The Time Is Now To Get Healthy

A recent study in the Journal Neurology indicated that most adults have evidence of brain disease whether or not they had symptoms of dementia.   As part of the long-term Rush Memory and Aging Project, researchers evaluated the spectrum of abnormalities found in the brains of 141 older adults, with and without clinically evident dementia.   At the time of death, only 20 persons (14.2 percent) were free of brain disease, Dr. Julie A. Schneider, from Rush University Medical Center, Chicago, and colleagues found. Most older persons with dementia (i.e., memory and other cognitive impairments) had more than one type of pathology in their brain causing the impairment, Schneider told Reuters Health.

http://news.yahoo.com/s/nm/20071228/hl_nm/older_adults_brain_dc

“This most commonly was Alzheimer’s disease pathology and cerebral infarcts (strokes), followed by Alzheimer’s disease and Lewy body disease, a disease related to Parkinson’s disease,” she said.   Older persons without dementia also frequently had brain disease, most commonly Alzheimer’s-like disease, but also multiple other abnormalities, Schneider noted. Having more than one disease in the brain significantly increased the likelihood that symptoms of dementia will be present.   “Older persons can often handle one pathology in their brain, but the burden of more than one pathology may tip them over the threshold of clinical dementia,” Schneider said.   Therefore, prevention of not only Alzheimer’s disease but these other pathologies, particularly stroke and those things that may increase the risk of stroke, like high blood pressure, high cholesterol, cigarette smoking, obesity, “are likely to significantly decrease the prevalence of dementia,” Schneider added.

In our book Preventing Alzheimer’s, written with neurologist William Shankle, we argued that early prevention is the key to keeping the brain young and necessary for a true effort at Alzheimer’s prevention.   In my experience looking at older brains, most looked terrible, consistent with this study.   However, there are notable exceptions, my mother for one and Anna for another.

Several years ago, in one of the graduate courses I taught at Vanguard University, I asked for volunteers for our healthy brain study.   By the year 2000, we had amassed tens of thousands of brain scans for things like ADHD, anxiety, depression, autism and Alzheimer’s disease.   To further our research efforts we needed to build a large database of healthy brain scans.   I tried to find them wherever I went.   Surprisingly, healthy brains were not that easy to find, consistent with the above study.  

Christy, one of my favorite students, came up after class very excited.   She said, “You have to scan my 82 year old grandmother, Anna.   She is one of the most normal people I know. You will love her.”   On Christy’s advice and her grandmother’s consent, I screened Anna and indeed found her to be healthy.   She met all of the criteria for the study: no psychiatric illness at any point in her life, no substance abuse, brain injuries, and she was not on any medications.   Anna had been married for 58 years and was a loving wife, mother and grandmother.   She had a sharp, curious mind and was active in her church and her community.   She had solid relationships that spanned many years.   Anna never drank or smoked and tried to eat healthy.   Anna has one of the prettiest brains I had ever seen, out of nearly 50,000!   Her brain fit her life.   A healthy brain makes a healthy successful life much easier.

Take care of your brain”¦protect it from head injuries, get enough sleep, don’t poison it with too much alcohol, nicotine or caffeine, eat right and exercise it.   A healthy brain is associated with a healthy, successful life.   Strive to keep your brain healthy.   Until next time, please know that success starts with a healthy brain.   Failure is often the result of a brain gone wrong.   The good news is that no matter how bad you have been to your brain it is never too late to change your brain and change your life. To your brain health,

Daniel Amen, MD    

Here is a fascinating piece from the NIMH website about optimism, pessimism and the lower portion of the anterior cingulate gyrus.   This is the same area of the brain we found dramatic decreases in our suicidal patients.

Humans tend to be overly optimistic about the future, sometimes underestimating risks and making unrealistic plans, notes NIMH grantee Elizabeth Phelps, Ph.D., New York University. Yet “a moderate optimistic illusion” appears to be essential for maintaining motivation and good mental health.

Using functional magnetic resonance imaging (fMRI), Phelps and her colleagues have now shown that such “optimism bias” may be rooted in the same brain circuitry as depression, which is marked by a tendency to be overly pessimistic.

The same circuitry was also in play when this normal bias toward positive thinking was temporarily turned off by depriving the brain of the mood-regulating chemical messenger serotonin, in another recent fMRI study by NIMH intramural research psychiatrist Wayne Drevets, M.D., and colleagues.

Through this circuit, the anterior cingulate, just behind the front of the brain, regulates the amygdala, an emotion hub deep in the brain.

Phelps and colleagues reported their findings in the October 24, 2007 issue of Nature.They set out to discover why, for example, people tend to expect to live longer than average, underestimate their chances of getting a divorce and overestimate their likelihood of successful careers.

Fifteen healthy volunteers were scanned while they were remembering or imagining future events ““ like “winning an award” and “the end of a romantic relationship” ““ to see how their brain activity related to their ratings of these experiences and their scores on standard scales of optimism.

True to form, the participants rated future positive events as more vivid and expected them sooner than negative ones.

The cingulate/amygdala circuit showed more activity and connectivity with optimistic than with negative imaginings. The higher an individual scored on rating scales of optimism, the more an area at the cingulate activated. This rostral anterior cingulate appears to be the seat of these judgments, where emotional, motivational and autobiographical information is weighed ““ with an eye for the positive.

But the same circuit has a flip side. Citing an earlier study by Drevets and colleagues, Phelps’s team pointed out that this cingulate/amygdala circuit may also underlie the pessimism and impaired imagining seen in depression.

In the recent study by Drs. Drevets, Jonathan Roiser, and colleagues, healthy volunteers who had never been depressed lost their optimism bias and showed brain activity changes in similar regions to Phelps and colleagues when they lacked tryptophan, the precursor chemical that the body uses to make the chemical messenger serotonin.

This first fMRI study to document neural and behavioral responses to emotionally-charged words when the healthy brain is starved of serotonin was published online September 19, 2007 in Neuropsychopharmacology.

Researchers had previously shown that people with a history of depression experience mood symptoms following such serotonin depletion, along with alterations in emotion-regulating brain circuits.

In the current study, 20 healthy participants initially made significantly more inappropriate responses to positive words while performing a task that required them to respond only to negative words, indicating that their attention was grabbed by the positive words ““ the optimism bias. However, after they took capsules containing essential amino acids, minus tryptophan, depriving their brains of serotonin, this normal bias toward positive words disappeared.fMRI scans revealed that this loss of focus on the positive was accompanied by decreased cingulate activity in response to positive stimuli, particularly in a region toward the back of the cingulate cortex that was also implicated in the Phelps study. Drevets and colleagues have proposed that by taking the breaks off the amygdala, such decreased cingulate activity may play a role in depression.

By helping to accentuate the positive, serotonin, which is enhanced by antidepressants, may provide resilience in the face of life’s hard knocks, suggest the researchers.

See the full post at http://www.nimh.nih.gov/science-news/2007/depressions-flip-side-shares-its-circuitry.shtml

A healthy brain is associated with a healthy, successful life.   Strive to keep your brain healthy.   Until next time, please know that success starts with a healthy brain.   Failure is often the result of a brain gone wrong.   The good news is that no matter how bad you have been to your brain it is never too late to change your brain and change your life. To your brain health,

Daniel Amen, MD