What Contributes to a Healthy Brain?

Caregiver, patient expert

Modern medicine has given the average person an increased lifespan but not necessarily an increased health span. Most of us want both. We’d like to live longer than the norm of even a couple of decades ago, but we want to do so with good health, and that is particularly true for our brain when it comes to brain health.

HealthCentral’s interest was piqued by a new book that is focused on keeping our brains healthy, Brain Rules for Aging Well, written by Dr. John J. Medina, a developmental molecular biologist who has had a lifelong fascination with how the mind reacts to, and organizes, information. Brain Rules is a wonderfully readable roadmap that is backed by scientific evidence artfully combined with very human stories. Dr. Medina is an affiliate Professor of Bioengineering at the University of Washington School of Medicine.

HealthCentral conducted an email interview with Dr. Medina so that we could pass along to our readers the science and human thought that could help our brains age well.

HealthCentral: Dr. Medina, you are a scientist and your work is solidly grounded in science, so ― perhaps unfairly ― we were surprised and pleased by the readability and even the warmth of your book. Socialization is number one on your list for brain health and that includes people at risk for Alzheimer’s. What are the top two or three reasons you place socialization so high?

Dr. John Medina: Two reasons. First, the data regarding the cognitive benefits of relational activity in seniors are remarkably strong. Second, they’re strong in several areas, different researchers in different fields of inquiry coming to the same remarkable conclusion that it’s good for you. The psychiatric literature, for example, shows that being highly socially integrated reduces your risk for depression and anxiety disorders. The physiology literature demonstrates that high social integration scores reduce your risk for cardiovascular disease, possibly because it lowers the level of stress you routinely experience. They even get less cancer. The geroscientific literature shows that seniors with lots of friends live longer ― much longer, in some studies ― than seniors who are lonely, possibly because of the physiological benefits.

HC: We know that dementia is what you call a “catchall” term, of which Alzheimer’s disease (AD) is only one type. However, according to your book, you feel that there are many types of Alzheimer’s, which is one reason doctors will word the diagnosis as “dementia of the Alzheimer’s type.” Do you feel that this approach will, in the end, help more people than the past focus on only one type of AD?

Dr. M: I don’t really know about the future impact, but characterizing the symptoms properly is the only way to ensure that productive research directions will be followed. If you don’t know the characteristics of the disorder you are studying, your ability to find a successful treatment is not much better than chance. Medical progress always begins with a solid set of diagnostic criteria, and right now there isn’t unified agreement about what separates Alzheimer’s from other types of dementia. Some of the controversies are even named (the amyloid hypothesis controversy is one that currently exists in the Alzheimer’s literature, for example). I believe eventually we will get to successful treatments, but only when we can all agree on what it is that's being studied.

HC: You discuss exercise and diet and mention the MIND diet, in particular, which is based on the Mediterranean diet melded with the DASH diet (heart health). Do you feel that following a diet of this type will help people who may develop Alzheimer’s of any type? We’re thinking of those who have a high genetic risk.

Dr. M: Risk is always understood as a set of probabilities. But statistically, eating a PREDIMED (Primary Prevention of Cardiovascular Disease with a Mediterranean Diet) diet lowers the risk for developing Alzheimer’s-like dementias, in some cases, dramatically. Once again it all depends upon how you define the dementia you are examining, including the types for which a genetic risk has been rigorously identified.

For the longest time, I shied away from advocating any type of dietary intervention for changing cognition, mostly because the variables of food content and diner metabolism and subsequent cognitive function were just too uncontrolled to make much meaningful sense to me. That all changed with the Mediterranean diet story, and its MIND and DASH variants. There has truly been some terrific progress, even for this grumpy scientist. Enough to cause me to switch my eating habits years ago.

HC: You are solidly in the group of scientists who feel that in order to age in a healthy manner we must keep our minds active. You mention so many ways that we can keep our brains sharp that there is little excuse for anyone in decent health not to at least do some of them. Yet, back to those who are at high risk because of genetics: do you think that such steps will help those who have witnessed generations of Alzheimer’s in their families?

Dr. M: It can’t hurt. It’s always important to remember that statistics don’t apply to individuals, so even those people at high genetic risk for acquiring Alzheimer’s are not 100 percent guaranteed to come down with the disorder. Yet it seems prudent to me that these vulnerable populations should take special care to implement any interventions the literature has shown to be worth doing. That includes behavioral recommendations mentioned in the book.

HC: Your book feels personal. Have you experienced dementia through the eyes of a loved one or close friend or has your work simply brought you so close to this topic that it comes through as personal?

Dr. M: I don’t have anybody close to my family with Alzheimer’s, but I have plenty of friends who had (or have) loved ones facing the disease. It is heart-breaking to watch them react to their loved ones' declining health. Perhaps it is that heartbreak that you sense. I feel it just writing down my response to this very good question.

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