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Alina Solomon, a medical doctor and Adjunct Professor dividing her working time between the University of Eastern Finland in Kuopio, the National Institute of Health and Welfare in Helsinki, and Karolinska Institutet in Sweden, studies the ageing brain, with a special focus on dementia prevention. 

When you take good care of your health in general, you also protect your brain. Some choices should be easy: eat healthy food, exercise, don’t smoke, use alcohol in moderation, if at all, and take your prescribed medicines to keep cardiovascular risk factors under control. But it may require more self-awareness to ward off dementia by keeping your mind active in a good way and by paying attention to how your mindset affects your lifestyle habits. 

How to cope with stress is a good example. “Stress can be a positive force that helps you to stay motivated and get things done. But you have to be aware of your personal limits. Too much stress and too little recovery is a risk,” Solomon says. 

In the Finnish CAIDE study, people who reported higher work-related stress at midlife were more likely to have dementia 21 years later. In MRI measurements of the brain, high work-related stress was linked to grey-matter volume atrophy within the same follow-up period. In other words, stress build-up at work could literally shrink your brain in the long run. 

The study was the first to focus specifically on work-related stress and long-term dementia risk. Work-related stress was measured using two scaled questions: ‘How often do you struggle to cope with the amount of work?’ and ‘How often are you bothered by constant hurry at work?’ 

Interestingly, it was the time pressure and not work demands as such that seemed to increase dementia risk. Other studies have found that higher work demands may even have a protective effect. “It probably makes a difference if your work is intellectually stimulating,” Solomon says. 

The researchers also noticed that the link between work stress and dementia or brain atrophy was only limited to the first follow-up. In a 30-year follow-up, the statistical association could not be found anymore. “This may mean there’s a critical time window when work-related stress can be especially harmful.” 

“This finding is something to consider when the retirement age is being raised and people are exposed to work-related stress for longer than before. Well-being at work becomes all the more important,” Solomon points out. 

Naturally, stress is not limited to work and middle age. It may also affect the diagnostics, prognosis and treatment of memory clinic patients. “In fact, decreasing stress tolerance can be an early symptom of dementia.” 

In an ongoing study at the Memory Clinic at Karolinska University Hospital, Solomon and her colleagues are investigating the associations between patients’ self-reported stress levels, stress biomarkers such as salivary cortisol, cognitive and daily functioning, and the impact on cognitive decline and dementia. Results may be of use in addressing stress-related factors properly in the care of ageing patients. 

Like stress, sleep disturbances often haunt the busy working person. In old age, one in two has sleep problems. According to a recent multi-centre study, they too may increase the risk of cognitive decline. More specifically, midlife nightmares, but not insomnia, were linked to poorer late-life cognition after accounting for lifestyle habits. In the ageing population, people with sleep disturbances, such as waking up in the middle of the night or too early in the morning and having trouble falling back asleep, had poorer cognition in a follow-up after a few years. 

Personality traits seem to affect dementia risk, too. “We found that people with the highest level of cynical distrust in late life had a higher risk of dementia. That is something we will study more in the future and may take into account in lifestyle interventions as well.” 

“A good question is how personality changes with age. You may not be able to avoid cynicism, but you can pay attention to how it affects your lifestyle habits.” 

Born in Romania, Solomon first went to Karolinska Institutet to do research, but was soon lured by Professor Miia Kivipelto to do her PhD work on cholesterol and late life condition in Kuopio. 

She became one of founding members of the Nordic Brain Network, a collaborative research forum led by Kivipelto and involving the three centres she now works in.  

“The network makes it possible to be involved in a variety of multidisciplinary research projects focusing on dementia prevention. Starting from observational studies, we have moved on to interventions and developed tools to support diagnostics and risk prediction.” 

An important milestone was the FINGER trial, which showed that cognitive decline can be prevented with a comprehensive lifestyle intervention – even in carriers of the APOE4 gene, a common risk factor of Alzheimer’s disease. Intervention trials based on the FINGER model are now being launched in the USA, Singapore and China, in continuous collaboration with researchers from the original trial within the worldwide FINGERS network.