32 Ways to Reduce Your Dementia Risk

I'd like to welcome everybody to Today's presentation on 32 Ways to Reduce Dementia Risk. I'm your host, Dr. Donnelly Snipes. Now, let's just start out with a little bit of background. More than 50% of dementia cases, they estimate, could be prevented by targeting these 32 risk factors. And that's really important. 50% of dementia cases. Let that sink in. 50% of the people who are in memory care right now may not have had to go there. That's, that's kind of shocking. Each additional risk factor for dementia, including stress, is associated with a lower cognitive performance equivalent to three years of aging. So the more of these risk factors, the more cognitively aged you are. And we know as, as we age cognitively, our, our thinking slows, we have more difficulty with memory, etc, so if you're 60 and you've got the cognitive age of a 90 year old, you know, that's different than if you're 60 and you have the cognitive age of a 66 year old or something. What do these risk factors have in common? And I'm going to harp on this throughout today's presentation. Control of systemic inflammation caused by stress in each piece of life. Dementia is the result of loss of neurons and loss of the ability of the brain to function correctly, largely due to inflammation. And that inflammation is caused by chronic and overwhelming stressors. I also want to highlight the difference between correlation and causation. Some of these things we're going to talk about, you have to ask, is that something that really contributes to dementia or is it associated with things that contribute to dementia? For example, our first one, lack of early life education or enrichment. Well, what do we know about people who lack early life education and enrichment? They were likely struggling with poverty. Their caregivers may have been working a lot, so they may have been in daycare. There may have been a lack of, they may have not have had the toys and the benefit of stimulation that other people did. So I, I want to highlight the fact that yes, early life education and enrichment is a risk factor, but what we really want to look at is what else was going on that was causing that lack of early life education and enrichment that could have been stressful. When people are younger, during that early life period, our brains are super malleable and growing and very. They have a lot of plasticity. And it's important to understand those that have more early life education and enrichment. They think basically build up more neurons so they have more cognitive reserve, they have more stuff that they can actually stand to lose as they get older. So that is one argument for early life education and enrichment actually having a direct effect on the progression of dementia later in life. But a lot of times, by the time we see patients, they're past that early life stage and there's nothing we can do about this except help them strengthen the neurons that they do have left, Help them create a situation in the environment as well as in their bodies that promotes neurogenesis. It promotes the building of neurons. We, we continue to build neurons our entire life. It's not just, you know, this period we have back here, and that's all you get. We continually generate neurons. And I read an article one time that indicated that humans only use about 10% of their brain, which means we got a lot of area that we can move into and we can explore and we can expand on. Midlife hypertension is also associated with dementia. Now, let's think about hypertension itself can reduce blood flow, can reduce oxygenation, which kind of starves the brain cells, if you will. But midlife hypertension is also often associated with stress, which we know increases systemic inflammation, and poor diet, which, which we know increases systemic inflammation. So it could be the lack of oxygenation, it could be the inflammation from the stress, it could be a variety of things. But we know that people who have midlife hypertension are at greater risk of developing dementia. I will say it's important for each individual to talk with their physician about what is hypertensive, because they keep changing the goal posts on what's hypertensive. When I was a young person, 120 over 80 was beautiful. It was normal. And that is considered, like borderline hypertensive. Now I'm like, no, I'm not borderline hypertensive most of the time. Therefore, I encourage people to talk with their physicians and decide what is healthy for them and what could be a risk factor. All right, that, that aside, there's only so much we can do about hypertension from a cognitive standpoint. We can help people try to reduce stress. We can educate them about healthy nutrition and antioxidants. Other than that, it's between them and their physician. Hypoxia, which is a lack of oxygen to the brain. The brain needs oxygen to live, if you will. And when it's starved of oxygen, you start losing brain cells. People who have cardiovascular issues, copd, congestive heart failure, etc, may start evidencing hypoxia. My grandfather did when and, and he was an active man for, for many, many years, and even when he was in his 60s, he was running five miles a day. And once he started develop to develop congestive heart failure, his cognition plummeted. Unfortunately, the doctors didn't put two and two together, so he was never put on supplemental oxygen, which I think really could have improved his quality of life for a significant period of time before the congestive heart failure kicked in. If you're working with a person, and I'm not even going to say an older adult, if you're working with a person who has cardiovascular disease, copd, etc, and you notice their cognition is starting to slip, encourage them strongly to go talk to their doctor because it could be that they're not getting enough oxygen to their brain. And that's an easy fix. That really is an easy fix. Depressant misuse and that includes opioids. When we use depressant medications and opioids, it's a system depressant, it slows us down. And