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How Not To Become Demented

What weird quirk of human nature makes us more excited about a cure than prevention?  Imagine the headlines:  “Cure for Dementia!”  Wouldn’t you want to be one of the lucky ones to have bought stock in that company?

I have a friend who’s a dental hygienist, and you couldn’t pay me to do her job: Nobody wants to go to the dentist, nobody wants to hear about all the things they’re not doing to protect their teeth and not get gum disease. 

Nobody wants to be preached at.  We all know we need to floss our teeth*, and brush twice a day.  It’s pretty simple.  But how many people don’t floss, except maybe right before they go to the dentist?  How many of us have lied through our teeth, so to speak, and vehemently denied doing this? 

Dude, all they have to do is start poking around in there, and when they see plaque and your gums bleed at the drop of a hat, they know.  How many of us say, “I hate going to the dentist,” and then pay big money to have fillings and root canals, or worse, to get bad teeth pulled and get dentures.

Well, it’s the same thing happening here, except instead of losing your teeth, you could lose your memory, and your ability to think right. 

This story appeared in the news last week.  It didn’t make nearly as big of a splash as I thought it should:  “Exercising in Mid-Life Prevents Dementia.” 

Prevents dementia!  If you’ve ever watched a loved one struggle with dementia or Alzheimer’s, you know that this is hell on all sides. 

But this! This is really wonderful news:  Some basic lifestyle choices can delay or even prevent this from happening. 

Can you imagine if some drug company had developed a magic pill, something you take in your 40s and 50s, that prevents dementia?  People would be saying, “Sign me up!”

exerciseThis is better than a pill.  Also, it’s free!  The good news from this story is that – like many things we’ve talked about in this blog – every little thing you do makes a difference.  You don’t even need to lift weights or buy a gym membership.  You get points for walking the dog.  Just keep moving!  Any activity is good! 

An Australian researcher, Cassandra Szoeke, Ph.D., and colleagues just published these findings in the American Journal of Geriatric Psychiatry.   They followed nearly 400 women, aged 45 to 55, for more than 20 years, and gave them periodic memory tests; the women learned 10 unrelated words, and then tried to remember them 30 minutes later.

The investigators looked at everything – diet, education, marital status, employment, children, smoking, mood, physical activity, Body Mass Index, blood pressure, cholesterol, hormone levels, etc.   Although younger age and better education (this goes with the “cognitive reservoir” that seems to protect against Alzheimer’s that we talked about in this post) were linked to a better baseline test, the one factor that proved most powerful in determining who didn’t get dementia was regular physical activity. 

Note: In these posts, I talked about weight loss and smoking, and exercise as a way of not dying of cancer.  This isn’t even about big-effort activity.  You don’t have to jog, or pump iron, or do some extreme sport to keep your brain working. 

According to Szoeke: “Regular exercise of any type, from walking the dog to mountain climbing, emerged as the Number One protective factor against memory loss.”  Also, she continues:  “The effect of exercise is cumulative.  How much and how often you do over the course of your life adds up.”

walkingEvery little bit helps.  What if you didn’t start at age 40?  That’s okay!  Even if you start at 50, “you can make up for lost time.”  I’m going to add my two cents here and say that at any age, doing something is better than nothing, and if you can do your brain a tiny favor every time you move around, then do it.  Don’t cop out and say, “Well, I’m too old to start now, I’m toast.”  No, you’re not.  Conversely, “I’m way younger than 40, I’ve got plenty of time,” is just a terrible attitude.  You’ve got an even better chance of making a difference in your lifetime health!  

After exercise, the other things that proved to be strong protectors against memory loss were having normal blood pressure and having a high level of “good” cholesterol. 

One neat thing about this study, funded by the National Health and Medical Research Council and the Alzheimer’s Association, is that a lot of studies of memory loss start over age 60.  This is because the risk of dementia doubles every five years over age 65. 

The other:  There’s no prescription here for what you do, how hard you work out or how fast you run or walk.  The researchers found that it didn’t matter what people did, just that they did something.  The key is just daily exercise.  Seven days a week. 

“Start now,” says Szoeke, because if you wait, you will disadvantage your health.” 

*Note:  It turns out that dentists have been recommending flossing for a century without having done scientific studies to prove that it works.  Oops.  However, flossing does make your gums stronger and healthier, and removes food that otherwise might remain stuck between your teeth indefinitely, so it is a good thing to do.

