Advances have been made in the world of dementia research compared to even a few years ago. There is now a blood test that can accurately diagnose Alzheimer’s 90% of the time, and more is being understood about the factors (many of which are lifestyle habits) that can put you at greater risk for the condition.
In a new dementia report published in The Lancet by researchers from the Lancet Commission, two new modifiable risk factors have been identified: high cholesterol after 40 and untreated vision loss.
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In 2020, the same researchers determined 12 modifiable risk factors known to put people at greater risk of developing dementia. These are:
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Excessive alcohol consumption
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Rare social contact
According to the report, these 12 factors, along with the new two, account for 49% of dementia cases worldwide. The researchers determined these two new risk factors by looking at meta-analyses and recent studies on these topics; reviewed 14 papers on vision loss and 27 on high cholesterol.
“It makes a lot of mechanistic sense,” said Dr. Arman Fesharaki-Zadeh, a behavioral neurologist and neuropsychiatrist at Yale Medicine in Connecticut. “Many of these factors are very interconnected.” (Fesharaki-Zadeh is not affiliated with the report.)
“There are many sources of vision loss, of course, but it tends to be much more common in people who have metabolic risk factors like high blood pressure, like poorly controlled diabetes, like high cholesterol, which is the other risk factor. [identified in the report]he said.
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In addition, vision is our primary sensory organ — it’s how we process the world around us — and when you can’t see clearly, you’re less likely to spend time doing brain-stimulating activities like puzzles, reading, or even spending time with other people, Fesharaki-Zadeh said. And these activities are known to help prevent dementia.
When it comes to high LDL cholesterol (the so-called bad cholesterol), it can lead to hardening of the blood vessels in the heart and brain, Fesharaki-Zadeh said, adding that high blood pressure and uncontrolled diabetes also affect blood vessels.
This can make it harder for oxygen to reach the brain, which over time can lead to damage to neurons — “and dementia is essentially an end product of neuron death, so it’s a neurodegenerative process,” Fesharaki-Zadeh explained.
“I can’t tell you how often I see in our patient populations, especially those over the age of 60, certain parts of the brain that are more vulnerable to damage … and those are the areas that are particularly vulnerable to hardening of the blood vessels. Someone who has … high cholesterol, the correlation between that and hardening of the blood vessels is quite high, and we see it very frequently in our clinic.”
“The saying I like to use with patients quite often is what affects your heart will affect your brain, and we see that time and time again,” the doctor said.
If you suffer from vision loss, it is important to manage it for your future health. Olena Ruban via Getty Images
You can reduce your risk. First, you have a good medical team and primary care physician.
“I cannot stress the importance of a collaborative model between primary care and specialty physicians,” said Fesharaki-Zadeh. Having a primary care physician who understands your health and is willing to share pertinent information with specialists such as cardiologists and neurologists will help you stay on top of any issues that put your well-being at risk.
Your primary care physician should also work proactively to help you control your risk factors—such as high cholesterol and high blood pressure—whether through medication, diet, or exercise.
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Fesharaki-Zadeh said you and your doctor should focus on these lifestyle changes as early as possible, at least in midlife, not when you’re at the point where dementia starts to set in.
“The front line of health care is primary care physicians. These are the people who, by having early discussions … can go a long way to prevent dementia,” he explained.
There are also tests that can detect early signs of neurodegeneration and genetic markers of the disease. A primary care physician can help you learn about these options.
“Up to 40 percent of dementias are preventable,” he added, but it’s worth noting that dementia can also be genetic, making prevention more difficult. But someone who is diagnosed with dementia or mild cognitive impairment may also benefit from managing these risk factors.
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“The research also shows that if you have two groups of people, someone who has comorbid metabolic diseases like high blood pressure, high cholesterol, diabetes, compared to someone who doesn’t, and both people have dementia, the rates of dementia progression in someone who doesn’t have metabolic risk factors tend to be slower,” Fesharaki-Zade explained.
It’s never too late to make changes and corrections, he noted, whether you’re a young, apparently healthy person in your 80s or 90s, or someone who’s already been diagnosed with dementia.
Our brains are very malleable, Fesharaki-Zadeh said. So if you decide to make healthy lifestyle changes at any point, your brain will respond and be healthier for it.
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