Risk reduction is something that we are being quite diligent about right now. Anxious to cut our chances of getting coronavirus, we have become a nation (and world) of gloved, face-mask-wearing social isolationists. It’s fantastic that people are paying so much attention to their own health and wellbeing, and to the health and wellbeing of their fellow humans. It’s just a shame that it only happens during crisis situations.
If you think COVID-19 is bad, as a global pandemic it doesn’t come close to dementia. It’s just more dramatic.
The fatality rate for COVID-19 is somewhere between 1.4 and 3 percent, according to infectious disease experts. The fatality rate for dementia is one hundred percent. Since the coronavirus outbreak began, there have been about 1.6 million cases reported. There are over 50 million people living with dementia. On average, someone in the world is diagnosed with COVID-19 every five seconds. Dementia has that one beat too: someone in the world is diagnosed with dementia every three seconds. On the economic front, dementia wins. In March, the OECD predicted that COVID-19 will lower global GDP growth by one-half of a percentage point in 2020. But according to the WHO, the total global societal cost of dementia in 2015 was estimated to be 818 billion USD, equivalent to 1.1% of global GDP.
Apples-to-apples, there’s no comparison. Dementia is way, way worse than COVID-19. It’s just slower, less dramatic and far less sexy to the news media and to drug companies. And perhaps most critical: unlike coronavirus, most people don’t believe there’s any way to cut their chances of dementia. But they’re wrong.
Like the coronavirus, your risk for getting dementia goes up or down based on exposure to certain hazards or risk factors. And like the coronavirus, you can’t completely avoid the risk of getting dementia, but you can decrease the probability.
What kinds of hazards or risk factors for dementia are there? Research shows there are five main areas or categories of dementia risk: demographics, biomarkers, lifestyle, medical, and environmental. Some of these risks are easier to control than others.
In the United States, you have the highest risk for dementia if you’re a white female over age 65 who didn’t go to college. Indeed, the risk of dementia goes up as we get older although younger-onset dementia does exist. In fact, diagnosis rates in the US increased by 200% from 2013-2017 for people between the ages of 30 and 64. And Caucasian, non-Hispanic whites are by far more likely to develop dementia than other races. In fact, they account for over 80% of people with dementia in the United States.
Globally, your risk is higher if you live in a low- or middle-income country and you have little to no formal education. Women generally are about twice as likely to develop any form of dementia. Scientists aren’t certain why having less formal education correlates to a higher risk of dementia, but many believe it has something to do with “early deprivation” and its effects on lowering brain reserve.
From a risk management perspective, we have the least control over our demographic risks than any other domain. But by making sure our children get a formal education, we lower their risk of dementia.
The second dementia risk domain is genetic biomarkers. While some dementia cases do have a clear, acquired hereditary reason, most cases result from complex collaboration between hereditary and natural causes.
While you may have biomarkers that increase your risk – like the APOE4 gene variant – you can largely control how your genes express by adjusting environmental conditions. This is called epigenetics: the way that organisms change – not by altering the genetic code itself, but by modifying the way that genes express.
Simply put, you are not a victim of your genetic variants. You have the power to adjust lifestyle and other conditions that activate or repress your genes. Since an estimated 25% of people carry at least one APOE4 allele – the single most important risk factor for Alzheimer’s disease – we would all do well to pay attention to reducing our risk in this area.
The third risk domain is lifestyle. Recent studies have linked dementia and Alzheimer’s disease with several lifestyle-related factors including physical activity, dietary fat intake, alcohol drinking, and smoking.
The facts are clear: if you don’t exercise regularly, you risk of dementia literally doubles. And exercise doesn’t mean a leisurely stroll or gentle stretching. From a risk-reduction perspective, exercise is defined as “leisure-time physical activity lasting at least 20-30 minutes each time and causing sweating and breathlessness.”
Keto is a trendy diet these days and often includes excessive amounts of saturated fats. These fats are solid at room temperature and include keto staples such as butter, coconut oil, ghee, cheese, sour cream, fatty cuts of beef, pork and lamb as well as dark chicken meat and poultry skin. But research shows that even moderate intake of saturated fats doubles your odds of dementia.
And for the 25% of us who carry at least one APOE4 allele, the risk is even higher. If you carry the APOE4 allele, your risk of dementia is seven times higher from saturated fat intake alone. Alcohol drinking increases your risk by five times and physical inactivity triples it. These effects magnify when compounded together in the typical American lifestyle of skipping exercise in favor of trendy diets and drinking too much.
If you haven’t yet been tested to see if you carry the APOE4 gene variant, you can read about my experience with it here.
The fourth risk domain is medical. There are several comorbidities that increase your risk for dementia, but a good rule of thumb is that your health in midlife defines your health in late life. What you do today impacts your health for decades.
There are several known medical conditions that increase your probability of developing Alzheimer’s and other forms of dementia including high blood pressure, low blood pressure, stroke, head trauma, and type 2 diabetes. Other medical risk factors for dementia include suboptimal hormones, vitamins and minerals as well as chronic inflammation, sleep apnea, obesity, and depression. In his bestselling book, The End of Alzheimer’s, Dr. Dale Bredesen lays out 36 different metabolic factors that can trigger Alzheimer’s disease. I’m currently doing a modified, DIY version of his protocol in my own wellness in aging journey, which you can read about here.
Certain medications – known as anticholinergics – are strongly associated with an increased risk of dementia. Anticholinergics are drugs that act by blocking a neurotransmitter called acetylcholine, therefore inhibiting nerve impulses responsible for involuntary muscle movements and various other bodily functions. Even if you’ve never heard of anticholinergics, chances are that you take them regularly.
Anticholinergics are used to treat a plethora of conditions, from overactive bladder to COPD. If you take over the counter or prescription medications for gastrointestinal or urological conditions, depression, Parkinson’s, asthma, or allergies, do some research, talk to your doctor and make sure you’re not taking something that has “definite cholinergic activity”. Some surprisingly common medications are in this category including Zyrtec, Benadryl, Claritin, Phenergan, and Elavil.
The fifth and final risk domain is environment. This includes environmental risk categories such as air quality, toxic heavy metals, other metals and trace elements, as well as occupational-related exposure. Studies show that air pollution, aluminum, silicon, selenium, pesticides and toxic molds and mildews all increase your risk of Alzheimer’s and other forms of dementia.
Silicon comes in numerous forms and is very common in personal care products such as skin moisturizers and leave-in hair products. Aluminum is also used extensively in pharmaceuticals, OTC drugs, cosmetics, and antiperspirants. These are not the only two things to watch out for in your personal care products, but they are the most studied in terms of dementia risk.
COVID-19 is scary and it’s deadly serious. But so is dementia. While you may not be able to completely avoid the risk of infectious diseases like coronavirus or chronic, degenerative conditions like dementia, it is well within your power to decrease the probability. Like handwashing and social distancing, let’s make dementia risk reduction part of the “new normal” in the interests of both public health and personal wellbeing.