When I talk with patients about dementia, many are quick to recall the struggles of prior generations. They tell me stories of their parents or grandparents, asking with worry whether they’ll age into a similar mental decline.
The good news is most cases of Alzheimer’s disease, the most common form of dementia, are not passed down in families. Our research is identifying many risk factors we can each influence by building our own healthy habits.
Dementia most often appears in older people, but so do wrinkles. I remind my patients that age is the most important risk factor, which explains why they remember their ancestors’ dementia symptoms appearing late in life. People in general are living longer lives, so more younger generations build relationships with older people, some of whom will experience cognitive decline.
Symptoms of dementia include problems with memory, attention, communication, and judgement. These can include:
- Becoming lost in a familiar place
- Calling familiar objects by unusual words
- Forgetting names, such as those of family members or friends, or old memories
- Inability to complete daily tasks independently
About 6.7 million people in the U.S. over age 65 are living with Alzheimer’s disease.. As the population of older people increases, researchers estimate that number could double to 13.8 million people with Alzheimer’s disease in the U.S. by 2060.
In the UNM Health Sciences Center’s Center for Memory and Aging, some of our research is dedicated to identifying other risk factors that can impact the risk of developing dementia, and developing it earlier in life. They’re most often related to conditions that damage blood vessels and reduce blood flow to the brain, so we call them vascular risk factors.
Vascular Risk Factors for Dementia
It can take years to develop dementia, and the preclinical stage before symptoms appear can last for decades. Dementia is most often the result of a collection of risk factors that result in inflammation in the brain. Inflammation that’s present for a long period of time can speed up the time it takes to develop dementia symptoms, sometimes by years.
There’s a lot we can do to limiting the impact of these factors and reduce our individual risk. Vascular risk factors include:
- Diabetes and prediabetes: High blood sugar can damage blood vessels, and boost inflammation.
- Drinking alcohol: Drinking a lot can cause brain damage, making the brain shrink and impacting cognitive function.
- High blood pressure: Hypertension can damage blood vessels in the brain and worsen blood flow.
- High cholesterol: High cholesterol can cause proteins to build up in the blood vessels, leading to stroke and other damage, one of the strongest risks of Alzheimer’s disease.
- Sleep disorders: Not getting enough sleep can make it harder for the brain to restore and refresh itself while you rest.
- Smoking tobacco: Smoking can damage blood vessels in the brain, which leads to less blood flow and oxygen, which can contribute to dementia.
The more research we conduct, the more we learn about the connection between brain health and heart health. When the heart is healthy, it provides the brain with the oxygen and nutrients it needs. Plus, evidence shows that behavioral health conditions such as chronic stress, anxiety, loneliness, and depression can increase the risk of developing heart disease and dementia.
We’re working to understand how vascular risk factors lead to a person to being more likely to develop dementia sooner. In the meantime, there’s a lot each of us can do to help reduce our risk due to vascular factors.
You can’t age more slowly, but you can seek treatment for high blood pressure and diabetes. It’s difficult, but quitting smoking and limiting alcohol consumption can go a long way toward reducing inflammation and lowering risk. One of the most important ways to manage your risk is to improve your sleep.
Related reading: Could Better Epilepsy Detection Prevent Alzheimer’s?
How Sleep Impacts Dementia
There is a growing body of evidence that difficulty with sleep can play a major role in how dementia develops and progresses.
Disorders such as insomnia and sleep apnea can disrupt the normal sleep-wake cycle that is central to brain health. One study showed that people in their 50s and 60s who got less than 6 hours of sleep per night were 30% more likely to be diagnosed with dementia later in life than people who get more than 7 hours per night.
We suspect this is probably because our brain is just as active during sleep as when we’re awake. Using electroencephalogram (EEG), a device to measure electrical activity in the brain, we’ve learned a lot about what’s going on. Much of the work the brain does during sleep is to wash itself out.
During deep sleep, the third of four phases, readings on the EEG machine show electrical and fluid activity that means cerebrospinal fluid flushing out the proteins that are the byproduct of brain activity. Alzheimer’s disease, a type of dementia, is caused in part by the buildup of these proteins, some of which aren’t easily washed away.
To test this, researchers injected mice with Alzheimer’s-causing protein and measured how long it stayed in their brains. The proteins disappeared more quickly from the brains of sleeping mice, highlighting sleep’s important role in brain health.
Conditions that disrupt sleep can lead to more of these harmful proteins building up in the brain and increase the risk that dementia symptoms will develop sooner.
How Alcohol Influences Dementia Risk
A new study has shown that any amount of alcohol consumption increases the risk of dementia, contradicting earlier studies that found that only heavy drinkers had increased risk.
Alcohol can raise the risk of dementia in several ways:
- Alcohol can significantly disrupt sleep and worsen other conditions like diabetes and mood disorders
- Blood vessels in the brain can be damaged, leading to high blood pressure
- Drinking alcohol can interfere with the body’s ability to absorb thiamine (also known as vitamin B1), a nutrient that’s important to brain health
- Over time, heavy drinking can be toxic to brain cells, causing them to die
- The hippocampus, the part of the brain that controls memory and learning, can be especially affected by alcohol
If you choose to drink, the U.S. government’s Dietary Guidelines recommend not more than two drinks per day for men, and just one for women. When it comes to dementia risk, less alcohol is better.
Related reading: Collaborative Research Aims to Crack the Gut-Brain Connection
Caring for Patients with Dementia and Their Families
In our clinic, the first thing we do is we take patients seriously. Gone are the days of dismissing patients when tests don’t show the cognitive decline they say they experience. Instead, we closely monitor people with subjective cognitive impairment to learn whether they have symptoms we can measure over time.
In the subspeciality of geriatric neurology, we get to know our patients. Often, we discuss how they can modify their lifestyle to help control vascular risk factors. We talk about the importance of limiting alcohol and getting a good night’s sleep.
We build long-term relationships with people from a wide variety of backgrounds. Our physicians and trainees work closely with patients. Because many are experiencing cognitive decline, we work with their family members and caregivers, too. This is a rewarding specialty with a growing patient population where dedicated physicians can make a real difference.
Are you or a loved on experiencing symptoms of cognitive decline? The Memory and Aging Clinic schedules new patient visits upon referral from your primary care provider or neurologist. Discover more about how to make an appointment.