Keep Your Brain Healthy Dr. Nancy Hoffman

Transcription

1 Keep Your Brain Healthy Dr. Nancy Hoffman Dr. Hendler: Hello and welcome to KP Healthcast. I m your host, Dr. Peter Hendler, and our guest today is Dr. Nancy Hoffman who is a neuropsychologist at Union City Kaiser. Dr. Hoffman did her doctorate in Clinical Psychology at the California Institute of Integral Studies and did her postgraduate training at Kaiser. Welcome. Dr. Hoffman: Thank you for having me. Dr. Hendler: What kind of work, what is it that you do? Dr. Hoffman: What I do is I see patients from all over the medical center that are having difficulty with memory, with concentration, or attention, and I test them to try to find out what might be wrong with their thinking. Dr. Hendler: Okay, and did you want to start before my questions just giving us a little background in keeping your brain healthy? Dr. Hoffman: I did. I got interested in brain health because most people think about health from the neck down, and if your brain is not healthy, it really doesn t matter if your body s healthy, if your bank account is healthy. Everything we do really depends on good brain health from thinking, feeling, working, playing, even sleeping is dependent on good brain health. And now that 78 million of us baby boomers are aging, suddenly we ve got a lot of interest in keeping our brains healthy. Dr. Hendler: Okay, people talk about staying mentally active. What do they mean? Dr. Hoffman: Well, your brain works because you ve got a hundred billion cells that are connected to one another. Over time those cells, those connections start to fall apart as part of normal aging, but if you learn something new, a new activity, new information, a new language, your brain actually creates new connections to try to keep that information flowing in your brain. So by staying mentally active, by learning new things, increasing the connections in your brain, you can actually try to stave off dementia. Learning new things actually increases those connections. So one of the things they have found in these studies is that people with higher levels of education tend to have no outward signs or fewer outward signs of Alzheimer s disease even if they have the plaques and tangles that other people have when they ve actually had a diagnosis of Alzheimer s. I m not saying that well-educated people don t get Alzheimer s, but the symptoms can appear much later if you are mentally active. Dr. Hendler: That s very interesting. You re saying that even though they have the same abnormalities seen in the microscope in their brain, they somehow can get around that by the exercise they ve given their brain. Page 1

2 Dr. Hoffman: That s what appears to be, there was a nun study done in Minnesota by a psychologist named David Snowdon, and he got a couple hundred of these nuns to donate their brains to science, meaning that they are going to be autopsied at death, and one of the things that they have found is that the better educated nuns, even though they have the plaques and tangles in the brain on autopsy, never showed any outward signs of Alzheimer s dementia. So their speculating from this that education, learning new things, creating new connections somehow protects your brain from dementia. Dr. Hendler: Very good. What kind of things can people do to keep themselves mentally active? Dr. Hoffman: Anything that requires focused attention. You can take a class in anything that interests you. Doing crossword puzzles is always something that can be challenging for your brain. These new Sudoku puzzles that people are doing are really helpful. There s a New York Times website where you can play crossword puzzles and these Sodoku games. Any game like that that improves your mental speed, watching Jeopardy trying to guess the questions before the contestants. Nintendo has a game called Brain Age that was actually designed by a Japanese neuroscientist, and it keeps track of your progress so the idea is to try to bring the age of your brain down to something a little bit lower. There s a website called happyneuron.com where you can play games on-line. You can go to lectures and plays. You can take classes at a community college. Playing Bridge is good for your brain. Bill Gates and Warren Buffet both play Bridge and they do all right. Dr. Hendler: Well, as a matter of fact I do have a Nintendo DS and I do have Brain Age. Dr. Hoffman: Well good. Dr. Hendler: And when I tried it the first time, my brain age was 84, and I practiced and practiced and once after a long time when I got it down to 24, I quit and never opened it again because I was afraid, you know, it could only go bad from there. But that s a very fun thing. It s not one game. It s many many different activities. Have you seen it? Dr. Hoffman: Yeah, I have it actually and I do play it and I m trying to get my brain down past the 40s, cuz it was in the 70s. Dr. Hendler: The only way I could get my score down is I actually had to go back to multiplication flashcards. Dr. Hoffman: Uh huh. Dr. Hendler: After I did that a while I got it down. Page 2

