New Insight on Preventing Dementia

An aging brain depends on blood flow.

Posted Jan 24, 2020

"Senile" is a term that, medically speaking, simply means "old."  Over the years, it has unfortunately become something of an epithet.  "You must be getting senile!"  For years, the picture of aging meant that we became slow (physically and mentally), frail and daft—sitting on our front porch watching the grass grow and maybe yelling at the neighbor's kid.


This was our picture of age because that's what aging does—if we let it.  Guess what:  We don't have to.  Our current understanding of aging has advanced considerably, and we now have tools to better manage it.

Dementia is a loss of cognitive function.  We don't think as well as used to.  Alzheimer's is a specific variant, which poses many challenges, but it is quite possible that the most common form of dementia is actually not Alzheimer's.  It's vascular dementia. 

Vascular dementia is in fact what used to be known as senile dementia—the age-related loss of higher brain function.  It is also called multi-infarct dementia because clearly, if you have a stroke (a brain infarct), your brain will not work as well as it did before the stroke.  A stroke is brain damage.

So, vascular dementia is the loss of cognitive function from interrupted or inadequate blood flow to the brain. 

Guess what: there is a lot of overlap between Alzheimer's and vascular dementia.  We may not have a complete understanding of the progression of Alzheimer's, but we certainly have an extensive understanding of vascular health and of vascular aging.

A major problem is this:  Brain doctors deal with brains.  They don't deal with blood flow.  Who does that?  Cardiologists.  When is the last time you went to a cardiologist and asked, "Hey doc, can you help me prevent dementia?"

Cardiologists (heart and vascular doctors) typically don't even know that they hold all of the tools for the prevention of vascular dementia (but they do).  So, make it simpler for them.  Ask your doctor, "Are we doing everything we can do to prevent a stroke?"  At least maybe your doctor will listen to that question.

You see, heart disease is related to natural aging.  It is a well-described, predictable process.  That makes it measurable and manageable.

If you want a healthy brain, you need a healthy heart.  If your heart is not healthy, you will have trouble pumping blood up to your brain.  If you don't get enough blood to your brain, your brain will eventually suffer.  That is, you will fade into the senile sunset.

How healthy is your heart?  To know you have to look.  Yes—heart and vascular disease is a "silent" killer, silent because it does not have to produce symptoms.  It is silent, but it is not invisible.  You can see it, but you have to look.  This is not hard to do.  Start with an ultrasound.  If we can look at babies, we can look at hearts.  Any doctor can order a cardiac ultrasound (also called an echo).

What's between my heart and my brain?  Your arteries (known as the carotid arteries).  How healthy are your arteries?  I don't know—did you look?  You can.  Again, it's not hard to do.  Why look?  Age alone will give us plaque growth (it's the body's natural healing response to the stress of 100,000 heartbeats a day).  I don't care how good you look on the outside, you don't know your health on the inside until you look.  Everybody ages.  No one is immune.

Diet and exercise are great ways to slow aging. Statin medications can also help slow or stop vascular aging.

Also, the older we get, the slower and more irregular our heart becomes.  Young athletes have a slow heart because they are fit, but once we crest over the hill into our 60s, 70s, 80s, and beyond, our hearts will continue to slow because we are old, not because we are fit.

If your heart is beating zero times a minute, you are dead.  If you're beating 20 times a minute, you're almost dead.  If your beating 40 times a minute, either you're an Olympic athlete or you're old and not getting enough blood to the brain.  Fix that.  It's what pacemakers are for.  I have seen many men go completely daft out of stubbornness (and not getting a pacemaker). 

What's more, the slower you are, the more likely you are to have atrial fibrillation.  That's what the heart does when it's impatient, waiting for a heartbeat:  It becomes irregular.  Sustained irregular heartbeats are what we call atrial fibrillation (or afib) and it's really, really common.  Most people don't even feel it, but the blood isn't flowing smoothly.  When that happens, it starts to clot.  When you cut yourself, a clot is good.  When clots form inside our hearts, they have a tendency to travel to the brain.

That is exactly what a stroke is.  The most common strokes are blood clots in the brain.

Well, who allowed that to happen?

All heart and vascular health is knowable.  Are you taking a Stoke Prevention Med?  No?  Do you know the health of your heart?  Do you know the health of your arteries?  Do you know your heart's rate and rhythm? 

Or are you just making assumptions based on feeling good and looking good?

Symptoms don't predict risk.

You don't know your health on the inside until you look.

No one is immune to aging.

If you don't want vascular dementia, then prevent strokes.

You can prevent a stroke.  You may need to ask your doctor how.