Episode 48: The Lifestyle Prescription for Dementia Prevention

Dementia can be a devastating diagnosis for patients and families, and treatment options remain limited. But there is good news—prevention is possible. In this episode of The Starting Gate, we explore how lifestyle choices in midlife can significantly reduce the risk of dementia and delay cognitive decline. From nutrition and exercise to sleep and social connection, the evidence is clear: these habits are far more powerful than any supplement on the market.  Dementia may not show symptoms until later life, but the groundwork is laid decades earlier. Join us as we uncover why lifestyle medicine offers the strongest defense against cognitive decline, and how the steps you take today can help you enjoy a sharper, healthier mind for years to come.   

 Midlife habits lay the foundation for lifelong brain health !

Alzheimer's Association- Brain Health

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specific individual’s medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis or treatment. This podcast does not create a physician- patient relationship and is not a substitute for professional medical advice, diagnosis or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different so make sure you consult your own healthcare professional before seeking any new treatment and before you alter, suspend, or initiate a new change in your routine.

Transcript

Episode 48: The Lifestyle Prescription for Dementia Prevention

[00:00:00] Before we start today's episode, I would like to quickly read you our podcast disclaimer. The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive or to be applicable to any specific individual's medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis, or treatment.

This podcast does not create a physician patient relationship and it's not a substitute for professional medical advice, diagnosis, or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different, so make sure you consult your own healthcare professional before seeking any new treatment.

And before you alter, suspend, or initiate a new change in your routine.

Welcome to the starting gate. We're your host, Dr. Kitty Dotson and Dr. Sarah Sheets, two internal medicine doctors who spent years practicing traditional primary care. Over time, we realized something was missing from modern healthcare, a [00:01:00] real understanding of how everyday lifestyle choices impact overall health.

We will help you cut through the noise of the countless health influencers and their conflicting opinions because no matter who you follow, the basics of lifestyle medicine are at the heart of it all.

Welcome to the starting gate. We're your host, Dr. Kitty Dotson 

and Dr. Sarah Schuetz. 

 Well, today we're gonna have our third neurology episode in our series, and we're talking about dementia. So if you are a younger listener out there hearing me say, we're talking about dementia, and you're thinking, maybe I don't need to listen to this one, I strongly encourage you to stick around and listen to this because what we're really hoping to convey today is that dementia is not a disease of old age.

It's a disease of midlife. You probably wouldn't see the effects of it until old age, but the pathology is starting now. So what you need to do in order to prevent dementia or lead a life in your older years that's still rewarding and full 

[00:02:00] you need to be acting now, 

and you may wonder, why do we care about dementia? Well, I'll give you all the reasons why you should care. And the United States, nearly 7 million people are living with Alzheimer's disease, which is the most common form of dementia. And in 2025, dementia care is going to cost our country $384 billion, and by 2050, so just in 25 years, these costs are going to rise to nearly a trillion dollars.

So not only is the number of people impacted by this at super high numbers, but the cost. To care for someone for dementia is extreme, and that becomes a burden not only for the patient, but for their family members as well. 

Right? Nearly million people provide unpaid care for those with Alzheimer's and other types of dementia.

And these caregivers that are not paid are usually loved ones, and they're providing billions of hours of care each year, often at [00:03:00] the expense of their own health and wellbeing. 

And one in three older adults go on to die from Alzheimer's or one of the other forms of dementia, and it kills more people in their older age than breast cancer and prostate cancer.

combined. Between 2000-2022 deaths from heart disease declined by 2.1% while deaths from Alzheimer's disease increased by 142%. Can we pause with that kitty? Yeah. 142%. So if we have not got your attention yet, I, I just don't know what else to say because this is definitely a condition that is rapidly increasing and we all need to be paying attention to it because we do not want to develop this when we're older if we're able to control that.

Right. And you think about the advancements that we've had in medicine between 2000 and 2022, and it makes sense that we would see deaths from heart disease go down because we've made so many great medical advancements. But then to [00:04:00] hear despite that, and despite how much research we've put into Alzheimer's disease, the deaths from Alzheimer's disease have increased by 142%.

We have to be paying attention to this. 

 And hearing these stats, I know that makes everyone a little uneasy. Especially as you age and you're getting close to that time of your life where you're seeing loved ones develop this or friends develop this and you start worrying about your own risk, you start wanting to research.

So what can I do? Is there a medicine I can be taking? Research has shown that nearly 92% of Americans say they would want a medication to slow the progression of dementia. And four out of five feel hopeful that some of these new Alzheimer's treatments will emerge in the next decade. But we're not quite there yet.

Even this newest class of medications that have come out, which are the monoclonal antibodies that are given by an IV infusion, that work by clearing amyloid plaque from the brain. And we'll get a little more into this here shortly. They really are working to just help slow the [00:05:00] progression of Alzheimer's disease and they slow it by about 30%, but they also carry significant risks and side effects.

 It is encouraging that we've made progress and been able to develop these medications because as you can imagine, making a medication that has an effect on the brain is difficult to do because it's likely gonna have side effects that. Might not be side effects that we want.

