Healthy to the end

In order to increase your chances of a healthy old age, it is important to keep both body and mind in shape. One positive aspect here is that many of the things that activate the body are also good for the brain.

“What is good for the heart is also good for the brain,” says Miia Kivipelto, Professor of Clinical Geriatric Epidemiology at the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.

She has recently compiled the first results from the world’s first interventional study of protective factors relating to dementia. So far, all research looking at positive and negative factors for a good old age has been based on epidemiological studies. This means that researchers look at people's health and investigate their prior activities. This type of research provides some answers, but cannot provide definite evidence of a causality between a certain factor and an outcome, or whether there are other influences.

This is why interventional studies are necessary. They involve researchers randomly selecting which of the test subjects should do what, and then monitoring them over time. Interventional studies are considered to have the strongest evidentiary value, but they are significantly more costly and time-consuming. Certain obviously unhealthy behaviours, such as smoking, are not ethically justifiable or practically possible to study this way, but many other behaviours can be randomly assigned to the research subjects.

In the current FINGER study (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability), 1,260 Finnish test subjects aged between 60 and 77 years were randomly assigned either to an intervention programme or to regular health advice. The intervention programme entailed individual diet counselling based on the Nordic Nutrition Recommendations (NNR), individual gym exercise set by a physiotherapist to strengthen the muscles, as well as group activities like walking, aquarobics, jogging or gymnastics, memory training using special computer programmes and regular physical check-ups which focused particularly on monitoring and taking measures against vascular risk factors such as high blood pressure, obesity, diabetes and high cholesterol.

The test subjects have now been monitored for two years, and it is already possible to see certain positive effects on the brain.

“The results are very positive. The people who were part of the intervention group had much better cognitive ability in terms of memory, speed and planning ability,” says Miia Kivipelto.

She and her research group will monitor the subjects of the study for seven years, which will hopefully yield even clearer results.

“Right now, we see differences in cognitive tests, later we may see differences in the number suffering from dementia. But the results already indicate that it is possible to influence the outcome and achieve effects in the brain,” says Miia Kivipelto.

However, it is not yet possible to see which of the different measures in the intervention group have the greatest preventive effect, but she will investigate this issue when the subjects have been monitored a while longer.

Lifestyle changes prevent Alzheimer's

A British-American research group published an estimate last year, however, of the importance of various risk factors in Alzheimer’s disease, and the group is of the opinion that in western countries, with low levels of smoking and a high level of education, physical inactivity is the greatest threat. This is partly because it is so common, and partly because physical activity impacts on so many other risk factors for developing dementia, such as obesity, diabetes and high blood pressure. The same research group also estimates that up to 30 per cent of all Alzheimer’s cases could be prevented through lifestyle changes.

“And if it’s 30 per cent for Alzheimer’s then it’s even more for dementia, since there is a clear vascular component there too,” says Miia Kivipelto.

Reducing the number of Alzheimer’s and dementia cases by 30 per cent or more through lifestyle changes could have an immense effect on the prognosis for healthy ageing. Not to mention how much it would mean for the individuals concerned. A major benefit is that the risk factors are more or less the same as for cardiovascular diseases. These individuals are therefore relatively often already found within the primary care system, but Miia Kivipelto believes that the healthcare centres can do more to help them. She hopes that the new findings will change the view of these risk factors within the health services.

Many people live with high blood pressure, obesity and diabetes. We know that the health services do not always have an ideal approach to these people. Perhaps it would increase the motivation of healthcare providers to take better care of these risk factors if they know that they also have a negative effect on the brain, she says.

To assist the health services, and also to give private individuals a chance to estimate their risk, Miia Kivipelto has created a dementia risk indicator, which allows you to calculate your risk of being affected by dementia within 20 years. The dementia risk score was developed in 2006, and is based on the CAIDE (Cardiovascular Risk Factors, Aging, and Dementia) study.

“Using this score, it is also possible to calculate the reduction of the risk if you manage to decrease a risk factor,” says Miia Kivipelto.

Other than the FINGER study, two other interventional studies are currently under way, one in France and one in the Netherlands, which are looking at ways to prevent Alzheimer’s and dementia. And according to Miia Kivipelto, there is a completely different level of openness between researchers than was previously the case.

“We work very closely with the other research groups, and we will compare our results and also pool our data. This gives us a total of 6,000 individuals, which will allow us to be even more sure in our conclusions of what works and what does not. We have realised that we have to share our data if we want to get results more quickly,” she says.

And they are in a hurry. The number of elderly people is constantly growing, and with it the number who suffer from Alzheimer’s or dementia. There is no cure in sight. There are four approved drug treatments for Alzheimer’s disease, but they have a rather limited effect on the symptoms and none at all on the cause of the illness. Nor has there been any new drug in over ten years, and there does not appear to be any promising research on the subject.

Widen the term "health"

The only thing that can be done instead is to attempt to prevent ill health during old age as far as is possible. But this is not a question of all 80-year-olds being fit as a fiddle. In order to understand the concept of healthy ageing, Laura Fratiglioni feels that we have to widen the term "health" when it comes to the elderly. Normally, we view health as the absence of illness, but this definition no longer works when we get older.

“After the age of 75, very few people are completely free from chronic illnesses, because you will almost certainly encounter a few illnesses over a lifetime. To describe health in the elderly, we must instead consider "function" – how well do we function despite the illnesses. Are we able to manage without help, take care of our personal hygiene, etc.?”

She also argues that it is important, at least from middle age, to assume a healthy lifestyle with physical and mental activity, in order to reduce the risks. Then when you are old, it is important to keep active – physically, mentally and socially.

“You should do things you like to do. Reading a book is great, for example, but it only stimulates your mind. There are other things you can do that are physically, mentally and socially stimulating. Many take a course at a university, or join a health club, where you have to join in with the exercises. I usually bring up dancing as a nice activity that includes all three components,” she says.

She has recently proven that people over the age of 75 who lead a healthy lifestyle live 5.5 years longer than those who do not.

“5.5 years more of life when you are 75 years old; that’s a lot,” she says.

Future healthcare environment

Another discovery made through research is that it is good to live in your own home for as long as possible.

“It is really important to remain at home, surrounded by your own things. But this can also lead to people becoming very isolated. They may lack stimulation, and stop cooking proper meals for themselves. This is something the healthcare systems must also keep in mind. It is great if people can stay at home, but home must not turn into a prison,” she says.

This last part is also the vision of Tore J Larsson, who believes that in the future, the home will not be a prison, but a place where care is administered. He is Professor of Safety Management and Occupational Injury Prevention at the Royal Institute of Technology (KTH), and is the Director of their Centre for Health & Building.