Dr. Patricia Yarberry Allen is a collaborative physician. This week, she asks Dr. Richard S. Isaacson, Director of the Alzheimer’s Prevention & Treatment Program at Weill Cornell Medical College/New York–Presbyterian Hospital, to counsel a 45-year-old woman whose mother and aunt have Alzheimer’s disease and who is determined “to do everything I can to prevent this from happening to me.”

Image courtesy of the University of Michigan Health System.

Dear Dr. Pat:

I am only 45, but I have decided to do all that I can to prevent dementia.  My mother and her sister have this frightening and debilitating disease, and at 83 and 85, both require full-time care.

My mother and aunt were both overweight, had decently controlled high blood pressure, and never exercised. My mother was widowed at 55 and her sister never married. They had friends, but mostly met to eat, go to movies or the theater, and play cards.  And they both smoked a pack a day from age 16 till age 45. Both lived alone before needing to enter assisted living.

I want to do everything that I can do to prevent this from happening to me. I play games on the Internet that are promoted to enhance memory, but I have no idea whether this is worth doing. I am besieged by ads for supplements and then warnings not to take the very same supplements.

Can someone give me some common-sense help?

Katherine

Dr. Pat Responds:

Dear Katherine:

The incidence of cognitive decline and outright dementia of various types (vascular,  Alzheimer’s and other causes) are increasing with the rising numbers of people who are aging. Members of the boomer generation were the first to do so many things; now this generation will be the first to have more people with Alzheimer’s in its cohort than any generation in history.  It is important that we change habits early in life to prevent diseases that cause cognitive decline and to adopt behaviors that may make a difference in cognitive health.  Infomercials, advertisements, and alternative-health gurus all promise a magic pill or brain exercise that improves the bank accounts of these snake-oil salesmen but most have no evidence-based scientific support. We are fortunate to have a new member of our Medical Advisory Board, Dr. Richard S. Isaacson, to discuss your concerns. Dr. Issacson will be available to answer questions from readers on a regular basis.

 Dr. Pat

Dr. Isaacon Responds:

Dear Katherine:

At any moment, anyone can start to make changes in his or her lifestyle that should benefit overall health, help protect brain function, and even improve the ability to fight memory loss, which is quite common with advancing age. As an Alzheimer’s specialist directing the Alzheimer’s Prevention & Treatment Program at New York-Presbyterian/Weill Cornell Medical Center, and having several family members with the disease, my clinical practice and research are focused on providing the latest evidence-based and comprehensive management options for treatment, as well as for reducing risk.

The answer to your question is based on the latest scientific research (which I have incorporated into my own health choices), and focuses on lifestyle habits (like exercise, diet, and nutrition) in order to stay as brain-healthy as possible.  

The Problem:

Over time, our brains age, just as our bodies do.

The Solution:

While there is no “magic pill” or surefire way to 100% prevent cognitive or other decline in brain function, the strategies listed below make sense in terms of being relatively low-risk and balanced in scientific evidence. 

Of course, please do not make any changes without first discussing and seeking approval by your treating physician. 

Studies have suggested that physical, mental, and social activities, combined with dietary modifications, may be protective to the brain (and delay the development of AD).  Several recent studies have shown the positive benefits of physical activity (from regular exercise to household chores) in possibly reducing the risk of Alzheimer’s and mental decline, even in people older than age 80. 

Considering the evidence, and based on my clinical experience, I am a strong advocate for increasing physical activity as tolerated and as approved by the patient’s primary care physician. Oftentimes, I suggest a personal trainer if motivation is a problem, as physical exercise improves brain function as well as benefiting the rest of the body. I suggest exercise at least three to four times a week, for 45 to 60 minutes, if tolerated.

However, it is important to work up slowly to this regimen. As an example, if a person does not get any exercise at all, even starting with a five-minute walk once or twice a day is better than nothing. Ten minutes is better than five, twenty is better than ten, and so on. Some studies suggest that aerobic exercise is important, and other studies suggest that adding muscle mass through weight training is also helpful. We do not have enough scientific evidence to be able to tell which is better, or in what combination, so I usually recommend a mixture of both, increasing as tolerated. When patients have mobility issues due to arthritis and other problems, pool therapy is an option to consider. Tai chi has also been studied, and is an option. A home exercise program is also worthwhile to consider.

