This is a transcript f a radio show post I did. At the bottom, I’ve included the Dementia Risk Factors handout I give patients with a link to the PDF.
Hello everyone. Dr. Chuma here once again and I would like to talk to you today a bit about dementia.
Dementia is the 7th leading cause of death in the US but more concerningly, it’s the fastest rising chronic disease. I am finding myself having more and more conversations with patients about dementia. People want to talk about it so much that I am working on a short handout summarizing the most common and reversible risk factors. I’ll include this handout in the transcript of this show which I post on my website doctorchuma.com and my facebook page.
You may be wondering why an Ear, Nose and Throat doctor would be having such conversations. The reason has to do with how intimately linked hearing loss is with dementia.
A study in 2020 published in the renowned medical journal the Lancet, reported that hearing loss was the most important of all the 12 modifiable risk factors they identified.
Someone in middle age with a mild hearing loss which is unaddressed doubles their risk of dementia. A moderate loss can result in a tripling of the risk. But doing something about it, meaning getting hearing aids and wearing them all the time, significantly reduces that risk. Those who only wear them when they think they need to, do not get the benefit. You need to wear them most of the time.
The reason hearing loss is so connected with cognitive decline is very complex. Hearing is essentially the body’s ability to perceive vibrations around us. Our brain is constantly listening for the vibrations which produce sound as a means of gathering information about our surroundings, essentially to protect us. The parts of the brain which process sound are always on, and always analyzing. The auditory cortex is almost as active when you are asleep as when you are awake. When you don;t hear things around you, those areas are not active and deteriorate. Use it or lose it.
In most people, hearing deteriorates very slowly, often starting decades before a patient appreciates they have an issue. People also erroneously feel that if they are able to communicate well, their hearing must be good enough, but this is not the case. Our brains process everything we hear, and again, this analysis provides us with protection. You may not be aware of a sound, but if your auditory system hears the sound, it processes the sound. A good comparison is how when someone moves into the city from the country, they initially can’t sleep very well because they are not used to the background sounds of the city. Our brain is telling us that something is new and we need to be aware. But after a few weeks, the brain realizes that this is a non threatening sound and they get used to it and their sleep improves. They may not be aware of the sound anymore, but they hear it and their brain processes it as something they do not need to worry about.
Anyone over 50, or even sooner if you have had any amount of noise exposure, should have their hearing tested and consider wearing hearing aids if they have a significant amount of loss. Online or smartphone apps may provide a good hearing screen, but a formal test with an audiologist is much better because they can also test your ability to understand what you hear, which deteriorates much sooner than your ability to hear the beeps of a test.
Some of the other reversible risk factors associated with dementia were not surprising. Smoking, cardiovascular disease and diabetes all cause inflammation and vascular changes in all our organs, including the brain, leading to deterioration of brain tissue. Alcohol is a toxin to all our cells, including the brain. Traumatic brain injury also significantly increases dementia risk. And it is not just the obvious concussions. Soccer and football players all have low levels of injuries to their heads all the time. Helmet hits and heading a soccer ball directly injure the frontal lobe of the brain, which continues to develop well into our 20s. This area of the brain controls executive function like impulse control and decision making.
Some of the more surprising risk factors were level of education, air pollution and depression. Lack of physical activity was also significantly linked.
Although diet was mentioned as important, it did not make the top twelve. But in my opinion, diet is the most important since it impacts directly on almost all of the other risk factors. A healthy, minimally processed plant-based diet can reverse diabetes and heart disease. It improves mood and can ease depression. It improves sleep quality, another dementia risk factor.
And, it even impacts the expression of genes.
Dr. Dean Ornish is one of the pioneers of lifestyle medicine. His mantra “Eat well, move more, love more and stress less” is pretty close to perfect. His studies have shown that adopting healthy lifestyle habits can reverse prostate cancer, heart disease and most recently, even some early symptoms of dementia, something no drug has ever done.
A fantastic book about dementia prevention is “The Alzheimer’s Solution” by Drs. Dean and Ayesha Sherzai, both neurologists. It’s an easy read and available on Amazon.
Just to change gears a little, Covid is still out there. Numbers have not changed much but one concerning trend is that the proportion of hospital admissions is rising most rapidly in kids, no doubt as a result of going back to school with virtually no Covid rules anymore.
Please get vaccinated and be careful.
See you next time.
DEMENTIA RISK FACTORS HANDOUT (This is a link to the PDF DEMENTIA RISK FACTORS)
Cardiovascular disease has been the #1 cause of death worldwide for the last 100 years, but dementia is #7 and is the most rapidly increasing chronic disease in the developed world. There are over 200 types of dementia. Alzheimer’s Disease is the most common (~ 60%), followed by Vascular Dementia (20%) and Lewy Body Dementia (5%). Other common types include Fronto-Temporal Dementia, Alcohol Induced Dementia and Parkinson’s Related Dementia. In the US, Alzheimer’s Disease is by far the costliest disease to manage since people can live with it for many years and rely almost 100% on help.
Billions have been spent on developing drugs but not even one has improved let alone cured any form of dementia. The most recent drug at best slows progression but it comes at a great cost, both financially ($50-100,000 a year) and from side effects like bleeding in the brain (10% of patients). Prevention is key and now is the time to start since the damage leading to dementia starts 30 years before symptoms develop.
