Get exercising and work up to 7 or 8 hours weekly is the best way to maintain brain health and stave off Alzheimer's disease and other dementia is Sanjay Gupta's primary recommendation in his book “Keep Sharp: Build a Better Brain at any Age”.
Forget those over-the-counter memory pills or reliance on mental puzzles and games other than to improve your skill in those areas. Going forward, evolving computer games may provide a breadth of stimulation in exercising the brain, with some hope of replacing drugs, says the author
Gupta says, that while there are several other lifestyle focuses that seem likely to help, exercise is the only one backed up by conclusive scientific evidence.
His fairly complete guide to fixing and maintaining your mental acuity comes at an opportune time as fear of 'losing it' is at the forefront of the concerns of many in an aging society.
The book is an extensive, often repetitive, primer on how to take some charge of your fate in this respect. Much of it will be familiar to people who have investigated the subject.
Gupta, widely known as the medical journalist for the CNN TV news station, is a neurosurgeon. While his celebrity will certainly help in sale of books and interest in his, he does have credentials to warrant his recommendations. He brings a rare, specialized and relevant perspective to the issue.
His 'manual' on how to follow his recommendations and other specific guidance might better have been reserved for an appendix, rather than be repeating material already presented earlier in detail.
His style, maybe because it is aimed at a novice readership, is somewhat folksy and not tight. He mentions taking a “tall” glass of water when the dimensions of the glass are not really relevant.
The book is well laid out for easy reading with lots of sub heads providing convenient places to stop. I particularly like his grey boxes of “Myth” and “Truth” where he provides something that is colloquially believed followed by the contravening facts of the matter. These alone can provide a quick education.
I can understand his loyalty to the medical profession as he is regularly advising readers to consult and follow the advice of their physicians.
And while I have never gone to medical school and it may be changing, my belief is that subjects such as exercise and nutrition got short shrift in class time, along with health maintenance, in favour of direct medical intervention to fix the problem of the moment.
While readers will likely be 50 and above, or those concerned about them, factors related to dementia may start accumulating in people in their 30s and 40s, making the lifestyle changes advocated by Gupta, relevant to the young and middle aged.
Not armed with tested evidence, he believes that people can remedy some of the damage and reduce deterioration by lifestyle changes. He writes that most of dementia is the result of lifestyle and not genetics.
Certainly Gupta is in his wheelhouse in his chapter 'Diagnosing and Treating an Ailing Brain” toward the end of the book. However, it delves into treatments and locations for such treatments in the U.S., and as such loses general relevance to readers outside that country, so like his prescriptions might better be placed in an appendix for those wishing such detail.
Rates of cardiovascular diseases and cancer are decreasing while that of brain-related impairment is increasing. And there has been little, if any confirmed breakthrough in treatment in 20 years, despite 400 clinical trials.
A resilient brain, rather than high IQ or education is what makes visionary thinkers. It is the ability to improve the brain through challenging experiences. However, high education may have some protective effects against cognitive decline, but not necessarily if slow memory loss has started.
He says a long term study found that only about seven per cent of deaths are gene related when it had been thought to be 20 to 30 per cent.
“Clean living” can slash the risk of a serious mind destroying disorder, including Alzheimer's, as it has for cardiac, he adds.
He presents a useful 24-point list of environmental factors that could lead to brain deterioration.
Although the brain only accounts for about 2.5 per cent of bodyweight it utilizes about 20 per cent of the blood and oxygen in the body.
Despite the growing marvel of computers they can only really compete in processing speed and storage capacity. The brain interprets a wide variety of information brought in by our senses and continues doing it with little limit. It will always be able to do some things a computer cannot, he adds.
An important quality of the brain is its “neuroplasticity” .....rebuild damage, regrow in response to demands made on it through learning more and different things.
The brain, he says, starts slowing down at 24, just before reaching maturity, but different cognitive skills peak at different times and you can still get better at certain things indefinitely. Vocabulary may peak in the the early 70s.
He describes “memory as the cornerstone of all learning because knowledge and processing starts there. Our memory is not a true record, but one that can change over time.”
Memory is also influenced by how the new information is interpreted by us with regard to our worldview and values and may be stored or discarded based on how it fits in. It is a learning process of constantly interpreting and analyzing incoming information.
The hippocampus is the brain's memory centre and as it shrinks so does one's memory. Shrinkage also seems to correlate with carrying extra bodyweight. After 40 it seems to shrink at the rate of 0.5 per cent per year.
Frequency of a signal between two brain cells increases the strength of the connection. Hence repetition leads to learning. New experiences and learning causes connection to grow. Without use the connections decline, but reviewing can cause them to regrow quickly.
If some things are not forgotten the system can become overwhelmed. The brain may attend according to how important new information seems to be.
People have different and individual facilities in what they remember.
Although Alzheimer's gets top billing, there are several different forms of dementia, he says, with different treatments. Early onset Alzheimer's may have a greater genetic component.
Changes in blood flow to the brain seem to relate to degeneration.
There are indications that Alzheimers may, to an extent, be a product of sugary Western diet and sometimes is referred to as type 3 diabetes. There also seems a correlation with obesity. Chronic inflammation may also be a factor in brain decline. It is the most common form of dementia and affects one in nine Americans over 65 and about two thirds are women (why, is not known). However, with better language skills they may more effectively hide it thus getting diagnosed later. Among eighty-fives and older about one third have dementia. Decline may have started 25 or 30 years earlier and for some even a decade or two earlier.
