Dr Jenny Brockis » memory loss

Don’t blow a gasket. Keep your blood pressure down to save your brain.

solutions — Sun, 01 Aug 2010 02:13:45 +0000

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.

Why eating eggs for breakfast and skipping the cough medicine is better for your memory.

solutions — Mon, 26 Jul 2010 01:12:03 +0000

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.

Honey, I’ve shrunk my brain, by smoking.

solutions — Mon, 05 Apr 2010 04:33:47 +0000

OK, hands up!
Which one of you didn’t know that smoking is bad for your health and is associated with an increased risk of heart disease, stroke and cancer?

Apart from the remote tribes people such as those living in the Envira region of the Brazilian/Peruvian rainforest, most people are aware of the negative effects cigarettes have on your health.

But did you know about the damaging effect smoking actually has on your brain?
And did you know about the damaging effect of smoking on your kids’ brains that are subjected to second hand smoke?

Do I have your attention?

Let’s start with the evidence available which tells us that

• smokers have poorer memories
• reduced problem solving skills
• and an increased risk of dementia.

In the 10 seconds it takes for the nicotine and other chemicals to reach your brain after the first drag on the cigarette, changes occur in your brain affecting your mood, your well-being and memory.
The effects of that cigarette will last for about 20 to 40 minutes in your body.

Thought that smoking makes you more alert?
Think again. A US study by the University of Michigan has shown that smokers have a slower and less accurate thinking ability.

Long term smoking damages your memory, your ability to problem solve and reduces your IQ.

Ouch!

Why is it so hard to quit smoking?

In the brain, we have a neurotransmitter called acetylcholine that is associated with a number of the body’s functions including learning and memory. It also facilitates other neurotransmitters that are associated with mood, memory and appetite. The nicotine attaches to the acetylcholine receptors in the brain mimicking its actions and promotes dopamine levels. Dopamine is associated with pleasurable feelings.
Ever wondered why some people say they enjoy smoking? Could be the raised dopamine levels talking.
Plus the elevated dopamine is the partial answer to why it is so hard to stop smoking, as the nicotine addiction wants you to keep those nice dopamine levels up.

If you smoke, you will score lower on memory tests. Period.

Smoking more than a packet a day will lead to increased difficulty remembering names and faces.

And remembering names is one of the most commonly voiced concerns about memory loss.

Smoking more than a packet a day provides you with a regular cocktail of toxins including toluene (also found in paint thinners and solvents and we know what that does for your brain), which can cause confusion and memory loss.

Ladies.
Those of you who smoke into middle age and menopause need to be aware that nicotine will lower your blood oestrogen levels and may inhibit the effect oestrogen has on your brain, exacerbating any brain cell effects of the fluctuating oestrogen levels.

Women who smoke will score 20% lower in tests of executive thinking ie reasoning, planning and organising.

So what is the evidence supporting smoking affects memory?

Dr Marcus Richards at University College London did a study on 5362 people born in 1946 and divided them into groups as either smokers, non-smokers and ex smokers.

They were given a list of 15 words for 2 seconds each and were then asked to write sown as many as they could remember,
In the second part of the test they were shown a page of letters and they were given one minute to find and remove all of the “P’s” and “W’s”

The results showed the smokers had the lowest scores for memory.

Those who had given up smoking, had a lower level of decline than those who had continued to smoke. So if you do smoke you will still be doing your brain a huge favour by stopping.

The relationship between memory and smoking was most marked in those who smoked 20 a day plus. In other words, the more you smoke the worse the effect on your memory.

Smoking can therefore be seen as accelerating age related memory problems.

Is this surprising?
Well, impaired memory is not uncommon in smoking related illnesses including cancer, heart disease, stroke, bronchitis, emphysema and asthma.

Why smoking has this effect remains unclear but it is thought that it could be because smoking increases a person’s risk of developing high blood pressure (itself a risk factor for dementia). it has also been found that tobacco contains a substance called NNK which can cause neuroinflammation. It is this inflammation that may lead to neurodegenerative disorders.

Or it may be that smoking has an effect on the supply of oxygen on the brain.

Or it could be a direct toxic effect of the multitude of other toxins found in cigarette smoke.

Whatever the underlying reason, it is clear that smoking affects memory and is an increased risk for dementia.

Hint, this is a really good reason to give up the smokes.
It would be a really good idea to stop now.

The benefit of stopping is that there is less memory deficit the earlier you quit.

And it’s never too late to stop.

I look forward to hearing your comments. But no excuses about how hard it is to give up smoking. I’ve heard them all.

If you smoke you have an addiction (as well as a shrinking brain) so it takes a decision, commitment and perseverance to quit.

You can do it.

In Part Two of this blog on smoking Jenny will be covering the worrying evidence of the effects of passive smoking on our kids and the effects on kids brains if they themselves smoke.

Stay tuned.

Ref: American Academy of Neurology (2007, September 6). Smokers Are More Likely To Develop Dementia.

Why it’s all in the NAME as the key to prevent memory loss.

solutions — Sat, 06 Feb 2010 05:26:04 +0000

The statistics for the numbers of people expected to develop dementia and Alzheimer’s over the next 40 years are really quite frightening.

Starting with a 5 % risk at the age of 65, this then doubles every five years. By the time we reach 85, up to 50% of us are likely to have developed dementia.

I don’t know about you but I’m not very happy with that statistic!

And what will become of us who actually live even longer?

Over the next twenty years our lifespans are forecast to increase even further, what will the relative risks be then?

The good news is that neuroscience has now provided us with many new insights and information about how our mind works. This includes the fact that it is our choices of how we live our lives, our lifestyles that can make a fundamental difference to the outcome of our future brain health.

If you have a positive family history of dementia or Alzheimer’s disease, this does elevate your risk for developing it yourself.

BUT and it’s a really big but, genetics only accounts for 20 to 30% of the factors contributing to determining our lifespan. It is our lifestyle choices and environment that determine the other 70 to 80%.

Guess what folks.

It’s up to us to decide what do we want for ourselves as we get older and to put in place the necessary choices to enable us to get what we want.

In my presentation, “All Your Marbles” I speak about the four key areas that are essential to include in any brain training program when looking to improve your mind in terms of memory, focus and attention.

To make it easy to remember all four areas, I came up with the acronym N.A.M.E .

N. stands for Nutrition.

A. stands for Attitude and Stress management.

M. stands for Mental Training.

E. stands for Exercise.

Each of these four areas is complimentary and synergistic with the others.

In order to build up your brain or cognitive reserve which will help protect us from cognitive decline, each requires the others to provide the full benefit.

It’s a multi-pronged approach.

There is heaps of information available to us that many of us know would make a difference to our overall health and well-being.

The question is “Why aren’t we doing the things we know are important?”

“What is it that keeps us deferring taking action?”

We have to look inside and be honest with ourselves.

Only you can answer what it is that might be stopping you from choosing those super brain foods and including them in your diet.

You may have been thinking about starting a new exercise plan but haven’t gotten round to it.

There could be a number of thing you have always wanted to do, such as learn to play the trumpet, do Italian cooking or visit long distance friends or family in other countries. What has stopped you from doing these?

And what about those things that wear you down, the worries and the stress you deal with. How are you managing those?

Remember, we all have the capacity to play a big role in determining our future brain health.

It is possible, through a combination of eating really healthily, exercising adequately, stimulating and stretching our mind and managing our stress that we can maintain our brain.

It’s all in the N.A.M.E.

Dr Jenny Brockis » memory loss

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