Protecting Your Brain

Now it is appropriate to discuss strategies for dealing with some health issues that are associated with aging—stroke, Alzheimer's disease, doctors, and medications.

As you age, it becomes more likely that you or someone you know will have a stroke, sometimes referred to as a brain attack. The extent of damage inflicted on an individual depends on the severity and location of the stroke, as well as the speed with which you receive treatment. The term golden hour was coined by Dr. R. Adams Cowley of the Maryland Institute for Emergency Medical Services, who is regarded as the pioneer of modern trauma care. Medical intervention within the first hour after trauma is critical for increasing the patient's chance of survival. This hour, called the golden hour, begins the moment the injury occurs. Very recent advances may have increased this window of opportunity to three hours. Nevertheless, if you think that you might be experiencing a stroke, seek help immediately. Do not delay. It is better to be safe than sorry. The effects of a stroke can be minimized with immediate attention.

Remember the discussions in Chapter 2 of where the different brain functions are located? The long-term potential for healing any damage caused by brain injury depends largely on your age. At birth, for example, both hemispheres seem to have potential for a language center. Based on observations of severely epileptic infants whose hemispheres must be surgically severed, language still can be acquired and handled in the right hemisphere. If severe damage occurs to a mature brain, the right hemisphere may not be able to accommodate speech other than an odd word here or there.

An intriguing example of the left/right hemispheres is the case of N.G., a homemaker whose corpus callosum had been severed so that no communication from one hemisphere to the other existed. Jean-Pierre Changeux describes an experiment in which objects were presented to N.G. on a split screen, so that what is presented in the left visual field is seen only by the left eye, and what is presented in the right visual field is seen by the right eye only. What the left eye sees is transmitted to the right hemisphere of the brain, and what the right eye sees is transmitted to the left hemisphere of the brain. N.G. is left-brain dominant, and therefore her language and verbal capabilities are in the left hemisphere.

When a cup was exhibited in the right visual field, the image was transmitted to N.G.'s left hemisphere and recognized. Because her verbal ability was in that side of the cortex, N.G. stated that she saw a cup. When a spoon was exhibited to her left eye, and the image was transmitted to the right hemisphere, N.G. could not verbalize the name "spoon." Instead, she could choose a spoon from a number of available objects with her left hand. The right brain identified the image to the left hand, but without the verbal abilities of the left hemisphere, N.G. could not name it. When shown a naked woman on the left side of the screen, N.G. blushed and laughed behind her hand. But when asked what she had seen, she said she had seen a flash of light. Again, she could not correctly verbalize her stimulus, but the right hemisphere recognized the image and reacted emotionally.

An acquaintance, a male engineer, had a stroke in the corpus callosum. Thus, he had trouble passing information from one hemisphere to another, as did N.G. With his emotions on one side and his math and language skills on the other, he had no trouble counting to 100 but could not answer the question "How do you feel?"

If you are dealing with the effects of a stroke, and one method does not produce improvement or recognition, keep trying other methods. If the person cannot talk, try writing. Perhaps they can sing, instead. Try presenting information from the other side or to the other hand.

Alzheimer's Disease

Interestingly (in a rather sad way), a research study reported that how we view forgetfulness depends on how old the person is that forgot the information. Both older and younger adults view forgetfulness in an older adult as a sign of senility. The same degree of forgetfulness in a younger person is considered just due to bad luck by both older and younger adult observers. A bumper sticker reads "You are never wrong until someone is listening." Isn't it a shame that we do not listen to how often we are correct and how often we remember those important facts, dates, and errands? Instead, we amplify the times we are incorrect or cannot immediately recall a desired piece of information.

Every time we forget something, it does not mean that we are entering the beginning stages of Alzheimer's. Many of us joke about Alzheimer's or senility when we cannot remember something or cannot find the word we are trying to say. But these jokes hide our fears that we will be one of those members of the population who truly do suffer from senility and Alzheimer's. There are many other reasons we may be forgetful. Increased stress can keep our minds occupied. Vitamin deficiencies, cardiovascular disease, simple disuse of brain cells, and other factors must be eliminated as legitimate causes of forgetfulness and memory impairment. After all other possible causes of memory reduction have been eliminated, then we need to consider Alzheimer's disease as a possibility. Many studies also indicate that mental "fuzziness" resulting from lack of sleep, poor nutrition, lack of exercise, or simple disuse of those neuronal connections can be misinterpreted as the beginnings of Alzheimer's disease. Don't live in fear that the doctor may tell you something you don't want to hear. Your doctor may tell you that you suffer from a simple vitamin deficiency and that changes to your diet will take care of the problem.

One other possibility for memory impairment in women is a lack of estrogen. Women in their thirties who had certain diseases and were receiving estrogen-suppressing drugs exhibit verbal, but not visual or spatial, memory loss and reduced levels of concentration. Men also have estrogen receptors in their brains. Researchers are beginning to examine the possibility that estrogen therapy may improve memory function in men as well. You need to weigh the risks against the benefits. Estrogen replacement therapy (ERT), although proven to be effective in reducing the symptoms of senility and Alzheimer's disease in women, is not for everyone. Although ERT helps control osteoporosis, improves memory, improves coordination, and protects against Alzheimer's, it also is thought to increase

Scores

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â–ˇ Using Estrogen

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Test Category

Figure 6-5 Test Scores for Women Alzheimer's Patients. Data from Jon Queijo,"Tracking the Estrogen Effect, Connections to Memory and Alzheimer's Disease," Brain Work (January/February, 1998): 1-3.

the risk of endometrial and breast cancer. For women with a family history of breast cancer, ERT may not be an appropriate therapy. Consult your doctor.

