Welcome to St. Alphonsus Wellcast, the podcast where we explore the many facets of health
and well-being.
This podcast is brought to you by St. Alphonsus Corporate Health and Well-Being and a generous
grant from the St. Alphonsus Foundation.
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Hello, good afternoon. This is Kim Cleveland with the St. Alphonsus Wellcast. I'm the family
nurse practitioner with the Department of Corporate Health and Well-Being.
And today we have a special guest on Dr. Abelash Desai. He's a geriatric psychiatrist with
St. Alphonsus in the Memory Center.
And today we will be talking about protective factors and risk factors for dementia.
Dr. Desai, thank you so much for coming on with us.
Hi, Kim. Delighted to be here.
Yeah, this is great. It's been a long time coming. We've been having this in the works
for a while and we've been really excited to have this conversation and introduce this
series of information as well as resources for family members and for patients who have
questions about dementia and memory impairment. So tell us what you have to say.
All right. So before we get started, let me ask you some questions and put you on the
hot seat.
Okay.
So far, research has identified a certain number of factors that are considered potentially
modifiable risk factors for dementia. So how many factors do you think research has identified?
Just give a guess.
Okay.
Three, six, nine, or 12?
I guess I would guess 12.
You're right.
Yeah, good.
Oh my goodness. All right. Second question.
Okay.
So if all these 12 factors were eliminated from our population, right, our country, the
whole world, what percentage of dementia would be prevented? So the answer is 10, 20, 30,
40%.
Maybe 30%.
40%.
Wow.
Exactly.
Yeah.
Now, obviously, as I go through the factors, you realize how hard it's going to be to
eliminate them.
Right.
But so this is theoretical. But just for you to know how much, you know, our lifestyle
and how we handle chronic diseases can influence our future risk of dementia.
Yeah. I think that's something we'd all love to hear about. If there's anything we can
do to keep ourselves healthy, difficult or not, I think we would at least like to know
what direction to head.
Right. All right. One more question. In the next year, across the whole world, how many
new cases of dementia will occur over one year? So the answer is, you know, 2 million
people, 5 million, 10 million, 15 million.
10 million.
Right.
Oh, my goodness.
Oh, great. Look at that.
So then if 40% are preventable, right? So let's imagine that we went back into time
and we took care of all these risk factors.
Yeah.
Then 4 million people the next year would not get dementia.
Right.
That's not a small number.
No, it's not at all. That'd be a huge quality of life improvement.
Exactly.
So many people.
And again, as you hear the factors, you'll realize that this same factors will influence
your length of life, quantity of life. It's a good thing to do that anyway.
Right.
It'll also reduce your cardiovascular risk of say heart attacks, reduce your risk of
stroke. So as you see, all these things are coming together where based on your genetics,
the risk factors will cause that specific problem.
Right.
So even if I'm not at high risk, what's a dementia? And this is true. I'm at high risk
for coronary artery disease. If I follow these things, it will reduce my risk for heart
disease.
So there's a little downside to making some of these changes.
There's no downside. Well, downside is that it's hard work.
Right.
Okay. All right. Let's get started. So in 2017, the Lancet Commission, very reputable organization
on all the experts identified nine potentially modifiable risk factors and I'll go through
them. So first is no secondary education or more.
Okay.
So if everybody in the world got secondary education, 100,000 less people will develop
dementia every year.
Okay.
So again, education is key starting early. And the thinking is that you're developing
brain reserve or cognitive reserve, basically brain bank balance. I think it's more to it,
you know, with education, you are more likely to understand all the health literacy information
and follow all the things that you're supposed to do and so forth. So anyway, so that's number
one.
Then in midlife, so 45 to 65, there are certain factors that were identified. One is hypertension,
which means if you treat it, you'll reduce your risk of future dementia, hearing impairment,
which was surprising when I first saw it. But it makes sense because, you know, we listen
and talk and that stimulates our brain.
