Brain Health

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Brain Health - By Anne Corwin

Jul 11, 2008

Originally appearing at Existence is Wonderful

In many respects, the brain's health is intricately dependent upon the overall body's health (e.g., a problem in the circulatory system, such as a clot, can wreak havoc on the brain via disrupting its blood supply). Anyone who wants to keep their brain in good shape over the long term would therefore do well to monitor their body, paying attention to such variables as diet and activity level as well as "lab values" like blood pressure, cholesterol, and other measurable factors.

Of course, due to individual genetic and other factors (socioeconomic class, etc.), it's still possible for a person to try their very best to maintain their health and still end up developing dementia and other brain-affection conditions, but the following common suggestions still represent good basic sense:

- Keep hypertension under control to help ward off vascular dementia

- Avoid or quit smoking

- Check your HDL levels and try to keep them high

- Keep challenging yourself cognitively -- and don’t restrict yourself to crossword puzzles! Volunteer, read about interesting things on the Internet or from books or magazines, listen to podcasts, learn new computer interfaces as they come out, etc.

- Get plenty of physical activity, at least to whatever degree your individual life variables (disabilities, location, etc.) permit.

I'm sure the above suggestions will be quite familiar to most readers, as they're a pretty standard set of Helpful Hints for Aging Brains.

But what happens when a person is already doing all the above? What about the 90-year-old who has followed every guideline she could find with anything resembling decent scientific support -- how much will "good basic sense" help her as she moves toward her tenth decade and beyond?

Those are precisely the questions I often find myself coming back to when I read popular articles on the subject of brain health in the elder phase of life. I don't think there's anything wrong with such articles, and I'm sure some folks who read them end up beneficially changing some aspect of their lifestyle or going for an overdue doctor's visit as a result -- but the bottom line is that no amount of common-sense health maintenance can guarantee anyone good cognitive functioning* as centenarians or supercentenarians.

One of the most fascinating things about the brain is how it must simultaneously change constantly over time (in response to new information and other inputs) and maintain the aspects of its structure that permit it to keep functioning as a person wants it to as he or she ages. This is true for the body as a whole, of course, but particularly interesting to consider in the case of the brain, as (unlike other organs and parts, which can be transplanted or replaced by prostheses) the brain is unique to each individual in such a way that you wouldn't ever be able to replace it with another and expect to get "the same person" as a result.

In other words, while a heart transplant (certain urban legends notwithstanding) won't give you a personality makeover, a brain transplant (if such a thing were physically feasible) would essentially replace an entire individual consciousness with another.

It is this uniqueness and irreplaceability of brains that makes them of special concern in thinking about healthcare across the lifespan.

Before continuing, a brief disclaimer: I am not suggesting in anything I write here that I expect humans to someday become "immortal" in the sense of being basically omnipotent and invulnerable to any possible threat. While it's fun to write science fiction stories about infinite electronic "consciousness backups" and futures in which the descendants (or intelligent creations) of today's humans manage to escape from this universe through a wormhole into a fresh, new universe, I would hardly call such scenarios relevant to real people facing the effects of brain aging now or in the relatively near future -- except in the sense of being engaging to the imagination.

That said, I do think it more than reasonable to surmise that the conditions presently grouped together as "the dementias" will likely someday:

(a) subsume the phenomenon of milder memory loss and progressive cognitive difficulty currently considered "normal aging", and

(b) become amenable to preventative, maintenance, and rejuvenation treatments.

As far as existing options go, certain pharmacological agents seem to improve cognitive functioning in persons with dementia. For example, many individuals with dementia currently take drugs that work on the cholinergic system in the brain. The rationale here is that since some dementia-affected brains show reduced numbers of cholinergic neurons (and related activity), cognition in these individuals can be improved by increasing the amount of choline available in key areas of the brain (such as the hippocampus and cortex).

This explanation strikes me as somewhat simplistic, though, and I strongly suspect that dementia will be revealed as more and more complex the more it is studied. I don't see the current generation of drugs as either "optimal" or capable of accounting of what is likely the full picture of what causes people's brains to change over time in ways not welcomed by those experiencing the changes. It will be interesting to see the long-term results of drugs intended to break up amyloid plaques, of potential treatments that alter protein regulation, but it should probably not be assumed that any treatment will comprise a single "magic bullet" that protects the brain indefinitely.

Rather, future preventative, maintenance, and treatment regimens for age-related memory and other difficulties will likely consist of a system including:

(1) Early detection -- the sooner physical changes associated with Alzheimer's and other dementia variants can be identified, the sooner the person experiencing them can begin treatment, thereby diminishing the likelihood of "compounding" degeneration.

(2) Maintenance of the healthiest possible brain state. While the essential functions of human metabolism make it impossible to prevent all degenerative signs, we can certainly at least think in terms of minimizing the impact of these signs. Some contemporary drugs (e.g., cholinergics) will likely assist in this regard, and more advanced medications with fewer side effects will likely be developed over time.

(3) Rejuvenation of brains which have accumulated functionality-affecting compounds, or which have experienced the beginnings of cell loss or other neuronal degeneration. It remains to be seen how much functionality (i.e., memory and cognition) can be restored in brains that have experienced such things as widespread cell death, but the brain's incredible plasticity and built-in redundancy give us a hefty leg up in this regard even in the face of the relentless march of metabolic processes.

(4) Failing the above three options in the near-term, adventurous types may even consider cryonic suspension in the event of severe brain injury or illness. While most assuredly a gamble, there are some cryonics options with costs comparable to typical funeral expenses, making these options a reasonably valid (if still controversial) incarnation of Pascal’s Wager suitable even for atheists.

As far as what I'd like to see, in addition to the above (primarily technical) developments, one thing that strikes me as tremendously important is the accessibility and equitable distribution of any effective brain-maintaining resources that end up being developed. I'm no great shakes at socioeconomic policy, but I have seen the great lengths people will go to to access, preserve, and affirm the value of that which they consider precious.

Another thing to remember is that efforts to develop treatments must occur in concert with efforts to avoid such things as abuse, neglect, and overmedication in the present and near-future population of persons with dementia. Plenty of people alive today are already dealing with dementia first-hand -- and it's important to avoid letting these people get pushed aside and "warehoused", forgotten in the energetic rush to find cures.

It would be wonderful if humans made such progress in mitigating brain-degenerating conditions that our primary concern looking forward was the possibility that someday we might run out of room for our vast memories, but we're not there yet.

The way I see it, if people can afford fancy cars, designer slippers, golden toilets, advertising for endless "Reality TV" series, and rhinestone-encrusted dog collars, there's no reason to figure that the world-at-large is somehow lacking in raw resources. At the very least, it's worth running the experiment that entails (1) affirming the value of all persons regardless of age, and (2) making fair access to life (and brain) sustaining care resources a priority for individuals of all ages, regardless of disability or other status.

After all, whenever a brain is lost (whether it be to one of the fatal dementias or to accident or other illness), an irreplaceable individual is lost forever -- and I would say that individuals merit at least the same courtesies most humans reserve for old paintings and books and other one-of-a-kind treasures!

- Anne Corwin

* By "good cognitive functioning" I mean "functioning capable of sustaining a person's life and permitting memory retention, recall, and lucid conscious awareness". I don't mean "functioning typically" or "functioning normally" in the sense that "good cognitive functioning" is sometimes assumed to imply.