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Improving Your Brain Health: Disease Prevention and Research

May 10, 2016 11:59 AM with Dr. Jim Maraganore

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Brain disorders such as Alzheimer’s and Parkinson’s disease severely affect muscular and cognitive functions, and have lasting impacts on millions of Americans and their families. At NorthShore, we provide innovative strategies to prevent these conditions, and are continuing research efforts targeting treatment and diagnosis. Are you unsure of what steps you can take to improve your brain health? Join us for an online chat with Dr. Demetrius "Jim" Maraganore, NorthShore Neurologist. He will be taking your questions on brain disorders and prevention techniques, everyday ways you can work to improve your brain health and NorthShore’s current research efforts.

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Kathryn (Moderator) - 12:02 PM:
Our brain health chat is now open. Feel free to submit questions at any time during our chat.

Jim Maraganore (NorthShore) - 12:03 PM:
How are you! This is Dr. Demetrius ("Jim") Maraganore. I am the Chair of the Department of Neurology and the Medical Director of the NorthShore Neurological Institute. I also direct the new Center for Brain Health. We aim to prevent Alzheimer's disease, by improving brain health. We can do it! Ask me how!!!

  Agnes (Wauconda, IL) - 12:04 PM:
I am 45 years old and want to know if there is a vitamin that could protect me from getting Alzheimer's/dementia when I grow older?
Jim Maraganore (NorthShore)
Hi Agnes! There is evidence that vitamin D deficiency is a risk factor for Alzheimer's disease. Vitamin D deficiency is common in the Midwest due to reduced sunlight exposure. Vitamin D is made by your skin primarily. Your doctor can check to see if you are vitamin D deficient and depending on your blood levels and dietary preferences, either prescribe vitamin D2 orally once a week, or over the counter vitamin D3 at the appropriate strength for you. I believe that vitamin therapies should be taken under a doctor's direction. Vitamin B complex (B12, B6, Folate) also may reduce the rate of aging-related brain shrinkage (atrophy) by 50% per year as compared to a placebo. Again, this is most effective at prescription strength; best that your need for vitamin B complex and the dose be directed by your doctor. Great question!

  Sara (Northbrook, IL) - 12:09 PM:
Are there specific mental activities that you recommend to older adults who want to prevent brain disorders such as dementia and Alzheimer's? Does research support any online games and puzzles for brain fitness?
Jim Maraganore (NorthShore)
Thanks Sara. I recommend that we remain lifelong learners. Learning forces our brain to form new connections and to prune and maintain connections. I am especially fond of learning new languages. Did you know that people who speak multiple languages have bigger brains (greater cognitive reserve)? Re-learn an old language from school, or learn a new one! It is never too late. I speak English, Greek, and Italian! Music is also a language. Re-learn an old instrument, or learn a new one. Read sheet music. Yes, puzzles and crosswords and computer games are fun and stimulating in some instances, but the key is always to learn. And it is OK to make mistakes! If you are not making mistakes, you are not having a learning experience. So challenge yourself!!!

  Jane (Lake Bluff, IL) - 12:14 PM:
I'm in my mid-40s, and am starting to experience some memory problems; for example, sometimes I suddenly forget my colleague's name when I bump into them a hallway, or forget what I want to say in the middle of a conversation. Are these the symptom of early dementia? Is there a way to prevent it? Any brain exercise needed?
Jim Maraganore (NorthShore)
Jane, there are many reasons why a person in your age group might be forgetful, including several treatable and reversible reasons. The best thing to do is to see a neurologist who has expertise in brain health or memory disorders. There are simple office tests that can quickly determine if you have a memory disorder or not, and there are many assessments that we can perform to identify the underlying reasons. Don't be afraid to have this checked out, because there is so much to offer! And in the event that it was a "false alarm", you will be empowered by the reassurance and by the brain healthy lifestyle and behavior factors that can be reviewed.

