Building and Maintenance.

The two key mechanisms for keeping your brain healthy are: 1) building brain capacity (cognitive reserve), and 2) preserving that capacity by protecting the brain from detrimental changes.

It’s thought that people with larger cognitive reserves are better able to maintain their cognitive function for longer. Simply put, the more neurons and connections we have in our brains, the more losses we can sustain without noticeable effects. Anything that damages the brain or its blood vessels can take away some of that cognitive reserve.

Let’s take a look at everyday actions you can take to build and maintain cognitive reserve:

Be careful.

Numerous studies have found an association between head injuries and subsequent development of dementia. Wear a helmet when biking and appropriate protective gear when playing sports. Use a seatbelt every time you’re in a car. Keep walkways clear of clutter, secure the ends of area rugs, use non-slip mats and grab bars in tubs and showers, and have good lighting in your home to minimize the risk of falling.

Rest up.

Poor sleep is associated with increased risk for cognitive decline and dementia. It may also increase risk for many of the other dementia risk factors discussed here, including cardiovascular disease, high blood pressure, high blood sugar, obesity, and depression, and falls. The current recommendation is that most adults get seven to nine hours of sleep each night.

Experts recommend going to sleep and waking up around the same time every day, staying off screens and away from caffeine in the hours before bed, and adjusting the light, temperature, and any other environmental conditions so you are as comfortable as possible. If insomnia, sleep apnea, anxiety, or urinary problems are disrupting your sleep, seek help from a healthcare provider.

Avoid tobacco.

Studies have found smoking and vaping increase the risk for cognitive decline and, possibly, dementia. The chemicals can also damage blood vessels, including those feeding the brain. This results in the build-up of cholesterol-laden plaque in the carotid arteries, causing narrowing. The good news is, quitting smoking lowers these risks. Air pollution may have similar effects.

If you smoke, make a plan to quit. “Quitlines” and smoking cessation programs can help. Seek help from your healthcare provider if necessary. If you don’t smoke, try to limit your exposure to second-hand smoke. If you live in an area with high air pollution, filter indoor air and limit outdoor exercise.

Increase physical activity.

Regular physical activity has been associated with lower risk of cognitive decline. Getting your heartrate up increases blood flow, which may benefit brain cells by delivering more oxygen and nutrients, but some studies have shown even engaging in less vigorous activities—such as walking or strength training—is associated with brain benefits. Being active also helps prevent or control high blood pressure and type 2 diabetes, both of which increase risk for dementia, and it can lower your risk of falling.

The current recommendation is to aim for 150 minutes a week of moderate activity (like gardening or brisk walking) or 75 minutes of more vigorous activity (like jogging or pickleball) every week. Engaging in resistance training at least two days a week is also recommended. But any activity, in any amount, at any age is good.

Nourish yourself.

Regularly consuming a healthy dietary pattern can reduce your risk of heart disease, stroke, diabetes, and obesity—all of which are associated with increased risk for cognitive decline and dementia. A healthy diet is also associated with lower risk for Alzheimer’s disease as well as Parkinson’s disease (which can cause dementia).

Fill your plate with whole or minimally processed fruits, vegetables, beans, lentils nuts, seeds, whole grains, seafood, poultry, lean meats, low fat or fat free dairy, and healthy plant oils in place of foods high in saturated fat (fatty meats, full fat dairy, and tropical oils) and ultraprocessed foods (UPFs). A study that looked at the dietary intake of nearly 11,000 adults in Brazil found that dietary patterns containing more UPFs (like white bread, baked goods, processed meats, desserts and sugar-sweetened and artificially sweetened drinks) were associated with a higher rate of cognitive decline in six to 10 years of follow-up. (The study did not determine if this was due to the UPFs or the fact that they replaced healthier choices.)

It’s never too late to adopt a healthy diet. Studies show making these changes even in later life can benefit brain health.

Hear well.

Hearing loss has been associated in some research with higher risk of developing dementia. One reason is hearing loss can cause social isolation, which means less time interacting with others and learning new things.

In a study of over 430,000 adults aged 40 to 69 years, uncorrected hearing loss was associated with a higher risk of developing dementia compared to not having hearing loss or wearing hearing aids. A randomized controlled trial involving nearly 500 participants found a connection between hearing loss and cognitive decline only in participants already at higher risk for cognitive decline.

If you suspect you or someone close to you suspects you have trouble hearing, it is important to be tested. If it is determined a hearing aid will help, get one!

Evaluate health conditions.

Several common health conditions can increase dementia risk. Mid-life high blood pressure, for example, is associated with dementia later in life. Studies have also shown an association between type 2 diabetes and increased risk of cognitive decline and possibly dementia. High blood levels of LDL cholesterol can lead to hardening of the arteries, which contributes to vascular dementia by restricting blood flow to the brain and causing ischemic stroke. There is some evidence of a link between depression and cognitive decline as well, but not all research agrees.

Get regular check-ups, consume a healthy dietary pattern, be physically active, and take medications as prescribed if you have these conditions.

Avoid excessive alcohol use.

Heavy drinking is associated with cognitive impairment and dementia. (Research has found this association with weekly intake of the amount of alcohol in around two 750 milliliter bottles of wine, nine typical beers, or two cups of liquor or more.) While the impact of moderate drinking is unclear and some studies have found light drinking to have a possible protective effect, it is best to stick to the recommendation of no more than one alcoholic drink a day for women and two for men (and, if you don’t drink, don’t start.)

