Starting Fresh in the New Year

Contributed by: Dennis Fortier, President, Medical Care Corporation

It is that season when it is enjoyable, and in some ways instructive, to pause and reflect on the passing of another year. It is also an excellent time for setting priorities and establishing habits that we will be happy to reflect upon twelve months from now. With that in mind, this article suggests 5 simple practices with clear “brain health” benefits that you may wish to consider as you embark on a fresh new year.

To be sure, there are higher ideals than those I have listed here, toward which we could all strive. However, my intention is to provide readers with some ideas that are relatively easy to pursue but can still yield important benefits; the goal is to offer maximal return for minimal effort and sacrifice.

With that said, here are five considerations for starting fresh in 2010:

1. Improve Cardio-Vascular Health

This suggestion is not new but deserves repeating because it has been proven beyond a doubt that good cardio-vascular health leads to better over all health and lower risks for heart disease, diabetes, and Alzheimer’s disease. What is new is certain evidence about how easy it may be to start moving the needle in the right direction.

Improving cardio fitness need not involve strenuous exercise and really doesn’t even require that you sweat. Walking is one of the overall best and most underrated forms of exercise and can often be incorporated into daily errands. Also, don’t think that because walking is easier than running or swimming that you must do it longer to gain a benefit; a daily 30-minute walk is immensely beneficial to a person with no current routine of physical exercise. Especially if the walk can be augmented with a few trips up and down the stairs in lieu of the usual elevator ride.

In terms of staying motivated to maintain a routine of physical exercise, try to find a quantitative measure that will reveal your progress and keep you looking for more gains. In the past, much emphasis has been placed on body weight, a measure that is easy to obtain but can be difficult to improve. As an alternative, check your pulse rate at the end of your work out and track it for one month of daily walks; you might be surprised to see it fall. When you consider how many beats of your heart you can save over the course of a year by keeping your heart rate low, it can be very motivating.

Also, whether or not you suffer from high blood pressure or high cholesterol, be sure to get these measures from your physician during your next check-up and keep track of them as you exercise. Even something as simple as a daily walk is good for your brain and can produce meaningful improvements in both of these bio-markers as you gain better fitness.

2. Reduce Stress

This suggestion might top the all time list of things that are easy to suggest but difficult to achieve. However, it turns out that for many of us, a high percentage of the daily stresses we encounter are self-inflicted. That’s right; choices we make and attitudes we willingly assume end up creating stress that we could otherwise avoid.

Reducing stress is important because we know how detrimental stress can be to our health. Real physical processes are triggered by emotional reactions to stress and, as far as our science can tell, none of those processes are beneficial while all have harmful side effects.

Here is a simple suggestion for reducing stress that, although it won’t work for all of you, must be tried by the rest of you before you can fully believe its effects. Put simply, you should make a conscious decision to drive with patience and courtesy. Look for other drivers trying to cut traffic and motion them in. Don’t speed up to close the gap when another car wishes to enter your lane; slow down and allow them in. Embrace yellow lights for the opportunity they foretell to pause for a moment – this is certainly less stressful than treating them as a threat to your rapid progress. Don’t tailgate or change lanes incessantly seeking opportunities to move one car length closer to the front of the crawling traffic; it is just not worth it. Instead, accept the pace, listen to some music, and keep an eye out for other drivers who might benefit from your courteous cooperation.

If you are not aggressive driver and cannot benefit from that tip, perhaps you can benefit from becoming a less aggressive “parker”. When visiting an establishment with a large parking lot, rather than seeking the spot nearest to the entrance, subjecting yourself to the anxiety of passing up a mediocre spot for the possibility of finding a better one, all the while monitoring the flow of motorists who might be competing for the best spot, try driving to the far end of the lot and parking in the open expanse of remote spots. It is a stress-free approach with the added benefit of a short cardio workout as you walk to your final destination.

While this might seem silly, it’s a step toward avoiding self-inflicted stress that just might carry over into other realms of your life as well. Get the right attitude, reduce your stress, and enjoy a healthier brain and body.

3. Stay Socially Active

While most of us are not in danger of becoming accidental hermits, making new friends and interacting socially are activities that have been documented to decline as we age. We are most prolifically social as young students, followed by fairly intense socialization in adulthood when our children are students, and we tend to be least active when we are older and our children have grown and moved on.

