Brain Health Tip of the Day: Fight Fatalism with Facts
As I rest my brain on a break with my family, my medical partner and brilliant friend Dr. Clay Ackerly will educate us about keeping our brains healthy. Dr. Ackerly is an internal medicine physician and geriatrician. He studied at Harvard and did his medical training at Duke and Massachusetts General Hospital in Boston. He is one of the smartest people I know. I hope you enjoy his sage advice.
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Dear All,
During Lucy’s well-earned and all-too-brief vacation, I wanted to write about a topic near and dear to my heart – “cognitive health.” It is the yin to “mental health’s” yang. Whereas mental health focuses more on mental well-being (e.g. anxiety, depression, stress management, etc.), cognitive health is more about mental acuity or lack thereof (e.g. memory, executive function, “brain fog,” etc.) Unfortunately, just as the field of mental health has suffered from stigma and underinvestment, cognitive health has suffered from a dangerous fatalism (i.e. “there is nothing we can do to change it”) that keeps many people from seeking the help and care that they need to optimize their brain function.
You may be asking: why talk about cognitive health when we’re still in the midst of a pandemic? In many ways, the pandemic has heightened the need for cognitive health assessments and treatment. First and foremost, many people (including many of my patients) are suffering from a notable decline in their cognition that has been triggered by the cumulative impacts of stress, burnout (Lucy even wrote about it), social isolation, weight gain, substance use, medication misuse, and sleep disturbances brought about by the pandemic. In addition, too many preventive health visits and screening tests have been pushed off during the pandemic. As you begin to schedule those deferred maintenance appointments, now is a perfect time to raise any concerns you might have about your cognition with your medical providers.
Drivers of Cognitive Health:
Our brains are amazing structures which include complex networks of tens of billions of “neurons” (specialized cells that transmit nerve impulses) with hundreds of trillions of synapses (connections between neurons) amongst other important structures and functions. Thus, I apologize if I offend any neuroscientists by my overly simplistic approach. I tend to look at cognitive health from two perspectives: 1) Neuronal Supply (making new connections and preventing neuronal or “brain cell” loss), and 2) Neuronal Performance (making the most of the neurons that you have).
As for Neuronal Supply, the key is to make as many new neuronal connections as you can. Put simply: exercise your brain to keep your neurons healthy and maximally connected to each other. That includes staying socially engaged, trying new and different experiences, and engaging in physical exercise (which, beyond other positive effects, also helps reinforce the neuronal pathways related to balance and coordination).
In the case of Neuronal Loss, there are various factors that lead to neuronal decline, many of them preventable. Cardiovascular disease, for instance, is a common cause of neuronal loss. Uncontrolled high blood pressure and high cholesterol can kill off neurons directly and increase the risk of stroke and vascular (i.e. blood-vessel-related) dementia. Excess alcohol and drugs [recreational, prescription, and over-the-counter] can also kill off neurons. By managing your cardiovascular health (your brain likes well-controlled blood pressure and clean blood vessels) and being mindful of the risks of substance use (and abuse), you can work to prevent this neuronal damage. In the best of circumstances, it is true that we still lose neurons with age and some modest changes in cognition are expected as we get older. Even in the case of aging, however, there are ways to get the most out of the neurons you have, which brings us to: Neuronal Performance.
Neuronal Performance is exactly as it sounds – take the neurons you have and make sure that they are able to function as well as possible. Don’t think “Prevagen” (I have not seen any compelling data behind any “memory supplement” - but think adequate sleep, stress management, hearing optimization (as I go into below). As I mentioned above, there is widespread fatalism about cognitive health: a general misconception that there is nothing to be done about it. All of us can benefit from replacing fatalism — and resulting inaction — with a proactive mindset. Many un- or under-recognized factors that lead to cognitive decline can be reversed. In other cases, decline can be slowed, leading to a better quality of life over a longer period even in severe circumstances such as dementia.
Reversing and/or Slowing Cognitive Decline:
The most important way you can support your cognitive health, particularly if you are noticing changes (such as increased memory loss or persistent brain fog unrelated to a specific cause such as COVID-19 or pneumonia - which often lead to transient changes), is to acknowledge that there might be a problem and to seek help. The unfortunate truth is that too many of us are not proactive about cognitive health, leading to a lack of intervention and continued cognitive decline.
For instance, hormonal imbalances (e.g. thyroid dysfunction or even perimenopause) can have effects on cognitive function that can be managed, often reversed and do not necessarily portend a permanent reduction in cognitive function. Vitamin deficiencies (especially vitamin B12) can also be insidious in impacting the brain and can be easily evaluated and treated. Sleep disturbances, too, (either too little sleep or impaired sleep through sleep disorders such as sleep apnea) can have a profound effect on your brain’s functioning and are too often dismissed as a “typical consequence of a stressful life.” But most sleep challenges can be overcome with consistent effort. Working with your medical providers to review your medications is another important step to take regularly, as polypharmacy (when one takes many different medications/supplements) and the consistent use of sedative medications can have a detrimental impact on cognition (be especially careful of Tylenol PM and other over the counter sleep aids which can damage the brain when used chronically).
One of the most common reversible causes of cognitive decline is depression. If the depression is severe enough, it can cause “pseudo-dementia”– dementia-level cognitive impairment that can be reversed with the treatment of the 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 (this is a source of ongoing research). In short, do not be shy to get your hearing checked (but be forewarned: hearing aids have not yet been shown to cure “selective hearing loss”).
Speaking of Dementia, while most causes cannot yet be cured, we can absolutely work to slow it down. Some of us are at higher risk of dementia simply by genetics alone. For those at risk of such a future, there is real hope. Diagnostic tests are improving every day, from specialized brain scans to emerging blood tests. Early diagnosis and intervention is key. I won’t dive into the ongoing controversy around the Alzheimer’s disease treatment aducanumab, but this is just one of many promising therapeutics in the pipeline. Clinical trials are available with increasing frequency. If you have a family history of dementia, talk to your doctor. Even absent full cures (which we hope are around the corner), we know that things as simple as exercise and social and cognitive engagement can help slow down the disease. In other words, gone should be the days of: “I don’t want to know my risk since I can’t do anything about it.” We should all feel empowered to take real action to improve our cognitive health and quality of life.
In sum:
If you or a family member are experiencing even modest changes in your cognitive function, talk to your doctor:
Changes to cognition are often transient or reversible, and even many irreversible changes can be managed;
Even if you are not currently concerned about your cognition, investments in your overall health (as simple as exercise, cardiovascular risk factor management, social engagement, etc.) can help build the foundation for strong mental performance in the coming years and decades.
Cognitive function is often an afterthought, a taboo topic avoided for fear of invoking the (misconceived) vision of an unalterable pathway to senility. I encourage all of you to take control of your brain health. Replace the all-too-prevalent fatalism with hope and proactive management.
Your brain will thank you.