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Anthea Rowan

This is the 97th instalment in a series on dementia, including the research into its causes and treatment, advice for carers and stories of hope.
The seeds of dementia may be sown long before our first birthday – or even before we are born. New research shows that while risks such as high blood pressure and cholesterol compound over decades, early sugar exposure can harm the brain before we take our first breath.
A study by the Hong Kong University of Science and Technology (HKUST) published in the journal Neurology in July 2026 suggests restricting sugar during pregnancy and in children up to age two could significantly protect the brain against future cognitive decline.
“We were interested in whether nutrition during the first 1,000 days of life could influence brain health decades later,” says Dr Jiazhen Zheng, who was part of the research team at HKUST that examined medical records of almost 65,000 people from the UK Biobank.

They compared data from people conceived and raised during World War II sugar rationing against those born immediately after the restrictions were lifted, when average sugar intake doubled. “The end of UK sugar rationing provided a rare natural experiment,” Zheng says.
Sugar rationing began in 1940 and effectively limited everyone to between 30 and 50 grams of sugar a day – depending on whether they lived in the UK or the US. There are around five grams of sugar in a teaspoon.
Sugar became widely available again in 1953, when average sugar consumption was estimated to have nearly doubled from roughly 41 grams to 80 grams a day.
By comparison, today’s average sugar intake, which includes added, unseen sugar in ultra-processed foods, can be three to four times as much as people consumed during the rationing period.
The news that limiting sugar early in a child’s life could protect their brain later confirms two things: how susceptible our brain is to high glucose levels and how early that vulnerability can impact us.
The impact on the brain seemed to present in different ways.
“Participants exposed to rationing had slightly greater grey-matter volume, fewer white-matter hyperintensities, and better performance in several cognitive domains later in life,” Zheng says. “Longer exposure was also associated with lower hazards of all-cause dementia and Alzheimer’s disease, and a delay in onset of up to approximately 2.6 years.”

That is significant because brain volume shrinks with age as neurons and connections are lost. Since grey matter is made up of neurons and is where these connections happen, having more grey matter as we age is beneficial and suggests a younger-looking brain.
White matter is the bundles of nerve fibres that carry signals between brain regions. On an MRI, “hyperintensities” are bright spots that indicate small areas of damage, usually from reduced blood flow, inflammation or general wear.
They are common in older brains and are associated with things such as slower processing speed and higher dementia risk. So “fewer” hyperintensities means less damage – a marker of a healthier, younger-looking brain.
Why might too much glucose – and a diet high in sugars – cause damage in the brain?
There are several possible reasons.
According to Zheng, heavy sugar exposure before and soon after birth hits the developing brain in two distinct phases. In the womb, high maternal sugar can trigger elevated blood sugar, insulin resistance and inflammation. This can impair placental function and disrupt early fetal brain growth.
In early childhood, a high-sugar diet can interfere with how brain cells form connections (synapses), build protective nerve coatings (myelination), and build up “cognitive reserve” – the brain’s resilience against later decline.
Zheng was eager to stress this was only a hypothesis, but given what we are learning about the effect of sugar on the brain, it makes sense.
People with diabetes are known to be at higher risk of dementia than those without it. But it is not just high sugar levels that are bad for the brain; frequent episodes of low blood sugar are linked to risk of cognitive decline. The brain does best when blood sugar, or glucose, levels are neither too high nor too low.
At the root of type 2 diabetes is insulin resistance – a condition in which cells become “numb” to insulin’s signals, forcing the pancreas to work overtime. This often leads to prediabetes, in which blood sugar levels are higher than normal but not yet at diabetic levels.
Clinicians worry about prediabetes because it drives hidden vascular damage in the heart and brain even before a full diabetes diagnosis is made, according to Hong Kong-based general practitioner Dr Wong Sze-man.

A typical Western diet – one with a much higher sugar content than during rationing years – causes blood glucose to run too high too often, which means insulin will, too. When that happens, you risk becoming insulin resistant.
It is for this reason that some doctors recommend wearing a continuous glucose monitor – a device that tracks glucose levels round the clock, without needing repeated finger pricks.
Originally designed for people with type 1 or type 2 diabetes to manage insulin dosing and avoid dangerous glucose highs/lows, in recent years people without diabetes have also started using them to see how their blood sugar responds to specific foods, exercise, sleep, or stress.
You don’t need to wear a monitor to notice how sugar in your diet affects you, though, Wong says. Practical physical signs, such as fatigue, energy crashes and mood swings, are equally telling. Sweet cravings, dental issues, poor sleep and weight gain are other red flags.

