For years, on my instruction, Google mailed news alerts to my inbox: Depression. Every morning, messages declared themselves loudly as they landed in Outlook with a deceptively cheerful ping. Shameless really — given that they were either announcing the collapse of the human spirit or the disintegration of world economies.
Neither are any fun.
Not long ago, I altered my Google alert: Dementia is less ambiguous. It doesn’t bombard me with reports of fiscal calamity or send me down Wall Street. But nor does it promise antidotes in the hopeful way depression sometimes did; people get better from depression.
They don’t from dementia.
Sometimes, depression’s remedies sent me scurrying through the invisible archives of the ether as I tried to identify the author of this study or that, begging for interviews, haranguing doctors with endless questions. Sometimes these “cures” made me gasp, or laugh out loud: “Nicotine may improve the symptoms of depression in people who do not smoke”, I read with incredulity or, even more suspect, a treatment administered in Siberia: “whipping therapy becomes much more efficient when a patient receives the punishment from a person of the opposite sex. The effect is astounding: the patient starts seeing only bright colours in the surrounding world, the heartache disappears, although it will take a certain time for the buttocks to heal, of course.”
Science and snake oil: it’s a heady mix.
Once, mired in an especially resistant episode, mum was persuaded her diet was the cause of her melancholy. A nutritionist urged her to stop all her prescription drugs and in their stead take handfuls of minerals and vitamins, stop eating wheat, ditch the dairy, definitely outlaw anything with any sugar in it, opt for rice cakes and soya. Mum was elated — how easy this quest for eternal wellness would be! Elated until she got sick again and then with the crutch usually afforded by anti-depressants and lithium kicked out from under her because, of course, she’d stopped taking those weeks ago. She fell hard, sunk to the lowest she’d ever been.
In her astonishing In Love: A Memoir of Love and Loss, Amy Bloom (who describes her husband’s decision to end his life at Dignitas when he was diagnosed with early onset Alzheimer’s) writes, “‘Lessening the likelihood of developing the disease’ is a common phrase in the Alzheimer’s universe, and it is used about getting enough sleep, eating blueberries, doing crossword puzzles, and a lot of things that are good for all of us, and no one, not one medical website, states that these good things actually prevent anyone — anyone — from getting Alzheimer’s”. Later, in a pique of frustrated sadness, she tells a friend, “There is literally no treatment. The most advanced Alzheimer’s research in the world says: eat fucking blueberries. Get enough fucking sleep”.
Google assures me: Walnuts improve cognitive function. Blueberries boost memory. Fish oil supplements lower your risk of Alzheimer’s disease.
Promises, promises. And they are hard to resist, even though you know none of these things, in isolation, will make the blindest bit of neuro-protective difference.
So what can we do — prophylactically and sensibly speaking, given that there is no failsafe treatment — yet — for this horrid condition?
Professor of Ageing and Intellectual Disability at Trinity College Dublin, Mary McCarron tells me that the 2020 Report of the Lancet Commission “identified 12 modifiable risk factors, which, with appropriate interventions, could prevent up to 40 per cent of dementia cases worldwide: Education, hearing loss, hypertension, alcohol, obesity, smoking, depression, social inclusion, physical activity and diabetes”.
Dr David Robinson, consultant geriatrician at St James’s Hospital, says, “I tell my patients that when I was young, my older relatives died of heart attacks and strokes in their 60s and 70s. We’ve fixed that with statins and stents, now people are living into their 80s and 90s and their brains are falling apart.”
He agrees in the imperatives of staying physically, socially and mentally active and adds, “Novelty is important — when we are young, everything is new and our brains grow. But as we get older, we tend to do the same things over and over.” So go somewhere new, do something new, he urges. I had never considered this but, of course, it’s true: in our youth we reach, stretch, seek, grow into new experiences. We’re inclined to shrink with age. “And, yes” he says, “impaired hearing is an independent risk factor for dementia”; get a hearing test.
Yup, says president of the Irish Gerontological Society, Professor Rose-Anne Kenny who recently published Age Proof: The New Science of Living a Longer and Healthier Life, all of the above — plus variety and laughter; “they have a positive impact on inflammation which is a key mechanistic pathway for dementia”.
And what do I do?
I adopt the mantra that what’s good for my heart is good for my head. I try to avoid being lured to quick-fix complacency — those blueberries, the walnuts I hate. Instead I think: eat well most of the time, walk briskly most days, do Wordle most mornings, read a book most evenings, learn French...
When my mother first fell ill with depression, nobody spoke about it; in the 1970s mental illness wasn’t A Thing. She named the way she felt using the Oxford Dictionary. Then she took that word “depression” as diagnosis to the GP who thus far had failed to identify whatever it was that ailed her: “Could I be depressed?”.
I was lucky: I had Mum as an example. I understood depression better, earlier, and more intimately than most people because of her. Was it, then, because I could recognise depression, what caused it, how it manifested, that I was able to avoid it? I don’t know.
Will I avoid Mum’s Alzheimer’s for the same reason? I don’t know. I won’t know.
All I know is that I never considered the reality of my vulnerability to dementia until I had to stare into the face of forgetting every single day.
Keeping Mum: A dementia diary
- ‘I forgot you were my daughter’
- Time for a holiday before Mum forgets
- Is depression key to her dementia?