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Could the behaviours you engage in today impact your risk of Alzheimer’s?

Dr Laura Meade

Dr Laura Meade

Dr Christina Jackson

Dr Christina Jackson

It’s National Alzheimer’s Awareness Month, and did you know that certain lifestyle factors can influence your risk of developing Alzheimer’s disease?

 

Modifiable risk factors have been linked to increased risk of dementia and Alzheimer’s

 

There is growing evidence from longitudinal observational studies that a combination of genetic, vascular, metabolic and lifestyle-related factors can lead to the development of Alzheimer’s.1 In particular, high blood pressure, high cholesterol and obesity in mid-life have been found to be risk factors for late onset dementia and Alzheimer’s.2

Additionally, increased dementia risk has been found to be associated with smoking,3 excessive alcohol consumption,4 depression,5 as well as psychosocial factors including work-related stress and minimal social contacts.6-8 On the other hand, engaging in regular physical activity,9 participating in mentally stimulating leisure activities10 and regular social engagement11 have been found to reduce the risk of dementia and Alzheimer’s.

Overall, it has been estimated that approximately 35% of dementia cases worldwide could be attributed to these nine modifiable risk factors:12

  • low educational attainment in early life
  • midlife hypertension and obesity
  • diabetes mellitus
  • smoking
  • physical inactivity
  • depression
  • social isolation
  • hearing loss over the entire adult life course

Therefore, managing your daily behaviours today can modify some of these risk factors and have long term benefits to prevent the onset or progression of dementia and Alzheimer’s.

 

Using behavioural science to address modifiable risk factors

 

Increasing regular physical activity: make an action plan

There is strong evidence to suggest that physical activity is linked to brain health.13 Large observational studies spanning decades have shown that individuals who are regularly active are less likely to develop cognitive decline, all-cause dementia, vascular dementia and Alzheimer’s disease when compared to those who are inactive.14-17

Action planning can be an effective tool to help increase physical activity levels while also decreasing sedentary behaviour.18 Action plans are detailed plans of what you are going to do.

How to make an action plan:

  • Think about your end goal (be as detailed as possible)
  • What steps do you need to take to get there (think of when, how, where, with who)
  • Are there any barriers or obstacles that may get in the way?
  • How will you overcome them?

 

See our previous blog post on using mobile apps to help you stick to your physical activity goals here. 

 

Quitting smoking: create a support network

Observational studies have provided evidence for the association between tobacco consumption (including in mid-life) and dementia, or cognitive decline, in later life.13

Pharmacological interventions paired with behavioural programs produce the best outcomes in smoking cessation.19 Social support has been found to prompt greater commitment, leading to better outcomes in smoking cessation.20

Find a local support network near you:

https://medlineplus.gov/ency/article/007440.htm

https://www.nhs.uk/live-well/quit-smoking/nhs-stop-smoking-services-help-you-quit/

https://csl.cancer.ca/smokershelpline/en

 

See our previous blog post on providing equitable support to help people quit here. 

 

Reducing alcohol consumption: monitor your behaviour

There is strong observational evidence supporting the correlation of heavy alcohol drinking and increased risk of cognitive impairment.13

Self-monitoring has been shown to improve outcomes in people trying to reduce alcohol consumption.21 Try keeping a diary or using a calendar to track your daily or weekly consumption.

 

Managing diet and weight: problem solving

Hypertension, obesity and diabetes have been attributed to a higher risk of dementia and Alzheimer’s. Factors related to diet and weight may therefore be both directly and indirectly involved in the development of dementia.13 Previous dietary intervention studies have shown that dietary changes are involved in the prevention of many conditions that increase the risk of dementia.22,23

Using tools such as problem solving can support people’s efforts in maintaining a healthy diet.24 First, identify areas of challenge (for instance, snacking in the evening) and brainstorm a list of possible strategies that may help overcome this challenge. Keep this list in an accessible place.

 

Reducing social isolation and increasing social networks: restructure your social environment

Social disengagement has been shown to increase the risk of cognitive impairment and dementia.25 More specifically, lower social participation, less frequent social contact and loneliness have been found to be associated with dementia.26 Barriers often faced by aging individuals such as retirement, reduced mobility, living alone and dealing with health issues can further compound the issue.13

The recent increase of digital therapeutics and online programming has led to increasingly more apps and programs made to target older adults, albeit of varying quality.27 However apps allow greater accessibility to an increased social network and research has found that older adults are receptive to engaging in these programs to support their mental health.28 For those with mobility issues or limited access, online programming may lend itself to an accessible means to increase social networks.

 

See our previous blog post on leveraging digital innovations to provide greater support for patients and carers of people with dementia here.

 

