Essential Tools to Prevent Cognitive Decline

I'd like to welcome everybody. Today's show on integrated behavioral health. I AM your host, Dr. Donnelly Snipes. Today we are talking about dementia and stress. We're going to look at the connection and ways to prevent dementia or at least slow the prog progress of dementia and cognitive decline. We're going to talk about three different types of prevention. Primary prevention means preventing yourself from getting it ever. And some forms of dementia. Some. Some causes of dementia are not preventable. Cognitive decline is not completely preventable. As we age, we are going to experience some cognitive decline, but there are things we can do to slow the progress and keep ourselves sharper for longer. Secondary prevention means preventing the progression of the issue. And there are a lot of things that we can do to slow the progression of inevitable cognitive decline that comes with aging, but as well as slowing the progression of dementia and maybe Alzheimer's, there's a little bit of controversy about that. But you know, anything we can do to help ourselves live a richer, fuller, more meaningful life for as long as possible is definitely something we want to do. And tertiary prevention means preventing comorbid conventional conditions. So, for example, we're going to talk a lot about how the relationship between cognitive decline, dementia and depression. If we can prevent that depression from happening, if we can help people stay happy, that is something that we really want to work towards. Briefly, let's talk about the effects of cognitive decline or dementia. So it answers the question, why do I care? Even if you are a teenager or in your 20s, it is not too soon to start doing things that are going to help you prevent the develop later development of dementia and to do things to enhance your cognitive resources. So it slows the cognitive decline process later in life. When people develop cognitive decline or dementia, female physically, it can make it more hazardous for them to live by thems. They may forget to eat, they may do things that are. Are physically harmful. It's also related. There are correlations between cognitive decline and ill health, including hypertension, coronary artery disease, worsening of diabetes. So we really want to help people stay mentally sharp, effectively. Cognitive decline, even that cognitive decline that is just a natural part of aging impacts mood. It increases depression. And a lot of people, it also increases anxiety because they're afraid they're going to get, quote, put in a home. So we do want to address that. There's a grieving process that goes along with cognitive decline. As we start to realize that we're not quite as sharp as we used to be. And those are all very normal feelings that we. It's important to help people address. But the longer we can help them stay sharp and stay independent and stay empowered and stay safe, the longer we're going to stave off some of these dysphoric emotions. Cognitively. Obviously, cognitive decline contributes to difficulty concentrating, difficulty remembering, difficulty with directions, getting lost easily. Environmentally, people can be very unsafe when they are experiencing cognitive decline or dementia. When it gets to be severe, they can forget that they have something on the stove. They for can forget that you can't put metal into the microwave. And with dementia specifically, there is a concept called confabulation in which people with dementia may not remember what happened. But if you ask them, they will tell you something. And, and I avoid the word make up something because they're not making it up in their own mind, it really happened. They're trying to figure out, well, logically, how could this have happened? Well, it must have been, you know, they are not, especially in the later stages of the disease with confabulation. They are not intentionally lying in their mind. That must be what happened. And that is fact then. So it's important to recognize that environmentally people can be become more unsafe and they may have a lot of reasons or excuses or stories about how it happened. But we do need to use some good judgment. And interpersonally, as people start to experience cognitive decline, some people get depressed and withdraw. Some people just withdraw because they don't feel like others understand them and they have difficulty understanding others. As people get older and they start experiencing cognitive decline. And I keep saying older, but it's not necessarily just age. There is cognitive decline or cognitive effects of chemotherapy, for example, they call it chemo brain. And those of you who have had children probably are very familiar with. We used to call it mommy brain, but we'll call it parent brain now because when we are sleep deprived, our cognitive function kind of goes down a little bit. So any of this can cause stress and, and challenges. But when we're talking about something that's permanent, something that's not going to be able to be remediated by getting a few good night's sleep, then it can really start causing challenges in relationships because people like, like I started to say, have difficulty comprehending as quickly. You need to slow down for them a little bit. And not everybody recognizes that. I have a video on the YouTube channel on communicating with the cognitively impaired