Food and Mental Stimulation to Prevent Dementia docx

Food and Mental Stimulation to Prevent Dementia Gerontological Gerontological Research Programme, , National University of Singapore National University of Singapore Department of Psyc

Food a n d M e n t a l St im u la t ion t o

Pr e v e n t D e m e n t ia

Gerontological

Gerontological Research Programme, ,

National University of Singapore

National University of Singapore

Department of Psychological Medicine

Department of Psychological Medicine

Ng Tze Pin

Public Seminar: Good News of Ageing, 1 March 2008

Food and Mental Stimulation to

Prevent Dementia

Gerontological

Gerontological Research Programme, ,

National University of Singapore

National University of Singapore

Department of Psychological Medicine

Department of Psychological Medicine

Ng Tze Pin

Public Seminar: Good News of Ageing, 1 March 2008

Stay mentally healthy in old age

“Do not go gentle into that good night”

The Last Battle

of the Mind Dementia

“Do not go gentle into that good night”

The Last Battle

of the Mind Dementia

“Do not go gentle into that good night”

The Last Battle

of the Mind Dementia

National Institute of Neurological Disorders and Stroke

A brain problem that makes it hard for a person to remember, learn and communicate

Unable able to think well enough to do normal

activities, such as getting dressed or eating

Lose their ability to solve problems or control their emotions

Personalities may change

Become agitated or see things that are not there Memory loss is common but by itself does not

mean dementia

National Institute of Neurological Disorders and Stroke

A group of symptoms due by damage and poor functioning of brain cells

Caused by head injury, stroke,

Alzheimer's disease, drugs, alcohol, nutritional deficiencies, etc

Available drugs cannot cure dementia but may improve symptoms or slow down the disease

Prevalence of Cognitive Impairment

Among Elderly Aged 60+ in Singapore

6%

18%

76%

Severe Mild to Moderate No

Cognitive impairment is defined by MMSE score <24;

Mild to moderate: 19 to 23; Severe:18 or less

Prevalence of Dementia in Singapore

National Mental Health Survey of the Elderly, 2003

Fight dementia

Maintain good cognitive function

Maintain good cognitive function

The brain is ‘plastic’

Brain cells are able to grow and

regenerate even in old age

Build up functional ‘cognitive reserve’

Demented Cognitive decline

Age

Factors Influencing Cognitive Functioning

Age, Gender, Ethnicity

Education

Vascular factors: high blood pressure,

diabetes, heart disease, stroke

Nutrition: Anti-Oxidants and Micronutrients Physical, social and productive activities

Mean Cognitive Function (MMSE) Scores

# Adjusted for demographic, social, biological and health variables

Education makes a difference

Don’t stop your education

Develop the habit of life long learning

Social activities

Attending church/temple/mosque

Joining group activities (karaoke)

Joining senior citizen club activities

Hobbies (reading, music, painting, gardening, etc) Unpaid community work

Paid community work Other paid leisure employment/business

Physical/fitness activities

Walking/ jogging

Physical calisthenics routines

Active sports or swimming

Taiji

Stay physically, mentally and socially active

Infrequent Leisure Activities: never or less than once a month

≥55+yr ≥65yr ≥75yr

Infrequent Exercise 28.7% 30.2% 35.4% Infrequent social activities 13.3% 17.3% 25.3% Infrequent productive activities 6.8% 10.2% 19.1%

Senior Lotus Eaters?

Data from Singapore Longitudinal Aging Studies: older adults aged 55+

Leisure activities – Tertiles Low Medium High

Whole sample

Sample size, No 1635 524 601 510

Median number of activities 6.0 3.0 6.0 9.0

Frequency at least once a week, % 64.2 48.4 67.2 77.1

Data from Singapore Longitudinal Aging Studies: older adults aged 55+

Data from the Singapore Longitudinal Aging Studies: Niti M, et al; International Psychogeriatrics, 2008

Relative Risk of Cognitive Decline

Low Moderate High

Level of Leisure Time Activities

‘Use it or lose it’

Activity Type No

participants

Relative Risks of Cognitive Decline

At least one physical activity

Nutritional deficiencies in elderly

Nutritional deficiencies are common in the elderly

More than a third of elderly in the community are at risk of

age-related physiological and social changes.

