Improving Brain Health ... for babyboomers

More than 100 new discoveries in the past 10 years have confirmed that you can indeed ward off Alzheimer's and keep your brain younger. If you, like many of the 78 million baby boomers, worry about losing your memory and higher brain functions as you get older, please listen carefully. Here is a summary of the latest scientific research on how to keep your brain healthy and make it stronger so that it could fight Alzheimer's in the future.  I have organized this information into six steps.

1. Forget about Alzheimer's; Jump start your memory 

2. Strenthen your heart; Rejuvenate your brain with a strong source of fresh blood

3. Unleash your brain's full potential; Your brain can accomplish a lot more

4. Be happier, be sharper; Stress kills your brain cells 

5. Eat smart; Make fruits and vegetables your friends, add some wine and fish

6. Exercise to boost your prain power; Walking can expand your brain's volume, reverse the effects of aging

You can learn more details about each of these steps in my books. The following is a summery of some of the main points. I hope to help you put aside your worries and start learning tricks to enhance your memory, starting today.

More than 90% of people who think they may have Alzheimer's disease don't have it
Differences between normal age-associated memory lapses and Alzheimer's disease
Frontal lobes; planning ahead, one step at a time
Parietal lobes; where, when, and how much
Temporal lobes; feeling emotions and remembering names
Sensational cortical areas
Remembering your wedding night
What happens to your memory parts of your brain as you grow older?
What happens to your brain with Alzheimer's?
Fighting Alzheimer's; start early to prepare your brain for the future
How can you make components of your brain stronger?
Brain plasticity; endless potential for expansion
A story of personal triumph; researcher with crushed brain
Your job and hobbies as brain building opportunities
Unleash your brain's full power, through easy steps

More than 90% of people who think they may have Alzheimer's disease don't have it

These days, almost every one beyond his or her 40's may have wondered if their occasional memory lapses are the first signs of Alzheimer's. I was recently invited to give a lecture at a prominent University in Japan. I spoke about my recent research at Johns Hopkins about the role of vitamins and supplements in preventing Alzheimer's to a large group of scientists and clinicians. After my presentation, the professors invited me to dinner at a traditional restaurant. I enjoyed sitting on the floor with them and eat a dozen different sushi's. After a few drinks of alcohol, they started to tell me how they themselves were worried about developing Alzheimer's. The people in their 80's are the fastest growing segment of the population in Japan and these baby boomers were concerned their government will not be able to pay for their nursing home costs in the future. It was quite surprising for me to see these very bright and successful researchers themselves carry the same worries millions of people have in the United States and almost every other country in the world. Alzheimer's is a frightening disease that is truly a global issue for the ever-aging populations. In my opinion, it is in fact a bigger problem than global warming.

However, I would like to reassure you, as I did at the dinner table with my Japanese colleagues, that Alzheimer's is not the cause of why you can't find your keys or glasses and why you may walk in the room and can't remember what you were looking for. As in more than 90% of cases, your memory problems are not serious and may be due to lack of adequate sleep, stressful job and family environment, medication side-effects, feeling overwhelmed, depression, or sleep apnea in the setting of snoring, feeling exhausted all the time, and being over-weight. These factors do impair your ability to concentrate and learn new names and information on a daily basis, but they are different than the complete loss of major memories in Alzheimer's disease.

Last year, I was working very hard to finish my book with the New York Times and Mr. Will Shortz. For many nights, I was typing until the very late hours in the morning. During the nights I was not working, our two little daughters were keeping me up. One morning, one of my colleagues asked me to give him the password for a computer I use almost daily. I was shocked to realize I could not rehearse this simple 5 digit number. Of course, I remembered it as soon as he stepped out of my office.  I realized I had to take a break from work and improve my sleep. My occasional memory lapses soon vanished.

Differences between normal age-associated memory lapses and Alzheimer's disease

Some slowing of memory powers with aging is inevitable. Several studies have shown memory performance among people in their 40's is not as fast as those in their 30's or 20's. This gets worse for people in their 70's and 80's.  However, the memory decline is minor and does not interfere with fulfilling their day-to-day responsibilities.

One more factor to keep in mind is the variability in memory among different people.  Just like you and your neighbors or siblings differ with regards to heights and color of eyes, you also differ with regards to your ability to remember or forget. If your memory was always modest when you were in high-school, you cannot blame your current memory lapses on a decline with aging or Alzheimer's.

