About the Speaker
Claire Steves is a Professor of Ageing and Health and the Clinical Director of TwinsUK at King’s College London. As a leading expert in geriatric medicine, she has made significant contributions to understanding the variability in aging processes. Her research focuses on the role of genetics, the environment, and the microbiome in aging, particularly how these factors contribute to cognitive decline, frailty, and multimorbidity.
Dr. Steves has led groundbreaking studies using large-scale twin data, providing insights into how lifestyle and biological factors interact in the aging process. She has also played a pivotal role in the development of the ZOE COVID Study app, which tracked millions of participants and advanced research on the health impacts of the COVID-19 pandemic.
With over 100 peer-reviewed publications, Dr. Steves’ work continues to influence the fields of gerontology and epidemiology, driving forward our understanding of healthy aging.
Video: Claire Steves on ZOE Science & Nutrition Channel
"If somebody is changing in their function and in particular, losing the ability to keep hold of, for example, short-term memory issues, then that's a warning sign."
Claire Steves
Description
28.03.2024
In this episode of ZOE Science & Nutrition, Jonathan is joined by Professor Claire Steves to explore the multifaceted world of dementia. They delve into the significance of dental health, genetics, impact of diet and physical activity. By exploring the latest research, this episode will give you practical strategies for dementia prevention.
In this interview, Dr. Claire Steves discusses five key actions to reduce dementia risk, focusing on diet, physical activity, social interaction, and cognitive health. She highlights the benefits of a plant-based diet, regular walking, and resistance training. The link between diabetes, hearing loss, and dementia is explored, stressing the importance of managing these conditions. Claire also touches on new dementia drugs and the role of hormone replacement therapy (HRT) in cognitive health during menopause, while calling for more research into their long-term effects.
Content
For your convenience, the interview text is divided into sections, with some parts cut/hidden under a “Read more” link. Click the “Read more…” button to expand full section text.
Introduction
Claire Steves
00:00:00 — The most common cause of dementia is Alzheimer’s disease. If somebody is changing in their function and losing the ability to keep hold of short-term memory, then that’s a warning sign.
Jonathan Wolf
00:00:10 — Could you just explain what exactly is dementia?
Claire Steves
00:00:13 — Dementia is actually an umbrella term. There are about 25 different other types of dementia.
Jonathan Wolf
00:00:18 — Are some people more at risk?
Claire Steves
00:00:20 — Having diabetes increases the risk significantly.
Jonathan Wolf
00:00:22 — And so what are the treatment options?
Claire Steves
00:00:24 — So it’s really exciting that we now have some new drugs because we’ve been waiting actually about 20 years.
Jonathan Wolf
00:00:28 — So that’s very exciting. So is there anything that I could be doing with my brain over the next 20 years?
Claire Steves
00:00:33 — Make sure you’re… So I tell all my patients about… One thing I haven’t really talked about ever before with you is…
Jonathan Wolf
00:00:40 — Welcome to ZOE, Science and Nutrition, where world-leading scientists explain how their research can improve your health. I’m your host, Jonathan Wolff, founder and CEO of ZOE. Today, we’re discussing a topic that’s close to my own heart and as many of us know all too well, impacts millions of families around the world. And that topic is dementia. Nearly 7 million people in the US and almost 1 million in the UK live with a form of dementia, like Alzheimer’s disease.
00:01:10 — And these numbers are a concern for many of us. But today we’re not just discussing challenges. We’ll learn what steps to take to help prevent dementia. We’ll also hear how to recognise the early signs. And we’ll find out if promising new Alzheimer’s drugs are worth the hype. I’m delighted to have dementia expert Professor Clare Steves back on the podcast. Clare is a medical doctor, a professor of ageing and health, and head of the Department of Twin Research and Genetic Epidemiology at King’s College London.
00:01:40 — Clare, thank you for joining me again today.
Claire Steves
00:01:43 — Thank you very much for having me.
Quickfire questions
Jonathan Wolf
00:01:45 — Now you may remember that we always like to start with a quick fire round of questions and Claire looks suddenly shocked because she’s clearly forgotten about this, which we carefully designed to make professors deeply uncomfortable. And just to remind you, the rules are you can say yes or no, or if you absolutely have to, you can have a sentence to answer. Are you willing to give it a go?
Claire Steves
00:02:06 — Yeah, I’ll give it a go.
Jonathan Wolf
00:02:07 — All right. Is the brain the most complex structure in the known universe?
Claire Steves
00:02:13 — Yes, it is.
Jonathan Wolf
00:02:15 — That’s pretty cool. Is dementia inevitable as part of the ageing process?
Claire Steves
00:02:24 — Hmm, no.
Jonathan Wolf
00:02:25 — Are women more likely to get dementia than men?
Claire Steves
00:02:27 — Yes.
Jonathan Wolf
00:02:28 — If my parents have dementia, am I certain to get it as well?
Claire Steves
00:02:32 — No.
Jonathan Wolf
00:02:33 — There are a bunch of new Alzheimer’s drugs, are they going to stop the disease for most people?
Claire Steves
00:02:38 — No.
Jonathan Wolf
00:02:39 — If I change what I eat, can I lower my risk of dementia?
Claire Steves
00:02:43 — Yes.
Jonathan Wolf
00:02:44 — And finally, and you don’t have to say yes or no, you can give us a whole sentence or two, what’s the most common misconception you often hear about dementia.
Claire Steves
00:02:53 — That there’s nothing you can do about it.
Jonathan Wolf
00:02:56 — And that isn’t true?
Claire Steves
00:02:57 — That isn’t true, no. That isn’t true if you have it, and that isn’t true about preventing it to happen.
What is dementia?
Jonathan Wolf
00:03:03 — This is a topic that’s very close to my own heart. I think like a lot of our listeners who’ve listened to the podcast very regularly will know that my grandmother got Alzheimer’s. It’s an awful experience for the whole family. You know, it was awful for me, but particularly awful for my father. And not just during the period when my grandmother got this and got very sick and actually died quite fast.
Jonathan Wolf
00:03:30 — Basically, ever since that, my father has lived under the shadow, this fear that he was going to get Alzheimer’s. And he’s actually a lot older now than my grandmother was when she got this. But I think even now he feels like he doesn’t ever know. Is he just going to have another six months or 12 months of his brain working? And I think it’s had this profound impact on him. So I think I’ve definitely seen this firsthand.
00:03:57 — And it’s always struck me as one of the diseases that I’m most scared of having, partly for the effect of myself and partly for the way that it would affect my family and the way that my family ends up thinking about me. So there’s it’s a topic that’s close to my heart as a way of saying this. I’m really excited to talk about it, but also very excited that you sort of started there by saying there’s some things you can do, because I think I always assumed there was nothing you could do about this.
Control over fate with dementia
Jonathan Wolf
00:04:26 — This was something that just came externally somehow as a roll of the dice, a stroke of fate. And so I’d love to make sure we really get into today about how we can lower our risk, but I’d love to start right at the beginning, Claire. And could you just explain what exactly is dementia?
Claire Steves
00:04:47 — So dementia is actually an umbrella term, so lots of different things actually fit into that term of dementia. But if we want to sort of classify it, it’s a condition that involves cognitive function, so thinking and learning and memory, more than one domain of it, which is altered in somebody, that that’s altered to such a degree that it then causes a problem in day-to-day living and that it’s gradually progressive over time and needs to have been around for longer than a six-month period at the very least.
Claire Steves
00:05:21 — And actually most people who get diagnosed with dementia have probably had some symptoms going back for you know maybe years, unlike your grandmother maybe who sounds like it was more rapid progression.
