Happy Healthy Long Life

The Healthy Librarian's Brain Back-Up: Brain Plasticity, Dr. Michael Merzenich, Vitamin B-12's Alzheimer's Connection, and "Enlightened" Spicy Sweet Butternut Squash and Black Beans

 

Sweet and Spicy Butternut Squash & Black Beans

 

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Tuesday October 19, at 6:30 PM

My husband:  What do you want to do for dinner tonight?  We've got leftovers, I think.

Me:  Not enough.  I've got a taste for that spicy butternut squash & bean dish that Beth & Dave make.  I've got the squash.  If I get it in the oven now, and run to the grocery store to get the rest of the ingredients, will you make it?

My husband:  Sure!

 

What a lucky shopping trip for me.  Out the door at 6:40 PM to get 2 red peppers, 2 cans of black beans, some fresh marjoram, 2 jalapenos, and Italian parsley.

On the ride home, I tuned into my local NPR station which was running a 2 hour interview/fund drive with my favorite brain/neuroplasticity guru, Dr. Michael Merzenich.  What a lucky break for me!   Got home by  7:15, gave the ingredients to my husband, and worked real slowly on folding & putting laundry away while I listened to 45 more minutes of Merzenich's interview.

What Dr. Michael Merzenich Says about Keeping Your Brain Sharp

• The only way to keep building brain cells & new connections is by continuously engaging in serious, challenging learning for the rest of your life.
• It requires effort, and it has to be something that's important and interesting to you!  It requires intense focus.
• If your daily work is just doing the same thing over and over again--and all you do is read the daily paper--and yes, even if you watch PBS, the History channel, do crossword puzzles, and read regularly--that won't do it.  It's not that engaging--and it's not serious learning--it's the "replay of already learned skills", as well as entertainment.
• Practice makes perfect.  Whether learning a new language, a computer skill, or a muscical instrument--you need to work on it--regularly--or you'll lose the skill, and the brain connections.

I first learned about Dr. Merzenich about a year ago through one of the psychology fellows at my hospital.  Back in February 2010 I posted this pithy excerpt from Dr. Norman Doige's book about Merzenich's work: "The Brain That Changes Itself.  Stories of Personal Triumph from the Frontiers of Brain Science".

Brain Plasticity in Older Adults.  Why We Need to Continue to Learn New Things

One of the perks of my job is that I get to see what all the top researchers are reading.  A few weeks back one particularly interesting book crossed my desk, "The Brain That Changes Itself.  Stories of Personal Triumph from the Frontiers of Brain Science,"  by Dr. Norman Doidge. The book is about neuroplasticity--how our brains are not static, but can change and improve, even as we age.  Much of this research is credited to Dr. Michael Merzenich who has pioneered computer-learning activities for children, and has recently developed memory-training programs for adults.  Click here to learn more.

Writing this blog has given me a chance to take time out to study, learn, and concentrate on new areas of research--and to understand it well enough to be able to write about it.  Without undergoing any "brain testing" I can tell you that my learning skills and memory have definitely sharpened and improved through blogging.  I'm now a believer in neuroplasticity.

So, in light of my almost 3 year blogging experience, I was really struck when I read this quote by Merzenich in Doidge's book:

Merzenich:"We have an intense period of learning in childhood.  Every day is a day of new stuff.  And then, in our early employment, we are intensely engaged in learning and acquiring new skills and abilities.  And more and more as we progress in life we are operating as users of mastered skills and abilities."

Doidge: "Psychologically, middle age is often an appealing time because, all else being equal, it can be a relatively placid period compared with what has come before.  Our bodies aren't changing as they did in adolescence; we're more likely to have a solid sense of who we are and be skilled at a career.  We still regard ourselves as active, but we have a tendency to deceive ourselves into thinking that we are learning as we were before.

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."

More Brain Inspiration from Merzenich--an Interview on Brain Science Podcast

About a year ago I also had the opportunity to listen to an interview with Dr. Merzenich, on Dr. Ginger Campbell's fantastic series, Brain Science Podcast.  If you're interested in neuroplasticity and brain training, listen to the entire podcast, or read the transcript of the show.  Click here for the links.

Here's an excerpt that resonated with me:

Dr. Ginger Campbell: Thank you. So are there some basic principles that a person who wants to tap their plasticity needs to know?

Michael Merzenich: Well there are, of course, but it's a little complicated. One thing I can tell you is that commonly, people who are struggling, basically have withdrawn from life and engagement in serious learning or serious brain change, and they have to reinvigorate their mechanisms and processes that control learning.

You have to find things that you can work on and improve at that are rewarding to you. You have to look at a life of continuous learning. I don't mean just reading and watching interesting new TV programs, I mean new learning.

I mean really engage your brain to acquire new ability. And what you learn has to be serious.

You get almost nothing out of exercise or activities in which you're not really focused or engaged, that don't really matter to you. If they don't matter to you, they don't matter to your brain and nothing will change as a consequence of your activities, and so forth.

And then your physical status, your physical well-being, physical activity counts for a lot also from the point-of-view of your brain health. You have to keep that up. So there are principles. It's hard to summarize them in simple ways, but I say a life of continuous learning that's important for you and your brain are really important sides of it.

Ginger Campbell: When I interviewed Dr. Elkhonon Goldberg he told me that one of the
things he does is he makes it a point of doing things--in particular he mentioned computer things that are somewhat difficult that he could get his graduate students or whatever to do for him--that he makes a point of doing at least some of those himself for that very reason.

Michael Merzenich: Right. Well one of the things we do is we disengage and we seek a life of ease, and we seek a life that's not challenging, that never really demands anything of us or very little of us.

We think that's the happy elder life, and that's a big mistake. Rather than trying to struggle with continuously trying to get across town, we buy the device that tells us where we're at at every second so we can do it in a brainless way.

Michael Merzenich: Rather than go out and do something actively, we try to figure out how to bring it in front of us in some way so that we don't have to move off of our butt. And then all of the interactions that would come from actually being there and seeing it and witnessing it or being a part of it are lost.

In all kinds of ways we do things that are designed to destimulate and to reduce our capacity to operate in the world, and certainly reduce the way in which we're growing in the world, and that disengage our brains. And that's a mistake. We should be trying to increase and reinvigorate our brains, not disengage them.

Spicy Buttenut Squash & Black Beans - Food for the Brain

The last time I had this fantastic dish I made the "light" version--cutting the oil--from 1/3 a cup of olive oil, to 1/4 cup of oil.  Well, this time I CUT OUT ALL THE OIL--and honestly, I couldn't taste the difference.  The dish lost nothing from the loss of oil.

"Enlightened" Spicy Sweet Butternut Squash & Black Beans

 My sister and brother-in-law made a version of this for us when we visited them in Cincinnati, and I couldn't stop raving about it.  It's amazing.  Their version, came from Sara Foster's "Fresh Every Day" cookbook--of Foster's Market fame.  It uses black-eyed peas, but I decided I liked the taste of black beans better than the black-eyed peas--and it was a lot easier to just open a can.  I also cut the oil down, doubled the recipe, and ditched the goat cheese.  It so delicious, that when I made the regular recipe I was  sorry I didn't have more.

Cook's Note: This dish is spicy, and it needs it.  But, if jalapeno peppers aren't your thing, cut it down to one, or add them a little at a time, tasting as you go.

Serves 6

2 pkgs. (18 ounces each) of Trader Joe's butternut squash chunks (uncooked in the produce section)   Use 2 1/4 lbs. of peeled cut-up squash if you aren't near a Trader Joe's.

If you like, you could lightly spray the squash with a canola oil spray, but it's not necessary.

A little bit of real maple syrup to rub on the chunks for roasting.

A little coarse salt (or not) & coarse black pepper for roasting

2 cans (15 oz.) of drained & rinsed black beans

2 red peppers, cored, seeded, and diced.

2  jalapeno peppers, cored, seeded, and diced. (use your judgement here--but the spice really adds to the dish)

4 TBS. chopped fresh marjoram leaves.  (if you don't have this--don't worry about it--but it's a good additon)

4 TBS. chopped fresh flat (Italian) parsley
 

Sweet and Spicy Vinaigrette - makes 1 cup

1/3 cup apple cider vinegar  (if you think it's needed--you could add a couple TBS. more of vinegar)
2 TBS. honey
1 large (or 2 small) lemons, grated for zest, and juiced.  (1/3 cup juice)
1 tsp. crushed red pepper flakes
Kosher or sea salt (optional), and black pepper to taste

Stir the vinegar, honey, lemon zest and juice, red pepper flakes, salt, and pepper together in a medium bowl. 

Whisk up the mixture until everything is incorporated.  Use immediately or refrigerate in an airtight container for up to a week.

Directions:

1.  Preheat oven to 400 degrees.  If you have the convection roast control on your oven, it works best.

2.  Using a large baking pan lined with parchment paper (keeps squash from sticking) scatter the squash cubes in one layer.  Drizzle with just a little maple syrup and rub it evenly on the cubes.  Sprinkle with a little salt & pepper.  If you prefer to spray lightly with a canola spray, do it now.  Roast for about 30 minutes, or until soft & browned on the edges.  Watch carefully, especially if you have the convection roast option!

3.  Cut the cooked, cooled cubes into smaller pieces, and scrape into a large mixing bowl.  Add the drained black beans, the red peppers, the jalapeno peppers (do it in small amounts if you're not into spicy), the marjoram, the parsley and mix well.

4.  Add as much of the dressing as you like. We used all of it last night--but it's up to you.  Add extra salt or pepper if you think it needs it.

5.  Transfer to a serving platter. 

6.  Enjoy the leftovers.

Nutritional Information based on 1/6 of the recipe

Nutrition Facts The Healthy Librarian Spicy Sweet Butternut Squash & Black Beans
Serving Size: 1 serving
Amount Per Serving
Calories	221
Total Fat	0.4g
Saturated Fat	0.1g
Trans Fat	0g
Cholesterol	0mg
Sodium	554mg
Carbohydrate	50.8g
Dietary Fiber	6.8g
Sugars	14.9g
Protein	8.4g
Vitamin A 284% Vitamin C 261% Calcium    13% Iron 19%

 

Update: Vitamin B12 and the Possible Prevention of Alzheimers Disease

Speaking of B12 (Monday, Oct. 18, 2010's post).  Thanks to Tom & Steve for alerting me to this "just published" study that was published in Neurology on Tuesday, Oct. 19th,  "Homocysteine and holotranscobalamin and the risk of Alzheimer disease,"  Neurology 75:1408-1414, Oct. 19, 2010.

Summary:

Vitamin B12 may help protect the brain against Alzheimer's disease, according to new evidence that suggests the vitamin and an amino acid called homocysteine may both be involved in the development of Alzheimer’s.

High levels of vitamin B12 in the blood are already known to help reduce levels of homocysteine, which has been linked to an increased risk of Alzheimer's disease, memory loss, and stroke.  But researchers say the relationship between homocysteine and vitamin B12 levels and Alzheimer's disease risk has been unclear.

The seven-year study followed 271 Finnish people ages 65 to 79 who did not have any symptoms of Alzheimer's disease at the start of the study.

During the study, published in Neurology, 17 people developed Alzheimer’s disease. Researchers found that each picomolar increase in blood vitamin B12 level was associated with a 2% reduction in the risk of Alzheimer's disease among the elderly.  Click here to read the entire summary of the Neurology article on the WebMD site.