Examples of persistent (not occasional) memory loss requiring further medical attention would be if someone forgot how to drive home, how to cook a familiar meal, or how to play his usual game of golf. Forgetting names of grand-children, not knowing what year it is, or getting lost in one's own home are serious, but sometimes reflect a urinary tract infection or pneumonia. I had a patient in his 80's who was brought to my clinic by his wife. He had stopped answering the phone, listening to radio, or participating in social gatherings.  It turned out he had developed serious hearing loss and did not wish to wear hearing aids. He was limiting many of his daily activities to get around his deafness, not because he had Alzheimer's disease.

We diagnose elderly who gradually develop profound memory loss and become dependent to others for even simple daily chores such as taking a shower with dementia. When no specific cause, such as depression or infection, can be identified we then assume their dementia is secondary to Alzheimer's.  Sometimes people in their 70's and 80's have a great deal of memory problems but yet manage to keep up with their responsibilities. There is a new label for such elderly; we diagnose them as having Mild Cognitive Impairment, or MCI.

You can learn more about different types of memory problems in chapter three of my first book, The Memory Cure, or you may try and take a memory quiz on chapter eight. For example, asking my patients to draw a clock tells me a great deal on whether their brain is still functioning well. As in the more than 90% of my patients taking these tests, you will realize your memory lapses are minor and do not herald the onset of Alzheimer's dementia. Like the majority of them, you are most likely a worried-well. You simply need to forget about Alzheimer's and focus on improving your memory, starting today.

Cardiologist and scientists in this field had long known that high blood pressure, diabetes, high cholesterol, obesity, and couch-potato lifestyle all lead to heart attacks. About 10 years ago, neurologist and neuroscientists discovered that the same medical problems lead to serious memory loss or even Alzheimer's. For example, they found that people with high blood pressure throughout midlife were two or three times more likely to develop Alzheimer's disease.  A group of scientists in Europe discovered that fixing people's blood pressure indeed lowered their risk for becoming demented.

Brain researchers soon figured out that the link between vascular problems and loss of higher brain functions was "mini-strokes."  Patients with atherosclerosis have poor blood circulation not only to their heart but also in their brain. Poor brain circulation deprives many small areas of the brain of fresh blood and they subsequently die. Each of the dead pieces may be the size of a grain of rice and as such don't cause any clear symptoms.  As such, they are called "silent strokes".  Unlike regular strokes, mini-strokes don't lead to paralysis on one side of the body or a sudden inability to speak. It now appears that when these mini-strokes accumulate over decades, they gradually chew away on the brain, causing it to shrink and become vulnerable to affects of aging or any small hint of Alzheimer's.

In an important study of the link between mini-strokes and Alzheimer's in 1980's, Dr. David Snowdon and his team studied around 1000 nuns in several mid-west cities. To help promote science of aging and memory, these nuns had agreed to undergo regular memory tests and then donate their brain to scientists after their death. One of the nuns, Sister Grace, was an articulate and sharp woman in her late 90's. She enjoyed knitting, making crochets, and reading the New York Times every day. She also enjoyed doing cross-word puzzles. She remained sharp until the very last days of her life. Dr. Snowdon expected her brain autopsy report to be close to normal. To his surprise, the pathologist examining her brain felt she had Alzheimer's disease. This was puzzling.

Dr. Snowdon's team analyzed the data from other nuns to solve the mystery. It turns out those who had fewer mini-strokes were able to stay sharp even if their brain contained Alzheimer's. Those who had plenty of mini-strokes became demented sooner and with fewer Alzheimer's foot-prints in their brain. In other words, nuns who were careful about taking care of their blood pressure, weight, cholesterol, and overall fitness had fewer mini-strokes and their brains were strong enough to resist the effect of Alzheimer's. They remained normal on the outside even though Alzheimer's had attacked inside their brain. Put simply, nuns with healthier brains were successful in warding off Alzheimer's.

A dozen other studies around the world have now provided strong evidence for the idea that "mini-strokes" or "silent strokes" harm your brain in a serious manner and render you vulnerable to becoming demented and get labeled as having Alzheimer's. You need to lower your risk factors for developing stroke (large or mini) by improving your fitness and following your doctor's recommendations for dealing with your medical issues such as hypertension, diabetes, high cholesterol, heart failure, or kidney disease.  You need to keep your body healthy below your neck in order to keep your brain sharp above your neck.

In summary, you know how to keep your heart in good shape. The same heart-healthy lifestyle has now been shown to be critical for keeping your brain healthy and sharp. A parallel and exciting line of research indicates that a normal brain can become a stronger brain with training, at any age and with or without mini-strokes. 

