Reducing our Risk for Dementia

There are things we can do to prevent -- or at least reduce -- our chances of getting dementia. These include laughing, socializing, learning new skills, moving our bodies, eating whole foods, getting enough sleep, relieving stress through healthy outlets – basically, heeding our mom’s advice and living life to the fullest.That was my takeaway, at least, from my interview with neuroscientist Patricia Spilman. But don’t take my word for it, read it for yourself in the following excerpt of our conversation on The Aging Boomers.

Frank: Patricia Spilman is a neuroscientist with over 20 years of experience in neurodegenerative disease research, including 12 years with world-renowned neuropathologist, Stephen J. DeArmond, and a Nobel Laureate, Stanley Prusiner, at the University of California, San Francisco.

For the last 10 years, Patricia's focus has been on the development of new therapeutics as part of an Alzheimer’s disease drug discovery team following a pharmaceutical industry model in an academic research setting in the Bredesen Lab. This work resulted in one candidate entering clinical trials. The lab, the John Bredesen Drug Discovery Lab, continues this work that started at the Buck Institute for Research on Aging in Novato, California, and at the Mary S. Easton Center for Alzheimer's Disease Research at UCLA.I want to welcome Patricia Spilman.

Patricia: Thank you for having me, Frank.

Frank: Alzheimer's is such an important subject. I'm curious what the catalyst was for you deciding to do research in this field.

Patricia: When I was in college, I had a very good friend and I was at his family table, and the woman of the family burst out in tears and said, "My husband is sitting next to me, but the man that I love is gone." We were all so startled. He had just gotten a diagnosis of Alzheimer's disease. I had just learned about it. It was such a surprise to me as a young person to find out that your body can remain relatively healthy while your cognitive abilities -- your ability to remember or think -- can decline due to a disease. It was so moving and so dramatic that I knew it was the field that I wanted to go into to understand better and, of course, now recently, to help find a cure for.

Frank: You mentioned cure, which I want to talk a little more about. First, you had, to me, a very moving quote. I don't know if it was an article that I read, but, if you don't mind, I'd like to read it. It's something you said, and that will lead into our discussion.

You said: "While I have devoted my career to the discovery of an effective treatment for Alzheimer's disease, I would rather people never experience cognitive decline and never need treatment for Alzheimer's. To that end, I have assembled a comprehensive overview of the known risk factors for Alzheimer's disease based on epidemiological studies and scientific experimentation and what to do to address them. Not all Alzheimer's disease is avoidable, as some disease has a strong genetic basis, but I hope, by sharing this information, more people will be able to prevent or at least delay the onset of cognitive decline."

I thought that that was very profound. I thought it was a good lead-in to our discussion. Can you first just talk about Alzheimer’s in terms of a cure. Are we . . . .

Patricia: Oh, we're not close.

Frank: Okay. I just want to bring that up. Yeah.

Patricia: The word cure is the word of the great optimist. I like to think that I am one because I do dedicate so much time to this. It's probably more realistic to say that through a combination of lifestyle, diet changes and maybe some drug therapy, we can preserve cognitive function for longer or delay the onset of decline. Certainly, there are a lot of health issues with aging persons. A cure is a bit unlikely, although it's certainly something we're always shooting for as well as earlier and better diagnosis, which would certainly help address the issue of cognitive decline.

Frank: In your research, is it showing that, with some of the things that we're going to talk about, that you actually have a much better chance of preventing cognitive decline that could lead to Alzheimer's?

Patricia: I absolutely believe that if an older personreally does increase their exercise, have a good diet, participate in life, keep challenging themselves intellectually, it indeed lowers the risk for Alzheimer's disease. It will never be zero, but certainly there are people out there of a very advanced age who do not suffer from cognitive decline. I do believe that we can really make some headway if we get the information out there, which, of course, you're helping to do.

Frank: Let's talk about exercise. You hear all sorts of things: "Oh, go for walks 3 days a week. Don't just do aerobic exercise. You’ve got build the muscles, as well." What should we believe?

Patricia: Believe all of it. Just get out there. Get moving. Start exercising. I know scientists really want to quantify things. Often, people want to hear, "Oh, I want to exercise 30 minutes a day, three days a week. That's the dose I'm going to take." In reality, exercise is an everyday thing. It involves a variety. Sometimes it's walking. Sometimes it's dancing around, playing golf, playing tennis. Embrace all of it. Do all of it. Don't set out a certain amount that you're going to do.

