SPEAKER_00 0:00

Your brain is your body's control center, shaping how you think, feel, and move. When something goes wrong, it can affect everything. Welcome to Your Brain, Your Health, a podcast from St. Luke's Neurosciences. We'll explore conditions that impact the brain, spine, and nervous system and how they connect to your overall well-being so you can stay informed and take charge of your health. Thank you for joining us on today's episode, Caring for the Aging Brain, What You Need to Know. I'm your host, Dr. Eric Eustace, emergency medicine physician at St. Luke's University Health Network, and I'm joined with Dr. Daniel Ackerman, Section Chief of Neurology and Director of Stroke and Vascular Neurology here at St. Luke's. Together we'll talk about what happens to the brain as we age and why things change or don't change. So, Dan, welcome. Thank you.

SPEAKER_01 0:48

Thank you for having me. I mean, this is uh this is such an important topic. I think in my entire career I've had like maybe eight people who said uh memory is their strong suit. Otherwise, the that worry of what happens when we're getting older and particularly linked to memory is such a shared experience that we have. Um I'm just glad we can talk about it.

SPEAKER_00 1:09

So let's jump in. What actually happens to the brain as we age?

SPEAKER_01 1:14

So physically, what happens, um, there is some shrinkage in the brain as we age, and that's actually a normal, healthy process. Um, in fact, if you go back to the way the brain forms, uh, it forms with a ton of connections, a boatload of connections, actually more than we need and more than would be ideal. Over time, as we use our brain and as our brain gets older, we reinforce certain connections, other connections we don't use so much kind of get paired away. And so the brain gets more and more specialized and and more customized to us as individuals. Um, in terms of what physically happens, expect to see some degree of shrinkage physically in what the brain looks like. Um but beyond that, um, you know, the the issue that a lot of people get concerned about is well, how is my brain gonna stop functioning? Like what what am I not going to be able to do?

SPEAKER_00 2:11

Aaron Ross Powell What changes? So so are there any change with that shrinking of the brain, does that affect cognition? Does that affect memory? Does that affect our mood? Can you see those changes? Is that normal, or does that mean maybe something else is going on?

SPEAKER_01 2:28

Aaron Ross Powell The degree of shrinkage in the brain does not necessarily correlate perfectly to changes in function that we see.

SPEAKER_00 2:36

Okay.

SPEAKER_01 2:36

Okay. Now, in theory, someone who has a lot of shrinkage in certain areas of the brain, and particularly if that shrinkage is a result of certain not normal or what we call pathological processes, yes, of course, that's going to cause changes. It is not the case that you can just measure the brain volume and then determine what kinds of symptoms people experience. That being said, absolutely people can experience changes in not only memory, which we'll talk about, but in our function from day to day. So things like how much sleep do we need, what is our energy level like, how much endurance do we have, certainly things like mood can also shift considerably when we go through puberty and our brain changes some. And then we go through young adulthood and our brain changes some more. Well, as we get older, there are also some changes that are expected. Part of the problem is we develop a little bit of trepidation because there's no perfect line to figure out all right what is normal and what is not normal, or what's expected and what's not expected. Um, you know, there's no blood test for that, although we're working on that. Um but there really isn't. There's there's not a simple way to tell, and that's going to be different from each from one individual to the next. So there are some principles we're going to talk about that may help us to um conceptualize what's okay and what's not okay, but ultimately that's that's a that is an individual ballgame. That's each person uh one at a time.

SPEAKER_00 4:01

Okay. So in order to you know prevent some worsening of memory or changes related to that brain, uh do I just need to do Sudoku every day for five hours to prevent my brain from aging rapidly, or are there certain things that need to happen in my life to prevent that abnormal aging or rapid aging and ways to delay that?

