Opportunities for enhancing brain health across the lifespan
Published online by Cambridge University Press: 22 March 2021
As we age, there are characteristic changes in our thinking, reasoning and memory skills (referred to as cognitive ageing). However, variation between people in the timing and degree of change experienced suggests that a range of factors determine individual cognitive ageing trajectories. This narrative review considers some of the lifestyle factors that might promote (or harm) cognitive health. The focus on lifestyle factors is because these are potentially modifiable by individuals or may be the targets of behavioural or societal interventions. To support that, the review briefly considers people’s beliefs and attitudes about cognitive ageing; the nature and timing of cognitive changes across the lifespan; and the genetic contributions to cognitive ability level and change. In introducing potentially modifiable determinants, a framing that draws evidence derived from epidemiological studies of dementia is provided, before an overview of lifestyle and behavioural predictors of cognitive health, including education and occupation, diet and activity.
Normal Pressure Hydrocephalus, NPH, is an important condition. Although uncommon, affecting less than 5% of the population, it is a TREATABLE form of DEMENTIA.
If you or a loved one has been suspected of having Alzheimers or Parkinsons disease, NPH should be considered. It can be ruled out by MRI. Problems with Walking (“ Gait”) is often the first symptom, followed by mild Dementia. Loss of urinary control, incontinence, is often a later symptom.
The classic 3 symptoms are gait problems, dementia and incontinence, Hakim’s triad. A politically incorrect MNEMONIC is “wet, wacky and wobbly”. Gait “deviations”, with a broad based, slow, “stuck to the floor” movement are present almost all the time, and often suggests the more common Parkinson’s disease.
Some difficulty in planning, attention and concentration is present more than half of the time. Frequency of urination and incontinence comes later, but is often present by the time the diagnosis is made. Block in the reabsorption of Cerebrospinal fluid is thought to be the cause.
This produces intermittent elevation of pressure in the brain cavities, the ventricles. Thinning of the cortex follows, and it is this loss of brain tissue that produces the symptoms the diagnosis, usually by a Neurologist, is made by a number of tests, including MRI, and measurements of CSF Pressure.
An interesting test is to remove 30-50 cc of CSF and see if the walking improves. Treatment is with a tube connecting the Ventricles to the abdominal cavity, which restores drainage of the CSF. One of my friends was diagnosed with NPH, and benefitted with treatment. I consulted a neurologist about another of my friends with dementia, and an MRI to rule out NPH was suggested.
Treatability is the main virtue of discovering NPH, rather than another cause of dementia.
Unexplained weight loss is rare in our society, where weight gain is so common. Weight loss usually occurs in the context of a causative illness, like prolonged diarrhea, where it is not the main symptom, but just an associated problem. However, sometimes the loss of 5 or 10% of the body’s weight can occur in a few months without explanation or clues, and a consultation is needed.
Proper Nutrition is critical for Health, including maintenance of “normal” weight. The Gastrointestinal tract extracts nutrients from the food we eat, and illnesses such as COELIAC DISEASE, or REGIONAL ENTERITIS can prevent proper absorption. Our HORMONES regulate energy and chemical balance, and Thyroid, Parathyroid, Pancreas and Adrenal malfunction can disturb weight Homeostasis.
Chronic infection, such as AIDS and TB can sap energy quietly. NEUROLOGICAL PROBLEMS such as Depression, Dementia or Parkinsons can result in an improper diet, and subsequent weight loss. CANCER is the first thing we worry about when we unexpectedly lose weight, but Neoplasms usually betray themselves with other, more dramatic symptoms.
It is a good idea to regularly check your weight at the same time every day. Almost always it will reassure you by staying the same. Sometimes it will warn you to cut your feasting. Occasionally an unexpected drop in weight will direct you to your Doctor to find an explanation.
LOS ANGELES — Modifying 12 risk factors over a lifetime could delay or prevent 40% of dementia cases, according to an updated report by the Lancet Commission on dementia prevention, intervention and care presented at the Alzheimer’s Association International Conference (AAIC 2020).
Twenty-eight world-leading dementia experts added three new risk factors in the new report — excessive alcohol intake and head injury in mid-life and air pollution in later life. These are in addition to nine factors previously identified by the commission in 2017: less education early in life; mid-life hearing loss, hypertension and obesity; and smoking, depression, social isolation, physical inactivity and diabetes later in life (65 and up).
Schneider and commission members recommend that policymakers and individuals adopt the following interventions:
Aim to maintain systolic blood pressure of 130 mm Hg or less from the age of 40.
Encourage use of hearing aids for hearing loss and reduce hearing loss by protecting ears from high noise levels.