Let's learn how the brain works before we can find out how we can make it stronger.

Frontal lobes; planning ahead, one step at a time

The cortex in front of your brain is called the frontal lobe.  This is the area most essential for your ability to make decisions, to solve problems, to plan your weekends, and to organize your days, your weeks and your retirement plan.  Your frontal lobe helps you plan and execute your movements, from a simple bending of your finger to complex set of motions during a dance.

Parietal lobes; where, when, and how much

The parietal lobe on the right side of the brain is essential for your ability to navigate your way, not only in your own home or in the building where you work, but also as you drive from one part of the city to another part of the city.  When you are confronted with a traffic jam and then think of an alternate route to get you home, it is your parietal lobe taking charge in pointing you in the right direction.  The parietal lobe on the left side seems to have an important role in guiding you through the maze of mathematical problems.  When you calculate the 15% tip at a restaurant, it is the particularly the left parietal cortex making additions and subtractions. 

Temporal lobes; feeling emotions and remembering names

Further back are the temporal lobes. They contain many of the emotional parts of your brain, also known as the limbic system.  When you experience stress of a deadline, fear of a rubbery, the joy of kissing someone you love, or when you become excited to start a vacation, your temporal lobes are quite active.  

Deep inside the temporal lobe, there is a structure that is shaped almost like a banana.  This part of the brain is called hippocampus.  There is one hippocampus on the right side of the brain and one hippocampus on the left side of the brain.  Hippocampus appears to be quite essential for short-term memory; for you to remember a phone number or someone's name when you meet them at a party. 

Without your hippocampus, you cannot form new memories.  Without your cortex, you will not be able to remember events from your distant past.  Your hippocampus helps with learning new information in the world around you.  The information deemed to be necessary for you in the future is then shipped to different parts of the cortex for long term storage. 

Sensational cortical areas

In between the frontal lobe, parietal lobe, and temporal lobes are areas of cortex that process sensory information from your hands, hearing information from your ears, olfactory information from your nose, and visual information from your eyes. Needless to say all the dozen different cortical areas mentioned here are interconnected.

Remembering your wedding night

Let's take an example.  Do you remember your wedding night?  Do you remember when you were standing at the altar looking at your spouse and feeling nervous and excited?  Do you remember seeing some of your friends and family members who had traveled long distances to be at your party and watch you walk down the isle?  When you were at your wedding, your hippocampus was working overtime.  So much of the information was important and worth remembering later.  The sounds around you were sent to the part of the cortex for hearing, the sights around you were shipped to part of cortex for vision. The sensation of holding the knife as you cut your wedding cake was shipped to the sensory parts of your cortex.  The taste of your cake and your other sensations were forwarded to other corresponding areas in the cortex.  Now, as you recall those events, somehow magically, all of that information is pulled together and you can see, hear and feel the events of that evening, at the blink of an eye. How this happens so magically remains a mystery. 

What happens to your memory parts of your brain as you grow older?

Hippocampus is one of the most sensitive parts of the brain. It has a tendency to shrink with the normal wear and tear of chemical processes in the brain, and especially in those with stressful lives. As a result, people develop short term memory problems in their retirement years, to varying degrees depending on their lifestyle, overall health, and genetic background.  With healthy aging, however, cortex remains less affected and people learn to compensate for their memory problems with taking notes, asking their spouse for help, and other tactics.

What happens to your brain with Alzheimer's?

In those who experience Alzheimer's, both hippocampus and cortex shrink rapidly.  Such patients don't have only serious memory loss such as asking the same question 10 times, but also lose their functional abilities for their day-to-day routines. They may not be even able to prepare a sandwich or operate the microwave.  They can become lost in a familiar neighborhood.  They cannot quite make decisions and feel overwhelmed by the world around them.  This progression of symptoms reflects a progression of the Alzheimer's disease in their cortex. 

As the frontal lobes shrink, people lose motivation to take part in their routine activities or hobbies. As the parietal lobes shrink, they get confused with directions and with time of the day. Toward the end as most of their cortex and much of their brain shrivels to half its original size, they lose insight into the gravity of their brain damage; they become like a child and smile without any appreciation their social, financial or health problems.

Fighting Alzheimer's; start early to prepare your brain for the future

The solution and an important strategy to fight Alzheimer's are to make your brain a stronger, healthier working machine now, before Alzheimer's touches your brain cells late in your retirement years.  By nourishing and strengthening each corner of your brain, you will make it more difficult for Alzheimer's to injure it.  In other words, you can indeed increase your brain reserve, your brain's richness of connections and complexity.  A stronger brain can withstand the damage brought on by Alzheimer's more effectively, enabling you to function almost normally – even if your brain harbors the foot print of Alzheimer's. The sooner you start, the more years you have to build a more powerful brain.

