Dealing with Cognitive Decline
Whilst we all understand the threat and impact of a pandemic, the growing epidemic of Alzheimer’s disease demands attention as one of the biggest global health crises of the 21st century.
Stewart Partners has a responsibility to be vigilant and alert to a client’s ability to make informed decisions. For example, if a client signs a Will and is later deemed to have not possessed the capacity to make an informed decision at the time of signing, the Will may be void. Some lawyers are now filming meetings where Wills are signed to demonstrate a person had capacity at the time.
This article explains what mental incapacity may look like, and steps we can all take to try and keep our brain healthy.
Alzheimer’s and Dementia
It is important to understand the differences between Alzheimer’s disease and dementia.
Dementia describes a group of symptoms associated with a decline in memory, thinking, behaviour and emotion, whilst Alzheimer’s is a degenerative brain disease that is caused by complex brain changes following cell damage. This damage interferes with the ability of brain cells to communicate with each other, and when brain cells cannot communicate normally, thinking, behaviour and emotions can be affected. Alzheimer’s is the most common cause of dementia and accounts for 60-80% of all cases[i].
Dementia affects over 50 million people worldwide, with a new case of dementia occurring somewhere in the world every 3 seconds[ii]. It is estimated there are currently 472,000 Australians living with dementia[iii], with a further 250 diagnosed each day. But raw numbers don’t always paint a clear picture – most of us will have a personal story of how dementia has touched someone we care for.
Unfortunately for women, dementia is the leading cause of death in Australia[iv], and whilst this in no way dismisses the many men that also suffer from dementia and Alzheimer’s, the reality is that two out of every three Alzheimer’s patients are women. A 45 year old woman has a one in five chance of developing Alzheimer’s in her lifetime, whilst a man of the same age has a one in ten chance[v].
The most common early symptoms of dementia are trouble with memory, often around everyday matters like:
Keeping track of your purse or wallet
Remembering to pay your bills
Planning and preparing meals
Remembering appointments
Other symptoms include:
Difficulty in finding the right words or understanding what people are saying
Difficulty in performing previously routine tasks
Personality and mood changes, restlessness, anxiety, and depression
Although each person will experience dementia in their own way, eventually those affected will be unable to care for themselves and need help with all aspects of daily life. Dementia affects the individual with the condition, as well as their relatives and other supporters who must cope with seeing a family member or friend become ill and decline, while responding to their needs, such as increasing dependency and changes in behaviour.
Dementia also has a high economic cost. In 2015, the total global societal outlay was estimated to be US$818 billion[vi]. That’s roughly four times the current wealth of Jeff Bezos (US$210B), spent each and every year.
Sadly, despite billions of dollars poured into research over the past several decades, no cure has been found for Alzheimer’s. The main goals of treatment are to maintain quality of life, maximise function in daily activities, enhance recognition, mood and behaviour. Treatment drugs are available that improve dementia symptoms, however, many of them do not treat the underlying disease or delay its progression.
Now for some good news. Firstly, research is progressing. Last year scientist brothers Professor Lars Ittner and Dr Arne Ittner from Macquarie University in Sydney made a ground-breaking discovery in their therapy testing on mice, where the new therapy not only halted memory loss, but also reversed the previous loss. The Pro Vice Chancellor of Research Innovation at Macquarie University, Professor Dan Johnson, said they were hopeful of realising immediate local benefits. “If all goes well, we may find ourselves with a clinical trial done at Macquarie Hospital with this therapy”[vii].
The US Food & Drug Administration, under their accelerated approval program, recently announced approval for Aduhelm, a treatment drug that showed a reduction in amyloid beta plaque associated with Alzheimer’s. Dementia Australia medical advisor Associate Professor Michael Woodward said removing amyloid protein could significantly reduce the rate of Alzheimer’s-related decline. “It is possible that, if used very early in Alzheimer’s disease, this drug will prevent the emergence of the symptoms of Alzheimer’s, but there is still research to be done in this area.” The Australian Therapeutic Goods Administration is currently reviewing an application for this drug.
There is no single cause of Alzheimer's disease. Researchers believe it likely develops from multiple factors such as genetics, lifestyle and environment. Those factors identified to increase the risk of Alzheimer’s - age, family history and heredity - cannot be changed, however, emerging evidence suggests there may be other factors we can influence.
Neurologist Donn Dexter, M.D., of the Rochester Mayo Clinic, recommends the following tips, in order of importance, to keep your brain healthy and help slow any decline in memory and lower your risk of developing Alzheimer’s disease or other dementias[viii];
Exercise Regularly
Aim to exercise several times per week for 30-60 minutes. You can walk, swim, play tennis or any other moderate aerobic activity that increases your heart rate.
Multiple research studies show people who are physically active are less likely to experience a decline in their mental function, and have a lower risk of developing Alzheimer’s disease. We believe these benefits are a result of increased blood flow to your brain during exercise. It also tends to counter some of the natural reduction in brain connections that occur during aging, in effect reversing some of the problems.
Get Plenty of Sleep
It is important that you try to get seven to eight consecutive hours of sleep per night, not fragmented sleep of two- or three-hour increments. Consecutive sleep gives your brain time to consolidate and store your memories effectively.
There are some theories that sleep helps clear abnormal proteins in your brain and consolidates memories, which boosts your overall memory and brain health.
Eat a Mediterranean Diet
A Mediterranean diet emphasises plant-based foods, whole grains, fish and healthy fats, such as olive oil. It incorporates much less red meat and salt than a typical Australian diet.
Studies show people who closely follow a Mediterranean diet are less likely to have Alzheimer's disease. Further research is needed to determine which parts of the diet have the biggest impact on your brain function, however we know omega fatty acids found in extra-virgin olive oil are vital for your cells to function correctly and appears to decrease your risk of coronary artery disease and increases mental focus and slow cognitive decline in older adults.
Stay Mentally Active
Your brain is like a muscle — you need to use it or you lose it.
There are many things you can do to keep your brain in shape, such as doing crossword puzzles or Sudoku, reading, playing cards or putting together a jigsaw puzzle. There is a lot of evidence that proves practicing a second (or third) language and learning a musical instrument have a protective effect on cognitive decline. Consider it cross-training for your brain.
Remain Socially Involved
Social interaction helps ward off depression and stress, both of which can contribute to memory loss. Look for opportunities to connect with loved ones, friends and others, especially if you live alone. There is research linking solitary confinement to brain atrophy, so remaining socially active may have the opposite effect and strengthen the health of your brain.
Be Aware of the Heart-Head Connection
Several conditions known to increase the risk of cardiovascular disease — such as high blood pressure, diabetes and high cholesterol — also increase the risk of developing Alzheimer's. Some autopsy studies show that as many as 80% of individuals with Alzheimer's disease also have cardiovascular disease[ix].
In recent years all contact sports have taken big steps forward in trying to protect players heads. Moderate to severe head injuries, even without diagnosed concussions, increase the risk of cognitive impairment.
The prevalence of Alzheimer’s will continue to grow in part because of our aging population. While research is not yet conclusive, taking care of your health now may help improve your outcomes in the long term, such as reducing your risk for developing Alzheimer's disease and other dementias.
Elder Abuse
The Stewart Partners team periodically comes across cases of financial elder abuse. One recent experience where a client asked us to assist with a close friend sadly ended in tragic circumstances which required us to contact ASIC.
If you suspect a loved one may be experiencing elder abuse because they can no longer make informed decisions, or simply has lost the capacity to manage their own situation, do not hesitate to contact your adviser to discuss how we may assist.
Matters we think about
It has been shown a person’s financial adviser is typically amongst the first to identify cognitive decline. Our team regularly discusses this topic so we can be alert to this issue.
The financial impact of ageing is also a great unknown for most people, however we do include assumptions for aged care costs in the long-term planning we do for clients.
It is essential appropriate Powers of Attorney are in place to cover personal financial and health/lifestyle decisions for people with declining mental capacity. These need to be put in place well before any risk of cognitive decline is likely. We work to ensure all clients have these documents in place – at any age – because our role is not to manage money, but to manage risks around your goals, objectives and wishes not being realised.
Author: Christie Britten
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[i] www.alzint.org/about/dementia-facts-figures/types-of-dementia/alzheimers-disease/
[ii] www.alzint.org/about/dementia-facts-figures/
[iii] www.dementia.org.au/statistics
[iv] www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/leading-causes-of-death
[v] The XX Brain – Dr Lisa Mosconi
[vi] www.who.int/news-room/fact-sheets/detail/dementia
[vii] https://lighthouse.mq.edu.au/article/july-2020/New-hope-as-dementia-therapy-reverses-memory-loss
[viii] www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/5-tips-to-keep-your-brain-healthy
[ix] www.alz.org/alzheimers-dementia/research_progress/prevention