Do You Know Your Six Pillars of Brain Health?
by Women’s Brain Health Initiative:
REDUCE DEMENTIA RISK THROUGH YOUR LIFESTYLE CHOICES
Dementia risk is affected by many factors, some of which we have no control over such as genetics and age. However, research shows that there are several things that we can do (or not do) to help support our brain health as we age and decrease the risk of developing dementia.
When it comes to research about dementia prevention, one paper that is often referenced is “Dementia prevention, intervention, and care: 2020 report of the Lancet Commission,” which was written by more than 25 researchers from around the world.
Based on their extensive review of the current evidence, the researchers suggest that there are 12 modifiable risk factors that collectively account for approximately 40% of worldwide dementias.
In other words, if those 12 modifiable risk factors were eliminated, then 40% of the cases of dementia globally could theoretically be prevented or delayed. Those risk factors are outlined below (along with the estimated percentage reduction in dementia prevalence if each risk factor was eliminated independently).
Although these figures are estimates only and further study is needed, the overall message from this research sends an important signal: a sizeable amount of dementia cases may be prevented or delayed through our own actions or behaviours.
Many such actions are related to lifestyle choices. Some are choices to not do something (e.g., smoke or drink excess amounts of alcohol), while others are choices to do something (e.g., exercise).
“For more than a decade, Women’s Brain Health Initiative has been working to spread the word about all of the positive choices that individuals can make to help keep their brains healthy as they age and decrease the risk of developing dementia,” said Lynn Posluns, President and CEO of Women’s Brain Health Initiative. “We refer to these choices as the ‘six pillars of brain health.’”
In this article, we summarize some of the latest research behind why each of these six pillars are so important individually for dementia risk reduction, as well as the synergies when they are combined.
“The more people who know about the importance of eating well, getting regular exercise and enough sleep, connecting with others, engaging in cognitively challenging activities, and managing stress for optimal brain health, the better,” said Posluns. “If even a small number of cases of dementia are prevented or delayed, the positive impact on individuals, families, and society will be immeasurable.”
TAKE ACTION IN ALL SIX PILLARS TO MAXIMIZE IMPACT
Research aligns with what logic might imply: the greater the number of healthy lifestyle behaviours a person engages in, the lower the risk of developing dementia.
For example, a study conducted by Dr. Klodian Dhana and colleagues (published in 2020 in Neurology) found that participants who engaged in two to three healthy lifestyle factors had a 37% lower risk of Alzheimer's disease (AD), compared to participants who did not engage in any healthy lifestyle factors or only one healthy lifestyle factor.
For the participants who engaged in four to five healthy lifestyle factors, the risk was even lower (60%). In this study, the five lifestyle factors considered were: (1) non-smoking; (2) 150 minutes or more per week of moderate to vigorous physical activity; (3) light to moderate alcohol consumption; (4) high-quality diet; and (5) engagement in late-life cognitive activities.
NOT ALL CASES OF DEMENTIA ARE PREVENTABLE
While we want to empower people with the knowledge that there are actions one can take to decrease dementia risk, it is equally important to educate people that not all cases of dementia are preventable.
There are so many variables (not all of which are even understood at this point) that may influence whether a given individual develops dementia or not. Even if someone follows the recommendations for all six pillars of brain health and addresses all other known modifiable risk factors, there is still the possibility of developing dementia.
We mention this not to put a damper on enthusiasm about lifestyle change, but rather to mitigate any potential stigma. We do not want to leave anyone with the impression that if someone develops dementia, it is somehow her or his “fault” because she or he could have made different choices to prevent it.
Another important factor to note is that motivation and willpower are only part of what influence lifestyle choices; there are environmental, cultural, and other influences that can make it difficult for some people to make healthy lifestyle choices (e.g., not everyone has readily available and affordable nutritious food).
“There’s already so much stigma about having dementia, it’s really important that when we talk about lifestyle strategies to decrease dementia risk that we emphasize we are only talking about risk reduction, not risk elimination,” emphasized Colleen Hill, an Executive Director with the Alzheimer Society of Ontario. “There isn’t a way to guarantee that an individual won’t get dementia, even if they do everything that is currently known to help prevent it.”
