As we age, a healthy brain ensures independence, the ability to look after ourselves, have hobbies, live on our own, and use transportation without help. Being "of sound mind" gives us the ability to stay in our homes longer without the need for constant supervision. Not only is having a well-functioning brain a matter of maintaining independence, but there's also a financial aspect. Having round-the-clock care for an entirely dependent person with cognitive impairment is expensive, with estimates being over $100,000 a year for a "semi-private" room in a nursing facility (1). It literally pays off to have sharp mental faculties.
What if preparation for the decades of "retirement years" included nurturing and fostering cognitive abilities, mental clarity, and memory? What kinds of activities would boost those abilities? Early and prolonged care of the brain can significantly protect mental functions, providing a buffer against cognitive decline or dementia, and even Alzheimer's Disease. How is brain health evaluated in a healthcare setting? What simple things can the average person do to nurture and protect the brain?
The Brain - A Quick Review
The human brain is wired to facilitate voluntary movement, speech, and other actions. The processing of input from eyes, ears, nose, skin, and thousands of sensors inside and on the body's surface is categorized, compared, and analyzed at levels both conscious and below consciousness, all signals passing through the brain at some point. The brain processes sensory inputs and coordinates reactions simultaneously, thousands of times per second. Some instruments, such as the WAVi scans, can measure these processes.
When the brain functions optimally, it effortlessly conducts the symphony of actions and reactions. Memory, a cognitive function that is vital to a healthy life, includes being able to recall events from 20 minutes ago or 20 years ago. Memory is crucial to learning, building upon itself into a body of knowledge that is drawn upon for understanding, interpreting, and navigating the world around us. A well-functioning brain with a capable memory enables us to think, have sustained concentration, and create.
What's Normal Brain Function? Signs of a Healthy Brain
There's too much incoming information for everything to be worthy of remembering or thinking about, so the brain prioritizes it. This means that losing your keys or wallet every once in a while is okay. The human brain is not designed to pay attention to everything in the environment! What the brain prioritizes has been studied for decades and remains a fertile field of scientific inquiry. If focusing on basics, a healthy brain can (2):
Remember important information
Comfortably navigate a frequently visited place
Follow written steps or interpret graphic information (e.g., recipes, maps)
Distinguish between peoples' faces, particular instances of time, and different locations with ease
Engage in self-care (bathe, feed oneself, protect the body)
Beyond these basics, a highly functioning brain yields the ability to (3):
Solve complex problems
Control emotions and strong impulses
Focus attention at will
Plan for a desired outcome
Predict outcomes of actions
Where the Problem Begins - Red Flags for Brain Health
Defining what is "normal" has always been a problem because nature produces a stunning array of diversity. However, most researchers and healthcare practitioners can agree that when a person is no longer capable of self-care or has behavior that presents a danger to themselves or others, there is a problem. There are many ways to frame this, but perhaps three broad categories form the most significant red flags for brain health: executive function disorder (EFD), mild cognitive impairment (MCI), and dementia.
Executive Function Disorder (EFD) - This term is often used for describing younger patients, but it can also be applied to older patients. As compared to their age group, individuals who exhibit EFD have difficulties (3):
Planning tasks and following through with those plans
Organizing and retaining information and items
Staying motivated (long enough to complete tasks)
Controlling emotions, impulses, or focusing attention
Mild Cognitive Impairment (MCI) - This category satisfies the stage between "normal" aging of the brain and the extreme manifestation of dementia. Signs of MCI include some of the same symptoms as dementia but in a milder form (4):
Forgetting what you're talking about, losing train of thought, or having problems understanding a conversation that bounces between multiple people
Difficulty making decisions, finishing tasks, following instructions
Suddenly feeling lost in places that were previously very familiar
Making poor decisions; loss of judgment capabilities
Mood changes (anxiety, depression, anger/aggression, disinterest)
Dementia - This category involves a group of symptoms that harm memory, the thought process, and the ability to navigate in society (5). Symptoms in this category are severe and negatively affect daily life. There are many potential causes for dementia. Depending on the root cause, it may be reversible. Note that Alzheimer's Disease is a severe form of dementia. Typical symptoms of dementia are the same as for MCI listed above but are more severe (5).
