I’m Here for You: How the Brain Improves by Having a Good Listener Around

If only they would listen….

It’s a common refrain, isn’t it?  I’d venture to say that not “hearing” another person (donning my counselor hat here) is a major factor undermining any relationship.  Sadly, in the prevailing us- versus-them culture in which we now live, this lament is increasingly common.  

 Supportive social interaction in adulthood has long been known as a key element in staving off cognitive decline.  Now, a new study, published August 16 in JAMA Network Open, finds that simply having someone available to talk with most or all of the time is associated with higher cognitive resilience.  Moreover, the researchers point out that although social support is important in younger decades of life, strong social relationships may overrule cognitive problems associated with brain aging in later years.

The Study:  Brain Tests, Volume Measurements for over 2,000 Seniors

I am impressed that this study used one of the longest-running, close-monitoring cohorts in the United States for their 2,171 participants – the Framingham Heart Study.  Average participant age was 63.  

The data consisted of self-reported information on the availability of supportive interactions which included love, affection, listening and receiving good advice.  They also reported how available that support was and how sufficient the contact frequency.

Then those participants underwent MRI scans and neuropsychological assessments.  Through the scans, the researchers were able to measure cerebral brain volume (lower volume is linked to lower cognitive function).  

Sifting through this information, linking brain volume, cognitive fitness and social connection, the researchers determined the most important variable underlying brain health based on all the gleaned data– “listener availability”.

Friendless and Forty?  You Stand to Lose 4 Brain Years

Having a good listener around is perhaps even more important in younger decades of life.  This study argues that individuals in their 40s and 50s with low listener availability had a cognitive age that was four years older than those with high listener availability.  Four brain years!

That’s why I relentlessly chirp about incorporating brain health practices – exercise, nutrition, mental activity, socialization and stress management – throughout one’s lifespan.  Brain health, in many respects, lies with the individual, not with magic pills nor even with your trusted doctor.  (Have you ever been asked if you’re lonely or friendless at a routine physical?)

Taking Stock

Good friendships and partnerships take work.  Indeed, those of us introvert-types can find that reaching out to a friend, old or new, is an effort.   But chronic loneliness undermines health.  Ask yourself honestly:  do you truly have someone in your life who will listen to you in a supportive way?

The reference:

NYU Langone Health / NYU Grossman School of Medicine. "Having a good listener improves your brain health." ScienceDaily. ScienceDaily, 16 August 2021

Get Outside! How Nature Makes Us Smarter, Happier, and Nicer

Last week, I visited Florida for a bit of fishing, beach strolling, and seashell hunting.  The fishing was a wipe-out; I caught one pitiful fish that looked more like a grass snake.  But just having some time on the edge of a coast, soaking up the lapping waves and watching tiny crabs scramble for cover, seemed to reshape my perspective.  In a good way.

And my fellow beach-mates appeared to be in a similar frame of mind.  There is no sense of urgency as people build sandcastles, wade, swim and walk outdoors. It’s as if we are collectively ticking to a different clock, the hours measured by the shifting sun and tide.  As time slows, so pauses all the busy thoughts that occupy us otherwise.  Is the brain responsible for why we are so drawn to outdoors in spaces blue and green?

You know where this is headed.  It turns out that, indeed, exposure to nature is linked to all sorts of brain health benefits, including better attention, mood, and upticks in empathy.  Past research has looked at green spaces and cognitive health and more recently has studied the effects of “blue space” – like rivers, oceans and lakes.  Let’s see how it all adds up.

Nature Makes Us Pay Attention

Spending time outdoors and in nature, even with limited exposure, greases the cognitive gears and perks up attention. A 2019 review from the University of Chicago reported that green spaces near schools promote intellectual development in children while green views near children’s homes promoted self-control behaviors. Meanwhile, adults who were assigned to public housing units in neighborhoods with more green space demonstrated better attention than those assigned to units with less access to natural environments.  Other research observations have found that being exposed to natural environments improves working memory, cognitive flexibility, and attentional control, while exposure to urban environments is linked to attention deficits.

Why do natural settings have a positive effect on cognition?  One argument is an evolutionary one - our ancestors evolved in wild settings and therefore we have a built-in drive to connect with nature. Another theory suggests that spending time in nature triggers a physiological response that lowers stress levels. A third idea holds that nature replenishes one’s cognitive resources, restoring the ability to concentrate and pay attention.

