3 Ways to Prevent Dementia (more than doing a crossword puzzle)
Kyle Kittleson: Some of the most commonly asked questions about Alzheimer’s and dementia are what causes it and am I at risk? Dr. Sportelli does a deep dive on whether you can prevent the disease.
Kyle Kittleson: How do I prevent this?
Dr. Sportelli: If you stay intellectually active – now, this is a big one – there’s something called cognitive reserve. You guys could probably figure out what that means, cognitive reserve. It turns out that people that are in intellectual positions on a daily basis, or using their mind a lot, tend to have a lot of cognitive reserve. They have a lot of gas in their tank, so even if they get dementia, it tends to progress a little bit slower.
Kyle Kittleson: What?
Dr. Sportelli: Yes, absolutely. Right?
Kyle Kittleson: So I hear that a lot. Like, “Oh, let’s do a crossword every morning. Brush your teeth with your non-dominant hand.” Do those work?
Dr. Sportelli: So it’s really funny, I’m in the doctor’s lounge the other day and we had a prominent neurologist in the doctor’s lounge having a cup of coffee with me and I asked him this very question. I’ve been pouring through the literature and I really want to give the best answers I can here, obviously. And I asked this gentleman who lectures all the time on that subject, and he told me, he said, “Doc, you know what? The literature doesn’t really support it. However, it’s not going to hurt you, right? It’s going to keep you busy and keep your mind busy and may help with some of that cognitive reserve.”
Most of the research is showing that the same things that we can do to lead a healthy heart and cardiovascular lifestyle all apply to dementia. So if we don’t smoke, if we eat a healthy diet, specifically, they research the Mediterranean diet, which apparently has some protective factors against dementia. If we remain active, physically active, if we remain social. Social ability, that being involved in your community, volunteering, working later, right? If you cut out drinking. We know alcohol affects the brain in negative ways.
All of these things prevent or lower your risk of developing dementia, okay? Those are the modifiable risk factors. Now your genetics you can’t change, right? If you are depressed, you are more likely to have dementia, and that does make scientific sense because we know when we look at the brains of people who are depressed, they have issues with the part of the brain of memory, like the hippocampus, for example. So we see that in research. Treating that depression is going to lower my risk of developing dementia down the line. You are modifying that risk factor.
What Causes Dementia?
Kyle Kittleson: What causes dementia?
Dr. Domenick Sportelli: Okay. We’re going to break this down. We talked about the dementia as being the heading. The cause of dementia can be Alzheimer’s, the most common form of dementia. We talked about statistics. About 60 to 80%, or maybe even two thirds of all dementia is Alzheimer’s disease. Just to break it down, what’s happening in something like Alzheimer’s disease is that there is a genetic mutation that creates something called amyloid plaques. Okay? These amyloid plaques attach to certain parts of the brain and basically cause a disruption. Two things happen. Number one is cell death of the neuron, so the neuron actually dies. The other thing is that it just causes a disruption in the cell communication by affecting something called acetylcholine. Acetylcholine is a neurotransmitter that we need to think. It’s sort of the gasoline that’s running our brain and causing these neurons to interact.
Dr. Domenick Sportelli: So, with Alzheimer’s disease, it’s the amyloid plaques that are attaching themselves to certain parts of the brain, disrupting acetylcholine, and causing cell death. It’s very specific where the Alzheimer’s disease attacks. The temporal lobes and part of the Basler system of the brain were memories involved. Okay? Now, that’s Alzheimer’s disease. When we take another step down under our dementia heading, vascular dementia, and this is the next most common type of dementia. People need to understand this. What this is, Kyle, are like mini strokes. For those of you that don’t know what a stroke is, a stroke is a blockage of a blood vessel or a tiny bleed in the brain that prevents blood from getting to a certain part of the brain.
Dr. Domenick Sportelli: Now, listen, if blood is not reaching a certain part of the brain, it’s considered hypoxic, and the cells are going to die. So, if you’re having these tiny little mini strokes, those areas of your brain are going to have inflammation and damage. Depending where that happens, you’re going to have trouble with memory, with speech, with movement, all of the things that are under that dementia criteria, right? That’s called vascular dementia, and it presents in a very specific way. It’s usually sudden onset. It’s not as insidious or slow as something like Alzheimer’s disease. It happens in a step wise pattern, meaning they’re doing just fine, all of a sudden something happens. “Wow. What happened to mom? She’s suddenly really forgetful and losing things and not herself.” Then she’s there, and then boom, again, it happens again, and it gets worse. So, you see this step wise pattern of progression. Now, that’s vascular dementia.