  Maria (Highland Park, IL) - 12:18 PM:
What role does mental illness (ie anxiety, depression, bipolar disorder) play into one's chances of developing Alzheimer's/Parkinson's disease?
Jim Maraganore (NorthShore)
Maria, studies have consistently shown that anxiety disorders and depressive disorders occur more commonly in the prior lives of persons who develop dementia or Parkinson's, than in the prior lives of people who do not. Anxiety and depression are risk factors for dementia and Parkinson's disease (even events occurring 30 years earlier can be associated with the onset of these conditions later in life). In addition, anxiety or depression can mimic brain disorders such as Alzheimer's or Parkinson's. An expert neurologist can rule those conditions out (depression, anxiety), which are otherwise treatable or reversible. Otherwise, anxiety and depression occur frequently in persons with Alzheimer's or Parkinson's disease after they are diagnosed. Identifying incident anxiety and depression and treating it will improve the quality of life of persons with Alzheimer's or Parkinson's. In the Center for Brain Health and the NorthShore Neurological Institute, we routinely screen for these.

  Betty (Park Ridge, IL) - 12:23 PM:
I often have trouble sleeping, and I read that sleep is associated with risk for Alzheimer's. How are they connected?
Jim Maraganore (NorthShore)
Betty, absolutely. Sleep deprivation is a risk factor for dementias, including Alzheimer's disease (the most common cause of dementia). I recommend to my brain health patients (persons with concerns about their brain health, perhaps because they have risk factors for Alzheimer's) that they should sleep 6-8 good quality hours a night (ideally 7 hours). If they are unable to sleep that long, or if the sleep is not restorative (they are sleepy during the day), I refer my patients to our sleep center for further evaluation and management. During sleep, our brain is washed of toxic proteins and waste. It is important that we all get a good night's sleep!

  Nancy (Chicago, IL) - 12:26 PM:
My family has a history of Alzheimer’s. My mom and all her siblings have been diagnosed before age 50. At this time, she is in a nursing home. What is recommended I do to find out my risk or prevent it? I'm 37 years old with no symptoms.
Jim Maraganore (NorthShore)
Nancy, most everyone has a family history of Alzheimer's somewhere in their family tree. But if you have a first degree relative affected, the risk for Alzheimer's is at least doubled. Given that women have a 1:5 lifetime risk for Alzheimer's (all comers), a woman with a family history could have as much as a 40% lieftime risk. Of greater concern is when the Alzheimer's is of early age at onset (before age 50). Then we need to be concerned regarding a rare genetic cause of Alzheimer's, such as mutation in the presenilin or APP genes (like Alice in the movie "Still Alice"). We can review family histories and test for mutations or risk variants in our Center for Brain Health. We can provide lifestyle, behavioral and medical treatments to reduce the risk by greater than 60%. A bad genetic test result is not deterministic. We can delay or prevent Alzheimer's disease!

  Carole (Wilmette, IL) - 12:32 PM:
I have a 12 year old boy. He tests well, and is a good student, but sometimes out to space. Seems like he needs a supplement to help him concentrate. Would fatty acids help his memory problems?
Jim Maraganore (NorthShore)
Carole, I am an adult neurologist and I can't profess expertise regarding children, but the brain health principles that benefit adults benefit children too. Is your child sleeping well at night? Is he getting regular aerobic exercise? Is he strictly following a Mediterranean diet? These are simple principles, best learned early in life, that can help to improve brain performance and otherwise to prevent Alzheimer's disease. Note that the Mediterranean diet is rich in omega-3 fatty acids: lots of olive oil, nuts and fish! Diet is more effective than supplements: Hippocrates said, "Let food be your medicine, and let medicine be your food". Boy, was he right! But as a Greek I may be biased. :)

  Diane (Hinsdale, IL) - 12:36 PM:
What should we be doing now to prevent Alzheimer's and dementia? I have read that there are studies of drugs that can reverse the build-up of ameloid plaques in the brain. Would these work before plaques begin?
Jim Maraganore (NorthShore)
Diane, it is never too late to improve your brain health and to prevent Alzheimer's disease. Studies show that even people in their 70's when they exercise aerobically can grow the size of the memory parts of their brains and improve brain performance! I recommend that everyone do aerobic exercise (heart rate above 100, breaking a sweat) for at least 30 minutes at least 4 times a week (the more frequent and the more intense, the better). I also recommend that everyone strictly follow the Mediterranean diet. When we quiz people on their diet, we find that very few people in our geography are truly adhering to the Mediterranean diet. For this reason, we have a master level dietitian in the Center for Brain Health. I also advocate for 6-8 hours of good quality sleep each night. I am a big believer in lifelong learning. I promote the use of vitamin D replacement and B-complex under a doctor's direction. Socialization to prevent depression and anxiety are important. Many more examples.

