A fear of dementia looms large in the minds of many, and understandably so. It is a condition with potentially devastating effects – incurable, progressive and which threatens to rob us of the essence of who we are. It is also a condition surrounded by unhelpful myths, however, and our bleak view is often unjustified. Prevention or delay are possible, and much can be done to help even if dementia develops.
The first myth is that memory loss is an inevitable part of dementia. This is not the case and may lead to under-recognition of the condition. Memory loss is the archetypal symptom of dementia due to Alzheimer’s disease – the most common cause of dementia – but dementia can be due to numerous disease processes and these may lead to other symptoms. As an example, frontotemporal dementia may present first with changes in personality and behaviour, or with language problems. Vascular dementia symptoms vary according to which part of the brain has compromised blood supply. Any change in cognitive function – not just memory, but language, social cognition, visuospatial abilities and the like – should prompt you to seek medical advice.
Ageing is the biggest risk factor for dementia, but there is probably still a greater chance you won’t have it by the time you reach your mid-80s. Discussion around risk brings us on to the second myth – that if someone in your family has dementia, you will get it too. It is true that genetics plays a role in risk, but for many this is minor. Having multiple family members develop dementia before the age of 65 (so-called early onset dementia) is a cause for concern, though having one or two relatives acquire it in their 80s less so. Other factors – such as lifestyle choices – play as much a part in risk generation, and these are under our control.
The third myth is that nothing can be done about dementia. This is in some ways the most problematic, as such nihilism may lead to years of undue anguish. The truth is that there is help available. Medications that help with cognition can have a meaningful impact for some and can also be helpful for the psychological and behavioural changes that often accompany the condition. These latter difficulties may distress the person experiencing them, but also their carer, and research clearly demonstrates the negative health impact of the carer role.
Psychological disturbance and alterations in behaviour are also often amenable to other interventions – ones that focus on understanding the specific and unmet needs of the person with dementia and which may involve environmental, social and behavioural changes. Support is also critical, and services are available to provide this. Education around dementia is key and organisations such as Dementia Australia are wonderful resources in this regard.
It is not unreasonable to expect a number of years of good quality of life, of enjoyment and contentment and satisfying relationships despite dementia being present. The chance of this is greatly improved by early recognition and institution of adequate support.
The fourth myth is that dementia is inevitable. This leads to avoidance of diagnosis, a problem for a number of reasons. Without a diagnosis you cannot plan, and without a plan – where your future health and other wishes are known – the burden of decision may fall on those you love. Interventions – whether they be cognition-preserving medications or lifestyle modifications – are also more powerful when put in place earlier rather than later. Additionally, uncertainty about the cause of your problems often generates anxiety. Knowing what’s going on – even if the news is not what you’d prefer – helps explain things and allows you to adjust.
Finally, studies focusing on dementia prevention and delay are a cause for great optimism. It has been estimated that 40% of cases of dementia worldwide could be avoided with attention to various risk factors. It is better that we address these early on – brain changes underpinning Alzheimer’s disease may start as early as our 30s – but there are benefits to be had at any age.
So what are the magic ingredients to prevention and delay? This is a growing area of research, but we already have robust evidence in a number of areas: you should remain physically active and regularly engage in moderate aerobic exercise and resistance training (preferably with periods of high intensity); what you eat should include the elements found in a traditional Mediterranean diet; and you should prioritise your sleep. Staying in touch with others is equally important – loneliness is toxic for the brain – and you must strive to do novel and challenging things with your brain. Finally, care for your heart, go easy on the grog and check your hearing.
The message is clear: mind your brain and don’t be afraid to seek help.
Dr Kailas Roberts is the author of Mind Your Brain – The Essential Australian Guide to Dementia (UQP, $34.99)