The nation already expends nearly 200 billion dollars annually in the care of those with Alzheimer’s disease and there are nearly 15 million caregivers who are directly or indirectly affected by the disease. Indeed, our entire society is affected and the national strategy is an important step. Former Speaker Gingrich has talked openly about the need for the neurosciences to be a major source of innovation for the health of the brain and I hope other politicians help to make this a reality. The Obama Administration is developing the first National Alzheimer’s Plan to address the medical and social problems of dementia. This plan is not just for treatment, but also for better daily care for dementia patients and their caregivers.

Among the major goals of the plan are to:

1. Begin a national public awareness campaign of dementia’s early-warning signs to improve early diagnosis.
2. Give primary care doctors the tools assess signs of dementia as part of Medicare’s annual checkup.
3. Have caregiver’s physical and mental health regularly checked.
4. Improve care planning and training for families, so they know what resources are available for their loved one and for themselves.

These are important and necessary goals for inclusion in any national plan. However, they are not comprehensive which is what is needed. Some critics of the plan argue that the government is not being bold enough. My suggestions for a more comprehensive plan would include the following additional goals:

1. Teach the basics of the human brain to every middle school student in order to develop personal investment in the workings of the brain and how to keep the brain healthy.
2. Promote and prioritize a brain health lifestyle ® using the latest research on what we can do individually and as a society to live a proactive and lifelong lifestyle that promotes the health of the brain.
3. Understand that diseases the manifest late in life begin early in life. We need to consider early nonmedical interventions such as education, diet, spirituality, mental stimulation, and socialization tools that begin when a baby is developing in the womb.
4. Create tax benefits for families who care for their loved ones or pay for others to care for them in the person’s home.
5. Create a chronic care system for older adults that understands chronic care is not the same as acute care and that hospitals are actually not a healthy place for older adults to be admitted.
6. Incentive medical doctors and other health care professionals to become specialized in geriatrics and to promote “primary care status” to the geriatrician.
7. Include brain health lifestyle ® within every wellness program and incentive all persons to live such a lifestyle.
8. Develop annual standardized assessments for persons to undergo to measure the health and functioning of their brain. The brain should be treated as a priority rather than continue to be neglected in our culture.
9. Revise the antiquated and outdated nursing home model of care.
10. Increase the funding for dementia care, lifestyle approach, and caregiver programs sufficient to achieve success much earlier than 2025.

It is well established that reduced sleep can lead to cognitive dysfunction. However, prolonged sleep disturbance may play a role in pathologic processes underlying disease.

The authors indicate that levels of amyloid beta increase and decrease naturally. In healthy people, levels of the protein drop to their lowest level about six hours after sleep and then return to their highest levels six hours after peak wakefulness. The transition from sleep to wakefulness strongly correlated with the rise and fall of amyloid beta. The relationship was most pronounced in healthy, young people and less so in older adults who suffer shorter or more prolonged periods of disrupted sleep.

The authors suggested that the brain’s low activity during sleep allows the body to clear amyloid beta through the spinal fluid. Levels of the protein in Alzheimer’s patients, however, appear to be constant. The authors note that more research is needed, but there are reasons to believe that better sleep may be helpful in promoting brain health and reducing risk of Alzheimer’s disease. Sleep may be a factor in the known relationship between exercise and reduced risk of Alzheimer’s as sleep is related to enhanced sleep.

I believe it is important to always be conscious of our bodies and our brains (minds) so we can identify when we lose balance or symmetry in our natural state. I also believe it is important to understand the physiological mechanisms that underlie stress so we can make changes and achieve equilibrium. In order to achieve the latter, we need to understand our “autonomic nervous system” that has two major parts to be discussed in this blog: the “sympathetic nervous system and the parasympathetic nervous system.”

The Autonomic Nervous System (ANS) is located in the brain and has effects on the entire body. One major part of the ANS is the Sympathetic Nervous System (SNS) that helps our bodies and brains get into a “fight or flight” state and have actually helped our species survive until today. Recall that dinosaurs and other potentially catastrophic events or threats that required us to fight or flee confronted our ancestors. Without the SNS we would have expired as a species.

The SNS serves as a type of alert and action system in which specific structures in our brain and body engage to enable us to fight or flee. Once the SNS kicks in our brain releases norepinephrine and our body releases epinephrine (adrenaline) to get our system hyper-engaged. The brain is also alerted by the hypothalamus (master gland), which triggers the pituitary gland that in turn triggers the adrenal gland (periphery of the body). These glands release hormones including cortisol and glucocorticoids that put our amygdala on overdrive and our hippocampus (learning center) on hold. These physiological reactions result in our heavy breathing, a restriction in body fluids leading to dry mouth, halt in the digestive system, and in the reproductive system. Our brains become hyper focused and vigilant as we try to deal with the threat in front of us.

Our bodies can tolerate this jolt to our equilibrium for some period of time, particularly as it helps us to survive. However, our bodies are not designed to handle such acute stress for extended periods of time. It is important to note that dinosaurs no longer confront us and life-threatening stressors on a daily basis typically do not confront us. Despite this, we continue to respond to small, non life-threatening stressors with the same SNS response.

Fortunately we have a counterbalance to the SNS known as the Parasympathetic Nervous System (PNS) sometimes referred to as the “rest and digest” system. Our bodies do quite well with our natural balance of PNS and SNS and in fact our resting state is the PNS. Our reactions to daily non-life-threatening stressors results in the SNS overpowering the PNS and increasing our risk for the physical and psychological problems noted earlier. How can you engage the PNS to keep it at least in balance if not the lead in your daily management of life stressors?

Consider the following tips to finding and engaging your PNS:

1.    Stop and identify (make a list) of your daily life stressors.
2.    Identify where your body feels stress (physical and psychological).
3.    Practice rhythmical breathing by taking a slow and deep breath in for four seconds and exhaling slowly for the same four seconds.
4.    Practice the breathing for five minutes, three to four times daily.
5.    Give yourself at least thirty minutes daily of sitting upright in a quiet place where you can simply turn inward and let all stimuli flow over and through you. Be patient and focus on simply being.
6.    Self-talk using positive words such as “love, joy, patience, forgiveness, kindness, happiness, trust, and peace.”
7.    Work daily to not react negatively to small things your brain may have considered “big” in the past.
8.    Do something nice each day for someone.
9.    Slow your pace down and work consciously on inner balance.
10.    Understand this is a lifetime effort and you will experience positive steps and some setbacks. Simply remain conscious of your inner balance and remind yourself “I am trying to reach and use my PNS”

Good Luck!

Criticism against the existing research on lifestyle and risk reduction of dementia has generally been that more controlled and randomized studies are needed to move from the correlational to the cause and effect. This is fair and represents ongoing efforts by many to show such a cause and effect. Lifestyle does matter for the brain as it does for the rest of our body.

A new study to be published in Lancet Neurology provides the latest support for lifestyle and reduction in risk of dementia, including AD. Indeed, according to this study, about half of the risk factors for AD are potentially changeable and that reducing them could substantially decrease the number of new cases of the disease worldwide.

Factors that increase one’s risk for AD that are modifiable include diabetes, hypertension, obesity, smoking, sedentary behavior, depression, and low education level. In the United States, the most significant modifiable factor is physical activity accounting for 21% of the risk for AD, followed by depression and smoking. Added together, the three factors account for 50% of the risk.

The authors of this study indicate that if these risk factors were decreased by just 10%, about 184,000 AD cases in the U.S. and 1.1 million cases worldwide could be prevented. A reduction of 25% on all seven risk factors could prevent nearly half a million cases in the U.S. and more than three million world-wide.

With 5 million cases of AD in the U.S. and nearly 35 million in the world, this analysis is significant as maybe as many as 50% of all AD cases could be modifiable and that by changing the risk factors increased quality of life could be achieved. This and more research will be published to further support the importance of a proactive brain health lifestyle for everyone.

Most if not all humans have some interpersonal conflict with another. Perhaps our conflict is with a peer at work, a friend or former friend, a family member or other. We may carry a grudge, feel uncomfortable and anger towards this person. Who is hurt by these chronic and sustaining feelings and what does such toxic emotion do to the body?

Research is generally robust on the negative effects of chronic anger and stress. It is far better for us to get rid of these emotions, and even better to recognize their emergence and stop them prior to their taking hold of our interactions with others. We are blessed as humans to be able to say, “I am sorry” and to forgive. This is not hard to do unless we get stuck in pride and other face saving roadblocks.

Perhaps this week we can all forgive one person in our lives who has hurt us. Forgiveness is a cleansing of your body and spirit, it does not necessarily indicate right or wrong judgment. Maybe we can tell someone we have hurt “I am sorry.” If millions of us do this we will not only be healthier on an individual level, we will create a more peaceful planet to live.

The findings support the idea that social isolation caused by deafness may be part of the cause of dementia. This may be particularly true as the association to dementia was only seen for deafness above the level at which verbal communication was impaired.

Over a five-year period from 1990 through 1994, 795 participants had both hearing and cognitive testing as part of the Baltimore Longitudinal Study of Aging. Of these, the current study consisted of 639 people, ages 36 to 90, free of confirmed or suspected dementia.

The participant subset was followed until May 31, 2008, for a median of 11.9 years. During this time, researchers found 58 participants to be diagnosed with dementia from all causes, including 37 with AD. Most of the participants (456) had normal hearing at baseline with a mean age around 60, while 125 had mild hearing loss, 53 had moderate hearing loss, and six had severe deafness.

Interestingly, in the 15 years before the study period, those who developed dementia had an average yearly hearing loss that was nearly twice average for those who did not develop dementia.

Seniors who practice foreign languages over their lifetime and have the ability to speak more than two languages demonstrate the cognitive protection. The research studied 230 people with average age of 73 and findings support the growing body of literature that describes cognitive reserve thought to be developed by engagement in the complex and novel.

Similar studies have shown the health promoting effects of language development and in this case development of more than two languages. In this particular study, participants who had spoken three languages were significantly more likely to be protected against cognitive impairment. Those with four languages were even better off in terms of cognitive health. Those with five or more languages had similar protection to mastering four languages.

We all might want to get started on our second, third, or fourth language today!

A random sample of 926 elderly, ages 70 through 90, completed questionnaires on physical exercise, cognitive activities, and caloric intake during the previous year. All were considered non-demented and the diagnosis of MCI, if appropriate, came later. 817 of the original sample were considered normal cognitively and 109 were diagnosed with MCI.

Significant differences were found between the two groups as the normal subjects were younger, better educated, less likely to suffer depression, and had fewer medical problems. When these factors were controlled, the following was found:

• Any frequency of moderate exercise was cognitively protective.
• Any frequency of computer use was cognitively protective.
• Caloric intake was deleterious.

When caloric intake was controlled, physical exercise and computer use had an additive interaction that was significant. For purposes of this study, computer use seemed to have more value than other cognitive enhancing activities such as reading

This study adds to other research that demonstrates brain health promoting effects of computer use with physical exercise.

Dr. Nussbaum’s brain health lifestyle ® combines physical activity, mental stimulation, socialization, spirituality, and nutrition into an integrated and comprehensive approach to maximizing the health and potential of your brain. While no single slice of the five part brain health pie is more important than the other, all should be considered and implemented into your daily life.

Recently, I started hot yoga as I included it as a recommendation to my pain patients and thought I needed to understand this activity better. After four or five sessions of hot yoga I believe it to be a healthy and cleansing type activity that includes aerobics and stretching with a focus on breathing. To this end, hot yoga encompasses at least three of the five major brain health lifestyle ® components: physical activity, spirituality, and socialization.

Personally I feel very good mentally and physically after hot yoga. I will likely make this a regular part of my lifestyle and pursuit of emotional and physical health. The activity is also a good one to try with your partner.

Give it a shot and see how you feel.

A quick piece of advice regarding resolutions is to make it simple, small, and most important personal. Diets and resolutions that involve food, alcohol, or nicotine tend not to be very personal. Think of things that are more life shaping and perhaps involve relationships or how you approach others. Keep the idea small as one baby step change a year can add up to a new and better you.

The resolution needs to be something personal, practical, and capable of being consistently completed or changed. Keeping things small and in baby step progression will help you to be successful.

Happy New Year!