Having a sweet tooth as a child exposes a person to a lifetime risk of a taste for highly sugared foods. That is worrying in Hong Kong, Wong says, where clinicians are increasingly concerned about rising rates of diabetes, especially in younger people. Hidden sugars run high in the city’s popular iced teas, sweet dim sum glazes, bakery items and other popular foods.
A developing fetus can taste flavours from its mother’s diet – including sweetness – by around the second trimester. According to the theory, called flavour-flow or prenatal/early flavour learning, repeated exposure to a flavour in utero and early infancy primes a preference for that flavour later.
A high-sugar diet during pregnancy has been associated with children showing a stronger preference for sweet tastes and less acceptance of bitter ones, such as those of many vegetables, later in childhood. Moreover, if a mother has a sweet tooth, the diet in the home in which a child grows up is likely to be higher in sugary foods.
Those with a sweet tooth – which may have developed because of their mother’s diet during pregnancy – can find ways to reduce sugar in their diet without feeling its deprivation, Wong says.
She suggests “gradual sensory adaptation” to dial down the sweetness, for example, by reducing the sugar in your tea by a little every few days until you don’t notice how little is in it. Boost aroma by adding sweet-smelling spices to dishes – cinnamon, nutmeg, or vanilla extract.
One easy hack to manage post-meal blood-sugar spikes is to eat the vegetables and protein on your plate before your carbohydrates. This also reduces later sugar cravings, Wong says.
Take small and manageable steps rather than making drastic cuts to stand a greater chance of cutting sugar out for good, and safeguarding your brain.
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Wellness

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A mother’s sugar intake can trigger elevated blood sugar, insulin resistance and inflammation in her unborn child, experts say. A researcher and a doctor explain the links between sugar exposure early in life and cognitive decline down the road. Photo: Shutterstock

Dr Jiazhen Zheng was part of the research team at the Hong Kong University of Science and Technology that studied the link between early sugar intake and dementia. Photo: HKUST

With so much unseen sugar in ultra-processed foods, today’s diet can contain three to four times as much as people consumed during World War II rationing. Photo: Shutterstock

Hong Kong-based general practitioner Dr Wong Sze-man says prediabetes drives vascular damage in the heart and brain before a diabetes diagnosis is made. Photo: Marina Medical 

Continuous glucose monitors help those with diabetes monitor their blood sugar levels throughout the day. Photo: Shutterstock

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Lifestyle

Health & Wellness

Health

Decoding dementia

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Author Anthea Rowan (right) with her mother.

Author Anthea Rowan (right) with her mother, who has Alzheimer’s disease, the most common type of dementia. Photo: Anthea Rowan

Anthea with her mother. Photo: Anthea Rowan

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Timothy Rittman, the neurologist who led the dementia research at Cambridge University. Photo: Cambridge University

A brain scan showing signs of dementia. Photo: Getty Images

Lizzie Perry, founder of This is Dementia, with her father, who was diagnosed with the disease at 58. Photo: This is Dementia

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The cover of one of Dr Sanjay Gupta’s book. Photo: Simon & Schuster

The cover of Marc Milstein’s book. Photo: Marc Milstein

Drink alcohol mindfully and ask yourself why you are having that drink. Photo: Shutterstock

Learning new things creates new brain cell connections and helps keep your mind sharp. Photo: Shutterstock

Reading is good for brain health. Try to read a wide range of book styles, and join a book club to discuss with others what you are reading. Photo: Shutterstock

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Relationships keep us engaged, interested and interesting, and may help prevent dementia. Photo: Shutterstock

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A person with dementia may experience “sundowning” syndrome - towards the end of the day they become more agitated, confused, panicked, resistant to instruction and restless. This affects their carers, too. Photo: Shutterstock

A person in bed, unable to sleep. Conservative estimates suggest about 20 per cent of dementia patients experience sundowning at some point.