A variety of research has studied social interactions, including social ties and networking, and their effects on cognitive functioning. The interactions between social, psychological, and physical activities are important, as they work in combination to maintain cognition and possibly protect from later decline. From an intervention perspective, multimodal programs that are integrated into everyday life will likely yield the most benefit.  

Social engagement may not only delay onset of memory loss/dementia, but may also increase the chance of living longer. The best tip I can give is simply, “Stay engaged in life!” Considering this, researchers have recently begun to study whether online social networking (e.g., Facebook) can help delay memory loss or even promote cognitive functioning. A new research study even showed that the more Facebook friends people have, the bigger their brains are! 

Increasing mental activity may also be helpful. Some studies suggest that the more one challenges the brain, the more one will be able to maintain it later (the “cognitive reserve” hypothesis). Taking classes and learning a new language or a new skill may also be especially important. New hobbies and group socialization activities are also worthwhile.

In terms of cognitive exercise, I believe that the key is focusing on cognitive activities involving higher-order reasoning. What types of brain training work best? I do not typically recommend activities like Sudoku, although I also do not discourage patients who enjoy it. I would rather that a person focus on more complicated cognitive tasks that are enjoyable. As you alluded to in your question, this is opposed to doing an activity like Sudoku, where repeated puzzles will only help to improve one’s abilities at Sudoku.

Recent exciting research showed that lifelong musical experiences can slow down brain aging and memory loss. Music is a safe and enjoyable means of stimulating the mind, and exercising memory and intensive musical training may improve brain function even late in life. Going to a musical performance, the theater, or the symphony on a regular basis may be helpful. Learning how to play an instrument, or even practicing an instrument one has played in the past, may also be worthwhile. 

Memory‐Boosting Diet Recommendations

Here are some top memory‐boosting dietary recommendations that can work in synergy with the activities just discussed to help support brain health.  

1. Wean yourself off high‐glycemic carbs. These include sugars, high‐fructose corn syrup, processed cereals and grains, anything baked, ice cream and sorbet, crackers, salty snacks such as chips and pretzels, and anything made with white flour. High‐glycemic carbs raise insulin levels rapidly, which may be harmful to the brain (and body) over time.

2. Eat Mediterranean style. A brain‐healthy Mediterranean‐style diet includes fruits and vegetables, lean protein (fish, chicken, and turkey); low‐fat yogurt and cheeses; and nuts and seeds. Stay away from red meat and processed foods. The “style” part also includes exercise on a regular basis, as approved by a physician.

3. Have more good fat and less bad. Brain foods high in good fats include olive oil, avocados, certain nuts, natural peanut butter, certain seeds, and certain fish. Foods high in bad, or saturated, fat include most fast foods, anything hydrogenated, dried coconut, butter, animal fats, milk chocolate and white chocolate, and cheese.

4. Boost your omega‐3 intake. Omega‐3 fatty acids (DHA and EPA) are essential for memory functions and brain health.

5. Feed your brain antioxidants. Antioxidant‐rich foods are great for mental function. Some of the best are berries, kale, 100% pure unsweetened cocoa powder, mushrooms, onions, beans, seeds, sardines, herring, trout, and Alaskan wild salmon (wild may be more expensive, but also has a higher content of DHA).

6. Consume enough brain vitamins. Ensure adequate intake of folic acid, B6, B12, and vitamin D in particular. If you’re not eating vitamin‐rich foods on a regular basis, it may be helpful to supplement as needed.

7. Choose whole foods. In general, whole foods have only one ingredient—for example, strawberries, broccoli, or barley. If you must have a convenience (manufactured) food on occasion, find those items with the fewest ingredients—especially ingredients that you readily recognize and understand.

9. Opt for low‐ or nonfat dairy. Any recipe you make with full‐fat milk, cheese, or yogurt can be made with nonfat versions. 

10. Enjoy a cup or two of Joe. Caffeinated coffee, one to three cups early in the day, may be beneficial over time to your brain. Studies have shown that men who drank coffee regularly for many years showed less of a decline on memory tests than those who did not drink coffee.

Dr. Richard Isaacson