So it's really encouraging that we've made this progress with medications for Alzheimer's, but despite these billions of dollars that have been invested in research, there is still no treatment to date that's been able to restore lost memory or reverse cognitive decline once it started. So sometimes I think people are, putting all their eggs in one basket thinking that we're gonna have a medicine or some sort of treatment that's going to help cure dementia when they get it. But really we have to be thinking about it a different way. 

So that's why we really wanna take today to be focusing on [00:06:00] prevention and really thinking about the hope that we have when we look toward prevention as opposed to trying to fix something that's already started

It is all about prevention and that is where we have the best evidence to make a difference I like to bring this good news, right? Like some of this seems very daunting and sad, but here's the good news. Lifestyle medicine is here to help reduce that risk. We know, and evidence has shown that improving our nutrition, exercise, sleep, and social connection can delay and even prevent the onset of dementia.

Hoo woo. , And these strategies are powerful. They're evidence-based, and they are more effective than many people realize. And that's why we wanted to do this show. So we could give you these amazing statistics about making changes in your lifestyle and how you can prevent dementia. 

Before we tackle these lifestyle medicine [00:07:00] pillars, which, you know, we're going to do.

'cause that's what we love to do. We do wanna give some definitions because I think that helps, especially as we talk about studies, , that we're gonna bring up, is giving a little bit of framework on two specific definitions. Dementia and mild cognitive impairment, I want people to think of it almost as a spectrum,, that occurs when we're talking about memory loss for many patients.

And also understanding that dementia can be caused by more than one thing. We usually think of Alzheimer's, 'cause that's the most common etiology of dementia, but there are other causes as well. , I'll start with mild cognitive impairment.

This is when someone is having more trouble with their memory or thinking as they age, but they can still do their everyday task. , This is things such as they can still shop, they can still, Drive to the grocery store without getting lost. They can cook, they can put their clothes on. They may start noticing that they're having more forgetfulness and may [00:08:00] have trouble problem solving at times, or may lose track of things or lose track of conversations.

This is something that if you do have concerns, your primary care doctor can do a simple screen in order to assess whether or not it is just a small deficit that you're noting and it's normal aging. Or is there concern that you are developing mild cognitive impairment? And I know that's something that I did routinely with many of my patients because as you age, you start getting nervous when you forget things and really understanding, should I be concerned?

Am I falling on the spectrum or is it normal aging? 

Yeah. And you don't need to be concerned if you recently forgot where you put your keys. , That happens to all of us, but. When you start having things occurring over and over, that's really when it is gonna grab your attention. And mild cognitive impairment can stay the same for years, and someone can be in that level of memory impairment for the rest of their life.

[00:09:00] Sometimes it can get better. There are certain things you can do to improve mild cognitive impairment, some of which we will bring up today. Or it can progress to dementia. And so dementia is the next step, the more serious step. And that is really where these problems with memory and thinking or behavior are bad enough that it makes doing your normal daily activities more difficult.

So things like cooking, things like managing your finances, paying your bills, those things become more problematic and you really need help from other people to help you do those if you are someone that can't find yourself, going through a normal recipe that you've made for years, that could be a sign that you've progressed to dementia.

If you are needing help with basic tasks that you do around the house that you're used to, if you're needing help getting to appointments, then we're at the point where this is really affecting your day-to-day life. And that's when we would call it dementia. 

And again, if you had these [00:10:00] concerns.

It's definitely a reason to set up an appointment with your primary care doctor to help tease these things out because there are also a lot of, , mimics of dementia that they need to rule out as well. So this is a serious topic and definitely something that should be discussed if it's on your mind and you're having concerns, , because we want to make sure there's not something that's reversible really early, , that could be causing some of this as well, 

 Even things like depression can seem like you have dementia and getting the appropriate treatment for that can.

resolve those symptoms. So when we say dementia, we're really referring to quite a few different diseases. There's multiple diseases that result in dementia, but what we're going to talk primarily about today is Alzheimer's disease, which is about 70% of those dementias.

, 

There are some more rare causes of dementia. , Lewy body dementia, patients who have Parkinson's [00:11:00] disease can also develop dementia later in their course of their disease state. so there are other causes of dementia, but those specifically, we're not gonna spend as much time on today because they are,, a lower incidence and really are spending most of our time talking about Alzheimer's, as well as that, subset called vascular dementia, which tends to have a lot of the same risk factors as.

Heart disease and stroke. 

So with Alzheimer's, you're having a buildup of abnormal proteins in the brain, and it's primarily two proteins, an amyloid beta protein that can form a plaque between the nerve cells, and then another protein called tau that can form tangles inside of the nerve cells.