that gives a really practical tips that can be helpful if you've got a loved one who is experiencing moderate to significant cognitive decline. So let's talk about what causes it and what we can do to stave off the progression or prevent it if possible, during period. And let me back up, Cognitive decline is something that happens as a natural course of aging. Dementia is different than cognitive decline. Not everybody who experiences cognitive decline will develop dementia. And so I want to separate those two in some research has indicated that dementia may be preventable for people who have lifestyle factor related causes of dementia. You know, if they have genetic predispositions, that may not be preventable. But what we're talking about today are those factors that can be modified during periods of high stress. And we've talked about the HPA axis repeatedly, but we're going to talk about it again. We're going to talk about it pretty much every day. Probably when we are under high stress, our body dumps cortisol, our stress hormone, norepinephrine, our focus hormone basically, and glutamate, our main excitatory neurochemical. Now, when there is too much glutamate and too much norepinephrine surging through because of too much stress, the environment in the brain becomes what we call neurotoxic. If you want to think of it as running too hot. And we actually start to see the development of the shrinkage of, of brain tissue and the loss of neurons during periods of high stress. We also are, if you want to think about it this way, thinking a lot more. And when we engage in these processes, it there, there are byproducts, there are waste products whenever our brain does things. And those, that is, those can be thought of as free radicals or oxidative stress. And if our body can't keep up with, you know, clearing out the waste products, then they build up and they can cause a lot of problems from inflammation to, to worse diseases. So it's important to recognize that high stress can contribute to neuronal cell death, you know, brain damage in, in and of itself, which will contribute to cognitive decline. And it can also contribute to things like hypertension, high stress, hypertension. We don't think twice about linking the two of those. Hypertension is the leading cause of strokes, which can lead to vascular dementia. When your brain is deprived of oxygen again, it starts killing brain cells, which ends up causing vascular dementia. We want to make sure that the brain is getting oxygenated. So controlling hypertension is really important, whether it's met medication, lifestyle factors, nutritional factors, cognitive things that you're doing to handle your stress. There are a lot of ways, a lot of things that you can do concurrently to manage hypertension and it's really important because it is related to so many problems later down the road, but also current problems when people have hypertension and diabetes. The. The two of them work almost synergetic, synergetically, in a negative fashion. So hypertension control, really important. Now, interestingly, and I have put links to these articles that I'm citing in here in the notes because I found a really lot, a really lot. I can't even speak this morning, a lot of really fascinating articles about lifestyle factors and how they contribute to dementia. So instead of just taking my word for it, I wanted to give you the link so you could go read it from the proverbial researcher's mouth. But obesity has been found to increase systemic inflammation. Now, when we're talking about obesity, we're talking about over fatness and especially over fatness that's associated with insulin resistance. So this obesity is associated by increasing the risk of dementia in general by 42%, Alzheimer's by 80% and vascular dementia by 73%. The body mass index, so the percentage of fat you have is linked to decreased brain volume independent of age and morbidity. So as body mass index goes up, brain volume goes down. And it's also linked to. Blood flow to the prefrontal cortex is also linked in the same way to body mass index. As BMI goes up, blood flow to the prefrontal cortex, which is where we do all of our planning and executive functioning and memory and, and things like that and impulse control, that's in your prefrontal cortex. So decreased blood flow to that area, decreased nutrients to that area is, you know, no bueno. Diabetes is also associated with the development of dementia, especially if the person has a history of recurrent severe hypoglycemic episodes, which I thought was interesting. I would have thought it was the other way around with hyperglycemia, but they say no. The research seems to indicate hypoglycemia. So when blood sugar gets too low, that HPA axis kicks off, and if it gets really low, the HPA axis kicks off with a vengeance and starts dumping all those stress hormones and potentially making it neurotoxic. Diabetes is not always preventable. You know, some people develop it, are. Are born with it. So diabetes is one of those things that it's important to control. Diabetes in and of itself, as long as it's well bl. Blood sugar is well controlled, is not a super huge factor for the development of dementia that they've found out so far from the reading that I was doing. But if blood sugar is out of control, then you're going to have a problem, especially hypoglycemia. Poor nutrition is also associated with