Written by Marsha Seidelman, M.D.
July 21, 2024
I think it’s fair to say that we’d like our brains to be working as well as possible for as long as possible. So here’s an important point – brain health is dynamic. Although we lose some nerve connections as we age resulting in impaired processing, so too can we increase those connections by what we choose to do. We have some agency in affecting our long- term cognitive function. This is true even if we have a genetic predisposition to dementia.
Amyloid plaques and tau proteins are associated with Alzheimer’s dementia. From autopsy studies, we have learned that some people with very low levels of these in their brains have marked memory loss, while others with a significant plaque load seem to be functioning well. How can we explain that? One part of the explanation is cognitive reserve.
Cognitive reserve is the buffer we build up with lifelong learning and curiosity; it improves our ability to resist cognitive decline. Challenging activities increase the number of connections or synapses between nerve cells, allowing us to more efficiently and flexibly use our memory, problem solving abilities, verbal skills, and much more. These day-to-day adjustments for overall improvement is called neuroplasticity. In a previous article, I described the process in a chessboard analogy. Instead of a pawn-like move connecting only adjacent squares, building new synapses allows formation of bonds all over the chessboard. In the brain, this creates redundancy and allows more neurons to participate in any given task.
Fortunately, the factors that help us build our cognitive reserve and help delay cognitive decline, are the same factors that help us prevent or treat high blood pressure, high cholesterol, heart attacks and strokes, and type 2 diabetes. One set of suggestions for wellness in many domains.
Here are some pointers:
Nutrition – the MIND (Mediterranean- DASH Intervention for Neurodegenerative Delay) diet is based on a plant-forward diet with an increased emphasis on green leafy vegetables and berries. A study out of Rush University added cruciferous vegetables – anything that is cabbage or related to it, like cauliflower, Brussels sprouts, broccoli. There’s a double bonus with green leafies that are also cruciferous, like arugula, collard greens and kale.
Physical Activity – a minimum of 30 minutes of movement daily, of any intensity, even if it’s not all at once, is beneficial. It increases blood flow and releases hormones that foster synapses, as well as releases stress. There’s a bonus if you have to think and move simultaneously, as with Zumba and martial arts.
Sleep – during deep sleep, the amazing glymphatic system clears the toxins that accumulate in the brain every day, including beta amyloid and tau mentioned above. This cleansing is effective primarily during deep sleep. In addition, new connections that incorporate the day’s adventures into your memory also happen in these phases. During this rearrangement of pathways, your brain can creatively solve problems that you couldn’t imagine the previous day. Have you ever awoken with a clever solution in mind and wonder how it appeared? Seven or more hours of sleep is essential … not the ‘waste of time’ that many busy people, myself included, have claimed in the past.
Stress reduction – cortisol, a hormone associated with stress, gradually harms the hippocampus, the main control and memory center of our brain. Constructive ways to reduce stress include deep relaxed breathing, especially deep exhalation, which activates the parasympathetic nervous system, or the opposite of the ‘fight or flight’ stress mode. Others include taking a walk, doing yoga or Tai Chi, singing, participating in art or music, journaling, meditating… Do something that makes you feel like your jaw and shoulders can relax, and your heart and respiratory rates can slow.
Social interaction – social connections have been shown to be very important in studies of Blue Zones where an unusually high percentage of people live to 100, and of Super Agers over 85 years old whose brains are equivalent to those 20 years younger. Walk or garden with a friend or play pickleball and you’re getting activity and socializing at the same time. Move your mind, move your body, move toward others.
Brain exercise – to maximize its impact on the brain, these activities should be new to you, progressively challenging, present a situation where you can answer incorrectly and learn from it, and be at a ‘frustration minus 1’ level – challenging but not TOO challenging. Ideally, you would do this activity most days of the week and integrate it into your daily activities. Examples might be learning a new language or playing a new instrument. Doing things like sudoku or crosswords should be continued if they’re fun, but they probably just improve your ability to complete those types of puzzles rather than improve your cognitive reserve.
Avoidance of toxic substances like nicotine and alcohol – these are not helpful for brain health. A recommendation years ago to have a glass of red wine daily has since been withdrawn. No amount of alcohol is considered ‘good’ for your health. Get resveratrol from red grapes, not red wine.
Treatment of other medical conditions – the brain depends on good blood flow just as every other organ system does. Optimize this with exercise, and by treating other conditions such as high blood pressure, high cholesterol, heart disease, and type 2 diabetes.
Last month, a remarkable study was published by Dr. Dean Ornish, et. al. about our ability to slow or even slightly reverse cognitive impairment with intensive lifestyle changes. The results are hopeful but the protocol was quite time-consuming. Our chances of success are much greater if we start protecting and improving our cognitive reserve while we are functioning well.
Stack the odds in your favor by incorporating as many positive factors as possible into your daily routine. And be sure you choose activities you enjoy!