Measures to enhance cognitive resilience and reduce dementia risk
With increasing longevity for many Singaporeans, it is essential to modify behaviours in order to lead meaningful and fulfilling lives
BY 2030, it is projected that 24 per cent of Singapore’s population will be aged 65 or older. A recent report from August 2024, based on the second Well-Being of the Singapore Elderly study conducted by the Institute of Mental Health, showed that the risk of dementia increases with age.
Individuals aged 75 to 84 are 3.1 times more likely, and those over 85 are 11.2 times more likely, to have dementia compared with those aged 60 to 74. The silver lining in the study was that it showed a decrease in dementia prevalence among older adults aged 60 and above, from 10 per cent (one in 10 individuals) in 2013 to 8.8 per cent (one in 11 individuals) in 2023.
Types of dementia
Alzheimer’s disease (AD) and vascular dementia (VD) account for about 60 to 70 per cent and 10 to 20 per cent of dementia cases, respectively. Other types include frontotemporal dementia (characterised by significant changes in behaviour and personality, language difficulties and movement disorders), Lewy body dementia (associated with visual hallucinations, sleep disorders and muscle rigidity), traumatic brain injury and various neurodegenerative conditions.
Recognising dementia
Common symptoms of dementia include progressive memory loss, cognitive impairment, difficulty concentrating and confusion about time and place. The hallmark of AD is amnestic cognitive impairment. Initial symptoms may involve depression, anxiety, social withdrawal and altered sleep patterns. Eventually, the disease progresses to severe memory loss, hallucinations, delusions and extreme behavioural and emotional issues in advanced stages. Unfortunately, AD is often diagnosed at a late and irreversible stage, with an average survival period of four to eight years.
Preventing dementia
Increasing evidence suggests that certain modifiable factors can help prevent dementia. The study found a significant reduction in the rate of undiagnosed dementia, decreasing from 70.6 per cent in 2013 to 51.5 per cent in 2023.
Retirees and homemakers were 11.3 times and 9.4 times more likely, respectively, to have dementia compared with employed individuals. Those with a history of stroke or depression were 6.5 times and 2.8 times more likely to develop dementia. Improved employment status and education levels in the 2023 cohort, along with a decrease in stroke prevalence and general preventive efforts (such as healthier diets and lifestyles), contributed to this decline.
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These findings align with the 2024 update from the Lancet Commission on dementia, which reported that modifying 14 risk factors could prevent or delay nearly half of dementia cases. Early changes in the brain associated with AD may manifest six to 10 years before mild cognitive impairment (MCI), with about 15 per cent progressing to AD within two years and one-third within five years. Therefore, early detection and intervention during the pre-symptomatic and MCI stages can potentially lower the risk of onset or delay progression.
Building cognitive resilience
The encouraging news is that the risk of dementia is modifiable, regardless of genetic predisposition. A strong cognitive reserve helps the brain cope better with neurodegenerative changes associated with ageing. Improved physical health, increased cognitive activities and social interactions enhance cognitive reserve and mitigate the effects of neurodegeneration.
Better childhood education, higher educational attainment and ample cognitive stimulation are linked to a stronger cognitive reserve. Workplace cognitive stimulation has a more lasting impact than cognitive interventions or hobbies.
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Sight and sound
There is a well-established link between hearing loss and dementia; longer exposure to hearing loss correlates with a higher risk. In noisy environments, such as concerts or workplaces, consider using ear protection. For those with hearing impairment, evidence suggests that hearing aids may reduce dementia risk. Therefore, maintaining good hearing is essential for cognitive health, and if in doubt, get your hearing tested.
Increasing evidence also supports an association between untreated vision loss and dementia risk. Address any visual impairments promptly, as early intervention can help.
Cardiovascular risk factors
Cardiovascular risk factors such as high LDL (bad) cholesterol, diabetes, hypertension, smoking, obesity and a sedentary lifestyle are linked not only to increased risks of stroke and heart disease but also to dementia. VD is more common among smokers, diabetics and stroke survivors. Midlife hypertension, high LDL cholesterol and obesity increase the risk of all-cause dementia. Smoking cessation is critical, as continued smoking heightens dementia risk.
Diabetes often involves insulin resistance, which increases amyloid beta toxicity, tau hyperphosphorylation, oxidative stress and inflammatory processes – all of which elevate the risk of AD. Patients with AD typically present both extracellular amyloid-beta plaques and intracellular tau-containing neurofibrillary tangles in the brain. Some studies indicate that certain diabetes medications (for example, SGLT2 inhibitors, GLP-1 receptor agonists and DPP-4 inhibitors) are associated with reduced dementia risk, while others (sulfonylureas) may increase it.
Research shows that individuals with a healthy lifestyle – characterised by a balanced diet, regular physical exercise, active social contact, frequent cognitive activity and a non-smoking, low-alcohol lifestyle – have a lower risk of dementia. Regular moderate-to-vigorous exercise appears beneficial for cognition, with those engaging more frequently showing relatively larger brain volumes. Therefore, managing weight, controlling LDL cholesterol, quitting smoking, optimising blood pressure, reducing insulin resistance (through exercise and weight management), exercising regularly (more than 150 minutes weekly) and maintaining good blood sugar control are essential for reducing dementia risk.
Lifestyle choices
Avoid or limit alcohol consumption. Excessive alcohol intake (more than 21 UK units, 12 US units, or 168 g of ethanol a week) is linked to a higher risk of dementia compared with moderate drinking (less than 14 UK units). Heavy alcohol use correlates with an increased risk of all-cause dementia and reduced brain grey matter volume.
Avoid sports that may increase the risk of head trauma, such as boxing and martial arts, which have a higher risk of traumatic brain injury. Implementing head protection, minimising collision risks and avoiding play immediately after head trauma are measures being adopted by various sports organisations.
Socialise with friends at least twice a week. Social isolation or infrequent social contact is a known risk factor for dementia. Engaging in social activities helps build cognitive reserve, promotes healthy behaviours and reduces stress and inflammation.
Current evidence suggests that depression increases the risk of dementia at all adult ages. If you feel mentally unwell, seek professional help.
Breathe well
Air pollution, particularly particulate matter (PM2.5 and PM10), is associated with dementia and cognitive impairment. Avoid highly polluted areas and take precautions to minimise exposure when necessary.
Scientific studies indicate that obstructive sleep apnea (OSA) is linked to neurodegeneration, which can lead to cognitive impairment and eventually, dementia. An earlier onset of OSA correlates with a greater likelihood of developing dementia types, such as AD and VD. If you snore, feel fatigued upon waking or have a dry throat in the morning, consider getting assessed for OSA.
With increasing longevity for many Singaporeans, it is essential to take preventive measures now to enhance cognitive resilience and lead a meaningful and fulfilling life.
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