Whenever I mention that I work in mental health and aging, I am typically asked, “How do I keep my brain as sharp as possible for as long as possible?” Although I rarely encounter fear of aging or death in these conversations, I regularly hear others express dread about losing memory and functioning. We all want to live a long and healthy life, and being older with impaired memory and functioning is not usually something we desire.
Statistics undeniably show that our risk of dementia increases as we grow older. The possibility of Alzheimer's disease or vascular dementia doubles every five years for a senior over 65. At 85 years of age, the risk reaches 33 percent. Although we cannot do much about certain genetic and environmental components, there are many risk factors of cognitive decline and dementia that we can address earlier in life. These factors impact what's going on below the surface, and we may not think about them until they cause more severe problems. Making changes in one or all of these areas can reduce your dementia risk. Although we cannot wholly avoid what may be inevitable, with accurate information about what increases one's risk, what can help with brain health, and how to build cognitive reserve, we have more awareness and greater control. In this article, I hope to share some valuable information on what you can consider in mid- and older adulthood to optimize brain health and lower one's risk of developing dementia.
Modifiable Risk Factors to Optimize Brain Health
What to Consider in Young to Mid-Adulthood
1. Heart Health
A healthy cardiovascular system is an excellent indicator of a healthy brain! With blood carrying the brain's necessary fuel of glucose and oxygen, our brain is at its healthiest when blood flow to it is optimal. Many cardiovascular conditions impact the heart's ability to pump that fuel. They also narrow blood vessels and reduce blood flow. Some of the most substantial risk factors for dementia, including Alzheimer's and vascular dementia, are cardiovascular conditions like high blood pressure and high cholesterol. Given that, and that studies have shown that the relationship between these cardiovascular conditions and dementia can start in midlife, it seems important to consider ways to keep your heart as healthy as possible in young adulthood and onward. Regular exercise in young to mid-adulthood is a great, if not the best, way to keep that heart (and brain) working its best. The beneficial effects of exercise on brain health truly last throughout the lifespan.
2. What We Eat and Drink
Many patients ask me about the best foods for preserving or improving brain health. Although I am not a nutritionist or dietician, it seems clear that certain foods we eat can impact cardiovascular conditions and, therefore, the brain. For instance:
- High amounts of saturated fat increase cholesterol
High amounts of salt increase stroke risk and high blood pressure
High amounts of sugar heighten the likelihood of Type 2 diabetes.
These diet and health relationships are present in young and mid-adulthood, with cognitive decline linked with factors like high saturated fat intake in midlife and beyond.1 Therefore, it would make sense to consider heart-healthy foods in young to mid-adulthood to help your future brain health. Also, although the effects of alcohol use in moderation are still unknown, the use of alcohol at significantly high levels for 15+ years increases the risks of developing certain types of dementia, including vascular dementia. Awareness of your alcohol intake, and the possible impact later on in life, may be useful to consider in young to mid-adulthood.
3. Oral Hygiene and Inflammation
Although sometimes not spoken about as much as general medical checkups and wellness, regular dentist visits and prevention of oral disease can be pretty important for brain health. More specifically, those with severe periodontal disease can have a greater risk for cognitive decline. We know that gum disease is a form of inflammation, which increases the risk of many disorders later on in life. With severe periodontal disease impacting those in mid-adulthood, taking steps in midlife to prevent gum disease and inflammation would be a modifiable factor that would benefit you and your dementia-risk potential.
Pro Tip: Learn more about your oral health and preventative care in our senior oral health and hygiene guide.
4. Mental Complexity in Life Roles
A day-to-day life that offers some level of complexity provides protective effects against developing dementia. Whether this is in professional, educational, parenting, or other life roles, challenging your brain as early as young and mid-adulthood pays off with its associated development of cognitive reserve.
FYI: If you're retired and looking for ways to work with people, consider volunteering in your community. Visit our guide to volunteering and charity involvement for ideas on how to get started.
Interestingly, working with people has even more of a brain-protective effect versus jobs with “things” or numbers.2 Furthermore, making decisions as often as possible helps us develop intellectual flexibility. In a job or other life roles, regular intellectual stimulation and complexity, particularly during young and mid-adulthood, is linked to improved brain health.3
What to Consider in Older Adulthood (65 years and older)
1. Medication Management
Eighty-nine percent of Americans age 65+ take at least one prescription drug regularly.4 Those 65 and older who take prescription drugs, take 4.5 medications on average. Polypharmacy is the regular use of four or more medications (prescription and non-prescription). It is also very prevalent in older adults. With age, the length of time a drug stays in our body increases, primarily due to age-related changes in kidney and liver functioning (the parts of our body that filter and detoxify our system). Age-related muscle loss, called sarcopenia, can also impact our sensitivity to medications. Altogether, given the impact polypharmacy has on the body, especially in aging, there can be a heightened risk of adverse medical outcomes and cognitive impairment.
