Catherine Whicher

Catherine Whicher

In search of what’s best for the brain

1 September 2022

By 2025, more than one million people in the UK will be living with dementia, but we still can’t answer the question: ‘What can I do to lower my risk?’

Dementia is a syndrome associated with a family of illnesses that include Alzheimer’s disease. This devastating condition of progressive cognitive decline includes memory loss, problems with reasoning and personality changes. It is a life-changing diagnosis for the person as well as their loved ones, and there are no effective treatments as yet. It’s no wonder that many of us who have lost someone to dementia want to know, ‘What is my risk? And what can I do about it?’

Frustratingly, the short answer from science is, we don’t know.
 

Balancing the modifiable risk factors

In 2020, the Lancet Commission on dementia prevention, intervention and care published a report identifying 12 modifiable (lifestyle-dependent) risk factors for dementia, which may account for up to 40% of all cases. They are:

  • depression
  • diabetes
  • hypertension
  • obesity
  • air pollution
  • smoking
  • physical inactivity
  • low social contact
  • hearing impairment
  • less education
  • excessive alcohol consumption
  • traumatic brain injury (TBI).

Paradoxically, we can see from this list that engaging in physical activities could be both a help and a hindrance to dementia prevention. Exercise may provide protection against numerous risk factors, including depression, diabetes, hypertension, obesity, physical inactivity and low social contact. The Lancet Commission estimates that up to 2% of all cases of dementia could be eliminated if more people were physically active.

Exercise may provide protection against numerous risk factors, including depression, diabetes, hypertension, obesity, physical inactivity and low social contact. At the same time, many sports by their nature put us at a higher risk of a traumatic brain injury.

 

At the same time, many sports by their nature put us at a higher risk of a traumatic brain injury. The media increasingly cover stories of former professional footballers and rugby players coming forward with diagnoses of dementia which they attribute to traumatic brain injuries sustained during their sporting careers. Other sports such as cycling, skiing and horse riding may not have such a high frequency of head contact, but when a person falls, it can be with such high speed and intensity that they may suffer a serious brain injury. We know that helmets can protect the skull, but they cannot prevent the brain from ‘bouncing’ around inside, causing injury. Another of the Lancet Commission’s findings is that brain injuries sustained in adulthood may be associated with 3% of all cases of dementia.
 

To play or not to play?

We have so many questions around the relationships between sport and dementia. Is an amateur footballer who loves playing once a week really supporting their brain health by staying home to avoid scoring a header, and missing out on miles of running up and down the pitch? Is a bicycle, a horse or a pair of skis any safer, given the risk of a high-speed collision or fall? How do these risks and benefits differ for groups such as children and adolescents?

Yet sport and physical activity are integral components of good physical, social and mental wellbeing – no one is suggesting cancelling sport. With an ageing population, widespread obesity and increasingly sedentary lifestyles, it has never been more important to get people moving, and to keep them moving throughout their lives. At the same time, more and more people are asking themselves if participation in sport may be worth the risk to their long-term health. Parents may worry about allowing their children to participate in contact or high-speed sports. What can be done in the absence of sufficient evidence for an informed decision?

Better, longer-term research into not just elite athletes but grass-roots players, investigating males, females, adolescents and children, will help forge the best way forward.

 

We just don’t have the answers – yet

The fact is that the science is not yet ‘there’ in terms of telling our amateur weekend footballer what they should do to minimise their individual risk of dementia. We do not understand why some professional athletes have had devastating diagnoses of dementia, while teammates with equivalent careers do not. What factors make a person more or less susceptible? What warning signs can we find, at the moment of a traumatic brain injury or in the months and years afterwards, that the brain has been damaged and is not healing well? What are the mechanisms, from initial damage by impact or whiplash, that lead to cognitive decline and eventually dementia? And how can we intervene?

Given the complexity of individual genetics and the culmination of exposure to the 12 modifiable risk factors over a lifetime, it seems clear that each person – each brain – has their own unique risk profile for dementia.

Better, longer-term research into not just elite athletes but grass-roots players, investigating males, females, adolescents and children, will help forge the best way forward. Biomarkers in measures including blood and saliva will facilitate diagnosis and treatment of traumatic brain injuries and dementia. One day, hopefully not too far off, we will be able to assess each individual for their pre-existing risk factors and tailor a custom brain health plan that appropriately manages their risks throughout their life. Until then, I’ll be doing what I can to keep moving – and mind my head.

 

To learn more about the next steps needed in research around sport and dementia prevention, read about our recent work with Alzheimer’s Research UK.

 

The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.
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