What leading brain health experts do every day to help protect themselves from dementia
It’s the UK’s biggest killer, but right now there is nothing that can be done about dementia other than to treat its symptoms. In fact, while it currently affects 900,000 people in the UK no new treatments have been approved for dementia in the last 20 years.
So, it’s no wonder the medical world rejoiced last year when two new drugs were found to clear out amyloid in the brain. Amyloid plaques are the proteins that build up on neurons and stop the brain working properly, causing diseases like Alzheimer’s.
Dementia is a group of symptoms (including memory loss, confusion, language problems and behaviour changes) caused by different diseases that damage the brain and get worse over time. Alzheimer’s is the most common, but they also include vascular dementia and Lewy body dementia.
The two drugs, lecanemab and donanemab, are both in the final stages of their clinical trials, awaiting approval in the UK. Trial data from their makers suggests they can slow cognitive decline in Alzheimer’s patients by 27-35 per cent compared with placebo. But experts have also raised the alarm, claiming trial data also showed serious side effects.
So, with one in three people in the UK set to develop dementia in their lifetimes, what can we do to protect ourselves? The Telegraph spoke to leading experts in dementia to find out the small things they do daily to help reduce their risk.
‘I sew’
Dr Catherine Pennington, 44, is a consultant neurologist and senior clinical lecturer specialising in neurodegenerative cognitive disorders at the University of Edinburgh. She is clinical adviser to Brain Health Scotland.
“When it comes to the evidence base for dementia prevention, there are proven ‘big ticket items’ like avoiding smoking as well as eating a healthy diet, specifically a Mediterranean style diet – which I try to follow, but often slip – that can reduce your risk and they’re also good for your heart health.
“Alcohol is damaging for your brain too so I only have a drink or two every couple of weeks. I’ve also found it has a bad impact on my sleep, and sleep probably helps remove harmful toxins from the brain and is essential to healthy cognitive function. I also run 6k [3.7 miles] a few times a week which takes me about 45 minutes each time. My motivation for running is my heart health, but I know that it can help protect my brain too.
“There are other things with less clear-cut evidence that may protect the brain. For example, in population studies, people who have a hobby – any hobby – in midlife and later seem less likely to develop dementia. For me, that’s sewing a few times a week. I’m so busy I might only manage 15 minutes, but it’s amazing how much you can fit into that. I might copy out a pattern, pre-wash a fabric or tidy up a hem. I like using my hands and love visual arts and design. It gives me control over what I’m wearing and a lot more choice in terms of design, so I don’t have to buy what’s in the shops.
“It’s hard to know why hobbies are brain-protective, but keeping on using and challenging our brains probably comes into it, plus the social side of things – I share a sewing passion with two old friends. But we also find that when people start to forget things, they might stop doing their hobbies. For example, someone might forget people’s names at their bowls club and then stop going. It’s important to support people to keep going with their interests. Overall what matters is keeping up something that brings you pleasure and social connection.”
‘I play jazz piano’
Dag Aarsland, 65, is professor of old age psychiatry at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London.
“I started playing piano when I was six. I can remember listening to Oscar Peterson at that age and being stirred towards jazz. I’ve been playing on an essentially daily basis (about 30-60 minutes a day) ever since then, both for fun and enjoyment. Now I play as part of a band with other brain researchers here in London. Our band is called Hoxton Square, which is the place James Parkinson was born – he is the man who first identified the shaking palsy we now know as Parkinson’s Disease. We play at charity gigs and music pubs.
“Mental activities that are challenging for the brain increase cognitive reserve, which makes the brain more resistant to diseases and dementia. Musical activity seems to be particularly useful, and our group at King’s found that playing a musical instrument was associated with significantly better performance in working memory and executive function. Jazz includes the additional creative element of improvisation which has been shown to involve key brain areas relevant for cognitive functioning.
“I also swim two mornings a week at 6.30am. I do freestyle for 30 minutes straight and despite my age I’m one of the fastest in the pool. I used to swim as a child and two years ago I decided to take it up again. We have population studies showing that people who exercise regularly could reduce their risk, and we know it has indirect benefits to the brain by keeping your heart healthy.
