A new study of older adults shows how making some lifestyle changes such as changing diet and increasing physical activity can lower the risk of dementia, even if the person already has been diagnosed with and is experiencing cognitive decline.

The term dementia describes a collection of disorders that are characterized by difficulties with cognition, memory, and reasoning. Alzheimer’s is the most recognized and common type of cognitive decline.

According to the Centers for Disease Control and Prevention (CDC), at least 5 million Americans live with Alzheimer’s and related dementias. As our population ages, experts expect this number to grow significantly.

Although the precise biological cause of Alzheimer’s is still not known by scientists, some lifestyle factors that have been studied have been shown to increase a person’s risk of developing one of the disorders related to dementia. These factors include smoking, alcohol consumption, poor diet, and a lack of physical activity. One study has estimated that up to 50% of all Alzheimer’s cases in the world may be linked to these lifestyle factors.

Results from the study below published in the Journal of the American Geriatrics Society suggest that changing these lifestyle factors may help to improve cognitive processing in older adults who may be experiencing cognitive issues that commonly precede dementia.

The study included 119 people 65 or over who were suffering from either subjective cognitive decline (SCD), which is a self-reported condition of confusion or memory loss, or mild cognitive impairment (MCI), which is a clinically diagnosed form of cognitive decline. Doctors consider both conditions as early signs of dementia. However, not everybody with SCD or MCI goes on to develop dementia.

The researchers separated the study group into two segments. They created an active control group and an intervention group for 8 weeks. The control group was plied with online information related to dementia and lifestyle risk factors, Mediterranean diet, physical activity, and cognitive engagement. Another 2020 study has shown that the Mediterranean diet, exercise, and cognitive engagement can slow cognitive impairment. Participants were not required to implement this information into their own lifestyles.

The intervention group completed the same online training and were encouraged to participate in practical activities, including meeting with a dietitian and exercise physiologist and completing brain training exercises.

The study, which is part of the Body, Brain, Life for Cognitive Decline (BBL-CD) trial, is hoping to learn more about the connection between diet and activity levels and reducing the risk of dementia in people who are beginning to show cognitive decline.

By the end of the study, the intervention group’s participation levels and cognition levels were significantly higher than that of the control group. 

Over the 6 months of follow-up data, investigators noted that the people in the intervention group were able to improve their lifestyle and had higher cognition scores than those in the control group. The results suggest that lifestyle-based changes may help stem cognitive decline thus reducing a person’s risk of developing Alzheimer’s. However, the evidence suggests that individuals need to maintain these dietary and activity changes to see the continued benefit.

Ultimately, the study is quite hopeful. It indicates that those already experiencing cognitive decline can make some reasonable, cost-effective lifestyle changes and reduce their risk of developing dementia, which is especially promising.

“We’ve known for some time that lifestyle changes such as these can reduce dementia risk in the general population. What this study adds is that with the right intervention, people experiencing cognitive decline may retain sufficient neuroplasticity for their brain to ‘bounce back’ from decline,” said lead author Mitchell McMaster, a Ph.D. student at The Australian National University.

Dr. Mark L. Meyer received his M.D. from the Yale University School of Medicine and his J.D. from Yale Law School. He has a private cardiology practice in Manhattan.

Findings Underscore Need to Get a Flu Shot Early, Lead Researcher Says.

People with heart disease and those who have had a stroke are at higher risk for developing serious complications from the flu. If you're in that group, it is especially important that you get a flu vaccine every flu season to potentially serious complications.

Among adults hospitalized with flu during recent flu seasons, heart disease was one of the most commonly-occurring chronic conditions—about half of adults hospitalized with flu that season had heart disease. Studies have shown that influenza is associated with an increase in heart attacks and stroke. A 2018 study in the New England Journal of Medicine found that the risk of heart attack was 6 times higher within a week of confirmed flu infection. These findings were most pronounced for older adults and those experiencing their first heart attack.

And most recently, an August 2020 study from the CDC & published in the Annals Of Internal Medicine that looked at more than 80,000 U.S. adults hospitalized with the flu over eight flu seasons (2010-11 through 2017-18) found that sudden, serious heart complications were common and occurred in one out of every eight patients (~12% of patients). Of adults hospitalized with flu, 12% had acute heart complications. Of these, 30% were admitted to the ICU and 7% died while in the hospital. The study found that 5% of patients hospitalized with the flu had a cardiac complication despite having no documented underlying conditions.

