Understanding your Choice & your Future on World Alzheimer’s Day 2024: Healthy Brain Ageing Roadmap

  •   Sat, Sep 21 2024
  •   By Dr B P Shelley

September 21, 2024 

Under the aegis of Alzheimer’s Disease International (ADI), people coming together from all around the world celebrates the month of September as World Alzheimer’s Month and commemorates World Alzheimer's Day every year on September 21st, as an global campaign to raise the awareness of dementia, in particular Alzheimer’s Disease (AD), the challenges of people living with dementia, early and timely diagnosis, and for the advocacy of a public health and policy initiative for sustainable dementia healthcare. This year the ADI is poised to release its annual World Alzheimer Report on World Alzheimer's Day with its focus on “Attitudes towards dementia” with the aim to promoting adequate information about the crippling brain disease in order to build and work together to become ‘Dementia Friendly Society’ across the world.

As a neurologist with specialist training in Cognitive and memory disorders and dementia, it is quintessential for me to educate our society that dementias, traumatic brain injury and stroke are now the hidden epidemic of 'neurologic disability' sweeping across India .In addition, India and other LMICs have a ‘Triple burden’ of not only non-communicable (NCDs) and communicable disorders (CDs), but also Nutritional Diseases. Acknowledging the young population demographics of India as comprising 29% of the total population (420 million) with a median age of 28.4 years in 2024, it becomes unquestionably evident that the ‘triple burden’ disorders would certainly have the potential for disastrous outcomes on our ‘mental and brain capital’ and the well-being of India as a Nation. It is estimated that 57 million people have dementia worldwide, and in India about 8.8 million Indians older than 60 years live with Dementia.

On World Alzheimer’s Day, what is it that I need to advocate for ‘knowing dementia’ and ‘knowing Alzheimer’s’ (AD)? The two most common causes of dementia are AD and vascular dementia. AD accounts for 50-70% of all cases of dementia, about 20-30% have either vascular dementia or a combination of vascular dementia and AD. Is dementia a normal part of ageing? Does ageing per se cause Dementia? Is dementia a curse that is inescapably linked to old age? The answer is that Dementia is not inevitable with ageing. Dementia is a disorder on the “Continuum of aging casualty” and therefore aging is not necessarily accompanied by typical age-associated declines in function. The proof of the pudding comes from people with ‘life at extreme limits’, the dementia free Centenarians (> 100 years age) and Supercentenarians (>110 years age) in certain parts of the world such as Okinawan Islands of Japan and other ‘Blue Zones’ in the world such as Sardinia, Italy; Nicoya, Costa Rica; Icaria, Greece and Loma Linda, California which holds the secrets to successful ageing and healthy longevity.

The secrets to Dementia-free life expectancy (DemFLE) embraces the Science of well-being (SWB), the ‘Wheel of Wellness’ or ‘Salutogenic Health’, the concepts of Brain Health, Brain Well-being and Healthy Brain Ageing (HBA). The SWB approach to Brain Wellbeing, Brain health and Brain Fitness underscores the quintessential integration of biological, behavioural, psychological, social, and spiritual domains over the entire life course, from early (20-40 years) to mid (40-59 years)-late life (after 60 years). It is imperative to be aware that research has shown that AD develops in the course of 20-30years. The dementia process and brain pathology for dementia inexorably creeps in from early to midlife. By the time AD manifest as dementia, the brain neurodegeneration can no longer be prevented.

Healthy Brain Ageing (HBA) through the Science of Brain Health and Brain Well-being would thus form the pivotal route of prevention of dementia. HBA is a burgeoning field that proposes a link between brain health behaviours (brain healthy lifestyle) and maintenance of brain health. Dementia should be understood as a ‘Lifestyle Disease’ and the public and our society at large need to be taught regarding Brain healthy Lifestyles for ensuring Brain Health, and brain well-being from the angle of a life course perspective, as a ‘cradle-to –grave’ approach. Such preventive neurology public health roadmap would pave a sustainable path for brain fitness and charting a successful longevity trajectory towards a future where AD brain process could be stopped before the onset of dementia.

What are the ‘cradle to grave’ life course strategies for Brain Health and Well-being that would protect and enhance the Brain’s cognitive, vascular and emotional health that will keep dementia at bay? The adoption of ‘brain healthy lifestyles’ (Being Brain Smart) would unquestionably pave the way forwards to HBA and a DemFLE. The brain healthy lifestyles would mandate staying physically fit, adopting an active socially integrated lifestyle, (leisure activities, walking, bicycling, gardening ,playing musical instruments, social networking, visiting friends and relatives, going to movies, Hobbies) staying mentally and cognitively active( brain gym activities such as learning, reading, playing games, sudokos, puzzle games, meditation, yoga), being spiritually active, finding purpose in life (PIL or ‘Ikigai’) ensuring eudaimonic well-being (EWB), eating smart adhering to brain healthy diet (the Asian-Mediterranean diet, diets high in fish, fruit, and vegetables fruits), sleeping well, quitting tobacco and alcohol, andcoping stress, depression and anxiety, and by promoting mental resilience for subjective psychological well-being. We should also be ‘Heart Smart’ to be ‘Brain Smart’ by controlling high blood pressure, treating diabetes mellitus, and preventing obesity.

HBA and understanding brain health and brain well-being in a deeper and broader concept, understanding behavioural lifestyle risk factors and biological factors as a life course model approach from the ‘cradle- to- grave’ would alter the risk of dementia in later life. This would undoubtedly guarantee ageing gracefully, and a promise for a positive, creative, healthy brain aging trajectory. Education on ‘knowing dementia, knowing Alzheimer’s’ across our society from children, school professionals, teenagers, adults, and the elderly about brain health and brain well-being should be a wakeup call for our society. Advocating a public health message such as “Take as good care of the brain as you do your body” would sow the seeds of promise for a proactive brain-healthy lifestyle for our children, grandchildren, and future generations.

 

 

 
By Dr B P Shelley
Dr B P Shelley is a senior neurology professor and head of the department of neurology at Yenepoya Medical College.
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Title: Understanding your Choice & your Future on World Alzheimer’s Day 2024: Healthy Brain Ageing Roadmap



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