MEDICAL LIFESTYLE INTERVENTIONS FOR BRAIN HEALTH Nicci Kobritz, President Center for Brain Health & Youthful Aging Home Health 1
Our Goal Reduce the impact of modifiable medical risk factors associated with Alzheimer s disease and related dementias and improve cognitive function by increasing protective factors associated with lifestyle interventions.
Exercise, Mediterranean Diet & Mental Stimulation Used Therapeutically Reduce the impact of modifiable medical risk factors known to compromise the integrity of the brain, risk of Alzheimer s disease
Modifiable Medical Risk Factors National Institute of Health Level 1-2 1. High mid-life BMI 2. Smoking 3. Diabetes mid-life 4. Low education attainment 5. Physical inactivity 6. High homocysteine 7. Depression 8. Hypertension mid-life 9. Traumatic Brain Injury o A-Fib o Atherosclerosis o High Cholesterol o Stroke o Vitamin Deficiency o D o Folate o B-12 o Magnesium o Coronary heart failure o Sleep disorder o Stress
Why Lifestyle Intervention? A. Reduces systemic inflammation B. Increases cardiovascular circulation C. Increases production of neurotransmitters
Exercise Cardiovascular Circulation Tau levels Blood flow Vascular dementia Systemic Inflammation Atherosclerosis, diabetes and other chronic pathological conditions Increase systemic levels of anti-inflammatory properties Neurotransmitters Brain Derived Neurotrophic Factor Neurogenesis
Cardiovascular Circulation Atherosclerosis plaque Lower fat; saturated fat Mediterranean Diet Systemic Inflammation Polyphenols and flavonoids Genetics Neurotransmitters Neurochemical Glutamate; dopamine; serotonin; endorphins; oxytocin
100 100 Physical exercise and Diet influence on the Risk for Alzheimer s disease 80 70% 60% 60 50% 40 20 0 Low activity & low diet Low activity & high diet High activity & low diet High activity & high diet 8
100 80 Adherence to a Mediterranean Diet and Risk for Alzheimer s Disease (482 MCI patients) 100% Rate of conversion to Alzheimer s disease were 50% of rates of people not on the Mediterranean Diet. 60 55% 50% 40 20 0 Low diet Medium diet High diet Scarmeas N, et. al., Archives of neurology 66:216.
Mental Stimulation It s all about brain reserve. Increase the production of neurotransmitters, strengthens communication between neurons. Increases density of neurons neuroplasticity Lifelong learning; complex and difficult topics; socialization
Building Brain Reserve Usually used Pathway Underused Pathways
FINGER Study Two-Year Clinical Trial of Multifaceted Lifestyle-Based Intervention Provides Cognitive Benefits for Older Adults at Risk of Dementia COPENHAGEN, DENMARK, July 13, 2014 Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER Study). Trial, funded by the Finnish government, the U.S. National Institutes of Health, and the national Alzheimer s Association. The study with 1,260 older adults at risk for cognitive impairment and Alzheimer's Same therapeutic lifestyle interventions Improved cognitive performance: executive function 12
FINGER Study It is the first time that is has been shown in a longitudinal study that it is possible to reduce the risk of cognitive decline with lifestyle changes. We have seen epidemiological studies suggesting associations between various risk factors and cognitive impairment or dementia but now we actually have a randomized study showing that lifestyle interventions can reduce the risk. It has been very difficult to prove anything works for reducing dementia or cognitive impairment in a randomized trial. Now we have done it. Our results suggest prevention is key. Our interventions are not difficult to do, they are very simple and pragmatic. Miia Kivipelto Professor of Clinical Geriatric Epidemiology at the Department of Neurobiology, Care Sciences and Society 2015 13
Michael Hoffmann, PhD, MD Brain Beat: A Scientific and Evolutionary Perspective of Brain Health examines the origins of the pillars of brain health, expounding the current scientific basis for recommending physical exercise, cognitive exercises, sleep hygiene, socialization and brainfoods.