Is dementia preventable? What the UK Biobank is telling us

This month, US clinical researcher and physician Dr Kenna Stephenson (left) reviews the UK Biobank findings and how dementia risk can be reduced through lifestyle changes and hormone replacement therapy for women during menopause.

This community-based project followed 500,000 adults aged 40–69, with comprehensive assessments that have the potential to reshape how we think about disease prevention.

Dr Kenna, advisor to curranz.com, 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 all rank in the top 20 countries most impacted by dementia, yet analysis of more than 300,000 UK Biobank participants suggests many cases may be preventable – even in people with a genetic predisposition. Lifestyle factors and medical conditions emerged as the strongest drivers of dementia risk.

Conditions such as diabetes, depression and hypertension, along with visual and hearing impairment, are all linked to increased risk. For patients with diabetes or cardiovascular disease, improving blood sugar and blood pressure through diet, exercise and appropriate medication may help lower dementia risk.

Recently, I diagnosed a 60 year old female patient with hearing loss and recommended a formal assessment by an audiologist. She initially refused, saying she would “never wear hearing aids – they were for old people” and worried about looking older. When I explained that correcting hearing loss may help protect against dementia, she reconsidered.

At her next visit she was beaming, full of energy. Her daily life had been transformed by this investment in her health, and she became an advocate for other women to address hearing loss proactively.

Unfavourable lifestyle habits that significantly increased dementia risk included smoking, excessive alcohol intake, physical inactivity, prolonged sitting and screen time, low mood and social isolation. Shifting from these patterns to more positive behaviours is an essential step in lowering risk.

If a patient spends hours watching social media or TV, I suggest turning that time into movement – using home exercise equipment, jumping rope, running on the spot or other aerobic activity while they watch favourite shows or sports.

For patients struggling with persistent sadness, worry or irritability, I prescribe mind–body interventions to help them move up the emotional scale toward hope, joy and serenity, illustrated in case studies at www.doctorkenna.com.

Quitting tobacco and reducing or stopping alcohol improves both health and financial wellbeing.

Hormonal impact on brain blood vessels in menopause

Women are around twice as likely as men to develop dementia, making female-focused prevention strategies especially important.

New research in more than 9,000 women used brain MRI to measure white matter blood vessel changes associated with dementia.

Scientists examined how lifetime exposure to female sex hormones affects dementia risk, since both estrogen and progesterone show beneficial effects on brain blood vessels and neurons in the lab. Women with longer natural exposure to these hormones (more years from first period to menopause) and a higher number of pregnancies had more favourable MRI findings, with less age related inflammation.

Among menopausal women using hormone therapy at the time of the scan, those applying hormones to the skin (patches or creams) showed more favourable measures than women taking oral pills or no hormones at all.

These findings support my CHOIICE landmark study, in which we used only transdermal (topically applied) estrogen and progesterone in hormone deficient peri  and postmenopausal women for three years. We observed beneficial effects on immune, inflammatory and neuroendocrine biomarkers within The Hormone Restoration Model of Care.

Together, this evidence suggests that for patients who need hormone support, applying hormones to the skin may offer superior benefits for brain and body health. The overarching message from this expert analysis is encouraging: patients have real power to influence their future health, and dementia appears to be more preventable than we once believed.

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