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Jan 31, 2012

10 questions: Alzheimer’s expert Dr. Gary Small

Scientists are working hard to unravel the mysteries of Alzheimer’s, a disease in which waxy plaques and tangled threads of protein crisscross the brain, leading to devastating mental decline in its elderly victims. Dr. Gary Small, director of the UCLA Longevity Center at the Semel Institute for Neuroscience and Human Behavior and the Parlow-Solomon Professor on Aging at the David Geffen School of Medicine, has been studying Alzheimer’s for more than two decades and sharing his findings in bestselling books and frequent media appearances. With Alzheimer’s on the rise as baby boomers age — 5 million people have the disease today, a number that could reach 16 million by 2050 — he shares new research findings and advice in his latest book, "The Alzheimer’s Prevention Program: Keep Your Brain Healthy for the Rest of Your Life" (Workman Press, 2011). Small recently shared a few highlights with UCLA Today’s Judy Lin.
 
Alzheimer’s is a topic of huge concern — in the past month alone, more than 5,000 news stories mentioned the disease, according to Google. But given that Alzheimer’s is genetic and there’s no cure, doesn’t all this attention just make people worry and feel helpless?
 
Genetic factors account for only part of the risk. While about 20 percent of the population have a known genetic risk — the common genetic variant ApoE4 — this doesn’t predict that they’ll get Alzheimer’s. For the average person, non-genetic factors are more important. Lifestyle choices have a greater impact than most people realize. A healthy-brain lifestyle strengthens the brain’s neurons, postpones mental decline and improves memory ability and brain efficiency.
 
What are the main lifestyle changes we should make?
 
Mental and memory exercises, physical fitness, stress management and a brain-healthy diet all appear to strengthen cognitive abilities and delay the onset of Alzheimer’s symptoms. Take memory, for instance. Our UCLA research group has found that using specific memory techniques can activate and strengthen specific neural circuits in the brain’s front lobe, a critically important memory-processing center. In another study, physical exercise performed several times a week over a two-week period lowered a person’s future risk for memory decline by 46 percent.
 
How much of a difference can being proactive about Alzheimer’s make?
 
Prevention can have significant benefits. Our UCLA research group, in collaboration with the RAND Corporation, reviewed epidemiological studies showing connections between healthy lifestyle behaviors and the risk of developing Alzheimer’s. We concluded that if everyone in the United States adopted just one Alzheimer’s prevention lifestyle behavior, within five years we might expect one million fewer cases of Alzheimer’s disease than otherwise anticipated. If we engaged in more than one healthy lifestyle habit, we could possibly delay the onset of Alzheimer’s even more, because combining these strategies creates a synergy that has a greater impact than doing just one or two on their own.
 
That sounds good, but complicated. After all, physical exercise comes in countless forms, and popular nutrition advice runs the gamut from cutting out carbs to eating like a Neanderthal. So how can one determine what’s best for your brain?
 
I encourage people to give the seven-day Alzheimer’s prevention program in my book a try. A tested program, it combines the various lifestyle strategies in a way that’s easy and fun. Our studies have shown that this program can demonstrate significant effects in a brief time period. Many people report weight loss, improved sleep, more energy and better everyday memory abilities — such as recalling names and faces. The book provides assessment tools so readers can document their own improvements after that first week — something that also serves to motivate people to make brain-healthy behaviors long-term habits. In order to reduce Alzheimer’s risk, we need to continue these behaviors for years.
 
Timing, you say, is important. People shouldn’t just wait until they retire to make lifestyle changes?
 
Our UCLA studies indicate that the physical evidence of Alzheimer’s disease — brain plaques and tangles — starts accumulating decades before people develop cognitive symptoms of the disease. We think that a better strategy than trying to repair a damaged brain is to protect it before the disease disrupts neuronal function.
 
Small's boook offers this quick brain trainer.
So let’s talk specifics, starting with mental and memory exercises. Chances are that many of the brains at UCLA already get pretty hefty workouts on the job — from faculty giving lectures and grading papers to staff managing department schedules and budgets. Is this the kind of mental exercise that can help prevent Alzheimer’s?
 