It doesn’t take long for nature to work its magic on the brain. Australian researchers asked students to engage in a dull, attention-draining task requiring them to press a computer key whenever certain numbers flashed on a screen. Students who looked out at a flowering green roof for 40 seconds midway through the task made significantly fewer mistakes than students who paused for 40 seconds to gaze at a concrete rooftop.

Does Nature Make Us Happier?

Back in the day, we all played outside as kids; by the end of the summer, the soles of our bare feet were as tough as shoe leather.  But a sad part of our world today is that children spend so much time inside (looking at a screen) rather than playing outdoors.  In fact, the CDC reports that children ages eight to 10 spend an average of six hours per day in front of a screen.  For kids ages 11 to 14, the number increases to nine hours a day! 

Research suggests that when children get outside, it leaves a lasting impression on mental health.  Danish researchers used satellite data to assess people’s exposure to green space from birth to age 10, which they compared with longitudinal data on individual mental health outcomes. The researchers examined data from more than 900,000 residents born between 1985 and 2003. They found that children who lived in neighborhoods with more green space had a reduced risk of many psychiatric disorders later in life, including depression, mood disorders, schizophrenia, eating disorders and substance use disorder. For those with the lowest levels of green space exposure during childhood, the risk of developing mental illness was 55% higher than for those who grew up with abundant green space.  

If you absolutely must plant yourself in front of a screen every day, you’ll be interested to hear that scientists have begun exploring whether virtual reality nature experiences are beneficial. In a review of this work, researchers at the University of Exeter in England concluded that while the real deal is best, virtual reality can be a worthwhile substitute for people who are unable to get outdoors, such as those with mobility problems.

Blue Space Counts Too

While most of the nature effect has been studied in green spaces, other researchers are looking at blue space, including a variety of marine and freshwater environments.  The conclusion?   These spaces are not only good for well-being, they may be even more restorative than green spaces.  Is it any surprise that so many of us are drawn to the waterfront? 

Nature Makes You Nicer 

Nature might also make us nicer—to other people as well as to the planet. In a Canadian study, undergraduates were shown either nature documentaries or videos about architectural landmarks. Then the participants played a fishing game in which they made decisions about how many fish to harvest across multiple seasons. Those who had watched the nature video were more likely to cooperate with other players.  They were also more likely to make choices that would sustain the fish population.  In another experiment, researchers found that elementary school children acted more positively to classmates and strangers after a field trip to a nature school than they did after a visit to an aviation museum.  

All it Takes is Two Hours a Week

With so many benefits linked to nature, you might wonder: How much time outside is enough? A UK study has addressed that question by studying a sample of 20,000 adults across the United Kingdom. They found people who had spent at least two recreational hours in nature during the previous week reported significantly greater health and well-being. That pattern held true across subgroups including older adults and people with chronic health problems, and the effects were the same whether they got their dose of nature in a single 120-minute session or spread out over the course of the week.

I could go on and on, citing research that connects the feelings of contentment and self-worth with nature exposure, how it buffers loneliness and depression.  (The references to such research are listed below).  But I suspect most people, especially you explorers, gardeners, and neighborhood walkers, have already experienced the mood and mental health benefits that nature bestows.  

What are you waiting for?  Get OUT THERE!

Links to references in studies cited for this blog:

Current Directions in Psychological Science, Vol. 28, No. 5, 2019).

Lee, K.E., et al., Journal of Environmental Psychology, Vol. 42, No. 1, 2015

Engemann, K., et al., PNAS, Vol. 116, No. 11, 2019

Neuropsychiatric Disease and Treatment, Vol. 14, 2018

Gascon, M., et al., International Journal of Hygiene and Environmental Health, Vol. 220, No. 8, 2017

Journal of Environmental Psychology, Vol. 42, No. 1, 2015

Dopko, R.L., et al., Journal of Environmental Psychology, Vol. 63, No. 1, 2019

Scientific Reports, Vol. 9, No. 1, 2019 

The Truth About a Controversial New Alzheimer's Drug

If you haven’t already heard, the FDA announced that it has approved a new drug, Adulhelm, developed by pharma-giant Biogen, for the treatment of Alzheimer’s Disease on June 7.   Adulhelm is the brand name for of generic drug name aducanumab.

 The bad news?  For starters, the drug hasn’t been shown to significantly improve or delay symptoms of the disease.  One of two clinical trials showed that using the high dose of the medication slowed cognitive decline only slightly — by about four months in an 18-month period or by an improvement of .39 of an 18-point cognitive test.  A subsequent identical study showed no significant clinical effect compared to placebo.  While the drug is “intended” to impede disease progression, there’s no hard evidence that this will happen.  