Exercise
Most people are aware that exercise is good for your physical health and well-being. The importance of exercise for cardiovascular health, for example, has been widely understood and communicated for years. However, many people do not realize that exercise benefits your brain health as well.
Large observational studies with lengthy follow-up periods have found that individuals who lead physically active lives are less likely to experience cognitive decline or develop dementia compared to those who are inactive.
A large meta-analysis – conducted by Dr. Francesco Sofi and colleagues and published in 2011 in Journal of Internal Medicine – found that participants with high levels of physical activity showed a 38% reduction in the risk of cognitive decline, compared with sedentary participants. Even the participants who engaged in low to moderate levels of physical activity experienced a significant risk reduction (35%). Interestingly, the findings also suggested that the effect of physical activity on cognitive function may be stronger in women than in men.
An even larger meta-analysis – conducted by Dr. Mark Hamer and Dr. Yoichi Chida – found that physical activity was associated with a 45% reduction in the risk of developing AD. These findings were published in 2008 in Psychological Medicine.
Why does physical activity benefit brain health? Research has found that exercise:
· Improves blood flow to the brain, thereby boosting the supply of oxygen and nutrients;
· Stimulates increased levels of crucial brain compounds such as brain-derived neurotropic factor (decreased levels of brain-derived neurotropic factor are linked with neurodegenerative diseases involving neuronal loss, such as AD, Parkinson’s disease, and multiple sclerosis);
· Boosts neurogenesis and neuroplasticity (i.e., helps build new brain cells and form/reorganize connections between cells);
· Alters the activity of microglia (the brain’s immune cells) in a way that lowers inflammation in the brain (inflammation in the brain can impair cognitive function and is a risk factor for AD); and
· Helps reduce dementia risk indirectly by improving sleep, relieving stress (thereby reducing cortisol levels), lowering blood pressure and cholesterol levels, and reducing risk of cardiovascular disease, diabetes, depression, and anxiety.
What type of physical activity is best, and how much activity is enough? Research has not definitively answered these questions yet and more research is needed to determine optimal exercise “prescriptions” to maximize brain benefits.
The latest Canadian Physical Activity Guidelines for adults aged 18 and over (for overall health, not just brain health) recommend a total of 2.5 hours of moderate to vigorous aerobic activity each week, in sessions of ten minutes or more, as well as one or more strength-building activities at least twice a week. In addition, adults aged 65 and over are advised to engage in physical activity that challenges balance.
EVIDENCE CONTINUES TO GROW SHOWING THAT PHYSICAL MOVEMENT (IN PRACTICALLY ANY FORM) BENEFITS THE BRAIN.
Whether it is aerobic exercise or strength training, performed in long or short sessions (and at varying intensity), physical movement supports healthy brain function to some degree.
Formal exercise sessions are not the only physical activity that count, either; being less sedentary in your day-to-day life helps support brain health as well – whether you are walking and cycling for your errands, gardening, cleaning your home, or playing actively with children or pets.
“Physical activity doesn’t just help provide protection for cognitively healthy people; rather, it can also have a positive impact on cognitive function and well-being in people who already have neurodegenerative diseases,” said Hill.
“Further, physical activity can benefit the brain regardless of age or existing fitness level. So, even if a person cannot meet the Canadian Physical Activity Guidelines, because of illness or disability for example, I encourage them to do what they can. Perhaps it’s just stretching in bed or walking around the room or down the hall with a walker. Every bit of movement appears to help support brain health.”
Mental Stimulation
When it comes to keeping your brain healthy, exercising your mind is as important as exercising your body. Engaging in cognitively stimulating activities throughout one’s life is associated with a lower risk of developing dementia.
There is strong evidence linking higher educational levels with lower dementia risk. (You will recall that “less education” was the second-strongest modifiable risk factor listed in the Lancet Commission’s paper, accounting for approximately 7% of dementia case reduction if eliminated.)
IT APPEARS THAT HIGHER LEVELS OF EDUCATION STIMULATE THE BRAIN TO BUILD “COGNITIVE RESERVE.”