3 Dr. Hoffman: And see what happens is by doing that activity you re creating more connections, and you are actually creating an environment in your brain where information can pass along those neurons, those brain cells much more quickly. Dr. Hendler: Okay, now is watching TV a healthy mental activity? Dr. Hoffman: Unfortunately, no. But the average person watches over four hours a day of television. The reason that television isn t a mentally healthy activity is that you re very passive when you re watching it. So if they hooked you up to some sort of a machine, they would find that your brain waves were somewhat flat when you were watching it as opposed to brain waves if you re reading Shakespeare or attending a lecture, and your brain has to be much more active to take in that information. So you want focused attention unless of course you re watching Jeopardy and trying to outguess the contestants. Dr. Hendler: Well, I would also like to add that I would at least think that computer programming would keep your brain young. Dr. Hoffman: We ll see. How s your brain? Dr. Hendler: Well 84 but down to 24. Um, now you mentioned social activity. How s that good for your brain? Dr. Hoffman: Well, they re not completely sure how social activity is good for your brain, but a study just came out that said lonely people are twice as likely to get Alzheimer s disease as people who have a very active social network. And by an active social network they don t necessarily mean that you have hundreds of friends but that you perceive yourself as having a good strong support group. You could have two or three very close friends, two or three very good relationships, and feel like you ve got support or you could have 200 friends and feel very isolated. So it s not the number of people. At the same time they don t know which comes first in somebody with Alzheimer s. Are you developing Alzheimer s and you tend to start to withdraw from social activities or is there actually something in the social activity that keeps your brain young. One of the things that socializing does is to reduce stress, and stress is really bad for your brain. Dr. Hendler: Did you want to mention anything about animal studies? Dr. Hoffman: Actually in animal studies that they ve done because of course we can t do these studies on human beings, but on animal studies they ve shown that animals that are socially and cognitively living in enriched environments. So for animals it means cages with lots of things to climb in or wheels to run around in or other animals to interact with, that they actually have bigger cortexes, so the cortex is the outside part of your brain, and more complicated circuitry. They have more brain connections than the animals that are in cages by themselves with nothing to do. So they re extrapolating from animals to human beings that having an active social life, having a physically active life is good for your brain. Page 3

4 Dr. Hendler: The study I d like to see is where the people play with the animals and the animals play with the people and both of their brains get bigger. Dr. Hoffman: Maybe get an innovations grant for that. Dr. Hendler: Yeah, we ll try for that. Um, why is stress bad for your brain? Dr. Hoffman: Stress causes your body to release a hormone called cortisol, and cortisol is like battery acid for your brain cells, especially the part of your brain that is responsible for indexing and maintaining your memories. That s your hippocampus, and the good news is if you can reduce your stress, they ve shown that the brain cells in the hippocampus actually regenerate themselves. So by practicing stress reduction you can actually make improvements in your ability to think and to remember to concentrate, and if you re a Kaiser member, you can find stress reduction classes in the Health Ed Department that are either free or offered to members at a reduced rate. So stress reduction is really important for brain health overall. Dr. Hendler: Okay, so social activity is good for your brain. What about physical activity? Dr. Hoffman: Physical activity is actually really important for maintaining your brain health, and part of it is because blood circulates throughout your brain carrying oxygen and nutrients so the more you exercise, the better blood flow you have. And also this blood flow seems to encourage the growth of new brain cells. So again, going to the animal studies they put mice in cages with wheels and mice are notorious for loving to run on these wheels. So they let them run as much as they wanted and found that they doubled their brain size but only when they were allowed to run at will. When they forced mice to run and there was probably some unpleasant consequence of not continuing to run, they found that their brains actually shrunk, and the hypothesis there is that the stress of being forced to run probably killed brain cells, but the enjoyment of the exercise actually increased brain cells. And then of course if you exercise regularly and live a healthy lifestyle, you re going to have less of a chance of having a heart attack, of having strokes, of having diabetes. Any of those illnesses are going to adversely affect the health of your brain. So, and exercise also helps to combat depression and stress, both of which we already know are bad for your brain. And if you do something, it doesn t necessarily have to be strenuous. You could walk 30 minutes a day, and if you want to walk with a friend or with your partner, with one of your children, with your neighbor, you ve got the benefit of exercise combined with social interaction. One of the things about exercise though is you don t want to fall into a rut because you stop paying attention to what you re doing. If you learn a new activity, let s say you usually walk but you decide to take a tango class, the motor cortex in your brain, that s the part of your brain that controls your muscles, actually grows and changes. It has to change as you re learning new muscle skills, and they ve done studies that show that people who are fit have sharper brains. So you can start anytime. If you weren t active in your 20s but you want to get active now, it s never too late to start. You might want to consult your doctor Page 4