Jonathan Wolf
00:05:34 — And how is that what you’re describing different from normal aging? Because I think many people to this will say, isn’t that just what happens? I think, again, this is how I was brought up, and I know this is now more contentious. I was brought up with this idea that, well, when you just start to get old, then you fall apart, your body falls apart, your brain falls apart. So this is just literally the normal process of aging.
Claire Steves
00:06:01 — So there are changes that happen with age in most people, which we might call normal aging. The typical things are, for example, the brain looks different when you look at it, so there’s some atrophy in older people.
Jonathan Wolf
00:06:15 — Which doesn’t sound good. Nobody likes the word atrophy. The older I get, the less excited I get about this idea of my body or my brain atrophy.
Claire Steves
00:06:22 — Yeah, so there is that, but of course some of that might not be so detrimental. Then also there’s some changes in processing speed in older adults generally, so the speed at which things happen.
Jonathan Wolf
00:06:35 — So when you say processing speed?
Claire Steves
00:06:37 — Yeah, so the ability for the brain to get through a problem or execute an action.
Jonathan Wolf
00:06:45 — So this is like do the crossword or what do you mean when you…
Why older people get more fractures
Claire Steves
00:06:49 — Well, more simple than that really, but basically any task you’re looking at the time it takes to do that task. One of the simplest is a reaction time task. Say for example, you’re given a stimulus and you have to say when you see it or a choice reaction time when you have to press one button when one stimulus comes and another button when another stimulus comes. Those are relatively simple tasks which measure the speed of processing.
Jonathan Wolf
00:07:10 — So I’m thinking a bit like whack-a-mole, is this what you’re saying?
Claire Steves
00:07:12 — Like something comes up and you’re hitting it on the head, is that what you’re saying?
Jonathan Wolf
00:07:14 — And as we get older, we get worse at this. My son already feels that I’ve got slow reaction speeds, so I don’t want to know what I’ll be like when I’m 80.
Claire Steves
00:07:22 — Yeah, no, so this is really important, and it’s really important, that sort of aging, because that’s why some older people, when they fall, or younger older people, they would fracture their wrist, whereas older, older people might fracture their hip because they’ve got time to put out the hand.
Jonathan Wolf
00:07:38 — So what you’re saying is as you get older, things like just being able to protect yourself when you fall over by responding is slowing down.
Claire Steves
00:07:44 — And that’s your brain which is slowing down. Your brain is slowing down in normal aging. And I think that’s something that we definitely see. Then there are dementias which are really quite different from that where there’s progressive decline in other functions. And different dementias have different constellations of symptoms, but we don’t always get it completely right. Sometimes actually what’s going on in the brain is not necessarily fully reflected in how people present.
Warning signs of dementia
Jonathan Wolf
00:08:10 — And just before we get into that, I just want to make sure I’m, this sort of difference between being health, like a normal agent, if you like, and not, I think you’re saying it is normal to sort of slow down a bit in terms of the speed with which you respond. You can see changes. It sounds like you’re saying, like almost like if you’re imaging the brain or something, see this. But it’s not normal for you to not be able to think and interact and all the rest.
Jonathan Wolf
00:08:34 — And where I’m getting this is, you know, I think everyone listening to this can think of people that they know, relatives or friends who are very old, who are incredibly sharp, exactly the same as they were many decades before. Is that what you would think of as typically normal? Or is the reverse, which is that they are the exception and your normal expectation should be that you sort of lose sort of your core personality and capability as you reach old age?
Claire Steves
00:09:03 — Really interesting questions. I mean, if somebody is changing in their function and in particular, losing the ability to keep hold of, for example, short-term memory issues, then that’s a warning sign. The other thing that’s a warning sign is if they’re not able to function in normal activities of daily life. So one of the first things that might be affected it might be say ability to manage finances or medication.
00:09:28 — So if someone else has to come in and take over because things are going a bit wrong, those are the sort of like early warning signs for most types of dementia.
Jonathan Wolf
00:09:37 — And that’s because you wouldn’t consider that just the inevitable normal part of aging. You’re saying that actually, and the reason why I’m asking this again is because I feel that that’s a bit of a shift from how I was brought up because you’re saying, I guess, quite a positive thing, I think, Claire, right? That actually you know the normal expectation of aging is you can still manage your medication and your finances and your short-term memory should still exist.
Claire Steves
00:10:00 — Exactly, exactly.
Unique aspects of dementia
Jonathan Wolf
00:10:02 — So tell us a bit about you know what happens with dementia. Why is it that this isn’t the case for some people? Why is it that this is this thing that so many people you know are worried may happen to them?
Claire Steves
00:10:13 — The most common presentation and the most common cause of dementia is Alzheimer’s disease. And Alzheimer’s disease characteristically presents with a very gradual progression. And generally the person is physically relatively well. And their gait, for example, their ability to, you know, their walking is not too slow and it’s not too altered. And yet they ask maybe repeated questions. They maybe don’t catch hold of a full conversation.
Claire Steves
00:10:41 — So they might ask the same question again. Or you might realize that actually you said something five minutes ago they don’t recall it. So that early laying down of that episode, in a sense a tape recorder, for short-term items just isn’t functioning very well.
Jonathan Wolf
00:10:56 — So this is when you were mentioning short-term memory loss, this is like remembering things just in the last few minutes, rather than something that maybe happened to you 50 years ago.
Claire Steves
00:11:05 — And of course, be careful because not everybody with short-term memory loss has dementia. Sometimes when the brain is really working on lots of other tasks, maybe in the subconscious, whatever, maybe there’s a stressor or there’s something else happened, then obviously short-term memory can be affected. So it doesn’t necessarily hold that short-term memory loss is early. Alzheimer’s disease. But it certainly, if it’s sort of like there and consistently there, definitely that’s a sort of signal to say, we ought to get this checked out, see what’s happening here.
Jonathan Wolf
00:11:33 — What’s going on? Why is this happening?
Claire Steves
00:11:35 — Most of the common dementias that are really brain focused, as it were, are because of. Neurons dying basically in certain areas of the brain in particular.
Jonathan Wolf
00:11:45 — And what are neurons?
Claire Steves
00:11:46 — Neurons are the nerve cells. Okay. And they’re dying probably from a combination of factors in our genes and factors in our environment that contribute to that.
Jonathan Wolf
00:12:00 — And so they’re dying a lot more in these people than they would be doing in an equivalent person the same age who is not having these dementia issues.
Cellular level discussion on dementia
Claire Steves
00:12:09 — Exactly. And one of the things we see when we look at those cells under the microscope is we see inclusions of certain proteins. So certain proteins have aggregated together and either inside the cell or outside the cell. So there’s something going wrong.
Jonathan Wolf
00:12:22 — And that’s not normal.
Claire Steves
00:12:23 — And that’s not normal. This is one of the big conundrums of dementia is why that happens. Why some people more resilient to those protein depositions in the brain and have relatively high degree of changes in the brain, but that’s not necessarily translating into how they present.
Jonathan Wolf
00:12:43 — And so just to make sure I’ve got this, you’re saying that there are these proteins sort of forming these clumps in these nerve cells in the brain, that that seems to be very related to whether or not you get Alzheimer’s, dementia in general or Alzheimer’s specifically?
Claire Steves
00:13:01 — So Alzheimer’s specifically has certain types of protein inclusions and other more rare forms of dementia, rarer forms of dementia have different sorts of protein inclusions. But ultimately a lot of these neurodegenerative diseases that we call, neurodegenerative types of dementia, they have protein depositions within the brain. In different parts of the brain, different patterns, different exact proteins as well.