Reduce exposure to air pollution and second-hand tobacco smoke.
Prevent head injury (particularly by targeting high-risk occupations).
Limit alcohol intake to no more than 21 units per week (one unit of alcohol equals 10 ml or 8 g pure alcohol).
Stop smoking and support others to stop smoking.
Provide all children with primary and secondary education.
Lead an active life into mid-life and possibly later life.
Reduce obesity and the linked condition of diabetes.
We ARE our brains. Reduce the function of any other organ, and we may be sick, but reduce the function of the brain, and WE have changed.
PROGRESSIVE LOSS of brain function is called DEMENTIA. A sudden, temporary (if the cause can be found) is called Delirium. A variety of bad things can cause dementia, such as infections (AIDS), toxins (lead, mercury), chemicals (alcohol), traumatic (CTE from football), diet deficiencies (B12, folic acid), Endocrine deficiencies (thyroid),Psychiatric problems (depression), drugs, and Vascular problems.
The Preceding article on dementia discussed APATHY, as opposed to the somewhat similar DEPRESSION, as a warning sign for SVD, or small blood-vessel disease. SVD is the most common VASCULAR cause of Dementia.
The most common overall cause of Dementia, especially in old age, is ALZHEIMER’S disease (AD). “Senior Moments” are so common as to be a cliche. But this problem is not limited to old age. My 3-year-old Grandson came crying to me that he lost his favorite toy. “Where was it when you last saw it”?, I asked. “It was in my hand” he answered.
He had laid it somewhere, unthinkingly. You can’t remember something unless you ENCODE it. You must be paying attention to, be “mindful” of an action if you are to remember that action.. You will not remember where you put your glasses if you wander around in “default mode”, daydreaming, preoccupied. Everybody occasionally forgets a name, or item which hangs on “the end of my tongue”.
These things, especially “short term memory” do DETERIORATE AS WE GET OLDER. It is common to wonder if we, or a loved one. are getting Alzheimer’s disease, as our mental powers wane.It is often difficult to distinguish the normal forgetfulness of age from DEMENTIA, including Alzheimer’s Disease (AD) It might be a source of REASSURANCE to realize that if you are worried about getting AD YOURSELF, you almost certainly don’t have it; It takes a lot of mental functioning to contemplate that possibility.
Most often, you will be wondering about the possibility in a loved one having AD. There are 2 ideas that I ran across in my reading that might help you do a little evaluation Yourself.
BCGuidelines.ca has a 21 item questionnaire that you can score yourself. 4 points or less is considered normal, so common is forgetfulness. 5-14 points suggests mild cognitive impairment. 15 or more points suggests Dementia, of which AD is the most common type.
The test I really liked was the “Clock Test”. In this test, you draw a large circle. You then ask your loved one to draw a clock, with all the numbers and hands that will indicate 10 minutes after 11. If it is drawn correctly, you can with reasonable certainty EXCLUDE Dementia.
If incorrect, further tests are warranted. I consulted with a Neurologist regarding a friend of mine who has marked memory loss, but is very sweet, is physically capable, takes care of herself personally, doesn’t wander around, has no apparent anxiety, depression or other psychological problems.
I asked if it was reasonable to just watch without any medical intervention. The neurologist said that she should have a blood test, a metabolic panel, TSH (thyroid), LFTs, folic acid and B12 tests, and a CT to rule out NPH (normal pressure hydrocephalus). It is rare to find anything treatable, but a shame to neglect it if present.
If you do see a doctor about a Spouse or Parent with possible dementia, you might request that they discuss the possibilities with you, but ask them not to write the diagnosis of “Alzheimer’s “ in the chart. Private Assisted Living Homes CHARGE A LOT MORE for that Diagnosis– locked facilities, more personnel and the like. BDNF- brain derived neurotrophic factor- can fend off Dementia.
That is the good news. The bad news is that it takes effort and discipline to increase your level od BDNF.; I’m sure medical science is hot on the trail of a pill. But until then, our old friends, Sleep, Diet and Exercise ride to the rescue. Sleep, both N3 and REM stages, increases BDNF. Dietary polyphenols and butyrate increase BDNF. exercise of all kinds will do it.
The BDNF gene codes for the BDNF protein, which promotes the survival, expansion, and differentiation of Neuronal stem cells, and promotes neuronal PLASTICITY, neuronal response to experience. Grit your teeth and develop the HABIT of exposing your Postmodern Body to 3 of the most ICONIC and NATURAL things mandated by Evolution, Treat your Body to the Health-giving Benefits of SLEEP, DIET and EXERCISE!