the development of cognitive decline and dementia. Good nutrition, let's start there. Good nutrition is anti inflammatory. If we're not eating a lot of processed foods, good nutrition provides the antioxidants and helps reduce inflammation. Eating a lot of processed foods and omega sixes and other inflammatory substances contributes to systemic inflammation, which contributes to what we were talking about earlier with excitotoxicity and neuronal cell death. What we want to look for in a healthy diet is reducing sodium, reducing stimulants, and trying to make sure we're getting enough omega 3s, antioxidants and B vitamins in our food. In order to bolster normal health mechanisms that are naturally deterrent to to a variety of chronic health conditions, not just dementia, people need good nutrition. And again, there are videos on the YouTube channel on nutrition that you can look at and learn about. Antioxidants are available in most of your fruits and vegetables. So if you're thinking, well, where do those come from, fruits and vegetables? We're not doing anything too crazy here, but we want to make sure that throughout their life people have access to these things because antioxidants are necessary to prevent that damage, which eventually could be additive and lead to increased rate of cognitive decline. Hearing loss in late life might also contribute to depression and a sense of isolation and loneliness, which have both been factored found to be factors for cognitive decline. When people have hearing loss, it's challenging for them to interact with others because they're not hearing what's going on. They have difficulty understanding what's being said, and it can be extraordinarily frustrating to them as well as to the people they're communicating with, which can cause tension in relationships. So hearing loss often makes people feel isolated from the world that they once knew. And that can be very frustrating. Now. The great thing is that there are a lot of resources out there. There are headphones and different things that people can get so when they're watching tv, they can hear what's going on a little bit better without having to crank the full TV volume up to, you know, 87. There are hearing aids that people can get that will amplify sound that are not as expensive as your prescription hearing aids. So there are things that people can do. And obviously prescription hearing aids are available to people. Smoking and vaping increase oxidative stress and problems in the heart and blood vessels which increase the risk of vascular dementia and Alzheimer's. If you can quit smoking and vaping, it's ideal. Not everybody's willing to do that, but we know that that is one very modifiable factor that is associated with dementia, Alzheimer's, as well as a variety of cancers and other things. Physical inactivity. When we are physically active, we are moving blood through the body, which serves a variety of factors or functions. One of them is bringing oxygen to all the tissues, including the brain. So that's good. We're getting the oxygen there. That's one of the things we need. We're getting nutrients there. That's another one of the things we need. And it's also sweeping away some of the toxins. So exercise and blood circulation is super important. When we have hypertension, our blood flow is not so, so good. So you know, that's a problem. When we're not exercising, our blood flow is not so good. So that can be a problem. When you have hypertension and you don't move, it's sort of a double whammy. 30 minutes of activity per day, and it doesn't have to be. You don't have to go to the gym and work up a sweat and be in your target heart rate training zone. It's great if you can, but if you don't, that, that's okay. We want to see people breathing more deeply and moving their body. 30 minutes of activity per day has been shown to decrease dementia risk. Even more perfect protection was found by the involvement in four or more types of activities. Why four or more? Well, because everything may impact the body a little bit differently. So walking, biking, swimming, gardening, yoga, tai chi, vigorous house cleaning. Walk it well, walking the dog, playing with your grandkids, you know, playing hide and go seek can actually use a fair amount of energy. So thinking about things that you can do. And even with gardening, a lot of people, and I'm getting to that place, have difficulty getting down to garden in the ground, especially if they're doing a lot of gardening. There are raised garden beds that you can get now that are raised to like table height. That can be very helpful. There are a lot of benefits to gardening. Number one, people are outside, so they're getting. Even if they're in dappled sunlight or under a pavilion or something, it's helping set their circadian rhythms. The passive sunlight that they get going in and out to wherever they're gardening helps increase their vitamin D levels, which reduces vitamin D, reduces inflammation, improves the immune system, so and is associated with reducing depression. So That's a bonus. Messing around with plants that put off oxygen, well, you can see where that can be a good thing. So there are a lot of benefits to it aside from just movement. Tai chi, while I'm on it, there are a lot of videos on Tai chi. I looked at this a lot when my mother had cancer and she was not able to stand anymore. She didn't have the