Much research on the benefits of intellectual stimulation, the act of using our brains in challenging ways, has shown a positive correlation with maintained cognitive health. I will write more on that below but will make a separate point here. Meeting people, learning about them, interacting and cooperating with groups, and cultivating relationships are all activities that require deep and comprehensive cognitive activity. In socializing, especially with persons we are still getting to know, we use memory, verbal skills, and judgment along with a poorly understood melding of emotions and executive function. In the opinion of many scientists, socializing may be the best mental activity we have.

Two great ideas for remaining socially active are club membership and volunteering. While you may or may not have interests that lend themselves easily to club membership, a regular card game or social activity with a committed group brings the same benefits. As for volunteering, hospitals, churches, and many non-profit organizations are begging for help in nearly every community. Incidentally, one of the most meaningful gifts you can offer through volunteering is friendship and interaction with a lonely, usually elder, person. Doing so will yield a double benefit because every interaction will be a work-out for both of your brains, not to mention the good it will do for your hearts.

4. Eat Well

You had to know this one was coming. As I did with the section on cardio-vascular fitness, I will try to present this in a new perspective that might be easier to embrace than those perspectives you have heard in the past.

Here is my fresh take on eating well. You needn’t necessarily deny yourself the junk food you’ve grown to love nor worry too much about your daily intake of calories. You do need, however, to worry about getting proper nutrition first. While consuming empty calories is harmful because it leads to weight gain and poor vascular health, the more damaging impact is that it strips away your appetite and prevents consumption of necessary vitamins and nutrients. A fresh approach to diet in the new year might be to focus first on what you should eat and set, as a second goal, the elimination of foods that you should not.

The good news is that the diet shown to produce the best vascular health was also shown this year to also promote the best cognitive health. One should be sure to consume a diet rich in cruciferous and green leafy vegetables, nuts, fish, and tomatoes and low in red meat and high-fat dairy products. Ideally, you will eventually adopt a diet whereby you take in what you need and avoid what you do not, but an easy place to start is to ensure that you get enough fruits and vegetables prior to filling up on junk; this will offer the best opportunity to keep your brain functioning at a high level in the new year.

5. Seek Intellectual Stimulation

If you have pondered the health of your brain at all, you have likely read or heard about the importance of ongoing intellectual stimulation. While it is not yet completely understood, it does appear that active brains decline more slowly with age than those that are relatively unchallenged.

A potential red herring in the discussion is the value of crossword puzzles, sudoku, and the like. Yes, they are mentally challenging activities but they may not produce the rich neural rewards that other activities, such as socializing, might yield. The key seems to be related to the concept of “learning”. If you don’t know the rules of crossword or sudoku then these may be great activities for your brain. However, if you know how the games are played, then merely working through new forms of each puzzle requires no new learning and may offer few benefits to brain health.

Among the most challenging yet rewarding intellectual activities that you pursue are learning to play a musical instrument and learning to speak a foreign language. Both of these have become much easier in the digital age with the advent of tools and software to aid in the learning process. While this might seem counter-intuitive it is actually quite well-grounded. With better tools, the learning becomes easier so the process yields faster proficiency and remains interesting through time. Despite the ease, the learning is real and the brain builds new circuits in accordance with the new learning. The whole process can be great fun, deeply rewarding, and very good for your brain.

So there you have 5 good suggestions to start fresh in the new year and keep your brain healthy in the process. Work on that cardio-vascular fitness, reduce your stress, stay socially active, eat well, and challenge your brain with new learning. If you do so, you can expect that twelve months from now you can look back with clarity and reflect on a year when you made a worthy commitment to the health of your brain.

Bio-Marker Diagnostic Test for Alzheimer's Disease

Contributed by: Dennis Fortier, President, Medical Care Corporation

Researchers at the University of Pennsylvania have published in the Annals of Neurology the development and standardization of a test to accurately diagnose Alzheimer's Disease (AD) by measuring the levels of beta-amyloid and tau protein in the spinal fluid. While many news stories are forwarded to me on a daily basis, I sense a particularly high level of interest in stories such as this one.

My primary take on news about bio-marker diagnostic tests is two-fold.