Jonathan Wolf
00:13:24 — But basically there’s a lot of stuff that isn’t in your brain when you’re 21 years old.
Claire Steves
00:13:28 — That is later.
Jonathan Wolf
00:13:29 — And there’s a real link.
Claire Steves
00:13:31 — There’s a relationship. But it’s not a completely 100% link.
Jonathan Wolf
00:13:33 — It’s complicated. Like, I think one of the things I’ve learned on this podcast that most things are. So it’s interesting, I, when I hear that, I naturally think about these analogies that a lot of guests have talked about with cardiovascular disease and things being sort of laid down in your arteries, you know, mainly based on poor diet over decades building up and eventually that leading to like these pipes being blocked or something breaking free and into the heart.
00:14:01 — Heart. Is that a terrible analogy or is there something, is there some similarity with what you’re describing with things sort of, you know, ending up being laid down in our brain that are not being cleared away or?
Claire Steves
00:14:14 — Well, so yes, I think that’s really interesting. Yes, the clearing away bit is absolutely the case. But the difference in a way between the vascular, you know, cardiovascular diseases you mentioned is that the focus is really on the arteries and the blood vessel lining. Whereas in dementia, the focus is on the actual neuron cells and the cells beside the neurons that help keep them healthy. So the microglia or the other cells that are around supporting those neurons to function.
Jonathan Wolf
00:14:42 — Is everyone having these proteins laid down in their brain, but normally we’re unable to clear them away? Do we understand, I guess, what’s going on here? And therefore, does that help us to understand, as you’re going to start to talk more about what we might do, why the things that help do help?
Claire Steves
00:14:56 — You know, our cells, very complex organisms or complex structures that are constantly rebuilding the structures within the cells, but also the ways in which they communicate outside that cell. So what’s happening when you get these proteins deposited is that there’s a problem with either the manufacture or the clearance of those proteins.
Risk factors for dementia
"There is evidence that the clearance of protein and also just simply the way that the fluid system around the brain, the CSF, the cerebrospinal fluid, the way that flows around the brain is affected by sleep."
Claire Steves
Jonathan Wolf
00:15:18 — We had a really interesting podcast with a professor called Matt Walker talking about sleep quite a long time ago. And I remember one of the things that he talked about was his idea that when you sleep, you know, again, I was brought up to think that nothing happened when you slept, you just had to sleep for some reason. And he was saying, no, actually, we now know your brain’s very active. And one of the things that’s going on is somehow a sort of clear up of your brain. Is that in any way related to this? Or have I just put one and one together and made seven?
Claire Steves
00:15:46 — Yeah, no, there is evidence that the clearance of protein and also just simply the way that the fluid system around the brain, the CSF, the cerebrospinal fluid, the way that flows around the brain is affected by sleep. And then probably there’s something that’s happening much more deep within the brain tissue, which affects the clearance of these proteins. So I think there is a relationship between sleep. Hi there.
Jonathan Wolf
00:16:09 — I hope you’re learning a lot about dementia from my conversation with Claire today. I certainly am. Now making this show takes a lot of time. We think it’s well worth it, all in the name of improving your health so you can enjoy many more years to come. What I ask in return is this, send a link to this podcast to someone you think would benefit. And if you haven’t already done so, hit the subscribe button and turn notifications on.
00:16:37 — And if you’d like to listen on the go, head to your podcast player of choice and follow us there.
Inheritance and dementia
Jonathan Wolf
All right, back to the episode. I would love to shift maybe to, you know, one step away from the detail of what’s going into the brain and more about people listening to this trying to understand, okay, what are my risks? So are some people more at risk of dementia than others?
Claire Steves
00:16:59 — That’s true. And we know that genetic factors are important in the development of dementia. And they’re most important in the early onset dementias. So people who have developed dementia in their 50s or 60s, there’s a stronger genetic influences on those. It doesn’t mean that they’re definitely going to be.
Jonathan Wolf
00:17:17 — I was gonna say, does that mean that if I have bad genes, I’m doomed to get dementia?
Claire Steves
00:17:21 — Like this is sort of like- No, it doesn’t. And of course, there’s an interaction between those genes and the environment, which might be very important. So one of the most talked about, because it’s actually a really important gene, is ApoE, of which all of us have two. And ApoE4 is associated with increased risk of dementia. And so if you have two of those, you’re actually much greater risk of having dementia. It doesn’t mean it’s definite.
Jonathan Wolf
00:17:46 — And how bad, like just to help us understand, like if you have these two, what do you call them? E4 genes.
High-risk factors for dementia
Claire Steves
00:17:53 — It’s about eight times greater risk.
Jonathan Wolf
00:17:55 — Okay. So that sounds pretty bad. And how many people will have two of these E4?
Claire Steves
00:18:01 — Oh, not very many. So I think it’s, you say about 25% of the population have one.
Jonathan Wolf
00:18:05 — So there’ll be a couple of percent of people, like two or 3% people listening to this who could have both. And their risk really would be much more, because eight times higher on something that’s relatively common sounds like that’s a very high risk.
Claire Steves
00:18:17 — But you’re saying they’re not doomed to get.
Jonathan Wolf
00:18:20 — This if they have these two genes?
Claire Steves
00:18:21 — No, absolutely not. Yeah. Well, we don’t actually know completely why APOE4 confers the risk, but it’s something to do with the way that our brain cells use fats in the body. And it’s probably influenced by things in our diet and maybe medications that we take.
00:18:43 — So that’s why, you know, you can still increase your resilience, even if you have two of those ApoE4, Alex.
Jonathan Wolf
00:18:51 — So could you talk a bit more maybe about the thing? Because I think the thing about genes is always it’s so depressing, right? Like you have your genes and you’re sort of stuck with them. I think one of the joys for me about this journey with Zoe is realizing that almost everything that I’d been taught, that basically we were just sort of this victim of our genes, that was going to define our health, turns out not to be very true. And that actually the way that we live our life is much more important in terms of certainly most aspects of our health. Though as I keep telling my son, it seems like our genes are still quite important for your height.
Fetal development and dementia risk
Jonathan Wolf
00:19:24 — And since I’m rather short, he’s rather disappointed that he’s not going to be, you know, six foot five. But it seems that in general, actually, the height is a bit of the exception. And generally our health, we have much more control. What are the other things that mean that people are at higher risk of dementia?
Claire Steves
00:19:39 — Well, if we start like early on in life, really important because ultimately all of our cells in our body are aging right from the beginning when we’re after we’ve conceived. So you know, even things in utero can be really important for later life development.
Jonathan Wolf
00:19:54 — This is while I’m a fetus.
Claire Steves
00:19:56 — So if any pregnant mums out there, you know, actually, you know, what you’re doing is preparing your child for the whole of their life. So it’s really important to be thinking about that and making sure that you’re giving them.
Jonathan Wolf
00:20:07 — I always think it’s also terrible as, you know, we both have children, there’s enough pressure I always feel on pregnant mothers. It’s pretty tough, I think. And then now you’re just about to layer on some more, but go on, I know this is a science, tell us the science.
Claire Steves
00:20:19 — But also society needs to do that as well, really, I mean, that’s really a key message for society. We need to really look after pregnant mums.
Jonathan Wolf
00:20:25 — That seems unobvious. How does what happens to me as a foetus affect, what are the things that will change my risk of dementia?
Claire Steves
00:20:33 — It’s about cognitive reserve. So that’s the kind of maximum cognitive ability that we might have, not just in terms of sort of intellectual ability, but also psychological state as well. So the reason why that’s really important for dementia is, is that dementia is something whereby our functions are interfering with daily life. And obviously if we start off with really high functioning, then we get to that point much later in any disease process.