when people overuse depressants that you take really big doses or something, not encouraging it, it can slow the body down so much that we're not breathing enough and we're not getting enough oxygen. Solution there is obvious, don't overuse depressants. Stroke is another issue that contributes to hypoxia. When people have a stroke, a lot of times the oxygen temporarily is shut down to their brain and it can cause brain damage. If you've known people with strokes, known people who've recovered from strokes, you know they can recover. However, if people are at risk of stroke, then encouraging them to take the steps recommended by their physician to mitigate their risk is important. Be aware and educate them about the risk factor. Risk factors and early warning signs of stroke like lack of coordination on one side of their body or numbing on one side of their face. That's really important. And, and that's for everybody, not just people who are at risk, but everybody should know the early warning signs of diabetes, heart attack and stroke. That way we can intervene because all three of those things can be prevented if we catch them early enough. Anemia is another issue that we'll talk about a little bit later. But when we have anemia, it means our blood cells are not able to carry, hold on to the oxygen and carry it around our body like it needs to. That means our blood is kind of deficient, if you will. And there are a lot of things that cause anemia. It's not just iron. Iron, iron and B12 are, are two of the big ones. And then apnea and this is another one we're going to talk about a little bit later because it's that important. What is apnea? Apnea is a sleeping disorder that when people who have it are asleep, they quit breathing. Well, when you quit breathing, you're not getting enough oxygen to your brain. They suddenly startle and start breathing again. When the brain gets the. Gets the message that, hey, I'm getting no oxygen. It's getting kind of sparse in here. Encouraging people who have sleep apnea to talk with their doctor. There are CPAP machines, there are lots of other machines that are alternatives to CPAPs. There are surgeries. There are a lot of things that can be done. Even people who are not overweight may develop sleep apnea. People who have a lot of stress and people who are struggling with PTSD and CPTSD have a much higher risk of having sleep apnea because they hypothesize of the tension in the neck and the jawline. If your person says that their significant others complain that they snore like a freight train, that might be something to look into, if nothing else to rule it out. If they're snoring like a freight train, it also may mean they have bad allergies or something that are keeping them from breathing and getting enough oxygen. All right, those things, hypoxia, we can educate about, we can advocate, and we can encourage people to go see their doctor. We can be aware of signs of slipping cognition and alert people that, hey, you may need to talk to your doctor. But there's not a lot of talk therapy that's going to help people with hypoxia. Now, obesity is another issue that is directly related to dementia risk. And what I mean is high adiposity, high levels of adipose or fat tissue. And I'm not body shaming. The fact is that when we have high levels of adipose tissue, we tend to have higher levels of estrogen and we tend to have higher levels of systemic inflammation. They. There's a plethora of studies that show the direct correlation between obesity and circulating inflammatory cytokines. We know that obesity increases inflammation in the system, encouraging the person to think about whether that is a part of their life that they are willing to address. And, and we'll go into that in a different video. Not everybody's willing to address their body weight. Not everybody's even willing to talk about it. And they may get offended. So you need to tread lightly here. But recognizing that it is a significant cause of inflammation. Diabetes. I know I sound like a broken record in these past few videos. Diabetes diabetes. Diabetes. 25% of Americans are either diabetic or pre diabetic, and most of them are not diagnosed yet. So there are a lot of people who are struggling with diabetes and insulin resistance and other metabolic issues. Those are all kind of under the same rubric of pre diabetes in most cases. But diabetes occurs when the body can't manage its blood sugar effectively. When our body can't manage a blood sugar effectively, it contributes to drummer inflammation. And guess what? Stress contributes to increased blood sugar. And increased blood sugar contributes to inflammation. And when the body has inflammation, the, The. The. The stress s. Wow. The stress system recognizes it as a problem, a stressor, and it activates more and sends out more blood sugar. So we need to break this cycle. But stress is going to increase blood sugar, it's going to increase A1C levels, and it's going to worsen diabetes. That inflammation is going to also create an environment that's neurotoxic in the brain. Controlling diabetes, that means watching your blood sugar. That means taking the physical steps you need, but it also means controlling your emotional and mental stress. Diabetes is made worse by emotional and mental stress. In the video we did a couple weeks ago on hearing loss, people with hearing loss have a higher cognitive load because they're straining and struggling to hear that stress. And they also may feel frustrated and ignored and left out or whatever as a result of hearing loss, especially undiagnosed hearing loss. All of those things. Increase stress, increase blood sugar, increase A1C, increase problems like peripheral neuropathy and the risk of dying, risk of dementia, hypothyroidism. And I know the O is intentionally big because sometimes we just read over it. Hypothyroid is when your thyroid is underactive. Now, that can be an autoimmune issue or it can be caused by a variety of things. It can be caused when you go through menopause or andropause hyper, both. Thyroidism