And so the changes that happen with these two proteins building up is that ultimately they. Kill the neurons in the brain. They make it harder for these neurons to communicate with each other and send signals to each other. And over time the [00:12:00] death of these neurons leads to shrinkage of the brain and then the lack of them , being able to signal each other, causes memory loss, confusion, trouble with just everyday reasoning and thinking.

this is 

something we mostly see in older adults, but just like we talked about at the beginning of the show, the pathology starting in midlife, it just takes decades before the symptoms start to appear as it's taking time for all those plaques to occur and the risk is going to increase with age and more women, I'm sorry, women, I feel like we always get the negatives.

But anyways, more women than men are affected. Two thirds of Alzheimer's patients are women. And the risk to develop this is multifactorial and it involves your family history, specific medical conditions like high blood pressure, diabetes, obesity, your environment. I know there's lots of research looking at different environmental factors since it's on the rise, lower educational level can increase risk.

As well. So it has [00:13:00] a lot of things playing into this pathology. 

Yeah. There's never just one thing that's causing someone to develop Alzheimer's , and touching on this increased rate in women, two thirds of Alzheimer's patients being women. It was thought for many years that that was due to just women living longer.

And now we know that that is not the case. There's been a lot more research recently looking into why we see more women with Alzheimer's disease. And I think we're gonna be uncovering a link with our decline in estrogen because they're seeing that.

When changes start happening in women, and as again we've said this starts in midlife, it seems to correlate when women start having changes in hormones. And so it looks like the research coming out is gonna give us a lot more information on how we can better handle that and hopefully how we can better protect the brain of women in the future as well.

So looking forward to, in the next few years, having more information to report on [00:14:00] that for women. But the other thing that can impact people is their genetic risk and. There are several genes that have been identified that can increase risk. There's some less common genes that really increase that risk of early onset dementia, but the one most people hear about is this APOE4 gene.

And that's the most common genetic risk factor we see for late onset Alzheimer's. and with that, you can have one copy of this abnormal allele for APOE4, or you can have two copies of this abnormal allele for APOE4 and having one copy. Conveys less risk to you than having two copies as far as your risk for developing Alzheimer's disease.

But even if you do have two copies, not everyone that has this genetic makeup gets Alzheimer's disease, 

and the lifestyle is thought to play into that. Because lifestyle factors such as regular exercise, healthy eating, staying mentally active, can reduce [00:15:00] the risk or. Delay the onset, which is really important as well,, for those who have that higher genetic risk.

And so if you feel like based off your family history, you already have this in your cards, there can be a big difference in your quality of life by making changes now and making this a focus of your overall lifestyle. , So if you do have a chance of developing this, you're developing it in your nineties, not in your sixties.

And I know it's always powerful knowing that you may have some control when you feel like you genetically drew a short straw. I know that really stinks at times. , But this is one that you can make a big difference. 

Yeah, I mean, thinking about when memory impairment hits you at the age of 60 versus 95, , that would be a very different life.

And so we're hoping with this episode that we can inspire you to think of it. In that way as whatever is in my cards, whether you know or not, I want to [00:16:00] delay any potential dementia and do everything I can to make sure that my quality of life lasts as long as possible. 

Okay. So to give us a little bit of framework on , what we're gonna talk about today.

. We like to use the pneumonic NEURO to help us remember all the things that are gonna help decrease our risk. 

And we got this from, , Dean and Ayesha Sherzai, they are two neurologists that promote a lot about brain health and lifestyle medicine. , And we loved their acronym NEURO to help cover these basics.

And so what does that mean? So guess what the N stands for? Nutrition. Nutrition. So it's nutrition. E is for exercise, U is for unwind, also known as stress management. R is for restorative sleep and O is for social optimization. And so as you can see, these are very similar to the lifestyle medicine pillars in general.

All of them make an impact. So let's get started with our favorite [00:17:00] nutrition. What can nutrition do to help reduce your risk? We do know that a diet high in. Unprocessed foods as well as high in plant foods are going to help reduce and lower our risk for Alzheimer's and all cause dementia, so other causes of dementia as well.

And that is because diets that are high in those plant foods and less processed foods are gonna have more phytonutrients. They're gonna be high in fiber. As you learn from us, when we talked about the gut brain axis and making that optimal, our gut loves fiber and that's going to help our brain as well.

And polyunsaturated fats, especially those omega threes, those are really critical for our brain health. 

Two diets, if you want to look into them more that have been well studied in neurology are both the Mediterranean diet, which we've talked about on this podcast before multiple times.

This is a diet rich and nuts and seeds and whole grains and [00:18:00] plants and olive oil fatty fish, as well as the MIND diet, which is a hybrid of the Mediterranean diet and the DASH diet. The dash diet is one we've talked about before as well, and that's one that's really aimed at a low sodium aiming to help hypertension.

And so the MIND diet specifically looks at adding a lot of green leafy vegetables, a lot of deep colored berries, and seems to have less animal proteins, even less fish than the Mediterranean diet, and has a lot of neuroprotective qualities 

 So What is actually , some of the risk reduction?