Trey Todd is a neuroscientist at the University of Wyoming. Photo: Trey Todd

Sundowning was coined in 1987 by Lois Evans of Penn Nursing at Pennsylvania University. Photo: University of Pennsylvania

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Taking a patient with sundowning syndrome for a walk at a consistent time each day, morning or evening, may alleviate symptoms. Photo: Shutterstock

Getting out into the daylight early in the day is good for our sleep patterns, whether we have dementia or not. Photo: Shutterstock

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Research suggests that people who have stayed married for a long time have a lower risk for dementia because they feel less lonely, are more likely to eat well and exercise more, and are more cognitively engaged. Photo: Shutterstock

Vegard Skirbekk is a researcher at the Norwegian Institute of Public Health. Photo: Norwegian Institute of Public Health

Anthea Rowan’s parents on their wedding day. Photo: courtesy of Anthea Rowan

A long-time married partner represents a security that provides a buffer against stressors. Photo: Shutterstock

Anthea Rowan and her husband on their wedding day. Photo: courtesy of Anthea Rowan

If you live with a partner long term, you are more likely to develop healthy daily patterns, to eat well and exercise more. Photo: Shutterstock

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The Hogeweyk, a “dementia villlage” in the Netherlands, provides care and a familiar and safe environment in which people with dementia live while retaining their own identity and autonomy as much as possible. Photo: The Hogeweyk

Jannette Spiering is the senior managing adviser and co-founder at The Hogeweyk in the Netherlands, which offers “humanising care for people with dementia”. Photo: The Hogeweyk

Residents relax around the fountain in the theatre square at The Hogeweyk. Photo: The Hogeweyk 

Residents of The Hogeweyk respond positively to their increased autonomy. Photo: The Hogeweyk

Residents at the healthcare facility take part in a painting class. Photo: The Hogeweyk

Hearing loss dramatically raises the risk of dementia, so why are so many people in midlife doing nothing to prevent it? A test is easy to arrange

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Alison Huang, a senior research associate at the Cochlear Centre at Johns Hopkins, in the US, says hearing loss makes the brain work harder to process sounds. Photo: Johns Hopkins

Jiang Fan from the School of Public Health at China’s Shandong University. Photo: Shandong University

Checking your hearing in midlife is crucial, and can help you stave off cognitive deterioration. Photo: Shutterstock

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HRT use has been linked to better cognition, blood flow and brain size and a reduction in all neurodegenerative disease in recent studies. Photo: Shutterstock

HRT (hormone replacement therapy) use has been linked to better cognition, blood flow and brain size and a reduction in dementia and other neurodegenerative disease in recent studies. Photo: Shutterstock

If HRT is started after the age of 65, brain cells will have already been deprived of oestrogen for many years. This could mean there is a decline in neuronal connections – the brain’s messaging system. Photo: Shutterstock

HRT was found to be most effective when introduced early in menopause, says Anne Marie Minihane, director of the UK’s Norwich Institute of Healthy Ageing at the University of East Anglia. Photo: University of East Anglia

Dr Andrea Kwakowsky from at the University of Galway in Ireland believes the “critical period” for starting HRT is within five years of menopause. Photo: University of Galway

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The new free “Think Brain Health Check-in” online tool from Alzheimer’s Research UK doesn’t test your memory but checks how well you’re looking after your brain and gives tips to help prevent dementia. Photo: Shutterstock

Dr Susan Mitchell is head of policy at Alzheimer’s Research UK. Photo: Dr Susan Mitchell

The Think Brain Health Check-in asks how often you challenge your brain - and then highlights why challenging your brain is key to staving off dementia. Photo: Shutterstock

Getting a good night’s sleep every night is one way to lower the risk of developing dementia. Photo: Shutterstock

Up to 40 per cent of dementia cases could be prevented if people were mindful of the risk factors for the illness and made lifestyle changes to prevent them. Photo: Shutterstock

Can lack of sleep raise dementia risk? Yes, studies say – but with one exception

Having only five hours of sleep a night can increase dementia risk by 30 per cent for adults over 50, one study says. Photo: Shutterstock

One tip to overcome insomnia is to avoid clock-watching. Photo: Shutterstock

Taking a warm shower or bath in the hour or so before bed may help you fall asleep – and stay asleep. Photo: Shutterstock

Professor Roger Wong of the department of public health and preventive medicine at the State University of New York’s Upstate Medical University. Photo: Roger Wong

Sleep aids can heighten dementia risk, Wong says. Photo: Shutterstock

Can’t sleep? Try getting up and engaging in cognitively stimulating activities, like reading or making jam. Photo: Shutterstock

Dementia and ACB scores: how common prescription and over-the-counter drugs raise the risk of memory loss and cognitive decline

