By Brad Tyson, PsyD
EvergreenHealth Neuropsychological Services
Dementia is not a specific disease in itself; rather, it is a general term that means cognitive decline, or a decline in certain areas of thinking such as attention or memory that far exceeds normal age-related changes.
In addition, this cognitive decline significantly disrupts someone’s ability to safely perform tasks important for independent living, such as driving or coordinating transportation, taking medications as prescribed, managing finances appropriately, grocery shopping and completing necessary household chores.
There are many causes of dementia, though Alzheimer’s disease is the commonest and most well-known. Next comes vascular dementia, followed by dementia with Lewy bodies, a dementia involving a movement disorder similar to Parkinson’s disease, and Parkinson’s disease itself, which can also progress to dementia.
An accurate diagnosis of dementia requires that all reversible causes of cognitive difficulties be identified and addressed.
Common, treatable causes of cognitive decline in older adults include anxiety, depression, sleep disturbance, nutritional deficiencies, unidentified or untreated medical disorders, and medications with cognitive side effects.
The most significant risk factor for dementia is age, with the commonest forms of dementia typically beginning in the 60s or 70s. As it currently stands, approximately 50 percent of people 85 years or older have some form of dementia.
The idea of losing the ability to independently care for yourself can be concerning. However, dementia is not inevitable with age. There are several things you can do to reduce your risk of dementia:
1. Get regular medical checkups. Many medical conditions are associated with an increased risk of dementia, particularly if poorly treated, including hypertension and other cardiovascular diseases, diabetes, kidney disease, liver disease, etc. Make sure you schedule your regular medical checkups and treat any underlying conditions. Review your medications with your doctor; identify those drugs with potential cognitive side effects; and reduce, replace or remove them if possible. Your primary care provider or health care partner can be your best ally in helping to manage any potential dementia risk factors.
2. Exercise. Aerobic exercise is a powerful way to reduce your risk of dementia. Designate a certain time each day for some light physical activity, even if it’s just walking around the block, and schedule more intense workouts three times per week. Consult with your doctor before starting any new exercise regimen.
3. Keep on learning. Staying mentally active in older adulthood is just as important as staying physically active. The key to staying mentally sharp is active learning and variety. Participate in a wide range of thought-provoking activities such as reading, puzzles, stimulating hobbies, learning a musical instrument, learning a new language, painting and dancing, etc.
4. Improve your mood and reduce your stress. Depression and anxiety/stress are among the commonest causes of cognitive difficulties in older adults and can resemble several different types of dementia. Even if you just have mild depression or stress, improving your mood and reducing your stress can help optimize your cognitive performance. If you are having more significant difficulties, treatment options such as counseling and/or medication can be very helpful for both mood and cognition.
5. Eat healthy. Nutritional deficiencies can be associated with cognitive changes, particularly deficiencies of the B vitamins. Try to get your antioxidants and vitamins from your diet, though a multivitamin can still help. The Mediterranean diet has demonstrated benefits for cognition and brain health. It is fairly easy to follow and includes things such as fruits and leafy green vegetables; nuts and whole grains; fish and chicken instead of red meat; and cooking with olive oil instead of butter.
6. Stay socially active. Maintaining healthy friendships and making new friends are great at every age and are particularly helpful for cognition as you get older. There is plenty of research supporting the beneficial impact of frequent social activity on brain health and immune-system function.
7. Practice good sleep hygiene. Good sleep is important for cognitive and emotional health. Everyone is different, but the typical guideline is approximately six to eight hours of sleep per night. Helpful sleep-hygiene techniques include maintaining a consistent sleep schedule with a regular time to go to bed and get up in the morning; using the bed for sleep and sex only; avoiding sleep disrupting substances such as afternoon caffeine and night time alcohol; and developing a consistent “wind-down” routine an hour or so before sleep. If you snore, get a sleep study to evaluate for sleep apnea. Avoid sleep medications if possible, as most are sedating and can negatively impact cognition.
8. Stop smoking and limit alcohol use. Smoking is associated with a staggering number of medical conditions, including some forms of dementia. Nicotine itself is not the culprit. Anything that chronically reduces oxygen to the brain--smoking, sleep apnea, lung diseases--can affect brain substance and in turn, cognition. Limit your alcohol use, and if you have any attention or memory problems, avoid alcohol altogether.
9. Have your hearing checked. Hearing loss is a common cause of attention and memory problems in older adults. Untreated hearing loss is associated with an increased risk of dementia.
10. Get baseline neuropsychological testing. A neuropsychologist evaluates cognitive abilities such as attention, memory, language and perception as they relate to brain function. Neuropsychologists can help identify whether your cognitive difficulties are age-related or suggestive of dementia. If you are 65 or older, consider having baseline neuropsychological testing and re-evaluations every few years. This is particularly important if you have any cognitive concerns or a family history of dementia.