10 Unexpected Things that Lead to Dementia
"Alzheimer's disease is death before death, and I'm terrified of it."
—Joey Comeau
Dementia, an umbrella term encompassing conditions like Alzheimer's, Parkinson's, and others, is a rapidly escalating global health crisis. Once primarily associated with the elderly, the disease now affects individuals as young as their 40s and 50s. The World Health Organization reports a staggering 55 million people currently live with dementia, a number projected to nearly double every two decades, reaching 78 million by 2030 and 139 million by 2050.
Despite its growing prevalence, the treatment of dementia remains very poorly understood. A disheartening reality is the often limited support and guidance provided to patients when they’re diagnosed. It infuriates me to hear a story of a diagnosis of a patient who was then provided with no strategies for addressing or reversing dementia, and an elusive “see you in 6 months” from the neurologist.
Once considered an inevitable consequence of aging, a fate sealed by genetics and time, dementia is now recognized as being influenced by a complex interplay of factors. While genetics and aging play a role, emerging research finds the critical impact of lifestyle choices on brain health. Beyond the well-known benefits of diet and exercise, surprising elements such as hearing loss, vision problems, and even anxiety can significantly impact the risk of developing dementia.
Let's delve into some unexpected ways to protect your brain.
How to Boost Brain Health & Reduce Your Dementia Risk
1. Hearing Loss
It might seem counterintuitive, but there's a strong link between hearing loss and dementia. A study published in JAMA Neurology found that those with hearing impairment were significantly more likely to develop dementia compared to those with normal hearing. Specifically, for every 10 decibel increase in hearing loss, the risk of all-cause dementia rose by 27%. Compared to individuals with normal hearing, those with mild hearing loss had nearly twice the risk of developing dementia, those with moderate hearing loss had three times the risk, and those with severe hearing loss had nearly five times the risk.
This correlation is believed to stem from the brain's increased effort to process sound, potentially accelerating cognitive decline.
Do this:
It's recommended that you get your hearing checked every 10 years if you're 18-60 years old and every 1-3 years if you're over 59.
Keep the volume as low as you can for all devices such as your headphones, TV, and phone with phone calls.
If you have hearing loss, consider using hearing aids. They not only improve hearing but also reduce the cognitive load on the brain, helping maintain cognitive function.
2. Vision Loss
Similar to hearing loss, vision problems can also increase the risk of dementia. Studies have shown that individuals with vision loss are at a higher risk of developing dementia. One 2021 study involving 3,817 older US adults showed that all types of visual impairment—including distance acuity, near acuity, and contrast sensitivity—were linked to higher dementia prevalence, with multiple visual impairments showing a stronger association than a single one.
Specifically, the prevalence of dementia was 12.3% overall but increased significantly to 21.5% with near acuity (difficulty seeing objects up close), 32.9% with moderate to severe distance acuity (difficulty seeing objects at a distance), and 25.9% with contrast sensitivity impairment (difficulty distinguishing objects from their background).
Do this:
It's recommended that you get your vision checked every 2 years for 18-60 year olds and annually if you're over 59
Check out this article on ways to improve your eye health through nutrition and supplements
Drink enough water, avoid staring at screens for too long, walk outside, and get enough sleep. These are all associated with improved vision.
3. Head Injuries
Concussions and other head injuries can have long-term consequences, including an increased risk of dementia. Moderate to severe TBIs (traumatic brain injuries) have been found to increase dementia risk 2- to 4-fold, while the association between mild TBIs and dementia is less clear, although multiple mild TBIs, such as those in professional athletes, are linked to chronic traumatic encephalopathy (CTE).
Another study found that while there were no differences in objective cognitive function between older adults with and without a history of TBI, those with a history of TBI involving loss of consciousness were 28% more likely to report subjective memory impairment compared to those with no TBI history, even after adjusting for demographics, medical conditions, and depression.
Do this: Protect your head. Wear a helmet, wear a seatbelt, limit or avoid contact sports, and never drink and drive. The more TBI and SCI I’ve seen in the hospital, the less risky I’ve become. It’s better to play it safe than to have one moderate head injury and increase your risk of dementia by four times. Also, if you do have a concussion, seek medical help.
4. Alcohol Use (kind of)
This one surprised me. I assumed drinking more than a couple of beers a week would increase your risk of dementia but the research says otherwise.
In a 2020 systematic review, researchers found that low to moderate alcohol consumption does not significantly increase the risk of dementia and may even be protective compared to abstainers. High alcohol consumption (>14 drinks per week), however, is linked to an increased risk of dementia and brain damage. That being said, the variability in study results and potential confounders like underreporting, socioeconomic status, and "sick quitters" (those who abstain because they have health problems related to their drinking habits) make it challenging to establish causality.
