"How do you stay mentally fit in old age when dementia is playing an increasingly important role in our ageing society?" The World Health Organization (WHO) has put experts to work on this question. In addition to definitions of terms, the result is concrete information on how to recognize the disease and which recommendations for daily living have emerged from studies.
The City Health Department of Offenbach am Main has compiled information on this for Offenbach residents. In response to the question "How do you recognize dementia?", Dr. Bernard Bornhofen, medical officer of the City of Offenbach, names seven warning signs with reference to the American National Institute on Aging: People suffering from the onset of dementia often repeat the same question or the same short story. Sometimes they repeat a question asked of them instead of an answer. They lose the ability to carry out everyday tasks such as cooking or playing cards - including using the television remote control. They can no longer handle money, bank transfers and bills safely. Sufferers place objects in unusual places without meaning to and then can no longer find them. "It can even go so far that other people are suspected of having taken the missing items," explains Bornhofen. Another visible sign is when people neglect their appearance - but deny this when asked.
"If those affected or their relatives notice these warning signs, they should seek medical help."
Causes not yet clarified
The causes of dementia are not yet fully understood. Genes and heredity play a role. There are also factors that can have a positive or negative influence on the course of the disease. "Age is the strongest known risk factor for the onset of dementia, i.e. the older people get, the greater the risk of developing dementia. However, dementia is not a natural or inevitable consequence of ageing," says Bornhofen. In recent decades, several studies have shown a link between the development of dementia and its precursor diseases and risk factors such as physical inactivity, tobacco consumption, an unhealthy diet and harmful alcohol consumption. Lifestyle is also linked to some diseases with an increased risk of dementia. These include high blood pressure, diabetes, hypercholesterolemia and obesity. Other controllable risk factors are loneliness, lack of interest and inactivity.
"The presence of controllable risk factors means that it is possible to prevent or slow down the onset of dementia," explains Bornhofen.
Recommendations for everyday life
In May 2019, the WHO presented evidence-based recommendations for the first time in Geneva with the aim of reducing the incidence of primary dementia in the coming years. Evidence-based means that the recommendations are supported by studies and evidence. The quality levels of evidence are high, moderate, low and very low.
"The WHO has categorized its recommendations into "strong" and "limited" depending on their strength. As many people as possible should adhere to strong recommendations, as the benefits outweigh the risks," says Bornhofen, explaining the procedure. For the restricted recommendations, there are either alternatives or they are only suitable for specific groups.
The City Health Department therefore recommends above all exercise, not smoking and controlling blood pressure. Vitamin and nutritional supplements are expressly discouraged.
Physical activity is at the top of the WHO list. The WHO strongly recommends this for all cognitively healthy adults. This is based on decades of studies in which dementia rates were lower the more the participants had exercised in the course of their lives. Physical activity appears to have both a direct beneficial effect on brain structures and indirectly reduce the risk of dementia by improving heart and metabolic functions.
Aerobic endurance training, strength training or training with various components is considered suitable. "Aerobic here means that you don't overdo the effort so that your heart rate and breathing don't increase unhealthily." The WHO recommends that everyone aged 5 to over 65 should exercise every day. There are two options for people over 65: Either moderate exercise for up to 150 minutes per week (i.e. 25 minutes per day). Alternatively, you can actively exercise intensively for only 75 minutes per week (i.e. 15 minutes per day). No training session should be shorter than 10 minutes.
If you want to do even more for your health in the over 65 age group, you can increase both options. This means moderate training for 45 minutes per day and 300 minutes per week or intensive training for 25 minutes per day and 150 minutes per week.
"Even older people with limited mobility should exercise at least three days a week to train their balance and reduce the risk of falling," emphasizes Bornhofen.
For people who have already developed cognitive impairments, the WHO believes that the benefits of exercise are no longer as great. Here, there is only a limited recommendation as protection against dementia. "But here, too, the rule is: you snooze, you lose."
No smoke, good nutrition and blood pressure control
Tobacco and smoking are known risk factors for cancer, heart attacks and respiratory diseases. It is assumed that substances contained in tobacco also directly damage the brain, and smoking also contributes to the development of dementia as a risk factor for cardiovascular disease. Smoking cessation is therefore also strongly recommended because the benefits of quitting outweigh the risks.
Good blood pressure control in people with high blood pressure is also strongly recommended by the WHO. According to study data, high blood pressure is particularly relevant in middle age for the later risk of dementia; according to the WHO analysis, the connection is less clear for high blood pressure in old age. According to the WHO experts, it is important to prevent the development of high blood pressure through a healthy lifestyle with plenty of exercise and a healthy diet and to treat high blood pressure with medication in line with guidelines.
Vitamin and fatty acid supplements are expressly advised against. Studies show that taking vitamins B, E and polyunsaturated fatty acids has no positive effect on the risk of dementia. High doses of vitamin E were problematic. A limited recommendation is given for the Mediterranean diet and a balanced diet based on existing WHO guidelines. This includes lots of fruit, vegetables, nuts, wholegrain products, fish, little sugar, little salt and few unsaturated fatty acids.
Further recommendations
Little or no alcohol, cognitive training, social activity and weight management each receive a limited recommendation. Doctors should also offer behavioral or psychotherapy to prevent dementia in alcohol-dependent people or those with risky consumption and refer patients with weight problems to weight loss measures. Cognitive stimulation - i.e. brain jogging - and help against social isolation and loneliness can also help, but the evidence from the studies is limited. In the case of diabetes, lipometabolic disorders and hearing loss, which are also on the WHO list of dementia risk factors, the WHO refers to existing treatment guidelines. These should be followed as closely as possible. If this is successful, a reduced risk of dementia is likely as a side effect.
Even if not explicitly mentioned by the WHO, Dr. Bornhofen believes that dancing is the best way to prevent dementia. The movement, the music, the joy and the social interaction activate several positive factors at the same time. It is best to start dancing at a young or middle age and not to be put off by strokes of fate.
In Offenbach, those affected can contact the City Health Office in the Stadthaus, Berliner Straße 60 (telephone number: 069 8065-2611). The Dementia Center StattHaus Offenbach of the Hans and Ilse Breuer Foundation at Geleitsstraße 94 (phone number: 069 2030 5546) and the Alzheimer Society Offenbach Region, Dr. G. Plaut (phone number: 069 8787 6506) are also available as contacts. Further offers can be found on the Internet at www.offenbach.de with the keyword "dementia" using the search function (magnifying glass top right).
Clarification of terms
The term "dementia" is derived from the Latin "demens": to be unreasonable' without reason, and can be translated as "loss of reason". Dementia is a generic term for more than 50 forms of illness. They progress differently, but all lead to a long-term loss of mental capacity. The causes of dementia are varied. A basic distinction must be made between primary and secondary dementia. Primary dementia originates in the brain. Secondary dementia is the result of another, pre-existing underlying disease. According to the World Health Organization, 50 million people around the world were affected by dementia in 2015. This corresponds to around 5% of the world's population over the age of 60. As the population ages, the number of people with dementia is growing. There are currently 10 million new cases worldwide every year. By 2050, 152 million people are expected to suffer from dementia worldwide. The most common form of dementia is Alzheimer's disease.