Reducing Modifiable Risk Factors for Alzheimer’s Disease and Other Dementias in Seniors

The relationship between Alzheimer’s and seniors is the subject of abundant clinical and scientific research. One in three seniors dies with Alzheimer’s disease or another form of dementia, according to Medicare data in a 2014 report released by the Alzheimer’s Association. An estimated 5.4 million Americans have Alzheimer’s disease, including approximately 200,000 people under 65 who have younger-onset Alzheimer’s.

The term “dementia” refers to the loss of cognitive function that affects memory, language, planning, and judgment that is triggered by a disease. Once dementia is suspected, clinicians face the work of identifying the specific disease causing cognitive changes. While there are a number of diseases that cause dementia, Alzheimer’s disease accounts for 60 to 80 percent of dementia cases.

Researchers believe that Alzheimer’s disease, vascular dementia, and other dementia-related illnesses develop as a result of several factors, the most significant of which are age and genetics — which cannot be changed. However, researchers have also found several nongenetic risk factors that may increase the risk of developing dementia and other neurodegenerative diseases later in life.

There is no known cure for dementia or dementia-related illnesses, and older adults with dementia have higher mortality rates than seniors who don’t have the disease. Additionally, the Alzheimer’s Association reports that people with dementia who live alone are exposed to risks including malnutrition, inadequate self-care, wandering from home unattended, falls, untreated medical conditions, and accidental deaths.

These sobering facts underscore the need to screen seniors for dementia yearly and inform them of the several modifiable risk factors for the disease that scientists have identified. These could play a role in protecting seniors from cognitive impairment, insofar as they support brain health. More research is needed to fully understand exactly how these modifiable risk factors may decrease a senior’s chance of developing dementia, but nonetheless, you may be able to help your senior patient cut his risk by informing him of these known associations and by ensuring he is being properly treated for any conditions he might have that could be linked to dementia.

Dementia, Alzheimer’s, and Seniors: Heart and Vascular Disease Risk Factors

A growing body of evidence shows that the health of the heart and blood vessels is directly linked to the health of the brain. As such, heart and vascular disease risk factors such as high blood pressure, high cholesterol, and atherosclerosis are associated with an increased risk of dementia and Alzheimer’s disease later in life. Further, being overweight or obese at midlife has been shown to independently increase the risk of dementia, vascular dementia, and Alzheimer’s disease, according to a 2011 study published in Neurology. Lowering their intake of saturated fat and cholesterol; increasing their consumption of fruits, green and yellow vegetables, and fiber-rich grain products; and staying active are strategies identified by the American Heart Association that seniors can use to improve cardiovascular health. Of course, antihypertensives and statin drugs may play a role here as well.

In addition, older adults who smoke cigarettes, a known cardiac risk factor, are more likely than nonsmokers to develop Alzheimer’s disease, perhaps because of the oxidative stress it causes to the brain. It’s worth noting that senior patients who smoke may or may not know the severe health risks associated with the addiction, such as respiratory damage, emphysema, and chronic obstructive pulmonary disease (COPD); they can benefit from being told that quitting can help them cut their risk of dementia in addition to these other diseases. It could be the reason they finally decide to kick the habit.

Diabetes

Because uncontrolled diabetes can damage blood vessels, it is a known risk factor for vascular dementia, which results from blood vessel blockage or damage from strokes or transient ischemic attacks (TIAs). But diabetes and poor blood sugar control may also be risk factors for other types of dementia, particularly because these conditions impair the body and brain’s ability to utilize glucose from food. In fact, a 2013 study published in the New England Journal of Medicine found a relationship between high blood sugar levels and dementia prevalence even in those who did not have diabetes. Among people with diabetes, the study found that those whose blood glucose levels were generally higher were 40 percent more likely to develop the disease. Ensuring that your senior patient with diabetes is taking advantage of all the diabetes management education and therapy for which she is eligible can help her stay on top of her diabetes care.

Depression and Mental Distress

While a diagnosis of Alzheimer’s or other neurodegenerative disease can often lead to anxiety and depression, research has shown that the reverse may also be true. A study published in JAMA Internal Medicine found that, of 10,000 study participants who died within a 10-year period, those who had the highest mental distress scores were more likely to have died from dementia than those who had better psychological health. Researchers suggest that this may have to do with cortisol, the stress hormone, which at chronically elevated levels may cause damage to the part of the brain that controls memory. Further, a report published in the British Journal of Psychiatry suggests that 31 out of every 50 seniors with a history of depression may eventually develop Alzheimer’s, and 36 out of every 50 seniors with late-life depression may develop vascular dementia. While there is no explicit connection between prevention of Alzheimer’s and seniors being treated for depression, treating depression may help to lower their risk, and this is certainly proven to improve seniors’ overall physical, social, and emotional health.

