Know Your Risk Factors

Better Brain Blog: Know your risk factors

Welcome to the Better Brain Blog!

In this post, we will be highlighting the difference between normal age-related memory changes and mild cognitive impairment and dementia. We will also help you identify red flags in a family member or a friend who might be experiencing early signs of cognitive decline. And finally, we will touch on some reversible causes of memory loss and your own non-modifiable and modifiable risk factors for dementia. This should help you develop a long-term plan for dementia prevention.

First, let us get familiar with common memory disorders…

Note that dementia is an umbrella term used to describe a range of symptoms associated with cognitive impairment. By far, the most common type of dementia is Alzheimer’s disease.

Other less common Memory Disorders are:

·         Dementia with Lewy Bodies

·         Frontotemporal dementia

·         Vascular dementia

·         Parkinson disease with dementia

Dementia is defined as a change in function in one or more cognitive domains. But this change in function must ALSO interfere with daily function and independence to meet the criteria for dementia.

Examples of cognitive domains include Learning and Memory, Language, Executive Function, Complex Attention, Perceptual-Motor Skills, and Social Cognition.

As you can see in this graph, abnormal cognitive decline is really now realized as a continuum. Well before memory and clinical changes occur, there are ongoing changes in brain pathology that we call “biomarkers.” Biomarkers can develop 15-20 years PRIOR to the development of cognitive changes. First, there is a reduction of the normal clearance of amyloid beta 42 from the brain, resulting in amyloid plaques being deposited and disrupting neuronal function. Then, tau, which makes up the neurofibrillary tangles in Alzheimer’s disease, begins to show up in spinal fluid and the brain begins to shrink. It is only AFTER these pathological changes in the brain that a person might begin to develop symptoms of cognitive decline.

So, What is Mild Cognitive Impairment?

Mild Cognitive Impairment (or MCI) is not normal aging, but it is a clinical stage of cognitive decline BEFORE dementia, as seen on this continuum. In short, mild cognitive impairment is the presence of cognitive difficulty beyond what is expected for normal aging but not severe enough to cause disruptions in daily life. There are some individuals who have MCI but never go on to develop Alzheimer’s disease, although this is fairly uncommon. You can see again in this chart that pathological changes are happening in the brain for almost two decades PRIOR to clinical symptoms.

Some examples of normal aging include:

·         Forgetting the name of an acquaintance

·         Forgetting a word you want to say but remembering it later

·         Missing a monthly payment

·         Making a bad decision every now and then

·         Forgetting the date and remembering it later

·         Losing things from time to time

Some examples of ABNORMAL cognitive functioning, such as MCI or dementia, include:

·         Change in work performance

·         Mistake in finances

·         Getting lost

·         Repeating questions

·         Repeating stories/statements

·         Forgetting appointments

·         Difficulty with judgment or reasoning

·         Trouble learning a tool

·         Forgetting the month/year/season

As well, many individuals who are developing dementia can exhibit social and emotional changes around the same time. These include:

·         Depression

·         Increased anxiety

·         Irritability

·         Apathy/loss of interest

·         Change in personality or behavior

Current dementia research is focused on intervening EARLY in the continuum to stop the damage BEFORE someone begins to show signs of cognitive decline. We will likely have several preventive and therapeutic medications available in the coming years, but you can start your prevention plan now!

The first step in preventing MCI or dementia is to identify your own risk factors. Some risk factors are not modifiable, while others are factors you can work to change.

Risk Factors for MCI and dementia that cannot be changed include:

·         Age >65

·         Females are slightly more likely to develop MCI and dementia than men

·         Having a family history of dementia/ apolipoprotein E epsilon 4 genotype

·         Being a part of the Black or LatinX communities

Risk Factors for MCI and dementia that CAN be changed include:

·         High blood pressure

·         Smoking

·         Obesity

·         Inactivity

·         Elevated Lipoproteins

·         Cerebrovascular disease / Stroke

·         Cardiac disease

·         Heavy alcohol use

·         Altered glucose metabolism or Diabetes

·         Repeated brain trauma

·         Depression

·         Fewer years of education

·         Hearing impairment

·         Cataracts

·         Sleep disorders including obstructive sleep apnea

In addition, certain medications can alter brain function. These include antihistamines such as Benadryl, certain pain medications, anticholinergics, and benzodiazepines.

Chronic stress likely also contributes to many of the modifiable risk factors above. Think about how stress and your personal response to stress can impact blood pressure, your diet, smoking and alcohol use, your exercise plan, and your sleep hygiene.

So now that you know about risk factor modification, what can you do TODAY to begin your dementia prevention program?

Lifestyle Modification is the best way!

·         Increase your Exercise/Activity Level to at least 45-60 minutes daily

·         Lose weight

·         Be mindful of your diet and consider even moderate adherence to the MIND Diet.

·         Increase your Cognitive Reserve by learning new tasks and ideas

·         Wear a hearing aid if you need one

·         Have cataract surgery if you need it

·         Follow closely with your primary care provider to modify your vascular risk factors including blood pressure, glucose tolerance, and cholesterol levels

·         Quit smoking

·         Avoid heavy alcohol use

·         If you are snoring, get checked for sleep apnea

·         Work on stress reduction through mindfulness or meditation, exercise, and/or socialization.

·         Treat depression

·         Wear a seat belt always

·         Wear a helmet for any high-risk activities

The next few blogs in this series will address how you can minimize your own dementia risk and even improve your cognitive reserve.