Stroke, dementia, and subsequent depression. These are significant issues that become more prevalent as we age—often overlooked, yet surprisingly frequent in our older population.
Moreover, the abundance of information available today makes it challenging to determine effective preventative measures. Are these conditions purely genetic? Do they stem from our environment? Or can we actually enact changes that make a difference?
Recent research published in the Journal of Neurology, Neurosurgery and Psychiatry offers encouraging insights and a clear starting point.
Led by Dr. Sanjurasin from the Brain Care Lab at Massachusetts General Hospital and Harvard Medical School, the study systematically reviewed data on modifiable lifestyle factors linked to the three critical brain conditions.
The team discovered 17 interconnected risk factors associated with stroke, dementia, and subsequent depression—all of which are within an individual’s capacity to change.
“These are actionable steps that everyone can incorporate into their lives,” Shin explained in an interview with BBC Science Focus. “For example, dietary choices, physical activity, or adhering to blood pressure medications prescribed by a doctor—all factors influenced by socioeconomic conditions that may not be easily altered.”
Instead, the emphasis is placed on daily habits that can be reshaped, such as diet, sleep, exercise, social connections, and mental engagement.
17 Modifiable Risk Factors for Brain Health
This study outlines 17 overlapping factors impacting the risks of stroke, dementia, and consequent depression, which encompass both protective and risk-enhancing behaviors. They can be categorized based on quality and context, such as dietary choices and social engagement.
Here’s the complete list:
Protective Factors:
- Low or very low alcohol consumption
- Regular engagement in cognitive activities like reading, puzzles, and acquiring new skills
- A nutrient-rich diet comprising vegetables, fruits, dairy, fish, and nuts
- Moderate to high levels of physical activity
- A strong sense of community
- Extensive social networks or substantial social involvement
Risk-Increasing Factors:
- Hypertension
- Elevated Body Mass Index (BMI)
- Hyperglycemia
- High cholesterol levels
- Hearing impairment
- Kidney disease or renal dysfunction
- Chronic pain affecting daily activities
- Symptoms of depression
- Diet high in lean meats, sugary beverages, sweets, and sodium
- Sleep disorders or prolonged sleeping periods
- History of smoking
- Feelings of loneliness or social isolation
- Chronic stress or stressful life events
Each factor was associated with at least one of the three conditions explored in the study, and often with two or three. While certain factors, like kidney dysfunction and hearing loss, may not intuitively seem linked to brain health, their impacts can be significant.
Noteworthy Findings
To pinpoint the most influential risk factors, Singh’s team reviewed 182 meta-analyses from the last two decades and selected the 59 most reliable. They calculated the impact of each factor using disability-adjusted life years (DALYS), which measures the burden of conditions, and assigned normalized scores.
One risk factor rose to prominence: hypertension.
“People often associate blood pressure with heart health,” Singh noted. “However, our review highlights it as the most critical factor for brain health. It’s essential to monitor your blood pressure and understand your numbers. If elevated, consult your doctor and adhere to prescribed treatment.”
Hypertension is known to harm small blood vessels in the brain and contribute to the development of all three conditions. However, it’s not the sole important factor.
The study also underscores that kidney dysfunction, hyperglycemia, depressive symptoms, poor sleep, obesity, smoking, and chronic stress negatively affect brain health. These risk factors tend to compound one another.
Healthy Choice Menu
The encouraging news is that these factors are interconnected. Addressing one area can often lead to improvements in others.
However, this doesn’t mean that an all-at-once overhaul is necessary. Singh cautions against attempting to tackle everything simultaneously. “Our aim is to suggest gradual changes; bombarding someone with all 17 factors can be overwhelming. We encourage individuals to select what resonates with them and work on that—other improvements will often follow.”
Indeed, motivation presents a significant challenge. “Behavioral science indicates that maintaining lasting changes is difficult.” Other obstacles, like time constraints and financial means, can also impede habit formation.
A potent strategy is to involve others. Whether walking with friends, cooking healthy meals with a partner, enrolling in classes, or engaging in activities that blend lifestyle changes with social connections, you’re more likely to stay committed.
“We strongly advocate for collaborative exercise,” Singh emphasizes.
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When to Start
Some risk factors are more critical at specific life stages. For instance, hypertension during middle age seems particularly detrimental to long-term brain health. Nonetheless, it’s never too late to make changes.
And what if you’re starting later in life? Don’t wait.
“You’re never ‘too old.’ Addressing modifiable risk factors is beneficial at any age. Whether you’re 20 or 80, everyone can take steps, however small, to better brain health.”
Notes on Limitations
This study presents a robust framework for prevention, but it does not demonstrate causality. It relies on observational studies, which can indicate associations but do not establish direct cause-effect relationships.
As Dr. Anya Topiwara, a consultant psychiatrist at Oxford University who did not participate in the study, remarked in an email to BBC Science Focus: “It’s important to recognize that this paper examines associations rather than experimental findings. Hence, due to various biases, one cannot directly infer causation between risk factors and disease.”
For example, while alcohol consumption may appear protective in moderate quantities, it can mislead. “Individuals with higher socioeconomic status or education levels tend to drink moderately. These individuals are typically healthier and less likely to face dementia diagnosis and perform better on memory assessments.”
In essence, some correlations may stem from other underlying variables, like education, income, and healthcare access.
A Message of Hope
Despite the limitations, the overall outlook is optimistic. Singh emphasizes that the findings aim to empower rather than overwhelm. “This is a hopeful paper. There are numerous controllable factors that can lower your illness risk.”
“Based on estimates, up to 45% of all dementia cases could potentially be prevented by managing modifiable risk factors, alongside 80% of strokes and 35% of later-life depression. There’s a lot you can do to maintain a healthy and happy brain.”
So whether it’s taking a walk, learning something new, monitoring your blood pressure, or cooking a meal with a friend, the core message is simple: start where you can. Your efforts may yield more benefits than you realize.
About Our Experts
Sanjurashin is a physician scientist and Oxford-trained epidemiologist, whose expertise merges clinical medicine, epidemiology, behavioral science, and global health innovation. She became a professor at Massachusetts General Hospital and Harvard Medical School by the age of 28. Singh founded Singh Lab within Brain Care Labs, where she and her team are innovating scalable, evidence-based interventions aimed at preventing stroke, dementia, and subsequent depression.
Anyatopiwarra earned her medical qualification at Oxford University and subsequently specialized in elderly psychiatry. In 2017, she completed her DPhil in Psychiatry centered on an MRC-funded study, “Predicting MRI abnormalities using longitudinal data from the Whitehall II study.” In 2019, Topiwala received the Wellcome Trust Clinical Research Career Development Fellowship to investigate how physical mechanisms related to alcohol consumption impact brain health.
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Source: www.sciencefocus.com
