As the average lifespan of people in most industrialized countries slowly increases, we are seeing a sharp rise in new cases of dementia. According to World Health Organization forecasts, there are already the equivalent of 7.7 million new dementia patientss diagnosed every year and the number of new cases will likely skyrocket in coming decades. Given the critical shortages that are already being seen in trained support staff to care for dementia patients, it is hardly surprising that global health experts consider dementia to be a "ticking time bomb" that could overwhelm the health care systems in most countries over the next thirty years.
Along with the most common form of dementia, Alzheimer's disease, we are also seeing more older adults being diagnosed with dementias linked to stroke and cardiovascular disease (also called multi-infarct dementia). Although the risk of dementia rises with age and as new medical problems emerge, it is still unclear why some people develop dementia while many others do not. Are there specific risk factors that can increase the chances of developing dementia? Since cardiovascular disease can increase the risk of stroke-related dementia, researchers have been taking a closer look at lifestyle factors that can reduce the body's ability to cope with stress. One factor in particular that has been attracting more attention deals with what is known as the Type A behaviour pattern (TABP).
First identified in the 1950s by cardiologists Meyer Friedman and Ray Rosenman, Type A behaviour is usually characterized by excessive work motivation, rigid thinking, free-floating hostility, impatience, and being overly competitive. By observing heart patients waiting for appointments, Friedman and Rosenman found that the ones they would later label "Type A" were far more tense than other patients. Even the amount of wear on their chairs was different since they were unable to stay seated for long or moved around frequently. Based onFriedman and Rosenman's early research, these Type A patients were a higher risk for heart disease and hypertension than the calmer patients, the ones they labelled "Type B".
In the decades since Type A personality was first identified, there have been thousands of research studies examining how Type A behaviour is linked to medical conditions such as cardiovascular disease. Though the reason for this link is still unclear, one hypothesis suggests that Type A individuals are more prone to react to stressful situations. This leads to the prolonged activation of the hypothalamic-pituitary-adrenal (HPA) axis - the primary system activated during a stress response. Prolonged activation of the HPA produces excessive amounts of stress hormones such as cortisol and leaves the body more vulnerable to stress-related health problems, including heart disease and reduced immunity.
But could this lead to people becoming more vulnerable to dementia as well? While cardiovascular disease can be linked to multi-infarct dementia, research investigating Type A behaviour and dementia risk is still limited. There have been studies looking at how midlife stress and later risk of dementia suggesting that people who react more negatively to stress are at a higher risk of developing dementia decades later. People who are more prone to emotional distress also seem to have a higher risk for Alzheimer's disease. Unfortunately, many of the studies looking at how stress and dementia risk are related tend to give contradictory findings.
A new research study published in the journal Health Psychology provides the first clear look at how Type A behaviour, cardiovascular disease, and dementia risk may be linked. Written by Kathleen Bokenberger and a team of fellow researchers at Sweden's Karolinska Institutet, the study used data taken from the Swedish Adoption/Twin Study of Aging (SATSA). First started in 1984, SATSA is a long-term study of human aging using research subjects listed in Sweden's Twin Registry. This allows researchers to study sets of twins who have been raised together or in separate families to check how heredity and environment can affect health and longevity.
For the Bokenberger study, 1,069 SATSA participants aged 50 and above were selected and completed questionnaires measuring Type A behaviour, general lifetyle factors, and cardiovascular disease. Among the different dimensions of Type A behaviour that were measured by the psychometric tests given were: ambition, being hard-driven, neuroticism, paranoia, and cynicism. They were then followed over twenty-three years with regular dementia screenings. For those participants who died before the end of the study period, information relating to cause of death was also recorded.
Overall, 18 percent of the 1,069 participants developed dementia with the average age when first diagnosed being 83.05. The most common dementia diagnosis was Alzheimer's disease (53 percent) followed by multi-infarct dementia (23 percent). Interestingly enough, the relationship between Type A behaviour and dementia risk appeared to be the opposite of what the researchers had assumed. Some aspects of Type A behaviour, including ambition, appears to protect against dementia though none of the other Type A factors measured showed a strong link.
When the researchers looked at how Type A behaviour was linked to cardiovascular disease however, the results were very different. Stress, neuroticism, cynicism, and paranoia were all significant predictors of cardiovascular disease although being ambitious and hard-driven were not. Cardiovascular disease was also linked to dementia risk, even when age, sex,and level of education were taken into account.
What these results seem to indicate is that people with cardiovascular disease are more sensitive to stress which, in turn, could make them more vulnerable to developing dementia. Different dimensions of Type A behaviour, including cynicism and paranoia can also make people more vulnerable to stress problems because they are less capable of coping effectively. These results also highlight the potential importance of stress management techniques to help avoid the sort of health problems to which Type A people are especially prone.
While more research is needed, Karen Bokenberger and her colleagues argue that personality factors such as cynicism, paranoia, and stress can have a dramatic impact on long-term health. Along with cardiovascular disease, people high in these Type A behaviours seem much more prone to developing certain kinds of dementia later in life. Learning proper stress management techniques, behavioural management therapy and relaxation training, may well be an effective investment when it comes to preventing some of the most serious problems linked to aging. At the very least, it can help older adults stay mentally and physically active for as long as possible.
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