5 though if you re older or if you have any health issues. And also when you re exercising, if you re going to ride a bike or rollerblade or things like that, you ll want to wear a helmet because another tip to keeping your brain healthy is not to get a brain injury. People who have head injuries have increased risk of developing Alzheimer s disease later on. Dr. Hendler: Well, now diet and exercise usually go together. Is there any research on the effects of diet on your brain? Dr. Hoffman: Actually there s a lot of research on the effects of diet on your brain, and a brain-healthy diet would be the kind of diet that would help to prevent strokes, heart attacks, high blood pressure, or diabetes primarily because those illnesses are going to lead to difficulty with thinking and memory and concentration later on. And also your brain needs the right balance of nutrients to work well. So one of the first things that you can do for yourself right away is to eat breakfast in the morning. Not doughnuts and sugary cereals but eat something with protein with whole grains. Eat something healthy so that your blood sugar levels are consistent throughout the day. And maintaining a healthy weight is also important because they ve shown that people who are obese in middle age are twice as likely to develop dementia. Also if you have high cholesterol and high blood pressure, you re said to be six times as likely to develop dementia. So one of the things that you hear with regard to diet and brain health is to know your numbers. Know your blood pressure. Know your weight. Know your blood sugar. Know your cholesterol. And if anything is high and especially if you re a Kaiser member, you can get a lot of help in lowering those numbers. You d also want to eat foods that are rich in antioxidants, and antioxidants are typically found in brightly colored foods rasberries, blueberries, beats, all the green leafy vegetables. You want to get Omega 3s which are found in some fish, and part of the reason for that is that 60% of your brain is made up of fat. They ve also done studies that show that folate or folic acid and B12 are good for your brain. And one of the studies came out of the nun study because when they were doing the autopsies, they found that the higher the folate levels, the less likely these nuns were showing symptoms of Alzheimer s. Dr. Hendler: Tell us a little bit about sleep and the brain. Dr. Hoffman: Sleep is very important. If you are fatigued, it s difficult to sleep clearly. Excuse me...if you are fatigued, it s difficult to think clearly, and obviously I m a little bit fatigued or I wouldn t have said that. One of the things I just read is that if you are sleep deprived for 21 hours or more, you are acting as if you re drunk. It s got the same effect on your brain as if you were drunk. So a good rule of thumb to follow is that you need one hour of sleep for every two hours of wakefulness. One of the things that wreaks havoc on your memory and your ability to concentrate and pay attention is having a sleep apnea, and I see a lot of patients who have memory difficulties because they have a sleep apnea and they re not taking care of it. And I happen to know that you have a podcast on sleep apnea so I won t go into the details here because people can listen to that. But a sleep apnea is essentially when a person stops breathing momentarily at night, and sometimes they themselves don t know they have the sleep apnea but their bed partner Page 5

6 will tell them. They may also snore excessively or find that they wake up with a headache or they re excessively sleepy during the day. And what s happening with the sleep apnea when you momentarily stop breathing, you re depriving your brain of oxygen over and over and over again, and depriving your brain of oxygen actually kills brain cells. And a number of the patients that I see don t use their CPAP machines. And if you suspect that you have a sleep apnea, of course Kaiser has a sleep clinic where you can be tested. But it s really important if you do, that you use your CPAP machine every night to avoid killing brain cells. It can also, a sleep apnea that s untreated can lead to hypertension, heart disease, and stroke which is very bad for your brain. You re more likely to have a car accident, and like I said if you develop a head injury for any reason, that increases your likelihood of developing dementia later on. So if you drive, drive a car with air bags and always use your seatbelt. Dr. Hendler: I ve heard that there s a link between smoking and dementia. Is that true? Dr. Hoffman: Well there seems to be. Studies that they ve done lately have shown that smokers tend to have greater mental decline than nonsmokers, and the number of years that a person smokes happens to be important as well. They re not really sure why that is. It may be because damage to your arteries from smoking leads to increased risk of stroke or blood clots, and then people who are in the early stages of COPD, so that s chronic obstructive pulmonary disease, often don t know they have it, but they re putting their body in a chronic state of hypoxia. That means there s consistently less oxygen going to the brain than you need and that kills brain cells. And also smokers tend not to exercise. So if you smoke and you want to keep your brain healthy, you should stop. Dr. Hendler: I recently read something about positive attitude and brain health. Is there a connection there? Dr. Hoffman: Well there seems to be. The New York Times just published an article that telling yourself that you can t remember or you won t remember seems to be a selffulfilling prophecy. So what they did in this study was they had people try to remember something, telling themselves they wouldn t remember and another group of people trying to remember something, telling themselves they would. The people who consistently told themselves that they don t remember things, consistently don t remember things. So there seems to also be, with positive thinking, a sense of effectiveness in your life. You can roll with the problems that life offers you. You don t feel overwhelmed all the time. You feel like you do have some control. And for some reason that seems to protect your brain. Dr. Hendler: Is there a relationship between depression and memory problems? Dr. Hoffman: There is. Actually depression is very much like stress in that your body releases cortisol, and it eats away at the cells in your hippocampus the part of your brain that s responsible for your memory, and it begins to shrink so they ve done autopsies on people who suffered from depression and found that their hippocampuses were actually much smaller than people who weren t depressed. The good news is that Page 6