It’s best to train but not strain your brain. So if you have a high-powered, mentally challenging UCLA job, take it easy during breaks. Cross-train the two hemispheres of your brain — the right brain, which specializes in visual and emotional functions, and the more analytical and verbal left brain — to increase neural activation and communication throughout the brain.
 
A faculty member in the arts, for example, is building primarily right-brain muscle through visual spatial tasks like sculpting or drawing architectural plans, so left-brain word puzzles can vary the brain game. A staff member who crunches budget numbers all day might balance out with right-brain visual puzzles.
 
Strength-building workouts like UCLA's Bruin Health Improvement Program build brain power, too, says Small.
You also recommend physical exercise. But what does a heart-pumping workout like, say, climbing Janss Steps, have to do with our brains, let alone weight-lifting or Pilates?
 
Cardiovascular conditioning gets the heart pumping oxygen and nutrients to our brain cells so those cells will sprout branches, communicate more effectively and remain healthier longer. A brisk 30-minute walk each day will lower your risk for Alzheimer’s disease. UCLA faculty and staff can make a point of walking on campus during lunch time. Or, if your parking structure is a distance from your office, pick up your walking pace to and from work to get an aerobic workout.
 
Muscle-building exercise also increases heart efficiency. Research also suggests that the mental focus required for strength training improves brain functions involving complex reasoning and attention skills. For a comprehensive workout right here on campus, consider joining UCLA Recreation’s Bruin Health Improvement Program (BHIP) to fortify both your body and your brain.
 
Nutrition-wise, have particular foods been found to be beneficial to prevent Alzheimer's?
 
The Alzheimer’s prevention diet includes foods in four main categories: antioxidant fruits such as berries and raisins, along with antioxidant vegetables like spinach and broccoli; foods rich in omega-3 fats, which include fish and walnuts; healthy proteins such as chicken breast and low-fat yogurt; and whole grains like brown rice and oatmeal.
 
This kind of diet also protects the heart. And it helps control body weight — especially important because overweight and obesity, which, of course, are major health problems, have also recently been linked to an increased risk for cognitive decline and Alzheimer’s disease. One simple thing you can do to follow this diet is to pack healthy snacks like almonds, raisins and bananas in your briefcase or lunch box — something which also helps you avoid the vending machine chips and cookies when you get hungry between meals.
 
Meditation, taught at UCLA's Mindful Awareness Research Center, relieves brain-draining stress.
You also address the all-too-common malady of stress. How does stress take a toll on the brain?
 
Chronic stress shrinks the brain’s hippocampal memory centers, and stress hormones like cortisol temporarily impair learning and recall. We can’t eliminate all the stress many of us experience on and off campus, but we can manage that stress better. Many of us, for example, are working at a computer for hours at a time. To break up the potential brain strain, take regular five-minute breaks: Stand up, stretch, have a conversation with a colleague next door or step outside and enjoy the sunshine and campus greenery.
 
Practices like meditation are also helpful. Neuroscientists have found evidence that meditating reduces stress, improves mental focus and even increases the volume of gray matter in the hippocampus, an area of the brain that controls learning and memory. UCLA’s Mindful Awareness Research Center offers workshops for learning meditation and also leads drop-in mindfulness sessions around campus.
 
What are you doing to ward off Alzheimer’s? 
 
I do crossword puzzles, Sudoku and KenKen every morning after reading the newspaper. If I don’t have time to swim or walk the dog for some cardiovascular conditioning, I take the stairs at work or pick up the pace when walking between campus appointments. I work in regular breaks from the computer to stretch, meditate or chat with colleagues. I make an effort to eat plenty of fruits and vegetables, omega-3 fats, and whole grains — but I admit that occasionally my sweet tooth gets the best of me. When that happens, I remind myself that moderation is the key — that chocolate does contain brain healthy antioxidants.
 
Hear Dr. Small speak about "The Alzheimer’s Prevention Program" with his co-author and wife, Gigi Vorgan, on Monday, Feb. 13, at 7 p.m. in a conversation with Dr. Linda Ercoli, associate clinical professor and director of geriatric psychology. The free public event takes place downtown at the Los Angeles Central Library, 630 West Fifth Street, Los Angeles, CA 90071. Find more information at this website.