SPEAKER_01 4:25

Aaron Powell So the answer is yes. There are certain things you should do. No, it should not be Sudoku five hours a day. Okay. You limit that to three hours so you can do other things. Um, there are there are four pillars of brain health uh that we teach in neurology, okay? Four four aspects of brain health that are very important. So one is adequate sleep, which of course we're all fabulous at as physicians, because I know you never work nights, right? It's not like you're ever awake all night. Um but yes, getting adequate sleep is actually really important. There's a whole system called the gymphatic system that that actually kind of operates when we're asleep and helps to, if you will, take the trash out. It helps to scrub things out of the brain. There's a lot of reasons adequate sleep is important, but adequate sleep is important. Okay. That's number one. Number two, physical exercise. And ultimately, what you know, that's not just about good cardiovascular health. There's a whole bunch of changes that happen in the brain and body associated with regular physical exercise that are extremely important. The third is diet. And usually from a diet standpoint, we recommend what's called a Mediterranean style diet, which is very common. People can look it up. There's also one called the mind diet, M-I-N-D mind, which is a take on the Mediterranean diet, and it combines it with aspects of what's called the DASH diet, which is about salt and high blood pressure. Exactly. So maintaining that good diet, you gotta put good fuel in there. Okay. Now, whenever we start talking about diet and exercise, there's a lot of like, oh, come on, really. But it makes it legitimate. No, it really is. And don't let perfect be the enemy of good. Okay? You do not have to live on cardboard and tofu for the rest of your life, but it is a matter of making wise dietary choices, including the good fresh fruits and vegetables. We're so lucky in our region to have such great access to a lot of really healthy dietary choices, limiting alcohol to an appropriate degree. Um, this is all part of that diet. So that's the third pillar. And then the last one is mental exercise. And this is where you you know you mentioned sudoku, right? So importantly, there is no one game or puzzle or activity or type of activity that is the good one for the brain. That's that's not how that works. However, um regular mental exercise, so that can include reading, that can include games and puzzles of many different types, it can include socialization. Socialization is actually really important. The way that you connect with people, the way that you pay attention to each other, the way you interpret body language and syntax and all of these kinds of things, um, that is really important exercise for the brain. That's really important to help maintain brain focus. Part of the challenge is also you don't want to keep doing the same thing again and again. So again, three to five hours of Sudoku a day? Probably not. Um, because if you keep doing the same types of exercise again and again, what you're really doing is practicing.

SPEAKER_00 7:15

Yes.

SPEAKER_01 7:15

And that's gonna help you get better and better, but it's not going to exercise your brain and challenge yourself, right?

SPEAKER_00 7:20

Build the synapses, whatever.

SPEAKER_01 7:21

Exactly. So again, those four pillars of brain health, right? Adequate sleep, physical exercise, good diet, mental exercise. These are the things that can build up something we call in neurology cognitive reserve. But it's the idea of how much of a reserve do we have in the brain so that when there is a problem at some point, our brain can just compensate for that problem so that and that's not usually a conscious thing, you know, you don't you don't shift your brain into compensation mode. It just happens. But how much can the brain take before you start seeing any kind of symptoms? And that's actually one reason that you can't do an MRI or some other kind of scan to see if someone has dementia or someone at risk for dementia. Because what the brain looks like on the scan and someone's actual cognitive reserve and brain function don't necessarily match.

SPEAKER_00 8:13

Okay. You're mentioning dementia, and I think a lot of viewers are obviously concerned about developing dementia. If I had a family member, so my mom had dementia, my dad had dementia, am I at a greater risk of developing that? Uh as I get older? Are there genetic factors? Is it based off of my lifestyle? What would be your take from an expert in the field?

