Tips to Keep Your Brain Healthy
November is National Alzheimer’s Disease Month. It is also National Family Caregivers Month. In honor of those living with a dementia diagnosis and those caring for someone living with this disease, Habesha Health dedicates this month to them.
What is dementia? What is Alzheimer’s Disease? What is the main difference?
Dementia is a broad term that describes a number of different diseases that cause decline in cognitive abilities that are serious enough to interfere with daily life. People living with dementia may have difficulty with memory, driving, managing medications, preparing meals, and, in severe cases, putting on their own clothing. Alzheimer's disease is the most common cause of dementia and it is the sixth leading cause of death in the U.S. We don’t know the cause or have a cure yet, but there are ways to slow down the disease.
What is the difference between Alzheimer’s and typical age-related changes?
In Alzheimer's disease, there is a build up of protein in the brain that makes it difficult for your brain to send signals between its different parts. The affected parts of the brain have trouble working together to accomplish activities. Memory problems are not always because of Alzheimer’s. Memory problems can also be the result of anxiety and depression (over finances, retirement, children, etc.), medical problems, poor sleep, or many other factors.
In healthy individuals, forgetting a few things is a normal part of aging and part of day to day life. Normal aging may impact our ability to learn and retrieve information as quickly and effortlessly as we did when we were younger.
What are risk factors that can increase the chances of being diagnosed with dementia?
Some modifiable risk factors studied are:
Diabetes
Midlife Hypertension (high blood pressure)
Midlife Obesity
Physical Inactivity
Depression
Smoking
Low Educational Attainment
Sleep
Why are Black people at a higher risk to have AD or other dementias?
Black people are about twice as likely to have Alzheimer's and other dementias as older White people. Researchers say that may be partly related to some of the health issues that are more prevalent in the Black community such as higher rates of diabetes, hypertension, high cholesterol, heart disease, diabetes, and other cardiovascular complications. All of these health problems are risk factors for Alzheimer’s disease and dementia. Stigma associated with receiving care is a big hindrance in our communities. Part of the issue is that we are not well represented in clinical studies which would help produce earlier diagnosis. This is why we should participate in clinical studies. Representation matters in all aspects of health care.
How do you talk about dementia with family members considering cultural stigmas?
I encourage families to treat dementia the same way we treat other severe diseases don’t neglect to follow up with a specialist because you likely can slow down the progression simply by seeing a specialist who can make individualized recommendations.
How do older adults get screened for memory loss? What kind of doctor should they reach out to for any memory concerns?
Neurologists will likely ask questions to assess your thinking and judgement. Where I work, we complete cognitive screening such as MOcA, Blessed or other screeners to find a baseline or in other words we know where the patient stands cognitively at their first visit. We may ask for additional testing (neuropsychological testing which can last upto 4 hours), labs and imaging such as MRI or PET, etc. These coupled with interviews of a family member/friend/caregiver provide us with the patient's family history and cognitive changes. These would lead to an accurate cognitive diagnosis.
If an individual is experiencing increased forgetfulness they can ask their primary care physician/family medicine doctor to refer them to a neurologist specializing in dementia. There are Alzheimer’s Disease Centers around the country. If you live nearby and your insurance covers it then these centers are highly recommended.
Memory tests can be biased for non-English speaking communities - what do you recommend caregivers do if they are considering having a family member screened for memory loss?
Make sure your loved one is set up with an appropriate medical translator for their appointments. Keep in mind translators have legal and ethical obligation to keep your medical and family information private. If available, ask for a summary of the visit and recommendations at the end of each visit.
Family history helps to aid your medical provider to assess, diagnose and treat. If you don’t have a reliable family history, family members are recommended to take notes of the changes they notice as early as possible. History is a great indicator of the future.
What can someone do to keep their brain healthy (delay cognitive decline)? Potential protective factors?
Socialization:
Remaining socially active decreases depression and delays the onset of dementia. Find social activities that are meaningful to the individual. With Covid- it is difficult to be social. Many places of worship are not operating however people can find these activities virtually. Have structure in your day. Have an accountability partner who may have the same goal as you.I recommend virtual exercise videos and programs to my patients. A systematic review of 29 longitudinal cohort studies reported:
Individuals who had less frequent social contact had a 57% increased risk of developing dementia.
