What does lifestyle modification to reduce the risk of dementia and stroke look like?
First, I think it's super exciting to say that the lifestyle modifications that are recommended to reduce the risk of stroke and dementia in the long term, have the benefit of making us feel better today. The main categories of impactful lifestyle choices include:
#1. Physical activity - moving your body, conditioning your cardiovascular system, strengthening your muscles
#2. Nutrition - becoming aware of the foods you choose to fuel your body and activities
#3. Sleep - allowing adequate time and appropriate conditions for your brain's homeostatic functions
#4. Mental Health - fostering relationships and connections, assessment of helpful vs. destructive thought patterns
#5. Exposures - understanding the role of alcohol in your life, quitting smoking, reviewing medications and supplements
There is no "one size fits all" approach to turning the levers on these aspects of our lives. That is why our assessment begins with a thorough health history and thoughtful consideration of laboratory and imaging measurements.
To further consider why there is no "one size fits all" prevention program, consider two scenarios:
Scenario A. Helen is 52-year-old African American mom of two who has a family history of her maternal grandmother having Alzheimer's disease and her mother recently being diagnosed with mild cognitive impairment. She does a 5-mile walk with a group of neighbors 2-3 times a month and relies on frozen or packaged meals for weeknights. She smokes 5-6 cigarettes a day and hasn't had time to see a primary doctor in 2 years, with children in many extracurricular activities and now having increased responsibility for the care of her mother. She is concerned about how irregular her periods have become recently.
Scenario B. Kira is a 41-year-old mom of three who was recently told by her physician that she has pre-diabetes. She is of Southeast Asian descent and there is no family history of dementia but her paternal side has heart disease and diabetes. She swims or bikes 2-3 times a week and meals are often prepared by her mother or mother-in-law who alternate living with them to help with taking care of the kids. This is an enormous help but also a source of stress in her marriage. She takes the edge off most evenings by drinking 1-2 glasses of wine.
Our top priority for intervention is going to be very different for Helen and Kira. As you might guess, neither Helen or Kira have a lot of extra time on their hands. We aren't going to type up a list of instructions that require seismic shifts in their daily lives. Many of these lists can be found on the internet and in magazines; without a supportive and evidence-based source of guidance and accountability, the suggested changes are hard to implement long term.
For Helen, we'll start with exploring the motivations for change. We're going to understand the utility of smoking and prioritize quitting on the first visit. We'll explore specific environments that trigger the urge to smoke or the passive habit of smoking. Establishing rapport and a relationship with a trusted primary care physician and gynecologist is going to occur in tandem. The compounded hits of smoking and likely menopause are going to be addressed.
Kira may not sound like she has much room to improve her lifestyle, at first glance. Similar to how small positive microhabits can make an outsized positive impact in the long run, seemingly innocuous habits can have an outsized negative outcome in the long run. A strong support system is going to be a great foundation for Kira so addressing the sources of stress will help her to engage that support to understand the utility of evening wine and understand the lifestyle choices contributing to pre-diabetes.
A continuous glucose monitor will likely be a tool we use for both women and something we employ early on for Kira. As we discuss her family dynamics and consider relationships with her husband, parents, and in-laws, we will also gain objective feedback about the impacts of stress, nutrition, and wine on her glucose throughout the day. Assessing Helen and Kira's sleep will begin with questions about how rested they are when they wake up in the morning, any mentions of snoring by their bed partner and considering evening routines.
Helen and Kira have taken an enormous step in self-evaluation. Focusing on making the assessment approachable and changes personalized and appropriate within their scope of responsibilities is key to long-term incorporation.
As Helen and Kira proceed with initial assessments and lifestyle modifications, checking in about those shorter-term gains is going to be impactful. Using that momentum, and having seen the possibility of change, will allow tackling the next big hurdle of carving out time to move and strength train. As the saying goes, "Slow is smooth, and smooth is fast." By tailoring a stability program and gradual strength training practice into their lives, Helen and Kira will be able to see and feel the impact to propel the continued modifications forward.
All the sayings and aphorisms apply to this process. Slow and steady does the trick. Comparing your chapter 1 to another person's chapter 15 is not going to motivate behavior change. You get the picture!