I’m sure by now you will have appreciated that one of the key messages I try to deliver is that lifestyle changes can drastically move the needle on the risk of developing a wide range of diseases, and maximise the chances of living healthily for as long as possible. You may also think I’m a bit nerdy in my own life about living it in such a way that I ‘practice what I preach’!
I have previously written about the concept of ‘what is your why?’ I encourage readers and patients to really delve into this question. Why do we do the things we do? I won’t go over old ground in my own case, but I will offer an update.
I have never written about this before, but it is highly relevant here. Very sadly my mum has dementia. She isn’t old (late 70s), and has enjoyed pretty good health up until recently. The progression over the last year or two has been alarming, and she would now be unable to manage a 24 hour period without assistance. I strongly believe that optimising my own lifestyle choices will help to minimise my own risk of developing this awful disease.
Dementia and other neuro-degenerative diseases are a huge issue, to put it mildly, and they are only going to become more prominent. Having watched the decline of my mum, I can honestly say that I would rather get pretty much anything else than dementia. The impact it has on patients and their families is profound. It is something we should all be thinking about, as will likely touch all of us in one way or another given how common it is becoming. There are nearly 1 million people in the UK with it, and 1 in 3 will develop it in their lifetime.
Over the next week or two therefore, I thought I would spend some time writing about the condition, the genetics, the treatments, and what we can do to help ourselves. Many of the principles are shared with other long term conditions, such as heart disease, another reason it is relevant for my blog! Brain health is probably not something many people think about often. I hope to convince you we should change that, because our own individual risk is not set in stone.
What is dementia?
There are a number of what are known as neuro-degenerative diseases (Alzheimers, Lewy-Body for example), and it is beyond the scope of this blog to outline the specific differences. Dementia itself it a catch-all term for the ability to remember, think or make decisions in day-to-day life. The conditions often take many years or decades to develop. Some are associated with movement disorders, others less so.
Why does dementia occur?
‘Senility’ was recognised long ago by the ancient Greeks, but it wasn’t until the 1960s that it was recognised that dementia was a disease rather than just part of ageing. Alois Alzheimer was a psychiatrist who worked in the state asylum in Frankfurt, Germany, in the early 1900s. He noticed on the post mortem of a patient who had symptoms of what we would now recognise as dementia, that her brain had a strange white substance entangled in her neurons. It took nearly a century for these tangles to be known as ‘Tau’. You may not have heard of Tau, but many have heard of amyloid? Amyloid is a protein that can become mis-folded, and prompt the collection of Tau in brain connections. More on this in a future post.
Genetics
Dementia appears more common in some families than others, but the genetics are complex. The commonest gene we look for is APOE (not to be confused with Apo A and B that I have written about before with respect to cholesterol and heart attack risk, although there are some similarities!). We each get two copies of the APOE gene, one from each parent. If you are unlucky enough to inherit a bad version of this from both parents, the risk of getting dementia is about 12x. Thankfully only about 2% of the population have this genotype.
I’m conscious that this all appears rather doom and gloom, but thankfully, it is not a death sentence – the risk is modifiable. For now, I hope you have found this introduction to the topic useful and thought provoking. In the next week or two, I will educate you on what the science says we can do to help ourselves and our loved ones.