The Future of Preventive Brain Medicine: Breaking Down the Cognition & Alzheimer’s Disease Alphabet Soup

By: Dr. Dharma Singh Khalsa @ Alzheimer's Research & Prevention Foundation

As the pres­i­dent and med­ical direc­tor of the Alzheimer’s Research and Pre­ven­tion Foun­da­tion (ARPF), it’s my job to stay on top of advances in the field of Alzheimer’s research. Recently, a num­ber of arti­cles in the med­ical lit­er­a­ture have caught my atten­tion. They are focused on a par­tic­u­lar ques­tion that con­cerns most Baby Boomers like me: “Is mem­ory loss just a nor­mal part of aging?”
Many of my patients in their fifties, six­ties, and older notice that they occa­sion­ally for­get things like a name, face, or where they put their keys. They won­der whether this behav­ior is nor­mal, or if it is a sign of Alzheimer’s dis­ease. It’s a rea­son­able worry: Alzheimer’s dis­ease is reach­ing epi­demic pro­por­tions and recent sur­veys by the Alzheimer’s Asso­ci­a­tion and oth­ers reveal that it is the Baby Boomers’ biggest health fear.
The answer to that ques­tion used to be, “Yes, we all expe­ri­ence some mem­ory loss as we age. Don’t worry—it’s not Alzheimer’s.” Indeed, it was once thought that a lit­tle mem­ory loss was an expected and accepted part of the nor­mal aging process. There was even a term for it: Age-Associated Mem­ory Impair­ment (AAMI). It included a gen­eral slow­ing of men­tal func­tions such as pro­cess­ing, stor­ing, and recall­ing new infor­ma­tion. It also included a gen­eral decline in the abil­ity to per­form tasks related to cog­ni­tive func­tion such as mem­ory, con­cen­tra­tion, and focus.
But here’s the rub: AAMI was never a clin­i­cal diag­no­sis, even though many physi­cians, lay people—and, yes, even yours truly—thought oth­er­wise. Instead, AAMI is a tech­ni­cal diag­no­sis. It’s made by a psy­cho­me­t­ric test, not by actual clin­i­cal symptoms.
These days, we have a num­ber of other, more accu­rate acronyms to describe the vary­ing states of mem­ory loss—a whole bowl of Alzheimer’s-related alpha­bet soup, if you will. And, unlike AAMI, these labels are based on real clin­i­cal diag­noses. They include:

• No Cog­ni­tive Impair­ment (NCI). This is just what it sounds like: You have no mem­ory issues or complaints.
• Sub­jec­tive Cog­ni­tive Impair­ment (SCI). This means that you feel your mem­ory isn’t work­ing as well as it used to or should—maybe you have trou­ble remem­ber­ing names, num­bers, or words, for example—and you com­plain about it to your doc­tor. Tests, how­ever, show that your mem­ory is normal.
• Mild Cog­ni­tive Impair­ment (MCI). You expe­ri­ence short-term mem­ory loss that is greater than what peo­ple describe with SCI but still doesn’t inter­fere very much with your daily life. Tests may show some abnor­mal­i­ties. MCI is con­sid­ered a seri­ous pro­gres­sive con­di­tion that many experts con­sider an early form of Alzheimer’s disease.
• Alzheimer’s Dis­ease. This is a pro­gres­sive neu­rode­gen­er­a­tive dis­or­der that is incur­able and fatal. It used to be that Alzheimer’s dis­ease could only be diag­nosed after death dur­ing an autopsy, but newer tests, some still inves­ti­ga­tional, can con­firm an Alzheimer’s diag­no­sis much earlier.

That’s a lot of letters—but these new labels aren’t what I want you to take away from this prover­bial soup bowl. The real issue here is not just a name change; it’s a shift in the way we think about mem­ory loss and aging. Indeed, these alpha­bet diag­noses are not sim­ply sta­tic states of mem­ory impair­ment. A grow­ing body of research sug­gests that they are instead points on a con­tin­uum of mem­ory loss that often ends with a diag­no­sis of the dreaded Alzheimer’s dis­ease. Unless prop­erly treated—in my view, with an inte­gra­tive med­ical program—memory loss tends to get worse over time. In my expe­ri­ence, with inte­gra­tive treat­ment, mem­ory loss can be improved and people’s func­tion­al­ity can be pre­served for a much longer time.
But is any mem­ory loss “nor­mal”? I recently asked that same ques­tion of Barry Reis­berg, M.D., Pro­fes­sor of Psy­chi­a­try and Direc­tor of The Aging and Research Cen­ter at New York Uni­ver­sity. Dr. Reis­berg is one of the world’s lead­ing experts on the sub­ject of mem­ory loss and has stud­ied it for decades. His answer: “Mem­ory loss may be nor­ma­tive (aver­age), but that doesn’t mean it’s nor­mal. The real ques­tion is what is pro­gres­sive over time.”
And that brings us back to our alpha­bet soup. In one land­mark study, Dr. Reis­berg and his col­leagues looked at 260 peo­ple, 60 of whom had NCI and 200 of whom had SCI. After 7 years, they dis­cov­ered that mem­ory declined in 7 peo­ple with NCI (15%) and 90 with SCI (54.2%). Of the peo­ple with NCI, 5 devel­oped MCI and 2 devel­oped prob­a­ble Alzheimer’s. On the other hand, of the 90 peo­ple with SCI who pro­gressed, 71 devel­oped MCI and 19 declined all the way to Alzheimer’s.
What this means is that SCI appears to progress to MCI and even to Alzheimer’s dis­ease. Sub­jec­tive or not, even minor mem­ory problems—the kind that many of us typ­i­cally attribute to just “get­ting older”—are not nor­mal and should be taken seri­ously. Con­sider these sta­tis­tics, also from Dr. Reisberg:

• At age 65, 25% to 55% of peo­ple have SCI.
• After 15 years, up to 55% of peo­ple with SCI will have pro­gressed to MCI. (Only 15% of peo­ple with­out SCI will develop MCI.)
• Even more sober­ing, accord­ing to the National Insti­tutes of Health,  about 40% of peo­ple over age 65 who have been diag­nosed with MCI will develop demen­tia within 3 years
• By age 85, an esti­mated 55% of all peo­ple will have Alzheimer’s disease.

Num­bers like these not only drive home the seri­ous news that no mem­ory loss is a nor­mal part of aging, but they also make it clear that we’re on the cusp of what many experts believe will be an epi­demic of Alzheimer’s dis­ease as Baby Boomers con­tinue to age.
I’ve shared infor­ma­tion on ARPF’s web­site about the inte­gra­tive med­ical approach to pre­vent and reverse mem­ory loss. But the fact is that pro­tect­ing against mem­ory loss isn’t just an individual’s respon­si­bil­ity.  They say it takes a vil­lage to raise a child. Well, it takes a vil­lage to sup­port the fight against Alzheimer’s disease—and the types of mem­ory loss that pre­cede it—too.
To that end, in late Novem­ber, U.S. Rep­re­sen­ta­tives Ed Markey and Chris Smith, co-chairs and co-founders of the Bipar­ti­san Con­gres­sional Task­force on Alzheimer’s Dis­ease, out­lined their rec­om­men­da­tions for the National Alzheimer’s Plan, a strat­egy pro­posed for Pres­i­dent Obama’s admin­is­tra­tion to tackle the dis­ease. I heartily agree with many of their sug­ges­tions, which include:

• Increased fund­ing for research. The fed­eral gov­ern­ment spends an astound­ing $130 bil­lion in Medicare and Med­ic­aid pay­ments for the treat­ment of Alzheimer’s dis­ease, and an esti­mated 15 mil­lion care­givers pro­vide some 17 bil­lion hours of unpaid care to loved ones with Alzheimer’s. Yet the National Insti­tutes of Health gives Alzheimer’s dis­ease just $429 mil­lion in annual research fund­ing, com­pared to $6 bil­lion and $3 bil­lion for can­cer and AIDS research, respec­tively. We need to start mak­ing Alzheimer’s dis­ease a top research pri­or­ity, as well as fund inno­v­a­tive screen­ing, pre­ven­tive, and treat­ment approaches.
• Increased resources. Peo­ple with mem­ory loss should receive the best care pos­si­ble. Yet many Alzheimer’s patients and their loved ones do not get the resources they need. This is partly due to insur­ance lim­i­ta­tions: Insur­ance com­pa­nies typ­i­cally cover some diag­nos­tic tests for Alzheimer’s, but tend to curb the amount of time doc­tors can spend with patients. As a result, patients and their care­givers may not get the best infor­ma­tion about the dis­ease or get con­nected to resources to help them man­age it prop­erly. We need to con­tinue to pro­mote early diag­no­sis of mem­ory loss and give patients and their fam­i­lies the sup­port they need.
• Increased pub­lic aware­ness. If the “alpha­bet soup” les­son I’ve shared here comes as big sur­prise, you’re not alone. Many peo­ple are woe­fully mis­in­formed about Alzheimer’s dis­ease and about mem­ory loss in gen­eral. While the ARPF and I do our part to try to edu­cate the pub­lic about opti­mal brain health, we still have a long way to go in spread­ing the mes­sage about symp­toms, diag­no­sis, clin­i­cal tri­als, treat­ment, and resources for patients and care­givers. We espe­cially need to improve the dis­sem­i­na­tion about infor­ma­tion on the cur­rent research proven meth­ods of prevention.

Mem­ory loss isn’t like gray hair or wrin­kles. Con­trary to what many of us used to believe, it is not a nor­mal sign of aging. In my opin­ion, that’s all the more rea­son to make Alzheimer’s disease—and the whole bowl of “alpha­bet soup”—a thing of the past by pri­or­i­tiz­ing pre­ven­tion treat­ment today. Beyond that, we clearly need to move past a “magic bul­let” drug approach mentality.
There is a lot we can do right now to live a brain healthy lifestyle and shar­ing that work with soci­ety is where I’d like to see our focus in the future.