How can you make components of your brain stronger?

You may wonder what you can do to train your brain into better shape.  Just like sit-ups help with your abdominal muscles, chin-ups with strengthening your arm muscles, you can, indeed, selectively strength different corners of your brain.  One of the most exciting recent discoveries about the brain is that you can make your normal brain a stronger brain.  I think you agree that you are not using anywhere near your brain's full potential.  You indeed can remember better, solve more complicated problems, improve your vocabulary, or learn a new language. 

Brain plasticity; endless potential for expansion

In your daily lives you may have encountered people who have overcome major brain deficits with their determination and persistence. For example, you may have seen people who, as adults, became blind and then learned to use the tips of their fingers to read Braille.  Forced to recruit their other sensations to compensate for their lack of vision, many of them master Braille to the point of reading novels with the tips of their fingers.  Their brain always had the potential to use the nerve endings on tips of their fingers and read Braille. This was a hidden potential that they did not know they had.  Some other people with blindness, such as Ray Charles and Andrea Bocelli became famous singers. You too have many hidden brain capabilities and talents that you have not discovered or fully developed yet. You have the opportunity to easily tap into your brain's deep and boundless capabilities and make it a more versatile and powerful working machine. Your brain potential is almost like having a million dollar in the bank; you need to take the initiative to use it and build on it. Unfortunately, most people realize they have such a rich resource for a sharper and healthier brain in their 80's.

A story of personal triumph; researcher with crushed brain

You can find numerous examples of what scientists call "brain plasticity" in stroke survivors. As they push themselves through rehabilitation they regain many of the brain functions they have lost.  You may have also heard stories of people who suffer brain injuries at war and yet, go on to return to their regular jobs.  Let me share with you one particular story of what I call a personal story of triumph against all odds. 

One of my friends at a major medical institution was biking on a weekend.  Unfortunately, he had forgotten his helmet that day; as he was biking down a steep hill, someone from a parked car opened the door unexpectedly.  My friend crashed into the door, flew in the air and landed on his head on the hard asphalt.  Parts of his skull was crushed and entered into his brain.  Comatosed, he was taken to the local trauma center and underwent numerous surgeries for broken arms and legs and bleeding in his head.  I remember standing at his bedside next to his mother.  She was crying and wondering if her bright and star son would ever recover and would ever be able to talk to her again.  I suggested that we wait three weeks and perhaps three months to see if there was any glimpse of movement or action from him.  In the coming weeks, he gradually opened his eyes and could move his fingers. 

Over months and months of rehabilitation, he gradually regained his ability to walk.  Surprisingly and truly amazingly, he was able to speak again.  In three years, he returned to his job as a researcher at a top medical university.  He had the will and the determination to train the remaining parts of his brain so that they could do more than they used to.  As a result, he now returned almost to the way he was before the accident. Mr. Bob Woodruff, the ABC anchorman also suffered a similarly horrific brain trauma and was able to recover and return to work.  The bottom line is that your brain can do a lot more than you think you can, at any age.

Your job and hobbies as brain building opportunities

The newest imaging techniques show how your brain indeed stretches and becomes literally bigger when you challenge and stimulate your brain.  In many occasions your brain may be expanding at your job, without you actively trying to enhance it. Researchers in London performed a simple experiment which beautifully illustrated this point. 

They invited cab drivers to undergo brain imaging in order to measure the size of their hippocampus.  As you may recall, hippocampus is the part of the brain essential for learning new facts.  Researchers discovered that taxi drivers who were more experienced had larger hippocampus than those who were novice.   There seemed to be a linear relationship with how much time they had spent navigating through the complicated streets of London and the actual size their hippocampus, especially its portion known to be essential for learning directions and maps.  In other words, the changes were not merely microscopic as I would have expected.  The changes in the brains of these individuals were so large that researchers could see them by the naked eye in comparing pictures. 

Another study provided compelling evidence that anyone's brain can grow in size with stimulation and trying novel hobbies.  A group of volunteers in Germany agreed to learn how to juggle three balls in the air for one minute.  Researchers obtained brain images at the beginning of the training and then at the end of the training three months later.  Surprisingly, parts of the brains of these volunteers had grown in size after simple training an hour a day.  These research studies clearly point to the fact that your brain has the potential to grow and become stronger.  You too can enhance your brain and make it stronger; keep in mind that a more powerful brain can resist and fight the effects of Alzheimer's much better than a brain idling at a minimal level. 