00:21:03 — So, you can put off significantly the time at which you fall below that threshold of being able to function in daily life much, much later.
Jonathan Wolf
00:21:14 — Could you explain a bit more what you’re describing? What is it that some people are getting and other people are not?
Brain reserves and mental health
Claire Steves
00:21:20 — We can think about it from multiple different ways. We can think about it in terms of the stimulation that a child is being given through education, through parental influence. We can think about it psychologically around that development that’s happening in early childhood. But we can also think about it about nutrition, as we talked about before, I’m sure we’ll talk about again. Nutrition starts in utero, there are factors which affect how the brain actually develops right from the beginning.
00:21:50 — And then we can then go even further than that and talk about things like smoking and alcohol, which have significant effects on the brain development.
Jonathan Wolf
00:21:56 — Of children. I think I’m understanding better now. I think you’re saying right back even when you’re as a fetus, depending upon like the nutrition that your mother is having, that’s gonna affect the way your brain is developed. Then after you’re born, continuing the food that you eat as a child, but also you’re saying the stimulation you get, I’d love for you to talk a little bit more about that. You’re saying that somehow the way that the world is interacting with you is going to give me a, I guess like a healthier or more robust brain
00:22:24 — that is actually going to have an effect on whether I get dementia 70 or 80 years later, is that?
Claire Steves
00:22:29 — You might still get dementia, but the chances are that the more that we can do to increase brain reserve, the later…
Jonathan Wolf
00:22:36 — And brain reserve is like the capacity of your brain to do things?
Claire Steves
00:22:39 — Yes, exactly. Exactly. So, and humans are incredibly varied in terms of their, you know, cognitive functioning. And so if you have a high cognitive functioning, obviously, you’ve got further to fall.
Jonathan Wolf
00:22:54 — It’s a bit like saying like my tank is, it’s a bit, I’m thinking about now a bit like a car. So my, you know, like the fuel in the car is your reserve. And when it goes below a certain point, you know, the car stops working. And is that your analogy a bit here with the brain that you’re saying you might have dementia. So your reserve is being reduced, but because it’s very capable, you can go a lot longer before it stops working, is that?
Claire Steves
00:23:17 — And so actually the processes might still be happening within that brain, but actually then it doesn’t play out in life. So this is, and this is really important because obviously that investment that we give, or we can give if we have the capability to give it, that investment will last out and make a difference later on.
Jonathan Wolf
00:23:35 — Got it. Because it might be that, okay, yes, you are signed to have dementia. And if you became 100, it would be really affecting you. But actually, if you die at 85 of a heart attack or something, then actually your brain was fine. Is that what you’re describing? Could you talk a little bit more therefore about this? Because I think everyone listening to this is probably thinking, okay, how do I make sure that maybe starting with perhaps thinking about their children or their grandchildren, how do they make sure their reserves are good? And then also, you know, perhaps what’s happening later.
00:24:03 — But right now, I think you’re talking about like early life. What is it that gives you these higher reserves before you’re 18, I guess?
Claire Steves
00:24:12 — Yeah. So I think we’ve already talked about diet, we’ve talked about intellectual stimulation, sort of also that stability, psychological balance, which is really important, mental health.
Jonathan Wolf
00:24:21 — That’s interesting. So mental health is linked to…
New advances in dementia treatment
"Physical fitness is really beneficial for brain health."
Claire Steves
Claire Steves
00:24:24 — Well, mental health is really interesting because it ends up, good mental health sets you up for a cascade of good things that are then happening to you late in life, which then give you more opportunity, more capability to take on these opportunities to then improve your brain reserve and stimulate your brain. Whereas problematical mental health then can lead to difficulties in the capability or the opportunities and motivations to take on these things that are gonna then help your future brain reserve.
Claire Steves
00:24:56 — So talking about some of those, I mean, the key things are around social stimulation, you know, things like physical fitness. I think I talked about that a lot in the last podcast that we know that physical fitness is really beneficial for brain health.
00:25:16 — And of course, we can then put in some physical reserve as well, and habits of daily life that then increase our physical activity and continue it going through midlife, which is going to be good for vascular health, but it’s also really good for brain health.
Jonathan Wolf
00:25:29 — So if I am doing more physical activity, what does that mean for my brain?
Claire Steves
00:25:35 — The habit is good. It’s the daily, regular physical activity, which doesn’t need to entail exercise. It’s the reduction even in sedentary time that we see has an effect not just on dementias, but actually on brain aging as well. So that just means my brain is effectively younger than it would be otherwise.
Jonathan Wolf
00:25:59 — That description you gave at the beginning, which is a bit depressing about like not being able to respond to anything or really know what’s going on. Like if I’m regularly active when I’m 70 or 80 or 90 or 100, some of my mental clarity is just gonna be a lot better, is that what you’re saying, because I’ve been consistently active.
Claire Steves
00:26:18 — Active. Yeah, that’s right. Right. So active, but not just in terms of physical activity, active in terms of social activity and all those things, those all contribute to brain reserve. But then there’s also things that sort of alter brain reserve and make it more tricky for us to maintain those cognitive functions. I’m not talking about the proteinopathies now, I’m talking about the reserve capacity. And of course there, that’s where interaction with other body systems is really important.
00:26:44 — So we know that there’s a real strong interaction between cardiobiotic health and brain health. We know that there’s a really strong interaction between say, for example, our hearing, our hearing ability, our sensory ability and brain health. Then likewise, infections can tip the balance of brain health, but chronic inflammation can also affect how our brain’s resilient to those changes which might happen in that balance between proteins being set down or not.
Jonathan Wolf
00:27:16 — So before we start to talk about prevention, which I know everyone listening is like, that’s really interesting. Yeah, all sounds quite scary. Let’s talk about everything we can do. I’d love to talk a little bit about symptoms and what the status of treatment is at the moment first. So could you tell me if someone’s thinking about the symptoms that they might notice in themselves or a loved one that would sort of probably trigger this thing that I think, you know, we should maybe go and talk to a doctor, what should they be looking for?
Claire Steves
00:27:47 — So really, it’s about a change in cognitive function. And different dementias have different patterns. But as I’ve talked about, you know, we’ve got things like Alzheimer’s dementia, which starts with short term memory loss. There’s other forms of dementia that can start with personality change. Again, further forms of dementia, actually the first presentation is around falling over and maybe difficulty with the blood pressure regulation, sleep even, sometimes can be the very earliest presentations of some forms of dementia.
Jonathan Wolf
00:28:24 — When those symptoms start to become common enough that you might be sort of on the alert for it, because again, I think many people listening are feeling like, ah, as people get old, I’m expecting this to happen and I’m sort of on become very vigilant about it.
Claire Steves
00:28:38 — Hmm, good question. So most people that are referred to my memory clinic are probably in their 70s. It’s quite rare to see people in their 40s being referred to me. If people do have these problems happening in their 40s, then they’re more likely to go and see a neurologist for an examination. But yes, so that’s that’s that’s those are the more.
Jonathan Wolf
00:29:01 — The 70s is sort of when you’re tending, in fact, to see them in your clinic. And so what are the treatment options? And I think I’ve definitely seen there’s been a lot of press about new drugs starting to come on board. What’s the situation today as a doctor thinking about treatment for somebody who comes in and who you do diagnose with dementia?
Claire Steves
00:29:24 — Yeah, so it’s really exciting that we now have some new drugs because we’ve been waiting actually about 20 years for some new changes and drugs. And what these drugs are doing, actually, it’s a really amazing proof of concept that these medications, they’re basically antibody-based medications that are sticking to the proteins and getting rid of them, clearing those proteins that we talked about at the beginning. And we know- Sounds good. Yeah, yeah. We’ve known for some time, actually, that we can do this and take them out, for example, from animal studies.