7 the brain has plasticity. That means it can grow and change so if you re depression is treated, your hippocampus can regenerate. You can regain your memory. There s actually something called pseudodementia which is a term that was used for people who were excessively depressed and began to look like they were demented. So treating your depression will actually help your neurons or your brain cells to regenerate. Dr. Hendler: Finally, do you have any tips for improving memory and overall brain health for all of us? Dr. Hoffman: Lots of tips. You can play the Nintendo Brain Age game we were talking about. You can do all kinds of little things in your daily life like when you go to the grocery store, organize your grocery list by sections of the grocery store. It will help you when you re in the store to remember what your looking for and you can make it into a memory game for yourself. You can learn a new language. Learning a new language actually creates a lot more connections in your brain and it s fun, and you can travel. Traveling is very good for your brain. You can put your new language to use. Use all your senses when you re trying to remember something. If you re trying to remember the name of a dog, visualize the feel of the dog s fur, get a sense of the smell of that dog, hear the sound of his bark. That will help you to remember, and the more that you remember things like a dog s name, the more positive your attitude and also again it becomes a memory game or a memory trick. Something else you can do is when you re trying to calculate numbers, try to do it in your head before you pull out your calculator, or don t let your computer remember your passwords. You could force yourself to try to remember them. If you re reading something, you can use a highlighter to try to remember key information. Read something different. They did a study when people were reading Shakespeare, it actually helped to create new connections in their brain because Shakespeare uses the language in a way that s not common so you actually have to work hard to understand it. Reading poetry is the same way. You can learn a new skill, take a cooking class, take up ping pong, play bridge, take dancing lessons, garden. Another thing you can do is to try to use your other hand your nondominant hand to open a drawer or open a door or if you re going to the grocery store or driving to work, take a route that s unfamiliar so that you have to think about what you re doing. Part of what you really want to do is to learn to pay attention because it s good for your brain. Dr. Hendler: You know, getting back to what you said about Shakespeare. I just read something about Shakespeare s language, and I thought that that s how everybody talked back then, but apparently even back in that time his language was unusual, that he would change the orders of like the subjects and the verbs on purpose to get people s attention. Dr. Hoffman: Oh that s very interesting. Dr. Hendler: Right. Dr. Hoffman: And it s kept our attention for hundreds of years. Page 7

8 Dr. Hendler: So it s now doubly hard because it was hard then and now it s much harder. Dr. Hoffman: But much better for your brain. Dr. Hendler: Yeah, if you can understand it. Well, there s always Cliff Notes. Dr. Hoffman: That s true. Dr. Hendler: Thank you Dr. Hoffman for being with us here today. Dr. Hoffman: Thank you for having me. Dr. Hendler: That was very interesting. I d also like to thank our audience for being with us today. KP Healthcast is created by the people at Kaiser Permanente in Fremont, Hayward, and Union City, California. These podcasts are for general information only. They re not intended to be used as a substitute for medical advice given to you by your personal physician. If you or a family member have any of the conditions discussed in any of these podcasts, we encourage you to discuss your individual case with your personal physician because every case is different, and your physician is in the best position to know what s best for you. You can find all of our podcasts on our home page at You can us at castmaster@kphealthcast.org. We d love to hear from you. Check our home page regularly for new topics and, as usual, be on the lookout for new ways to THRIVE. Page 8