In the United States there are almost 10 million people living with age-related dementia. Chances are that you know someone who has been affected by it. Dementia differs from the normal cognitive decline that occurs with aging and includes Alzheimer's disease, vascular dementia, Lewy body dementia, frontotemporal dementia, and unspecified dementia. In this post we will cover the types of dementia, the underlying causes, how dementia is viewed in Chinese Medicine, and the best way of preventing its onset.
Types of Dementia
Alzheimer's Disease
Accounting for 60-80% of all cases, Alzheimer's Disease, is the most common form of dementia. In 2023 there were 6.9 million documented patients, and the number continues to rise year after year. Women are twice as likely to develop Alzheimer's as men. Blacks and Hispanics are twice as likely to develop it than Whites. It is the fifth leading cause of death in patients over 65. Symptoms (problems with memory and completing everyday tasks) usually develop gradually. Classically connected to the buildup of amyloid plaques in the brain, the causes of Alzheimer's may be more complex than previously expected.
Vascular Dementia
Making up 15-30% of all cases, vascular dementia is the second most common form of dementia. Caused by damage to the blood vessels in the brain, this form of dementia is a common sequelae to strokes, heart attacks, embolisms, and aneurisms. Typically affecting older patients, vascular dementia is now becoming more and more common in younger populations with the concurrent rise in type 2 diabetes, cardiovascular disease, and hypertension.
Lewy Body Dementia
Approximately 5-15% of all cases are Lewy body dementia making it the third most prevalent form. Like Alzheimer's, Lewy body dementia primarily affects older individuals but is more common in men. It is caused by the buildup of a specific type of protein (Lewy bodies) in the brain. This type of dementia is usually marked by major changes in behavior and temperament.
Frontotemporal Dementia
Less than 1% of dementia is attributed to frontotemporal dementia. Caused by deleterious protein buildup in the frontal and temporal lobes of the brain, this form of dementia usually affects cognition, behavior, and speech. Patients are likely to have suffered some kind of traumatic brain injury, but there are also other causes.
Other Forms
This category includes all other forms of dementia including Creutzfeldt-Jakob's disease and some variants of Parkinson's disease.
Causes of Dementia
The causes of dementia is a long debated and contentious topic. Recently, a landmark paper that was published in the journal Nature in 2006 was actually retracted for falsified data. That paper, which was cited in 2,500 subsequent studies, claimed a clear link between Alzheimer's and a specific type of amyloid protein. While this retraction is concerning on many levels, above all it points to the need to better understand the causes and comorbidities of dementia.
There appear to be two clear types of dysfunction happening in the brain of someone with dementia. One type is structural, including the physical accumulation of proteins or the destruction of blood vessels or other necessary structures. The other type is metabolic, also including the build up of proteins, but the utilization of other metabolites as well.
There are clearly genetic and sex-linked factors at play with dementia. Interestingly, people who are homozygous (have two alleles) for Apoe4 have a 60% chance of developing Alzheimer's disease by age 85. Luckily that is only 2% of the total population. There seems to be a large component of epigenetic variability at play with developing dementia, meaning that the environment plays an important role in how genes are expressed.
Alzheimer's and Lewy body dementia are often diagnosed 20-30 years after the disease itself has started to progress. This leads little time and hope of reversing symptoms once they begin to show, which is why prevention and early detection of certain risk factors is key. Those factors include the following:
Insulin resistance and obesity
Hypertension
Chronic exposure to toxins
Alcohol and drug use
There is good research suggesting that dementia is linked to the brain's inability to use it's preferred fuel sources, thus resulting in metabolic byproducts. Some scientists are even calling Alzheimer's disease 'type 3 diabetes,' because the patients' brain cells have lost the ability to properly use glucose.
While a healthy lifestyle including a balanced diet, adequate exercise, and restorative sleep, seems like a no-brainer for curbing the risk of developing dementia, reaching these goals can be extremely challenging for people. Hopefully, the next two sections will help make it easier.
Dementia and Chinese Medicine
In Traditional Chinese Medicine (TCM) the brain is called a ;curious organ; and is lumped in with the Kidney System. This makes sense, in so much as the health of the brain is greatly affected by age and genetics and the Kidney governs both of those factors. In TCM the Kidney is responsible for maintaining our short term memory, which can fade as we get older. But what about other traits that we typically equate the brain/mind, such as intellect and personality?
Intellect is actually the spirit of the Spleen System and is called Yi. The Yi is responsible for long term memory. By no coincidence, the Spleen is also the system responsible for the digestion and assimilation of food, which means that it also governs blood glucose. The main pathology that affects the Spleen is the accumulation of Dampness or Phlegm. Both of these can negatively affect the intellect, slowing it down or harassing the Heart, which we will discuss next.
The 'eyes are windows the the soul' is how the saying goes. Eyes are direct connections to a person's Shen in TCM. The Shen is the spirit of the Heart System and is said to open into the eyes. Interestingly, the Heart also governs the tongue and speech. Aphasia, a common symptom in dementia is directly connected to the Heart. The Heart is also negatively affected by Dampness and Phlegm created by the Spleen, and is said to become blocked or harassed by it. Dementia and various mental disorders are actually categorized as 'phlegm misting the orifices' in TCM. This sounds eerily similar to the buildup of metabolic byproducts in the brain.
Prevention of Dementia
If most dementia begins decades before symptoms occur AND treatment of dementia is all but impossible at the moment, then prevention is truly the best policy. Each person has their own unique health landscape, but there are several generalized recommendations that will apply to the vast majority.
A low inflammatory diet, rich in nutrient dense plant and animal products seems to be a good starting place. Max Lugavere details the exact brain-boosting super foods in his book Genius Foods, but a quick summary includes antioxidant rich fruits and veggies, omega three fatty acids from wild-caught fish, and protein from grass-fed beef and pastured poultry. Recent studies suggest the power of a ketogenic diet to reverse certain diseases of the brain.
Adequate exercise as defined by the American Department of Health and Human Services includes a minimum of 150 minutes of moderate-intensity aerobic exercise or 75 min of vigorous-intensity aerobic exercise each week. Twice-weekly whole-body resistance training is also recommended. These measures are essential for increasing the body's sensitivity to insulin and lowering blood pressure.
We are exposed on a daily basis to millions of novel molecules due to the industrialization of processes and products. To limit toxic load on the brain it is important to avoid exposure to certain chemicals common in herbicides, pesticides, artificial colorings and flavorings, synthetic scents and cleaning agents. Chemicals found in cigarettes, alcohol, pharmaceuticals, and illegal drugs can also cause harm.
Last but not least, one of the most important factors in preventing dementia is a robust social network. Our brains evolved to interact with other people and accomplish unified goals. Today, our elders are becoming more and more isolated, leading to fewer and fewer social ties. The people that stay in connection with friends and family, making time to see them face-to-face and engage in meaningful ways, have a far better chance of staying cognitively sharp until the day that they die.
Further Reading
The Genius Trilogy, Max Lugavere
Brain Energy for Mental Health, Dr. Chris Palmer
The 36-Hour Day, Mace and Rabins
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