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How to reduce dementia risk

Bupa investigative news - 30 June 2003
written by Rachel Newcombe, reporter for Bupa's Health Information Team

Over 700,000 people in the UK are currently affected by dementia, with one in 20 people aged over 65 and one in five over 80 years old. Although there's no cure for most types of dementia, new research suggests that intellectual stimulation may reduce the risk.

KEY POINTS

According to the Mental Health Foundation,"Dementia is a decline in mental ability, which affects memory, thinking, problem-solving, concentration and perception". There are various forms, including Alzheimer's disease

A 21-year study carried out in America looked at people's leisure activities and the risk of dementia

It was found that people who regularly took part in intellectually stimulating activities (for example reading, playing board games and playing musical intruments) appeared to have a lower risk of developing dementia.

Conversely, regular physical activity did not appear to reduce the risk of developing dementia. The only exception to this rule was ballroom dancing, perhaps because people need to remember the steps.

Experts say that the study backs up previous research. But they caution that more research is needed to fully establish a link between intellectual stimulation and a reduction in dementia risk.

Intellectual stimulation is known to help people age well and remain alert. Most forms of dementia can't yet be prevented, although a healthy lifestyle can reduce the risk of developing a form called vascular dementia.

What were the headlines?

Examples of headlines include, "Dancing 'wards off dementia'", "Leisure time activities and the risk of dementia", "Ballroom dancing is the best step to avoid Alzheimer's", and "Leisure activities 'protect against dementia'".

What is the bigger picture?

The research was published in the New England Journal of Medicine (NEJM) and was carried out over a 21-year period at the Albert Einstein College of Medicine of Yeshiva University, New York, led by Dr. Joe Verghese, assistant professor of neurology.

A group of 469 men and women aged over 75 years old were studied between the years 1980 and 2001. Before being enrolled into the study, all the participants were screened to ensure they weren't already suffering from dementia. They each gave details about how often they participated in six cognitive activities (reading, writing, doing crosswords, playing musical instruments, taking part in group discussions and playing board games) and 11 physical activities (dancing, numerous sports, housework and babysitting) and the team developed a scale to assess frequency of activities each week. The people were studied for an average of 5.1 years.

For each beneficial activity, the risk reduction was related to how often it was performed. For example, people who did crosswords four days a week had a 47 per cent lower risk of dementia than people who only did puzzles once a week.

During the course of the study, 124 people developed dementia, 61 developed Alzheimer's disease, 30 vascular dementia, 25 mixed dementia and eight had other types of dementia. The researchers found no significant association between physical activities - except for dancing - and the risk of dementia. However they did find that people who who took part in intellectually stimulating activies (such as reading, playing board games or musical instruments) did seem to have a reduced risk of dementia.

The researchers say that they checked their results to make sure that other factors were not affecting their findings. Reassuringly, the results weren't affected. "Conceivably, protection from dementia in our study was really due to being smarter and better educated, and people with those attributes were simply more likely to engage in cognitively stimulating activities," said Dr. Verghese. "But adjusting the data for intelligence and educational level didn't weaken our results. Plus, when we restricted our analysis to individuals with a high school education or less, the association between cognitive-stimulating activities and reduced risk of dementia was maintained."

"This is very interesting research which has been carried out well. They've addressed all the possible weaknesses and it warrants more research, as intellectual stimulation does appear to be a possible preventive strategy.

This isn't the first time this has been suggested - a paper two years ago, also carried out in America, found similar results that people leading intellectually stimulating lives were more likely to be free from Alzheimer's disease."

Dr Graham Stokes
head of mental health
Bupa Care Services

What does this mean?

Dr. Graham Stokes, head of mental health at Bupa Care Services, said, "At face value, it's a real puzzle as to how stimulating intellectual activities could prevent brain cells decaying. Dementia isn't just the brain wearing out - it's a disease, or a host of diseases. Other research is looking at whether it's genetic factors that put people at risk, or toxins and poisons from the atmosphere."

