You CAN Prevent Alzheimer's!: A Neuropsychologist's Secrets to Better Brain Health

Chapter One

It Could Happen to You

Margaret looked nervously at me from across my desk. Her daughter, sitting anxiously next to her, fidgeted with a tissue in her hands. They both expected the bad news although neither was really sure they wanted to hear it. Well, what do you think, Doctor? Is it Alzheimer’s?

In my experience, there’s never a good way to deliver bad news. Just some methods that seem more tactful than others. As a neuropsychologist, however, whose job it is to assess individuals’ brain functions in a fast-growing geriatric population, it comes with the territory.

Margaret, or Margie as she prefers to be called, is typical among them. She’s in her 70s and living in a body weathered by time and neglect. And yet, in her mind, she identifies with a woman half her age. She’ll be the first to tell you she’s lived a healthier lifestyle than many of her peers. She was never a heavy drinker or smoker, though she occasionally imbibed, and she felt she maintained a fairly active and normal existence, never going so far as to do anything that might destroy her golden years. But it is that very definition of what we deem normal that perhaps is at issue. We’ll discuss more on that later.

The Typical Patient

Margie’s journey to my office reads like a blueprint for many previous patients. It began innocuously enough when her daughter, April, noticed a certain cognitive decline in her mother’s mental acuity. Things that used to come easily, like remembering recent events, or why she had walked into a room, or where she had placed common items like her car keys, were now suspiciously beyond her ability to recall. Up until now these suspicions were shrugged off and were commonly referred to as senior moments. As these so-called senior moments increased in their frequency, April shared her concern with a friend, who recommended her to me.

After an initial interview, I administered a series of tests that form the foundation of what is referred to as a dementia battery. A few days later, Margie and April returned for the news: Margie did not have dementia—not yet, anyway.

Here the term dementia’ does not refer to being psychotic or crazy.

The relief in Margie’s face was palpable. Already she envisioned herself on a cruise with friends sipping wine and enjoying dinner shows well into her 80s and 90s. But April wasn’t ready to share in her jubilation.

What do you mean ‘not yet’?

A person’s brain function, I explained, is like a continuum spread out between two outstretched hands. The hand on the left represents dementia, a general term used to describe the symptoms that occur (memory loss being the most common) when the brain is damaged by one of several diseases, such as Alzheimer’s Disease, or cerebral vascular disease.

The hand to the right, meanwhile, represents normal brain function.

Margie’s results put her squarely in the middle of the continuum, in an area that for her age is described as Mild Cognitive Impairment, or MCI for short. In other words, her current mental abilities were not at the level they should be for someone her age, though they were not so bad as to label her demented.

A little concerned, April asked, Are you saying that my mother will eventually reach the dementia hand, or will she stay where she is—in the middle?

It’s a good question, and a common one. In Margie’s case it was simply too early to tell. The good news, I told them, is that not everyone who develops MCI moves down the continuum to reach the dementia hand. There are many variables at play that can affect a person’s progression up or down the continuum and not all of them necessarily move you all the way into dementia. On the other hand, there are those, like Alzheimer’s Disease, that most certainly will.

Disease, Dysfunction, and the Brain

Let’s look closer at the word dis-ease. It means to be not at ease, or, on a cellular level, out of balance, unhealthy cell function, or dysfunction. Poor cell health and dysfunction open the door for an increased potential for decreased cell maintenance activities and other things to go wrong, such as the formation of neuritic plaques, neurofibrillary tangles, and inflammation in the brain that are associated with Alzheimer’s Disease.

The 800-Pound Gorilla

As we age, it is commonplace in our society to experience senior moments just as Margie did. Of course, it is only natural that as these instances become more frequent we begin to assume the worst: Am I losing my mind? Am I getting Alzheimer’s? Will I be that parent who becomes a burden on my children because I can no longer remember how to do even the simplest of tasks?

