Protecting Your Mind as You Age

When working with patients to control cardiovascular disease risk factors such as hypertension and high cholesterol, I find most people are more concerned with preventing a stroke than a heart attack. This is understandable. Our brain is responsible for so much of what makes life meaningful—talking, thinking, remembering, moving, feeling. Indeed, the brain is essential to who we are. People are justifiably concerned with protecting this most crucial organ.

Of course, strokes are not the only malady that can afflict our brains. Perhaps the most feared brain diseases are the dementias, the most common of which is Alzheimer’s. Although genes play a role in developing dementia, research tells us that there are a number of steps individuals can take to lower their risk of developing it. Prevention is especially important because unfortunately we currently do not have treatments stop progression in dementias such as Alzheimer’s. In honor of June being Alzheimer’s and Brain Awareness Month, below are seven steps you can take to promote brain health and lower your risk of dementia.

1. Exercise
   Exercise is the intervention with the most evidence for enhancing and protecting your brain. It does so through multiple mechanisms. Exercise lowers elevations in blood sugar and blood pressure levels that have been shown to be harmful to the brain. It also decreases inflammation and helps improve sleep. It increases our body’s production of endorphins which are chemicals that relieve pain and lift our mood. Finally, exercise stimulates the release of growth factors that promote function of brain cells.
   
   Aim for at least 30 minutes every day of some form of exercise. This can include aerobic activities such walking, jogging, biking, or tennis. It also includes resistance training to keep our muscles strong. This can involve going to the gym for weight training or using our own body weight with push-ups, planks, squats, lunges, or yoga. There is some evidence that racquet sports like tennis, pickleball, or racquetball offer the most benefit since they involve connecting with other people as we move.
2. Learn
   Keep your mind engaged with activities that provide joy and purpose. There is evidence that we may derive the most benefit from activities that cause us to stretch our cognitive capacities such as learning to dance, play a musical instrument or speak a language.
3. Sleep
   During sleep our brain washes away metabolic debris, including the proteins that contribute to amyloid plaques found in Alzheimer’s Disease. Sleep also decreases inflammation which has been associated with neurodegenerative diseases like Alzheimer’s. Thus, it is not surprising that lack of sleep has been associated with an increased risk of dementia.
   
   One common form of sleep disruption is obstructive sleep apnea (OSA). In OSA, tissues in the back of throat collapse, thereby blocking the airway. The person stops breathing, preventing them from getting deep, restorative sleep. OSA is manifested by the bed partner reporting the individual is snoring or even gasps for breath. The person may not feel refreshed in the morning and feel the need to sleep later in the day, especially while engaging in non-stimulating activities such as watching TV or sitting at a stop light. If you’re concerned you might have OSA, ask your physician if you should get a sleep study to measure brain and breathing activity when you sleep.
   
   Here are some keys to getting a good night of sleep:
   1. Go to bed and get up at a consistent time.
   2. Expose yourself to sunlight for at least 5 minutes in the morning as soon as you get up.
   3. Exercise.
   4. Don’t drink caffeine after midday. It stays in your system and impairs deep, restorative sleep.
   5. Don’t eat for four hours before bed.
   6. Limit alcohol at night since it can hurt quality of sleep.
   7. Keep the bedroom cool, quiet, and dark.
   8. Keep your cell phone out of the bedroom
   9. Set aside 30-60 minutes before bed for a relaxing bedtime ritual such as a bath, meditation, praying, reading, or calming music.
   10. Don’t do anything in bed except sleep or sex. You want your mind to associate bed with sleep.
   11. If you get up to go to the bathroom during the night, don’t look at the time. This will cause anxiety and make it harder to get back to sleep.
   12. If you can’t get to sleep, go to a dimly lit room and read a boring book until you feel sleepy. Then go back to bed.
4. Treat hearing loss
   Multiple studies show even mild hearing loss increases the risk of dementia. The use of hearing aids appears to mitigate the decline.
5. Control blood pressure
   Hypertension (persistently elevated blood pressure) is associated with damage to our arteries and increases the risk for strokes—the main cause of vascular dementia. Controlling blood pressure through exercise, nutrition, stress management, and medications lowers the risk of dementia.
6. Invest in relationships
   Social isolation increases the risk of dementia. This may be because loneliness results in less cognitive activity and increased stress. Prioritizing relationships is thus a key component of cognitive health.
7. Control blood glucose
   Impaired insulin sensitivity in the brain reduces its metabolism and impairs clearance of amyloid protein present in Alzheimer’s. Elevated glucose, as is found in diabetes mellitus, also increases inflammation and damage to arteries that supply blood to the brain. Controlling glucose through lifestyle and medicines is thus protective for the brain.

While we don’t have complete control of the cognitive changes with age, there are several important steps we can take to promote brain health.