Monday, April 3, 2017

Time to Rethink Brain Health and Dementia

Common Sense for Brain Health and Alzheimer’s Dementia

            I have studied dementia for many years and have cared for hundreds and probably thousands of persons suffering Alzheimer’s Dementia (AD) over the past 30 years. At this time I continue to believe this is a very complex disease and unfortunately, I do not believe we have a comprehensive and national strategy to understand, research, manage, and combat this disease. If we do not change our approach AD will eventually overwhelm our emotional, practical, and economic resources.

            Our research programs have really been far too targeted on cellular bases and this has not lead to any advancement of treatment. It is refreshing to see research turning somewhat to the immune system and inflammation as other avenues of insight. True, we continue to develop more sensitive technologies to detect earlier presence of the disease, but it is the treatment and prevention that is most important and we should just presume this disease starts in childhood in the brain as some research suggests and as I indicated from common sense even without research years ago. It is a proactive and neurodegenerative disease process. Are we to believe there is a magical age threshold when normal turns to disease in the brain? That is possible, but more likely is the idea that we need to think about neurodegeneration as lifelong and therefore need a strategic plan for brain health that is equally lifelong.

            Proactive health promotion is rather foreign to the United States and to our medical institutions. We are great at detecting disease and intervening, a rather reactive model. It is not of value to conditions that are proactive and degenerative. We need a proactive strategy built on the pillar of health promotion that is lifelong in duration. That means beginning at the earliest of ages, indeed in the womb.

            We certainly have no cure or even prevention of AD. However, while research is needed to continue on searching for such, we can and should add a National Strategy for Brain Health that is integrated into the very fabric of our society. The goal is to not only educate the general public of our ability to shape our brains for health, but to encourage and assist in the application of such shaping where we live, work, and interact daily. While I am not alone, I have worked on educating the general public for over 15 years on my own Brain Health Lifestyle ® that includes: physical activity, mental stimulation, nutrition, socialization, and spirituality.

Consider the following ideas:

1.        I have long championed a basic set of behavioral tips be given to   every mother-and-father-to-be so they can be empowered with             what behaviors can help shape their baby’s brain while        developing in the womb. Imagine if every hospital and birthing     center in the US provided such information. A few basic tips            might            include the parents talking and even singing to the baby in the      womb, the importance of brain health nutrition for the mother      and baby, and proper exercise for the mother that will be             experienced by the baby.

2.        We need to create Brain Health environments with proper stimulation and approaches that shape our toddlers’ brain that    occurs prior to onset of oral language. One example is the power   of sign language to propel the development of the articulatory    system and to help increase IQ. The latter has been found to relate           to reduced risk of AD later in life. Certainly, promoting each child’s      sensory systems and curiosity, filling the environment with love   safety and attention, and promoting brain health nutrition are             good ideas. This is how proactive brain health works.

3.        Our education system is not built on the premise of shaping            brains for health. Our children tend not to sleep enough, eat             unhealthy foods, and schools now have safety issues as major         concerns and unsafe environments are not conducive to learning.        Once again, even without focusing on curriculum, the school            environment, timing of classes, and even basic education on what            foods can help brain processing is needed. Teachers should all             understand they are shaping brains and hence can benefit from    knowing what structures in the brain are critical to learning and          how environment has a major role in brain health. Schools should            all begin with meditation and mindfulness as well as stretching     and even some aerobic exercise to prepare the brain to learn.         Obviously, we need to promote better sleep patterns and a           healthy breakfast and lunch to assist the brain in learning,   creating, and thinking.

4.        Our corporate and work environments can promote brain health by understanding that the Brain Health Lifestyle ® can be           integrated into the work culture. Some examples are promoting    less sitting,             more movement, more socialization and critical           thinking, more brain health nutrition in the cafĂ© and vending         machines, and methods of stress reduction such as meditation,           prayer, and             yoga onsite. Communication between men and women (a brain function) should be emphasized to enhance         understanding and even the bottom line.

5.        Our medical system can be encouraged to conduct mental status   examinations with neuropsychological testing each year   beginning at age 50. It strikes me as odd that we have set ages for            different medical procedures for men and women across the            lifespan, but nothing for the brain! Medical students should have brain health and lifestyle placed in their curriculum so they can          teach their patients how to shape their brains for health       regardless of age.

6.        Technology can certainly help educate persons on the power of      the brain and continue to create fun and engaging tools such as           we find in brain fitness and cognitive monitoring to keep people    thinking and creating. The same can be said for media and           educational organizations that can help to tell the story of our        individual empowerment to lead a brain health lifestyle ®.

7.        Physical fitness companies and the entire mindfulness industry    can do a better job of integrating brain health into their focus and      understanding so all clients and consumers know that when they             exercise, meditate, do yoga, etc. they are shaping their brains for       health.

8.        Home is our primary brain health environment and it is        worthwhile to review how brain healthy your home is. Novelty        and complexity promotes brain health as does socialization,            spirituality and stress reduction, nutrition, and physical activity. Is             your home promoting these lifestyle domains and can some small            changes be made to enhance the home environment.

I would hope that such understanding of our own individual role in shaping our brains across our lives continues to become available to more persons. Those who cope with fewer resources are most vulnerable and in need for the things I mentioned above, but all can benefit. Beyond individual responsibility is our society and our approach as promoted by our nation. The time for a real comprehensive and proactive approach to brain health is desperately needed now. It will require a national effort with changes made to all the institutional sectors of our life as noted above. As such, many leaders are needed to work together on such a national strategy that ultimately will define us as a nation. It will require money and effort, but the payoff is beyond measurement.

The cruel reality of AD is that a brain loses access to its life story and we all lose some access to those we love so much who fall victim to this disease. We all hope and pray for a cure for this devastating disease that will cripple our society and world in the next 30 years if we do not change. I hope we can consider a change in our approach, with an emphasis on proactive brain health promotion at the earliest of ages, and a comprehensive national strategy that not only seeks to cure, but also champions brain health!

Paul D. Nussbaum, Ph.D., ABPP
Board Certified Clinical and Geropsychology
Fellow National Academy of Neuropsychology
Adjunct Professor of Neurological Surgery
University of Pittsburgh School of Medicine
President Brain Health Center