the times | Tuesday July 28 2020 1GT 5
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University’s Institute of Mental
Health, cautions: “There is no study
evidence that giving people these
supplements subsequently prevents
them from developing dementia.”3 Do mentally stimulating
activities such as reading
and playing chessSome studies have found that people
who keep their brains active have a
lower overall risk of developing
dementia. These include a 2007
report in the journal Neurology by
Alzheimer’s researchers at Rush
University in Chicago.
According to Dallas, activities such
as word puzzles stimulate your brain
and can strengthen connectivity
between brain cells. “This connectivity
is broken down in dementia,” he says.
However, such studies show only an
association, not a cause-and-effect link
between mental stimulation and lower
incidence of dementia. No studies
have yet demonstrated that boosting
cognitive activity subsequently cuts
Alzheimer’s risk.4 Avoid diabetes through
healthy diet and exercise
One in ten people over 40 in the UK
has type 2 diabetes, according to the
charity Diabetes UK. Their bodies
have stopped responding properly to
insulin, leaving their blood sugar levels
harmfully out of control.
Dallas explains that as well as
causing physical damage to nerves
and arteries, type 2 diabetes can harm
neurons. “Insulin acts in the brain
similarly to how it works in the body,”
he says. “It is there to regulate levels
of glucose fuel. High glucose levels
are toxic to brain cells, and too little
glucose is also damaging. If insulin
regulation fails, there is a real danger
of brain-cell damage that leads
to dementia.”5 Protect your head
from injuriesThe peril is that brain damage from
head trauma is similar to that of
dementia, so this makes people more
vulnerable to Alzheimer’s if they
start to develop dementia-type
brain deterioration.
Indeed, Glasgow University research
in 2013 shows that former footballers
are three and a half times more likely
to die from brain disease.
In February UK football authorities
announced that children aged 11 and
under are no longer permitted to head
the ball during training. Parents may
now want to protect children of all
ages by banning them from heading
balls or playing full-contact rugby.
Midlifers who play senior football
and rugby should similarly give up
heading the ball and start wearing
a scrum cap.6 Under-65s should avoid
high blood pressure with a
healthier lifestyleHypertension raises the risk of heart
disease significantly. Both these
conditions diminish the quality of
blood supply to our nutrient-hungry,
oxygen-demanding brains.
Howard says: “In research studies so
far, only reducing hypertension has
looked as though it could significantly
reduce Alzheimer’s risk.” This is partly
because uncontrolled hypertension
increases the risk of strokes — and
Alzheimer’s is a common affliction
among stroke sufferers.
As for supporting a healthy lifestyle,
Dallas says: “Habits and physicalcondition in midlife play a crucial
role in determining dementia risk
in later life. It makes sense therefore
to see your GP for regular MoTs in
middle age to get the feedback and
advice you need.”7 People with a sudden fall in
blood pressure on standing
should have their cognition
closely monitoredExperiencing low blood pressure when
standing after sitting or lying down is
called orthostatic hypotension. It
indicates that the body is unable to
maintain sufficient blood supply to the
brain during posture changes.
“This lack of oxygen can cause
degeneration of brain cells and raise
the risk of dementia,” Dallas says.
“There are drugs for this. The
challenge for doctors is getting the
drug regime right because the levels
of hypotension involved can differ
dramatically between individuals.
Hence the need for close monitoring.”8 Maintain good mental
health; monitor people
with depressionPeople living with Alzheimer’s also
often suffer from depression, although
it remains uncertain if depression
causes Alzheimer’s or is just a
symptom of the disease.
With depression and other lifestyle
risks for Alzheimer’s, Dening says:
“So much of this is inter-related.
Depression and self-neglect are linked
to not eating properly, and thus
to sarcopenia.
“Low folic acid and B12 — which are
associated with homocysteine trouble
— tend to be indicative of nutritional
problems that are typical of depressed
people who live on toast, lose weight
and end up skinny and frail from
letting themselves go malnourished.”9 Receive as much education as
possible in early life
Lower levels of education are
associated with an increased risk
of Alzheimer’s disease. Conversely,
the longer people spend in education,
the lower their risk of developing
dementia. This may be explained
partly by Cambridge University-led
research in the journal Brain in 2010,
which examined people from different
educational backgrounds and found
that those who were more highly
educated had heavier brains.
Dallas says: “People with dementia
can lose as much as one third of their
brain weight. Thus a heavier brain
may actually make you more resilient.”10 Relax your mind and avoid
daily stressDening says: “There are good studies
which show that middle-aged people
who have high levels of stress
subsequently have a high incidence
of dementia.
“As for why this is exactly, the
mechanisms behind this seem many
and varied. It may be that having high
chronic levels of the stress hormone
cortisol can cause damage to the
hippocampus, one of the brain’s
memory centres.
“Moreover, being stressed has
behavioural consequences. For
example, it makes people more likely
to drink and smoke, which themselves
are risks for dementia. If at all possible,
the best thing is to keep out of this
vicious spiral by learning effective
healthy relaxation strategies.”
It seems that meditation and yoga
mats are for life, not just for lockdown.enthusiastic. “If you stick to the new
list of ten actions, you really do have
the best chance of staving off
Alzheimer’s,” he says.
Dallas argues that we must each
follow the list wholesale. Rather like
the biblical commandments, these
have to be adopted in full rather than
just selecting the ones we like. “There
is no cast-iron guarantee that if you
tick only some of the boxes that it
will work for everyone,” he says.
“Having just one of the risk factors
may swing your future path towards
Alzheimer’s, so you have to adopt all
the strategies together.”
Are you up for the challenge?
1 Set a healthy midlife BMI
and stick to it
There are two perils here: middle-aged
obesity and being underweight in mid
and later life. Sticking to the middle
path of a healthy BMI (generally
between 18.5 and 24.9) appears to
help to prevent Alzheimer’s.
The risk, Yu explains, is that body
fat releases chemicals that cause
plaques of amyloid-beta proteins to
accumulate in the brain. These are
associated with Alzheimer’s disease.
He adds: “Midlife obesity is also
linked to a variety of chronic
diseases, such as hypertension and
cardiovascular disease, which all
increase the risk of Alzheimer’s.”
The problem of weight loss,
meanwhile, seems to be related to the
disappearance of muscle rather than
fat. Muscle loss in later life — called
sarcopenia — has been found to afflict
about one in 20 Britons aged over 40.
According to Dallas, sarcopenia is
associated with chronically elevated
levels of body-wide inflammation that
accelerate age-related cell damage in
the brain, a phenomenon that has
been called “inflammageing”.
He adds: “Muscle loss is also related
to a loss of energy metabolism in the
whole body, which means there is less
fuel being produced for the brain.”2 Have a regular blood test for
homocysteine levels. High
levels should be treated with
vitamin B and/or folic acidHomocysteine is an amino acid that is
produced when digestion breaks down
proteins in our diet. Since the late
1980s, studies have shown that people
with Alzheimer’s have high levels of
homocysteine in their brains.
Excess homocysteine reduces levels
of antioxidants in the brain. These
antioxidants normally serve to protect
brain cells against oxidative damage,
Yu explains. Such damage can kill
neurons and cause structural
deterioration in the brain.
A study in The American Journal of
Clinical Nutrition in 2003 showed that
supplements of folate and vitamin B
can lower homocysteine levels.
However, Tom Dening, a professor
of dementia research at NottinghamPeople
with
dementia
can lose as
much as
a third of
their brain
weight