The daily habits that boost brain health and help ward off dementia, according to the experts
Survey after survey shows dementia is the disease we fear more than any other, even cancer – but there are simple steps we can take to protect ourselves, say experts.
This has been confirmed in a major study published today by Oxford University, which found that drinking less alcohol, reducing your risk of type 2 diabetes and avoiding traffic pollution are the most important factors in cutting your risk of dementia.
Dementia is characterised by a build-up in the brain of a protein called amyloid, and while there are new drugs such as lecanemab that can reduce this, it’s not clear what effect these will have on patients’ symptoms and there are potential side-effects, including brain swelling.
One expert recommends chewing mints to help combat the risk of dementia, as bacteria in the mouth is thought to trigger inflammation in the brain
But what is clear is that many people could avoid or delay the onset of the disease through healthy lifestyle measures and treating risk factors.
Indeed the Lancet Consortium on Dementia Prevention, published in 2020, concluded that as many as 40 per cent of dementia cases could be prevented or delayed by targeting 12 modifiable risk factors.
These are: Getting at least seven hours of sleep a night; regularly challenging the brain; looking after mental well-being; staying socially active; looking after your hearing; eating a balanced diet; staying physically active; quitting smoking; drinking responsibly; keeping cholesterol and blood pressure in check; and managing diabetes (if you have it).
We all need to realise that the processes that cause dementia don’t just happen in old age, explains Professor Paul Matthews, 67, a director of the UK Dementia Research Institute and head of the department of brain sciences in the faculty of medicine at Imperial College London.
‘The Finger study, which monitored 1,200 people in Finland at risk of cognitive decline [as a result of lifestyle factors such as high blood pressure] found that interventions to help with diet, exercise and cognitive training significantly improved or maintained cognitive function,’ he says.
‘This was an important finding – the first reasonably large study in dementia to show that you could possibly reverse the progression of early phase cognitive performance loss, with interventions.’
Other international centres are looking at lifestyle changes and adding in the diabetes drug metformin, which helps to lower blood sugar levels.
‘The hypothesis is that metformin can tweak the ageing process of cells, including brain cells,’ says Professor Matthews. ‘It could have a similar effect to the impact statins have had on preventing cardiovascular disease.’
Here, we asked top dementia experts what steps they take themselves to ward off the disease. (And it seems it’s never too young to start thinking about it, as some of our experts are in their 30s...)
Walks briskly for 33 minutes a day
Sir Muir Gray, founder of the dementia risk reduction programme, walks briskly for 33 minutes a day to reduce the risk of dementia
Sir Muir Gray, 79, is a senior figure in UK public health and screening programmes and the founder of the dementia risk reduction programme (livelongerbetter.uk).
‘To reduce my risk of dementia I walk briskly for 33 minutes every day – that’s the recommended 30 minutes, plus an extra minute for every decade past 60 (I’m in my 80th year now).
‘I make or take all my telephone calls while out walking. I’m a little breathless walking at this pace, but I’m still able to hold conversations – that’s what you’re aiming for.
‘This type of exercise reduces the risk of atherosclerosis – thickening or hardening of the arteries – which can cause dementia, strokes and heart attacks. Brisk walking also directly protects the brain tissue.
‘Isolation and lack of engagement have also emerged as key risk factors for dementia – I’d like to ban the word retirement and call it renaissance instead.
‘It is important for brain health to keep challenging yourself intellectually; that could be working to make more money, or even more important, doing something with a social purpose for the greater good. ‘Joining a committee of a voluntary group, charity, or a parish council is a great way to stay intellectually challenged and socially engaged in later life.’
Watch TV for half an hour after work
Dr James Gratwicke, 40, is a consultant neurologist at St George’s Hospital in London and the HCA London Bridge Hospital.
