Scientists reveal 3 lifestyle factors that may delay dementia by 12 years

 Not defined is whether high blood pressure being treated is still a risk factor, like me.

Scientists reveal 3 lifestyle factors that may delay dementia by 12 years

According to the National Institutes of Health (NIH), about 42% of Americans over the age of 55 will develop dementia at some point. Luckily, a growing body of research suggests there are concrete steps you can take to reduce your risk or delay the disease’s onset.

Most recently, a study in Neurology found that just three lifestyle factors may add up to 12 dementia-free years to your life. For the study, the researchers observed more than 12,000 participants over an average of 26 years, investigating how three vascular risk factors—diabetes, high blood pressure, and smoking status—affected their risk of developing dementia and its age of onset. Ultimately, the researchers found that people who had fewer of these risk factors at midlife were both less likely to develop dementia and less likely to develop dementia at an early age. In fact, compared to participants with all three risk factors, participants with no risk factors had about 12.6 additional dementia-free years. (Participants with just one risk factor also had 8.8 more dementia-free years, while participants with two risk factors had 3.5.)

“This builds beautifully on an important 2024 Lancet Commission report, which identified 14 potentially modifiable risk factors for dementia. Diabetes, hypertension, and smoking are only part of that much larger picture,” says David Perlmutter, M.D., F.A.C.N., A.B.I.H.M., board-certified neurologist and author of Brain Defenders. “The message from both reports is increasingly difficult to ignore: a meaningful portion of dementia risk is related to factors we can potentially influence.”

So, what does all this mean for you? Ahead, neurologists break it down.

Meet the experts: David Perlmutter, M.D., F.A.C.N., A.B.I.H.M., board-certified neurologist and author of Brain Defenders; Jeremy M. Liff, M.D., board-certified neurologist in New York City

Why are the findings significant?

The importance of the study’s findings is twofold. First, “they reinforce the idea that dementia is significantly preventable,” Dr. Perlmutter says. “To me, the important message is that brain health is very much connected to metabolic and vascular health, and what happens in midlife can have profound consequences decades later.” This is particularly important because we don’t yet have good treatments for dementia or Alzheimer’s disease, he notes.

Related video: Nearly half of dementia cases may be preventable, doctor explains (FOX 32 Chicago) Second, the results show that the risk factors appear to be additive. “One risk factor is concerning; two are worse; and three are considerably worse,” Dr. Perlmutter says. “People with all three had about 2.7 times the hazard of developing dementia compared with those who had none.”

What’s the takeaway?

While there’s no way to completely eliminate the risk that you’ll develop dementia—and preventing or delaying the onset of diabetes or hypertension is a complex, multifactorial process as well—the study shows that you can take some important steps to reduce your dementia risk.

“Threats to brain health begin long before memory problems appear. Know your blood pressure. Know your blood sugar and metabolic health. Don’t smoke,” Dr. Perlmutter says. “These aren’t exotic, expensive, or difficult interventions, and that’s precisely the point. Many of the most powerful tools we have for protecting the aging brain are available to each of us right now... This fundamentally changes the conversation from simply asking, ‘How can we treat Alzheimer’s?’ to asking, ‘How can we reduce the likelihood of getting there in the first place?’”

Taking these steps won’t just affect your dementia risk, either. “Smoking, diabetes, and blood pressure are clearly risk factors that would stop you from living a longer, generally healthier life—not just brain health, but overall body health,” says Jeremy M. Liff, M.D., board-certified neurologist based in New York City.

And it’s never too early to make healthy changes. “Don’t wait until you’re in your mid-70s,” Dr. Liff urges. “One of the points of the study is they were looking at people in their 50s, so the time to start with this is now, because what you do now will have that downstream effect 20 to 40 years from now.”

Dr. Perlmutter agrees. “This fits perfectly with what we’re learning about Alzheimer’s disease. The biological changes that ultimately manifest as memory loss may be developing for 20 or even 30 years before the diagnosis,” he explains. “I think we’ve made a mistake by viewing Alzheimer’s simply as a disease of old age. Increasingly, we should think about it as a disease whose foundations may be laid in midlife or even earlier.”

How can you support your brain health?

Again, there’s no surefire way to avoid developing dementia or Alzheimer’s disease; as Dr. Liff notes, there are plenty of otherwise healthy patients who still develop it.

