Dementia is a condition that usually strikes people in older age, leading them to become progressively more forgetful and confused. It is becoming the leading cause of death in many Western countries. Some of this is down to doctors being more willing to put dementia on death certificates, but there is also a real rise. Dementia doesn’t kill directly, but by making people frailer and less able to eat, it leaves them vulnerable to infections like pneumonia.
There is no effective treatment for dementia. But those affected can be helped with practical approaches like music therapy or reminiscence therapy, in which people are encouraged to talk about memories from their past.
The most common form of dementia is Alzheimer’s disease, characterised by a build-up of clumps in the brain, formed of proteins called amyloid and tau. Other forms are vascular dementia, linked with an impaired blood supply to the brain, and dementia with Lewy bodies, where there are deposits of another kind of protein. And some people have mixed dementia, when there is more than one disease process going on. Often the exact diagnosis is unclear, because it is only possible to be sure by looking at the brain after death.
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Dementia is of great concern to health services, not only because there is no good treatment, but because the number of those affected is rising. But the picture isn’t all gloomy. Although more people are getting dementia, it is because more of us are living longer. And our individual risk of getting dementia by a certain age has been falling for some time. In other words, even though there is a genetic aspect, you are less likely to develop it than your grandparents, other things being equal.
The reason for this fall in people’s risk over the generations is unclear, but the trend is not that surprising, because some lifestyle habits that are linked with dementia, such as smoking, are becoming less popular. You can also lower your risk by looking after your health and getting enough exercise. More specific lifestyle factors that have been linked with a reduced risk of developing the condition include eating a Mediterranean-style diet and keeping blood pressure under control. There is a saying among doctors that what is good for your heart is also good for your brain.
Less well-known is that people who stayed longer in education in their early life are less likely to get dementia. It seems that people whose lives are more intellectually stimulating are somehow protected from the mental decline that comes with old age, as if they build up a “cognitive reserve”. It might be too late to go back to school, but other ways of staying mentally sharp into old age also seem to be protective, such as starting new hobbies or just keeping up an active social life. Clare Wilson