‘A little bit of intermittent stress is not necessarily a bad thing as it increases levels of the hormones cortisol and adrenaline which can improve mental focus, but you don’t want to be continually stressed. ‘Too much stress, leading to persistently elevated levels of these hormones, can increase metabolism in brain cells, causing a build-up of toxic by-products, which damage brain cells.
‘This is why if you have a job or profession where you are under a lot of stress frequently and struggle to disengage, it’s important to find a way of destressing and relaxing.
‘My way of doing this is to watch TV – only for half an hour – but it’s a good way of disengaging from background cognitive stress. It can be a really useful way for people who find it hard to switch off from the rapid-fire of their busy working lives.
‘Visual attention is very strong in animals and humans and half an hour of TV is enough to absorb you and disengage your working memory from turning a lot of competing demands over in the background.’
.... and sleep between 10PM and 6AM
‘I also make sure I get seven to eight hours’ sleep – crucially in a window between 10pm and 6am,’ says Dr Gratwicke.
‘This is the time when the brain clears out waste proteins during sleep, so it’s not just about getting enough sleep, but sleeping during that precise window, as the brain’s clearing up of toxic proteins doesn’t work as well outside that time period.
‘This is because it works in-sync with the body’s 24-hour body clock.’
Join a choir and snacks on nuts
Dr Susan Mitchell, of Alzheimer’s Research UK, follows the Mediterranean diet which is thought to protect against damage to brain cells
Dr Susan Mitchell, 47, is head of policy at Alzheimer’s Research UK.
‘I try to follow the Mediterranean diet – it’s generally healthy and thought to be good for anti-ageing, while its high levels of antioxidants may protect against damage to cells including brain cells.
‘It means eating a mainly plant-based diet with lots of fruit and vegetables, nuts, pulses, wholegrains, olive oil and seeds. I love lentils and chickpeas, and I’ll often snack on nuts or add seeds to soup, yoghurt or salad. I only eat meat and fish occasionally and try to eat a variety – the “rainbow” plate – of different coloured fruits and vegetables.
‘I’ve also realised the importance of learning new things. I’ve recently joined a choir – partly because I want to learn a new skill and get better at singing, but also for the social interaction which has been shown to be protective against dementia.’
In bed by 10PM
Brain imaging specialist Dr Ian Harrison, of University College London, sticks to a strict bedtime of 10pm every day
Dr Ian Harrison, 36, is a senior research fellow at the Centre for Advanced Biomedical Imaging at University College London, who specialises in brain imaging.
‘When it comes to lowering my own dementia risk, I swear by a good night’s sleep. I used to go to bed later, but I’ve now become strict about going to bed at 10pm every day, even at weekends.
‘The time I wake up depends on my children, aged five and four, but I set my bedtime early to give my brain the best chance to rest and have a clear-out during the night.
‘The brain has a cleaning system, called the glymphatic system, which removes a build-up in proteins and waste products.
‘We know from studies that the glymphatic system is 70 per cent more active when we sleep. If there is an impairment in the system due to lack of sleep, then this may lead to a build-up of proteins, including amyloid.
‘Anecdotally, we all know that we have a fuzzy head if we have a bad night’s sleep: this may be due to the glymphatic system not clearing out all the waste products.
‘We know from animal studies that exercise boosts the function of the glymphatic system, so I also go for a run and go to the gym every week, as well as cycling to work.’
Switch off phone at night
For the same reasons about sleep and brain health, Roger Watson, 68, an honorary professor of nursing at the University of Hull, who works in care of older people, always switches off his phone at night.
‘The light and potential buzzing can be disruptive to sleep – and studies suggest that broken sleep has an impact on our risk of dementia,’ he says.
Chew on mints with xylitol
Psychiatry professor Chris Fox, of the University of Exeter, uses mints containing xylitol. The artificial sweetener improves oral health which is thought to be linked to dementia
Chris Fox, 57, is a professor of psychiatry at the University of Exeter and a consultant old-age psychiatrist at Norfolk and Suffolk NHS Foundation Trust.
‘As well as looking after my health generally, I take good care of my teeth to reduce the risk of dementia.
‘I use mints containing xylitol [an artificial sweetener]. This not only reduces dental cavities but xylitol actually gets rid of nasty bacteria, too.
‘There is emerging evidence that it creates a healthier oral microbiome [the community of microbes in the mouth].
‘One study from Bristol found the same bugs that can cause problems in the mouth were found in post-mortem brains of people who died from Alzheimer’s.’
One suggestion is that oral health may be linked to dementia as the bacteria may trigger inflammation in the brain.
The thinking is that porphyromonas gingivalis, the bacterium that causes gum disease, crosses the blood brain barrier – a protective boundary.
This can potentially alter brain cells, contributing to dementia.
Consciously avoid walking on busy roads
Dr Tom Russ, 43, is a reader in old age psychiatry at the University of Edinburgh and champion of the NHS Research Scotland Neuroprogressive and Dementia Network.
‘I make a conscious effort to avoid walking along main roads and find back street routes where possible.’
Air pollution was added to the list of modifiable factors to reduce dementia by the Lancet Commission in 2020. This follows studies, including one in Canada of 6.6million people, that have shown living on a main road is associated with a higher risk of dementia.
Those living within 50 metres of a major road were 7 per cent more likely to develop dementia than people living more than 300 metres away, where fine particulate matter levels [the particles of pollution that can get into the bloodstream] can be up to ten times lower.
‘Pollutant distribution depends on weather conditions, though,’ adds Dr Russ.
Heatwaves and high pressure, for instance, can create stagnant air and pollutants are not dispersed – and winds can distribute pollutants over a wide area.
‘There are questions that remain unanswered about pollution and the brain, though,’ he says. ‘One is whether pollution is just a subtle effect on your thinking skills or does it have a structural effect on the brain?’
Avoid traffic, wood fires and passive smoking
Dr Russ is not the only one who avoids traffic – there is some suggestion that pollution contributes to brain inflammation, says Gill Livingston, 64, a professor of psychiatry of older people at University College London.
‘My work is located near one of the most polluted roads in London, so if I walk there, I drop back a street and walk parallel to the road, to avoid traffic.
‘It’s why it is also important to try to get away from pollution as much as possible, by spending leisure time or doing exercise in parks or in the countryside.’
She also avoids exposure to wood fires and passive smoking as both produce particulate matter.
Cut weekly alcohol intake from 14 to seven units
Professor Paul Matthews of the UK Dementia Research Institute has reduced his alcohol intake to between seven and ten units a week, down from 14
Professor Matthews has reduced his alcohol intake since finding a link between drinking and a shrinking of the brain.
‘A few years ago we did a study that showed an association between drinking alcohol and higher rates of brain volume loss.
‘In adults, the brain begins to lose half a teaspoon of its size [about 0.3 per cent of its volume] every year, and on average drinking two small glasses of wine a day doubles the rate of volume loss.
‘The base rate is low, though – doubling only increases the volume loss from 0.3 to 0.64 per cent. But we know people who experience more rapid rates of brain volume loss tend to develop more cognitive symptoms earlier than people who don’t have a rapid rate.
‘We have observed this association between alcohol and loss of brain volume in people who drank within the normal range, though the effect was larger in those who drank heavily.
‘I have certainly reconsidered my own alcohol consumption since completing this study – and I’ve cut back to between seven and ten units a week, down from 14.'
Learn the piano and cycle 20km a day
Dr Bal Athwal, 58, a consultant neurologist at the Royal Free Hospital and The Wellington Hospital, both in London.
‘As you get older I believe it’s really important to challenge your brain by learning new skills. I’ve taken up the piano, I’m not very good at it yet but it’s something I find mentally challenging. I am also learning Italian.
‘What you are doing when you learn a new skill is fostering the interconnectedness of the brain’s regions and pathways.’ In other words, boosting connections which is thought to help maintain cognitive function and mental resilience even if there is some deterioration in the physical structure of the brain, he explains.
