Sometimes I cry myself to sleep at night. My 94 year old father has dementia and is in an assisted living facility where he feels trapped, totally unaware of the care he truly needs. I’m sad because I want him to be happier, to have insight into his physical limitations and accept the winding down of a well-led life. Despite my unrealistic hopes, I feel the guilt and burden of having his life in my hands. And I will do whatever it takes to try and prevent myself from developing dementia so my kids and spouse won’t have to go through what I’m going through. Knowing that I have those dementia genes does not make me fearful.
I know genetics plays a role in the development of Alzheimer’s disease, but environment and lifestyle can mitigate the outcome.
There are different types of dementia. Dementia is a general term for a decline in cognitive function caused by many different processes. Alzheimer’s Disease is the most common making up 60-80% of all dementia. Over 5 million Americans have Alzheimer’s Disease (AD). AD is a progressive neurological disorder caused by the buildup of amyloid plaques and tangles that destroy neurons of the brain over time, strangling brain function.
Vascular dementia makes up about 10% of the cases and is caused by blockages or damage to blood vessels from poorly controlled blood pressure and small strokes within the brain.
Dementia with Lewy Bodies (DLB) is caused by the clumping of certain proteins in the cortex of the brain also leading to memory loss and problems with thinking. Early symptoms can include sleep disturbances, hallucinations, and gait disturbances.
Parkinson’s Disease often leads to dementia similar to DLB or AD, and also causes destruction of certain brain cells that produce dopamine.
There are other types of dementia but these are the most common. The Alzheimer’s Association states that although genetics and age play a role in the development of dementia, lifestyle choices can turn on or turn off the genes.
The Alzheimer’s Association stresses the importance of physical exercise and lifestyle in preventing Alzheimer’s Disease and other types of dementia. There is a head and heart connection in the development of dementia:
protecting the blood vessels in our body is essential.
Keeping cholesterol, blood pressure and blood sugars in good control through diet and exercise protects our blood vessels. And now there is new research supporting a link between insulin resistance and cognitive decline.
Insulin resistance(IR) develops over time and is associated with obesity and a sedentary lifestyle. The body’s own fat, liver and muscle cells become more resistant to insulin. Insulin is a hormone made in the pancreas that helps usher glucose absorbed from our food into our cells. Insulin resistance causes the pancreas to make extra insulin, which it can do for a while, but eventually the pancreas cannot keep up with the demand, and blood sugars rise in the blood stream. Insulin resistance is a precursor to type 2 diabetes. These high blood sugars act like sandpaper inside the blood vessels, causing inflammation and damage to the walls of the blood vessels. High blood sugars are often accompanied by high cholesterol and high blood pressure.
Insulin resistance and dementia
In March’s Journal of Alzheimer’s Disease, a Tel Aviv University study found that insulin resistance is linked to more rapid decline in brain function. In a twenty year study of 500 people with cardiovascular disease, some with diabetes, and some without, there was accelerated cognitive decline in those with higher levels of insulin resistance. After determining each subject’s level of insulin resistance using the homeostatic model of indexing (HOMA)which is based on fasting blood sugar and fasting insulin levels, memory, executive function, visual-spatial processing and attention were assessed at 15 years, then five years later. Those with higher indexes of insulin resistance had more accelerated cognitive decline, even after adjusting for other preexisting health risk factors. The researchers did not examine interventions that could reduce insulin resistance but mentioned that more research is needed.
Insulin resistance is reversible!
It’s not a done deal. There are no symptoms of insulin resistance other than a skin condition called acanthosis nigricans that can cause dark patches around the neck, under the arms, around the knuckles, knees and elbows. But there are genetic conditions that increase someone’s likelihood of having IR:
- Polycystic ovarian syndrome
- Giving birth to a baby that weighs greater than 9 pounds
- Having gestational diabetes
- Having a parent or sibling with diabetes
- Certain nationalities that have the “thrifty gene” (ancestors exposed to periods of famine): African-American, Pacific islanders, American Indian, Latino/Hispanic, Asian American, Alaskan American
- Carrying extra weight around the waist
- Having high blood pressure
- Having a low HDL or good cholesterol
- Leading a sedentary lifestyle
Do you have IR?
A glucose level is part of a standard blood test done at most annual check-ups in conjunction with fasting lipids. If your blood glucose level is above 100 mg/dl, then chances are you have insulin resistance. You could have your fasting insulin level tested but having any of the above conditions along with an elevated fasting blood glucose is pretty much a guarantee, but not the end of the world!
I have witnessed many people make lifestyle changes to improve their health. The Diabetes Prevention Program found that just a 7% weight loss and exercising 150 minutes a week, reduces the risk of developing diabetes in those with prediabetes. People with prediabetes have insulin resistance. In a 200 pound person that means a 14# weight loss can change their life and reduce their risk of dementia as well as many other devastating diseases.
AD and other types of dementia cost the nation almost 260 billion dollars a year. And that doesn’t even take into account the emotional toll dementia takes on family members who give the direct care or are responsible for healthcare decisions of loved ones.
The hand I’ve been dealt includes diabetes and dementia, but I’ve also put some other cards in there like daily exercise, healthy eating, good sleep, close family and friends, manageable stress and fun hobbies(love my uke!) that keep my mind active. I’m hoping that those cards will trump the other two in my hand, or at least I will have fun trying!