The approval has been accompanied by heavy controversy, including the voices of the FDA’s independent advisory committee involved in this trial.   In fact, as of this writing, three members of said committee have resigned in protest over the decision to approve the use for a broader than intended population. By the way, the FDA was not acting here as a tiebreaker: 10 of 11 advisers voted to reject Biogen’s application and the 11th was undecided on how to interpret the data.

Then There’s the Cost

Biogen has established the list price of the drug, which must be administered intravenously once a month, at $56,000 a year.   That’s just for the price of the drug.  And while an insurer (namely Medicare) will likely cover some of that cost, those who receive this drug treatment will be required to have PET scans to detect amyloid clumps, deemed crucial to diagnosing Alzheimers.  Pet scans can cost thousands of dollars and are not covered by Medicare. Nor are the multiple follow-up scans needed to check for tiny brain bleeds (microhemorrhages) or brain swelling which are potential side effects of the drug.  In fact, during the clinical trials, some 40 percent of participants given the highest dose had one or both of these side effects.

We’ve Been Down this Road Before…. Many Times

But never mind the cost and the ambiguous “hope this helps” claim that the drug manufacturer holds out like a carrot on a stick.   The rationale, according to the FDA for its approval of Aduhelm, is that reducing amyloid, the sticky stuff responsible for brain plaque, could be reasonably expected to benefit brain function.

 But this is the same thinking that drove Pfizer’s development of a similar anti-amyloid antibody drug called bapineuzumab, over ten years ago.   Those trials were reported in The Lancet Neurology in 2010. Pfizer ultimately abandoned bapineuzumab because, although amyloid accumulation was reduced over the course of the trials, there was no meaningful impact on clinical outcome.

Since then, the failure of amyloid reduction in a decade of drug failures like bapineuzumab, solanezumab, (I know, they all have long, funny names) and others, the absence of clinical benefit by solely attacking amyloid brain plaque has been noted by many experts.

Should Aduhelm Be Available for All Stages of Alzheimer’s?

With luck and a prayer and a shred of evidence, the drug’s proponents suggest that it’s possible that when mildly impaired patients are treated for five years or 10 years or more with Aduhelm, there will be an obvious benefit.   Fingers crossed that this is the case. 

But the FDA’s surprise approval included the decision to use a broad label for the treatment.  That means that any of the more than 6 million people in the U.S. with Alzheimer’s would be eligible, not just those in very early stages.  Will it be the physicians’ and insurers’ call as to who will be treated?  That’s a tough job to face without guidance from the manufacturer.

What Will Happen if the Confirmatory Trial Fails?

As I write this, the news headlines tell me that the drug is now being readied for shipment and administration within two weeks.  Patients and their families are already scrambling to get their place in line for the new drug.  

But there’s another caveat.  The FDA’s approval is conditional – Biogen must conduct one other massive scientific trial to validate the outcomes generated in a subset of sufferers in solely one in every of its two scientific trials.  That’s called a confirmatory study, one that confirms how well a new treatment works after it was shown in early-phase clinical trials that it might be beneficial for patients.

I’m not surprised to learn that Biogen does not expect to start a multiyear study until 2022.  The proposed study design is long and time-consuming, effectively giving Biogen nine years' time to market the drug without fear of repercussions. If the trial fails, then the company gets to keep its earnings from the drug -- with no refunds.

The Cruelty of False Hope

I winced when reading the headline from the Alzheimer’s Association website on June 7: “It’s a New Day in the Fight Against Alzheimer’s — Aducanumab Approved”.  To give them a fair shot, I listened in on a live broadcast sponsored by the Association on June 24.  In the broadcast, physician Stephan Solloway explained basic differences between Adulhelm and drugs that are currently available for Alzheimer’s Disease and emphasized that the drug should only be used for those with mild cognitive impairment, not in advanced stages of the disease.   Agree.

 But I didn’t hear anything about how significant the clinical benefit was when measured in the one trial that showed improvement nor how this drug is different from previously developed – and abandoned – amyloid antibody treatments that have failed so many times before. I asked both of these questions in the short Q&A time, but neither was addressed.

I hope I’m dead wrong and that the treatment will mean better quality of life for those it helps.  I hope it works in spades for the patients who choose to jump on board in desperation and in gratitude for the research scientists who work at Biogen and a forward-thinking FDA.  Yet behind that hope is a sinking feeing in my gut that questions how this will be different from so many other attempts to fix Alzheimer’s by removing its hardware.  Time will tell.

