Until recently, we thought today’s grim facts about Alzheimer’s disease could not be changed. According to the Alzheimer’s Association “2022 Alzheimer’s Disease Facts and Figures”:
One in three seniors dies from Alzheimer’s disease or another form of dementia.
More than 6 million Americans currently have Alzheimer’s disease.
Since 2000, heart disease deaths are down 7.3%, but AD deaths are up 145%.
Dementia will cost the U.S. $362 billion in 2022, projected at $1 trillion by 2050.
Years ago, when I was a fourth-year medical student at the University of Arizona College of Medicine in Tucson, I had the privilege to spend several months at the Neurological Institute of Columbia University in Manhattan. Dr. Houston Merritt, emeritus chairman and perhaps the most famous neurologist in the history of American medicine, met with our group of students every week. On one of those occasions, he noted that the worst thing about getting old was listening to his brain cells commit suicide.
That seemingly programmed, self-destructive behavior of brain cells (neurons) was the central dogma of the aging brain until the last 20 years. This old dogma stated that the human brain — the most complex, creative and remarkable object in the universe — started to unravel at about the age of 40. If you were “lucky,” it unraveled slowly and you maintained mental agility into your 60s, 70s and beyond. If you were “unlucky,” it unraveled more rapidly and you became senile — or in modern medical parlance, demented.
It is true that the normal wear and tear of the aging brain causes some loss of gray matter brain cells and the white matter connections between them and results in an 80-year-old brain not being as nimble as a 40-year-old brain. But if properly maintained, the brain, even in those 90 or even 100 years of age, can maintain its sharpness, agility and creativity. Alzheimer’s disease is not an inevitable consequence of aging.
The new science of the aging brain
Charles Darwin predicted what modern neuroscience has now proven: “If I had my life to live over again, I would make it a rule to read some poetry, listen to some music and see some painting or drawing at least once a week, for perhaps the part of my brain now atrophied would then have been kept alive through life. The loss of these tastes is a loss of happiness.”
The new science of the aging brain is founded on two fundamental principles. The first is neuroplasticity. Neuroplasticity is the brain’s ability to rewire, improve and fortify itself. Neurologists have known for many decades that a child’s brain can take advantage of this inherent property to compensate for injuries occurring in childhood. We have learned over the past few decades that neuroplasticity can be activated throughout the lifespan. New cells can be generated — especially in the hippocampus, the seahorse-shaped structure responsible for new memory formation — and new synapses (connections) can be formed between brain cells.
The second fundamental principle is cognitive reserve, also called brain reserve.
Cognitive reserve is like physical reserve. Physical reserve results from regular physical exercise, a heart-healthy diet and controlling medical risk factors such as hypertension, diabetes, smoking, cholesterol and obesity. Physical reserve significantly reduces the risk of heart attack and stroke; it hastens your ability to recover from the flu, COVID-19 or an operation.
Similarly, cognitive reserve is preserved, built and strengthened by practicing brain-healthy lifestyle behaviors and managing the same risk factors. There are six evidence-based lifestyle components that contribute to cognitive reserve and to happier, healthier aging:
Brain workouts that engage, stimulate and fortify your inherent abilities to learn, think and remember; modest physical exercise on an almost daily basis; an active social life; healthy nutritional habits; stress reduction; and memory strengthening sleep.
Cognitive reserve is an insurance policy. Building and maintaining it will not guarantee that you will not get Alzheimer’s disease but it greatly reduces your risk and will enrich your life.
Preventing cognitive decline and Alzheimer’s disease
In 2015, “The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability” (FINGER Study) was published in The Lancet, the leading British medical journal. This scientifically rigorous clinical trial involved 1,200 aging Scandinavians. It showed that it is possible to prevent cognitive decline by employing a multi-component lifestyle intervention in at-risk older people. Individuals participating in the active arm of the study received cognitive training, physical fitness, socialization, nutritional guidance and monitoring and treatment of medical risk factors. Participants in the control arm received only general medical advice.
The results were so noteworthy that two years later, they made the cover of Scientific American (April 2017). “A Success in the Fight Against Alzheimer’s: New Ways to Stop the Fog of Dementia Before it Starts.” The authors, Miia Kivipelto and Krister Håkansson, wrote “A gold-standard clinical trial provides evidence that diet, exercise and an active social life can help prevent cognitive decline.”
Medical-science advances when experimental results are tested by other investigators and findings are reproduced. The Alzheimer’s Association recently launched the U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER) study. This two-year clinical trial evaluates whether lifestyle interventions that simultaneously target many risk factors protect cognitive function in older adults who are at increased risk for cognitive decline.
Dementia has been declared a public health priority by the World Health Organization. The WHO 2021 report on dementia stated: “Studies show that people can reduce their risk of cognitive decline and dementia by being physically active, not smoking, avoiding harmful use of alcohol, controlling their weight, eating a healthy diet and maintaining healthy blood pressure, cholesterol and blood sugar levels. Additional risk factors include depression, social isolation, low educational attainment, cognitive inactivity and air pollution.”
As of 2022, approximately 300 trials have failed to conclusively identify a drug or biological intervention to prevent or modify the relentless, progressive course of Alzheimer’s disease. The only proven approach to slow the growing epidemic of Alzheimer’s disease is the management of risk factors, both medical and lifestyle. This means a personal commitment to a brain-healthy lifestyle. Each of us has to be our own brain health quarterback.
One final note: There are numerous causes of memory problems and dementia, some of which are treatable and reversible. If you, a loved one, or a friend are experiencing increasing memory lapses, forgetfulness or have any concerns about your brain health, I urge you to speak with a health care provider. PJC
Dr. Paul E. Bendheim is a clinical professor of neurology at the University of Arizona College of Medicine – Phoenix and author of “The Brain Training Revolution: A Proven Workout For Healthy Brain Aging.” Bendheim is also the founder, chairman and CEO of BrainSavers, Inc. This first appeared in the Jewish News, an affiliated publication.