When my mother was in her 80s, she always started with the same question every day when she gave my brother **: "Did you have a bowel movement today?" I used to roll my eyes and pray to the old gods that I would never do that.
Some days, the conversation includes other bodily functions: "How did you sleep? Does rain affect your arthritis? How can the heart murmur? But I've never heard either of them ask the question, "How is your memory today?"
The most ironic thing is that people run or worry about their gut for their heart health, and the organ of worry is our brain," said vascular neuroscientist Dr. Natalia Rost, associate director of the Comprehensive Stroke Center at Massachusetts General Hospital and professor at Harvard Medical School in Boston.
Shouldn't we be worried about the main organ of our body, the command and control center of all human beings within us? There wouldn't be us without our brains," said Rost, president-elect of the American Academy of Neurology (AAN).
Be prepared to focus on your brain because, according to AAN, the era of preventive neurology has arrived. In fact, the academy hopes that by 2050, all Americans will have access to healthy brain training.
It's a revolution in brain health," Rost said. "We want to help the public understand that a lifetime of health starts with brain health.
The college's vision is that one day in the next 25 years, you, your child, and your grandchildren will see a doctor once a year for "brain health" checkups that are covered by insurance as preventative care. In fact, the first visit may even occur before the child is conceived.
We want major insurance payers to have brain health visits as early as when moms are thinking about getting pregnant or pregnant," Rost said. "Then, when the baby is born, we bring in a pediatric neonatologist, and then we use everything we've learned about brain function optimization to follow the child into puberty.
Interventions may include encouraging expectant mothers to breastfeed for as long as possible, limiting their children's exposure to screens, and improving sleep habits that can continue into adulthood.
As you age, each brain health check will focus on early prevention of diseases known to damage the brain, such as diabetes, obesity, heart disease, and more. These visits will continue "until the end of life, because even if we get older or develop cognitive diseases, we can still optimize brain health while suffering from brain disorders," Rost said.
What can you expect during a brain exam in the future? To find out, let's dive into one of the most advanced brain examinations that exist today.
It was a beautiful, warm Florida morning, and I felt my spirits lift and push my worries aside. I was on my way to the Boca Raton office of preventive neurologist Dr. Richard Isaacson, who opened one of the nation's first Alzheimer's prevention clinics at Weill Cornell Medical College and NewYork-Presbyterian Hospital in New York City in 2013.
In his new project, the Institute for Neurodegenerative Diseases of Florida, I will be the 20th participant in a novel clinical trial focused on cultivating aging brains. The study will identify my genetic, behavioral, and lifestyle risks for cognitive decline, provide me with a personalized inventory of areas for improvement, and track my progress with new experimental blood tests.
These unique blood tests can determine levels of amyloid, tau and other iconic biomarkers for Alzheimer's disease and other degenerative diseases. Deposits of amyloid can begin to accumulate in the brain decades before symptoms begin, even in a person's 30s and 40s.
"There are currently an estimated more than 46 million Americans with presymptomatic Alzheimer's disease, and pathological features of the disease can be detected in the blood and brain before cognitive decline begins," Isaacson said.
In order to participate in this new study, I will need to undergo a series of physical and cognitive tests to determine the baseline and areas of my brain that are at highest risk.
First, blood was drawn and sent to a lab in Boston to determine my good and bad cholesterol levels, inflammation, insulin resistance, and nutrition, all of which could set me down the path of cardiovascular disease and stroke, both of which are major contributors to poor brain health.
Vascular risk factors such as high blood pressure, high cholesterol, high blood sugar, or diabetes may not be the cause of Alzheimer's disease, but it can speed up the pathology of Alzheimer's disease," Isaacson told me. "I'd rather slam on the brakes than accelerate the engine on a path of cognitive decline. ”
Another key question: Do I have one or more copies of the APOE4 gene? People who inherit one or more copies of this genetic variant are at greater risk of developing Alzheimer's, although many never develop the disease.
Next, bone and body scans determined my risk of osteoporosis or osteoporosis, which is associated with cognitive impairment and fractures and falls that can disrupt the ability to stay active, exercise, perform daily tasks, or practice self-care.
The scan will also provide critical information about my muscle mass, body fat percentage, and distribution, which is especially harmful to the brain when fat accumulates around the waistline. "As your belly gets bigger, the memory centers in your brain get smaller," Isaacson told me.
A thorough examination of my eyes will not only determine if I have vision problems that may affect my cognition, but it will also allow for an observation of the back of my eye or retina. Due to diabetes, high blood pressure, coronary artery disease, and even cancer, the tiny blood vessels there may show early signs of nerve damage.
I was scared of cognitive tests, which I knew were necessary to establish a baseline in the brain. How many of the 15 words I hear are immediately recalled? I closed my eyes and tried to paint a picture in my mind, and the voices repeated one after the other: "Tree, rabbit, book, apple, lake." Well, the rabbit sits on a tree, reading a book, eating an apple with a lake in the background. Whew, it's easier than I thought.
Ladder, farmer, pipe, sofa, airplane, socks, kids, robin. Uh, well, now there's a ladder leaning against a tree, a farmer climbing up a ladder with a pipe in his mouth, and a plane flying over – wait, I forgot! Well, now there is a robin in the tree, but what is the rest?
And so it passed. After being introduced to 10 other people, can I remember the faces and names of the various people I saw on my computer? (Oh my gosh, I don't remember other people's names.) Can I recall and draw a complex geometric figure and then draw another, more complex shape? (Please don't, my spatial abilities are the worst.) At the end of each test, I cringe, believing that my cognitive score would quickly prove that my brain was going to the garbage heap.
The soothing voices from the interdisciplinary testing team tried to ease my fears. "Oh no, you're doing a great job! (Yes, yes, says my inner critic.) "No, really, you remember a lot of these names! ”
History is paramount. Do I have a family history of Alzheimer's? (No, as far as I know, but my mother has vascular dementia.) What about diabetes, cancer, thyroid disease, high blood pressure or heart disease? (My half-brother had two open-heart surgeries, and my aunt died of a stroke.)
Have I had a fall, brain** or traumatic brain injury (called TBI)? This is important because even a minor traumatic brain injury from a fall, car accident, or sports can have long-lasting effects on the brain.
How many years of education have I received since kindergarten? Education and learning can develop a "cognitive reserve" that is thought to counteract damage to the brain. Do I have hearing loss? Like vision, poor hearing can affect brain health. (I wouldn't be surprised – those ** meetings I attended in college were noisy.) What are my physical activity and eating patterns? (Unfortunately, not as good as I would have liked.)
The question about my dental hygiene is next on the list. Am I getting regular check-ups and cleanings (yes) and am I flossing regularly? (No comment.) Not only is there a link between tooth decay and heart and premature death, but research has also linked gum disease to cognitive decline.
How many hours of uninterrupted sleep do I have? Lack of sleep is a well-known cause of brain decline. Adults need to get seven to eight hours of quality sleep each night to give the brain time to regenerate and "remove" the garbage from dead and dying cells.
For those who don't write about brain health, some of the questions may seem unexpected. When did I start menstruating? How many times have I been pregnant? Did I have an early hysterectomy? Studies have found a strong link between a woman's lifetime estrogen content, the number of children she gives birth to, and her risk of cognitive problems and health problems.
Am I going through menopause, and if so, do I have hot flashes? Hot flashes are associated with an increased risk of heart disease and cognitive decline, while the loss of estrogen during the menopausal transition is a major risk factor for dementia and Alzheimer's disease.
Women have very different and unique risk factors for dementia than men," Isaacson said. "Women have a 39 percent higher risk of dementia if they have fat deposits around their abdomen. The rapid decline in estrogen during the perimenopausal transition may actually be one of the most influential risk factors for the development of Alzheimer's pathology in the brain.
Then there's my emotional health. Was I neglected as a child, did I lose a parent or loved one, or suffered a mental or ** treatment? This adverse childhood experience, known as an ace, has been shown to hinder healthy brain development in children and lead to multiple health problems throughout the lifespan.
Even in adults, depression, anxiety, and other mental illnesses can affect brain function, while emotional trauma, such as domestic violence, the loss of a child, spouse, or job, can flood the brain with corrosive stress hormones that can take a toll over time.
As it turns out, I'm lucky to have no known genetic risk factors for Alzheimer's, and currently I only have precious amyloid and tau proteins in my brain. Over the years, I've produced and written stories about almost everything, and my cognitive reserve seems to be balancing my brain's typical age-related atrophy.
However, I am at high risk of developing vascular dementia, which is the second most common type after Alzheimer's disease. Not only do I have a family history, but some of my cholesterol and blood inflammatory markers are borderline or worse, making me susceptible to small vessel disease.
In recent years, my blood pressure has increased, which is common with age, which hasn't helped with couch potato behavior during the pandemic. Instead of getting up and moving like many smart people do, I chose to sit and work longer. It was a terrible choice with serious consequences – bone scans showed that my muscle mass had been reduced to pitiful numbers.
Muscles make it easier to exercise and build strength, while weakness can lead to falls and injuries. I've fallen a few times in recent years. Muscle mass also increases calorie burning, so losing it can lead to weight gain. Coupled with an age-related slowdown in metabolism, it's no surprise that I've also gained some weight.
I lost two husbands, one from a tear disease and the other from a brain tumor, so I'm no stranger to chronically high levels of cortisol and other stress hormones. According to the Mayo Clinic, these disrupt almost all bodily processes and cause anxiety, depression, sleep problems, weight gain, memory and concentration problems, and "heart disease, heart attack, high blood pressure, and stroke."
Once again, I was fortunate because I was a strong, resilient woman – just like many of us. Thankfully, the ability to take life's challenges in stride and still thrive is something science tells us all can learn and teach our children. In addition, many of my medical concerns can be addressed by focusing on healthy behaviors, such as stress reduction, strength training and aerobic exercise, and a renewed commitment to a healthy plant-based diet – behaviors outlined by Isaacson and his colleagues in a recent review published in the journal Nature.
I went home with a list of evidence-based action items that were created by research conducted by his team over the past 15 years. He calls it precision medicine – a risk management approach that is personalized to my specific needs.
"Our goal is that by following a program that's specifically tailored to each individual, brain decline can be prevented, just as heart attacks can be prevented by controlling cholesterol and high blood pressure," Isaacson said.
Just imagine what we could accomplish if we started the process at birth.
One piece of advice I have when I get home is to wear a blood glucose monitor for a few weeks to determine which foods are spikeing my blood sugar. "This spike causes inflammation in the brain, disrupts brain metabolism and increases the atrophy of the thinking part of the brain," Isaacson said.
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