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Aging for Amateurs: Charleston doctors take another look at optimizing brain health

In earlier columns we’ve discussed the 10 ways to love your brain summarized by experts and consultants to the Alzheimer’s Association. I want to do a quick review of those recommendations and report on several exciting advances that will likely help us have healthier brains, even as we age.

I discussed brain health with Dr. Jacobo Mintzer, gero-psychiatrist and director of the Research and Innovation Center at Roper St. Francis. Mintzer says that all of the major authorities agree on what’s best for our brains. 

These habits and practices include: regular aerobic exercise (at least 30 minutes, 5 days a week), at least two sessions a week of muscle-strengthening exercise, a heart-healthy diet (the Mediterranean or DASH diet, or the combination of both called the MIND diet (a little more about this later), around eight hours of good sleep per night, no smoking, taking care of problems that affect vascular health (high blood pressure, high cholesterol and diabetes) and brain stimulation through activities such as learning a new language, reading a book or watching a movie and discussing it, taking a college course, etc.

A little down the list in importance are limiting stresses and taking care of our mental health, remaining socially involved and protecting the brain from injury.

We are waiting for follow-up research on the MIND diet. In the next 18 months or so, we should have enough information to help decide whether the specific recommendations in the MIND diet are better than those of the Mediterranean or DASH diets alone.

For the present, eat a heart-healthy diet that emphasizes a wide variety of fruits and vegetables, avoids most red meat and limits trans fat. While we are on the subject of nutrition, it is important to point out that while supplements of many kinds are advertised that they “support brain health” or “improve brain metabolism or function” or similar statements, the Global Council on Brain Health has stated that no supplements have been shown to significantly improve thinking (in the absence of a specific nutritional deficiency). The bottom line here is to follow a healthy diet and don’t waste your money on heavily advertised “brain-boosting supplements.”

Regarding treatments to reduce the risk of Alzheimer’s disease and other dementias, a recent study in the European Heart Journal suggests that by making a change in the way we treat high blood pressure, we can decrease heart and blood vessel diseases by almost half.

Since the blood vessels in our brains are part of the cardiovascular system, better control of high blood pressure should protect the vessels in our brains, too. This simple change in treating high blood pressure doesn’t cost anything. Just move at least one of the medications that are being used to treat blood pressure to the evening.

Patients who did that had a 45 percent reduction in cardiovascular events (heart attacks, strokes, cardiovascular disease death, coronary artery bypass surgery and heart failure). Before changing how you take your medication, be sure to discuss it with your caregiver, but this small change appears to have a dramatic effect.

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There are three interventions on the horizon that may allow us to prevent or at least slow the onset of dementia. Dementia is associated with the development of amyloid and tau protein in the brain. Targeting amyloid with a chemical that removes it from the brain may improve thinking, especially if it is done early in the disease.

A drug manufacturer has submitted a request to the FDA to begin marketing aducanumab, a human monoclonal antibody, that has been shown to remove amyloid from brain tissue. If approved, the drug could be available in 12-18 months.

Another way to target amyloid and tau protein is to use a vaccine. Previous vaccine trials have produced rare but serious side effects. A new vaccine is in testing in mice and appears to be effective in decreasing both amyloid and tau without significant side effects. It could conceivably become available in the next three to five years, but often success in animal studies isn’t reproduced with humans.

Another method being studied in humans is photobiomodulation. While it sounds too good to be true, preliminary research in a very small number of patients has shown significant improvement in function in patients with dementia.

The treatment is supposed to work by firing 40-Hz gamma waves directly into the skull using LEDs mounted on a headset. A separate nasal clip also channels light directly up the nose toward the hippocampus, the part of the brain which is responsible for memory, and one of the first areas to deteriorate in Alzheimer’s disease.

Theoretically, the more direct light to the hippocampus might be more effective than gamma waves sent through the skull. The University of Toronto is carrying out trials of the treatment in more than 200 patients in eight centers in the U.S. and Canada. Results could be available in a year, or perhaps two.

Dr. Mintzer and many other physicians and therapists have recognized another intervention that appears to help many patients with dementia and other diseases associated with aging. It is music therapy. Exposure to familiar music often improves mood, day-to-day interactions, mobility and alertness. For a very interesting eight-minute TedX presentation, Google “Mintzer music medicine.”

Dr. Mintzer’s team is involved in research on prevention and treatment of dementias. Contact the Center for Research and Innovation (at 843-724-2214) if you would be interested in participating in research or have questions about available research opportunities.

Bert Keller and Bill Simpson write the occasional column, “Aging for Amateurs.” Simpson, a retired physician, wrote this installment. Comments, questions and suggestions are welcome at agingforamateurs@gmail.com.

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