Top 6 Ways to Prevent Dementia

Up to 40% of dementia may be prevented through lifestyle changes [Livingston Lancet 2020]. Let’s find out the top six ways to reduce dementia risk with lifestyle from todays expert guest.

Sarah McEwen, PhD, is a Cognitive Psychologist with 15 years of clinical research experience, specializing in the study of physical activity and cognitive enhancement interventions to investigate biological, behavioral and health-related outcomes in patients suffering from cognitively debilitating disorders. 

Dr. McEwen graduated with a bachelor’s degree from the University of California, Davis and a PhD in Psychology from Trinity College.

Dr. McEwen serves as Section Editor for the peer-reviewed journal NeuroReport, and Associate Editor for the Journal of Alzheimer’s Disease, and has published over 45 peer-reviewed journal articles. 

Up to 40% of dementia may be prevented through lifestyle changes [Livingston Lancet 2020]. 

Neuroplasticity – brain can change throughout life

-Physical exercise can actually result in hipoocampal growth on MRI in adults. 

-Diet- Follow the MIND protocol


-Reduce chronic stress-MBSR Mindfulness Based Stress Reduction

     Hippocampal volumes can increase following MSSR [Holzel 2011] 

-Social Isolation

Genius Gyms

Pacific Brain Health Center ( 



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Robert Lufkin 0:00
Welcome back to the health longevity secrets show and I’m Dr. Robert Lufkin, up to 40% of dementia may be prevented through lifestyle changes. According to a recent Lancet article, let’s find out the top six ways to reduce dementia risk with lifestyle from today’s expert guest. Sara McEwen PhD, is a cognitive psychologist with over 15 years of clinical research experience specializing in the study of physical activity and cognitive enhancement interventions to investigate biological behavior and health related outcomes in patients suffering from cognitively debilitating disorders. Dr. mcgeown graduated with a bachelor’s degree from the University of California Davis, and a PhD in psychology from Trinity College in Dublin. Dr. McEwen serves as section editor for the peer reviewed journal neuro report, and as associate editor for The Journal of Alzheimer’s disease. And she has published over 45 peer reviewed articles. we’re experimenting with a new format in this episode of having a presentation rather than the usual interview style. Please let us know how you feel about it. And now, Dr. Sarah McEwen.

Sarah McEwen 1:26
Hello, my name is Dr. Sarah McEwen, and I’m a cognitive psychologist in senior research scientist at the Pacific brain house center. I dedicated my research career to trying to better understand brain function and risk for brain disorders using brain imaging tools. One of my roles at the brain house center is to develop new evidence based interventions to help people improve their cognitive functioning through lifestyle changes to boost brain plasticity. Through the course of my research, I’ve had the fortunate opportunity to see firsthand the remarkable power of our brain’s innate ability to repair itself across a wide variety of brain illnesses. I’m excited to be here today to show you six of the most effective and scientifically based ways to improve your brain health and boost neuroplasticity through changes in lifestyle behaviors. I will also talk about these interventions in the context of reducing risk and progression of late life brain disorders. I’ll be focusing predominantly on the reduction of risk for dementia. Research has actually shown that 40% of dementia cases could be prevented if changing lifestyle behaviors was adopted. But I hope today’s topic appeals to a wide audience because all of the interventions I’m recommending can benefit everyone at any age seeking to maintain optimal brain health. So let’s start by discussing what brain health is. The US Centers for Disease Control and Prevention has defined brain health as the ability to perform all of the mental processes of cognition, including the ability to learn and judge use language. Remember, play and concentrate. throughout your life. Your brains job is evolving and ever changing to help you make sense of the world and help you carry out your daily activities. As we age, our experiences of events and knowledge keep our brains working, developing and learning. brain health is being able to draw on the strengths of your brain Information Management logic, judgment, perspective and wisdom. Simply put, brain health is all about making the most of your brain and helping reduce some risks. As we age. The ability to maintain brain health during one’s life should be of the utmost importance in pursuing health and longevity.