Anticholinergic drugs5 are commonly used in older adults and are also a common source of adverse events in this age group. People take these drugs to treat colds, allergies, urinary incontinence, overactive bladder, COPD, depression, and symptoms of Parkinson's disease. Anticholinergics are a particular class of medication that blocks the action of acetylcholine. In the brain, acetylcholine has a role in learning and memory. Short-term and reversible cognitive impairments are known side effects of anticholinergic drugs. However, there are longer-term cognitive impairment risks, including a greater likelihood of developing mild cognitive impairment, primarily if used at higher doses.6 Dementia risk is also higher, especially for those with more significant cumulative years of anticholinergic use.7 Therefore, speaking to your doctor about your medications and what may or may not be necessary to take can be helpful for polypharmacy risk and prevention of adverse outcomes.
Someone can experience a sense of being alone, regardless of the amount of social contact they have daily. Although social isolation can lead to loneliness for some, others can experience loneliness without being socially isolated. Both loneliness and social isolation have been associated with increased risk for cognitive decline and dementia,8 as well as increased mortality rates in older adults.9 Considering ways to address perceived loneliness or increase the frequency of interactions with others can be helpful for brain health.
Delirium is a serious worsening or change in a person's mental state that happens suddenly, over a few hours or days. The person often becomes confused, or more confused than usual, and has reduced awareness of their environment. An episode of delirium can increase brain vulnerabilities that may already be present and can increase the risk for future dementia.10 Delirium often worsens dementia and its related symptoms, if already present. These acute mental changes are most common due to an infection, right after an operation, or during a hospital stay. Predisposing risks to hospital stays and infection involve some modifiable health factors like high blood pressure, kidney disease, alcohol dependence, and the use of certain medications like benzodiazepines. Unfortunately, if the predisposing risk is there, the delirious state threshold gets a lot smaller during a hospitalization or other acute medical events. Given this information, doing what you can to stay well and out of the hospital (unless you need to go in an emergency!) can decrease delirium and dementia risk.
4. Hearing Loss
Hearing loss is prevalent in older adults. It is one of the most common conditions affecting older and elderly adults. Approximately 1 in 3 people between the ages of 65 and 74 experience hearing loss, and almost half of those 75 and older report difficulties hearing.11 Those with hearing loss can find it challenging to engage in conversations, including those with friends, family, and medical providers. With social engagement as a critical aspect of brain health, diminished hearing can impact mental stimulation and heighten social isolation. More significant hearing loss is also associated with worsened cognitive functioning.12
Addressing hearing loss with medical and environmental changes and adaptations is key for brain health. Thankfully, the use of hearing aids is associated with delayed diagnosis of dementia, including Alzheimer's disease. It also buffers against depression, anxiety, and injurious falls among older adults with hearing loss.13
5. Sleep and Conditions That Impact Sleep
Sleep is vital for our health and well-being. In my work, patients are often concerned about restless nights, inadequate hours of sleep, and impaired sleep quality. We all enjoy time to rest and reset, and your brain is thankful for the therapeutic benefits of sleep. Sleep is essential for brain functioning, including creating and consolidating memories and maintaining daytime energy and concentration.
Adults, in general, need around seven to eight hours of sleep a night. Those who sleep seven to eight hours perform better on cognitive tests than those who sleep more or less than that amount.14 Interestingly, for older adults, short (under six hours) and extended (over nine hours) time in bed, as well as delayed rising (after eight am), predicts increased dementia incidence. Extended time in bed and late rising may also represent early signs of dementia, and short times in bed may be a risk factor for dementia.
Older adults are also more vulnerable to sleep disturbances that affect sleep quality and brain oxygen levels, such as sleep apnea.15 Sleep apnea is a medical condition characterized by loud snoring, moments of paused breathing during sleep, daytime insomnia and fatigue, and impaired attention. This condition is troublesome for brain health for a few reasons:
Sleep apnea increases amyloid, a protein associated with Alzheimer's disease.16 Sleep quality is then further compromised with increased amyloid in the brain.
Sleep apnea also worsens cardiovascular health conditions, like high blood pressure, heart disease, and diabetes, and can place people at greater risk for heart attacks and stroke. This is important to know given the close relationship between heart and brain health.
Sleep apnea impacts the levels of oxygen and neurotransmitters in the brain. Given this, those with sleep apnea may struggle with symptoms like forgetting, memory formation, making decisions, and poor concentration.
Decreased gray matter has been shown in the brains of those with sleep apnea.17 This impact on brain structure may cause some of the cognitive and cardiovascular disturbances in those with more severe sleep apnea.
Altogether, diagnosing and addressing sleep apnea is quite vital for brain health.
Hopefully, the take-home message here is that many factors that impact brain health and dementia risk are modifiable. I have found that relaying this information to patients, family, and friends can offer hope and ideas. Even more, it provides ideas about what to address and change throughout adulthood, and not just when you are older.