The brains of individuals with high cognitive reserve continue to have normal cognitive function even when their brains develop dementia-type physical damage; their brains are resilient, forming new connections between neurons to rewire around damaged ones.
These resilient individuals are surprisingly not rare. It is estimated that approximately 30% of older adults have enough amyloid-beta
and/or tau in their brains to qualify for a diagnosis of AD, yet they do not exhibit any outward symptoms.
Education is not the only way to build cognitive reserve. Other ways include having a more mentally demanding occupation, speaking more than one language, and engaging in mentally stimulating leisure activities such as playing a
musical instrument, reading, and solving puzzles.
The key to reaping maximum brain benefits is to choose activities that are mentally challenging – in other words, activities that provide novelty, variety, a high level of engagement, and go beyond what is easy or comfortable for you. The more challenging the task, the higher the positive impact.
“Challenging your brain with novel activities and new ways of doing things helps to build new brain cells and strengthen connections between them. And, what’s especially great about mental stimulation as a dementia prevention tool is that there are no side effects, plus many of these activities are fun and add to your overall quality of life and emotional well-being,” said Hill. “It’s an easy, low-risk way to support your brain health, and it helps at any age. It’s never too late to learn new things and challenge yourself mentally.”
Social Activity
Social isolation has been linked with an increased risk of cognitive impairment and dementia, while high social contact (measured by one’s social activity levels and/or the size of one’s social network) has been associated with better late-life cognitive function.
SOCIAL ENGAGEMENT IS A PREDICTOR OF OVERALL WELL-BEING THROUGHOUT LIFE.
Why is social activity important for brain health? Researchers
do not know for certain all of the ways in which social engagement supports brain health, but some of the proposed explanations for the positive effect include:
· Social contact helps to build cognitive reserve (perhaps through intellectual stimulation from interacting with others);
· Social engagement improves the immune system;
· Positive social interactions and support can help reduce chronic stress (stress management is one of the other six pillars of brain health); and
· People with strong social engagement are known to be much less vulnerable to some dementia risk factors, including smoking, alcohol misuse, depression, and obesity.
Social activity can be broadly defined and does not just mean socializing formally with friends and/or family. Rather, it can include any positive interactions that you have with others, including with neighbours, colleagues, and/or customers at work or while volunteering, and members of your church or political organization. Even interaction with animals can help alleviate feelings of loneliness.
“Social connection is one of the pillars of brain health that we focus on a lot at the Alzheimer Society of Ontario because of its overarching impact. When you have a vibrant, positive social life, you tend to feel less stressed, have opportunities to stretch your mind, and maybe have friends to support you in exercising more or eating healthier,” said Hill.
“It’s important to note that each person’s version of a vibrant, desirable social life will be different. We all have unique preferences about how many relationships we want to nurture, how often we enjoy connecting with others, and what activities we engage in when we do. Everyone needs at least one person in their life that they feel close to and can confide in, though. So, take steps to build the type of social life you like best, and remember that the quality of relationships matters more than quantity.”
Nutrition
The human brain requires a constant supply of glucose, vitamins, minerals, essential fats, and amino acids in order to function. These nutrients work collectively to help support learning, memory, sleep, mood, and focus – making nutrition essential for a healthy brain.
WHEN ANY NUTRIENT IS IN SHORT SUPPLY, BRAIN FUNCTION IS NEGATIVELY AFFECTED.
What should you eat for optimal brain health? A well-researched and effective brain-healthy diet is the “MIND diet” (Mediterranean-DASH Intervention for Neurodegenerative Delay). It borrows elements from the heart-healthy Mediterranean diet and the blood pressure-lowering DASH diet (Dietary Approaches to Stop Hypertension).
While all three of these diets emphasize plant foods and a low intake of high-fat foods, the MIND diet specifically focuses on foods and nutrients that are linked with optimal brain health.
The MIND diet has been linked in multiple studies with less cognitive decline, as well as lower risk of dementia. For example, a study of adults in the United States found that high adherence to the MIND diet was associated with a 53% lower risk of AD, compared to low adherence.
Even moderate adherence was linked with a lower risk of AD (35%). That research was conducted by Dr. Martha Clare Morris and colleagues and published in September 2015 in Alzheimer's & Dementia: The Journal of the Alzheimer's Association.
