. For example, a walk in the woods or a visit to the spa can help reduce stress and increase feelings of appreciation.

Avoidance of Alcohol, Smoking, and Air Pollution

It is well-known that smoking, alcohol consumption, and air pollution are risk factors for dementia. Therefore, you should avoid smoking, both actively and passively. Alcohol should only be consumed in moderation, but it’s essential to remember that alcohol is a cell poison that can be harmful even from the first drop.

While you have limited control over air pollution, you can still take steps to protect yourself from ozone, particulate matter, and nitrogen oxides. Avoid high-pollution areas like traffic hubs and avoid exercising there. If you live in a traffic-heavy area, do not air out your home during peak traffic times. Opening your windows in the early morning can also help reduce ozone exposure in your home. (Source: What You Can Do About Air Pollution (aok.de))

Healthy Diet

A balanced diet rich in nutrients and vitamins helps keep your brain fit. Regularly include vegetables in your diet. Fruits and vegetables are rich in polyphenols, which have anti-inflammatory and antioxidant effects. Polyphenols are also found in green and black tea and coffee. B vitamins are essential for normal nervous system function and are abundant in legumes like peas, beans, and lentils. Omega-3 fatty acids, found in fish, walnuts, flaxseed oil, and chia seeds, can enhance brain performance and protect against cardiovascular diseases. To prevent arteriosclerosis, consume enough vitamin C from sources like black currants, lemons, kale, or bell peppers. Whole grains also positively affect concentration by maintaining stable blood sugar levels. (Source: Dementia: Five Foods That Promote Brain Health (24vita.de))

A large observational study showed that the Mediterranean diet, rich in vegetables and olive oil, can reduce the risk of dementia by up to 23 percent.

Regular Medical Check-Ups

Regular medical check-ups can help identify risk factors for dementia. The following examinations are particularly important:

• Hearing test
• Blood pressure measurement
• Blood sugar level check
• Weight control
• Inflammatory markers in the blood (C-reactive protein)
• Vitamin D level check
• Blood lipid levels and ApoB level check

If you are diagnosed with hearing loss, it is advisable to get hearing aids since untreated hearing loss is a significant risk factor for dementia. The same applies to hypertension and diabetes. High blood pressure and elevated blood sugar levels should be avoided and, if necessary, treated with medication.

We mentioned obesity as a risk factor for dementia earlier. Monitoring weight is also important to detect unintended weight loss, which can indicate early-stage dementia. (Source: Preventing Weight Loss in Dementia Patients (aerztezeitung.de).

A blood test should include inflammatory markers, vitamin D levels, blood lipid levels, and the ApoB level. C-reactive protein (CRP) is a protein and part of the body's immune system, produced by the liver in response to inflammation and infections. Since CRP is linked to dementia development, it is worth monitoring this inflammation marker. However, an elevated CRP level only indicates a general inflammatory response in the body without specifying the cause. If you do not have other symptoms like pain, it could be a "silent inflammation" – an unnoticed inflammation. Typical signs include listlessness, fatigue, lack of concentration, and withdrawal. Your doctor can determine additional inflammatory markers in your blood to confirm silent inflammation and create a treatment plan.

Vitamin D is a fat-soluble vitamin stored in the liver, muscles, and fat tissue. Most Swiss people have a deficiency at least temporarily because they do not get enough sunlight exposure to produce sufficient vitamin D. The Swiss Federal Nutrition Commission (EEK) assumes a "widespread vitamin D deficiency." Therefore, you should regularly check whether vitamin D supplementation is necessary. As mentioned earlier, vitamin D deficiency is also a risk factor for dementia.

Monitoring and optimizing your blood lipid levels and ApoB level can further reduce the risk of vascular diseases and dementia. High LDL cholesterol and an elevated ApoB level are risk factors for arteriosclerosis, which increases the risk of strokes and vascular dementia.

Early Detection of Dementia

Talk to your doctor if you think you notice early warning signs of dementia. These include:

• Slight memory lapses and mood swings,
• Decreased learning and reaction abilities, and
• Initial speech difficulties.

Early detection, as with other severe diseases, significantly contributes to positively influencing the course of dementia. Therefore, take early signs seriously. At the same time, be aware that not every mild cognitive impairment automatically marks the beginning of dementia. It may only be a temporary condition caused by stress or lack of sleep.

If you want to be sure, an apolipoprotein E genotyping test at your doctor's office can provide important diagnostic or risk assessment information. This genetic test only requires a simple blood sample.

Your genotype consists of two copies of the gene (alleles) – one from your father and one from your mother. There are three main variants of this gene: ApoE2, ApoE3, and ApoE4. The combination of alleles influences the form of the APOE protein in your body and thus your risk for Alzheimer's.

Here is an overview of the approximate relative risk for Alzheimer's depending on the APOE genotype:

These figures are approximate values. Your individual risk will be influenced by various factors, including lifestyle, environment, and other genetic factors. The presence of the ApoE4 allele increases the risk of Alzheimer's but does not guarantee that someone with this allele will develop the disease; it is not deterministic. Similarly, the absence of the ApoE4 allele does not entirely protect against the disease. A healthy lifestyle is very important to reduce the risk of cognitive impairment. Studies indicate that cholesterol levels are particularly important in this context. A change in diet and physical activity could be more effective for ApoE4 carriers than cholesterol-lowering drugs (statins).

What Are the Risk Factors for Dementia That I Cannot Influence?

As described earlier, there are several risk factors for dementia. Most can be influenced, but not:

• Your genetic predisposition,
• Your age, and
• Your gender.

The risk of inherited dementia is smaller than previously thought. Age has a more significant impact: While the dementia risk for 60- to 70-year-olds is about 2.5 percent, it rises to about 5 percent for 70- to 80-year-olds and about 20 percent for 80- to 90-year-olds (Source: Signs of Dementia (aok.de)). Additionally, gender appears to play a role: In Switzerland, 66 percent of people with dementia are women.

The causes of dementia are not yet fully understood. However, it is clear that lifestyle can significantly contribute to preventing dementia or at least positively influencing its course. Therefore, it is always worth taking preventive measures.

Conclusion

Dementia is a serious condition that can severely impact the lives of those affected. However, it can be prevented or at least delayed through various measures. A healthy lifestyle, including mental and physical activity, social integration, avoiding risk factors like smoking and alcohol consumption, and regular medical check-ups, can reduce the risk of dementia. Although some risk factors like genetic predisposition, age, and gender cannot be influenced, a conscious lifestyle can significantly impact the development and course of dementia. Use this knowledge to improve your quality of life and minimize the risk of dementia.

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