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Welcome to St. Alphonsus Wellcast, the podcast where we explore the many facets of health

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and well-being.

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This podcast is brought to you by St. Alphonsus Corporate Health and Well-Being and a generous

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grant from the St. Alphonsus Foundation.

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Thanks for listening and enjoy the show.

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Hello, good afternoon. This is Kim Cleveland with the St. Alphonsus Wellcast. I'm the family

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nurse practitioner with the Department of Corporate Health and Well-Being.

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And today we have a special guest on Dr. Abelash Desai. He's a geriatric psychiatrist with

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St. Alphonsus in the Memory Center.

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And today we will be talking about protective factors and risk factors for dementia.

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Dr. Desai, thank you so much for coming on with us.

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Hi, Kim. Delighted to be here.

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Yeah, this is great. It's been a long time coming. We've been having this in the works

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for a while and we've been really excited to have this conversation and introduce this

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series of information as well as resources for family members and for patients who have

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questions about dementia and memory impairment. So tell us what you have to say.

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All right. So before we get started, let me ask you some questions and put you on the

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hot seat.

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Okay.

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So far, research has identified a certain number of factors that are considered potentially

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modifiable risk factors for dementia. So how many factors do you think research has identified?

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Just give a guess.

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Okay.

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Three, six, nine, or 12?

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I guess I would guess 12.

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You're right.

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Yeah, good.

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Oh my goodness. All right. Second question.

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Okay.

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So if all these 12 factors were eliminated from our population, right, our country, the

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whole world, what percentage of dementia would be prevented? So the answer is 10, 20, 30,

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40%.

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Maybe 30%.

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40%.

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40%.

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Wow.

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Exactly.

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Yeah.

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Now, obviously, as I go through the factors, you realize how hard it's going to be to

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eliminate them.

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Right.

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But so this is theoretical. But just for you to know how much, you know, our lifestyle

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and how we handle chronic diseases can influence our future risk of dementia.

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Yeah. I think that's something we'd all love to hear about. If there's anything we can

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do to keep ourselves healthy, difficult or not, I think we would at least like to know

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what direction to head.

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Right. All right. One more question. In the next year, across the whole world, how many

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new cases of dementia will occur over one year? So the answer is, you know, 2 million

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people, 5 million, 10 million, 15 million.

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10 million.

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Right.

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Oh, my goodness.

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Oh, great. Look at that.

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So then if 40% are preventable, right? So let's imagine that we went back into time

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and we took care of all these risk factors.

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Yeah.

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Then 4 million people the next year would not get dementia.

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Right.

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That's not a small number.

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No, it's not at all. That'd be a huge quality of life improvement.

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Exactly.

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So many people.

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And again, as you hear the factors, you'll realize that this same factors will influence

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your length of life, quantity of life. It's a good thing to do that anyway.

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Right.

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It'll also reduce your cardiovascular risk of say heart attacks, reduce your risk of

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stroke. So as you see, all these things are coming together where based on your genetics,

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the risk factors will cause that specific problem.

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Right.

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So even if I'm not at high risk, what's a dementia? And this is true. I'm at high risk

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for coronary artery disease. If I follow these things, it will reduce my risk for heart

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disease.

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So there's a little downside to making some of these changes.

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There's no downside. Well, downside is that it's hard work.

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Right.

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Okay. All right. Let's get started. So in 2017, the Lancet Commission, very reputable organization

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on all the experts identified nine potentially modifiable risk factors and I'll go through

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them. So first is no secondary education or more.

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Okay.

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So if everybody in the world got secondary education, 100,000 less people will develop

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dementia every year.

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Okay.

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So again, education is key starting early. And the thinking is that you're developing

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brain reserve or cognitive reserve, basically brain bank balance. I think it's more to it,

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you know, with education, you are more likely to understand all the health literacy information

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and follow all the things that you're supposed to do and so forth. So anyway, so that's number

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one.

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Then in midlife, so 45 to 65, there are certain factors that were identified. One is hypertension,

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which means if you treat it, you'll reduce your risk of future dementia, hearing impairment,

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which was surprising when I first saw it. But it makes sense because, you know, we listen

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and talk and that stimulates our brain.

