Lifestyle changes and dementia

Although we know there is no cure for dementia yet, the good news is that your risk of being affected by dementia can be influenced by keeping your brain healthy.   Improvement in brain health happens at the level of public policy, and national plans, but on a daily level, you, yourself, can do things now to make your brain work better for longer.  The sooner you start the better, and it’s never too late to try some of these ideas which are based on research about what works.

The biggest risk factor for dementia is ageing.  The older you are, the more likely you are to be affected.  But ageing isn’t just about how many birthdays you have had.  Some people have “lucky genes” so that they appear to be younger for longer.  How old you seem is not just about superficial wrinkles.  The ageing of your internal organs makes a difference.  Research has shown that human “biological age” marches ahead of “chronological age”.  Signs of ageing can show up in cholesterol levels, blood pressure, dental health, eye health – and issues with balance and motor co-ordination.  People of the same age can have significant differences in all of these, but you can take action to prevent premature ageing of your own body – and your brain.

You can’t slow your chronological ageing, but you can slow your biological ageing, and that will help delay the onset of the cognitive impairment that heralds dementia.  Other disease risks increase with age, such as heart diseases.  Through public education campaigns we’re very familiar with how to ward off those illnesses.  Exercise, diet, and smoking cessation are well-known strategies.  Anyone who is paying attention to these health measures is also helping to reduce their risk of dementia. It’s known as “brain health”.  And what is good for your heart, is good for your head.

None of these recommended lifestyle changes carries a guarantee.  However, the research shows that each of them carries considerable benefits, and as many of them are low cost and probably fun, it is well worth considering including them into your own life as much as you can.

Smoking, alcohol, and head injuries

The proportion of people smoking in the UK has declined over the last forty years.  The government taxes smoking heavily, and all doctors encourage patients to give up. Bans on smoking in public spaces make it easier not to smoke.  It’s a leading cause of preventable death, and a risk factor for many diseases, including dementia. There is evidence that it causes brain damage.

One of the difficulties in focussing on tobacco is that smoking is associated often with other factors that might lead someone to neglect their own health. According to the Office for National Statistics, people who are unemployed, or who have no or few educational qualifications, are more likely to smoke.  It’s a complex social picture. If those people are more likely to be living with poverty, other lifestyle choices that cost money might be closed to them. So smoking is one hazard on top of others.

ARBD (alcohol related brain damage) is a preventable cause of dementia, along with head injury.  The World Health Organisation (WHO) gives advice to countries about supporting people who have hazardous drinking patterns. Alcohol can be toxic to nerve cells and as they die, the brain shrinks. Repeated head injuries from falls or fighting are a risk, and inebriation can increase the risk of being a victim of violence with similar lasting effects. Head injuries from sports must be avoided or mitigated for the same reason. Looking after your skull is looking after the box that protects your precious brain. Hitting it, starving it of oxygen through smoking, or poisoning it with alcohol is taking a risk you probably can’t afford.

Diet and body weight

Healthy nutrition, even before you are born and during childhood, plays a crucial role in brain development and later life brain health.  It’s another lifestyle factor that is affected by social factors, such as poverty and health education. A good amount of fruit, vegetables and fish are often quoted in the research as beneficial, along with nuts, olive oil and even coffee.  Diabetes is strongly associated with poor nutrition, and there is an association between metabolic illnesses and brain health. Diet and dementia is worthy of more detail, but put simply, the WHO recommends a balanced and varied diet, limiting sugars and fats to prescribed levels. Processed foods, trans-fats and salt are the villains. A healthy diet is associated with better cognitive performance and even behaviours.  Despite commercial claims, there is no magic vitamin pill or dietary potion.  No matter what the headlines say, they will not prevent cognitive decline.  Obesity, however, is identified as a risk for several non-communicable diseases including dementia and is on the rise. There is even evidence that if people with obesity deliberately lose weight it can improve their cognitive function.  And losing weight is more about nutrition than exercise, though exercise is very important.

Physical activity

The strength of the evidence that exercise helps cognition is argued about in the research papers sometimes, but there is no doubt that it slows ageing and delays frailty.  The good thing is that exercise is widely available.  You just need to do it.  To repeat… what is good for the heart is good for the head.  Physical exercise has positive effects on hypertension, insulin resistance, cholesterol levels, has anti-inflammatory properties, and boosts the immune system.  Physical activity is good for the brain. Taking advice on starting it up is important, so you are not put off by an injury. The best exercise to do is the one that you enjoy and are most likely to maintain. Any loss of body fat is a bonus, but your weight might even increase as you develop some impressive muscles.  So, it’s the metabolic effect that matters more than the effect on weight.  You can’t exercise your way out of a bad diet if weight loss is your goal.  But it’s very good for your health.

Management of hypertension, diabetes, and depression

These three clinical conditions are associated with an increased risk of late life dementia.  It’s more of the same.  Reducing your blood pressure can be achieved by a healthy diet, maintaining a healthy weight and physical activity.  All of these are associated with reducing dementia risk. There is medication for hypertension and so if you’ve been prescribed it, don’t forget to take it, though there’s no evidence that taking it prevents dementia on its own if you didn’t need it for your blood pressure. Poorly controlled diabetes can cause problems with your kidneys, eyes, and hearing, which in themselves can lead to dementia. The WHO makes recommendations for the management of depression because of the link between depression and cognitive impairment or dementia.  There are questions about what comes first, the depression or the dementia.  It has been suggested that the psychological burden of the person having insight into their declining capacity could cause the depression symptoms.  Either way, older people with depression should have access to psychological interventions and medication if needed.  The key message is this: any of us can come down with a physical or mental illness but you need to get clinical advice and follow the treatment plan.  Taking care of your body is vital, to take care of your brain.

It’s a lot to think about, and doing everything at once can be hard.  Some things you might be doing already, and some might seem impossible.  So here are four final simple things you can do that will also help to maintain brain health.

  • Don’t forget to floss (there’s some evidence of a link between gum disease and Alzheimer’s disease)
  • Get your hearing checked (people with mild hearing loss are more at risk, so getting hearing aids early is a good idea)
  • Get a decent night’s sleep (good sleep is important for general health)
  • Keep social and keep your brain working (if you don’t use it, you lose it).

Brain health is a lifelong challenge.  For the future of our world, we should get children started on this at the earliest stage. The longer they spend in education and training, the better their brains will be when they are older.  But it’s never too late for us to start.

Professor June Andrews

Design and dementia

While we work hard for a dementia cure in the future there is a lot that can be done to make life easier for people who live with dementia now. In this blog I want to focus on what can be done in the design of the environment.

All the best design ideas are based on understanding what a person with dementia might find hard, and what could help.   Everyone with dementia is different, and the experience of dementia changes over the years for any individual affected.  There are some patterns.  The person often finds it difficult to adapt to anything new, or unfamiliar.  It’s not unusual to lose things or to become disorientated even in a familiar environment.  Memory is an issue. Unnecessary noise can be disabling because it makes it hard to concentrate.  This is true for anyone, but in dementia, there is less spare cognitive capacity to cope with distraction.

One criticism of what has come to be known as “dementia friendly design” is that it might be institutional, or brutal in décor.  A sign on the door can help you to remember what is behind that door, but signs would be unusual in a domestic setting and it has been said make the place look “institutional”.   People need to be flexible and practical about this.  If the choice is between elegance and finding the toilet fast, I know what I’d pick.  There is nothing less elegant than being caught short because the bathroom door is not dead obvious.

A person with dementia might be living in their own home, or temporarily in another place such as a hotel or a hospital, or they might decide to live in a care home or nursing home.  There are design essentials for each of these.  Some things don’t cost much and can be done without much disruption. Some of the other ideas are more expensive and would involve a significant change so should be thought of at the earliest stage such as the fit out of a care home, or when moving to a new home in later life.

I don’t have dementia, but I consider that future possibility. I hope to live to be 100 and still be in my own home. By that age I probably have a 50% chance of having dementia and so making my home dementia friendly is future proofing it. It can still look homely and comfortable.  If I am choosing a floor covering, which can be expensive and is meant to last my lifetime, I can choose one with wild patterns, or one that is smooth and self-coloured. It is not just a matter of taste. A person is more likely to trip if they misperceive the pattern on the floor and it distracts them when they’re trying to walk across it.  So, my floor coverings are smooth, matt, and avoid major changes in colour at thresholds between rooms.  A fall and a fracture leading to hospital admission is one of the junctions for someone with dementia that diverts them from home to a care setting.

Elements of design potentially could delay the day when a person with dementia would have to go to live in a care home.  I have seen very many lovely care homes where I would gladly move into one day. But not too soon.

One basic requirement is to increase the light level as much as possible. Most people with dementia are older and some are very old. This means that they have the normal changes of aging including reduction in their visual acuity. The structures in the aging eye become yellow and as a result colours are harder to distinguish – and that’s without any other problems of the eye that would require spectacles or surgery, and eye problems that can’t be cured. Many older people are anxious about the cost of fuel and may economise on the electricity that is required to brightly light their home. It is a false economy if as a result the person has a fall or becomes more confused because their environment is hard to interpret at low light levels.  When you can’t remember where things are, being able to see them helps.  Stress is reduced if you can find things easily and people with dementia may be easily stressed.

To increase the light level inside the home, use the brightest available bulbs for the light fittings.  In day time, simple things like keeping the window glass clean, keeping vegetation away from the outside, making sure that the curtains can be pushed right back to allow the maximum amount of light into the room, all make a difference. I choose light coloured wall paints and curtains so that even if I am in the house with the curtains closed in winter there is good reflection from my lamps to make the room as bright as possible.  However, if the person with dementia is accustomed to a particular décor, it may be too late to change some things.  They might agree to the change, but wake up the next day having forgotten that, and not understanding why the walls and drapes are a different colour.  They might even think they are in the wrong house.

A recent fashion in care homes was to create a simulated historic environment, such as a “fifties” sitting room.  The problem is that every resident’s home would have been different then, depending on social, environmental, and ethnic characteristics, so landing on one clichéd decade was no better than modern furniture with classic shapes.  People with dementia are not living in the past.  Another fashion was to festoon the interior with masses of sensory stimulation, but this didn’t always help create a calm environment and one fire officer told me of concerns about fire hazard.  Obviously, there is a happy medium to aim for.

There are many sources of information about what works.  It is important to distinguish between ideas based on sound evidence, ideas that have some credibility, and things that are being pushed by commercial interests who really are making it up as they go along.  Good sources of advice include the Dementia Services Development Centre at the University of Stirling (  This advice is from modern professional architects embedded in an internationally famous dementia centre, and it is based on evidence.   Internationally there is also The Dementia Centre at HammondCare ( which offers a tool for checking out devices, as well as environments.  The associates working there have produced guidelines on toilets and other specific areas.  All with the involvement of people who are living with dementia across the globe. 

The hardest thing for people with dementia is stress.  It sometimes gives rise to distressed responses that families and carers cannot support at home.  Anything you can do to create a dementia-friendly, easy to use, stress free environment will be good for everyone.

Professor June Andrews