Certain common drugs, including antihistamines, antacids, antidepressants and anti-anxiety medicines, can disrupt the neurotransmitter acetylcholine, dubbed the “memory molecule” increasing the risk of dementia. Photo: Shutterstock

The writer, Anthea Rowan, with her mother. Photo: Anthea Rowan

Taking medications that block the action of acetylcholine can lead to memory loss, problems with spatial awareness, and cognitive decline. Photo: Shutterstock

Studies have found that anticholinergic drugs carried “significant’ dementia risk” for the over-65s. Photo: Shutterstock

Doctors need to be mindful of the risks posed by anticholinergic drugs, especially to an already at-risk population: the over 65s. Photo: Shutterstock

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The phrase ‘use it or lose it’ is not just a hypothesis, it’s a basic biological fact that holds as true for our brains as our muscles or bones. Photo:
Shutterstock

Our brains, like our muscles need regular use to stay healthy and flexible, say experts, and keeping our brains active builds our ‘cognitive reserve’, helping us to stave off dementia. Photo: Shutterstock

Geriatric psychiatrist Dr David Merrill recommends the active pursuit of activities that keep the brain sharp to stave off dementia. Photo: Dr David Merrill

Dorina Cadar says cultural and social engagement, reading, doing crossword puzzles, visiting art galleries, clubs and cinemas, and volunteering all increase our cognitive reserve. Photo: Dorina Cadar

Visiting an art gallery or doing something new and different are good ways to build up cognitive reserve. Photo: Shutterstock 

How yoga benefits dementia patients: new study uncovers brain-health boosts, supporting earlier research

Yoga has health benefits including better brain neuroplasticity, improved sleep quality, and more robust cardiorespiratory fitness, all of which help people experiencing cognitive decline or dementia. Photo: Shutterstock

Dr Diana Karamacoska is a research support programme fellow in healthy ageing and dementia at the NICM Health Research Institute at Western Sydney University. Photo: Courtesy of Diana Karamacoska

Yoga could be helpful in managing brain inflammation, particularly with its mindfulness component. Photo: Shutterstock

Wendy Du is the founder of Shan Studios in Hong Kong. Photo: Wendy Du/Shan Studios

Du has maintained a daily yoga practice for 10 years. Photo: Courtesy of Shan Studios

5 nutrients good for brain health that can delay dementia, or prevent it, and foods to eat with a high concentration of them

Research has identified some key nutrients we need in our diets to maintain good cognitive function and delay or prevent the onset of dementia. Photo: Shutterstock

Eating healthy isn’t just good for our bodies, it’s good for our brains, too. Photo: Shutterstock

Zahinoor Ismail, of the O’Brien Institute for Public Health at the University of Calgary. Photo: University of Calgary

Kale with pine nuts is a dish high in magnesium, and so good for brain function. Photo: Shutterstock

Oatmeal, and other wholegrain foods such as brown rice and quinoa, are rich in magnesium. Photo: Shutterstock

Mackerel is a fish that is especially high in magnesium. Photo: Shutterstock

Why you have to keep smiling at a dementia patient – you’ll feel better and it could evoke a positive response

A smile can bring a smile in return from a dementia patient, and may make them more amenable to your requests. Photo: Shutterstock

Author Anthea Rowan with her mother, who suffered from dementia. As a carer you’ve got to keep smiling, an expert on the condition tells her - and it’s not for the reason you might think. Photo: Anthea Rowan

Timothy Kwok, professor of geriatric medicine at the Chinese University of Hong Kong and Director of the Jockey Club Centre for Positive Ageing. Photo: Timothy Kwok

Dementia sufferers cannot be reasoned with, and their emotions can run the gamut from highly positive to negative in the course of a day. Photo: Shutterstock

Many dementia sufferers end up in residential care homes because caring for them is difficult and time-consuming – especially for family members with jobs. Photo: Shutterstock

The living room at Jockey Club Centre for Positive Ageing, in Hong Kong. Photo: Jockey Club Centre for Positive Ageing

‘An attack by aliens’: how to deal with a dementia patient’s delusions – experts’ tips for carers

Carers often find it challenging to calm a dementia patient down when they suffer from paranoia, hallucinations and delusions. Experts offer advice on what to do. Photo: Shutterstock

It can be heartbreaking for a carer, especially if they are a family member, when a dementia patient cannot recognise them. Photo: Shutterstock