I will say though that strength building is an important component of it because strength building, keeping your muscle massed up is really, really good for your brain. It induces production of something called Brain-derived Neurotrophic Factor, which is sort of a mouthful, but, essentially, just means it's a factor in the brain that's really good for the cells of the brain, the neurons. Weight training really helps with that.

Frank: That's good to know. It's a combination.

Patricia: Combine movement, aerobics, walking and strength training in a variety of ways that's fun and enjoyable for you, combined with social activity. Golf can be social,so can walking with a friend. It's really one of the best ways to exercise and keep the brain healthy.

Frank: What about music? Is music helpful from a preventative standpoint as well?

Patricia: I'm so glad you mentioned music. It's so, so important for brain health. People that play a musical instrument or sing in groups or really enjoy music stimulate areas of the brain that are important for neurogenesis, and that means the formation of new brain cells and, as the name would suggest, new neurons.

I recently read that music stimulates more areas of the brain than even language. Musical memory is one of the last to go. I just saw a beautiful documentary,”Alive Inside,” about memory and music that showed that when people – even those with advanced dementia -- get to enjoy the music of their youth again, it lights them up. It literally lights them up, and they remember not just the music, but they start talking about other memories, friends they used to have, things they used to do. It is an absolute tonic, that really does help cognition.

Frank: It's never too late to learn a new musical instrument. Am I right?

Patricia: Oh, it's so true. In fact, I give talks where I use PowerPoint slides, and on one slide I have a harmonica and bongos, because most people will balk a little at a very complicated instrument like a violin, but almost anybody can pick up a harmonica and learn how to play, get a book and learn how to play. Of course, bongos, there's so much joy in playing drums and percussion. I guess you could argue there's some exercise involved as well.

The one instrument we always have with us is our voice. Sing out in the shower, in the car, and, hopefully, around other people. That, too, is really good for your brain.

Frank: What are other things that come to mind? Nutrition is so important. We could do a whole show on just nutrition, but let's talk about other areas you think people should emphasize to hopefully reduce their chance of cognitive decline?

Patricia: Right now my interest is on how we output ourselves into the world and how that can help our mind. Enjoying laughter, humor and comedy is for short-term memory and for brain health and for releasing stress. Stress, of course, it's great to say, "Well, I have a low-stress life," but most of us can't control the stresses in our life. What we can do is respond to stress with stress-relieving activities. Certainly, yoga and meditation are found to really help with stress on a scientific level. There're a lot of peer-reviewed publications on that.

I like finding in that same literature the effects of laughter. It raises one's pain threshold. Of course, pain can be quite a stressor for older people. It made me recall a book from many years ago written by Norman Cousins called Anatomy of an Illness where he treated his own rare form of arthritis by prescribing himself comedies, and I think he particularly liked the Marx Brothers, and how much it helped him heal. It's a very real phenomena.

I think this would be clear as well, continued intellectual stimulation. I think I'll say, unfortunately, for a lot of people, they sort of picture a life arc where they learn a lot in their youth, they employ it a lot in early adulthood, in middle age and career, but they have might not pursue it as much as they get older, which is a wrong way to look at the world. It should be a time after career to really start learning new things, read more, take classes, learn something and teach it. The brain just loves that. You have to convince your brain that you're still 25 if you want it to perform like you're 25.

Frank: Right. That's a great point. What are your thoughts on sleep?

Patricia: Sleep is always needed. We absolutely have to have quality sleep to have memory consolidation and the ability to keep learning and functioning. It's so critical. I'm glad that you brought it up. Sleep issues have to be addressed.

Dr. Bredesen sees some individuals with cognitive decline. I asked him, "What are the top things that you see again and again that, in your opinion, lead to what we call mild cognitive impairment?" Of course, he did say stress and he said, "Poor quality sleep." There, of course, are sleep centers that people can go to and ways that they can help themselves sleep better, but it's absolutely critical. Exercise improves sleep.

Frank: I want to go back to the quote I brought up a little earlier about some diseases having a strong genetic basis. People with a parent who’s been diagnosed with some form of dementia like Alzheimer's, do they have a little more to worry about?

