Concerned About Brain Health, Alzheimer's or Dementia? Some Q & A with Dr. Randolph Schiffer of the Cleveland Clinic Lou Ruvo Center for Brain Health

"What looks to me now, based on the science we have, what really counts in your 40's  is to maintain a well integrated life of moderation, intellectual growth, and physical activity and you will probably reduce your risk substantially for Alzheimer's Disease."

-Dr. Randolph Schiffer, Director, Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas, NV-

If you're receiving this via email click here to get to the web version of this post and all the links.

Lucky me.  If I hadn't switched my work schedule, and decided to go to that early Monday morning yoga class I never would have had the chance to hear Dr. Randy Schiffer's NPR/WCPN interview on the Prevention of Alzheimer's Disease and Dementia.  Anything I can do to protect my brain is something I want to hear about.   Click here if you'd like to listen to the interview.

The Lou Ruvo Center for Brain Health was built as a center for the research, treatment, and prevention of brain diseases--and Schiffer is at the forefront of treating the earliest stages of dementia--what's known as Age-Associated Cognitive Impairment (AACI) and Mild Cognitive Impairment (MCI)--and preventing their escalation into Alzheimer's Disease and dementia.

So, Here You Go.  Q & A on Brain Health with Dr. Randolph Schiffer

If I Have Alzheimer's Disease in My Family History What Can I Do Now to Prevent It?

The best thing you can do is work on improving your cardiovascular risk factors

• Get regular physical exercise
• Get your blood pressure under control
• Get your cholesterol levels to a healthy number
• Get your blood glucose levels to a healthy number
• Improve your diet with lower fat, increased fruits & vegetables, increased anti-oxidants and phytonutrients

What's the connection between cardiovascular risk factors and brain health?

Cardiovascular diseases and the Alzheimer/brain diseases share similar blood vessel pathologies.  OK, Schiffer admits we lack the exact kind of science we'd like to have concerning this connection--but the science is extensive showing that risk factors like elevated blood pressure, elevated blood glucose, and elevated cholesterol are all robust predictors of cognitive impairment.  What the Ruvo Center hopes to determine is a direct correlation between lowering these risk factors and lessening dementia.

Tell me more?  What's the connection between the tiny blood vessels in the brain & Alzheimer's?

In the old days doctors said dementia was caused by "hardening of the arteries", and then that went out of fashion.  In fact, years ago, Schiffer snickered at that explanation.  He's not snickering anymore.  We now know that Alzheimer's is partly driven by the pathology of the tiny blood vessels of the brain. 

Here's what happens.  Think inflammation & oxidative stress in the brain.  In early Alzheimer's there are a number of changes in the brain that are caused by the body trying to fight off free-radical damage and oxidative stress--and this results in inflammation of the blood vessels of the brain--which leads to brain cell damage.  And the causes of this inflammation in the brain's blood vessels are the same as the causes of inflammation in the cardiovascular system.  What's good for the heart is good for the brain.  Think exercise, blood glucose control, blood pressure control, and eating foods high in antioxidants.  Click here to read more about lowering inflammation.

What else can I do to control the risk of getting dementia or Alzheimer's in addition to controlling cardiovascular risk factors?

• Keep physically active
• Keep mentally active in a way that causes you to learn new tricks & new information
• Avoid depression--or get it treated.  Depression later-in-life correlates with twice the risk of developing Alzheimer's
• Maintain your social networks  Click here to read more
• Drink some red wine in moderation  (OK red wine is high in polyphenols, and there is lots of research to back this up, but I'm wondering if it's a bit of a coincidence that this is the only "food" Dr. Schiffer mentions, and the fact that the Ruvo family is Nevada's largest wine, spirits, beer, and beverage distribution company)

Is there any connection between toxins in the environment and Alzheimer's?

Schiffer says no.  The old aluminum theory originated by Linus Pauling over 30 years ago is history.  Turns out that yes, there is increased aluminum in some of the plaques and tangles of the Alzheimer's brain--but now we know that aluminum just "goes into areas of injury".  It isn't the cause of the injury.  It also appears in the brains of stroke patients, and in brain tumors.

Schiffer also doesn't think it's likely that BPA from plastics is a player in Alzheimer's.  I have heard Alzheimer's expert Dr. Peter Whitehouse propose the theory of lead as a cause of Alzheimer's, and the research is compelling.  Click here to read more.

What about the "plaques and tangles" theory of Alzheimer's?  Isn't that the cause of dementia?

Yes, plaques and tangles were the oldest objective evidence that Alzheimer's was a neurological disease, and they've seen for years.  But, even though they are a partial marker of "risk" for Alzheimer's--here's the problem with the "plaque-and-tangle" theory.   Many people will die and have a brain full of plaques and tangles, and still have normal cognition.  Some people will have full-blown Alzheimer's and have very few plaques and tangles.  According to Schiffer, the relationship between those traditional Alzheimer neuro-pathologies and the clinical disease is not very strong.

Tell me more about how learning new things can help prevent Alzheimer's?

Schiffer says you need to make sure you engage in some kind of lifelong learning process--learning new tricks causes the brain to add new synapses, it produces new brain cells, and it enables new regions of the brain to acquire new functions.

Here's a big tip:  If the the learning isn't difficult it won't work.  So quit complaining & stretch yourself outside of your comfort zone.  

