Dementia is the Number 1 cause of death in Australia, and it's coming for Britain.
Dementia can be immensely destructive. But you can take actions to reduce your risk.
There are nearly 500,000 Australians living with dementia, and it’s projected to grow to over 1 million by 2065.
That’s astounding when you consider the population of Australia is currently estimated at 28 million.
Dementia is an ignored disease.
We think it’s a disease of the future, not today. One for the ‘old people’.
“It won’t affect me, my mind is sound. I’ve got other things that need my immediate attention, such as saving for retirement.”
What retirement, if you have dementia?
We may also think it’s the disease of which you can’t do anything about.
The concept of old age is so foreign right now.
Yet, some of you reading this are in your 50s. The patient in my clinic this week is in his 60s.
Your parents or grandparents may have, or died from, dementia.
It’s what you do now, in mid-life that has the biggest impact on your development of dementia in the future.
Dementia is not simply a progression of poor memory.
It’s a progressive disease that obliterates the brain.
Once it has started, it is virtually impossible to stop. We can slow it down but it currently can’t be easily halted or reversed.
If it’s not the heart attack or stroke that gets you, then dementia is lurking behind the scenes.
And this is what has happened in Australia.
Australian healthcare is world-renowned. Alongside public health systems it has enabled its citizens to live beyond the heart attack.
But beyond the heart attack, is dementia.
My patient this week with Alzheimer’s dementia can’t care for himself.
He doesn’t recognise his family.
The burden of care was too high.
He would leave the house and not return; not knowing where he was or where he was going.
They couldn’t keep up with his care needs, or unpredictability of his behaviour.
He lives in a care home now, over 100 miles from his family, who have visited him once in 3 months.
They are unable to care for him, as they manage the complexities of their own lives.
At this stage in his illness he lives a relatively comfortable life with the support and care that he receives.
But clearly, this illness has left a devastating impact.
The tragedy of this experience includes:
his lost consciousness
An inability to converse, socialise or learn
We lose his knowledge, wisdom and contributions
Living outside his typical home environment where his life now revolves around his care needs.
The gradual deterioration of his body and mind that will lead to a loss of all body functions.
The impact on loved ones is devastating, as he has not left this world, but he is also not the person they know.
The financial impact
He will lose his ability to feed himself, swallow safely and even feel hunger.
He will most likely die from a chest infection due to a poor swallow, or starvation.
What does he know about his condition?
If you are diagnosed with dementia, it is in the early stages where you maintain an awareness of what is happening.
There is often fear of progression, grief of their future that they had once imagined, and worries about becoming a burden.
In London I had a patient who is a well known public figure.
Over time he gradually withdrew from public appearances and now he has silently disappeared from the public eye.
During this period he had good insight of his progression, but then even his insight was starting to fade.
Alongside this, the impact on his ability to contribute to society, to share his knowledge has now been lost.
The impact on mental health
The chance of developing depression rises.
There is often guilt associated with the diagnosis, due to the feeling of burden, feelings of uselessness and hopelessness about the progression.
Once symptoms are apparent, the illness is quick to move.
We now have medications that help to slow this down, but they are not perfect.
You may worry about the loss of dignity and respect due to the diagnosis and if you are diagnosed.
It’s completely understandable why you might withdraw from society and increase your isolation from the world.
There is an embarrassment associated with a decline in memory that people don’t want the world to see.
What about mental health and dementia?
Behavioural and psychological symptoms of dementia affect over 90% of people who are diagnosed with dementia.
This includes insomnia and loss of the typical sleep-wake cycle, increased agitation and aggression, hallucinations, delusions, wandering.
Many people experience increased suspicions and fright from family and care givers, which can be particularly distressing to those looking after people with dementia.
The pre-frontal cortex at the front of the brain manages our executive functions.
This means it helps us to maintain control of the actions we take, push back inappropriate thoughts that would otherwise be hurtful and land us in trouble.
It keeps our actions acceptable to those around us, and helps us to make independent decisions, that are protective for us and acceptable to society.
It is what makes us uniquely human.
But in dementia our pre-frontal cortex erodes until it is just a fragment of what it used to be.
The impact on you as the caregiver
Early caregivers to people living with dementia are the family. This is often the pact made by spouses at the altar many decades before.
It’s an attrition over time.
Commitment starts to waver, love starts to erode and patience leads not just to frustration, but anger and tears.
Grief comes before someone dies.
While you are caring for a loved one with dementia. It’s known as anticipatory grief, as your loved one is still alive, but paradoxically not here as they were before.
When he loses the ability to maintain continence, recognise you or is more likely to be suspicious and violent, then this is where caregivers can’t continue to cope.
There is the guilt associated with letting a loved one go to a care home, even more so if they expressed wishes against this when they did have capacity.
The burden on caregivers increases the chance of depression, and burnout.
Other positive activities for the mind often take a backseat to the pressing and continuous care needs of a loved one with dementia.
Why did my patient get dementia?
The fact he has developed dementia in his 60s is surprising.
But he isn’t the only person in my clinic developing dementia at a young age.
I don’t know all the aspects of his life, as the risks for developing dementia are also related to his earlier years of upbringing and many social factors which I don’t have knowledge of.
But let’s paint a picture of what his risk factors are, and what else may contributed to his risk.
Perhaps there are some of these that you will identify with.
He played footie.
He had a multiple knocks and head injuries. In Australia and the UK we have seen high profile sports players with dementia. It’s a well-recognised risk.
He didn’t have a long education and left school early. The evidence shows the risk of dementia is much higher without years of education.
We have to look past this. It’s not the education that directly protected him. It’s the action of using the brain as a muscle to build resilience.
He was a ‘man’s man’. In the pub daily, with a cracking sense of humour. He smoked daily.
CT scans of my younger patients show ‘small vessel disease’
Small vessel disease is essentially coronary artery disease of the brain.
When I see this I note the concern that this person might be at increased risk of dementia.
Since the brain requires a healthy and constant blood flow, when the vessels are diseased, the brain is at risk.
Hence why smoking is associated is associated with an increased risk.
These aren’t the only risks but they are some of his that we know.
Here are 14 key risks for developing dementia based on a collaboration of evidence, which you can see on the references.
Hearing loss
High LDL cholesterol
Less education
Social isolation
Depression
Physical inactivity
Diabetes
Smoking
High blood pressure
Obesity
Excess alcohol intake
Traumatic Brain Injury
Air pollution
Emerging evidence:
The impact of diet.
There’s more to discuss in coming articles.
I will be writing more on dementia, as we haven’t even started to cover the genetics of this devastating disease.
The key take-home from this list is these on their own do not cause dementia.
When you combine dementia risk factors, the risk of developing dementia compounds.
Your healthy brain in your later years is related to the choices you’re making throughout the lifetime, but you can take actions now, including in your 40s, 50s and 60s.
We still can’t guarantee you won’t get dementia but you can dramatically shift the odds.
At the very least, you can make the most of your retirement fund.
Such a valuable information Dr Kiran!
It strikes me how many of these 14 risk factors—like social connection, physical activity, and limiting alcohol—are essentially cost-free interventions.