Reducing risks of Alzheimer’s and living better with it

Alzheimer’s disease is the health condition Americans 60 or older are most afraid of getting, according to a large poll. But dementia experts say research is increasingly demonstrating that there are ways to reduce that risk.

Five authorities on dementia spoke about them at the “Living Well With Dementia” panel I attended during the American Society on Aging’s national conference, On Aging 2023, in Atlanta.

“We have come so far that we can talk about dementia risk reduction. That is a sea change,” said Sarah Lenz Lock, executive director of AARP’s Global Council on Brain Health.

Alzheimer’s dementia affects 6.5 million Americans, a number expected to nearly double to 12.7 million by 2050, the Alzheimer’s Association predicts. The risk of developing dementia doubles every five years after 65. By 85, roughly one in three Americans will have it, most of them women.

An article in the American Society on Aging’s spring 2023 Generations Journal — an issue devoted to living well with dementia — noted, however, that “several reports have reached the conclusion that cognitive decline may be slowed, and dementia may be delayed or prevented, through the implementation of interventions that address certain risk factors.”

The five big factors increasing the risk for cognitive decline, dementia or both: diabetes, midlife hypertension or high blood pressure, physical inactivity, smoking and midlife obesity.

Reduce those factors, the experts said, and you can lower your chance of Alzheimer’s or another dementia.

Research has found that the presence of these five risk factors increased memory or thinking problems known as subjective cognitive decline (SCD), an early warning of potential future dementia, the Generations Journal article authors wrote.

They noted that smokers were 82% more likely to report SCD problems than nonsmokers. Similarly, people with diabetes were 76% more likely to report subjective cognitive decline than those without diabetes.

Two-thirds of adults have at least one of these five risk factors.

And “over three-quarters of Black adults have at least one,” said On Aging panelist Heidi Holt, a Centers for Disease Control and Prevention (CDC) public health adviser specializing in Alzheimer’s.

A 2015 clinical trial in Finland said exercise, diet and intellectual and social stimulation could maintain or even improve cognitive functioning in older adults at risk for developing Alzheimer’s. Recommended foods: green leafy vegetables, berries, nuts, beans and fatty fish.

And a 2022 clinical trial, known as EXERT, proved the importance of exercise for people who’d been diagnosed with mild cognitive decline related to Alzheimer’s.

The older people in this study who did either aerobics or balance and stretching exercises several times a week over a year’s time didn’t experience further cognitive declines. Cognition deteriorated significantly for the ones who did neither type of exercise.

The On Aging panelists noted that reducing risk factors for Alzheimer’s and related dementias has become a U.S. governmental mission.

The U.S. Department of Health and Human Services (HHS) in 2021 added a sixth goal to the National Plan to Address Alzheimer’s Disease, released in 2012: “to accelerate action to promote healthy aging and reduce risk factors for Alzheimer’s disease and related dementias.”

HHS says an aggressive public health effort to reduce the prevalence of dementia risk factors could result in roughly 1 million fewer Americans living with Alzheimer’s in 2050, compared with current projections.

The conference panelists and Generations Journal authors believed doctors could do more to help people reduce the risk of dementia, detect signs of dementia in patients and aid those who have dementia.

Said Nora Super, a senior fellow at the Long-Term Quality Alliance, who co-edited the Generations Journal issue: “Physicians prescribe a pill when you ask for something. We say: nonpharmaceutical approaches should be the first line of defense” for Alzheimer’s and other dementias.

If a patient shows signs of cognitive impairment during a routine visit, Medicare, since 2017, has covered a separate visit to more thoroughly assess the person’s cognitive function and develop a care plan. But fewer than 1% of eligible beneficiaries were given a cognitive assessment and care plan visit in the first year the coverage was available, according to Generations Journal authors Soo Borson and Joshua Chodosh, co-leads of the BOLD Center of Excellence on Early Detection of Dementia.

During the conference panel, Lock cited AARP research urging doctors to talk with their patients with dementia about lifestyle factors to let them live better with the disease.

“When physicians were asked about lifestyle factors that could help dementia patients live better lives, they knew all about them,” she said. “They just weren’t telling them.”