Is dementia preventable?

This month, US clinical consultant and physician Dr Kenna Stephenson (left) reviews the results of the UK Biobank study and how dementia can be prevented through lifestyle changes and hormone replacement therapy for women during menopause. 

This community-based study, which enrolled 500,000 participants between the ages of 40-69, includes a comprehensive assessment of each enrollee, which offers the potential to profoundly alter our approach to prevention of diseases.

Dr Kenna, a respected researcher, writes, “As a Family Medicine physician, prevention is a hallmark of my practice, and the UK Biobank study is an excellent guide in illuminating the paths to health. 

The UK, USA and New Zealand are in the top 20 countries most impacted by dementia worldwide. An expert analysis of over 300,000 UK Biobank participants concluded that many dementia cases may be prevented - even in participants with genetic risks of dementia. Lifestyle factors and medical conditions were the most powerful factors related to dementia risk.

Medical conditions such as diabetes, depression, and hypertension along with visual or hearing difficulties are linked to dementia risk. 

For my patients with diabetes or cardiovascular disease, achieving improvement such as lowering blood sugar or blood pressure through diet, exercise, and effective medication may decrease dementia risk.

Recently I diagnosed a 60-year-old female patient with hearing loss and advised her to undergo a formal hearing evaluation by an audiologist. She refused, stating that she would “never wear hearing aids - they were for old people”, and she didn’t want to age her appearance by such devices. When I shared more about it offering a possible protection against dementia through correction of hearing loss, she changed her mind.

At her next visit, she was beaming with renewed vitality. Her daily life had been transformed through this investment in her health, and she became an advocate for other women to be proactive in addressing hearing loss. 

Unfavorable lifestyle choices that were associated with significantly increased risk of dementia included: tobacco and alcohol use, lack of physical activity, prolonged sitting and watching media, depressed mood, and social isolation.

Focused attention in shifting from unfavorable to favorable lifestyle are essential steps in decreasing dementia risk.

If a patient enjoys hours of watching social media, I advise that they exercise while watching favorite shows or sports events through home exercise equipment or jumping rope, running on the spot or other aerobic activity.

For patients with a negative mood and persistent feelings of sadness, worry and irritability, I prescribe mind-body interventions to help them move up the emotional scale to feelings of hope, joy and serenity and these are highlighted with case studies (www.doctorkenna.com ). Tobacco and alcohol cessation increases health and wealth. 

Hormonal impact on brain's blood vessels linked to changes in menopause

Further exciting research included over 9,000 female participants who were evaluated by brain MRI imaging to measure blood vessel changes in white matter which are associated with dementia.

Researchers were curious about the effects of female sex hormones across the life span and dementia risk, as both estrogen and progesterone have beneficial effects on brain blood vessels and neurons in the laboratory.

They discovered that women with longer natural exposure to these hormones during their lifetime through menstrual cycles (years from starting menstruation to stopping at menopause) and a higher number of pregnancies had favorable MRI images with less age-related inflammation.

In menopausal women taking hormone medication at the time of the brain scan, those who were applying hormones through the skin via patch or cream had more favorable measurements, compared to postmenopausal women taking oral pill forms or not taking any hormones.

These findings further affirm my clinical research CHOIICE landmark study in which we exclusively utilized transdermal (topically applied on the skin) estrogen and progesterone in hormone deficient peri-postmenopausal women for 3 years. We discovered favorable effects on immune, inflammatory and neuroendocrine biomarkers in The Hormone Restoration Model of Care. 

This provides more evidence that, for patients who need hormone support, applying hormones to the skin is superior for brain and body health.

In conclusion, the good news from this expert analysis is that patients have the power to take control of their health and dementia may be more preventable than previously thought.

References:

Zhang Y, Chen SD, Deng YT, You J, He XY, Wu XR, Wu BS, Yang L, Zhang YR, Kuo K, Feng JF, Cheng W, Suckling J, David Smith A, Yu JT. Identifying modifiable factors and their joint effect on dementia risk in the UK Biobank. Nat Hum Behav. 2023 Jul;7(7):1185-1195.

Yang, Liu et al. Depression, depression treatments, and risk of incident dementia: A prospective cohort study of 354,313 participants. Biological Psychiatry, 2023 May 1;93(9):802-809.

Lepage JF, Whittingstall K. Association of cumulative lifetime exposure to female hormones with cerebral small vessel disease in postmenopausal women in the UK Biobank. Neurology. 2023 Nov 14;101(20):e1970-e1978.

Stephenson K, Neuenschwander P, Kurdowska A The effects of compounded bio-identical transdermal hormone therapy on hemostatic, inflammatory, immune factors; cardiovascular biomarkers; quality of life measures; and health outcomes in perimenopausal and postmenopausal women. International Journal of Pharmaceutical Compounding,2013;17(1):74-85.

For more information on Dr. Stephenson’s book and clinical research, see www.doctorkenna.com