By Michael Castleman
I’ve never misplaced my keys—at least not yet. But the little notes I jot to myself, to do this or that, have multiplied of late in alarming fashion. Car needs tires. Call plumber. Pay quarterly taxes. I stick the scribbled calls to action on my computer, dresser, and car steering wheel—a veritable snowdrift of Post-its that remind me how absentminded I’ve become. Everything I’ve read says not to worry, that these notes are simply a practical way to tweak memory, not a sign that something’s amiss. But for the past few years, I’ve wondered.
Then last summer, my 84-year-old father was diagnosed with mild cognitive impairment, a condition that, depending on which neurologist you consult, is either the annoying but benign mental equivalent of age-related aches and pains or the ominous beginning of progressive dementia. Around the same time, my 85-year-old mother-in-law was placed in the Alzheimer’s unit of a nursing home. Both my father and mother-in-law are 30 years older than I am, but their diagnoses rattled me. I started to worry over what’s in store for them—and for me. Is there anything I can do to avoid the same fate?
Only a few years ago, most neurologists would have told me, “Not much.” Losing memory was considered an inevitable part of aging, and Alzheimer’s simply struck its victims out of the blue. But recently the message has changed: Not only is it possible to head off memory loss, I should waste no time in getting started. All manifestations of a fading memory—from middle-aged misplacing of car keys to “senior moments” to dementia—exist along the same physiological continuum. In other words, that pile of reminders on my desk could indeed signal something far more serious down the road, unless I start doing something about it. Pretty scary stuff for this absentminded writer.
Far more encouraging is the latest news about how to preserve memory: It turns out that the health of your brain and heart are closely connected, which means that the same lifestyle and nutritional strategies that can ward off heart disease and stroke—eating healthy fats and lots of fruits and vegetables, exercising regularly, and taking the right supplements—can help keep your brain healthy as well.
In fact, many experts believe that adopting these approaches may even help us to avoid Alzheimer’s disease. “Nearly everyone struggles with memory loss by middle age,” says geriatric psychiatrist Gary Small, director of the UCLA Memory Clinic and author of The Memory Bible. “But serious memory problems are not inevitable with aging. They can be prevented.”
Of course, living a brain-healthy lifestyle doesn’t guarantee a lifetime of mental sharpness; at least one form of Alzheimer’s is triggered by a gene, and others may be as well. But experts like Small now believe that making the right lifestyle choices can improve your chances of delaying it—or even staving it off entirely.
Knowing that memory loss can often be prevented is one thing. Understanding exactly how it works is something else entirely. Memory is a bit of a mystery. We know that it depends on three things: healthy brain cells, an adequate supply of blood to those brain cells, and the actions of specific neurotransmitters that allow these cells to communicate with one another. But no one knows how the combination of well-nourished brain cells and optimal neurotransmitter levels adds up to recalling the name of the kid who sat on your left in second grade, but not the one on your right, or where you were when you heard about the World Trade towers collapsing, but not where you were at four o’clock that afternoon.
It’s also hard to predict how individual cases of memory, like my father’s, say, or my own, will deteriorate. We know memory declines with age; it’s like a cognitive version of osteoarthritis. But with joint pain we can use X-rays and MRIs to see which hips and knees might need replacing. Doctors don’t have the same ability to track our memory. My father’s neurologist assured him, for instance, that his mild dementia is not the beginning of Alzheimer’s. But neurologist David Perlmutter, director of the Perlmutter Health Center in Naples, Florida, and author of The Better Brain Book (due out in August), told me that conditions like my father’s can, indeed, signal the beginning of the disease.
The other factor complicating our understanding of memory is whether middle-aged folks, like yours truly, are more forgetful because of physical changes, or because we’re simply more mentally taxed than we were as youngsters. I can certainly make a case for the latter.
In the old days—maybe ten years ago—everyone I knew just had home and work phone numbers. Now they have those, plus fax and cell numbers, email addresses, and websites, and I get irritated when I forget any of them. Meanwhile, I feel busier and more scattered than ever. In addition to a hectic career and the effort required to maintain my home, marriage, and social life, I have a daughter applying to half a dozen high schools and a son applying to as many colleges, with each application generating dozens of details I need to remember. Not to mention my aging parents’ health problems, which have me flying from California to New York every few months to spend time with them.
Memory expert Ward Dean agrees that a too-crowded life can definitely contribute to the problem of memory loss. “These days, we have more to remember,” says Dean, a gerontologist based in Pensacola, Florida, who has written several books on memory, “so we have more to forget.”