First of all, it is tremendously positive in the following sense. We are currently detecting patients with AD, on average, when they have end-stage pathology (up to 95% of patients are detected 8-10 years after the onset of symptoms according to published data). One of the reasons we intervene so late is that many physicians believe (erroneously) that a brain biopsy is the only reliable method of establishing a certain AD diagnosis. While it is true that a brain biopsy is one certain diagnostic method, following the published NINDS-ADRDA diagnostic criteria yields a very acceptable diagnostic accuracy rate of about 90%-95%. Nonetheless, the presence of a lab test with high accuracy would increase physician comfort with the diagnostic process and hopefully lead to a more proactive attitude toward early intervention.

My second reaction is rooted in 20 years of experience commercializing health care technologies. The discovery of a scientific means to diagnose a given condition is a very early step on the long and often arduous path to making a product available. This scientific advance is absolutely positive but the practical implications of the discovery are many years away from helping real patients.

Does Surgery Cause Memory Loss?

Contributed by: Dennis Fortier, President, Medical Care Corporation

Sometimes there are contradictions between anecdotal evidence and scientific evidence. Even when the two are aligned, there is often a disconnect between the published evidence and the way it is reported in the lay press. Such is the case with the seeming correlation between surgery and memory loss.

A recently published study in Anesthesiology, did not contradict the widespread sense that memory loss is a common consequence of surgery but some of the press coverage indicated that it did. As you can see, the story to which this posting is linked opens with the statement that researchers found "no post-surgical issues in older patients". However, it is clear in the publication (and even from the rest of the story) that there were indeed two areas of concern.

First, in patients who did not recover well physically from the surgical procedure, lingering cognitive issues were indeed present. That is essentially a confirmation of the link between surgery and cognitive impairment.

Second, even among those patients who had complete physical recoveries, cognition was not always fully restored until a period of six months to a year later. To suggest that anything short of a permanent disability should be ignored is not really a defensible approach to reporting this science.

Both of these findings are perfectly consistent with the anecdotal belief that cognition is sometimes impaired following a surgical procedure. It is unclear why the author of this article chose to open with a contradictory position but should serve as a reminder to readers that scientific research must be carefully interpreted and many journalists do not exercise care when reporting on new findings.

Is Western Medicine Clueless about AD?

Contributed by: Dennis Fortier, President, Medical Care Corporation

It is not always the most important stories that get the most press. Often times, a provocative title or a contrary view can drive news circulation to impressive heights. A story published this week by Natural News has had a lot of online coverage and I wanted to comment on it here.

The title of the story, "New Research Proves Western Medicine is Clueless about Alzheimer's Disease", is indeed provocative. However, despite the sensationalistic slant, this is really not news. Practically every published story includes the comments that the disease is poorly understood and no cure is available. I think both of those comments communicate that scientists the world over, not only those in the "west", have not yet figured out this complex disease.

If taken literally, the term "clueless" really distorts the truth. I contend that the research community has learned much about the disease in the past twenty years. For example:
  • They understand that there is a pretty clear distinction between the early-onset form of AD and the more common late-onset form.
  • They have identified some twenty risk factors that increase likelihood for AD and other forms of dementia.
  • They have gained much insight into possible genetic factors that may drive disease progression in individuals with certain genetic profiles.
  • They have developed treatments that operate on at least two distinct mechanisms (cholinesterase inhibition and glutamate blocking) that improve symptoms in most patients and slow disease progression in some.
  • They have developed a host of additional treatments, operating on novel mechanisms, that are currently progressing through the FDA pipeline.
  • They have developed multiple bio-markers for diagnosing the disease with increasing certainty.
While we have a long way to go and everyone recognizes as much, it seems to me that this particular article was probably written to attract attention and not to inform the public in a meaningful way.

When will we get a cure for Alzheimer's Disease?

Contributed by: Dennis Fortier, President, Medical Care Corporation

There is no definitive answer to this ubiquitous question. The best we can do is to watch the advance of science through the published literature and to follow the clinical trials from which the answer will one day emerge.

While the pathology of Alzheimer's disease is still not well understood, scientists have developed a host of well-grounded theories. Several treatment agents, based on those theoretical foundations, are currently in development or in clinical trial.