00:29:56 — It’s only really been in the last year that we’ve had evidence that taking out those proteins in the case of Alzheimer’s disease actually has an effect on human progression of the disease. But the issue is that actually, when we do that, the level of gain is actually quite modest. It doesn’t…
Jonathan Wolf
00:30:18 — You mean when someone takes these drugs?
Claire Steves
00:30:19 — Yeah, so we can take the proteins out of the brain, but it doesn’t necessarily mean that we’ve significantly affected their cognition and their function.
Medications and life expectancy
"That's the new, that's the game changer. The process is slowed."
Claire Steves
Jonathan Wolf
00:30:27 — We hear about all sorts of wonder drugs, right? That suddenly solve everything. And then you hear about other drugs where people say, oh, well, it doesn’t really, you know, ultimately didn’t really make much of a difference. How excited are you about these new drugs?
Claire Steves
00:30:39 —Well, I’m excited in principle. I’m excited in principle because we’ve shown a proof of principle that this works in humans and therefore it could be developed on. But the issues are this, that first of all, the gain over a year is only a few points on a cognitive measure. So it doesn’t get, it doesn’t mean that the person then doesn’t have dementia, it’s just that they’re not cured. They’re not, they’re not cured. They probably are, you know, the process is slowed though.
Claire Steves
00:31:07 — That’s the new, that’s the game changer. The process is slowed. Whereas before we’ve been able to give drugs that manage symptoms, but ultimately the process isn’t slowed. So that’s the really exciting game change.
Jonathan Wolf
00:31:19 — How much slowing down are they delivering?
Claire Steves
00:31:21 — So at the moment, not very much slowing down.
Jonathan Wolf
00:31:23 — Okay. Okay.
Claire Steves
00:31:23 — So that’s not so ideal. But we haven’t talked about the main problem with it. Okay. The main problem is, is that actually there’s increased risks. So as you’re taking away the proteins from the brain, you’re also increasing the risk of edema happening in the brain. So that’s swelling in the brain, which can be quite catastrophic. If the brain swells a little bit, there’s inside a fixed space, there’s an increased risk of hemorrhage, little micro hemorrhages within the brain. And so people that are having these drugs…
Jonathan Wolf
That’s bleeding, isn’t it?
Claire Steves
That’s bleeding, yeah. So the people that are having these medications have to have a scan every month.
Jonathan Wolf
00:31:55 — And so what does that mean in reality there? Because those sound like quite scary side effects. Are they very rare or are they quite common?
Claire Steves
00:32:07 — It means that actually the balance of risks and benefits is not totally clear, ultimately.
Jonathan Wolf
00:32:07 — So as a doctor, does that mean you’re not necessarily just saying to everybody who comes in, you should take this drug?
Claire Steves
00:32:12 — Well, they’re not approved in the UK for that reason.
Jonathan Wolf
00:32:16 — And they have been approved in the States?
Claire Steves
00:32:17 — They’ve been approved in the States, yeah.
Jonathan Wolf
00:32:18 — Okay.
Claire Steves
00:32:19 — And normally when that happens,
Jonathan Wolf
00:32:20 — That tells you it’s a bit on the edge. Is that what you’re saying about the balance of benefits?
Claire Steves
00:32:23 — I think the benefit and risk is definitely on the edge if you had all the resources available and then you’ve got to think about actually how are we logistically going to get everybody to be able to have scans every month and what knock on effect is that going to be on being able to get scans for cancer or scans for other things? So there’s a resource issue as well. So if the gain was massive, then you might say, well, that was worth that risk personally and also as a healthcare system.
Jonathan Wolf
00:32:50 — And how many extra years of sort of well-functioning brain am I going to get?
Claire Steves
00:32:57 — Well, we don’t really know yet as well because we’ve only had a couple of years of lead time.
Jonathan Wolf
00:33:02 — Got it. But if you’re going to guess, like, are you talking about like a year or are you talking about like an extra decade?
Claire Steves
00:33:07 — Yeah, it’s not an extra decade.
Jonathan Wolf
00:33:09 — This is not the sort of transformational drug that means we are just, we feel like we’ve conquered dementia.
Claire Steves
00:33:14 — No, but it is a transformational drug because it’s showing us the proof of the idea that it it is possible to take away the proteins from the brain. So all we need to do is do that safe, more safely. Got it. And we need to try doing it in different proteins because it may not be the proteins that are gone after. So you’re saying this like proves.
Jonathan Wolf
00:33:31 — That this approach can work.
Claire Steves
00:33:33 — Exactly.
Jonathan Wolf
00:33:33 — And then maybe this generation of drugs are not ideal, but you’re sounding quite optimistic that maybe this means there’s a path to a next generation of.
Diet and dementia prevention
Claire Steves
00:33:40 — There’s a path to a next generation. Within the next five years, we need to really get our services in order so that we can be thinking about delivering these things because it’s coming.
Jonathan Wolf
00:33:49 — So that’s very exciting. So if you’re living with maybe a family member who’s having this today, then it may not be as positive as you’d like, but if you’re thinking about what might be happening in a decade to a family member or yourself, then actually it sounds like this is quite positive, which is exciting. Like the science is really moving forward and I know you’re quite careful, Claire. So the fact you’re quite positive here, it makes me feel that you’re, you know, that you’re feeling actually really quite enthusiastic about the potential in the longer term.
Claire Steves
00:34:18 — Yes, that’s right.
Jonathan Wolf
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The role of physical activity
"I do tell all my patients to make sure they're physically active at least three times a week."
Claire Steves
Jonathan Wolf
00:35:20 — Well look I think I would love to switch to the stuff that doesn’t involve taking a drug that might make your brain explode because I can understand why that might not be ideal. Let’s start with me so you know I’m someone in my late 40s, I really want to make sure that I don’t have dementia. Give me the advice if I was walking into your clinic tell me what you would be saying that I should be doing in order to try and sure I never had to come back to your clinic in you know 20 years.
Claire Steves
00:35:47 — So actually what I realistically say to patients is it’s about getting as many different colors of fruit and vegetables into your diet as possible and making sure that you’re getting good plant-based fats into the diet because the brain is hugely metabolically active, it needs a lot of nutrients and we know that a wide variety of plant-based nutrients is really important for brain health.
Claire Steves
00:36:11 — And I talk about colors because actually there’s evidence that flavonoids are really key phytonutrients for brain development. It may be because you’re changing the microbiome, because there’s such a thing as a gut-brain axis. So we think that there’s a very strong relationship between what’s going on in our gut.
Jonathan Wolf
00:36:30 — Lots of plants with lots of fiber, lots of different colors, and then you said lots of healthy fats, which means a lot of plant-based fats and so I think you were mentioning nuts. We often talk about things like avocados, right, Zoe, these are the sorts of things that you’re talking about.
Claire Steves
00:36:47 — Yeah, and I think…
Jonathan Wolf
Olive oil, I guess.
Claire Steves
That’s right, and you know, there’s quite a number of studies now showing Mediterranean diet helps to improve cognitive health.
Jonathan Wolf
00:36:59 — So that there is real evidence that the Mediterranean, like changing this, this isn’t just like something, because, you know, doctors always say you should eat more healthily, right? And everyone’s like, yeah, yeah, yeah. There’s real scientific studies that show that switching to this Mediterranean diet, which is high in the things you’re describing and low in like the more traditional Western diet of meats and like white bread and all the rest of it like that actually has an effect on dementia?