 One specific study that looked at nutrition was a study done in 2017 called Increased Consumption of fruits and vegetables related to a reduced risk of cognitive impairment and dementia meta-analysis. It. Actually quantified what we needed to be doing to reduce this risk. So it looked at a hundred [00:19:00] grams of fruits and vegetables, which is equivalent to about two cups of green leafy vegetables or a cup of a cooked vegetables such as broccoli or a medium apple as a fruit.

And for each serving of a hundred grams of those fruits and vegetables, you have a 13% reduction in cognitive impairment and dementia. That is crazy. It is crazy. It really is. It's crazy. It's like if this was a medicine. We would be prescribing it left and right. And higher intake and variety of fruits and vegetables in midlife are reducing those odds of mild cognitive impairment in later life as well.

So just as we talk about all the time on this show is variety also matters. Now what are some of those foods that are gonna make. You have the biggest bang for your buck when it comes to your brain health? Well, these diets that we mentioned, the MIND diet, the Mediterranean diet, both of those are emphasizing green leafy vegetables, and that is because green leafy vegetables have been shown to be neuroprotective because they have lutein, [00:20:00] folate, polyphenols, antioxidants.

So really trying to get regular intake of dark green leafy vegetables. That would be things like spinach or kale in order to reduce cognitive decline and decrease that dementia risk. 

 And then from there, another one that gets lots of press, and you've probably seen something about this before and there is evidence to back this up, but there is one all star fruit that we all should adopt as a part of our diet if we're wanting to reduce our dementia risk.

And that is blueberries. Blueberries are rich in anthocyanins and flavonoids, and they have had multiple studies done on them and showed to improve memory, help with processing speed, executive function. And this can be just a half a serving of blueberries a day to get that impact in your brain health.

So if you're not a blueberry lover or you do love them and you just don't think about eating them, this is a reason to make them a part of your [00:21:00] normal routine, because they are making a difference for your brain health. Another big one that we like to talk about is fatty fish. As we mentioned, omega threes are great for your brain.

 , It has been shown that having one to two servings of fatty fish within a week can help reduce Alzheimer's risk. So that is something we definitely wanna consider. I know that's not. Normal in many Americans, diets, especially depending on where you live. But that is something that can be done to reduce your risk.

And one that I had not heard as much about,, was tea consumption, but black tea, green tea, they have flavonoids as well. And having regular tea in your diet can help reduce your dementia risk. 

And it's delicious. And 

it's delicious. Right? It's a great alternative to those sodas that we don't wanna be drinking, which actually would be increasing our risk.

Yeah, 

we definitely wanna try to limit those added sugars.

There was a study called the Rush Memory and Aging Project that showed that people that [00:22:00] consume one to two servings a day of green leafy vegetables actually had the equivalent of being 11 years younger in age when looking at their brains. , You know, we wanna encourage you to do all of these things.

And we know that the more closely you stick to these diets, the better reduction in Alzheimer's. You have those who stuck closely to that MIND Diet we mentioned had a 53% reduction in Alzheimer's. And I, I wanna stress how important that is because there are no supplements or medicines out there that come anywhere near this.

And so That's a huge reduction in risk for dementia. But you don't have to be perfect. I don't follow the MIND diet perfectly, so don't feel like you have to do these things perfectly in order to be reducing your risk. Just as Sarah said, adding some blueberries, adding a handful of kale to, I've found I can add a handful of kale or spinach to almost any dinner 

I make.

Oh yeah. [00:23:00] It's, they're greats to sneak in,, all sorts of things. And your smoothies always tell people, like you, if you're a smoothie person, there's no excuse to not throw some of those greens in there because you, you're not even gonna taste them. Yeah. 

So if, you just wanna get started, see, can you throw a handful of greens somewhere into your day and can you get a cup of some dark colored berries?

, It's something you really can do and make a difference.

 Okay, Sarah. So if we're enjoying our meal of salmon and greens, should we also have a glass of wine? 

Oh, that one's a little tricky. There was evidence that previously show that light to moderate drinking may have a reduction in risk of dementia, but now there has been more, , research looking into that because there was concerns for, confounders in those prior studies.

And we are realizing that no alcohol is the best answer for our brains. It's always gonna be the best answer for our brains because alcohol causes so [00:24:00] many changes, in how our brain works, that it was probably more related to some aspect of the lifestyle those people were living versus the actual alcohol that they were taking in.

And 

so since. Now we know alcohol is not a way for us to help preserve our brain. One thing I feel like a lot of people look to is supplements, and you already mentioned omega threes and how important that is in our diet. I wanted to bring up Omega-3 supplements too because I think that's something that that gets a lot of attention.

Over half of our brain is fat, and the Omega-3 fatty acid, DHA is a large part of that. we have to remember this is not the same fat that's in the rest of our body, but that the DHA is found in the membranes that surround the brain cells and really help with them being able to send signals to each other and communicate well.

 But interestingly, our body, even though this is something that's so important to [00:25:00] our brain functioning well, our body does not make DHA. So it is something that we have to get in our diet. And there have been studies looking at. Individuals with higher DHA levels in their blood, and they've been found to have a 49% lower risk of developing Alzheimer's disease when they looked at those with the highest amount of DHA versus those with the lowest amount of DHA in their blood.

