Download Mixed Brain Maintenance

Your mind matters. Here's how to stay sharp.
Prof Yoram Barak, MD, MHA.
“Dementia Beyond Disease”
We tend to presume that science and technology will create the future
brain health…(Dr G. Allen Power)
Our “social” brain must be harnessed in order to truly achieve a
comprehensive humane well-being.
This presentation is partly based on work by Dr Yakir Kaufman (Jerusalem) and Dr Max Cynader (Vancouver).
The secret to increasing brain function is growing neurons.
More neurons means a better ability to learn and to remember.
Get quality rest
One way to grow neurons? During the day, while you learn, you grow neural
connections in your brain. Then at night, you replay the day's memories while you
sleep, helping neurons to wire and fire together.
Take the blues seriously
A 2010 study published in Cognitive, Affective & Behavioral Neuroscience showed
people with depression performed worse on cognitive tasks than their nondepressed counterparts. 'Treat the depression and you can improve the cognitive
function,' says Aaron Newman, a neuroscientist and associate professor at Halifax's
Dalhousie University.
Manage stress
When we're agitated, our bodies flood our brains with cortisol. The hormone
attaches to receptors in our neurons, which allows more calcium to pass through
their membranes. Neurons overloaded with calcium fire too rapidly. That hyper
firing kills neurons.
Play
Research from the Berlin-based Max Planck Institute for Human Development and
two other German institutions showed that regularly playing Super Mario 64
increased study participants' brain volume in the regions that control memory and
spatial thinking.
Drink your coffee
Coffee contains polyphenols, antioxidant compounds that may protect the
hippocampus and the cortex, areas that are important for memory. Three to five
cups a day is ideal.
Brush up
A study published in the Journal of the American Geriatrics Society found that
people with none of their own teeth performed 10 per cent worse on memory tests
than those with some natural teeth. Researchers have yet to determine why.
Monitor your hearing
A 2013 Johns Hopkins study concluded that cognitive decline progressed 30% to
40% faster for people with hearing loss than for those with normal hearing. Treating
impairment can improve cognitive ability.
Avoid smoking
The cortex, the bumpy surface layer of the brain, naturally thins as we age. Smoking
hastens this thinning, which is associated with cognitive decline.
BACKGROUND (1)
• The prevention of dementia, and particularly of
Alzheimer’s disease, is a major challenge for
researchers and clinicians.
• Currently there are 1,278 clinical trials listed on
ClinicalTrials.gov
• In the last 30 years not a single new molecule
was approved by the FDA for Alzheimer’s
disease.
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Prof Y Barak, MD, MHA.
Multiple factors causing disease
Meaning
Environmental
exposure
Lifestyle
Loneliness
Dementia
occ.,social,
physical etc.
Stress
Depression
Diet
Pathogens
Metabolic
Genetics
Health
behaviors
Cause of disease is multifactorial
therefore effective prevention and treatment must
be integrative
‫ד"ר יקיר קאופמן‬
Nine Risk Factors May Explain
Two Thirds of AD Cases
• We do NOT need to know the cause of
Alzheimer’s disease in order to plan preventive
strategies.
• Protective and Risk factors are our focus.
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Prof Y Barak, MD, MHA.
Nine Risk Factors May Explain
Two Thirds of AD Cases
Risk factors include:
• Obesity
• carotid artery narrowing
• low educational achievement
• Hyperhomocysteine
• Depression
• Hypertension
• Frailty
• current smoking
• type 2 diabetes (only in Asian populations).
J Neurol Neurosurg Psychiatry. August 20, 2015.
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Prof Y Barak, MD, MHA.
Prof Y Barak, MD, MHA.
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Antihypertensive medications (1)
The largest body of evidence since 1972 has
focused on the treatment of hypertension and its
effects on preventing or delaying the onset of AD.
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Prof Y Barak, MD, MHA.
Antihypertensive medications (2)
the future ?
• Timing:
• For each additional year of antihypertensive
treatment in middle-age there is a reduction in
the risk of incident dementia.
• In one large study the risk for dementia in subjects
with more than 12 years of treatment was lower
than for hypertensive participants (hazard ratio for
AD: 0.35; 95% CI: 0.16–0.78), and was similar to the
normotensives
• Specificity of Drugs:
• ARS … modulation of the renin-angiotensin
system (RAS)
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Prof Y Barak, MD, MHA.
Prof Y Barak, MD, MHA.
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Diet & nutrients (2)
• One of the recent concepts regarding the
relationship between diet and the risk of
developing AD is that of dietary pattern (DP)
analysis.
• DP analysis utilizes a broad view of nutrition.
• Humans eat meals with complex combinations
of nutrients or food items that are likely to be
synergistic.
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Prof Y Barak, MD, MHA.
Don't count on superfoods
Studies have shown that turmeric, for example, breaks up brain plaque (which has
been linked to Alzheimer's), but it's no cure-all. 'It's not the food that's beneficial; it's
the chemicals in it,' says Newman. It's impossible to get a high enough concentration
of those chemicals in your diet to recreate lab results.
Primary Prevention of
Cardiovascular
Disease with a Mediterranean Diet
Estruch R et al.
