As we age, dementia will touch many of our lives. More than 55 million people worldwide are currently living with the condition, and nearly 10 million new cases are diagnosed every year.
As populations age, those numbers are expected to climb sharply, with researchers predicting that the global total could reach 139 million people by 2050.
Yet dementia is no longer the mystery it once was. Researchers are learning more about the condition every year, helped by billions of pounds and dollars in new funding – the US government alone now invests around $3.9bn annually in dementia research. As a result, scientists are uncovering new ways to protect brain health, and there is growing evidence that the risk of developing dementia may actually be falling from one generation to the next.
But while scientists have transformed our understanding of dementia, public perceptions have been slower to change. As a result, myths and half-truths continue to shape how we think about the condition. Take, for instance, these six myths.
Myth 1: ‘Symptoms start when you’re elderly’
Many people think dementia only affects the very old. In reality, some forms of the disease can emerge decades earlier. Frontotemporal dementia, for example, is most commonly diagnosed between the ages of 45 and 65, while early-onset Alzheimer’s can strike before the age of 65.
Across dementia types, the disease may be present far before a diagnosis comes. “Dementia starts 20 years before symptoms manifest,” explains Dr Antonella Santuccione Chadha, a neuroscientist and CEO of the Women’s Brain Foundation, which carries out research into dementia.
In Alzheimer’s disease, proteins called amyloid and tau can gradually accumulate inside the brain. Over time, these clumps interfere with the normal functioning of brain cells and eventually contribute to the cognitive decline associated with dementia.
The process is so slow that damage may be building for years, or even decades, before anyone notices a problem.
Even when symptoms do emerge, they are not always dramatic. Early warning signs can include subtle changes in mood, motivation, energy levels or behaviour that are easily dismissed as stress or just ageing. In hindsight, many families recognise that something had changed years before a formal diagnosis was made.
For that reason, Chadha argues that persistent changes in cognition, mood or behaviour should not be ignored. If symptoms continue for several months, she recommends discussing them with a healthcare professional and considering further assessment to establish whether something more serious could be developing.
Myth 2: ‘Dementia is all to do with memory’
When most of us think about dementia, we picture the heartbreaking memory-related symptoms: forgetting the names of loved ones, becoming confused about where you live, or getting lost in familiar places. But dementia can affect far more than memory, and the symptoms often depend on the type of dementia involved.
Alzheimer’s disease, the most common form of dementia, is often thought of as a memory disorder. In reality, says Chadha, it can affect many aspects of everyday functioning long before the classic signs of memory loss appear.
“Alzheimer’s is about much more than memory,” she explains. “It’s about how you function.”
Early signs can include changes in movement, repeated falls, tremors or difficulty carrying out familiar everyday tasks. A person who has made coffee the same way every morning for years may suddenly find themselves unable to follow the steps.
“It’s not just getting lost because you don’t find your way,” says Chadha. “This comes much later.”
Again, other dementia types will manifest differently. The second most common type, vascular dementia, affects executive functioning more than memory, particularly in the early stages. This may mean struggles with planning, concentrating and experiencing slower-than-usual thinking.
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Myth 3: ‘Dementia is inevitable for some people’
Unfortunately, some people are genetically predisposed to dementia. Carrying one or two copies of the APOE4 gene, for example, can significantly increase a person’s risk of developing Alzheimer’s disease later in life.
But genes are not necessarily your destiny. Some researchers estimate that 45 per cent of dementia cases could potentially be delayed or reduced, depending on lifestyle.
To lower that risk, Chadha recommends regular exercise, maintaining strong social connections, monitoring vitamin D levels, ensuring adequate omega-3 intake through oily fish or supplements, and prioritising sleep.
It’s important here to note that good sleep hygiene involves more than simply getting seven to nine hours a night. Consistency matters too. Going to bed and waking up at similar times each day, allowing for deep restorative sleep, and keeping the bedroom cool, dark and quiet can all help support long-term brain health.
Keeping your brain active is important as well. “Keep educating yourself, learn a new skill or play an instrument,” says Chadha.
And if you’re concerned about your own risk – or that of a loved one – don’t put off seeking advice. A diagnosis can feel daunting, but catching dementia early may provide access to treatments and lifestyle changes that can help slow its progression. Once significant damage has occurred to the brain, however, there is far less that doctors can do to slow it.
Myth 4: ‘Symptoms are the same in males and females’
Dementia doesn’t always look the same in men and women. In fact, some researchers worry that important differences in how symptoms appear can make the condition harder to spot in women.
One recent study found that women with Alzheimer’s disease tend to retain their verbal memory for longer than men – on average, around 2.7 years longer.
That means they may appear to be coping well during conversations, even as changes are occurring elsewhere in the brain. When decline does occur, however, it can be much steeper, with women experiencing a 25–50 per cent faster deterioration in cognitive abilities.
The earliest signs can differ too. Women are more likely to experience symptoms that resemble mental health conditions, such as social withdrawal, anxiety, depression or sleep problems. Men, meanwhile, are more likely to display aggression, impulsive behaviour or inappropriate sexual behaviour.
The result is that two people with the same underlying disease may present in very different ways – and neither may match the stereotype most of us have of dementia.
Myth 5: ‘HRT can slow cognitive decline’
Women are diagnosed with dementia more often than men, prompting researchers to investigate whether the hormonal changes that occur during menopause could play a role.
One reason for the interest is oestrogen. The hormone appears to help protect the brain, supporting the health of neurons and potentially aiding the clearance of amyloid – one of the proteins associated with Alzheimer’s disease. During menopause, however, oestrogen levels fall sharply.
That has led some people to wonder whether hormone replacement therapy (HRT) – a treatment commonly used to ease symptoms such as hot flushes and night sweats – might also help protect against dementia.
It’s a logical idea, but according to Chadha, the evidence isn’t there. While HRT can be highly effective for managing menopausal symptoms, there is currently no convincing evidence that it slows cognitive decline or prevents dementia.
Myth 6: ‘Brain and heart health are totally separate’
We often think of dementia as a disease of the brain alone. In reality, some of the biggest threats to brain health begin much lower down in the body.
The brain depends on a constant supply of oxygen and nutrients delivered by the circulatory system. If the heart and blood vessels aren’t functioning properly, the brain can suffer too.
The link is perhaps most obvious when it comes to stroke. Damaged or narrowed blood vessels increase the risk of clots forming and travelling to the brain, where they can block blood flow and kill brain tissue.
But cardiovascular problems may also contribute to dementia. Reduced blood flow can damage the brain’s delicate network of blood vessels, making it harder to clear away waste products. Some researchers believe this may worsen the build-up of proteins such as amyloid and tau, which are associated with Alzheimer’s disease.
In other words, protecting your brain isn’t just about doing crossword puzzles and learning new skills. Looking after your heart matters too.
“My strong recommendation for people with cardiovascular risk factors is to check their brain [with an MRI],” says Chadha.
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