means that your brain is not metabolizing as quickly. And it also means your blood's not moving around as fast. You've slowed down, if you will. And that can contribute to less oxygen to the brain. That can contribute to increased inflammation because the brain's not processing stuff as quickly. If people seem like they're hypothyroid, if they seem sluggish, if they seem depressed, if their skin is getting dry. Now, some of this happens as we age anyway, but it's important to recognize the impact that it has on cognition and. And risk of dementia and then hearing loss. I mentioned that earlier, we're going to mention it again real briefly because I know we just did an entire video on it, but hearing loss causes stress, and hearing loss often is associated with diabetes, not always. But that progressive hearing loss that we see is very common in people who have diabetes and are developing peripheral neuropathy. Hearing loss increases stress for a variety of reasons. People need to have assistance managing their adjustment to their disability. They need to have advocacy and encouragement to advocate for themselves in environments, to make the environments more hospitable to them. And. And there are a lot of things people can do to feel empowered so they don't get stuck in situations where they can't hear and they feel like they're just stuck. And those are all strategies that we can use to help people with hearing loss reduce their stress, reduce their inflammation, and reduce their dementia risk. Another problem with hearing loss is the fact that a lot of people with hearing loss, whether it's diagnosed or not, often, especially if they're having difficulty hearing, will withdraw. When we withdraw from social activities, that means we're not engaged. That means we're not using our brain, and when we don't use it, we lose it. If you want to think about it that way, encouraging people with hearing loss to participate in activities is really important. Even if it's not auditory activities. You. They may not want to or be able to participate in discussions effectively, but art classes, horticulture therapy, animal therapy, there are a lot of things that they can do that will. Even crosswords and playing card games can activate those brain circuits and keep that brain active. Think about when you've gotten sick or gotten hurt or something and you haven't been able to move a body part. I know I hurt my shoulder sometime back, and it was in a sling, and when I got it out of the sling, it was just like, oh, my gosh, it was so stiff, and it hurt to move it because it hadn't been used. We want to keep the flexibility of the brain going by encouraging people to use it in different ways. Listening to music, remembering times that they heard that music. You know, I listened to stuff from when I was in high school, and I remember memories from being in high school or, you know, from beyond that. There are some songs that I have on my playlist that my grandmother used to sing all the time, and it just takes me back. But it uses brain circuits that I'm not usually using. I mean, the Andrew Sisters is not something that I think of on a daily basis. Vision loss is very similar to hearing loss because people who are losing their vision have more difficulty doing seeing the television, reading books, playing sudoku, or doing crossword puzzles or a lot of the things that we encourage people to do to keep their brain flexible. If you can't see, it's hard to do. There are a lot of tools out there that we can use, adaptive equipment that we can use to help people continue to be able to see a fair amount. But if the vision is causing them stress, if they're still straining and struggling to see, okay, let's find a different way to help you get engaged. Let's find a different way to help you exercise those brain circuits. Let's find a different way to help you reduce your stress. I know for me, not being able to see is stressful and it's very frustrating sometimes. And I can see with my glasses on. I can't see a thing without them on. And for me, that's one of those things that's frustrating. I can't thread a needle anymore, even with my glasses on. And I love sewing. I used to love to do cross stitch and things, but that ain't happening anymore. And I had to grieve that. I had to grieve that loss because my eyes just aren't there. And some of our older adults or people with progressive vision loss, regardless of their age, may struggle with that. And, and again, I want you to remember that any of these things can be addressed in patients regardless of age. It's not just our older adults. Any of these things can be addressed in our older adults who have dementia to slow the progress. The more we slow the stress, the more we help them reduce the inflammation, the better chance they have of slowing the progression. Smoking reduces oxygenation, increases blood pressure, causes lots of problems. I'm not going to belabor this because I think most people know that smoking is something that is going to potentially cause a myriad of problems. And if they're willing to give it up, then we can help them develop a quit plan. Using smoking cessation medications is one tool, but they found that smoking cessation medications with counseling is much more effective because a lot of people smoke to handle stress, and if they're not smoking, they still don't have the tools to handle stress. So that's where we as clinicians can come in and we can help them develop those skills. We can even, for some patients, help them start developing those skills before they even start trying to quit. Let's start developing these distress tolerance skills and a plan so you feel like you may not need the cigarettes anymore. And then when you're, when you get to that point maybe two, three months from now, then you'll start on the nicotine replacement therapy or something. So that's possible. Alcohol and drug misuse is another issue. Drug use stimulants are going to increase blood pressure and potentially increase the risk of stroke in some people. Anti cholinergics and