Preventing Dementia and Cognitive Decline: The Power of Lifestyle

SHOW NOTES:

Save the Brain: Lifestyle Medicine and Dementia Prevention

In this episode of 'Healthy Looks Great On You,' Dr. Vickie Petz Kasper delves into the critical issue of dementia, a condition affecting millions worldwide. She emphasizes the importance of early detection and lifestyle changes in preventing and managing dementia, including Alzheimer's disease. Dr. Petz Kasper, drawing from her transformation through lifestyle medicine, shares the potential of exercise, restorative sleep, and dietary modifications like the MIND diet in preventing up to 40% of dementia cases. She highlights the dire need for social awareness around dementia, which currently impacts over six million Americans, with rates doubling over the past 20 years. The episode also dismantles misconceptions surrounding dementia, informs on recognizing early symptoms, and underlines the significance of modifications like hearing aids and engaging in regular physical activity. Moreover, it offers a deep dive into the evidence-supported MIND and Mediterranean diets and their role in neurodegenerative delay, alongside strategies for stress management, enhancing sleep quality, and fostering social connections to bolster brain health.

00:00 The Shocking Truth About Dementia Prevention
00:38 Welcome to Healthy Looks Great On You!
01:29 Understanding Dementia: More Than Just Memory Loss
03:24 Breaking the Stigma: It's Time to Talk About Dementia
07:04 The Science Behind Dementia: Types and Causes
14:59 Lifestyle Changes: The Key to Preventing Dementia
15:17 The MIND Diet: Your Brain's Best Friend
22:49 Exercise and Other Pillars of a Healthy Brain
25:56 The Don'ts: Avoiding Risk Factors for Dementia
28:02 Final Thoughts and Caregiver Support

RESOURCES (may contain affiliate links)

Previous episodes on high blood pressure, cutting out tobacco and alcohol, stress management and more can be found HERE

To download card, MIND diet and MIND diet checklist, subscribe to emails HERE. You'll get weekly emails, plus 7-Day Prescription for Change. Next week's podcast episode is for caregivers and will include all downloads. 

How Not to Die by Michael Gregor

How Not to Die Cookbook 

How Not to Diet by Michael Gregor

Smoothie Blender

Black Bean Brownie Recipe

TRANSCRIPT:

Did you know that lifestyle modifications such as exercise and restorative sleep and controlling blood pressure can prevent up to 40 percent of dementia cases in the world?

Dementia is one of the most dreaded diagnoses, along with cancer. And just think, breast cancer and prostate cancer can be treated if caught early. But listen, it is just as important to treat and prevent dementia. Save your brain! Now is the time to make changes that may prevent the development of this terrible disease., ,

You're listening to Healthy Looks Great On You, a lifestyle medicine podcast. I'm your host, Dr. Vickie Petz Kasper. For two decades, I practiced as a board certified obstetrician gynecologist, navigating the intricate world of women's health. But life took an unexpected turn when my own health faltered.

Emerging on the other side, I discovered the transformative power of lifestyle medicine. Now, I'm on a mission to share its incredible benefits with you, so buckle up because we are embarking on a journey to our very own mini medical school, where you'll learn how lifestyle medicine can help prevent, treat, and sometimes even reverse disease.

This is episode 112, Save the Brain.

When someone is diagnosed with dementia, it doesn't just affect the patient, but the caregivers and the entire family as well. It's likely you know someone with dementia because 1 in 3 seniors has been diagnosed with this. And when people think of dementia, they think about memory loss. But it's really much more than that.

 It's also fatal resulting in the death of more people than breast and prostate cancer combined. In fact, it's the seventh leading cause of death in the United States.

And do you think it seems like more and more people have dementia? Well, it's true. Over the last 20 years, deaths from dementia have doubled. By contrast, death from heart disease, which by the way is still the number one killer, have decreased over that same period of time. If you or a loved one is experiencing symptoms of dementia, don't feel alone.

