CNN Heroes Help People With Brain Injuries Through Yoga 9:50

(CNN) --

When my mother was 80, her daily call to her older brother always began with the same question: "Did your bowels move today?" She used to roll her eyes and pray to the gods of old age that she would never do the same.

Some days the conversation included other bodily functions: "How did you sleep? Is the rain affecting your arthritis? How's that heart murmur?" But the question I never heard either of us ask was: "How's your memory today?" ".

"It's just ironic that people rush about their heart health or worry about their gut when the organ they're worried about is our brain," said vascular neurologist Dr. Natalia Rost, associate director of the Comprehensive Stroke Center at Massachusetts General Hospital. Massachusetts and professor at Harvard Medical School in Boston.

"Shouldn't we be concerned about the main organ in our body, the command and control center for everything human within us? There is no us without our brain," said Rost, president-elect of the American Academy of Neurology ( AAN).

Get ready to focus on your brain, because according to the AAN, the era of preventive neurology has arrived. In fact, the academy hopes that all Americans will be on the healthy brain train by 2050.

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"It's a brain health revolution," Rost said. "We want to help the public understand that a healthy life begins with brain health."

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Louise Dittner with her grandchildren, Krysta and Ryan LaMotte. (Credit: Courtesy of Sandee LaMotte)

The academy's vision is that one day within the next 25 years, you, your children and your grandchildren will visit the doctor for annual "brain health" checkups that are covered by insurance as preventative care. In fact, that first visit may occur before the child is even conceived.

"We want major insurance payers to cover a brain screening visit as soon as the mother is considering getting pregnant or is pregnant," Rost said. "Then when the baby is born, we bring in pediatric neonatologists and then follow the child into adolescence using everything we're learning about optimizing brain function."

Interventions could include encouraging expectant mothers to breastfeed as long as possible, limiting a child's exposure to screens, and improving sleep habits that can continue into adulthood, among many others.

As a person ages, every healthy brain scan would focus on early prevention of diseases known to damage the brain, such as diabetes, obesity, heart disease, and more. Those visits would continue "into the final stages of life, because even as we age or acquire a cognitive illness, we can still optimize brain health while living with brain disorders," Rost said.

What might I experience during a brain checkup in the future? To find out, let's delve into a cutting-edge brain test that exists today.

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Studying the aging brain

It was a beautiful, warm morning in Florida and I felt my spirits lift, pushing my apprehension aside. He was on his way to the Boca Raton office of preventive neurologist Dr. Richard Isaacson, who in 2013 opened one of the first Alzheimer's prevention clinics in the United States at Weill Cornell Medicine and New York-Presbyterian in New York City.

In their new program, the Florida Institute for Neurodegenerative Diseases, I was to be participant number 20 in a novel clinical trial focused on nourishing the aging brain. The study would determine my genetic, behavioral and lifestyle risks for cognitive decline, provide me with a personalized list of areas for improvement, and track my progress using new experimental blood tests.

These unique blood tests could determine levels of amyloid, tau and other biomarkers characteristic of Alzheimer's disease and other degenerative conditions. Amyloid deposits can begin to accumulate in the brain decades before symptoms begin, even in your 30s and 40s.

"It is currently estimated that more than 46 million Americans have presymptomatic Alzheimer's disease, in which pathological features of the disease can be detected in the blood and brain before cognitive decline begins," Isaacson said.

To participate in the new study, I needed to undergo a series of physical and cognitive tests to establish my brain's baseline and highest-risk areas.

First, they took my blood and sent it to a lab in Boston to determine my levels of good and bad cholesterol, inflammation, insulin resistance, and nutrition, all of which could put me on the path to cardiovascular disease and stroke, both factors. important in poor brain health.

"Vascular risk factors such as high blood pressure, high cholesterol, high blood sugar or diabetes may not be the cause of Alzheimer's disease, but they can accelerate the pathology of the disease," he told me. Isaacson. "I would rather hit the brakes than rev the engine on the path to cognitive decline."

Another key question: Did he have one or more copies of the APOE4 gene? People who inherit one or more copies of this genetic variant have a higher risk of developing Alzheimer's, although many never develop the disease.