Lose weight (if you have obesity).

A mid-life body mass index (BMI) of 30 or above (defined as obesity) has been associated with increased dementia risk. Having an “overweight” BMI in midlife (25 to 30) has not. In fact, a 2023 study of older adults found that reduced BMI and waist circumference was associated with an increased risk of dementia in participants who did not have obesity.

If you have obesity, make healthy dietary choices, be as active as you can, work to address stress and emotional issues, try to get at least seven hours of quality sleep a night, and talk to your healthcare provider or a weight loss specialist to get help and support.

Train your brain.

Education builds cognitive reserve. Less education in early life (age 20 and under) is strongly associated with risk of developing dementia. While it has not been proven that continuing education later in life reduces risk for cognitive decline or dementia, taking an adult class in your community (or online), studying a new language, or learning a new skill is highly recommended.

Based on research to date, experts recommend regularly challenging your brain. This increases blood flow to the brain and builds new connections. Choose activities for which you need to make an intellectual effort and focus. Learn a new language or skill, be creative, take up an instrument or hobby, travel, or regularly play strategy games or do puzzles. Be aware that, while some so-called “brain-training” games may be beneficial, many make unsubstantiated claims. There is no “app” that has been proven to prevent Alzheimer’s disease or any other form of dementia.

Have fun!

Social isolation has been associated with higher risk of developing dementia. It can be hard to disentangle this from dementia increasing social isolation, but experts agree socializing is important. So, call a friend or, better yet, get out, get moving, register for an adult course, join a walking group, volunteer, and stimulate your brain with others!

The post Taking Care of Your Brain appeared first on University Health News.

Being a dementia caregiver for a loved one does not have that same appeal. And yet there are similarites in the call to serve. It is with love, determination, courage, and a sense of duty that many people become dementia caregivers. The experience is profoundly life changing.

Dementia, be it Alzheimer’s, Lewy body disease, vascular dementia, or a consequence of Parkinson’s disease, is one of the most feared conditions. Its trajectory is filled with many unknowns, and there’s no escaping the progressive decline. While each person’s journey is unique, there are plenty of similarities and even opportunities to deepen relationships and understandings of what it means to care for a loved one under such extremely difficult conditions. The key is knowing you are not alone. Other people have been there, are there, and are willing to support you and your loved one on this journey.

The UCLA ADC Program

The UCLA Alzheimer’s and Dementia Care (ADC) program is designed to help people with dementia and their families with the complex medical, behavioral, and social needs associated with Alzheimer’s disease and other types of dementia. For example, Paula, a caregiver in the ADC program who took care of her husband Sam, described her caregiver journey this way: “Sometimes we don’t have a choice on whether we want to take on this caregiving role. I would advise you to develop a sense of patience. Looking back, there were times when I could have been more patient because I was looking for the old Sam. Try your best to look for the person you know and remember the person you love. That person is still in there. Slow down and take it easy. Live in the moment. Get help and support. Reach out.”

UCLA gerontological nurse practitioner Michelle Panlilio, DNP, GNP-BC, also knows these challenges well. Her interest in dementia care stems from her own experience caregiving for her grandmother. Dr. Panlilio has been an integral part of the UCLA ADC program for over a decade, working with countless patients and caregivers. As the National Lead Dementia Care Specialist, she disseminates the ADC program to health-care systems nationwide. Dr. Panlilio believes that there are three key components that are vital to caregivers: educating yourself about the disease process and prognosis, attending support groups or receiving one-on-counseling, and practicing self-care. “The number one thing I recommend is to reach out for help,” she advises. “Even if you are not in the UCLA program, there are people out there to help you.”

Good Days and Bad Days

Just like the disease trajectory can be a winding road with good days and bad days, so too is the caregiver journey. Feeling overwhelmed is part of the process. So is heartbreak, confusion, and a sense of helplessness. Dr. Panlilio compares dementia caregiving to a marathon. To be there for the long haul, you must pace yourself and know there will be plenty of obstacles on the path, including caregiver guilt, anger, and depression.

“Anyone reading this article may find themselves having to take care of someone with dementia, be it a parent, a spouse, or even a child with early-onset dementia, which is a diagnosis received under the age of 65,” explains Dr. Panlilio. “Families often have a hard time figuring out how to provide the best care for their loved one with dementia. As a result, it is very common for caregivers to experience stress, strain, and depression.”

Recognizing Depression

Depression symptoms in caregivers are both similar and different compared with general depression. Sadness, for example, is common to both, but caregivers have the added responsibility of having to take care of a loved with a progressive disease.

“Family caregivers often tell us they are withdrawing from friends and activities because of the responsibilities involved,” Dr. Panlilio says. “Being a caregiver for someone with dementia can be an isolating experience. Caregivers often report emotional and physical exhaustion, sleeplessness, poor concentration, and difficulty coping.”

UCLA ADC participant Kevin joined the program to provide better care for his mother. He shares this:

“There isn’t an “easy” way to get through this. Seek out all the resources because many of them are free. It’s easy to put our own needs aside when we are busy taking care of our loved one, but you need to take care of yourself to take care of the person with dementia. Attend support groups to learn how to become a caregiver for the long term. Having that information empowered me to make better decisions for myself and my mom.”

