ASK THE DOCTOR: Brain Health
Nationwide and in Humboldt County, the proportion of the population age 65 and older is increasing. We also know that dementia risk increases with age. Research continues to work toward a way of diagnosing the condition earlier, then reducing the risk of dementia or even slowing down progression. In the meantime, what can we do to improve our brain health?
The term “dementia” is being replaced in the diagnostic medical realm to “neurocognitive disorder,” meaning a brain problem leading to problems in function and memory. These are being classified as minor or major. Part of the reason the terms are changing is the stigma associated with the word dementia (literally meaning “out of one’s mind”), as well as the imprecision of that term. There are dozens of things that can lead to reduced brain function over a lifetime, and understanding which of these are avoidable or at least modifiable is key to reducing risk of brain disorder.
The 2024 Lancet Commission on Dementia Prevention, Intervention and Care collated data to name modifiable risk factors. By addressing these risk factors starting in childhood and all the way through the lifespan, we may be able to reduce risk for developing neurocognitive disorders. Some of these adjustments require societal buy-in and a close look at equitable access to reduce risk. Some things can be done on an individual basis.
In early life, having more education reduces later risk for developing dementia. As we age, learning new things can help us stay connected with people, as well as challenge ourselves and perhaps impact brain health. Other risk factors identified by the Lancet Commission include traumatic brain injuries, hearing loss, obesity, high LDL levels, high blood pressure and alcohol use. Starting to protect the brain from these factors starting in early adulthood and through the lifespan can make a real impact on risk of brain disease.
Other modifiable risks that continue to accumulate even after age 65 include smoking, lack of exercise, untreated depression, vision loss, diabetes mellitus, poor air quality and social isolation or loneliness. It is worth having this list handy and talking with your doctor about what things you might be able to impact so that your brain can stay as healthy as possible.
Something that jumps out at me here includes having a healthy diet, something that might be difficult if you cannot get to a market offering healthy choices, or if you cannot cook for yourself. How can we as a society make healthy food more accessible to everyone, and more the norm?
It turns out that nutrients are a type of preventive medicine, and food that contributes to obesity, high cholesterol and diabetes sets up our society for potentially having more people with neurocognitive and other disorders, which can lead to more healthcare use, less independence and higher costs. For that reason alone, investing in broad access to healthy food would save money across the board. But it also seems like the right thing to do regardless.
Alcohol is readily available and marketed, and certainly can be an enjoyable social and celebratory thing. But it is an outright poison if used regularly, leading to brain shrinkage, nerve damage and other organ damage as well. Smoking affects the blood vessels, and vascular problems are shown to be one of the four most common causes of neurocognitive disorders (along with Alzheimer’s disease, Lewy-body disease and frontotemporal disease). High blood pressure and cholesterol also affect blood flow, so managing these from a young age helps brains get the oxygen and nutrients needed to stay heathy.
Of course, some risk factors are not modifiable — age, for one, and genetic tendencies toward vascular disease, diabetes and neurocognitive disorders. Understanding risk factors is not meant to make people feel they are doing something wrong or that they can have control over every aspect of brain health. Still, it is nice to have the knowledge that gives us some opportunity to stay as well as possible for as long as possible.
Our brains are precious, and healthier brains for all will help us better manage the good news and societal realities of so many people living longer lives. Talk to your doctor, friends, family and anyone who will listen about being savvy about brain health.
Dr. Jennifer Heidmann is chief medical officer at Humboldt Senior Resource Center and Redwood Coast PACE (707-443 9747). This column should not be taken as medical advice. Ask your medical provider if you have health questions. Send comments to SN@humsenior.org.
