Cheryl Martin (Host): We all want to keep our minds sharp and healthy as we age. The good news is, there are lifestyle changes that can help reduce the risk of developing dementia. Dr. Michael Soboeiro, a Primary Care Physician, is with us to share some practical tips and great resources that can assist in preventing memory loss. This is WakeMed Voices, brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. I'm Cheryl Martin. Dr. Soboeiro, great to have you on to discuss this topic. 

Michael Soboeiro, MD: Thank you, Cheryl. I'm glad to be here.

Host: First, what is dementia? 

Michael Soboeiro, MD: The definition of dementia is a decline in cognition involving one or more of the main cognitive domains. And those are learning and memory, language, executive function, complex attention, perceptual and motor function, and social cognition. Now to be defined as dementia, a person must have one of these declines that interferes with daily functioning and independence. 

Host: Now, when we talk about Alzheimer's, what's the difference there? 

Michael Soboeiro, MD: Alzheimer's disease is a form of dementia. About 60 to 80 percent of cases of dementia are Alzheimer's disease. There are other causes of dementia. There is vascular dementia. There is Lewy body dementia. There is frontotemporal dementia. There is dementia caused by Parkinson's disease. The majority of these are neurodegenerative, meaning that the process that's caused by the disease causes degeneration of the brain. So they're different diseases that all end up causing dementia. 

Host: So if a person begins to experience some memory loss, some of the symptoms that you mentioned, it doesn't necessarily mean that they have dementia, right? 

Michael Soboeiro, MD: That's right. So, the first point to make is that memory loss is a normal part of aging. It is normal for those of us who are getting into our 50s and 60s and 70s to have some memory loss. Memory is, is probably best when you're about 18 to 20. So some memory loss is normal. And patients often ask us, gee, doc, I'm having some memory loss, is this dementia? Is this early dementia? One of the important things that we see is that patients with dementia don't usually present to doctors saying, hey, doc, I'm losing my memory. They're usually brought in by family members. So one of the easiest ways to differentiate is when patients say to me, Hey Doc, I'm losing my memory. It's usually not dementia. 

Host: What is the current state of treatment for those who've definitely been diagnosed? 

Michael Soboeiro, MD: Let me kind of get to my main theme to answer that question. Patients have been coming in to see me for years saying, Doc, I want that pill for dementia. I want to take what's out there so I don't get dementia, or I want my mother or grandmother or aunt to take that pill for dementia, and my response for 30 years that I've been doing this is there really is no pill to prevent dementia.

The best way to prevent dementia is with good, healthy lifestyle. And then recently, if you've followed the news, there have been some new drugs out for dementia. And this has really, increased the number of questions about, hey doc, what about this new drug for dementia? So let me tell you a little bit about this drug.

And I'm certainly not trying to take anything away from this drug and the people who worked very hard to bring it to the market. But the newest drug we have is called Leqembi. And Leqembi, in a clinical trial showed about 25 percent less cognitive decline than what is normal or baseline for people who have Alzheimer's disease.

To quote one of the researchers who worked on Leqembi, "it takes people who are declining at 60 miles an hour and slows them to declining at 45 miles an hour." So, when somebody takes a drug like Leqembi, it might keep them out of long term care for six months. It would have a very modest benefit like that.

Again, to quote another Alzheimer's researcher, "Leqembi is slowing an already slowly progressive condition. It's probably not a perceptible slowing day to day." So clearly this drug has modest benefit. Now, the drug cost when you throw everything in, is probably over $100,000 a year. It also has a significant number of side effects, including swelling of the brain and brain bleeding.

 The point I'm trying to make is this drug and drugs like it are not the answer for Alzheimer's. The answer for Alzheimer's disease is prevention. It is lifestyle and prevention. And so that's the case that I try to make to my patients. 

Host: Let's talk about lifestyle and the changes that can help reduce the risk of someone developing dementia. 

Michael Soboeiro, MD: There are currently 159 studies in progress of lifestyle interventions to prevent dementia. Now these studies are hard to do because you're using large populations and it's hard to kind of pinpoint what you're looking for, but some of this research has already shown the benefits of certain factors and the benefits are seen for controlling blood pressure, Mediterranean diet, good adequate sleep, daily physical activity, social engagement, being engaged with other individuals, cognitive training, keeping your mind active, doing puzzles, reading, playing games, the treatment of hearing loss. If you have hearing loss, it significantly increases the chances of developing dementia. So the treatment of hearing loss, smoking cessation and also the avoidance of binge drinking or heavy alcohol use. So those are all factors that have had some benefit in research studies thus far. 