So it makes sense. Thinking about that, thinking about DHA, okay, this is good for our brain. It's been linked with slower cognitive decline, we should just supplement it. But interestingly, when we actually look at randomized controlled trials with people taking supplements, it doesn't seem to have that benefit.

There are certain populations where it seems to be more helpful, particularly older populations and older adults that carry that. APOE4 allele that we talked about earlier, that puts you at a higher genetic risk. [00:26:00] So. Omega-3 may particularly help that patient population. We also know it helps early in life, especially in those very early years up to age five, it can have a lot of effect.

But when they look at randomized control trials of middle age adults, there's mixed results. So there, there really can't be any conclusion that DHA is preventing Alzheimer's dementia. And so then the thought is, why not? 'cause we know DHA in the brain is good and.

The thought behind that is possibly, it's related more to the lifestyle aspect of this. And again, that goes back to why dementia does not boil down to one specific thing. It's a lot of factors coming together. So someone that has a higher DHA in their blood may be someone that's eating salmon regularly.

And usually when you're eating salmon, you're eating that with broccoli or some other vegetable, as opposed to just eating that with french fries, which is what [00:27:00] you would put with maybe another meat. I think the Omega-3 is still kind of a mystery. There's a lot more studies happening on that to see if we can find a dose that does show consistent benefit in randomized controlled trials.

But for now, it is one of those things that you really need to think about as maybe it could have a little bit of benefit, but really you need to think about diet and lifestyle more. 

Yeah. And just like we talk about many times on this show, you cannot out supplement a bad diet. So I wish there was a shortcut, but when it comes to this, again, we wanna try to lean in towards our food as an option

and even if you do not like those fatty fish, there are other sources of omega threes that you can eat. You know, some of these are kitty's favorite options. 

Gotta get those hemp seed. 

Um, but in walnuts, , there's other ways to increase your diet if you're really not into, , eating fish. So at least [00:28:00] trying to get some of it in your diet, and not just leaning only on the supplements as an option.

That being said, I think taking a DHA supplement has low risk to it. Yes. If, that's something that you wanna do, another one that has pretty low risk and some questionable evidence behind it is creatine. And I feel like that's been in the media a lot recently. There's still no established cause and effect relationship between taking creatine and preventing dementia.

But we know that it does play a role in brain energy metabolism and there are some studies that show some improvement in cognitive performance, particularly in older adults. We also know that it's really safe. It's one of those supplements that has been around for a long time. It's been studied for years in the realm of muscle building, and we know it's safe.

So as of now, I think everyone's been really excited about creatine as far as dementia prevention. [00:29:00] Maybe it's gonna end up showing that it helps a little bit, but again, we're talking about a drop in the bucket compared to some of these other lifestyle changes that have so much more robust evidence about it.

So again, supplementing what you're already doing. Maybe this might pan out to show a little bit of benefit in the long run. 

And if you have kidney disease, you always wanna be discussing with your doctors if you're taking one of those supplements. 'cause it can impact your labs and they need to be aware.

 Another vitamin that people may talk about are the B vitamins. One thing to know is making sure you do not have B12 deficiency, because that is something that can have a significant impact on your cognition and you want to have that at appropriate levels. , Taking it when you're not deficient and trying to drive it up even higher, there's not any evidence to show that that's going to improve or reduce your risk of dementia.

CoQ10 another one. A lot of people take. This kind of [00:30:00] got started because they found that if you have low levels of coq 10 in the blood, that people had worse cognitive function. However, when they try to supplement, there have not been any consistent randomized control trials showing that supplementing improves cognitive function.

So still no strong evidence behind coq 10. Now, just like the B vitamins, if your vitamin D is low, , then that can be associated with an increased risk of dementia. So if it's low, then you should be taking vitamin D. However, if your vitamin D levels are good, there's not evidence that going above and beyond is going to improve that risk for you.

, The supplements out there for dementia are vast. There are so many and of all different price ranges. And I can definitely see why someone would want to take a supplement to prevent dementia or to try to slow down dementia. I definitely understand why you [00:31:00] would feel that way, and I don't want you to feel that we're saying don't take anything.

But what we really want you to understand is that starting these other habits in midlife, especially if you can, but although I will say here too, it's never too late, but starting these habits early will have a much greater benefit for you down the road than taking a pill. 

And that takes us to probably the most, I really like always being able to lean in nutrition and give it all, you know, the highest regards.

But in this field specifically, the pillar of exercise wins. If we had to pick one. Thing that we can reduce your dementia risk the most. It is going to be exercise, and that is just because of exercise effect on the brain. It's going to improve those metabolic rates and processes. It's gonna help your vasculature.

Just as we talked about specifically when we talked about stroke last week. It [00:32:00] helps with the psychological processes. It's going to provide rapid proliferation of those neuronal connections, and it's going to increase BDNF, which increases neuroplasticity. It does so much for our brains. It is incredible.

Yeah. And there's evidence behind both aerobic exercise and resistance training. Separately. So looking at aerobic exercise, this has been shown in a large meta-analysis to result in a 45% lower risk of developing dementia in those that were participating regularly, 45%. 

There was a study that beat that. Um, it was a smaller study, but it was incredible.

There was a 44 year Swedish study that followed women and exercise and their dementia risk, and it showed. Wait for it. 88% reduction in risk of dementia based off of their cardiovascular fitness. [00:33:00] In midlife. So if they were fit in their midlife and were active at that time, they reduced their risk so much over those 44 years that they followed, , these patients.

So it can have the most incredible response in your long-term risk reduction. Why would you not wanna do this if this is a concern? 

Yes, definitely.

And the Framingham study, which we've referenced multiple times on this podcast, also showed 40% lower risk of developing Alzheimer's dementia If you take a daily brisk walk, so we're not talking about you have to go to one of these big classes and do these crazy HIIT workouts. Even taking a daily walk is going to lower your risk of dementia by 40%.

 And, , this isn't just cardio. So aerobic exercise in general has this great protective effect, but so does resistance training. There has been, [00:34:00] study has shown that greater leg strength, so , your legs have some of the biggest muscle groups in your body. So greater leg strength shows improved cognitive performance and it's thought that the bigger muscle groups have better blood flow and you're going to increase that BDNF production and that is where that comes from.

So making sure you're holding onto that muscle mass as you age is also a way to help protect your brain 

There was another, study looking at patients with mild cognitive impairment and they had them doing resistance training two to three times per week for six months and close to 47% achieved normal cognitive scores on testing when they were doing this resistance training.

And that Whoa. I know. And that continued for 18 months while they continued to monitor these patients. So it really has a huge effect. And thinking about that mild cognitive impairment time, that's another time that a lot of people will start [00:35:00] medications. Some, , common ones like Aricept are started during this time when they compared physical activity to these medicines in patients with mild cognitive impairment.

They actually saw. Both improved, but physical activity improved even more. The scores for the patients with mild cognitive impairment and then both helped when patients were already in the dementia category. And this is one of those things that, you know, I wanna make sure we're clear too. When we're talking about lifestyle, we are not anti-medication.

But what we want you to understand is you can do both. if you're someone in this category, just don't forget that, that sometimes it seems silly. You might think it would seem silly that something like what you're eating or how you're moving throughout the day would help as much as a medicine, but often it does and often more.

Yeah. and that is something why we felt so passionate about having this show is just helping get that message out, that lifestyle. Really can [00:36:00] make a huge difference when it comes to this. And so please feel empowered to make a difference in your possible future outcome by making these lifestyle changes.

outside of exercise, there's also one that we know that can have a difference and that is stress chronic psychological stress can trigger inflammation within our brain. , It's increasing those pro-inflammatory cytokines. And so there is thought that some of that is also contributing to neurodegeneration and development of dementia.

 it is just one that's a little bit more challenging to study and get concrete evidence on what exactly we need to do to reduce that in order to decrease our dementia risk. 

Chronic stress can actually exacerbate the accumulation of those proteins that we mentioned earlier that are key to developing Alzheimer's disease.

 Also, that bad stress can have an effect negatively on growth hormone insulin resistance. It reduces that BDNF that we [00:37:00] keep talking about increasing with exercise. They've even done studies using imaging showing that elderly patients that had increased stress showed a 14% reduction in hippocampal volume in the brain, which is a part of the brain that's very important in memory.

So bad stress. Is harmful to the brain, you wanna try to minimize your bad stress as much as you 

can. one way you could work on that is doing the practice of mindfulness or meditation.

We don't have clear recommendations on how often you need to do this practice, but we do have evidence that shows people who use this on a regular basis have improved brain function, less atrophy and lower neuroinflammation. So if you do feel like you're dealing with chronic stress that you can't get rid of, really trying to adopt a meditation or mindfulness practice is a way you can try to counteract what is occurring in the brain.

So using those to decrease your [00:38:00] bad stress and then putting yourself in situations where you have good stress, like maybe where you're in a competitive game of bridge or you're pushing yourself , and stress to give a presentation. Those kind of things where you're really using your brain in a stressful but good way will help build resilience.

That's something that I always joke with my grandmother she's in her nineties and she is sharp as tack, and I tell her that I think her key was playing cards her whole life because she has, she's always played cards with friends and it didn't matter, , how old she was.

She continued to do that, always doing. Things that made her brain be active, whether that's puzzles you name it. There was always something that she tried to do to keep learning and doing something new or challenging, and I really do think that was her secret to keeping so sharp. 

yeah, so keeping your brain active and learning is just so important. And it doesn't have to be anything [00:39:00] specific. You do not have to learn a new language or learn how to play an instrument if that's not what you wanna do.

If you wanna learn how to do woodworking, how to build a bird house, something like that is a great way to challenge your brain and continue learning.

