Brain health and indeed the human brain is now securely positioned on the radar screen of the American psyche.
The belief that a proactive approach can help to reduce the risk of brain disease is the core principle of the brain health movement. While the focus of this book and my career is brain health, there remains a need to understand the consequences of brain disease. It is from this understanding of the devastation caused by brain disease that a strong energy to learn about and implement brain health emerges, not out of fear, but out of a motivation to build and preserve access to our own life story.
When thinking about brain health, we often think about brain disease. This makes sense, as disease in general has traditionally been the focus of our medical training and approach to health care. “Brain disease” refers to an array of conditions that negatively affect the function of the brain. Examples range from progressive neurodegenerative diseases, such as Alzheimer’s, Parkinson’s, and Lewy body dementia, to mental illnesses, such as depression, anxiety, bipolar disorder, schizophrenia, pervasive developmental disorders, and substance abuse, to trauma, such as closed head injury. Each of these conditions, and hundreds of others, impacts the structure and function of the brain, resulting in cognitive, emotional, and functional decline for the person. Such conditions and diseases also result in significant disruption of the family system and place a tremendous emotional and practical toll on the caregiver. Because the brain is so complex and we know so little about it, our interventions are symptom-based, not curative. When considering the brain, we tend to rely on the medical approach to the human brain that overly emphasizes disease, but we should strive to take on another perspective with an eye toward brain health, development, and growth rather than relying on reactive, quick, and invasive procedures only. Brain health is proactive and lifelong, with nothing quick about it. It’s a lifestyle.
For many years we have believed that the brain is a fixed and rigid entity that has a limited window of opportunity to develop, the “critical period of brain development.” Traditional thinking taught us that this critical period occurred early in life and new skill development could not happen beyond that time. Similarly, the ideas that brain disease is inevitable with advanced age and that once the brain is damaged it cannot be treated or healed were generally accepted. With our new understanding of the human brain, we have begun to challenge these ideas, and the new concept of brain health maintains that a proactive approach can be implemented at the earliest period of life and followed across the entire life span. Brain health further maintains the belief that we can shape our brains for health by exposing ourselves to a specific type of environment and by engaging in specific activities as often as possible.
Dementia is a clinical condition characterized by decline in overall intelligence relative to premorbid intellect, memory loss, personality change, and functional loss. There are nearly one hundred causes of dementia, and 95 percent of the causes of dementia are irreversible. Examples of the causes of dementia include Alzheimer’s, Parkinson’s, substance abuse, tumor, head injury, multiple strokes, and Lewy body. Most, though not all, types of dementia manifest in later life beyond age sixty-five. Examples of reversible causes of dementia include thyroid disorder, vitamin deficiency such as B12 deficiency, and depression.
Alzheimer’s disease is a progressive neurodegenerative disorder, the number one cause of dementia in the United States, accounting for 50 to 70 percent of all dementias, and is often used as the model of brain disease. The disease strikes specific regions of the brain and manifests in a predictable pattern of forgetfulness, loss of appreciation of space, personality change, and other deficits in thinking and function.
As a progressive disease, the course of Alzheimer’s lasts on average ten or more years and cannot be reversed. Unfortunately, this horrific disease is the leading cause of dementia in the United States, presently affecting nearly five million persons, and is a major cause of dementia internationally. The number of Alzheimer’s cases in the United States will increase to a staggering fifteen million or more by the middle of this century. Indeed, the United States presently spends over one hundred billion dollars annually on direct care of Alzheimer’s, and corporate America loses over thirty billion dollars annually, as the employees, who are also caregivers of parents or loved ones with Alzheimer’s or dementia, miss work and develop physical and mental illness themselves.
Alzheimer’s disease is a deeply personal catastrophe that robs a family of their personal connection. For me, the ultimate question is, what is the dollar amount for the fact that somebody’s father or grandmother has not been able to communicate with his or her grandchild during the past decade?
