Living Longer Better

Ageing is not a cause of major problems till the later nineties. The problems we fear—dementia, disability, and dependency are due to three other processes: loss of physical fitness, which starts long before old age, diseases, many of which are preventable, and pessimistic attitudes. Both lay people and our professional colleagues have difficulty with the meanings of dementia, Alzheimer’s disease, vascular dementia, and cognitive ageing and use these terms in different ways, often incorrectly. Now is the time to use your assets—preserving and increasing your brain reserve to reduce your risk of dementia. The fitness gap can be closed at any age by increasing both physical and social activity. There is no upper age limit for prevention. The steps we recommend for reducing the risk of dementia will also help you reduce the risk of other diseases, keep you fitter, and help you feel better, and are equally relevant for people who have already developed mild cognitive impairment or dementia.

Keep Your Brain Tissue Healthy

This chapter starts by advising how to reduce the impact of stress. When stress becomes long term, the immune system becomes less sensitive to cortisol, and since inflammation is partly regulated by this hormone, this decreased sensitivity heightens the inflammatory response and allows inflammation to get out of control, increasing our risk of many diseases. You can reduce your stress yourself through a variety of methods, including physical activity and mindfulness-based stress reduction. Adequate sleep is also a major factor that can improve cognitive abilities and reduce the risk of dementia, and this chapter outlines what we need to know about sleep cycles, insomnia, and sleep disordered breathing, and how to sleep more and sleep better. The chapter then covers how to protect your brain from over medication (polypharmacy). It finishes by discussing how to maintain and indeed increase your levels of physical activity, and how increasing physical activity has both direct and indirect effects on the brain.

Increase Your Ability to Interact with People and Ideas

Neuroplasticity is the ability of the brain to create new connections throughout the whole of an individual’s life course. Any intellectual activity is better than inactivity and the more challenging the intellectual activity the better. It is important to give priority to intellectual activity that involves engagement with other people. The benefits of being involved with other people and avoiding isolation is that it keeps the brain healthy and, for many people, prevents depression and feelings of loneliness. New findings about neurologic mechanisms from brain imaging studies help explain how uncorrected deficits in vision and hearing can lead to cognitive decline. By sustaining one’s hearing and improving vision it is possible to avoid or at least delay the consequences of hearing and vision loss that include communication difficulties, social isolation, depression, an increased risk of falls, decline in physical functioning, and decreased quality of life.

The Future of Brainability

Individuals have to live in society and it is society that creates the environment, both social and physical, which influences many of the decisions that individuals make. Perhaps the strongest message is the influence of others in a world in which the number of people aged over 65 will outnumber the number of people aged five or under for the first time. Our environment is changing and the digital revolution, which includes imaginative use of artificial intelligence, is leading us all to question the way we do things. Social isolation will be avoided through use of mobile phones and beyond, thus reducing this significant risk factor for dementia. This will ensure people remain connected with their environment and community to help us all to be more resilient. Even work is a very positive factor here—some of us say we should never retire. As we develop our understanding of what increases our Brainability, this will help us move to a new world of productive healthy ageing and change the image some of us have around old age.

Understanding the Potential for Protecting and Improving Brainability

By putting into practice the advice in this book (based on evidence from systematic reviews, along with the authors’ collective experience), people would not only avoid dementia but they would also keep their brains healthier, their minds sharper, and would develop fewer diseases, be less disabled, be more independent and active, be less likely to have to go into a care home, and they would feel better. Don’t worry about your genes. Instead, fight back against the modern environment by reducing the impact of stress, sleeping better, becoming more active, stopping smoking, and rebalancing your diet. We need a new approach to increase our Brainability—understanding and accepting ageing, getting and keeping fitter, reducing the impact of disease, and thinking more positively. Based on this way of looking at living longer we have developed the Triple Whammy Brainability Programme—keep your brain tissue healthy, increase the blood supply to the brain, and increase the ability of your mind to interact with people and ideas.

Maintain and Increase Blood Supply to the Brain

There are two imbalances in diet that increase the risk of dementia: the intake expenditure imbalance and the dietary mix imbalance. It is important to change your food choices Recent research has emphasized the importance of type 2 diabetes (non-insulin dependent) as a factor that increases the risk of dementia. This chapter presents perspectives of what you can do, how your family and friends can help, agencies to seek help from in the community, and types of assistance that can be obtained from the health service to manage type 2 diabetes. Keeping your cholesterol as low as you can and reducing blood pressure is essential. The chapter covers the evidence on statins, as well as the modifiable risk factors affecting blood pressure. The chapter ends by discussing the risks of smoking and smoking cessation support and self-care of atrial fibrillation, beginning with an understanding of the treatment goal and actions to take if the treatment goal is not met or if adverse effects of treatment occur.