For many of us, dementia is not an inevitable part of growing older. We have talked about this before, but I feel strongly that it’s time to talk about it again. The idea is still a fairly new one to wrap your mind around, no pun intended, and I’m pretty sure that most people are not going around thinking, “What can I do today to prevent dementia?”

            But they ought to be. We all ought to be.

So here, if you will, is a “Dementia Grab-Bag,” which sounds like a really bad party gift. I have collected some research studies and decided to give them to you all at once. Maybe “Dementia Round-Up” is better, although that just makes me imagine of a lot of sad old cows, or cowboys wearing adult diapers.

What can you do to prevent dementia? In addition to the things we’ve already discussed, here are three easy actions for your consideration. The main thing to think about with all of them is that what is good for the heart is also good for the brain.

Embrace Leafy Greens

Maybe you’re old enough to remember the pickle episode from the Andy Griffith Show, in which Aunt Bee somehow manages to make pickles that taste like kerosene. Andy and Barney try their best to get rid of them, and Aunt Bee makes even more. At length, Andy figures, all they can do is “Learn to love ‘em.”

If you already love salads (not the pale green Iceburg lettuce wedge, but salads with dark green leaves), kale, spinach, collards and other greens, you’re in luck! If not, the best thing you can do is learn to love ‘em, so you can get the brain-helping powers they seem to offer.

In a recent study published in Neurology, scientists found that healthy seniors – there were 960 participants in the study, average age 81 – who ate leafy green vegetables every day had a slower rate of cognitive decline than did those who ate few or no greens.

The seniors (none of whom has dementia) are part of the Memory and Aging Project at Rush University in Chicago, a longitudinal study in which participants undergo yearly tests to assess their memory; they also keep track of what they eat, their exercise, etc. In this study, researchers led by Martha Clare Morris, Sc.D., Director of Nutrition and Nutritional Epidemiology at Rush, divided the participants into five groups, based on the amount of greens they eat. The seniors in the top group ate about 1.3 servings of leafy greens a day (a serving is about half a cup of cooked greens, or a cup of raw greens); those in the bottom group ate hardly any.

After about five years, the rate of decline for those in the top group was “about half the decline rate of those in the lowest,” reports Morris.   And get this: Their mental processes were “the equivalent of being 11 years younger in age.” Higher intakes of leafy greens “were associated with slower cognitive decline.”

Now why is this? Well, the scientists aren’t entirely sure, because even a simple leaf of kale has a bunch of nutrients and bioactive compounds in it, including phylloquinone, lutein, nitrate, folate, alpha-tocopoherol, and kaempferol.   All of these, says Morris, “have different roles and different biological mechanisms to protect the brain.” One thought, she adds, is that if you don’t get enough folate, you can have higher levels of homocysteine (an amino acid), which can lead to inflammation and the buildup of plaque and fat in the arteries – and this, in turn, can lead to a heart attack or stroke. In another recent study, Korean scientists reported that higher blood levels of homocysteine in older adults were associated with cognitive impairment.

And, of course, we can’t overlook the fact that if you’re eating a salad, maybe you’re not also eating fries or chips or macaroni at that particular time.

Note: This study didn’t report that these people never eat red meat, or that they exercised all the time; in fact, they adjusted for a bunch of factors, including education, overall health, exercise, activities, smoking and drinking. All the people in the top group did was eat leafy greens every day. Also, the scientists don’t claim that leafy green vegetables will stop memory decline forever. But there is a definite link: “The association is quite strong,” says Morris.

It’s easy to add greens to your daily diet. You can buy them in a bag salad. Eat collard greens from a can. Drink kale disguised in a strawberry-banana smoothie, if you don’t like the taste.

Embrace Exercise

You need to exercise. Please note that I did not have some condescending headline on here, like, “Get off the couch, you bum.” I don’t presume to know how active you are, and I hate it when people virtue-signal about exercise and diet and just make me feel like a loser because I’m not doing enough.

We’ve all got enough stress – and this is the interesting aspect of the next study I want to tell you about.   Scientists at Brigham Young University (BYU) in Utah found that running sharpens memory and mitigates the damage of chronic stress on the brain.

You don’t like to run? That’s okay. This article is about exercise and the scientists used mice; mice can’t ride a bike, do a rowing machine, or lift weights, so in this study, they ran, maybe with little track suits and sweat bands, I don’t know. The point is, if you don’t like to run, don’t discount this study; you could walk fast, or swim, or ride an exercise bike, or do the rowing machine – anything that gets your cardiovascular system going.

Remember the hippocampus? It’s the part of the brain that’s very important in memory, learning, spatial navigation, and other things. (It’s also deprived of blood flow when you smoke marijuana, which we’ve discussed here.) Well, chronic stress can be hard on the hippocampus; it weakens the synapses (electrical messages fired off by one neuron to another). Specifically, it affects a process called long-term potentiation (LTP), which helps us remember things more clearly.

