Doing These Things Can Lower the Risk of Dementia
Senile dementia, also known as late-life dementia, is a severe cognitive disorder that onset in old age, often accompanied by marked impairment of social and daily functioning and varying degrees of neuropsychiatric symptoms. Patients show impairment of remote and recent memory, aphasia (difficulty understanding or expressing language), agnosia (normal sensory function but inability to recognize or discriminate perceived objects), apraxia (normal motor function but inability to carry out purposeful activities), and executive dysfunction (in planning, organization, reasoning, and abstract thinking); of these, memory impairment is the most typical symptom.
In Chinese folk speech we say an old person becomes a "little child again"; this "old child" state is in fact a manifestation of late-life cognitive impairment. Many elderly decline to the point where they cannot care for themselves at all and require full-time care, which ravages both the patient's physical and mental health and imposes a heavy financial and emotional burden on the family. Those who remain sharp-eyed and clear-minded in old age are enviable. Professor Dick Swaab, the Dutch neuroscientist and author of We Are Our Brains, once said that a healthy brain is the strongest guarantee of late-life quality; he believes that exercising the brain matters far more than exercising the body through fitness.
Late-life dementia is classified by etiology into Alzheimer's disease, vascular dementia, frontotemporal dementia, dementia with Lewy bodies, Parkinson's disease dementia, and other dementias. Alzheimer's accounts for about 50% of dementia patients, vascular dementia about 20%, Lewy body dementia about 15%, and other types about 15%. Vascular dementia is mostly related to cerebrovascular disease; some patients after cerebral infarction or cerebral hemorrhage develop vascular dementia as a sequela.
Having a dementia patient in the home places enormous strain on the whole family. Some patients cannot care for themselves; others cannot manage their emotions, developing hallucinations, delusions, agitation, depression, anxiety, and aggressive outbursts, and frequently erupting into fierce interpersonal conflict with those around them, which severely disrupts normal life. People who in youth had anxiety, depression, schizophrenia, or cardiovascular and cerebrovascular disease face a higher risk of late-life dementia.
It is generally held that senile dementia is related to genetic factors, β-amyloid deposition, neurotransmitter dysfunction, tau protein hyperphosphorylation, neuronal apoptosis, oxidative stress, free-radical damage, and to infection, intoxication, head trauma, hypertension, hypoglycemia, stroke, and obesity. With aging, brain function declines; neurons undergo inflammatory reactions that lead to the production of various deposits, and neurotransmitter function becomes disordered—all of which together produce late-life dementia in some older people.
Preventing dementia must begin in youth.
First, we must take psychological and mental illness seriously, shed the stigma attached to them, and approach them scientifically. Like malignancy or the common cold, psychological and mental illness are simply physiological illnesses. People who eat all kinds of grain come down with all kinds of disease; we cannot prevent illness entirely, but preventing it before it comes and treating it early is far better than seeking help after it has worsened.
Occasional low mood or stress response after a life upheaval is nothing to worry about, but if someone is chronically tense, anxious, repressed, depressed, obsessive, or insomniac—with, in severe cases, all sorts of delusions (delusions of reference, persecution, jealousy, etc.) and hallucinations—this demands attention. It may not be that the external world is unfriendly, but that we ourselves have a mental illness and need to see a psychiatrist. Usually this is also a sign that our brain has been damaged, a cry for help from the brain.
Whether these symptoms appear in a family member or in ourselves, we cannot dismiss them with a simple label of "fragile," "can't take stress," or "bad temper." China lags behind developed countries in psychiatry; the number of psychiatrists is far too small, and public education about mental health is inadequate. Many people, when mental illness is mentioned, neither know where to seek help nor can shake off a deep stigma.
Mental illness belongs among brain disorders; it usually arises when some region of the brain is abnormal or damaged, and the patient's EEG, brain MRI, or neurotransmitter tests may be abnormal. Life stress, trauma, and hormone secretion can all trigger mental illness. Once a patient is in an active episode, untreated, the health of the brain deteriorates further; chronic poor brain health easily progresses to senile dementia. Mental illness should be treated in psychiatric departments, mental health centers, or brain hospitals.
People with outgoing, cheerful personalities are less likely to develop dementia; those who are introverted, reserved, poor at communicating, and prone to conflict with others face a greatly increased risk. Interpersonal interaction—especially communication between intimate partners—is the single most important way to relieve psychological pressure; beyond that, daily reading, hobbies, and moderate physical labor and activity all help. People who act to extremes usually lack effective outlets for psychological pressure; when their unhappiness builds to a certain point it comes out as self-harm or aggression. Anger, grief, fear, depression, anxiety, self-blame, and shame all further damage the brain.
High-pressure work can also damage the brain. Former U.S. president Reagan and Britain's former Iron Lady Prime Minister Thatcher both developed dementia in old age, a fact related in part to the excessive work pressure they bore in earlier years.
Recent research led by Dr. Dale E. Bredesen of UCLA shows that for middle-aged and older adults, leaving a 12- to 16-hour interval between dinner and the next morning's breakfast helps lower the risk of dementia. Such eating habits are beneficial to brain health. His research also shows that adjusting micronutrient and hormone levels, relieving stress, and improving sleep quality can restore balance to brain function and effectively reduce dementia risk.
Middle-aged and older people with high blood lipids, hypertension, or high blood sugar should pay attention to preventing vascular dementia; routine monitoring of blood pressure, blood sugar, and lipids, along with periodic brain MRI, is worthwhile, because dementia is one of the sequelae of stroke. Preventing stroke lowers the risk of dementia. Many people over 70 have lacunar infarcts, white-matter degeneration, or brain atrophy; for such patients there is as yet no especially effective treatment, though long-term B-vitamin supplementation can modestly improve brain health. Chinese herbs such as Tianma (Gastrodiae Rhizoma), Yuanzhi (Polygalae Radix), Shichangpu (Acori Tatarinowii Rhizoma), Baizhi (Angelicae Dahuricae Radix), Manjingzi (Viticis Fructus), Bajitian (Morindae Officinalis Radix), Chuanxiong (Chuanxiong Rhizoma), and Dilong (Pheretima) have a preventive effect against senile dementia.
Regular reading of scientific works, systematic study of general scientific knowledge, and deliberate memory and calculation training can also slow brain decline in middle-aged and older adults. Early-stage dementia, treated professionally by neurologists, can also be slowed.
Senile dementia is essentially incurable, but it is preventable, and dementia caused by tumors or trauma has a relatively better treatment response. The series of measures the United States has taken in recent years—public education and preventive medicine among them—has lowered the national incidence of dementia, an encouraging result. This shows that although we cannot yet cure dementia, we can, through a series of preventive measures, reduce the harm it does to us.