Healthy living with dementia

Introduction
Diet
Physical activity
Staying socially and mentally active
Conclusion
Further information

Introduction

This information sheet is for people with early dementia who would like to know more about healthy living. It will also be of interest to carers of people with dementia. It includes information and advice on diet, physical activity, staying socially and mentally active and other ways of looking after your health and well being.

Diet

Some research has linked diet with the risk of developing Alzheimer’s disease and other dementias. Little research currently exists on whether diet is effective in slowing the progress of dementia. However, what is clear is that a healthy diet is very important for everyone. It can help in preventing complications from other health problems. Eating too little or missing out on essential nutrients will reduce your resistance to illness and may also increase confusion.

It is also important to maintain a healthy weight as you get older. Being overweight will affect your mobility and can also increase your risk of heart disease and diabetes. Most people need fewer calories as you get older - this is because the metabolism slows with age and people generally become less active.

Diet is important in preventing constipation. It can cause discomfort and can also make you more confused. Foods rich in fibre, fruit and vegetables, plenty of liquids and physical activity will help to combat constipation.

A healthy balanced diet reduces the risk of coronary heart disease, strokes, some cancers and diabetes. With multi infarct dementia, diet and lifestyle may play an important role in preventing further strokes. Multi infarct dementia, a type of vascular dementia, is when a series of small strokes or changes in the brain’s blood supply may result in the death of brain tissue.

Vitamin E has been used as a treatment for people with Alzheimer’s disease in the USA. (1) However, there is not enough evidence to be sure whether Vitamin E has any benefit in the treatment of people with Alzheimer’s disease. (2) High doses of Vitamin E supplements may increase the risk of bleeding in people taking blood thinning drugs like warfarin or aspirin. It is important to check with your doctor before taking any vitamin supplements, as they may not be suitable for you.

---

Try to:

• Eat a variety of foods
• Aim for 5 portions of fruit and vegetables per day
• Eat iron rich foods such as red meat, but go for lean cuts. Iron is also found in pulses, eggs, green vegetables etc.
• Aim for 2 portions of fish per week, one should be oily such as mackerel, sardines or salmon
• Read labels, particularly with ready made meals, paying particular attention to salt and fat levels.
• Boil, steam, grill or poach foods instead of frying or roasting
• Cereals, potatoes, rice or pasta should make up the main part of each meal. Wholemeal, wholegrain and high fibre varieties are best.
• Calcium-rich foods are good for your bones. Dairy products are good sources but should be eaten in moderation. Choose low fat varieties such as semi skimmed milk.

Limit:

• Spreading fats and vegetable oils
• Saturated fats such as butter
• Salt, try not to add this to your food out of habit. You should aim to keep your salt intake to less than 6g per day.
• Vitamin A, too much may increase the risk of bone fracture. You should not have more than 1.5mg per day from food and supplements.
• Try not to skip meals

---

Ginkgo Biloba

Ginkgo biloba comes from the dried leaves of the maidenhair tree. It is widely available over the counter in pharmacies and health food shops. Some research has shown that it may help people with dementia by aiding cognitive (thinking) abilities. (3) (4) However, more research is necessary to identify any benefits that ginkgo may have in helping slow the progress of dementia. There is also concern that ginkgo may have side effects when taken with some other medications. Consult your GP first if you are considering taking ginkgo. It is also important to be aware that the quality of ginkgo products on sale can vary.

Drinking

It is important that you drink plenty of fluids to keep your body hydrated. There is a risk of confusion as a result of dehydration. Try to drink plenty of water and other fluids in addition to any tea and coffee you drink. If you do not like the taste of water try adding a little fruit juice to give it flavour.

Alcohol

If you have a type of dementia related to alcohol use it is very important not to drink alcohol because it may make your symptoms worse. Check with your doctor whether it is all right to drink alcohol.

For people with other kinds of dementia make sure you keep within the recommended maximum weekly limits of 21 units for a man and 14 units for a woman. A unit of alcohol is a small glass of wine, a half pint of beer/lager or a pub measure of spirits. Too much alcohol can cause confusion. Alcohol also takes fluid from the body, so balance this out by topping up with non-alcoholic drinks.