Why You’re so Sensitive to Sound and Why Certain Noises Drive You Nuts

When I was in nursing school, we took our tests at desks lined up in neat rows, arranged alphabetically.  To my dismay, the guy who sat behind me had insufferable allergies – every breath he took sounded like a drooling slurp followed by a sputter.  Inhale, exhale, slurp, sputter.

I wouldn’t have minded so much except that at exam time, his continual clamor accentuated the silence as we made marks with our pencils.   I felt like I was undergoing a slow form of torture.  In desperation, I plugged my ears with my fingers to concentrate on each question. 

(Which worked.  I passed!)

Do You Have a Supersensitized Brain?

If you can relate to this story or have experienced other sounds that drive you up the wall (nails screeching across a blackboard?), you might have a ‘supersensitized’ brain.  That’s a neural connection that has been identified in people who suffer a negative reaction to certain trigger sounds.

In extreme circumstances, sufferers feel disgust and even rage when exposed to certain noises.  That reaction is a real condition called misophonia, meaning hatred of sound.  Now, researchers at Newcastle University in England have discovered that people who have such a condition have an abnormal communication between the auditory and motor brain regions such as the face, mouth and throat.

According to the lead researcher, this is the first time that such a connection in the brain has been identified.  The study was published in the Journal of Neuroscience, May 21, 2021.

The Most Hated Sounds

People with misophonia experience intense and involuntary reactions to particular sounds made by others. Common trigger sounds are usually related to mouth, throat or facial activity – such as chewing, breathing or speaking.  Reactions vary in range but they can be acute, including anger, fight-or-flight response or a desire to hurt the person making the noise!

Any of these common culprit sounds push your buttons?  

• snoring

• wheezing

• nose whistling and sniffling

• talking with food in one's mouth

• teeth grinding

• loud throat clearing

• slurping

• chewing with one’s mouth open
  

Misophonia sufferers may feel that sounds from others are intruding into their bodies and that they have no control over their reactions.  In severe cases, sufferers find aspects of family life (such as sitting around the dinner table) difficult to bear.

The study provides support for why sounds provoke such responses since they are caused by brain activity invoked by particular sounds.   The condition is fairly common, affecting up to 20 percent of the population.

Is There a Cure or Medication for Misophonia?   

No medicine or “cure” is available for this condition but there are approaches that seems to work, including tinnitus retraining therapy and cognitive behavioral therapy. Tinnitus retraining therapy (TRT) involves teaching people with misophonia how to improve their ability to tolerate certain noises. Cognitive behavioral therapy involves changing the negative thoughts that may contribute to the patient's suffering.

 Another treatment involves adding background noise to the person's environment in an effort to help them ignore their triggers for negative reactions. Fans and "white noise" machines are examples.  As a sensitive listener myself, I don’t travel anywhere without ear plugs and a portable clip-fan.

Guess mom was right with her advice - stop smacking and chew with your mouth closed!

You can find the study here:

https://www.jneurosci.org/content/early/2021/05/20/JNEUROSCI.0261-21.2021

More Evidence that the Mediterranean Diet is Best for the Brain

You are what you eat.  The real you is your brain. Ergo, your brain is what you eat.

Over the years, a plan of eating called the Mediterranean diet has been studied – and contrasted with Keto, Paleo, low fat, low carb, and the Standard American Diet (with the appropriate acronym SAD) – with respect to the impact of diet on brain health.   Consistently, the Mediterranean diet, studied alone and in meta-analysis, has borne out as the most protective way of eating for the brain.

Now a new study, recently published in Neurology, reinforces that claim and in a strong way.  

Meet the Mediterranean

The Mediterranean diet is a way of eating based on the traditional cuisine of countries bordering the Mediterranean Sea.  Imagine that you live in France, Spain or Italy.  Your meals are largely comprised of fresh vegetables, fruits, whole grains, beans, nut and seeds, and olive oil.  Animal protein is mostly from fish, rarely red meat, and dairy intake is low if at all.  

What’s to Like about this Study: Older, At-Risk Participants, Extensive Tests

Although the Mediterranean diet has been studied with respect to brain health in other research, there are some factors to this study that I really like.  For starters, the average age of the 512 participants was 70 and the majority were identified as higher risk for Alzheimer’s Disease since they were already suffering from mild cognitive impairment, a common precursor to Alzheimer’s.  These participants filled out detailed questionnaires in which they indicated which portions of 148 different foods they had eaten in the past months. Those who frequently ate healthy foods typical of the Mediterranean diet, such as fish, vegetables and fruit, and only occasionally consumed foods such as red meat, scored highly on a scale.