And it’s no wonder. Alzheimer’s Disease (AD) is the most notorious attributable factor to dementia in the world—and for good reason. AD is a type of neurodegeneration caused by an accumulation of amyloid plaques and neurofibrillary tangles within the brain that decrease brain plasticity and interconnectivity, and which eventually leads to cellular death. Put simply, AD kills brain cells—and lost brain cells equal lost brain function.

AD is a progressively degenerative brain disease that accounts for approximately 62 percent of dementia cases worldwide and will eventually rob you of your friends, family and loved ones. They will ultimately become nothing but strangers to you, shadows moving through an unfamiliar world. What is possibly worse for those you leave behind, however, is that you will also no longer resemble the person they knew and loved either. In time, AD will eventually even rob you of your life. For most people worried about a decrease in their mental acuities, AD is the ultimate 800-pound gorilla looming over them.

Is Memory Decline Inevitable?

But let’s take a step back for a moment and look at the facts. There are many reasons as to why we have these so-called senior moments as we age. Not all of them lead to AD. In fact, there are various forms of dementia. Some of them are reversible, while others are entirely preventable if we have the tools and understanding of how to prevent them. A little early tip: How we treat our brain today will have a significant effect on our brain function tomorrow.

Take a look at the chart that follows. The Z-scores are nothing more than statistical data points, so don’t be intimidated. All you need to know is that 0.0 represents average memory function; just as a 100 IQ score would represent average intelligence.

Average Lifespan Memory Function

Verbal Memory is the ability to remember that phone number you just heard, or a list of words read aloud to you. Visuospatial Memory is the ability to remember things like where you parked your car or how well you do on a memory card game. Notice how on average both types of memory function reliably decline as we age down to –1.0, or what is considered a very low average range of function. Is this an inevitability? you may wonder. Is it the future that is in store for all of us?

The answer is a resounding NO! This chart is based on data collected from a population unaware of how to maintain their brain function over time. It is based on a public enamored with junk food, fad diets, lazy lifestyles and unstimulating mental pursuits. It is our goal here to change all that you think you know and show you how to prevent that decline so that your golden years are everything you want them to be!

Before we can do this, however, we must first provide you with a foundation for understanding how the brain works and ages in relation to the rest of your body. Following is a table that shows healthy brain aging compared to AD and mild cognitive impairment (MCI):

Age-Related Brain Atrophy

Just like the rest of your body, your brain goes through changes as you age. Because you can’t see it, though, you aren’t typically aware that these changes are occurring. So let’s talk about an organ you can see—your skin.

Close your eyes for a moment and think back to when you were ten years old. You are looking at yourself in the mirror, perhaps brushing your teeth or combing your hair. Puberty hasn’t set in yet, so there isn’t a blemish on your face. The word wrinkle has no meaning to you. Now, through your mind’s eye, you look at the back of your ten-year-old hands, fresh and spotless. Remember how if you suffered a minor scrape or cut you could almost watch your skin knitting itself back together? A wound like that would heal in something like a day. It was absolutely amazing!

Now open your eyes and look at the back of your hands. Wrinkles. Scars. Age spots. Sure, you call them freckles, but we all know what they really are! And the wrinkles—they just gradually get deeper over time, and more pronounced. But some of you, maybe, see skin that is remarkably smooth and supple for your age. Why do you think that is?

There’s no trick to it, really. Aside from some genetic factors, the quality of your skin today comes down to how well you have taken care of it throughout your life. Too much sun, cigarette smoking or alcohol, all have an impact on the health and vitality of your skin. Take notice, though, that these are environmental factors we can control, and how well we take care not to expose ourselves too much to these factors today will determine what our skin will look like tomorrow.

Like our skin, our brains have similar reactions to negative environmental factors. And as in our care for our skin, those environmental factors that adversely affect the brain’s development and sustainability are entirely under our control. How well we take care not to expose our brain too much to these risk factors is a major player in determining our brain function for tomorrow.