How Support Groups Help

Support groups offer a community of encouragement and solace. “Group meetings are an excellent way to learn about the disease and how other people cope as their loved one progresses through the different stages of the disease,” Dr. Panlilio says.

Dementia caregiver support groups can be found through local chapters of the Alzheimer’s Association (alz.org), area medical centers, and senior centers. Attending in person is quite valuable, but there also are virtual online meetings.

However you choose to attend, support groups offer the opportunity to commiserate, vent, share, discover new ways to cope, and even laugh. It’s a place to learn how other caregivers deal with such situations like repetitive questions, reluctance to shower, and why power of attorney and health-care proxy are essential legal documents to secure.

If you’re not ready to participate in a group, seek out one-on-one counseling. Your loved one’s physician may have some recommendations. The ­Alzheimer’s Association has a 24/7 helpline (800.272.3900) staffed with knowledgeable people that can help you anytime day or night. They can also help you find a support group near you.

Learn All You Can

© Halfpoint Images | Getty Images
Taking time out for fun with friends can help you relax and better care for your loved one.

UCLA recently launched a monthly webinar series called Better Caregiving for All (https://www.adcprogram.org/better-caregiving-for-all). Accessible nationwide via Zoom, it delivers live and recorded content for on-demand viewing. The material covered each month addresses the needs of people who have not been the focus of traditional caregiver education (for example male caregivers, long-distance caregivers, and early- onset dementia caregivers). Each session includes a local content expert and caregivers who share their knowledge and experience.

Learning all you can about the trajectory of the disease can help you prepare in many ways, including emotionally and strategically. For example, no one wants to go to a memory care home, but it’s impossible to promise someone that this won’t happen. How can you know when this is truly necessary? How can you choose the best one? What resources might be available to help you keep your loved one at home for a bit longer? What can you do if your loved one becomes aggressive, sexually inappropriate, or refuses to take medications? The caregiver education page on the UCLA website (https://tinyurl.com/UCLACaregiverEd) has a wealth of resources available to answer those concerns and many more.

The short caregiver videos (located on that same website above) cover subjects in role-play scenarios. They portray real-world experiences and offer strategies for dealing with common behaviors, explaining why they may be happening and what can be done to minimize them. For example, if you are irritable and rush someone, the person with dementia can pick up on your emotional energy and react with agitation or even violence. How you respond to challenging situations influences your loved one. Not that you should expect yourself to be perfect, but these videos provide options that can help guide you.

The UCLA webinar lecture series presented provides information about disease diagnosis and other subjects like addiction, managing late-stage disease, and in-home and residential placement.

Practicing Self-Care

It can seem like an indulgence to take that yoga class, go for a long walk, or meet friends for a movie, but it’s not an indulgence: It’s a necessity. “Caring for a person with dementia is intense, and caregiver burnout is real,” says Dr. Panlilio. “What many caregivers don’t understand is depth of responsibilities. Caregivers need to be healthy and well so they can take good care of their loved one.”

When you have so many responsibilities, it may seem impossible to eat healthfully, rest adequately, and stay connected to friends. Remember, this is not a sprint, it’s a long-term journey. Be patient with yourself and just make a plan, talk to friend, or go read something at a café. Small actions can help rejuvenate you.

Of course there will be times of extreme stress, grieving, and anger. Think of self-care as a strategy that helps bolster your physical energy and mental clarity to meet the demands of dementia caregiving more effectively. It can help you to provide support over the long haul without overly compromising your own health and well-being.

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A: Exercise helps the brain in many ways. For example, aerobic exercise (running, brisk

walking, swimming, etc.) boosts levels of a chemical called brain-derived neurotrophic factor (BDNF). Research shows that BDNF both protects existing neurons (brain cells) and helps in the development of new ones, all of which support better learning, memory, and other thinking skills. Exercise also helps main­tain healthy circulation in the brain—particu­larly its white matter—which helps protect against vascular dementia. Better blood flow also helps clear away toxins in the brain, which promotes the development of new neurons.

Regular exercise also offers other brain bene­fits. Getting up and moving, whether you’re

dancing, cycling, or simply walking the dog, can help reduce your stress levels and ease symptoms of anxiety and depression. Exercises such as yoga and tai chi may be especially help­ful with stress reduction. And if you exercise with others, you may enjoy the benefits of socialization, which support both healthy cog­nition and greater mental well-being.

Remember that the type of exercise you do is

less important than simply doing something. Aerobic exercise is important for circulation and overall cardiovascular fitness, and should be part of a regimen that includes resistance training, balance exercise, and stretching.

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1. Eat Minimally Processed Plants.

“We know that a Mediterranean-style dietary pattern (which is high in minimally processed plant foods) may help delay age-associated cognitive dysfunction and probably prevent or delay the onset of Alzheimer’s disease,” says Richard Dupee, MD, chief of geriatrics service at Tufts Medical Center. Researchers are working on getting more detail on what roles different nutrients play in this relationship.

The new study: Researchers studied the association between dietary patterns rich in magnesium-containing foods and markers of brain health in just over 6,000 participants aged 40 to 73 years at baseline. On average, consuming more magnesiumrich foods was associated with larger brain volumes, especially in women.