Each of our 87 billion neurons we have has the ability to either make as few as a couple connections or up to 30,000 connections. And this really depends on how you stress your brain. So continuing to learn, continuing to stress your brain to make new connections will really help you build a reserve that can help delay or prevent symptoms of dementia in the future.

. They have looked at this The. Wisconsin Registry for Alzheimer's Prevention showed that a greater lifetime job complexity resulted in better cognitive performance and reserve going into these older ages. And in 2018, a meta-analysis looked at the effects [00:40:00] of cognitive gains in people with mild cognitive impairment and focusing on an individual's personal cognitive weakness helped them if they really challenged themselves, say they, you know, really struggled, with their math skills or their directional skills, and they challenged themselves as they age.

It helped them improve their overall cognitive function in the long run. . We have to learn to continue challenging ourselves as we age if we want to have a good, healthy brain. 

And there's so many options these days. You know, you can take a class online, we record here at our local library. There's always free classes available to come learn something new.

take a look and see what you can figure out. And especially coming to a class or doing something like playing cards gives you another benefit, and that is socialization. 

We know that loneliness is associated with a 26% increased risk of developing dementia. I mean, that's huge. If you stop and think about that, that is huge.

Like it is [00:41:00] so important that as we age, that we don't let that become the loneliest part Of our lifetime. But , I hate it because I feel like that is what so many people experience. , , , sometimes people move as they age and they might move to a different community to be close to their family and they don't have as many friends or places to go for social outings.

So it's really encouraging individuals to find that network. So you have that continued social exposure, as you age. 

Another thing that's been found to help continue making neural connections and keeping your brain active is making sure that you can hear. So if you develop hearing loss at some point, it is very important that you get this assessed and get hearing aids.

There are all sorts of great devices now to help people with hearing. . Dementia risk doubles with mild hearing loss, triples with moderate hearing loss, and increases fivefold with severe [00:42:00] hearing loss. So if you can't hear, definitely get help to fix it. 

Now we've talked a lot about learning and trying to get, , all these new neuronal connections to occur, but as we've learned from our previous podcast about sleep, we know to make good improvement in our brain health.

We also need to have that high restorative sleep as part of our toolkit, and we cannot express this enough. It is so important for Alzheimer's prevention. 

 approximately 15% of Alzheimer's disease in the population can be attributed to sleep problems. So that's really incredible. 

Insomnia can increase your risk of Alzheimer's by 43%.

That is a lot. And other sleep conditions such as sleep disorder, breathing by 22% sleep issues like excessive daytime sleepiness, or just self-reported sleep problems have been shown to increase risk by [00:43:00] 34%. we need to value our sleep and not try to shortcut it because it is so crucial for our brain.

 I hope that people have gotten this message from us. We did a whole month dedicated to it. So, , I just want to make sure that our listeners today, if you have not listened to those sleep. , Podcast that we did back in June. Take a moment and go back and listen to those, , as we try to break down the importance of sleep as well as navigating issues with insomnia, , because this is making a huge impact in your overall dementia 

risk.

Yeah. So you've gotta give your brain that time at night for your glymphatic system to become active, which is when our brain cleans all the debris that's accumulated during the day when we're being active , and doing all this learning now that we know that you're gonna be doing. , It is really just crucial in preserving your brain, and it's never too early to start getting good sleep.

Another thing [00:44:00] that can affect dementia risk related to sleep is sleep apnea 

. Studies looking at severe sleep apnea, and this is severe sleep apnea. If you've ever had a sleep study and have been diagnosed with sleep apnea, there's usually a scale of whether you have mild, moderate, or severe.

But looking at patients with severe sleep apnea, this has been associated with more than double the risk of all cause dementia, a 66% increased risk in Alzheimer's dementia specifically. So if you need a motivator 

to wear your CPAP, here it is. Yes, it's here. It is. 'cause I know, you know, sometimes it, it is very hard to get used to using those.

 , if you need that good motivator here it is. We're always trying to cheat sleep, right? We're trying to get more done in our day and work, work, work, work. But just as a reminder, sleeping less than seven hours compared to that goal of seven to up to nine. Is associated with twice the risk of all cause [00:45:00] dementia.

So even if we're living healthy lifestyles elsewhere, but we're trying to cheat ourself all the time in the sleep bucket, we're actually hurting ourselves. So we cannot cheat ourselves on getting sleep and not be putting ourselves at increased risk for dementia. 

Yeah, so if you do have issues with sleep, it truly is worth your time and energy.

To address it, you may need to look into cognitive behavioral therapy. Don't just lean into over the counter medicines when we tell you we want you to be getting those eight hours of sleep. Don't go for. Grabbing an antihistamine or something else over the counter because a lot of these both prescribed and over the counter medications that help with sleep have actually been shown to worsen the risk for dementia.

So if you're dealing with obstructive sleep apnea, as I mentioned, getting the appropriate CPAP treatment, , or if you're dealing with insomnia, really trying to work on that sleep hygiene or seeing a [00:46:00] specialist and having cognitive behavioral therapy to help you work through, improving your sleep in general, that is gonna be your best.