Risk Factors, Briefly

You’ll hear me use the term risk factor a lot. A risk factor is something that increases a person’s chances of developing a disease. I will cover many of these at length in subsequent chapters, but I at least want to give you a working knowledge of what they are before we go on. A health risk factor can be your age, your sex, lifestyle, personal health history or family health history. Environmental risk factors are things such as smoking, air pollution, stress, or toxins in your food or water supply.

If you are exposed to certain risk factors, you may be considered at high risk. For example, if you have a family history of heart disease, you are considered at high risk for heart disease. However, being at high risk does not mean you will definitely develop that disease, just as being not at high risk does not necessarily mean you will escape getting that disease. The number and severity of risk factors your brain has been or will be exposed to plays a large role in how far down the brain aging graph your brain function has declined or will decline.

Dispelling Common Misconceptions about Dementia

Many people associate dementia solely with Alzheimer’s Disease and are thus surprised to find themselves in the preliminary stages of the disorder with no sign of AD in sight. They fail to realize that there is a plethora of diseases and/or disorders that can lead to some form of demented state. Perhaps the most common misconception with regard specifically to patients who are diagnosed with AD, however, is that they did not think they could get it with no previous family history of the disease.

Take a look at the pie chart shown here. It describes the percentages by population of the numerous degenerative brain diseases that could cause a loss of mental function:

While it is true that AD accounts for a whopping 62 percent of dementia cases, there are a slew of others to consider as well. And that patient who was diagnosed with AD but had no family history of the disease? What he doesn’t realize is that AD comes in two forms—Familial AD, or FAD, and Sporadic AD. Only a small percentage of total AD cases are diagnosed as FAD, the genetic variant that runs in families. The overwhelming majority of AD cases are Sporadic, and they are caused by certain lifestyle choices, or other risk factors (hypertension, diabetes, etc.) that lead to poor brain cell maintenance and function. We are all at risk of developing Sporadic AD if we do not adhere to the prevention strategies we will be discussing later in this book.

Neurodegeneration

Many of the risk factors that cause the onset of Sporadic AD are, in fact, preventable. Inadequate nutrition (due to the typical American diet), decreased oxygen levels (due to constricted capillaries—again, poor diet and other lifestyle factors), coupled with little to no stimulation of memory systems (due to inactivity), and an environment filled with toxins set the stage for the beginnings of a complex neurodegenerative cascade. This downward spiral involves multiple changes in decreased levels of neurohormones, neurotransmitters, lipids, enzymatic activity, increased cytokines (involved in the inflammation response), changes in the cellular structure itself, and even changes in the genetic material of the DNA. All of these changes contribute to cellular dysfunction, loss of synaptic connectivity between neurons (30 percent or more in the case of AD), and even neuronal death.

What you may be surprised to hear, however, is that this imbalance begins quite early in life. Some researchers have uncovered evidence suggesting that the process starts extremely early. Atherosclerosis, or vascular disease, has been seen even in babies. Research has also shown significant inflammation and plaque buildup in arteries of 20-year-olds! One study of young soldiers with an average age of about 20 who died in the Korean War found that over half had significant atherosclerosis in their coronary arteries and aortas.

As this neurodegenerative downward spiral continues into our later years, the brain will continue to lose neurons and the synaptic connections between them. In place of these healthy neurons and connections are occlusions such as amyloid plaques and neurofibrillary tangles that are the hallmark of AD, and which accumulate over time. Research presented at the 2010 International Conference of Alzheimer’s Disease indicated that biomarkers such as amyloid beta levels rise significantly long before (15-plus years) any behavioral changes such as measurable memory changes occur. While some neuronal loss is normal, how much is presently unclear. What is clear is that unhealthy neuronal cells cannot produce the chemical messengers, known as neurotransmitters, in enough quantity to keep up with the demand we place on them to maintain the flow of information among the neuronal population, and this becomes especially so as they decrease in number. It isn’t until we are older that the damage we have perpetrated over a lifetime shows up in the form of cognitive dysfunction (e.g. poor memory) in our aged, slower, shrunken brains.