A foundational component supporting lifelong brain health is through an incredible phenomenon called neuro plasticity. The brain is remarkably plastic, meaning it can be changed and improved throughout your entire lifetime. However, up until about 1962, it was believed that the human brain was fixed at birth and not capable of growing more brain cells. But extensive scientific research has shown that this is clearly not the case. The brain has an incredible ability to grow and reorganize itself by forming new neural connections throughout life. neuroplasticity allows the neurons in the brain to compensate for brain injury and disease by adjusting their activities in forming new connections in response to new situations and your environment. This is known as experience dependent plasticity. The fact that what we do affects our brain function and structure has been well described in epidemiological research. The best example of this was conducted by the Lancet commission This landmark report published last year by the Lancet commission, world experts in the field of dementia convenes to review all of the available data surrounding risk for Alzheimer’s and dementia. They concluded that around 40% of dementia cases worldwide can be prevented through a healthy lifestyle. They identified 12 risk factors for dementia that seemed to be the most impactful when implemented and happening during certain life stages. First, in early life, the most important is educational attainment. In the mid life years, hearing loss seems to be the most significant contributing factor. Also having a traumatic brain injury, hypertension, high alcohol consumption in obesity were also impact important factors during the midlife years and later life years. The most impactful factors on dementia risk reduction, were decreasing smoking, decreasing the depression, having higher social contact, physical activity, being out of the air pollution, and also not having diabetes. So although there’s no cure for dementia related illnesses, lifestyle changes, and early intervention give us hope that we can prevent or maybe even halt the progression of this disease at any stage of our life. This figure here represents the trifecta of brain health, and the three pathological categories that are driving dementia on set. The first at the top there is increasing our cognitive reserve. This is the brain’s ability to maintain resilience to the effects of aging on the brain. Research has shown that exercise is actually one of the best ways to increase cognitive reserve, along with increasing education and continued lifelong learning. The second category is reducing brain damage. Reducing unhealthy lifestyle behaviors helps to prevent neuro degeneration in the brain, and the buildup of the sticky beta amyloid plaques that form that we know are implicated in Alzheimer’s disease. ways to do this are through treating chronic conditions and also reducing unhealthy behaviors like smoking. The last category is reducing neuro inflammation. This is critical. The most compelling new research in the field of Alzheimer’s disease shows that a heightened chronic inflammation, which weakens the immune system, and the body’s natural defense system is the primary driver behind the onset of the disease. Today, I want to share with you six of the top prevention strategies for reducing risk for dementia and keeping your brain healthy as you age. The top six are exercise, diet, sleep, learning, reducing stress, and socializing. So let’s get started with the first one.

If you choose to adopt only one healthy lifestyle behavior after today’s discussion, the one with the most evidence for decrease increasing cognitive reserve is exercise. Exercises is essentially a panacea for the brain, as it contributes to an infinite amount of benefits to the brain and the body. There has been extensive research over the last few decades dedicated to exploring the neuroplasticity benefits of exercise. pioneering research conducted by Henrietta von Prague and Fred gage in 1999, was the earliest to do animal research to examine directly what’s happening in the brain during exercise. And what their studies found was that animals that did daily aerobic exercise actually grew twice as many new neurons in the brain within the hippocampus as the control animals that didn’t do any exercise. This was the first time there was direct evidence shown that exercise can increase the size of the brain. This increase in brain volume has been shown in humans as well too. And many studies pointing to the hippocampus which is our memory center in the brain, in the prefrontal cortex, which is our executive functioning reasoning reasoning center in the brain. Those are the brain areas that seemed to increase in size along with other brain regions known to shrink with age that they increase due to exercise. The increase in brain volume has been shown to be related to improvements in thinking skills, such as learning and memory, attention and executive functioning such as planning and reasoning. The mechanisms behind the relationship between exercise and increased cognitive functioning are hot topic and research in something we’re actively studying at the Pacific brain health center. Some of Unknown mechanisms are increasing cerebral blood flow to the brain through exercise, creating new blood vessels known as angiogenesis through exercise, and creating new brain connections, which is known as synaptic Genesis. Exercise also reduces neuro inflammation, and increases trophic growth factors are brain nutrients, like brain derived neurotrophic factor, and all of these support overall brain health. As I already mentioned, exercise increases cognitive reserve, and resilience to brain aging and damage. Studies have shown that physical exercise leads to additional benefits beyond those two cognition, including improved mood, reducing mortality, improving functioning and reducing fall risk to