The essence of this question drives the motivation for my work in the area of brain health. There can be no greater loss than the inability to connect with one’s own identity and further connect with the loved ones in our lives. It is the precise reality of the husband who entered my office so many years ago in a deep depression because he could no longer connect with his wife, who was suffering from dementia, and wanted her back with him.
Alzheimer’s and other brain diseases are a fact of life and an unfortunate reality for too many families. Brain disease, like brain health, does not discriminate; it unites us in a common cause regardless of background. Our energy and resources are committed to finding cures for these diseases, but our incomplete understanding of the human brain most likely means a cure for dementia is not near. However, we can and should consider the behaviors and activities that relate to brain health as a viable and necessary path to follow now to forestall or reduce the risk of brain disease.
Brain dysfunction and disease can be caused in many ways. We have discussed dementia as a description of predominantly progressive forms of brain dysfunction. However, there are many other etiologies for brain dysfunction that may not be irreversible. In human brain function, so many processes need to be in balance or atypical or abnormal thinking and behavior can result. As a clinician, I have seen cognitive or thinking problems result from high and low blood pressure, urinary tract infection, medication side effect, lack of sleep, too much coffee or other stimulant, anxiety, stress, hormonal imbalance, and sugar imbalance. These and other everyday occurrences can affect a person’s thinking and mood regardless of age.
It is quite common for a person in his or her fifties to begin noticing problems with memory or an inability to find an appropriate word or name as easily as in the past. For some, this may be alarming and suggest onset of a disease such as Alzheimer’s. Indeed, I am often asked if I believe this represents Alzheimer’s. In most cases, such slips of the tongue, temporary forgetfulness, or misplacement of objects are not disease-based. Rather, these cognitive hiccups most likely reflect stress caused by trying to do too much all at once, hormonal changes that occur naturally around the fifties, and perhaps mood fluctuations related to changes in life circumstances. But to remove any question or doubt about the severity of the problem, I recommend doing a neuropsychological assessment at any respected academic medical center.
You can always have an annual neuropsychological examination beginning in the middle fifties to monitor your memory and other cognitive functions, but dementia is quite rare at this age. The diagnosis that one does not have a degenerative dementia is good news, but it does not help with the fact that memory problems can still be frustrating. It is important to speak to your doctor about change-of-life issues, as hormonal imbalance is real, and it can cause both mood and memory problems. And it is not only those in their mid-forties and fifties who understand the power of hormonal changes. Teenage brains are notorious for distractibility, inattention, impulsivity, and downright “goofiness.” Hormonal changes are a fact of the teenage brain and underlie the behavioral and cognitive changes that also can be seen at this time of life.
You can also take a personal assessment of your stress level and be honest with the idea that you may be doing too much and going too fast. Stress increases hormonal activity that can be damaging to the structural and functional capacity of the brain, particularly if the stress is severe and sustained. Animal studies demonstrate that chronic stress and overstimulation cause brain dysfunction and structural changes in the hippocampus (see Chapter 2), the part of the brain critical to new learning. On a more moderate level, stress can cause depression and anxiety, both of which alter our neurochemistry and can interfere with information processing. You should also take note of how much sleep you are getting a night. Brain functions can be affected by your sleeping patterns. Without deep sleep and dream sleep, otherwise known as REM (rapid eye movement) sleep, the brain will not process information efficiently. Increased stress and reduced rest can certainly result in cognitive mistakes, forgetfulness, mood disorder, and frustration.
Changes occur to all parts of our body as we get older, and the brain is certainly not excluded from this reality. The main message of this book is to know about your brain and to care for it for life. Hopefully, the care begins well before age fifty-five, but no age is too late to start. Lifestyle modification can be very helpful to easing the mental lapses, dysnomia (inability to name things), and misplacement of objects. You will find that writing things down can be an effective strategy for your recall. By writing things down, we provide cues and prompts that help our brains to more easily locate the information to be retrieved. The reason is that with healthy aging, the hippocampus continues to encode information fine. Our brains simply have more difficulty retrieving information, and we therefore can benefit from cues that get us to the material our brain has already encoded. Writing things down turns a free recall task into a more simple recognition memory task.
