Dementia awareness and prevention should start earlier

We all know by now that a healthy lifestyle lowers the risk of common chronic diseases, including cardiovascular disease, which was confirmed in a recent study. However, you may not be aware that a healthy lifestyle may also be our best ammunition against Alzheimer’s disease and dementia.

Poor nutrition, sedentary lifestyle, and a lifetime of smoking are all risk factors for development of dementia and cognitive impairment. Yet, dementia prevention through a healthy lifestyle is rarely the focus of public health campaigns for the younger or midlife adult populations. Instead, education on dementia and lifestyle risk factors is reserved for older adults only.

Prevention of cardiovascular disease through a healthy lifestyle is emphasized as early as adolescence and young adulthood, including schools, primary care settings, and even grocery stores. “Let’s move!”, “5 a day!”, “1 million hearts!” — these are all popular public health campaigns that stress the importance of a healthy lifestyle, including a nutritious diet, more physical activity, less sitting, or no smoking. This is vital work, undoubtedly, as over half of Americans have at least one chronic disease, such as cardiovascular disease or diabetes, and a healthy lifestyle can ameliorate the risk of chronic disease development.

But why isn’t brain health highlighted in these campaigns? Dementia, which includes impairment caused by Alzheimer’s disease and other disease processes, is a chronic disease that affects 47 million people worldwide. Patients with dementia are more likely to be hospitalized, have poor physical and psychosocial health outcomes, and having dementia is independently related to increased mortality.

In research, there is a revolving door of drugs aimed to prevent Alzheimer’s disease that fail at the clinical trial stage. Since there is no promising cure at this time approved for patients, prevention, especially early prevention, must be where public health efforts and health care providers focus their time and resources.

Studies suggests that the protective benefit of a healthy lifestyle is most effective when these behaviors are maintained throughout adulthood. Higher levels of physical activity in midlife decreases the risk of dementia, as does avoiding tobacco and maintaining good nutrition. Health care providers often fail to discuss dementia risks with patients until symptoms surface. Instead, proper prevention education is dismissed until late adulthood, when risk of development dramatically increases. Aging is the single biggest risk of dementia, but you cannot change this. It would be a greater benefit to patients and the health care system to stress brain health and prevention in younger age groups.

There is a genetic component that predisposes individuals to the development of Alzheimer’s disease and dementia. I acknowledge that you cannot alter genetic make-up, and that many individuals will develop dementia in spite of exemplary healthy lifestyles. However, adopting a healthy lifestyle can still improve physical and mental well-being, enhancing quality of life.

True, health behavior change is notoriously difficult for many patients. These risky health behaviors may not improve even if we increase public health awareness. However, most providers already encourage a healthy lifestyle, so it is logical to stress another reason: to protect the brain. There is also a sharp increase in targeted lifestyle programs that are currently being tested, which can encourage adopting and maintaining healthy behaviors.

In my son’s pediatricians’ office, there are several posters of popular healthy lifestyle campaigns. These posters depict fruits and vegetables in the shape of a heart, or a heart wearing sneakers, all emphasizing the importance of a healthy lifestyle for heart health. It’s time that heart moves over for another important symbol: the brain. Dementia should not be dismissed as “forgetfulness” that’s part of the aging process, but should be integrated into healthy lifestyle education for all generations.