"Previous to our study, there had been suggestions between the link, but our study shows just how common it is," said lead author Eric Chow, an infectious-disease fellow at University of Washington School of Medicine, who worked as an epidemic intelligence service officer, or "disease detective," at the Centers for Disease Control and Prevention.

The study underscores the importance of getting a flu shot early. "There are few respiratory viruses we have a vaccine for," he said. "Get a flu shot."

Dr. Mark L. Meyer received his M.D. from the Yale University School of Medicine and his J.D. from Yale Law School. He has a private cardiology practice in Manhattan.

COVID-19 lockdowns are easing across the U.S., and there is a lot to process as these restrictions begin to end and transition.

What is the new safe? Can we return to the gym? Can we schedule regular medical appointments again? What should we include on our post-quarantine list of health practices? And if you forged some new habits or rediscovered old hobbies while staying at home, should you consider making those part of your new normal routine?

As the world begins to recover from some of the unfortunate consequences of the pandemic such as shuttered businesses, lost jobs, and social-distancing, there have been some positive changes, too.

More than before, people are spending more time outdoors in the sunshine. Almost everyone I know has picked up a new exercise habit. People are spending more time with their families, bringing people together and making interpersonal bonds stronger.

So perhaps the first thing to do is decide which of the new habits will you keep, and maybe you'll decide to keep them all.

The next step is to put together a list of your health priorities. To do this, you'll need to understand your own risk for contracting COVID based on your age and particular issues. Then make sure that you know your local data - know the COVID rates in your area, and understand any new trends such as an increase in new cases. Pay attention to what experts are counseling people to do in your area with respect to your own care.

Here's a helpful list with some annotations:

1. If you've missed medical appointments, testing, or treatments, it's time to reschedule any missed procedures or screenings, especially high-priority ones. Most likely your health care providers have already or will soon begin to see patients in their offices.

As an article in the American Heart Association News mentions:

In a recent report, 16 North American cardiovascular societies issued guidance for health professionals on safely reintroducing diagnostic tests and invasive cardiovascular procedures, with an eye to regions with lower rates of infection.
The pandemic has taken a toll on cardiovascular care, said cardiologist Dr. Robert Harrington, chair of the department of medicine at Stanford University in California. He co-authored the report as president of the American Heart Association.
"We've seen a large drop-off in patients seeking acute care for suspected heart attacks and strokes. There's been a decrease in more elective procedures such as exercise testing, cardiac catheterization and other procedures. Anecdotally, we also hear of people having worsening symptoms at home, with a reluctance to seek care for issues such as heart failure management."

The new report goes on to highlight the need for cardiologists to prioritize procedures or screenings with the most benefit for the most people in an attempt to "balance the risk of further care postponement against the risk of further spreading COVID-19."

Other medical provider organizations such as the American Cancer Society are also in favor of resuming cancer screenings and exams in the hopes people will be able to work with their health providers to take into account their own personal situations.

2. Get back in touch with your primary care provider to let them know how you've been and if there have been any changes in your health. Update your doctor on any ongoing conditions, and most especially, if you've had COVID-19.

Interestingly enough, your primary care provider may be a great source of local COVID data and be able to balance your personal health vulnerability against local COVID-19 infection trends to determine whether and when to pursue in-person visits for routine care such as vaccinations and dental checkups.

3. Get back to regular exercise & try to lose any bad habits you may have picked up.

Hopefully, you haven't gone back to smoking, but some have. Maybe it's some extra wine, but no matter what the habit, now is a good time to take an inventory and start formulating your exit strategies. For many, however, the worst habit developed during this long period of quarantine was once again staying on the couch instead of moving our bodies. That may be the easiest exit strategy to plan: time to get up off the couch and get back to it.

4. Set some goals and follow-through check-ins.

The new normal, post-COVID reality is still very much the same as the old normal, pre-COVID world. Your health priorities are still to eat healthfully, exercise, manage your stress, and pay attention to your mental health. The things that worked before to achieve those goals still work. Exercise, meditation, yoga, etc. all work to promote both physical & mental well being.

5. Don't forget to maintain personal protective precautions.

It's still important to assess the risks of every return. Whether it's the gym or a physician's visit, you must use the same amount of pragmatism and caution. Don't forget that in all situations, you must continue to observe the proper social distancing and masking when near others as well as always remembering to maintain good hand hygiene.

Dr. Mark L. Meyer received his M.D. from the Yale University School of Medicine and his J.D. from Yale Law School. He has a private cardiology practice in Manhattan.

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