Kyle Kittleson: But the vascular, that’s the one when they’re having strokes?
Dr. Domenick Sportelli: Strokes. Yeah.
Kyle Kittleson: Do they know they’re having strokes?
Dr. Domenick Sportelli: When you’re talking in the neurology world, there’s a stroke, right? Where you have a deficit in something, like one-sided gate disturbance or something, or facial droop, in a lot of cases, these are such mini ischemic episodes, ischemia meaning a blockage or hypoxia or not getting oxygen, mini, mini, mini strokes that you don’t even really notice. It could be something called frontotemporal dementia, which is where you have problems in the brain, in the frontal lobes of the brain. This also has to do with plaques as well. Then you have something called Lewy body dementia, named after the doctor, Lewy, that figured out that there are these things called alpha-Synuclein proteins, another type of protein that wreaks havoc in the brain in certain areas, and that’s Lewy body dementia. I just wanted to make sure that we understood a little bit of all of the dementias and what’s causing them.
What is Not Dementia?
Kyle Kittleson: What is not dementia?
Dr. Domenick Sportelli: Yeah. And this is important because as frightening as dementia is, as you wrote that down when you were a child, people worry about it. I worry about it. You worry about it. I got to be honest, if I lose my keys I say to myself, oh my God-
Kyle Kittleson: Don’t you though?
Dr. Domenick Sportelli: Do I have a cognitive problem, right?
Kyle Kittleson: I get it.
Dr. Domenick Sportelli: So people worry about it. So it’s important to understand what is not dementia, even for family members that are noticing something in their mom, dad, or spouse, or family member for that matter. What is not dementia? Okay. So normal aging. Normally as we age, we start to have some difficulties with memory, our brain is not as efficient in the memory department so we are going to forget things. Our working memory is going to be a little bit delayed. So if we have distractions, we’re going to be distracted a little bit easier as we’re older. But we’re going to remember the important life events, we’re going to remember biographical information about ourselves. We’re going to be able to take on daily tasks without too much difficulty all the way through our lives. That’s normal aging.
Dr. Domenick Sportelli: There’s something very important called delirium. Delirium is often confused with dementia and I treat delirium all the time in the hospital. The difference is this, delirium is temporary. Delirium is a cognitive impairment, a memory impairment, a sensorium impairment that is caused by something that usually resolves. That could be a medication side effect. It could be a bad infection. It could be another physical process happening. And as we age, we’re more likely to have a simple infection like a urinary tract infection or a pneumonia cause cognitive disturbance.
Dr. Domenick Sportelli: So, if someone’s in the hospital, your mom or your dad, or an elderly family member, or a friend is in the hospital and they don’t know where they are and they’re super confused, people go, oh my God, is this dementia. It’s probably unlikely. It has a very fast onset. And usually when that medical picture clears up, they return to baseline.
Kyle Kittleson: So there is a cure for delirium?
Dr. Domenick Sportelli: Yeah. We can use the word cure. As your body sort of regains itself you get back to baseline. So sort of the way that you think about this is delirium is temporary and it’s caused by something else. And it has, what’s called a waxing and waning presentation. You have periods of lucidity and periods of significant confusion. Usually only lasts days to weeks and clears up. Now that’s delirium.
Kyle Kittleson: Got it.
Dr. Domenick Sportelli: Kyle, something super important that I want to bring up today too, is depression. So what is not dementia? In the elderly population depression can present as something called in the medical community, pseudo dementia, believe it or not because in the elderly severe depression can present with cognitive side effects, forgetfulness difficulties undergoing daily tasks, poor care, poor self care, not bathing or caring for yourself. And you may think that’s dementia when in fact it’s not, it’s depression. It’s depression.
Dr. Domenick Sportelli: And then of course, ruling out the medical stuff. Thyroid conditions can look like cognitive impairment like depression. Vitamin deficiencies in certain circumstances can present as a dementia, like B vitamin deficiencies, folate, thiamine, that sort of thing can present. So we have to rule all of that out. So those are the not dementia.
Kyle Kittleson: I’m really glad you brought that up. First of all, I didn’t even know that dementia was the umbrella term, I thought they were two separate things, dementia and Alzheimer’s. And I had no idea about the depression thing, that’s going to open a lot of people’s eyes.
Dr. Domenick Sportelli: Yeah, it’s a big deal.