SPEAKER_01 8:34

Aaron Powell Well, I I think we have to start with defining dementia. Okay. Right? Because dementia is, so first of all, in my office I say the word dementia very flippantly. I throw that word around a lot because we have to be able to have a conversation about this. All right. When we talk about dementia as a concept, that means in my mind, trouble with memory or thinking or both. And those are not really the same thing. And so many times people come in and say, I have trouble with my memory, but it might not actually be memory at all. We just only have so much language to describe it. Let's say you see a neurologist who has all kinds of fancy words to describe it. But um trouble with thinking or memory or both, that's significant enough that it really messes with your life from day to day. That's how I would define dementia. Now there are a lot of different causes for dementia, but you can group them into a few specific ones. One of them are what we would call primary dementias or primary neurodegenerative processes, processes where the brain is getting injured over time. Those are things like Alzheimer's disease, which I know we'll talk about on another episode, dementia with Lewy bodies, frontotemporal dementia. These are dementias that happen because of a primary problem in the brain. Then there are dementias that happen because of brain injuries that build over time. That's not so much like people who have concussion, that happens. That doesn't necessarily lead to dementia. Okay. There are cases where people can get a condition called chronic traumatic encephalopathy. That's not like someone who's had a history of concussion or even several concussions, that's not usually going to put them at risk for it. It's a specific group of people we think that has risk for that. Or people who have vascular damage over time. So people have lots of stroke and things like that, scarring in the brain from uncontrolled high blood pressure, high cholesterol, diabetes, smoking, you name it. They're building up brain injuries that can manifest as dementia. And then there's a third group of dementias where the trouble with thinking and memory is a symptom of something else that's not a brain injury. That can be a symptom of an inflammatory process in the body. There's a diagnosis pseudodementia, where patients who have significant mood challenges can develop the symptoms and signs of dementia that can be very tough to distinguish between dementia due to a brain injury. I bring that up because I, you know, it's important that we understand, first of all, is there a risk when someone has dementia that runs in their family? Yes, there can be. But it depends on the type of dementia, right? It depends on the cause for dementia. And for a lot of people, there may not be one single cause. The other thing is, particularly, you know, back in the day, if you will, when we talk about our parents, our grandparents, our great-grandparents, dementia was, and even sometimes still is today, very much a blanket term. And so the fact that we say, oh yes, my parent or my grandparent had dementia, or even saying they had Alzheimer's disease back in the day, we we didn't do a great job of being sure that was really what was going on.

SPEAKER_00 11:33

I hear that a lot, especially in the emergency department. Um, you know, my loved one has Alzheimer's disease, but there's do they truly have that, or is there some other type of form like you mentioned? So um are there certain types of interventions or treatments um that patients with dementia or developing dementia can be put on to possibly help slow this process? Because I know there's no unfortunately there's no cure for this, I'm assuming, unless something technologically advanced comes out. But um I'm sure there's maybe some things that we can do from a medical perspective to maybe help.

SPEAKER_01 12:08

Absolutely. And and I think that's where that's where understanding the root cause, number one, and being able to differentiate between what we might call normal cognitive aging or some of the expected changes that happen in thinking and memory over time, you know, differentiating that from something that's actually pathological, something that that shows there's a problem. So the answer is yes, there are treatments. There are there are some treatments that are specific for Alzheimer's disease that can help slow it down. Um hopefully we will see in the next several years some of those similar treatments for other primary dementia illnesses, there are some important similarities between those and Alzheimer's disease that I'm hoping the research community will be able to use to expand what they have done, their success with slowing down Alzheimer's disease into some of these other realms. But because dementia can be caused by some of these other things, if someone has, again, pseudo-dementia related to mood challenges, and you treat those underlying mood challenges, that can have a major impact on their thinking and memory. Someone who has dementia symptoms because of a metabolic process or an inflammatory process in the body, well, if you treat that underlying process, their cognition can improve. And as they recognize, as any of us recognize a an issue with cognition and take steps to improve our cognitive health, those four pillars of brain health we talked about, that can help to stabilize and improve things as well to a degree. And again, it's going to depend on what that underlying cause is.

SPEAKER_00 13:46

And um and what do we have to offer them?

SPEAKER_01 13:48

Aaron Powell I think first of all, it's a matter of having you know having a conversation with your clinician, with your physician or or PA or nurse practitioner, and um and being able to be open about it and say, I'm worried about this and coming in with those examples. We get we get very nervous about it and we don't really want to talk about it because we're worried if we talk about it, someone's gonna find something. Trevor Burrus, Jr.