Physical Activity

Keeping well physically is important for everyone. Physical activity is important for maintaining fitness and keeping muscles and joints flexible. There are also benefits for your mental health and it can help you get a better night’s sleep. (5)

Regular physical activity can reduce the risk of disability and other health problems such as high blood pressure, heart disease and osteoporosis. (6) Our bodies are made to move, all living tissue benefits from exercise and weakens when movement stops. Physical activity may also help in avoiding, delaying or reducing some of the mobility problems that are associated with dementia. It can offer protection against falls through improved balance and strengthening of muscles. (7)(8) (9)

Physical activity is also beneficial to your mental health. There is evidence that supports the benefits of physical activity in improving mood and reducing stress. A study of exercise and people with Alzheimer’s disease found that it improved physical health and depression. (10) As physical activity provides an opportunity for social contact it can also reduce feelings of isolation and loneliness.

It is recommended that you have at least 30 minutes moderate physical activity most days. This can be split across your day and does not have to be strenuous. It is a good idea to look at your daily routine to see what activity you already do and what improvements you can make.

Moderate physical activity is anything that makes you feel warmer and gets your heart beating faster. It should feel comfortable and should not lead to injury; it is the equivalent of a brisk walk. Do something that you can enjoy, for example gardening, swimming, golf, bowling etc. Walking is a great way to exercise, as it does not require any equipment and can be built into your daily routine.

For more information on the benefits of walking and local walking groups visit Paths to Health at www.pathsforall.org.uk/

By fitting physical activity into your life now it is more likely that you will be able to maintain it, extending the benefits to your health and wellbeing for as long as possible. If you are thinking of starting a new exercise programme you may want to discuss any concerns you have with your doctor. Build up any exercise programme, rather than starting from a high level. Make sure that you rest when you are tired.

Staying Socially and Mentally Active

“Dementia is not a major part of your life, just part of it. I don’t waken up with my first thought being I have dementia. I plan ahead and wake up thinking of activities I have arranged to do that day” (11)

Keeping involved and active in the things you enjoy is very important. Try not to allow embarrassment about memory loss, or not being able to do things as well as you used to, hold you back. Concentrate on the things that you do well instead of worrying about the things you can no longer do. Try not to give up on activities that you enjoy, it may be possible to adapt them with the help of family and friends.

There may also be opportunities to try something new. Some people with early stage dementia have discovered that they have become more creative and enjoy painting or photography. It may also be possible to enjoy the process of carrying out an activity even if you are unable to complete it. For example, if you enjoyed dressmaking you may still gain pleasure from working with fabric and sewing even if you can no longer follow a pattern. (12)

If you enjoy mental activities such as crosswords and reading, keep doing them for as long as they continue to give you pleasure, adapting them to suit your mental energy levels. Studies have looked at whether memory training can improve cognitive (thinking) abilities of people with mild Alzheimer’s disease and there have been some positive results. (13) However, more research is required before it can be promoted as a therapy for dementia. (14)

Spirituality

For many people spiritual faith is an important strength in dealing with dementia. For some this may be through religious involvement. For others a sense of spirituality is gained through spending time with family, enjoying nature or meditation. It is very important to keep enjoying the things that give meaning to your life or that provide you with a sense of peace.

Health and Wellbeing

It is important that you have regular check-ups and get concerns you may have about your health checked out. Other medical problems can make the symptoms of dementia worse and may make you feel more confused until the problems have been treated:

• If you are on any medications have them reviewed regularly. This will make sure you are not continuing to take unnecessary drugs. Some drugs or combination of drugs may have unwanted side effects.
• Ask your doctor about a hearing test if you are concerned about your hearing. Problems with your hearing can make you feel isolated and add to confusion. (15)
• Make sure you get your eyesight checked regularly; any problems with this can make it harder for you recognise people and objects.
• Have regular dental check ups to make sure there are no problems with your teeth, gums or dentures, as this can give problems with eating and drinking.
• Healthy feet are important in keeping you active and mobile. Make sure you get any problems with your feet checked out by your doctor or a podiatrist (also known as a chiropodist).