Individuals who feel/endorse loneliness had a 58% increased risk of developing dementia.
Exercise:
Find a physical activity that is safe for you. Some examples are:
Brisk Walk 30 minutes a day. Leisurely walk after dinner.
Exercise with friends can be helpful to keep motivated. Join workout or dance classes.
Results of above pie chart/study: Compared with no exercise, physical activity was associated with lower risks of cognitive impairment, Alzheimer disease, and dementia of any type. Significant trends for increased protection with greater physical activity were observed. High levels of physical activity were associated with reduced risks of cognitive impairment.
Conclusion: Regular physical activity could represent an important and potent protective factor for cognitive decline and dementia in elderly persons.
Mediterranean Diet:
Replace butter (Kibe/Tesmi) with healthy fats, like olive oil.
Limit red meat. Eat fish and poultry at least twice a week.
Encouraged daily water intake
Focus on fruit, vegetables, nuts and grains.
Use herbs to flavor food rather than salt.
Keep your heart healthy: It is VERY important to prevent/manage these conditions, as they increase your risk for Alzheimer’s disease and other dementias as you age. Conditions that are bad for the heart and blood vessels are also bad for the brain:
Hypertension
High cholesterol
Diabetes
Atherosclerosis
Stop Smoking: Current smokers have an 80% increased risk of developing Alzheimer’s disease compared to people who have never smoked.
Current smokers have a 70% increased risk of developing Alzheimer’s disease compared to former smokers.
It is never too late to stop!
What should caregivers and family members know as they care for someone diagnosed with dementia?
When dealing with dementia, the person living with the disease may not have a full insight into their physical and cognitive changes therefore it is often harder on those around them. Often carepartners/caregivers are under stress navigating the complexities of the health care system on behalf of the person living with dementia.
As they say before the plane takes off, you have to put your seat belt before your child, the same approach goes when caring for a loved one. You have to take care of yourself before you can effectively take care of others. Ask for help when you need it because you can not pour from an empty cup.
Creating routines both for you and the individual you provide care for is important in this journey. This will allow you to know what your day consists of and be able to plan ahead.
If you have a family member (ex. a parent) diagnosed with dementia, you are not guaranteed to get dementia because it is in your family. You may have a higher chance of getting it but I have seen it skip generation/s.
Advocacy for things such as coordinating medical translation when needed. You can contact the neurologist and ask what to expect in the upcoming appointment. Let them know your goals for the appointment as you may not be comfortable sharing your concerns during the appointment. Ask to be connected with resources and further education because you will need to continue learning the best way to support your loved one.
What resources are available to learn more about cognitive decline and brain health as we age?
The Alzheimer’s Association is a great place to start with classes to continue learning as the disease may worsen. They have classes and support groups for all stages of dementia. I haven’t seen a Tigrinya or Amharic course but we hope to see that change in the near future.
Understand the financial resources that are available in your area. If you have access to a case manager/social worker through your insurance or doctors office, utilize them to continue planning for the future challenges and better prepare yourself and your loved ones.
It is important to complete Advance Healthcare Directive for health and finances while the person has the capacity to make a decision. What this means is the person identifies an individual they trust to make healthcare and financial decisions for them if they are no longer able to.
Summary:
Alzheimer’s disease is the most common cause of dementia, but is only one type of dementia. Dementia is not part of “normal aging.” There are many modifiable risk factors that can decrease your risk of developing dementia:
Exercise! Anything helps
Eat a balanced diet
Healthy heart = healthy brain
SLEEP!
Stay engaged in life – socially and intellectually
If you are concerned, get screened , early detection matters
-Almaz Nigusse Bland (Sutter Health)
References:
Alzheimer’s Association: https://www.alz.org
Anstey, von Sanden, Salim, and O’Kearney, 2007
Old Ways: https://oldwayspt.org/
Laurin, et. al, (2001) Arch Neurol