The Odds of Becoming Demented

So, what are the odds of becoming demented? I do a lot of seminars in the course of my work and I am often asked something to this effect. Would you believe 50/50? That is not to say that half of the people reading this book will develop Alzheimer’s. Rather, there is a 50 percent chance that whoever is reading this now, given what the typical person’s lifestyle is, will develop some form of dementia as he or she advances in age—whether it be vascular dementia, frontotemporal, Parkinson’s, or even the dreaded AD, among many others.

The ugly truth is that statistics show you will either become demented yourself, take care of someone who has become demented, or know of a demented person in your immediate family—unless we decide to do something about it now!

Even if you are already into your later years, there is hope. In a 2006 article in the journal, Neurobiology of Aging, researchers at the University of Illinois showed that with a little task-specific training (such as proper memory exercises), the brains of older individuals can blunt cognitive functional decline and even start to look and act younger. Using fMRI brain imaging, researchers discovered that training for specific tasks not only improved performance in older people, but also caused increased activity in the brain regions that were being targeted (in this case the ventral prefrontal cortex, a common site of age-related atrophy). The results suggest that age-related functional decline is not an inevitable process of aging, but can be reliably reduced, and possibly reversed, via brain stimulation, or neurotraining. Other studies across the country are showing similar results, and it is now generally accepted that stimulation of the mind is good medicine for the brain and can even help maintain brain health.

Sharp vs. Dull

Have you ever known of an elderly person who possessed the mental acuity or sharpness of a person half their age? They do exist—Dr. James Craine, my mentor and the principal researcher whose material this book is based on, was one of them. He worked on neuropsychological evaluations with me right up until the day he passed away. He loved the field of neuropsychology, and had the mental acuity to carry out such complex work up to the very end of his life.

So why then is it that some individuals stay mentally sharp while others, although they may not become demented, clearly have dulled mental function? Dr. Craine attributed his superior brain function to neurotraining exercises (he was also a track-and-field athlete, holding several titles in his age group). He claimed that you didn’t have to be the recipient of a traumatic head injury to benefit from neurotraining. There’s always room for improvement, he would often say, and he was living proof.

The Goal

Dr. Craine was the embodiment of what I call Mature Body—Youthful Mind, a concept I encourage you to take on as a goal while you progress through this book, learning the techniques put forth in it. After all, you’ve most likely worked long and hard to obtain your life’s achievements and get to where you are today. But what good is it to accomplish so much and not be able to remember any of it in the end? You should want to retain your memories and sustain or improve you brain health so that you can enjoy yourself well into your golden years. This is certainly better than being strapped to a wheelchair drooling into your lap and not knowing anybody or anything around you, right? If you’ve never been to a care facility with an Alzheimer’s Unit, go take a look for yourself and see what you think then. I’m sure, after working hard all your life (or perhaps you’re still working and want some reassurance against a future living with dementia), your goal is to retire and enjoy life. Not to let that 800-pound gorilla rob you of what you’ve worked so hard for!

The Solution

Let me make this clear right now: There isn’t a magic pill we can swallow or a surgery we can undergo that can fix what we have done to our brains throughout years of abuse and neglect. Not long ago, when poor cardiovascular health began resulting in a significant increase in number of heart attacks, the medical community got busy figuring out how to perform heart repair and replacement surgeries. The result is that today our health care system is more prepared than ever to handle serious heart problems. However, brain dysfunction due to similarly poor cardiovascular health usually does not show up until later in life, and even if it did make itself apparent earlier in the game, there are no methods at a surgeon’s disposal to repair the damage that has been done. Likewise, there are no new pills as purported in magazine and late night television advertisements to restore memory loss. Bottom line—there is no magic bullet or miracle cure.

But the damage that has been done is reversible, if it isn’t too severe or too late in the game. Back in the mid-1970s when science thought the brain was static, my