Reduce Dementia Risk When You Have Diabetes

By Roberta Kleinman|2023-08-29T10:30:23-04:00Updated: June 23rd, 2023|Diabetes Management|0 Comments
  • Dementia and Diabetes

Reduce Dementia Risk When You Have Diabetes

Recent studies revealed people with diabetes could be at a higher risk of developing dementia. Other factors that are noted in brain deterioration are family history, aging, smoking, cardiovascular disease, being a female (have twice the risk of dementia) and lack of quality sleep. African Americans, American Indians and Alaska Natives also have a higher risk for dementia as well as diabetes.

Your brain remains active even during sleep. Your brain has three main regions each with a specific job, all the parts work together through nerve cells called neurons. Your brain has the ability to think, learn and remember. It basically controls everything in your body. It processes your emotions, interprets information, and regulates multiple bodily functions. It is where intelligence, creativity and memory are located.

Your brain health is connected to the overall health of your physical body. The old adage “use it or lose it” applies to both your physical and mental health. Physical exercise is always discussed in a diabetes care plan when learning how to improve your quality of life. A constant supply of oxygenated blood from physical exercise can also assist in improving your brain function.

A physical exercise plan for your diabetes is encouraged since “it promotes vascular health to protect brain tissue.” Should you also have a program in place to enhance your cognitive health and mental abilities? Should you have a specific plan in place to prevent neurological damage due to aging and/or diabetes?

Certain lifestyle changes can reduce your risk of getting dementia, with or without diabetes. Dementia is not considered part of normal aging of the brain. Find out how to lead a healthier life each day for both your body and your mind.

Having a “brain mental exercise” plan in place and living a healthy lifestyle may help you function at a higher level for a longer period of time. Managing several important numbers such as blood pressure, cholesterol, blood sugars and weight is important not only your body but also your brain. Just as out of control blood sugars and high blood pressure can cause blood vessel damage in the body, it can affect the blood vessels in the brain.

Diabetes Link to Cognitive Health

Diabetes can affect multiple organs like your eyes, kidneys, nerves, heart, blood vessels and feet in a negative way when poorly managed. The more severe the diabetes and the longer you live, the more likely you will have cognitive decline. Besides high or low blood sugars, other conditions like hypertension and high cholesterol (often paired with diabetes), can negatively affect your brain.

Your brain uses half of all the sugar circulating in your blood stream. When your blood sugar goes too high or too low, you may experience mood swings, memory issues and a reduced ability to learn. High blood sugars are dangerous to brain blood vessels and nerves. “Brain fog” is a very common condition, although not a medical term, may develop. Brain fog is when you feel spacy, have difficulty finding the correct words, are irritable and lack the ability to focus.

High blood sugars also lead to inflammation in the brain causing poor judgment and confusion. The brain blood vessels may become clogged with plaque, just like your coronary arteries. Oxygen rich blood will not enter your brain causing brain cells to die. Even insulin plays a role in your brain health. Insulin resistance, often seen in type 2 diabetes, can negatively impact your brain.”Insulin resistance” means your body has insulin but it is not utilizing it correctly. That raises the risk for vascular dementia, memory problems, mood swings and possibly dementia as well as Alzheimer’s.

Low blood sugars resulting from diabetes are dangerous to the brain as well. Low blood sugars can produce symptoms such as headaches, dizziness, weakness, irritability, and confusion. If not treated, low blood sugar can result in a coma. “Older people with diabetes have documented higher incidences of dementia, Alzheimer’s and vascular dementia compared to older people with normal blood sugars.” Forgetfulness and confusion are often present. Self-care begins to disappear.

If and when cognitive problems develop for the patient, the diabetes care team should try to simplify the health care routine as much as possible. When the patient starts forgetting to keep their medical appointments, forgetting to renew or take medications or forgetting to prepare and eat meals, action must be taken by the care team and family. The term “dementia” means the inability to live and function independently. The medical provider along with the family need to make sure there is a proper support system in place either in the home setting or in a medical facility.

What are we currently learning about Diabetes and Brain Health?

