In my 25 years of clinical practice I worked with a number of patients diagnosed with Alzheimer’s and the dementias. I have followed the research over the past 30 years, and what has struck me the most about this mystifying and frightening problem is that we still don’t have clear answers, despite the billions of dollars spent searching for causes. The cause and prevention of Alzheimer’s is still a question that comes up at almost every Q&A that I do: is it a gene? Is it inherited? Is it dietary? Is it a brain disease? Is it inevitable?
Before we go into too much detail, I want to remind you that our expectations can change the nature of our biology, including our brains! Indeed, recent research suggests just fearing that you will get Alzheimer’s can potentially increase your chance of getting it by up to 60%. So, as you read this blog, and whenever you read or hear about Alzheimer’s and the dementias, it is incredibly important to remind yourself to stay as calm and objective as possible. I know that this can be hard—losing one’s memory is an incredibly frightening prospect—but learning to control our emotions is so important when it comes to both our physical and mental health.
I also want to say that this week’s blog and podcast offers just a brief overview of my opinion of Alzheimer’s and the dementias, which is based on my research and clinical experience, and definitely does not cover everything that would need to be covered when dealing with such a vast and challenging topic. I don’t have all the answers, but I do have a few important observations to make that are consistent with new research into Alzheimer’s and the dementias. Thankfully, this is a message of hope, which is where I will begin this blog.
As I mentioned already, it is important that we try not to fear getting Alzheimer’s—this may trigger the very process. Although the media tends to frighten us with headlines and makes us think cognitive decline is inevitable, this is not the case, as I will discuss in this blog; we do have control. Unrestrained fear, however, can generate a very damaging signal throughout the brain and body, creating biological chaos right down to the level of the DNA. This, in turn, affects the entire genome of the body, which, as a feedback loop, affects the quality of our thinking and remembering.
In fact, Yale University released a study showing that negative beliefs about aging actually predict Alzheimer’s and the dementias. The researchers in this study show how individuals who fear and hold negative beliefs about aging are more likely to show the brain changes associated with Alzheimer’s and the dementias, which highlights the link between the changes in the brain seen in Alzheimer’s and the dementias and our own cultural-based psychosocial beliefs. As I discuss in my book, Think, Learn, Succeed, stress generated by the negative beliefs about aging can be internalized by individuals and damage the brain. Even the volume of the hippocampus, which is a brain structure related to memory and processing information, can be reduced with negative thinking! It is therefore unsurprising that professor Stuart Hammerhoff of Arizona University, who has done groundbreaking research on consciousness and memory, argues that the kind of thinking and resultant memories we build impacts our cell division and can contribute to the development of Alzheimer’s and the dementias.
When it comes to Alzheimer’s, professionals generally describe the process of neurofibrillary tangles and amyloid beta plaques, which are the neuropathological hallmarks of short-term memory processing failure, which eventually leads to the cognitive decline associated with people suffering from this form of dementia. To this end, billions have been invested in looking for the genetic or neurobiological causes of these tangles and plaques, as well as particular drugs to combat them. However, as much as science has advanced in this area, effective solutions still haven’t been found, while the number of people afflicted with Alzheimer’s and the dementias has been increasing.
There is now a growing body of research that approaches the question of Alzheimer’s and the dementias as a preventable lifestyle disease, rather than a genetic or biological fault. More and more scientists are looking at Alzheimer’s and the dementias as the result of a combination of factors, including how toxic stress and trauma are managed, the quality of someone’s thought life, individual diets and exercise, how we can be exposed to certain chemicals and toxic substances, the impact of former head injuries, and the effect of certain medications. One of the many studies that have come out of this research, done by the Buck Institute for Research on Aging, showed dramatic improvement in patients diagnosed with Alzheimer’s and the dementias when they were put on an individualized lifestyle-based program that includes diet, exercise and learning. Another famous study, known as the “Nun Study,” followed a number of nuns over several years, showing that, although extensive Alzheimer’s markers were seen in their brains during autopsy (namely neurofibrillary plaques and tangles), none of them showed the symptoms of Alzheimer’s and the dementias in their lifetime. These nuns led lifestyles that focused on disciplined and detoxed thought lives, extensive learning to build their cognitive reserves, helping others and healthy diet and exercise, which helped keep their minds healthy even as their brains aged!
Research headlines like the following abound, highlighting the fact that our lifestyles can impact how our brains age:
What you eat could impact your brain and memory
New Alzheimer’s therapy with brain blood flow discovery
Dementia risk tied to these commonly prescribed drugs
50% increase in chance of getting dementia when on psychotropic drugs
Negative beliefs about aging predict Alzheimer’s disease
Caloric restriction and intermittent fasting can strengthen the nervous system against neurodegenerative diseases
Link found between concussions and Alzheimer’s
Elderly discovered with superior memory and Alzheimer’s pathology
Alzheimer’s found to be a diabetic disorder of the brain
Probiotics improve cognition in Alzheimer’s patients
Does a western diet increase the risk of Alzheimer’s disease?
Sleep behavior disorder linked to brain disease
Stress can impair memory, reduce brain size in middle age
As of today, no-one fully knows the impact of the interactions of all of our lifestyle choices on our brains, but there is enough evidence from scientists working in the field of psychoneuroimmunology to show that there is a link between the parts of the brain that respond to our thoughts and emotions and our neurological and immune systems. Based on this research, one of the best things we can do to prevent cognitive decline as we age is to adopt an individualized approach that incorporates every aspect of our lifestyles, and has a heavy emphasis on two particular areas: building cognitive reserve and implementing preventative measures. This is the approach I used with my patients during my 25 years in clinical practice with dramatic results, which is why I still recommend it today. In fact, the earlier you make this part of your lifestyle, the more you protect yourself from Alzheimer’s and the dementias!
Let’s look at how we build cognitive reserves first:
A cognitive reserve essentially means that you have been thinking deeply and learning on a regular basis, which means that there are more functional synapses and dendrites in the brain that create a buffering effect against the development of Alzheimer’s and the dementias when it comes to both your short and long-term memories. You are essentially using the new nerve cells you produce on a daily basis (through a process known as neurogenesis) and building them into complex thought patterns in the brain through neuroplasticity, which means that the brain is constantly changing and growing.
Research shows that education, literacy, regular engagement in mentally-stimulating activities and so on results in an abundance of and flexibility in these neural connections, which help us build up and strengthen our cognitive reserves and protect our brain against the onset of Alzheimer’s and the dementias.
Like everything in life, the more you use your ability to think, the more you get better at it and the stronger your brain gets!
1. Using neuroplasticity to build short-term cognitive reserve:
This is kind of like flexibility in the synapses around the brain, such as stretching before an exercise class or a run. You are essentially preparing your brain for thinking action and deep, meaningful connections between neurons, which are the foundation of a good, healthy memory.
One of the early indicators of cognitive decline and the onset of Alzheimer’s is the inability to recall information and events in the short-term, even if the person still has a good grasp of their past (that is their long-term memories). How can you determine if your level of forgetfulness is normal, or if there is a bigger issue with your cognitive reserve? An exercise I regularly used with my patients helped them distinguish between normal levels of forgetfulness (which happens to all of us!) and actual memory loss by focusing on "tip-of-the-tongue" memories (something you can almost remember) and how we respond to certain prompts and triggers: in a short time the forgotten word or thought pops back into our minds. We all experience this; in fact, the average 25-year-old experiences 3 to 4 tip-of-the-tongue memory losses a week, and this can increase with age.
However, with people at risk for Alzheimer’s and the dementias, when the word “drops out” they can’t remember the first letter, number of syllables or concept, and it doesn’t come back a few hours later or in response to certain prompts. They can even have trouble remembering what happened a few minutes ago, which can be an indication that their short-term memory is compromised and should be taken seriously, especially if coupled with increased frequency and short-term processing issues.
Building a good cognitive reserve means that just being aware of this difference already starts building the neural buffering, while being deliberate and intentional about building memory in the brain through mental stimulation can prevent further damage and help heal the brain. We do this every time we learn something new because we are building new connections, that is mental “scaffolding”, which support our minds. This is why it is so important to practice being conscious of what we forget, and deliberately finding out why we are forgetting things by observing our thought patterns, asking and/or googling information we forget and then writing down in a list of “things I forgot” in a thought journal or on our devices. I recommend doing this daily, or as soon as you forget something, alongside practicing memorizing small details you use every day, such as phone number, shopping lists and addresses. See my book Think, Learn, Succeed for more information on how to do this.
2. Using neuroplasticity to build long-term cognitive reserves:
Long-term cognitive reserves require deep thinking to understand, and also needs to be done on a daily basis. You will need to take around 45 to 60 minutes every day to really learn something new, as though you are preparing for an exam, presentation or interview. This deeper level of thinking makes changes in the brain that go beyond the synaptic connections, affecting the dendrites of the neurons and building a much stronger cognitive reserve. The type of connections built in point one above are more transient and can collapse or degenerate more easily—they are like a ‘warm-up” before you do the exercise. Building up both your short and long-term cognitive reserves as part of a daily routine is essential for a healthy mind and brain.
You can build good quality cognitive reserves by reading book or articles or listening to podcasts and then discussing what you have read and heard, listening to different opinions in a debate and trying to see things from a different angle, learning something new about something you already know a lot about, studying something really challenging like learning a language with a difficult alphabet, watching and analyzing a lecture and practicing “teaching” the content to someone (or even to yourself!), and so on. I fact, I do this every morning, challenging myself to learn new information in a field of research that interests me, taking the time to think about the information and discuss it with myself (almost as if I were talking to a friend about the research and how it applies to mental health, society and so on). You should do this on a daily basis, even when you are on holiday, and start as young as possible!
For more information on this, and for the exact 5 steps on how to build short and long-term cognitive reserves, see my book Think, Learn, Succeed.
What else can you do to prevent Alzheimer’s and the dementias, or help someone already suffering cognitive decline?
1. Detoxing the brain:
I have written extensively about the importance of detoxing the brain by dealing with our thought life in a deliberate and intentional way. Our minds and brains are simply not designed to keep toxic habits and toxic trauma; we are designed to process and deal with issues. If, however, we suppress our problems, over time our genome can become damaged, which will increase the potential for cognitive decline as we age. This is why it is important to build up a strong cognitive reserves AND live a “detoxing lifestyle”, which essentially means that you make examining and detoxing your thoughts and emotions a daily habit. We want to have good stuff in our brain, yes, but we don’t want the neurochemical chaos of a bad thought life affecting our healthy cognitive reserves!
I usually spend 7-16 minutes a day every morning detoxing my brain before I practice building my cognitive reserves through learning and researching. My new app Switch is a great tool for helping you learn how to do this. It is based on my 5-step program, which is designed to help you identify and eliminate the root of your toxic thoughts and habits, and help you build healthy, new thinking patterns through the mental process of reconceptualization.
2. Social connections:
Intentionally developing deep meaningful relationships can help build up our cognitive reserves against Alzheimer’s and the dementias—our brains are designed to socialize! Loneliness and social isolation, on the other hand, can seriously impact the health of our brains, making us vulnerable to all sorts of diseases, including ones associated with cognitive decline and the dementias.
So, take the time out of your busy schedule to build these meaningful relationships:
- Make your conversations matter, whether you are speaking with your spouse while making dinner, or your kids in the car to school, or grabbing coffee with a colleague, or at lunch with a friend. Choose to initiate and keep a discussion going, even if you have to search around for topics or don’t always agree. Everyone loves to talk about themselves or get praise and encouragement, so that could be your icebreaker! Take the time to listen to people’s stories. Everyone has a unique story and something to share—something you can learn from!
- Serving others is a wonderful way to become part of a meaningful community, improving both your mental and physical health—studies show how helping others can increase your own chance of healing! Join a local institution, spiritual center or non-profit organization and see what you can do to help.
- The average person spends up to eight hours a day using technology. Some of the worst effects of electronic devices seem to be mitigated when devices are used less than two hours a day. Find ways to limit your use of technology throughout the day, and increase your face-to-face interaction with your loved ones. Maybe put your phone aside when you are eating. Or leave it at home when you go for a walk.
- Think about what you could do to get out of the house and foster community in your area. Perhaps start a book club, a hiking meet-up or arrange dinner parties and invite someone new each time. Get to know your neighbors and invite them for a walk or for coffee, or join a local community or spiritual center. The possibilities are endless. This may be a little uncomfortable at first but just remember everyone loves to be included, and you never know who may be really struggling with loneliness.
For more information on how to develop healthy relationships see my book Think, Learn, Succeed.
Dr. Lisa Genova, a neuroscientist, wrote the book Still Alice (this was also made into a movie), which describes the impact of the early onset of Alzheimer’s. She believes that buildup of plaques and tangles associated with Alzheimer’s can be averted, since it takes about 10 to 20 years before a tipping point is reached and cognitive decline becomes symptomatic. We all build plaques and tangles, but it takes at least a decade for them to actually affect our ability to remember, so there is hope!
There are things we can do to prevent this buildup, and sleep is an important one. During a slow-wave, deep sleep cycle, the glial cells rinse cerebrospinal fluid throughout our brains, which clears away a lot of the metabolic waste that accumulates during the day, including amyloid beta associated with the dementias. Bad sleeping patterns, however, can cause the amyloid beta to pile up and affect our memory. Essentially, sleep is like a deep cleanse for the brain!
When it comes to sleep, remember to avoid panicking when you can’t fall sleep, as I mentioned above. This fear will cause more damage in the brain than no sleep at all, and can impact your cognitive reserves. If you are battling to sleep, take the time to look at where you are in life: how busy you are, what you are eating, and so on, seeing if you can improve your sleeping habits by taking more time to rest, for example, or improving your diet. Most importantly, take the time to examine your thought life, as mentioned above; a chaotic mind will affect your quality of sleep and how much you sleep. For example, if you go to bed worrying about everything you need to do the next day, or try to suppress all your fears before turning off the light, this toxic energy will move through your brain and body, causing neurochemical and electromagnetic chaos, which will disrupt your body’s ability to regenerate as you sleep.
Of course, you are not going to resolve everything perfectly by the time you go to bed, but you can choose how you want to go to sleep. You can tell yourself something along the lines of “I cannot solve all this now, but I will write them down and work on these issues over the next few days—I have got this!” before you go to sleep. This will bring a degree of closure in your mind, enabling you to compartmentalize your thoughts and sleep well.
To help detox thoughts that are keeping you awake, see my app Switch.
We can now say with a good degree of certainty that consuming highly processed, sugar-, salt-, and fat-laden foods contributes to increased levels of obesity, cardiovascular disease, diabetes, stroke, allergies, autism, learning disabilities, and autoimmune disorders and Alzheimer’s! Some of the ways modern, highly processed and refined foods can contribute to Alzheimer’s and the dementias include added, highly-processed sugars, which cause your insulin to spike and the enteric nervous system of your gut to secrete an abnormal amount of amyloid protein. This will start destroying the blood-brain barrier, and can contribute to the formation of the amyloid plaques of Alzheimer’s disease. Some researchers now even refer to Alzheimer’s as type III diabetes!
Another important point regarding your diet and cognitive function relates to cholesterol: your brain cannot communicate very well without good, natural and healthy sources of cholesterol. Dietary cholesterol intake is an important factor in the prevention of amyloid plaque buildup (which contributes to the development of Alzheimer’s disease) and it should be included in a healthy diet. For more on this, see my book Think and Eat Yourself Smart.
There is extensive research on the importance of exercise as a preventative tool against Alzheimer’s and the dementias. A number of studies show that people who exercise often improve their memory performance, and show greater increase in brain blood flow to the hippocampus, the key brain region that deals with converting short-term memory to long-term memory, which is particularly affected by Alzheimer’s disease.
For more on this, see my book Think and Eat Yourself Smart.
When it comes to helping someone that is already showing symptoms of Alzheimer’s or the dementias, I would recommend making all the tips above an important part of their lifestyle. As I would tell my patients, it takes a village: helping this person is a family affair, so I recommend making the necessary changes as a family or as a friend group, which will not only help the person in question but also help all the people involved prevent against cognitive decline.
We all need to be active participants and teach ourselves and our future generations how to safeguard our precious ability to think and build memory, which are the hallmarks of humanity.
If you would like to learn more about how to prevent cognitive decline and improve your mental health, join me at my Mental Health Solutions Summit this December in Dallas, TX December 6-7, 2019! This conference is for everyone: teachers, CEOs, students, parents, doctors, life coaches...everyone! For more information and to register click here.