A more recent 2023 study of nearly 4 million South Koreans, found that maintaining mild to moderate alcohol consumption was linked to a lower risk of dementia compared to sustained non-drinking, while, again, heavy drinking increased dementia risk. Specifically, people who reduced their alcohol intake from heavy to moderate levels or began drinking mildly showed a decreased risk of dementia. The results indicate that a modest amount of alcohol consumption could be beneficial for reducing dementia risk, and changes in drinking habits can significantly impact this risk.
Do this: Maybe the best news I’ve uncovered yet? While this may sound good for light and moderate drinkers, take it with a grain of salt. Here are some other tips to mitigate the negative effects of alcohol, if you decide to drink:
Time your alcohol intake 3 hours away from bedtime (and 3-4 hours away from a workout)
Avoid low-quality alcohol
Have protein before you drink
Drink with friends
5. Your Breath
That thing we do thousands of times a day and rarely think twice about, has a profound impact on our health. Controlling it, in the form of breathwork, has been shown to improve pain management, anxiety, asthma, depression, and overall well-being. But how does it impact our risk of dementia?
When I work with a patient with any type of dementia, such as Alzheimer’s disease, one of the most obvious signs tends to be their breathing patterns. Alzheimer’s disease causes respiratory issues such as pneumonia, shortness of breath, muscle weakness, and obstructive sleep apnea. One review highlights the complex relationship between Alzheimer’s disease and sleep apnea, suggesting that sleep apnea might both result from and contribute to Alzheimer’s disease.
So researchers looked at the use of breathwork as a way to help manage the symptoms of Alzheimer’s.
In one study participants practiced either slow-paced breathing to enhance heart rate variability (HRV) or used personalized techniques to reduce it over four weeks. Those who engaged in slow-paced breathing (which increased heart rate variability) experienced a significant decrease in plasma amyloid beta levels. Conversely, those who used strategies to decrease heart rate variability saw an increase in amyloid beta levels.
Another study explored the impact of deep and slow breathing on cognitive functions such as learning and memory. Participants were divided into three groups: a rest group, a before group who practiced deep and slow breathing before learning new skills, and an after group who practiced deep and slow breathing after learning. Significant improvements in cognitive skill retention, attention, working memory, and spatial perception were seen in the deep and slow breathing group compared to the other groups.
While there’s limited research on the correlation between dementia and respiratory function, the good news is that controlling your breath is free and you can always practice it.
Do this:
Track your HRV (find out what that is here) and look for ways to increase it.
Practice a handful of breathwork techniques and pick 2-3 favorites that you can do on a daily basis.
My favorites: Bellows Breath, Extended Exhales, and Resonance Breathing (find them here and here).
6. Loneliness
Loneliness has been a growing concern for years, but the COVID-19 pandemic starkly illuminated its impact on our well-being. While occasional solitude is normal, prolonged social isolation poses a significant risk to both physical and mental health.
As humans, our survival has historically depended on cooperation and community. Our ability to thrive in groups is ingrained in our DNA and when we don’t fulfill this innate desire for social connectedness, our brain function suffers.
Research underscores the alarming consequences of social isolation. Studies have shown a direct link between loneliness and an increased risk of premature death from various causes. Moreover, the impact on brain health is particularly concerning. Social isolation has been identified as a potent factor in accelerating cognitive decline, increasing the risk of dementia by 50%.
Do this: Schedule trips with friends, monthly dinners with family, weekly bike rides with your friends, or backyard happy hours with the neighbors. Sign up for a pickleball league, a morning walk and coffee group, or volunteer. Whatever activity you put around it, just make sure you’re in the physical proximity of friends and family more often.
7. Exposure to Toxins
Environmental toxins are significant contributors to dementia, including Alzheimer's disease (AD). Here are some of the many environmental toxins affecting our health:
Heavy Metals: Lead, mercury, and aluminum can accumulate in the brain, causing neuronal damage and cognitive decline. Chronic exposure to these metals increases the risk of AD.
Air Pollution: Fine particulate matter (PM2.5) in polluted air penetrates the blood-brain barrier, leading to brain inflammation and oxidative stress. High pollution levels are linked to higher dementia risk.
Biotoxins: Toxins from bacteria, molds, and viruses can cause chronic brain inflammation and cognitive deficits. Viral infections like HSV-1 activate pathways linked to AD.
Pesticides and Herbicides: Long-term exposure to agricultural chemicals like organophosphates is associated with increased dementia risk due to their neurotoxic effects.