But this research, which Dr Stokes described as "excellent" and "very interesting", appears to show that staying mentally active may have an effect that counters the buildup of such toxins or genetic effects. He added that this isn't the first study to suggest this. "Two years ago a paper by Dr. Robert Friedland [published in the Proceedings of the National Academy of Sciences] found that people who watched an excessive amount of television in old age ran a greater risk of Alzheimer's disease. TV was bad for the brain because the brain wasn't functioning at its peak potential. So, like this study, it seemed to suggest that those free of Alzheimer's lead more intellectually stimulating lives."

Commenting on the findings, Dr Susanne Sorensen, head of research at the Alzheimer's Society, said, "The results indicate that physical activities alone are not associated with a diminished risk of dementia and that the more mentally demanding the leisure activities are, the higher the association with diminished risk of developing dementia. This research strengthens the 'use it or lose it' school of thought that states that complex and precise brain activity can build up a brain reserve that may protect people from Alzheimer's disease in later life."

However, Dr Sorensen warned that people also need to remain physically active in later life. "Maintaining physical activity has been linked to better general health as people get older, preventing cardiovascular disease and falls, and this research should not be taken as a recommendation to concentrate on cerebral exercise only."

Jim Jackson, chief executive of Alzheimer Scotland - Action on Dementia, was interested in the findings, but expressed a degree of caution: "The recently published study in the New England Journal of Medicine points to another potential factor which will hopefully form part of an effective approach to preventing dementia. However we need to be cautious because, although the results were statistically significant, the reduction of risk was quite small."

He added that, "The next step will be to incorporate leisure activities into a controlled trial to find out how powerful the effect will be."

Alisoun Milne, programme consultant in mental health in later life at the Mental Health Foundation and senior lecturer in social gerontology at the University of Kent, agrees that more research is needed. "The study offers a positive and solid foundation for taking forward further research in this important area. Controlled trials are now needed to assess the protective effect of leisure and other activities on the risk of dementia."

But why was ballroom dancing the only physical activity that appeared to be associated with a reduced risk of developing dementia? Dr Vergehese offered the theory that the requirements of ballroom dancing - remembering the steps, moving in precise time to the music and adapting to the movements of one's partner - are mentally demanding exercises. Therefore ballroom dancing offers both physical and mental stimulation.

ACTION POINTS

If you want to grow old gracefully, keeping yourself intellectually stimulated and physically active can help.

Remaining intellectually stimulated - for example by reading, playing board games or a musical instrument - may help to reduce the risk of developing dementia in later life.

Keeping physically active can help to reduce the risk of other problems such as heart disease and loss of coordination (which can result in falls).

Ballroom dancing may help you to be both intellectually stimulated and physically active.

If you could be at risk from vascular dementia, it may be worth adressing your lifestyle and habits by eating healthily and exercising regularly.

Although more research is needed to fully determine if intellectual activity helps dementia, there's no harm in keeping yourself busy and active.

What does this mean to me?

According to Alisoun Milne, "The implications of this work are that we need to encourage older people to engage with, or maintain, their participation in leisure activities, hobbies and interests throughout later life."

Dr. Stokes agreed: "For people growing old who want to age well and be alert, without a doubt keeping yourself intellectually stimulated is excellent."

Most people who develop dementia do so after the age of 60. There are three major causes of dementia (Alzheimer's disease, vascular dementia and mixed dementia) and, according to Dr. Stokes, only one of them can be actively prevented. "Vascular dementia is the only one for which there is some preventative action, because vascular dementia is all to do with having strokes. It affects 20 per cent of people in their old age and is connected with high blood pressure, cigarette smoking, weight and too much salt. So, for people at risk of vascular dementia, they can address their lifestyle and habits and reduce their risk."

As a result of this study, it might be that remaining mentally stimulated may also help to reduce the risk of developing dementia. But Jim Jackson had this warning, "We need to remember that dementia affects people from all walks of life, including the intellectually active, and therefore there are other factors that we still need to learn more about before we can develop an effective approach to preventing dementia."

Summary

The possible effects of leisure activities on dementia risk are interesting, especially as remaining mentally and physically active are factors that people can do something about. It seems that intellectual stimulation and some physical activity may play a part, but more research is needed to fully establish their role.

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