Dementia
is the biggest cause of death in the UK. For those affected and their families, it can be frustrating that current treatments can only slightly ease the symptoms of memory loss and confusion.
There has been some disappointment that the NHS will not offer patients two new drugs for Alzheimer’s disease, the most common form of dementia.
The drugs had already been rejected in
preliminary guidance
from Nice, the body that makes NHS funding decisions for England, Wales and Northern Ireland. Now it has been reported that its final verdict remains the same.
The two drugs have been called breakthroughs, but Nice’s decision will not surprise most experts. While innovative in how they work, they
slow the progress of Alzheimer’s almost imperceptibly
, and can also cause dangerous side effects like brain swelling and bleeding.
Drugs aside, maintaining brain health is a major concern for many people, as doctors warn the number of people with dementia is set to increase.
There is a lot that we can do to stay mentally sharp though, including for people who are approaching retirement. In fact, there are medical and lifestyle steps you can take at every age that help
lower your risk of cognitive impairment and dementia
.
Teens and twenties
Younger people may not be thinking much about getting older. But there’s an important decision people take, which usually happens when they are teenagers or in their early twenties, that will impact their long-term health, including their cognitive health.
It is whether someone takes up smoking. Almost nine in 10 smokers start their habit by the age of 21. And most smokers want to quit, but cannot.
Smoking is one of the single biggest lifestyle factors to raise our odds of getting dementia – in fact, it doubles the risk. It does so in at least three ways: by narrowing blood vessels in the brain, by causing strokes, and by directly harming brain cells through oxidative stress.
“These are the kinds of things that we need to think hard about,” said Professor Jugdeep Dhesi, president of the British Geriatrics Society. “There are things we can do to lower our risk from a very early age.”
Thirties
Other lifestyle habits that affect our brain health include how much exercise we do, how much alcohol we drink and whether we keep a healthy weight.
It can be easier to stick with good health routines if we begin them as young and middle-aged adults. “We have to take a life-course approach to maintaining good brain health,” said Professor Dhesi.
Keeping fit and avoiding heavy drinking have long been shown to improve our cardiovascular health. And things that are good for your heart are generally also good for your brain, said Dr Leah Mursaleen, head of research at Alzheimer’s Research UK. “It’s never too early or late to start doing these things.”
Forties
Between 40 and 74, the NHS starts offering people a health “MOT” from GPs or pharmacists every five years. This assesses the risk for a range of common conditions such as heart attacks, strokes, diabetes and kidney disease, and many of the risk factors for these conditions are shared with dementia.
People may be offered medicines to lower their blood pressure, statins to lower their cholesterol, and diabetes medicines to regulate their blood sugar. “It’s important to make sure you are using all those opportunities for screening for these kinds of health issues,” said Professor Dhesi.
Fifties
Getting your ears and eyes tested are more surprising additions to the interventions that could lower dementia risk. Hearing and vision problems often start becoming noticeable in our fifties.
Studies have long shown a correlation between hearing loss and brain health. And two years ago, a randomised trial confirmed that getting their ears tested and wearing hearing aids if necessary kept people mentally sharper if they were at higher risk for dementia to begin with.
Dr Richard Oakley, associate director of research and innovation at Alzheimer’s Society, said it is still unclear why this happens. “Is it because there’s a biological link between hearing loss and dementia, or is it that if you aren’t able to hear, you remove yourself from social situations?”
Evidence is also emerging that people who have poor vision due to cataracts – when the lenses inside the eyes become cloudy – are also more likely to get dementia.
A large UK study has found that having
untreated cataracts
is linked with a higher rate of vascular dementia. As with hearing loss, poor vision could lead to people becoming socially isolated. “We know staying socially active and keeping up with conversations, is really good mental exercise,” said Dr Oakley.
When people retire or start working fewer days per week, that can cause them to become more isolated, said Professor Dhesi. “As people step out of the work place you end up losing that community that you have at work. It can be harder to make social connections once your children have left home.
“You have to actively seek out opportunities to engage with your local community, whether that’s with your place of worship, hobbies or voluntary work. We know that maintaining good community connections is a predictor of core health outcomes, and gives meaning and purpose to your life.”
Sixties
As we get older, our immune systems become less effective at fighting off harmful bacteria and viruses.
So, after 65, people start being offered a range of vaccines, including against flu, Covid and RSV, and, more recently, shingles, caused by the chicken pox virus. A surprise benefit was that the shingles vaccine also seems to protect against Alzheimer’s disease.
Most people have already had a bout of chicken pox when younger, but the virus tends to live on in a dormant state inside our nerve cells. As our immune systems weaken, it can reactivate to cause a painful rash.
The vaccine may protect against Alzheimer’s by preventing the inflammation that happens when the chicken pox virus is reactivated.
“We cannot say definitely having a shingles vaccine would reduce [risk], but the early indication from a small number of trials indicates that it does,” said Dr Oakley. “So a number of people have decided to have [the vaccine] on the basis of that.”
Seventies and beyond
If an older person becomes ill or frail, it is crucial that they have a special “comprehensive geriatric assessment” from several experts in different medical specialties, for both their cognitive and physical health, said Dr Kirsty Colquhoun, a geriatrician in Glasgow.
Read Next:
Dementia care is broken in the UK – here’s why
As older people can be more sensitive to side effects from medication – especially if they are taking many different tablets that can interact – the dose of blood pressure drugs and other medicines may need to be lowered.
Taking doses that are too high can cause blood pressure to drop on standing up, leading to dizziness and falls.
And if an older person falls and needs hospital treatment, that raises their risk of delirium – a temporary bout of confusion caused by stress to the brain – which in turn
triples their likelihood of later developing dementia
.
“When you are younger, then we do want to look at optimising all the things like reducing the likelihood of having a stroke, reducing the likelihood of having heart attacks,” said Dr Colquhoun. “As you get older, you have to balance that with the side effects of the medication. If, when you stand up, you get dizzy and fall over, that’s a greater risk.”