Marginal or biochemical (‘subclinical’) deficiencies have significant health effects

Nutritional Health of Singaporean Seniors

DETERMINE Your Nutritional Health Checklist

At Risk of Poor Nutrition N=2611

Having illness that change the kind and/or amount of food consumed 40.3% Taking 3 or more different prescribed or over-the-counter drugs a day 25.0%

Eating few fruits/vegetable/milk products (less than once a day) 9.0%

Without wanting, having lost or gained 4 kg in the last 6 months 3.5% Having 3 or more drinks of beer/liquor/wine almost every day 3.1% Not always physically able to shop, cook and/or feed by self 2.6%

Weighted score:

0-2: Good nutritional status and Low risk 3-5: Moderate risk of poor nutrition

6+: High risk of poor nutrition

Nutritional Status of Senior Singaporeans

Body Mass Index1 (BMI, kg/m2)

Increased Waist-Hip ratio (>0.8 in women or 0.9 in men) 63.2

High Homocysteine (>15 in men or >20 umol/L in women) 18.1

A healthy and well-balanced diet is not only good for the body, but also good for the mind

Does Nutrition Help?

0-20% 21-40% 41-60% 61-80% 81-100%

20 Percentiles of Haemoglobin

0.0 0.5 1.0 1.5 2.0 2.5

Underweight and Chronic Illness

General Nutritional Status and

Cognitive Health

Relative Risks of Cognitive Impairment

Data from the Singapore Longitudinal Aging Studies: Ng TP, et al, Age and Ageing, 2008 (In Press)

% with cogntive decline

Low BP Normal BP High BP Low BP Normal BP High BP

Diagnosed and Treated for High BP

Not diagnosed and Not

Treated

Go gentle on those sauces

Micronutrients and phytochemicals possess

anti-oxidant, anti-inflammatory properties

Vitamins A, C, E from vegetables and fruits Cachecins from tea

Flavonoids and terpenoids from herbal plants e.g ginkgo biloba

Omega-3 Poly-saturated Fatty Acids (PUFA) from fish and other sources.

Curcumins from turmeric in curry

‘Brain’ ’ Food?

Current state of knowledge

Experimental evidence abundantly support

biological basis

Human evidence are limited

Few randomized controlled trials have provided conclusive evidence to support the safe use of nutritional supplements for preventing or slowing dementia.

-0.12 -0.1 -0.08 -0.06 -0.04 -0.02 0

None 1 fish meal 2+ fish meals per week

Rate of

Cognitive

Decline

per year

Salmon, cod, tuna

Morris MC, et al Arch Neurol 2005;62:1849-1853

Never or

0 0.5 1

1.5

Relative Risk of Cognitive Decline

Omega 3 Supplements (DHA, EPA)

Data from Singapore Longitudinal Aging Studies

Omega 3 supplements

Omega-3 PUFA

Omega-3 PUFA (linolenic acid, DHA, EPA): Flaxseeds, hempseeds, walnuts, pumpkin seeds, Brazil nuts, sesame seeds, avocados Canola oil, soybean oil, wheat germ oil

Salmon, mackerel, sardines, anchovies,

tuna

Immediate Recall

Delay Recall

Verbal Learning

Forgetting %

Language

-0.2 -0.15 -0.1 -0.05 0 0.05 0.1 0.15 0.2

Folate

Ng TP, et al, Am J Clin Nutrition, 2007Eat your

broccoli, George

Foods rich in folate

Dark green leafy

vegetables

Fruits

Peas and beans

Rice, Grains and

Cereals

18 20 22 24 26 28

Rarely (Less than once in 6 months) Occasionally (Less often than once a month) Frequently (Once amonth to Daily)

Cognitive Scores

Ng, T P, et al American Journal of Epidemiology 2006

Cook them in curry

Data from the Singapore Longitudinal Aging Studies

Ng TP, et al., American Journal of Clinical Nutrition, 2007.

Tea, anyone?

0.000.200.400.600.801.001.20

Relative Risk of Cognitive Decline

Tea Intake

Ta Bau,

A simple menu for good cognitive health

Stay physically, socially and mentally active Eat a healthy well-balanced diet

Eat lots of fish

Cook them in curry

With lots of green vegetables

Wash down with cups after cups of tea

Thank You