Alzheimer’s disease (AD) is the leading cause of progressive dementia in the United States accounting for 95% of all dementias. It is believed that approximately 5 million Americans suffer AD and that this number will nearly triple in the next 40 years. AD is also on the increase worldwide.
AD is a progressive dementia that affects functions of memory, language, spatial skill, personality and functional ability. The disease continues to erode these functions rendering the patient completely dependent. It is generally believed that patients with more advanced AD are not aware of their condition and do not have an awareness of the people or places around them.
New research on awareness in those with vegetative state suggests this may not be true. Communication may also be possible for those in vegetative state. One case of a 29 year-old patient in a vegetative state was able to answer yes no questions by visualizing specific scenes the doctors asked him to imagine. The brain yielded different activity when different scenes were viewed. This particular patient was in a vegetative state for five years.
This new study published in the online version of the New England Journal of Medicine supports previous cases of awareness in those with vegetative state and raises significant issues concerning understanding of brain function and ethical matters dealing with end of life decisions.
Another suspicion this raises for me is whether a patient with advanced Alzheimer’s disease maintains some awareness of his surroundings. Perhaps the patient’s smile or blink to a family member has more meaning than we previously believed. It is not unreasonable to believe that the complexity of the human brain will not permit complete disconnect from those persons or things that are most important to that brain. We may simply not yet have the ability to measure such activity.
The new study reported in the online New England Journal of Medicine will help to spur research into this and other questions. We are on the frontier of an entirely new understanding of the human brain and we will be very surprised by how we have underestimated its ability and power. I refer to this new exploration of human brain potential as “neural energies.”
We have seen tragedies play out on the evening news describing how different people, including some famous persons, have lost their lives from accidents on the ski slopes or sled riding. For most, the winter related accidents involve falls with head injuries and head injuries remain a major problem for the young and old.
Sitting with our skull is our 3 to 4 pound brain that enables our every thought, movement, and emotion. It is critically important that everyone consider the sage advice of wearing a helmet when skiing, sledding, tubing, and even ice or roller skating. The same is true of bike riding, motorbike or motorcycle riding, skateboarding, and anything that involves wheels. As it is winter for many of us I want to reinforce the need for helmets with the sports in the snow.
While it may not be cool or attractive to wear a helmet, it certainly is much better than suffering a head injury that can lead to cognitive, emotional, and motor deficits or even death. Take a few moments this winter and place a protective helmet on your brain!
I am often asked about the value of having and caring for pets on general health. Research supports a positive relationship between having a pet and general health with more specific value in reducing blood pressure. Pets can create a vital role for someone as the dog, cat or other pet needs to be fed, walked, cleaned etc. Sometimes, caring for a pet can be the major role in a person’s life, particularly if someone is living alone.
A pet can also provide unconditional love, friendship, companionship, and a sense of family. Many people consider their pets significant members of the family and it is quite normal to experience grief when a pet dies.
For those who do not and cannot own a pet there are opportunities in the community to spend time with animals and to even “pet sit” for a family who may be out of town. I am also aware of some places that simply ask for the animals to be walked every so often. These are good opportunities to interact with a pet and to enjoy some of the health benefit that comes with it.
I read with some interest a recent article in The Wall Street Journal Tuesday, November 3, 2009 about caregivers of spouses with Alzheimer’s Disease (AD) who find new companions for love. The article questioned whether such behavior could be considered adultery?
We have nearly 5 million Americans with AD and at least that many at risk. The number of those with AD will likely continue to grow to as many as 15 million by 2050. A recent survey reported there will be nearly 35 million with AD across the planet. Many of those suffering AD are married and the healthy spouse can serve the role of caregiver for many years, including a significant amount of time when their spouse with AD no longer recognizes them. The role of caregiver is difficult and ripe with emotional, physical, and financial stress. The article in the Wall Street Journal raises another stressor which is the idea that the healthy spouse may be without intimacy, love, and companionship for many years.
It is nearly impossible to understand how emotionally difficult it must be to care for a spouse with AD. Some describe AD as two deaths, one when you are told about the diagnosis and the second with the actual physical death of your loved one. Along the course of AD, a spouse will no longer recognize his or her partner. A healthy spouse who provides care to their partner with AD is vulnerable to loneliness, depression, and ongoing loss. How does one cope with loss of the emotional connection or loss of love in the traditional sense when your spouse is physically still present?
The Journal article raises many thoughts and ideas that do not have easy answers. I think it points out that we need to support even more our caregivers who dedicate so much of their time to their spouses with AD.
I often am asked what one thing is most important for brain health promotion. I cannot answer this question because I do not believe there is such a thing. The human brain requires a comprehensive and integrated approach to health which is why I have developed my five part brain health lifestyle (see www.paulnussbaum.com).
I do believe that eating one meal a day with family members or even friends and those you may not know very well (be safe first) can be a major brain health activity. Sitting down to a meal helps you to slow down, you can listen to some music in the background, and tell stories over your meal. You can also use utensils that typically means you will eat healthier and eat less than when you eat with your fingers. These are several brain health boosts with one activity.
It is good to learn from Rasmussen Surveys that 65% of those surveyed by telephone eat with their family twice weekly. 38% eat a meal three times a week with their family and 27% report eating between two and three times weekly with their family. Only 22% do not eat with their family during the week.
I encourage everyone to carve out the special time necessary to sit down and eat a meal with your loved ones on a daily basis. Your brain and body will thank you.
A recent article in US News discussed the brain health of all 50 states and the District of Columbia in the United States. An index that was comprised of diet (36%), physical health (25%), mental health (24%), and social well being (15%) was used to compare the states. Data was gathered from the Centers for Disease Control and Prevention, the National Institute of Health, and the Bureau of Labor Statistics.
Results from the study revealed the following top ten brainiest cities:
1. Washington DC
3. Washington State
8. New Jersey
10. New Hampshire
It is important to be proactive in your brain health lifestyle. Dr. Nussbaum (www.paulnussbaum.com), Chief Scientific Officer for Fitbrains, Inc. underscores the importance of a brain health lifestyle that includes socialization, nutrition, physical activity, mental stimulation, and spirituality.
A recent study demonstrates daily surfing of the internet activates the brain of older persons. This is another example of how the environment in many forms can shape the brain and illustrates the power of neural plasticity.
24 neurologically healthy adults, aged 55 to 78, surfed the internet while their brains were being scanned by an MRI machine. Prior to the study, half the participants had used the internet daily while the other half had minimal experience. After the initial MRI scan, the participants were instructed to do internet searches for an hour a day for seven days in the next two weeks. Then they returned to the clinic for another MRI.
At baseline, those who had internet experience had much greater brain activation relative to those without internet experience. However, those who practiced on the internet during the study demonstrated significant activation in their brain to the point that they were nearly equal to the brains of the experienced internet users.
The idea of “use it or lose it” can really be taken a step further and the idea is to “use it in new ways” and novelty and complexity really is the foundation to brain health.