Good Sleep is Vital for a Healthy Brain

Contributed by: Dennis Fortier, President, Medical Care Corporation

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We know this intuitively. We feel foggy when sleep deprived, and mentally sharper when well-rested.  Understanding why this is true raises three very important possibilities.

New Findings
Research out of the University of Rochester Medical Center (URMC) sheds light on an important brain cleansing process that occurs during sleep in the brains of mice, and presumably, in human brains as well. The study, published in the online version of Science, describes a cleansing process that becomes very active during sleep.

It appears that a process, whereby brain cells contract to create more space between them and cerebrospinal fluid flows through the spaces to remove proteins, is ten times more active during sleep than during wakefulness. From this, we suggest the following three possible conclusions:

1. Caffeine is Not a Substitute for Good Sleep
This research suggests that the mental fog of sleep deprivation may be partially caused by an excess of proteins in the brain. If so, these proteins may be, in some way, interfering with optimal communication between brain cells. While a jolt of caffeine may increase the intensity of signals between brain cells and allow for improved mental acuity, it won't solve the problem of excess proteins that may be gumming up the communication process. In this regard, sleep trumps coffee.

2. Excess Proteins in the Brain may cause Irreversible Damage
As readers of this blog know, a leading theory about the cause of Alzheimer's disease is the accumulation of beta-amyloid proteins in the brain. Given that the brain seems to actively flush proteins during sleep, including beta-amyloid proteins, it is plausible that sustained periods of sleep deprivation could increase the risk of Alzheimer's disease.

3. Sleep Disorders may be Especially Dangerous
If the brain engages in important processes of maintenance and repair during sleep, and these processes prevent long-term progression toward neurodegenerative diseases, then sleep may me even more important to our health than we previously suspected. If you snore, or wake often in the night, speak to your physician about a sleep study.

Can B-12 Vitamins Prevent Memory Loss?

Contributed by: Dennis Fortier, President, Medical Care Corporation

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Can B-12 vitamines prevent memory loss?  As with so many questions, the answer to this one is "it depends".

Remember, there are many causes of memory loss, including depression, anxiety, diabetes, medications, thyroid disorders, head injuries, strokes, Alzheimer's disease, Parkinson's disease, tumors, sleep disorders, and drug use, just to name the most common. Vitamin deficiency is also on the list of common causes, especially for older adults who become less proficient at absorbing B vitamins from the foods they eat.

According to a recent study conducted at Rush University Medical Center and published in Neurology, research subjects who had markers for vitamin B deficiency, such as brain shrinkage and high homocysteine levels, also performed worse on cognitive tests compared to subjects without vitamin B deficiency.  These findings are consistent with other studies linking vitamin B deficiency to poor cognition.

So, it would be a stretch to conclude that taking a B-12 supplement will protect a person from all causes of memory loss or cognitive decline.  However, the evidence suggesting that proper intake of B-12 is important to ongoing brain health is quite strong.  In that regard, think about including fish, meat, poultry, eggs, milk, and cheese in your diet as good sources of B vitamins.

New Guidelines for Alzheimer's Disease are a Step in the Right Direction

Contributed by: Dennis Fortier, President, Medical Care Corporation

The announcement of new guidelines for diagnosing Alzheimer's disease is being widely covered in the press today.  The move is a solid step in the right direction, but is spawning some confusion about why the change is necessary, and how it might help.

Biggest Change: AD starts prior to Dementia
The most important change is that we will now recognize Alzheimer's disease in its early stages, prior to the patient suffering massive brain damage and becoming demented.  This is a more difficult diagnosis to make and, as such, requires a thoughtful approach.

I wrote more extensively about the benefits, and the ensuing confusion about new diagnostic guidelines for Alzheimer's disease, when the draft versions of these documents were first discussed in the summer of 2010.   I encourage you to click back and read those thoughts, but the short summary is below.

Perspective on Former Guidelines
According to the former guidelines, put in place nearly 30 years ago, Alzheimer's disease was defined in part by the presence of dementia.  As readers of this blog know, dementia requires impairment so severe that a person cannot independently care for themselves.  In this regard, the term "mild Alzheimer's" means "barely demented due to Alzheimer's pathology"'  This is a misnomer because, even in its "mild" stages, dementia is a severe condition.

To put that in perspective, imagine if we could note the high blood sugar and blurry vision caused by diabetes, but we couldn't diagnose and treat it until the patient's kidneys failed.  Any guideline, suggesting that symptoms must be severe before diagnosis, is in direct conflict with early intervention.

The former guidelines were problematic as illustrated by this example:  Suppose a 75 year old person, with a family history of Alzheimer's, noticed subtle signs of memory loss and visited a physician.  The physician then confirmed the declining memory and sought the cause of the problem.  After ruling out depression, sleep disorders, medications, thyroid malfunction, poorly controlled diabetes, vitamin deficiency, and stroke as possible causes, he noted on an MRI scan of the brain that the patient's hippocampus was shrinking.  This would be a strong indication of Alzheimer's disease.

However, since the patient in this example had only subtle memory loss, not severe cognitive impairment meeting the criteria for dementia, the physician could not diagnose Alzheimer's and initiate treatment.  According to the old guidelines, the physician would let the Alzheimer's pathology progress for months or years, until the patient suffered enough irreversible brain damage to become demented, and then they could diagnose Alzheimer's and initiate treatment.  That clearly makes no sense.

New Guidelines
Under the new guidelines, if a patient has memory loss or other cognitive deficits, and common causes of such deficits are ruled out, and pathology is consistent with Alzheimer's, then we should recognize the condition as early stage Alzheimer's disease and begin treating it.  This holds even if the patient's cognitive problem is subtle and does not meet the criteria for dementia.

Since earlier intervention bodes well for better treatment outcomes, this is a solid step in the right direction.

Worried About Your Memory? Maybe You Just Need to Sleep Better

Contributed by: Dennis Fortier, President, Medical Care Corporation
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We say it over and over; many common conditions cause memory loss.

Some minor forgetfulness, like inability to recall a particular word or entering a room and forgetting why, is pretty common, even in healthy people over the age of forty.  However,  more severe symptoms may indicate the presence of an underlying medical condition.  Among the many known causes of memory loss, all can be treated with some degree of success, and most can be completely cured.

While we often mention depression, medications, and thyroid disorders among the very treatable causes of memory loss, sleep disorders should also be on that list of common and treatable conditions.  A great article about this very topic was posted today on CNN's health blog, the Chart.

Sleep apnea, or interrupted sleep due to lapses in breathing, is fairly common, especially in middle-aged and older men. It can be diagnosed with high certainty in a sleep study, and generally treated with good results.  If untreated, sleep patterns can severely degrade, and chronic sleep deprivation can significantly impair alertness and cognitive function.

Given the prevalence of sleep apnea and other sleeping disorders, many worrisome signs of memory loss may be attributable to these treatable conditions.   Please keep this in mind if you are worried, or know someone who is worried about their memory, and may not be sleeping well.