a review from 2017. A physical activity studies and risk for Alzheimer’s disease found some consistent findings for the benefits of reducing risk. They concluded that engaging in regular physical activity could stave off the development of Alzheimer’s by up to 20 years. That’s a lot of extra good years. However, unfortunately, more than 80% of adults don’t meet the American Heart Association guidelines for doing exercise. What we recommended the Pacific brain health center is doing aerobic strength, neuro motor, and also flexibility exercises. These are the recommendations of the American College of Sports Medicine, and have also been interventions that show effectiveness on increasing cognitive functioning. So we recommend two to five days a week of 150 minutes of moderate intensity aerobic exercise, two days of strength training, resistance exercises, and also doing neuro motor exercises. So interestingly, these neuro motor or skill based exercises, or fault are a form of goal oriented movement, in which the temporal or spatial accuracy is important for achieving predefined objectives. So novel activities with dynamic environments like playing tennis, dancing, or doing Tai Chi, all have increased physiological benefits on the brain, predominantly increasing the connection between New synapses in the neurons in the brain. The next topic I want to talk about today is diet. The best diet for optimal brain health with the most scientific evidence is the mind diet, which stands for Mediterranean dash intervention for neurodegenerative delay diet. This isn’t some trendy diet of the moment. Born is a hybrid of two existing eating styles with decades of research the DASH diet in the Mediterranean diet, university researchers developed the mind diet to emphasize foods that impact brain health. The research is in eating 10 certain types of foods and avoiding five other types has been shown to slow brain aging by seven and a half years and lessen the chances of developing Alzheimer’s disease. The mind diet, which is low in meat and dairy and high in vegetables and fish, has been shown to lead to fewer vascular risk factors and reduced insulin resistance and reduced markers of neuro inflammation. When doing the mind diet, you should emphasize foods that are low in sugar and carbs, those with the low glycemic index, and also include foods that are high in lean protein and leafy vegetables such as kale, spinach, or arugula watercress, which are packed with vitamins and five minerals, which have an eye oxidants strawberries and blueberries also have high Kemper fall flavonol nutrients. A recent study published last year found that people with the highest levels of these flavonol nutrients intake, they were 40% less likely to develop Alzheimer’s disease, and many of them were on the mind diet. We recommend eating at least four to six cups of non starchy vegetables every day. Also, the timing of eating is also important for brain health, do an overnight fast of 13 hours and don’t eat at least three hours before bedtime to allow the digestive processes to complete. Speaking of bedtime, my next topic today is on sleep. Sleep isn’t is a critical lifestyle factor that needs to be addressed in all of our lives, trouble falling asleep or staying asleep poor sleep quality, sleep disordered breathing or sleep apnea and short or long sleep duration or gaining attention as potential risk factors for cognitive decline and dementia. The new findings were or have been describing how tau which accumulates an abnormal tangles in the brain of people with Alzheimer’s disease. is occurring when people aren’t getting proper sleep, and the Healthy Brain active neurons release somehow during waking hours, but it normally gets cleared away when we sleep. So essentially, your brain has a system for taking out the trash when you’re sleeping. The National Center on sleep disordered research recommends that for the brain to fully rest and reset, generally need eight hours of quality sleep. Many sleep study centers have public tips on sleep hygiene, which describes the best practices to encourage sleep. The top tips include keeping the room quiet and dark, controlling temperature and eliminating electronic devices from the bedroom.

