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A Healthy Head

The latest on brain health, and how you can sustain yours.

When the local market opens an hour late during the winter—well, it’s one of the few things that can get under Harvey Miller’s skin. 

He’s exceedingly good natured, but he’s also pretty stubborn about his routines, and when he has to walk to the market for his two newspapers at 7 a.m. on cold Michigan mornings, that changes things. 

He’s usually up at 5 a.m., spends an hour on email or written letters (one letter once a week for each of his eight grandchildren) then he’s off to get the newspaper. He has a Cheerio breakfast and reads one paper, exercises at the gym on the treadmill, returns to read more, then begins a day that is generally full of activities, spending time with friends or working to raise awareness about the need to protect public education.  

“I’ve always thought it was very important to stay active” says Miller, 81, who worked for 38 years as a teacher and administrator. He and his wife of 53 years, and the pets they frequently rescue, enjoy an active life in Tustin, Mich. That’s also where Miller taught, advanced to superintendent, and returned to teaching because he missed it. “I know for certain it’s even more important now.”

Now in his 10th term as head of the area NEA-Retired chapter, Miller is obviously doing a lot of things right to maintain his physical health. But experts say he also may be doing the exact right things to keep his brain healthy, maintain his good disposition, and avoid dementia.

Miller’s healthy habits, and other regimens—like walking, Tai Chi, eating a Mediterranean diet, and sleeping soundly—reduce inflammation in the brain, increase blood flow and perhaps either reduce the sticky plaque and “tangles” that gum up the communications between brain cells or allow a cleansing mechanism to be more effective, the Alzheimer’s Association reports. 

Conclusions about the aging brain are streaming in, including several key new reports at a major conference in London this summer about the ways age can cause brain cells to misfire, and the illnesses that can be detected early, or prevented, one third of the time with lifestyle changes that might also reverse the symptoms.

“We are determined to develop and deliver a more-specific recipe for Alzheimer’s risk reduction,” said Maria Carrillo, chief science officer at the Alzheimer’s Association. “We now can effectively prevent and treat heart disease and some cancers with a combination of drugs and lifestyle. The same may also be true for dementias in the not too distant future.”

What We Know

Dementia is a general term covering “physical changes in the brain that result in loss of memory and other mental abilities,” the Alzheimer’s Association says. Alzheimer’s disease, which causes brain cell connections to lose function as they build up deposits or become damaged or die, accounts for about 70 percent of dementia cases. Another 10 percent comes from Vascular dementia, which results from blood vessel damage or blockage, often from a stroke.

Alzheimer’s is the sixth leading cause of death in the U.S. (one in three seniors die from it) and the only leading killer that doesn’t have a cure. The reported rate of death from it rose 90 percent from 2000 to 2014 (the rate of heart disease and other major killers declined), and 16 million people have it right now, a number that could rise to 50 million by 2050, the Association projects. 

It affects women much more often than men, and Latinos and African Americans more often than Whites, research shows. People with specific genes are also likely to be affected by the disease, and Alzheimer’s is more likely to affect people with specific genes. Failure to complete high school, hearing loss, smoking, excessive drinking, poor eating, and a sedentary lifestyle create the greatest risk.

Miller thinks educators may be susceptible too because stress can also increase dementia risk. Others say because they work with learning and brain function they may be more aware of brain health and more likely to seek out cognitive and social stimulation, which researchers say can help.

Dementia is different from the normal aging-brain slowdown, though the first stage begins with “mild cognitive impairment,” similarly appearing as memory loss and confusion or loss of communications skills. But with Alzheimer’s, symptoms worsen and eventually cause death when the brain stops controlling key physical functions.

New Findings 

There is no cure for dementia, and efforts to diagnose or treat it have been limited. But researchers have taken major steps recently on ways to better detect the disease and guide people to helpful life-style changes.

New preliminary findings of one study show that a positron emission tomography (PET) scan can enhance the diagnosis of Alzheimer’s, leading to earlier treatment or less over-diagnosis. 

“We envision that one day soon, as part of a regular screening for cholesterol and blood pressure, a person may also get a blood test to find out if the amyloid protein is building up in the brain, and then go on specific treatments,” says Randall Bateman, a researcher at Washington University heading research on a test that showed how a blood test might accurately detect the disease. 

Perhaps most attention has been given to the abundant research showing the value of lifestyle changes, including extensive new research from the Lancet Commission on Dementia Prevention, Intervention and Care (see sidebar) that reports nearly 70 percent of dementia cases could be prevented. That report and others prompted a new $20 million study by the Alzheimer’s Association, which will look at what lifestyle changes might be most effective—earlier in life and after 60.