Still, there are things you can do to support your brain health throughout your life. “I encourage people to think beyond any single supplement, food, drug, or ‘brain hack.’ Brain health reflects what we do consistently over many years,” Dr. Perlmutter says.

In addition to monitoring your risk of developing diabetes or hypertension, and refraining from smoking, both Dr. Liff and Dr. Perlmutter recommend the following habits for good brain health:

• Get regular exercise
• Prioritize restorative sleep
• Maintain meaningful social connections
• Eat a minimally-processed diet rich in fiber and whole foods
• Continue learning and challenging yourself
• Protect your hearing
• Avoid large amounts of alcohol
• Avoid stimulants late at night

The bottom line

This study and others like it suggest we have more control over our dementia risk than we previously thought, but it’s important to keep these findings in context. Both Dr. Liff and Dr. Perlmutter point out that the research is observational, which means that while the studies found a clear association between vascular risk factors and dementia risk, they can’t establish a cause-and-effect relationship. Additionally, the researchers only assessed the participants for diabetes, hypertension, and smoking status at one point in midlife, rather than tracking the evolution of these risk factors over a longer period of time.

“And, of course, dementia is complicated. Genetics, environmental exposures, education, physical activity, social circumstances, and many other factors matter as well,” Dr. Perlmutter adds. “But again, many of these other factors reflect our lifestyle choices. And that gives each of us agency over our brain’s destiny.”

Three Factors Tied to 13 Additional Dementia-Free Years

 Ask your competent? doctor how your stroke affects these possibilities! There better be an answer.

Three Factors Tied to 13 Additional Dementia-Free Years

Key Takeaways

• Midlife vascular health was associated with nearly 13 more dementia-free years in a prospective U.S. cohort study.
• At age 55, healthier study participants averaged 30.1 additional years without dementia.
• Smoking, hypertension, and diabetes together sharply increased dementia risk and mortality.

Maintaining three key health factors during midlife -- normal blood pressure, no diabetes, and not smoking -- was associated with nearly 13 additional dementia-free years, a study of 12,000 people in the U.S. showed.

Individuals who met these criteria at age 55 lived an average 30.1 more years dementia-free, reported Josef Coresh, MD, PhD, of NYU Langone Health in New York City, and co-authors.

Conversely, those who smoked, had hypertension, and had diabetes at age 55 had dementia-free survival of only 17.5 years, Coresh and colleagues wrote in Neurology Open Access.

People with all three risk factors had a higher incidence of dementia (HR 2.69, 95% CI 1.94-3.73) and a higher incidence of dying before a dementia diagnosis (HR 5.61, 95% CI 4.67-6.74) compared with those who had no risk factors.

Overall, women lived longer without dementia than men at all risk levels. White participants had more years free of dementia than Black participants, and APOE4 carriers had shorter dementia-free survival than noncarriers.

"Our findings argue that people need to actively avert these factors in midlife as a strategy for preserving brain health for more than a decade," Coresh said in a statement. "Discovering new ways to delay dementia is crucial with 42% of Americans at risk for developing the condition at any time after age 55."

The findings were based on 12,409 participants in the prospective Atherosclerosis Risk in Communities (ARIC) study, which started in 1986 to evaluate midlife vascular risk factors and late-life dementia.

Previous research from the ARIC cohort suggested that 22% to 44% of dementia risk by age 80 could be attributed to three vascular risk factors measured in midlife and early late life, after accounting for risk factor concurrence and interactions.

Hypertension was defined as systolic blood pressure ≥130 mm Hg, diastolic blood pressure ≥80 mm Hg, or the use of blood pressure medication; diabetes as fasting glucose ≥126 mg/dL, non-fasting glucose ≥200 mg/dL, a physician's diagnosis, or the use of any diabetes medication; and current smoking was self-reported.

"Our study complements this important work by shifting focus from probability-based and attributable risk metrics to a time-based estimand -- dementia-free survival years, which quantifies the expected duration of life lived cognitively intact," Coresh and colleagues wrote.

"This outcome integrates two clinically relevant processes: incident dementia and death before dementia, therefore reflecting the competing risks that shape real-world aging trajectories," they pointed out. "In contrast to previous ARIC studies, this framework emphasizes how vascular health influences the balance between longevity and cognitive health over the life course."