benzodiazepines are also problem problematic and using them can cause drug induced neurotoxicity. Basically what they're doing is causing too much stress in the brain and too many stress chemicals, too much stress chemical bathing all your neurocircuitry. So you start losing neurons and neurotoxicity is no bueno. It's especially problematic for older adults. Remember when we talked a couple weeks ago, when people go through menopause or andropause, our gonadal hormones are neuroprotective and when we lose those go nadal hormones, then we're losing those soldiers, if you will, that are there to help protect our neurons. We don't have that level of protection anymore. So we're more susceptible to neurotoxicity, we're more susceptible to stress. Heavy alcohol use, any alcohol use is going to cause inflammation. Heavy alcohol use is going to cause a lot more inflammation. And I'm not going to belabor that today. But understanding that alcohol in and of itself is a toxin and when we ingest it, our body registers it as stress. And yes, the immediate effects may be a calming, there's the immediate sort of depressant effects, but then as it wears off, people's blood pressure goes up, people's anxiety goes up and inflammation and stress go up. So initially just exposure to the toxin is a stressor that can increase inflammation in the gut and disrupt the gut microbiome. And then as the alcohol leaves the body and the blood pressure goes up, that's perceived as another stressor. Blood sugar goes up, blood pressure goes up, inflammation goes up. We don't want to do that on a regular basis. It's not good for our brain. Korsakoff syndrome can be caused by heavy alcohol use, specifically thiamine deficiency as a result of heavy alcohol use. And Korsakoff syndrome can become Weirnicki Korsakoff syndrome, which is called in general alcohol related dementia. If someone receives an infusion, they have to go to the hospital, get an IV infusion of thiamine. If they've got Korsakoff syndrome, they can reverse the impact most of the way or sometimes all the way of the thiamine Deficiency, but it is a medical emergency. And the longer it takes between the onset of symptoms and the infusion of thiamine, the more permanent and more devastating the effects will be. And cirrhosis is also caused by a lot of things, but in this case, alcohol misuse. And that can lead to a condition called hepatic encephalopathy, or swelling of the brain, basically as a result of the liver not being able to clear out the toxins. So then those toxins start crossing the blood brain barrier and causing chaos, causing distress, causing inflammation, stress and inflammation. Let's prevent it. So let's keep the liver healthy so it can get rid of the toxins, it can, can get rid of the, the free radicals. And let's keep the body healthy. Poor Diet, mild dehydration, 1 to 2% can lead to impaired cognition, particularly in older adults. Older adults are much more susceptible to dehydration. So making sure that they are getting enough water, and I have it right here, older adults actually have a naturally diminished thirst response. I never understood why some older adults just didn't ever seem to drink anything. And they don't have in a. A lot of them have a much higher threshold, if you will, for thirst, and they can easily get dehydrated. Older adults may have difficulty recognizing or responding to their body's hydration needs, especially with those with conditions like Alzheimer's disease. The more out of touch you are with your body, the more out of touch you are with your body's needs. There are some things that, you know, with advanced dementia or moderate to advanced Alzheimer's, there may be no way to help the person really stay mindful of what their needs are. And that's where the treatment plan is really essential. But as when we get dehydrated, we're going to have inflammation because our body can't wash out, if you will, the toxins. Keeping hydrated is essential. A lot of the medications that older adults are on are very sensitive to dehydration. And if they get over hydrated or under hydrated, the effectiveness of those medications will change. And that can be another big issue that not only contributes to systemic stress and inflammation, but also, you know, other problems because the medication that they're taking, whatever they're taking it for, isn't being addressed correctly. Anemia, including various types of amine anemia, such as iron deficiency, vitamin B12 deficiency, and folate deficiency, are all associated with cognitive impairment. Getting a good healthy diet is so important. But a lot of older adults particularly may not have teeth May not have dentures that fit correctly, may not have an appetite, or may not be able to cook because of peripheral neuropathy or something. If our older adults are especially the ones that aren't going to the doctor, if they seem to be losing weight or seem to be getting sluggish, kind of seeming depressed, it's really important to refer them for a physical evaluation and help them recognize that there are easy interventions to help them feel a lot better. When we're anemic, we're not getting enough oxygen to the brain. It's going to impact cognition, it's going to impact energy, it's going to impact in general how we feel more with the poor diet. A diet low in antioxidants is strongly associated with accelerated cognitive decline and risk of dementia. Overcooked and or ultra processed foods, increased dementia risk. And it depends on what study you look look at. Which is why I highlighted two studies, one at each end of the spectrum. One said 16% increased risk and another said 44% increased risk. And looking at the studies, it was hard to differentiate why there was such a wide gap. But ultimately, people with a poor eating a poor diet often don't have many antioxidants. Antioxidants are those chemicals in the food that make your food colorful, that go in and clean up all of the oxidative stress, all of the, the free radicals and nastiness and garbage that is floating around in your system that are the