Host: When you say adequate sleep, what is adequate sleep? 

Michael Soboeiro, MD: Adequate sleep really means in the population of older adults, about seven to nine hours of sleep a day. So not getting too little sleep and also not getting too much sleep. 

Host: So really, applying all of these changes can probably make the most difference then in preventing dementia? 

Michael Soboeiro, MD: I really think that if those of us in our 40s and 50s and 60s start thinking in terms of how can I best modify the risk factors that I have and improve the behaviors that I have, that we can make a significant difference in preventing cognitive decline. And I want to tell you about one other study that inspires me.

So, this study was published in the CDC, Centers for Disease Control Weekly in 2022. And it showed eight important risk factors for cognitive decline. These are the things I mentioned before. High blood pressure, lack of physical activity, smoking, excessive alcohol use, obesity, diabetes, depression, and hearing loss.

Now, the presence of cognitive decline was 3.9 percent in patients with no risk factors, and it was 25 percent in patients with four or more of those risk factors. So clearly, getting those lifestyle issues, risk factors under control can make a significant difference in whether an individual develops cognitive decline and dementia. 

Host: Now, what about those who have a history of dementia in the family? Let's say one parent or both had dementia, does that increase your chances? 

Michael Soboeiro, MD: Most of the research shows that like almost any medical disease that having a family history, does increase the chances. And, those chances vary depending on the disease. But, if someone has a family history, then I think it's even more crucial to be working on these lifestyle approaches, lifestyle changes, behavior modifications, earlier and more aggressively. 

Host: Are there common believed causes of dementia that lack strong scientific evidence? 

Michael Soboeiro, MD: There are. People have often wanted to attribute dementia risk to medications. There hasn't been much evidence of that. Clearly, there are some medications specifically, medications like opiates and benzodiazepines, which we think probably contribute to cognitive decline.

But there have not been any studies showing vitamins or statins or estrogen or any of the medications that we commonly give to people are related to dementia. And I'm sure there are also beliefs out there about other behaviors. But really the factors that I've talked about are the factors that we've seen related and they're the common things we talk to patients about every day.

Smoking, alcohol use, obesity, lack of exercise, things like that. 

Host: Are there any resources or tools that you can recommend for people looking to improve their brain health? 

Michael Soboeiro, MD: There are. There's a lot out there on the internet and I would point people to a couple of specific places. The Alzheimer's Association has a lot of information about Alzheimer's disease itself, how to deal with it in a family member, but also preventive measures. The National Institutes on Aging has a website that presents a lot of this information for patients and for lay people that's easy to use. And the other resource that I think is excellent is using one's primary care provider and discussing one's concerns or one's family history or one's lifestyle. 

Host: Now, you mentioned the new drug that came out, but are there any new research findings or upcoming studies on dementia prevention that you're excited about? 

Michael Soboeiro, MD: I'd go back to the 159 studies that are in progress of lifestyle interventions. I'm really interested in seeing the results of some of those and maybe we'll see something that really comes to the fore as a factor, such as exercise or such as Mediterranean diet, or maybe a factor we have not yet identified.

And I also think, there's a lot of research being done on new pathways, new mechanisms for medications, which can have more of an effect on the treatment of dementia than what we currently have available to us. 

Host: Anything else you wanted to add before we wrap up just on reducing the risk of dementia? 

Michael Soboeiro, MD: I think that if patients are informed about where this data is, what lifestyle can do to prevent dementia, to prevent cognitive decline and to prevent physical decline; then people are in the best situation to keep themselves healthier for longer. 

As a primary care provider, that's really what we want for our patients. We want them to live a long life, but we want them live a healthy life where they're able to participate and contribute and enjoy the time that they have. 

Host: Dr. Michael Soboeiro, thank you for sharing your expertise on ways to reduce the risk of developing dementia. Thank you. 

Michael Soboeiro, MD: Thank you for having me.

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Thanks for listening to WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina.