I was sitting in my GP’s office recently, being told something I didn’t want to hear. My blood pressure was too high and I needed to start medication with antihypertensives.

I didn’t want to have to take medication. I had always planned not to be on anything apart from fish oil and glucosamine supplements until I was at least 90 years old. I consider myself fit. I exercise daily, my weight is normal, I eat healthily, I don’t smoke and I keep an eye on how much wine I drink each week.

But my family history includes hypertension and stroke on both my mother’s and father’s side.
And I do recall a conversation with my obstetrician who was managing my pregnancy-induced hypertension a number of years ago. He said, “Jenny, you are likely to develop hypertension as you get older.” Harrumph. I heard, but didn’t want to listen. But who am I trying to kid?

I have what is called “essential hypertension”. The cause is as yet unknown.
I don’t like it. But I can deal with it and take my pills.
The reason why? Because I value my brain cells too highly not to. As a Doctor my medical training has taught me what the consequences of untreated hypertension are.

Hypertension has been described as a silent killer. You can’t feel if your blood pressure is too high. We rely on readings taken with a sphygmanometer to get an accurate idea of the state of our blood vessels.
The blood pressure reading essentially tells us the peak or systolic pressure our heart has to exert with each contraction to pump the blood around our body. The lower reading or diastolic pressure gives us the resting pressure of the circulatory system in between heartbeats.

If the readings are too high we run the increased risk over a period of time of blood vessel rupture causing a stroke or cerebrovascular accident. Other organs are affected as well, including the kidney, eye and heart. None of which is good news.

So, back to the brain and high blood pressure. Sure it’s good not to be at risk of stroke. But what about the effect of high blood pressure on memory and cognition?

Studies have shown that having high blood pressure can contribute to memory loss and other decline in brain function in people over the age of 45.

In one study of over 19000 participants aged 45 or older, they found that with each 10-point increase in diastolic pressure, the risk of cognitive difficulty increases by 7 points.

But how high is high?
We need to keep our diastolic pressure (the lower of the two reading indicating the pressure of the arterial system at rest) at below 90mmHg.

With around 25-30% of the Australia adult population having high blood pressure I am clearly not alone.
For the vast majority of people like myself we have “essential hypertension” where no specific cause is identified. However having high blood pressure causes problems by causing our arterial walls to thicken and lose their elasticity, leading to reduced blood flow and tissue death.

Having reduced blood flow to your brain becomes an issue when you need it to be working harder. For example when you want to be able to pay attention or work out a solution to a problem, the decrease of available blood flow to your brain leads to fewer brain cells being activated and an increased number of memory lapses happening as a result.

In older people, having high blood pressure can predict who is at risk of developing impaired executive function (organising, planning and decision making) and a greater risk of progressing to dementia. One study of 900 octogenarians showed that high blood pressure was associated with an increased risk of developing dementia when frontal lobe functioning was impaired

Because stroke and TIA are leading causes of risk of cerebrovascular disability followed by dementia, controlling hypertension is a simple and effective way to significantly potentially reduce the incidence of forecasted dementia in this group.

So attending to diagnosing and treating hypertension in midlife would appear to be essential to protect you from developing cognitive impairment further down the track.

If you are over 45 and haven’t had your blood pressure checked for a while, now would be a good time to make an appointment and get it checked by your GP.

If it is too high then some simple lifestyle changes could help:

• Keeping your weight in the healthy range
• Don’t smoke
• Reduce your alcohol consumption.
• Do some regular exercise
• Keeping your cholesterol in the normal range
• Eat less saturated fat.
• Use less salt in your diet.

Hypertension has no symptoms, but is easily managed and keeping it in the normal range could make a big difference to being able to save your brain.

References:
Shahram Oveisgharan; Vladimir Hachinski. Hypertension, Executive Dysfunction, and Progression to Dementia: The Canadian Study of Health and Aging. Arch Neurol, 2010; 67 (2): 187-192

JAMA and Archives Journals (2007, December 12). High Blood Pressure Associated With Risk For Mild Cognitive Impairment.

Radiological Society of North America (2007, November 29). High Blood Pressure May Heighten Effects Of Alzheimer’s Disease.

I’m sure many of us may have experienced adverse effects on our brain, as a result of taking certain types of medication. The most common ones include some of the older anti-histamines, which, while alleviating symptoms of allergy can make the person taking them really sleepy and tired because they cross the blood-brain barrier.

Having a groggy brain for a day or two is an inconvenience, but what if the medication resulted in long-term cognitive impairment? Results of a recent study have now shown that there is a group of medications called anti-cholinergics, which can cause long-term mild cognitive impairment associated with memory loss. Some of these drugs are readily available as over-the-counter preparations and others are prescription only.

This was an observational study carried out over a 6-year period on 1,600+ people. They were all over the age of 70, of African-American descent and had normal cognitive function at the beginning of the study. The researchers diligently recorded all of their over-the-counter medications, as well as all prescribed drugs, over that 6-year time frame.

The results showed that those subjects who took one anti-cholinergic medication had a significant increased risk of developing cognitive impairment. Taking two doubled that risk.

In an ageing population where the various risks for developing cognitive impairment abound, this finding is of great significance.

So what are anti-cholinergics? Well these are the medications whose effect is to block acetylcholine. They are commonly used to help with sleep problems, allergies, urinary incontinence and cough. And these just happen to be symptoms that are not uncommon in the older population. Brands and medicines include Benadyl® or Benylin®, Nytol® and Paxil®, Olanzepine, Paroxetine, Amitriptyline and Promethazine to name just a few.
They seem innocuous enough but the findings of this study should alert everyone to the need for vigilance in taking anything that could be potentially a cause of cognitive impairment. All older people would be well advised to check with their Doctor about medications they have been prescribed or have bought for themselves over-the-counter.

The findings from this study means that further research will now be undertaken to see whether the cognitive impairment produced by these drugs, is reversible and whether the effect is the same in different population groups. Both Dr Campbell and Dr Boustani who were involved in this study believe that these findings are likely to be generalised across all races.

A downloadable list of medications with definite and possible anticholinergic effects can be found at www.indydiscoverynetwork.com under the service/tools tab.

Which brings me onto eggs.

What is the connection between anticholinergics and eggs?

Well, eggs are a rich source of choline, along with sardines, liver, soya beans, lecithin and peanuts.

Choline is an essential nutrient we need to form acetylcholine. And the medications discussed in the study causing long-term cognitive impairment were the anticholinergics.

We need choline in our diet because our body cannot produce enough of what our brain and body requires. It is the egg yolk, which provides us with the richest source of choline, 200mg per yolk. Adult women need approximately 425mg choline per day. Men need 550mg.

Choline is essential for good brain health as it

• Forms acetylcholine, a vital neurotransmitter and key for encoding memory. (We need other vitamins as well to make acetylcholine, including B1, B5, B12 and C.) Acetylcholine is also essential for muscle control.
• As Citicholine, it helps to boost levels of dopamine and other brain neurotransmitters.
• Is an essential component of brain cell membranes vital for their integrity and plasticity. Much of the brain is made up of phosphatidycholine and sphingomyelin, which require choline for their synthesis.
• Is vital to healthy brain development in the unborn child and in early childhood, and to maintain good memory throughout life.
• A lack of choline can lead to deficiency of folic acid, a B vitamin that is also crucial for brain health.
• Choline and its derivative Betaine are associated with reducing homocysteine. Homocysteine is a normal by product of metabolism but in excess is linked to increasing inflammatory responses, which can cause heart disease and dementia.

There are lots of other good reasons to enjoy eggs, but for boosting choline levels and helping to maintain a healthy brain, enjoying six free-range eggs a week is a great start.

I think I will enjoy two poached eggs on toast for breakfast tomorrow

So how do you like your eggs?

Refs:
1 Indiana University of Medicine (2010, July13th). Medications found to cause long-term cognitive impairment of ageing brain. “Neurology”
2 Duke University Medical Center (1998, April 9). Extra Choline During Pregnancy Enhances Memory In Offspring.
3 University Of North Carolina At Chapel Hill (2004, March 18). Scientists Discover Why Not Enough Choline Results In Fewer Brain Cells, Poorer Memory.

It’s been one of those days. You overslept and were late for an important meeting at work. Your boss is giving you the evil eye and you are feeling physically sick. The photocopier then spits the dummy and refuses to print out the 150 sheets you need for tomorrow’s presentation. A driver cuts in front of you in the freeway almost causing you to have an accident and you realise you forgot to collect your son from his after school sport training. Your son is cross as he gets into the car, throws his muddy sports gear across the back seat and slams the car door. You react by shouting at him.

Anger is a normal human emotion. We all get angry. We see anger expressed all around us, from screaming toddlers having tantrums in the supermarket, to belligerent teenagers slamming bedroom doors, to news reports of stabbings. When we are angry we say things which can be deliberately hurtful to the intended victim, we may even be physically aggressive.

Anger is a protective emotion. It guards us against attack. It provokes a physiological change in our body getting us ready to fight or flee and is associated with a psychological change in our brain.

When angry, our emotion can be usually easily detected by others: clenched tight muscles, facial flushing, narrow focused attention on the source of anger, raised blood pressure, increased breathing and heart rate. Our testosterone levels increases as does our adrenaline and noradrenaline.

How we react when angry, varies from person to person. We all learn to handle anger differently, depending on culture, socio-economic background, gender and personality. Some people deal with anger better than others. Some people are constantly irritable, hostile, and short tempered with a short fuse. Others are slow boilers, mostly easy going but capable of blowing off like a volcano occasionally.

In order to learn how to handle anger better, we need first to understand our amygdala.

Our amygdala is part of our reptilian brain, the oldest part of our brain developmentally and it is concerned with our emotional regulation. Nestled deep in the brain the two almond-shaped amygdala (one in each hemisphere) react to potential threats. They do this so well that our body reacts and primes itself to respond before the thinking part of the brain, the cortex, can evaluate what the situation actually is and whether any or what response is actually warranted.

Losing your cool at work.

At best this may have a negative impact on the relationship you have with your colleagues. At worst you may find yourself at risk of either losing your job ( unless you are the boss where you might lose an employee) or missing out on a promotion. Women who display anger in the workforce are seen in a particularly negative light. Fair or not, anger in men in the workplace for some reason is more tolerated.

Learning to control your anger is possible and can make a significant difference to your own level of happiness and well-being. Angry people have a much higher incidence of stroke, heart disease and impaired immune function. It’s bad for your health to be angry and it also has a bad effect on your thinking skills and mental performance.

Have you heard the saying that “As emotion goes up, intelligence goes down.” ? Or, as my mother always said. If you argue with an idiot, then you have two idiots. That doesn’t mean only stupid people get angry and argue, but that when you are angry your level of reasoning and logic is greatly reduced. What you may say or how you behave, can be completely irrational and out of character.

Once the amygdala has triggered the alarm, the cortex registers this and if our thinking brain goes along with the experience of anger, several things will occur.

First up the left side of our brain becomes more active and draws us closer to the source of our anger. When we are happy or experiencing positive emotions we expect our thoughts to bring us closer to the stimulus. Conversely when we are sad or afraid we would otherwise seek to get away from what is causing us to feel negative emotions and this involves stimulation of the right hemisphere. Anger is different because it is a negative emotion and yet we are drawn closer to who or what is making us angry, rather than moving away from it.

Anger management.

There are a number of strategies we can adopt to deal with anger:

• Because being angry provokes a focus onto the source of the irritation or anger, the easiest way to defuse the emotion is to remove yourself from the stimulus. Try going for a walk or at least leaving the room before you blow your top.

• By physically moving away or trying to detach yourself emotionally from the situation gives your cortex or thinking brain time to evaluate the situation. Try counting slowly to ten before allowing yourself to say anything!

• Take six deep slow breaths in through your nose and out through your mouth. Use diaphragmatic breathing: put your hand gently on your tummy and when breathing in or out allow your tummy muscles to go in and out. This helps to alleviate muscular tension and calms you down.

• Journal or write down your thoughts and then tear them up, preferably the following day. Never ever,ever send an email in anger. It might come back to bite you on the bottom.

• Try smiling. It’s really hard to stay angry at someone while smiling at the same time. It helps to lighten the moment.

• If someone is displaying anger at you, remember that that is their framework that they are looking through. You don’t have to share the same frame and buy into it. Is their anger really directed at you? Or are they just voicing their frustration/irritation and you just happen to be the nearest venting post? We don’t know what is going on in someone elses head. It’s their issue and they have to deal with it. The important thing is to not allow yourself to be infected by their negativity (somehow!)

• Give your anger a time-frame. OK, so someone has really gotten under your skin or made you feel really mad at them. How long are you going to allow yourself to experience that anger? By choosing to stay with your anger/hurt pride/wounded feelings etc it impacts your ability to respond and deal with what else is going on in the world. Angry people are not fun to be around. So you’re upset, now get over it.

• None of us are perfect and even with practice there are going to be times when our hot buttons get pressed and we react badly. So don’t beat yourself up if that happens. Afterwards, look at what may have been the trigger and learn from it. Was there a way you could have handled it differently?

• Don’t forget to apologise. It doesn’t matter whether you were in the right or wrong. You are apologising for your behaviour. You may or may not be forgiven for your anger but acknowledging your reaction was perhaps inappropriate or unhelpful can help. As long as you are sincere Saying sorry can go a long way to resolve conflict.

So what do you do to handle anger?

Ref: Neus Herrero, Marien Gadea, Gabriel Rodriguez-Alarcon, Raul Espert, Alicia Salvador. What happens when we get angry? Hormonal, cardiovascular and asymetrical brain responses. Hormones and Behaviour, 2010; 57 (3): 276 DOI: 10.1016/j.yhbeh.2009.12.008

P7C3. Remember this name!

Each week I scan different science reports from around the world, which continue to supplement our understanding of how our brain works.
Sometimes one report will leap out from the page when I read it, as it seems to herald a particularly important finding and this week I came across one such report.

