Dr. Patricia Yarberry Allen is a collaborative physician. Her patients, she believes, will be her best partners in providing diagnostic information—as long as they are asked the right questions. She also believes in consulting with the best medical minds on issues that require specialization or unique clinical experience. Today, during Alzheimer’s Disease Awareness Month, Dr. Pat calls on the expertise of neurologist Joseph Safdieh for a discussion of modifiable risk factors for dementia—risk factors that a patient can lessen by a change to a more disciplined lifestyle.
Dear Dr. Pat:
My sister is 55 years old and I am worried about her. She is a nurse and works the night shift. She never gets enough rest, and even when she is sleeping, her husband says she snores and then has some period of not breathing well. She never exercises, and she drinks three glasses of wine every night she is not on duty. Our mother had some kind of dementia; I am not sure if it was Alzheimer’s or not. I am a health and phys ed teacher and my sister never listens to me when I try to discuss how we can avoid or at least lessen the risk of the dementia that affected our mother in her late 60s. By the way, Mother drank too much, was overweight, and never exercised either. I thought I could send your recommendations to her and it might make a difference.
Sibling rivalries always make the transmission of advice to a brother or sister difficult. You are certainly thoughtful to gather information about your sister’s lifestyle. She might choose to change it if she could understand the relationship of these behaviors to the development of dementia. She clearly needs to find a support system to help her modify her overeating and consequent obesity, too much alcohol, undiagnosed sleep disorder, and sedentary life. In addition, there is evidence that people who work the night shift for years have earlier mortality and more depression. Perhaps she can use her years of work in the hospital as leverage to gain access to a day-shift job.
The good news is that she has no diagnosis of any serious illness at this time. Let’s hope that she can understand how much you care about her and that she will begin to make changes in her life to avoid not only dementia, but the many other chronic illnesses that are likely to occur if she continues her current behavior. I have asked Joseph Safdieh, M.D., our resident neurologist, who is also the Medical Director of the Neurology Clinic at Manhattan’s Weill Cornell/New York–Presbyterian Hospital, to consult.
Dr. Safdieh Responds:
Dementia is a progressive condition that is manifested by the development of multiple cognitive deficits in memory, language, and organizational abilities, among others. Although dementia has many potential causes, most cases are caused by Alzheimer’s disease, a feared and common disorder for which there are mildly beneficial treatments but nothing close to a cure at this time.
Alzheimer’s disease usually develops slowly, often sneaking up onto patients in their 60s and 70s with early subtle memory loss until it progresses to a point where it is no longer subtle. The disease causes major burdens on patients and their caregivers, and its financial costs affect all of us in some way or another.
I want to start by saying that there are no bona fide ways to prevent Alzheimer’s disease. It can strike anyone: any race, any sex, and any rung on the social ladder—richer, poorer, married, divorced. However, there are definitely well known risk factors that certainly increase the risk of development of dementia. Some of these, such as age and family history, are not modifiable. However, many of the risk factors can be modified with lifestyle changes or medications. Here is a list of some of the important modifiable risk factors for dementia:
1. Alcohol: Large amounts of alcohol seem to increase the risk of dementia. Half a drink per day for women may be protective, but more than that is quite detrimental.
2. Smoking: It goes without saying that smoking is bad for the brain!
3. Poor diet: A recent study in animals clearly demonstrated that consumption of fatty foods actually reduced the animals’ ability to learn new tasks—an almost immediate and dramatic effect on memory.
4. Lack of exercise: More and more research is showing that exercise is good for the brain, whether the exercise is walking, running, or lifting weights. In fact, in the animal study referenced above, those animals that ate fatty foods and also exercised actually developed an improvement in their memory.
5. Diabetes that is related to both genetic risk and obesity.
6. High blood pressure, which is also more prevalent in obese people.
I am also worried that your sister may be suffering from sleep apnea, and this may be related to her weight. Sleep apnea is a definite risk factor for stroke, so I suggest that she see a specialist regarding obtaining a diagnosis and appropriate therapy.
As you can see, most of the recommendations that we advise in regard to dementia prevention are common-sense suggestions. I hope that your sister can empower herself to take better care of herself.