I am a 69-year-old retired neurologist with early-stage Alzheimer’s disease, the beginnings of neurodegenerative processes that will progress over time and some day kill me if something else doesn’t get me first.

Although I cared for many patients with Alzheimer’s and other dementias during my career, it never occurred to me that I might one day have it too. Now I’m on the patient’s side of the experience, an expert from the inside out on my own Alzheimer’s as it stakes out its slowly growing presence in my brain.

Most Alzheimer’s patients in high-income countries are diagnosed when symptoms of the disease show up in their behaviour or cognitive functioning – typically around the time that the damage to brain cells has become moderate to severe, too late for lifestyle changes to make a meaningful difference.

I found mine much earlier, in 2015. It was a fluke really, that I stumbled across some genetic information that prompted my clinical search. It’s easy to say I’m unlucky to have Alzheimer’s. But in truth, I’m lucky to have found what I found when I found it.

I have been able to access cutting-edge medicine through clinical trials and other progressive treatment options. But I’ve also made some simple lifestyle choices about diet, exercise and social and intellectual activity that evidence-based science has found can benefit brain health and, in some cases, slow the progression of Alzheimer’s in the early stages of cell-level changes — the 10 to 20 years before significant cognitive impairment.

At a societal level, science and statistics show a perfect storm under way and growing: the world-wide prevalence of Alzheimer’s disease and related dementias is expected to rise to 115 million by 2050.

So much about Alzheimer’s throws you into uncertainty. These fairly simple choices, then, become an organised counterattack. They help provide structure to my thoughts and actions, hope for the future, and a greater sense of happiness and wellbeing that feels realistic, not merely optimistic.

As close to a prescription as you can get, the five main anti-Alzheimer’s strategies are:

  1. Aerobic exercise
  2. A Mediterranean-style or MIND diet (see below)
  3. Mentally stimulating activity
  4. Social engagement
  5. Good sleep, along with good control of diabetes and high blood pressure, if present

If there were a drug for Alzheimer’s disease that would slow progression by 50 per cent, we’d hail it as a miracle, and it would be worth billions to the pharmaceutical industry. We already have it, and it is free: exercise. Aerobic exercise has been shown, without a doubt, to have a positive, protective effect in the early stages of the disease. A number of research studies have shown up to 50 per cent decline in the rate of developing Alzheimer’s among those who start the study with no clinical evidence of dementia. There is also evidence that your brain is sharper during exercise than when not exercising. Mine is, and reliably so. I am most able to think clearly and creatively during and for a few hours after exercising, even if it is just walking the dog.

Even modest levels of exercise are helpful, but there does seem to be a dose-response effect: more activity is more effective than less activity. Starting it in your 40s if possible is better than waiting until your 60s or 70s. I aim for at least 10,000 steps a day, but recent research has found that 8,000 steps or even less may be beneficial.

The data for a beneficial effect of diet is strong, if not quite as robust yet as that for exercise. Most studies have shown that a Mediterranean-style diet promotes brain health as well as cardiovascular health. In 2015, the MIND diet (Mediterranean–DASH Intervention for Neurodegenerative Delay) was introduced to specifically target slowing of cognitive deterioration, focusing on foods that have the most evidence for benefits to brain health, such as whole grains, green leafy vegetables, beans, nuts and berries.

One study followed 923 community residents, aged 58 to 98, who did not have Alzheimer’s at onset for an average of four and a-half years on the MIND diet. Those who stuck to the diet even moderately developed Alzheimer’s disease at a 35 per cent lower rate than those with poor adherence to the diet. Those with high adherence to the diet did even better, developing Alzheimer’s at a 53 per cent lower rate.

Participating in mentally stimulating activity has long been shown to postpone the onset of cognitive impairment caused by Alzheimer’s disease. Reading books five to seven days a week, using a computer three to seven days a week, participating in social activities two to four days a week and doing craft activities all lead to about a 30 per cent reduction in the rate of developing cognitive impairment.

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