This diagram represents how poor sleep has negative knock on effects for the brain. As I mentioned, when you sleep, you get housekeeping that occurs in the brain, you’re clearing out the beta amyloid and the tau tangles. What they found in research is you can actually remove about 50% of those negative neuro pathologies in the brain when you sleep. So you need to make sure that you’re getting proper sleep every night. And if you’re having any trouble with your sleep, please see your doctor who can refer you to a sleep study to find out what’s going on. The next topic I want to talk about today is learning. For years, researchers have noticed that people with more education and intellectually demanding careers have a lower risk of dementia. But what about protecting your brain in the later life years? Well, new research suggests that lifelong learning is an integral factor for cognitive growth and functional dependence later on in life. Lifelong Learning is a form of self initiated education that focuses on personal development. A study conducted at the Mayo Clinic actually found that intellectual and Christian enrichment occurring in early or mid life years gauged by education and occupation, in mid to late life years gauged by a questionnaire. What they found was high lifetime intellectual enrichment was associated with higher cognitive function. And then those who had a high genetic risk for Alzheimer’s, but, but had a high level of lifetime intellectual enrichment. They were shown to have their cognitive impairment delayed by almost nine years. So it’s really important, but also in late life years. We’re also engaging in cognitively stimulating behaviors. What a recent study found was when people were older adults were learning new skills, taking over taking place over three to four months, like studying a new language, painting and drawing music composition, photography classes, or learning a new device like a tablet, or a phone or an iPhone. What they found was it had a significant improvement on cognitive functioning. They also found that simultaneously learning more than one skill at a time is more beneficial than sequentially learning only one skill at a time. So what are the best types of cognitive training that are most effective on reducing risk for Alzheimer’s? Well, a recent review reviewed dozens of cognitive training studies on older adults, and shows that multi component training is the best for treating cognitive deficits. These include the use of computerized cognitive training programs, the one that we recommend is posit science by brain HQ, as it has a lot of evidence behind it. And also wanting to do that five times a week at a maximum of 30 minutes, but we recommend restarting in about 10 to 15 minute sessions. And there’s also compensatory training, which is different from the computerized cognitive training. Well, compensatory training is really skilled training. So it teaches you skills and strategies to remember things to help you from forgetting. And the last thing is novel skill learning. So a recent paper found that it followed 800 women from midlife to old age and follow them for 44 years. And what it found was that those who were most cognitively active in the midlife years 40s and 50s, they had a 60% reduction in developing Alzheimer’s disease, specifically, activities like reading, writing, language, learning, playing an instrument or being engaged in activities or clubs are all important ways to reduce the risk for Alzheimer’s later in life. So the key is it’s never too late to get started. We recommend about 10 to 15 minutes a week for the computerized cognitive training course like posit science, brain HQ, but also doing novel new activity. So about two to three hours a week of those. So you want to keep building up that cognitive reserve throughout your entire life.

