Everyone knows someone today who’s dealing with dementia. And as a geriatrician — that means a lot of questions come my way. Questions about parents who recently had cognitive testing, about the role of assisted living, about prevention — you name it. Dementia is out there in a way it never was before. People have questions, and they need answers.

Dementia is not a normal part of aging

This is where I always start. It’s true: dementia is not a normal part of aging — it is not inevitable. But it is really hard to talk about dementia. In this sense, dementia is the cancer and heart disease of yesteryear, often shrouded from public view by secrecy and shame, which is ironic because resources abound. Innovative tools, practices, and technologies are emerging for the field of dementia care. People with dementia are learning to endure and thrive in ways that seemed impossible a generation ago, while communities around the world understand how to better support their neighbors and loved ones with dementia through specialized programs and activities.

Dementia doesn’t equal Alzheimer’s disease

Most dementia is not curable, but the risk of developing dementia can be decreased by treating depression, long-standing heavy alcohol use, high cholesterol, and heart disease. Because nearly one-third of dementias have a vascular component, anything that improves the health of one’s arteries and veins throughout her lifetime will lead to less cell death in the brain, lower memory loss and a decreased risk for dementia.

Your brain likes it when you work out

Of all the strategies known to prevent or delay dementia, exercise may be the most impactful. Research suggests vigorous exercise leads to changes in brain chemistry and more and tighter connections between neurons, which may build one’s degree of resistance to dementia. Exercise also helps to improve mood, so depression is another risk factor for dementia that exercise can modify.

Anticholinergics may affect cognition permanently

New research is pointing to another risk, one that geriatricians have warned about for years. According to a recent article by The New York Times, long-term use of anticholinergics, including certain antidepressants and medications for things like incontinence, epilepsy and Parkinson’s disease may increase one’s risk for dementia over time. We’ve known for a while that anticholinergic medications can cause acute delirium — lots of medications have side effects — but this longer-term link with dementia is new.

The study, well designed and conducted in England, compared prescription patterns in the three to 13 years preceding a diagnosis of dementia in 59,000 people with a matched sample of 225,000 people who did not develop dementia. They calculated the total “anticholinergic burden” individuals were exposed to over time, like the way we think about radiation exposure over time. Those with the highest exposure over time — people with daily use of a strong anticholinergic medication for over three years — showed a nearly 50 percent increased odds of developing dementia.

These findings serve as a wake-up call to all physicians to pay closer attention to the anticholinergic burden as their patients live longer and for patients to look for less anticholinergic alternatives if long-term use is recommended.

Learn more about dementia

As you continue to learn from a growing body of research and collaborative communities, remember that knowledge is power. Armed with greater wisdom and empathy, we can overcome the narrative around dementia and equip the current generation of people with dementia, their loved ones and their caregivers with the resources, support, and courage to thrive.

Marc Rothman is a geriatrician who blogs at The Geriatrician Next Door.

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