Claire Steves
00:37:22 — Yeah and then you so you’ve just mentioned the other thing which is meats and white bread yeah so so we know that there’s a relationship between vascular health and brain health.
Jonathan Wolf
00:37:34 — And vascular health means?
Claire Steves
00:37:36 — The blood vessels within your body and your heart. That’s because one of the other types of dementia that we haven’t really talked about is a vascular dementia. And often there’s a combination actually of vascular factors that then bring on those other processes like Alzheimer’s. So if you’re eating a diet that’s.
Jonathan Wolf
00:37:54 — Good for your heart basically, then that’s also going to be good for your brain.
Claire Steves
00:37:59 — Yeah, it’s going to be good for your brain and it’s going to again put backwards the balance of things that are going on in your brain that might relate to Alzheimer’s.
Jonathan Wolf
00:38:10 — There is real scientific evidence that this shift in diet really can reduce your risk of dementia?
Claire Steves
00:38:16 — So, for example, in the Mediterranean diet, there have been really large randomized control trials that were conducted over a year period in five different countries in Europe. And when they compared the group that were randomized to the Mediterranean diet against the control group, they didn’t find very significant differences.
Jonathan Wolf
00:38:38 — If you manage to change your diet in a sustainable way, it really can reduce your risk of dementia, but you have to stick at it.
Claire Steves
00:38:44 — You have to stick at it.
Jonathan Wolf
00:38:45 — You can’t just do it for a few months and think that you’ve solved it.
Claire Steves
00:38:47 — And the trouble is, that’s difficult.
Jonathan Wolf
00:38:48 — What else would you tell somebody?
Claire Steves
00:38:50 — So the second thing is about physical activity. So, you know, I do tell all my patients to make sure they’re physically active at least three times a week. And they’re going out every day, you know. So these are really important things to do and that can help preserve your physical function as well and your cardiovascular function. It’s probably the biggest thing that you can do to help your overall fitness.
Jonathan Wolf
00:39:15 — And when you say physical activity, when you think about dementia, what’s really required? Because we talk to a very wide range of people who vary between, you know, if you even get up from your chair for two minutes, you’ve done everything amazing to, you know, if you’re not doing a massive workout four times a week, then you’re sort of dooming yourself. But what should people be thinking, like, this is what I really need to make sure that I’m building into my life.
Claire Steves
00:39:42 — So to improve your cognitive health, you need to do more exercise than you’re doing now.
Jonathan Wolf
00:39:47 — Okay.
Claire Steves
00:39:47 — Okay. Up to a point, unless you’re like an Olympic athlete.
Jonathan Wolf
00:39:50 — I’m not an Olympic athlete.
Claire Steves
00:39:51 — So, and so that’s the, and that’s the key thing. Okay. So, and, and this is again about the difference between scientific proof and practical advice. So the reason why there’s this debate between scientists about, you know, what is the dose required of exercise is because to show a change over a short period, you have to have an, a big enough dose to be able to detect that effect. Whereas if we look at really big population studies, um, we can see effects, even with minimal levels of exercise.
00:40:23 — And it’s fairly linear. So even being more up and about, less sedentary time, makes a difference. But then you can still make more difference by putting every egg on. So whatever you’re doing, if you go up by a third, you’ll be improving yourself.
Jonathan Wolf
00:40:38 — And is there any particular sorts of exercises you’re thinking about this?
Claire Steves
00:40:43 — So probably the most evidence is around resistance training exercise for overall frailty and and so on. Then, you know, for cardiovascular fitness, there’s aerobic exercise.
Jonathan Wolf
00:40:55 — I’m one of your patients. I’m not very physically active. What would you be telling me that I should do that can really make a difference?
Claire Steves
00:41:02 — Walking.
Jonathan Wolf
00:41:03 — Walking.
Claire Steves
00:41:03 — I think you need to get out and do walking, you know, 45 minutes, at least three times a week.
Jonathan Wolf
00:41:09 — And that will really make a difference.
Claire Steves
00:41:10 — If I’m not doing that, that will really make a difference.
Jonathan Wolf
00:41:11 — So that, I think again, is amazing. Claire, I think you were like, well, it seems sort of obvious, But again, I think many people listening to this grew up with the assumption, there is nothing you can do about your dementia. It’s just literally a consequence of getting older. And you’re saying, actually, if you went for a walk three times a week, compared to just not doing that, you’re going to make a really significant reduction in the risk. It is rather extraordinary. And does suggest that, you know, our current way we live our life is not very well optimized for avoiding this.
00:41:43 — If that is almost like your starting advice to people, is that?
Oral health and dementia
Claire Steves
00:41:47 — One thing I haven’t really talked about ever before with you is teeth, the importance of teeth. In the UK population, about 35% of older adults have periodontal disease, inflammation of their gums. And we know there’s a quite a strong tight relationship between periodontal disease and cognitive health.
Jonathan Wolf
00:42:07 — And this is, you believe this is true? Because we had somebody on, just if anyone’s interested, a few weeks ago, put a link who was a dental researcher saying this, but I was curious because obviously if you’re a dentist you’re going to be convinced that the teeth are important, but you’re not a dentist so therefore you’re unbiased on this. This is really true, is it?
Claire Steves
00:42:25 — It’s really true. There is a vicious cycle though, obviously, because as you start to get dementia it’s more difficult to look after your teeth and also we know that looking after teeth, actually diet, is really important in looking after teeth. So teeth are much more healthy if you have a good varied diet that we’ve been describing and less sugar and so on and so forth.
00:42:47 — But actually, this is a very common inflammatory load, which is tickling the systemic.
Jonathan Wolf
00:42:53 — Which is amazing. I just heard this literally a few weeks ago. I was shocked to hear this.
Claire Steves
00:42:56 — And actually when I see my patients in clinic, okay, the thing that sort of, just eyeballing, the thing that’s related to that cognitive reserve we were talking about, i.E. The difference between what’s in their brain and how they’re actually living, you know, how they actually present, the people that have the bad teeth will be doing badly. The people that have the good teeth will be doing well.
Jonathan Wolf
00:43:20 — You would be saying if someone is having problems with their teeth, like absolutely going to get it fixed right away because that really could be a big risk factor. What else could people do? And I feel like you mentioned a little bit about intellectual stimulation and social stimulation. Is there anything you can do with your, is this all fake or that, you know, doing things with the brain can help prevent dementia or is there something real about this?
Claire Steves
00:43:43 — Well, no, I think the thing is, it’s about that cognitive reserve as well. Again, okay, so I don’t think, we mustn’t be getting the idea that if you have got a, you know, managerial, high paid job, whatever, you’re doing lots of intellectual activity that you’re immune to dementia. Everybody can get dementia. It’s just that you will present later.
Jonathan Wolf
00:44:04 — So I’m in my late forties. I’m thinking about this right now. Is there anything that I could be doing with my brain over the next 20 years that will change my risk factor? Is there anything I can do there that is actually going to shift it?
Social interaction and brain health
Claire Steves
00:44:19 — Probably one of the most complicated things that we do in our brain is to really interact socially. And so that’s a brain workout.
Jonathan Wolf
So that is better than a crossword puzzle.
Claire Steves
There’s better than a crossword puzzle, but I think much more fun as well.
Jonathan Wolf
00:44:31 — So it’s good news. I know not everybody feels that way. Some people who are more introverted feel this is hard work, but it’s really good for your brain.
Claire Steves
00:44:36 — It doesn’t necessarily mean that some of these brain games aren’t helpful. I think the thing is that what brain games tend to do is they tend to make you better at that brain game. They don’t necessarily.
Jonathan Wolf
00:44:48 — So you need to have lots of different brain games.