Healthy heart, lively brain
But there’s one thing about memory that’s crystal clear: Whether it’s senior moments or dementia, memory loss shares its risk factors with cardiovascular disease. “There’s no longer any question about this,” says Perlmutter. He and Dean have been saying so for years, but only recently has mainstream medicine caught up with them.
Indeed, several studies published in major medical journals, particularly over the past three years, have shown that memory loss and dementia are associated with any number of heart disease risk factors, including hyper- tension, high cholesterol, a sedentary lifestyle, elevated blood levels of certain inflammatory proteins, and an excess of plaque in the arteries.
We know, for example, that the same plaque buildup that can lead to heart disease and stroke can also spawn a host of memory problems, including Alzheimer’s. A primary source of this plaque is a nasty combination of free radical damage and low-level inflammation. Over the years, our bodies increasingly convert oxygen into free radicals, unstable molecules that damage cells. An excess of these freewheeling substances can damage the lining of the arteries, and this, in turn, triggers the development of the cholesterol-rich deposits, or atherosclerotic plaques, that narrow them and do further damage.
The hippocampus, where most of the brain cells linked to memory reside, is particularly sensitive to free radical damage. And though scientists are not sure exactly how, free radicals appear to play a role in the development of the two anatomical hallmarks of Alzheimer’s disease: abnormal protein deposits in the brain, and knots of deformed, impaired brain cells.
Meanwhile, low-level inflammation introduces substances into the blood that also accelerate the growth of artery-narrowing plaque deposits. In the past few years, a high level of one indicator of inflammation, C-reactive protein (CRP), has emerged as an important marker for cardiovascular disease—and for mental problems. “Inflammation damages the brain,” Perlmutter says, “and contributes to both minor memory problems and dementia. That’s why so many studies show that nonsteroidal anti-inflammatory drugs help prevent dementia: They reduce inflammation.”
So what does all this mean for you—and for me? For one thing, it means it’s really important to eat smart, since poor food choices are a leading cause of artery-clogging plaque. Eat fish and you’re actually fighting inflammation—and plaque buildup—because of the essential fatty acids it contains. Cutting out saturated fats, like those in beef and butter, helps keep arteries clear and curbs inflammation. Other inflammation-fighters include whole grains, beans, and fruits and vegetables. And plant foods offer the bonus of antioxidants—nutrients like C and E and beta-carotene, among others—that can neutralize free radicals, thereby giving your body a chance to repair the damage.
This is the diet that visionaries like Ward Dean, who coauthored Smart Drugs and Nutrients: How to Improve Your Memory and Increase Your Intelligence, have been suggesting for the past three decades: Eating foods high in antioxidants, they say, can combat memory loss. In fact, as the evidence builds, many gerontologists also think we should be stocking up on supplements. UCLA’s Small now recommends that patients take 400 to 800 IU of vitamin E and 500 to 1,000 mg of vitamin C every day. Perlmutter also likes ginkgo and curcumin.
Of course, nutrition isn’t everything. A memory-boosting lifestyle also includes getting enough sleep, learning how to relax (stress can actually inhibit memory), cultivating friends, family, and other social ties, exercising regularly, and, yes, taking up crossword puzzles and other mental challenges. “It’s best to adopt a memory-preserving lifestyle when you’re young,” Small explains, “but it’s never too late.”
So I’m doing what I can to reduce my need for all those Post-its. I already live a reasonably heart-healthy lifestyle, I exercise, I sleep seven hours a night, and I enjoy plenty of mental stimulation and an active social life. That means my best memory-boosting bet appears to be supplements.
There’s just one problem: I don’t like taking pills, and except when medically necessary, I limit myself to a daily multivitamin. There’s no way I’m going to take every purported cognitive enhancer—close to a dozen at last count. But I have opted for two: I now take ginkgo, which tops just about every list of brain boosters, and curcumin. As I write this, I notice I’m running low on curcumin tablets. I jot myself a note to remind myself to go buy some—and feel fine about it.
A brain-healthy diet
So how should you eat to protect your brain? It turns out a diet that’s good for your heart is good for your head, too. But heart-healthy diets can vary: The one recommended by the American Heart Association, for instance, focuses on limiting saturated fat. The heart- and brain-healthy plan suggested below by Gary Small, director of the UCLA Memory Clinic, has four key components: calorie control, antioxidants, good fats (omega-3s), and good carbs (that don‘t spike blood sugars). For more dietary tips, visit his website, www.memoryfitnessinstitute.org.
