Deep within our minds lies a fear that transcends mere forgetfulness and the clinical definition of dementia: the fear of losing not just our memories, but the essence of who we are.

However, Charles Alessi, a physician in London and the chief clinical officer of éditohealth — a content agency promoting global digital health adoption for clinicians and health professionals — offers a perspective that challenges this fear.

In an interview with Korea Biomedical Review, Dr. Alessi explores the application of his book, “Increase your Brainability and Reduce your Risk of Dementia,” to deeply ingrained cultural activities, particularly in Korea, that may heighten dementia risks. 

Reflecting on his four decades in medicine as a primary care physician, Dr. Alessi recalls witnessing the rapid societal shift brought about by the aging population. 

"Over these decades, it became apparent how quickly the aging revolution crept up on us," he says, emphasizing the changes in longevity and health expectations in recent years. 

"But what struck me is that it was very, very clear that people were not managing aging very well.” 

In ancient times, death could come suddenly, slowly, and unexpectedly – from accidents, illness, or even basic daily activities like eating or drinking. Survivors remained vigilant against threats such as snakes or minor injuries, learning to fear the unknown.

Today, our concerns have shifted from basic survival skills to managing aging and diseases such as cancer and dementia.

Regarding cancer, Dr. Alessi points out that it has become a manageable long-term condition rather than a death sentence. “Cancer is often curable and almost always treatable,” he notes. “It is less of a threat compared to dementia, which currently has no cure.”

In contrast, dementia is a very complex condition with multiple potential etiologies that interact and coexist, making it difficult to understand. Dr. Alessi believes this complexity contributes to the widespread fear and misunderstanding surrounding the disease. 

“People generally understand cancer better than dementia,” he says. “We haven’t sufficiently educated people about what dementia is and what can be done to reduce its risks.”

"Scaring people to death is not the answer," Dr. Alessi says. “Regardless of age, scientific evidence shows that the risk of dementia can be decreased, and the capacity of the brain can be increased.”

Lifestyle factor 1: What we inhale

One subtle yet pervasive danger linked to dementia risk is nearly invisible yet encounted daily by many commuters. In bustling Seoul, where public transportation is a lifeline for 10 million residents, fine pariculate matter poses a significant concern. 

"These microscopic particles, often released by braking systems, infiltrate the air commuters breathe daily," he says, noting the potential cumulative effects on cognitive function.

“If you’re exposed to these conditions twice a day,” Dr. Alessi warns, “it can have a cumulative effect, even if you’ve never smoked.”

Fine particulate matter not only raises cardiovascular risks but also contributes to cognitive decline, a concern given the well-established connection between cardiovascular health and cognitive function. 

Most dementias, including Alzheimer’s and vascular dementia, involve mixed pathology, with cardiovascular risk factors, such as hypertension and other heart issues, exacerbating the chances of cognitive decline.

Compounding this issue in Korea is the prevalence of tobacco smoke, which Dr. Alessi describes as “one of the biggest risk factors for dementia.”

Unlike food or alcohol, which can be moderated or enjoyed culturally, smoking offers "no health benefits whatsoever,” Dr. Alessi says.

“The nicotine inhaled while smoking, whether through traditional cigarettes, cigars, or newer forms like vaping, exposes users to significant health risks to the cardiovascular system.”

Dr. Alessi notes that traditional forms like cigarettes carry higher health risks due to tobacco combustion, whereas newer methods like vaping are seen as less harmful alternatives, though their long-term health effects are still under study.

Lifestyle factor 2: What we drink

While the verdict against smoking is unequivocal, advocating for complete abstinence, the evidence regarding alcohol is less definitive – especially when discussing moderate consumption. While some studies suggest that a daily glass of red wine may potentially lower the risk of heart disease and stroke, the evidence isn’t conclusive.

“It’s fair to say that abstaining from alcohol is probably the safest option, but the evidence showing that small amounts are harmful is not very strong,” Dr. Alessi says. “Until the science is clearer, it makes sense to moderate alcohol consumption as much as possible.”

Dr. Alessi writes in his book that ethanol and its byproduct, acetaldehyde, can inflict “direct neurotoxic effect, leading to permanent structural and functional brain damage.”

Heavy drinking is also linked to other conditions that can harm the brain, including epilepsy, head injury, and hepatic encephalopathy in patients with cirrhotic liver disease. Moreover, alcohol’s impact extends beyond direct neurological harm to indirect associations with vascular dementia. The narrowing of blood vessels inside the brain, coupled with heightened risk of high blood pressure and hemorrhagic strokes, poses significant threats.

Alcohol interferes with liver metabolism and can irreversibly destroy brain cells – which lack the regenerative capacity of other tissues, Dr. Alessi says. However, he also highlights the brain’s plasticity, allowing it to develop neural pathways to compensate for damage. 

It’s not about restoring original brain cells but “fostering new pathways to perform the same cognitive functions,” he says. “Yet, the simultaneous destruction of liver cells can reach a critical point where damage becomes irreversible. A failing liver combined with brain cell destruction is a serious issue.”

“Alcohol is particularly problematic in cultures with heavy drinking, and Korea could be one of them.”

Lifestyle factor 3: Sleep 

The influence of alcohol is also undeniable when it comes to sleep. Consuming alcohol before bed causes insomnia, frequent wakings, and negatively impacts rapid eye movement (REM) sleep, which Dr. Alessi describes as “essential” for quality rest.