This type of normal memory change is quite different from disease such as Alzheimer’s, which prevents the brain from encoding new information and in which cues will not provide any benefit. That is because dementia caused by Alzheimer’s erodes the hippocampus, the encoding system for the brain, while changes typical of advanced age alone do not. Indeed studies have shown that healthy seventy- and eighty-year-old persons will perform as well as thirty-year-old persons on tests of recognition memory. One cannot recognize something unless it has been encoded, which requires a healthy hippocampus.
The human brain has always been a mysterious, misunderstood, and neglected part of the human being. Study and interest in the brain has generally taken a traditional academic approach that does not permit personalization or consumption by the general public. This is a major problem for those of us who believe all humans need to understand the basics of their brain to achieve success with promoting brain health. With the advent of new, more sensitive neuroimaging technology, our understanding of the human brain has increased and changed. We now know the human brain has “plasticity,” which means it is dynamic, constantly reorganizing, and malleable—capable of being shaped structurally and functionally by the environment. This deviates from our traditional view of the human brain as a rigid and fixed system not capable of developing much beyond childhood.
It is this new thinking about the human brain that permits a new applied practice for health in both the personal and societal approach to the brain. A brain that can be shaped by environment can be shaped for health and health promotion across the life span. The key is to learn and apply those behaviors or activities that maximize brain health on a personal level. In addition, major sectors of society, including education, business, health care, religion, and nutrition, have begun to integrate our new understanding of the human brain into their particular activity for the consumer.
In order to raise awareness for brain health, grocery stores could begin labeling their products with brain icons for foods that are known to promote brain health, and the same is true for our restaurants. Schools could plan curricula on the human brain at the earliest of ages, and Head Start and baby wellness programs should be enriched with brain health information. Corporations could include brain health as part of every employee orientation and wellness program, and our nation’s prevention and wellness programs need to include brain health. It is from the personal and larger societal recognition of new brain research that a not-so-quiet revolution on brain health has emerged in the United States and internationally.
Today more of the general public is interested in the human brain, how it operates, and how it can be shaped for health. The human brain is no longer the domain of academia or medicine. Indeed, the general public has now taken some ownership of this part of their body, and there is great excitement and motivation to learn about what behaviors can help to shape a healthy brain. As the general public gets more involved in learning about the human brain, people are understanding that health of the brain is a very personal issue. This is particularly true when we consider that our brain contains our life story and that a significant concern for baby boomers is the loss of our memory (life story) as we get older. Brain health is no longer a technical or academic story. Rather, the general public has made it a highly personal priority to be integrated into daily lifestyle for health.
The human brain contains our very identity, catalog of memories, ability to communicate, and life story. A cruel reality is that brain disease can rob the brain of one’s life story and even disconnect one’s own identity and relationships with family members. It is from this personal devastation that a dedication to promotion of brain health becomes paramount. Indeed, a lifelong and proactive pursuit of brain health is critical to each person, because everyone has a life story that needs to be shared. My work and this book are dedicated to educating each person on the basics of his or her brain and to promoting a brain health lifestyle that can help maximize access to one’s life story at any age.
We are indeed undergoing a not-so-quiet revolution about the human brain and brain health. The concept of brain health is now discussed in major sectors of society, including personal development, health care, business, media, and even religion. It is quite common to see information on brain health in major news outlets, popular magazines, peer-reviewed medical journals, business periodicals, new business start-ups that apply product and educational information on brain health to the general public, retail, and even television programming. This is good news because it indicates a cultural shift in which the United States and other nations are prepared and willing to begin the process of integrating brain health into our language and, more important, into our daily health regimen.
