ALBUQUERQUE, N.M. — If you forget your keys, can’t think of word or a name in the middle of a sentence or have to return home to get your cellphone – and you are in the over 50 crowd – the thought of early Alzheimer’s might cross your mind. Those thoughts become more frequent as you and your parents age.
Unless you are in your 80s, you may be catastrophizing about a very unlikely problem. Alzheimer’s disease develops in only 1 in 100 people in their 60s and only 2 or 3 in their 70s.
Neuroscience research leads me to believe that Alzheimer’s is not inevitable and your lifestyle plays a definite role in your risk. The key is developing what neuroscientists call cognitive reserve or the ability of the brain to function at a high level despite serious anatomic changes.
The concept is supported by autopsy studies performed in the 1990s on cognitively normal older women’s brains. The researchers discovered the same distorted brain wiring indistinguishable from the brains of severely demented individuals.
Researchers explain this discrepancy between the clinical findings of normal cognitive function and the distinctly abnormal brain pathology on cognitive reserve. The brain has been able to rewire itself despite the pathology to allow older people to maintain the ability to concentrate, remember, use computers and make decisions. These findings suggest there is much you can do to try to delay or prevent dementia.
Exercise your body and your brain. Epidemiologic studies show that individuals who have been physically fit throughout their lives are less likely to develop Alzheimer’s.
One measure of brain aging is called executive function, which is an umbrella term for functions such as planning, working memory, inhibition and mental flexibility, as well as the initiation and monitoring of action. Executive function declines with aging, but individuals active throughout their lives maintain that function far better than sedentary individuals. Research has shown it is never too late to benefit from exercise. A meta-analysis of 18 studies found that as little as 30 to 60 minutes of exercise a week can improve executive function, but I think 30 minutes a day is better.
The brain shrinks with aging and this shrinking is likely a factor in age-related changes in cognitive function. In a study comparing exercise with stretching on the hippocampus, an area of the brain particular to memory and learning, researchers reporting in the National Academy of Sciences found that older subjects who were placed on an exercise program of 40 minutes three times a week did not show the normal shrinkage that a control group that did stretching exercise did. The people in the study did not have memory problems initially so we don’t know the precise significance of the size increase.
A biochemical finding supports the idea we can delay or prevent dementia. Researchers have shown that a protein that stimulates new brain cells to develop and grow, called brain-derived neurotrophic factor (BDNF), increases with exercise when compared to sedentary controls. In animals that translates into the creation of new brain cells.
Brain fitness is important, too, and that means just because you retire, you should not retire your brain. Both laboratory and human data say engaging in stimulating activities promotes healthy brain function. The brain is like a muscle and if you stop exercising it, you lose it. Going to lectures, taking classes, reading, playing cards and being engaged with other people builds cognitive reserve.
The emerging field utilizing games that build memory, multitasking and decision-making offer a promising approach to providing immunity against Alzheimer’s.
In a study from UCLA, volunteers in their 60s and 70s were split into two groups: the first group used a brain fitness program for an average of 73.5 (20-minute) sessions across a six-month period while a second group played it fewer than 45 times during the same period. Researchers found that the first group demonstrated significantly greater improvement in memory and language skills. We will be seeing more research in this area and it might be a reason for my wife to let me buy an Xbox.
Another element in this vaccination against Alzheimer’s is diet. Researchers from Columbia studied the Mediterranean diet on cognitive function. Nearly 1,400 cognitively normal subjects were followed for five years. The individuals who most strictly adhered to the Mediterranean diet (emphasizing fish, vegetables, legumes, fruits, cereals and unsaturated fatty acids [mostly in the form of olive oil]) were significantly less likely to develop mild cognitive impairment compared to those least compliant with the diet.
Importantly, even those who adhered to the diet but still did develop mild cognitive impairment were less likely to later develop Alzheimer’s disease. So here again, although neither the diet nor exercise completely prevents deterioration of cognitive function, the efforts seem to lesson the severity.
Other factors provide some degree of immunity from Alzheimer’s. Connectedness is very important. Being part of a community keeps you engaged and provides opportunities to help others. Spirituality was found by MacArthur Foundation researchers in the 1990s to be an important source of immunity.
Finally, as many as half the cases of dementia are linked to atherosclerosis and hypertension. Excellent control of weight and blood pressure and not smoking are all-important factors in prevention of dementia.
Certainly, some of us will develop dementia even with the healthiest lifestyle, but the emerging neuroscientific research suggests that is our best hope for delaying or preventing the disease.
Dr. Barry Ramo is a cardiologist with the New Mexico Heart Institute and medical editor for KOAT-TV. Send questions for him to Albuquerque Journal Live Well, P.O. Drawer J, Albuquerque, NM 87103, or email them to firstname.lastname@example.org.