byproducts of living. We need antioxidants to reduce stress. Antioxidants will reduce inflammation, will reduce stress by clearing out the free radicals that contribute to oxidative stress. Unfortunately, even if the person is eating vegetables and fruits, a lot of times they are overcooked. And the level of antioxidants roughly can be assessed by the color of the vegetable. If the vegetable or fruit is kind of gray, you know, it's been, it's been sitting there cooking for four hours on the, on the warmer. There's not much nutritional value left in it. If it's, you know, bright green or bright blue, then you know that it's got a fair number of antioxidants. But a lot of people who have difficulty chewing their food especially may overcook their food in so it's more mushy and well, that's great. They can get it in their belly. They're getting calories, but they're not getting a lot of antioxidants. Some doctors will address this through vitamin shakes or supplements. There are a lot of different Ways to address it. That's not something we are going to address, but we do need to educate patients about the importance of antioxidants and eating a relatively healthy diet. Now, those ultra processed foods, the white breads, the white rice, the things that send your blood sugar kind of skyrocketing and increase inflammation, they're good, they're yummy. I, I, I don't disagree with you there. But they've got very little nutritional value. They increase inflammation and they fill us up. So we're not hungry to eat the healthy foods. It's a balancing act. Pe most people are not going to give up all ultra processed foods, especially not in America. Okay, so how can you combine, how can you eat some ultra processed foods if you insist and eat healthy foods to balance it out? And we can help people brainstorm what foods in each color group that they might be willing to eat. You have yellow, orange, green, purple, blue, and I usually do blue, blue and black together or purple and black together because like black rice is really purple, it's just really dark purple. But each one of those colors. And white, don't forget white. You've got onions, garlic, potatoes that are white, but any of those have different antioxidants in them. So you want a variety of colors. So you're getting all the different antioxidants. Physical inactivity can increase dementia risk because you're not using your brain. You're not getting up and thinking about what I need to do, but you're also reducing your oxygen intake. People who are physically active breathe more. I mean, that's pretty straightforward. Excess physical activity that leads to pain and inflammation, that's not good. That's not what we want to do. Encouraging people to just get up and be active, walk, play shuffleboard, play ping pong, table tennis, do things where they're up, moving around, especially using those big muscles. Tai chi can be good for some. Not everybody has the balance to do some of those things. They have chair versions of yoga and tai chi. The big thing is movement, keeping those joints lubricated and increasing some oxygenation. That's all we're asking. And that will actually help reduce cortisol levels and reduce associated inflammation. We mentioned earlier, low testosterone and low estrogen. Both of those are neuroprotective. And when we are not producing them anymore or producing them at the same levels, we're losing that protection, that level of protection against stress, against the toxic environment in our brain when we get stressed out. Not everybody's okay with hormone replacement therapy. I get it. It's something to talk about with your doctor if it's something you're interested in. Recognizing ways you can manage stress despite having low testosterone or estrogen is something else that people can do if they're not willing to consider some of the others. Or what? How can I replace that level of neuroprotection if I don't have estrogen in my body? What else can I do that will help? Can I increase antioxidants? What is it that I can do? And that's something a doctor can answer. It's important for us to understand though, that when people go through menopause or andropause or even just as we start aging at the age of 45, our gonadal hormones start to decline and our mood may start to decline, our neurotoxicity sensitivity goes up, encouraging people from a very young age to figure out what can I do to increase the neuroprotection because I can't avoid all stress. Autoimmune disorders. Well, we know autoimmune disorders can be exacerbated by stress. We're going to have people with autoimmune disorders. It's just the way the world is now. Lot of people have them. We know that the key feature of autoimmune disorders is inflammation. And a lot of times it's systemic inflammation. And that in and of itself, people who have autoimmune disorders, the more times they flare, the the more they have more risk they have for dementia. We need to help them figure out ways to reduce stress and heal their nervous system in all pieces of their life. Physically, how can you reduce unnecessary stress? Interpersonally, how can you reduce unnecessary stress and maybe even build up a social buffer? Emotionally, how can you reduce unnecessary stress like resentment and guilt? Cognitively, how can you reduce unnecessary stress? And environmentally, and we'll get down to environmental in a minute. Encouraging people to be aware of this, that if they've got an autoimmune disorder, it doesn't mean they're going to develop dementia, but it does mean that they are at a greater risk. Gut health is another thing that is important. If somebody has been on a lot of antibiotics, if somebody just generally has bad gut health, a a disrupted microbiome, then they're probably going to have more, what they call pro inflammatory microbes. And so the bacteria that's in their gut is more geared toward stress response and that fight or flight reaction and inflammation. Gut health is really important. And some people will take probiotics and prebiotics, some people Will drink kefir. I love it