I'm a dementia professor. Here's how I'm reducing my risk

Telegraph

a day ago

The human brain is endlessly fascinating, as is how people lose their memory, and how that affects their thinking and interactions. So I've always been drawn to working with older people. Dementia is the umbrella term for the symptoms of a group of diseases (Alzheimer's being the most common) that cause a decline in cognitive abilities, including memory, thinking and reasoning.
When I first entered medicine, there was an assumption that little could be done to ward off dementia in old age. While age remains the biggest risk factor, over the course of my career it has emerged that up to 45 per cent of cases are preventable, or at least their onset can be delayed. Our research identified 14 lifestyle factors that you can now control and reduce your risk of developing the disease
This breakthrough is extremely exciting, a beacon of hope. Knowing that measures can be taken inspires me personally to stay as well as I can. Here's what you can do, too.
Wear hearing aids
My family has a history of early-onset hearing loss and I've worn hearing aids for nearly 10 years, since I was in my mid-50s. I got tested after my husband told me that my hearing wasn't as good as it used to be. I know there's a stigma with hearing aids – it makes people feel old. And even though as a doctor I know this is ridiculous, I also felt this. But it's too important to be put off.
The single biggest modifiable risk factor with dementia is untreated hearing loss. A decade ago this seemed controversial, but now multiple studies show that those with hearing loss in midlife are about 40 per cent more likely to develop dementia (compared with those without hearing loss).
Scans show that the brain actually shrinks – there's loss of brain mass – in those with hearing loss. The encouraging news is that the evidence to date shows that using hearing aids takes away that increased risk, as natural studies and one randomised control trial have indicated. Hearing aids do stop working quite frequently, so you do need to change batteries or charge them, and return to the audiologist for repairs.
What I've noticed is that many people aren't actually aware they have hearing loss; they blame other people for muttering, or turn up the television instead, thinking it doesn't matter. But, slowly, people find themselves going out less because they can't hear well, and become embarrassed they're not catching everything. Probably the biggest stimulation for our brain is having a conversation with someone: listening and responding. Once people start withdrawing and isolating themselves, they're getting even less stimulation, and there can be a cascade of behaviours harmful for the brain.
Get your eyesight checked
The role that vision loss has to play in dementia has become clear more recently, and has now been added to the list of 14 modifiable risks. People who can't read more than halfway down the line of the optician's eye chart would be classified as having vision loss, and research shows that untreated vision loss makes us about 50 per cent more likely to develop dementia (than those without vision loss).
I've been myopic (short-sighted) since I was a small child, so I've always worn glasses and attended optician appointments, so they pick up and correct any changes in my eyesight.
Currently we don't know exactly why there's a relationship between vision loss and dementia. But in the way that hearing loss means people have less input in terms of cognitive stimulation, it's the same with vision loss. When people are restricted from walking around, or rapidly reading things, or socialising, your brain is receiving less stimulation.
That's why eye tests are crucial. But it's not just about being long or short sighted; common eye diseases such as cataracts are also risk factors. Picking these up means you can be treated.
What surprises me is that people don't necessarily notice when their eyesight has deteriorated. A friend told me that while he was driving last year, his wife mentioned something she had spotted out the window.
When he said, 'I can't see it,' she looked terrified and said, 'Stop the car – I'm driving!' It transpired that my friend, despite being a professor of medicine, had no idea he had cataracts, which he's since had treated.
Get your eyes checked regularly – after the age of 40 you should do so every two years. And by our 60s there are few people who don't need some corrections to their vision. Keep on top of it.
Make sure you're cholesterol aware
I'm actually not on statins, because my cholesterol levels are fine. This is partly down to luck, but I'm careful to eat a lot of fruit and vegetables – I don't keep track, but I probably eat more like seven or eight a day instead of the recommended five. I also rarely eat red meat. But there are many people who eat a perfect diet and still have high cholesterol. They need statins to decrease LDL cholesterol. High cholesterol increases stroke risk and the build-up of proteins in the brain such as amyloid and tau. This may lead to an increased risk of Alzheimer's disease and vascular dementia.
Keep track of your blood pressure
I will probably take blood-pressure-lowering medication at some point, but I don't currently, as mine is still a bit below what they recommend as treatable. I'm thinking that I should consider treating it a bit earlier than 140[/90], which is when medication is usually given.
I think anything much over 130/80s might be worth trying to medicate a bit sooner. It may be that high blood pressure leads to a lowering of cognitive reserve and therefore makes people more likely to show symptoms from a variety of brain pathologies. Over time, uncontrolled high blood pressure can damage your blood vessels, including the blood vessels in the brain, which can interrupt the flow of blood, leading to a type of dementia known as vascular dementia.
Don't drink too much and give up smoking
Too much alcohol is another dementia risk. Excessive alcohol damages brains, plain and simple, but it's something we can ward against.
I do enjoy wine, but I never drink more than the recommended amount. Make sure you know what a unit of alcohol actually looks like. I purposely use smaller wine goblets.