Patricia: It's a very good question. It's a complicated one. I think that your listeners might really appreciate some science on this. There are types of Alzheimer's diseases that are called familial. They involve genetic mutations that lead to what we call Early Onset Alzheimer's disease. That typically means the Alzheimer's disease that manifests before the age of 60. In general, if it's Alzheimer's disease that appears after, say, age 60, 65, 70, then that's late onset. Really, for most people, it's in the 70s or 80s.

If there is a genetic component to that, it's actually the expression of what we just call a genetic variant called apolipoprotein 4. I had to throw out 1 large word there, but that protein in the brain helps with lipid metabolism in the inflammatory response. It has a lot of different roles in the brain. People can have one of three kinds. There is an apolipoprotein 1, but it's almost unheard of. There's 2, 3, and 4. We get a copy from both of our parents, so we have two copies of this. People who have 2 copies of apolipoprotein 4 are at higher risk for Alzheimer's disease.

Even if you have that component and your parent did, you can still lower your risk by the same methods that anybody does. Perhaps, it becomes even more important to you then to exercise, to keep your intellectual pursuits up, to relieve your stress, to have good nutrition. I think it's even worth getting genetically tested to see if one is APOE-4 so that they know that they have a task ahead of them to keep their brain functioning well.

Frank: That's a great point. Going back to social interaction. I know you mentioned that. What about for someone who has already been diagnosed and might at that early to mid-stage level of the disease? In my work I have seen people who may have been very outgoing in the past now start to just want to be alone or maybe just sit in front of the TV. I've had families members, adult children say, "Well, that's what mom wants. She doesn't want to do anything. And I'm not going to force her." What do you say to someone in that situation?

Patricia: That's a really important issue actually. Post-diagnosis, there is often the symptoms of apathy or what we call anhedonia, which is not caring so much about the things that we used to care about, whether it's paying bills or taking a walk. I do think it's really good in those cases to discuss this with the family and the friends of the person who's received the diagnosis to find ways to keep the individual, the patient or client involved in life. Sometimes, it involves changing how one interacts with them.

I'll you an example because my father-in-law does suffer from Alzheimer's disease. That did make some people pull away from him because his behavior changed. We spent some time understanding what he can do now and the timeframe in which he can answer questions, and we do it his way. Everything is right in the moment. One has to be very patient. You can see him really start to engage and light up again. Even if you're willing to point to the same picture in the newspaper a few times, you can change what you say about it, they keep interacting because he doesn't have short-term memory, or even walking through a garden, "Oh, there is a rose. There is a pansy," right there in the moment.

Don't ask questions that challenge memory over and over again because that's what can be quite a stressor for people with memory decline. Unwittingly, their loved ones will say, "Well, don't you remember that?" or, "Do you remember Joe?" It's a way of talking that we use all the time. It has to be rewired so that the person with the diagnosis doesn't pull back and feel awkward as well.

Frank: Wouldn't you say that if you're looking for just a discussion with someone who has the disease, instead of talking about what they did this morning or yesterday, talking more about what they did many, many years ago would be a better way to deal with the situation?

Patricia: Oh, that can often work really well because the way Alzheimer's typically progresses is the short-term memory goes first, and then recent memories maybe going back a year, but, indeed, very old memories are preserved really until the end, especially sense memories, musical memories, memories that have to do with smell. It can be very enjoyable to engage the friend, loved one, client, patient in discussions of their old memories especially combined with stimulation that helps them to remember like music from that time period, or even a smell or other sensory experience.

Frank: Before we have to finish up, is there a site people could go to learn more about what you and your colleagues are doing? Any suggestions to keep up with what's going on?

Patricia: Of course, I have great admiration for the Alzheimer's Association. They have an excellent website: http://www.alz.org/. They keep up with and present the latest in research on Alzheimer's disease.

The Buck Institute for Research on Aging in Novato, California, also has a really great website http://www.thebuck.org/. You can go and look at what the Bredesen Lab is doing there and Dr. Bredesen's work with patients.

The Mary S. Easton Center for Alzheimer's Disease Research at UCLA puts out a newsletter, and it presents our research as well as that of others at UCLA. Just go to the Easton Center website at,http://www.eastonad.ucla.edu/ and ask for an electronic copy of the newsletter.

Frank: Thank you, Patricia Spilman. Thank you so much.

Patricia: Frank, thank you. I'm so glad we covered the subjects of stress release, sleep, exercise, music, comedy. I hope your audience remembers all of it.

Frank: Yeah. That'll be great if they can listen to it again.

Patricia: That's right.