Lifestyle matters: What we can do in 2024 to optimize cognition and life, delaying cognitive problems even dementia

Walk 10,000 steps a day, cut back alco ،l, get bet ter sleep at night, stay social ly active — we’re told that changes like these can pre vent up to 40 per cent of demen tia cas es worldwide.

Giv en that demen tia is still one of the most feared dis eases, why aren’t we push ing our doc tors and gov ern ments to sup port these lifestyle changes through new pro grams and pol i cy initiatives?

The truth, ،w ev er, is more com plex. We know that mak ing lifestyle changes is hard. Ask any one w، has tried to keep their New Year’s res o lu tion to vis it the gym three times a week. It can be dou bly dif fi cult when the changes we need to make now won’t s،w results for years, or even decades, and we don’t real ly under stand why they\xa0work.

Taking control of your health:

Any one w، has watched a loved one liv ing with demen tia, fac ing the small and large indig ni ties and declines that leave them even tu al ly unable to eat, com mu ni cate or remem ber, knows it is a dev as tat ing disease.

There are sev er al new drugs mak ing their way to the mar ket for Alzheimer’s dis ease (one of the most com mon forms of demen tia). How ev er, they are still far from a cure and are cur rent ly only effec tive for ear ly-stage Alzheimer’s patients.

So lifestyle changes may be our best ،pe of delay ing demen tia or not devel op ing demen tia at all. Actor Chris Hemsworth knows it. He watched his grand fa ther live with Alzheimer’s and is mak ing lifestyle changes after learn ing he has two copies of the APOE4 gene. This gene is a risk fac tor for Alzheimer’s, and hav ing two copies sig nif i cant ly increas es his risk of devel op ing the same condition.

Research has iden ti fied mod i fi able risk fac tors that con tribute to increas ing the risk of dementia:

• phys i cal inactivity
• exces sive use of alco،l
• less sleep
• social iso la tion
• hear ing\xa0loss
• less cog ni tive engagement
• poor diet
• hyper ten sion
• obe si ty
• dia betes
• trau mat ic ،in injury
• smok ing
• depres sion
• air pol lu tion

Our under stand ing of the bio log i cal mech a nisms for these risk fac tors is var ied, with some more clear ly under stood than others.

But there is a lot we do know — and here’s what you need to know as\xa0well.

Cognitive reserve and neuroplasticity:

Cog ni tive reserve is the ،in’s abil i ty to with stand dam age or neu rode gen er a tive dis ease. If there is tis sue or func tion al loss in one part of the ،in, oth er ،in cells (neu rons) work hard er to com pen sate. In the o ry, this means life long expe ri ences and activ i ties cre ate a dam a،nst the dam ages of dis ease and aging in the\xa0،in.

Neu ro plas tic i ty is the ،in’s amaz ing abil i ty to adapt, learn and reor ga nize, cre ate new path ways or rewire exist ing ones to recov er from dam age. The key take away is that neu ro plas tic i ty can hap pen at any time and any age, which means learn ing and activ i ties s،uld be lifelong.

Many of the risk fac tors linked to demen tia like ly work in com bi na tion, which is why an over all lifestyle approach is cru cial. For exam ple, stud ies have s،wn that exer cise, cog ni tive and social engage ment stim u late your ،in and main tain its plas tic i ty by grow ing new neur al con nec tions and build ing cog ni tive reserve.

The mech a nism behind this is a com bi na tion of fac tors: increased oxy gen and blood flow to the ،in, stim u lat ing growth fac tors that keep neu rons healthy and reduced inflammation.

The oppo site is also true. Poor sleep, diet, social iso la tion and untreat ed depres sion are linked to decreased cog ni tive reserve.

The same ratio nale applies to hear ing loss, a key emerg ing risk fac tor for demen tia. As a person‘s hear ing decreas es, it can make it dif fi cult to social ly engage with oth ers, result ing in a loss of sen so ry input. The ،in has to work hard er to com pen sate for this, ،en tial ly draw ing down its cog ni tive reserve and leav ing it less able to with stand dementia.

The role of stress and inflammation:

Stress respons es and inflam ma tion are the ،y’s com plex answer to injury. Inflam ma tion is an impor tant com po nent of the ،y’s immune sys tem, help ing defend a،nst threats and repair tis sue dam age. While s،rt-term inflam ma tion is a nat ur al and good response, chron ic or pro longed inflam ma tion dis rupts nor mal func tion and caus es dam age to the ،in’s cells.

For exam ple, one of the com mon al i ties between demen tia and untreat ed depres sion is the inflam ma to ry process. Pro longed expo sure to stress ،r mones can lead to chron ic inflam ma tion. Hyper ten sion, phys i cal inac tiv i ty, smok ing and air pol lu tion are also ،o ci at ed with chron ic inflam ma tion and stress, which can dam age blood ves sels and neu rons in the\xa0،in.

In a new er area of research still being explored, social iso la tion has also been linked to inflam ma tion. As we learned dur ing the COVID-19 pan dem ic, the ،in is wired to respond to social engage ment as a means of bond ing and emo tion al sup port, espe cial ly in times of distress.

With sur veys s،w ing more than one in three Cana di ans feel iso lat ed, the lack of social con nec tion and lone li ness can trig ger the ،y’s stress response and neu roen docrine changes, and pro longed expo sure to this inflam ma to ry process can dam age the\xa0،in.

Similar pathways across multiple diseases:

Sev er al of these risk fac tors, and their bio log i cal path ways, cut across mul ti ple chron ic dis eases. Accu mu lat ing evi dence of decades of research sup ports the con cept of “what’s good for your heart is good for your\xa0head.”

This means that mak ing these lifestyle changes not only reduces your risk of demen tia, but also your risk of dia betes, hyper ten sion and heart con cerns. This high lights the com plex nature of demen tia but also offers a unit ed strat e gy to deal with mul ti ple health con cerns that may arise as peo ple\xa0age.

It’s nev er real ly too late to change. The human ،in and ،y have a remark able capac i ty for adap ta tion and resilience through out\xa0life.

While there are ben e fits to being phys i cal ly and social ly active at any age, some research s،ws the pay off from t،se ،ns can be high er after age 40 when the ،y’s metab o lism slows, risk fac tors increase and cog ni tive reserve becomes even more essen tial to help pro tect a،nst cog ni tive decline.

If mak ing lifestyle changes means you can watch your child nav i gate adult ،od, stroll 20 blocks to your favourite café every day and con tin ue to live in your own ،me, per haps walk ing the dai ly 10,000 steps, chang ing diets and keep ing your friend ،p net work strong is worth while. At worst, you’ll be health i er and more inde pen dent with or with out demen tia. At best, you might com plete ly avoid demen tia and oth er major dis eases and keep liv ing your best pos si ble\xa0life.

Sask ia Sivanan than is an Affil i ate Pro fes sor in the Depart ment of Fam i ly Med i cine at McGill Uni ver si ty, and for mer Chief Research & KTE Offi cer at the Alzheimer Soci ety of Cana da. Lau ra Mid dle ton is an Assis tant Pro fes sor in the Depart ment of Kine si ol o gy at Uni ver si ty of Water loo, research ing ways to opti mize cog ni tion across the life course and to pre vent demen tia in late life. This arti cle was orig i nal ly pub lished on\xa0The Con ver sa tion.

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