Cognitive Health is Health

Notes on President Biden’s debate performance 🇺🇸

Jul 01, 2024

ICYMI 👉

If you want to understand why cognitive health is often considered a taboo subject, look no further than President Biden’s debate performance last week.

Oof.

My heart ached as he struggled on stage for words and looked like a shell of his former self. This isn’t just about age. This is what cognitive decline looks like. It isn’t pretty, and it’s hard to talk about. It makes onlookers uncomfortable. It sends families into the arduous process of grieving the loss of their loved one’s former self. And, in the case of Biden’s cognitive issues, it has sent the country into an anxious tailspin.

It has many people calling for his replacement. And while that is an essential conversation, I’d like to call attention to cognitive health in general—specifically the drivers of cognitive health and how we can reverse or slow the decline.

I’m not saying I know anything about President Biden’s medical situation. (Parkinson’s? Lewy body dementia? Alzheimer’s?) However, I am saying that each of us should do what we can to prioritize our own cognitive health.

Similar to some misperceptions about mental health, declines in cognitive health are often believed to be inevitable and unalterable, which often discourages people from seeking necessary diagnostic assessments and care. While we naturally lose neurons with age, and some changes in cognition and memory are expected as we get older, there are ways to get the most out of the neurons (brain cells) we have and to foster new synapses (neural connections) over time.

Why prioritize cognitive health?

Cognitive health and mental health are distinct but inseparable products of brain health. While mental health encompasses issues like anxiety and depression, cognitive health centers on memory, executive function, and overall mental clarity. Cognitive health affects every aspect of our social-emotional, behavioral and physical health. It plays a crucial role in maintaining overall well-being and quality of life. It informs our sense of self.

Our brains are immensely complex structures composed of billions of neurons (brain cells) and trillions of synapses (neural connections and pathways). Optimal cognitive function relies on three things: 1) maintaining healthy neurons, 2) creating new neural connections, and 3) preventing neuron loss.

Understanding Cognitive Decline

There are a number of modifiable risk factors that contribute to neuronal loss and cognitive decline. For example, cardiovascular problems can directly impact neuronal health by compromising blood flow to the brain. Brain cells need oxygen and other nutrients, supplied by small blood vessels throughout the brain. We injure neurons when they aren’t given adequate nourishment as a result of damaged or blocked blood vessels. Controlling cardiovascular risk factors (such as hypertension, high cholesterol, atrial fibrillation, and diabetes) is crucial in preserving the health of our blood vessels—and, therefore, cognitive function—over time. Similarly, substances like nicotine, alcohol, other sedatives, and even some prescription medications, including benzodiazepines, can negatively affect cognition, particularly if taken for an extended period of time. Limiting or abstaining from using these substances can improve—and sometimes reverse—cognitive impairment.

Beyond preventing neuronal loss, maximizing neuronal performance is equally important. This involves ensuring that neurons function optimally by getting adequate sleep, brain rest (which is distinct from sleep), exercise, and nutrition; by appropriately managing stress; and by managing our underlying health. Addressing these lifestyle factors can be more difficult than taking a pill (I vote “no” to Prevagen!) but can materially enhance brain function.

Activities that challenge and delight your brain—socially, intellectually, and emotionally—contribute significantly to neuronal health and connectivity. For example, learning a new language, taking up an artistic pursuit or even a card game like bridge, or planning a summer picnic with friends will help keep your brain and its synapses healthy.

Put simply: use it or lose it. Exercise your brain to keep your neurons healthy and maximally connected to each other. And even just walking outside, particularly in a variety of environments and in nature, helps.

Intervening in Cognitive Decline

Arguably the most important way to support your cognitive health is to acknowledge that there might be a problem and to seek help. The sad truth is that it’s easy not to be proactive about one’s cognitive health, particularly in our current healthcare landscape where time with a doctor is often limited and the nuances of a thorough cognitive assessment can take multiple visits and require multiple tests. The problem is that avoiding this conversation with your doctor (or with your loved ones) can lead to a lack of intervention and continued cognitive decline.

It’s important to realize that many conditions that affect cognition, such as hormonal imbalances (e.g., thyroid dysfunction or perimenopause), nutritional deficiencies (e.g., vitamin B12 deficiency), “polypharmacy” (i.e., taking unnecessary or conflicting medications), stress-related brain fog, hearing loss, and sleep disorders (such as insomnia or sleep apnea) are reversible or manageable with appropriate medical care.

One of the most common reversible causes of cognitive decline is depression. If the depression is severe enough, it can cause something called “pseudo-dementia” (i.e., cognitive impairment that can be reversed with the treatment of depression.)

Hearing loss may also play an important role in cognitive decline. We know that wearing hearing aids can improve cognitive performance for those with hearing loss. We also know that even mild hearing loss doubles one’s chances of developing dementia. There is optimism that the use of hearing aids can substantially reduce this risk. In short, don’t hesitate to get your hearing checked.

The upshot: addressing the whole person—from head to toe—can significantly impact cognitive function, highlighting the importance of holistic health management.

Addressing Dementia Risk

Patients often ask me why they should get tested for cognitive impairment or dementia if there isn’t anything they can do about it. To them I say: While some causes of dementia remain incurable, early diagnosis and proactive management can significantly delay disease progression and improve quality of life. Ongoing research into diagnostic tools and therapeutic interventions offers hope for more effective management strategies in the future.

It cannot hurt to get a baseline understanding of your cognitive health which may include blood work, brain imaging studies, and neuropsychiatric testing. While undergoing this process can be time consuming and stressful, getting a good baseline can help your medical team provide reassurance and/or appropriate next steps to optimize your cognitive health.

Regardless of your current cognitive status, proactive measures like regular cognitive assessments, lifestyle modifications, and various medical interventions can significantly impact long-term cognitive health. Investing in activities that promote brain health, such as lifelong learning and social engagement, can help mitigate age-related cognitive decline and optimize cognitive function across the lifespan.

I encourage you to take control of your brain health. Replace fear with hope—and passive resignation with proactive management. Your brain will thank you!

In the meantime, tell me: What did YOU think of President Biden’s debate performance? Have you had personal experience with a loved one going through cognitive decline? If so, what was the most helpful intervention or lesson learned from that experience? I’m all ears.