Right now, more than six million Americans have been diagnosed with dementia. And the numbers are rising sharply. About 33 percent of people over the age of 85 have some form of dementia. It's not part of the normal aging process and it doesn't affect everyone, but it is more common. Back in the old days, people said, they're just getting senile, but now we know so much more.

10 percent of the people over the age of 65 have symptoms of cognitive decline. Progress is slow and affects different people differently. Most people with dementia over the age of 65 live 4 to 8 years, but others live as long as 20.

Typically, older people are affected, but not always. There are rare cases of early onset dementia that occur in midlife, which is particularly tragic, isn't it? But, people often don't seek treatment. Why do you think that is? Well, for one thing, there's a weird stigma associated with dementia.

I mean, like, if your heart is failing, you'd tell your friends, right? But if your brain is failing, somehow that's embarrassing. But dementia is literally brain failure. Second, there's a misconception that nothing can be done. Ready for some good news? There is. While dementia cannot be cured, it is possible to slow progression.

And prevention is also possible. And obviously, most important. How do you know if you're experiencing symptoms of dementia versus just being forgetful? Which can happen for a variety of reasons. Memory loss is a hallmark sign of dementia, but it's so much more. It's things like poor judgment. And this one is really dangerous, especially if people continue to drive.

It can be dangerous in other situations as well. And I may or may not have a story about fireworks, catching a field on fire, and the fire department coming and, um, we really weren't sure who to blame, but we won't talk about that. Another symptom is confusion. People may think they're somewhere that they aren't. Or they may call people or their pets by the wrong name. And they may have trouble finding the word they need.

Along with trouble writing. and understanding what they read. They may wander or get lost and have difficulty handling their finances, paying the bills and keeping up and writing checks. I mean, that's hard for everyone, but it can be so much worse if you're experiencing cognitive decline. Some people repeat the same question over and over.

They may say, “When is my hair appointment?” And then five minutes later, “When is my hair appointment?” Sometimes they'll use unusual words to refer to familiar objects. Another key feature, which has only recently been brought to the forefront, is slowing down. People who used to walk really fast, suddenly walk slower.

People who used to eat very fast, eat slower. And everyday tasks, like getting ready in the morning, take forever. Also, there can be a loss of interest in normal, everyday stuff. A change in appearance because the person may quit caring so much about their hygiene.

For instance, someone who was meticulous about their hair suddenly quits brushing it. There can be hallucinations, delusions, or paranoia. A common one is, they took my money. And then they tell their friends and at first their friends don't notice that they're having problems and so they believe that someone took their money.

Another thing is not caring about other people's feelings. They might say, “Look at that woman, she's ugly and her baby looks just like her.” That can be really embarrassing for the family members.

 One thing that can help is to get little business cards that say, “Thank you for your patience. The person I am with has dementia.”

I created a little template and I put a link in the show notes for you.

Another thing that can happen is impulsiveness and this can be worse than a teenager. They may have trouble controlling their emotions and may experience a personality change. Someone who is usually really sweet may become mean and vice versa. They may have problems with balance or movement and this can be really dangerous because it can make them more likely to fall.

And a lot of times the symptoms are not noticed by the person who has the cognitive decline but by their friends and family members. But nobody wants to talk about it. And that's unfortunate because this disease has a huge impact and it needs attention. Before I give you some good news about what can be done to prevent dementia or possibly even slow progression, we need to review some science.

You didn't think you were getting out of mini medical school today, did you? First of all, what causes dementia? Well, that depends on the type. There are several different types of dementia, and the most common and most familiar is Alzheimer's. Now, pay attention closely. It's not Alzheimer's. It's AllTimer's.

Well, that's a weirdly spelled word, isn't it? Turns out, it's somebody's name. A German man, to be exact. Alois Alzheimer was a psychiatrist who first described the disease in 1905. Good job. Think I would hate having my name associated with such a terrible disease. So if you insist on saying All Timers, I'll forgive you.