What it means: While this study does not prove cause and effect, it suggests that increasing your intake of magnesium-rich foods may be good for brain health and, by extension, cognitive health. Magnesium-rich foods like leafy green vegetables, legumes, nuts, seeds, and whole grains are also packed with other beneficial nutrients. Whether it is the magnesium itself, or (more likely) a combination of factors, that is responsible for the observed association with brain health, choosing these foods in place of less healthy options is always a good idea.

What to do: Increase your intake of whole and minimally processed plant foods: Have a salad with leafy greens daily; choose whole grains and whole grain foods over refined; snack on a handful of nuts once a day, or sprinkle them on salads, whole grain low-sugar cereals, or grain dishes; and look for simple beanbased main courses or add beans to soups, stews, salads, and dips.

2. Avoid Ultra- Processed Foods.

Ultra-processed foods generally bear little resemblance to whole foods, either in appearance or nutrient makeup. They are manufactured composites of extracted parts of foods, often mixed with artificial ingredients. More and more research is tying dietary intake high in ultra-processed foods to health problems.

The new study: Researchers looked at the dietary intake of over 10,700 individuals (average age, 51-and-a-half years) living in Brazil. Higher consumption of ultraprocessed foods (including breads, crackers, cookies, candy, cereal bars, sodas, mayonnaise, sausages, ham, pizza, instant noodles and soups, deli meats, chips and other baked and fried snacks, and juices) was associated with a higher rate of cognitive decline in six to 10 years of follow-up.

What it means: Eating highly processed offerings may increase your risk for cognitive decline.

What to do: Focus on eating mostly whole and minimally processed foods. This means filling your plate with plenty of fruits, vegetables, legumes, nuts/seeds, whole grains, seafood, lean meats, dairy, and healthy plant oils. Watch out, in particular, for foods with refined flour, added sugars, and lots of sodium. Foods loaded with processed protein isolates may also be problematic.

3. Listen Up.

“As we get older, our hearing gets worse (more so for men than women, for whatever reason),” says Dupee, MD. “There is no question poor hearing increases risk for loss of cognition.”

The new study: A study analyzed information from over 430,000 individuals aged 40 to 69 years. At baseline, participants were asked to report any hearing loss and use of hearing aids. Hospital records and death data were used to ascertain dementia diagnoses during the follow-up period. Compared to participants without hearing loss, hearing loss without use of hearing aids was associated with a higher risk of developing dementia. This association was not found in people with hearing loss who wore hearing aids.

What it means: Even if you have hearing loss, correcting the problem may help preserve brain function.

What to do: If you suspect you have any hearing loss or a family member or close friend mentions they have noticed a problem, it is important to be tested. If it is determined a hearing aid will help, get one. “There is significant resistance to getting hearing aids,” says Dupee, “perhaps because of appearance, or perhaps due to cost. If you can correct a hearing problem, do, not just for the sake of your hearing, but for your brain health as well.”

4. Get Moving.

“Along with a healthy dietary pattern, regular physical activity is known to be important to preserving brain health,” says Dupee. “These are the same measures that protect cardiovascular health.” We know being active helps keep veins and arteries clear, which decreases risk for vascular dementia and strokes. Researchers are trying to understand other ways physical activity may help the brain.

The new study: It is suspected that physical activity causes long-term changes in the hippocampus, the part of the brain that controls the autonomic nervous system and is thought to be the center of emotion and memory. Working in a lab, researchers exposed hippocampal cells to chemicals released by contracting muscles. Neuronal activity increased and the number of cells increased rapidly.

What it means: In addition to aerobic activity (which increases heart rate and breathing), resistance training (which uses muscles against a force like a weight or band) may cause beneficial changes in the brain.

What to do: Get moving! Any kind of physical activity, in any amount, started at any age is beneficial to heart and brain health. “The current recommendation is to aim for 150 minutes a week of moderate activity, like gardening or brisk walking, or 75 minutes of more vigorous activity every week,” says Dupee. “Engaging in resistance training at least two days a week is also recommended.”

5. Tame Stress.

“We do see that stress increases difficulty multitasking and adapting— especially in the aging brain,” says Dupee. “We also know that life stress, like the death of a spouse, is associated with higher risk for cognitive decline.”

The new study: A study assessed the level of perceived stress of nearly 25,000 participants aged 45 and older at baseline and at one follow-up visit. Cognitive function was assessed at the start of the study and annually throughout the study period. Higher levels of perceived stress were associated with about 40 percent higher risk of poor cognitive function.

What it means: If you feel you are under a lot of stress, you may be at higher risk for cognitive decline.

What to do: It may not always be easy, but stress can be managed. Think about what life changes (a new job, more vacation or personal time) you might be willing and able to make that could reduce the stress in your life. If you are a caregiver, look for resources that can give you some time off. Physical activity is a great way to relieve stress (and boost health!). Research also supports meditation as a way to relieve stress—even if it’s just setting aside a few minutes each day to close your eyes and breathe deeply. Laughter is another great choice, so find time to laugh with friends, go to a comedy show, or watch a funny movie. Get social, regular interaction with family and friends can help reduce stress.

Putting it All Together.

These new studies reinforce our understanding of how lifestyle choices can help delay onset or slow progression of cognitive decline— even in people with a genetic predisposition to dementias. In addition to the behaviors discussed above, there are other things you can do that have been shown to help.