SPEAKER_00 14:09

And I also know I mean I sorry to jump in, but I also notice uh and maybe you can weigh in on this is that family members don't like to talk about these things in front of the individual maybe who's experiencing that. In your uh like in in your experience, is it helpful to bring in the person that may be having these issues and and hear it from the actual patient itself?

SPEAKER_01 14:30

Well, you you have to. Yeah, no, it's it's it it is the case. I mean, look, we don't want to upset people with these conversations, and for people who are having challenges with thinking or memory or both, their awareness of those challenges may be uh maybe somewhat limited. And this can become a contentious issue in someone's home or family. And that's why sometimes family members want to have these conversations separately. But it's really important that we do this together, that we we have this conversation together, that we recognize we're gonna talk all together, and your answers may not agree, and that's okay, because first we have to figure out what is actually going on.

SPEAKER_00 15:11

Aaron Powell It's better to be to be out in the open, I think, and and transparent with your provider, your physician, your nurse, your NP, your PA, uh as opposed to keep things from them, because they can they can ultimately help.

SPEAKER_01 15:23

All right, so what what do we have at St. Luke's to help? Well, first of all, um there are there are different types of cognitive testing, right? So when you someone comes in and they complain about some challenge that we're talking about, uh whether aging in general or cognition, thinking, memory, dementia in particular, uh, there are things that we do to help measure how things are going, look at what areas of thinking and memory can be uh can be impacted. If we suspect there's a problem, that's where referring someone to either the neurology group or what we call the senior care group. We are the two groups that kind of have expertise in trying to help patients figure out where their symptoms fall on that line of is this expected or is it unexpected? We actually offer a cognitive rehabilitation program too, both through our speech therapy group and also through our occupational therapy group. We can actually do cognitive rehab, just like you can do physical therapy for your elbow or your shoulder. You can do rehab that actually is meant to help help the brain. If someone's primary challenge is with communication, speech, language, and the like, then we do that through speech therapy. If it's other stuff, we usually go through occupational therapy. And that can also be separate from medications that we can use to treat an underlying cause. When we can find an underlying cause that's treatable, well, we can we can try and help deal with that. Or things that we can do to help legitimately treat the symptoms, medicines that are symptom specific for cognition and the like. So there's a lot of things that we can do to help.

SPEAKER_00 16:56

What is the one piece of advice you would give to somebody who's concerned about the aging brain?

SPEAKER_01 17:02

Aaron Ross Powell I would say it's you know being mindful of our brain health, recognizing those four pillars, right? Sleep, physical exercise, diet, mental exercise. Okay. Keeping engaged with that process and recognizing that just because you have a little bit of trouble with thinking or memory does not necessarily mean you are on the road to having dementia at some point, but also taking those changes seriously and talking about them with your physician and seeing a specialist when indicated, especially because the treatments that we do have, and particularly when we're talking about Alzheimer's disease, are most effective when they are applied very early in the process. So we are really getting much more into screening people when we are a little bit younger and when the symptoms are more mild to try and help figure out what can we legitimately predict for the future.

SPEAKER_00 17:58

I think it goes back to the title of this podcast. Our health, our overall health is so impactful on our overall brain health. The two are linked and connected. And so I think it's amazing that we're we're talking about these simple principles of health. The four pillars of the brain is directly basically the four pillars of the brain health. So well, Dan, thank you so much. It's been a pleasure as always. Thank you for being here. And that's it for today's episode of Your Brain, Your Health. Thank you for spending time with us, and we hope you're walking away with tips and tricks how to make sure that the aging brain stays healthy. Until next time, take care. Your brain health matters, so keep learning and listening. If you found this episode helpful, share it with someone you care about. And for more resources on brain health, visit St. Luke's Neurosciences at sluh.org. Until next time, take care of your brain and your health.