In addition, dementia sometimes creates psychological changes, including paranoia, suspicion, and agitation. There may be a more pronounced inability to communicate effectively, or perhaps recent memory seems to be missing while older memories remain intact. Persons experiencing dementia may hide their purses, wallets, or jewelry for fear of their valuables being stolen but then be unable to recall they hid them.
Genes Do Not Entirely Define Brain Health
In addition to inherited genes, many lifestyle factors such as diet and exercise influence brain health. Having MTHFR genetic mutations (6) and the ApoE 4 genetic type can increase the odds of incurring dementia (7). For example, people who have two copies of the ApoE 4 gene, estimated to be about 2-5% of the population, certainly have an increased risk of having Alzheimer's dementia, but this is not always predictive (7).
In other words, you may have genes that increase the risk of dementia, but that doesn't automatically mean you will get it! Many factors feed into cognitive decline; not everyone genetically coded for it will actually experience it. Knowing this makes it even more important to focus on what you can control, for example, the five pillars of health which include diet and lifestyle factors. We might suggest gene testing for some patients. However, since TCIM believes so strongly in building resilient health, we recommend mastering the fundamental five pillars of health because it will help all situations, even an unfavorable genetic type.
Tips for Improving Cognitive Performance:
It's not the rare piece of birthday cake that causes the problem. Rather, it is the daily habits that can either build health or actively work against your health. The more healthy habits you can perform daily, the better off you will be. Consistency is key.
1. Master the five pillars of health - As mentioned above, mastering the five pillars of health will go a long way towards building a strong body and brain. The longer and more consistently the five pillars of health are practiced, the more resilient to stress and disease the body will become. Consistency is critical, similar to how brushing one's teeth twice daily builds dental health.
2. Adopt a whole food, Mediterranean-based diet - The Mediterranean Diet is always a good bet for brain health, emphasizing fresh vegetables, whole grains, and lean meats. Here is an excellent example of how to implement a Mediterranean diet. Going one step further to address cognitive decline is the Mediterranean-Dash Intervention for Neurodegenerative Delay (MIND) diet. The MIND diet focuses on foods that help heal tissues (rather than inflame) and keep the blood thin to flow properly. High in anti-inflammatory nutrients such as Omega 3s (fish) and the tissue-healing pigments in berries, the MIND diet has been shown to slow the rate of cognitive decline (8).
3. Address nutrient deficiencies - Nutrition testing and evaluation of the diet can identify nutrient deficiencies so they can be addressed through proper supplementation. Supplementation with coconut oil, which contains medium-chain triglycerides (MCT), may be advised to combat dementia symptoms (9-10).
4. Address toxicity - Detoxification of the liver through manipulating diet and adding supplements can help reduce the toxic burden on the body, clearing brain fog and potentially improving memory. Detoxifying the liver two or three times a year is highly recommended (9, 10).
5. Incorporate Activity Involving the Brain & the Body
Any activity that increases heart rate and causes sweating will improve cognition by increasing circulation and the excretion of toxins through the sweat. However, it is important to activate both the brain and the body.
HIIT Walking - High-Intensity Interval Training (HIIT) involves alternating high effort followed by low effort in cycles, which helps condition the heart, increase metabolism, burn fat, and increase circulation to the brain. HIIT walking would involve walking fast for 30 seconds followed by 90 seconds of walking slowly or standing still, then repeating this cycle up to eight times. Many people may do this while walking their dog without thinking about it!
Contralateral movement - Exercises that move opposite sides of the body at the same force the different sides of the brain to work simultaneously. Swimming is a natural way to stimulate the brain with contralateral movement. Contralateral "supermans" are another excellent and easy-to-perform exercise.
Meditation - Meditation is an exercise for the mind! Even 10 minutes of meditation a day improves the ability to focus and reduce stress. There are many easy guided meditations online. Meditation allows one to experience stillness by quieting the mind and emptying it of thoughts. Meditation trains the mind to generate fewer and fewer distractions, increasing the ability to focus attention when needed later on.
Make your brain work - Activities such as puzzles, word puzzles, memory games, reading, painting, coloring, and playing musical instruments are fantastic ways to exercise the brain! They engage the brain in ways that strengthen it and expand its internal connections.