Conclusion at the end of the Neurology article:

"Our results indicate the involvement of both serum tHcy (homocysteine) and holoTC (holotranscobalamin, a biologically active fraction of vitamin B12) in the development of AD (Alzheimer's Disease).  

This emphasizes the need for further studies on the role of sensitive markers of B12 status in identifying individuals who are at increased risk of AD.

High Hcy (homocysteine) and low levels of vitamin B12 are surprisingly common conditions in the elderly, both in developed and developing countries.  However, few randomized controlled trials have so far investigated the usefulness of vitamin B12 supplements in preventing cognitive impairment or dementia, with mixed results.

Limitations of statistical power, study duration, and choice of target population make such studies difficult to interpret. Supplementation may be most effective in prevention during a critical time window, and larger and better planned randomized controlled trials are necessary to formulate efficient treatment guidelines (dose, treatment start and duration, target population)."

 

 

 

 

 

 

 

 

 

 

The Latest Framingham Heart Study. Brain Shrinkage? Atrophy of the Brain? Getting to the Heart of the Matter - It's All About the Cardiac Index

Left Image:  Normal Brain  Right Image:  Atrophied Brain  

"Those with the lowest cardiac index and the middle group both had smaller brain volumes than those with the highest cardiac index.  (Cardiac Index is the measurement of blood flow from the heart, based on one's body size.)

Our results definitely suggest that cardiac health is related to brain health.

These participants are not sick people.  A very small number have heart disease.

The observation that nearly a third of the entire sample has a low cardiac index and the lower cardiac index is related to smaller brain volume is concerning and requires further study.

The structural (brain) changes may be early evidence that something is wrong.  There are several theories for why reduced cardiac index might affect brain health.  For instance, a lower volume of blood pumping from the heart might reduce blood flow to the brain, providing less oxygen and fewer nutrients needed for brain cells. 

It is too early to dole out health advice based on this one finding, but it does suggest that heart and brain health go hand in hand."

Dr. Angela L. Jefferson, lead investigator, Boston University, "Cardiac Index is Associated with Brain Aging.  The Framingham Heart Study",  published online August 2, 2010, Circulation.

This just-published article in Circulation certainly got my attention.  Who wants brain shrinkage a.k.a. brain atrophy?   Not if there is something you can do to prevent it.

OK, we've been hearing this for years, "What's good for the heart is good for the brain."  And although the authors are quick to say "further investigations into the mechanisms and clinical significance of the association between cardiac index and brain aging is merited",  Dr. Angela L. Jefferson says flat out:  "Generally speaking, it seems that heart and brain health are related, so proper management of cardiovascular risk factors may have important implications on brain health."

Bottom line here:  Those study participants whose hearts pumped less blood, had brains that appeared older than the brains of those whose hearts pumped more blood--to the tune of two years worth of brain aging. 

The biggest surprise to the researchers was that of this group of 1504 mostly healthy middle-aged volunteers--all offspring of the original Framingham Study volunteers--not only did the folks with lowest cardiac index show significant brain volume shrinkage, but so did the folks with a cardiac index in the middle range!  Only those with the highest cardiac index showed significant retention of their brain volume.   

"We expected an association between the lowest levels of cardiac index and smaller brain volumes, but we were surprised to find people on the lower end of normal cardiac index also have smaller brain volumes when compared to people with the very healthiest cardiac index."  Dr. Angela Jefferson

The researcher's other big surprise was the high number of "normal healthy" adults who had a cardiac index below normal.  Around 30% of these seemingly healthy middle-aged adults had a low cardiac index. 

"In light of the current observation that cardiac index is associated with cross-sectional markers of accelerated brain aging, such a high proportion of cardiac index values below clinical criteria warrants further investigation."  (excerpted from the article)

It's important to remember that these were pretty healthy participants.  The study excluded anyone who had a previous history of stroke, TIAs, dementia, or significant cardiovascular disease.  Only 7% of the group had any heart disease at all, 10% were smokers, 9% had diabetes, and 28% had high blood pressure.  And all these risk factors were controlled & adjusted for when the results were compiled.

The researchers also tested the cognitive function of the participants with 5 different neuropsychological tests. 

The good news (sort of), was that the folks with the smallest brain volumes didn't yet show any obvious cognitive deficits.  But, one function, how quickly one can process information, had a positive correlation to brain volume.  Less brain shrinkage equaled faster processing speed.  And who doesn't have a little slow processing speed as they get older?

The bad news: The researchers question exactly how precise these standard neuropsychological tests are when it comes to picking up subtle early cognitive deficits.  Were the tests powerful enough to pick up underlying deficits?

The jury's still out about the future brain function of those who exhibited decreased brain volume. 

"We observed (that the) cardiac index is related to structural changes in the brain, but not cognitive changes.  The structural changes may be early evidence that something is wrong."  Dr. Angela Jefferson

The Cardiac Output-Brain Shrinkage Connection

Here's what the authors think might be going on:  "The mechanism accounting for associations between cardiac index and markers of brain aging is unknown; however, reduced systemic blood flow may contribute to subclinical brain injury because of its impact on cerebral blood flow hemostasis.

My Mother's Brain

When my mom was in her late seventies she had a CAT scan (not an MRI as in the Framingham Study) of her brain to see if there might be a reason for her strange constellation of symptoms:  unexplained dizziness, some unsteadiness, a few minor falls & the occasional odd experience of her body tipping to one side while she sat on the couch.

The results:  The doctor said the CAT scan didn't show a thing.  She was just fine.  Just normal brain shrinkage from aging--everyone has that, he told us.  No one connected any dots back then that perhaps her "normal brain shrinkage" might have had something to do with her heart disease, her earlier severe blockage of the left main coronary artery, for which she had an angioplasty, or her hypertension. 

Within a few years of that CAT scan her memory slowly declined, tiny subtle strokes accumulated, and the results were the usual story of a slow downward health spiral--without hope of turning it around.  This new Framingham Study is one more bit of evidence that demonstrates just how interconnected brain health is to heart health.  It's all in the plumbing!  Consider yourself warned.

What Can We Do With This Information?

Dr. Ralph Sacco, the president of the American Heart Association, and the co-author of the Circulation editorial that accompanies the Framingham article, says:

"It will take years to know the fate of all 1504 Framingham participants. 

Whether lower cardiac index leads to reduced brain volumes and accelerates neurodegeneration on an eventual path to dementia is not yet clear.

What is known is that various vascular risk factors, including declines in cardiac function, are determinants of dementia--both Alzheimer's disease and variants of vascular cognitive disorders.

This is an interesting, strong association.  Just as we measure someone's weight, blood pressure and cholesterol to assess their heart disease risk, we now have numbers for cardiac index and brain volume.

The key message for the public is the connection between heart vascular issues and brain vascular issues. 

The things that affect the heart can affect brain health. 

Exercising regularly, eating right, maintaining a healthy weight, not smoking, and managing high blood pressure, cholesterol, and diabetes--will all lead to better heart, blood vessel, and brain health.

Know that these things are important, not just for the heart but also for the brain."

I got into this whole exercise-healthy-diet-gig for stroke prevention and cognitive retention.  Needless to say, I'm feeling even better about staying the course.  Brain shrinkage--who needs it? 

Can't help wondering how the MRIs of cardiac output & brain volume would look in long-time exercisers, and for those with pristine heart health.  

Skip the ice cream, cheesecake, and cheeseburger this weekend.  Go out and exercise.  If not for your heart, then for your brain.

To read more about the heart-brain health connection read: 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 Does Katy Butler's "My Father's Broken Heart" Have to Do With Following a Heart Disease Prevention Diet, Meditation, Yoga, Osteoporosis & Movies?

 

photo by Eugene Richards for the New York Times

"The pacemaker bought my parents two years of limbo, two of purgatory and two of hell.  In 2005, the age-related degeneration that had slowed my father's heart, attacked his eyes, lung, bladder, and bowels. 

Clots as narrow as a single human hair lodged in tiny blood vessels in his brain, killing clusters of neurons by depriving them of oxygen...A few months later, he forgot his way home from the university pool.  He grew incontinent.  He was collapsing physically, like an ancient, shored up house."

Katy Butler, "My Father's Broken Heart: How Putting in a Pacemaker Wrecked My Family"  New York Times Sunday Magazine, June 20, 2010

If you've received this post via email, click here to get the web version with all the links.

Two weeks ago while I was still vacationing in Maine I received an email from Katy Butler, the author of this not-to-be-missed memoir in the New York Times.  Click here to read it.

Hi there, thanks for your comments on my piece for MORE on silence.
You sound like a kindred spirit.

Please read my upcoming piece next Sunday online if you don't get the Times.
Food for thought. warmly, Katy

"My Father's Broken Heart: How Putting in a Pacemaker Wrecked My Family," runs June 20 in the New York Times magazine.  I hope you get to read it, especially if you have elderly parents."

"One October afternoon three years ago, my mother made a request I dreaded and longed to fulfill. She had just poured me a cup of Earl Grey from her Japanese iron teapot, shaped like a little pumpkin; outside, two cardinals splashed in her birdbath in the weak Connecticut sunlight.  Her white hair was gathered at the nape of her neck, and her voice was low. "Please help me get Jeff's pacemaker turned off," she said. I nodded, and my heart knocked.
Upstairs, my 85-year-old father Jeffrey, a retired Wesleyan University professor who suffered from dementia, lay napping in what was once their shared bedroom. Sewn into a hump of skin and muscle below his right clavicle was the pacemaker that had helped his heart outlive his brain....."

Uh. I had to think long & hard to remember who Katy Butler was, & what I had written about her.  Aha!  It was her brilliant piece about silence, "How to Access Your Inner Calm"--her experience at a 6 day silent meditation retreat back in 2008.  To read her thoughtful piece that appeared in More, click here and the article is on pgs. 96-100. 

Little did I know what difficulties, sadness, and frustrations were going on in Katy's life at the time she wrote that article.  No wonder she was at a meditation retreat.  

And speaking of meditation--yesterday evening I had a chance to listen to the podcast of Diane Rehm's NPR broadcast on the Power of Meditation.   Click here  to listen to her hour-long interview of three top meditation researchers, experts, & practitioners--or just download it through iTunes and listen to it on a nice relaxing meditative walk.  Thanks to hubby for the tip about Diane's show.

"Millions of Americans practice some form of meditation to promote relaxation and reduce stress. But claims for greater health benefits are in need of further study." 

So, Why Am I Recommending That You Read Katy's Memoir?

"When people tell me my diet's extreme, or too strict, I ask them, 'How would you like to spend your last years in a nursing home, sitting in a wheelchair, incontinent, immobile, unaware, with saliva dribbling out of the side of your mouth?'"

The paraphrase of comment Dr. Caldwell Esselstyn made to me a few months ago.

Katy's story is a variation of my family's story.  My dad survived a massive stroke at age 69, just as life was starting to get nice-and-easy for him.  Both daughters were married, he could work less, and his first grandson (my now 30 year old son) was just 9 months old. Time for the travel my parents had always put off.

He lived on for 16 years after that initial stroke, until age 85, without being able to speak, read, or understand language--and reading was his joy--especially the New York Times.  He lost mobility, and everything else that makes life worth living.  My dad was kept alive by powerful anti-seizure medicines that prevented the severe seizures that were caused by the strokes' damage to his brain.  Later, he was kept alive with the help of a feeding tube.

My mom lovingly and without a single complaint took care of my dad at home for over 10 years, seeing her own health decline, and her world close in. Care-giving stress brought her weight loss, friend-loss, and unknown to her at the time, she was having her own silent imperceptible micro-strokes, as well as angina, osteoporosis and high blood pressure.  A year after my dad passed away those tiny strokes had started to take their toll on both her physical balance & memory.  After a number of falls, bone fractures, and full-blown strokes she spent her last year in that wheelchair, just as Dr. Esselstyn had described.

Read Katy's story if you have older parents, or an older spouse.  Read it for yourself, for goodness sakes.  Read it if you want the motivation to finally take your health into your own hands.  Read it if you want to understand why our medical system and Medicare lean toward expensive medical devices and expensive interventions that aren't always in our best interests. 

As for me, if there is anything that I can do that will prevent me from experiencing the same slow half-dead-half-alive fate that my parents had to experience in their final years, I'm going to give it my best shot.  Cheeseburgers & sausage pizza aren't worth the price.  And if I can prevent my husband & children from experiencing the incredible stress of care-taking--I'm going to give that a shot, too.

"It doesn't take a scientist to figure out that the possibility of death has been holding pretty steady at 100% for quite some time.  There's only one thing that we have to do in life, and that is to die.

I have often met people who use this fact to justify their ambivalence toward health information.  But I take a different view.  I have never pursued health hoping for immortality.

Good health is about being able to fully enjoy the time we do have.  It is about being as functional as possible throughout our entire lives and avoiding crippling, painful and lengthy battles with disease.

There are many better ways to die, and to live."

-Dr. T. Colin Campbell, "The China Study"  Dallas, TX: Benbella Books, 2006, pg. 75-

Katy's story expertly weaves together her families' most private emotions, with an explanation of how 21st century medicine has come to trap us into a cascade of expensive procedures, devices, and drugs at the end of our lives, that often extends our years, but not the quality of our lives.  She's a beautiful, poetic writer and has shared the most intimate details of her families' life to benefit others.  Read it!

Excerpts from "My Father's Broken Heart":

• I don't like describing what dementia did to my father--and indirectly to my mother--without telling you first that my parents loved each other, and I loved them.
• Anton Chekov, who died of tuberculosis in 1904, wrote:  "Whenever there is someone in a family who has long been ill, and hopelessly ill, there come painful moments when all timidly, secretly, at the bottom of their heart long for his death."  A century later, my mother and I had come to long for the machine in my father's chest to fail.
• I watched (my parents) lose control of their lives to a set of perverse financial incentives--for cardiologists, hospitals and especially the manufacturers of advanced medical devices--skewed to promote maximum treatment.
• Thanks to advanced medical technologies, elderly people now survive repeated health crises that once killed them, and so the "oldest old" have become the nation's most rapidly growing age group.  Nearly a third of Americans over 85 have dementia. 
• (M)y 77-year-old mother found herself on duty more than 80 hours a week.  Her blood pressure rose and her weight fell.  On a routine visit to Dr. Fales, she burst into tears.  She was put on sleeping pills and anti-depressants.
• If (Dr. Fales) had had a chance to sit down with my parents, he could have explained that the pacemaker's battery would last 10 years and asked whether my father wanted to live to be 89 in his nearly mute and dependent state.
• In a fee-for-service medical economy...communication is haphazard...thinking is often short-term.  Nobody makes money when medical interventions are declined; and nobody is in charge except the marketplace.
• Medicare rewards doctors far better for doing procedures than for assessing whether they should be done at all.  The incentives for overtreatment continue...because those who profit from them--specialists, hospitals, drug companies and the medical-device manufacturers--spend money lobbying Congress and the public to keep it that way.
• And so my father's electronically managed heart--now requiring frequent monitoring, paid by Medicare--became part of the $24 billion worldwide cardiac-device industry and an indirect subsidizer of the fiscal health of American hospitals.
• The pacemaker bought my parents two years of limbo, two of purgatory and two of hell.
• Of the 17 cardiologists who wrote the 2008 guidelines on pacemakers for the American College of Cardiology, 11 received financing from cardiac-device makers or worked at institutions receiving it.  Seven, due to the extent of their financial connections, were recused from voting on the guidelines they helped write.
• We learned that if we called 911, emergency medical technicians would not honor my father's do-not-resuscitate order unless he wore a state-issued orange hospital bracelet.
• More than half of heart-bypass patients suffer at least a 20% reduction in mental function.

Yikes, I started out writing this post as a brief segue into my first week following Dr. Esselstyn's heart-disease-reversal-and-prevention diet, and it just morphed into something else. Can you tell how much I adored Katy's article?

Sorry,  more about the Tips, Tricks, How-Tos of the Diet tomorrow, or later this week.  My son, daughter-in-law and adorable grandson arrive here late on Monday night, so I guess blogging may once more take a back seat.

Quick Diet Update:  So far so good.  This is definitely a lot easier than I thought it would be, thanks to all of Ann Esselstyn's amazing tips.  I have noticed that I definitely need to eat before I get hungry--because when I get hungry--I'm ravenous.  I'm noticing that I'm staying up about one hour longer each day than before.  No idea if that's diet related or not.  Loving fat free roasted red pepper humus, Ezekiel wraps & English muffins.

Sample Menu This Week

Breakfast:  Steel-cut oats, with dried apples and flaxmeal.  I never get tired of this!

Snack split over mid-morning & mid-afternoon:  My green smoothie made with kale or chard, apple, grapefruit, berries, and carrots.

Lunch: Giant salad of mesclun greens, roasted corn, steamed lentils (Trader Joe's precooked), tomatoes, cucumbers, Trader Joe's Corn Salsa & balsamic vinegar.  Plus, an Ezekiel-brand sprouted grain English muffin.

Dinner: Bok Choy with portobello mushrooms, carrots, ginger, pea pods, barbecued seitan, and soba noodles.  Fabulous!  A variation of Rip Esselstyn's recipe.

Additional snacks:  Cherries, watermelon, whole wheat pita, baby carrots, cucumbers with fat-free red pepper hummus

Update on Dr. Loren Fishman's Osteoporosis Study

The study is still open if you are interested in participating, and you will receive Fishman's DVD of 10 minutes of daily poses. Details on the study are here.

To enroll, email Dr. Fishman at:  [email protected]

You will need to send copies of the SMA-18 (electrolytes & blood chemistry); CBC (complete blood count);  TSH (thyroid-stimulating hormone); Vitamin D 1,25-dihydroxy;  ESR (erythrocyte sedimentation rate); parathyroid hormone test, and DEXA scan results, before you can enroll and receive the DVD.

I'm planning to enroll as soon as I can get together all the tests results.

I still don't have an answer about whether 2 or 3 times a week of hour-long classes would provide the same positive results as the 10-minute every day practice.

Movies I've Loved This Summer

City Island--do not pay attention to negative reviews.  This is a winner.  Everyone I know who has seen it has loved it.

Please Give with Catherine Keener--more than meets the eye.

Enjoy this lovely weekend!

Saturday Shares: Brain Science Podcast on the Myth of Alzheimers, Alkalol for Cold Control, Too Much Alcohol Shortens Telomeres, Entertaining without Cheese or Cake, and Kathryn Stockett's "The Help"

Click here to go to the web version of this post with all the links if you've received this via email.

What a terrific Saturday it was.  Jam-packed with finishing-up reading Kathryn Stockett's, The Help, for book club.

Then about a 1/2 hour on my computer to catch up on a couple of new health studies that grabbed my attention. 

Followed up with an hour long walk in light rain--while I listened to Dr. Ginger Campbell's interview with Alzheimer's expert, Dr. Peter Whitehouse--before heading off to an all-afternoon bridal shower.

Then it was stopping off at Trader Joe's to load up on healthy fare--to feed the book club crew who were coming to my house at 7:30 pm.

Get home--unload groceries--straighten up the house--bring more chairs into the family room--quickly down some black bean soup for "dinner"--and set-up the book club smorgasbord on my kitchen/family room island.

By then I was definitely starting to feel a bit of a cold coming on--and I had just enough time to get in a quick neti pot saline/Alkalol nasal cleansing to nip that cold in the bud.

So there you have it. 

My Saturday.  And my show-and-tell for the day.

• From my walk: Dr. Peter Whitehouse's not-to-be-missed interview about Alzheimer's and brain aging.
• From my computer reading: A study just-presented at the annual meeting of the American Association of Cancer Research about the negative effects of too much alcohol on our telomeres--which are strong markers for aging.
• Alkalol--my new favorite 1897 pharmacist-developed "nasal douche" to ward off colds
• From my book club smorgasbord:  My first-ever book club "hosting" where I didn't serve any food that I wouldn't eat myself.  No cookies.  No soda pop.  No cheese.  No junk.
• The Help, by Kathryn Stockett.  This is only the 3rd time in the 17 years since this book club has been meeting that all ten of us--men & women--liked the book.  Not everyone LOVED it--but everyone finished it--enjoyed reading it--and we had so much to talk about.

My Saturday Share Number One:  Brain Science Podcast - Dr. Peter Whitehouse on The Myth of Alzheimer's: What you aren't being told about today's most dreaded diagnosis

I'm a big fan of Dr. Peter Whitehouse--he's the real deal--a geriatrician, Alzheimer's expert, researcher, clinician--and he tells it like it is.  Alzheimer's is just a label for a constellation of dozens of different brain conditions that all add up to brain aging.  Whitehouse doubts that we're ever going to find a "one shot" magic bullet to "make it go away"--and throwing money looking for a cure isn't the best use of resources.

I wrote about Whitehouse's book two years ago when I first started this blog--so here's my handy "Cliff Notes" synopsis of what he's all about:

Dr. Peter Whitehouse, one of the leading experts on Alzheimers has pulled down the Alzheimer's curtain in his new book, The Alzheimers Myth.   He frankly charges that the advocacy groups, the researchers, and the pharmaceutical industry all have a vested interest in raising funds for a disease that will be impossible to "cure".  The hope lies in prevention and care.  Be sure to check out his web site.

Why is a cure so elusive:

1. Alzheimers is not one singular disease.  It's impossible to differentiate it from brain aging - it is brain aging.  At age 85-95 it's normal for the brain to age.  If you've seen one Alzheimers patient, you've seen one Alzheimers patient.  There's no one biological profile.

2. What we call Alzheimers is caused by multiple assaults to our brains; including vascular dementia (caused by silent, tiny or large strokes) or atherosclerosis; inflammation; environmental toxins like lead, poor diet, head injuries and just plain normal aging.  Many of these processes start early in life.

3. We don't really know how to diagnose this disease. We all get some of the so-called characteristic plaques and tangles of the brain--it's just a symptom of aging, not  the cause of Alzheimers.  Autopsies of perfectly normal functioning adults have shown the same plaques and tangles as seen in Alzheimers patients.

4. To cure Alzheimers, we'd have to arrest the process of brain aging.

If brain aging and dementia is a concern or interest of yours, be sure to take a look at the link to the Brain Science Podcast's April 14, 2010 eye-opening interview with Dr. Whitehouse that I listened to--along with a helpful transcript.  Click here for that link--which contains additional links to Whitehouse's blog

The Whitehouse Interview Highlights:

1.  What about the genetics of Alzheimer's?  What if you've inherited the "dread Apo E4" gene? Genes Aren't Destiny.

Dr. Whitehouse:  Now, we are increasingly realizing genes modify our risk for diseases—they’re called genetic susceptibilities—that aren’t causative.

And so, there are genes that, if you have them, can modify your risk for getting a late-life dementia, but don’t necessarily cause it. I’ll illustrate that with the strongest associated one—apolipoprotein E4.

Apolipoprotein is a fat-related protein that relates to cholesterol transport. We all have one version of it—either a 2, or a 3, or a 4 (1 went away somehow).

If you have the 4 kind, everybody can transport their cholesterol OK, but that kind makes you more at risk for bad things to your brain as you get older.

And I put it that way because it’s not only so-called Alzheimer’s and memory problems, it’s stroke and it’s other diseases. It’s also bad for your heart. So, if you’re an ApoE 4, you may be more at risk for various heart conditions.

That’s a susceptibility gene.

Dr. Campbell: So, it’s very important, I think, to emphasize that increased risk
is not the same as predicting disease. Genes are not destiny.

2.  What Can You Do to Reduce Your Risk of "Alzheimer's" or Brain Aging? (from the transcript)

• Keep Your Mind Active Doing Something You're Passionately Interested In--That Benefits Your Community.  There are computer programs you can try. Do you do crossword puzzles? Do you
  do Sudoku? I don’t think what you do with your brain is really that important, as long as you enjoy it and do it. I would have a caveat to that, and say if you use your brain to help other people, that’s probably best, because every sage, every religious leader says helping other people is the best way to help yourself. So, keeping your brain active in a community helping other people, I think, is the most important thing.
• The Importance of Exercise.  People have a sense that being physically fit is important for your health in general. But I think it’s important to emphasize it’s particularly important for your brain, not only because it supports your heart and the pump to the brain, but also because of a lot of evidence that exercise, itself, helps brain function.
• Low Glycemic Mediterranean Diet.  I’m (Dr. Whitehouse) personally a believer in something like the Mediterranean diet, which is not what most of us follow, and getting rid of too much red meat, too many processed foods, foods that are high in sugar. So, a low glycemic index, roughage, fruits and vegetables, that’s the way to go.  A just published (early release) Columbia University study in the Archives of Neurology shows a 40% reduction in the risk of developing Alzheimer's with a plant-heavy Mediterranean diet--including omega-3s, nuts, cruciferous vegetables, fruits, and dark leafy greens.  Click here for the Columbia study and my earlier post with Dr. Gomez-Pinilla's advice on "feeding" the brain.
• A Good Healthcare Provider.  I would add number four is have a good healthcare provider that you trust to have a relationship with, because there obviously are things that go along with brain aging where you need a doctor’s attention occasionally, and you should have that relationship to build on.

3.  Making Money on Alzheimer's Disease

Dr. Peter Whitehouse:  I think we have amazingly distorted our notions of health because of an unholy alliance between two isms—scientism and capitalism.

Now, I’m a scientist, and I believe that science can do powerful things. Scientism is the religion that science can do more than perhaps we are right to believe that it can. So, it’s the faith that science, with enough money, can do anything.

And, of course, short-term capitalistic approaches to health have led to the dominance of multinational pharmaceutical companies, and to the "commodification"—to use that word—of everything medical.

So, doctors do what they get paid for, and drug companies use direct-to-consumer marketing to convince people that their pills are wonderful. Frankly, I think we should get rid of direct-to-consumer marketing in this country.

We’re only one of two countries in the world that have it, and I think it is basically a social harm.

Dr. Campbell: Related to that is the fact that every time we see a patient, because of the way reimbursement works, we are forced to label them with a diagnosis, because we have these thick books full of codes for diagnoses. And so,doctors are sort of pushed into labeling people ‘Alzheimer’s disease,’ to a certain extent, aren’t they?  Even the doctors who don’t have any financial rewards from, say, prescribing drugs or whatever, still are sort of being cornered.

My Saturday Share Number Two:  Cutting Back On Alcohol Can Prevent Your Cells From Aging Before Their Time.  Too Much Alcohol Damages Our Telomeres--The Protectors of Our DNA--Speeding Up Aging & Cancer Risk

I'm fascinating by the whole science of telomeres.  They are markers of how fast (or how well) we are aging--they normally shorten the older we get.  But "good behavior" has been shown to lengthen them: Like eating lots of omega-3s and exercising regularly.  So, now we know to watch out for drinking too much alcohol--because it shortens telomeres--speeding up aging--and increasing cancer risks.  Definitely something to share with any teen-agers or twenty-somethings you happen to know who are tipping a few too many.  For the NPR summary click here.  For the American Association of Cancer Research press release click here. To read my earlier posts on telomeres, click here here and here.

My Saturday Share Number Three:  Alkalol--My New Favorite Cold Crusher/Cure

 

Back in December, when I was moaning about how I missed my now-off-the-market Zicam Nasal Gel, a New York reader wrote to tell me:  "Also try using Alkalol with your Neti pot. It's a very popular remedy in our neck of the woods here in NY!"

I passed his recommendation on to a friend when she had a terrible cold--and her neti pot was not doing the trick.  She was an instant fan.  So, one day when I felt a cold coming on--in spite of using a neti pot to "nip it in the bud"--I headed over to CVS to give Alkalol a try.  OMG!  It's amazing.  It opened my sinuses, and it kicked any newbie cold germs right out of my nasal passages. In other words--the cold vanished.

It was developed by a Massachusetts pharmacist, James P. Whitters, back in 1896--and it's still family-owned by Whitters' grandson, James P. Whitters III.

It's made with methol, eucalyptus, thymol, camphor, and oils of wintergreen, spearmint, pine, and cinnamon.  Its "an alkaline saline solution specifically formulated to clean and moisturize the nasal passages, dissolve mucus, kill germs and bacteria, and provide natural relief from the symptoms of sinusitis and allergies."  You can even use Alkalol as a mouthwash or gargle.

You definitely need to dilute it with water--or you'll get the same strong sinus popping sensation you can get when you eat strong horseradish or wasabi.  I mix 1 ounce of Alkalol with 7 ounces of warm water, together with my neti pot mixture of 1/2 tsp. salt, and 1/4 tsp. of baking soda.  Click here for my neti pot/cold prevention post.  Click here to read more about Alkalol.

One last thing: I had to ask the 70-something pharmacist for Alkalol--it was behind the counter and he was the only one in the store who even knew what it was.  They keep a very small supply.  My friend had to have her pharmacist order a bottle--but it was there the next day.  I paid about $5.00 for a 16 ounce bottle.

Saturday Share Number Four:  My Book Club Smorgasbord Goes Healthy.  No Cheese.  No Cookies. No Brownies. No Soft Drinks.

My "Old" Unhealthy Book Club Smorgasbord

Feeding the 5 couples that make up this over-17-years-standing book club has always been a "piece of cake".  Just pick up some good cheese, hummus, baba ganoush, fruit, veggies, crackers, cookies, brownies, candy, nuts, sugar-free Fresca & Coke, and a bottle of wine.  Spread it all out on the island in my family room & Voila! Easiest entertaining you can imagine.

Last Saturday I decided that I couldn't feed this kind of junk to my friends any longer.  Enough already. 

This time I spread the family room island with strawberries, blackberries, clementines, crusty bread, healthy blue corn chips, "homemade" guacamole, salsa, Dr. Kracker Klassic 3 Seed Flatbreads, hummus, Trader Joe's Red Pepper Spread with Eggplant & Garlic, Trader Joe's Bruschetta, Trader Joe's Roasted Red Pepper & Artichoke Tapenade, miniature red, yellow, & orange sweet peppers, and as a concession to giving up the cookies,  I broke up bars of Trader Joe's Swiss 71% Dark Chocolate.

Instead of Fresca & Diet Coke, I had sparkling water with cut-up lemons & limes--and a great pinot noir called:  Cloudline.

No one complained a bit--they loved the spread (I think) and we ate almost everything up!

My Saturday Share Number Five:  Kathyrn Stockett's The Help.  When 10 men & women with diverse reading tastes all like a book--it's got to be good.

Rarely does everyone in my book club unanimously like a book.  We've got our distinct camps: those who like the dysfunctional family stories; those who like non-fiction--biographies, current events, science, history--and those who just want a "rattlin' good yarn".

This book filled the bill for all of us.  Who couldn't resist a novel set in 1962-64 pre-civil rights Jackson, Mississippi--with a story told from the perspective of the maids who work for the bridge-party Junior League set, raising & loving their children and keeping their family secrets?

It's was the time of Jim Crow laws--Medgar Evers' bullet-in-the-back assassination by the Ku Klux Klan--a time when a maid could go to jail on the accusation that she stole a piece of silverware from her employer--and a time when a young man could get his face bashed in if he used a toilet reserved for whites.

Lots to talk about.  And for me, this was one of the most enjoyable reads I've had in a year--and when I finished, I was reading through tears.

The book is more than a story of pre-civil rights Mississippi.  It's about taking risks to move forward--and change your life.  It's about strong friendship--how women support one another--and how it makes life's worst bearable.  It's about how we're unknowingly shaped by the culture and companions that surround us.  And it's about how easy it is to make assumptions about someone else's life--and be dead wrong.

"There is so much you don't know about a person. I wonder if I could've made her days a little bit easier, if I'd tried.  If I'd treated her a little nicer.  Wasn't that the point of the book?  For women to realize, We are just two people.  Not that much separates us.  Not nearly as much as I'd thought."

The Healthy Librarian's Brain Back-Up: Sugar Raises Triglycerides, Fat Damages the Brain, Marriage and Health, Tips From Integrative Medicine Physicians, Estrogen and the Brain

"Once You're Through Learning, You're Through"

-John Wooden, retired UCLA basketball coach, age 99-

If you received this via email Click Here to get the web-version of this post--with all the links.

OK, guys, bear with me.  I'm going to do something I rarely do--be brief.

I'm long on information and short on time.

If I don't blog now about some of the thought-provoking new articles I've read this week--and some recommendations from readers--they'll get pushed aside by the next new studies or articles to cross my path.

So here's what I've been reading this week:

It's Time to Ditch the Sugar Once and For All!  Sugar is Shown to Increase Triglycerides, Lower HDLs, and Increase the Risk of Metabolic Syndrome, Cardiovascular Disease, and Stroke.

We already know that excess sugar can pack on the pounds, put you at risk for type-2 diabetes, and cause blood sugar spikes that damage the brain--no I'm not making that last one up--click here for "that story".

But here's the "hot off the press" news just published today in JAMA  showing that sugar can raise triglycerides and lower HDLs, increasing our risk of heart disease and stroke.

The JAMA article is based on the latest analysis of data from the 1999-2006 National Health and Nutrition Examination Survey (NHANES)--and it backs up recent findings from the Framingham Heart Study. 

Bottom Line:  Increased sugar consumption promotes elevated triglycerides and lower HDLs--which are strong markers for metabolic syndrome and cardiovascular disease.  And if you want to know exactly why high triglycerides are so nasty read my earlier post: "Why You Might Want to Keep Your Triglycerides Under 80. Following the New AHA "Ditch the Sugar" Guidelines Will Help!"