Right.
When people have hearing impairment, they don't engage in social interactions as much.
They might get depressed. Anyway, but really, in the future, we should start screening for
hearing impairment and then helping them take care of that seriously because not only their
quality of life will improve, but their future risk of dementia will go down. Smoking, not
surprising, but now it's an established risk factor for dementia. Remember that's separate
from your risk factor for heart disease and strokes. So again, if you stop smoking, you
will reduce your risk of future dementia.
And so get all the help for that. And then obesity is also midlife, all right, increases
your risk of future dementia. So maybe the hypothesis is that obesity is linked to inflammation,
that is increased inflammation. And then obviously that compromises brain function. It affects
our vasculature, so there is decreased blood circulation. So again, you know, we need to
realize that all these are modifiable. But as you know, it's not easy, right?
Right.
So we need to realize that we need to take care of our patients or ourselves. And then
there is four late life factors. So that's older than 65. So one is depression, believe
it or not, if you have late life, serious depression, you are at high risk of future
dementia. And so I to say, but in some cases, this might be the earliest evidence of start
of dementia.
Okay.
That's two is different things. And so we really need to aggressively treat dementia
as a way to help them. They have underlying memory problems and help them. Physical inactivity,
not surprised. So to me, I think it applies to midlife, but the research is definitely
there for late life physical inactivity. Cedentry lifestyle is a no, no. And so if you dramatically
improve that, you will reduce your risk of dementia. Diabetes, not surprising.
Right.
And then low social contact. So really, we need to really be very active in our social
activities. And sometimes our, our culture is so focused on sort of achieving and production
that we don't spend enough time with friends and family and just wasting time with them.
Right.
Yes.
So no time to stop that.
Yeah.
So there are three more factors, but any thoughts on what I've said so far?
Yeah, I just, I think it's interesting because, you know, these are 12 different factors that
independently impact somebody's risk, but then also you think about how they play together,
you know, depression makes people less likely to be active and also less likely to engage
in social relationships.
Okay.
Similarly with, you know, hearing loss. If you have hearing loss, it's harder to interact
socially and maybe you aren't able to even have your brain stimulated in the same way
because you're losing out on one of your senses part of the time. So I'm seeing a lot of overlap,
but also how addressing each one separately can maybe create a whole picture of wellness
and health span as well.
Right. Right. So this is both for the people listening and if they are not sure, they should
bring this up with their primary care physicians and providers regarding why brain health for
them is important. And this is not just for people who have family history of dementia
or, you know, some genetic risks, but in general, one of the biggest risk factors for dementia
is age, which means that all of us are at risk because there's a good chance that the
average life expectancy is like 75, 80, even 85.
Right.
So, all right. So, and by the way, if all these factors, believe it or not, hearing impairment
has the highest risk compared to others. So if nobody had hearing impairment, 800,000
less people would get dementia next year.
Yeah. Turn off that rock music.
Oh my goodness.
All right. And then in 2020, Lancet Commission came back because there was more research
to identify three more potentially modifiable risk factors for dementia. So number one,
excessive alcohol consumption, more than 21 units per week. Second, traumatic brain injury.
So seed bells, you know, helmets and anything else you can do to protect your brain.
Concussion management.
Exactly. Exactly. And then air pollution. So that's where, you know, the government
and where we live come and play. So on a side note, you know, one in eight deaths in Europe
are linked to pollution. I'm sure we'll have some similar statistics in the US.
So we have three more. Alcohol, TBI, air pollution. Any thoughts?
Yeah. I mean, I think we've talked a little bit about alcohol in the podcast before and
how we've kind of seen the swing in the other direction with upcoming generations and how
they're realizing the harmful effects of alcohol and abstaining a little bit more. And then
there's sort of some of the, if you generalize, some of the middle-aged generations are still
imbibing quite a bit. And I think there is a, there's a little bit to be said, you know,
what other ways can we use to manage stress and to socialize and involve ourselves in
situations that maybe are a little less harmful for our health.