One of the great paradoxes of our time is the fact that the human brain is the single greatest, most magnificent system ever designed in the history of the universe! Simultaneously, most Americans do not know the basics of their own brain, and they cannot be expected to take care of their brain. The same is most likely true of nearly everyone around the world. A 2006 survey of Americans on brain health sponsored by MetLife Foundation and the American Society on Aging (asaging.org) found only 3 percent identified brain health as a leading health topic. More promising, the same survey found a majority (88 percent) believe they can keep their brains fit, and nearly 90 percent believe regular checkups for their brain are important. Americans also demonstrate a decent understanding of what activities are considered good for brain health. In order for our nation and nations around the globe to be enlightened about brain health, we need to do a better job educating all citizens about the human brain, and I believe this education should begin early in life. The story of your brain needs to be a personal one!
As one example of health promotion that is personal, the United States has done a good job educating the public about the importance of cardiac, or heart, health. We decided to prioritize heart health because many of our loved ones have cardiac illness, and cardiac illness represents a primary cause of death. Interestingly, over the past decade, research indicates that while cardiac illness remains a leading cause of death, inroads have been made to slow the rate of cardiac-caused premature death.
Our culture has also adopted a great awareness and, in some sense, a fondness for the heart as a favorite organ in our body. Like the ancient Egyptians, we have a belief that our being revolves around the heart. Our language contains many statements that give the heart meaning it really does not deserve. For example, statements such as “I love you with all my heart,” “the Steelers played their hearts out,” and “you broke my heart” suggest our heart has the capacity for emotion or feelings. Indeed, the human heart is a pump that perfuses blood throughout the body. It has no capacity to feel emotions like love, have thoughts, or direct motor skills. All of the emotions and thoughts that we relate to the heart are really owned by the brain. In this regard, our brains have not been treated fairly, and I believe it is time we begin to show our brain a little love and the attention it deserves. Similar to the sense of urgency we feel about cardiac health because we lose so many of our loved ones prematurely due to heart disease, we must be vigilant to the fact that we are also losing many of our loved ones to Alzheimer’s, stroke, Parkinson’s, and other diseases of the brain.
We have persistent educational campaigns to teach the public about behaviors that promote cardiac health. Consider the relatively recent introduction of aerobic centers, exercise clubs, and television programs on exercise. Grocery stores and our nation’s restaurants have sections dedicated to heart-healthy foods. There are even icons of red hearts that identify for the consumer those foods that promote heart health. These are concrete efforts that help consumers live heart-healthy lifestyles. The message of heart health is not academic or clinical; it is personal.
We are so lucky to be alive at this period in our nation’s history. We have an unprecedented opportunity to be part of a societal shift toward brain health that will likely lead to an unleashing of human potential and a reduction in brain disease. Some of our advances may occur in the development of traditional medical interventions such as a vaccine or new medication therapy. Gene therapy and stem cell research, which uses our own stem cells to combat disease, may offer an entirely new frontier of treatment or prevention options. Another major advancement is a new national priority on the human brain that declares our desire to address the fact that we are losing many of our family members to brain disease.
The United States and other countries can foster a new and enlightened outlook on brain health by implementing life-long educational programs on the basics of the human brain. Schools can integrate basic curriculum on the human brain and brain health promotion at the earliest ages. Libraries can be reintroduced as community brain health centers, where basic education and actual implementation of brain health lifestyle programs can be offered. Preventative programs, both publicly and privately based, can adopt and help to pay for a brain health lifestyle for all of us, and brain health centers that recognize and offer research-based activities for the consumer can emerge. Our grocery stores and restaurants can begin the process of identifying for the consumer foods that have brain-health-promoting effects. New businesses and retail outlets that cater to the vitality of the human brain and our cognitive and emotional abilities will continue to emerge.
A nation that prioritizes brain health understands that a lifelong and proactive lifestyle is needed. Individuals must educate themselves about their own brain and begin to make the behavioral changes necessary to develop as healthy a brain as possible. Businesses, schools, churches, the media, and health care systems can begin to promote brain health in their own specialized ways, and our daily language will reflect a society that embraces the importance of caring for our brains. Ultimately, however, the desire for education on the basics of the human brain and desire to change behavior toward a proactive and lifelong brain health lifestyle begins with the individual.