And there's more bad news when it comes to high triglycerides--it increases the risk for strokes. "Bad News: High Triglycerides Are Linked to Stroke Risk. Good News: You Can Do Something About It!"

Being Fat Is Bad for the Brain--New York Times'  writer  & evolutionary biologist Olivia Judson has compiled the latest research on why belly fat is bad for the brain.  Click here for her article, Brain Damage in the April 21, 2010 New York Times.

• Belly fat at age 40 puts one at a higher risk for dementia in one's 70's--California study.
• Folks who were overweight in their 40's had a more rapid decline in their brain function as they aged--compared to their thinner counterparts.  Swedish study.
• A study of middle-age people (44-66 years old) found "that the obese tended to have smaller, more atrophied brains than thinner people."

Judson's well done piece continues with more studies, complete with journal citations, and she speculates as to the reasons why overweight people are at a greater risk for dementia--and more importantly--is it possible to turn the process around?   Seems fairly obvious to me--inflammation, elevated cholesterol, hypertension, type-2 diabetes all affect the blood vessels of the brain--as well as the heart.

To read more about the belly fat--brain connection click here and here.

Is Marriage Good For Your Health?  That All Depends.  But It Pays To Be Nice To Your Spouse!

Tara Parker-Pope's article, Is Marriage Good For Your Health, published in the April 18, 2010 New York Times Sunday Magazine is fascinating.  Click here for the article.

It's a worthy read, based on 30 years of stress/immune function research conducted by the Ohio State University duo, viral immunologist Dr. Ronald Glaser, and his wife, psychiatrist Dr. Janice Kiecolt-Glaser-- as well as researchers from the University of Chicago, the University of Utah, and the University of Virginia.

• Your marriage affects your immune system--for good or for ill.
• A good marriage brings health & well-being--with less chance of having pneumonia, surgery, cancer, and heart attacks.
• A troubled marriage, or a nasty divorce will adversely affect your immune system.
• If you're single and never married--you're apt to be healthier than those who have divorced.
• Any health advantage from marriage comes from the quality of the relationship--not the institution of marriage.

Here are some gems:

1. The Glasers conducted a fascinating experiment on married couples to measure how quickly their skin healed when their arms were subjected to eight tiny blisters--using a dermatologic blistering device.  After the procedure the couples were asked to talk for 30 minutes.  At one session they were asked to talk about subjects that evoked conflict and tension.  At another session they discussed topics that evoked pleasant, loving, supportive feelings.  The results were remarkable.  When couples argued it took a full day longer for the blisters to heal, than when they discussed something pleasant.  The couples who exhibited the highest hostility when they argued, took two full days longer to heal their blisters, than those who had less animosity.

2. "Kiecolt-Glaser told [Parker-Pope] that the overall health lesson to take away from the new wave of marriage-and-health literature is that couples should first work to repair a troubled relationship and learn to fight without hostility and derision.  But if staying married means living amid constant acrimony, from the point of view  of your health, 'you're better off out of it."

3. From Timothy W. Smith's research on couples who have been happily married for around 36 years:  Smith found the quality of one's marriage even affected coronary calcium scores. "The solution isn't to stop fighting.  It's to fight more thoughtfully.  Difficulties in marriage seem to be nearly universal.  Just try not to let the fights be any nastier than they need to be.  Saying, "Honey, you're driving me crazy!", a pat on the back or a squeeze of the hand, all signal affection in the midst of anger. "Most of the literature assumes that it's how bad the arguments get that drives the [negative health] effect, but it's actually the lack of affection that does it."

Advice from the Glasers based on 30 years of studying the effects of stress on health & marriage:

• Take time off together and make sure disagreements don't degenerate into personal attacks.
• Don't fight dirty.  Never go far enough down the road where you hurt each other.  Know enough to avoid those kind of arguments.
• Some level of stress is inevitable--even in the happiest of marriages.  So use those moments of stress as an opportunity to repair the relationship--rather than damage it.
• An on-going disagreement is so uncomfortable.  "It's a pit-in-your-stomach kind of thing.  But when your marital relationship is the key relationship in your life, a disagreement is really a signal to try to fix something."

Advice from Six Top Minnesota Physicians Who Practice Integrative Medicine.

A big "Thank You" to the Minnesota reader who sent me this Minnesota Monthly article, Heal Thyself, by Sarah Moran, that appears in the magazine's May 2010 issue.   Click here to read the sage advice of these six physicians.

"People are clamoring for--doctors who uncover the root cause of illness instead of just treating or masking the symptoms--physicians who take body, mind, and spirit into account and look carefully at the influence of lifestyle habits like diet, activity, and rest."

Dr. Thomas Sult on Digestive Health:

• For digestive health eat whole foods. Unprocessed fruits, vegetables, nuts, seeds, lean protein, and whole grains result in more probiotics, the "good" bacteria in your gut that detoxifies, improves immune function, and aids digestion.
• Choose foods with soluble fiber, like shallots, bok choy, chicory, garlic, and onions.  They encourage growth of good bacteria.
• Eat fermented foods regularly.  Make or find live fermented vegetables, sauerkraut, kefir, kimchi, and miso, which breed probiotics.

Dr. Carolyn Torkelson on Breast Cancer Prevention:

• Maintain a healthy weight.  There's a connection between obesity and breast cancer.  Estrogen production in fatty tissue may be to blame.
• Reduce omega-6 fatty acids, found in fast food, and polyunsaturated vegetable oils, and increase omega-3 fatty acids, found in cold-water fish.  Consider daily supplements of 1-2 grams of fish oil.
• Ask your doctor to check your vitamin D level.  There may be a relationship between low levels and breast-cancer risk.
• Drink green tea.  Its antioxidant properties may decrease risk.

Dr. Henry Emmons on Dealing With Depression and Anxiety:

• Exercise. Mild aerobic exercise quells anxiety.  Vigorous aerobic exercise reduces sluggishness.
• Take a daily B vitamin complex, 2,000 mg of an Omega-3 fatty acid supplement, and 2,000-4,000 IUs of vitamin D
• Calm your mind with meditation, breathing, and yoga practice.
• Develop close, meaningful relationships.
• Eat healthy foods.  Learn your Ayurvedic type to further tailor your diet.

Check out the entire article--it's a quick worthwhile read!

Hormone Replacement and the Post-Menopausal Brain.  Why Timing Is Everything!  Here's Hoping.

Don't miss Cynthia Gorney's balanced ground-breaking article, The Estrogen Dilemma, that appeared in the Sunday April 18, 2010 New York Times Magazine.  Click here for the article.

Millions of women either stopped taking hormones--or decided not to start them after the Women's Health Initiative was abruptly ended in 2002.  Too bad it was studying the wrong kind of hormone replacement--estrogen from the urine of pregnant mares--and a synthetic progestin--Wyeth's Premarin and Prempro.

Gorney does an excellent job of explaining why the W.H.I. didn't end up telling us what we really need to know about the benefits of hormone replacement--or how estrogen can benefit the post-menopausal brain when hormone replacement is started at the right time--within a small window of time--when a women is in her fifties.  But timing seems to be everything.  And the hormone replacement needs to be the bio-identical kind--estradiol and natural progesterone.

"That’s why University of Southern California brain scientist Roberta Diaz Brinton says that the timing hypothesis — the proposition that estrogen could bring great benefit to a woman who starts it in her 50s while having the reverse effect on a woman 10 years older — makes sense even though it is still experimental.

She and other scientists know there are ways estrogen improves and protects the brain when it is added to healthy tissue. It makes new cells grow. It increases what’s called “plasticity,” the brain’s ability to change and respond to stimulation. It builds up the density and number of dendritic spines, the barbs that stick out along the long tails of brain cells, like thorns on a blackberry stem, and hook up with other neurons to transmit information back and forth. (The thinning of those spines is a classic sign of Alzheimer’s.)

But when estrogen hits cells that are already sick — because they’re dying off as part of the natural aging process or because they’ve been damaged by beta amyloid — something else seems to happen. Dropped in as a new agent, like the wrong kind of chemical solvent sloshed onto rusting metal, estrogen doesn’t strengthen or repair. It appears useless.

Sometimes it sets off discernible harm. You may recall additional W.H.I. news a few years ago about hormones increasing the risk for aging-related dementia; those stories emerged from a subgroup of W.H.I. participants who were all at least 65 when they started the hormones. There are arguments about that data, like nearly everything else connected to the W.H.I., but the age factor alone reinforces what Brinton and other timing-hypothesis researchers observe in the labs when they give estrogen to ailing cells.

“It’s like the estrogen is egging on the negative now, rather than the positive,” she said.

“We know that if you give neurons estrogen, and then expose them to beta amyloid, many more will survive. But when we expose them to amyloid and then give them estrogen — now you don’t have survival of the neurons. In some instances, you can actually exacerbate their death.”

And since once again it will be years before we get to the bottom of the estrogen dilemma--and find out if the combination of right timing and taking natural hormones at ever-decreasing doses as one ages--is a wise decision--Gorney leaves us with this to consider:

"Every midlife woman I know keeps redrawing for herself the defensible lines of intervention in the “natural” sequence of human aging.

Obsessive multiple plastic surgeries are silly and desperate. Muscles kept in good working order are not.

Where on that spectrum is a hormones-saturated pharmaceutical patch? What if the timing hypothesis is even partly right?

Suppose all we learn about replacement estrogen, in the end, is that if it’s started early enough it might protect the heart and the brain, and that its chemistry makes some of us feel more the way we did at 40 than the way our mothers did at 65?  Not an elixir of youth. More like . . . reading glasses."

Certainly something to think about!

To read more about the estrogen debate check out:  "Is It Time to Reconsider Hormone Replacement Therapy? Winnifred Cutler's "Hormones and Your Health: The Smart Woman's Guide to Hormonal and Alternative Therapies for Menopause"

There are even more excellent reads in the April 18, 2010 New York Times Magazine "The Science of Living a Healthy Life"

Consider taking a look at:

Weighing the Evidence of Exercise--Does working out really help your lose weight--or keep it off?

Dr. Does-It-All: He publishes books, writes for magazines and newspapers, hosts TV & radio shows nd still performs surgery every Thursday.  How Mehmet Oz became America's doctor.

Oops!  I did it again.  Thought I'd knock this off in one hour.  Not even close.  Sorry!

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!!!!

To Improve Your Brain and Sharpen Your Memory - Try Blueberry Juice Twice a Day and Start Learning Something New

"These preliminary memory findings are encouraging and suggest that consistent supplementation with blueberries may offer an approach to forestall or mitigate neurodegeneration."

-Robert Krikorian, PhD, University of Cincinnati Academic Health Center, lead author of "Blueberry Supplementation Improves Memory in Older Adults" J Agric Food Chem 2010.

"We now know that exercise activity in animals generate and sustain more brain cells, and we have many studies confirming that humans who lead mentally active lives have better brain function.  But, not all activities are equal in this regard.  Those that involve genuine concentration--challenging mental activities will increase the likelihood that hippocampal neurons will survive."

-Dr. Norman Doidge, "The Brain That Changes Itself.  Stories of Personal Triumph from the Frontiers of Brain Science"

If you are reading this from your email, click here to go to the web post with all the links.

Back in August I wrote a post about the many virtues of blueberries, and discussed Dr. Robert Krikorian's promising  "not-yet-published" study on the positive effects of blueberry juice on memory.  Click here

• Berry protection for the brain in animal studies. Rats who feasted on blueberries and strawberries were able to protect their brains when they were irradiated to simulate the kind of cognitive & memory damage the brain sustains through normal aging.  The interesting point:  the blueberries and strawberries actually protected different parts of the brain--so diversify your berry munching.
• Blueberries & humans.  Once more, Dr. Robert Krikorian is the man doing the research on people.  He has recently shown that a number of learning and memory skills improve when humans supplement with blueberry juice.  He's planning to also assess the effects of blueberries on behavioral skills.

In January 2010, Robert Krikorian's blueberry and memory study was published online ahead-of-print and I just had a chance to read through it yesterday.  You'll find it in the Journal of Agricultural and Food Chemistry  DOI:10/1021/jf9029332

Why it's a big deal?  It is the first human trial to look at the effects of blueberry supplementation on memory. 

Who was in the study?  This was a small study--it compared nine older adults against a control group of seven, whose average age was 76,  and who had age-related memory decline, like forgetfulness and memory lapses, that put them at risk for dementia.

What kind of blueberry supplement did they take & for how long?  For 12 weeks the trial group drank from 2 to 2 1/2 cups of wild blueberry juice--the amount was based on their body weight.  During the test period everyone had to avoid any additional berries, cherries, grapes, pomegranates, grape juice, or wine to make sure that only blueberry juice was affecting the results.

How were their memories tested?  All the participants took  pre and post tests that measured their memory function--the Verbal Paired Associate Learning Test (V-PAL) and the California Verbal Learning Test (CVLT).  Both tests are good measures of progressive neurodegeneration and are sensitive to both age-related memory changes, as well as early and more advanced Alzheimer's disease.

So, how did the blueberry juice folks do compared to the fake blueberry juice folks?  Turns out that the blueberry juice definitely improved their memories.  There was significant improvement in the post test of the blueberry juice drinkers, and at the end of the 12-weeks, the blueberry juice group tested significantly better against the placebo group.  After 12 weeks the blueberry group's  V-PAL cumulative learning test scores went from 9.3 points to 13.2 points.  The scores on their CVLT word list recall improved from 7.2 points to 9.6 points. 

Memory wasn't the only thing that improved with the blueberry juice.  The researchers also did pre and post tests on depression and fasting glucose levels.  After 12 weeks the blueberry juice drinkers had notable reductions in their depression symptom scores, and their fasting glucose levels were reduced. 

Both of these changes further support the neurocognitive benefit of blueberry juice.  It turns out that the anthocyanins (the polyphenols in blueberries) are not only anti-inflammatory, but they help to "get rid of" excess glucose, which is known to damage the brain--and just might be one of the reasons that blueberries help to improve memory.

How do blueberries benefit the brain?  They contain polyphenolic compounds, most prominently anthocyanins, that have antioxidant and anti-inflammatory properties.  Anthocyanins are known to increase the signaling between neurons in the brain, improve memory function and slow down neurodegeneration.

What happens next?  This was just a first step.  It's a small study, but the results were encouraging and suggest that consistent supplementation with blueberries may offer an approach to prevent or slow down neurodegeneration.    As every researcher says at the end of their articles--"Replication of the findings in a larger, controlled trial will be important to corroborate and amplify these data."  Stay tuned.

What am I going to do?  When I was at Trader Joe's on Sunday, instead of picking up my usual pomegranate juice for my green smoothies, I decided to try a bottle of their Just Blueberry Unfiltered 100% Juice.  It's not made from wild blueberries, but what the heck.  I think I may also start throwing in some of the Wyler's Frozen Wild Blueberries into my smoothies as well--alternating with TJ's Frozen Black Raspberries.  A memory is a terrible thing to lose!

Brain Plasticity in Older Adults.  Why We Need to Continue to Learn New Things

One of the perks of my job is that I get to see what all the top researchers are reading.  A few weeks back one particularly interesting book crossed my desk, "The Brain That Changes Itself.  Stories of Personal Triumph from the Frontiers of Brain Science,"  by Dr. Norman Doidge. The book is about neuroplasticity--  how our brains are not static, but can change and improve, even as we age.  Much of this research is credited to Dr. Michael Merzenich who has pioneered computer-learning activities for children, and has recently developed memory-training programs for adults.  Click here to learn more.

Writing this blog has given me a chance to take time out to study, learn, and concentrate on new areas of research--and to understand it well enough to be able to write about it.  Without undergoing any "brain testing" I can tell you that my learning skills and memory have definitely sharpened and improved through blogging.  I'm now a believer in neuroplasticity.

So, in light of my 2 year blogging experience, I was really struck when I read this quote by Merzenich in Doidge's book:

Merzenich:"We have an intense period of learning in childhood.  Every day is a day of new stuff.  And then, in our early employment, we are intensely engaged in learning and acquiring new skills and abilities.  And more and more as we progress in life we are operating as users of mastered skills and abilities."

Doidge: "Psychologically, middle age is often an appealing time because, all else being equal, it can be a relatively placid period compared with what has come before.  Our bodies aren't changing as they did in adolescence; we're more likely to have a solid sense of who we are and be skilled at a career.  We still regard ourselves as active, but we have a tendency to deceive ourselves into thinking that we are learning as we were before.

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."

So, yes, maybe go ahead and add blueberry juice to your daily diet, but better yet, find something that's really interesting to you and start learning all about it--even though there won't be a test on it in 2 weeks!

From the Archives of Internal Medicine--Seven Good Reasons to Exercise and Increase Your Chances For Healthy Aging

Exercising Ladies in their Eighties

Weight Machine Workout for Muscles and the Mind

"Exercise is better than any drug or anything else we have for aging.  There's no downside.  If this were a drug, it would be the safest, most effective drug in the universe."

Dr. James O. Hill, Director of the Center for Human Nutrition at the University of Colorado at Denver

Seven articles--count them!  All in the January 25, 2010 issue of the Archives of Internal Medicine.  

All of them saying the same thing, "Exercise works. Just do it.  Whatever your age.  Start now!"  click here for the Table of Contents.

I must be an exercise geek, because honestly, I find this kind of news exciting, encouraging, and hopeful.  It shows how we really can change our health.  Sure diet is an important partner in health--but exercise has a dual, and synergistic role in the equation.

Why Exercise?  What We Can Learn from Six New Studies & One Editorial?

• Weight-lifting improves the brain. "Resistance Training and Executive Functions,"  Liu-Ambrose, Teresa et al, University of British Columbia.   The Study: Women aged 65-75 who spent 1-2 hours a week on progressive strength/resistance training with dumbbells and weight machines significantly improved their cognitive function after 12 months.  They improved their performance by 10.9-12.6% on the most important brain function: executive ability.  They saw improvements in their decision making, their ability to resolve conflicts, and they were better able to focus on subjects without becoming distracted by competing stimuli.  But alas, no improvements were seen in 2 skills: keeping numbers in their working memory, and shifting from one task to another. The strength training group's skills were measured against a control group who only did balance & toning exercises.  As for the balance and toning group--their scores on executive ability deteriorated by .05%.  The added bonuses found in strength-training?  It counteracts the inevitable muscle loss of aging while improving bone density and strength.  The Canadian group also improved their walking speed--which is a predictor of substantial reduction in mortality.  Big Point: The cognitive benefit showed up after 12 months of training--but not after 6 months.  Those who lifted weights 2 x a week experienced less muscle discomfort than those who lifted only once a week.  No surprise!  Take Away Message: Add strength-training to your exercise routine.  2 or 3 times a week is best.

•  Start exercising at middle-age if you want to stay healthier as you age.  "Physical Activity at Midlife in Relation to Successful Survival in Women at Age 70 Years or Older,"  Sun, Qi et al, Harvard School of Public Health and Harvard Medical School.  Click here for the article.  Harvard researchers looked at the health of over 13,000 women from the well-known Nurses' Health Study who had reached 70 years of age without any physical or mental impairment. Those who had higher levels of physical activity beginning at midlife were less likely to have chronic diseases, heart surgery or any physical, cognitive or mental impairments as they aged.  Take note: regular moderate-intensity (not wimpy) midlife physical activity made all the difference in the world to one's health after age seventy! Those who regularly walked at a moderate pace starting from midlife had a better chance of exceptional health than those who walked at an easy leisurely pace.  Picking up the pace made a huge difference in health--the fastest walkers significantly increased their odds of successful aging over the lollygaggers!  And don't despair, moderate walking improved later-life health in both lean and overweight women.  But those who kept their weight down (BMI range of 18.5-22.9) and exercised more vigorously than moderate walking improved their odds the most. 

Understanding METS.   For women, these are the METS for 1 hour of activity: 12 for running, 8 for stair-climbing; 7 for jogging; bicycling; lap swimming; and playing tennis; 6 aerobics or calisthenics; 2.5 to 4.5 for walking, depending on the pace--easy (<2 mph) normal (2-2.9 mph) brisk (3-3.9 mph) very brisk (4 mph or more)  To get over 15 METS a week you would need to walk 3.5 hrs./week at 4 mph or more.  Example: 30 METS=2.5 hrs of running; 30 METS=6.6 hrs of walking at a pace of 4 mph or more

• Exercise for stronger bones, a better heart, less chance of falls, and to decrease your health care costs. "Exercise Effects on Bone Mineral Density, Falls, Coronary Risk Factors, and Health Care Costs in Older Women-the Randomized Controlled Senior Fitness and Prevention (SEFIP) Study," Kemmler, Wolfgang et al, the Friedrich-Alexander University of Erlangen Nuremberg, Germany. 

"Contrary to pharmaceutical agents, which are typically dedicated to specific diseases, physical exercise affects a variety of risk factors and diseases and therefore plays a vital role in general disease prevention and treatment of the elderly."

In this randomized single-blinded controlled German study, 227 women over age 65 participated in an either an 18 month group exercise program, or in a wellness program (the control group).  The exercise program included 2 60-minute group exercise classes, and 2 20-minute at-home sessions--including aerobic exercise at 70%-85% maximum heart rate, balance training, isometric floor strength training for the lower body, stretching, and upper body thera-band strength training.  The wellness group participated in low-intensity exercise,walking at 50%-60% maximum heart rate, very low-moderate intensity strength training, and progressive relaxation exercises.  Results: Compared to the wellness group, the exercise group significantly improved their bone mineral density in both the lumbar spine & hip; their fall risk decreased with a 50% lower fracture incidence; and both groups (wellness & exercise) significantly reduced their 10-year coronary heart disease risk, mainly because both groups lowered their blood pressure.  Interesting Finding: Participation and adherence was much better in the group exercise classes than with the home exercise component.  Not a surprise to me at all.  I prefer group exercise, hands-down.  Take Away Point:  Even starting after age 65, exercise has a tremendous impact on one's health--and strength training definitely improves bone density.

