The information available on the internet and in newspapers is sometimes confusing, because the journalist or reporter does not explain or perhaps even understand that there is a difference between 'Alzheimer's disease' and 'dementia'.

So when they highlight a new wonder food or activity that can 'slow Alzheimer's disease' they might be talking about slowing the rate of build-up of the plaques and tangles in the anatomy of the brain, or they might specifically be talking about slowing up the dementia symptoms. It is hard to follow, especially when they don't distinguish between the different symptoms, like memory loss, difficulty in working things out, stress reactions, difficulty in learning new things, etc.

It's of no benefit to me if the medication stops my brain shrinking but my mental capacity continues to shrink.

The most definitive clinical measure of the underlying disease process unfortunately comes only from weighing and dissecting the brain tissue post-mortem. Because dementia symptoms are about worrying changes in how a person is behaving and thinking, you can see whether those symptoms have increased or decreased while the person is still alive.

You can help with memory problems, one symptom of dementia, without reducing the Alzheimer's disease. And you can reduce one symptom of dementia, without affecting other symptoms of dementia. From a practical point of view we have to ask if it makes a difference to the patient whether you are slowing the underlying disease or slowing the symptoms. Personally, I do not care if my brain shrinks a bit as long as it is not too noticeable in my daily life. It's of no benefit to me if the medication stops my brain shrinking but my mental capacity continues to shrink. What matters to me is the quality of my daily life.

The things that you can do that we think keep dementia at bay are worth sticking with (or starting) even if you already have a diagnosis. They will help you to stay well, and so keeping them up as long as possible is a really good idea.

Smoking and Alcohol

Don't smoke. It would be better if you never had, but improvements will start the day you give up. There is clear evidence of this in the case of heavy smokers. If you give up in middle age, the risk of dementia after twenty years is the same as if you had never smoked.

Alcohol-related brain damage (ARBD) is the only preventable form of dementia. Women's brains are more vulnerable to alcohol.

Previous Education

If you examine brains after people have died, you can see 'neurodegeneration', whether or not the person had dementia symptoms while alive. The amount of damage is the same, no matter how much previous education the person had. The fascinating finding is that if the person did have a lot of formal education they could have had quite a lot of cell death and vascular damage while still not demonstrating dementia symptoms. So studying and becoming highly educated do not stop you getting Alzheimer's disease, but they will help you to cope with that damage happening inside your skull if it does.

Exercise

It is well known that exercise reduces stress, boosts your mood and increases energy, but you may not realise that it actually appears to increase the physical amount of grey matter in your brain. If you take exercise, even in middle age, it reduces the dementia risk. It protects your brain and slows down the decline and reduces the risk of those mini-stokes that cause vascular dementia.

Socialising is really important also, so if you can combine the two that's great. Think of dancing. You socialise, you exercise and with a bit of luck you get a glass of wine.

Vitamins

Studies have shown that lower vitamin D concentrations in the blood are associated with poorer cognitive function and a higher risk of Alzheimer's disease. You can get it from food, but even in our misty islands we get most of our vitamin D from exposure to sunlight.

Mental Stimulation

If you don't use it, you lose it! Learning something new is good for your brain. The more you use your brain, the better it is for you. You develop a sort of spare capacity that will stand you in good stead if some of your brain tissue starts to shrink or fails because the blood supply has been compromised.

Vary your habits. Don't live life on autopilot. Challenge yourself with something new every day of your life. Explore, read, talk to people and find things out. If you develop dementia a whole lot of life will start to become challenging, so practise facing challenges now.

Active Social Life

Volunteer! There are so many reasons for volunteering: making a difference to other people, having fun, keeping up skills, making friends. People once thought of volunteers as 'do-gooders' who help other people by giving of themselves for no reward. In fact, you can't escape the reward, even if you won't take any money for what you do.

Keeping connected with family and friends offer great health benefits. It could be that just keeping tabs on them is a significant mental exercise that keeps the grey matter alive.