There are about 5.4 million Americans living with dementia (Godman, 2016; Mercola, 2017) and the condition affects 50 million people worldwide, predicted to rise to 131.5 million by 2050. Someone in the world develops dementia every 3 seconds! And dementia is expensive, costing more than $15 billion in Australia in 2018 and $236 billion in the United States in 2016. The cost of Alzheimer's disease alone is expected to blow out to more than one trillion dollars in the U.S. by 2050 (Godman, 2016).
As a mental health professional, these statistics are likely to be relevant to you at some stage in that, given the burgeoning prevalence of dementia, you are likely to receive into your helping rooms someone who is deeply disturbed by a new diagnosis - either theirs or a loved one's - or else your client will be one of the millions already involved in the care of someone with dementia. As a third possibility, your client may just be worried about the potential decline of their own or a loved one's brain.
Admittedly, dementia is a harsh and heartbreaking disease, but having it come into a client's life does not mean the complete evaporation of all hope. This article offers psychoeducation about its causes, five important steps toward prevention, and a perspective on how life may continue to be joyfully lived with it.
Dementia is an umbrella term used to describe the symptoms of a number of illnesses which cause a progressive decline in a person's functioning. The symptoms include loss of memory, intellect, rationality, social skills, and physical functioning. To be considered dementia, it must affect at least two brain functions (such as memory, thinking, language, judgment, or behavior). The most common types of dementia are Alzheimer's disease (60 - 80% of cases) and vascular dementia (15 - 20% of cases). There are also frontotemporal dementia, Lewy body disease, and dementia from Parkinson's disease (Dementia Australia, 2019; Leonard, 2018).
Despite the fact that dementia is a prevalent cause of death, there is much yet to learn about the causes of the disease. In general, it results from the degeneration of neurons or disturbances in other bodily systems that affect how neurons function. Alzheimer's disease, Parkinson's disease (with dementia), and vascular dementia are among these neurodegenerative diseases, as are diseases arising from the side effects of medication, chronic alcoholism, and some tumors or infections of the brain. Other causes of dementia include frontotemporal lobar degeneration (meaning: damage to the frontal and temporal lobes of the brain), metabolic disorders, and toxins (e.g., lead) (Leonard, 2018; Dementia Australia, 2019).
The role of genes
Your client may be particularly worried if, for example, they see a beloved parent struggling with the condition and worry that it will be their turn in another 15-20 years, merely as a result of genetics. You can reassure them on this point, in that, while a particular gene (the apoliprotein E, including ApoE2, ApoE3, and Apo4) is associated with some cases of dementia, it is only thought to be one risk factor among many. With Alzheimer's specifically, no more than 40 - 50% of what causes the condition is thought to be attributable to genetics. Gene mutations only account for 5% of cases. Thus at least half the time, dementia may be a preventable condition (Mercola, 2017; Dementia Australia, 2019).
Plaques and tangles
Other people who have read about dementia stress about the most common hallmarks of Alzheimer's disease: the beta-amyloid plaques and the neurofibrillary tangles. The sticky beta-amyloid fragments clump together and form plaques, which prevent messages being passed along the brain's pathways: that is, creating a communication/transportation problem. Tau is a protein which normally helps to maintain the structure of brain cells by strengthening the internal scaffolding of the cell; in Alzheimer's patients, the tau proteins don't function properly and instead form protein tangles inside the cell, leading to breakdowns in cells' ability to communicate with other cells and eventual cell death (Dementia Australia, 2019).
Research continues on what causes these, but again, you can reassure worried clients that plaques and tangles are also found in the brains of those who do not have Alzheimer's, so they are not an ultimate determining factor. The bottom line here is that we need to look past the presence of these toward other factors - ones which we can control -- in order to understand and prevent the condition.
People with Alzheimer's disease have high levels of brain inflammation and "there is some evidence that this could contribute to the disease" says Dementia Australia (2019).
But before we look at prevention, let's check out the main symptoms of dementia, which can start as "mild cognitive impairment" and then progress to mild, moderate, and severe dementia.
In the early stages, dementia can show up as symptoms such as:
- Not coping well with change (having a hard time accepting scheduling or environmental changes)
- Subtle changes in short-term memory making (i.e., remembering childhood or 30-years-ago events as if they happened yesterday, but having problems recalling what was on the breakfast plate)
- Difficulty with word recollection or association
- Being repetitive
- Confused sense of direction (even with driving routes taken for years)
- Struggling to follow storylines or descriptions
- Changes in mood (depression, frustration, and anger become more common)
- Loss of interest (apathy about hobbies or activities that were once enjoyed)
- Confusion (people, places, and events no longer feel familiar)
- Difficulty completing everyday tasks (ones performed for many years) (Leonard, 2018)
The first port of call if you observe these symptoms in yourself or a loved one is to your physician, to request a thorough medical work-up, including: medical history, a careful physical examination, laboratory tests (including blood tests), a review of symptoms, and a family history.
Let's see first, however, what can be done in the realm of prevention.
Prevention of dementia
The Your Brain Matters website (2015) organises prevention into five simple steps.
Step 1: Look after your heart
It's true: our heads and hearts are connected. We increase our risk of dementia if we do not tend to conditions, particularly at mid-life, which affect our heart or blood vessels. The conditions include: high blood pressure, high cholesterol, Type 2 diabetes, and obesity. Having any of these conditions and not treating them effectively can damage blood vessels in the brain, affecting brain function and thinking skills. The good news here is that, if these can be treated in mid-life, the risk for developing dementia also goes down. This is also true for smoking, which creates an increased risk factor for heart disease, cancer, stroke, and other diseases. Again, if the person stops smoking, the risk for heart disease and stroke is rapidly reduced.