• Moderate physical exercise reduces the risk of cognitive impairment. "Physical Activity and Incident Cognitive Impairment in Elderly Persons. The INVADE Study,"  Etgen, Thorleif et al, Technische Universitat Munchen, Germany.  This study followed a large group of Bavarians (3,903) age 55 and older for two years.  At the end of the period they compared the incidence of cognitive impairment in the group with their levels of physical activity. The researchers adjusted for all the usual vascular risk factors that might contribute to cognitive impairment.  The Results:  Moderate or high physical activity was associated with a reduced incidence of cognitive impairment after the 2 year follow-up.  For those with no physical activity the incidence of cognitive impairment was 13.9%.  In those with moderate physical activity (less than 3 x a week) the incidence of impairment was 6.7%.  The high physical activity (greater or equal to 3 x a week) seniors had a 5.1% incidence of impairment.  Take Away Point: Exercise can the lower the risk of cognitive impairment--and the more days the better!

• Even in a nursing home exercise can improve the quality of life--but not by that much. "Effects of Exercise Programs to Prevent Decline in Health-Related Quality of Life in Highly Deconditioned Institutionalized Elderly Persons," Dechamps, Arnaud et al, Universite Victor Segalen, Bordeaux, France.  This study included 160 institutionalized out-of-shape elderly (average age of 82) who were still able to understand basic motor instructions & who could move from one position to another.  They were divided into 3 groups: adapted tai chi for 30 minute sessions 3x a week; a cognitive action program which is a type of exercise that is related to everyday actions--from 30-40 minutes 2x a week; and a control group which had no exercise program.  Results:  After 12 months, the non-exercising control group experienced a greater decline in the activities of daily living than the exercisers.  Those in the  exercise programs slowed their health quality decline, however, the improvements experienced by the elderly exercisers weren't considered clinically significant.  Bottom Line:  Although exercise programs in nursing homes can slow down health decline, expecting actual physical improvements may be too much to ask. Don't wait until your eighties to start that exercise program.  You will have a much better shot if you start young--or at middle-age.

• Add exercise and weight loss to the DASH Diet and you will see even greater improvements in blood pressure. "Effects of the DASH Diet Alone and in Combination with Exercise and Weight Loss on Blood Pressure and Cardiovascular Biomarkers in Men and Women with High Blood Pressure," Blumenthal, James et al, Duke University Medical School, North Carolina.  The DASH Diet emphasizes moderate calorie, low fat, low sodium, whole grain foods, along with 6-12 servings of fruits & vegetables a day.  Click here to learn more. The Study: 144 participants with an average age of 52, with an average blood pressure of 138/86 mm Hg, and not on any BP medication were enrolled in the study, and divided into 3 groups: 1. DASH Diet alone with counseling, 2. DASH Diet with a behavioral weight loss program & a supervised exercise program 3x a week at a level of 70%-85% heart rate, or 3. The  "usual diet control" group.  The study lasted 4 months.  Results: The DASH diet + weight loss & exercise group did the best, of course.  Their blood pressure was reduced by 16.1/9.9 mm HG.  Those on the DASH diet alone reduced their blood pressure by 11.2/7.5 mm HG, and those in the  "usual diet control group dropped theirs by only 3.4/3/8 mm Hg. Weight loss: The DASH Diet + exercise & weight management group lost an average of 19.1 pounds.  The DASH Diet alone group lost .7  of a pound.  The "usual diet group" gained 2 pounds.  Cardiovascular Markers:  The DASH Diet + exercise  weight loss group had the greatest improvements in this area-- including less arterial stiffness as measured by pulse wave velocity, an average of 19% improvement in their aerobic capacity (VO2 max), improved baroreflex sensitivity of 33% (less stiffness in the arteries--which is an early side effect of hypertension), and decreases in the size of the left ventricle--a side effect of high blood pressure (increases in the muscle tissue that makes up the wall of the heart's main pumping chamber-the left ventricle).  TAKE AWAY POINT:  The DASH Diet (high in fruits & vegetables, low in salt) + weight loss + exercise is the best combination to lower blood pressure and improve cardiovascular risk factors.

• Exercise--the most effective prescription out there.  It's the best "drug" available to prevent dementia and insure successful aging.  "Evidence Regarding the Benefits of Physical Exercise,"  Drs. Jeff Williamson & Marco Pahor, Institute on Aging, University of Florida.  This editorial in the Archives of Internal Medicine highlights the benefits of exercise on successful healthy aging.

"It is now well established that higher quantities of physical activity have beneficial effects on numerous age-related conditions such as osteoarthritis, falls and hip fracture, cardiovascular disease, respiratory diseases, cancer, diabetes mellitus, osteoporosis, low fitness and obesity, and decreased functional capacity, all conditions that greatly increase the risk of reduced independence in late life. 

Two of these studies (in the Archives of Internal Medicine) evaluated the relationship between physical exercise and decline in cognitive function, a major contributor to loss of independence and related institutionalization in elderly individuals.

Optimism in this area is sorely needed owing to the failure of promising interventions aimed at preventing cognitive decline and dementia in the recent past.

Physical inactivity is one of the strongest predictors of unsuccessful aging for older adults and is perhaps the root cause of many unnecessary and premature admissions to long-term care."

The Healthy Librarian's Brain Back-Up on a Better Brain: Midlife Cholesterol, Belly Fat, Grape Juice, Berries, Blood Sugar, Naps, and Better Sleep

Once You're Through Learning, You're Through"

-John Wooden, retired UCLA basketball coach, 98 years old-

My piles of interesting health-related articles for my blog have been growing exponentially this crazy busy summer. Now it's time to either blog about it--or dump the piles in the recycle bin. 

This time I'm zeroing in on the brain--how to keep it going for as long as possible.  Here's my brain prescription based on my piles of files:

• Make sure your cholesterol numbers are down earlier than your 40's--or you risk both vascular dementia or Alzheimer's.
• Keep that waist whittled when you're middle-aged.  Banish the belly fat.  Weight in your middle during middle-age ups your dementia risk.
• Bring on the berries and the Concord grapes to protect your brain through old age.  Research shows both protective benefits from aging, and improvements in learning and motor skills.
• Keep your blood sugar stable (even if you're healthy) by exercising and eating high-fiber low-glycemic foods like beans, nuts, oatmeal, and quinoa.  Blood sugar spikes damage the memory center of the brain.
• Indulge in a mid-day nap of at least 1 hour.  Mid-day REM sleep enhances problem-solving.
• For the best sleep, keep your bedroom cool.

Dementia Risk is Linked to Even Slightly High Levels of Cholesterol at Midlife

I was all ears when I read this study.  As far as I'm concerned--it's all about protecting the brain as we age, trumping heart disease and cancer.  This study out of California underscores the advice we've been hearing for years:  If it's good for the heart--it's good for the brain.

Alzheimer's Disease gets all the attention, but tiny silent strokes diminish the blood supply to the brain resulting in a slow progression of vascular dementia.  Both diseases are years in the making.  Too bad we wait until it shows its ugly face in our 70's or 80's before we scramble to do something about it. 

Finally, we have a large study of almost 10,000 multi-ethnic participants who were followed for almost 40 years through Kaiser Permanente in California to provide epidemiologic evidence that even modest increases in cholesterol at midlife result in a substantially increased risk of dementia 20 to 40 years down the road.

Bottom line:  Those with blood cholesterol levels over 240 in their mid-40's were 57% more likely to develop dementia than those who were at optimal levels.  Even borderline cholesterol levels between 200 and 239 were at a 50% greater risk of developing dementia.

If you don't take statins--or if you don't want to take statins--now you have one more good reason to consider a plant-based diet to prevent both heart disease and dementia is one fell swoop.  The cholesterol drops are considerable with a plant-based diet.  "Yes, You Can Prevent and Reverse Heart Disease, But Are You Up for the Challenge?  Let, Dr. Esselstyn Convince You!"

Source:  Whitmer, RA, Solomon, A. et al.  "Midlife Serum Cholesterol and Increased Risk of Alzheimer's and Vascular Dementia Three Decades Later,"  Dementia and Geriatric Cognitive Disorders; 2009 Aug. 4;28:75-80.

Read more about the study here.

 Rachel Whitmer--Kaiser Permanente's Dementia Guru.  A Fat Belly at Midlife Increases the Risk of Dementia

Bells went off when I read about the Kaiser cholesterol-dementia-midlife study.  Rachel Whitmer--the senior epidemiologist--sounded so familiar.  Where had I heard that name before?

Sure enough, Dr. Rachel Whitmer, who was the chief investigator in the cholesterol study, was also involved in a 2008 study linking excess belly fat to dementia.  I wrote about it in April 2008.  It bears repeating.

Belly Fat & the Dementia Connection.  Rachel Whitmer, a research scientist at Kaiser Permanente in Oakland, California, reported in the March 26 2008 online issue of Neurology on her study that followed 6,583 Kaiser Health Plan members.  The study began in the late 1960s and early 1970s and measured the abdominal fat of this large group of 40 and 45 year olds.  She followed up with them between 1994 and 2006 when they had reached their 70s and beyond.

Back in 2005 Whitmer had previously reported that senior citizens who were overweight at middle age were 74 percent more likely to develop dementia.  This new study specifically looked at whether belly fat was the culprit.

• Those people who were obese and had the most belly fat in their 40s were 3.6 times more likely to develop dementia than those with the least amount of belly fat.
• Those who were overweight--a step below obese--and had large bellies in their 40s, were 2.3 times more likely to develop dementia.
• 21 percent of those with high levels of belly fat developed dementia.
• The belly fat dementia connection persisted, even when researchers adjusted their statistics to take into account the effect of stroke & diabetes.
• Other recent studies found that obese middle-aged adults have decreased brain volume compared with those of normal weight, decreased hippocampal (the memory center) brain volume and greater brain atrophy. These findings imply that the harmful effects of belly fat on the brain may start long before clinical signs of dementia appear and are not limited only to those whom are overweight.  Rather chilling, I'd say!
  

Waist circumference guidelines:

Women-Keep it at 30 inches or under

Waist of over 31 inches (about 80cm) indicates slight health risk.
Waist of over 35 inches (about 90cm) indicates substantially increased risk.

Men-Keep it at 36 inches or under

Waist of over 37 inches (about 94cm) indicates slight health risk.
Waist of over 40 inches (about 102cm) indicates substantially increased risk.

Read more:  This Belly Fat Is Going to Be the Death of Me and Now I Understand Why.

Source: Whitmer, R. et al.  "Central obesity and increased risk of dementia more than three decades later,"  Neurology; 2008 Sep 30;71(14):1057-64. Epub 2008 Mar 26

Read more of Rachel Whitmer's articles on the relationship between dementia & cholesterol, body fat, type 2 diabetes, and exercise.

It's Grape Juice and Berries to Improve the Aging Brain

James A. Joseph is the Director of the Neuroscience Lab at the Jean Mayer Human Nutrition Research Center on Aging at Tufts University in Boston.  He is THE expert in the health effects of berries & grapes.  Check out some of his research projects, here.  I had heard him speak on brain nutrition on a People's Pharmacy podcast back in April 2009.  Click here to hear it.

So, when my friend Anna told me he had a "just published" review article in The Journal of Nutrition called "Grape Juice, Berries, and Walnuts Affect Brain Aging and Behavior",  I couldn't wait to get my hands on it.

Yes, we all know that berries & grapes are full of potent antioxidants and anti-inflammatory properties that both protect & enhance the brain--at least in lab rats--but does this research translate to humans?

