Dr Thomas Stuttaford examines how far our family history
can affect our risk of dementia and why, although the odd bit of
memory loss in old age may be inevitable, dementia
isn’t.
When chatting to fellow candidates before an oral exam, there
was always a certain feeling of relief to discover that they too
didn’t know the answer to all the knotty questions that an
examiner might ask.
As in youth so in old age. Now when contemporaries meet, or
there is a gathering of friends and family of all age groups, the
ravages of time that have occurred in the brain inside the skull
are soon as apparent as those that have greyed the hair or thinned
or eliminated it from the scalp. Our brain cells and the inter
connections between them are precious commodities that need
cosseting. Fortunately as we learn more about the effect of ageing,
we are also learning more about how these cells, the neurones and
the connections (synapses) between them can be protected and how
those that remain can be kept active and in reasonable order.
We will have to accept some problems of old age, but this is no
good reason to allow our neurones to be destroyed any faster than
necessary. We may not mind when with a party of older people if we
all have to check that we have remembered keys, cheque book,
wallet, two pairs of glasses and our mobile telephones and we
accept that inevitably some of us will have to rush back to look
for one or another of these essential aids. But frankly, although
we don’t mention it, we don’t want to become as dotty
as our second cousin Marjorie, who never has any of her essential
kit and hasn’t the slightest idea of where she is or where
she is going and is getting more than a little irritable about
it.
All of us of course like to believe that we are suffering from
benign memory loss and that dementia is something that affects
others. We may be right, but we should be taking a few simple steps
to ensure that our own diagnosis is correct and that cousin
Marjorie’s trouble won’t become ours. Even if we forget
where we left our reading spectacles, we should remember that one
first-degree relative with dementia increases the odds of us
suffering from it fourfold. Two first-degree relatives and the risk
is increased eightfold. Nor should we ever forget that in the
United Kingdom 600,000 people have been diagnosed with a form of
dementia. Over half of those have Alzheimer’s disease so that
there are more than 300,000 people in the UK with it, of whom two
thirds have only mild to moderate symptoms. Between 15 and 20% of
the rest have vascular dementia, the type that follows a multitude
of small strokes. An almost equal number suffer a combination of
Alzheimer’s and vascular problems. The rest of the 600,000
are made up of people with dementia from a multitude of other
causes such as some with Parkinson’s disease or Lewey body
dementia.
The great reassuring feature of forgetfulness when older is that
although memory loss may be an early symptom of Alzheimer’s,
it is an almost inevitable accompaniment of ageing and
Alzheimer’s presents problems that are far more complex than
those of the simple forgetfulness of old age. With
Alzheimer’s the whole personality begins to disintegrate and
a relative with an early or moderate form will find it hard, if not
impossible, to take the simplest decisions or to assume a trivial
responsibility without becoming agitated and distressed.
Concentration can become poor, and reading and watching TV once
enjoyable have lost their interest. Any flexibility needed to adapt
to a changing scene has disappeared and instead of a once cheery,
efficient disposition, cousin Marjorie, and others with early
Alzheimer’s, have become moody, confused and frustrated with
their own incompetence.
Now that the NHS is not dispensing the three drugs that help
these early to moderate symptoms of dementia, following the best
lifestyle has become essential. Research shows that the most
important single step that people can take is to maintain a wide
social network. There is an added advantage if this is coupled with
a hobby, especially if it stretches the intellect. Crosswords,
writing, even doing the accounts may keep someone’s neurones
firing and their synapses intact.
Food comes next. Our diet should be low in saturated fats and
rich in antioxidants. It should be loaded with fruit and
vegetables, including brightly coloured peppers, tomatoes,
pomegranates, oranges and spinach. A couple of glasses of red wine
will help but too much alcohol makes the problem worse. There is
increasing evidence that statins help delay Alzheimer’s and
blood pressure must be kept low so as to reduce the likelihood of
small strokes and vascular dementia. Anyone with a fibrillating
heart rhythm needs anticoagulation for the same reason. Those of my
age should be buying omega 3 supplements. These provide the DHA
that throughout life is essential for the central nervous system.
We should buy additional vitamin supplements including a
multivitamin and mineral one. I also recommend folic acid this is
now back in fashion, especially for those whose memory may be
slipping and selenium. Recently a new supplement has come onto the
market, Phosphatidyl Serine. This is the major acidic phospholipid
in the brain. There is evidence that additional PS may improve
concentration and memory. At my age it is no time to be taking
chances: in future I will be having PS with my claret, vitamins and
omega 3.
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