“In fact, of all the lifestyle factors that influence the risk of dementia, physical exercise is probably the one we have the best evidence for – not only cardiovascular but also muscular work, as muscles release positive molecules called myokines that benefit the entire system, including brain tissue. I hate the gym but do some pull-ups and push-ups a few times a week to help build some muscle.
“I also take an omega-3 fish oil supplement every day. Though there isn’t definitive evidence saying it can prevent dementia, our research with the PREDICTOM study at King’s [to pioneer early detection of Alzheimer’s using AI screening] is looking into how supplements like this might help. We know a lot of what omega-3s are doing – reducing inflammation and oxidative stress – is good for blood vessels. And may even also be good for some of the protein changes linked to brain symptoms. So there are a lot of reasons to assume they will be helpful for brain protection.”
‘I take vitamin D and get a good night’s sleep’
Kieran Clarke, 72, is emeritus professor of physiological biochemistry at the University of Oxford. Her research interests include physical and cognitive function.
“Sleep is important for brain health in helping prevent toxins accumulating in the brain but also for healthy weight and blood pressure, which is essential to preventing cognitive decline. I am serious about my basic sleep hygiene. I make sure my feet are warm, I don’t have coffee after breakfast and I read a book instead of looking at my phone before bed.
“Diet-wise, I avoid sugar, potatoes, pasta, bread and rice and eat mainly fruits, vegetables, nuts and fish. A protein-rich diet like that helps control my blood sugar which is key to brain health.
“I take vitamin D which everyone in the UK should be taking and I take vitamin K with it to help its absorption. If you look at people who have dementia they often have abnormally low, almost unmeasurable vitamin D levels. A prospective cohort study published last year in the Journal of Alzheimer’s and Dementia assessed the effects of vitamin D incidence on 12,388 participants with Alzheimer’s and found that vitamin D exposure was associated with a 40 per cent lower incidence of dementia compared to those with no exposure.
“I also avoid social media because of the high stress it causes, but I do read newspapers. Having high levels of catecholamines starves the brain of glucose. Catecholamines are a group of stress hormones that play an essential part in our ‘fight or flight’ responses and they include dopamine and adrenaline. Chronically high levels affect sleep, blood pressure and many other functions essential for brain health. Dealing with stress is essential for preventing cognitive decline.”
‘I avoid sugar’
Dr Bal Athwal, 58, is a consultant neurologist at the Wellington Hospital in London, part of HCA Healthcare. His specialisms include dementia, memory problems and neurological rehabilitation.
“I avoid sugar and ultra-processed foods (UPFs) wherever I can. Both sugar and UPFs cause spikes in blood sugar that we know, over time, could contribute to the development of diabetes, a risk factor for dementia. People with Type 2 diabetes are at increased risk of developing Alzheimer’s and research published in May 2023 in the journal JCI Insight found elevated blood glucose and increased sugar intake over time can lead to the proliferation of amyloid plaques in the brain.
“I always eat a protein breakfast of nuts, some cheese and perhaps a protein shake or an omelette with ham with a coffee, then that keeps me on an even keel, so I miss lunch and just keep myself well hydrated with plenty of water through the day. Having protein in the morning is great for keeping my blood sugar and energy level, as cereal and toast make me hungry by 11. At night, I would have a home-cooked dinner – the kind of dishes anyone else would eat, as long as it’s not processed.
“When people present to me in clinic with dementia or Alzheimer’s, there is often a history of diabetes as well as hypertension [high blood pressure] and high cholesterol. In brain scans you see these factors associated with deteriorating brain cognition. Blood pressure induces stress on blood vessels which respond by thickening their walls. Now the smallest of these have got very thin walls and deliver all the nutrients and the oxygen to the tissues, but if that ‘microcirculation’ is not working well [because they’ve thickened], then your brain will accumulate damage over time. That’s why they say ‘what is good for the heart is good for the brain’.
“For that reason, I always keep an eye on my blood pressure and cholesterol and would advise everyone over 40 to have these tested as they won’t show symptoms until things start to go wrong.”
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