What You Can Do 

Work Your Brain

Lisa Genova, a neuroscientist famous for her novel Still Alice and TED Talk about Alzheimer’s, says neuroplasticity is key—learning something new, not necessarily just doing repetitive memory exercises.  She says we want to stimulate ourselves and build a reserve of synapses in the brain by learning “rich new information” rather than “crossword puzzles, which is like traveling down old familiar streets.”

“Building an Alzheimer’s resistant brain means learning to speak Italian, making new friends, or reading a book…,” she says.

In one study, when subjects changed their lifestyle and did brain exercises three times a week involving working memory, mathematical and verbal skills, and processing speed such as matching shapes, they had a 25 percent increase in “global cognition” while executive functioning scores rose more than 80 percent and thought processing speed more than doubled. 

Eat Well

“We have always felt it was important to have a balanced diet, but now know it helps our brains,” Connie Wittig says. She ticks off their meals, which sound much like those recommended in recent research on the positive impact of a Mediterranean-style diet. It includes relatively little red meat, whole grains, fruits and vegetables, fish and shellfish, nuts, olive oil, and other healthy fats. Four studies released this summer supported the Wittigs in this approach.

There are a variety of dietary supplements marketed for brain health, but the Alzheimer’s Association warns that “there are legitimate concerns about using these drugs as an alternative or in addition to physician-prescribed therapy.”

Get Physical 

Like Harvey Miller, former educators Connie and Larry Wittig religiously walk, bike, swim, and work in their large yard in Phoenix because they believe it will keep them both physically and mentally healthy. 

“We know people who are more sedentary, and it is evident that their brains are less active too,” Larry, 80, a long-time teacher, says, chatting while on a three-month camping trip with their recreational vehicle.

Researchers say a mix of aerobic exercise and resistance or weight training seems to work best for brain health, and that walking and yoga (the latter is also a weight-bearing exercise) are good, too. One study found a dramatic improvement in memory and independence among adults over 75 after a single session of low intensity exercise, and older adults who practiced Tai Chi or stretching regularly for one year improved thinking and recall.

“While it’s best to start early and continue healthy lifestyle behaviors over your lifespan to build cognitive reserve, experts emphasize it’s never too late to see benefits,” says Sarah Lock, director of the American Association of Retired Persons Global Council on Brain Health (GCBH).

Hang Out 

Linda Gringas retired in 2009 after 28 years with Clark County School District near Dayton, most recently supervising clerical workers throughout the district. She believes one key to brain health is active involvement with others—and she does it through her retired educators group, college courses, travel, the local senior center, and a group of friends (Bocce ball is one of their favorites), and connections with her family.

“My mother showed signs of Alzheimer’s at about 70. It was terrible. It was a nightmare to watch and I can’t do that to my children and grandchildren.”

A recent GCBH report supports her: “From a brain health perspective, research suggests that older people who are more socially engaged and have larger social networks tend to have a higher level of cognitive function.”

Gringas is also a participant in a Cleveland Clinic study that is examining the potential benefits of pioglitazone. As a result she has lost weight and watches her diet.  

Get Some Sleep

It’s sometimes difficult for seniors to get a good night’s rest, but it’s important to try (by observing a regular bedtime, limiting exposure to electronics at least one hour before bedtime, and by avoiding alcohol too close to the time you want to turn in). Poor sleep habits, research shows, damages brain cells, and causes inflammation, but it can also inhibit the brain-cleansing activity that experts believe takes place when we are asleep.  

In July, the Lancet Commission on Dementia, Prevention, Intervention, and Care released a 70-page report which included these recommendations:

  • BE AMBITIOUS ABOUT PREVENTION. Interventions for established risk factors may have the potential to delay or prevent one third of dementias.
  • TREAT COGNITIVE SYMPTOMS. To maximize cognition, people with Alzheimer’s dementia or dementia with Lewy bodies—a type of dementia that worsens over time—should be offered cholinesterase inhibitors at all stages, or memantine for severe dementia.
  • INDIVIDUALIZE CARE. Good dementia care spans medical, social, and supportive care; it should be tailored to unique individual and cultural needs, preferences, and priorities.
  • CARE FOR FAMILY CAREGIVERS. They have a high risk of depression. Effective interventions reduce the risk, treat the symptoms, and should be made available.
  • PLAN FOR THE FUTURE. People with dementia and their families value discussions about the future and important upcoming decisions.
  • MANAGE NEUROPSYCHIATRIC SYMPTOMS. Management of the neuropsychiatric symptoms of dementia—including agitation, low mood or psychosis—is usually psychological, social, and environmental, with drug treatment reserved for more severe symptoms.
  • CONSIDER END OF LIFE. A third of older people die with dementia, so it is essential that professionals working in end-of-life care consider whether a patient has dementia as they may be unable to make decisions about their care or express their needs and wishes.

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