Over 195,000 people were studied for 8 years. They were all age 60 or older and had no dementia at the beginning of the study. After 8 years, it was found “a healthy lifestyle was associated with a lower dementia risk” even with genetic risk factors in place for Alzheimer’s and other dementias. Alzheimer’s is considered only one type of dementia. Those who did not smoke, ate a healthy diet, were physically active and consumed low to moderate alcohol did better with their brain health. Those with high stress levels, anxiety, depression, less than 5 hours of nightly sleep, insomnia, sleep apnea and lack of vitamin B 12 had 2 times the risk of dementia.

Another study in 2020 published in Neurology found reductions in Alzheimer’s risk after following a healthy lifestyle including a Mediterranean style diet. Besides eating a well-balanced diet high in fruits and vegetables, low in saturated fat, the Mediterranean diet includes whole grains, seeds, legumes, beans, and healthy fats such as olive oil, olives, nuts, and fish. It also includes herbs, spices, and a small amount of red wine. Eating with others is also a part of the Mediterranean plan to provide a social setting.

Although there are currently multiple online games and APPs stating “they can enhance cognitive function” to improve your brain, more research still needs to be done. They can’t hurt but they may not be the panacea that claim to be. Most experts and medical professionals are confident your mind will be maintained if you continue to stick to real life activities. Whatever you do should be somewhat challenging and new to you. “A passive brain with or without diabetes has a tendency to atrophy.”

Which real life experiences can help activate your brain?

  • Drive home on a different route.
  • Use your non-dominant hand to brush your teeth or hair.
  • Eat with your non-dominant hand.
  • Write with your non-dominant hand.
  • Do Sudoku and keep elevating the challenge.
  • Do word puzzles and jigsaw puzzles. “Puzzles activate cognitive functions like memory, perception and reasoning.”
  • Look at “Where’s Waldo” pictures and find new items each time.
  • Create a list of words and memorize them. Try to recall and write them down one hour later.
  • Visualize. When meeting someone new, close your eyes and say their name. Learn to associate the new name with that specific face. Visualize a place, an event and close your eyes. This may help you remember more later.
  • Join a choir. Learning words to songs can be challenging, pushing your mental capacities.
  • Learn to play a musical instrument.
  • Learn to read music if you do not know how.
  • Join a book club. Read the book instead of listening on Audible. Challenge your comprehension. Pick a difficult book. Either highlight important points or write notes for your future group discussion.
  • Find a part-time job in something you never did before.
  • Play games. Board games, checkers, or chess. More challenging games require sharpness and memory. They also assist you in setting goals and working in a timely manner.
  • Learn card games such as poker, canasta, or bridge. Try to build on the rules and memorize them.
  • Do simple math problems. Start with addition and subtraction and move on to multiplication and division. First, write them down and then try to do all the math, in your head.
  • Learn a new cooking cuisine.
  • Take up baking if you are a cook, take up cooking if you are a baker.
  • Take up woodwork.
  • Learn a foreign language.
  • Volunteer especially in something unfamiliar to you.
  • Read the classics.
  • Build models like ships. Small pieces with increase your coordination.
  • Stay socially active. Loneliness impacts brain health. It can increase your chance of a stroke by 32%. Social isolation in the elderly can increase dementia by 26%. Just being with a group of friends in a mentally engaging activity may help preserve your cognitive function. Your brain is stimulated by discussions, participating in group courses and by sharing your thoughts and opinions.
  • Enhance your fine motor skills. Seniors may naturally lose fine motor skills as they age. Skills such as buttoning a shirt, pouring a cup of coffee, using scissors, or holding silverware may become more difficult. Practice things to maintain the skills. Open and clench your fists. Bounce, throw and catch a ball. Take up knitting, crocheting, or sewing. Paint, draw or play video games. Find a glass cutting class. Make your own greeting cards which will require cutting, folding, and printing. Try Origami. Learn to use a potter’s wheel.
  • Take up ballroom, disco, or Salsa dancing.
  • Join a Zumba class. You need to follow and learn dance moves. Tai Chi classes also require you to learn a pattern of movements.
  • Take up a new and challenging sport. Pickle ball is big right now. It enhances your ability to use oxygen, develop balance, strength and encourages you to learn and remember new rules. Become a referee.