Then (and this part I like most of all) the scientists looked at brain volume and atrophy by examining the brain with magnetic resonance imagery (MRI’s). It is well established that brain shrinkage is commonly seen in those affected with profound memory loss from Alzheimer’s Disease.  Such shrinkage, as you can imagine,  can rapidly progress and exacerbate Alzheimer’s symptoms.  

In addition, all subjects underwent various neuropsychological tests in which cognitive abilities such as memory functions were examined. The research team even looked at biomarker levels (measured values) for amyloid beta proteins and tau proteins in the so-called cerebrospinal fluid (CSF) which are considered biomarker precursors to Alzheimer’s.

The Results are In

The conclusions of the researchers pointed to higher benefits of the Mediterranean diet eaters in all respects.  Compared to those who ate other (less healthy) diets, the participants on a Mediterranean diet did better on the cognitive memory tests and had fewer pathological biomarkers for Alzheimer’s in their cerebral spinal fluid.  

And their brains were bigger!  There was a positive correlation between a closer adherence to a Mediterranean diet and higher volume of the hippocampus, the part of the brain responsible for short term memory and new learning.  People with Alzheimer’s tend to lose volume early and severely in the hippocampus.

Conclusions and a Note-Taking Challenge

Can one conclude that following a Mediterranean diet protects the brain from atrophy, memory loss and risk of dementia in later years?  Not entirely.  Remember, optimal brain health is a compendium of lifestyle practices which include exercise, mental activity, socialization and stress management.  Of course, other risk factors may also cloud cognition during the soup of life experience - like head trauma, infections, genetics.

But the role of diet in cognitive health cannot be ignored.  

Last week, I made a food journal for a dear friend who suffers with various gastric problems, encouraging her to record food intake to rule out whatever might be causing symptoms.  Reading this study made me think of a similar recording practice of daily diet to see how the rest of us are faring in diet.  To this end, I’m working on developing my own Mediterranean rating scale to help people determine how smart their current diets stack up.  When it’s done, I’ll post on my website.

Food for thought?

The study referenced in this article is here:

Mediterranean Diet, Alzheimer Disease Biomarkers and Brain Atrophy in Old Age. Neurology, 2021 DOI: 10.1212/WNL.0000000000012067

The Zen of Dishwashing: Sharpening Brain Focus by Practicing the Everyday

This week, as I scanned the brain health headlines for blog ideas, I debated between two stories – one involving the clinical trials of a “promising” new Alzheimer’s prescription drug and the other about how dishwashing (yes, you read that right) can help your brain with focus.

The clinical trial headline (Novel Alzheimer’s Drug Slows Cognitive Decline) was more exciting than the actual story.  The study was small, the difference in cognitive scores only marginally better, and the drug had to be administered intravenously every four weeks up to 72 weeks.  The proposed medication is another stab at reducing beta-amyloid plaque, a road that’s been unsuccessfully travelled by other pharmaceutical researchers seeking to diminish the cognitive destruction of Alzheimer’s Disease.   Admittedly, I’m a skeptic when it comes to fixing a complex disease like dementia by medication.   I’m hopeful that effective treatments are on the horizon but, in the meantime, we need to do as much as possible to keep our own cognitive gears whirling.

So I’m going with the dishwashing story that caught my eye with this headline: Why These Neurologists Want You To Wash Dishes For Better Brain Health (Really!)

 The story concerns two neurologists, Dean and Ayesha Sherzai, who singled out attention as the “gatekeeper of consciousness”, noting that without attention, brain abilities like memorization and learning new information become more arduous tasks.  Since the ability to focus naturally wanes with age, utilizing strategies to employ attention are paramount.

But the Sherzais also point out that enhancing focus doesn’t have to come from brain games and puzzle-solving.  It’s better developed by incorporating into everyday endeavors. 

Take the dirty dishes that are languishing in your kitchen, for example.  When you wash dishes, you're completely focused on the task at hand. It's difficult to try to multi-task, like responding to texts or phone alerts, with soapy fingers.  Remember, multi-tasking (attempting to do several things at once) is a myth – it means that you are merely doing many things badly.  The brain is unable to split attention.  Over time, attempting to multi-task erodes the ability to discern between what’s relevant and what’s not.

Think of the act of dishwashing as a ritual when you are paying attention to what's in front of you and focusing on the task from beginning to end.  The neurologists liken it to a Japanese tea ceremony.  The important consideration is not about brewing and drinking the tea but the act of going through the process in detail, while in a state of meditative focus.  