myself. Some people will eat lots of yogurt, not too much, because you know that can cause another imbalance. There are a lot of different options that people can do. But paying attention to your gut and recognizing that everything goes in your mouth is going to go down to your gut. And how is it going to affect those little microbes that live down there is really important. Your gut is connected to your brain through your vagus nerve. And if your gut is unhealthy, if your gut is inflamed, it's going to signal stress to the brain and lead to systemic inflammation. Gut health real important. I have several videos on gut health on the YouTube channel that you can take a look at if you want to do a deeper dive. Sleep disruption. The more sleep deprived you are, the more the body registers it it as a stressor. It says, hey, you're kind of foggy this morning. That means you're vulnerable. That's a stressor. The hungry lion could get you. Our primitive brain kicks in and says when you're sleep deprived, that's a threat. So it kicks off the stress response, dumps a bunch of cortisol and a bunch of adrenaline and other things. Sort of like trying to give you an internal shot of coffee, which in and of itself seems like a reasonable response to help us survive. But for people who are regularly experiencing sleep disruption because of apnea we already talked about, or just generally, they've got poor sleep quality, they've got horrible sleep hygiene, they sleep with the television on and cats in the bed and a spouse that snores like a freight train. Then we may have somebody who is experiencing inadequate quality sleep. They may be asleep for seven or eight hours, but it may not be good sleep. And that contributes to systemic inflammation, contributes to negativity, cognitively intrusive thoughts and ruminations, which increase stress and cause even more inflammation and blood sugar spikes. Etc. A's dementia complex is another risk factor for dementia. And if you're working with somebody who has HIV or AIDS, making sure that they are aware that this can lead to dementia. It's about 7% prevalence in people who are not taking HIV. HIV, HIV drugs. Repeated head trauma can contribute to dementia. We've heard about chronic encephal CET when boxers and football players develop brain damage as a result of getting their bell rung too many times. This can be true for soldiers, this can be true for people who've had a few car accidents. Now it's more likely in people who engage in really rough and tumble activities, you know, your college rugby players and your college football players, etc. But repeated head trauma is something that can cause dementia. If you've got an older person who falls a lot and has hit their head multiple times, they're even more susceptible. And we need to be cognizant that that could be causing a problem. Social isolation reduces cognitive stimulation. If you're sitting in your room by yourself watching TV all day, you don't have cognitive stimulation. Your, your brain is just kind of turn into jelly. It can also increase loneliness if the person feels isolated and feels lonely. That's a stressor. Increase the stress response, increase the inflammation and okay, here's some of that research stuff I said we were going to stay away from. Reduced oxytocin. Oxytocin has emerged as a significant player in modulating systemic inflammation. It's not just our social relationships. It's actually that chemical oxytocin. And they've started in some people administering intranasal oxytocin, so little nose sprays, and they are finding that it works. It helps with schizophrenia, it helps people with autism spectrum disorders, and they're finding it also helps with cognition. Oxytocin appears to have a benef beneficial effects on glucose metabolism and may potentially impact A1C levels in diabetes. People who have higher oxytocin levels are better able to manage their stress for whatever reason, partly because probably they can manage their, their blood glucose better. So they have less inflammation as a result of uncontrolled blood glucose, blood glucose, which means their A1C levels are going to be better. Oxytocin is a good thing. We need to really, this is one of those things we can help people develop. Oxytocin can reverse learning and memory impairment associated with Alzheimer's disease. Remember I said that intranasal oxytocin. Oxytocin inhibits cell death in our brain. So even when it gets neurotoxic, remember I said maybe we don't have the estrogen anymore. Well, well, we can just ramp up that oxytocin. It's not going to do everything, but it's going to help. And oxytocin reduces cortisol levels. Cortisol is our stress hormone. You know, cortisol is what's released when we feel really stressed. We have high cortisol levels. We're like, yeah, that's the beginning of the stress response. Oxytocin helps reduce those and buffer against those. And that's important. We do want to understand that helping people increase their Oxytocin? Yes. Physical contact helps. Petting a, petting an animal increases oxytocin. But doing nice things for other people increases oxytocin. Doing things that increase a person's sense of connectedness, even if there is no touching, even if there is no necessarily acknowledgment. You know, you went around and you helped clean up somebody's house for them or something, and they don't know who did it, but you feel good about doing it because you know you did something nice. That increases oxytocin. Encouraging people to brainstorm things that they can do. And I encourage you to go online and ask my, Ask my AI about, for example, about different ways to increase oxytocin levels. All right, so now emotional issues, now that we're out of all the physical issues related to dementia and all those things that can increase stress and inflammation, and then oxytocin, which is, you know, your fighter, that's going to help protect, protect against it. Depression is a sense of hopelessness and helplessness. Okay, well, we feel vulnerable. That's stressful. And when people are depressed, they often don't