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Right.

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When people have hearing impairment, they don't engage in social interactions as much.

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They might get depressed. Anyway, but really, in the future, we should start screening for

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hearing impairment and then helping them take care of that seriously because not only their

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quality of life will improve, but their future risk of dementia will go down. Smoking, not

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surprising, but now it's an established risk factor for dementia. Remember that's separate

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from your risk factor for heart disease and strokes. So again, if you stop smoking, you

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will reduce your risk of future dementia.

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And so get all the help for that. And then obesity is also midlife, all right, increases

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your risk of future dementia. So maybe the hypothesis is that obesity is linked to inflammation,

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that is increased inflammation. And then obviously that compromises brain function. It affects

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our vasculature, so there is decreased blood circulation. So again, you know, we need to

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realize that all these are modifiable. But as you know, it's not easy, right?

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Right.

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So we need to realize that we need to take care of our patients or ourselves. And then

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there is four late life factors. So that's older than 65. So one is depression, believe

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it or not, if you have late life, serious depression, you are at high risk of future

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dementia. And so I to say, but in some cases, this might be the earliest evidence of start

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of dementia.

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Okay.

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That's two is different things. And so we really need to aggressively treat dementia

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as a way to help them. They have underlying memory problems and help them. Physical inactivity,

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not surprised. So to me, I think it applies to midlife, but the research is definitely

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there for late life physical inactivity. Cedentry lifestyle is a no, no. And so if you dramatically

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improve that, you will reduce your risk of dementia. Diabetes, not surprising.

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Right.

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And then low social contact. So really, we need to really be very active in our social

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activities. And sometimes our, our culture is so focused on sort of achieving and production

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that we don't spend enough time with friends and family and just wasting time with them.

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Right.

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Yes.

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So no time to stop that.

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Yeah.

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So there are three more factors, but any thoughts on what I've said so far?

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Yeah, I just, I think it's interesting because, you know, these are 12 different factors that

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independently impact somebody's risk, but then also you think about how they play together,

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you know, depression makes people less likely to be active and also less likely to engage

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in social relationships.

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Okay.

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Similarly with, you know, hearing loss. If you have hearing loss, it's harder to interact

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socially and maybe you aren't able to even have your brain stimulated in the same way

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because you're losing out on one of your senses part of the time. So I'm seeing a lot of overlap,

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but also how addressing each one separately can maybe create a whole picture of wellness

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and health span as well.

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Right. Right. So this is both for the people listening and if they are not sure, they should

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bring this up with their primary care physicians and providers regarding why brain health for

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them is important. And this is not just for people who have family history of dementia

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or, you know, some genetic risks, but in general, one of the biggest risk factors for dementia

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is age, which means that all of us are at risk because there's a good chance that the

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average life expectancy is like 75, 80, even 85.

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Right.

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So, all right. So, and by the way, if all these factors, believe it or not, hearing impairment

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has the highest risk compared to others. So if nobody had hearing impairment, 800,000

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less people would get dementia next year.

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Yeah. Turn off that rock music.

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Oh my goodness.

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All right. And then in 2020, Lancet Commission came back because there was more research

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to identify three more potentially modifiable risk factors for dementia. So number one,

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excessive alcohol consumption, more than 21 units per week. Second, traumatic brain injury.

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So seed bells, you know, helmets and anything else you can do to protect your brain.

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Concussion management.

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Exactly. Exactly. And then air pollution. So that's where, you know, the government

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and where we live come and play. So on a side note, you know, one in eight deaths in Europe

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are linked to pollution. I'm sure we'll have some similar statistics in the US.

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So we have three more. Alcohol, TBI, air pollution. Any thoughts?

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Yeah. I mean, I think we've talked a little bit about alcohol in the podcast before and

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how we've kind of seen the swing in the other direction with upcoming generations and how

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they're realizing the harmful effects of alcohol and abstaining a little bit more. And then

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there's sort of some of the, if you generalize, some of the middle-aged generations are still

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imbibing quite a bit. And I think there is a, there's a little bit to be said, you know,

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what other ways can we use to manage stress and to socialize and involve ourselves in

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situations that maybe are a little less harmful for our health.