Here is an excellent summary of the leading treatment hypotheses as well as the development status of the most promising treatment agents. Some of the information is a bit technical but I think the lay person can read this and get a good sense of the time frame for a meaningful advance. It should be clear that no cure is imminent but equally clear that several treatment agents are in advanced stages of clinical trial.

Predicting the results of these trials is hampered by our vague understanding of what causes Alzheimer's Disease. On the bright side, one or another of these agents may be surprisingly effective in altering the disease course and could be available in less than five years. On the dark side, they may all turn out to be ineffective in which case we would be more than five years away from a meaningful new medication. Only time will tell.

In the meantime, we all need to be proactive in identifying and managing our risk factors for cognitive decline (the topic of an upcoming blog) and physicians must be vigilant about acting on evidence or suspicion of decline among their patients. Until better treatments are discovered, we must intervene as early as possible with the current medications to maximally delay the progression of Alzheimer's disease.

7 Facts about Stroke and Cognitive Impairment

Contributed by: Dennis Fortier, President, Medical Care Corporation

A good source of information about risks for dementia is The site is sponsored by Medical Care Corporation but, like this blog, it is non-commercial and seeks only to educate. This content about stroke was a popular article from a past issue of Ounce of Prevention, the newsletter associated with that site.

Stroke is the third leading cause of death, behind heart disease and cancer. Each year, about 700,000 people suffer a stroke. Stroke can be a cause of dementia and cognitive impairment.

The following are 7 interesting facts about stroke and cognitive impairment.

1. Stroke is the second most common cause of cognitive impairment and dementia.

2. A thimble full of damaged brain due to stroke can cause dementia.

3. Stroke begins after age 50 and can gradually build up in the brain for decades. This gradual accumulation of tiny strokes progressively interferes with the brain’s function until the individual end’s up demented.

4. The risk of developing cognitive impairment is highest in those persons with vascular risk factors, including hypertension, hyperlipidemia, atherosclerotic vessel disease affecting the aorta, carotid, vertebrobasilar, or major cerebral arteries, homocysteinemia, diabetes, heart disease, hypotension, obesity, physical exercise less than two days per week and 30 minutes per session, smoking, alcohol dependence, coagulopathies, and prior stroke.

5. The most common types of cognitive deficits arising from stroke are disturbances of attention, language syntax, delayed recall and executive dysfunction affecting the ability to analyze, interpret, plan, organize, and execute complex information.

6. The risk of vascular cognitive impairment and dementia as well as the rate of cognitive decline in cerebrovascular disease is highly dependent upon the control of the underlying risk factors for stroke.

7. If left untreated, vascular cognitive impairment and dementia worsen. Annual screening for cognitive impairment in attention, memory and executive function starting at age 50 years old will help detect gradually accumulating cerebrovascular disease that may otherwise typically be undetected for many years.

Depression and Memory Loss

Contributed by: Michael Rafii, M.D., Ph.D - Director of the Memory Disorders Clinic at the University of California, San Diego.

Studies show that prolonged stress leads to elevated levels of cortisol, a "stress" hormone produced by the adrenal glands. This in turn appears to shrink or atrophy the hippocampus, the sea-horse shaped part of the brain associated with many kinds of memory and learning. The hippocampus is a part of the brain that is particularly vulnerable to stress and stress hormones.

While cortisol levels normally fluctuate over the course of a day and night, they often soar when a person is faced with a stressful situation. Many studies have shown that this affects short term memory. For example, researchers have shown that people taking cortisone pills (which metabolize to cortisol in the body) were not as good at remembering a list of words as people taking placebo pills.

For many people, depression appears to cause similar damage; their cortisol levels remain slightly elevated as long as they are depressed. This moderate, but constant elevated cortisol appears to wear down the hippocampus--and lead to memory difficulties.

More studies are needed to fully understand the molecular connection between stress, depression and memory, and perhaps better treatments.

Can Alzheimer's be Prevented?

Contributed by: Dennis Fortier, President, Medical Care Corporation

Recently I noticed an article published in Scientific American that succinctly summarized the current state of treatment and our march toward a cure for Alzheimer's disease.

For those of you who would appreciate a slightly more comprehensive overview of our current knowledge about AD, I recommend this recently updated report from the National Institute on Aging. It concisely describes the scientific landscape in terms of the pathology of AD, risk factors (including how to manage them), and treatment strategies (both current and in the pipeline).