In the current analysis, ARIC participants had a mean baseline age of 56 and 56% were women. Dementia was tracked through cognitive assessments, informant interviews, and continuous surveillance. Deaths without dementia were captured from multiple sources including the National Death Index.

Over a median follow-up of 26.3 years, 3,008 cases of dementia and 5,238 deaths without dementia were documented. Better vascular health was linked with longer dementia-free survival in a dose-response pattern.

"Several biologic pathways likely underlie our observed associations between vascular health and dementia-free survival, including chronic cerebrovascular injury, neuroinflammation triggered by vascular damages through hypertension and diabetes, and cumulative oxidative stress resulting from smoking," Coresh and colleagues wrote. "Together, these factors likely accelerate atherosclerosis, increase stroke risk, and may facilitate Alzheimer's disease pathology through promoting amyloid plaques and tau tangles."

The findings relied on one midlife assessment of risk factors, the researchers acknowledged. Dementia ascertainment may have differed between participants who attended recent visits and those who didn't. In addition, the study was observational and residual confounding may have influenced outcomes.

Varenicline May Increase Risk of Adverse Cardiovascular Event

You'll have to ask your doctor if this research puts stroke into the cardio disease category or they are up-to-date and have it in neuro.
Stroke — no longer categorized as a cardiovascular disorder but as neurological by the World Health Organization (WHO) and the Global Burden of Disease study group. 
http://dgnews.docguide.com/varenicline-may-increase-risk-adverse-cardiovascular-event?

NEW YORK -- December 20, 2017 -- Varenicline, one of the most commonly prescribed drugs for helping people quit smoking, may put them at higher risk for a cardiovascular event, according to a study published in the American Journal of Respiratory and Critical Care Medicine.
In an observational, self-controlled trial, patients prescribed varenicline were 34% more likely to have an emergency department visit or hospitalisation for a cardiovascular event while taking the drug. Among those patients who had not previously experienced a cardiovascular event, the increased incidence was only 12%.
The researchers estimated that among all patients, there were 3.95 adverse cardiovascular events per 1,000 varenicline users that could be attributed to the drug.
The researchers also found a small increase in emergency department visits and hospitalisations for neuropsychiatric symptoms, but they said the findings were not robust and did not appear to be clinically meaningful.
“Previous studies regarding the safety of varenicline have been conflicting and most examined people with relatively similar characteristics and backgrounds in highly controlled settings,” said lead author Andrea S. Gershon, MD, University of Toronto, Toronto, Ontario. “We wanted to study varenicline among all kinds of people in the real world. “
The researchers analysed the medical records of 56,851 new users of varenicline between September 2011 and February 2015 living in Ontario. The records were studied from a year prior to the year following the date when varenicline was prescribed. During that time, 4,185 and 4,720 patients experienced 1 or more cardiovascular or neuropsychiatric events, respectively, that resulted in an ER visit or hospitalisation.
Patients served as their own controls. Varenicline is usually taken for 12 weeks. Those weeks were considered the risk interval and were compared with the weeks before initiation of treatment and after treatment should have ended. The researchers excluded from the control period the 6 weeks before varenicline was prescribed to avoid biasing results by including patients who had just suffered a cardiovascular event and started varenicline to reduce their risk of another event.
Cardiovascular events included myocardial infarction, stroke, arrhythmias, unstable angina, and peripheral vascular disease, among others. Among neuropsychiatric events, the researchers included depression, anxiety, psychosis, hallucinations, insomnia, and self-harm.
Because the study is observational, it cannot determine cause and effect. The authors said the study was limited by a number of other factors, including not having information about whether the patients quit smoking, whether they took other medications to help quit smoking and whether nicotine withdrawal accounted for some of the neuropsychiatric events reported.
According to the authors, other studies have found that varenicline triples the odds of a person quitting smoking. That long-term health benefit has to be taken into account when considering the potential risks of taking varenicline for 12 weeks.
“Quitting smoking greatly reduces a person’s chances of developing heart disease and cancer and has many other health benefits,” said Dr. Gershon. “Our findings should not be used to suggest people not take varenicline. The findings should be used to help people make an informed decision about whether they should take varenicline based on accurate information about its risks as well as its benefits.”
The finding also suggests that physicians should monitor patients taking varenicline more closely to catch adverse events early if they do occur.
Reference: https://doi.org/10.1164/rccm.201706-1204OC
SOURCE: American Thoracic Society