Maybe. Not all dementia is Alzheimer's, but Alzheimer's is always dementia. Did I just hear you say, huh? Let me explain. Think of it this way. A poodle is a type of dog. And while all poodles are dogs, not all dogs are poodles. Got it? Alzheimer's is a type of dementia, but You're welcome. But not all dementia is Alzheimer's, there are other types. So what are the other types of dogs besides poodles? Well there are German Shepherds, Beagles, Dachshunds, oh wait, never mind, we were talking about types of dementia. But I hope that analogy helps you remember that not all dementia is Alzheimer's. Alzheimer's is a type of dementia. The others are things like frontotemporal dementia.

Now that may sound familiar because of Bruce Willis, you know, the actor from Miami Vice who starred in the action packed Die Hard movies? His family announced that he had Frontotemporal Dementia. There's also Lewy Body Dementia that looks similar to Parkinson's Disease with shuffling, tremors, and hallucinations.

It can be particularly devastating and it's rumored that that's what Robin Williams had. Vascular dementia is caused by disease in the blood vessels, like little mini strokes. And then there's mixed, where dementia is attributed to multiple causes. How do you determine which type of dementia is present?

Well, it's not that easy. Lewy bodies are really specific, and they're a clump of protein that is found inside the brains of people with this type of dementia. The problem is, you can't see them, except on autopsy. And since it's related to Parkinson's There are clues to the diagnosis, like the inability to draw a clock face.

This is a fascinating thing. Certain parts of the brain are responsible for certain cognitive tasks. So there are neurologic tests that can help your doctor make the right diagnosis. It starts with a complete medical history and physical exam, and there are specific memory and psychological tests that evaluate certain areas of the brain.

 Some of these can take hours to complete, and that's exhausting. So a lot of people don't want to pursue it. But the doctor should check your reflexes, watch you walk, check for balance and sensation. Didn't you always wonder what that tuning fork was for? It's to see if the patient can feel vibration. And patients are sometimes diagnosed with depression.

There are also mental performance tests that check memory and thinking skills. Imaging studies like MRI may be helpful, but they're not usually conclusive. The definitive way to check for Alzheimer's is a spinal tap because there are amyloid proteins in the cerebrospinous fluid. Now I know that sounds awful, but it's really not that bad.

If you had an epidural when you had a baby, that's a much bigger needle than the one used for a spinal tap.

Another symptom that some people have is confabulation. That's a really big word that means making up stories. But the tricky part is that some people are really good storytellers.

 So good storytellers who get dementia may be able to tell fantastic stories. The trick is to know when they're telling the truth or not. At first, with dementia, the symptoms often wax and wane. And it's super easy to attribute it to something else. So, why do the symptoms come and go? Well, think of it like tangles in your hair. The neurons in your brain get tangles in them sometimes.

Other times, thinking may be clear. Don't you wish we could just spray some no more tangles on the brain? Although, I'm not really sure that stuff worked well anyway. I remember it still hurting when my mom brushed my hair when I was little now, for people on Medicare, the annual wellness visit requires an assessment of cognitive function.

And it can be very brief and simple. There are several different questions to choose from. So that may explain why sometimes your doctor is asking you weird questions. So, what's the point? Well, it's to identify people with cognitive decline in the earliest stages so that interventions can be made. And guess what the most effective interventions are?

I hope you guessed lifestyle changes. There are medications that slow progression and there are some promising treatments on the horizon too. We'll talk about both later, but first just a little more terminology. MCI stands for mild cognitive impairment. And this is usually the first thing noticed by the patient, family, or friends.

Don't panic, but this is stuff like losing your keys or your cell phone.

Now, don't talk to my husband about how many times I lose my cell phone. But it's also forgetting important events or appointments, trouble coming up with words and forgetting names. Another thing is a loss of the sense of smell can happen with early disease.