‘Exercise is also really important for brain health because it improves blood flow and enhances wellbeing and mental alertness (though the mechanisms for how this happens are complex).
‘I tell patients it has to be the vigorous kind – you need to push yourself and get a little bit sweaty and do this several times a week. The way I fit this in is by cycling 20km to work and back in the summer months and doing a couple of gym sessions a week.’
Have an eye test every year
It’s now well-established that hearing loss is a leading preventable cause of dementia, and addressing it could reduce the risk by 8 per cent, according to the Lancet Commission on dementia prevention.
Mild hearing loss doubled dementia risk, moderate hearing loss tripled it and severe hearing loss increased the risk by five times.
The theory is that not being able to hear well and the lack of social stimulation that follows is associated with a higher risk of brain shrinkage and damage.
But while it’s no surprise to learn that wearing hearing aids when you need them is key, Dr Emer MacSweeney, a former NHS consultant neuroradiologist and founder of Re:Cognition Health brain clinics, says it is also important to have your eyes checked.
Research published in the journal JAMA Neurology in 2022 by the University of Michigan found that 1.8 per cent of all dementia cases are vision related, equating to 100,000 of the 6million US dementia cases. The authors concluded that vision impairment should be considered alongside other risk factors for dementia.
‘The less well we hear – or lip read, which is key for our understanding of what’s being said – the less opportunity there is to have meaningful conversations that can stimulate the brain,’ says Dr MacSweeney.
‘It’s why I make sure I have an eye test at least once a year. And if you think you might need glasses, you should see your optician.’
...and deliberately use 'wrong' hand
Another step Dr MacSweeney takes is to try to put pressure on her brain by using her non-dominant hand for some tasks.
‘So as well as making sure I brush my teeth and use interdental brushes [to protect against mouth bacteria linked to dementia], I swap hands when using my toothbrush,’ she says. ‘Using the non-dominant hand can provide an additional workout for the brain.’
Similarly, she ‘supercharges’ her exercise regimen.
‘It’s well-recognised that exercise plays a role in helping reduce the risk of Alzheimer’s.
‘But research also tells us that you’ll get an even greater boost if you do a form of exercise that say, unlike jogging, makes you have to think about what you’re doing.
‘So as well as running, I do HIIT – high-intensity interval training – four to five times a week.
‘This involves short bursts of exercise, with lots of instructions to follow. This mental effort can play a part in reducing your risk – which is why I also do yoga, which requires concentration. These activities are essential at every age.
‘It’s never too early or late to create and maintain habits to maintain a healthy brain and delay the potential onset of all causes of dementia.’
Don't add salt to food
Dr Sarah-Naomi James, 33, is a senior dementia research fellow at University College London.
‘Dementia doesn’t just happen in old age, it starts decades before. We now know that there is an association between high blood pressure [around 140/90 from midlife, roughly between the age of 40 and 50] and developing dementia.
‘I’m in my 30s but I look after my physical health and I’m particularly careful about checking salt levels on packets. And I don’t add salt to food, either.
‘Blood pressure tends to rise with age, but there is something about what happens in mid-life that seems to be particularly important, although we don’t know what the mechanism is yet. One theory, though, is the pulsating pressure damages the brain.’
Try to speak and read French
Carol Brayne, 66, is a professor of public health medicine at the University of Cambridge.
‘Studies have shown that factors such as social engagement, intellectual engagement, having a complex occupation and higher education are associated with a lower risk of dementia, although they don’t eradicate it completely.
‘Our brains change quite a bit as we age, in the ways they are wired, and I think at the highest level our brains are meant to be stimulated.
‘My message would be that you need to do things you enjoy, though. Enrich your life by taking up activities that you like and can become better at, at any life stage.
‘On a personal note, I enjoy trying to sustain my French language skills through reading and speaking whenever I can!’