Then, a bone and body scan determined my risk for bone thinning or osteoporosis, which has been linked to cognitive decline, as well as fractures and falls that can derail the ability to stay active, exercise, perform daily tasks, or practice self-care. staff.

The scan would also provide critical information about my muscle mass and the percentage and distribution of body fat, which can be especially harmful to the brain when it accumulates around the waist. "As belly size increases, the memory center in the brain gets smaller," Isaacson told me.

A thorough examination of my eyes not only determined if I had vision problems that could affect my cognition, but also allowed me to look at the back of my eye or retina. The small blood vessels there can show early signs of nerve damage due to diabetes, high blood pressure, coronary artery disease, and even cancer.

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A cognitive baseline

I dreaded the cognitive tests I knew were necessary to establish a baseline of my brain. How many of the 15 words I heard could I immediately remember? I closed my eyes and tried to paint a picture in my brain as the voice repeated one after another: "Tree, rabbit, book, apple, lake..." (OK, the rabbit sat on a tree, reading a book while eating an apple with the lake behind. Phew, that was easier than I thought it would be.)

"Ladder, farmer, pipe, couch, plane, stocking, boy, nightingale..." (Uh, um, now there's a ladder leaning against the tree, and a farmer is climbing it with a pipe in his mouth, while a plane flies by , but wait, I forgot one! Ok, now there's a nightingale in the tree. But what were the others?)

So it was. Could I remember the faces and names of several people I saw on a computer after being introduced to 10 others? (Oh God, I'm terrible at remembering people's names.) Could you remember and draw a complex geometric figure and then another even more complex one? (Please no, my spatial skills are the worst.) I shuddered as each test ended, convinced that my cognitive score would quickly prove that my brain was headed for the trash heap.

Reassuring voices from the interdisciplinary testing team attempted to ease my fears. "Oh no, you did good!" (Yes, of course, said my inner critic). "No, really, you remembered a lot of those names!"

This is how doctors will know if your forgetfulness is dementia 2:53

Medical history is important

Medical history was essential. Did you have a family history of Alzheimer's? (Not that I know of, but my mother had vascular dementia.) What about diabetes, cancer, thyroid disease, high blood pressure or heart disease? (My half-brother had two open heart surgeries and my aunt died of a stroke.)

Have I had falls, concussions, or traumatic brain injuries, called TBIs? This is important because even a mild traumatic brain injury caused by a fall, car accident, or playing sports can have a lasting impact on the brain.

How many years of education did I have from kindergarten on? Education and learning can develop a "cognitive reserve", which is believed to compensate for damage to the brain. Have I had any hearing loss? Like vision, poor hearing can affect brain health. (I wouldn't be surprised: those concerts I attended in college were VERY LOUD.) What were my physical exercise and diet patterns? (Unfortunately, not as stellar as I would like.)

Questions about my dental hygiene were next on the checklist. Did I get regular checkups and cleanings (yes) and floss regularly? (No comment.) Not only is there a link between cavities and the heart and premature death, but studies have also linked gum disease to cognitive decline.

How many hours of uninterrupted sleep did I get? Lack of sleep is a known contributor to brain decline. Adults need seven to eight hours of quality sleep each night to give the brain time to regenerate and "take out the trash" of dead and dying cells.

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Some of the questions may seem unexpected to those who don't write about brain health. When did my period start? How many pregnancies did I have? Did I have an early hysterectomy? Studies are finding strong links between the amount of estrogen over a woman's lifetime, the number of children she had, and her risk for health and cognitive problems.

Was I going through menopause and if so, did I have hot flashes? Hot flashes have been linked to an increased risk of heart disease and cognitive decline, while loss of estrogen during the menopause transition is a major risk factor for dementia and Alzheimer's disease.

"Women have very different and unique risk factors for dementia than men," Isaacson said. "Women have a 39% higher risk of dementia if they have accumulated fat around their abdomen. And the rapid decline in estrogen during the transition to perimenopause may actually be one of the most impactful risk factors for developing the pathology of Alzheimer's in the brain.

And then there was my emotional health. Was I abandoned as a child, lost a parent or loved one, or suffered mental or sexual abuse? These adverse childhood experiences, known as ACEs, have been shown to hinder healthy brain development in children and contribute to multiple health problems throughout life.