And of course that's become a lot more complicated in the era of COVID. But the

key time for intervention is early disease or mild cognitive impairment. Oh wait, there's one thing even better, and that's prevention. Whether you are trying to arrest or slow progression or minimize your own risk, the treatment is the same. I promise we'll talk about that soon, but let's discuss who is at risk first.

Women are at greater risk. Two thirds of people in the United States with Alzheimer's are women. For women at age 45, the lifetime risk is 1 in 5. And for men, it's 1 in 10. And not only are women at greater risk for developing the disease, they carry 70 percent of the caregiver burden. Older African Americans are at greater risk than older whites, and older Hispanics have a 1. 5 percent increase in rates of dementia compared to older whites. We often talk about modifiable risk factors versus

non modifiable risk factors. Those are the ones you can't control, like your gender, ethnicity, or genetics. When we see a parent or a grandparent experience dementia, it feels like looking in a mirror at our own fate. But it doesn't have to be that way. Lifestyle interventions for prevention should begin as early as possible, even in childhood.

In other words, if you're concerned about your family history, then make changes together with your whole family. Let's talk about modifiable risk. First of all, the number one preventable contributing factor to the development of dementia is wait for it. Hearing loss. Did you hear that? Now, you can't help it if you can't hear well, but by golly, you can get some hearing aids.

I've had them for about six years and my hearing isn't terrible, but I don't want that part of my brain that processes hearing loss - the spoken language to start shrinking. So I wear them. Well, I wear them most of the time. All right. Now let's talk about lifestyle modifications. Whew, finally, right? All six pillars of lifestyle medicine are important in preventing cognitive decline. Diet, stress management, exercise, social connectedness, minimizing harmful substances, and restorative sleep. First, let's talk about diet. Hmm, you probably knew that was coming. There is some evidence that the MIND, M- I -N -D, diet may prevent dementia and even slow its progress, especially in early stages.

This has been headline News in Forbes and U. S. News World Report. It was developed in 2015 by a nutritional epidemiologist named Martha Claire Morris and her team. Geez, I don't even know any nutritional epidemiologists. But anyway, MIND stands for Mediterranean DASH Intervention for Neurodegenerative Delay.

Whew, that was a mouthful. Let's try that again. MIND stands for Mediterranean DASH Intervention for Neurodegenerative Delay. That's a mouthful. Basically, what she did was combine two well-known diets, the Mediterranean diet and the DASH diet. If you listen to my podcast on hypertension, you know the DASH diet stands for Dietary Approaches to Stop Hypertension, and it focuses on lowering salt in the diet.

I'll put a link to that in the show notes.

The MIND diet is similar to Mediterranean with less emphasis on fish and fruit with the exception of berries. If you remember one thing today, remember berries. Now, let's go over the specific recommendations of the MIND diet. And don't worry about taking notes because I've put a downloadable printout in the show notes along with a smoothie recipe that helps you knock out some of these things all at once.

But here's the weekly dose. Six servings of green leafy vegetables every week. You know, Popeye never had any cognitive decline. Uh, maybe that's a terrible example, but hopefully it helps you remember. Spinach, kale, arugula, collard greens. Swiss chard, turnip greens are rich in folate, lutein, vitamin E, beta carotene, and other nutrients that protect cognition, especially as people get older.

You need at least one other serving of vegetables that aren't starchy, so not potatoes. Think more broccoli, squash, asparagus, beets, bell peppers, cabbage, carrots, eggplant, and okra. Also, five servings of nuts, or more, weekly, and I think just make it simple and eat a handful every day. Almonds, Brazil nuts, cashews, pecans, pistachios, or walnuts.

Nuts are good for the brain. And, they're a rich source of vitamin E, B vitamins, healthy fats, as well as minerals such as magnesium, potassium, and calcium. Now, I mentioned before, berries are important. Eat at least two servings a week? But I say more. Put some blueberries or raspberries on your oatmeal or eat strawberries for dessert.