balance, didn't have the physical energy to do standing, let alone Tai chi. But Tai chi and variety of other things can be done from a chair and you can find full length YouTube videos on these things. So I'm not going to go into a lot of depth there. Alcoholism Alcohol is toxic to the brain and results in reduced thiamine levels which in extreme circumstances in alcoholism, the disease can cause something called Korsakoff Syndrome or alcohol related dementia. What we do know about alcohol is small amounts in some studies have been found to be protective, but they've recently, recently revised the guidelines that for men that small amount is one drink or less per day and for women it's even lower than that. So, you know, thinking that three or four glasses of wine in the evening is not a big deal. That's it actually is pretty stressful on your body. That's again a lifestyle factor that some people are not willing to, to give up and, and that's a choice. I am not judging either way. But it is important that people have the information and they can make educated decisions from that point in. If people have HIV or aids, remember yesterday was World AIDS Day. The AIDS dementia complex develops in about 10% of people who are not taking HIV medications. So people who are taking those antiretrovirals can be, can protect themselves from the development of the AIDS dementia complex, which is really good. It doesn't necessarily prevent all of the neurocognitive issues associated with HIV or aids, but it really can help stave off dementia treatment compliance. That's really what it comes down to affectively when people have dementia. We talked about all the different ways that it may affect their, their life and it can contribute to anxiety and depression and grief. They've also found that depression and the associated high levels of cortisol have been associated with the development of dementia. So not only can dementia cause depression, but depression has been associated with the development of dementia. Addressing depression is important for so many reasons. I mean, we know h, depression affects, affects us physically, emotionally, cognitively in our relationships. You know, depression is not something that you really want to be living with all of the time. So helping People figure out the causes of and interventions to address their depression is going to be really important. Depression is also an early warning sign of dementia. In some studies they have found that up to five years before the onset of dementia, people develop a significant level of depression. So that a sudden onset of depression with no perceivable cause, not, not like there was a death in the family or a major upheaval, could be an indication that you need to look a little bit more closely for dementia. PTSD is something that can make dementia worse because PTSD, when it is uncontrolled, when it's not in remission, contributes to hypervigilance and high levels of stress and impairs stress sleep, all of which are going to keep that HPA axis revved up and create that neurotoxic environment. Helping people develop strategies to deal with their PTSD is important. The same thing is true for chronic stress. Even if it is low to moderate grade chronic stress. That engine, if you think of it that way, that HPA axis engine is constantly idling, it's constantly using some energy and it's constantly, you know, keeping everything a little bit warm if you instead of super hot. But chronic stress starts leading to conditions of hypocortisolism and glucocorticoid resistance which can lead to feelings of depression, can lead to increased systemic inflammation, which both of those have been related to depression or I'm sorry, dementia. So we do want to make sure that we are doing everything we can to develop those coping and distress tolerance skills, get a good social support system to deal with chronic stress and use psychological flexibility in order to live our most rich and meaningful life, even if or and with the problems that inevitably come with life cognitively. Interestingly, they found early life education can contribute to preventing dementia. Higher education decreases the risk of dementia by 30%, possibly due to the fact that people with more education are often more financially secure and have access to better health care and nutrition. But they've also identified in some people that using your brain, think of your brain like a big old muscle and the more you use it, the more neurons are activated in your brain, the more you have, the more spare neurons, if you will. And this is very non clinical, I apologize to you neuropsych people out there, but the more spare neurons that you have to lose before you start evidencing cognitive decline. So keeping yourself sharp, trying to consistently learn, even if you didn't have, you know, higher education can still help stave off cognitive decline. Continued learning, even if you did Go to college. Continued learning and cognitive stimulation are really important throughout our lifestyle. Engaging in activities that increase our awareness. Mindfulness is great. You know, going on walks and noticing things that are going on, using our memories, using our creativity, whatever that looks like for you. You know, not everybody is, you know, good at drawing or painting or even wants to do that. Some people would love, prefer to cook or woodwork or do something