In part one of our series on early detection of dementia, we reviewed survey insights about patient and provider perspectives on brain health and the importance of finding signs of cognitive impairment early. For part two of our series, we spoke with Dr. Joyce Gomes-Osman, VP of Interventional Therapy at Linus Health with affiliation at the University of Miami Miller School of Medicine, about the latest research on life and health-based interventions for cognitive impairment and dementia – and the impact proactive steps can have on people’s cognitive function as they age.
Challenges in the cognitive care status quo
When asked about the current state of cognitive healthcare, Dr. Gomes-Osman identifies two key barriers to more widespread preventative care. “There's a couple of challenges in primary care. The first is time,” she says. “In a primary care visit, we've got essentially 8-14 minutes to talk to a patient to understand why they're there and understand everything about them; there's very little time to be able to discuss lifestyle and coach somebody into leading a healthier life.”
The second key barrier pertains to the largely reactive nature of brain health today. Dr. Gomes-Osman explains, “There are very well established preventive care practice models for many different systems. For example, breast and colorectal cancers; you start screening for these cancers very early on. A young adult patient comes into the office and the physician asks: ‘do you have breast cancer or colorectal cancer in your family?’ Interestingly enough though, there's not something like that established for brain health. In order to prevent or delay cases in the future, we need to institute screening and intervention programs in the years before people show symptoms, because we know that it is possible to capture age-related brain changes that increase the likelihood of neurodegenerative diseases like Alzheimer’s Disease.”
Taking proactive steps to protect and maintain cognitive function is key. “Half of dementia cases in the United States are attributed to obesity, hypertension, and diabetes. If we were able to do something significant to address the risks, we would be able to decrease dementia cases next year by as much as 40 to 50 percent,” Gomes-Osman says. She is referring to a 2020 report from the Lancet Commission, which found that up to 40 percent of dementia cases could be prevented or delayed by addressing modifiable risk factors. In fact, research continues to reinforce the effectiveness of lifestyle and health interventions—positive, often simple changes people can make to address these risks and take greater control of their cognitive health.
Lifestyle and health-based interventions for dementia
Lifestyle interventions that have a positive effect on both preventing and slowing the progression of cognitive decline do not need to be cumbersome or impractical for people to adopt in their daily lives. “Simple changes to a patient’s lifestyle can lead to significant reduction in modifiable risk factors,” Gomes-Osman says, emphasizing, “The earlier we implement lifestyle changes, the better.” While there are many behaviors people can address to support their cognitive health, two practical and effective interventions Dr. Gomes-Osman recommends primary care providers share with their patients are getting physical activity and staying mentally and socially active.
Being physically active bolsters brain health
“Physical activity is one of the best things a patient can do for their brain health,” Gomes-Osman says. This goes for both mid-life and later life. Exercising two to three times a week could slow or even lessen the symptoms of mild cognitive impairment. In one study, researchers monitored the exercise habits of a large group of older adults and found that those who did the least physical activity were nearly three times more likely to develop Alzheimer's disease than those who exercised more often.
Gomes-Osman notes that there are many different ways exercise benefits brain health. “Another benefit of physical exercise is that it also addresses many other risk factors for Alzheimer’s disease and other dementia. It’s not just being more active; by exercising regularly you are helping to lower your blood pressure and blood sugar, and improve your sleep quality, so you reduce many risk factors for dementia by embracing one brain healthy habit,” she says. Exercise changes our brain circuits. Exercise improves our inhibitory control, making it easier for us to make healthier choices. For example, a person after exercising may make the decision to reject a piece of chocolate, and instead reached for a fruit to maintain the healthy gains achieved from the activity.”
However, to help patients capitalize on the many benefits of exercise, providers need to recommend an appropriate amount of physical activity for individual patients. An exercise plan that’s right for someone in mid-life might not be right for someone in later life, especially if a person already has dementia. In those cases, dementia and MCI-inclusive exercises are likely more suitable.
Keeping mentally and socially active supports cognitive function
Staying mentally and socially active reduces stress, promotes mental health, and improves mood. It also builds up the brain’s defenses against cognitive health issues like mild cognitive impairment, Alzheimer’s disease, and other dementia.
Sample interventions in this area include:
- Doing mental puzzles, such as crosswords, quizzes, and Sudoku
- Developing skills, such as playing musical instruments or learning new languages
- Playing board or card games
- Reading books
Not only do these activities exercise the brain, but they also often involve a social element, which can further enhance cognitive health. Social contact develops cognitive reserve and can also positively impact mental health conditions like anxiety and depression.
Some actionable ways people can couple mental and social activities together include playing games with friends and joining book clubs. In fact, even something as simple as having a conversation can help fight cognitive decline. “We are all social creatures, providers should encourage their patients to be socially engaged with their peers and caregivers, as these interactions will encourage people to maintain other healthy habits,” Gomes-Osman says.
A proactive approach works in other areas of healthcare – cognitive care needs to catch up
Studies like the World-Wide FINGER study are demonstrating the benefits of multi-domain lifestyle modifications in reducing people’s risk of cognitive decline. This research underscores the importance of shifting the approach to cognitive healthcare from a reactive one to proactive one.
This starts with understanding patients’ unique modifiable risk factors and their interconnectedness, which empowers providers to develop actionable plans to help patients take more control over cognitive health. Encouragingly, lifestyle interventions can have a variety of positive tangential effects that magnify their impact. Physical activity, for example, can boost mood. And this makes people more likely to be social, which leads to an increased uptake in mental tasks. This cascade of positive effects is an encouraging message for people looking to adopt healthier habits.
Ultimately, one of Dr. Gomes-Osman’s key message for both providers and patients is that small, positive steps can make a big difference in reducing dementia cases. “Even if you were only able to change 15 percent of the prevalence of modifiable risks,” she says, “that would save almost 450,000 folks next year from developing a form of cognitive impairment.” She concludes by emphasizing, "we’ve seen the benefits of early detection and intervention in other areas of medicine, such as cancer treatment and heart health. Now it’s time for us to do the same for brain health.”