So I want to finish with just a mention of some protective factors, which would be obvious.
One is moderate to vigorous physical activity. So that's a little more than mild. So anybody
who's, you know, interested in truly reducing their risk or protecting themselves should
make sure that they are doing moderate to vigorous physical activity. And now we have
all these amounts of time and intensity. And so I think people should read up and maybe
in the future we can just talk about exercise itself.
Oh, definitely.
As a whole separate podcast.
Yeah. And I think with cardiovascular disease risk protection, you're thinking about getting
so active that you can breathe, but you can't sing, right? Or you can maybe talk, but you
can't sing for 30 to 45 minutes, most days of the week, if you can. I think that's what's
studied the most. And certainly that's something we can all strive for.
The second is again, obvious, very rich social life, spend more time with family, friends,
have fun. And if you feel guilty, feel guilt on what I say a timer, 10 minutes a day.
Yeah.
Your day's quote off guilt is a lot.
Yeah, exactly.
And believe it or not, nutrition, so obviously balanced nutrition, right? We have all kinds
of macronutrients, micronutrients, probiotics, and we'll have another show for that. But
there are some studies to show that Mediterranean diet plus plus dash diet dietary approaches
to stop hypertension have been linked to better brain function in general, reduced risks of
dementia. And so I think in general, if your diet is sad, standard American diet, I would
be very sad.
Yes.
So again, in the past, we didn't realize that we can really alter our health and brain health
trajectory. And so the main messages that we need to kickstart, kick off a brain health
and wellness journey now.
Yes.
That's it.
That's all. Yeah, I think this was super enlightening. I mean, I think this opens the
door to so many different things that we can talk about in terms of how to lower our risk,
improve our overall health, improve our brain function, you know, in our house, my kids love
to eat junk food. And whenever I try to give them something healthy, we always say it's
brain food.
Right.
And it usually gets them going on eating the right thing. And I think, you know, those
are just ways that we can kind of reframe the way we're looking at our lives in terms
of how we can protect ourselves and go forward into overall health.
So what's the take home message here?
What's the number one piece of advice you would give to someone who's looking to protect
themselves from dementia?
Well, you know, make a commitment to really strongly make brain health, your priority
going forward and radically alter your lifestyle if that needs to happen.
Yeah, and take such courage. That's great.
Right.
Well, thank you so much for the information today. I think this was really informative
and, you know, at least gives us some context moving forward as well about what we can do
for our overall health and to protect our brain.
Hey, I've talked about memory. I forgot something.
Yeah.
So that's just me. All right. I think there's going to be increased research on regular
meditation, yoga, Tai Chi relaxation exercises for 20 minutes that will also have a protective
effect.
Yeah. I mean, that'll be more research to come on that for sure. I was a little surprised
to not hear sleep on the protective factors.
Well, another thing I forgot.
Or risk factors.
No, you're right. So I think in the future, we will see more potentially modifiable risk
factors added. I think sleep problems, sleep disorders will be probably the first thing
to come online. Totally agree.
Yeah. Well, hopefully we'll have more research and we can get a study going of our own.
Yeah, for sure.
Well, great. Okay. Well, we will see you next time where we hopefully will be talking about
nutrition and really guards to dementia with Amy James, our registered dietitian as well.
And if you are a loved one, feel as though you could benefit from some of the resources
from the brain center, the memory center. You can contact the memory center via 208-302-5400
and see a provider there. There is no self-referral process, but you can also be in touch with
your primary care provider in order to obtain a referral or you can always call to get more
information. Thank you so much. And I hope you have a great day and we will see you next
time.
Thank you.
Thank you for listening to this episode of St. Alphonsus Wellcast, brought to you by St.
Alphonsus Corporate Health and Well-Being and the St. Alphonsus Foundation. Always be
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