The title of the report is Can Alzheimer's be Prevented? There is growing evidence for the case that, for may of us, it can probably be delayed until we are likely to die from some other malady. We call this concept "Prevention through Delay".

One day we will have a cure but for now, prevention through delay offers a realistic approach to reducing the tragic impact of this poorly understood disease.

Clear Summary on the Many Links Between Diabetes, Alzheimer's, and Dementia

Contributed by: Dennis Fortier, President, Medical Care Corporation

This article about the links between Diabetes, Alzheimer's disease, and dementia, published by Huffington Post, has been well publicized over the past week or so. I think the publicity is well deserved and I want to summarize some if its highlights for my readers.

First of all, the article describes Diabetes in a clear and simple manner: an inability to control levels of sugar in the blood. You can get more complex and drill down on diffenerences between Type I (body doesn't make insulin) and Type II (body doesn't respond to insulin) but it can be grasped quite usefully in its simplest defined form.

What I found so valuable in the article was the clarity with which it established the path by which diabetes increases risk for both Alzheimer's and dementia. This passage is particularly noteworthy:

The most obvious reason that Diabetes increases the risk of Alzheimer's Dementia is because it increases the incidence of heart disease; high blood pressure; high levels of fat in the form of triglycerides in the blood; decreases in the levels of the good cholesterol, HDL; and increases in levels of the bad cholesterol, LDL. All of these factors are individually known to increase the risk of Alzheimer's Dementia. These conditions also increase the risk of stroke and other forms of damage to blood vessels in the brain, which thus increases the risk of vascular dementia.
Additionally, the article goes on to describe several direct roles of insulin in a healthy and normally functioning brain. If the body, for whatever reason, is either not producing or not responding to insulin, many neurological processes may also become disrupted and cognition can be impaired.

While the relationship between Diabetes and Alzheimer's is often mentioned in the press, rarely is it so cogently described.

More Evidence that Beta Amyloid May Not Be Not All Bad

Contributed by: Dennis Fortier, President, Medical Care Corporation

I recently wrote here about research published in the online Journal of Alzheimer's Disease suggesting that beta amyloid, widely considered a key culprit in Alzheimer's pathology, might play a key role in learning. This alludes to a more complex relationship between beta amyloid and overall brain health compared to the more simplistic view that this particular molecule is always bad.

Now, a new study out of Tel Aviv University's Department of Physiology and Pharmacology, and published in Nature Neuroscience, has offered the first biological explanation of how beta amyloid might aid learning. The research, performed in vitro on mouse brains, demonstrated that beta amyloid helps regulate synaptic function. The results support the earlier hypothesis that there is an optimal level of beta amyloid as opposed to the original thinking that "less is better".

If these results are confirmed and further found to hold true in human brains, it could greatly alter current drug development activities, many of which are pursuing strategies to prevent the production of beta amyloid or to eliminate it from the brain.

Validity of a "Home Alzheimer's Test"

Contributed by: Dennis Fortier, President, Medical Care Corporation

One type of Alzheimer's news stories that I see on a recurring basis is that a test of some sort has been developed to diagnose the disease easily and accurately. Usually these stories take one of two forms.

The first form of these stories are those about "basic science" which means pure, theoretical science that has not yet embarked (and may never embark) on the long and arduous path to commercialization. Often times however, the stories are written in a manner that suggests the scientific endeavor has been successfully concluded and that doctors are now ready to improve care using a new advance in medical knowledge. Sadly, that is almost never the case. The chasm between a scientific discovery and an applicable clinical product is both wide and difficult to cross but stories in the popular press usually convey the opposite.

The other form of these stories is to take an existing technology and tout it with claims that are misleading or unrealistic. An example of this was recently noted in an article on Live Science where several "questionable screening tests" were discussed. One example is the Alzheimer's Smell test that has been marketed for some time as a do-it-yourself approach to identifying the disease. While the test is not regarded as valid in the scientific community, consumer marketing messages imply otherwise.

It is difficult to to understand the evolving landscape of technologies for identifying and treating Alzheimer's disease without access to the scientists performing the research and without a solid understanding of how these technologies might pass through a regulatory process on the way to becoming part of a clinical solution. The purpose of this blog is to help readers gain a more accurate perspective on the daily news and what it means in terms of real progress in this area.