Disinhibition, poor control or restraint over emotions or actions, is common in patients with advanced dementia. Photo: Shutterstock

Professor Fiona Kumfor is a neuropsychologist at the University of Sydney in Australia. Photo: Fiona Kumfor

When a dementia patient cannot remember where they put something, they might jump to the conclusion that it has been stolen. Photo: Shutterstock

Dementia begins in the memory centres, the hippocampus and the medial temporal lobe, then moves to other parts of the brain like the temporal lobes and then into the frontal lobe and the parietal lobes. Photo: Shutterstock

Sometimes dementia patients lose the ability to recognise loved ones’ faces, and so they may say they have never met them before. Photo: Shutterstock

Timothy Kwok is a professor of geriatric medicine at Chinese University of Hong Kong. Photo: Timothy Kwok

Unravelling 2 Alzheimer’s markers: what are amyloid plaques and tau tangles, how do they form and what do they do to the brain?

“Sepia galactic storms”: the rust coloured clumps are the stained amyloid plaques, the little black squiggles are the tau tangles. Photo: Andrew Lee

Amyloid plaques and tau tangles found in Alzheimer’s sufferers’ brains are caused by build-ups of proteins that block electrical messages. 
Photo: Shutterstock

Dr Andrew Lees, author of “The Silent Plague”, is a professor of neurology at the National Hospital in London and University College London. Photo: Dr Andrew Lees

Lee’s image of “sepia galactic storms”: the rust-coloured clumps are stained amyloid plaques, the little black squiggles are tau tangles. Photo: Andrew Lee

Two neurons: a healthy one and one with Alzheimer’s disease – with tangles and disintegration of the microtubules. Photo: Shutterstock

Daniele Vigolo and his team were able to monitor the change from liquid to solid in “fused in sarcoma” proteins, and study their internal structure. Photo: Daniele Vigolo

5 Alzheimer’s experts’ lifestyle advice on avoiding and delaying the onset of the most common form of dementia

Lifestyle tips for avoiding or delaying the onset of Alzheimer’s disease, the most common form of dementia, include staying active and socially engaged. Photo: Shutterstock

Keep your brain active throughout your lifetime – particularly by learning new skills as you age. Photo: Shutterstock 

Regular physical activity – even having a daily walk – can help delay the onset of dementia. Photo: Shutterstock

Dr Andrew Lees is professor of neurology at the National Hospital in London, and University College London. Photo: Dr Andrew Lees

Professor Timothy Kwok is professor of geriatric medicine at the Chinese University of Hong Kong. 

Professor Craig Ritchie is professor of the psychiatry of ageing at the University of Edinburgh. Photo: Professor Craig Ritchie

Dr David Merrill is an adult and geriatric psychiatrist and director of the Brain Health Centre at the Pacific Neuroscience Institute in California. Photo: courtesy of David Merrill

David Robinson is a consultant geriatrician at St James’s Hospital in Dublin. Photo: David Robinson

At risk for Alzheimer’s disease? 2 new blood tests could detect it early – here’s how they do it

New blood tests developed in Hong Kong and the US deliver an easier, less invasive and more cost-effective way to detect Alzheimer’s disease early. Photo: Shutterstock

Professor Amy Fu is on the Cognitact team at The Hong Kong University of Science and Technology. Photo: Professor Amy Fu

Previously, Alzheimer’s disease diagnosis relied on costly MRI scans. Photo: Shutterstock

Simulated results of Quest’s AD Detect Test for Alzheimer’s Disease. Photo: Quest

The author, Anthea Rowan, pictured with her late mother, who suffered from Alzheimer’s disease. Photo: Courtesy of Anthea Rowan

Excess belly fat linked to higher dementia risk, research shows. Experts explain, and advise how to shrink your waist to protect your brain

Having excess belly fat increases the risk of suffering from dementia, especially for women, according to recent research. Experts explain the link and give tips on how to shrink your waist to prevent your brain shrinking. Photo: Shutterstock

Why too much sugar early in life, even in the womb, could increase your dementia risk later

.css-1c6uqr6{color:inherit;font-weight:inherit;font-size:inherit;font-family:inherit;line-height:inherit;overflow-wrap:break-word;}Hong Kong study finds links between lower sugar intake in utero and up to age two and reduced risk of dementia in older age. Experts explain

Hong Kong study finds links between lower sugar intake in utero and up to age two and reduced risk of dementia in older age. Experts explain