The New England Journal of Medicine, Feb 2013
A randomized trial of this diet pattern for the primary prevention
of cardiovascular events was conducted.
Ramón E, et al. N Eng J Med, 2013
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Mediterranean Diet and Age-Related Cognitive Decline:
A Randomized Clinical Trial
CONCLUSIONS AND RELEVANCE
In an older population, a Mediterranean diet
supplemented with olive oil or nuts is associated
with improved cognitive function.
JAMA Intern Med. 2015;175(7):1094-1103.
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Prof Y Barak, MD, MHA.
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Cognitive engagement
• Valenzuela and colleagues (2008) systematically
reviewed recent evidence linking mental activity
and dementia risk, which commonly invokes
‘brain reserve’ as the mediating construct.
• Significant protective risk ratios for individuals
with higher mental activity in the range of 0.41–
0.67 were demonstrated in research.
• In addition, a number of these studies point to dosedependent effects.
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Prof Y Barak, MD, MHA.
Get Zen
Meditating for half an hour a day, for eight weeks, has been shown to grow grey
matter in the hippocampus, which may improve memory and learning.
Prof Y Barak, MD, MHA.
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Break a sweat
One-hour weightlifting sessions, twice a week, have been shown to slow the
progress of mild cognitive impairment
Physical activity (2)
“A sound mind in a sound body is a short but full description of a
happy state in this world.”
John Locke; English empiricist philosopher (1632–1704)
Identification of elderly individuals who
consistently demonstrate intact cognition
demonstrated:
maintainers had a unique profile associated with being a
maintainer and not a decliner :
 Weekly moderate or vigorous exercise (OR: 1.31)
 Not smoking (OR: 1.84)
 Exercising translates into DAILY 30-45 minutes fast
walking.
 “Breathing” measure
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Prof Y Barak, MD, MHA.
Physical activity (3)
“A sound mind in a sound body is a short but full description of a
happy state in this world.”
John Locke; English empiricist philosopher (1632–1704)
An analysis of 13,500 participants in the Nurses’
Health Study found that the likelihood of
‘successful survival’ (living past 70 years of age
in general good physical and mental health) was
nearly doubled for women who had been in the
highest quintile of overall physical activity 10–15
years earlier, than for the most sedentary
participants.
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Prof Y Barak, MD, MHA.
Loneliness
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Prof Y Barak, MD, MHA.
Build friendships, volunteer.
As little as 10 minutes of socializing a day improves cognitive performance.
Volunteering has been shown to increase successful ageing.
Social isolation in old age has been associated
with risk of developing dementia.
• Wilson (Rush Alzheimer’s Disease Center,
Chicago) and his fellow researchers aimed to test
the hypothesis that loneliness is associated with
increased risk of Alzheimer's disease.
• The risk of Alzheimer's disease doubles in lonely
persons.
• Loneliness did not change significantly over the study
period so that lonely elderly in essence remained
lonely for many years.
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Prof Y Barak, MD, MHA.
Social isolation
• Objective markers such as:
• small social network
• Unmarried
• participating in few activities with others
• are now confirmed as associated with increased
risk of Alzheimer's disease.
• It is intriguing to follow the way knowledge
accumulated rapidly to unravel the link between
these social markers and dementia.
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Prof Y Barak, MD, MHA.
Purpose in Life
• A dictionary definition of purpose will
incorporate the following elements:" The reason
for which something exists or is done, made,
used. An intended or desired result; end; aim;
goal. Determination; resoluteness."
• It is hard to imagine a purpose in life, especially
for older adults, that does not involve a social
aspect.
• Indeed, when researchers looked at the purpose
in life of nearly 1,000 people over a seven-year
period those with a high score on the purpose in
life measure were approximately 2.4 times more
likely to remain free of Alzheimer's disease.
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Prof Y Barak, MD, MHA.
Hope at last !
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New Insights into the Dementia Epidemic
Larson et al, Nov 2013
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Prof Y Barak, MD, MHA.
Although demographics will drive an increase
in the number of dementia cases, recent
reports — generally based on populationbased community studies or survey data —
point to declining age-specific prevalence or
incidence rates among people born later in
the first half of the 20th century.
Prof Y Barak, MD, MHA.
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New Insights into the Dementia Epidemic
Larson et al, Nov 2013
• They conclude that populations born later
have a lower risk of dementia than those
born earlier, probably because of:
• even in the face of countervailing factors
such as diabetes and survival after stroke,
which could increase age-specific dementia
prevalence.
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Prof Y Barak, MD, MHA.
• higher education levels
• better prevention of vascular disease
Hope at last !
• The study in England and Wales published in July
of 2013 made the following headline in the New
York Times: "Dementia Rate Is Found to Drop
Sharply…“
• The article in the New York Times goes on to say
that this is the strongest, most credible evidence
yet. At the close of the article Dr. Anderson, of
the National Institute on Aging, said the news
was good. “we are beginning to see that more
and more of us will have a chance to reach old
age cognitively intact, postponing dementia or
avoiding it altogether. That is a happy prospect.”
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Prof Y Barak, MD, MHA.
Thank you for your attention…
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Prof Y Barak, MD, MHA.