Loneliness and Social Isolation

While they might not always admit to it, feelings of loneliness affect many seniors, especially those who are living alone or managing chronic diseases. A recent study shows that older adults who feel lonely are significantly more likely to develop dementia than those who don’t report feeling lonely. While social isolation wasn’t identified as an independent risk factor for dementia in this study, there is a well-established link between healthy sociability and improved cognitive function in older adults. In fact, a 2011 study published in the Journal of the International Neuropsychological Society found that seniors who were frequently socially active had a 70 percent lower rate of cognitive decline. This research validates what we know intuitively — humans are social creatures who need relationships to be healthy. Encourage your senior patient to stay involved in a social network, whether through a book club, church group, or simply his own circle of friends. Mention that staying connected can help keep him sharp.

Physical Inactivity

Aside from markedly damaging their physical health, a sedentary lifestyle appears to boost seniors’ risk of developing cognitive impairment. Likewise, regular exercise has been shown to protect the brain from developing these changes. In a study published in the American Heart Association journal Stroke, the protective effect of physical activity on the brains of seniors living independently was present even for those who had a history of stroke or diabetes. This is important research for healthcare professionals to note, especially those who minister to baby boomers. Urge your patients in their 50s, 60s, and beyond to engage in at least 150 minutes of moderate exercise every week, or 75 minutes of vigorous exercise if they are physically able, which are the guidelines set forth by the American Heart Association. Remind them that moving is crucial to staying vibrant as they age, and that they should choose a physical activity they enjoy and do it as often as possible, whether it be walking, cycling, or taking advantage of active older adult fitness classes at senior centers or local YMCAs.

Poor Nutrition

Aside from its correlation with other dementia risk factors, such as heart disease and obesity, a poor diet alone is also linked to the development of dementia, especially a diet high in processed foods and meats. This is likely because poor nutrition causes deficiencies in vital nutrients. Some studies have demonstrated that a deficiency in vitamin B-12, naturally found in animal products such as poultry, eggs, and low-fat dairy products, is associated with cognitive decline. Others show that thiamine deficiency induced by alcoholism and alcoholism’s negative impact on nutrition may contribute to cognitive impairment. Suggest that your patients limit consumption to fewer than seven drinks per week, per the current guideline set for seniors by the National Institute on Alcohol Abuse and Alcoholism.

The Alzheimer’s Association advises that people adopt a diet rich in antioxidants and omega-3 fatty acids, which have been shown to have brain-healthy benefits. Remind your senior patient that what’s on her plate at mealtime can help boost her brain health, and that she should take care to incorporate dark-skinned fruits and vegetables; cold water fish such as halibut, salmon, and tuna; and almonds, pecans, and walnuts. If you suspect your senior patient is malnourished, a registered dietitian can assess her dietary needs and provide nutritional support based on individual preferences. If it’s an issue of cost or access to food, signing her up to receive healthy, nutritious meals through her local Meals on Wheels program can be a tremendous help.

Dementia, Alzheimer’s, and Seniors: At the Point of Diagnosis

Genetics do play a significant role in the development of Alzheimer’s disease and dementia, and physicians and scientists know that no single action will prevent the onset of these diseases. Taking the above steps to help your senior patients minimize their nongenetic risk factors for these diseases, and in doing so, promoting positive lifestyle and wellness behaviors, can have far-reaching effects on their brain health. These just might be their greatest defense against cognitive decline. But if a senior has been diagnosed with Alzheimer’s or another form of dementia, all is not lost.

There are several things that healthcare professionals can do to help their older adult patients better cope with the disease process. Medications are available to help slow disease progression, though they will not bring back the cognitive function that has already been lost. Mental health professionals have an important role in helping seniors with dementia deal with the emotional and adjustment-related issues that are common after diagnosis, says Dr. Ivan Wolfson, licensed clinical psychologist based in the Chicagoland area.

“For many people, they know enough to know that they no longer know what they used to know,” Wolfson says. “Psychologists can offer coping strategies and help the senior reframe things, if they have the cognitive ability to do so.”

Pamela Atwood, MA, CDP, DCCP, CLL, certified dementia practitioner, dementia capable care provider, and director of Dementia Care Services at Hebrew Health Care in Connecticut, suggests that seniors join a support group, assemble a care support team made up of family and friends, and if necessary, hire a home care manager who can help administer medications and coordinate meals.

 

 

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