Studies are conflicting to indicate that diet, exercise and cognitive activity prevent dementia, which are usually due to methodological issues and cohort studied. However there are studies that do show good results, inconsistent as they are. The Mediterranean diet is one that has consistently showed positive results in preventing cognitive decline but not towards the relationship with dementia.
The Mediterranean diet consists of less meat, more of fish, legumes, moderate levels of red wine, extra virgin olive oil, fruits and vegetables. The Mediterranean diet is also about connecting with people while preparing the meal and eating, therefore increasing social activity. This is because Mediterranean's prepare their meal together with family and/or friends (unfortunately Mediterranean's are steering towards the Western diet) Increased social activity is also another preventing factor in dementia. People who follow the Mediterranean diet also eat their main meal at lunch-time and have fruit for dessert.
Social activity can help improve cognitive functioning, especially during intellectual conversations. Talking to people about what you have read and learned will also help improve memory by working it. Researchers investigated older people volunteering to help students learn. The activity improved their physical strength, social support networks and cognitive activity.
It is important to be careful what you read, especially when it comes to research findings, as the result may be influenced by other factors such as type of people participating, type of methods used and number of participants involved. If researchers repeated the same study, it may prove otherwise.
Healthy cognitive ageing includes:
All of the above will help prevent dementia, delay dementia and even prevent mild cognitive impairment from progressing to dementia.
Diabetes is a risk factor for dementia as the brain is starved of glucose, so if you have diabetes it is important to be extra vigilant in eating a healthy diet and keeping fit. Your diet may include medium-chain triglycerides by taking MCT oil, coconut oil or both which will provide the brain with the same energy as glucose would.
Another factor to consider is maintaining a healthy heart with a normal blood pressure reading by managing stress, including regular, moderate physical activity, limiting alcohol, and eating healthy. Low or high blood pressure is related to cognitive decline.
As well known, the hallmark of Neurocognitive Disorder due to Alzheimer's Disease is caused by neurofibrillary tangles that wrap themselves around the neuron causing the neuron to die and the brain to shrink. Moreover, the amyloid (a variety of different proteins) plaques that form between the neurons are mostly found in the gray matter of the neocortex, the hippocampus and the basal ganglia, thalamus, cerebellum and some in the hemispheric white matter. Self aggregating peptides that form in the plaques are b-peptide or amyloid peptide. This peptide is joined to a much larger protein called Amyloid b-protein precursor (APP). Interestingly the extracellular plaques containing amyloid can be found in older people who don't have an impairment causing disagreement to the consensus that APP is in fact a cause of Alzheimer's disease.
Another arguement as to the cause of Alzheimer's disease is the heart, brain and mind connection. Researchers have said that to prevent a stroke will help prevent dementia (not only Alzheimer's). Dr de la Torre, MD PhD, study led him to believe that Alzheimer's disease is a vascular disorder of the brain of older people caused by chronic cerebral hypoperfusion leading to neurodegenerative damage, cognitive decline, Alzheimer's and then death.
Cerebral hypoperfusion means that there is insufficient blood flow to the cerebral cortex of the brain, which is the hallmark of the incidence of stroke. Incidentally, Alzheimer's disease risk factors (e.g., smoking, obesity, physical inactivity) also tend to reduce blood flow to the brain. As reduced blood flow to the brain will lead to cognitive decline and then Alzheimers, the APP deposition is then not the cause of Alzheimer's but the pathological product.
The findings that low blood flow is the cause of Alzheimer's means that more accurate tools such as brain neuroimaging (e.g., positron emission tomography) that measure blood flow to the brain can help identify at risk patients of Alzheimer's disease. The patient can also measure their heart with a noninvasive ultrasound to identify blood flow through the heart chambers and valves together with psychometric testing (e.g., Memory Alteration Test and Mini-Mental State Examination) to measure cognitive functioning.
Stroke prevention clinics in America are already helping patients identify if they are at risk of a stroke and also work with them to prevent the onset of a stroke. Research identifying the cause and risk factors of Alzheimer's and other forms of dementia will also help discover who is at risk and how to prevent its onset.
With this in mind, it is important to take care of your heart, to take care of your brain and mind in order to prevent the onset of stroke and dementia.
When Mary Newport's husband Steve was struck with Alzheimer's at the age of 53, she worked tirelessly to find a research study that he could participate in an take advantage of the treatment effects the study would provide.
While searching for a suitable study she also found out that AC-1202 (medium-chain triglycerides [MCT]) was found to improve the symptoms caused by Alzheimer's disease. Alzheimer's disease is also known as type 3 diabetes because the brain of people with Alzheimer's does not use glucose and the cells therefore die. Therefore the ketones from MCT can replace glucose and feed the cells so they can continue to work, meaning each neuron will continue to communicate with each other.