• Limit calories. Excess body fat increases our risk for illnesses like diabetes and high blood pressure. These conditions can increase our risk for small strokes in the brain, which can lead to memory loss, dementia, and even Alzheimer’s.
• Eat more good fats. Essential fatty acids, like the kind found in fish and flaxseed oil, help prevent both atherosclerosis and inflammation. Nuts, avocados, expeller-pressed canola, and olive oil are also good sources. If you can’t rely on getting a sufficient supply through your diet, consider taking fish oil supplements.
• Replace butter and margarine with olive oil and canola oil.
• Lean toward lean meats, like skinless chicken, pork tenderloin, and even buffalo. Meats high in saturated fat, like hamburgers, have been linked to atherosclerosis as well as inflammation.
• Build your diet around good carbs, such as fruits, vegetables, beans, and whole grains. They increase the good form of cholesterol (HDL), curb appetite, and help us burn off fat. Produce, especially brightly colored varieties, is also high in brain-preserving antioxidants.
• Add curry. The yellow color of the spice comes from turmeric, also referred to as curcumin (its active ingredient), and it has high anti-inflammatory and antioxidant properties. Shake it into stews and soups. You can also get it in tablet form: Take 250 mg of turmeric (containing 242.5 mg of curcumin) daily.
• Drink black and green tea… They’re calorie-free and high in antioxidants.
• …and wine, as long as you have no medical reason not to. One daily drink of any type of alcohol may help protect against dementia, according to a study in the Journal of the American Medical Association, and red wine also contains antioxidants.
• Take a daily multivitamin. Try to find one that includes vitamins A, D, and K, B vitamins, chromium, iron, magnesium, selenium, calcium, and zinc. But don’t stop there: Boost your daily intake of vitamin C to 500 to 1,000 mg, and vitamin E to 400 to 800 IU.
• Consider taking ginkgo and phosphatidylserine. In several studies, patients showed significant improvement in cognitive skills after taking these supplements. For phosphatidylserine: Take 100 to 150 mg twice a day for three months, and taper off to 50 mg twice a day. For gingko, take 60 to 100 mg.
• Cut the junk. Avoid sugary snacks and processed foods, all of which contribute to inflammation and high blood glucose levels.
Worried about your memory?
Test it.In-depth memory testing requires a consultation with a neurologist and a battery of sophisticated tests. But Gary Small, director of the UCLA Memory Clinic and author of The Memory Bible, offers this quick self-test that’ll do if you don’t have the time or money for the other. Study the following list of ten words for one minute, then see how many you can remember 20 minutes later:
plank, banker, sauce, umbrella, abdomen, reptile, lobster, orchestra, forehead, jury
A score of 8 or better means your memory is fine. If you score much lower, study the list more intently and retest yourself. If you continue to see no improvement, consider talking to your doctor.
Other ways to boost your brainpower
• Exercise regularly. Physical activity improves blood flow to the brain, reduces risk of obesity and diabetes, and helps control cholesterol and blood pressure—all of which can keep memory sharp.
In a 2001 study published in Archives of Neurology, Canadian researchers followed 4,615 elderly people for five years and found that among those who exercised most, the risk of cognitive impairment plummeted 42 percent.
• Get some sleep. In a study of 1,026 people age 60 and older, Stanford researchers found that those who slept the worst had double the odds of performing poorly on cognitive function tests.
• Challenge your brain. You’ve heard it before, but it bears repeating: The brain is like a muscle, so use it or lose it. At Albert Einstein College of Medicine, in the Bronx, researchers tracked 469 people over age 75 for an average of five years. People who read, danced, and played board games or musical instruments enjoyed significant protection from dementia. With mental exercise, Perlmutter explains, brain cells produce more dendrites, which make the brain more agile.
• Make new friends, and keep the old. Harvard researchers followed 2,812 people 65 or older for 12 years. Compared with loners, those who had a spouse, had regular contact with friends and relatives, or participated in social activities were much less likely to experience cognitive decline.
• Take ginkgo. Ginkgo became the memory supplement in 1997, when a study in JAMA showed that a dose of 120 mg a day slows the progression of Alzheimer’s. Many other studies, using varying dosages, confirmed this effect. “Ginkgo should be part of any memory preservation program,” says Perlmutter. He recommends taking 60 to100 mg a day.
• Try not to worry. It won’t help. In fact, worrying—about memory loss or anything else—may make things worse. “Worry releases stress hormones,” says Perlmutter, “which can impair the hippocampus, the brain’s memory center.” One of the most effective ways to relax is to practice some form of meditation at least ten to 20 minutes a day. You’ll not only feel calmer, you’ll think more clearly.