PROFESSOR ROB GALLOWAY: Like most people, my greatest fear is dementia, but there is a PROVEN way to help prevent it

Dementia is the condition I fear most of all the terrible diseases and injuries I treat. And last week came the grim news that the number of people with dementia in England and Wales alone will double by 2040, according to a study published in the Lancet.

I have seen hundreds and hundreds of patients with this terrible condition, eroded by the decline of their cognitive abilities, change in personality and loss of independence, all of which basically means you die years before your body does.

It is also terrible for their loved ones.

One of the first patients I ever saw with dementia was as a junior doctor many years ago: an elderly, incontinent and confused gentleman in his late 70s, who was brought to A&E by his daughter after a fall.

To determine the severity of his dementia, I went through the questions we routinely ask such patients, including when he was at fault. He clearly had advanced dementia.

His daughter then told me with tears in her eyes: ‘You know that a few years ago he was able to define how time actually began. He was a professor of astrophysics.’ Then she took from her bag one of his textbooks, which contained equations that I couldn’t even fathom.

We continued talking and I explained what I had learned in medical school; that dementia – and especially its most common form, Alzheimer’s disease – was a case of bad luck, in which genes played a major role, leading to the build-up of excess protein (amyloid plaques) in the brain.

But twenty years later, I now wonder what I was taught about the disease. Yes, there is a subset of Alzheimer’s disease that is strongly linked to specific genes – and causes dementia at a very young age. However, this concerns less than one percent of the cases.

The biggest risk factor for dementia is growing older. However, it is not self-evident that you will develop dementia as you get older.

And in a way, this is the good news, because it raises the question of whether dementia is really due to bad luck, or whether we can influence our chances of developing it. And according to the latest research, the answer is yes, it can.

But why can’t you just rely on those amazing new drugs we’ve all heard about, like aducanumab, that can clear amyloid plaques from the brain?

When you look at the details of the studies, the results are disappointing, despite what the drug companies would have us think.

Yes, these drugs have been shown to clear amyloid plaques, but what we don’t know yet is whether they will actually make any difference in patients’ lives.

At this point, all we can say is that these drugs slow the decline in people with mild or moderate Alzheimer’s. They are also expensive and may have some very serious side effects.

But maybe we’re focusing on the wrong thing. What if amyloid is the smoke, but the fire that actually burns down your house is something else? And that ‘something’ is high blood pressure.

We have known for years that high blood pressure is linked to an increased risk of dementia, but definitive evidence has been lacking.

However, new research from the Center for Healthy Brain Aging in New South Wales, Australia, published last month in the respected JAMA Network Open, proves the role of high blood pressure in dementia – and questions the traditional view of the disease’s cause.

The researchers analyzed data from more than 34,000 people from a total of 17 studies and looked at the risk of dementia if you had high blood pressure that was treated or not, or if you had normal blood pressure. This analysis found that there was a proven increase in the risk of developing dementia – a 42 percent increase – if you had untreated high blood pressure or hypertension.

However, if the hypertension was treated, your risk was the same as if you had normal blood pressure without medication.

That’s an astonishing finding, and for me it has finally put to rest the debate about the important role high blood pressure plays in both causing dementia and worsening symptoms once you have it.

But how does this explain the amyloid plaques you see in Alzheimer’s disease? One theory is that poor blood flow to the brain tissue damages cells and leads to dementia – and it is this damage to cells that causes the amyloid plaques to form, rather than the amyloid plaques themselves causing the problem.

This would explain why cheap medications such as blood pressure pills like ramipril reduce the risk of Alzheimer’s disease. This was proven by the JAMA study, which also found that treating high blood pressure reduced the risk of dementia by 26 percent.

It would also explain why expensive new drugs that clear amyloid plaques don’t actually improve Alzheimer’s symptoms.

Based on this insight, other things that improve blood flow to the brain would also reduce the risk of Alzheimer’s disease.

And that’s exactly what was confirmed by a 2020 review published in The Lancet, which brought together all the studies that looked at what increased the risk of dementia.

Lack of exercise increased the risk of dementia by 40 percent; smoking, obesity and diabetes all independently increased the risk by 60 percent each; and air pollution increased the risk by 10 percent.

Knowing this, I now walk daily if possible (but at least five times a week), check my blood pressure every few months, and have lost some weight.

When it comes to alcohol, the accepted wisdom is that small amounts of alcohol are safe, provided it is less than 14 units per week in total.

Data published in the BMJ in 2018 confirmed that for every seven units over 14 per week, you increase your risk of dementia by 17 percent.

Research shows that people are now more afraid of dementia than cancer. If that’s you, I think there’s a really positive message that you can significantly reduce your risk by doing some simple things: exercising regularly, eating healthy (so you maintain a healthy weight), not smoking, cutting back on alcohol and check your blood pressure.

What’s more, these steps will also help slow the decline in dementia patients – and just how effective is evident from a study published this month in the Journal of Alzheimer’s Disease.

A group of 55 patients with early Alzheimer’s received standard care or standard care plus telephone coaching on lifestyle management.

This included cognitive brain training, nutritional recommendations based on the MIND diet (a Mediterranean diet proven to reduce the risks of developing dementia), physical activity, advice on sleep (such as aiming for 7-8 hours a day) and stress management (e.g. breathing commands).

The study found that memory declined significantly more slowly in those who underwent this program than in the control group. But because all these interventions were offered at the same time, it cannot be said which had the greatest impact.

Either way, the results make scientific sense: The brain training would help build new brain cells to counteract some of the declining function of Alzheimer’s, and lifestyle factors would improve blood flow and reduce inflammatory processes that damage the brain and brain. cause subsequent symptoms.

Like many things in medicine, dementia is more complicated than we initially thought. One day we may get a cure, but until then you have to make your own luck and try to reduce the chances of needing that medicine by reducing your chances of getting dementia in the first place.

@drrobgalloway