What’s good for the heart is good for the brain, so make sure you keep your blood pressure, blood sugar, and cholesterol levels under control. If behavior change is not enough, medication may be necessary. Quality sleep is also essential. Work with a healthcare provider to address any issues interfering with your sleep. Research is clear that at least seven (but not more than nine) hours of sleep a night is ideal. Not smoking or vaping and being socially active are also important for cognitive health, as is learning new things. Doing the same types of puzzles you enjoy is not enough; make sure you are challenging your brain with new tasks to build new neural connections.

While there is currently no cure for Alzheimer’s disease or other forms of age-related dementia, we are not powerless. Research is clear that healthy lifestyle choices and addressing health problems can help.

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High Blood Pressure and Mental Decline

Hypertension (the medical term for high blood pressure) is a leading risk factor for stroke. Stroke is the fifth-leading cause of death in the United States, and it’s also one of the leading causes of long-term disability. Elevated blood pressure also raises the risk for a cognitive disorder, such as vascular dementia. This is because the brain has an extensive network of blood vessels, and about 20% of the blood pumped with each heartbeat supplies the brain.

Though cognitive decline is mostly associated older adults, middle-aged adults with hypertension are not spared, according to a study published in the journal Hypertension. Brazilian researchers used data from an ongoing study of 15,105 individuals ages 35 to 74 to better understand the impact of hypertension and duration of elevated blood pressure on cognitive function. Study participants underwent three memory and verbal fluency tests at two visits conducted at least four years apart, and their blood pressure was recorded along with other variables, including physical activity and body mass index. Upon analysis, prehypertension (which study researchers in Brazil defined as 120 to 139 millimeters of mercury [mmHg] systolic to 80 to 89 mmHg diastolic) independently predicted a greater decline in verbal fluency and global cognition. Hypertension in middle age was associated with a steeper decline in memory, compared with normal blood pressure. At an older age, hypertension was associated with a steeper decline in both memory and global cognition.

On a more positive note, multiple studies suggest that blood-pressure-lowering medications may benefit cognitive health and reduce the risk of developing dementia.

Impact on Vision

Chronic high blood pressure can cause hypertensive retinopathy, in which damage to tiny blood vessels decreases blood flow to the retina, the light-sensitive structure at the back of your eye that converts light to nerve signals and transmits them to the brain. Parts of the retina may be damaged by this lack of blood flow. Symptoms of hypertensive retinopathy usually develop later rather than sooner in the disease process (although a hypertensive crisis may cause rapid vision disturbances).

Harm to Kidneys

Like all organs in the body, the kidneys need a steady supply of oxygen- and nutrient-rich blood. While it’s common for some kidney function to decline as we age, high blood pressure accelerates this process. It is the second-leading cause of chronic kidney disease (CKD) and kidney failure (diabetes is the main cause of kidney disease). Statistics show CKD plagues one in seven adults, and that number is even higher in people over age 65. If you have high blood pressure, ask your doctor about getting screened for CKD, which is diagnosed through blood and urine tests.

Sexual Problems

High blood pressure is associated with erectile dysfunction in men—poor blood flow, poor erection. In women, high blood pressure can reduce blood flow to the vagina and therefore influence how a woman responds (or not) to sexual stimulation. It also can decrease overall interest in sex. However, studies suggest that women who control their blood pressure lower the possibility of problems in the bedroom.

Blood Pressure: How Low Can You Go?

As Dr. Shahid explains, the natural process of aging includes the hardening of our blood vessels, making it more critical that we control our blood pressure over the course of a lifetime. But there is no one set blood pressure level for everyone. “For patients who are at risk of falling, very strict control of blood pressure with medications may be harmful,” she says. “The best way to manage your blood pressure is to create a long-term treatment plan with your doctor to prevent all of the silent but detrimental consequences that come along with high blood pressure.”

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Alzheimer’s Disease

Alzheimer’s disease (AD) typically affects people ages 80 and older, though it can occur in those under age 65. “The disease is characterized by a buildup of abnormal proteins that form clumps and tangles in the brain,” says Dr. Bloom. “It is thought that these deposits disrupt communication between brain cells and eventually destroy the cells.” The effects develop gradually and include memory lapses, getting stuck for words, regularly misplacing things in odd places—for example, putting the TV remote in the cutlery drawer—becoming less able to coordinate tasks that involve multiple steps, such as preparing a meal, and getting lost in familiar surroundings. As AD progresses, it begins to impact a person’s mood, making him or her agitated, short-tempered, hostile, and even aggressive—he or she also may suffer delusions. Poor sleep is a common problem, as is wandering.

There currently is no cure for AD, although drug treatment may help mitigate symptoms. Older drugs include donepezil (Aricept®), rivastigmine (Exelon®), galantamine (Razadyne®), and memantine (Namenda®). The first three boost the function of remaining brain cells, while the fourth helps maintain effective levels of a brain chemical that plays an important role in memory. They help some people maintain cognitive function without significant decline for anything from six months to two years, after which the effects tend to wane. Newer drugs reduce one of the abnormal proteins that may underpin AD. Of these, aducanumab (Aduhelm®) has been approved by the U.S. Food & Drug Administration. However, Medicare coverage of the drug is limited due to its serious risks and the fact its benefits are unclear—trial data for the drug indicated little in the way of practical cognitive improvements. A similar drug, lecanemab, is currently under investigation (see our February issue for more).