However, research from the National University of Singapore and the Finnish Health Technology Company in 2021, conducted across 35 countries, shows that cultural factors also play a significant role in sleep patterns. 

People in Japan and Korea, for instance, tend to sleep less on average, compared to Europeans. 

The study revealed that Koreans sleep an average of 6.3 hours a day, which is second shortest compared to Japenese people, who sleep 6.1 hours a day. 

Dr. Alessi attributes this to cultural norms and the fast pace of life in these countries. While addressing sleep deprivation is critical as it poses significant health risks, it’s also difficult to measure exactly how much sleep one needs, for the optimal amount of it seems to remain debated. 

“Determing the ideal amount of sleep is challenging because individual differences and genetic factors play a role,” Dr. Alessi says. “But one night of poor sleep is unlikely to have long-term effects if it happens occasionally. However, if inadequate sleep becomes a regular pattern, it can have significant health implications.”

Because deep sleep plays a crucial role in maintaining brain health, not getting enough of it can increase the risk of developing brain-related diseases such as dementia. 

Dr. Alessi also warns about the dangers of relying on medication to aid sleep. “Relying on drugs, especially benzodiazepines, which are essentially tranquiliziers, is problematic,” he says.

According to his book, there are twenty drugs that can cause memory loss, and the leading ones are sleeping pills. 

“Benzodiazepines act like a hammer on your head—effective but not healthy in the long run.”

These medications may offer the illusion of “short-term gain but result in long-term pain.” While sleeping tablets can make you feel drowsy, they prevent you from experiencing the restorative effects of deep sleep, causing chemical unconsciousness and leading to habituation over time.

Any drug that can make you feel drowsy and is psychoactive needs to be taken with caution, monitored, or avoided if possible, Dr. Alessi advises in his book.

Lifestyle factor 4: Media consumption and activity

In an era where sleep deprivation is common, the problem may run deeper than just getting fewer hours of rest. Some studies show that our attention spans are also shrinking, a trend linked to the rise of short-form content. 

But while there may be downsides to a short attention span, including poor performance at work or school and decreased executive functioning, Dr. Alessi suggests that the core issue isn’t the content itself but the sedentary lifestyle that often accompanies it. 

“The problem arises when we engage with content passively, leading to inactivity,” says Dr. Alessi. He suggests that people could integrate physical activity with content consumption by going for a jog or a walk while watching or listening. “There is no reason people can’t combine physical activity with content consumption,” he says.

Dr. Alessi says that the issue is not about the type of content but the lifestyle choices surrounding its consumption. 

“If you’re lying down while scrolling through your phone, it's going to be a problem – not because of the short-form content, but because of you way you ingest that activity,” he says.

According to Dr. Alessi, there is no concrete evidence suggesting that short-form content itself negatively impacts cognitive functions. 

“If it’s done while being active, it's much less of a concern. The important thing is to stay active while consuming it.”

Lifestyle factor 5: Exercise and physician resilience

In today’s world, the combination of stress, inactivity, and excessive food consumption has given rise to a new set of health dangers: obesity, type 2 diabetes and high blood pressure. Prolonged sitting, often up to eight hours a day, exacerbates these conditions, but they can significantly mitigated through regular exercise. 

One of the main processes behind the problems we fear — dementia, disability, and dependency – is the loss of physical fitness, which starts long before old age. 

In his book, Dr. Alessi explains that the probability of developing osteoporosis is determined not by diet or genetics, but by how quickly one loses bone strength and how strong the bones were in their prime.

“The level of strength at any age is determined, in part, by the maximum level before any decline starts,” writes Dr. Alessi. Those with greater reserves, even if they lose bone strength at the same rate, are more resilient and can cope better with the demands of aging and a physically challenging environment. 

The same principle applies to the brain. The higher the initial level of brain power or cognitive reserve, the better one can cope with any challenges to brain function. 

Dr. Alessi notes that the the hippocampus – a crucial brian region for memory – normally shrinks by 1 to 2 percent a year in older adults without cognitive impairment. However, walking has been shown to increase hippocampal volume by 2 percent, enhance brain connectivity, and reduce the risk of dementia by improving blood flow to the brain, direcrly affecting grey and white matter.

“While everyone loses some bone density with age, regular weight-bearing exercise and staying fit are key to mitigating this loss.” says Dr. Alessi. “The key is to engage in activities that get you moving regularly, stretching, and maintaining overall physical fitness.”

Investing in cognitive well being

The brain is an organ that can grow and develop throughout our lives. And while Dr. Alessi says the management of cognitive risks starts ideally starts from childhood, even from birth, it is “definitely worthwhile to start managing these risks early so you’re in a better position to mitigate them later,” he advises.

“The evidence is clear that we can positively impact our chances of developing dementia,” Dr. Alessi says. While recent developments, such as new drugs for dementia, are promising, they are not definitive solutions. 

“Only yesterday there was a new drug for dementia. Are these going to be the answer? That’s very unlikely.”

“We don’t have all the answers yet,” he says. “We’re not at a point where we can cure dementia, which makes prevention even more crucial at this stage.” 

By investing early and consistently in our brain's well-being, we can significantly improve our resilience to cognitive decline and enhance our quality of life throughout the years.

“The fitness gap can be closed at any age by increasing both physical and social activity. There is no upper age limit for prevention."