Unleash your brain's full power, through easy steps

So, you may wonder what you can do to make your brain and specifically, different corners of your brain, stronger.  You do not necessarily need to learn how to juggle three balls in the air. 

There are dozen simpler ways.  One of my favorite hobbies for a good "brain work-out" is to learn new dance steps.  It cross-trains many corners of your cortex simultaneously. When you take on ballroom dancing classes, you have to pay attention to the sequence of steps; you need to memorize and perform them while following the rhythm of the music.  In doing so, you are strengthening your brain muscles involved for memorization, for coordination, and for music.  You also exercise and improve your physical health which, as we will discuss in the next part of our presentation, will support your brain building program. 

Another example of how you can expand different areas of the cortex at the same time would be for you to learn a new sport or improve the sport you already enjoy.  If you play tennis, learning how to serve better can be considered not only a physical exercise but also a mental exercise.  If you are sitting in traffic and feeling stressed and angry about being late, try playing mental games.  Spell Mississippi forward and then try to spell it backward.  How about Massachusetts?  If this is too difficult for you, you may want to start with Boston.  You will be amazed how quickly you will improve with daily practice. Alternatively, try to rehearse your home phone number backward.  If you are stuck in traffic for many hours a week, try learning a new language.  It is not important whether or not you become fluent in the language; it is important that you engage your brain to learn new words and sounds.  It is the stretch out the brain exercise that is important for you and not so much the actual final results.  

To sharpen your parietal lobe, the area of cortex responsible for orientation to space, try to memorize your way around when you follow a map to a new address.  On the way back, try as much as you can to guess at the next turn.  In large buildings, try to keep your orientation as to which way is north and which way is south.  To tone up your left parietal lobe with mathematics, try to guess what your total grocery bill is while you are in line for the cashier.  Try to calculate the 15% or 20% discount on a sale.  To firm up your "frontal lobe" brain cells with following directions and planning steps of movements, trying a new recipe. Cooking new dishes can be considered a great brain stimulating hobby.  Learning to follow instructions in the right order and timing will require some mental gymnastics. 

Making the same cookie or the same dish you have made for 20 years will most likely not be brain gymnastics, since many of the steps are easy for you and do not have to pay extra attention or watch out for catastrophic errors.  To firm up your temporal and frontal lobes with language, try crossword puzzles.  You may also try Sudoku and other great brain stimulating exercises.  In summary, become engaged and be open to trying new hobbies, activities or challenges.  Instead of making the same old dish, try to cook a Vietnamese dish.  Instead of taking the same route home, try a new shortcut.  Light up your brain every chance you get. Give yourself positive feedback at every step of the way!

1. Getting ready for the next step

Now that you have a general idea of the global organization of short term and long term memory in the brain, I will share with you how exactly you can tone up your brain muscles and how you can protect your brain against Alzheimer's by keeping it healthy and strong. I will teach you how to make your hippocampus happier, which will, indeed, enable you to have a much better memory – now and in the future.

Be happier, be smarter
Your positive attitude and approach to life in general are as important as stretching your brain muscles.  Did you know that stress kills brain cells?  Hundreds of research studies have provided compelling evidence that stress is particularly harmful to the brain.  Stress hormones and mostly cortisol, the so-called fight or flight hormone, help with increasing your blood pressure and attention when you are in danger or when you are under a deadline.  It serves you well when you need to take care of a crisis.  However, the same hormone has been shown to be toxic to brain cells, especially those in your hippocampus.  Individuals and animals exposed to stress over many years develop smaller hippocampus on either side of their brain. 

Stressful circumstances at home or work, especially if severe and frequent, can raise your blood pressure and lead to dangerous hypertension.  In addition to damages brought on by cortisol, high blood pressure by itself leads to narrowing of the blood vessels around your heart and in your brain.  The result is a higher risk of developing heart attack and brain strokes.  Laborious and limited flow of blood in vessels hardened by atherosclerotic plaques limits the supply of fresh nutrients and oxygen to your brain.  If you want your brain cells to function well, and remain strong to battle the burden of Alzheimer's in the future, you need to keep them healthy and happy, in part by minimizing stress.