©Janet Farrar Worthington

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How to Age Well, Part 2

This is the second part of a series on aging well. – Janet

It all makes sense, but sometimes we need to hear this stuff anyway.  Eat right, get vaccinated, and get some sun, because Vitamin D protects your body and helps prevent cancer.  This is from How to Age Well, Part 1.   Part 2 is about how we all need to get off the couch, mentally as well as physically.

Jeremy Walston, M.D., a gerontologist at Johns Hopkins, co-directs the Biology of Frailty Program and is co-principal investigator of the Older American Independence Center.  He has spent his career studying how we age.  In addition to many studies on specific aspects of aging, he has looked at what healthy older people have in common — at what they eat and don’t eat, and how they live – and has come up with some practical tips.  I recently interviewed Walston for Breakthrough, the magazine for the Johns Hopkins Center for Innovative Medicine.

Here’s more of what he had to say:

Keep Moving

exercise“Stay active as long as possible,” says Walston.  “Don’t sit for long periods of time, especially in the late afternoon or evening.  Studies show that those are low-activity times for many people, so it’s good to try to boost your activity during those times.”  Go for a walk after dinner.  Walking is good; in fact, you should walk a lot, or do some aerobic activity – there’s plenty to choose from. 

Just a few examples include taking a Zumba or Jazzercise class, riding a bike, swimming or doing water aerobics, hiking, jogging, or dancing.  In addition to getting cardiovascular exercise, “it’s also important to do exercises that help you stay flexible, that help your balance and gait, and that help strengthen your muscles.  Don’t forget your shoulders,” which are important for maintaining core body strength and higher levels of function.  And if you have an “orthopedic issue,” like knee or hip trouble, address it.  “It is essential to maintain your mobility as long as possible.”  This may mean that you need a knee or hip replacement – but it also could be something as simple as starting to use a cane.

However, while you’re staying active: 

Don’t Fall

balanceThe body literally takes a hit when you fall.  Many older people, who otherwise have been doing pretty well, take a turn for the worse after a fall.  Just being laid up for a few days, or even longer, can be difficult for the elderly because they tend to lose strength quickly. 

The best way not to fall is to be aware of the risk, and do your best to prevent it, says Walston.  “Things that can make you fall include not watching your medication; vision problems; weakness in the lower extremities; and balance and gait problems.” 

One huge risk factor is easy to fix:  “low lighting and a cluttered living area.”  Make sure your rooms are well lit – that you not only have enough lamps or ceiling lights, but that the bulbs are high-powered enough so you can see where you’re going.  And go after the clutter.  It doesn’t take much – maybe a stack of books or magazines that slips over, or a puzzle left by a grandchild on the floor – to make a walkway treacherous. 

Sometimes, you’re so used to looking at clutter that you don’t see it.  This is why Walston recommends bringing in an independent party – a friend or relative who is not used to your home, who can see potential trouble spots you haven’t noticed.

You can lower the odds of falling, as well, by working on your balance.  Tai Chi is a great way to do this, and many community centers offer classes (another bonus: taking a class helps you stay connected – see below).  Weights and exercises can also help your legs get stronger. 

Keep your mind active, too

puzzle“Cognitive risk factors include diabetes, elevated lipids, and high blood pressure,” says Walston.  Medications can keep all of these problems in check.  Even if you are currently being treated for these, it’s good to go the doctor for “tune-ups” every so often, to make sure you’re still on the right dosage.   

But other things can affect how well you’re thinking and functioning, too, and they may not be what you’d expect:

Poor hearing:  If you don’t feel connected, you may tend to withdraw from the conversation, smiling politely, not engaging, because you don’t know what people are saying.  This is bad.  “Get a hearing aid if you need one.”  It won’t just help your hearing; it will help your brain.

Personal note: I find this especially poignant.  There’s a feedback loop between our brain and the world.  We need stimulation to keep our brain going.  If we withdraw and isolate ourselves, we don’t get that feedback, and this hurts us mentally.  If all you need to do to help stop this from happening is get a dang hearing aid, swallow your pride and go get one!  Do it for your brain.

Physical inactivity:  Being active affects every part of your body.  It helps your heart work better, helps your lungs get more air, strengthens your muscles, and helps your brain work better.  Many studies have shown that older adults who are active are less likely to get dementia and Alzheimer’s. 

Depression:  If you are depressed, you are going to be withdrawn, you may not eat or sleep very well, and you may not get enough exercise.  All of these can affect your cognitive skills. 

Addressing all of these risk factors is good “cognitive protection,” says Walston.  And one of the most important ways to protect your brain is to stay active is to “interact with others more frequently.”  Stay connected.  Talking to people — volunteering, interacting with others in church, clubs, or other groups, being around family or friends – is good medicine. 

