Preventing Dementia

As the Baby Boomers enter their late sixties and seventies, increasing attention is focused on dementia and other diseases of the elderly, especially since the costs of treating individuals with those conditions is expected to rise dramatically.  Almost every day, the results of another study are released in the media, associating dementia with a variety of lifestyle choices that were made earlier in life.

First of all, such data should be viewed with some suspicion; while many are based on scientific analysis,  isolated studies are of limited value and must be confirmed by other scientific investigations.  To date, the pathophysiology of Alzheimer's disease (the leading cause of dementia) is poorly understood and one's age and the presence of this disorder in the family history are the only clear risk factors.  On the other hand, dementia caused by vascular disease in the brain is predisposed by the same factors that increase risk for vascular disease in other organs of the body (i.e. the heart, kidneys, etc.); it is thus reasonable to conclude that hypertension, chronic tobacco use, diabetes, hyperlipidemia and a family history of cardiovascular disease are important risk factors and that a healthy, well balanced diet, regular aerobic exercise and appropriate medical control of associated risk factors should reduce the incidence of this form of dementia.  Finally, it has become evident that repeated head injury, such as occurs in football players and boxers, is responsible for another form of dementia, often presenting in middle age.

Hopefully, continuing research will lead to effective preventive therapies for Alzheimer's disease.  In the meantime, individuals are advised to adhere to lifestyle choices that reduce the risk of both vascular disease and brain trauma.  In addition, current evidence suggests that ongoing cerebral "exercise", as occurs with reading, games, academic pursuits and other cognitive activities, may slow the onset of dementia.  Should early signs of dementia appear, it then becomes important to have frank discussions with family members, caretakers and health care providers, clarifying the level and intensity of medical care that one finds personally acceptable; too often, patients with dementia end up dying in hospitals (sometimes in ICUs) when they would have preferred to forego aggressive intervention and to have died at home.