Notice the test scores for women diagnosed with Alzheimer's disease who were and were not using estrogen therapy. In all cases, the women using estrogen scored higher, especially on comprehension tests.

Notice Figure 6-6, which demonstrates the results of estrogen therapy on a group of retired women. This study demonstrates that those who took estrogen longer had a significantly lower risk of Alzheimer's disease.

Nonsteroidal anti-inflammatory medications such as Ibuprofen actually may reduce the risk of Alzheimer's. People who had taken these drugs for a minimum of two years had half the risk of Alzheimer's disease as those who had not taken the drug.22

Never used 3 or fewer 4 to 14

years years

Estrogen Use

15 or more years

Figure 6-6 Relative Risk of Contracting Alzheimer's Disease. Data from Jon Queijo,"Tracking the Estrogen Effect, Connections to Memory and Alzheimer's Disease," Brain Work (January/February, 1998): 1-3.

15 or more years

Figure 6-6 Relative Risk of Contracting Alzheimer's Disease. Data from Jon Queijo,"Tracking the Estrogen Effect, Connections to Memory and Alzheimer's Disease," Brain Work (January/February, 1998): 1-3.

Vitamin E and ginkgo, rich in antioxidants, also have been demonstrated to slow the progress of Alzheimer's disease in more than half the patients taking these supplements. Ginkgo is a regulated drug in Europe. In the 1980s, it was the drug most widely prescribed, at 120 mg daily, to increase concentration. The standard dosage was 40 mg, with 24 percent ginkgo flavoneglycosides and 6 percent terpenelactone as the active ingredients, taken three times daily. Although this dose of ginkgo is considered safe, it has a mild blood-thinning effect and can lead to restlessness, diarrhea, or vomiting in some users. Vitamin E was given at a dose of 2,000 I.U. per day, and studies indicate that it increased the amount of time before Alzheimer's patients required institutional care. Note that 800 I.U. per day of vitamin E is considered safe and that increasing the dose to 2,000 I.U. per day can increase the risk of bleeding.23 Antioxidants reduce the damage caused by free radicals and have been linked to reducing the risk of cognitive impairment.

The effects of vitamin and herbal supplements sometimes are controversial. It is possible to overdose and harm yourself. Recall from earlier discussions that you must check with your doctor first before you embark into new self-help territory, especially if you already are taking some medications.

Some researchers believe that having a high degree of education and maintaining a high level of mental activity protect the brain against the ravaging effects of Alzheimer's. Learning new things keeps the brain's connections robust and flourishing. This gives you a greater supply of connections to use as surplus in order to maintain your mental ability if Alzheimer's disease does affect you.

Doctors and Medication

We cannot begin to impress on you enough the importance of a yearly physical exam. As you can tell from the information we have presented regarding sleep, nutrition, exercise, psychological attitude, and spiritual values, your mental health and physical health are intimately intertwined. Sometimes what we think are irreparable consequences of aging can be corrected. If you notice changes, especially if they are sudden, in memory, energy levels, or even just a general feeling that all is not well, seek out your doctor. Have your doctor test you for inappropriate hormonal levels, vitamin deficiencies, high blood pressure, and so on. And if you check out fine and are physically able to start an exercise program, try various techniques described in the text to get those muscles moving and oxygen pumping.

If your doctor cannot find anything wrong with you, but you still do not feel quite right, get a second or even third opinion. For example, Virginia Chestnut (whom you met earlier) suffered for many years from high blood pressure that was not adequately controlled by medications. She also felt "bone-tired" all the time and would fall asleep within minutes of sitting down. Three doctors, including a geriatric specialist, did not find an underlying condition that might cause the symptoms and just prescribed more medication. After all, she thought, she wasn't 29 anymore. Within 10 minutes of meeting her, a cardiologist using only a stethoscope determined that both carotid arteries (which feed the brain) and the arteries to her kidneys (which elevated the blood pressure) probably were blocked. Further testing confirmed his diagnosis. Surgeries to remove the blockages reduced Virginia's blood pressure and improved her memory, and she no longer falls asleep whenever she sits down. That was two years ago when she was 79. She is now 81, and a stronger, more vigorous woman you will never meet.

We tell you this story to illustrate our assertion that you know your body. You've lived in it your whole life. If you don't feel your doctor is meeting your needs, find another one. It only takes one right opinion to start you on the road to better health, happier spirits, and clearer thoughts.

Now let's address medications. Many medications slow the brain. Simple over-the-counter antihistamines come with the warning not to operate heavy machinery while taking the medicine. That's because it slows the speed of your mental processing and reaction time. Heavy machinery, by the way, includes your car and the riding lawn mower. Other medication, as previously mentioned, can disrupt your sleep patterns, dull the senses with which you input information, or affect your nutritional intake.

Read the labels. Become a more careful consumer of your medications. Check with your pharmacist and doctor for side effects. Perhaps, if you feel like your brain is packed in cotton or are experiencing other side affects, you can switch medications. Another consideration is medicinal interactions. My husband, for example, who has had a severe heart attack, takes numerous medications. The doctor and pharmacist were keeping an eye on everything, and the pharmacist's computer was programmed to flag for various interactions (including this particular one). But things sometimes slip through the system, and it wasn't until two of my husband's medications ran out at the same time that the pharmacist saw the two prescriptions together and immediately informed us that we needed to contact the doctor.

Take all of your medications to your doctor and to the pharmacist. Ask the pharmacist to check them all and determine whether there are any potential adverse interactions. And when you are doing this, bring along your vitamins and supplements.

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