Berries are great for making smoothies and you can drink all those antioxidants which are not only good for your brain but your body too. For Valentine's Day this year, I served Nice Cream. It's a recipe I got out of the How Not to Die cookbook. I'll put a link for that in the show notes too.

You need a minimum of four servings a week of beans. I know that's a lot, but they're so, so good for you. Lots of protein in a great source of fiber too, so you feel full and there's such variety. You can incorporate beans in creative ways like chickpeas in hummus or pinto bean dip. White beans, make a good salad mixed with cucumbers and olive oil and vinagerette.

Kidney beans go great in soups, and if you've never made lentils, look up some recipes. They're easy, versatile, and delicious. Black beans make a great meat substitute, and you can even make brownies with them. And don't knock it unless you've tried it. They're really yummy. I'll put a link in the show notes.

When cooking, always use olive oil instead of canola, vegetable oil, or safflower oil. When it comes to whole grains, you need three servings a day. The other recommendations are for the week, but this one's daily and it's hard to eat whole grains because most breads and cereals are processed.

So try quinoa, oatmeal, and brown rice. They're chocked full of vitamin B and vitamin E and a good source of fiber. I still think it's a challenge to get in three servings a day, but if you start your day with oatmeal, that works. You can add oatmeal to a smoothie by the way. At least one serving of fish each week is included on the MIND diet.

Now these should be fish that are high in omega 3s. Typically those are your fattier type fishes like salmon and tuna. Chicken or turkey twice a week, and I hope it goes without saying that we're not talking about chicken nuggets and we are not talking about fried chicken. And originally they recommended one glass of red wine a day, but there's been some uncertainty about whether or not this is beneficial, and certainly limit it to one.

Now, here's the what not to eat list. butter and margarine and gosh it kills me to even say that. You would not believe how much butter I like to cook with. Actually, I don't cook with it like I used to because the evidence is so good that diet can prevent dementia. I've cut back. The limit is however one tablespoon a day.

 Now you may not be slathering it on your bread or toast, but think about sauces. And such as that. And here's a good substitute. If you want to smear something on a piece of bread, try a mushy avocado. It tastes delicious. And if butter was hard, the next one's even harder.

Cheese. Ugh. Only one serving a week. Now, one thing I've done to help with this is swap it out for nutritional yeast. It has a cheesy taste and it's used in a lot of cheese free recipes to give it that flavor. Red meat on the MIND diet is recommended no more than three weekly servings. But we know it's not good for your blood pressure or heart and it increases the risk of cancer.

So I would skip this one. Last on the limit this list is sweets and pastries. It says no more than four times a week, but personally I think that's generous. For me, I need to go pretty much all or none. Once I start with sweets, I want them more and more. So I'd say limit to a very small amount on very special occasions.

And remember, you're going to have to define what is a special occasion. Do you think you could follow the MIND diet? How about a little more motivation? In one study of approximately a thousand older adults, there was a 53 percent lower risk of developing Alzheimer's in those who followed the MIND diet compared to those who didn't. 53 percent is impressive. The MIND diet has only been around for about 8 years, so there aren't as many studies on it as there are on the DASH and Mediterranean diets. But there was a really big study published in a British medical journal in March of 2023 that showed that the Mediterranean diet reduced the risk of developing dementia by 25%.

And that's even in people who were genetically predisposed. And when I say big study, there were 60, 000 seniors in this one. That's powerful data. And there are other benefits to following either of these diets too, such as prevention of heart disease, diabetes and cancer as well as lower blood pressure and improved digestive health.

If that's not convincing enough, then you should know that whole foods and those with high fiber also help you lose weight. Alright, maybe we can do without the cheese and butter, right? Now that we've talked about diet, let's move on to an equally important pillar of lifestyle medicine. Exercise. It is well known that physically active bodies have sharper minds.

We need 30 to 60 minutes of activity per day, but any amount reduces your risk and it's dose dependent. A Harvard study showed that even light activity such as running errands or getting up and cleaning the house is a lot better than doing nothing.

