Preventing dementia

What’s good for the heart is good for the brain is the message from University of Sydney researchers who are leading programs to prevent a disease that will affect more than 100 million people across the globe.

Dementia is a term for a constellation of illnesses causing a progressive decline in a person's mental functioning. It can affect memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgment.

“Dementia is a condition affecting people’s memory and thinking skills due to a number of conditions affecting the brain,” says Professor Sharon Naismith of University of Sydney’s Brain and Mind Centre. “It can be due to things like Alzheimer’s disease, or vascular risk factors like high blood pressure, cholesterol, obesity and smoking.”

“It is predominantly a problem of aging so we will see more cases arising as the average age of the population increases,” she says.

"In early stages, people with dementia face problems such as difficulty with recalling events and conversations, or difficulty with high level visual tasks such as finding where they parked their car or navigating their local environment.

"In later stages of the disease, people can have difficulty caring for themselves, such as getting dressed or even making a cup of tea. This has major effects on carers and family members as they need to increasingly assist or take over these tasks on behalf of dementia affected people."

"The focus of our research is to identify early signs of cognitive decline, which can be a prodromal stage of dementia. Our research assesses the efficacy of  programs that address risk factors for dementia so if we can improve cognition and/or slow the disease. We are also providing advice and programs to address these risk factors in an effort to prevent cognitive decline and consequent dementia.

“This is a different focus from former research and interventions. In the past we use to wait until people had dementia but what we now know is that prevention is better than the cure. We really need to be tackling these risk factors for dementia ten or twenty years before the illness presents.”

About 50 per cent of people with identified risk factors for dementia will develop the disease within five years so it is a critical time to tackle these risk factors. Dementia begins to show itself at age 60, affecting just one per cent of people but then doubles in prevalence every five years from age 60, says Professor Naismith.

“It is a disease of age and the older we get the more likely it is that we begin to notice these symptoms. By age 80 approximately one on four people will exhibit some of the symptoms consistent with dementia.”

"There are many medical risk factors we can tackle including heart disease, high blood pressure, diet, obesity and high cholesterol. But also educational activity and depression are considerable risks – together, these risk factors account for almost 50% of the risk of Alzheimer’s disease, the most common form of dementia. 

"Regular exercise is an important way that people can begin to reduce their risk of dementia. Exercise at least 3 times per week can reduce the risk of dementia by 40 per cent. Vigorous exercise, moderate exercise and muscle strengthening exercise are all important. 

"Keeping one’s brain active is another useful way to lower the risk of developing dementia. These include engaging in news tasks and skills, and staying socially active.”

Research trials at the University of Sydney are addressing a wide range of dementia risk factors says Professor Naismith.

“We are taking a holistic, multifaceted approach to dementia prevention and treatment. We run group programs tackling issues like depression, poor sleep, exercise and getting people more socially engaged in their community.

“A key message is what’s good for your heart is good for your brain. Many people are aware of the things they should be doing to maintain a healthy heart – so certainly, try to adhere to those principles but in addition, try to keep your brain active. For example, introducing more novelty into your life – if you normally play Sudoku then try other puzzles as well.

“Doing new tasks and challenges supports neuroplasticity in the brain in order to stimulate the growth of dense new connections between neurons in the brain. It’s also important to look after your mood – depression is a major risk factor for dementia and can be very easily detected and treated.

“Australia is among the world’s leaders in dementia research, however, it’s fair to say that the world has a crisis about dementia because there is no cure for the disease. Really the focus across the world is on these lifestyle interventions. There are a number of research trials occurring to see if we can start to reduce the rate of dementia as people age.”

Some of these trials are large public health interventions aimed at altering dementia risk factors among people in mid-life rather than solely on older people where it may be too difficult to undo the damage that has been done. The rationale is to alter the risk profile of large populations of people earlier in life as a way to avert and reduce the burden of disease in the community that’s likely to occur as people age.

“The results of my trials show that people doing multifaceted healthy brain ageing programs targeting these risk factors are doing better not only on memory performance but also show improved mood and sleep, which in turn should have a beneficial effect on dementia risk,” says Professor Naismith.

Later this year the Brain and Mind Centre will launch an Australia-wide electronic health platform on the Internet aiming to assist 40,000 people.

Interested people will be able to have their dementia risk factors assessed, do memory testing online where they can get reports and feedback about their status and performance.

Importantly, they will have access to evidence based interventions targeting medical and lifestyle risks such as depression, exercise and vascular risk factors.

More information about dementia research and participating in research at the Brain and Mind Centre.