When a friend came to stay, recently she remarked, 'Your glasses are very small.' But what it means is that you find you have had enough earlier and drink less. Of course, if you have large glasses, you pour more. The good news is that if you stop drinking excessively (less than 21 UK units of alcohol a week) you can lose your extra risk quickly – within a couple of years.
I've never smoked, which is good, because smoking increases dementia risk through several mechanisms, including reducing blood flow to the brain, causing oxidative stress, and raising the risk of stroke. These factors can damage brain cells and increase the risk of developing vascular dementia and Alzheimer's disease. Smoking also contributes to brain shrinkage, further impairing cognitive function.
Like alcohol, after a couple of years stopping smoking means you lose your extra risk – provided you do not already have dementia.
Don't drink coffee in the late afternoon
I love coffee and have no desire to stop drinking it. It makes me feel more awake and keeps me going. There's some evidence that it might help reduce dementia risk, though it's not strong evidence admittedly.
I make sure I don't drink it too late, as I don't want it to interfere with my sleep.
Don't stress about sleep – just build a 'sleep pressure'
We're not sure how sleep and dementia are linked. There is some evidence to suggest that a lack of sleep may increase a person's risk of dementia, but does poor sleep increase dementia risk, or does dementia lead to poor sleep?
It's possible both these theories could be true, and the relationship could be circular, but it's not clear. Whatever the case, sleeping well is clearly good for enjoying life.
Stressing about sleep never helps. The more you think about it, the less likely you are to manage to sleep. But if you try to get to bed at a reasonable time and to wake at the same time, you will probably be all right.
I have to be an early riser for work, so I'm usually in bed by midnight and up before 7am. I keep active during the day and avoid napping, which ensures I build up a 'sleep pressure', a level of exhaustion that means I'm tired enough to sleep at night. If you're not tired enough, you will struggle to sleep.
Keep active throughout the day
We all need to move more. Several dementia risks – such as obesity, physical inactivity, high blood pressure and diabetes – can all be helped by taking plenty of exercise.
I try to do more than 10,000 steps, on average, every single day, so I choose phone calls over video calls, if I can, so I can walk as I talk. Sometimes I listen to podcasts or music, or just quietly notice the world around me. I factor in extra time to walk to the station or meetings, and for many years now I've done weight training twice a week.
My natural inclination is to sit on the sofa, which is why I have a personal trainer. I was overweight as a child and I do need to watch my weight. For some people, weight-loss jabs are amazing, and I think they will change things in the same way that drugs for diabetes and hypertension were a breakthrough.
But there has to be policy change, too. It's no coincidence that the world suddenly got fat at the same time: humans didn't change but our environment did – the food we buy and the ease with which we can exist moving less. So while individuals have more control, there has to be change at a policy level, to reduce the amount of sugar and salt in our diets.
Stay social and keep your brain working
One of the best things for our health and ageing is socialising, because of the brain stimulus it provides. I know there's a lot of talk about puzzles and sudoku and the like, but I don't personally agree. I read and write my papers all the time at work and I feel that I'm cognitively stimulated by talking to friends and family and going out with them.
The important thing about brain training is doing different things, so if you do sudoku regularly, you get good at sudoku, but it's not general brain training.
Don't obsess over longevity, it's not realistic
As much as I try to do everything I can to stay physically and cognitively well, no one lives forever; we all die and most of us get ill in the end.
The best I aim for is to have a long, healthy life and a short, unhealthy bit at the end. It's unrealistic to expect to live forever – yet it will be possible for most people to live healthier for longer.
If everyone took precautions to avoid these risks, there would be fewer people getting dementia, and those who did get it would get it for a shorter length of time. We call it a 'compaction of morbidity', to try to get these disabling illnesses for only a short time.
So, I try not to worry about which is worse: losing my mental or physical faculties. Instead I focus on remaining well for as long as possible, and make sure things are in place for my husband and children, for example, to have power of attorney, like we had for my own parents. Both my father and my mother died with dementia. It was strange going from the role of doctor to the daughter of ill parents, but my knowledge was helpful, too, because I understood what was happening. So before they became sick, my three siblings and I had discussed the future with them and set up lasting power of attorney.
I've talked with my husband and two adult children about how I see the end of my life so they know the sort of things I want. If I have an illness, I do not want to prolong dying or be kept alive, unconscious, for a long time.
It's better to discuss it when everyone is well, so that it seems a long way off and not a frightening thing. In the end, none of us know whether we'll be well tomorrow.
What does the future hold for Alzheimer's?
My hope for dementia is that we find more effective drugs, because the ones that have been approved for use in the UK by the Medicines and Healthcare products Regulatory Agency (MHRA) – lecanemab and donanemab – are difficult to use, there are side effects, and they do too little. These first drugs aren't perfect, but show us what's possible. This, ultimately, will lead to better drugs – and we're just at the start of that journey now.
But what is my biggest hope? That fewer people get dementia to begin with, because prevention is always considerably better than any drugs.
As told to Susanna Galton
Prof Gill Livingstone is supporting Alzheimer's Society's Forget Me Not Appeal, which funds life-changing support and groundbreaking research for the UK's biggest killer – dementia. Donate at alzheimers.org.uk/telegraph.