With a contribution by Dr Jerry Thompson

If you have concerns about you or a loved one developing dementia, Mary Jordan guides you through how to assess your personal risk and the many things you can do to mitigate that risk based on the latest evidence.

Whether you have a close relative with dementia, a history of high-risk factors for this condition, or a diagnosis of MCI (mild cognitive impairment) you may be concerned to know how personally ‘at risk’ you or a loved one is, and what you can do to ‘dodge’ what is definitely not inevitable. In this second edition of her highly regarded Essential Guide to Avoiding Dementia, Mary Jordan guides readers through the many factors associated with developing dementia and the science behind our current understanding, including: diet, exercise, trauma, pharmaceuticals, genetics, social isolation, sleep, neurological deficits such as hearing loss, insulin resistance and diabetes type 2.

Based on her professional and personal experience, Mary offers a programme from which the individual reader can choose what works for them and their individual risks and circumstances.

Social inclusion – Extract

Having social networks and interactions with others is a key factor in avoiding dementia. In this respect, the Covid-19 ‘lockdowns’ and discouragement of social meetings had a specific and direct bad effect on those who either already had a diagnosis of dementia or were suffering from MCI. Only time will tell how many new cases of dementia can be laid at the door of the Covid-19 restrictions. 

‘Infrequent social contact’ is one of the risk factors stated in the Lancet Report and it can be worthwhile to assess your ‘social interaction’ status if you are seriously thinking about avoiding dementia. 

It is worth first thinking about all the people you know – your social networks – and considering how big a part these play in your current life. 

Many friendships and acquaintances are made through our work activities (that is our paid jobs) or through our children, and often these social contacts continue for many years, surviving changes of job, children growing up and differing circumstances. Other relationships fall away when we change job, move house or our children grow up and leave home. 

Some social contacts are made through hobbies (walking groups, sports clubs) and shared interests or volunteering (church communities, Scouts and Guides, Rotary clubs) and these contacts may be reduced when we cease to take part in the shared activities. Conversely, some people find that the friendships they made through these activities outlive the activities themselves so that, for example, the friend you met when escorting your child to football matches is still a close companion although your football-mad child is now a grown person with children of their own. 

Neighbours too, can play a part in our social interactions as can casual contacts such as the person who you get to know at the supermarket checkout, the delivery person who brings your mail, the dog walker you pass the time of day with, the allotment holder who rents the plot next door to yours and other people you may ‘know’ although you would not call them regular friends. 

There seems to be a connection between being married (or in a long term partnership) and a lower risk of dementia. This is postulated to be because married people have a wider social circle and more social contacts rather than any benefit from the married state as such. A systematic review and meta-analysis of relevant research, including in total 812,047 people worldwide, found an elevated dementia risk in lifelong single and widowed people compared with married people and the association was consistent in different sociocultural settings.

Loneliness is considered to be a huge problem in the older population and some specific associations have been set up to try to combat this (for example, The Silver Line who claim to ‘offer friendship, conversation, and support to those who need it’), but there are many older people who have few friends and acquaintances and yet would not consider themselves to be lonely. People also vary in their interpretation of loneliness, which does not necessarily correspond to having few social contacts. Interestingly, loneliness is not associated with an increased risk of dementia but lack of social interaction is.

Although research indicates that wide social networks and frequent social contact are associated with a reduced risk of developing dementia, it is almost impossible to itemise what the terms mean. Do we get more protection from meeting a lot of people at large social events or from frequently meeting fewer people? If loneliness is not a significant factor, is it sufficient to just chat to a wide range of people in a casual manner or should we be making efforts to deepen our friendships and have more intense relationships? Is it more important to have social contact with someone every day or to have ‘meaningful’ prolonged contact even if at less frequent intervals? Research does indicate that belonging to a social group, such as a club, church, or set of people who meet regularly, is an important protective factor but it is rather difficult to break down what elements of that ‘belonging’ are significant. 

During the Covid-19 outbreak, a great deal of emphasis was placed on ‘remote’ social contact such as that using social media (Facebook, Twitter, etc) and technological ‘meetings’ (such as Zoom), and many found this both useful and effective to ensure the maintenance of contact with others. However, as soon as face-to-face meetings were permitted once more, it was clear that in general, people were relieved to resume that form of contact. It was also significant that (apart from some who were exceptionally afraid or felt they had to ‘shield’ due to severe ill-health), many people accepted a degree of discomfort and endured complicated arrangements in order to meet others. For example, many more people than usual met in groups outside even during cold and wet weather, and large numbers were prepared to take inconvenient and slightly unpleasant Covid tests in order to attend meetings, to travel or to meet up with others. 

(Covid note: One very interesting fact I came to realise which emerged in the welter of ‘remote’ meetings and conversations is that most people with any form of dementia are unable to use technology to maintain relationships. This is not simply because of the difficulty in manipulating technology and learning new systems but because of the difficulty for someone with dementia of understanding that the remote image and voice are in any way ‘real’. Probably this should not have come as a surprise because even before Covid it was understood that, as dementia progressed, many of those with cognitive problems had difficulty coping with such things as telephone conversations, reflections in mirrors, television images and social media of many kinds.)

The main conclusion to take from these experiences is perhaps that it is not social ‘contact’ (via telephone, email or remote meetings) that has most significance when trying to avoid dementia, but in-person social interaction – the physical seeing, speaking and interacting with others. If this is so, then the casual chat at the supermarket checkout, an exchange with a fellow dog-walker or with the delivery person, may be more useful for avoidance of dementia than a telephone call or social media post. 

Many thanks to Grace Pilkington – grace@readmedia.co.uk for the extract.

About the Authors

Mary Jordan is a director and founder of Adapt Dementia Ltd formed to help people find a better way to live with dementia. She has specific first-hand experience of dementia through her work for Alzheimer’s Society, a UK dementia charity. She also has many years of experience working for the National Health Service and in the field of medical publishing. Mary qualified to deliver the Alzheimer’s Society CrisP programme which specifically caters for family carers and is QCF assessor in vocational achievement for Dementia.

Mary’s ability to use her first-hand experience to illuminate points in the training make her an inspirational and motivating trainer. Her specialist area is delivering Cognitive Stimulation Therapy to those in early stage dementia. Mary is also known for her books The Essential Carer’s Guide, The Essential Carer’s Guide to Dementia and Coping with Mild Cognitive Impairment as well as The ‘D’ Word co-authored with Psychiatrist Dr Noel Collins. Mary co-authored the award-winning: End of Life, The Essential Guide to Caring with Judy Carole.

Dr Jerry Thompson has been working as a doctor for over four decades, mostly in general practice. He now works part-time in general practice in the East Midlands. He has been a long-standing member of the British Society for Ecological Medicine (BSEM), is a member of the committee and has given regular talks for the society. In the last two decades he has been fascinated by people who have recovered from major illnesses, against the odds, when using methods poorly understood by conventional medicine but applying basic principles of good health and this is the basis for his book Curing the Incurable: Beyond the limits of medicine. He has
a special interest in toxicity and was the co-author of The Health Effects of Waste Incinerators published by BSEM. He has also written many patient leaflets on common conditions which are available on his website http://www.drjerrythompson.co.uk