like that. But something that uses that creative side of your brain is helpful and other do other things that use the logical side of your brain. My mother did sudoku or however you pronounce it for a long time before the chemo just became overwhelming and she had a hard time focusing. But logic puzzles, words with friends, those sorts of things can be really helpful at keeping people sharp. We don't want people spending their years, even young years. We're not just talking about people who are over 65 or 70, but even as young people, we don't want to spend our time just vegetating in front of the television. Use your brain and environmentally stressful environments obviously create that excitotoxic, whatever word I'm looking for. It's interesting. I'm having a hard time finding words today when I'm talking about cognitive decline. But I digress. Stressful environments create excitotoxic environments in our brain. So the more you can do to create an environment that feels, feels physically safe and that is pleasant to all of the senses, sound, sight, smell, the better off you're going to be. Also, creating environments that are conducive to sleep can be really, really helpful. Sleep deprivation contributes to difficulty with focusing and concentration throughout the day. When your circadian rhythms are balanced throughout the day, you develop something called adenosine in your brain. As you think that's just one of those byproducts that develops, that's fine. As adenosine levels go up, cortisol levels go down. As adenosine levels go up, we start feeling tired. It creates what the sleep people call sleep pressure. When we sleep and we get into that quality deep sleep, our brain actually clears out the adenosine. Not during REM sleep, but during that deep sleep period. So if you don't get enough good quality deep sleep, you may wake up in the morning and still feel a lot of sleep pressure, still feel kind of foggy headed. So sleep is really important in regulating our stress and helping us feel our best. But also under stimulating environments, we don't want to spend time, as I said, just sitting there vegetating in front of a Television screen or, you know, a mobile device. We want to be able to get out there and use our brain. We also need to use our body. Remember, at least four different types of activities every, every week can be really helpful. And I know that's a lot to remember. I put the all of this in the notes to the presentation so you can go back and review some of these things and pick and choose. Not everybody is going to be willing to do everything that we've talked about. Some people will be because they're like, well, the earlier I start, the more resources I'll develop and the better prepared I'll be to stave off dementia and cognitive decline. And other people are like, nah, I'm really enjoying life right now and I'll take what happens, when it happens. And that's their choice. But being aware and making informed choices is part of a healthy lifestyle. Are there questions? As I said, I do have a couple of videos on social work case management with people with dementia, communicating with the cognitively impaired on the YouTube channel. So you can look at those if you want more information about, you know, ways to prevent and slow the progression of dementia. But I think it's interesting and if you spend some time kind of looking at all the connections between your physical health and your cognitive health and your mood, I think you'll find that there are a lot of factors that are very similar. Prevent, predict, preventative factors that are very similar for a lot of things, not just dementia, but also cancer and, you know, reduced immunity, making you more susceptible to, you know, opportunistic illnesses, etc. And remembering that diet impacts dementia several ways. Diets that are high in sodium are more likely to increase blood pressure and make hypertension worse, which makes you more likely to have cardiovascular problems. So that's one, eating a lot of inflammatory foods, foods that are high in omega sixes and processed, you know, processed carbohydrates, those things, simple sugars, those contribute to inflammation, inflammation contributes to depression as well as HPA axis activation and excitotoxicity, neurotoxic conditions in the brain. So those are a couple of things that we want to look at. B vitamins are really helpful for energy production as well as, you know, just helping people keep their immune system up. And then our antioxidants that are found in a lot of our fruits and vegetables are really helpful at assisting the body in clearing out that those free radicals and oxidative stress and that we create when we do anything throughout the day, but we create them a lot faster when we are revved up when that fight or flight system is going, when that HPA axis is over activated, we are just cranking out those free radicals and putting a lot of oxidative stress on our body. So in those cases, introducing antioxidants through the diet can be one way of assisting the body in clearing out the pipeline, so to speak. Alrighty everybody, thank you for being here with me today. Tomorrow is Thursday and we will be talking about, oh, the environment. I am going to be talking about aromatherapy tomorrow because that just sounds like a fun thing to talk about. So I will see you tomorrow. And thank you again for being with us today.