Sleep your way toward a healthier brain
Stress is often accompanied by inadequate sleep.  Individuals under a great deal of stress often cannot sleep well or wake up early in the morning, worrying about their many responsibilities.  Lack of sleep, in turn, limits a person's ability to function well.  As a result, they cannot complete their tasks and fall under even more pressure and feel even more stressed.  A vicious cycle of lack of sleep followed by frustrating days leads many people to depression and anxiety that interferes with jobs and family dynamics.  If you have too much stress or poor sleep habits, please see your doctors. There are many ways to address these common problems successfully.

Stress reduction strategies, step by step
The first approach would be to change your attitude toward life in general.  Seeing the bottle half full versus half empty is a great way to start.  Another important factor would be to develop a sense of organization.  At the beginning of each year, set goals for the year.  At the beginning of each month, set goals for the month.  At the beginning of each week, set goals for that week.  On a daily basis, in the morning, write down 4-5 things that need to be accomplished that day.  Be reasonable in setting goals and be serious about completing the goals you do set.  Avoid procrastination and focus on the goals you set for yourself on a daily basis.  In doing so, you will find yourself with excess time which you can enjoy. 

I also recommend micro-adventures, short treats to make you excited and smiling.  For example you can buy small presents to yourself for having completed the work and your responsibilities ahead of schedule.  Or you can go for a half-hour massage, buy yourself or your spouse beautiful flowers, surprise someone you love, and pamper yourself with whatever you wish you could do but normally don't do.  Periodically, give yourself a bigger adventure such as taking a weekend getaway or buying a new outfit. Be careful to give yourself a reward only after you do your homework. 

Another strategy would be for you to establish a feedback system in order to establish how stressed you are.  Measuring your blood pressure at work would be an easy way to determine whether anxiety has caused you to spike your stress hormones.  Normal blood pressure is usually 120/80.  A blood pressure of 140/90 is quite concerning and requires medical evaluation and treatment. 

Try Meditation: Sit down in a quiet room, take your shoes and socks off, close your eyes and then breathe in and breathe out slowly.  Count 1001, 1002, etc with each deep breath.  If other thoughts come to your mind, gently set them aside and continue counting.  Let the muscles in your face, your shoulders and your hands fall loose.  Breathe deeply and slowly. 

Another variation would be for you to repeat a mantra as you sit quietly with your eyes closed.  Some words you can repeat quietly in your brain would be peace, shalom, the Lord is my shepherd, or love.  Slowly and comfortably repeat these words while relaxing your facial muscles, shoulder muscles, lower back muscles, buttock muscles, and your feet.  Repeat the same mantra for 10-15 minutes.  Then, gently open your eyes, sit for another two minutes and put your shoes back on.  If you find yourself to be stressed often, you may have an underlying anxiety or depression that needs to be treated. 

See your doctor if you feel hopeless, helpless, all alone or if you feel you lack energy, if you are gaining or losing too much weight and if you cannot concentrate.  Sometimes, too much or too little thyroid, low B12 or anemia can be the culprits.  Obstructive sleep apnea, a condition of not obtaining adequate oxygen throughout the night in patients who snore and are obese, can easily be diagnosed and treated.  Many of their symptoms such as excessive fatigue, poor memory, and being sleepy vanishes with proper medical attention.

Treat your brain to a social gathering or a good joke
One of the best ways to reduce anxiety and stress would be to mingle with people you love or with social gatherings.  Many studies have shown that individuals who enjoy the company of others, socialize, join organizations, travel often or participate in church activities have less stress and are less likely to develop significant memory loss with aging.  The exact biochemical pathways involved remains under intense research.  Specific proteins may be the link between a more fun and engaging social life and a healthier and stronger brain. 

In summary, stress is a part of our busy lives and cannot be completely avoided.  However, you need to make an effort to minimize stress by getting control of your schedule, practice relaxation techniques and have a positive attitude toward life.  It would also help if you laughed more often, tell a joke, give yourself a "humor break", find delight and amusement in ordinary things and spend time with people who have a tendency to laugh and be happy.  If you want your brain and your hippocampus to be happy, then make sure you keep yourself happy and laugh.

You've just learned how to tone up different parts of your brain and more importantly, you just learned how to prevent the hippocampus from shrinking prematurely.  You have learned that if you want to avoid killing your hippocampus and developing serious memory loss by the time you are in the last decades of your life, you need to have a healthy and happy attitude toward life.  In the next and final part of the program, you will learn the best food for your brain and how walking 30-45 minutes a day can make your brain three years younger.  You will learn how diet and exercise can do wonders in keeping your brain young and delay the onset of memory problems in the future. We'll be right back…

Eat a diet to fight effects of aging on your brain
Three factors damage the brain with aging and lead to slower and duller brain capacity later in life.  These include:

1. Inflammation.
2. Atherosclerosis. 
3. Amyloid buildup.

Let me review with you each of these factors. 

