When thinking about the causes of dementia, old age is probably the first thing that comes to mind as it is primarily associated with Alzheimer’s, a disease that hits the older age groups hardest. Diabetes and high cholesterol are in the high-risk category, according to Stanford Medicine, along with family history, smoking, and alcohol use. One cause you may not have linked to this devastating condition is air pollution, but according to a recent study from the University of California, San Diego, there is a link.

health concerns

If you think this doesn’t apply to you as someone who lives far from a busy highway or industrial facility, you might be in for a chilling surprise. The pollutants cited in the study are particulate matter (PM 2.5) and nitrogen dioxide (NO2), “which are associated with accelerated age-related cognitive impairment and Alzheimer’s disease and related dementias (ADRD),” according to the study’s authors from UCSD’s Psychiatry Department and Aging departments.

They studied 1,100 men between the ages of 56 and 68 and found a decline in cognitive performance associated with higher exposure to the pollutants studied, concluding in particular that “the risk of cognitive decline in later life or the progression of dementia can begin in midlife”. In other words, environmental factors in your home and neighborhood can contribute to devastating health effects later on.

particulate matter

Higher PM levels can be a health and safety factor in your home. According to the Environmental Protection Agency, our indoor air can be up to five times more polluted than the air we breathe outdoors. “Indoor particulate matter can be generated by cooking, combustion activities (including burning candles, using fireplaces, using unvented space heaters or kerosene heaters, smoking cigarettes), and some hobbies.”

Outdoor sources entering our homes can include air pollution from vehicles and industry, and smoke and ash from wildfires, which can spread thousands of miles beyond the blaze.

Not only can PM pose a risk of dementia, but it can also worsen heart and lung diseases and irritate the eyes, nose, and throat.

nitrogen dioxide

NO2 can also arise in your home. The National Institutes of Health said on its website: “Among the most important indoor sources are tobacco smoke and particularly gas, wood, oil, kerosene and coal appliances such as stoves, ovens, room and water heaters and chimneys that are left unflushed or poorly maintained Devices.”

Outdoor sources that could easily enter your home include NO2 from gas powered vehicles, lawn and garden equipment, and construction sites, all of which can be as close as the yard or property line beyond your window.

In addition to posing a risk of dementia, NO2 can aggravate breathing problems, particularly in asthmatics, may contribute to the development of asthma, and has been linked to learning disabilities in children and Parkinson’s disease in other studies.

Wellness Planning Strategies

Architects, interior designers and remodeling professionals deal with these questions when they take on residential projects. For his Bay Area clients, San Francisco resident Daniel Ian Smith must consider wildfires alongside the other factors that contribute to a healthier and safer home in the city. “For major renovations at San Francisco Victorians, new HVAC systems with HEPA filtration are a no-brainer. However, for the simplest of design projects, we still plan to have standalone air purifiers in each bedroom and living room. They’re invaluable during fire season, but there’s growing evidence they’re just as valuable year-round for removing common indoor pollutants,” he commented in a design industry discussion on Facebook. These solutions he quotes can address all PM risks.

Smith also observed the impact of California’s phasing out of gas appliances for newly built homes as consumer awareness of indoor pollutants increased. “Combined with a federal discussion, the concern has spread to our East Coast customers.” He noted that while gas has long been a gold standard for cooking, induction is proving to be an attractive alternative for his customers. This can help eliminate a cause of NO2 exposure.

Architectural firm Mithun, with offices in San Francisco, Seattle, and Los Angeles, frequently works on large-scale, multi-family and mixed-use projects. Principal Hilary Noll pointed out that recent California and Bay Area regulations now require improved ventilation and filtration systems and other proactive measures for buildings in target areas with poor air quality. “Many of our multifamily projects installed MERV 13 before it was a code requirement,” she shared in an email.

“Another strategy we use is the installation of heat or energy recovery ventilation systems (HRVs or ERVs) that provide continuously filtered fresh air while tempering the air supply with the exhaust air to improve indoor thermal comfort and indoor air quality to improve. These are installed in each dwelling unit and exceed energy regulation compliance,” she noted.

Noll also commented on the elimination of natural gas in building systems and appliances in favor of electrification, which she called “another proven strategy to improve indoor air quality and particularly pollutants associated with burning fossil fuels, including nitrogen dioxide.”

Wellness Maintenance Strategies

Kim Levell designs for homeowners in Tampa and Chapel Hill, North Carolina, and suggested clean building practices and non-toxic materials in another designer group discussion on Facebook. “I have air purifiers that I recommend. Cleaning chemicals, perpetual chemicals, bad water, things like PFAs and the use of toxins are ubiquitous,” she explained. “Outgassing from furniture and building products affects me more than a properly ventilated gas range,” she added.

Studies have shown that many homeowners don’t use their kitchen exhaust fans because they are noisy and inefficient. Therefore, there are gas stoves that should be properly ventilated, but are not. In addition, some fans that can be described as “working” only circulate air in the room.

