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How to avoid dementia? I never used to think about this. Now I think about it every day.
Every day as I peel my mother’s diaper down.
Every day as I hold her steady and ask gently, "Have you got your balance?"
Every day as I watch her grimace at a spoonful of food—often a spoonful I have raised to her lips: "This doesn’t taste of anything."
And in my mind’s eye, I see an abacus. Ten beads a row, ten rows a frame.
I am doing my dementia math.
What was it that made Mum vulnerable?
What loaded the beads in the dementia’s direction?
Was it her depression?
Research suggests depression presents a two-fold risk for dementia.
I load the row I have identified as "Mum" with a single bead: A marker for her long-lasting, treatment-resistant mental illness.
I have never suffered. My row bears no burden yet.
The 2020 Lancet Commission identified 12 modifiable risk factors in 40 percent of dementias worldwide—that is, things you can do to make a difference, to lower your risk profile by nearly half.
Those risks are
- physical inactivity
- excess alcohol
- obesity
- smoking
- hypertension
- diabetes
- depression
- traumatic brain injury
- hearing loss
- fewer years of education
- social isolation, and
- air pollution
I take a deep breath and consider the list, fingers on beads.
Mum, slender all her life, never bothered with exercise. I, on the other hand, was a plump child and then an adult who, observing my mother’s depression (see above), developed a keep-fit habit because I learned that moving did two things: It kept the weight down, and it nudged endorphins up. Even as a slender adult, I kept—keep—swimming and walking. Always a step, or two, ahead of my mother’s black dog.
I give her another bead. I tell myself I will walk farther, faster, more frequently.
Excess alcohol? Nope, neither of us has ever drunk too much. Or smoked. My mother’s blood pressure errs on the low side; mine only spikes in response to white coats. I tell myself that doesn’t count.
Diabetes. We’re safe. Even if my mother takes—she tells me today—six spoons of sugar in her tea, she didn’t always.
Mum’s row bears two beads, mine has none. I exhale. I’m halfway through the list.
Traumatic brain injury. Mum’s sinister necklace is lengthening. Her stroke seven years ago does not meet the criteria for 'traumatic' but it was an assault, a blow: the science says that one in three stroke sufferers develop dementia within five years.
Why a stroke though, I asked her neuro. (Mindful of the fact there was no excess drinking, no smoking, no high blood pressure, and no obesity.)
Her depression, he said, in a tone that told me I ought to have known that.
He registers my blank expression with something like impatience, then elaborates: She sat too still for too long (two years too long that time). "A clot formed."
An infarct in her left occipital lobe: It caused pure alexia, which robbed her of reading. Which, in turn, exacerbated a too-brief education for a clever girl. A paucity of learning which she always tried to augment herself with challenging texts. Until she could no longer navigate words on the page.
I slide two more beads along Mum’s row: one for brain injury, one for fewer years (and certainly fewer years than me) in school. Her cognitive reserve drained because she could no longer immerse herself in books, like a dam running dry, something precious saved for later was lost.
Social isolation. I shift uneasily in my seat. A tentative finger poised to slide my beads one way or the other.
But I have a husband of 36 years. Mum lost hers—my father—suddenly, tragically, after just 20. She was always on her own after that. Research tells us a long—lifelong if you’re lucky—partnership, whatever form it takes, may minimise the risk of dementia. And I have my job—which means I engage in the ether daily, in virtual conversation regularly. Does that mitigate the lack of human contact across a room? It must, I tell myself. It must.
My mother’s redundancy—lack of a role as her nest emptied, the absence of company or career—was made lonelier by depression, which marinated her brain for months and months and months on end in cortisol that itself might have set the cerebral stage for the pathology of dementia.
My mother’s row bears five big red-for-danger beads. Mine is naked. And vulnerable. You can't be complacent in the face of this illness.
I regard them with sadness—mum's beads—sometimes, I think, she didn’t stand a chance.