We tested the hypothesis that apathy, but not depression, is associated with dementia in patients with SVD. We found that higher baseline apathy, as well as increasing apathy over time, were associated with an increased dementia risk. In contrast, neither baseline depression or change in depression was associated with dementia. The relationship between apathy and dementia remained after controlling for other well-established risk factors including age, education and cognition. Finally, adding apathy to models predicting dementia improved model fit. These results suggest that apathy may be a prodromal symptom of dementia in patients with SVD.
Cerebral small vessel disease (SVD) is the leading vascular cause of dementia and plays a major role in cognitive decline and mortality.1 2 SVD affects the small vessels of the brain, leading to damage in the subcortical grey and white matter.1 The resulting clinical presentation includes cognitive and neuropsychiatric symptoms.1
Apathy is a reduction in goal-directed behaviour, which is a common neuropsychiatric symptom in SVD.3 Importantly, apathy is dissociable from depression,3 4 another symptom in SVD for which low mood is a predominant manifestation.5 Although there is some symptomatic overlap between the two,6 research using diffusion imaging reported that apathy, but not depression, was associated with white matter network damage in SVD.3 Many of the white matter pathways underlying apathy overlap with those related to cognitive impairment, and accordingly apathy, rather than depression, has been associated with cognitive deficits in SVD.7 These results suggest that apathy and cognitive impairment are symptomatic of prodromal dementia in SVD.
“On a high-sugar diet, we find that the fruit flies’ dopaminergic neurons are less active, because the high sugar intake decreases the intensity of the sweetness signal that comes from the mouth,” Dus said. “Animals use this feedback from dopamine to make predictions about how rewarding or filling a food will be. In the high-sugar diet flies, this process is broken—they get less dopamine neuron activation and so end up eating more than they need, which over time makes them gain weight.”
It is well known that consuming food and drink high in sugar is not great for us, but scientists are continuing to unravel the intricacies of how the sweet stuff drives negative health outcomes. The latest finding comes from researchers at the University of Michigan, who through studies in fruit flies have found that excess amounts of sugar can shut down crucial neural circuits linked to regulating satiety, possibly leading to overeating in humans.
A novel illustration of sugars’ lethality was the Georgia sugar refinery explosion in 2008, which killed 14 people. Finely ground sugar is flammable.
Sugar appeared early in civilization, but it was expensive, sparing all but the wealthy of its’ depredations, mainly tooth decay. Only with the post WWII expansion of wealth was it consumed excessively to produce the diseases of overeating. The developed world now consumes over 70 pounds of sugar per person, amounting to over 250 CALORIES PER DAY!
This article shows how SUGAR acts like a DRUG In its INTERFERENCE with the DOPAMINERGIC Reward system. The neurons send less signal, so you need MORE SUGAR to satisfy.
The metabolic systems through which overeating and sugar causes the OBESITY, DIABETES, VASCULAR DISEASE and Early DEMENTIA are convoluted.The best detailed explication is in the NEJM article in intermittent fasting, a healthful practice that is the polar opposite of overeating.
Two very important metabolic mechanisms are discussed, the mTOR system and the Sirtuin system. These systems are important for NUTRIENT SENSING and repair, and conserved in all animals. They worked just fine in our early ancestors.
It seems that primitive man was not blessed (or is it cursed) with easy overabundance or food, and actually spent hours or days in Hunger. When times were good, his body put on muscle, and stored fat against the hard times to come. This is called ANABOLISM. When times were bad, his body went into repair mode, and used the fat for energy. This is called CATABOLISM.
Anabolism has evolved expressly for Young Animals, where extra food is welcome for Growth. After the growing and Reproductive years, our Bodies’ evolutionary “warrant” expires, since the genes it carries have already been spread. Our older bodies are left to deal with machinery more suited to an earlier vibrancy. Our metabolism didn’t evolve to deal with the calories we shove into our aging Bodies. Many mechanisms beneficial in the young prove harmful later on. This divergence has been called “ antagonistic pleiotropy”.
Whatever the explanation, the observation remains: if adults eat more than they can use, they gain weight. With insufficient exercise, this weight is fat. With excessive fat, the joints, blood vessels, liver, heart and brain suffer, and lifespan is shortened.
RETHINK YOUR LIFESTYLE AS SOON AS POSSIBLE. AVOIDING SUGAR, and ALL THINGS CONTAINING SUGAR is as good a place as any to start. You will be rewarded by being able to fully taste and enjoy the natural sweetness of many REAL FOODS, and afforded a longer life to partake in this pleasure.
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