Vascular Dementia

Vascular dementia is linked to a disruption in the supply of blood to the brain, as can happen during a stroke. While AD affects neurons, vascular dementia affects the nerve fibers (“white matter”) that connect and enable communication between the different regions of the brain.

Vascular dementia initially manifests as problems concentrating and communicating, with memory problems developing later. “In AD, cognitive decline happens gradually, but in vascular dementia it tends to happen in stages—for example, there may be a sudden decline after a stroke, followed by a period of stability, and then further sudden deterioration if another stroke occurs,” Dr. Bloom says. “However, some people get multi-infarct dementia due to multiple small strokes. This looks more like AD because it doesn’t have the stepwise deterioration of vascular dementia.”

You’re more susceptible to both vascular dementia and AD if you’re at high risk for stroke. Research has suggested that strokeprevention strategies like consuming a healthy diet, getting plenty of exercise, not smoking, and controlling high blood pressure (a major risk factor for stroke) may protect against vascular dementia and slow the rate of cognitive decline in people who have the condition.

Lewy Body Dementia

Lewy body dementia (LBD) is characterized by an abnormal buildup of deposits called Lewy bodies in the brain. “The deposits mainly consist of alpha-synuclein protein, which is found throughout the brain,” Dr. Bloom explains. “We don’t fully understand the protein’s function, or why it accumulates in some people.” Lewy bodies also are present in Parkinson’s disease, and many people with LBD also have the abnormal protein deposits that have been implicated in AD. “LBD shares symptoms with both AD and Parkinson’s, and it’s possible that a person with dementia may have changes in the brain that stem from more than one of these conditions,” Dr. Bloom adds.

Memory impairment is less prominent in early LBD—it is more likely to cause delusions, hallucinations, misidentification of familiar people, and fluctuations in alertness. Movement problems similar to those of Parkinson’s disease also are a feature of LBD, and include balance problems, a shuffling gait, and rigid muscles.

As with AD, there is no cure for LBD—treatments are aimed at managing the symptoms. Medications need to be closely monitored, since drugs that are used to manage AD and Parkinson’s disease can worsen LBD symptoms. “LBD typically has a very rapid decline, which means it is very important to think about future care if you are diagnosed with the condition,” Dr. Bloom says.

Frontotemporal Dementia

Frontotemporal dementia (FTD) is most likely to affect people younger than age 65 (the average age at diagnosis is 57), particularly men. It is characterized by the degeneration of cells in the frontal and temporal lobes of the brain. “Specific symptoms vary, but in general, people with FTD lose their inhibitions and behave irrationally and impulsively—for example, they may make tactless comments about somebody’s appearance,” Dr. Bloom explains. “Their sense of empathy becomes blunted, and they may become emotionally withdrawn. Personal hygiene also suffers, as does the ability to plan and organize.”

FTD may overlap with a condition called primary progressive aphasia, which causes language impairments— for example, problems with reading and writing, and finding the right word for naming objects (for example, people with FTD may refer to “the thing that opens cans,” instead of the can-opener). Speech may become generally hesitant, with pronouns being omitted. About 10 to 20 percent of people with FTD develop movement disorders similar to those of Parkinson’s disease.

“There is no cure for FTD, but antidepressants and antipsychotics may help control its behavioral symptoms,” Dr. Bloom says. “People with the condition also may benefit from speech and communication therapy.”

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Q: Does having depression as an older adult raise the risk of developing dementia?

A: There is a strong association between severe depression in older adults and an increased risk for dementia. That risk appears to be greater compared with people who have mild depression. Many studies in the past several years suggest that having depression raises the risk of Alzheimer’s disease and other forms of dementia. One study involving more than 120,000 older adults notes that depression was more closely associated with vascular dementia than with other dementia types, including Alzheimer’s.

One theory is that depression may be among the earliest signs of dementia. Another theory is that depression injures the brain significantly enough that it becomes more vulnerable to Alzheimer’s and other diseases that cause dementia. Depression is also associated with memory and thinking skills problems, in part because depression can make it difficult to concentrate and make decisions.

It’s important to understand that a depression diagnosis doesn’t guarantee that dementia is down the road. However, it may increase your risk. And while researchers are still investigating whether getting treatment for depression may actually decrease your dementia risk, there is no reason not to seek treatment with psychotherapy or medications. The benefits of treating depression can’t be understated.

WOMEN AND ALZHEIMER’S RISK

Q: Do we know why women are more likely than men to develop Alzheimer’s disease?

A: The latest statistics suggest that women are two times more likely than men to develop Alzheimer’s and usually live longer with the disease than men. For a long time, women’s heightened risk was chalked up to the fact that women live longer than men and Alzheimer’s is a disease that is associated with advancing age.

And while that may explain part of the discrepancy, there are also other factors that may play a role. Recently, a study published in Science Advances suggests that harmful form of an inflammatory immune protein called complement C3 is present at much higher levels in the brains of women who had died with Alzheimer’s disease compared with men who had died of the disease. The study also showed that estrogen, which drops in production during menopause, normally protects against the development of this dangerous form of complement C3. Other studies have also implicated changing levels of estrogen as a factor in heightened Alzheimer’s risk.