In other words, prolonged stress hurts the brain and can affect our memory. But exercise acts as an antidote: It is “neuroprotective against the negative effects of stress” on hippocampal LTP, says Jeffrey G. Edwards, Ph.D., on the faculty in the Department of Physiology and Developmental Biology at BYU and the study’s senior author.

For this study, the scientists divided the mice into four groups: sedentary no stress, exercise no stress, exercise with stress, and sedentary with stress. (Don’t worry; they didn’t waterboard the mice or anything like that. They exposed them to some temporary stressful situations, like walking in cold water or on elevated objects).  The mice that had stress but also exercise had “significantly greater LTP” than the sedentary mice did. They also performed much better in a maze – as well as the non-stressed mice did.

Of course, the best way for us to improve our learning and memory “would be to experience no stress and to exercise,” Edwards says. Although we don’t always have a say in how much stress we have in our lives, “we can control how much we exercise,” and it is empowering to know that we can offset the negative effects of stress on our brains simply by giving our cardiovascular system a workout.

How does this relate to dementia? A lifetime of better brain stewardship will put us in a much healthier position to prevent dementia as we get older.

Don’t Drink Too Much

In a new study published in Lancet, French and Canadian scientists showed that too much alcohol is bad for your brain. They weren’t the first to show this, but their research adds to a growing body of evidence showing a clear link between heavy drinking and dementia.

The researchers looked at the French National Hospital Discharge database and examined the association between alcohol use and dementia, particularly early-onset (younger than age 65) dementia. Out of 1,109,343 patients diagnosed with dementia who had been discharged from French hospitals between 2008 and 2013, there were 57,353 cases of early-onset dementia. Most of these cases of dementia, the scientists report, “were either alcohol-related by definition, or had an additional diagnosis of alcohol use disorders.” They did not include patients who already had certain neurological or other diseases that can lead to rare types of dementia; they just wanted to focus on alcohol consumption.

Now, you may be wondering, what’s an alcohol use disorder? It’s problem drinking that become severe. I’m including a link to the National Institute on Alcohol Abuse and Alcoholism, which has some questions to help people determine if they have a problem. They call alcohol use disorder (AUD) a “chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using.” Some questions include: “In the past year, have you had times when you ended up drinking more, or longer than you intended? Spent a lot of time drinking, or being sick or getting over the aftereffects? More than once wanted to cut down or stop drinking, or tried to, but couldn’t?” These and others are here, and they’re good ones.

Also, you may be wondering, what is heavy drinking? The study’s authors used this definition, also used by the World Health Organization and European Medicines Agency: “at least 60 grams of pure alcohol per day for men and at least 40 grams for women.” Definitions for what constitutes a standard drink vary, but in the U.S., a standard drink contains about 14 grams of pure alcohol. This is found in 12 ounces of beer, which is usually about 5 percent alcohol; 5 ounces of wine, typically about 12 percent alcohol; and 1.5 ounces of spirits – your basic shot of whiskey, tequila, etc., — which is about 40 percent alcohol. You can do the math, but if one of those drinks has 14 grams, then knocking back a little over four drinks a day would put you in the heavy drinking category.

Drinking in moderation is one thing; in fact, many reviews show a possible beneficial effect of a glass of wine a day. But drinking more than one or two drinks every day, or even several days a week, is another thing altogether.

We are talking about a big preventable risk factor here. Dementia affects 5 to 7 percent of people age 60 and older worldwide. There are several categories of dementia; Alzheimer’s is the most common, followed by vascular dementia and other types, and some people have mixed types of dementia – problems with the blood flow to the brain, plus some damage from alcohol, disease, or something else.

“Heavy drinking seems detrimentally related to dementia risk, whatever the dementia type,” the researchers say. Too much alcohol affects the brain in several ways. “First, ethanol and its metabolite acetaldehyde have a direct neurotoxic effect, leading to permanent structural and functional brain damage. Second, heavy drinking is associated with thiamine deficiency.” Here’s a link to another paper on thiamine deficiency. Basically, thiamine – vitamin B1 – is an essential nutrient; your body needs it to do many things. It’s especially important for your heart, liver, kidneys, and brain. Thiamine deficiency can harm the body in many ways; mental changes include depression, decrease in short-term memory, confusion, and irritability.

“Third,” the scientists continue, “heavy drinking is a risk factor for other conditions that can also damage the brain, such as epilepsy, head injury, and hepatic encephalopathy in patients with cirrhotic liver disease. Fourth, heavy drinking is indirectly associated with vascular dementia” because it raises vascular risk factors and can cause “high blood pressure, haemorrhagic stroke, atrial fibrillation, and heart failure.” And finally, “heavy drinking is associated with tobacco smoking, depression, and low educational attainment, which are possible risk factors for dementia.” We have talked about cognitive reserve and dementia risk here. “This combined evidence has led to a discussion about establishing a specific diagnosis of alcohol-related dementia.”

© Janet Farrar Worthington