The key to maintaining our ability to learn new skills and lay down memory, as we get older is dependent in part in our ability to produce new brain cells.
This is neurogenesis, one component of what makes our brain “plastic”.
The production of new baby brain cells occurs in what is called the dentate gyrus, one region of the hippocampus, which is the area of the brain, associated with learning and memory. However many of the new cells produced don’t necessarily survive to get fully incorporated into our brain.

Think of it in the same way as when turtle hatchlings are released into the ocean. Only a very small percentage actually survive and grow to adulthood. It’s the same with our brain cells. It takes several weeks for new brain cells to fully mature and most of them die off. Plus, the ability for our new brain cells to survive declines, as we get older. So researchers have been looking to identify compounds, which could enhance our newborn brain cells survival.

The results of the recent study could prove to be a breakthrough for potential treatment of Alzheimer’s disease.
A team of researchers at the University of Texas Dallas have found a compound which (at least for rodents) has been shown to increase survival rates of newly formed brain cells and by helping the rats to form new memories, reverse their memory loss.

The compound (given the really sexy name of P7C3) was one of over 1000 molecules investigated by the team. Using genetically engineered mice that lacked a gene needed to allow newborn brain cells to survive, the addition of the P7C3 reduced the expected newborn brain cell death rate.

The next step of the study then looked at whether the compound could slow down age related brain cell death and cognitive decline.
Apparently they used rats for this part of the test because it involved a water maze test, which the genetically engineered mice couldn’t do because they couldn’t swim.
(This conjures up images of mice wearing water wings. But I digress.)
The P7C3 was given on a daily basis to elderly rats with memory problems for two months and they were then subjected to the water maze task. The rats that received the P7C3 performed significantly better than the rats that had not received it. Moreover it was found that the rats given the P7C3 had three times higher than the normal level of newborn brain cells in the dentate gyrus of their hippocampus.

The conclusion was that the P7C3 enhanced new brain cell formation as well as increasing their rate of survival.

This exciting finding indicates that it may be possible in the future to be able to use compounds such as this in humans, because it can be given orally, can cross the blood brain barrier, and can produce long lasting effects for preserving memory and enhancing new brain cell survival. And the compound appears to be safe.

Obviously this is a long way off from being a substance suitable to use in humans, but it heralds an exciting development that we may have treatments in the future that could potentially address some of the core problems associated with Alzheimer’s disease where brain cell death is a marked feature.

And the team have already found that a derivative of the P7C3 called A20 appears to have an even greater neuro protective effect. A20 is apparently 300 times more potent than another compound, which is currently being used in clinical trials as a treatment for Alzheimer’s. The team are now looking to work out how these compounds, P7C3 and A20 produce their effect.
So watch this space.

Reference:
Pieper AA, Xie S, Capota E, Estill SJ, Zhong J, Long JM, Becker GL, Huntington P, Goldman SE, Shen CH, Capota M, Britt JK, Kotti T, Ure K, Brat DJ, Williams NS, MacMillan KS, Naidoo J, Melito L, Hsieh J, Brabander JD, Ready JM, McKnight SL. Discovery of a Pro-neurogenic, Neuroprotective Chemical. Cell, July 8, 2010 DOI: 10.1016/j.cell.2010.06.018

I had great fun having a chat with Dr Jason Fox recently on a couple of tips that can make all the difference when studying for exams.
You can watch the short video clip on the link below.

Jenny chats to Dr Jason Fox about memory

I spent countless hours as a student at school and later at University, cramming. I would often be working late into the night trying to remember all the information I needed to know for exams and tests the next day. Little did I realise then, that I would have been so much better off revising my work in shorter chunks and then going to bed at a reasonable hour to ensure I got a good night’s sleep. Sleep is essential to allow our brain the time to revise what we have been learning and to allow us to encode it all in our memory. Revision and repetition are the key to learning.

How many conferences or seminars have you been to where the content was great, but the amount of information was so huge you actually couldn’t remember any of it?
A good presenter will have just a couple of relevant take home points. Don’t worry about all the “fill”. At the end of the lecture or talk, see if you can note down the main key points. There should be only three or four. Then re-read your notes at the end of the day (before you go to sleep) and again within 48 hours. You will find you remember so much more.

The other great study tip is to work with a buddy or friend. Being part of a study group or even just spending time with a friend going over some of the material you have been revising, will help enormously in assisting you to remember the information. Talking out loud or speaking about a topic with someone else really clarifies your understanding and ability to recall. So don’t be afraid to leave your books and talk to your friends and colleagues. If your friends are all busy, then going over what your have learnt with your Mum or Dad can help in the same way. Try it, it works!

Jason’s website is crammed with great ideas, articles and other videos all to do with how to help yourself get cleverer with exams. You can check it out at enjoyexams.com