Dementia Prevention: The Business of Mind

Mar 29, 2018

Somewhere along the line, we have all heard the admonition that we should mind our own business. There is a certain folksy wisdom in it that is hard to refute. If the advice pertains to anything, it pertains to the safeguarding of our own minds. What could be more our own business than that? So, yes- we should mind our business, and our minds are our business.

But our minds are fast becoming fodder for big business as well.

Over recent years, there has been increasing, and increasingly anxious, attention to the rising rates of dementia among an aging population. Projections have been made resulting in headlines about a looming Alzheimer’s “epidemic,” with staggering associated costs in human potential and dollars alike.

This, in turn, has fostered a market for every conceivable kind of relevant advance. Studies about new methods in Alzheimer’s diagnosis are published routinely, and often get coverage in mainstream media. So, too, do related efforts to characterize the brain changes seen in dementia, and to identify the implicated genes. Predictably prominent is the area of drug development, with several medications currently approved by the FDA for Alzheimer’s treatment. And there is a booming cottage industry in brain games as well.

Often overlooked in the mix is the potential we have to reduce our risk, perhaps dramatically, by minding the business of our daily lifestyle choices.

There are some varieties of dementia that can be reversed acutely with targeted treatment if diagnosed correctly; these include hypothyroidism, and vitamin B12 deficiency. But the two prevailing varieties cannot be reversed once diagnosed; the best hope we all have is to prevent them in the first place.

These two are multi-infarct dementia, and Alzheimer’s.

The first of them, as the name suggests, is due to the slow aggregation over time of multiple, tiny strokes, or infarcts of the brain. These are too small in isolation to present the way larger strokes due, with loss of body function, but little by little, they interfere with the transmission of impulses through the brain. That, in turn, erodes cognitive ability. Because this condition results from tiny strokes, the means to prevent it related to stroke prevention, which in turn is much like the prevention of heart disease. An optimal diet, routine physical activity, the avoidance of tobacco, the avoidance of excessive alcohol intake, weight management, stress management, social connections, and adequate sleep are all part of the formula that serve to minimize risk of all chronic disease, stroke- and therefore dementia- included.

The same applies to Alzheimer’s. While Alzheimer’s has long cast a shadow of confusion about its specific causes and manifestations, two interpretations have come to prevail.

One is that Alzheimer’s is an end product of vascular disease, and shares many of the same risk factors. The other is that Alzheimer’s is a kind of insulin resistance affecting the central nervous system preferentially; it has even been called “type 3 diabetes.”

Both assessments have very promising implications. We know how to prevent 80% or more of heart disease by using lifestyle as our medicine. For type 2 diabetes, and thus presumably type 3 as well, the news is even better; we know how prevent as much as 95% of that using much the same formula. Eating well, being active, and not smoking- good use of our feet, forks, and fingers if you will- takes us a long way toward the prize. In the Blue Zones, where living well prevails, dementia is rare- as are all chronic diseases.

Dementia is not a bogeyman waiting in the shadows to pounce on us unpredictably. For the most part, the risk factors that presage the threat are familiar, well understand, and eminently manageable. None of us gets a guarantee, of course. But we all have the means, in our own hands (and feet) to shift the odds massively in our favor.

Our minds are our own business if anything is. As the interest of big business is attracted to their preservation, we should not get distracted. An enormous opportunity to preserve and protect our cognitive abilities resides with us, and the lifestyle choices we make. We are all well advised to mind them accordingly.

by David L. Katz For Very Well