move a lot. They often have reduced oxygenation, and that can contribute. And they also have reduced interaction with others, reduced engagement, so they're not using their brain. You know, we've. We've all been depressed. We've all worked with people who've been depressed, and we can see how people who are depressed may not be exercising their brain and may have increased stress and increased inflammation. Remember that hypothyroid, a risk factor for dementia, can also have cause symptoms of depression. And people with diabetes may have symptoms of depression or anxiety. It's important to rule out all of the causes of mood disorders. Anxiety and anger are the stress responses. And when you feel stressed, it releases cortisol, it releases stress hormones, it increases blood sugar, it increases blood pressure. All of those things that we already talked about that are risk factors for dementia. Now, anger and anxiety, we don't want to make them go away completely. They're healthy, they're adaptive emotions, just like a smoke alarm is adaptive. I don't want it going off all the time, but if there's a problem, I certainly want it to go off and tell me I need to check it out. Anger and anxiety are feelings that tell us that there might be a problem and to get up and figure it out. We're not meant to sit here and nurture them and dwell on them and ruminate on them. Helping people develop cognitive skills to tolerate distress and manage Their anger and anxiety and is huge as well as their grief. I should have put grief in there as well because remember, grief is denial, anger, depression, acceptance. So you've got anger and depression in that grief envelope. And there's a lot of things that people grieve as they get older. And, and again, you can see that video that we already did. If you want to take a look at all the different losses that people have to adjust to. As we age. Chronic stress and chronic hypercortisolism can increase the risk of dementia. Hypercortisolism means there's too much cortisol in our bloodstream and just like when there's too much blood sugar in our bloodstream, we're going to start having inflammation and problems. When there's too much cortisol in our bloodstream, the receptors are not going to pay attention to it anymore. They're like, nah, you know, I had enough, I paid at the office, I'm not interested right now. So cortisol is not going to be able to have its anti inflammatory effects. Instead it's just going to be a stress hormone and we're going to see systemic inflammation reducing chronic stress, healing that nervous system. I can't emphasize how crucial that is to reducing risk for dementia, cancer, just general illness, as well as anxiety, depression, etc. Adverse childhood experiences, trauma and PTSD are all potentially risk factors for dementia. Why? Because they cause chronic stress. If we have adverse childhood experiences or someone who had adverse childhood experiences and they are still feeling unsafe and powerless, they are still struggling with the messages that they learn. They're still anxious, they're still angry, they're still depressed, that increases inflammation, that increases stress and that increases the risk of dementia. If you're working with somebody who you know has adverse childhood experiences, helping them process that so that they're not carrying around that inflammatory baggage is going to be a great way to help them reduce their risk for dementia. Cognitive load. Too much cognitive load. We want to engage the brain, we want to exercise the brain. But if the person is feeling mentally exhausted and overwhelmed, that's stressful. That's stressful. We don't want to overload the brain. Just like you don't want to overload your muscles or you're going to, you know, tear it. You don't want to overload the brain because that'll trigger the stress response. Helping the person manage what is a reasonable level of mental activity. For me, pessimism and negative perceptions can be addressed with cognitive behavioral therapy. Looking at the facts in this context at this time, Embracing the dialectics using mindfulness based stress reduction. There are a lot of tools that we can help people who are feeling very frustrated with the aging process, for example, adjust to their bodily changes and to the loss of their young vital self, as one person put it to me, and the new changes that they're, they're experiencing so they can learn how to live their rich and meaningful life and age at the same time. Because we can't prevent the aging, but we can figure out how to use our energy to continue to live a rich and meaningful life. And that also goes back to acceptance and commitment therapy. Rigid thinking patterns and cognitive distortions tend to pe keep people stuck in a box and negativity. There are very rarely people who have rigid positive thinking patterns. I'm just going to see every everything through rose colored glasses and you can't tell me any different. Those people are few, few and far between. Most of the time when we see rigid thinking patterns, it's about powerlessness, it's about pessimism, negativity, hopelessness, hopelessness. And we want to help people step back and identify possible options. They may not agree. Okay, you know, if this is the only way it can be done, then we need to address what it means if it doesn't get done that way. What does it mean to you? An environmental noise and light pollution. Oh my gosh. I'm usually fussing about making sure you get enough light to set your circadian rhythms. Because remember, circadian rhythms are set by light levels, activity levels and temperature. Light level needs to go down, activity level needs to go down, and temperature needs to go down to trigger that sleep response. And a lot of people, especially in institutional settings, aren't getting that. So their circadian rhythms are just all over the place. But in terms of noise and light pollution for people who, well, anywhere, both of these can cause neuroinflammation due to corticoid resistance and sleep impairment. Which basically means excess