If dishwashing is not a part of your everyday life (lucky you), other common activities that can get your mind into that mental state of calm alertness might be drawing, gardening, knitting, or folding the laundry.  In my brain health classes, I ask participants to quickly sort playing cards into suits or to separate beads by color to speed up the processing part of the brain and learn to allay the distractions around them.

I love the simplicity of this brain health lesson – it’s so easy to become distracted by a noisy world, internal thoughts and the endless serenade of pings and ringtones.  Righting the brain by reigning in focus is as near as your kitchen sink.

Read more here:

https://www.medscape.com/viewarticle/947410?src=wnl_newsalrt_210313_MSCPEDIT&uac=179016SV&impID=3246597&faf=1#vp_2

https://www.mindbodygreen.com/articles/neurologists-on-how-dishwashing-can-lead-to-better-brain-health

Sure, it’s Cold – But Your Brain Loves It!

How Temperature Affects Cognition

It’s hard to remember more atypical circumstances.  In my own life, I can’t recall such a freakish winter storm as the one I’m experiencing while I’m typing these words.  Single digit temps, blankets of snowfall, frozen pipes, power outages lasting days, everything closed (Walmart too) – in South Central Texas?  

In truth, I love the cold and the serenity of looking out to see the still, white majesty of an overnight snowfall.  Winter’s the time when I feel energetic, curious, refreshed.  Yet I fully understand why others disagree and will “take the heat” over a chilly day, hands- down.

But what does the brain say?

Is SAD Real?

SAD stands for Seasonal Affective Disorder, a type of depression that's related to changes in seasons. It begins and ends at about the same times every year.  The assumption is that for most people who experience SAD, symptoms start in the fall and continue into the winter months, draining energy and increasing irritability.  That makes for a lot of grouchy, depressed folks in January.

But research refutes the SAD theory as a general truth and notes that cold impacts us differently. In a large-scale study published in the journal Clinical Psychological Science, researchers found no evidence of any kind that symptoms of depression tend to be higher in winter — or at any other time of year. This study factored in geographical latitude and sunlight exposure on the day of the survey were also unrelated to depression scores.

Another study published in the journal Proceedings of the National Academy of the Sciences found that in younger populations experiencing normal levels of cold for winter, the brain actually works more efficiently than any other time of year. The study tested participants vigilance and working memory as well as other indicators of cognitive performance. The participants sense of alertness, their emotional state and melatonin levels didn’t vary with the seasons and their performance on tasks was largely the same. 

In older populations, however, a study published in the journal Plos Medicine found that memory and cognitive performance were at their worst in spring and winter. They also concluded that diagnosing new cases of dementia and mild cognitive impairment were 30% more likely during these seasons.

Does this suggest SAD is age-related?  If so, I can look forward to becoming a crabby old lady in winter.

Cold V. Hot

Sorry, summer lovers.  When brain function is compared during different seasons, cold looks like the winner for being easier on the brain.

Studies show that hot weather is harder on cognitive function because of heat’s effect on glucose consumption. Like all organs, the brain requires energy to function produced by burning glucose.  Generally, temperature regulation is more difficult in heat than in cold and the body needs more glucose in maintaining homeostasis when it’s hot outside.  That means fewer energy resources for the brain resulting in problems with mental clarity and decision-making. 

For the elderly, higher temperatures may increase the risk of mental disorders.  One study analyzed data on emergency admissions related to mental diseases and daily temperatures over a period of more than 10 years in 6 different cities. The results indicated that high temperatures might threaten mental health and exacerbate symptoms of mental diseases. According to the results, more than 30% of admissions for anxiety were attributed to hot temperatures.  Researchers postulate that exposure to hot temperatures brings reactions in the body that may cause an increase in stress hormone levels and brain temperature. Extremely hot weather, representative of a Texas summer day, may meddle with levels of serotonin and dopamine, the happy neuro-regulators that bring one a sense of well-being.  No surprise that we’re snapping at one another in August.

Of course, no matter the weather, the principles of brain health stay consistent.  Get some exercise, lay off the sweets, challenge your brain with new tasks rather than Netflix-bingeing from the couch.  Go out and help a neighbor who needs food, clearing a driveway or repairing a burst pipe.   Bundle up and marvel at the force of nature.  Make plans for a sunnier day.