If you’re replacing appliances with a design professional like Levell or Smith as part of a new build or remodel, they can provide advice on quiet models that are right for your cooktop. If you’re simply swapping out appliances at a dealership, be sure to ask if you can match your new (or existing) cooktop or range with a model of the right size and rating that will keep your kitchen cleaner and safer. Not only are you enjoying the benefits of a healthier and more comfortable home today, but you can contribute to your health for years to come.

follow me Twitter or LinkedIn. Cash my website or some of my other work here.

I am a Wellness Design Consultant and Mayo Clinic Certified Wellness Coach with 18 years of building, home design and remodeling experience.

my third book Wellness by designpublished by Simon & Schuster in September 2020, won a prestigious Bruss Book Award in 2021.

In addition to writing, I speak at regional and national conferences on wellness design topics, and advise companies and analysts in the design industry.

I currently host twice a month Wellness Wednesday Clubhouse rooms, 1st and 3rd week of month at 4:00pm Eastern/1:00pm Pacific. You can view the current schedule here.

You can read more of my writing on my website at jamiegold.net.

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JACKSON, Wyo – When Remo Health went live three months ago, it fulfilled a promise Jackson resident Matt LeKrey made to his father four years ago.

After years of navigating the complex world of caring for his father, who suffered from a rare form of dementia, LeKrey made a commitment to his father to improve the experience for everyone else going through it. Together with co-founders Will Poe and Jason DeCastro, LeKrey created Remo Health, a comprehensive digital platform that supports and engages dementia caregivers.

According to the World Health Organization (WHO), more than 55 million people worldwide suffer from dementia and 10 million new cases are diagnosed each year.

Dementia is currently the seventh leading cause of death among all diseases and a leading cause of disability and dependency among older people worldwide. Dementia has physical, psychological, social and economic implications, not only for people living with dementia, but also for their caregivers, families and society at large. There is often a lack of awareness and understanding of dementia, leading to stigma and barriers to diagnosis and care.

-World Health Organization; who.int

Despite these high numbers, Poe, a San Francisco internist with a master’s in public health, has treated dementia patients clinically and says many cases go undiagnosed because primary care physicians (PCPs) shy away from an actual diagnosis.

“Only 1 in 4 cases is diagnosed … often the GP doesn’t know what to do after the diagnosis,” Poe said. Having had a grandparent with dementia, Poe describes the illness as a one-way train ride. “With Remo we find out which train you are on and the length of the route. We talk to patients about their children and family and what is important to them. We want to save people emotional pain, stress and money.”

Because there are no standard treatments and medications for dementia like other diseases, it can be a particularly challenging experience for the patient and their loved ones, who are often faced with questions about the diagnosis, how to get to and from doctor’s appointments, and how to manage cognitive issues Confusing symptoms and figuring out how to pay for everything.

Prior to founding Remo, LeKrey had spent the past decade building apps for families struggling with chronic illnesses, giving him the technical background to complement his personal experience as a dementia caregiver. Through these past projects, LeKrey met Poe, whose grandmother suffered from dementia. The two bonded over the “problem that hides in plain sight,” as Poe described the lack of centralized care and support for dementia patients and their families.

They brought in DeCastro as co-founder and chief technical officer. A devoted programmer since he was 13, DeCastro had been developing digital products for the past decade but found the work he was doing didn’t matter much.

“I’ve cared for family members with illnesses, so I understand the issues,” DeCastro said. He wanted his work to make the world a better place, and Remo was a good fit.

Poe describes Remo as a “virtual geriatric center of excellence” where a group of brain health physicians help clarify a diagnosis and then stay with the person every step of the way, including prescribing and rejecting medications, avoiding slips, tripping and falling, handling memory, movement and mood, and assessing home safety.

building the business

In October 2022, Remo Health won the Panelist Choice Award, the grand prize at Silicon Couloir’s Pitch Day, where entrepreneurs pitch their companies to a panel of judges. It is the culmination of a three month process in which startups develop their business plan, pitch and marketing through coaching and practice from top business leaders in the region.

Matt LeKrey works to provide comprehensive, accessible dementia care. Photo: Silicon Couloir

Silicon Couloir is a Jackson-based nonprofit organization that aims to “align entrepreneurship with community vision to foster a diverse economy and healthy environment for current and future generations.” Their annual Pitch Day awards money and resources to winners so they can continue to grow their businesses.

“Silicon Couloir has been a wonderful community for us to find a way to not only meet people who have built businesses, but who have also helped us tackle the Intermountain West and shaped our history,” said LeKrey. Previously, LeKrey led Remo through gBeta Wyoming, an accelerator program that brings together entrepreneurs, investors, job seekers and others to create advancement opportunities in the business.

According to LeKrey, Jackson is a special and supportive place for entrepreneurs, where big names in business with access to money and resources live down the street. LeKrey also points out that many of the moguls who live in the Tetons have a friendlier, more supportive attitude.

“Everyone comes from a ‘How can we help?’ mentality that provides access to money, customers, talent and mentorship,” said LeKrey. “People have come out of nothing and tried to create opportunity … in a way that is without pretentiousness or arrogance or extreme bias that might come from bigger cities.”