noise and light that keeps you from especially that keeps you from getting good sleep is going to be stressful. That stress is going to trigger systemic inflammation and make your natural anti inflammatory mechanisms like cortisol. Unaffective 10 decibels or more of daytime noise was associated with a 36% higher risk of mild cognitive impairment and a 30% higher risk of Alzheimer's disease after they controlled for socioeconomic and lifestyle factors. That's huge, especially for people who are living near trains, who are living in big cities, or who are living near wind farms. The windmill farm things. Chronic exposure to noise has been linked to reduced attention, memory impairment and executive dysfunction. So problems planning, organizing, etc. Light pollution interferes with the body's natural sleep wake cycle, leading to sleep deprivation, which is a known risk factor for cognitive decline. If you've got too much light in your room, if you've got, you know, street lights beaming into your bedroom at night and keeping you from getting good sleep, if you're in the hospital and there's noise at all hours of the day and night and your roommate keeps their light on all day and all night, less light pollution and it can worsen dementia and increase stress. And finally, carbon monoxide poisoning, heavy metals, and pesticides. Not a lot talk therapy can do about these things, but we can educate people that if they notice a sudden change in their cognition, they need to check for cognitive for carbon monoxide poisoning. People who are exposed to chronic low levels of carbon monoxide poisoning may be at higher risk of developing dementia. The same thing is true with people who are exposed to chronic low levels of heavy metals like lead. If they're handling bullets a lot, if they're in the, in law enforcement or in the military, that can be one a problem. And pesticides, whether it's pesticides because you're gardening or you're a farmer or it's pesticides that you're eating, we know that pesticides are designed to disrupt the nervous system of the weeds and the bugs and whatever. And people who are exposed to higher levels of pesticides in their food or in their environment, especially on a chronic basis, do have a higher risk of dementia. There are nearly three dozen strategies we went over to reduce your risk for dementia. Some are as easy as getting a carbon monoxide monitor, a CPAP machine, or hearing aids. Others, like addressing ptsd, CPTSD or depression, may take some more time. I encourage people this month eliminate as many of the easy ones as possible. If you know that you've got too much light coming in through your bedroom window, get some blackout curtains. That's easy peasy. Done. If you know that your neighbors are really loud at night, maybe get a white noise machine or some earplugs done. There are a lot of easy adaptations that can be made, and then some of the others you can start working on gradually beginning in the new year, beginning in January, tackle one of those big risk factors per month. If you're having difficulty controlling your A1C levels. All right, let's start tackling that. If you are struggling with the effects of CPTSD or adverse childhood experiences, well, you can start Trying to tackle that one in February or March and gradually whittle them away. You don't have to change everything all at once. Every time you reduce a risk factor, you improve your cognitive age by about three years. So if you think about it that way, it can feel like you're making progress pretty quickly. I appreciate everyone being here today. Do you have questions about preventing dementia? And also as I asked at the beginning of class, do you have questions that you want me to cover in the next two weeks when we do our deep dive into the signs, symptoms and consequences of the different types of dementia? And thank you, John and Adriana, for, you know, I'm glad you were asking questions. I'm glad Adriana was able to help. I'm, I apologize. I wasn't able to respond as quickly. I did see. Oh, and John, you were the one who gave us the super thanks or whatever they call it on YouTube. And we really do appreciate, appreciate that dysphagia and, and yes, it is a swallowing issue that can be related to other things, but it's also common in dementia. We will be talking about, I don't think next week, I think the week after. I have to look at my outline about common co occurring conditions with dementia and that's one we will, I will make sure that we address. So let me just make a little note anyway, I'm pretty sure that's already on the list, but I don't want to, I don't want to miss it. You are quite welcome, David, for the information. I'm glad you're here. And remember, if you are a clinician, no matter what age, person you're working with, you can help them prevent, well, reduce their risk factor. You can't help them necessarily prevent it. Reduce their risk factors for dementia. And if they've already got dementia, all right, you can help them reduce the rate of the progression. We know that inflammation is going to increase the progression. So we know with a fair amount of confidence that this is one strategy that we can use to help people slow the progression. Well, we would love to have you take the courses. JG Strategies for Overcoming Resistance. Yes. And Paula, I'm not sure if you saw the video that I just did on developing rapport with the older adult and the cognitively impaired. That may address some of the issues, but we will, especially in the, the third week from now when we talk about agitation and delirium, we will certainly be talking about addressing resistance and increasing motivation in those who are cognitively able and increasing compliance, treatment compliance in those who may be in the advanced stages of dementia or. And. Or Alzheimer's. Okie dokie. Have a wonderful day. Have a wonderful week. And I will see. Well, we'll be doing our live Q A YouTube challenge on Monday and then we will be doing the part first part of the dementia class on Wednesday, so I will see you all then.