Gupta believes that one in three cases of impending Alzheimer's may be preventable “if the person does everything right”. He calls this a 21st century idea and about where medicine was 40 years ago with respect to cardio-vascular disease.
Some good news is that healthy older people can generate as many new braincells as the young. However, declining circulation may impair the connections.
And an important idea “Aging does not mean there will be an inevitable cognitive decline. Any cognitive decline, be it 'normal' or 'abnormal', is more than just a factor of age and brain deterioration.”
Mild cognitive impairment (MCI) occurs in 10 to 20 per cent of people over 65. It is often nearly unnoticeable.
He describes the symptoms of memory loss. Memories are cleaned out to make room for new ones when they are not much used or reinforced. Focus and hence multitasking gets harder with age. That may not be all bad.
Brain fitness programs focus on lifestyle strategies relating to circulation, vitamin deficiencies, obesity, diabetes, anxiety, sleep apnea and sedentary behaviour.
Gupta says when people focus on health they often don't consider brain health and here he includes the medical establishment. Whereas if you focus on the brain, pretty well everything else will be taken care of.
Learning a new language, memorizing a list maybe easier when younger, but vocabulary and judge of character may be better when you are older along with social communication, settling disputes and dealing with conflict as well as controlling emotions and dealing with stress.
Gupta describes six other “senses” beyond the five normally considered.
More information doesn't mean the brain gets larger but the number of brain cells and the complexity of the network grows. “Intelligence is not fixed.”
“Plasticity” refers to the changeability of the brain. However, changes can be both good or bad. Gupta quotes a scientist in the field “Old people are absolute masters at encouraging plastic brain changes in the wrong direction.”
This may be done with negative thoughts and constant worrying associated with depression and anxiety. Those doing it best “don't act like old folks”.
The five pillars of brain health are move, discover, relax, nourish, connect.
“Physical exertion has thus far been the only thing we've scientifically documented to improve brain health and function.” Drugs do not appear to be effective.
Exercise should incorporate both cardio and strength training, however brisk walking alone brings a good deal of the benefit. While a weight loss tool, that is not the most important service. Control of blood sugar is a prime benefit of exercise. Blood flow promotes proliferation and growth of cells in the brain and reduces stress and anxiety. Gupta recommends making exercise sacred on one's schedule and don't neglect upper body as you age.
He encourages people to try for 30 minutes of cardio a day five days a week, but tripling it should be a goal and it can be mostly walking. There can be brain benefits by frequently trying different exercises that provide new and different challenges.
The most prominent risks of dementia are presented by diabetes 77 per cent, smoking 41 per cent and hypertension 39 per cent studies suggest.
On another front, learning, discovery and purpose helps maintain brain health and keeping working at something helps that. It can reduce the chances of dementia by 3.2 per cent for each additional year of work one study revealed. Engagement and commitment to an endeavour can serve a similar purpose.
Gupta speaks of this as building up brain 'reserve' for situations where it is needed to get through a difficulty. Work, education and other activities over years build up reserve. Activities challenge the brain to build new networks and strengthen old ones.
He cautions that challenges from games and puzzles, that many rely on, provides a narrow type of stimulation concentrated on the skills needed for the games and is not the best path overall.
If people are using classes, he points out that live ones provide a wider variety of stimulation than one 'online'.
Having or learning second language is a good brain stimulant against dementia. A promising field is speed training where one has to recognize stimuli and respond to them, such as in video games, and research continues in this area with avoiding dementia as a goal.
Chronic sleep deprivation, another of the symptoms of our modern society, contributes to poor brain health. Few people thrive on fewer than seven to eight hours per day. Among many other factors integral to the sleep-wake rhythm is consolidating of memories during sleep.
While the patterns of sleep change with age, often earlier to sleep and earlier to rise, the amount needed does not.
Gupta is a proponent of meditation as part of none sleep brain rest.
He advises using mornings for creative work and reserving procedural for later in the day.
While people can accommodate certain simple tasks at the same time such as walking, talking and digesting, the brain doesn't like attention divided when the task involves focus and concentration. “The brain loves the rhythm of sequences.”
On the food side, Gupta suggests eating seven different coloured foods as a guide to good nutrition. He suggests restricting foods with added sugar and salt. He doesn't mention the Jack LaLanne food caution. ...“if man made it don't eat it.”
The combination and interactions of foods is instrumental in nutrition. This is one reason stand alone supplements may not do what is suggested they will. The supplement industry is not well regulated.
Using them should be for a specific need discovered by medical or nutrition specialists.
Social connection is needed for optimal brain health. This is where some retired men fall down.
Digital media seems to be substituting for “authentic connection” leading to a rise in isolation and loneliness. These factors can accelerate mental decline in older people. A challenging activity in a larger group seems most protective, says Gupta. Social connection seems a better predictor of long happy lives than almost anything else.
While some young people may be online too much, mental health in old adults seems improved with developing computer skills and using them as an adjunct in connectiveness, he adds.
Maintaining social connections with people of different ages than your own is a good strategy.
Gupta points out that twenty per cent of Americans are on five or more prescription medications and too often are the side effects and interactions are not monitored and some of them can mimic a disease like Alzheimer's. Some drugs even increase the risk.
He believes “we are on the cusp of revolutionizing how we view and treat dementia” along with improving the experience of both the patients and caregivers. He suggests delaying the onset of dementia by five years can cut the incidence in half.
Dementia is isolating and isolation worsens the prognosis. It is important that the place people with dementia live be such that they feel it is home.
And an unusual correlation “caregivers of spouses with dementia are up to six times more likely to develop dementia than people in the general population”.