Studies cited in this blog:

https://journals.sagepub.com/doi/abs/10.1177/2167702615615867

https://www.pnas.org/content/early/2016/02/04/1518129113.abstract?sid=9f065993-8681-437a-aed1-0eccea971a8b

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002647#pmed.1002647.ref002

Lee, S., Lee, H., Myung, W., Kim, E.J., Kim, H. (2018) Mental disease-related emergency admissions attributable to hot temperatures. The Science of Total Environment.616-617: 688-694. doi: 10.1016/j.scitotenv.2017.10.260

Punch Drunk – How Sports Head Injuries Can Wipe Out the Brain

Hey, I just heard that there is a Super Bowl coming up!  (I know, I haven’t been following sports one whit this year; no judgment please).  Football, our national pastime, means different things to different people – from wearing foam hats to betting wagers at the office. Full disclosure, I’ve watched my share of games, pumping my fist into the air and jubilantly yelling “Touchdown!” from the stands.  I live in Texas after all…

But as a neuro nurse, I’ve seen the ugly downside of head injuries and their long-term consequences. An impact injury to the brain, with or without a helmet, cannot be compared to an injury in any other part of the body.  It’s not like a bruise or a scrape or even a broken bone.  And the long-term effect of repeated small blows can eventually lead to the tragic cases we’ve heard about with former-professional players.

Boxer’s Dementia: A History Lesson

Long before the widespread recognition and long-awaited acknowledgement of what we now call “chronic traumatic encephalopathy” (CTE), scientists credited punch drunk syndrome to the violent sport of boxing.  Back then it was casually known as “boxer’s dementia”.  Studying boxers’ brains, researchers noticed a loss of neurons in the cortex along with an expansion of the brain’s cavities (ventricles), hallmarks of CTE. 

These unfortunate fighters also possessed tangled deposits of a protein called tau in their brains.  Tau is present in all of us and is usually folded into soluble molecules which stabilize the structures of neurons involved in transferring proteins from one end to another.   But in a traumatized brain, the tau folds abnormally into tangled filaments inside neurons.  And this is where cognition begins a slow death march as the mechanisms for brain cell communication become blocked, not unlike Alzheimer’s dementia.

What CTE does and How the Disease Spreads

CTE is a cruel master.  Not only does it impair thinking and memory but it can wreak havoc on a person’s emotional health.  Symptoms include difficulty thinking, Impulsive behavior, depression, short term memory loss, emotional instability, substance abuse, and suicidal thoughts or behavior.

Like Alzheimer’s, CTE is definitively diagnosed at autopsy.  But unlike Alzheimer’s, it’s not a disease of age.  Like it or not, CTE’s biggest risk factor is a history of playing contact sports. It’s an accumulative disease – the longer a person plays sports or the younger they are when they start taking head hits at practice , the more the process of CTE is speeded up.  As the tau tangles spread, more and more neural damage occurs.

Subconcussions: The Missing Piece

We’ve all heard of concussions, blows to the head that result sometimes in unconsciousness and followed by headache, confusion, pain or other symptoms.  But it’s easy to miss a “subconcussion”, a hit to the head which shakes the brain but quite so forcefully as a concussion.    Examples include most tackles and collisions in football, headers in soccer and body checks in lacrosse. There is still impact but it might not be immediately noticeable.

To make matters worse, according to the Concussion Legacy Foundation, evidence now suggests that subconcussive impacts, not concussions, are the driving force behind CTE.  The Foundation advises delaying the age of playing contact sports, modifying and eliminating contact in drills and practices when most head injuries occur.

From my perch, the brain is the most valuable real estate a person will ever possess.    While you’re masking up to face the world these days, don’t forget to do what you need to do to protect the brain.  Wear a helmet, buckle the seat belt, keep your smarts by not doing stupid things.

Mind your head,

Meredith

Food for Thought: What vitamins do I buy?

Making Sense of Vitamin Supplements and How to Get the Good Stuff

Taking supplements to augment cognition – or for any health condition - is a touchy subject in the medical world.  Some practitioners sneer at the idea of a vitamin making any difference at all unless, perhaps, a deficiency is identified.  And some go overboard at recommendations, leaving their patients with handfuls of capsules to swallow every day and often at great expense.

I sit in the middle ground of this camp.  I think that supplementation should be considered on an individual basis, based upon what a person really needs.  I don’t think it should be terribly costly or ridiculously time-consuming.  There’s no one-size-fits-all solution for everyone.

Be Careful at the Vitamin Store

To complicate matters, there is no lack of snake oil on the market.  The supplement industry is, for the most part, unregulated by the FDA or any other agency. Failure of proper regulation and enforcement of the guidelines for human consumption has resulted in varying degrees of purity and quality in drugstore supplements.   In research quality tests, over 80 percent of products from the shelves of stores like Walgreens and Target, did not have the ingredients listed on the label.