Even in adulthood, depression, anxiety and other mental illnesses can affect the brain's ability to function, while emotional trauma, such as domestic violence, rape, loss of a child, spouse or job, They can also flood the brain with caustic stress hormones that take their toll over time.

I'm lucky

It turns out that I am lucky enough to have no known genetic risk factors for Alzheimer's and currently have very little amyloid and tau in my brain. My cognitive reserve from years of producing videos and writing stories about just about everything seems to be balancing out the typical age-related shrinkage of my brain.

However, my risk of developing vascular dementia, the second most common type after Alzheimer's disease, is high. Not only do I have a family history, but some of my cholesterol and blood inflammation markers were borderline or worse, leaving me open to small blood vessel diseases.

My blood pressure has increased in recent years, a common occurrence with age, not helped by my couch potato behavior during the pandemic. Instead of getting up and moving like so many smart people did, I chose to sit down and work even longer hours. It was a bad choice with serious consequences: the bone scan showed that my muscle mass had reduced to a pitiful number.

Muscles facilitate exercise and strength development, while fragility contributes to falls and injuries. I have suffered a couple of falls in recent years. Muscle mass also increases calorie burning, so losing it can contribute to weight gain. Add to that the typical age-related slowing of your metabolism, and it's no surprise that you've also gained a few pounds.

I lost two husbands, one to a rip current and one to a brain tumor, so I was no stranger to chronically high levels of cortisol and other stress hormones. These can disrupt almost every process in the body and lead to anxiety, depression, sleep problems, weight gain, memory and concentration problems, as well as "heart disease, heart attacks, high blood pressure, and strokes," according to the Mayo Clinic. .

Once again, I am lucky to be a strong and resilient woman, like many of us. Fortunately, the ability to take life's challenges calmly and still thrive is something science says we can all learn and teach our children. Additionally, many of my medical concerns can be addressed by focusing on healthy behaviors such as stress reduction, strength training and aerobic exercise, and a recommitment to a healthy plant-based diet—behaviors that Isaacson and colleagues described in a review recent, published in the journal Nature.

I went home with a list of evidence-based actions created from research his team has conducted over the past 15 years. He calls it precision medicine: a risk management approach personalized to my specific needs.

"The goal is that by following a plan specially designed for each person, brain deterioration can be prevented, just as a heart attack can be prevented by keeping cholesterol and high blood pressure under control," Isaacson said.

"Imagine what we could achieve if we started this process from birth."

One tip I was given at home was to use a glucose monitor for a few weeks to identify which foods raised my blood sugar levels. "These spikes cause brain inflammation, alter brain metabolism and increase contraction of the thinking part of the brain," Isaacson said. (Credit: RichLeggE+/Getty Images)

Why join a study

Until brain check-ups become a standard part of preventive care, undergoing such an in-depth brain scan may be restricted to people participating in clinical trials, like me. And those with money and high-quality health insurance.

Volunteers are desperately needed for Alzheimer's and other brain health research. The Alzheimer's Association is seeking people living with Alzheimer's, their caregivers, and people without cognitive impairment to volunteer for clinical trials. The National Institute on Aging currently supports nearly 500 active clinical trials in Alzheimer's disease and related dementias. For information, visit this link.

Using technology can be a way to democratize access, Isaacson said. He is a co-investigator on a recently launched National Institutes of Health-funded clinical trial designed to see if preventative brain care can be provided to people in their homes. People with a family history of Alzheimer's who meet certain criteria can enroll in the study at Retain Your Brain.

"The study allows the public to access software that guides them through a free risk assessment, cognitive and memory testing, and personalized counseling from the convenience of their mobile phones," Isaacson said. "These types of digital resources for brain health could be used until the field of preventive neurology develops more widely."

As for me, I have a lot of work to do, but at least I know what my situation is and what I can do about it. The rest is up to me. Wish me luck!

Editor's note: CNN writer Sandee LaMotte has been covering health and wellness, including what's best for the brain, for more than 30 years. After learning that she was old enough to be eligible for a brain clinical trial, she jumped at the opportunity to sign up and then share this rarely reported process with readers.

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