The interplay of genes, environment, and lifestyle is responsible for most of our vulnerability and disease resistance. The influence of modifiable environmental and lifestyle factors has recently become a source of interest and optimism in the research on age-associated cognitive decline because several of these factors have been shown to impact (some positively, some negatively) the likelihood of experiencing cognitive decline that may or may not progress to Dementia.
Mental Flexibility As We Age
Mental flexibility usually decreases with age. Consciously remembering facts, events, and practical knowledge may become more challenging. Multitasking and executive functions that involve quick thinking, verbal communication, and mathematical reasoning tend to slow down, particularly after reaching 70 years of age. The capacity to quickly retrieve recently acquired information may diminish.
Mild Cognitive Impairment (MCI) is characterized by cognitive deterioration beyond normal aging expectations. It can stem from a neurodegenerative disorder or be linked to factors such as vitamin deficiency, sleep disturbances, or medication side effects, potentially allowing for reversibility. Individuals with MCI often experience heightened memory and cognitive challenges, leading to difficulties in daily tasks, verbal expression, feelings of frustration, disorganization, and being overwhelmed despite maintaining some level of independence.
While many individuals reach their 90s and beyond without showing any signs of Dementia, a gradual decline in cognitive abilities could lead to the development of Dementia. Research suggests that around 10 to 15 percent of individuals with Mild Cognitive Impairment (MCI) may progress to Dementia. However, a 2024 study found that this progression occurred in about 30 percent of participants with MCI, whose average age was 70. Heightened confusion, memory issues, and difficulties in communication, reading, and writing characterize Dementia. Common symptoms include repetitive questioning, wandering, impulsivity, and diminished empathy. In its advanced stages, individuals with Dementia often rely heavily on others to assist with their daily activities.
What Factors are Associated with Cognitive Decline?
Researchers can conclude the likelihood of developing certain diseases by collecting data on thousands of individuals and tracking them over many years or until their passing. The U.S. National Death Index (NDI) holds more than 100 million death records, enabling researchers to link a person's cause of death with information about their environment and lifestyle during their earlier years.
Recent extensive research utilizing the NDI to conduct follow-ups years later on individuals who participated in significant studies has revealed that elements such as diet, physical activity, social engagement, and specific physical and behavioral factors play a role in developing and advancing cognitive decline. For instance, age-related hearing impairment has been proven to heighten the likelihood of cognitive decline in older adults. However, addressing this impairment with a hearing aid may diminish the risk.
Below is a concise overview of certain factors linked to a higher or lower likelihood of cognitive decline. It is important to note that these factors are not direct causes or safeguards against decline; they have been demonstrated through extensive scholarly research involving large populations to have a statistically notable influence on risk.
Factors that have been linked to HIGHER Dementia risk
Diabetes, hearing and vision loss, high blood pressure, and high or low HCL cholesterol are common in older adults and can be treated and improved in almost all cases.
Obesity and poor bone health often result from unhealthy eating patterns. A common source is consuming too many ultra-processed, food-based products full of additives and stripped of nutrients, such as packaged snacks and desserts, sugary breakfast cereals, processed meats, sweetened beverages, and instant soups.
A sedentary lifestyle and social isolation have been linked with an increased risk of developing Dementia. This is also true of binge drinking and excessive alcohol consumption, smoking, chronic stress, depression, and the lack of deep sleep.
Nightmares, post-traumatic stress disorder, and regular laxative use have also been identified as risk factors that may be modifiable.
Factors that have been linked to LOWER Dementia risk
Healthy eating habits are protective, including a high-fiber diet.
It is helpful to consume leafy green vegetables and orange fruits because they contain carotenoid antioxidants, which defend against several degenerative disorders and enhance the immune system.
Also important are fruits (apples, berries, cherries), onions, soybeans, and teas that contain dietary flavanols, compounds that have anti-cancer, anti-inflammatory, and anti-viral properties.
The Mediterranean diet (https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801) and the MIND diet (Mediterranean diet intervention for neurodegenerative delay) (https://www.hsph.harvard.edu/nutrutionsource/healthy-weight/diet-reviews/mind-diet/) are recommended.
Regular exercise is crucial (see the article, "Get Moving! The value of exercise in reducing the risk of cognitive decline." CaringKind Newsletter 3:4) https://www.caringkindnyc.org/2022v3-newsletter.
Hearing aids, cataract surgery, and other interventions that improve the ability to communicate can lower your risk of cognitive decline.
Stimulating cognitive activities (crossword puzzles, games, reading) may build cognitive reserve.
Social activities (dancing, art classes, and other recreational and leisure activities that involve building relationships with others) are also linked with reducing the risk of cognitive impairment.
It is also essential to minimize the consequences of physical illness with interventions like getting an annual influenza vaccination. Covid-19 and RNA vaccines have not yet been convincingly linked to lowering the risk of developing Dementia. Still, because they minimize the risk of serious illness, it is reasonable to think they may also reduce the risk of cognitive impairment.
If you have type 2 diabetes, treatment with metformin shows evidence of reducing the risk of neurodegenerative disease.
A large study published in February 2024 about the use of Viagra and similar erectile dysfunction (ED) drugs has produced fascinating results. These drugs dilate blood vessels and have been shown to increase blood flow in the brains of animals. Men who received the most prescriptions for ED pills throughout the study had a significantly lower risk of developing Dementia. Further study is necessary to understand whether the drugs can protect against Dementia (for women as well as for men) or whether men who are less prone to the disease are more likely to use those drugs.
A Healthy Lifestyle May Lead to Better Brain Health
Recent speculation, as stated in a JAMA Neurology editorial dated March 25, 2024, suggests that the enhancement of brain health resulting from global advancements in living standards, education, and healthcare could potentially reduce the risk of Dementia in the future. This contrasts with the typical grim forecasts of a notable rise in Dementia cases as the global population ages. Only time will reveal the accuracy of these predictions.
In the meantime, why not push yourself to integrate a healthy lifestyle and environmental changes linked to improving cognitive function?
Eat healthily.
Find a way to exercise regularly to whatever degree is possible for you. Even modest increases in physical activity are beneficial.
If you aren't working or socially active, consider volunteering or getting involved somewhere to be socially and intellectually stimulated.
Try to get the best medical care possible if something seems to be physically or psychologically wrong.
Authors' opinions are not necessarily those of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, paid or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org
Contributing Author: Carol A. Butler, Ph.D.
Carol A. Butler was born and educated in New York City. She graduated from the Bronx High School of Science, Queens College, and New York University, receiving her Master's and Doctoral degrees. She has a private practice in Manhattan, providing psychotherapy for individuals and couples and clinical supervision for other therapists. She is currently active in the areas of research and treatment of various forms of Dementia, including Alzheimer's disease. She is a N.Y. State licensed Psychoanalyst with advanced training in mediation, arbitration, clinical supervision, and the treatment of sexual dysfunctions and addictive disorders. She has co-authored eight books and many articles.
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