When new patients come to his memory disorder center in Miami, Marc E. Agronin, M.D., says his first thought is not of a disease such as Alzheimer’s. As an expert in neurocognitive disorders, Agronin plays detective. He begins by exploring three possible causes for a person’s memory loss.
“I want to know what is going on in their day-to-day life that might be affecting their condition,” he says. “Someone who has hearing loss is not going to hear and thus not remember things. Hearing loss is a big issue and big risk factor for cognitive loss.”
Someone who is distracted, nervous or depressed is not going to be paying attention or concentrating as much. “This is going to affect memory and other cognitive skills.” Similarly, individuals who are not processing experiences and putting them into memory because of fatigue, sleep deprivation, illness or medication effects may also experience cognitive changes.
“All of these things can affect both short- and long-term memory. If we can identify some of these changes, these are easy to treat and reverse right away. We always should be keeping in mind how we can optimize our brain function.”
If it is determined that a person has a neurocognitive disorder, which Agronin says is now the preferred term for a memory loss illness, it’s important to separate that from the occasional confusion many people experience and explore the cause.
“Think about it like the term infection. If you have an infection, it means you could have many different types of infections — pneumonia, skin infections, things like that. Similarly, if you have a dementia or major neurocognitive disorder, meaning your brain function is declining, there are many different causes. It’s important to keep that in mind.
WHAT ARE THE RISK FACTORS?
“There are risk factors for both developing Alzheimer’s disease and perhaps other forms of neurocognitive disorders, but there are also risk factors for making it worse. If you look at all the risk factors for Alzheimer’s in particular, about 35 percent of them are potentially modifiable, meaning you can change them if you reduce them.” Agronin broke down the risk factors according to life stages. In early life, they are genetics and education. In midlife, they are hearing loss, hypertension and obesity; and in late life, after 65, they are smoking, depression, physical inactivity, social isolation and diabetes.
“One of the most well-recognized risk factors for late-onset Alzheimer’s is having one or two copies of the Apolipoprotein E4 or APOE-4 gene, which is found on chromosome 19 and produces a protein involved in cholesterol transport in the body. We don’t routinely test for this gene, however, because there isn’t anything specific to do if you have it other than to adopt a brain-healthy lifestyle, which everyone should do regardless of their genetic make-up.”
“Knowing what you have is really not going to do that much for you. That’s why we don’t routinely test for it. I don’t like people to find out and then fret about it. What I tell people is everyone should be on a risk-reduction, brain-healthy lifestyle regardless of their genetic risk.”
As for the role of education, “Theoretically, lack of education limits your cognitive reserves. The more you build up earlier in life, especially through higher education, seems to make a difference. Once you get into late 20s and middle age, it’s not clear whether education is really going to be the same risk reduction in terms of Alzheimer’s disease. Without question though, it’s going to build up your cognitive reserve, and so it’s important.”
OTHER POTENTIAL RISK FACTORS
“Traumatic brain injury, especially early in life with loss of consciousness, increases the risk of Alzheimer’s disease. Little bumps or minor concussions, not as much. Repetitive head injuries, such as in sports, is associated with chronic traumatic encephalopathy and Alzheimer’s disease.”
Researchers have found another contributing factor — oral hygiene.
“Studies have shown that poor oral hygiene increases bad bacteria and is associated with increased risk for amyloid protein, which is one of the toxic proteins that cause Alzheimer’s disease in a really stunning way. Think about how close the mouth is to the brain. People can get oral infections that can seep to the brain, so brushing your teeth and seeing your dentist are ways to reduce your risk of Alzheimer’s disease.”
Sleep disorders, such as apnea, deprive the brain of oxygen, creating the risk of brain damage, as do elevated levels of cholesterol. In menopausal women, the decrease of estrogen is a risk factor. “This is why many women are of much higher risk after menopause than men.”
WHAT CAN YOU DO TO MAKE THINGS BETTER?
Agronin says to skip all the “magic formulas” promised in overthe- counter brain formulas. “I will tell you none of which do anything. The only people benefitting from all these products are the people who are making and selling them.”
Agronin says to stick to “the old standbys” for cognitive enhancement. “You don’t have to spend a lot of money to address these.”
- Exercise – moderate exercise most days of the week, between 30 and 60 minutes, improves blood flow to the brain so your brain cells can make more connections.
- Diet – the 10 brain-healthy food groups are: vegetables (especially green leafy ones), nuts, berries, beans, whole grains, fish, poultry, olive oil and wine, but no more than one glass a day. To be avoided are sugar and processed foods.
- Keep your brain stimulated with games, puzzles, volunteer work, adult education and learning new skills and languages.
- Get enough sleep and hydration.
- Reduce stress and create mindfulness with meditation, yoga and prayer to help you center your brain.
- See your doctor regularly to discuss known risk factors.
PURPOSE IMPROVES HEALTH AND LONGEVITY
Maintaining strong relationships, doing volunteer work and keeping a positive attitude toward aging can reduce the risk of Alzheimer’s by nearly 40 percent and increase life by up to seven years, Agronin says.
“What I have found in my research on the strengths of aging is that people who have an increased sense of purpose have fewer heart attacks and strokes and lower rates of mortality, which reduce the risk of Alzheimer’s disease and other forms of dementia. It’s really stunning.”
This article is the second of a two-part feature adapted from AFA’s Care Connection webinar “Preventing Neurocognitive Decline: Before and After Diagnosis,” featuring Marc E. Agronin, M.D. Part One, “The Power of Healthy Brains,” was featured in the special year-end issue of Alzheimer’s TODAY.