This is the second part of a series on aging well. To read part one click here. 

©Janet Farrar Worthington

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Exercise and Alzheimer’s – Part 2

Darth Vader BoxingI’m going to talk about the brain via an organ I know a little bit better: the prostate.

Bear with me.

Scientists have long known that, at autopsy, many men are found to have prostate cancer that never spread, never caused a problem, and never needed to be treated. They died with it, not of it. Why that is, is the subject of future posts, but trust me on this. Sometimes, diseases only show up at autopsy. People live a good long life and never show any signs of trouble, and yet, when they die, there it is under the microscope. For whatever reason, the disease never got out of hand. People died with it, not of it.

I did not know, until I interviewed Richard O’Brien, M.D., Ph.D., for an article for Breakthrough,  http://www.hopkinsmedicine.org/innovative/research/newsletter.html a publication of the Johns Hopkins Center for Innovative Medicine, that the same thing happens with Alzheimer’s. O’Brien, who was Chairman of Neurology at Johns Hopkins Bayview Medical Center, now Chairman of the Department of Neurology at Duke University School of Medicine, told me that some people, at autopsy, have Alzheimer’s pathology. They have the telltale brain plaques and protein tangles seen in Alzheimer’s disease – but they never develop any cognitive impairment. Other people have the exact same pathology, and they die of heartbreaking dementia. Why is this?

O’Brien sees opposing forces at work in the brains of people as they age. Think of the good Anakin Skywalker, still a part of the bad Darth Vader: a light-saber fight, now tilting toward the good side, now toward the dark side. Eventually, the good tips the balance, and Darth Vader dies on the good side, after having done a very helpful deed.

Well, in Alzheimer’s, the tipping point – the game-changer, the key factor that weights the scales toward dementia – seems to be ischemic disease. Stroke, or mini-stroke. “With a given amount of Alzheimer’s disease pathology in the brain,” O’Brien told me, “there are two forces at work. One is driving you to become demented, and the other is protecting you from being demented. The biggest force that we’ve found thus far is cerebrovascular disease.”

Note: This does not mean that every man who has had a stroke or who has cerebrovascular disease is going to get Alzheimer’s. That’s not what he’s saying at all. What it does suggest is that if a man has significant atherosclerosis, or if he has had a stroke, even if it’s asymptomatic – AND he has the plaques and tangles, that is a very powerful predictor that he will develop dementia.

The body has a limited capacity for what scientists call “insults.” Stroke is an insult. Plaques are an insult. Think of a boxer who can take a lot of punches, but he can only withstand so much. The brain has a tipping point, too. O’Brien believes that “either one of these alone isn’t enough, but the two existing together in the same brain are enough to tip you over.”

But there is very good news here:
Doctors are getting better at spotting and treating the risk factors that lead to stroke. In fact, two studies published last year found that the incidence of dementia has declined over the last 30 years. “The primary reason for that is the treatment of coexisting cardiovascular risk factors,” O’Brien said. He cautions that none of these treatments prevents the Alzheimer’s pathology from building up – but they “prevent it from becoming manifest. So you die with your plaques and tangles, but you’re still cognitively intact.”

So, what can you do to protect your brain? A huge one is exercise. The choices that we make today can help influence our risk of dementia later. In a report published in the Annals of Internal Medicine, scientists followed up on about 20,000 people who took part in treadmill testing in the 1960s as part of a cardiovascular study. Today, these people are in their eighties, nineties, or are deceased. “By searching the Medicare records for dementia diagnoses,” said O’Brien, the scientists “found that the people who had been in the fittest 30 percent of that group had a dementia rate that was half that of the other people in the cohort,” which confirms that “one of the side effects of regular exercise is a significant reduction in your risk of dementia.”

Another huge factor is cognitive reserve, and this is from education. It turns out that people who go to college tend to have more cognitive reserve than people who don’t. Note: I would imagine, although it hasn’t yet been proven, that if you haven’t been to college but you read and learn a lot, you are building up a cognitive reserve, as well. Learning a language or playing a musical instrument, doing research for your work, or singing in a choir – basically, anything that challenges your brain, as opposed to sitting on the couch and staring passively at the TV – all of these things have been shown to have beneficial effects on your ability to think, on the brain’s ability to make neural connections inside itself.

