Our Future is Something We Make: Lifestyle and Dementia Risk
Once we have a basic understanding of what dementia is, the next important question to ask becomes, how can we best protect ourselves against it as we age?
As I mentioned in last week's post (So what is dementia exactly?), it's true that age is the number one risk factor for developing dementia, which means that the risk increases as we get older. However, that does not mean that dementia is a 'natural' or inevitable consequence of aging. Quite the opposite, in fact - there are many factors well within our control that have been shown to adjust the risk of cognitive decline up or down depending on how we choose to live our lives.
We often think the future is something that happens rather than something we make. However, as with so many other aspects of our lives, we have a hand in shaping the future of our cognitive health and dementia risk.
In the sizeable scientific literature on brain health and aging, these risk factors for cognitive decline and dementia are often called 'modifiable' risk factors, precisely because we have some degree of control over them as we go about our days, and as our days turn into years.
So what are these modifiable risk factors for cognitive decline and dementia? According to comprehensive World Health Organization (WHO) guidelines from 2019, they include: physical inactivity, tobacco use, unhealthy diet, harmful use of alcohol, social isolation, cognitive inactivity, depression, as well as certain other medical conditions including high blood pressure, high cholesterol, diabetes, obesity, and hearing loss.
The WHO guidelines specifically recommend that healthy older adults minimize the impact of these risk factors by, in short: exercising more, stopping smoking, eating better, cutting back on alcohol, remaining socially and cognitively engaged, and following up with physicians about optimally managing chronic health conditions. Simple, right?
This is all advice that you've probably heard before in relation to optimizing your physical health. As is have often said in clinical practice, "what's good for the heart is good for the brain", but unfortunately the opposite also holds true.
The difficulty here, of course, is not in knowing what you should do for better health, but in actually doing it. The key is not in just knowing that you shouldn't eat 20 mini chocolate bars at halloween, but in somehow walking by the candy bowl without picking another one up. The key is not in just knowing that you should exercise more, but in somehow actually going on that walk or run that you told yourself you would earlier this morning when the day seemed endless in it's possibility.
I'll have more to say about each of these 'somehows' in future posts. How to somehow make the difficult lifestyle choices that we know are in our best interest, but fall short of all too often. But for know, I wanted to define the problem at hand by 1) simply lay out the roadmap of behaviour changes that are important for reducing risk of cognitive decline and dementia, and 2) convincing you that you have a degree of control in the matter - because a problem defined is a problem halfway solved.
Risk reduction of cognitive decline and dementia: WHO guidelines. Geneva: World Health Organization; 2019.