Follow our social media campaign at #ExeterDementia

Five ways people can act on dementia

Dementia can happen to anyone and there's currently no cure. It can be devastating for people who have it, for their families and carers. Yet research is a cornerstone of hope. A key focus is identifying what action people can take to reduce their risk of developing dementia, and how we can support people to live well with dementia.

To mark Dementia Awareness Week we asked some of the world-leading researchers working on dementia at the University of Exeter to give us some insights into the condition based on their areas of expertise.

1. Your lifestyle influences your risk of developing dementia

There are many different types of dementia; the most common is Alzheimer’s disease. Many people don't realise is that in about one third of cases lifestyle plays a part in whether or not someone develops Alzheimer's.

The risk of developing Alzheimer’s is increased for people who:

• Are overweight or obese.
• Have high blood pressure in middle age.
• Smoke.
• Drink alcohol to excess.
• Experience depression.
• Have diabetes (at any age).

 There are ways of reducing this risk. These include:

• Being physically and mentally active.
• Being involved in social activities.
• Eating a healthy diet rich in fish and vegetables.
• Taking promotion or staying on in education
• Regularly engaging in evidence-based brain-training programmes

 Researchers are working on ways of helping prevent people developing dementia.

Professor Linda Clare, Professor of Clinical Psychology of Ageing and Dementia, The Centre for Research in Ageing and Cognitive Health, College of Life and Environmental Sciences

Dr Anne Corbett, Senior Lecturer in Dementia Research

2. 10 minutes of daily social interaction can reduce agitation 

People with dementia need meaningful and enjoyable activities to help them live well. Meeting these needs helps to reduce agitation, restlessness and aggression in people with dementia.

Just ten minutes a day of social activity, tailored to the interests of the person involved, made a significant impact in reducing negative behaviours, by almost a third.

The study was conducted in 318 people, and the team has called for a robust, large-scale trial to examine the effects in more depth.

Their results indicate that the social interaction approach could be useful to prevent agitation, restlessness and aggression.

This approach could reduce the numbers of people who are prescribed antipsychotics to manage their behavioural symptoms. The most commonly antipsychotics cause terrible side effects in people with dementia, quadrupling the risk of stroke and death in Parkinson’s disease. Reducing the prescribing of these drugs through preventing symptoms such as agitation from escalating is one way of helping people to live well for longer.

Professor Clive Ballard, Pro-Vice Chancellor and Executive Dean, University of Exeter Medical School

3. Gardens and mealtime music in care homes can improve lives for dementia residents

Around a third of people with dementia in the UK are cared for within long term care or nursing homes. Opportunities to help people to feel better without the use of medication are important.

Spending time in a garden or outdoor space can be relaxing and calming for residents of care homes, their families and staff.

A systematic review (a study that brings together all existing research on a particular question) lead by the PenCLAHRC Evidence Synthesis Team from the University of Exeter Medical School found 17 small studies that looked at the impact of horticultural therapy on the wellbeing of people with dementia with three of them looking at the impact of horticultural therapy on the wellbeing of people with dementia.

The key findings were:

• There was a promising impact on the level of agitation in care home residents with dementia who spend time in a garden.
• Gardens need to offer a range of experiences to suit different needs.
• Families valued somewhere pleasant to meet that stimulated interest and conversation.
• Staff said residents found the gardens calming.
• However, there were some barriers to use, such as the perception of the garden as a hazard and sometimes limited staff time for supervision.

The same team carried out a review around mealtimes, when any.  agitated or aggressive behaviours tend to occur. A systematic review of 11 studies looked at small, inexpensive changes, and found that they could make a positive impact.  They found that playing relaxing music had a particularly long-lasting effect, beyond that of the mealtime itself.

 The research suggests that simple alterations such as mealtime music and access to gardens could make a significant difference to people with dementia. Further work in this area should focus on measuring key concerns in consistent ways, and on understanding and solving the causes of limited accessibility.

In a similar vein, the team has recently been awarded Economic and Social Research Council (ESRC) funding to develop a training toolkit that helps care home staff improve residents’ access to nature.

Dr Jo Thompson Coon, Associate Professor and Dr Rebecca Whear, Research Fellow, Evidence Synthesis Team, University of Exeter Medical School

4. Your vitamin D levels are linked to dementia risk

Vitamin D deficiency is associated with a substantially increased risk of dementia and Alzheimer’s disease in older people according researcher led by Dr David Llewellyn at the University of Exeter Medical School.

In a six-year long study of elderly Americans it was discovered that adults who were moderately deficient in vitamin D were 53 per cent more likely to develop dementia, this increased to 125 per cent in those who were severely deficient.

Similar results were recorded for Alzheimer’s disease, with the moderately deficient group 69 per cent more likely to develop this type of dementia, jumping to a 122 per cent increased risk for those severely deficient.
Vitamin D comes from three main sources:

• Exposure of skin to sunlight
• Foods such as oily fish,
• Supplements

Older people’s skin can be less efficient at converting sunlight into Vitamin D, making them more likely to be deficient and reliant on other sources. In many countries the amount of UVB radiation in winter is too low to allow vitamin D production.

Dr David Llewellyn, University of Exeter Medical School

5. Eating a Mediterranean diet may help reduce dementia risk

Over recent years many pieces of research have identified a link between eating a Mediterranean diet and a lower risk of age-related disease such as dementia. A Mediterranean diet typically consists of high consumption of plant foods such as fruits, vegetables, legumes and olive oil, moderate consumption of fish and dairy products, and reduced intake of red meat and processed foods. Moderate alcohol intake, usually wine, during meals is another common characteristic.

A systematic review led by Ilianna Lourida from the University of Exeter Medical School found 12 eligible pieces of research; 11 observational studies and one randomised control trial. In nine out of the 12 studies, a higher adherence to a Mediterranean diet was associated with better cognitive function, lower rates of cognitive decline and a reduced risk of Alzheimer’s disease.

Researcher Ilianna Lourida said: "The Mediterranean diet is highly nutritious, and our systematic review shows it may help to protect the ageing brain by reducing the risk of dementia. While the link between adherence to a Mediterranean diet and dementia risk is not new, ours is the first study to systematically analyse all existing evidence. Robust clinical trials are now needed to confirm these observations."

Ilianna Lourida, Associate Research Fellow, University of Exeter Medical School

To find out more about dementia research at Exeter, visit: http://www.exeter.ac.uk/dementia/

Date: 12 May 2017