Healthy aging, compassionate care, the need for new treatments, and the preventive power of diet and exercise were the subjects of an inspiring discussion at the Forget-Me-Not Salon June 19. The event, which drew more than 70 members of the community, benefited the Memory Disorders Center at the University of Cincinnati Neuroscience Institute, a provider of advanced specialty care within UC Health.

The Salon, whose organizers included Barbara Gould and Cathy Crain, featured presentations by Joseph Broderick, MD, Director of the UC Neuroscience Institute; Carol Silver Elliott, CEO of Cedar Village Retirement Community; Jennifer Rose Molano, MD, a neurologist and sleep specialist at the UC Memory Disorders Center; and John M. Tew, Jr., MD, Professor of Neurosurgery, Radiology and Surgery at the UC College of Medicine.

Dr. Molano explained that the path to cognitive impairment is long and begins far sooner than we might imagine.

Alzheimer’s disease, the most common type of dementia, is associated with abnormal processing of two proteins, amyloid and tau, she said. “The abnormal processing of amyloid causes plaques in the brain, and then you get an abnormal process of tau. The tau pathology causes tangles in brain cells, which in turn cause the brain cells to die.

“We are finding that amyloid plaque formation is occurring in brain 10 to 15 years prior to the tau-tangle formation in the brain cells,” she continued. “The implication of this is that Alzheimer’s disease does not occur just at that stage when someone comes in to the doctor’s office with memory problems. We’re learning that it goes through a stage without symptoms and a stage we call mild cognitive impairment, when the individual can function without assistance but has issues with thinking that are noticeable when he or she is evaluated. These initial stages occur before the development of dementia, when the patient needs assistance to function due to his or her cognitive difficulties.”

The discovery that cognitive decline is a long process underscores the need for better treatments, earlier identification of people who are at risk for developing cognitive impairment, and prevention, Dr. Molano said.

Midlife behaviors matter

“What people do in midlife is very important and can dictate potentially what will happen to them later,” Dr. Molano said. “Studies have shown that if you have high blood pressure in midlife, if you’re obese in midlife, if you have diabetes in midlife, you are at higher risk for developing mild cognitive impairment or dementia down the road.”

Other studies, she added, show that sleep problems also play a role. Conversely, “healthy sleep is just as important as everything else in terms of maintaining your cognitive function.”

Dr. Broderick noted that a recent study found that during sleep the brain flushes out toxins that build up during the day. “You’re cleaning house,” he said. “It’s like running a hose to clean out a drain. If you don’t sleep, toxins build up in the brain. Sleep is fundamental.”

Optimists and aging

Dr. Tew outlined the tenets of healthy aging, including the core messages of Dr. David Snowdon’s landmark book, Aging with Grace: What the Nun Study Teaches Us About Leading Longer, Healthier, and More Meaningful Lives.

By studying a population of 678 Catholic sisters, Dr. Tew said, “they discovered how you can predict those who will age without grace. No. 1 is having a positive attitude. They looked back at the entry-level biographies of the nuns — stories they wrote about themselves when they entered the monastery. Those who told stories the best did the best; they aged the best.”

Other pillars of healthy aging noted by Dr. Tew are:

•    Avoid tobacco products
•    Eat well and avoid highly processed foods, as summed up by author Michael Pollan’s seven words of wisdom: “Eat food. Not too much. Mostly plants.”
•    Exercise vigorously every day, as exercise promotes the development of new brain cells (neurogenesis)
•    Stay connected and engaged in your community; live a life of purpose

“Ultimately, cognitive preservation involves protection of the blood vessels,” Dr. Tew said. “Having good blood vessels is the most important thing you can do.”

He said that orchestra conductors enjoy the greatest longevity of any group of professionals because, “They are moving and exercising with very aggressive use of the brain; it’s the best exercise you can do because you are using muscles and brain cells at the same time.”

Genes are not destiny

Genes, he said, are not destiny and by themselves will not determine whether you get a disease. He cited the new field of epigenetics, which explores how genes are expressed or suppressed by environmental factors.

Dr. Broderick agreed. “Life is a complicated path, and the path is not written. Genes tell us something about the path, but you can get off the road and take a new path. Epigenetics mean that our genes tell us what to do via messengers. There is a process that silences the genes, stops them from talking and sending out the message. Sometimes you can’t silence the genes, but how you care for yourself may change how that gene may express itself. I’m never going to play in NBA – that’s in my genes – but I can play basketball better if I practice. That’s the message. Because most cases of Alzheimer’s disease occur later in life, as opposed to early-onset, there are lots of things that modify it.”

Dr. Molano recalled a memorable moment in her training, when one of her professors diagnosed a 93-year-old man with mild cognitive impairment. Perturbed, the man said that he had lived a good life, was a vegetarian, exercised regularly, did yoga, and played bridge three times a week. “If I do all this,” he wondered, “why am I developing mild cognitive impairment now?”

Dr. Molano’s colleague answered kindly: “Think about it this way: if you didn’t play bridge three times a week, if you didn’t eat healthfully, and if you didn’t exercise and do yoga, when do you think you might have developed mild cognitive impairment?”

— Cindy Starr