A pproximately 50 million people live with dementia. And that number is expected to rise dramatically in the coming decade, according to an editorial published in The Journal of Prevention of Alzheimer’s Disease in September.
At the same time, our understanding of dementia and our ability to delay or possibly prevent cognitive decline are improving, according to Heather Snyder, Ph.D., vice president of medical and scientific relations at the Alzheimer’s Association.
As people live longer, healthier lives, many of those who develop dementia today do so much later in life, says Lon Schneider, M.D., a professor of psychiatry, neurology, and gerontology at the Keck School of Medicine of the University of Southern California in Los Angeles.
Recent research has begun to detail the lifestyle strategies that could most effectively protect our minds, and it now seems possible that we could further push back the average age for the onset of dementia, according to Sarah Lenz Lock, the executive director of the Global Council on Brain Health (GCBH), a research group. Delaying the onset of dementia by five years could dramatically improve people’s quality of life and cut overall incidence in half, Lock says.
“People think that cognitive decline is inevitable as you age,” Lock says. “That’s just not true.”
There are a number of ingredients in what Snyder refers to as the “specific lifestyle recipe” that’s linked to a reduced risk of cognitive decline. We’re still figuring out the best ways to combine these components, but we know enough already to say that these strategies are key.
The research: Evidence suggests that regular exercise may be one of the better ways to help prevent or slow cognitive decline in people who are cognitively healthy as well as in those already experiencing some memory problems.
One recent study, published in The Lancet Public Health in November, followed 30,375 Norwegians beginning in the 1980s and found that people who are in better shape are significantly less likely to develop dementia. With greater fitness came higher levels of cognitive protection. But even those who were not aerobically fit in middle age and got into shape in their 70s were less likely to show signs of dementia in later years.
The plan: Even small amounts of exercise can begin to make a difference over a relatively short period of time. One research review, published in the journal Neurology: Clinical Practice in 2018, found that on average, people started to see improvement in brain function after about 52 hours of exercise—which they reached in about six months, on average. (That comes out to about 2 hours a week.)
The Physical Activity Guidelines for Americans suggest at least 150 minutes of moderate-intensity aerobic activity a week and at least two days of strength training. But doing anything is always beneficial when compared with doing nothing, Schneider says. “It doesn’t take much” to see a benefit, he says.
No conclusive evidence says that one type of exercise is necessarily best, according to Snyder, so you should do whatever exercise you enjoy. Research has shown brain benefits linked to strength training, aerobic fitness (including walking), and mind-body workouts, such as tai chi. “The consistent finding is that exercise is beneficial,” she says.
Eat a Heart-Healthy Diet
The research: Generally, diets good for your heart are good for your brain, according to Lock. These include the MIND, Mediterranean, Nordic, Japanese, and DASH diets. One 2017 study found that the more closely older adults adhered to the Mediterranean or MIND diet, the less likely they were to show signs of cognitive impairment.
The plan: Eat a variety of colorful fruits and vegetables—something many of these diets designed for brain and heart health have in common. Foods that may be particularly important to eat, according to a report by the GCBH, include berries, leafy greens, healthy fats (such as those found in olive oil), nuts, and fish. No supplements, however, are known to prevent cognitive decline.
Control Blood Pressure
The research: A significant amount of research indicates that treating hypertension, especially in midlife, can reduce risk for cognitive impairment and potentially reduce risk for dementia. One study published in JAMA in January 2019 suggested that intensive blood pressure control—trying to keep systolic blood pressure in midlife below 120 instead of 140—could further reduce risk for cognitive impairment. Still, people should be cautious of using meds to reach such low numbers; lowering blood pressure too much or taking multiple BP meds can come with side effects. Other research has shown brain benefits in those who did not lower blood pressure so dramatically.
The plan: “Know your numbers,” Snyder says. Untreated hypertension can cause organ damage that affects the kidneys, heart, and brain, Schneider says. Take meds if you need them, but also talk to your doctor about how you can use diet and exercise to help bring your numbers down.
Engage Your Brain
The research: Engaging your brain in lifelong learning (of new skills and new activities) could contribute to a reduced risk of cognitive decline, according to Snyder. More research is needed to understand whether—and how—specific activities may affect a person’s risk.
One study of more than 15,000 older adults, published in the journal JAMA Psychiatry in 2018, found that people who regularly engaged in intellectual hobbies, such as reading books and playing board games, were less likely to develop dementia later on than those whose leisure time involved activities like watching television and shopping.
The plan: Anything that stimulates your brain and forces you to learn might help, Snyder says, whether that’s taking a class at a local college, trying to learn a new language, or even learning a new form of exercise.
Learning something new may also be an opportunity for social engagement, which Lock says is another factor that we know is important for mental well-being, even if we can’t yet measure exactly how it may protect the brain.
Four Habits to Curb for Your Mind's Sake
2. Junk food: Avoid highly processed foods and foods high in saturated fat.
3. Sleeping pills: Though healthy sleep is important for brain function, sleeping pills have been associated with an increased risk for dementia.
4. Alcohol: Drink alcohol only in moderation (no more than one drink a day for women or two drinks a day for men). A large French study, published in The Lancet Public Health in 2018, confirmed that alcoholism was a major risk factor for dementia.
Is an Alzheimer's Cure Any Closer?
We’re getting better at understanding the lifestyle strategies that may help prevent dementia, but recent clinical trials “have not yielded the results that are desperately needed: more effective treatments for Alzheimer’s,” according to the editorial published in The Journal of Prevention of Alzheimer’s Disease in September.
We may be moving closer to pharmaceutical solutions, says Schneider, of the University of Southern California. But progress is slow and incremental. If you read about trials where one drug suddenly appears to be especially promising, “be cautious,” he says. “It’s unlikely that one single drug is going to have major effects.”
We’re getting better at understanding the root biological causes of dementia and Alzheimer’s, says Snyder, of the Alzheimer’s Association. But because these conditions are complex, she says, treatments will probably look like treatments for heart disease—where people combine medicine, diet, and exercise to address cholesterol, blood pressure, and the particulars of their individual condition.
Future treatment for Alzheimer’s may prove to be most effective when multiple approaches are used together.
Editor’s Note: This article also appeared in the February 2020 issue of Consumer Reports On Health.
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