This is how Remo works

Through the use of telemedicine, Remo hopes to bring world-class healthcare to all parts of the country, from rural areas to densely populated cities. Remo also hopes to support caregivers who are often overlooked in the current healthcare landscape. Online forums, mental health professionals and treatment guidelines are an integral part of Remo’s approach to care.

Physician visitation virtually eliminates the barrier of taking patients to the doctor for in-person visits, which is difficult when caregivers need to change their own schedules and take time off work. The support and involvement of caregivers – who often experience burnout with dementia – is key to making a patient’s final years healthier and more balanced overall.

“It takes a whole village to take care of one person with dementia,” Poe said. “We’re bringing this interdisciplinary village to patients and families virtually, so the ethos of Remo — it’s an empathy service.”

Dementia is a difficult diagnosis because, unlike cancer or heart failure, there are no drugs to treat the disease. The reality is that all patients will die from the disease or its associated complications. Therefore, priorities are shifting from treating the disease itself to constructing what the patient and their family will be like in their final years.

“With Remo, there is only one true medicine: truth with compassion. We are in a world that is largely beyond drugs. That’s not diabetes. This is not heart failure. We don’t have any effective drugs or cures for dementia,” Poe said. “What we have is the courage to step up to the plate and bring clarity to the diagnosis and give families agency and empowerment back. You decide how to live the final chapter of life.”

By bringing timely, specialized care to a patient’s home, Remo also helps with another problem faced by patients with dementia: reducing unnecessary trips to the emergency room. Often patients with cognitive impairment come in for the visit with no real medical reason, and a burned-out nurse doesn’t know what else to do.

While Remo Health is fully operational in California with 11 full-time employees, the company has expansion plans into Nevada, Arizona and beyond, aiming to fill health care gaps for rural populations, including Wyoming.

“I would appreciate it for people to know that if you or someone you love is struggling with dementia, you are not alone. You don’t have to do everything by yourself,” LeKrey said. “We are here to help. This is a promise we made to loved ones and we intend to keep it.”

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Vacaville police on March 21, 2022, shared this photo of one of its officers walking with a woman who was found wandering on a busy street. The post triggered a community discussion on the difficulties faced when caring for a loved one with dementia.

VACAVILLE, Caif. – The Vacaville Police Department has received praise and triggered a compassionate, community discussion on the heartbreaking realities of caring for a loved one with dementia.

On Monday, the department posted a touching photo of one of its officers walking with an elderly woman who had been found wandering onto a busy street and into parking lots.

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Police said an alert community member had noticed the woman and went over to help her to safety.

“The community member stopped to help and recognized the elderly woman was a neighborhood member who was displaying signs similar [to] those she’d seen in her own grandmother who suffered from dementia,” police shared, adding that it prompted the community member to call police.

Officers arrived and were able to quickly identify the woman, thanks to a necklace she wore which included her contact information. They went on to notify a relative who worked nearby, police explained.

While waiting for the woman’s relative to arrive, an officer took the opportunity to go the extra mile.

“… the officer volunteered to continue to walk through the park with the woman to help keep her at ease while they waited,” police said. “As they walked, the officer chatted with the senior and she spoke about her favorite foods, how much she loves dogs, and how she just wanted to go home.”

For many local law enforcement agencies, their officers were no strangers to these situations, as they’re often called on by desperate family members trying to locate a loved one suffering from memory loss due to dementia.

These sensitive and stressful events were not lost on the Vacaville Police Department as it offered some insight, providing a compassionate look into the subjects of these all too common cases.

“Imagine: You’ve lived a long, joyous life. You’ve seen the world change through so many decades,” the department shared in its post. “But now, the destructive powers of dementia are slowly robbing you of those precious life memories, and you occasionally find yourself wandering around, unsure exactly of where you are or where you’re headed.”

The Facebook post received more than 1.6K likes and a huge response from community members, many who could relate.

“With tears in my eyes and losing my mother to a horrendous case of dementia thank you so much for taking care of this lady with loving kindness it’s the only thing that works when things start going this way,” Cathy Gentry-hendricks wrote in the post’s comments.

Facebook user Luke Witthar shared, “I’m going through with that with my mother right now. She’ll call me at work and ask me what day it is and what time it is. Is so hard on a family.”

Kay Johnson Nelson expressed appreciation for the care taken to help the distressed woman. “Most grandmas have spent their lives caring for family and others. It’s so good to see family and community caring for our elderly members,” she wrote.

Police also used the post to offer this safety tip for families who have a loved one dealing with memory loss: “If you have an elderly family member that is at risk of becoming lost or disoriented, a necklace or bracelet with helpful information is a major resource for any Good Samaritans or first responders working to help,” police shared.

And to those who praised the department for its efforts, the police returned the expression of gratitude to the community, noting the effort was a collective one.

“There are a ton of wonderful people in our community, and it’s always nice to share a story that reminds us about positive humanity,” the department responded, also saying, “Our community members prove time and time again that they are willing to look out for and help one another.”

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