Claire Steves
00:44:49 — You’d have to have lots of different brain games.
Jonathan Wolf
00:44:51 — Okay. So it’s not that bad, but actually you’re saying social interaction is so complicated for our brain. That’s really exciting, which also I. I guess ties into why loneliness is another reason why loneliness is not good for us.
Claire Steves
00:45:02 — Yeah. And then physical activity, certain physical activities are really taxing for the brain, aren’t they? In terms of activity. So if you’re like cycling in London, that’s for sure quite taxing.
Jonathan Wolf
00:45:11 — Yes, I always think that it might be lowering your life expectancy for other reasons.
Claire Steves
00:45:15 — Yes, yeah. But there are other sort of forms of physical activity like dancing or whatever, which is quite a good cognitive task.
Jonathan Wolf
00:45:22 — Essentially, so you’re saying, because your brain is having to think quite a lot as well. So basically what you’re saying is using your brain, making it have to do something that his heart is actually going to build, what you’re calling this reserve, which is basically meaning you’re less likely. To suffer from dementia.
Claire Steves
00:45:35 — It’s a tank, what’s in the tank, yeah.
Jonathan Wolf
00:45:36 — We had a lot of questions from our listeners about the link between blood sugar levels and the risk of dementia. And in fact, some of them said that they’ve been hearing people refer to Alzheimer’s disease as type three diabetes. In other words, that because we’ve seen this rise in huge rise in number of people with type two diabetes because of our diets and all of this high blood sugar, that actually this was potentially a risk that was increasing the risk of Alzheimer’s.
00:46:07 — Is this true or another one of these pseudoscience?
Diabetes and dementia
Claire Steves
00:46:11 — No, no, no. We know that having diabetes increases the risk of dementia. Is that right? Probably of all types actually. Significantly. Significantly, yeah, significantly. And then, you know, you do have to be a bit careful if you have dementia and you have diabetes, because it’s not quite as simple as having really tight control of your diabetes in that case, because we know the brain in the context of dementia, you know, does need blood sugar, and actually low blood sugars is really dangerous.
Jonathan Wolf
00:46:43 — This is once you have the dementia, but this is what you’re saying, or once you have the diabetes.
Claire Steves
00:46:48 — If you’re early in life, you know, and we’re talking about the preventative stage, everything you can do to help your blood sugars be normal is better. So over-control probably isn’t very good for the brain, but ultimately the bigger thing is around…
Jonathan Wolf
00:47:05 — Eating too little is not a good thing, is this what you’re saying?
Claire Steves
00:47:08 — Well, no, it’s not about eating too little because, of course, the liver produces the glucose and so on. So, you know, having a really low blood sugar is not good for the brain, for sure. But the main problem is around pre-diabetes or diabetes.
Jonathan Wolf
00:47:19 — So this is real, this rise in pre-diabetes and diabetes is a real contributory factor to dementia. And then presumably that means if you can reverse the pre-diabetes or suddenly control the type two so it doesn’t continue to get worse, that would lower your risk of getting dementia?
Claire Steves
00:47:37 — That would lower your risk of getting dementia.
Women, HRT, and dementia
Jonathan Wolf
00:47:40 — Brilliant. We had one other question from the community that I definitely want to ask, because it came up quite a bit, should women be taking HRT in order to reduce their risk of dementia as they go through menopause?
Claire Steves
00:47:54 — That’s a very interesting and controversial question. There’s quite a few studies that you may be aware of that have happened in the last year which have produced conflicting evidence.
Jonathan Wolf
00:48:02 — I’m not aware of them, so please, but I can tell that some of our listeners are and they of course therefore probably sitting here trying to decode that.
Claire Steves
00:48:09 — Yeah, yeah.
Jonathan Wolf
00:48:10 — What do those things say? What’s your reading of what that means as best we can understand with the latest science as it is today?
Claire Steves
00:48:18 — HRT is not going to be a cure-all that it probably will contribute to reserves, but also it really helps in active day-to-day cognitive function of people going through the menopause. So that’s probably where it’s really important to use it because people who are going through the menopause often have problems with brain function which can be really debilitating.
Jonathan Wolf
00:48:42 — I’ve heard some extraordinary and awful stories and you know I’ve said, I’ve talked about this before that I’ve been shocked because it’s not something when I was growing up that my mother never talked about, like nobody I knew talked about and so as I’ve started to hear some of these stories more recently it’s really extraordinary to me how some people have such a tough time for years.
Claire Steves
00:49:03 — The reason to take HRT is to help that, which is, you know, really important.
Jonathan Wolf
00:49:07 — And it can really help brain function through this period.
Claire Steves
00:49:10 — Yeah, that’s right, yeah. And then, you know, dementia later on, I don’t think that’s a reason to take HRT now.
Jonathan Wolf
00:49:19 — Got it. And you’re saying, at this point, there isn’t data that says this has this profound impact later on that makes you shift to think about it as a preventative?
Claire Steves
00:49:26 — No, in fact, there’s studies that go both ways on this. Okay. So I don’t think we should be taking HRT because of future risk of dementia at the moment unless, you know, let’s see what happens. Because actually the longitudinal studies, you know, bear in mind that people have only been using HRT for the last 30 years or so. So, you know, and who took it and who didn’t take it is confounded by other things.
00:49:52 — So, you know, we, it’s a space that we, that is uncertain, but what’s not uncertain is that many women who have problems with cognition during the menopause benefit from HRT.
Recap: types of dementia
Jonathan Wolf
00:50:02 — One of the things I’ve been really struck through the Zoe journey over the last seven years is how much in science we don’t know the answer to and how much is this constantly ongoing investigation. And I think one of the ways I always judge whether you’re talking to a really good scientist is their caution in lots of areas where they say, I think, as you just have done, Claire, Like the evidence isn’t really there yet and there’s lots more studies. And, you know, I think one of the joys of science is that however, we are making progress, we definitely do know more than we did 10 years ago.
Jonathan Wolf
00:50:35 — And I think this is, it’s just, I think this is a lovely example of that, where. I think you’re saying, um, it’s not yet clear. It sounds like it could be, you might be sitting here in five years time saying, actually, I’m looking at all the data and I do believe that this can really be beneficial long term against dementia, but that actually at this point, the data isn’t clear.
00:50:58 — And I feel that happens a lot in science to do with, you know, the human body because it’s so complicated. I have so many more questions, but I think that we have run out of time. I’m going to try and do a playback. This is a new topic for us and quite complicated one. So please correct me if I get any of this wrong. Is that all right? I think what you described to start with about what is dementia is really contrasting it with sort of normal, healthy brain behavior.
00:51:28 — And so, for example, you said the warning signs are things like starting to lose your short-term memory. So not remember something maybe from five minutes before or not be able to function with something. It seems like normal life, but maybe it’s a bit complicated like managing your finances or making sure you’re doing your medication properly. And that we have to bear in mind, however, that our brains do age as well, even though that’s hidden to us.
00:51:54 — And so I think you’re saying like, you know, if I looked inside my brain, you said this horrible word atrophies, which has really depressing idea. But also, for example, you can see that your reaction speed just naturally gets slower. So the point is, it’s like outside of that, that generally, this is a slow progression. So unlike, you know, a lot diseases it’s sort of like bit by bit rather than suddenly presenting with this very clear different function than you had last week, that it’s caused by nerve cells in our brain dying, this is what’s causing the problem, but that we can see the cause over time with these sort of proteins being stuck in these nerve cells and that indeed you’re quite excited because there are some new drugs coming that are clearing these proteins away. And although this current generation, you feel like the balance between benefit and harm is not that great.