Research on the role of individual foods or micronutrients in brain health has also been conducted. According to the World Health Organization, the individual foods that have consistently been associated with decreased risk of dementia are fruits, vegetables, and fish.
The MIND diet recommends eating certain foods while minimizing or avoiding others.
10 Brain-Healthy Foods to Emphasize
· Green leafy vegetables
· Other vegetables
· Nuts
· Berries
· Beans
· Whole grains
· Fish
· Poultry
· Olive oil
· Red wine
5 Unhealthy Foods to Minimize or Avoid
· Red meats
· Butter and margarine
· Cheese
· Pastries and sweets
· Fried/fast foods
WHEN IT COMES TO FRUITS AND VEGETABLES, YOU CAN MAXIMIZE THE POSITIVE IMPACT ON YOUR BRAIN HEALTH BY “EATING THE RAINBOW.”
In other words, it is important to eat a diverse range of fruits and vegetables (and/or any plant foods, including tea, legumes, nuts, whole grains, herbs, and spices) in a wide variety of colours.
Colourful plant foods are rich in phytonutrients. Diets that are low in phytonutrients have been linked with obesity, elevated cholesterol and blood pressure, insulin resistance, and prediabetes – all of which are dementia risk factors. Conversely, diets that are high in phytonutrients have been linked with better cognitive function and mental health (i.e., lower prevalence of depressive symptoms and anxiety).
“It is well-understood by most people that healthy eating can help reduce the risk of heart disease, stroke, and diabetes. Fewer people realize the impact of food on brain health, yet nutrition is critically important for the optimal function of your entire body, including your brain,” noted Hill.
“It’s not always easy to make changes to our eating habits, but research suggests that even moderate shifts toward eating healthier can help. So, I encourage everyone to become familiar with the MIND diet and begin following it as best as they can to enjoy a delicious journey toward improved brain health.”
Sleep
Not getting enough, good-quality sleep on a regular basis not only leaves you feeling tired and irritable, but also negatively impacts your brain health.
SLEEP PROBLEMS ARE ASSOCIATED WITH A HIGHER RISK OF COGNITIVE DECLINE AND DEMENTIA.
One meta-analysis of 27 studies – conducted by Dr. Omonigho Michael Bubu and colleagues and published in 2017 in SLEEP – found that individuals with sleep problems (including short and long sleep duration, poor sleep quality, circadian rhythm abnormality, insomnia, or obstructive sleep apnea) had a 1.55-times higher risk of AD, a 1.65-times higher risk of cognitive impairment, and a 3.78-times higher risk of preclinical AD, compared to those without sleep problems.
Even in the absence of serious sleep problems, how much sleep you get (and the quality of that sleep) affects your cognitive function, especially memory, attention, and mental health.
What makes sleep so important for brain health?
· Sleep plays an important role in learning and memory. Getting enough sleep helps with focus and attention while you are awake. Sleep itself is a time for consolidating memories (i.e., when recently learned information is transformed into long-term memory).
· Sleep helps clear away waste proteins in the brain, including beta-amyloid (which, in excess, has been linked with higher risk of AD). Just one night of sleep deprivation has been found to reduce clearance of those neurodegenerative proteins from the brain.
· Poor sleep is linked with various conditions, including depression, obesity, hypertension, and diabetes, which are each dementia risk factors.
· In cases of sleep-disrupted breathing disorders (such as obstructive sleep apnea), not only is sleep disrupted, but the brain also experiences intermittent drops in oxygenation, which contributes to brain cell death and dysfunction.
How much sleep is ideal for optimal brain function? Research suggests that there may be a “sweet spot” – i.e., a mid-range amount that is ideal, because not getting enough sleep or getting too much sleep can be detrimental.
Exactly where that “sweet spot” falls is still being determined, though. Research to date – including a recent study conducted by Xin You Tai and colleagues – points to it being somewhere between six and eight hours per night.