The same inflammatory process that causes you to bruise when you hit your arm against a wall or if you hurt yourself in a sporting accident takes place in the brain without any accident or injury.  While the exact mechanism is yet to be discovered, inflammation takes place in the brain perhaps because of the buildup of metabolic byproducts. 

The second factor is the same culprit that causes heart disease.  High blood pressure, diabetes, smoking, a sedentary lifestyle, and obesity are known to cause heart attacks.  They damage the heart because they lead to atherosclerosis or hardening of the blood vessels throughout the body.  The blood vessels which reach deep inside the brain are also affected.  As I reviewed earlier, they become narrower and lose their ability to supply brain cells with fresh blood filled with oxygen and nutrients.  High blood pressure, for example, by itself can double or triple a person's risk of developing dementia many years later. 

Some scientists have shown a direct relationship between the larger waistline and a larger probability of developing memory problems later on in life.  People who are overweight often have vascular problems, but many of them may also have obstructive sleep apnea, a condition characterized by snoring at night and lack of energy during the day.  These factors are now believed to play a major role in why some people remain sharp while others have increasing memory problems as they grow older.  A person with negative risk factors of high blood pressure, obesity, a sedentary lifestyle, diabetes, high cholesterol, and smoking is 16 times more likely to become demented than a person who is otherwise healthy and in top shape.

 The third and the one factor which is difficult to combat is the buildup of a specific protein in the brain called amyloid.  This protein has natural functions in the connection points between brain cells.   However, in some individuals, the levels of this protein rise rapidly and their clearance out of the brain slows down.  As a result, the seemingly benign proteins which are usually soluble like sugar and water, mount up and form small pieces of plaque.  They cannot be cleared from the brain and keep accumulating and become larger and larger in size. 
For now, some supplements appear to be front runners in lowering the amount of amyloid in the brain.  These include Omega III fatty acids (called DHA) and the curry spice, curcumin.  Many drugs are in different stages of development and some will become available in the coming years.  

For now, the best chance of maintaining and preserving brain health is to focus on reducing inflammation and reducing atherosclerosis.  The best approach to minimize the amount of inflammation in the brain is to eat five pieces of fruit and vegetables daily.  At least 3-4 large observational studies monitoring healthy volunteers for 20-30 years have shown that those who love to eat fruits and vegetables seem to stay sharp longer and keep their brain younger.  Those who eat fruits and vegetables on a regular basis also cut down on the risk of developing stroke and heart attack.  Overall, fruit and vegetable eaters seem to keep their brains about five years younger than their family or friends who live on junk food and greasy sandwiches.

With the overwhelming scientific evidence in favor of healthy diet, no one any longer argues that eating fresh fruits and vegetables on a regular basis is an excellent approach for a healthy body and healthy mind.  Vitamin E and vitamin C are also great antioxidants and for those who cannot eat five pieces of fruits and vegetables on a daily basis, represent a reasonable alternative.  Omega III fatty acids such as DHA and curcumin appear to also be strong antioxidant molecules, in addition to their ability to shrink amyloid build-up, and help with keeping your brain in top condition.

To fight atherosclerosis, you need for first and most importantly, monitor your blood pressure.  High blood pressure is a silent killer of brain cells and needs to be addressed as soon as possible.  High cholesterol is a culprit both for heart attack and stroke and many studies suggest a direct link with poor memory function as well.  If your cholesterol is high, you need to alter your diet and take medications, if necessary.  Walking daily and eating a high fiber diet also help to lower your cholesterol. 

Obesity, which is major health problem in the United States and the developing world, produces a great deal of stress for the brain.  Unfortunately, it appears that in people who have become significantly overweight, the normal link between the gut and the brain to control the appetite functions poorly and leads to overeating.  While the scientific details are yet to be finalized, there is no doubt that excess weight is bad for the heart and the brain. 

Recent studies have indicated that women with waistlines of 35" or higher and men with waistlines of 40" or higher are more likely to lose their memory as they grow older, as compared to their healthier and thinner neighbors and friends.  It takes only simple lifestyle modifications to gradually and steadily lose weight.  Many of you already have considered losing weight because of heart reasons.  Realizing that your brain health is also at issue, you now have a greater incentive to fight back.  Simple changes in our day-to-day routines are the best ways to shrink your waistline.  You may consider eating fruits and vegetables more often, try to say no to chocolate or cookies of any form, eat salads and fish more often, choose a baked potato instead of French fries, choose low fat milk, say no to sodas and sweet juices, forget junk food, and eat whole grains more often.  People who make small modifications in their eating habits are more likely to succeed than those who decide to lose excessive amounts of weight in a short period of time.  You may want to start by promising yourself to never again eat junk food during the weekday, and minimize during the weekends.