Joseph's own lab studies have suggested that blueberries, strawberries, walnuts and Concord grape juice can decrease the damaging oxidative stress and inflammation in the aging brain, as well as improve the ability of neurons to communicate with each other--faster thought processing and word retrieval.  In this hot-off-the-press article he reviews the extensive brain-berry-grape research.

In a "walnut" shell, here's the real exciting news:

• Concord grapes & humans. Dr. Robert Krikorian of the University of Cincinnati  "has shown that older adults with memory declines, but not dementia, had significant improvements in several measures of cognitive function when supplemented with 12 ounces of Concord grape juice a day  for 12 weeks compared with the placebo.
• Berries and grapes in animal studies. Rats enhanced their cognitive, spatial, and motor skills when their diets were supplemented with strawberries, blackberries, and Concord grapes.  There's evidence that supplementation even reversed age-related cognitive dysfunction, as well as improving balance and coordination.  Stay tuned to see how well this translates to humans. 
• Berry protection for the brain in animal studies. Rats who feasted on blueberries and strawberries were able to protect their brains when they were irradiated to simulate the kind of cognitive & memory damage the brain sustains through normal aging.  The interesting point:  the blueberries and strawberries actually protected different parts of the brain--so diversify your berry munching.
• Blueberries & humans.  Once more, Dr. Robert Krikorian is the man doing the research on people.  He has recently shown that a number of learning and memory skills improve when humans supplement with blueberry juice.  He's planning to also assess the effects of blueberries on behavioral skills.
• Berries & grapes may increase the "health span" (better than "life span") by reversing the damaging effects of aging on cognitive and motor behavior.  According to Joseph, if you are waiting for a molecular biologist to come up with a magic pill to protect you against the diseases of aging you'll be waiting a long time.  His advice:  eat a diet high in anti-oxidant rich berries, fruits & vegetables, get plenty of exercise, and exercise your brain by staying engaged & challenged throughout life!

Source:  Joseph, JA et al, "Grape Juice, Berries, and Walnuts Affect Brain Aging and Behavior," The Journal of Nutrition first published ahead of print July 29, 2009 as doi:10.3945/jn.109.108266.

Keep Your Blood Sugar Stable--Even Moderate Spikes Are Responsible for Memory Decline

The damaging effects of spiking blood sugar just may be one of the reasons for the widespread memory declines we see as we age.  Turns out that up & down blood sugar damages the "dentate gyrus", which is within the hippocampus--the part of the brain responsible for forming memories.

Using a high-resolution functional MRI to map the brain regions of 240 elderly subjects, the Columbia University researchers (lead by Dr. Scott Small) found that when blood sugar (glucose) was elevated, the cerebral blood flow in the brain's memory center was reduced.

Then, the researchers cleverly played with the blood sugar levels of mice & monkeys to confirm this association between rising blood sugar & damage to the dentate gyrus.

The disturbing part of the study is that even slight elevations of blood sugar--less than those seen in type-2 diabetes can cause memory decline.  Because blood sugar tends to rise as we age--even in healthy people--this study is a wake-up call to take steps to keep the blood sugar stable.

Earlier studies have shown a link between type-2 diabetes & damage to the "dentate gyrus", but this study demonstrated the hippocampal damage in people who are other-wise healthy.

What's the antidote for keeping a stable blood sugar and protecting the brain? 

"This is news even for people without diabetes since blood glucose levels tend to rise as we grow older. Whether through physical exercise, diet or drugs, our research suggests that improving glucose metabolism could help some of us avert the cognitive slide that occurs in many of us as we age," reported lead investigator Scott A. Small, M.D., associate professor of neurology in the Sergievsky Center and in the Taub Institute for Research on Alzheimer's Disease and the Aging Brain at Columbia University Medical Center.

Exercise.  Regular physical activity has been shown to offset the damaging effects of type-2 diabetes on cognitive function.  Because exercise improves the ability of muscles to process glucose, it makes sense that it helps protect cognitive function as we age, according to Small.

Low-Glycemic Diet.  Eat high fiber low-glycemic foods like beans, nuts, oats, and quinoa.  Dr. David Jenkins' study found that low-glycemic foods were superior to even whole grains, like whole-wheat bread and brown rice when it comes to keeping the blood sugar stable.  And processed foods should definitely be avoided.

The University of Sydney maintains a Low-Glycemic website and database with a wealth of excellent information on the subject.  Take a look at their FAQs if you want to learn more.  Click here.

Sources:  Jenkins, DJ et al, "Effect of a low-glycemic index or a high-cereal fiber diet on type-2 diabetes: a randomized trial,"  JAMA 2008 Dec. 17; 300(23):2743-53.

Small, SA et al, "The brain in the age of old; the hippocampal formation is targeted differenially by diseases of late life,"  Ann Neurol 2008 Dec;64(6):698-706.

Do Your Brain a Favor--Take An Afternoon Nap

This is my kind of study--the benefits of napping.  As far as I'm concerned, naps are revitalizing and reading Dr. Sara Mednick's nap study that was published June 8th in the Proceedings of the National Academy of Sciences made my day.

Here's the scoop:  The right kind of nap--one that is long enough to include dreaming (REM sleep) will enhance creative problem-solving and "foster the formation of associative networks in the brain."   REM sleep directly enhances creative processing  more than any other sleep or wake state and it helps the brain to make new and useful associations between unrelated ideas.

Mednick found that a nap with REM dreaming improved creative task performance by almost 40% over quiet rest or non-REM sleep. 

The catch:  to have REM sleep, your nap will need to last at least an 1 hour long.

"Dreams are fanciful.  They incorporate strange ideas that you would never have put together in waking life.  In REM sleep, it becomes more likely that ideas might come together in a solution,"  according to Dr. Mednick.

Source: Mednick, SA et al.  "REM, not incubation, improves creativity by priming associative networks,"  Proc Natl Acad Sci U S A. 2009 Jun 23;106(25):10130-4. Epub 2009 Jun 8. 

For the Press Release, click here.

Check out Dr. Mednick's 2007 book, "Take a Nap! Change Your Life"  I really enjoyed this reviewer's comment:

"This book has made a big impact on how I view my study time. Medical school is difficult and exhausting. If I attend all my lectures, eat three meals day, maintain good hygiene, commute to/from the university and get 7 hours of sleep, I only have 3 hours on the weekdays to study. I used to hardly be able to keep my eyes open during that study time and I couldn't remember anything I studied.

After reading Take a Nap! Change your life, I have the skills to use napping as part of my study routine. I used to feel guilty when I napped because I thought I was wasting valuable study time. I was just too tired to study. Now I plan naps into my study schedule and it is amazing how much better I recall everything. My test scores in Pathology have improved an average of 8 points since I started napping and my scores keep improving despite no other changes to my study routine. If you subtract out my naps, I'm actually studying less but getting better grades! As I prepare for my USMLE Step 1 Board Exam, consolidating memories and enhancing recall is especially important. I now consider napping a study skill and regular naps are part of my board prep study schedule. Naps have truly changed my life."

For a Good Night's Sleep--Keep the Room Cool

If I want to feel and think my best I need a good night's sleep.  In the winter we lower our heat to 55 degrees and I sleep great.  But come the summer--and even with the air-conditioning on--our bedroom temperature often climbs to over 82 degrees and my sleep starts slumping.

Check out Anahad O'Connor's August 3rd piece in the New York Times, "Really?  The Claim: Cold Temperatures Improve Sleep"

"Studies have found that in general, the optimal temperature for sleep is quite cool, around 60 to 68 degrees Fahrenheit."

Bingo!  As of 2 weeks ago, my husband and I came up with a solution.  We purchased an easy-to-use-portable-on-wheels room air conditioner with enough BTUs to cool our bedroom down to a comfortable 73 degrees.  Now we can turn off the useless-at-night whole house air conditioner and enjoy a peaceful sleep--and hopefully conserve on fuel costs.

The added bonus:  it has just enough white noise to block out the morning shower and kitchen sounds of the early risers in our house.

BMJ Online: Dr. Jeremy Brown's Simple New Test Screens For Early Alzheimer's and Dementia

A new test that evaluates cognitive ability -- and which you can give yourself -- appears to be faster and more accurate than current tests in detecting early dementia, according to British researchers.  

Published in the BMJ online June 10, 2009.  Dr. Jeremy Brown,  Addenbrooke's Hospital, Cambridge, England

Scroll right to the bottom of the page if you want to try out the test.

Is there anything more frightening than a diagnosis of Alzheimer's or dementia? 

Dementia is far more common than we'd like it to be. It's estimated that "24 million people in the world suffer from dementia and the number will double every 20 years."  Certainly, not all dementia is Alzheimer's disease.  Cognitive problems plague those with stroke, Parkinson's disease, head injury, and epilepsy.  And still more will suffer from milder forms of cognitive impairment.

But, as Dr. Clair Nicholl of Addenbrooke's Hospital says in an editorial accompanying Brown's BMJ article, "Without a diagnosis, patients and caregivers cannot access the services they need, so earlier diagnosis is a key component of the National Dementia Strategy in the United Kingdom.  However, early diagnosis is not easy and no definitive test exists.  A quick screening test is needed in primary care and general hospital practice."

Dr. Brown's new "Test Your Memory - The TYM Test" is quick to use, examines 10 skills, and reportedly detects 93% of the cases of Alzheimer's disease.  Brown says this self-administered test is a powerful and valid screening tool, more sensitive than the standard Mini-Mental State Examination (MMSE)  (93% vs 52%).

Remember, this is strictly a screening tool. Further professional evaluation is always necessary, and low scores may be attributed to anxiety or dyslexia.

This test has participants write 10 answers on a double-sided card, and the tasks evaluate a range of areas--the patient's semantic knowledge--the ability to calculate--name objects--recall information.  Looking at the questions it seems clear to me that the test would have to be modified (controlled) for age, ethnic, racial, & cultural biases to work in the U.S.

A sample of the questions:  List 4 creatures beginning with "S".  In what year did the 1st World War start?

It took people who had no history of cognitive problems about five minutes to complete the test. Their average score was 47. However, people with Alzheimer's took longer to finish the test and earned an average score of 33. People with mild cognitive impairment had an average score of 45.

Certainly, longer scales and more thorough testing would be required for a firm diagnosis, but this test looks like it just might be a simple accurate sensitive tool to diagnose cognitive problems.  Dr. Brown claims it is sensitive enough to distinguish between mild cognitive impairments that may likely progress to dementia within two years, from those that likely will not.

Read Dr. Jeremy Brown's BMJ article, "Self-administered cognitive screening test (TYM) for detection of Alzheimer's disease: cross sectional study" here.

Read Dr. Claire Nicholl's BMJ editorial, "Diagnosis of dementia.  The usefulness of screening tests varies according to the clinical setting" here.

And for the best or worst part--try the test yourself.  The scoring is included.  Click here.  **Remember this was developed in England--you might want to substitute the U.S. President for the Prime Minister--and consider the year the U.S. got involved in WWI--I'm by no means a test-maker--but those seem reasonable switches.

For more detailed scoring click here  I wasn't able to access this page at the time of this writing.

For a link to the Press Release about the test, click here.

And while I'm on the subject of dementia & Alzheimer's, take a look at this excellent short article from the New York Times: "Getting Insurance for One's Frailest Years", by Walecia Konrad. Nothing is more devastating to families and finances than getting good care for a family member with dementia.  After reading this, my husband & I are starting to research the options.