Mechanisms of Toxic Damage: Toxins promote amyloid-beta plaques, oxidative stress, inflammation, and apoptosis, all contributing to neurodegeneration.
Research has found that chronic exposure to environmental toxins works through a variety of mechanisms including amyloid-beta plaque deposition, apoptosis, inflammation, and oxidative damage.
Do this: Small choices in your daily routine can add up to big wins for your brain health.
Eat organic produce (use EWG's Clean 15 and Dirty Dozen as a guide).
Use glass containers instead of plastic ones.
Eat foods with limited or absent antibiotics, hormones, or toxins such as certified organic grass-fed and grass-finished beef, low-mercury fish, grass-fed and organic dairy, and organic pasture-raised eggs.
Filter your water (my recommendation here)
Prioritize natural ventilation in your home and use an air purifier.
Check your home for lead-based paint, especially if your home was built before 1978.
Choose non-toxic cleaning products.
To learn more about toxins, check out The Non-Toxic Living Guidebook: Hacks, Strategies, & Natural Products for Better Health. I wrote this comprehensive guide as a way to break down the complexity of toxins into a simple, easy-to-read format with practical tips and clickable links to the least toxic products I could find. Get your copy today and use the code MBD20 at checkout for a 20% discount. You can also get a paperback or hardcopy on Amazon.
8. Inflammation
Chronic inflammation is characterized by the activation of immune cells in the brain, leading to the release of harmful molecules that damage brain cells. Research suggests that factors such as oxidative stress, amyloid-beta plaque buildup, and tau protein tangles can trigger this inflammatory cascade, impairing synaptic function.
Furthermore, studies have shown a correlation between inflammatory markers in the blood and the risk of developing Alzheimer's disease. This study of a large cohort of 433,556 individuals found that higher biomarker levels were linked to worse performance in several cognitive tasks, such as 20.4% worsened prospective memory,36.6% worsened fluid intelligence, and a 34.9% increased risk of dementia, with significant associations remaining even when controlling for variables such as age, sex, and APOE ε4 status.
Do this: Hit the basics to lower your inflammatory levels. Also, get blood tested.
Eat an anti-inflammatory diet
Manage stress
Drink enough filtered water with enough electrolytes
Manage your stress
9. Poor Oral Hygiene
Poor oral health is a significant concern, with chronic periodontitis affecting approximately 20% of adults worldwide, according to the WHO, and even more older adults. Chronic periodontitis is a severe gum infection that damages the soft tissue and destroys the bone supporting the teeth, leading to tooth loss and an increased risk of systemic health issues. Dale Bredesen writes that,
"The mouth is one of the most important sources for the insults of cognitive decline."
A small study of 60 participants found that periodontitis was not related to initial cognitive state but was linked to a six-fold increase in cognitive decline rate over six months, along with increased systemic inflammation. Meanwhile, a systematic review and meta-analysis of 47 longitudinal studies found that poor periodontal health--periodontitis, tooth loss, deep periodontal pockets, or alveolar bone loss--was associated with a 23% increased risk of cognitive decline by and a 21% increase in dementia. Tooth loss alone raised the risk for both cognitive decline by 23% and dementia by 13%.
Another study with nearly 10,000 patients found that patients with 10 years of chronic periodontitis exposure had a 71% higher risk of developing Alzheimer's compared to those without chronic periodontitis.
Do this:
Address cold sores (a.k.a. herpes simplex virus type 1 or HSV-1)
Use an electric toothbrush and a water pic
Do oil pulling
Use a non-toxic mouthwash
And, you know, brush and floss
10. Anxiety
Speaking of managing stress, research has found that anxiety disorders, especially in midlife, may be a precursor to dementia, potentially accelerating cognitive decline. A longitudinal study involving over 2,000 participants (mean age 76 years) found that chronic anxiety and new onset anxiety increased the risk of all-cause dementia by 180% and 220% respectively, with an average time to dementia diagnosis of 10 years. The increased risk was particularly significant in those under 70 years old, with chronic and new anxiety raising the risk by 358% and 621% respectively, whereas resolved anxiety did not increase dementia risk.
The biological mechanisms linking anxiety and dementia aren't entirely understood; however, theories include chronically elevated cortisol levels, neuroinflammation, and anxiety-related behaviors such as sleep disturbances and unhealthy coping mechanisms, which may further exacerbate cognitive decline.
Do this:
Practice these three breathwork strategies
See out talk therapy with a licensed professional
Ask yourself, “How does this serve me?”
Focus on addressing the six dimensions of health: sleep, nutrition, movement and exercise, stress management, socialization, and mindset. Sign up for my newsletter for a PDF that ranks your success in these and provides specific ways to improve.
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