  Mary (Glenview, IL) - 12:41 PM:
Can certain medications such as ssRIs or ssNRIs increase or decrease someone's chances of getting Alzheimer's or Parkinson's disease?
Jim Maraganore
Mary, thanks for your question. A well designed pharmaco-epidemiological study from Europe published recently did not associate these drugs with dementia. Rather, proton pump inhibitors, frequently used to treat gastric reflux, were spotlighted as possible risk factors for dementia. There are no drugs otherwise that have been associated as risk factors for Alzheimer's or Parkinson's. Interestingly though, some drugs such as non-steroidal anti-inflammatory drugs, or statin drugs (that lower cholesterol), and even estrogen (when menopause is early before the age of 45) can reduce the risk for these aging brain disorders.

  Marie (Evanston, IL) - 12:45 PM:
What are the chances of developing Parkinson's if you have one parent that had it? What about if you had one grandparent that had it? Also, are there ways of preventing the onset of this disease? Thank you!
Jim Maraganore (NorthShore)
Marie, the lifetime risk for the general population to develop Parkinson's is low (only about 2%). Having a relative with Parkinson's doubles the risk (to 4%). That is not enough of a risk elevation to justify undo concern. Rarely, though, we encounter families in which many members and generations of the family are affected. In those cases, a rare genetic cause (mutation) can sometimes be determined if tested. The same brain health principles that I have described for preventing Alzheimer's (see previous comments) also may benefit risk reduction for Parkinson's (e.g., vitamin D replacement, aerobic exercise, Mediterranean diet). Of great risk for developing Parkinson's in your lifetime is for persons who had a concussion with loss of consciousness (up to 10 times greater risk for Parkinson's), or persons with a dream sleep behavior disorder. Those persons would benefit from evaluation and management in Center for Brain Health.

  Glenda (Evanston, IL) - 12:50 PM:
My mother suffered with TIA's, and dementia, however, she lived to be 92 years old. I would like to know how to prevent having TIA's, and dementia as I age. I am 58 years old and healthy.
Jim Maraganore (NorthShore)
Glenda, everyone's risk factor profile for dementia or stroke is personal. We recommend that adults see their primary care physician, dentist and gynecologist annually to identify chronic diseases such as hypertension, heart disease, obesity, hypercholesterolemia, diabetes, vitamin D deficiency, elevated uric acid, periodontitis, and to mitigate their late life effects (such as stroke or dementia). I would recommend that each year you undergo a series of health maintenance exams, and also consider the Center for Brain Health as an added measure. We can evaluate your personal risks, educate you in cross cutting benefits of exercise, diet, sleep, vitamins, etc., and partner with your primary doctors to keep you brain healthy for your entire life.

  Nancy (Highland Park, IL) - 12:54 PM:
I have no signs or symptoms of cognitive impairment but have a family history of Alzheimers (mother at age 80). Should I make an appointment with a neurologist as a preventative measure or is this unnecessary?
Jim Maraganore (NorthShore)
Dear Nancy, your pre-test probability of getting Alzheimer's as a woman is 20% in your lifetime. Your family history may as much as double that risk (~40%). We can do an evaluation of other health factors and habits in your life and figure out which fall in the risk or protective categories. We can mitigate the risks and double up on the protection. And we can teach you ways to reduce your risk by at least 50-60%. We also can offer a simple blood test for the APOE gene, the most common genetic risk factor for Alzheimer's. About 85% of patients have a good result, reducing their post-test probability to 10% or less. This can be very reassuring. Only 1-2% of patients have genetic factors at the highest risk, and those persons can plan more effectively and embrace brain health interventions more fully. Yes, I believe seeing a neurologist to discuss your brain health and to prevent Alzheimer's is worthwhile.

Kathryn (Moderator) - 1:00 PM:
This will be the end of our chat. Thank you for your questions. To learn more about brain health, or to schedule an appointment with a neurologist like Dr. Maraganore, contact the NorthShore Neurological Institute or The Center for Brain Health.

Jim Maraganore (NorthShore) - 1:03 PM:
Thanks for your questions about brain health! We can actually prevent the onset of Alzheimer's disease and related aging brain disorders (e.g., Parkinson's, others). You can learn more about this at www.northshore.org/brainhealth. Be well! Jim
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