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Chapter 1: What is the connection between heart health and dementia prevention?
The Clare Byrne Show on Newstalk with Aviva Insurance.
Going to go back. You're here to talk about dementia. You're a cardiologist though, preventative cardiologist. So what's the link?
The link is fundamentally, if you get heart disease right, you get most of the factors right for preventing dementia.
So talk to me about that. And what are the established links between having a healthy heart and preventing what's going on with your brain and your dementia diagnosis?
So when we talk about dementia, we have to break it down into two categories. There's lots of different types of dementia, but the broad ones are vascular dementia. That's lots of multiple small strokes or Alzheimer's dementia. And when you look at the pathology here, there's often a significant overlap.
And the big challenge is, is that dementia is obviously a very big concern for a lot of people. It often exceeds their concern for things like heart disease or sometimes even cancer because of what it actually involves in terms of what it takes away for people. So it becomes a big priority.
The treatments that we have for dementia are getting better, but they're just not as good as we would have hoped. So therefore, the emphasis on preventing dementia or pushing it out much later in life has to be a priority.
We know that getting the fundamental risk factors right, like smoking cessation, blood pressure control, getting weight right, avoiding diabetes, significantly reduces the likelihood of future dementia.
So this is where I come at it insofar as a cardiologist, is that if we get heart disease right, if we get all the core fundamentals of heart disease right, not only do we reduce our risk of dying from heart disease, we significantly reduce the future risk of dementia.
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Chapter 2: What are the main types of dementia and their characteristics?
So do we not have more cases of dementia because we are around for a longer period of time?
So that's an interesting question in terms of this is specifically the difference between incidence and prevalence. And the answer is, is in most developed countries, no. Which, again, surprises me.
We're just healthier.
We are. And so if you, again, when we look at, say, longevity in terms of how long people live, average lifespans have improved, you know, dramatically over the last, say, one to 200 years. But maximal lifespans actually haven't increased all that much over the last several hundred years. So just more people on average are living into their, say, 80s and 90s.
But in general, we're doing such a better job of managing things like blood pressure, people not smoking, getting good cholesterol control, et cetera, that the knock-on benefits to that is that, yes, people are developing dementia, but they're developing it much later in life.
I think people might feel on a very surface level, if I keep my brain active, I'm going to have a better chance at avoiding a dementia diagnosis at some stage. And I know that's probably very important, but actually the fundamentals from what you're saying are around physical activity, you know, looking at your weight, your cholesterol, your blood pressure.
Yeah, and one of the things you're bringing up here is the functionality and utility of brain training. So this idea, I kept my brain active over time, which is why I kept my brain healthy. And if you look at the literature here in terms of doing brain training, the evidence would suggest that doing brain training means that you get better at the test,
But the cross pollination of that in terms of other cognitive abilities is far less. So it makes you better at the test, but not necessarily better at the other things that you may have wanted to get better at. It's something that, you know, is advised in terms of it's useful to do it. But in terms of the strength of that evidence, it actually hasn't turned out as strong as we would like.
Ah, so if I decide I'm going to learn Mandarin Chinese to try and protect my brain and keep it healthy, I'll just end up being good at Mandarin Chinese.
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Chapter 3: Why is preventing dementia prioritized over treatment?
But there are other types of dementia, frontotemporal dementia, Lewy body dementia. People will kind of know Robin Williams, for example, had that kind of that unusual subtype. But broadly, what people are talking about is either the buildup of an amyloid plaque or mini strokes and often the combination of both.
OK, so when we talk about fitness and keeping yourself healthy, when do we need to do that? Because people will be listening to this. The clock is ticking now. When do I start today?
My answer always is today. But this actually has been studied very recently. And they looked at levels of fitness throughout life in terms of early in life, midlife and later life. And they looked at the likelihood of that having a protective benefit on dementia.
Chapter 4: What lifestyle changes can significantly reduce dementia risk?
And so a lot of people will be fit and healthy early in life, and that declines through midlife and later life. And they looked at that, and being fit early in life and not maintaining it, you really conferred little to no benefit. The real benefit... We won't go as far as that.
But really, it depletes very quickly, does it, in terms of your overall health if you don't maintain it?
Correct. And my line around this is fitness is a very cruel mistress. It is very hardly won and very quickly lost. And the benefits that you garner from it are really only maintained if you maintain levels of fitness throughout mid and later life. And that's what the evidence would strongly suggest.
OK, but if you're 60 or 65, is it too late?
It's never too late. And you can always garner benefit. Maybe you don't garner the same benefit from a prevention point of view, but maybe you get a substantial increase in your health span in terms of the functional capacity of the things that you can do with the time that you have. So I would always advocate to actually use those strategies.
And more often than not, what matters for people is how they function in their day to day life. And this is where exercise becomes really kind of crucial in that domain.
Because you want to be strong and you want to have a long and healthy life and be able to lift the shopping out of the boot of the car and so on. But when it comes to aerobic fitness, is there a greater advantage conferred by being aerobically fit in the context of avoiding dementia?
Correct. Correct, there is. And so one of the things is that if you actually look at, so dementia in general affects both males and females, but Alzheimer's specifically affects a disproportionate amount of females.
But if you look at aerobic fitness, and there is a study that has followed females for, say, 44 years, the people in the highest aerobic fitness capacity, fitness level, compared to the lowest, had about a 78% reduction in the risk of dementia. Now, it doesn't mean that if you're fit, you will never get Alzheimer's or dementia.
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Chapter 5: How does physical fitness relate to dementia risk?
Well, the answer is the same answer. But not only is it dementia, if you look at what's called all caused mortality, which is the chances of dying from anything. And if you get all the core cardiovascular risk factors right, your chances of dying from anything at an earlier time point goes down significantly.
And so this is why I really kind of push this in terms of if you get heart disease right, you pretty much get everything else right that you can get right. You can't take risk completely off the table. But if you're tilting the odds as much as possible, you'll get heart disease right and get a whole load of spillover benefits.
OK, Paddy, thank you very much. It's a lot of information, but it is fascinating. You can get in touch with us this morning on WhatsApp 087 1400 106. That's preventative cardiologist Dr. Paddy Barrett. We'll take a break.
The Clare Byrne Show. With Aviva Insurance. Weekday mornings at 9 on Newstalk. Conversation that counts.