When working with patients to control cardiovascular disease risk factors
such as hypertension and high cholesterol, I find most people are more
concerned with preventing a stroke than a heart attack. This is
understandable. Our brain is responsible for so much of what makes life
meaningful—talking, thinking, remembering, moving, feeling. Indeed,
the brain is essential to who we are. People are justifiably concerned with
protecting this most crucial organ.
Of course, strokes are not the only malady that can afflict our brains.
Perhaps the most feared brain diseases are the dementias, the most common of
which is Alzheimer’s. Although genes play a role in developing
dementia, research tells us that there are a number of steps individuals can
take to lower their risk of developing it. Prevention is especially
important because unfortunately we currently do not have treatments stop
progression in dementias such as Alzheimer’s. In honor of June being
Alzheimer’s and Brain Awareness Month, below are seven steps you can
take to promote brain health and lower your risk of dementia.
Exercise
Exercise is the intervention with the most evidence for enhancing and
protecting your brain. It does so through multiple mechanisms. Exercise
lowers elevations in blood sugar and blood pressure levels that have
been shown to be harmful to the brain. It also decreases inflammation
and helps improve sleep. It increases our body’s production of
endorphins which are chemicals that relieve pain and lift our mood.
Finally, exercise stimulates the release of growth factors that promote
function of brain cells.
Aim for at least 30 minutes every day of some form of exercise. This can
include aerobic activities such walking, jogging, biking, or tennis. It
also includes resistance training to keep our muscles strong. This can
involve going to the gym for weight training or using our own body
weight with push-ups, planks, squats, lunges, or yoga. There is some
evidence that racquet sports like tennis, pickleball, or racquetball
offer the most benefit since they involve connecting with other people
as we move.
Learn
Keep your mind engaged with activities that provide joy and purpose.
There is evidence that we may derive the most benefit from activities
that cause us to stretch our cognitive capacities such as learning to
dance, play a musical instrument or speak a language.
Sleep
During sleep our brain washes away metabolic debris, including the
proteins that contribute to amyloid plaques found in Alzheimer’s
Disease. Sleep also decreases inflammation which has been associated
with neurodegenerative diseases like Alzheimer’s. Thus, it is not
surprising that lack of sleep has been associated with an increased risk
of dementia.
One common form of sleep disruption is obstructive sleep apnea (OSA). In
OSA, tissues in the back of throat collapse, thereby blocking the
airway. The person stops breathing, preventing them from getting deep,
restorative sleep. OSA is manifested by the bed partner reporting the
individual is snoring or even gasps for breath. The person may not feel
refreshed in the morning and feel the need to sleep later in the day,
especially while engaging in non-stimulating activities such as watching
TV or sitting at a stop light. If you’re concerned you might have
OSA, ask your physician if you should get a sleep study to measure brain
and breathing activity when you sleep.
Here are some keys to getting a good night of sleep:
Go to bed and get up at a consistent time.
Expose yourself to sunlight for at least 5 minutes in the
morning as soon as you get up.
Exercise.
Don’t drink caffeine after midday.
It stays in your system and impairs deep, restorative sleep.
Don’t eat for four hours before bed.
Limit alcohol at night since it can hurt quality of sleep.
Keep the bedroom cool, quiet, and dark.
Keep your cell phone out of the bedroom
Set aside 30-60 minutes before bed for a relaxing bedtime
ritual such as a bath, meditation, praying, reading, or
calming music.
Don’t do anything in bed except sleep or sex.
You want your mind to associate bed with sleep.
If you get up to go to the bathroom during the night,
don’t look at the time.
This will cause anxiety and make it harder to get back to sleep.
If you can’t get to sleep, go to a dimly lit room and
read a boring book until you feel sleepy. Then go back to
bed.
Treat hearing loss
Multiple studies show even mild hearing loss increases the risk of
dementia. The use of hearing aids appears to mitigate the decline.
Control blood pressure
Hypertension (persistently elevated blood pressure) is associated with
damage to our arteries and increases the risk for strokes—the main
cause of vascular dementia. Controlling blood pressure through exercise,
nutrition, stress management, and medications lowers the risk of
dementia.
Invest in relationships
Social isolation increases the risk of dementia. This may be because
loneliness results in less cognitive activity and increased stress.
Prioritizing relationships is thus a key component of cognitive health.
Control blood glucose
Impaired insulin sensitivity in the brain reduces its metabolism and
impairs clearance of amyloid protein present in Alzheimer’s.
Elevated glucose, as is found in diabetes mellitus, also increases
inflammation and damage to arteries that supply blood to the brain.
Controlling glucose through lifestyle and medicines is thus protective
for the brain.
While we don’t have complete control of the cognitive changes with
age, there are several important steps we can take to promote brain health.
