Dementia is the end product of your whole system experiencing chaos. This chaos affects your heart, your lungs, your immune system and hormones, your musculoskeletal system, the mitochondria in your cells, and eventually your brain. Only when the chaos has done extensive internal damage do external signs of dementia.

That’s why this early stage of chaos, when the internal damage is occurring, is the optimal time to address risk factors. In fact, research indicates that damage to the brain begins 20 to 30 years before the first external symptoms of Alzheimer’s appear.

Begin now to address the risk factors listed below by making the lifestyle changes (link) discussed in Dementia Action Plan: sleep, exercise, nutrition, stress reduction, clean water, air and environment, social connections, and sensory and mental stimulation.

• Age: The most predictable risk factor for dementia, but not everyone who ages develops Alzheimer’s, so we need to look further.
• APOE₄ gene: This is the most prevalent genetic risk factor, but some groups of people with a high rate of this gene still rarely develop symptoms. Good choices can change the expression of this gene. (See the chapter on Genetics in Dementia Action Plan).
• A family history of Alzheimer’s: If you have a relative who has had Alzheimer’s, you will not necessarily get the disease. However, you need to start now and be very serious about healthier lifestyle choices, better habits, and reducing or eliminating risk factors for memory impairment.
• Heart and lung problems: Your brain makes up just 2% of your body weight, but consumes 20% of your body’s oxygen. A healthy lung ensures that your blood has the oxygen your brain needs, and a healthy heart ensures that your blood gets to and throughout the brain. Anything inside your body or outside that hinders good oxygen and nutrients getting to your brain creates a risk factor for dementia: smoking, air pollution, inactivity, obesity, hypertension (more on these later).
• Vascular problems: Your brain needs supple, flexible blood vessels to bring oxygen and nutrients from your heart to all the cells in your brain. Smoking, high blood pressure, high cholesterol, obesity, diabetes stiffens the blood vessel wall. These are also a risk factor for stroke, which cuts off oxygen to parts of the brain.
• Metabolic syndrome: A group of conditions that include high blood pressure, high blood sugar, excess body fat around the belly, and high cholesterol and triglyceride levels. Up to one third of Americans have this syndrome. It’s caused by obesity and inactivity,[1] and contributes to heart trouble, diabetes, sleep apnea, and other conditions that increase your risk of Alzheimer’s dementia. Address this risk by losing weight and exercising. (Not smoking also helps.)
• Continued learning: Research suggests that people with more years of formal education are less likely than other people to get Alzheimer’s dementia. I disagree. It’s people who keep learning throughout life, whether on their own or in classes, who decrease their risk of dementia.[2] This learning adds to their cognitive reserve, a term for the brain’s ability to efficiently use many pathways through the brain to complete cognitive tasks. A frank analysis of your continued learning—rigorous learning that stretches your mental endurance rather than just brain games—will protect you against dementia.
• Low socioeconomic status: This risk factor also has many variables. The higher risk is probably due to limited access to health care, poor nutrition, economic stress, neglect, limited opportunities to learn, abuse, or other stressors. A poor family with an enriched family dynamic, full of love and emotional support, who makes health a priority, could have a much lower risk of dementia.
• Traumatic brain injury: Any kind of trauma to the skull or inside the brain can disrupt normal neuronal function and increase this risk of dementia.
• Chronic kidney disease: This risk factor may be due to vascular problems, especially in capillaries, the smallest blood vessels in your body. The increased risk factor may also be due to toxins in your environment that have damaged your kidneys. Those same toxins may have damaged your brain as well. Talk to your doctor about what you can do.
• High blood pressure: High blood pressure damages the small blood vessels in your brain, hindering delivery of oxygen and nutrients to all your brain cells. Aggressive treatment of high blood pressure can significantly reduce your risk of Alzheimer’s.[3] It’s best to address this risk factor in your 40s or even younger.
• High LDL cholesterol: This refers to the “bad” cholesterol that can leave deposits in your blood vessels, eventually cutting off supplies of oxygen and nutrients. Happy heart—happy brain.
• Smoking cigarettes: Heavy smoking in middle age more than doubles your risk of Alzheimer’s,[4] so add Alzheimer’s to the list of health problems associated with smoking.
• Depression: Research consistently shows that people with a history of depression have about twice the risk of developing Alzheimer’s later in life, but no one is sure exactly why. Perhaps it’s elevated cortisol, the “stress hormone.” Chronic cortisol imbalance damages the brain. Perhaps it’s the inflammation associated with depression, or altered gene expression, or some other connection.[5] Whatever the cause, addressing the modifiable lifestyle changes described in Dementia Action Plan, such as sleep, stress reduction, exercise, could decrease this risk.
• Loneliness: Statistically, people who feel like they have no one in their lives who care about them or with whom they feel welcomed and accepted at a higher risk of death than obesity and alcoholism. Loneliness also increases a person’s risk of Alzheimer’s by up to 50%.[6] For more on this risk factor, please see the Interact Well Care video on Loneliness.
• Diabetes: The insulin resistance and flawed insulin-signaling system inherent in diabetes increases a person’s risk of Alzheimer’s by 50%, so for your brain, please use diet, exercise, and other means to decrease the harm that diabetes is doing to your brain.
• Air Pollution: In 2017, scientists announced that people living near a high-traffic area had a 12% greater risk of dementia.[7] The cause might be respiratory damage, cardiac problems, or other unhealthy lifestyle factors, but air pollution is definitely one of the suspects. (See also the section on smoking above).
• Diet: Most nutrition experts agree that the Standard American Diet, which includes lots of red meat, processed foods, fried foods, high-fat dairy, refined grain, added sugars, processed potatoes, contributes to the country’s health problems. In one study, on a scale of one to ten, the diet of most Americans scored barely over one.[8] Research into nutrition generates a lot of controversy, but almost all experts agree that a diet high in fruits and vegetables, healthy fats, nuts, lean protein including fish, and legumes will improve your overall health and coincidentally decrease your risk of dementia. Decreasing saturated fats, added sugars, and salt is also vitally important. If you want a structured diet to decrease your risk of dementia, I suggest the MIND diet.[9]
• Inflammation: This is an immune response to something your body considers a threat. When it becomes chronic, it contributes to many diseases, including Alzheimer’s and other dementias. Common symptoms include fatigue, digestive issues, skin rashes, body pain especially at the joints, heartburn, headaches, and brain fog. Dementia Action Plan has many suggestions for reducing your inflammation.

