Watching someone suddenly struggle to remember simple everyday things is heartbreaking.

The person is still physically present, but as their memory declines, personality and sense of self begin to disappear.

The loss and care required takes an enormous toll on families.

Researchers have examined potential causes and risk factors for dementia for years. In 2024, the Lancet Commission on Dementia Prevention, Intervention and Care suggested that up to 45% of dementia cases may be prevented by fully addressing 14 lifestyle risk factors including:

• not completing secondary education, resulting in less cognitive reserve,
• hearing loss, 
• high LDL cholesterol,
• depression, 
• traumatic brain injury, 
• physical inactivity, 
• diabetes, 
• smoking, 
• hypertension, 
• obesity, 
• excessive alcohol consumption, 
• social isolation, 
• air pollution, 
• and untreated visual loss.

Dr. Virginia Kellner, a Lafayette-native and neurologist, emphasizes the point that lifestyle changes can significantly reduce the risk of dementia. Kellner says that up to half of dementia cases could be prevented with these lifestyle modifications addressing the 14 risk factors. 

Even those with a genetic predisposition to dementia can decrease their risk through healthy choices:

• prioritizing cognitively stimulating activities throughout life,
• minimizing exposure to harmful noise,
• staying socially active and avoiding isolation;
• addressing vision loss when possible;
• maintaining healthy sleep and stress management habits.

The most critical period for making these changes is midlife, between the ages of 18 and 65, though benefits can still be seen later in life.

The role of diet in brain health

The Mediterranean-DASH Diet Intervention for Neurodegenerative Delay, or MIND diet, targets the health of the aging brain.

This diet combines the healthy diets based on food found in countries near the Mediterranean Sea, as well as the Dietary Approaches to Stop Hypertension diet that was created by doctors at Pennington Biomedical Research Center in Baton Rouge.

Dr. Cathy Champagne, a lead developer of the DASH diet, said it was a meal plan easy to stick with and works for the whole family.

“It is scientifically proven to lower blood pressure, lower the risk of stroke, lower the risk of cardiovascular events and works to improve metabolism regardless of your size,” Champagne said.

All three diets (the MIND, Mediterranean and DASH) highlight plant-based foods and limit the intake of animal and high saturated fat foods.

Research shows that individuals who followed the MIND diet experienced a 53% lower risk of developing Alzheimer’s disease.

“Even those who adhered to the diet moderately demonstrated a reduced risk,” said Lafayette neurologist, Kellner.

The MIND diet encourages the consumption of:

• extra-virgin olive oil (used as primary cooking oil)
• six or more servings per week of green leafy vegetables
• other vegetables (at least one serving per day)
• two or more servings of berries per week
• three servings daily of whole grains
• seafood (at least once a week)
• poultry (twice a week)
• beans and legumes (at least four servings a week)
• nuts (at least five or more servings per week).

Foods to avoid with the MIND diet include fried and fatty foods, sweets and pastries, butter and trans-fat margarine, whole-fat cheese and red meat.

The importance of cognitive engagement

Although improving diet and exercise will help lower the risk factors involved in dementia and brain aging, people must also work to keep the brain active throughout life.

Kellner advises that any activity that challenges the brain — such as reading, solving puzzles or learning a new instrument or language — can help build cognitive resilience.

Even little things, like memorizing a grocery list instead of relying a digital list on the phone, can be beneficial.

Dr. Jeff Keller, the director of the Institute for Dementia Research & Prevention at Pennington Biomedical Research Center and a professor of aging and neurodegeneration, said these little measures to test the mind, go a long way with latter-life brain aging.

A study published in Neurology in 2021 found that high levels of cognitive activity, such as reading, playing games like checkers, puzzles and writing letters, can delay the onset of Alzheimer’s disease by five years among those aged 80 years and over.

Another study from Journal of the American Medical Association Open, published in July 2023, found that frequently engaging in brain-challenging activities, including journaling, playing chess and solving crossword puzzles was associated with a lower risk of developing dementia among older adults.

“These activities increase the cognitive reserve, or mental library,” Keller said. “As new books are added, the library grows bigger and bigger. Building this library of information in your brain creates a buffer for memory loss.”

Although keeping the brain active throughout life is essential to reducing the risk of cognitive decline, managing other risk factors (like depression, isolation and environment) must accompany those activities.

Social and environmental factors

Social isolation is a considerable risk factor for dementia, increasing the likelihood of the condition by 27%. Staying socially engaged helps the brain become more resilient.

To address this challenge, Kellner recommends community involvement, family gatherings and joining clubs — anything that fosters connection.

Stress management is an essential factor, though an indirect one. Chronic stress increases inflammation and cortisol levels, which can contribute to dementia risk by worsening vascular issues.

“Stress can also lead to depression, which has been linked to increased dementia risk,” Kellner said. 

Louisiana residents may also face environmental risks due to air pollution. Matter from industrial processes, vehicle emissions and wildfires has been linked to vascular damage in the brain.

“We’re still learning about the direct effects, but minimizing exposure to pollutants is a smart move for long-term brain health,” she said. 

Habits like exercising, reading and eating well can be incorporated at any age. Assessments are available through primary care providers for those concerned about any cognitive issues.

For younger generations, the best advice is to establish a foundation of good health early.

“Aim for the highest quality education possible, stay physically and mentally active and care for your overall health,” Kellner said.