Here's how learning something new changes the brain:  The 2nd Nobel Prize ever won in the field of psychiatry was awarded a few years ago for the discovery of how the brain cells in snails change when they learn something new.  Now snails only have 8-12 brain cells, but when they learn something new the firing pattern of their brain cells changes in a structural way--just like putting a new software program  into a computer.

There are fixed measurable changes that occur when you learn new things, and it's thought that in the earliest stages of Alzheimer's these network connections of brain patterns--how the cells talk to one another--are the first brain connections to start failing.  The theory is that strengthening these connections, and building new networks will stave off cognitive decline

Read my "Stretching in St. Louis" post to see what Dr. Schiffer is talking about.   And Dr. Norman Doidge's quote about middle-age that I posted 2 weeks ago bears repeating:

"We rarely engage in tasks in which we must focus our attention as closely as we did when we were younger, trying to learn a new vocabulary or master new skills.

Such activities as reading the newspaper, practicing a profession of many years, and speaking our own language are mostly the replay of mastered skills, not learning.

By the time we hit our seventies, we many not have systematically engaged the systems in the brain that regulate plasticity for fifty years.

That's why learning a new language in old age is so good for improving and maintaining the memory generally.  Because it requires intense focus, studying a new language turns on the control system for plasticity and keeps it in good shape laying down sharp memories of all kinds.  And it keeps up the production of acetylcholine and dopamine.

Anything that requires highly focused attention will help that system--learning new physical activities that require concentration, solving challenging puzzles, or making a career change that requires that you master new skills and material."

How far do you have to go with learning new things?  What about learning a short poem, or learning about science from an interview like this?

According to Dr. Schiffer, we know it has to be something challenging, but everyone is different.  The key thing is that it has to be "active" learning, and it has to be in a new area--you have to push your brain to learn something new.  Right now the Ruvo Center is working on research to figure out which learning tasks are the best to improve specific memory deficits.  They're now using prescriptive learning tasks in visual memory, word recall, auditory recall, and in complex story reading.  To learn more about "cognitive training" check out the work of Dr. Michael Merzenich--a leader in the study of brain plasticity & a developer of "brain training" software--click here.

What's Different About the Treatment Approach at the Lou Ruvo Center?

The Center takes a multi-modal approach to treating early dementia.  It's dedicated to the proposition that cognitive brain disorders of later life are treatable--and the Center's purpose is to improve upon those treatments.

• Medication when appropriate
• Lowering cardiovascular risk factors like high blood pressure, cholesterol levels, obesity, elevated blood glucose levels
• Incorporating physical exercise
• Targeted cognitive strengthening exercises based on an individual's particular weaknesses--similar to strengthening weak quadriceps.
• Treatment of depression when appropriate
• Nutritional counseling

What's the Typical Work-up When Someone Comes to the Center Complaining of Some Memory Loss?

• The first step is determine a correct diagnosis, even though Alzheimer's is the most common cause of memory loss.
• The standard evaluation is an old-fashioned clinical history and physical examination.  This also includes a cognitive assessment battery, and some screening laboratory tests.
• According to Dr. Schiffer, even though the Center makes use of advanced brain imaging & technologies, in the early stages of Age-Associated Cognitive Impairment and Mild Cognitive Impairment, imaging will unlikely show any changes.  This is a slow acting disease, and imaging falls far short of the sensitivity of a good history and physical examination.
• When the diagnostics are complete, the staff has a consensus meeting to determine the diagnosis and the best approach to treatment.
• Schiffer believes that these disorders are treatable & there's ample evidence to support treatment with a multi-modal approach.

How do you know when an aging parent--or yourself--is having "abnormal" memory problems?

By the way, Schiffer says that now that he is losing his keys & cellphone, he doesn't consider that to be abnormal behavior.  So, how do we know what's going to become dementia, or what's going to just "stay the same"?  The short answer--we don't know yet.  When you run cognitive tests on  someone in the category of AACI (Age-Associated Cognitive Impairment) they're going to come out as "normal".  But, they are having changes in their thinking. 

Schiffer tells his younger physicians that a good rule of thumb is, "Anyone who comes in to see us--by definition, if they cross that threshold & complain about their memory--they're not normal.  We are not yet able to "see or detect" what's going on in their brains--but people don't come in unless something's going wrong."

Lest you get worried about this comment, remember, Schiffer is a believer in a multi-modal approach to improving brain health, and preventing unnecessary decline.  You can't argue with that! 

You'll have to excuse me now, while I down a glass of wild blueberry juice, and take off for my Spinning Class.  I've already exercised my brain enough, listening to Schiffer, and writing this post!!!!

Comments

[jeann]

thanks for this!

[JulesWdr]

This is a really interesting article, had not heard of Dr. Schiffer before. We need to be coached as we age to better age, so these tips for those of us in our 40s this info is especially useful - thank you - is has been a challenge to find such comprehensive information. For those of us helping family members to better cope with Alzheimer's I can recommend a DVD we watched "Remember Better When I Paint", it provides inspiration of how creative activities help, and attitudes as well. You can see a preview on youtube here http://www.youtube.com/watch?v=54AtoQVGfwU

[symptoms of dementia]

What's the difference between dementia and Alzheimers? what is the difference? I think my father may be suffering one of these? does anyone know the warning signs? thanks