Happy Healthy Long Life

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

2010-03-02T13:36:54-08:00

"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-

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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!!!!

The Healthy Librarian's "What's Working, What's Not?" Sprouting, Step Counting, Produce Bags, Switching Schedules and Exercise Routines

2010-02-27T10:08:51-08:00

The Easy Sprout - The Sprout People's Most Popular Sprouter

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I've let too much time go by without giving any updates on some of the new additions to my household and daily routine. I promise this is going to be a quick post (yeah right!) because I have some very interesting medical topics I want to get to--and this is one of the few mornings I have some time in which to do it.

We're Making Our Own Sprouts Now!

Thanks to a wonderful reader, Kim, who wrote after I posted "Straight from the Experts at Ohio State University, Johns Hopkins University, & Canyon Ranch: Three "New-to-Me" Super Foods: Black Raspberries, Broccoli Sprouts, & Chicory-Family Leafy Greens", we have started making our own sprouts at home.

"Why buy Brocco-Sprouts for $4.99 a container when you can make them yourself? It's much cheaper to do your own & it's really easy. Check out Sprout People!, " Kim said.

My husband took off running with Kim's suggestion. Soon we had 10 white plastic sprouters on top of our kitchen counter, and all kinds of seeds to sprout. He is now a huge fan of the Sprout People.

Sprouting is like having an indoor mini-fresh-garden in the winter.

He's now THE sprout-maven-indoor-farmer, and I just sit back and enjoy the harvest. Broccoli and alfalfa sprouts are our favorites--and you can't compare the cost & freshness of sprouting your own to buying them at Whole Foods.

He has broccoli sprouts ready to eat in 3-6 days and they last from 2-6 weeks in the refrigerator--although we eat up a batch in a week--adding them to sandwiches and salads.

He's experimented with all kinds of seeds, including sprouting up a batch of "Madison Market Mix" which is a combo of peanuts, sunflower seeds, pumpkin seeds, and almonds. The Sprout People say this is "more of a soak than a sprout", but it's delicious on a salad.

Wondering what the big deal is with sprouts?

"Sprouts are one of the most complete and nutritional foods on the planet. They're rich with enzymes and vitamins and amino acids. And perhaps most important of all, sprouts like alfalfa, broccoli, clover, mung bean, and the like contain concentrated amounts of phytochemicals that can have strong protective effects against disease.

When you eat a sprout, you're actually eating a very, very young version of the whole plant. You're eating the root, stem, and head.
Different glucosinolates--phytochemicals that convert to very healthy metabolites in the body--are concentrated in different parts of the plant. Some are still in the root, others are in the leaves that are thrown away, still others are in the stem.
According to Sonja Pettersen, N.D., "Sprouts are one of the most concentrated sources of nutrition. They're loaded with phytonutrients."

-Jonny Bowden, PhD, C.N.S., author of The 150 Healthiest Foods of Earth-

Storing Sprouts and Vegetables in PEAKfresh Produce Bags

OK, I admit it. When my husband said he was going to order PEAKfresh bags to store our sprouts, because that's what the "Sprout People" recommend, I rolled my eyes, and thought, "Uh oh! Now he's listening to some weird "Sprout People" on an internet site. What next?"

I had tried those Debbie Meyer Green Bags (thanks to SIL Lis) and was disappointed. These sounded like more of the same.

But according to "The Sprout People": These bags are amazing! We have tested sprouts, fruits and veggies. We had Cilantro in one of these bags for a month! Plastic bags will still do for storing your sprouts, but if you want the best - for every sprout, fruit and vegetable - try these!
You know us, we don't sell stuff just to sell it - these really are awesome. The bags are widely reviewed (positively), and like we said above - our personal experience is great, so we think it is a good bet you'll be happy with them.

Read more about these bags ($5.85 for 10 re-usable bags) here.

These bags really are superior to just storing produce in regular plastic bags! Really. I didn't expect them to perform at all. I stored a cut ripe avocado in a bag--following the directions to press out the air in the bag & seal with a twist tie. It stayed green and fresh for 10 days--and I had fresh avocado to spread on my sandwiches. Far superior to a regular bag or container.

Then I decided to try cilantro, which always ends up rotting in the bag after I use it once for a recipe. Not this time! The same for the lacinato kale. They are as fresh as the first day I bought them, after 10 days. I wish I could report that they lasted longer--but I used them up.

My light bulb discovery!

I followed the PEAKfresh directions. Pre-cool warm fruit and vegetables in refrigerator before storing in bag. Check!
Use a separate bag for each type of produce. Check!
Produce should be fresh, dry, and undamaged. Easier said than done. But a key step!

DRY! Wetness is what rots produce quicker than you can blink an eye. And with all those grocery store sprinklers drenching the greens & herbs getting them dry is tough. I've tried blotting them with towels - but when I wanted to test out the PEAKfresh bags the "towel dry" method was not doing the job.

I thought about laying the greens out to dry on the kitchen counter, but I didn't want to take the time to do it.