A lot better. According to an article published in the Journal of Neurology in 2022, The reduction of risk from just getting up off the couch is 21%. But aim for 150 minutes of moderate to high intensity exercise each week because that's associated with a 35 percent reduction.

This means you're exercising hard enough that it's hard to talk without being breathless. But again, every little bit helps, so just get started. And do something you like. Involve your kids or grandkids because the earlier you start, the better. Okay, now that you're motivated to eat healthy and get more exercise, you need to look at your sleeping patterns.

I covered restorative sleep in one of my earlier podcasts. I'll just put a link to that in the show notes. And what about stress? Does that affect our risk for dementia? Well, here's something particular when it comes to the risk. Recurrent negative thoughts. And that's a hard habit to break. So listen. If the news or the social media has you all riled up, then it's time to unplug.

 Complaining is another attitude that becomes routine. And you know what else? It is contagious. Be sure you don't get together with your friends and complain. Practice gratitude instead. It's the polar opposite. And you can't complain and be grateful at the same time. And think of this as a mental exercise to build a healthy brain.

You can work on some positive psychology if you want, but for me, I like to focus on the Bible verse that says, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is commendable.

If there is anything excellent or worthy of praise, think about these things. I don't know about you, but I think nature is lovely. So get outside and enjoy the trees, the flowers, the mountains, or lakes. It is literally good for your brain. You might think about social connection being important in the prevention of dementia, but studies show that people who have engaging relationships with family and friends

are less likely to experience cognitive decline. One study showed that the type of people who talk to the checker at the grocery store have a lower incidence. You know the type, right? Yes, that would be me. I actually had a great conversation with an elderly lady who scanned my groceries. Her name was Barbie, and she walks her dog every day for exercise.

Tell her I said hello next time you go to the store. It'll be good for both of you. Now we've talked about the do's. Eat the MIND, diet, exercise moderately 150 minutes a week. Manage your stress. Make sure you have good sleep hygiene. And nurture your relationships with others.

Now let's talk about the don'ts. We know that the use of tobacco and tobacco products is bad for the heart and lungs, but what about the brain? Well, duh. It worsens hypertension and vascular disease, which clearly aren't good for you. The World Health Organization estimated that 14 percent of dementia cases worldwide would be prevented with smoking cessation.

That's the good news. If you quit, your risk diminish too. Listen, I know it's hard. If you need help, I put a few resources in the show notes. And I also have a link to the podcast that covered that

now, let's wrap up with the association between alcohol use and dementia. Heavy drinking can increase the risk of developing dementia

or, alcohol related brain disease. When I was a kid, I was told that alcohol damages your brain. And it turns out that's true. Alcohol can damage memory and speed up disease in the blood vessels in the brain.

 There is even a specific form of dementia associated with heavy alcohol use over a long period of time. It's called ARBD, alcohol related brain damage. There was a large study in 2022 of nearly 37, 000 middle aged and older adults with no major health problems. Those who consumed more than three units of alcohol per day had less white and gray matter in their brain.

In fact, it made their brains look three and a half years older. What's a unit of alcohol? Well, it's half a pint of beer or a small glass of wine. So the most prudent thing to do to protect your brain is to abstain altogether or at least limit your alcohol to no more than one drink a day. You know, drink a smoothie instead.

Cheers to your health.

If there's one change you can make on the do list, it's eat more berries. If there's one change you can make on the don't list, eliminate ultra processed foods. And in the end, say the serenity prayer, God help me to accept the things that I cannot change. To change the things that I can change, and the wisdom to know the difference.

 I also think it's important for us to address caregivers. I have an upcoming episode on that. But for now, remember, the MIND Diet, stay active, both mentally and physically, and be social, because a healthy brain looks great on you.

The information contained in this podcast is for educational purposes only and is not considered to be a substitute for medical advice. You should continue to follow up with your physician or healthcare provider and take medication as prescribed. Though the information in this podcast is evidence based, new research may develop and recommendations may change.