Peak Performance Training

Peak Performance Training

Neurofeedback or EEG Biofeedback helps the brain regulate itself and self regulation is key to optimal brain functioning. It is best considered as mental fitness training that over time teaches the individual's brain improved skills of managing attention, arousal (level of excitability), and affective or emotional state. The individual's brain already manages attention, arousal, and affective state to a certain degree, and the relevant mechanisms are in place to do so. Simply exercising those mechanisms strengthens and engages them, and allows the individual to have better control over his or her own behavior automatically. And when your brain is performing in its optimal manner, you are able to perform at your peak. Isn't this just what we all want. Life is so much better and easier when our brain is working at its best. We are calmer, more focused, attentive, confident and able to enjoy life more. When we achieve this, we are just better at whatever we choose to do. Become a better parent, a better spouse, a better boss, a better student, a better performer, a better athlete, a better employee - A BETTER SELF. Become YOUR BEST SELF!

RELAX, ENJOY LIFE and ACCOMPLISH MORE.

Stress is a total body response to a real or imaginary threat. It can save lives in emergencies by producing knee-jerk reactions which were indispensable to our ancestors who routinely had to flee from predators. However, in today's world, our survival is usually not at stake, and the problems we face require a calm mind for creative solutions. Unfortunately, the very parts of the brain that allow such reasoned response are bypassed under stress. Instead, we make decisions based on fear. One of the goals of the neurofeedback software is to evolve the reactive brain into one that is interactive, and not only during a crisis but in everyday life.

When the human body and mind perceives a threat it goes into flight or flight mode. When this happens stress chemicals flood the body causing the heart to beat faster, the blood vessels to constrict, perspiration and breathing to increase and muscles to become tense. In addition, during this phase the auto immune system also becomes depressed making the body more vulnerable to illnesses. After the threat goes away, your body and mind are not quick to turn these responses off and often do not return to their original state and in part the body and mind continues with this unhealthy response to stress. The heart continues to be stressed and other muscles continue to hold tension. This "normal" stress response is ideally suited for real life and death situations. But when we have this response to other stressors in our lives that are not life or death, this response is over kill.

After a while a person can get used to these stress symptoms in their body, if they do not learn to cope with the stressors in their lives these symptoms start to cause problems in the body, even though the person may be unaware of it.

If someone does not pay attention to these signs and symptoms they can evolve into anxiety, depression, headaches and other pains, stomach and bowel problems and coldness in hands and feet. In addition the stress hormone cortisol can make you inattentive, disorganized and unable to remember simple tasks. The body and mind can no longer cope with the ongoing physiological changes and you are receiving a strong warning to make changes to your life.

Neurofeedback helps your brain to respond better to stresses. It can calm down your "over the top" responses to everyday challenges. Those things that you know shouldn't bother you, stop having an effect. And irritations start to roll right off. You are able to calmly approach your challenges, focus on your end goal and be your best.

For those who have high stress careers or high stress demands on life, have you already begun to see the effects of this over the top response to stress? Is it impeding your performance? Would you like to learn how to respond to these stressors in a healthier way - one that shields your mind and body from all of those disastrous effects and at the same time become a winner in your field? Take charge of your life, by empowering your brain to work at its optimum.

Seniors Hit the Brain Gym

The science of "brain fitness" is about to get a jump-start from a major health insurer. Humana, one of the nation's biggest health insurance companies, announced a partnership yesterday with a San Francisco company that is pioneering the concept.
At an assisted-living facility in the city, seniors are welcome to spend time at the in-house brain gym, "working out" on computers that improve attention span and help recapture memory and hearing -- flexing their mental muscles and improving their lives.
Inside the brain gym, elderly patrons receive instructions on headsets and respond to specific commands. So far, response from participants has been broadly positive, with most users pleased by the results
“Concentration is the one word that I really feel that I've really got better at doing,” said Ellen McCarthy, a 79-year-old brain fitness program user.
“It's made me listen more intently, be more aware of what I'm saying and how I'm speaking,” said Eda Carnilia, an 86 year old in the program.
The software that drives the workouts is the brainchild of Posit Science. The company has spent the last three years developing programs that "teach an old brain new tricks." Participants in controlled studies, aged 60 to 97, have shown the equivalent of 10 years of improvement. But, Posit Science refuses to rest on its initial success.
“It's just the beginning of what is unequivocally going to be a revolution in what we must do to maintain our mental fitness, our brain fitness in life,” said Dr. Michael Mernovich, co-founder of Posit Science.
This revolutionary product is now getting a mainstream stamp of approval. Humana, one of the nation's largest health insurers, plans to offer the brain fitness program to millions of seniors. In addition, Humana Medicare members will be able to purchase the software at a sizable discount. The company says it is a perfect fit with its desire to encourage active lifestyles for older adults.
“The more we can provide opportunities to keep healthy people, we expect people to look at that as a value that Humana is different from other health insurance companies,” said Scott Latimer, a Humana doctor.
If reactions by the brain fitness program’s participants are any indication, Humana
might be right.

- Hampton Pearson