That’s why my first choice in recommending a supplement is to use “pharmaceutical grade” practitioner-only sources for any supplements.  Pharmaceutical grade supplements adhere to stricter guidelines and procedures when producing a formula for consumer use.  Nutritional companies that supply pharmaceutical grade products will sample and test to ensure that the formulation protocols result in a high- quality product that is accurately labeled.  So you actually get what the label tells you is in the bottle.

 Looking at Vitamin B12

Let’s start with the example of one of my favorite supplements, one that people ask me for again and again.  Vitamin B12 is known as the “energy vitamin” because it’s such a powerhouse nutrient that helps keep the body’s nerve and blood cells healthy.  It also has a role in making DNA, the genetic material in all cells.

But it’s not uncommon for people to unknowingly have a B12 deficiency.  Because it’s found in animal products, including eggs and dairy products, a vegan or strict vegetarian might not consume enough B12-fortified foods to get the daily dosage, about 2.4 micrograms(mcg) per day, they need.  B12 is not manufactured by the body; it must be ingested in some form.

Another common factor affecting deficiency involves adults who do not have enough hydrochloric acid in their stomach to absorb the vitamin B12 naturally present in food.   In fact, according to the NIH, people over 50 should get most of their vitamin B12 from fortified foods or dietary supplements because, in most cases, their bodies can absorb vitamin B12 from these sources better than diet alone.

Symptoms of Deficiency

Vitamin B12 deficiency symptoms are all over the place, from fatigue to constipation.  But the most common ones I hear about are general tiredness, weakness, depression and problems with cognition and balance.  People with low B12 complain about brain fog, the muddled condition of slow mental processing described in last week’s blog. “I just don’t want to get out of my chair” a 48-year-old man (a strict vegan) told me.   

How to Get the Good Stuff!

Now comes the tricky part of finding a quality product of a pharma-grade and how to access without a medical license.  

Some of you have purchased a pharmaceutical-grade supplement, like sublingual liquid B12, from me if you live in my area.  But now the practitioner-only supplement companies are allowing us to let others shop online directly.  All you need is a website link and a patient code from me.  Of course, you’re not limited to purchasing B-vitamins – you can view and select any products you like, order online and have shipped to your door.  

If you’d like to peruse and purchase such products, please email me here and I’ll send you that link and patient code:  info@brainstormmindfitness.com

The Lonely Brain:What Happens When We Have So Much Time to Ponder?

Hello friends and welcome to a new year, one that we are collectively hoping will be better in many respects.  The experience of a pandemic with its attending social restriction has me thinking about how isolation might affect cognition, especially as this virus lingers for months on end.  What effect, if any, does loneliness have on the brain?

I didn’t have to look too long to find new research addressing that very question.  

This study, published last month in the journal Nature Communications, shows that the brains of lonely people are distinctive in fundamental ways, in both the volume of different brain regions as well as how those regions communicate with one another.

Using magnetic resonance imaging (MRI) data, genetics and psychological self-assessments, researchers looked at approximately 40,000 middle-aged and older adult volunteers who allowed their information to be included in the UK Biobank: an open-access database available to health scientists internationally. They then compared the MRI data of participants who reported often feeling lonely with those who did not.

 Differences in the brains of lonely people appeared in the “default mode network”, or DMN, of the brain - a set of brain regions involved in inner thoughts such as reminiscing, future planning, and imagining.  The DMN is responsible for how our minds travel when we’re daydreaming about the future or ruminating on the past, stepping away from focusing on the here and now.    We spend LOTS of time (almost 50 percent of our waking hours) in the DMN, pandemic or not.  Think of all the hours you’ve spent replaying an old conversation in your head.

It may surprise you that while the brain idles in this state, it is remarkably busy!  In the absence of social experiences, lonelier people exercise more internal thinking, reflecting, and reminiscing. In turn, the researchers found that lonely people have more strongly-wired connections and increased grey matter volume in the brain regions activated by our inner milieu.

Wait – isn’t it a good thing to grow brain volume and strengthen neural connections?  Has the pandemic championed the isolated with the advantage of memory enhancement just by the practice of rumination?

Well, yes and no. Previous studies have shown older people who experience loneliness have a higher risk of cognitive decline and dementia.  But understanding how loneliness manifests itself in the brain could be key to preventing neurological disease and developing better treatments.