00:52:46 — You’re quite excited about where it might go in the future. Then we talked a bit about why you might get dementia. And you talked, there are some specific genes. So I think you said something like an E4 gene, is that right? If you had two of those, then you have not won the lottery, but even then it’s not guaranteed that you’re going to get this. So that in all cases, actually, there’s a lot through your lifestyle that you can do.
00:53:12 — And I think the way that you helped me to understand it is to think about your brain has this brain reserve, which is not a word I’d ever heard before, which is sort of like this tank that you’re filling up with all this capacity. And that starts actually, even when you’re a fetus, so we can build the brain reserves of unborn children by the food that their mother is eating, but then as they’re born, like how much stimulation they have, their own food, all the rest of it, but you can keep building this reserve as we’re older.
00:53:41 — And so even if we might start to be getting this dementia, if your reserve is big, actually you can live much longer in a healthy way. And then I think in terms of the things that we can do, I think the number one thing you talked about was diet. And I thought it was interesting, you were very strong about how switching diet to something that looks like a diet that is very plant based with lots of different sorts of plants.
00:54:05 — You’re describing sort of eat the rainbow things with a lot of fiber in them. Lots of healthy plant fats. I think you mentioned nuts, for example, specifically as sort of the number one thing. I think the number two thing you said is physical activity. I think you made this great quote to improve your health. You need to do more than you are doing today. So almost whatever you’re doing, if you want to reduce further your risk of dementia. But interestingly, you were saying that actually for most people, but just like going out every day, going for a walk, if you’re not already doing that, we’ll have a profound reduction.
00:54:37 — And Claire is nodding her head hard at this point, if you’re listening on audio. Profound reduction in your risk of dementia. Look after your teeth, which is a new one, but like, so if you’re, look after your teeth. And then intellectual stimulation, particularly just meeting with other people. So socially, social interaction actually being almost the best brain training you can do.
00:55:00 — And you said there are all these different brain training tools and that’s fine, but actually they need to be changing all the time, but actually just sort of interacting with other people a lot probably is pushing your brain more than anywhere else. And then I think finally we said diabetes is a risk. So you want to avoid diabetes or you want to have it under control if you have type two diabetes.
00:55:23 — And HRT, the evidence isn’t there as a cure for dementia in the longterm, but there is great evidence about how it improves your cognitive function during perimenopause and menopause, and that’s a big deal. So you should be embracing it if you have those issues. How did I do?
Hearing aids and dementia prevention
Claire Steves
00:55:39 — Yeah, really good. Can I add two little, a couple of little things? So one is around dementia. When we were talking about it, we were mainly talking about the biggest form of the most common cause of dementia, which is Alzheimer’s, but remember it’s an umbrella term. And so there are lots of, about 25 different other types of dementia, and they do present differently. So ultimately that key is, you know, is this something changing and changing consistently over time in the functioning of the mental capacity of that person? And that’s when to seek help.
Claire Steves
00:56:11 — So don’t not seek help just because short-term memory isn’t the issue. And then the other thing that we didn’t talk about today, but is really important is sensory inputs. Yeah. So ultimately in the same way that social interaction is really important, our interaction with the rest of the world sensorily.
00:56:31 — So we know now that actually hearing aids, if you’ve got hearing impairment, delay the presentation of dementia.
Jonathan Wolf
00:56:39 — That’s amazing. So if you get, I think I remember you talking about this in our conversation a long time ago, you’re saying, if you get a hearing aid, that actually reduces the point at which you get dementia.
Claire Steves
00:56:46 — Exactly. So don’t delay on doing those things. And I think, you know, some people think, oh, I don’t really want to hear. Actually, it does make a difference. So do get those hearing aids, even if it’s a pain to start wearing them at the beginning.
Jonathan Wolf
00:56:59 — And you’re like, that is as good as going for, I’m not saying it’s instead of, but. I mean, we’re talking about it has the same sort of impact as you’re describing with going for a walk.
Claire Steves
00:57:07 — Um, actually, I don’t know whether I can quantify the difference. Yeah. I think this is like a big deal. Yeah, it’s a big deal.
Episode sign-off
Jonathan Wolf
00:57:12 — Amazing. Well, I think, um, uh, the hearing aid, uh, providers, uh, around the world are going to have a busy week, I think after that. Claire, thank you so much for unpacking that. And I think it was really clear. This is a complex topic and I think having done that first overview, I am sure we’d love to come back and dive into some of that again in the future.
Claire Steves
00:57:32 — Thank you very much.
Jonathan Wolf
00:57:33 — Brilliant, thank you. Thank you for joining me on Zoe Science & Nutrition today. It was incredible to learn from Claire just how much we can reduce the risk of dementia, including the critical role of eating the right food for your body. Now if you’d like more actionable tips from the podcast, simply go to zoe. Com slash podcast or click the link in the show notes now on the same link you can also learn more about how becoming a Zoe member can give you specific advice about what to eat for your body that can help you feel better now and reduce the risk of dementia in the years to come you can also get 10% off your membership as always I’m your host Jonathan Wolfe Zoe science and nutrition is produced by yellow humans Martin Richard Willen and Tilly Fulford. See you next time.
Summary with timestamps
Main topics of the interview (00:00:00 – 00:57:33):
- Introduction to dementia and its distinction from normal aging.
- The link between physical activity and reducing the risk of dementia.
- The role of diet and healthy eating in dementia prevention.
- The importance of social interaction and its impact on brain health.
- The influence of diabetes and blood sugar levels on the development of dementia.
- The role of hormone replacement therapy (HRT) for women during menopause.
- The importance of hearing and the use of hearing aids in preventing dementia.
The interview begins with a discussion about the nature of dementia, highlighting the most common cause – Alzheimer’s disease. The speakers discuss the warning signs, including short-term memory loss and difficulty managing daily tasks. The distinction between normal aging and dementia is emphasized, with examples of how reaction speed naturally slows down but shouldn’t be confused with dementia.
This section focuses on how regular physical activity, even simple tasks like walking, can significantly reduce the risk of dementia. The speakers stress that any increase in activity can make a noticeable difference, and it’s important to maintain regular movement throughout life. Physical activities like cycling and dancing are mentioned as beneficial for brain health.
The interview explores how a plant-based diet, rich in fiber and healthy fats, can help prevent dementia. Emphasis is placed on consuming a variety of colorful fruits and vegetables, as well as nuts and olive oil, to support brain health. The Mediterranean diet is highlighted as having scientific backing in reducing the risk of cognitive decline.
Social engagement is described as one of the most complex tasks for the brain, making it an excellent form of cognitive training. The speakers explain that loneliness can increase the risk of dementia, while regular social interactions can help build brain reserves. Intellectual stimulation, like solving puzzles or engaging in varied brain games, is also encouraged but with a focus on diversity in activities.
The conversation shifts to the impact of diabetes on dementia, noting that individuals with diabetes are at significantly higher risk. Managing blood sugar levels, particularly avoiding pre-diabetes, is crucial in reducing the risk of cognitive decline. However, overly strict control of diabetes can be harmful for brain health, especially in later stages of life.
The discussion turns to whether women should use hormone replacement therapy (HRT) to reduce the risk of dementia during menopause. While HRT helps with cognitive function during menopause, the evidence for its long-term effects on dementia prevention remains inconclusive. Women are encouraged to consider HRT for short-term brain function improvement rather than long-term dementia prevention.
The final part covers the importance of sensory health, particularly hearing. Using hearing aids is shown to delay the onset of dementia in individuals with hearing impairment. The speakers recommend not delaying the use of hearing aids, as hearing and sensory inputs are critical for maintaining cognitive health.