A 2020 Lancet study reviewed the factors contributing to dementia. They reported that 40% of the risk is attributable to 12 factors we have direct control over, called “modifiable risk factors”. 60% of the risk is attributable to age (the older you are, the greater the risk) as well as genetics. Clearly, you can’t do anything about age. As we learn more about how our lifestyle choices can impact how genes are expressed, even inherited genes are not as important as the modifiable risk factors. Dr. Dean Ornish showed that in just a few weeks, improving lifestyle factors like diet, stress management, exercise and social interactions, can alter the expression of over 500 genes, inhibiting genes which cause harm and expressing the genes which are protective. He also showed in a 2024 trial that those lifestyle changes can actually reverse some early dementia symptoms. This has never been seen before.
Below is a list of the 12 identified modifiable risk factors in order of their impact on the development or progression of cognitive decline and dementia. The additional 3 impact greatly on all the previous 12.
- HEARING LOSS. In addition to the lack of brain stimulation, the isolation hearing loss causes is very bad for brain health. Someone in mid-life with only a mild untreated hearing loss doubles their risk of developing dementia. Hearing aids have also been shown to improve balance and reduce fracture risk. Consider getting hearing aids even if your loss is mild.
- LESS EDUCATION. The greater your education level, the lower the risk. However, continuing to learn new skills as we age such as a new job, languages, musical instruments, sports… are very important when it comes to staving off cognitive decline and dementia.
- SMOKING. Every single disease process is negatively impacted by this terrible habit. Because it causes cardiovascular disease, it impairs blood flow to the inner ear, in addition to being directly toxic to the inner ear nerve endings and all blood vessels in your body.
- DEPRESSION. The link is partly age and duration related. Changes in brain structure, such as the hippocampus, the memory center, are seen in chronic depression, making dementia worse.
- SOCIAL ISOLATION. Humans evolved in societies. Social isolation was not sustainable for the vast majority of us. Lack of human interaction and stimulation is a significant factor. Married couples and those involved in social organizations like religion have lower dementia rates.
- TRAUMATIC BRAIN INJURY. Concussions and other brain trauma such as bleeding or strokes, result in damage to brain tissue as well as disrupting millions of neuronal connections in the brain. Even the “minor” recurrent trauma from heading a soccer ball or playing football has an effect.
- AIR POLLUTION. Poor air quality contributes to various conditions like dementia, heart disease and cancer. Breathing the air in Beijing, China causes the same health risks of smoking 1 pack of cigarettes a day. But it’s not just smog. Burning wood in the winter also increases rates of chronic disease. Get a good HEPA air filter for your bedroom, even if you have a whole house filter.
- HYPERTENSION. The number one killer worldwide, elevated blood pressure, damages arteries leading to poor blood flow and reduced oxygen and nourishment supply to all our organs, including the inner ear and the brain. The second most common type of dementia is vascular dementia, a direct result of arterial disease affecting the brain
- PHYSICAL INACTIVITY. There is a clear relationship between lack of physical activity and dementia. Most of the populations who live the longest and are the healthiest, with the least amount of dementia, don’t actually exercise, but they move constantly. Most of don’t live in such environments but the good news is that regular exercise improves cognitive function. Do whatever you like, just do it regularly.
- DIABETES. The most common complications and cause of death of diabetics is cardiovascular disease. This contributes to vascular disease in the brain. In addition, elevated blood sugars are toxic to all tissues and organs. Lastly, insulin has a significant impact on brain tissue directly as well as glucose management in the brain.
- OBESITY. The rate of obesity in the US amongst adults is 42%, with 20% of kids being obese. Adding up those who are overweight, 75% of Americans have an unhealthy weight. Fat doesn’t just sit there, doing nothing. Fat cells produce inflammatory compounds and hormones like estrogen, increasing cancer risk of various hormone related cancers like breast and prostate. The good news is that even losing just a few pounds leads to reduced dementia risk.
- ALCOHOL. Simply put, alcohol is a toxin to every cell in your body, including brain cells. There is a clear relationship between excessive alcohol consumption (more than an average of 1 drink a day for women and 2 drinks a day for men) worsens all diseases, especially dementia.
- SLEEP. Chronically reduced and poor-quality sleep is associated with various chronic diseases, especially cognitive decline and dementia. Sleep is when our brains clean up and remove the damaging proteins which build up during the day. And sleep medications do not reduce the risks because, although they may cause you to sleep longer, the quality of your sleep is poor.
- STRESS. To be alive is to be stressed, however how we deal with stress is the key. If you deal with it poorly, excessive stress hormones and inflammatory compounds are produced.
- DIET. Listed last, this is the MOST IMPORTANT of all the lifestyle habits which reduce the risks of all chronic diseases, including cognitive decline and dementia.
– Focus on a predominantly whole foods, plant-based diet.
- Fruit, especially berries (not fruit juice which is equivalent to soda).
- Greens (arugula, kale, cruciferous vegetables…).
- Whole grains. The more they are processed, the worse they are for you.
- Nuts and seeds. They do contain a good amount of fat so don’t overdo it.
- Beans. They’re all good, especially soy, lentils, chickpeas and black beans.
- Water. Filtered, just avoid plastic bottles since they leach chemicals.
– Eliminate processed foods. The more processed it is, the worse it is for you.
– Minimize added sugar, including honey and artificial sweeteners, and salt.
– Minimize fat and cholesterol, the majority of which comes from animal products like meat, fish, dairy and eggs. In other words, minimize eating animal products.
A great reference is “The Alzheimer’s Solution” by Drs. Dean and Ayesha Sherzai.