Step 2: Engage in physical activity
Do you want to give your brain a healthy boost? Physical activity increases blood flow to the brain, stimulates the growth of brain cells and the connections between them, and is associated with larger brain volume (all of which is associated with better brain function and reduced risk of dementia). Exercise reduces the risk of high blood pressure, obesity, diabetes, and high cholesterol, and not doing it increases the risk of dementia.
How much do we need to do? We are advised to be active on all, or at least most, days of the week, and further, to have:
- 150 - 300 minutes of moderate-intensity physical activity or
- 75 - 100 minutes of vigorous-intensity physical activity or
- Some combination of the above each week, with
- Muscle-strengthening activities at least twice a week.
Step 3: Challenge your brain
The proverbial daily round of Sudoku puzzles is just one option here! The idea is to challenge the brain with new activities in order to build new brain cells and strengthen connections between them. In that way, we give the brain more "reserve" or "back-up" power in order to keep going if some brain cells die or are damaged. Interestingly, keeping the brain active may also protect against the accumulation of damaging proteins in the brain. Do you hate puzzles? No drama. Learn a new language, take a dance class or take up a new sport: anything really, as long as your brain can't do it on automatic pilot and must think about it.
For those who must work past "normal" retirement age because of financial constraints, or who simply choose to do so, the findings associated with this step are good news: simply, that higher levels of mental activity throughout life are associated with better brain function and reduced risk of dementia.
Step 4: Follow a healthy diet
More research is needed here, but it appears that a high intake of saturated fats (such as those found in meat, fried foods, and takeout food, plus the "trans fats" found in pies, pastries, cakes, cookies, and buns are associated with an increased risk of dementia. The "good fats" that are desirable include the polyunsaturated and monounsaturated fats such as those in fish and olive oil. Also, foods high in antioxidants (such as tomatoes, beans, pecans, cranberries, blueberries, and oranges) appear to be among the nutrients that maintain brain functionality and reduce the risk of dementia. The omega 3 fatty acids, such as those in oily fish and walnuts, reduce inflammation in the brain and promote the growth of new brain cells. In fact, some studies have shown an association between high fish consumption and lower dementia risk. The National Dietary Guidelines advise eating a variety of foods, including: vegetables, fruit, fish, grains, nuts, legumes, and lean meat. The Guidelines recommend reducing foods high in saturated fats, including full fat dairy products, fried food, and desserts (Your Brain Matters, 2015).
Step 5: Socialize
It's not just that doing fun stuff with people you like is interesting and, hopefully, mentally stimulating. It is also that social engagement has benefits for the functioning of the brain such as helping to alleviate depression and improving vascular condition. Social engagement may also contribute to building brain reserve, which - as noted - contributes to a lower dementia risk. For those who want to go "whole hog", research shows that, when social activity combines both mental and physical activity (such as with dancing or team sports) there is an even greater benefit for brain health (Your Brain Matters, 2019).
Living with dementia
Whether it is your client or their loved one who has some form of dementia, the reality is that life is hard. It is painful, at least emotionally, and can quickly strip its sufferers of the dignity we rightfully claim as part of our humanness. Yet there can also be moments of lightness and joy, especially if people plan around it early in the diagnosis. Of course, people are advised to take common-sense steps, such as creating advance directives spelling out what kind of medical care they do and don't want when they can longer communicate it for themselves. Other documents can inform friends, family members, and carers what other, non-medical choices are preferred at the end.
But given that life expectancy for men is 4.2 years after diagnosis of Alzheimer's and for women it is 5.7 years (with shorter expectancies for the other forms of dementia: Leonard, 2018), we want to spotlight those several years before the end. What can make them easier for both carers and the cared-for sufferers is focusing on the strengths that the person can still manifest. Did/does the person with dementia enjoy music? Tia Powell (doctor, director of Montefiore Einstein Center for Bioethics, and author of a book on dementia, 2019) notes that many cities have choruses or other music programs where those with dementia, perhaps with their partners, can happily share a musical activity that brings joy to both parties. Some communities have museums or other programs in which dementia patients can go along and either appreciate the joy of seeing beautiful artwork (perhaps sparking a memory), or perhaps create art themselves. While dementia patients may no longer be able to read or even focus well on adult literature, they may enjoy children's literature, especially funny authors (Dr Seuss is fun for just about any age!).
The point is that, with a bit of forethought about the person's needs combined with some lateral thinking, there are many activities and possibilities that make otherwise drab, mindlessly repetitive days more interesting, and perhaps slow the progression of a condition that research is only beginning to understand and learn how to treat.
- Dementia Australia. (2019). Information about dementia. Dementia Australia. Retrieved on 6 June, 2019, from: Website.
- Godman, H. (2016). 10 surprising facts about Alzheimer's Disease. Healthline. Retrieved on 6 June, 2019, from: Website.
- Leonard, W. (2018). What do you want to know about dementia? Healthline. Retrieved on 6 June, 2019, from: Website.
- Powell, T. (2019). Can dementia and joy go together? Psychology Today. Retrieved on 5 June, 2019, from: Website.
- Your Brain Matters. (2015). Your brain matters: The power of prevention. Your Brain Matters. Retrieved on 6 June, 2019, from: Website.