Socialize - Interacting with other humans is essential! Work on deepening the relationships around you and forming new relationships. Activity within groups gives a sense of belonging, which we all need for mental and emotional health. Find a group that really lifts your spirits and meet with them regularly.
Double Up: Activities that Do Double Duty - Many activities combine multiple things that help foster brain health. For example:
Adopt a dog and walk it daily - Walking a dog forces you to exercise, plus you meet people when you walk a dog. The dog's presence helps combat loneliness but also gets you out of your house so you can meet new people. Create a neighborhood dog-walking schedule where several people simultaneously walk their dogs. This strategy provides protection and is a built-in conversation starter!
Join a dance or exercise class - It's best to attend a dance or exercise class in person. However, if you must stay in your house, many online options exist. If you need help with how to do that, ask someone to help you set it up at home so you can participate online through a laptop or cell phone. Invite neighbors over for an "exercise video," even if it's just something you can watch online together.
Take a class to learn a new craft or skill - Taking a cooking class for healthy eating not only teaches you how to prepare healthy food, but you also exercise the brain by learning something new, and you get a chance to socialize! There are many different crafts and skills, and it is great to think outside the box. For example, drum circles are another fantastic way to socialize, exercise the heart, arms, and lungs, and learn a musical instrument.
Start a card or game night - Don't wait for someone else! Be the life of the party by starting a game night at your house several times a month. Invite your neighbors. Playing cards or board games exercises the brain and provides a way to socialize regularly.
Testing Cognitive Performance
There are plenty of cognitive tests around where a patient has to identify animals or try to remember a list of objects five minutes after hearing it only once. However, an excellent new technology is WAVi, a non-invasive, FDA-cleared headset and software combination that tracks tiny changes in the state of the brain. The patient wears a headset that measures the brain's electrical activity through electroencephalography (EEG), the brain's reactions to sound and visual cues through evoked response potentials (ERPs), and even picks up the peaks and valleys of heart rate activity called heart rate variability (HRV).
The power of a WAVi scan is that it picks up tiny changes in brain activity that can signal a potential issue with brain processing speed. The many results from the scan can be analyzed for patterns that can give early warning signals about the brain, the cardiovascular system, and the autonomic nervous system.
WAVi has been through extensive peer reviewed research as a device for measuring activity of the brain, risks in regard to the vascular system, post-concussion recovery, and brain function following a wide variety of therapies (11). As a result of the reliable performance of this device, it is becoming a highly sought-after tool even beyond the research industry.
The Importance of a Baseline Scan
Since WAVi scans can pick up very small changes in brain activity, it's important to get a baseline. The baseline is the set of results from a scan done before cognitive decline noticeably occurs. This healthy baseline is then used as a comparison over the years, to see if brain functioning is improving or declining.
Getting a baseline WAVi is highly recommended in cases where family history indicates a tendency for cognitive decline, but that's not the only case where this technology is beneficial. For those who actively try to improve brain functioning, getting a baseline and then taking scans every 6 months to a year can provide exceptional insights into how well a particular therapy is working.
Other WAVi Benefits - ANS & HRV Information
WAVi testing provides a way to measure brain function, but also gives very good information about the vascular system and the autonomic nervous system (ANS). The ANS, if you recall, is the system of automatic responses of rest and digestion (parasympathetic) and fight or flight (sympathetic). The WAVi results can clearly show if someone's system is "stuck" in fight or flight mode, which keeps the system in a high state of alert, resulting in racing thoughts, feelings of anxiety, and the inability to digest food properly.
In regards to the vascular system, WAVi scans give useful information about heart rate variability (HRV). HRV is the difference between peaks and valleys of heart beat activity. This gives an indication of the health of arteries, veins, and capillaries that supply blood to the brain, muscles, and tissues of the body. In those with cardiovascular conditions or who are high risk for cardiovascular issues, this information can be a much-appreciated addition for fine-tuning treatment.
At TCIM, we often use technology such as WAVi during our two-step Executive Physicals to spot potential cognitive issues early. Early detection ensures enough time to take preventive measures to reduce or even reverse cognitive decline through the five pillars of health, targeted nutrition, medications, or whatever else is necessary. If you are concerned about your brain health and would like to experience the eye-opening results of the WAVi scan, express your interest in the WAVi scan when scheduling your two-appointment Executive Physical.
Jonathan Vellinga, MD is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.
Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.
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