References
  1. Rosenberg A, Mangialasche F, Ngandu T, Solomon A, Kivipelto M. Multidomain Interventions to Prevent Cognitive Impairment, Alzheimer’s Disease, and Dementia: From FINGER to World-Wide FINGERS. J Prev Alzheimers Dis. 2020;7(1):29-36. doi: 10.14283/jpad.2019.41. PMID: 32010923; PMCID: PMC7222931.
  2. Kivipelto M, Ngandu T, Fratiglioni L, Viitanen M, Kareholt I, Winblad B, et al. Obesity and vascular risk factors at midlife and the risk of dementia and Alzheimer disease. Arch Neurol 2005;62:1556-1560
  3. Cataldo JK, Prochaska JJ, Glantz SA. Cigarette smoking is a risk factor for Alzheimer’s Disease: an analysis controlling for tobacco industry affiliation. J Alzheimers Dis 2010;19:465-480.
  4. Anttila T, Helkala EL, Viitanen M, Kareholt I, Fratiglioni L, Winblad B, et al. Alcohol drinking in middle age and subsequent risk of mild cognitive impairment and dementia in old age: a prospective population-based study. BMJ 2004;329:539
  5. Gao Y, Huang C, Zhao K, Ma L, Qiu X, Zhang L, et al. Depression as a risk factor for dementia and mild cognitive impairment: a meta-analysis of longitudinal studies. Int J Geriatr Psychiatry 2013;28:441-449
  6. Hakansson K, Soininen H, Winblad B, Kivipelto M. Feelings of Hopelessness in Midlife and Cognitive Health in Later Life: A Prospective Population-Based Cohort Study. PLoS One 2015;10:e0140261.
  7. Sindi S, Hagman G, Hakansson K, Kulmala J, Nilsen C, Kareholt I, et al. Midlife Work-Related Stress Increases Dementia Risk in Later Life: The CAIDE 30-Year Study. J Gerontol B Psychol Sci Soc Sci 2017;72:1044-1053.
  8. Kuiper JS, Zuidersma M, Oude Voshaar RC, Zuidema SU, van den Heuvel, E R, Stolk RP, et al. Social relationships and risk of dementia: A systematic review and meta-analysis of longitudinal cohort studies. Ageing Res Rev 2015;22:39-57.
  9. Ngandu T, von Strauss E, Helkala EL, Winblad B, Nissinen A, Tuomilehto J, et al. Education and dementia: what lies behind the association? Neurology 2007;69:1442-1450.
  10. Wilson RS, Segawa E, Boyle PA, Bennett DA. Influence of late-life cognitive activity on cognitive health. Neurology 2012;78:1123-1129.
  11. Marioni RE, Proust-Lima C, Amieva H, Brayne C, Matthews FE, Dartigues JF, et al. Social activity, cognitive decline and dementia risk: a 20-year prospective cohort study. BMC Public Health 2015;15:
  12. Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, et al. Dementia prevention, intervention, and care. Lancet 2017;390:2673-2734
  13. Risk reduction of cognitive decline and dementia: WHO guidelines. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.
  14. Stephen R, Hongisto K, Solomon A, Lönnroos E. Physical Activity and Alzheimer’s Disease: A Systematic Review. J Gerontol A Biol Sci Med Sci. 2017 Jun 1;72(6):733-739.
  15. Hamer M, Chida Y. Physical activity and risk of neurodegenerative disease: a systematic review of prospective evidence. Psychol Med 2009; 39: 3–11.
  16. Sofi F, Valecchi D, Bacci D, et al. Physical activity and risk of cognitive decline: a meta-analysis of prospective studies. J Intern Med. 2011 Jan;269(1):107-17.
  17. Gallaway PJ, Miyake H, Buchowski MS, et al. Physical Activity: A Viable Way to Reduce the Risks of Mild Cognitive Impairment, Alzheimer’s Disease, and Vascular Dementia in Older Adults. Brain Sci. 2017 Feb 20;7(2).
  18. Schroé, H., Van Dyck, D., De Paepe, A. et al.Which behaviour change techniques are effective to promote physical activity and reduce sedentary behaviour in adults: a factorial randomized trial of an e- and m-health intervention. Int J Behav Nutr Phys Act 17, 127 (2020). https://doi.org/10.1186/s12966-020-01001-x
  19. Ziedonis, D., Das, S., & Larkin, C. Tobacco use disorder and treatment: New challenges and opportunities. Dialogues in Clinical Neuroscience 2017; 19(3), 271–280.
  20. Black, N., Johnston, M., Michie, S., Hartmann-Boyce, J., West, R., Viechtbauer, W., Eisma, M. C., Scott, C., and de Bruin, M. Behaviour change techniques associated with smoking cessation in intervention and comparator groups of randomized controlled trials: a systematic review and meta regression. Addiction, 2020;115: 2008– 2020. https://doi.org/10.1111/add.15056.
  21. Michie, S., Whittington, C., Hamoudi, Z., Zarnani, F., Tober, G. and West, R. Identification of behaviour change techniques to reduce excessive alcohol consumption. Addiction 2012; 107: 1431-1440. https://doi.org/10.1111/j.1360-0443.2012.03845.x
  22. Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344(18):1343-150.
  23. Rees K, Hartley L, Flowers N, Clarke A, Hooper L, Thorogood M, et al. ‘Mediterranean’ dietary pattern for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2013 Aug 12;(8):CD009825. doi(8):CD009825
  24. Lara, J., Evans, E.H., O’Brien, N. et al.Association of behaviour change techniques with effectiveness of dietary interventions among adults of retirement age: a systematic review and meta-analysis of randomised controlled trials. BMC Med 12,177 (2014). https://doi.org/10.1186/s12916-014-0177-3
  25. Fratiglioni L, Paillard-Borg S, Winblad B. An active and socially integrated lifestyle in late life might protect against dementia. The Lancet Neurology. 2004;3(6):343-53.
  26. Kuiper JS, Zuidersma M, Voshaar RCO, Zuidema SU, van den Heuvel ER, Stolk RP, et al. Social relationships and risk of dementia: a systematic review and meta-analysis of longitudinal cohort studies. Ageing research reviews. 2015;22:39-57.
  27. Portenhauser AA, Terhorst Y, Schultchen D, Sander LB, Denkinger MD, Stach M, Waldherr N, Dallmeier D, Baumeister H, Messner E. Mobile apps for older adults: systematic search and evaluation within online stores JMIR Aging 2021;4(1):e23313 doi: 2196/23313
  28. Andrews JA, Brown LJ, Hawley MS, Astell AJ. Older Adults’ perspectives on using digital technology to maintaing mental health: Interactive group study. J Med Internet Res 2019;21(2):e11694 doi: 2196/11694

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