16
Risk Factors for Dementia and How to Reduce the Risk

An ounce of prevention is worth a pound of cure.

Benjamin Franklin, in a letter to the Pennsylvania Gazette, February 4, 1735

Aging—the slow decline in vitality and ability—is impacted by the choices we make in life. As we have seen throughout this book, any factor that increases inflammation and oxidative stress accelerates aging, while actions that are anti-inflammatory slow aging. In this chapter we will examine specific risk factors for developing Alzheimer’s disease and specific actions that can be taken to minimize the risk and prevent the development of dementia. Some of the interventions are applicable to more than one risk factor.

ApoE4 Gene

Having two copies of this gene increases the risk of developing AD by 30–60 percent; however, this gene alone is not sufficient to cause AD. Those who apply the healthy choices listed in this book can reduce their risk and avoid developing AD—even if they have two copies of this gene.

Reduce risk by

• Regular exercise
• Mediterranean or vegan diet
• Avoiding use of substances that increase inflammation (tobacco, illegal drugs, excessive alcohol)
• Healthy spirituality and stress management
• Mental stimulation
• Getting 7–8 hours of sleep each night
• Drinking eight ounces of pomegranate juice daily
• Eating a handful of walnuts daily
• Getting adequate omega-3 fatty acids through either diet or supplements
• Having vitamin D level checked and keeping level at 75–100 nmol/L
• Ensuring adequate vitamin B12 and folic acid
• Getting vitamin E from food and daily vitamin C from food or supplements
• Using curcumin with black pepper regularly in food
• Daily NAC supplement
• Considering green tea and caffeinated coffee (balance this choice with risks of using these products)
• Avoiding artificial sweeteners
• Avoiding soft drinks

Oxidative Stress

Oxidation is the damage done to body tissues by molecules containing reactive oxygen capable of interacting and causing damage.

Reduce risk by

• Avoiding oxidizing substances (illegal drugs, tobacco, heavy alcohol use) and minimizing charred, grilled, or fried foods (these cooking methods create advanced glycation end-products, which are highly oxidizing)
• Exercising regularly (produces antioxidant cytokines that scavenge inflammatory cytokines)
• Regularly ingesting oily fish that is high in omega-3 fatty acids, which concentrates in neuronal membranes and scavenges free radicals, or taking supplements
• Eating fresh foods with color (berries, spinach, kale, etc.); flavonoids are antioxidant and scavenge free radicals
• Drinking eight ounces of pomegranate juice daily
• Eating walnuts (an antioxidant) daily
• Eating almonds, which are high in vitamin E that concentrates in neuronal membranes and scavenges free radicals
• Taking vitamin C supplements, which concentrate in cytoplasm (fluid inside neurons), scavenging free radicals and reactivating vitamin E
• Maintaining vitamin D level at 75–100 nmol/L
• Taking N-acetyl cysteine supplements, which stabilize mitochondria and reduce oxidative stress
• Using curcumin in diet, an anti-inflammatory that binds amyloid and helps clear it from the brain, reducing oxidative stress
• Avoiding fast foods and junk foods
• Avoiding artificial sweeteners
• Avoiding all soft drinks
• Coming into regular contact with the earth—your skin touching the earth (e.g., walk barefoot in the grass, swim in the ocean) in places where normal electrical conduction can occur to restore electron balance

Alcohol Abuse, Illegal Drugs, and Tobacco

Substance abuse is neurotoxic and oxidizing and interferes with the body’s antioxidant enzymes, thereby accelerating aging and increasing the risk of dementia.

Reduce risk by

• Avoiding all tobacco and illegal drugs (see addendum for smoking-cessation action plan)
• Avoiding alcohol use; if use then do so moderately, never to drunkenness as intoxication is oxidizing; also, using only wine as distilled spirits are oxidizing
• Obtaining professional help if not able to achieve these goals

Sedentary Lifestyle

A sedentary lifestyle increases risk of obesity, which increases oxidative stress, denies the brain various neurotrophins (proteins that keep the neurons healthy and trigger new neuronal growth), increases inflammation and reduces anti-inflammatory factors produced with exercise, and increases insulin resistance.

Reduce risk by

• Regular exercise; consult your doctor before starting an exercise routine
• Starting low and going slow to avoid injury
• See specific recommendations at the end of chapter 8

Head Injury

The most common causes of head injuries are motor vehicle accidents, falls, and firearms, but other causes include contact sports, bicycle accidents, and assaults.

Reduce risk by

• Avoiding known risks such as boxing and extreme sports; if you participate, use head protection
• Wearing a helmet when bike riding
• Using seat belts, airbags, and antilock breaks
• Ensuring home environment is free of trip hazards

Diabetes Mellitus Type 2 (T2DM)/Glucose Intolerance

Type 2 diabetes doubles the risk of AD as anything that increases inflammation increases the risk of T2DM.

Reduce risk by

• Exercising regularly, which reduces inflammation and improves insulin sensitivity in addition to burning calories
• Eating an anti-inflammatory diet—Mediterranean or vegan
• Avoiding added sugars, particularly soft drinks, and eating fewer processed foods
• Avoiding junk food and fast foods
• Avoiding third-shift work and maintaining regular sleep; if you suspect obstructive sleep apnea, speak with your doctor about a sleep study
• Consulting your physician to discuss risk for T2DM and specific interventions to reduce risk

Obesity

Obesity is an inflammatory state that increases the risk of dementia and early death.