Pump up your heart; achieve lobes of steel in your brain
Exercise is one of the best ways to keep your brain young.  Not only does exercise reduce atherosclerosis, lowers your risk of developing heart attacks or strokes and improves your mood, it also nourishes your brain cells.  In numerous studies, volunteers who participate in 30-60 minutes of walking a day are far less likely to lose their memory or to develop Alzheimer's disease.  The more a person walks the less likely it is that he/she would become forgetful. physical exercise leads to better and healthy brains. 

Researchers have now identified several proteins as the link between a stronger body and a stronger brain.  Brain drive neurotrophic factor (or BDNF) is a protein involved in healing and repair in the brain.  Regular exercise appears to increase the levels of this protein which, in turn, enables animals to improve performance in memory tests.  For example, if left in a maze with a running wheel for exercise, mice have a tendency to exercise. Researchers noticed that these mice can find their way better in the maze; and after they examined the brains they found higher levels of BDNF in those who performed better.  In short, more exercise leads to release of healing proteins in the brain which will strengthen your memory and higher brain functions.

Exercise, like brain stimulation, expands the brain
In an intriguing study, a group of retirees who claimed to be "couch potatoes" were invited to participate in a simple walking exercise.  Their brain MRIs were measured before and after a six month regimen of walking.  There was an increase in the size of the frontal lobes in individuals who simply walked 30-45 minutes a day for six months.  Their brain volume was slightly higher at the end of exercise, equivalent to those three years younger.  In another study in collaboration with Columbia University, identical patterns of activities were noted in the hippocampus of animals and humans participating in a parallel set of exercise programs.  They discovered increased activity in the hippocampus, the very part of the brain essential for learning and memory.  In animals, this increased in stimulation turned out to be due to generation of new brain cells; scientists were left to believe the same process must have taken place in humans. In short, exercise literally expands the brain and the actual processes are now being unraveled by scientists. So, keep moving and you will maintain your capacity to keep moving when you are much older.

A story of personal triumph over fear of Alzheimer's
One of my patients was a 54 year old stressed-out secretary.  She and her husband were trying to pay for college fees for their two daughters.  They were both overwhelmed by the amount of their full-time and part-time jobs.  She felt that she was losing her memory as she was forgetting people's names and misplacing things quite often.  Her mother had Alzheimer's disease and she wondered if she was going to be next.  When I saw her, I performed medical and neurological evaluations and obtained blood tests for reversible causes of memory problems such as thyroid and B12 levels.  All of her tests were normal and I realized that she needed a brain health makeover. 

I provided her with reassurance that she did not have Alzheimer's disease and that her memory problems were treatable and minor.  I encouraged her to reduce her work-load and give some time to herself.  She agreed to participate in meditation exercises.  I also encouraged her to monitor her blood pressure to make sure it remained within normal limits.  She decided to take dance classes with her husband which also reduced their stress and allowed some time for them to enjoy each other's company.  With the reassurance that she did not have a serious brain disease and with the positive feedback of relaxation and increased enjoyment in her life, she put aside the worries of developing Alzheimer's disease and began focusing on the positive aspects of her life.  Her children actually appreciated the fact that their parents were taking care of themselves instead of working overtime to pay for their college.  In two years, she was taking new classes and had put aside the worries of Alzheimer's altogether. 

Teaching old dogs new tricks
New research indicates that you can teach old dogs new tricks.  You need to insure physical health, proper diet, reduced stress and focus on the positive.  Dr. Carl Cotman divided a group of old dogs into four sub-groups.  One group received no particular attention, one group received enriched diet with addition of antioxidants and a third group received exercise and lived in a stimulating environment filled with toys.  A fourth group received both diet and increased physical and mental stimulation.  Interestingly, each of the groups of either diet or exercise performed better than the retired dogs which were left to be on their own – with no interventions.  The group that received both diet and exercise out performed all other groups significantly.  In fact, after two years, many of the "senior" dogs performed better than young dogs half their age.  You too can notice a similar pattern when you visit gyms filled with baby boomers looking younger and feeling stronger than many of their neighbors and friends that are 20 years younger.