The effects of dementia can be seen on the left as compared with a healthy brain on the right. Legal practitioners need to be more wary than most of the risk of dementia, writes DR NICOLA GATES.
Recently, a 64-year-old practising barrister with cognitive difficulties indicative of early dementia was referred to me. Due to his cognitive deficits he was incapable of having insight into the extent of his problems, let alone the ethical and legal ramifications. It was also evident that this barrister had no awareness of the various interventions he could adopt to protect himself and his brain. This is not an isolated case.
In Australia, within the next 40 years, the number of older adults (65 to 84 years) is expected to more than double, and the number of people with dementia to rise to 943,000. Lawyers and those in the legal profession delay retirement. It follows that there will be many lawyers still in active legal practice whose cognitive function is compromised. Yet dementia in the legal workforce is an issue that has been largely ignored.
What is Dementia?
Dementia is a popular term for neurocognitive disorders. The hallmark feature is progressive, irreversible brain degeneration resulting in cognitive decline. The most common cause of neurocognitive disorder is Alzheimer’s disease, with other causes including Lewy Body Disease, alcohol, Parkinson’s disease and AIDS. Alzheimer’s disease is indiscriminate, and subtle cognitive changes can begin to
occur as early as 15 years before diagnosis.
Early cognitive symptoms include word finding difficulties, poor memory for recent details and events, difficulty learning new information or systems, losing things, being distracted, and poor decision making. Dementia is the most feared medical condition, surpassing cancer and cardiovascular disease, and the topic is often avoided, negating the opportunity to consider prevention and intervention.
Dementia is not inevitable, with up to 60 per cent of dementia risk factors due to lifestyle choices. The legal profession is characteristically associated with a number of risks such as lack of physical exercise, high stress, long work hours, high alcohol consumption, and a dangerous mix of cardio-vascular-metabolic issues (low aerobic capacity, hypertension, obesity, diabetes).
Therefore, dementia risks are preventable, even in those with genetic risk. Ideally, we want to live a long life, feeling as young as possible, and to die of something other than brain degeneration. Overhaul your lifestyle by identifying your risk factors and then making necessary changes, recruiting help where you need it. A general rule of thumb is, “If it is good for your heart it is good for your brain”.
Targeted suggestions are: complete a minimum of 35 minutes daily physical exercise, drink a maximum 14 standard alcohol beverages per week, maintain a healthy weight, have eight to nine hours of sleep per day, eat a healthy diet modelled on the Mediterranean diet, manage hypertension and cholesterol, and significantly reduce stress. Sit down a lot less.
Sitting is a brain curse due to the cardio-vascular-metabolic triad. Stand every time you answer the phone, take the stairs, walk between offices, get your own coffee, or consider a standing desk option. Crucially, research indicates that what you do in your 30s to 50s determines how your brain ages, so I suggest tackling bad lifestyle habits early.
In contrast to what I was told during my training 20 years ago, research now indicates that adult brains have the capacity to change – use them to build them. Essentially, the brain is neuroplastic and adapts to new learning and new experiences by making micro and macro changes. These changes include new connections between brain cells, new firing circuits and, importantly, new brain cells (neurons).
Neuroscience describes this phenomena as building brain reserve and cognitive reserve. Studies show that the more you have used your brain in your lifetime the higher your resilience or protection against cognitive decline.