If I thought about dementia before, it was at a remove. Not my mother. Not like this. How wrong I was. I looked after mum for the last 18 months of her life. It was like watching a stick being whittled to nothing.
Dementia, I discovered, isn’t just common — the UK’s biggest killer for a second year running — and it’s about more than lost memories. It stole Mum’s bearings so she couldn’t orientate herself (“Where am I?”), her family (“Who are you?”), her mobility (“What do I do with my feet?” when I urged her to walk) and, in the end, it stole her.
When you lose a parent to dementia, painful slice by painful slice — “Death by a thousand cuts”, my husband says — there’s time to learn. You learn you don’t want to go the same way. You learn you might not have to.
The 2024 World Alzheimer’s Report found that 65 per cent of healthcare professionals believe dementia is an inevitable part of ageing and more than a quarter of the public believe that there’s nothing you can do to prevent it. But there could be. The Lancet Commission on Dementia Prevention lists 14 modifiable factors that could slash risk by 45 per cent. It urges us to be “ambitious” in risk management.
Dementia casts a long shadow of ten years or more. There’s a “stealth” phase before the damage is done when you could allay — even abort — it by knowing more. This is what I know now.
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Teeth are a marker for dementia
In a photograph on my desk Mum is smiling a white-toothed smile. She looks like a commercial for geriatric dental care. Two years before the photo was taken her diseased top teeth were removed. Her falsies transformed her appearance.
I never imagined teeth might be a marker for dementia later but poor oral health is associated with many diseases, including Alzheimer’s. The build-up of plaque can create a breeding ground for bacteria which leads to gum disease. That bacteria can travel through systems, triggering inflammation in body tissues, including the brain. A Japanese study found that having fewer teeth is associated with a faster rate of hippocampal atrophy. Animal experiments suggest that the removal of teeth might affect memory because of the loss of sensory stimulation.
Near the end I’d help Mum to brush the few she still had, her false teeth grinning at us from a glass. She’d pick up her toothbrush. “How do I use this? Which end?”
Gently, I turned it the right way around. She began, then faltered. “Am I doing it right?”
I consider my smile in the mirror. It’s not straight or white. But it’s strong. My dentist confirms this with an x-ray — but, “You’re brushing too hard,” he warns.
Hearing loss is associated with dementia
“Are you actually experiencing hearing difficulties?” the audiologist asks, bemused.
“No,” I say, “I just want to check.”
Research finds that mild hearing loss can double the risk of cognitive impairment. Moderate loss triples it. People with severe hearing loss are five times more vulnerable. Forty per cent of over-50s have some degree of hearing loss.
A researcher at the Cochlear Center at Johns Hopkins University in Baltimore tells me there are three mechanisms that may explain this. First, hearing loss makes communicating difficult, which causes social isolation, another of the Lancet’s risk factors. Second, “Because sounds become garbled, the brain has to work harder to process them so there’s fewer resources for memory and executive function.” Third, with hearing loss, the parts of the brain that are stimulated by sound become understimulated, which leads to changes in brain structure.
The audiologist instructs me to don a pair of headphones and register every sound I hear. Some are very faint. I take no chances (ambitious, see?). I mark every one, sifting the slightest from a background of white noise.
Despite doing my best, I am diagnosed with mild — though advanced for my age — hearing loss.
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Anthea Rowan celebrating her mother’s 82nd birthday in Tanzania in 2023
FRIEKE DE RAADT
Social engagement is highly beneficial
When my mother was mired in a depression — and she suffered often, for decades — she withdrew from the world entirely, curled into a chair like a comma: a life in hiatus.
Social engagement is crucial for the brain. It bears multiple benefits. Andrew Sommerlad, a principal research fellow at University College London (UCL), says: “It sharpens our cognition and keeps the circuitry of the motherboard firing in synchronicity.”
A contented loner, I steel myself to say yes to more. I join a book club, yoga classes … I just join in.
Strength training helps the brain’s white matter
Dementia wasn’t the reason I started strength training at the gym (I joined that too) — no, that was witnessing my mother’s struggle to lift herself from a chair. But dementia’s the reason I keep going.
Evidence suggests good muscle health — especially in midlife — protects the brain. Thigh muscle is a good indicator of whole-body muscle mass.
Compared with aerobic exercise, says Tommy Wood at the University of Washington, resistance exercise seems to support the brain’s white matter. “It stimulates the neuromuscular connections in the brain,” he says. Also, when we move muscles they release molecules called myokines. These support brain health — the more muscles we work, and the harder we work them, the more myokines are released.
Are my three strength sessions a week enough? Yup, Wood says, 60 to 90 minutes works. The key, though, is to keep challenging yourself. When it gets too easy up your game. I used to gracelessly heft 5kg weights. Now, even less gracefully, it’s 7.5kg.
Some of the positive brain changes resistance exercise delivers persist for months, so keep going. As we get older, Wood says, we expect less of ourselves so we do less. (I can still hear my mother’s lament as I urged her on a walk: “I’m too old for this.”)