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So I want to finish with just a mention of some protective factors, which would be obvious.

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One is moderate to vigorous physical activity. So that's a little more than mild. So anybody

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who's, you know, interested in truly reducing their risk or protecting themselves should

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make sure that they are doing moderate to vigorous physical activity. And now we have

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all these amounts of time and intensity. And so I think people should read up and maybe

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in the future we can just talk about exercise itself.

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Oh, definitely.

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As a whole separate podcast.

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Yeah. And I think with cardiovascular disease risk protection, you're thinking about getting

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so active that you can breathe, but you can't sing, right? Or you can maybe talk, but you

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can't sing for 30 to 45 minutes, most days of the week, if you can. I think that's what's

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studied the most. And certainly that's something we can all strive for.

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The second is again, obvious, very rich social life, spend more time with family, friends,

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have fun. And if you feel guilty, feel guilt on what I say a timer, 10 minutes a day.

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Yeah.

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Your day's quote off guilt is a lot.

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Yeah, exactly.

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And believe it or not, nutrition, so obviously balanced nutrition, right? We have all kinds

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of macronutrients, micronutrients, probiotics, and we'll have another show for that. But

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there are some studies to show that Mediterranean diet plus plus dash diet dietary approaches

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to stop hypertension have been linked to better brain function in general, reduced risks of

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dementia. And so I think in general, if your diet is sad, standard American diet, I would

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be very sad.

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Yes.

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Yes.

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So again, in the past, we didn't realize that we can really alter our health and brain health

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trajectory. And so the main messages that we need to kickstart, kick off a brain health

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and wellness journey now.

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Yes.

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That's it.

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That's all. Yeah, I think this was super enlightening. I mean, I think this opens the

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door to so many different things that we can talk about in terms of how to lower our risk,

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improve our overall health, improve our brain function, you know, in our house, my kids love

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to eat junk food. And whenever I try to give them something healthy, we always say it's

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brain food.

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Right.

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And it usually gets them going on eating the right thing. And I think, you know, those

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are just ways that we can kind of reframe the way we're looking at our lives in terms

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of how we can protect ourselves and go forward into overall health.

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So what's the take home message here?

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What's the number one piece of advice you would give to someone who's looking to protect

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themselves from dementia?

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Well, you know, make a commitment to really strongly make brain health, your priority

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going forward and radically alter your lifestyle if that needs to happen.

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Yeah, and take such courage. That's great.

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Right.

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Well, thank you so much for the information today. I think this was really informative

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and, you know, at least gives us some context moving forward as well about what we can do

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for our overall health and to protect our brain.

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Hey, I've talked about memory. I forgot something.

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Yeah.

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So that's just me. All right. I think there's going to be increased research on regular

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meditation, yoga, Tai Chi relaxation exercises for 20 minutes that will also have a protective

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effect.

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Yeah. I mean, that'll be more research to come on that for sure. I was a little surprised

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to not hear sleep on the protective factors.

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Well, another thing I forgot.

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Or risk factors.

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No, you're right. So I think in the future, we will see more potentially modifiable risk

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factors added. I think sleep problems, sleep disorders will be probably the first thing

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to come online. Totally agree.

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Yeah. Well, hopefully we'll have more research and we can get a study going of our own.

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Yeah, for sure.

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Well, great. Okay. Well, we will see you next time where we hopefully will be talking about

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nutrition and really guards to dementia with Amy James, our registered dietitian as well.

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And if you are a loved one, feel as though you could benefit from some of the resources

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from the brain center, the memory center. You can contact the memory center via 208-302-5400

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and see a provider there. There is no self-referral process, but you can also be in touch with

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your primary care provider in order to obtain a referral or you can always call to get more

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information. Thank you so much. And I hope you have a great day and we will see you next

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time.

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Thank you.

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Thank you for listening to this episode of St. Alphonsus Wellcast, brought to you by St.

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Alphonsus Corporate Health and Well-Being and the St. Alphonsus Foundation. Always be

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sure to catch new episodes by subscribing to us through all major podcast platforms,

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including Apple, Google and Spotify. We hope you will tune in again. Until then, be well.