Dementia is one of the most important health challenges we face as the population ages--about 5.3 million Americans are thought to have it to some degree, and its destructive effects on our cognitive abilities come at a huge cost. "The decline in reasoning and memory that accompanies dementia impacts on spousal and familial relationships, and impairs our ability to carry out everyday tasks," says Judith Neugroschl, MD, assistant professor of psychiatry at Mount Sinai's Alzheimer's Disease Research Center. "Many people with dementia eventually become totally dependent on others for their care."
Cluster of risk factors important. Despite ongoing research into dementia, its specific causes remain unclear. However, a study published online Aug. 5 in BMJ suggests that over the next seven years eliminating depression and diabetes, and eating more fruit and vegetables could reduce new cases of dementia by 21 percent.
"Certainly there is great hope that mod ifying these factors will actually change the incidence of dementia," Dr. Neugroschl says. "However, proof can only come from studies where they actually intervene before dementia occurs and see how that affects the number of people who develop dementia."
Depression: symptom or consequence? The BMJ study suggested that the greatest impact would come from eliminating depression (just over a 10 percent reduction). Previous studies also have shown an association between depression and dementia.
"It is possible that depression may actually be an early symptom of a dementia," Dr. Neugroschl explains, "or that there are neurochemical or neuroinflammatory changes that happen with depression that place an individual at greater risk for dementia." However, although the long follow-up for both studies lends support to the theory that depression might be a risk factor for dementia and not merely a consequence, Dr. Neugroschl notes that as yet, no studies have indicated that treating depression helps to stave off dementia.
Dr. Neugroschl also points out that people who are depressed are more likely to be socially isolated, eat a poor diet, drink too much, smoke, and avoid exercise--behavioral and lifestyle factors that have been shown to increase the risk for dementia. "Since depression can significantly affect quality of life and impact self-care, proactive and aggressive treatment for depression seems like a good thing all around," she says.
Diabetes link to plaque deposits in the brain. Diabetes is known to be a risk factor for dementia, and other recent study findings (Neurology, August 25) may pinpoint a possible mechanism. Its findings indicated that a condition called insulin resistance (a risk factor for diabetes in which the body produces insulin but doesn't respond to it properly) and/or existing type 2 diabetes raise the risk for developing the brain plaques and tangles that characterize Alzheimer's disease (AD), which is the main form of dementia.
Higher levels of blood sugar two hours after eating, high fasting insulin levels, and an elevated HOMA-TR score (a test used to evaluate insulin resistance) were associated with an increased risk of plaques. People with the highest levels of fasting insulin had nearly six times the odds of having plaque deposits between nerves in the brain, compared to people with the lowest levels of fasting insulin.
In the BMJ study, the percentage of dementia cases that hypothetically would be avoided if diabetes were eliminated was 4.9. "It's one thing to retrospectively assign risk, and another thing to be able to predict how modifying that risk would change the incidence of dementia," Dr. Neugroschl says. "However, given the high prevalence of diabetes among older adults, and the fact that insulin resistance and diabetes can be mitigated by lifestyle changes, intervention could have a large impact." Dr. Neugroschl urges anyone who has diabetes to control it: "The damage diabetes causes to the circulation, eyes and organs is well documented, even without a known effect on cognition."
The diet connection. Various studies have suggested that a diet: high in antioxidant-rich fruits and vegetables may confer a protective effect when it comes to dementia. "There are previous studies suggesting that vitamins consumed via food, particularly antioxidants, are helpful for reducing dementia risk," Dr. Neugroschl says. "This study adds another piece of observational data to the literature."
Antioxidants are believed to help neutralize free radicals, naturally occurring unstable molecules that damage cells. Many experts believe there is a link between free radicals and early changes to brain cells in people who go on to develop AD. Free radicals are associated with inflammation, and antioxidants may help to reduce inflammation in the brain.
"Again, the connections ate unclear," says Dr. Neugroschl. "However, it is fairly easy to increase fruits and vegetables in the diet, and a diet plan that prioritizes produce--for example, the Mediterranean diet--also helps mitigate cardiovasctdat risk factors, such as high blood pressure and high cholesterol, that have been linked to dementia."
RELATED ARTICLE: WHAT YOU CAN DO
* Get plenty of physical exercise to keep your blood pressure, cholesterol, an blood glucose at healthy levels.
* Eat a Mediterranean-style diet that focuses on fruits and vegetables, legumes, fish and monounsaturated fat sources such as olive oil, and is low in saturated fats, meat and dairy.
* Maintain your mental fitness with crosswords and puzzles.
* Socialize--it's associated with reduced cognitive decline and decreased risk of dementia.
Source Citation
"Diet, depression and diabetes could modify dementia risk." Focus on Healthy Aging Nov. 2010: 7. Health Reference Center Academic. Web. 5 Nov. 2010.
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Disclaimer:This information is not a tool for self-diagnosis or a substitute for professional care.
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