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Dementia Prevention: Reduce Your Risk, Starting Now

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Dementia is defined by loss of memory, problems with thinking and reasoning, and an inability to carry on with work and life activities independently. There are several kinds of dementia. Alzheimer’s disease is the most common, but for up to a third of people with dementia, even some of those diagnosed with Alzheimer’s, vascular disease is a major cause.

The good news is you can lower your risk of dementia. Rebecca Gottesman, M.D., Ph.D., a Johns Hopkins neurologist, explains how.

Understand Dementia Risk Factors Based on the Cause

Alzheimer’s disease is associated with sticky protein deposits on the surface of the brain. Vascular dementia results from atherosclerosis plaque buildup and narrowing of the arteries that compromise blood flow to the brain. “We now understand that many people actually have a mix of both types of dementia, so it’s important to think about ways to treat or prevent both kinds,” Gottesman says.

The Importance of Vascular Health

At present, researchers are still trying to understand the causes of Alzheimer’s disease and how to treat it.

But, says Gottesman, vascular causes of dementia are another story. Vascular disease can cause or worsen dementia. Diseased blood vessels, along with high blood pressure, can cause tiny areas of bleeding or blocked blood flow to the brain — “silent strokes” — that may not even cause noticeable symptoms.

But when these small areas of brain injury happen over and over again, a person can develop problems with memory, gait, balance and other brain functions. Researchers are exploring the role of vascular disease in the development of Alzheimer’s dementia in particular, but it’s not yet clear if or how this occurs.

If we look at all the causes of dementia, it’s been estimated that one in three cases is preventable.”

Rebecca Gottesman, M.D., Ph.D.

Taking steps to improve the health of your blood vessels involves lifestyle changes. Since brain changes can start decades before dementia symptoms appear, the earlier you begin preserving your vascular health, the better for your brain.

Here’s a bonus: Improving blood vessel health helps you avoid stroke, heart attack and other serious diseases as well.

Gottesman says, “If we look at all the causes of dementia, it's been estimated that one in three cases is preventable. We can’t do anything right now to stop or reverse the underlying mechanisms of Alzheimer’s disease, but we can do something about hypertension and vascular disease risk factors.”

Dementia Prevention: 5 Steps to Take Now

While forgetfulness and problems thinking most often show up in people age 60 or older, medical research is discovering that the disease starts making changes in the brain many years before that.

In a 2017 article in JAMA Neurology, Gottesman and co-authors looked at data from 15,744 people from all over the country to see the relationship between smoking, diabetes and elevated blood pressure and the chance of developing dementia over 25 years.

“People with high blood pressure in middle age increased their risk of having dementia over the next 25 years by 40%,”Gottesman says. “And in the case of diabetes, that risk goes up by 80%. That’s almost as much of an increased risk as having a genetic vulnerability for Alzheimer’s.”

Healthy choices and lifestyle changes in your 40s may make a difference in your dementia risk. Talk to your doctor about strategies to guard against plaque buildup and narrowing of your arteries:

  1. Control high blood pressure (hypertension).
  2. Address diabetes.
  3. Quit smoking.
  4. Achieve and maintain a healthy weight.
  5. Get more physical activity.

It’s never too soon to address vascular health and potentially prevent dementia. “You need to think about these things before you think you need to,” Gottesman says.

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