Analysis: like with other types of health, it is never too early (or too late) to start investing in your brain
By Francesca Farina, Global Brain Health Institute, TCD
Who comes to mind when you think about Alzheimer's disease? Probably not Chris Hemsworth, but the 39-year-old Thor actor recently made headlines when he disclosed his genetic vulnerability to the disease. Hemsworth carries two copies of a gene called APOE4, the strongest known genetic risk factor for Alzheimer's disease. Around 2-3% of the population have two APOE4 copies, making them 8 to 12 times more likely to develop Alzheimer’s.
Unsurprisingly, Hemsworth’s story garnered lots of media attention, prompting conversations around genetic testing, who should get tested and when. Scientists responded with two important points. First, having the APOE4 gene is not a guarantee that a person will go on to develop Alzheimer’s disease. And second, genetics are only one part of determining a person’s risk profile. An increasing number of lifestyle factors are being linked to Alzheimer’s disease, as well as other types of dementia. In fact, evidence suggests that 40% of all dementias worldwide are linked to so-called 'modifiable’ lifestyle factors, like alcohol use, hearing loss and social isolation.
The potential for people to reduce their risk of, or even prevent, dementia by adopting healthy lifestyle behaviours has spurred a positive brain health movement. The term 'brain health’ is still relatively new, but it can be defined as "the state of brain functioning across cognitive, social, emotional and behavioural domains that allows a person to reach their full potential". Like physical or mental health, brain health can change across the life course depending on a person’s circumstances and environment. And like other types of health, it is never too early (or too late) to start investing.
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Knowing the risk factors for Alzheimer’s disease and other dementias is essential to building and maintaining brain health. But results from a recent Irish survey with adults aged 50 and over suggests we still have some way to go. According to the findings, 66% of respondents agreed lifestyle improvements could decrease dementia risk, but awareness of individual risk factors varied considerably. The most recognized risk factor was head injury (91%), while hearing loss was the least recognized (35%). Low awareness is a massive barrier to risk reduction, especially when we consider that hearing loss is easily diagnosed and highly treatable (e.g., with hearing aids, cochlear implants).
An added challenge is that risk factors start to accumulate decades before any clinical symptoms of dementia will appear. This means that we must work to increase awareness of these factors, not just in people over 50, but across all age groups. Luckily, these efforts are already underway. Mid-life (i.e. 40+ years) is now recognised as a critical window for lifestyle interventions and there are a growing number of educational resources targeting this group. Similar programs are being developed for school children. For example, the Dementia Services Information and Development Centre (DSiDC) launched a dementia awareness programme for Transition Year students just this year.
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While these initiatives represent progress, one key demographic who are missing from the brain health conversation is young adults (18-39-year-olds). This is surprising given that exposure to many risk factors begin during this stage of life. For example, findings from the Growing Up in Ireland survey indicate that 89% of Irish 18-year-olds have consumed alcohol, and 18-24-year-olds reported higher levels of binge drinking during lockdown compared to the national average (55% vs. 46%). Alcohol is just one example. Young people are also the most common suffers of head injury, which poses a significant threat to brain health.
As well as being exposed to risk factors, many young adults in Ireland are personally affected by Alzheimer's disease and other dementias through their family, friends, or as care providers. And yet, we know very little about what they think or how they feel about their own brain health – or if they relate conditions like dementia to their brain health or lifestyle behaviours at all. As a scientist in the 'young adult’ age bracket who spends her days actively researching risk factors, even I find it difficult to think deeply about my own brain health, and how my actions today might influence my future risk for dementia. But these are exactly the conversations we need to be having.
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Engaging young adults on the topic of brain health is essential not just for future prevention, but also for reducing ongoing stigma that people living with dementia face today. Over 84,000 people on the island of Ireland are living with a diagnosis of Alzheimer's disease or another dementia – not counting their loved ones, who also live with the condition. Including younger generations in open conversations is one way that we can reduce misinformation and fear that leads to stigma and help to ensure that people living with dementia can have the best possible life as valued members of our society.
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Whether we want to talk about it or not, risk information is becoming more accessible. Companies like 23andme now offer genetic testing, making it easier for anyone to follow Chris Hemsworth’s lead and check their APOE status. The positive brain health movement must keep pace to ensure that people who choose to access this information also have access to tools that can support their brain health. With life expectancy currently at 82 in Ireland, younger generations have massive potential to become drivers of the positive brain health movement. All they need now is to become part of the conversation.
Dr Francesca Farina is an Assistant Professor at the Feinberg School of Medicine, Northwestern University Chicago, and a Visiting Research Fellow at the Global Brain Health Institute, Trinity College Dublin.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ
