Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

This is the seventh in our two-months-long series (40 Things for Every Woman in Her 40s) of Medical Monday articles intended to be useful to all our readers, but pointed especially toward those in their 40s—that in-between decade in which hormonal change has begun but fertility is still possible. Our first article focused on self-care; our second emphasized the need to pay attention to psychological issues; the third provided tips on preventing and repairing skin damage; the fourth focused on “exercise as medicine”; the fifth topic was on sexual intimacy. And most recently, Dr. Megan Riddle wrote about actions to reduce stress and improve mood.

This week Dr. Patricia Yarberry Allen turns our attention to the brain and offers four key strategies  to protect and improve brain function. —Ed.

brain gearssmImage courtesy of the University of Michigan Health System.

If you have not begun to think about brain health, forty is the age to create a strategy that works for your life so that you can sustain cognitive function for the long haul. Over time, our brains age just as our bodies do. Here are four strategies to start at forty that will improve your overall health, help protect brain function, and hopefully improve the ability to fight memory loss.

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Increase Physical Activity: Studies show physical exercise improves brain function as well as providing benefits for the rest of the body. Long term observational studies, most notably the Nurses’ Health Study, show a significant link between exercise and long term cognitive health. The goal is to exercise at least three to four times a week, for 45 to 60 minutes, if tolerated. Do consult your healthcare provider before beginning any new exercise program. Motivation and allotting time for exercise are serious obstacles to beginning and continuing an exercise program. The truth is many of us just can’t find an hour to go to and from an exercise class in addition to another hour for the class. Address the time issue by just starting to walk. Begin with five minutes, then ten. Then climb stairs. Start with one flight, then move on up.  Splurge on good walking shoes that are right for your feet and your gait.

After you find time to begin physical activity then you have to find the motivation to start and stay the course. Activity trackers may work to create motivation. Many people find that these gadgets improve goal setting and achievement of the goals.  Advocates of these devices wear them all the time and are justifiably proud of their progress.

Charts for the best activity trackers available today can be found on the site, werockyourweb.com — it puts “the technical stuff in laymen’s terms.”

 

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Commit to Proper Nutrition: Eating a healthy, balanced diet is important for general long-term health. Many observational and prospective studies have suggested a link between nutrition and dementia. For that reason, a nutritious diet—such as the Mediterranean diet, a low-glycemic diet, low caloric intake, low alcohol consumption and intake of omega-3 fatty acids (fish oils)—may decrease the risk of developing dementia and improve long term cognitive health. Simply increasing vegetable consumption is linked to slower cognitive decline and decreased dementia risk. Unfortunately, this information is from observational studies alone; fortunately, the risks associated with following these dietary practices are very low, and the reward may be a healthier and longer life.

Make sure you eat a balanced diet to avoid vitamin deficiencies, especially B and D vitamins. Deficiencies in B12 and B1 in particular can cause significant cognitive impairment over a relatively short time. A deficiency in either of these vitamins will not cause Alzheimer’s disease; still, such deficiencies can severely impact your functional independence. Other nutritional supplements—like antioxidants found in dark chocolate, coffee, and tea—have been linked to improved cognition.

 

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Keep Working: A paper published in the European Journal of Epidemiology (Impact Factor: 5 .34. 05/2014 DOI: 10. 1007s10654-014-9906-3) by French scientists reported there is “strong evidence of a significant decrease in the risk of developing dementia associated with older age at retirement.” The results were based on an evaluation of the age at retirement with the likelihood of developing dementia and examined records of 429,000 retired workers, of whom roughly 3% had developed dementia. There was a significant decrease in dementia risk with employment later in life, with those retiring at age 65 having 15% lower risk of developing dementia compared to those who retired at age 60. This study could have been biased by including workers who retired due to declining cognitive abilities. To mitigate this bias, the authors examined the same data after removing the workers who developed dementia within five years of retirement and found the same results. This study supports anecdotal evidence that the longer in life one works and remains intellectually active, the greater cognitive reserve or abilities one may have.

Other prospective studies have examined the connection between cognitive activity and the risk of dementia. These have generally found that participation in cognitively stimulating activities are associated with a lower risk of developing cognitive impairment, dementia, and in women, Alzheimer’s disease as well. Conversely, participation in leisure activities such as watching television, which are low in cognitive demand, are linked to an increase in cognitive decline.

In other words, when it comes to your mind and intelligence, use it or lose it!

 

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Be Social: Multiple studies have linked social engagement, social network size, and increased emotional support to decreased risk of dementia and rate of cognitive decline. Like most of the long-term studies in dementia and Alzheimer’s disease, these have been observational studies, so it is difficult to determine causation versus correlation. For instance, one study found that decreasing levels of social activity preceded declining performance on cognitive tests. The problem is, we do not know whether the decreased socialization actually caused cognitive ability to decline or if this was just a sign of cognitive decline not readily measurable or noticeable in day-to-day life.

Regardless of the cause/effect relationship, the health benefits of social engagement appear to be obvious: If one is socializing, moving, engaged in meaningful conversation, and involved in intellectual stimulation, one has greater social support, is less likely to be depressed, and even more likely to adhere to medical therapies.

A large ongoing research project, the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability, has shown in preliminary results that the combination of proper diet, physical exercise, and social interaction improve overall cognitive outcome. This study will be completed over another five years, but these common sense interventions seem to be a win win.  Start at 40, don’t wait five years.

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  • Diane Dettmann December 1, 2015 at 9:03 am

    Thank you so much, Dr. Pat, for sharing these helpful and very doable suggestions for protecting brain function.

    Reply