Genetic differences due to the composition of sex chromosomes—two X chromosomes in women compared with one X and one Y in men—may also play a role.

VITAL EXHAUSTION

Q: What is “vital exhaustion” and is it dangerous?

A: Vital exhaustion, sometimes referred to as “burnout syndrome,” is a mixture of irritability, fatigue, and demoralization. Other symptoms include low energy and sleep problems. It’s usually associated with chronic stress. Some studies suggest that vital exhaustion is more common among people who are exposed to psychological stressors for an extended time. One study noted that vital exhaustion was especially pronounced in men who had never married or who were divorced or widowed.

Vital exhaustion is associated with a number of cardiovascular problems, including atrial fibrillation, which raises the risk of stroke, heart disease, type 2 diabetes, headaches, and gastrointestinal issues. Lowering your risk of developing vital exhaustion means developing relaxation skills, such as meditation, deep breathing techniques, and engaging in regular exercise. If you live alone, or if you feel you need more interaction with others, increasing your social support can be very helpful in boosting your mood and helping you cope with the stressors in your life. 

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A: Yes, symptoms that seem to develop gradually may indicate a different type of dementia from the one that presents with more sudden-onset symptoms. But understand that there is no entirely reliable timetable for everyone who develops dementia.

Symptoms of Alzheimer’s disease, for example, tend to develop gradually and progress more slowly than other types of dementia. However, progression is sometimes faster in early-onset Alzheimer’s compared with the disease in older adults.

Vascular dementia, on the other hand, can often develop suddenly. Early symptoms can sometimes be difficult to detect, as they can include struggles with planning and concentration and subtle changes in mood or behavior. Memory loss, which is among the first signs of Alzheimer’s disease, is among the later symptoms of vascular dementia.

Whether cognitive changes occur slowly or quickly, they should not be ignored or written off as normal aging or as a mood disorder such as depression. If you are aware of changes in your thinking skills or those around you express their concerns, get a medical evaluation.

Q: When a stroke makes it difficult to walk, speak, or engage in other basic functions, is it possible to predict whether or how much of those skills might return?

A: Researchers continue to develop physical tests and computer models designed to do just what you’re asking—better predict the recovery of certain functions affected by stroke. And while we are learning more about what is reasonable or realistic to expect in stroke recovery, there are no guarantees because every person’s stroke experience is unique.

What we do know is that the first one to three months after a stroke continue to be the most important in terms of recovery. Most improvements usually occur during this time period, though with effort and patience, many stroke survivors can continue to experience improvements years after the event. The key is committing to physical, occupational, and speech therapies (as appropriate), and understanding that setbacks and detours on the road to recovery are to be expected. The medical community’s ability to treat stroke and enhance recovery has come a long way in recent years, and there is every reason to believe that progress will continue.

Q: After being widowed several years ago, I noticed that I get very sad every winter. I assumed it was the holiday blues, but a friend suggested it might be seasonal affective disorder (SAD). I don’t remember feeling this way when I was younger. Can SAD develop later in life?

A: SAD is diagnosed more often in younger adults than older adults, but various circumstances can affect when a person first notices symptoms or experiences a worsening of symptoms. Older adults, especially those living alone and susceptible to isolation or loneliness, can have a particularly difficult time with SAD.

It’s not always easy to distinguish between the “holiday blues” and SAD, but there are some important distinctions. SAD is a form of clinical depression and tends to be accompanied by significant changes in sleeping patterns, difficulty managing situations, feeling angrier and more irritable than usual, low energy, and often a desire to be alone. It may start in the fall and last well into the new year. The holiday blues tend to be fairly situational and limited to the holiday season or holiday events. It’s a psychological condition that brings on feelings of sadness, but after the holidays those feelings tend to ease up.

You may find it helpful to talk with your health­care provider and consider counseling and/
or medications, particularly if you notice that this time of year leads to negative, potentially harmful thinking or unhealthy behaviors. MMM

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Aspirin can cause internal bleeding, and bleeding risk is lower with low-dose “baby” aspirin (81 milligrams) than full-strength aspirin (325 milligrams). Research has shown that low-dose aspirin is just as effective at preventing cardiovascular events as full-strength aspirin, and it won’t raise your bleeding risk as much.

Aspirin helps prevent platelets in the bloodstream from clumping together and forming a clot, so it is called an antiplatelet drug; prescription antiplatelet drugs include clopidogrel (Plavix) and ticagrelor (Brilinta). Other medications that help prevent blood clots work by inactivating or inhibiting the production of clotting factors. These drugs, called anticoagulants, include warfarin (Coumadin), apixaban (Eliquis), rivaroxaban (Xarelto), and dabigatran (Pradaxa).

If you take any of these medications, be alert for signs of internal bleeding, such as blood in your stool, black, tarry stools, rectal bleeding, or vomiting blood (vomit may be red or dark brown and look like coffee grounds). Other symptoms include lightheadedness, difficulty breathing, fainting, and pain in the chest or abdomen. If you have any of these symptoms, report them to your doctor immediately. Internal bleeding also may cause iron-deficiency anemia, so check the results of blood work. Low levels of ferritin, hemoglobin, and hematocrit are possible indicators of iron-deficiency anemia.