That study, published in 2022 in Communications Biology, examined the impact of sleep duration on executive function and brain structure in healthy individuals between the ages of 38 and 73 years. When it came to cognitive performance, the researchers found that seven hours of sleep per day was associated with the best performance, and for every hour below or above seven hours, cognitive performance progressively decreased.
When they looked at grey matter volume, the researchers found that individuals who slept between six and eight hours each night had significantly more volume in 46 different brain regions. (More grey matter volume is a good thing; it tends to shrink with age and as it does, cognitive function tends to decrease.)
Stress Management
Stress is a normal part of everyday life. However, if that stress is severely traumatic, happens frequently, or becomes chronic, it takes a toll on your brain health and thereby increases the risk of mild cognitive impairment and dementia.
A recent meta-analysis of 16 studies – conducted by Katherine Franks and colleagues and published in 2021 in Journal of Alzheimer’s Disease – found that higher perceived stress was associated with 1.19-times the risk of mild cognitive impairment and 1.44-times the risk of all-cause dementia.
Another meta-analysis – conducted by Mia Maria Günak and colleagues and published in 2020 in The British Journal of Psychiatry – looked at the link between post-traumatic stress disorder (PTSD) and dementia risk across ten studies. The researchers found that those in the general population with PTSD had 2.11-times the risk of being diagnosed with dementia, compared to those without a PTSD diagnosis.
Why does stress have a negative impact on your brain health? It is partly because stress induces hormonal and vascular changes that, when experienced for a prolonged period, result in increased blood pressure, higher blood sugar levels, and inflammation – all of which are associated with dementia risk.
CHRONIC STRESS ALSO LEADS TO BRAIN CELL DEATH, SHRINKING BRAIN REGIONS INVOLVED WITH MEMORY AND MOOD REGULATION.
Further, stress is a major contributor to insufficient sleep and sleep is critical for brain health.
“Stress is a major presence in people’s lives these days. While it’s important to do what you can to reduce the number of stressors you face, there’s sometimes no way to avoid facing some serious amounts of stress. What’s critical is that you have strategies for coping with stress in healthy ways,” explained Ms. Hill.
“Meditation and mindful movement practices such as yoga, Tai Chi, and Qigong are great stress relievers. So is any other type of exercise and socializing, especially if you laugh a lot. Getting enough sleep and asking for help if you need it are also key during stressful times.”
DON’T DELAY - MAKE HEALTHY LIFESTYLE CHOICES TODAY
Dementia develops over a long period of time, with changes starting to occur in the brain decades before any symptoms appear. The earlier in life that you begin making healthy choices in all six pillars of brain health, the better.
Even though early intervention is best to prevent cognitive decline, it is never too late to make positive changes and still potentially benefit your brain health.
While the six pillars described in this article help protect brain health, they will do more than that. Our brains are just one part of an intricately connected body, so it is not surprising that when we eat nutritious foods, move our bodies regularly, challenge our minds, connect with others, relax, and get enough sleep that there are beneficial effects beyond cognitive function.
Making healthy lifestyle choices in some or all of the six pillars will also benefit your cardiovascular health and mental health, help prevent diabetes, boost your day-to-day energy and vitality, and more.
“To help adults of all ages in developing healthy habits to protect and prolong their brain health, Women’s Brain Health Initiative has developed a mobile application called ‘BrainFit™,’ thanks to the generous support from the Public Health Agency of Canada, BitBakery, York University, Telus, Royal Bank of Canada, RB33, and The Citrine Foundation of Canada,” said Posluns.
BrainFit™ offers timely and convenient evidence-based information, practical application tips, and encouragement to create brain-healthy habits to get and stay brain fit.
This one-of-a-kind behaviour design app takes habit tracking to another level. It is the only app to focus on optimizing brain health, with an emphasis on the six pillars of brain health, and it is completely free to use. There are no hidden costs to sign up, gain access to app features, track your achievements, or see the best content.
“BrainFit™ is personalized and customizable. The content is curated specifically to help users protect their brain health. It leverages our vast network of experts and advisors, builds on our Mind Over Matter® magazines, and includes access to the new Mind Over Matter® podcast and video series,” continued Posluns.
Available for both iPhone and Android, BrainFit™ – Free Habit Tracker launches this December in the app store.