We may be living longer, but a consequence of that is that those extra years are often beset by ill health and disease. According to Alzheimer’s Research UK, in January 2022 there were 944,000 people estimated to be living with dementia in the UK, more than ever before, with that number projected to increase. It also revealed that 49 per cent of adults (rising to 60 per cent of over 65s) say that dementia is the health condition they most fear getting in the future.
“Dementia has many different causes,” says Professor Paul Matthews, head of the Department of Brain Sciences in the Faculty of Medicine at Imperial College London. He’s also Head of the UK Dementia Research Institute (DRI). “The most common cause of dementia is Alzheimer’s disease, with the second-most common form being vascular dementia. Less common forms are frontotemporal dementia (FTD) and dementia with Lewy bodies.”
Professor Matthews says the greatest contribution to Alzheimer’s risk comes from the genes we inherit: “It’s not passed in a simple way from parent to child, but the result of inheriting a mix of many genes and the way in which they interact.”
He emphasises that, while about 70 per cent of the risk of getting Alzheimer’s is due to genes, 30 per cent is due to lifestyle and environment, something we can actively do something about.
One of the insidious aspects of dementia is that changes can take place long before they show up as symptoms. “We know that biochemical and cell changes in the brain are probably occurring two decades, if not more, before the disease is manifest in some form,” says Matthews.
Given this, what are the early warning signs that we should be paying attention to, and what are the lifestyle changes we can implement to give ourselves a better outcome?
Symptoms such as problems with forgetfulness (losing keys, not being able to recall names nor faces), speech and attention are among the more well known. But there are others. Matthews notes that what sets these factors apart from a natural age-related decline in memory is the rate at which it occurs.
“With Alzheimer’s, there’s a much more rapid deterioration of language functions. And something we find in people with dementia we call ‘accelerated forgetting’,” he says. However, there are some less commonly known symptoms.
1. Banking Mishaps
The US National Institute of Aging says on its website that money problems “may be one of the first noticeable signs of Alzheimer’s disease” and lists “trouble counting change, paying for a purchase, calculating a tip, balancing a cheque book or understanding a bank statement” as signs.
A study of 81,000 Americans from 1999 to 2018, found that missed credit card payments could show up as far back as six years before a dementia diagnosis, according to the Financial Times. Examples may be compulsive spending and missed payments or making payments to anyone who asks – whether a legitimate or scam request.
2. Frequent Nightmares
A 2022 study published in The Lancet’s eClinicalMedicine journal and carried out by Abidemi Otaiku, academic clinical fellow in neurology at the University of Birmingham, found that children experiencing regular nightmares between the ages of seven and 11 may be nearly twice as likely to develop some form of cognitive impairment by the time they are 50.
Middle-aged and older adults experiencing the same could also be more than twice as likely to develop dementia in the future. Otaiku states that nightmare frequency is largely dictated by our genes and one of the genes responsible is also linked to an increased risk in developing Alzheimer’s. Nightmares also disturb the brain-restoring job of sleep. People shouldn’t panic however as the numbers featured in this study are very small.
3. Inability to detect lies and sarcasm
A 2011 study at the University of California, San Francisco, made the link between the deterioration of parts of the brain and an inability to detect insincere speech. The ability to detect lies is in the frontotemporal lobe of the brain, so those with FTD couldn’t tell when someone was lying, whereas those with Alzheimer’s could.
However, those suffering from FTD or Alzheimer’s also found it harder to pick up on sarcasm. People with FTD often succumb to online scams because of trust issues.
4. Staring with a ‘reduced gaze’
An early sign of dementia may appear as someone developing a blank stare as some forms can affect the ability of the eyes to track. Katherine Rankin, PhD, neuropsychologist at the University of California Memory and Aging Center, adds that they may skip lines as they read. These symptoms are evident to the people around them, but they are unaware themselves.
Professor Matthews also says other visual problems may occur, for example, but misinterpreting a scene. “It’s called cortical blindness,” he says. “You look at something, but you are missing some key elements, and it’s because the brain isn’t putting together the picture in quite the right way.” People can also experience problems with judging distances such as using the stairs.
5. Eating rancid and ‘non-food’ items
Uncharacteristic changes in eating habits and food preferences can be a sign of dementia according to the UK Alzheimer’s Society. People may fail to recognise when food has gone mouldy, or as dementia progresses, they may not recognise non-food items and attempt to eat them.
In addition, sometimes people with dementia make food choices that don’t match their usual beliefs or preferences. For example, a person who has been a lifelong vegetarian may want to eat meat.
6. Problems with speech
“This is not to do with the way words are enunciated, but their fluency,” advises Matthews. He highlights how people may struggle with their vocabulary, finding the right words, and that the structure of the grammar they use may become simpler.
“In Alzheimer’s, there’s a much more rapid deterioration of language functions.”
What you can do
While a lot of the outcome is gene-related, people can help by addressing lifestyle factors. Matthews notes that the presence of hypertension, Type 2 diabetes, smoking and excess alcohol may have a causal relationship with dementia. “Even in midlife, if people focus on the causal risk factors, then they can modify them in ways that help.”
Essentially, looking after your heart by following a healthy diet, lowering your blood pressure and cholesterol, and taking exercise also means you are looking after your brain.
“There is strong evidence to suggest that not only is high blood pressure associated with dementia, but that it causes dementia,” says Matthews. “Blood vessels in the brain play a critical role in clearing amyloid, the bad protein, in the brain. These proteins produced in the brain will accumulate, and we believe that is toxic in some way unless they are pushed out through the blood vessels. As blood vessels become damaged, their ability to do that clearance may decline.” Matthews notes that the effect of good sleep on the clearance of these amyloid proteins from the brain is a hotly debated topic but doesn’t believe it changes our risk of dementia in the same way that treating hypertension does.
“There is no question that greater physical activity is associated with a reduced likelihood of getting dementia,” says Matthews. He cites the FINGER study (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) started in 2009 by the Karolinska Institutet, which demonstrated that an intensive intervention to get an inactive group of older, higher risk people to undertake physical activity resulted in significantly less dementia, about 30 per cent less than the control group.
Alzheimer’s Research UK recommends 30 minutes moderate exercise over five days, or 25 minutes of vigorous exercise over three days per week.
Any form of chronic inflammation such as that associated with gum disease or with obesity may be a causal factor for Alzheimer’s, notes Matthews. Inflammation in the body causes the brain’s inflammatory system to become activated which may reduce its ability to protect against dementia – a case for good oral health and a healthy diet.
Alzheimer’s Research UK advises people to “stay sharp” by engaging the brain in new activities and to “keep connected” by maintaining links with friends and family. It has a useful “Think Brain Health Check-In” tool on its website to help you assess your risk and implement steps to modify it.
“The wonderful thing about the modern world is that we are living longer lives,” says Matthews. “That means we have to take more responsibility for our health, attending to what your GP says, making sure you have regular follow-ups. There’s a huge amount we can do. If we make adjustments to our work and life, we can minimise the impact of a disease to allow ourselves to live more comfortably and happily for longer periods of time.”