Dementia and lifestyle: 14 factors to consider

What is vascular dementia?

Vascular dementia is dementia caused by damage to the blood vessels in the brain. As a result, brain cells receive less oxygen and nutrients, which makes them function less effectively. It usually occurs in people between the ages of 65 and 75. Damage to the blood vessels in the brain can be caused by multiple transient ischemic attacks (TIAs) or may result from a brain hemorrhage or stroke. This is also known as a cerebrovascular accident (CVA). Depending on where in the brain the damage occurs, the symptoms can vary widely. Most people experience difficulties walking, begin to speak more slowly, have trouble thinking, and suffer from memory problems (Brain Foundation - Vascular Dementia).

How does vascular dementia develop?

Normally, when the blood vessels in the brain are healthy, they ensure that oxygen-rich blood and nutrients reach the brain cells. On the other hand, the blood vessels also help remove waste products and oxygen-poor blood from the brain. In vascular dementia, the blood vessels are damaged, which impairs the exchange of substances with brain cells. In short, brain cells receive less oxygen and nutrients, and waste products accumulate in the cells. This negatively affects the functioning of brain cells, causing information between brain cells to be transmitted less efficiently or not at all within a brain network.

What are symptoms of vascular dementia?

Vascular dementia is often characterized by the sudden onset of symptoms, or symptoms develop slowly as multiple unnoticed TIAs occur in the brain. Depending on which areas of the brain are damaged, symptoms can be more physical or mental in nature.
Common mental symptoms include slower speech, thinking, and movement, difficulty maintaining attention, mood swings, difficulty initiating activities, and memory problems.
Common physical symptoms include difficulty walking and maintaining balance, difficulty swallowing and speaking, incontinence, a stiff and tense feeling in the legs, sometimes paralysis on one side of the body, and epilepsy.

What causes vascular dementia?

The causes of vascular dementia are not yet fully understood. However, it is known that certain hereditary factors play a role, and lifestyle influences the condition of the blood vessels. High blood pressure, high cholesterol, smoking, obesity, diabetes, stress, certain hereditary factors, and environmental substances are all factors that increase the risk of damaged blood vessels and thus vascular dementia (Heart Foundation - Causes of Cardiovascular Diseases).

Preventing dementia: healthy lifestyle

To keep the blood vessels in the brain healthy, the same lifestyle advice applies as for heart and blood vessels: one could say that everything that is good for the heart and vessels is also good for the brain. Additionally, for the brain, low stress and the right amount of stimuli are just as important to keep the brain healthy.

Recently, an important summary, supported by studies, was published on how healthy lifestyles can reduce the risk of dementia (Livingston The Lancet Commissions 2024). Additional evidence showed that lifestyle changes can be cost-effective and that the risk of developing dementia can be influenced, even for people who have a genetic predisposition to dementia.

The authors wrote that theoretically, 40% of dementia cases could be prevented by living healthily. They presented a hopeful picture, showing that about 45% of all dementia cases are associated with 14 risk factors that can be influenced by lifestyle changes or by providing sufficient cognitive stimuli.

These risk factors are:

1. Lack of education
2. Head injury
3. Lack of physical activity
4. Smoking
5. Obesity
6. Elevated cholesterol
7. High blood pressure
8. Diabetes
9. Depression
10. Lack of social contact
11. Air pollution
12. Excessive alcohol consumption
13. Untreated vision loss
14. Untreated hearing loss

The authors also outlined an action plan to prevent dementia by specifically addressing these factors (prevention). To achieve this, policy changes are needed at both national and international levels, with strategies tailored to individuals and made available to everyone, regardless of wealth. These actions to reduce the risk of dementia should start early in life and be sustained throughout life. Specific actions to take during life to reduce the risk of dementia include:

1. Ensuring that quality education is available to everyone and promoting activities that stimulate the brain throughout life to build cognitive reserve (cognitive reserve is the ability of an individual to compensate for damage in the brain, resulting in remaining mentally healthy in old age).
2. Mandating or encouraging the wearing of helmets to prevent head trauma in traffic or during sports.
3. Encouraging sufficient daily physical activity, as people who are physically active have a reduced risk of developing dementia.
4. Stopping or reducing smoking by informing about the risks, controlling prices, and banning smoking in public spaces. And helping people to quit smoking.
5. Maintaining a healthy weight and treating obesity as early as possible. This also helps prevent type 2 diabetes (also a risk factor).
6. Measuring and treating high cholesterol from age 40, and lowering it with medication if necessary.
7. Regularly measuring and monitoring high blood pressure from age 40, and lowering it with medication if necessary.
8. Detecting, treating, and stabilizing diabetes with medication.
9. Effectively treating depression.
10. Promoting an age-friendly environment that encourages social interaction and reduces social isolation.
11. Reducing air pollution and exposure to it.
12. Reducing alcohol consumption by controlling prices, making it less available, and raising awareness of the risks of overconsumption.
13. Making vision screening and treatment available through check-ups, surgeries, laser treatments, or prescribing glasses or contact lenses.
14. Making hearing aids available for people with hearing loss and helping protect hearing from damage due to exposure to harmful loud noises.

How can Bike Labyrinth help with healthy lifestyles?

Bike Labyrinth can contribute to a healthy lifestyle in various ways. First, cycling itself supports sufficient daily exercise. The distracting images can make you cycle longer than you initially thought. Moreover, the content of the images stimulates the brain in various ways. Discovering new environments, making choices during the virtual ride, and the sense of traveling activate brain areas involved in storing new information. Cycling through a familiar environment also evokes memories and stimulates the part of the brain responsible for retrieving these memories. By adding sound, both vision and hearing are stimulated. Cycling together or having a conversation about what is seen on the screen can lead to valuable social interactions and a sense of connection. The simplicity of the system and the possibility of using it with a wheelchair make Bike Labyrinth accessible to everyone, regardless of age or limitation.