Dementia, especially Alzheimer’s dementia, results from a complex interplay of genetics, emotions, biology, lifestyle, and environmental exposures. The quality of physical development from prior to birth through adolescence and adulthood also has a long-term effect on the brain, as does a person’s experiences related to education, socioeconomic conditions, philosophy, and religion also affect the brain, contributing to lifelong cognitive reserve.

As complex as all that is, however, dementia even more can result from a lack of sleep, inactivity, stress, rusty mitochondria, loneliness, a liver and kidney overtaxed by toxins, an exhausted immune system.

Someday, perhaps we will have dementia specialists who take hours or even days to get to know patients concerned with memory problems or already experiencing them. This specialist will investigate more than a medical or surgical history. The specialist will ask about a patient’s family life, commute, what keeps the patient awake, diet, breathing, emotional connections, continued learning, exposure to stress at work, at home, alcohol intake, exposure to water or air pollution, and much more. Only then will this specialist feel able to connect the dots to locate the chaos inside.

No one knows you better than you and your loved ones do. No one cares as much about a future free of dementia for you. No one yet is able to do as extensive an analysis of risk factors as you are. I hope this will help you make a start.

[1] https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916

[2] https://www.beingpatient.com/education-alzheimers-2/

[3] https://alz.org/blog/alz/july_2018/sprint_for_discovery_new_dementia_and_cardiovascu?utm_source=google&utm_medium=paidsearch&utm_campaign=google_blog&gclid=EAIaIQobChMI9Znl34WF5AIV8R6tBh08cwgpEAAYASAAEgJa_fD_BwE

[4] https://www.webmd.com/smoking-cessation/news/20101025/smoking-linked-to-alzheimers-and-dementia#1

[5] https://www.psychologytoday.com/us/blog/hormones-and-the-brain/201604/depression-is-risk-alzheimer-s-we-need-know-why

[6] https://www.rush.edu/health-wellness/discover-health/loneliness-and-alzheimers

[7] https://www.theguardian.com/society/2017/jan/04/living-near-heavy-traffic-increases-dementia-risk-say-scientists

[8] https://nutritionfacts.org/topics/standard-american-diet/

[9] https://www.healthline.com/nutrition/mind-diet