Resilience

March 15, 2021

I set my cellphone down on the bureau to get dressed. Five minutes later I had no idea what happened to it. I searched high and low for my glasses, then found them perched on my head. I left my keys on the kitchen counter, then ransacked the place searching for them. I gathered my wallet, jacket, and phone to return a book to the library. I opened the door to leave, then wondered where is the book? It was wedged under my arm.

What is going on? Almost everyone over the age of 60 knows. The mysterious connections in my brain—some of them—have become frayed. Agatha Christie’s eccentric detective, Hercule Poirot, took pride in his “little gray cells.” I took pride in mine, too. But lately, less than I used to. I’ve learned how to focus intensively when introduced to someone. Otherwise my mind is blank on the person’s name twenty minutes later.

Neurosurgeon and CNN health reporter Sanjay Gupta explains what is going on in Keep Sharp: Building a Better Brain at Any Age, his eloquent, disturbing, scary, but finally encouraging analysis of the stages of the loss of brain function and how it can be confronted.  He reports that a 2017 UCLA study found that 47 million Americans show some evidence of preclinical Alzheimer’s disease, named in 1910 for its discoverer, the German psychiatrist Aloysius Alzheimer. By 2060, the number of Americans with Alzheimer’s dementia or cognitive impairment is projected to grow from 6 million to 15 million. One new case of dementia will be diagnosed every four seconds. From 2018 to 2050 the worldwide number with Alzheimer’s will grow by 200 percent.

Nearly every adult, and many children, know someone who has experienced the tragic, sometimes terrifying consequences of severe cognitive decline. Sandy’s mother, in her seventies, would leave the house while unobserved. She hid the TV remote in her shoe. While home alone, she placed a coffee pot on the stove, lit the burner, then forgot about it. Her son and granddaughter arrived a short while later, smelled smoke, and shut the oven off before fire spread through the house. Within months she entered a facility that treated patients suffering mental decline. Shortly thereafter she was unable to recognize her children.

Gupta teaches that the brain, weighing roughly three pounds, “comprises all the circuitry we need to do just about everything.” The brain, he says, contains an estimated 100 billion brain cells, or neurons, and billions of nerve fibers linked by trillions of connections called synapses. These allow us think abstractly, feel angry or hungry, remember, rationalize, make decisions, be creative, form language, and on and on. Each part of the brain serves a defined purpose; all are linked to function in a coordinated manner.

Then, the decline. Gupta points out that “we often don’t and can’t know what triggers cognitive decline.” One uncomfortable fact: diseases like Alzheimer’s start twenty to thirty years before symptoms develop.

The great dilemma in research on cognitive decline is that no precise cause or causes have been identified. Gupta writes that what leads to grave cognitive decline in person A will not cause it in person B, C, or D. The “amyloid hypothesis,” he says, postulates that sticky proteins accumulate to form plaques that destroy the essential synapses that allow brain cells to communicate. Yet scientists aren’t sure whether the hypothesis is correct. Research has explored other possible causes of brain disease: genetics, infections, injury, nutrient deficiency, prolonged metabolic disfunction, exposure to dangerous chemicals, all of which can stimulate an inflammatory reaction in the brain. Inflammation, he tells us, is a common thread in all the theories about brain decline, and most other types of illness.

Gupta identifies three stages of decline: normal aging, mild cognitive impairment (MCI), and dementia, in several forms. Vascular dementia is caused by insufficient blood supply to the brain. Dementia with Lewy’s bodies results from protein buildup in parts of the brain that control cognition, movement, and behavior. Frontotemporal Lobar dementia is caused by nerve cell loss in the frontal and temporal lobes, leading to behavior changes and poor judgment. Alzheimer’s, a progressive disease, accounts for 60 to 80 percent of dementia cases, he says.

Dwelling on Gupta’s analysis is a dark experience. Yet he brings us back to light. With Keep Sharp he aims at training a resilient brain. He focuses on likely contributing factors that can be finessed by a transformative focus on resilience, and cites AARP’s five “pillars” of brain health: Move, Discover, Relax, Nourish, Connect. These lead just where they sound. Move: get regular exercise. Discover—do new things. Relax means get rid of stress. Nourish—get the sugar out of your diet. Connect: engage with others.

Gupta adds his own 12-week program, capturing all of those. “What’s good for the heart is good for the brain,” he reminds us. Exercise, get good sleep, open the mind to new challenges, form new relationships. Diet is a huge factor in achieving resilience. Gupta offers his own wrinkles, like “try to eat only when the sun is shining.” “Eat breakfast like a king, lunch like a prince, and dinner like a peasant.” His quick take is his acronym SHARP: Slash the sugar, Hydrate smartly, Add Omega-3 healthy fats, Reduce portions, and Plan meals ahead.

We’ve heard the diet-and-exercise piece elsewhere. Gupta weaves it together with reminders for the folks most likely to be getting nervous about not remembering what day it is, what was for dinner yesterday, the last movie they saw. He writes for caregivers, pointing out that about 60 million Americans are caring for someone with Alzheimer’s—more than twice the population of Texas. He offers solid guidance for them on where to find support, social engagement programs, appropriate clinical trials, how to keep a home safe, making legal and financial plans, and building a care team. The caregiver, he notes, is the “invisible second patient.”

He comes around, as promised, to a bright note. Teams of scientists are doing breakthrough research on cognitive decline, for example, an experimental vaccine developed at the University of New Mexico. Yale researchers are working on a “drinkable cocktail of designer molecules” that has restored memory in mice. The future of brain research, he argues, is exciting. So go look again for your keys. And get going on Gupta’s program.