Other Interesting Brain Health information

The Harvard Medical School News Review revealed a link for women between estrogen, diabetes, and dementia. Women with high levels of estrogen could be more likely to develop dementia including those who have gone through menopause. For this reason, doctors are now less likely to prescribe hormone replacement therapy containing estrogen to older women who have been in menopause for a while. Women who go through menopause prior to age 45 also have a higher rate of dementia later in life. If you have diabetes you should talk to your doctor in-depth before considering any type of hormone replacement therapy. There are newer medications for hot flashes and insomnia other than hormone therapy.

Women who are obese tend to have higher levels of estrogen and are also at an increased risk of developing both diabetes and dementia. Losing just 10 percent of your total body weight can make a difference. Obesity and high estrogen can have an impact on both men and women. The data collected by the CDC in 2021, states that “41.9% of adults have obesity.”

Research has also revealed aspects of type 2 diabetes. Insulin resistance, glucose intolerance, and impaired insulin secretion are all associated with an increased risk of dementia. Test your blood sugar regularly and report fluctuations to your doctor. Take all your medications on a schedule to avoid blood sugar spikes. Eat at least three meals and two snacks daily to keep your blood sugars regulated. Talk to a dietitian. Learn about diabetes with diabetes management skills classes. Know how to take control of your diabetes.

If you have a family history of diabetes and/or dementia, there are ways to reduce your risk of developing these chronic health conditions. Be aware of your family medical history and share it with your health care team.

What else can you do to protect your Brain even with Diabetes?

