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Rob McNab: Use it or lose it — your mind, that is : dementia in Lifestyle medicine and primary care)

I may have mentioned this before, but there is only one condition that truly worries me on a personal level: dementia. There are a few reasons for this. Any condition that decreases my ability to think or remember makes it hard to be me. Dementia runs in my family. I saw firsthand how it impacted the lives of both my grandmothers. It is painful to see proud, functional seniors lose their autonomy as their cognitive abilities decline.

As a doctor, I have partnered with many families as they struggled to recalibrate their lives to a new reality where a spouse, a partner or a parent is now fully dependent upon them. It is a painful process for most of us.

The risk of dementia rises as we age. According to the Population Reference Bureau, “Approximately 3% of adults ages 70 to 74 had dementia in 2019, compared with 22% of adults ages 85 to 89 and 33% of adults ages 90 and older.”

Surprisingly, women are a bit more likely to develop dementia than men. Among adults ages 70 and older, 11% of women and 8% of men had dementia in 2019. As of 2021, around 6.2 million Americans were living with Alzheimer’s disease, the most common type of dementia. As our population continues to age, we should expect those numbers to rise as well.

Unfortunately, there are no cures for dementia. In fact, there are few treatments available. The few medications marketed for dementia treatment are thought to slow down the disease progression in a disappointingly modest way.

That being the case, prevention in lifestyle medicine and primary care is where we need to be putting our resources. “An ounce of prevention is better than a pound of cure” is exactly the right strategy when thinking of dementia.

As a lifestyle medicine and primary care practicioner, this was on my mind as I read a research article from the Journal of the American Medical Association released Sept. 12. It was titled “Sedentary behavior and incident dementia among older adults.”

This was an observational study performed in the United Kingdom. It followed almost 50,000 people 60 years and older for almost seven years. All of the participants’ activity levels were monitored by a wearable device.

At the end of the study, the researchers looked at how many hours a day a person was sedentary and correlated levels of activity to risk of dementia. Bedtime sleeping was not considered part of the sedentary time in this study.

Before we look at the findings of the study, here are some things to consider:

• What is sedentary activity? It’s defined as awake behaviors that use little energy performed in a sitting or reclined position. This would include using a computer, playing video games, watching television or driving a car.

• Did you know that half of Americans sit more than 9.5 hours per day? The U.S. Bureau of Labor statistics for 2022 suggests about 65% of us work at jobs considered sedentary or “light” in physical exertion. Making the situation worse, according to some studies, up to 80% of our leisure time involves sedentary activities. There might be more esports than sports going on these days.

So what did the research find? Starting at about 10 hours of sedentary activity per day, our risk of dementia begins to rise. The more hours of sedentary activity, the higher the risk. Those who were sedentary for 15 hours per day or more were greater than three times more likely to develop dementia.

To me, this study is both a warning of a risk and a valuable insight into what to do about it. We know the majority of us have very sedentary daily lives

— “half of Americans sit more than 9.5 hours per day.” That is a lot of people whose risk is higher than they may be aware of. It’s hard to dodge a risk you don’t know about.

It also offers a solution: We need to ensure our work and leisure are active. Standing desks and taking stairs can help cut our risk of non-curable dementia. Less fantasy and more football will keep our risks contained. Anything that gets us out of our chairs, off the couch and onto our feet helps protect us from losing our most valuable possession — the ability to be ourselves.

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