Reduce risk by

• Eating an anti-inflammatory diet—Mediterranean or vegan
• Exercising regularly—walk twenty minutes each day; when combined with a vegan or Mediterranean diet, the impact is even more robust; both improve insulin sensitivity, leading to greater fat burning by the body
• Addressing known risk factors such as sleep apnea and medical conditions (hypothyroid, etc.)
• Reducing mental stress
• Sleeping eight hours each night
• Fasting twelve hours between dinner and breakfast each day
• Changing diet to alter gut flora (see chap. 5)
• Considering professional help and working with your physician if these measures do not work

Western Diet

The Western diet is an inflammatory diet high in processed foods, sugars, trans fats, advanced glycation end-products, and dairy, all of which increase the risk of dementia.

Reduce risk by

• Changing to vegan or Mediterranean diet
• Limiting added sugar
• Eating regular servings of fish
• Reducing dairy products; milk and cheese are inflammatory
• Avoiding all soft drinks
• Avoiding artificial sweeteners
• Avoiding junk food and fast foods
• Regularly eating fruit, walnuts, and almonds

High Blood Pressure

High blood pressure increases the risk of both vascular and Alzheimer’s dementias.

Reduce risk by

• Seeing your physician for treatment; studies show that controlling high blood pressure reduces risk for dementia1

Low Cognitive Stimulation

If you don’t use it, you lose it—the law of exertion. If you want to keep your mental acuity, then you must use your mental abilities regularly. Failure to do so accelerates cognitive and mental decline.

Reduce risk by

• Staying mentally active
• Doing puzzles
• Taking art lessons
• Learning to play an instrument
• Teaching a class at church, a neighborhood association, or other community group
• Learning a new language
• Taking a class at a community college
• Participating in a Bible study
• Taking dance lessons

Depression

Depression increases the risk of dementia.2

Reduce risk by

• Effective depression treatment
• Consulting your physician
• Recommendations listed in this book for reducing the risk of dementia in regard to exercise, diet, stress management, sleep, avoidance of toxins, and so on

Social Isolation

Loneliness and social isolation cause increased stress, resulting in increased activation of inflammatory cascades, and are associated with increased risk of dementia.

Reduce risk by

• Joining a group with shared interests—for example, a religious group such as a church, synagogue, or mosque, or a book club, an exercise group, a community outreach agency, or a golf club
• Starting a group in an activity you enjoy and inviting others to join you
• Volunteering at a local hospital, Goodwill, animal shelter, soup kitchen, or any other such program—helping others not only improves social connectedness but also activates the love circuits of the brain and calms the fear circuits, thereby reducing inflammatory cascades and slowing the aging process

Psychological Stress

Unresolved mental stress activates the brain’s alarm circuitry, which activates the immune system, increasing inflammation and contributing to oxidative stress, higher rates of metabolic syndrome, depression, and increased risk of dementia.

Reduce risk by

• Forgiving those who have done you wrong
• Practicing healthy spirituality with regular meditation on a God of love
• Taking a weekly vacation in time to set aside the routine stresses of life
• Spending time in natural settings
• Resolving existential anxiety such as fear about death and dying
• Considering seeing a counselor if you find yourself constantly stressed, worried, anxious, or ruminating on negative and pessimistic thoughts

Chronic Sleep Deprivation

Approximately one in three Americans is chronically sleep deprived, sleeping fewer than seven hours per night. Sleep is one of four physical requirements for life, along with air, water, and food. Chronic sleep deprivation is devastating to brain health. Without regular adequate sleep brain function is impaired, particularly the part of the brain in which we attend, focus, organize, plan, self-restrain, self-calm, and modulate mood.

Reduce risk by

• Establishing a stable sleep routine with structured and enforced going-to-bed and getting-out-of bed times to ensure 7–8 hours of sleep each night
• Sleeping at night and avoiding third-shift work, if possible; sleeping in harmony with normal biorhythms, meaning sleep at night and not during the day; third-shift workers, even if sleeping eight hours every twenty-four hours, still have a higher risk of obesity, mental health problems, dementia, and early death than those who sleep at night
• Sleeping in a dark room and taking actions to avoid environmental disruptions (keep animals out of room, use sound machine to minimize arousing noises, keep room cool, etc.)
• Avoiding eating late at night
• Considering getting a sleep study if chronically fatigued, a heavy snorer, obese, or have chronic headaches as these are symptoms of obstructive sleep apnea

One additional recommendation to reduce risk of dementia is to drink adequate amounts of water to maintain good hydration. Water is the single largest component of our bodies, comprising well over half of our body weight. Every cell of the body requires water. Water is essential for the functioning of our cells and the removal of waste products of metabolism. Dehydration shrinks the cells of the body, and their function becomes impaired. This results in increased oxidative stress and inability to clear toxins, which result in greater damage to our cells, including our brains. Concentration, memory, and general alertness can be negatively affected by dehydration. An average adult should drink eight, eight-ounce glasses of water each day, and more if exercising vigorously or working in hot, humid environments.

LEARNING POINTS

1. There are known risks to developing dementia—some inherited, others lifestyle related.
2. The inherited risks can be effectively reduced by healthy lifestyle choices so that AD can be prevented.
3. While we can’t avoid aging, we can make choices that slow the decline in abilities; maintain vitality, autonomy, and independence; and prevent the development of dementia.