The tips below have been suggested by people with early stage dementia for when you visit your GP or other medical practitioner(16) :

• You may need to be assertive or take someone with you
• Prepare before the appointment – be clear what you want from the consultation
• Ask the questions you want answers to – no matter how trivial they seem
• Take along a written list with you and ask the person to write the answers down so you can refer back
• Remember to ask your consultant for information about your condition.

Stress reduction

It is important to try and reduce stress as much as possible, as it can have a negative effect on memory.(17) Try not to do more than you can cope with and avoid trying to do more than one thing at a time. It is also important to listen to your body and rest when you are tired

Conclusion

It is important for everyone to have a healthy diet and to take regular physical activity. Looking after your physical and mental health is important in helping you keep well and avoiding complications from other illnesses. However, do not be disheartened if you are unable to maintain a healthy lifestyle all of the time. We all need special treats sometimes and do not always feel up to exercising. You will still benefit from adopting good habits the rest of the time.

Further Information

Call the Dementia Helpline on 0808 808 3000 for a free copy of any of these useful publications, or follow the links:

Don’t make the journey alone
Coping with dementia
Good for you good for your brain – leaflet
Good for you good for your brain – evidence booklet

For further information and tips on healthy eating and physical activity visit the Scottish Executive Healthy Living website at www.healthyliving.gov.uk or call their Helpline on 0845 278 8878

---

Footnotes:

1. Feinberg T & Winnie Y (2005) What to do when the doctor says it is early stage Alzheimer’s Fair Winds
2. Tabet N, Birks J et al (2000) Vitamin E for Alzheimer’s disease Cochrane Review Issue 4
3. Birks J & Grimley E J (2002) Ginkgo biloba for cognitive impairment and dementia The Cochrane Library
4. Le Bars PL, Velasco FM et al (2002) Influence of the severity of cognitive impairment on the effect of the Ginkgo biloba extract EGb761 in Alzheimer’s disease Neuropsychobiology 45(1):19-26
5. King A, Oman R et al (1997) Moderate intensity exercise and self rated quality of sleep in older adults – a randomised controlled trial JAMA Vol 277 No 1
6. Young A & Dinan S (1994) ABC of sports medicine: fitness for older people BMJ 309:331-334
7. Dinan S (1998) Fit for life: why exercise is vital for everyone Journal of Dementia Care Vol 6 No 3 May/June
8. Norton R, Galagali G et al (2001) Is physical activity protective against hip fracture in frail older people Age and Ageing 30:262-264
9. Skelton D (2001) Effects of physical activity on postural stability Age and Ageing 30-S4:33-39
10. Teri L, Gibbons L et al (2003) Exercise plus behavioural management in patients with Alzheimer’s disease JAMA Vol 290 No 15
11. Alzheimer Scotland Don’t make the journey alone – a message from fellow travellers
12. Truscott M (2004) Adapting leisure and creative activities for people with early stage dementias Alzheimer’s Care Quarterly April/June 2004
13. Moore S, Curt A et al (2001) Memory training improves cognitive ability in patients with dementia Psychology Press Vol 11 No 3-4:245-261
14. Clare L, Woods RT et al (2003) Cognitive rehabilitation training for early stage Alzheimer’s disease and vascular dementia Cochrane Review Issue 4
15. Uhlmann E, Larson EB et al (1989) Relationship of hearing impairment to dementia and cognitive dysfunction in older adults JAMA Vol 261 No 13
16. Alzheimer Scotland Don’t make the journey alone – a message from fellow travellers
17. Quervain DJ, Roozendaal B & McGaugh JL (1998) Stress and glucocorticoids impair retrieval of long term spatial memory Pub Med Nature 20:394(6695:787-790

---

To view this information in portable document format (pdf) click on the link below:

IS33: Healthy living with dementia (pdf, 4 pages, 115kb)

Information about dementia
Large print and audio versions of Alzheimer Scotland information