Brain Health Starts Early

What's good for the heart also tends to be good for the brain. If your patients want to live a long, healthy life and still be sharp enough at 85, today is the day to get started.

From childhood, through the teens, twenties, thirties and middle years, health habits and behaviors are building the heart and brain your patients will be living with in later years. The American Heart Association/American Stroke Association recently published A Primary Care Agenda for Brain Health in the journal Stroke. The advisory encourages primary caregivers to screen and monitor factors that affect brain health in patients and make them aware of what they can do now to have a healthier brain and better cognitive function throughout life.

Ronald Lazar, PhD, of UAB's Department of Neurology, and stroke epidemiologist Virginia Howard, PhD, known for her work on the REGARDS study, were two members of the panel of 19 who wrote the advisory based on collaborative research.

"Protecting brain health should begin as early as possible," Lazar said. "As of now, one in five people over 65 has mild cognitive impairment. One in seven has dementia. At current rates, dementia is likely to triple by 2050. Cognitive decline takes a tremendous toll on the patient, caregivers and families, and on the nation as a whole. On average, the cost of caring for someone with dementia is even higher than treating cancer."

In Alabama, the problem is particularly difficult. In addition to being medically underserved, the state has higher than average rates of brain diseases like Parkinson's that affect cognition and related health conditions that contribute to them, including hypertension, obesity, diabetes and stroke.

"To turn this trend around, we recommend that physicians and advance practice caregivers, particularly those who work in primary care, encourage patients to follow Life's Simple 7 guidelines that the American Heart Association recommends for cardiovascular health," Lazar said. "There are also six risk factors that should be monitored and addressed to prevent or slow cognitive decline."

"Atrial fibrillation, hypertension and restricted blood flow from narrowed blood vessels are as dangerous for the brain as they are for the heart. The same goes for diabetes, obesity and smoking, so it isn't surprising that the same recommendations apply to both.

"Primary care health assessments should include screening and monitoring of risk factors associated with cognitive decline. Detecting and addressing them early can make a significant difference in cognitive function in later years.

"It should be a priority to prevent changes to the brain before cognitive decline begins. We've made significant progress in research and treatment, but there still isn't much we can do to reverse damage after it is done."

Protecting the brain--the thinking essence of who a person is--should start at birth and before. With a child's first bike, there should be a bike helmet and lessons about how and why to use it. Helmets and hard hats should be standard equipment, particularly in sports and occupations at risk for head injuries. An important part of treating concussions and other head injuries is to make sure patients understand the importance of giving the brain time to heal and avoiding repeated injuries. Patients at risk of stroke should also be educated so they and their families know how to respond quickly to minimize damage.

Though conventional wisdom says brains are limited to the number of cells they are born with, neuroplasticity is showing that new connections continue to be made throughout life.

"Keeping the brain agile means keeping it active. That doesn't necessarily mean doing word and number puzzles. Staying connected with life and maintaining social connections are probably the most effective strategies," Lazar said. "When people are engaged with the world around them, they are continually responding to stimuli, evaluating new information and making decisions."

As more genes affecting cognition are identified, early screening for heritable risks will become easier. Even when there isn't a family history of Alzheimer's, Parkinson's, stroke or similar brain conditions, it can be well worth monitoring new research related to nutritional, lifestyle and therapeutic factors that show promise in protecting the brain.

Over a lifetime, even small changes can add up to a healthier brain and extra years of better cognitive function.

We need to do some kind of box for each of these. There is a chart here, but it doesn't look too easy to read to me:

https://www.heart.org/en/healthy-living/healthy-lifestyle/my-life-check--lifes-simple-7

Life's Simple 7

Manage Blood Pressure

Control Cholesterol

Reduce Blood Sugar

Get Active

Eat Better

Lose Weight

Stop Smoking

Six Risk Factors to Manage and Monitor