Coconut oil also provides ketones, which is the reason why Mary has been feeding her husband Steve with 20 grams of coconut oil in his morning oates every day. She then increased the coconut oil and MCT oil dosage to three times a day. Symptoms of diarrhoea and possibly vomiting means the person can't tolerate the dosage and it needs to be decreased.
Before taking the oils Steve was rejected from a study because his mini mental state examination (MMSE) score was only 11, which was too low to participate in the study. He also could not draw a clock. She was rejected from another study, until she found out about ketones. Before Steve attended the MMSE test for a second screening, Mary fed him 2 tablespoons full of coconut oil with his oats for breakfast. One the one hour drive to the test, they were practicing for the MMSE test (e.g., what is the day, what is the month, what is the season, etc). As usual he struggled to remember, when when they arrived and he completed the test his score was 18. He's score for the first screening was 14. He was then accepted in the study.
There is an argument that 20 grams of MCT or two tablespoons of coconut oil is not enough to make a difference, and others say that it is enough. Moreover, people with the gene Apo E4 (which Steve had) were unlikely to see any benefit from MCT. However, Steve showed improvements quickly.
Improvements included remembering how to complete daily tasks with little or no help, improved mood, improved memory, able to complete the clock test (however not a perfect drawing but better than his previous attempt) commonly used for people who have dementia and able to communicate well. By the time Steve started taking the oils he was in moderate the severe stage of Alzheimer's which includes symptoms of severe memory loss (can't recognise family members), difficulty with daily tasks (needs a lot of help), signs of physical capabilities (incontinence, trouble with gait and eating with support). Therefore, his improvements were substantial, however he declined again if he did not take his daily dose of MCT.
Mary has been working tirelessly to communicate the benefits of ketones for people with Alzheimer's as her husband's improvements were remarkable. However, in 2012 he suffered from an illness such as gout, and was prescribed with prednisone to reduce the pain and swelling. The prednisone caused Steve to constantly pace and obsess about things. A year later he showed symptoms of Parkinson's symptoms (tremors) and was prescribed valium to improve his sleep and to relax him. After three weeks of taking valium he began pacing, and obsessing again together with sweating. Mary later found that valium commonly causes akathisia (a movement disorder) which includes symptoms of sweating, pacing and chattering in older people, especially those with dementia. Steve started having infections amongst other complications, continued to decline and passed away in 2016.
During Steve's journey with Alzheimer's, the daily dose of MCT improved his quality of life and may have also prolonged his life. To this day, Mary continues to promote the benefits of MCT and advocate for more research so the benefits of MCT for people with Alzheimer's can be further understood. Taking MCT may also prevent Alzheimer's as it can improve the energy between neurons and brain health, however to my knowledge there is no study to verify this claim.
Source: Newport, M. T, M.D. (2013). Alzheimer's Disease: What is There was a Cure? (2nd End.). Basic Health: CA.
Major or Mild Neurocognitive Disorder (NCD) due to Alzheimer's disease is a progressive disease that includes a decline in memory and learning, changes in behaviour and personality, physical symptoms, confusion, impaired capacity to eat, chew and swallow and incontinence. The symptoms will interfere with daily living.
The Diagnostic Statistical Manual, fifth edition (DSM-5) now includes probable and possible Alzheimer's disease for both major and mild NCD. Probable type for mild NCD means that there is evidence of a genetic mutation from either genetic testing or family history. Possible type for mild NCD means that there is no genetic mutation but there needs to be evidence of a decline in memory and learning, the decline is progressive and there needs to be an absence of other neurodegenerative or cerebrovascular disease or other contributing factor to cognitive decline. Probably type for major NCD includes clear evidence in a decline in memory or learning, the decline is progressive and no evidence of mixed etiology or if there is a genetic mutation otherwise possible type of major NCD should be diagnosied.
Understanding these symptoms will help the person caring for them realise why the person with alzheimer's disease will, usually, present with short term memory loss at first. This can be frustrating for the carer if they don't realise that the lapse in remembering instructions or learning new things is actually from their illness not from being difficult.
Alzheimer's is not a normal part of ageing, but age related. It is preventative meaning that you can prevent the onset of Alzheimer's by a eating healthy diet, and exercising your body and mind.