The next topic I’m going To talk about is reducing stress. So the number one cause of inflammation is chronic stress to sleep disturbances coming in a close second, the mechanisms behind stress driving increased risk for dementia is likely to be multifactorial. Chronic stress. Chronic stress sets off this cascade of negative events in the brain, including dysregulation of our HPA axis, which increases cortisol and stress hormone release. This leads to increased activation of our innate immune system, and increased release of pro inflammatory markers, which then leads to increase beta amyloid deposits and tau tangles. And these build up and cause neuronal loss in the brain, especially in the hippocampus, and then the eventual development of cognitive disturbances that impact everyday functioning. It’s a bad cycle. And therefore, it’s critical that we stop this cascade of stress related outcomes before it sets off. One excellent means to do this is to combat unhealthy stress response by training our brains to better handle stress. One of the most scientifically backed ways to do this is through a practice called Mindfulness Based Stress Reduction, or mbsr. The study I’m showing here is a brain imaging study that found that an eight week course of mbsr was able to significantly increase brain volumes in various regions in the brain, including the hippocampus. So the regions in red on the bottom slide there show regions of the hippocampus that were significantly increased in volume. After doing the course, we recommend seeking out an mbsr course online or in your community. Or you can also try some home based programs on your phone, like headspace, or the neuroscientists developed program waking up, created by Dr. Sam Harris to learn mindfulness based practices and techniques. The last topic I want to discuss the social isolation. The national academy of sciences, engineering and medicine reports that social isolation in general, has been linked to 50% increase of risk for Alzheimer’s disease and other forms of dementia, as well as an increased risk for heart disease and stroke. More than 1/3 of adults aged 45 and over feel lonely, and nearly 1/4 of adults 65 and older, are considered socially isolated. Older Adults are at increased risk for loneliness and social isolation, because they’re more likely to face factors such as living alone, loss of friends or family chronic illness or hearing loss. Loneliness is the feeling of being alone. Regardless of the amount of social contact. social isolation is the lack of social connections. social isolation can lead to loneliness in some people, while others can feel lonely without being socially isolated. However, experts say we can take measures during these difficult times to especially during COVID in the later life years, to counter the negative consequences of social isolation. Some of their top recommendations are just picking up the phone or the computer to give someone a call or hearing someone’s voice offers a level of closeness that you can’t get with texts or emails. So using zoom or FaceTime are great ways to do this. Also, just reaching out to friends and asking how they’re doing is really important. Helping others, even if it’s small, can be an incredibly powerful and rewarding gesture. Also, you can try going for a socially distance walk with a friend or family member. Try to focus on the here and now. And whether there’s beauty in the new blooms in the garden, or the sounds of the birds in the morning. Focusing on the present moment can be good for combating anxiety and stress. Also, places like the National Council on Aging, which works with nonprofits, governments and businesses, provides community programs and services to help you find what programs are out there to assist with healthy aging, including the aging mastery program that’s shown to increase social connectedness and also eating habits. Also, the Area Agencies on Aging includes a network of over 620 organizations across America that provides information and assistance on nutrition meal programs, caregiver support, and also offers classes like catchy cooking, diabetes management. So these are all ways that we can try to increase our social connectedness and reduce social isolation. So in summary, here are the six take home tips backed by a copious amounts of scientific research to improve your brain health and stave off the negative effects of aging on the brain.

Exercise, we want you to be exercising at least 30 minutes five times a week with moderate aerobic exercise two times a week for resistance training, and two times a week of neuro motor training, in addition to stretching every day. For the diet, give the mind try to die. It’s very anti inflammatory and full of antioxidants. It’s low in carbohydrates, you want to eat lots of leafy greens, and berries and fish. And you want to also make sure you’re getting the 13 hour nightly fast. For sleep, it’s really important to keep a consistent sleep schedule with eight hours of sleep every single day. And also make sure to reach out to your doctor in order to sleep study, if you think that might be something you need. Lifelong Learning, this is really critical, we need to make sure that you’re considering different kinds of things you could be doing to increase your learning every single day. That could be computerized cognitive training, which we say about five times a week for about 10 to 15 minutes. Something like brain HQ are also new skills learning so trying to learn a new hobby, or learn photography, something like that, or new language for about two to three hours a week. Also, critically important is reducing stress. So we reduce that neuro inflammation in the brain. Learn new stress reduction techniques, such as Mindfulness Based Stress Reduction, and also give some apps and try and see if you can find one that you like. Waking up is a really good app that we recommend that the brain health center. And the last one is to say social, make sure that you’re always visiting friends, family, being on zoom, or being socially distant and make sure you’re staying safe. But all of these things are hard to instantiate by yourself. So a good thing to do is to get a health coach.

Robert Lufkin 26:46
Thanks so much for that fascinating presentation. Sara. How can we find out how to follow you on social media or find out more about your programs?

Sarah McEwen 26:59
You can find out more information about the Pacific brain health center clinical programs in clinical research at Pacific brain Thank you for listening today. No, this is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have. Never disregard professional medical advice or delay in seeking of it because of something you’ve seen here. If you find this to be a value of you, please hit that like button and subscribe and support the work we do on this channel. Also, we take your suggestions and advice very seriously. Please let us know what you’d like to see on this channel. Thanks for watching and we hope to see you next time.