“All things being equal, people who go to college are much less likely to get demented,” O’Brien says, “people who are very fit are much less likely to get demented.” And there’s a third thing – “People with certain types of personality traits are less likely to get demented. Our latest data suggest that obesity is playing a similar role, too.” We already know (see my previous post on Low T) that fat, especially belly fat, changes your levels of hormones. What else does it do? Scientists are still figuring that out, but chances are good that obesity is not of great benefit to the brain.

Personality traits?
People who are positive and upbeat seem to have some protection from dementia. Again, why this is, is uncertain. It may be that people who are positive are more likely to educate themselves and exercise. They may also be more likely to do crossword puzzles or sign onto Luminosity, although O’Brien said he doesn’t think doing a puzzle here or there is enough by itself. One study published in the New England Journal of Medicine showed that people who did crossword puzzles had a lower rate of dementia than did people who spent a lot of time watching TV. But, O’Brien noted, this might be because the brains of people who choose to do crossword puzzles are very different from those of people who like to watch TV. “If you forced the people who are watching TV all the time to do crossword puzzles, would they have a lower incidence of dementia? I doubt it.”

Cognitive reserve is a very robust thing, according to O’Brien. “If you look at the neurons of people with high levels of cognitive reserve, they’re pretty resistant to the toxic effects of Alzheimer’s disease pathology. They actually have bigger neurons in the key areas of the brain. Their neurons are more healthy, even though there’s a lot of Alzheimer’s disease pathology.”

And finally, there is diet. O’Brien suspects that the Mediterranean diet might also have a significant effect on dementia, because it also has significant effects on cardiovascular health. “The data’s pretty clear that if you can prevent cerebrovascular disease, your chances of becoming demented are much lower.”

 

©Janet Farrar Worthington

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Can Exercise Reduce Your Alzheimer’s Risk? – Part 1

300_200_walk_gravel

Part one of a two-part discussion of exercise and Alzheimer’s.

I’m not one for guilt trips. Mainly, because guilt backfires. If you were my dad, or brother, uncle, grandfather, or son and I were to try to guilt you into doing something that you already know needs to happen, like exercise, you might make a few grudging trips to the gym, but you might also resent it, and me, and wish I would shut the heck up. I would, and do, feel the same way when somebody does that to me.

So, this isn’t about guilt.

Instead, it’s some really positive findings that have to do with Alzheimer’s disease. A couple of years ago, a study led by scientists from the University of Maryland School of Public Health, published in the Journal of Alzheimer‘s Disease, found that just 12 weeks of moderate exercise – basically, this means walking fast enough on a treadmill to get your heart rate up, but not so much that you couldn’t carry on a conversation with someone else while you did it – made a difference in how people’s brains functioned. It made their brains work better; their neurons, or nerve cells in the brain, were more efficient. People could remember things more easily, and their brains didn’t have to work as hard to do it.

Just 12 weeks of moderate exercise causes your brain to work better.

The lead scientist, J. Carson Smith, of the University of Maryland’s Neuroimaging Center, and said at the time, “No study has shown that a drug can do what we showed is possible with exercise.” The people in the study weren’t spring chickens, either. They ranged in age from 60 to 88. They weren’t athletes – far from it; they were considered “physically inactive older adults.” Some of them had already shown some mild cognitive impairment, which suggests that they had a higher risk of getting Alzheimer’s. The people in both groups – those with the mild impairment and those with healthy brain function – improved their cardiovascular fitness by about 10 percent in the three months of the program.

They also improved their memory. MRI brain scans taken before and after the study showed “a significant decrease in the intensity of brain activation in 11 brain regions” while the oldsters did tasks including identifying famous people from back in their day – heart throbs like Frank Sinatra, for instance. Even more exciting, the places in the brain that got better are the same ones that are affected when some one has Alzheimer’s disease – the precuneus region, the temporal lobe, and the parahippocampal gyrus. Their word recall – remembering as many as possible out of a list of 15 words – got better, too, and Smith called this improvement “a very big step in the right direction.” In their paper, the scientists concluded that larger studies are needed to see if exercise can actually delay or slow the progression of Alzheimer‘s disease.

What does this mean for you? It means that, whatever age you are, you can make your brain work better even with a fairly pitiful amount of effort. You don’t have to be in marathon-running shape. You don‘ t have to go grunt and sweat and dead-lift huge weights and then drop them in an attention-getting way. Just walk for two and a half hours a week – 30 minutes a day, five days a week. If you don’t have 30 minutes, do it twice for 15 minutes. I don’t know if the results will be exactly the same, but I truly believe that this evidence shows that any effort is going to pay off. No guilt required.

 

©Janet Farrar Worthington

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