Bet on reducing your risk and getting your quality sleep back. And as we've talked about, it's not just dementia. There are so many chronic diseases that are higher risk when you're not getting your sleep. So don't let this be the only reason. 'cause there's lots. 

When we're talking about dementia, thinking about it in two buckets, you want to reduce damage to your brain and you wanna increase your cognitive reserve.

So one thing I wanna bring up as far as being in that reducing brain damage bucket is you do want to make sure you're trying to avoid head trauma. I am shocked by the number of people I see riding a bike without a helmet. 

I know it. It horrifies me. My daughter, literally this past weekend, had a bike accident.

She was wearing her helmet, but had she not, the whole accident would've been completely different for [00:47:00] her. And it was just like, just near our house even. You just never know what can happen. Wear your helmet, 

please Just wear your helmet. It is cool. It's cool 

to wear a helmet. Yes, it is. And parents out there wear a helmet as well.

So your children see that even as you age, you still need to be wearing a helmet. 'cause there's so many times, I'll see parents put helmets on their kids and they're also riding a bike, but they don't wear the helmet. 

I know. And you know what, as a parent, you're falling from a greater distance up to the ground.

You're gonna hurt your head even more. Yes. I'm, 

I'm very concerned about if I fall off the bike too. 

Okay. Please wear your helmet and then anything else you might do that could ultimately lead to head trauma. Make sure you're wearing the appropriate protection. So The Lancet, which is a prestigious medical journal in 2020, came out with a commission report.

Talking about 12 modifiable risk factors that could either [00:48:00] prevent or delay up to 40% of dementias. So I wanna go through those because a lot of them are what we've already talked about, but there are a few that we haven't mentioned to make sure that you're paying attention to.

So is less education. So again, working your brain as much as you can to keep those neural connections coming. Hearing impairment, smoking, I'm not gonna go into detail on this, but smoking is bad for the brain. Obesity, depression. Physical inactivity, diabetes, Hypertension. low social contact, excessive alcohol consumption, traumatic brain injury and air pollution.

And then in 2024, there was enough compelling evidence that they felt the need to add two more, untreated vision loss and high LDL cholesterol. 

So outside of our normal lifestyle medicine pillars, , just so you'll make sure you're all paying attention, hearing loss, [00:49:00] making sure you're treating that as well as vision loss and having appropriate,, correction for that.

So we wanna have our. All of our senses appropriately being used as well to decrease our risk. And then following with our healthcare providers making sure if we do have pre-diabetes or diabetes, we're managing it well, if we have high blood pressure, that we are managing it well. And if we have high cholesterol again, that we're managing it well.

, So outside of the lifestyle medicine pillars, there are these other things that we want to be sure we're doing a good job in order to reduce our risk as much as possible. 

And when we are talking about cholesterol, when they were studying this to decide to actually add that as one of the modifiable risk factors, they found that elevated total cholesterol measured in midlife is associated with an increased risk , of both Alzheimer's disease and vascular dementia.

And so, again, I wanna bring this back to. When we're talking about all of these [00:50:00] things, we're not talking about waiting until you're 75 years old to start these. These are things you really need to figure out how you can incorporate into your life now and be able to continue that in order to help preserve your brain the best you can.

the sooner the better that you act. And if you are a, a listener who is older , in their sixties or seventies, there is still a big impact you can make as well. So don't think that you've already missed the boat on making a difference in your dementia risk, 

right? Even if you already have dementia, starting these habits will still help the progression of your disease.

So everyone needs to be thinking about it and then really just realizing that those daily choices you make throughout the day are more powerful than any other prescription for your brain. , Although dementia is a disease that can devastate patients and entire circles of family and friends who walk through this diagnosis with them, what we want you to take away [00:51:00] from today is that there is hope.

And while we don't have a cure yet, research is still ongoing in that realm. And research has already showed us that lifestyle choices, like eating our leafy greens and our berries, moving our body, doing resistance training, getting that sleep, making social connection and learning new things can make a real difference in protecting our brain health and lowering our risk.

Dr. Dotson and I feel like there may need to be more information on this specific topic, getting out to the general population because it's just not a message that is being broadcasted enough, as well as not giving patients enough guidance on truly how to reduce their risk because many are concerned about their dementia risk.

So we are working on an option to give you all more guided education and information on this. So please stay tuned. We'll be sure to announce it on one of our shows [00:52:00] when it is ready for launch.. But,, we're just really excited to be able to give people actual tools that are gonna reduce their risk the most when it comes to lifestyle.

And next week we'll be, moving back into the hot topic of. Menopause, menopause. So we're gonna have a lot of really great guests going through different aspects of menopause and some aspects that we haven't touched on yet. we're excited about this upcoming series. And hopefully if you're local, you'll be joining us soon at the Unmuted Conference where we're gonna be diving in with lots of great speakers and guests as far as learning more about perimenopause and menopause and how we can support ourselves and support each other through this transition. So as always, thank you so much for listening, and we'll see you next time.