Alzheimer's disease is known to be caused by low blood flow to the brain resulting in senile plaques and neurofibrillary tangles ultimately causing the neurons to die and miscommunicate. The miscommunication will cause challenging and confusing behaviour, which may include aggression, a lack of impulse control, hallucinations, and psychosis, however understanding the person's life story will help the carer get to know why the person with dementia is acting in such a way.
When caring for a person with Alzheimer's it is important to consider the psychological and behavioural aspects to improve their quality of life. They still have an identity that needs to be considered and respected. They are more than their illness but a person with a history that needs to be shared and appreciated.
Understanding Alzheimer's will help you understand how to care for the person with the illness better. However understanding the person's identity and life story is just as important.
Source: American Psychiatric Association. (2013). Neurocognitive disorders. In Diagnostic and Statisical Manual of Mental Disoders DSM-5 (pp. 591-643). Arlington, VA: American Psychiatric Association.
Dementia is a set of symptoms and is therefore known as a syndrome. The symptoms will include memory loss. Other symptoms may include changes in behaviour and personality, physical symptoms, confusion, and impaired movement. Some types of dementia can be progressive but some can be reversed such as dementia from alcohol abuse. The timing of effective treatment will reverse some types of dementia. The main symptom of dementia is memory impairment which will intefere with work and social functioning.
Dementia can be present in other types of diseases. The most common is Alzheimer's disease and the second most common is vascular dementia. Other common forms of diseases that include symptoms of dementia are Lewy bodies, Parkinson's disease and fronto-temporal dementia.
Dementia can be confused as a progressive disease however symptoms may be due to alcohol abuse, which can be reversed and due to other other forms of medical conditions such as depression, trauma, tumor in the brain, lack of vitamins and infections.
Most types of dementia can be prevented by a healthy diet, and exercising your body and mind.
A lot of research as been implemented in the caregiving role as it is an important aspect in the ageing, mental health and disability community. Carers put a lot of selfless effort into their role because they just want to to be there for the people they love and care about. Their role is probably the most difficult because usually they will have to put their life on hold to care for others. It is not something that is planned, but an unplanned experience that comes with its own lot of challenges and personal growth for the carer.
Here are some quotes from carers who care for people who have cognitive decline or dementia, while the carers themselves adjust in their new and unplanned role. The quotes are from a book called "Family Caregivers: Disability, Illness and Ageing". The book contains information about a longitudinal research program about the carer's role and their health while caring to influence policy and intervention changes.
"They are not the person that you have known as a child, so you are adjusting to having a stranger in your house."
"It's terrible, it's soul-destroying, watching someone that you love go downhill."
"Our relationship has changed. Before he got sick our marriage wasn't too close because he was away a lot and we grew apart. All of a sudden he got sick and we were thrown together... I had a terrible lot of resentment because just as we should be starting to enjoy life, I had to stay at home and look after him."
"He's never asked me to do anything in all our 35 years of married life and now he finds that he's got to and that's the worst thing."
"A man caring for his wife felt that 'if you're feeding them three times a day, and you're standing there for two hours every meal, you start getting very uptight yourself."
As you can see the adjustment to the new caring role can be frustrating and challenging while you put on a brave face to cope. Sometimes you may need to crumble, sometimes cry, and sometimes resent your new role. But ultimately as I have experienced with many carers you will cope because you are strong, the most loving type of people I have ever met and the most giving. Just don't feel bad if you don't feel strong for the moment, because it is only a moment in time and you are not alone.
Vascular dementia is the second most common type of dementia and is caused by multiple strokes which damages the brain and therefore results in cognitive decline. The symptoms for vascular dementia are similar to alzheimer's disease (memory impairement and one or more of aphasia, apraxia, agnosia and problems with executive functioning) however includes cerebrovascular disease or focal neurological signs that are related to the symptoms of vascular dementia. The onset of vascular dementia is usually rapid however it can be patchy, depending on the where the damage of the brain is located.
While vascular dementia is caused by strokes and the risk factors of a stroke includes, physical inactivity, heavy or binge drinking, being overweight and drug use researchers have been investigating if improved health will indeed reduce the risk of various types of dementia including vascular dementia.
As a result, researchers have found that diet, exercise and mental stimulation will help prevent the onset of dementia. Social activity is also another preventative measure. Moreover, researchers have found that it is best to consider all the preventative methods being exercise, diet, mential stimulation and social activity together rather than one alone.
While studies have investigated the relationship of physical activity and alzheimers, it has also investigated the relationship between physical activity and vascular dementia with mixed findings.
