How to reduce your risk of early dementia, according to science


Cognitive decline can begin years before signs of dementia appear, which for some can be as early as age 30, a condition known as young-onset dementia. Worldwide, nearly 4 million people aged 30 to 64 are estimated to be living with the disease, according to a 2021 study, and the number of cases is rising.

The main risk factors for later-life dementia and Alzheimer’s disease are well known: older age and biological sex at birth (women are more likely to get Alzheimer’s). Genetics also determine risk—people who inherit one or more copies of the APOE4 gene are at greater risk of Alzheimer’s, although many never develop the disease. While these risks may not be modifiable, other risk factors are, including smoking, pre-diabetes and diabetes, obesity, high blood pressure, depression, social isolation and hearing loss.

Young-onset dementia is thought to be primarily caused by the APOE4 gene, with little research on other causative factors. However, a new study has found that many of the same risk factors may contribute to the early onset of dementia, offering new hope for slowing or preventing the disease.

“This changes our understanding of dementia at a young age, challenging the notion that genetics is the only cause of the condition and highlighting that a range of risk factors may be important,” said lead study author Stevie Hendricks, postdoctoral fellow in psychiatry and neuropsychology at Maastricht University in the Netherlands.

“In addition to physical factors, mental health also plays an important role, including avoiding chronic stress, loneliness and depression,” Hendricks said in an email. “The fact that this is also evident in young-onset dementia was a surprise to us and may offer opportunities to reduce risk in this group as well.”

The results mirror clinical work done with patients trying to fight the progression of dementia, said Dr. Richard Isaacson, director of research at the Florida Institute of Neurodegenerative Diseases, who was not involved in the study.

“Based on my observations from more than a decade of examining at-risk patients, I strongly disagree that people are powerless in the fight against early-onset cognitive decline,” Isaacson said in an email. “Rather, my clinical experience is much closer to the results of this new study — that it may indeed be possible to take the bull by the horns and be proactive about certain lifestyle and other health factors to reduce risk .”

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Staying active, socially connected and eating healthy are all ways to reduce your risk of cognitive decline, experts say.

In the study, published Tuesday in the journal JAMA Neurology, researchers followed 356,000 men and women enrolled at age 40 in a longitudinal health study called the UK Biobank. Blood, urine and saliva levels were collected, along with weight and other health measurements, and the researchers compared the levels between the groups who did and did not develop early dementia.

The analysis found many similarities between the risk of late-onset and early-onset dementia, such as alcohol abuse, diabetes, depression, and heart disease and stroke, both of which are associated with high blood pressure.

Given the young age of the participants, other risk factors were more surprising. Social isolation, living with hearing loss and low vitamin D levels are key risk factors for developing early dementia, according to the study.

“Social isolation was associated with depression, but depression did not mediate the association of social isolation with YOD (young-onset dementia) in our analyses, suggesting that both directly contribute to dementia risk,” the study noted.

Having higher levels of C-reactive protein, which indicates infection or inflammation in the body, was also associated with a higher risk of early-onset dementia, but only in women, the study found.

Orthostatic hypotension, a condition in which dizziness occurs when blood pressure drops when a person stands, is also a factor.

“The hazard ratios for orthostatic hypotension and depression are the highest, meaning that the risk of developing dementia at a young age is higher in individuals with orthostatic hypotension or depression compared to individuals who do not have these factors,” Hendricks said. . “However, the risks are still very small and most people with orthostatic hypotension or depression will not develop dementia at a young age.”

Having two copies of APOE4, a key genetic marker for Alzheimer’s disease, was also a factor, as was a person’s socioeconomic status and ability to obtain a higher education. Diabetes plays a role that differs by gender at birth: Men with diabetes had a higher risk than men without diabetes, but there was no association with diabetes in women, the study found.

There are a number of actions people can take to reduce their risk of early-onset dementia, Hendricks said, including quitting smoking and maintaining a healthy diet.

“Be curious: learn new things, make time for a hobby, stay engaged and socially active by visiting friends and family or attending social gatherings,” she said. “Exercise regularly: keep moving, all levels of exercise work, from walking to vigorous exercise, find something that works for you.”

Overall, people should feel empowered by the results of this study, Isaacson said.

“Although more research is needed to prove more definitively which factors may be most protective in different individuals, I urge people at risk not to wait,” he said.

“See your primary care doctor regularly and know your numbers—ask about vitamin D levels, track blood pressure goals, cholesterol results, and blood sugar values. Get your hearing checked and seek hearing aid treatment when needed.”

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