Protecting your brain

Prof Jenny Firman AM
Chief Health Officer
Department of Veterans’ Affairs

Have you ever run into someone you haven’t seen in years and can’t recall their name? ‘Senior moments’ happen to us all as we age. We all experience physical decline but cognitive decline also occurs. This might be forgetting a name, losing your keys or forgetting a word.

As people age normally, it is common to process information and learn new things less efficiently. Mostly this is a normal part of ageing. However, it can bring on concerns that this is an early sign of dementia.

In Australia, we enjoy a life expectancy of 82.8 years, the seventh highest among Organisation for Economic Co-operation and Development (OECD) countries. This means our ageing population is increasing. And because dementia is common in people of advanced age, so is the number of people living with dementia. In 2020, it was estimated that between 400,000 and 459,000 people in Australia with dementia.

Dementia is a general term used to describe when a person has developed difficulties with reasoning, judgement and memory. People who have dementia usually have some memory loss as well as difficulty in at least one other area, such as speaking or writing coherently (or understanding what is said or written), recognising familiar surroundings, or planning and carrying out complex or multi-step tasks. To be considered dementia, these issues must be severe enough to interfere with a person’s independence and daily activities.

There are several different types of dementia, with Alzheimer’s disease being the most common (60–80%) followed by vascular dementia. Less common types are Lewy body disease and frontotemporal dementia. Among those who are more advanced in age, dementia may have more than one cause — often Alzheimer’s disease as well as vascular damage.

While there are different types of dementia, there are some common risk factors — some of which you can influence and some you can’t. Increasing age and family history are factors you can’t control. We all age and as we do so dementia becomes more common — around 30% of people over 85 live with dementia. Some types of dementia, including Alzheimer’s, run in families. In these cases, the risk to you is highest if the relative with dementia is genetically close (a parent or sibling) and whether their dementia started at a younger age (less than 70).

However, there are modifiable risk factors. That means, if we make some lifestyle changes we can reduce the risk of dementia.

Stimulate your brain — ‘Use it or lose it’. You can improve your brain function at any point in your life, through paid or unpaid work and through pleasurable activities such as reading newspapers, playing card games, or learning a new language or skill. Reasoning and speed-of-processing training was found in one study to be more important than memory training. Lower education levels are associated with increased risk. Later retirement is a protective factor. So keep working and keep learning.

Better still, learning these new skills in a social setting appears to be beneficial. Social contacts are important to brain function — visiting family and friends, talking on the phone (or in these COVID times over video chat), or getting involved in group or community activities. Wearing hearing aids is protective and can help in maintaining social contacts and cognitive stimulation.

Sustained exercise in midlife and possibly later in life protects you from dementia. A recent systematic review in the British Medical Journal of Sports Medicine showed that exercise in over-50s improved cognitive function. The evidence indicated that exercise that was a mixture of aerobic and resistance exercise of moderate intensity (raises a sweat), from 45 to 60 minutes each time, on as many days of the week, as feasible, was the most effective.

Exercise helps control cardiovascular risk factors such as blood pressure, cholesterol and diabetes. Another cardiovascular risk factor is smoking. Dementia risk is higher in current smokers compared with past smokers and non-smokers — another good reason to quit. See your doctor and make sure your blood pressure is well controlled. High blood pressure and obesity both increase risk of dementia. Diabetes not only increases cardiovascular risk but also the risk of dementia.

Depression can cause changes in the brain that might increase dementia risk. Certainly, those who are depressed can have poor cognition, and depression can be seen in the early stages of dementia. An Australian study found that treatment with antidepressant medication delayed progression to clinically diagnosed Alzheimer’s.

Avoid heavy drinking as this is known to cause brain changes, cognitive impairment and dementia.

A healthy diet has also been associated with reduced risk of dementia and the World Health Organization recommends the Mediterranean diet, which has also been associated with improved mood.

Adequate sleep is also important and two meta-analyses on the effect of sleep and all causes of dementia showed that adequate sleep can reduce risk. Higher risks were seen with less than 5 hours of sleep and more than 10 hours of sleep.

So not surprisingly, looking after your health throughout your life looks after your brain health as well. It has been estimated that 35% of the risk for dementia is associated with these modifiable risk factors. So take regular exercise, maintain a good diet and good social contacts, and see your GP.

If you are concerned about dementia you should talk with your GP. The recommendations here are helpful for those who suffer dementia as well as those who want to look after their health.

DVA provides a range of supports to help you, from (for eligible clients) subsidising visits to your GP and appropriate medication, support to help you manage your diabetes, nutritional advice through a dietician, the Heart Health program (dva.gov.au and search for ‘heart health’) and physiotherapy and exercise physiology to help you exercise within the limits of your medical condition. Mental health treatment is available to all veterans through Open Arms — Veterans & Families Counselling and through Non-Liability Health Care.

Ex-service organisations can assist with social programs and activities to help you keep in contact with other veterans and their families, and your community.