Positive results include walking according to current health guidelines (3 times a week, 30 minutes each time) is associated with a 34% reduction in the risk of cognitive impairment. It is however recommended to exceed the current health guidelines, which may in turn increase benefits. Another study also found that physical activity improved cognitivie functioning in people who were at risk for dementia. The participants in the study had cognitive impairment, which improved after a 24-week home based physical activity program. Improvements were found 12 months after the intervention.
As the research indicates that physical activity can reduce the risk of vascular dementia, it is important to encourage people to exercise; especially for people who are at risk of cerebrovascular disease. Physical activity should be included in prevention programs.
Environmental and social factors needs to support the increase in a person's level of physical activity. Currently there are many western people who don't do the recommended levels.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Dag Aarsland , Farzaneh S. Sardahaee , Sigmund Anderssen , Clive Ballard & the Alzheimer's Society Systematic Review group (2010) Is physical activity a potential preventive factor for vascular dementia? A systematic review, Aging & Mental Health, 14:4, 386-395, DOI: 10.1080/13607860903586136
When cognitive decline is a result of Huntington's Disease then the diagnosis of Major or Mild Neurocognitive Disorder Due to Huntington's Disease is provided. For the diagnosis to be provided, Huntington's Disease or risk for Huntington's disease based on family history or genetic testing needs to occur before the cognitive decline. Also the criteria for major or mild neurocognitive disorder needs to be met, which a gradual and insidious progression. Lastly the neurocognitive disorder is not better explained by another medical condition.
Major neurocognitive disorder includes a significant decline from a previous level of performance in either complex attention, executive function, learning and memory, language, perceptual-motor, or social cognitive based on concern of a person who knows the informant or the clinical; and the impairment is documented by a standardised neuropsychological test or another quantified clinical assessment. Lastly the cognitive deficit is not better explained by another medical condition. On the other hand, mild neurocognitive disorder is when the person has a modest cognitive decline from a previous level of performance and the deficits does not interfere with the ability to be independent but needs greater effort or compensatory strategies are needed to cope.
Huntington's disease is a progressive genetic disorder and diagnosed from the ages of late 30s to early 40s. The person with Huntington's disease will usually have difficulty with memory retrieval, executive funcitoning and judgement early on. The person will have severy memory deficits as the disease progresses. Sypmtoms also include depression, irritability, anxiety and insidious changes in personality.
As Huntington's disease is a genetic disorder, a person over the age of 18 can have a test to identify if they have the gene, however this is not advised as he or she may become anxious by thinking they will end up with the disorder. There is a 50% change of a person with the gene to end up with the disorder.
Amereican Psychiatric Association. (2013). Neurocognitive disorders. In Diagnostic and Statisical Manual of Mental Disoders DSM-5 (pp. 591-643). Arlington, VA: American Psychiatric Association.
Major or Mild Neurocognitive Disorder Due to Prion Disease includes creutzfeld-jakob disease, fatal insomnia and kuru, however the most common type is creutzfeld-jakob disease. Major or mild neurocognitive disorder due to prion disease is a neurodegenerative disease which rapidly progressess over several months. The symptoms include fatigue, anxiety, problems with appetite, sleeping or concentration, which may be followed after several weeks by incoorrdination, altered vision, or abnormal gait or other movements that may be myoclonic, choreoatheoid or ballistic followed by the onset of rapidly progressive dementia.
Firstly, the criteria needs to be met for either mild or major neurocognitive disorder, there is a gradual and insidious progression of impairment and the disorder is not better explained by another mental disorder or attributable to another medical condition. Major neurocognitive disorder includes a significant decline from a previous level of performance in either complex attention, executive function, learning and memory, language, perceptual-motor, or social cognitive based on concern of a person who knows the informant or the clinical; and the impairment is documented by a standardised neuropsychological test or another quantified clinical assessment. Lastly the cognitive deficit is not better explained by another medical condition. On the other hand, mild neurocognitive disorder is when the person has a modest cognitive decline from a previous level of performance and the deficits does not interfere with the ability to be independent but needs greater effort or compensatory strategies are needed to cope. The impairment is rapid and insidious, motor features of prion disease (myoclonus or ataxia), or a biomarker are present and there is no attributable to another medical condition and not better explained by another mental disorder.
The disorder is transmutable (e.g., mad cow disease) with agents such as abnormal proteins called prions or otherwise known as slow viruses. The prions build up in the cells of the brain causing shrinkage.
People of any age may develop major or mild neurocognitive disorder due to prion disease but mostly people between the age of 40-60 are more susceptible to it.
American Psychiatric Association. (2013). Neurocognitive disorders. In Diagnostic and Statisical Manual of Mental Disoders DSM-5 (pp. 591-643). Arlington, VA: American Psychiatric Association.
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