Then it dawned on me! Use a hair dryer. I laid out the greens, zapped them with the hair dryer, and in 2 minutes they were dry enough to get bagged. Yes, it's an extra step, but produce is expensive. It beats having to throw out rotted veggies. Don't laugh. It worked.

My Step Counter Experience

This is my new toy. Last week I mentioned that as part of my workplace's incentive to lower our health insurance rates I have to report how many hours I exercise a week and how many cups of vegetables & fruit I eat.

I could have opted to report how many steps I walked a day if I had wanted. Everyone received a free Omron Hip Pedometer and after writing the post about Dr. Sharon Alger-Mayer's tips on keeping weight off--people who successfully kept their weight off put in 11,000 steps a day (5.5 miles)--I decided to clip that pedometer to my hip & see how much walking I was doing throughout the day.

OK--I admit it. Exercise is not a problem for me. I can easily exercise 6-7 hours a week, because I just like to exercise. But, honestly, my weight just stays the same--it doesn't budge. Maybe the pedometer will help me knock off a few pounds.

Here's what I'm finding out:

Wearing a step-counter is fun and motivating. Who would have thought?
Throughout a regular workday--I don't use the counter while I exercise--I manage around 6,000-6,500 steps a day--between 2.84-3.00 miles just doing my regular routine. It's a far cry from 11,000 steps a day. I guess I need to kick it up a notch.
My basic plain-Jane Omron step-counter/pedometer is as easy-as-pie to use. This is the pedometer my very large medical center has chosen to use, probably because it's easy, reliable, long-lasting, and low cost. There are more sophisticated pedometers out there, but this one is a no-brainer-which is a good thing. Just clip it on in the morning and go. It records a week's worth of steps.
The urge to do more. It's human nature to want to challenge yourself, and increase your steps. I find I want excuses to get up and walk around at work. Normally, I never take breaks, but next week I'm going to start--and see how many extra miles I can add up with speed walking for 15 minutes.
My friend Mary Pat told me that she takes every extra opportunity she can to pump up her daily step totals. Instead of sitting down for 30 minutes while she waited for a doctor's appointment, she just walked back & forth--boosting her steps. When she arrived at a movie theater an hour early--to be sure to get a ticket--she didn't go into the theater and sit down--she just walked around the theater.
Want to check out the best pedometers? Click here and here

Switching Up My Exercise Routine & Changing My Work Schedule

Since November I've tweaked my usual work & exercise schedule to maximize my time and energy. Hey, a little experimenting is always a good idea!

I am a true-believer in my post: Maximize Your Energy-Match Your Tasks To Your Daily Energy Levels, and it was high time to stop wasting my peak "9-11 am: Brain work-Creativity-Analytical work" time slot on housework, errands, or exercise on the days when I'm not at work. It really helps to pay attention to what your best times for brain work are, and make the most of those hours. I definitely lose motivation for "hard thinking work" if I don't do it early.

By carefully rejiggering my schedule, I was also able to get to a yoga class 3 times week, instead of maybe once every other week. And instead of doing my same-old same-old Nautilus weight-machine work-out, I added a killer old-fashioned weight-training class to kick things up a notch. And I still get to a Spinning class 3 times a week.

Why was I skipping out on yoga? I always planned to go to a yoga class after work--never happened. And the less I went, the harder it was. And the harder it was, the less I wanted to go. Guess what? Once I started going 3 times a week those planks & Chatarangas (the yoga push-up) started getting easier, and I started to really reap the benefits of a regular yoga practice.

Here's what I did:

On non-work days, I write or research in the morning when I'm fresh--the best time for brain work. Errands, housework, and everything else come later in the day. If I do decide to exercise I do it in the late afternoon, instead of exercising first thing in the morning.
I volunteered to work late every Thursday night, but I leave the house at 9:00 am. I go straight to the gym and take a tough old-fashioned weight-training class, and follow it up with a yoga class. Then I head on to work. Before this switch I never exercised on Thursday.
Early Monday morning I head to a yoga class before starting work. No need for a shower after class--I save time by changing into work clothes once I get to work.
Switching from weight machines to a weight-training class has upped my strength. It's so easy to stick to the same-old-same-old routine because it's comfortable and a no-brainer. But, Ann Esselstyn (Who is she? Click here.) convinced me to try this class, and what a challenge it is! She's over 12 years older than I am, and if she can do it--I can do it! There is no way I would do push-ups, squats, lunges, planks, and free-weights on my own. No way. This is like having a knowledgeable personal trainer without the cost. It's definitely a killer, but every week it just gets easier and easier. Thank goodness. Added benefit: This class keeps my heart rate in an aerobic range for most of the hour! A 2-fer! I never even budged into the aerobic range with the Nautilus machines.
Take away point: Look at your schedule. Are you doing your brain work when you are at your sharpest, or are you wasting your best hours on activities that don't need brain power? And look carefully at your schedule, and see where you can squeeze in some exercise. I'd rather stay at work later, and get my exercise in early. By evening time I'm just ready to chill out.

I know you all have wonderful discoveries that are making your life easier, healthier, and more productive. I get some of my best ideas from all of you. So, please, let me know what's new and working for you! What's working? What's not?