  • Try to keep saturated and trans-fats out of your diet. Avoid processed foods. Avoid foods with added sugars. Lose weight if you need to. Ask for help because losing weight is difficult. There are new medications to help with weight loss especially if you have diabetes. Make wise choices such as drinking water instead of soda or fruit drinks. Watch portion sizes. Count but include carbohydrates.
  • Consider taking krill oil. Talk to your health care provider to see if it is right for you. Krill oil is being studied to see if “it can protect against many neurodegenerative processes.” Krill oil has a high amount of long chain Omega-3 fatty acids, antioxidants and choline. Choline is an essential nutrient already known to aid in brain health, function, and development. Krill oil is “more bioavailable” than other marine oils making it even a better choice for inflammation control. Further studies are still needed. Krill oil contains EPA (Eicosapentaenoic Acid) and DHA (Docosahexaenoic Acid). EPA and DHA are already known to demonstrate multiple benefits including neuroprotection, immune boosting function and improved cardiovascular function. Since krill oil also contains choline which helps with memory regulation plus mood and muscle control. Krill oil has astaxanthin which is an antioxidant that holds potential benefits for:
    1. Antidiabetic effects
    2. Neuroprotective effects
    3. Cardiovascular health promoting
    4. Ocular and skin health promoting
  • Quit bad habits that increase your risk of developing other health conditions. Don’t smoke and eliminate or reduce alcohol from your diet.
  • Add good habits such as being joyful and grateful. Find the happy moments. Dwell on the positive and deal with the negative before it becomes overwhelming.
  • Attend all your health care visits. Know your A1C. Ask your physician what a good number is for you. With dementia the A1C should stay between 7-8%. Your A1C should be specific to you.
  • Get 7-9 hours of restful sleep. Test for sleep apnea and treat it if you have any concerns. Sound sleep is crucial for both body and brain health. Restful sleep enhances memory, reduces mental fatigue and helps regulate metabolism.
  • Set alarms, use “to do” lists and keep notes. Use a filing system so you can find things at a later date. It also helps to de-clutter your mind when you write things down.
  • De-clutter your home office of unnecessary papers. Only keep what is needed and make it easy to locate. Use your computer to keep records instead of loose papers.
  • Maintain a healthy body weight. Data collected by the CDC in 2021 states “41.9% of seniors are obese.” Low grade chronic inflammation is generated in obesity which can cause brain changes and neurodegeneration. “Obesity substantially raises the risk of dementia and diabetes.”
  • Eat for brain health. Each meal should contain protein and carbohydrates with fiber. Excellent sources for brain food include- whole grains, avocados, sweet potatoes, fatty fish, winter squash, berries, and chia seeds.
  • Include Omega 3s. The brain is mostly composed of fats. Higher levels of Omega 3s are “consistently associated with a lower risk of dementia and lower overall cognitive decline.”
  • Omega 3 foods help with the integrity of your neurons. Your brain is 60% fat. Healthy fats include Albacore tuna, salmon, mackerel, hemp seeds, walnuts, sardines, herring, and olive oil. You can also find a high-quality supplement with EPA and DHA. The usual amount is between 1000-4000mg a day but consult with your health care provider before starting. Omega 3s can increase your risk of bleeding.
  • Carotenoids. Since the brain is subject to inflammation-eating carotenoids is helpful since they have anti-inflammatory properties. Included are lutein, lycopene, beta carotene, alpha carotene,
    beta-cryptoxanthin and zeaxanthin. Eat carrots, pumpkin, pumpkin seeds which are full of zinc, copper, magnesium and iron, leafy greens, cantaloupe, Brussel sprouts, spinach, yellow corn, red, yellow and orange peppers, tomatoes and tomato products such as tomato sauce. Include tangerines, oranges, tangelos, peaches, papaya, and persimmons. Vitamin C found in citrus prevents damage from free radicals.
  • Get enough of vitamin B-12. B-12 is a key nutrient for the nervous system. It helps with blood cell formation, brain function and the body’s metabolism. B-12 is important in producing the mood enhancing neurotransmitters called serotonin and dopamine. Older adults sometimes do not absorb vitamin B-12 well. Vitamin B-12 is mostly found in animal products such as meat, poultry, eggs which are full of choline, folate, vitamin 6 and B-12. Eat dairy and cereals or other foods fortified with vitamin B-12.
  • Flavonols. Flavonols are polyphenols that belong to the flavonoid family. They are plant compounds and the best way to get them is to eat a variety of fruits and vegetables. “Flavonoids have an anti-inflammatory effect and protect your cells from oxidative stress.” They may help prevent cognitive decline. Foods to include with flavonoids are red grapes, red wine, berries, red cabbage, black tea, kale, parsley, citrus fruits, dark chocolate- at least 70% cocoa or more. Make sure to eat only one square. Include apples, pears, and onions. Eat the skins of fruits and vegetables that are considered edible. Phenols are also important to brain health. Include apricots, flaxseeds, olive oil, and coffee. Coffee contains both caffeine and antioxidants. These have positive brain effects and boost dopamine – a feel good neurotransmitter. These will help slow the damage from environmental pressures.
  • Sprinkle spices and herbs on foods to add antioxidants. Turmeric is an anti-inflammatory which may benefit memory. Include basil, ginger, garlic and cinnamon.
  • Increase your vocabulary. This exercises your brain and broadens your knowledge. Write down words that you are unfamiliar with while reading or watching a program. Later, look them up and try to put them into a sentence. Use them in the next few days in your conversations.
  • If you are sedentary, get up and start to move around for five minutes every hour. Become more active physically to help reduce the risks of complications. Fit in a walk 3-5 times a week. Add weight training 2-3 times a week. Weight training improves your body’s insulin response. Muscles store 80% of the sugar you consume in foods. Training makes your muscles more effective at absorbing sugar from your bloodstream- requiring less insulin.
  • If you have pre-diabetes, your health care provider might recommend a medicine such as Metformin to reduce the risk of developing diabetes and related health issues such as dementia. The health care provider will consider factors such as family history, having gestational diabetes during pregnancy, delivering a large baby and if you have excess body fat around the waist.

Having diabetes makes you more prone to other health complications such as high blood pressure, high cholesterol, dementia, and Alzheimer’s. Although aging and genetics plays a big role, good habits can move the needle to better brain health. Currently 10% of seniors over 65 have dementia with 60-80% of the dementia cases in those over 65 are Alzheimer’s. According to the Alzheimer’s Association “this will double by 2050.” Healthy lifestyle habits and ongoing education may help you avoid diabetes-related complications and keep your brain working without any problems.



About the Author: Roberta Kleinman

Roberta Kleinman, RN, M. Ed., CDE, is a registered nurse and certified diabetes educator. She grew up in Long Island, NY. Her nursing training was done at the University of Vermont where she received a B.S. R.N. Robbie obtained her Master of Education degree, with a specialty in exercise physiology, from Georgia State University in Atlanta, Georgia. She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past. She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups. More about Nurse Robbie

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