Reading the newspaper may help to reduce risk in women
My mother never went to university. “I should have,” she confided. “I was clever.” She was. But while less education is flagged by the Lancet as an early-life risk for dementia, a lack of formal education need not be. (I didn’t go to university either — I’m determined to fill gaps in other ways.)
Research at UCL found that reading the newspaper may reduce the risk of dementia in women. The women were from the English Longitudinal Study of Ageing, born before or in the 1950s. One of the researchers reminds me that back then, women in higher education were uncommon, “so the findings signal these women were self-teaching”.
I continue to “teach” myself with scientific papers in my writing. I alternate my reading choice of non-fiction with fiction, better for the brain.
My mother lost her reading with a stroke. I think it pulled the plug on her cognitive reserve, the precious saved-for-later that can be protective in the face of Alzheimer’s. Many things help to dam cognition, not just education or books. One doctor told me that “anything novel” can help: “Find another route home, try a new recipe.”
“Stump yourself,” urges the Alzheimer’s Association. I resist my grown-up children’s help when faced with tech challenges. “Let me do it,” I insist.
Walking fast can help you
You may not outrun dementia, no matter what you do. But walk fast and you’re heading in the right direction. How fast is fast? A hundred paces a minute.
Sometimes — I’m ambitious — I walk at 125. Sometimes I walk so fast that my laces come undone. I consider the little caps at the end of them as I bend to tie them. I touch them as you might touch wood. If those caps pop off, my laces will fray. Walking fast is associated with longer telomeres; telomeres are the “caps” at the end of chromosomes — and just as plastic tips at the end of shoelaces protect against unravelling, telomeres protect DNA. Longer telomeres are associated with slower ageing; a lifetime of brisk walking could make you years younger than your biological age.
Avoid a waist size of more than 34in
An abdominal surgery means I am granted close-up images of my insides.
“What’s that?” I ask the surgeon of glistening yellow ribboning my guts.
“Fat,” he says.
I’m slender, which is why I’m shocked. But this is visceral fat, hidden deep within us. It’s not the pinch-an-inch kind.
Poor sleep and cortisol are partly to blame. So is my (insomniac) menopause: oestrogen suppresses visceral fat. There’s a theory, Fredrik Karpe, a University of Oxford professor tells me, that insufficient fat storage in other locations, especially the legs, forces fat to be stored as visceral fat. (I’m reminded that if my slim mother with her slender legs put weight on, it was always around her middle.)
To compare, a researcher sends me images that show whole-body MRIs of two 61-year-old women: one with high levels of visceral fat, the other without. Their brain images differ too: the brain of the woman with higher body fat shows wide, blank spaces.
A good indicator of visceral fat is waist measurement: below 31.5 inches is ideal for women, while more than 34 inches can increase inflammation in the body and elevate risk of amyloid deposits, the protein markers for Alzheimer’s.
I suck my tummy in as the chill of tape measure touches skin; I’m on the cusp. I give up peanut butter sandwiches, start saying no to crisps.
Untreated visual loss is a risk factor
In July the Lancet added untreated visual loss to its risk list. During a routine test at Specsavers in October, I am diagnosed with age-related macular degeneration. AMD is the primary cause of irreversible blindness in over-50s.
Vision loss, like hearing loss, is isolating, which presents obvious challenges. But there are other reasons it’s a risk factor for dementia, says Thom Wilcockson, a senior lecturer at Loughborough University. “The ‘use it or lose it’ theory suggests it can lead to dementia by limiting the stimulation the brain receives.”
AMD is not treatable but its effects can be delayed if you know you have it. Distress at my diagnosis is tempered by reassurance from an ophthalmologist. “Don’t smoke,” he says (I don’t), “eat a Mediterranean diet, exercise, take supplements endorsed by the Age-Related Eye Disease Study.” I am struck by his whole-body health message.
I am also comforted by the memory of my grandmother, who had AMD. She died in her eighties, her vision poor, her mind tack-sharp.
Dementia is a whole-body illness
Look after your heart and you’ll look after your head, doctors say. If you thought dementia was just about memory, you’re wrong; if you thought it was just about your head, wrong again. Dementia is the sum of all parts: it’s a whole-body illness that only reveals its hand in symptoms when it’s too late to play a counter game.
We measure health in numbers: our weight, blood pressure, cholesterol, diabetes risk. We monitor all those things. Our brains? There is no numerical value for brain health, yet each of those numbers bears a tally on cognition. Look after all of you and you’ll look after your head.
Until Mum, we never talked about dementia as a family. Now we talk about it often. We have the “what if” conversations. About care and futures. If my ambitious plans don’t save my brain, my conversations with my children will save them the second-guessing I had to resort to in Mum’s last years.
A Silent Tsunami by Anthea Rowan (Bedford Square Publishers £20). To order a copy go to timesbookshop.co.uk or call 020 3176 2935. Free UK P&P on online orders over £25. Discount for Times+ members