Do Alzheimer’s disease and vascular dementia have different symptoms?

Alzheimer’s disease (AD) and vascular dementia do have many common symptoms, but there are some notable distinctions, especially in the early stages.

Memory loss is one of the hallmark signs of AD. People with AD may have trouble remembering recent conversations, forgetting important dates or events, or asking the same question repeatedly. Other symptoms include difficulty completing familiar tasks, problems speaking or writing, getting confused about time or place, misplacing items in unusual places and/or being unable to retrace steps to find them, poor judgment, withdrawing from social activities, and personality and mood changes, such as becoming suspicious, anxious, depressed, or fearful.

Initial signs of vascular dementia often include difficulties with planning, decision-making, and problem-solving, disorganized thinking, and trouble concentrating, but memory impairment also is common. Other symptoms include restlessness, agitation, confusion, depression, and apathy.

In some cases, vascular dementia is caused by a stroke or transient ischemic attack (often referred to as a “mini-stroke”) that impairs blood flow in the brain. In these cases, changes in thinking and perception may happen suddenly. If vascular dementia is present, imaging tests of the brain may reveal blocked blood vessels or areas where bleeding has occurred. However, vascular dementia also can develop gradually. Risk factors for vascular dementia include heart disease, diabetes, high blood pressure, high cholesterol, obesity, and smoking.

I recently started taking an antidepressant, and I’ve noticed that my interest in sex has decreased. Could this be a side effect?

Yes, sexual side effects are common with many antidepressant medications. In addition to a loss of interest in sex, difficulty becoming and staying sexually aroused and reaching orgasm may occur. Some people are unable to have an orgasm while taking an antidepressant.

Sexual health is an important topic that’s often overlooked as we get older. Report your decreased interest in sex to your doctor, and ask about medication options that may help restore your libido.

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In the United States, pain is the symptom most commonly treated with acupuncture. Research published in February 2022 in the journal BMJ showed that, among studies that evaluated acupuncture treatments, conditions for which acupuncture was found to be most effective included neck, shoulder, and muscle pain, lower back pain, and pain caused by fibromyalgia. Other conditions that responded well to acupuncture were allergy symptoms, post-stroke aphasia (difficulty expressing and comprehending language), lactation issues after childbirth, and vascular dementia symptoms.

“Acupuncture also can be very effective for nausea and vomiting caused by chemotherapy, and as a preventive measure for migraines,” explains Victoria Chan Harrison, MD, assistant professor of rehabilitation medicine at Weill Cornell Medicine.

Traditional Chinese Medicine

Acupuncture is just one modality used in the practice of traditional Chinese medicine (TCM). TCM originated in China more than 2,000 years ago.

“TCM views the body as composed of different elements (water, fire, metal, wood, earth) and organ systems (kidney, bladder, heart, pericardium, triple heater, gallbladder, liver, lung, spleen) that need to be in balance at all times,” says Dr. Harrison.

In TCM, all of the body’s systems are connected through a network of channels called meridians. Another key aspect of TCM is Qi (pronounced “chee”), the vital life force or energy that flows throughout the body.

“The Chinese medical model also looks at environmental pathogens— wind, heat, damp, cold—that may affect the human body. When a pathogen ‘invades’ the body, it can impair the flow of both blood and Qi in the meridians. If imbalances, decreased blood flow, and Qi stagnation remains unchecked over a prolonged period of time, people can experience symptoms of what Western medicine calls diseases or illnesses,” says Dr. Harrison.

TCM Tools

The TCM practitioner’s toolkit includes different techniques to relieve symptoms and prevent disease manifestation. For example, ‘gua sha’ and ‘cupping’ both work on the myofascial layer—the connective tissue that lies beneath the skin—to increase circulation to the treated areas. Gua sha involves scraping the skin, often with a rounded, smooth stone or a special type of spoon, and cupping involves creating a vacuum to lift subcutaneous tissue.

“The goal is to improve the flow of Qi in areas of pain and at sites of muscle tissue injury. It is also often used to promote an immune response to fight a cold virus (in TCM, this is called ‘cold wind invasion’),” says Dr. Harrison.

Acupuncture and Chinese herbs can be used together to address the imbalances in the body’s five elements and in a particular organ system, as well as trying to expel pathogenic environmental effects, such as damp heat or cold wind.

Chinese Herbs

TCM practitioners may also use herb formulas to correct imbalances and promote the flow of Qi. Dr. Harrison explains that, traditionally, herb formulas were boiled to create a tea, but most modern Chinese herb formulas now come in the form of pills or tinctures.

Dr. Harrison advises caution when choosing Chinese herbs. She says, “Chinese herbal remedies can be problematic because of the lack of environmental and pharmacological regulation in the production, processing, and purity of the herbs. I typically recommend that Chinese herbal products be purchased from an American company that tests for impurities such as heavy metals to ensure quality of the product.”

If you are interested in being treated with TCM, ask your primary care physician for a recommendation, or visit the website of the National Certification Commission for Acupuncture and Oriental Medicine (www.nccaom.org). Many states require a four-year master’s degree in acupuncture or traditional Oriental medicine and passing a board exam to become licensed.

Some insurance companies cover acupuncture for certain conditions; in 2020, Medicare and Medicaid began covering acupuncture as a treatment for chronic lower back pain.

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