Q&A with Dr. Gary Small on aging and dementia

We’ve all experienced it. That moment in our middle age when we pour the milk into the dog dish and the kibble into our cereal bowl. When we forget our neighbour’s name. When we’re convinced we’re losing it. When we think we’re getting Alzheimer’s disease.

Dr. Gary Small, 60, director of the UCLA Longevity Center at the Semel Institute for Neuroscience and Human Behavior and the Parlow-Solomon professor on aging at the David Geffen School of Medicine, has been studying Alzheimer’s for more than two decades. Along with his wife, Gigi Vorgan, he has co-authored half a dozen bestsellers on memory and the brain.

Their latest effort, The Alzheimer’s Prevention Program: Keep Your Brain Healthy for the Rest of Your Life, offers strategies for warding off dementia, which will become more prevalent as baby boomers age.

That’s a daunting — and expensive — prospect. According to the Alzheimer Society of Ontario,some 500,000 Canadians were living with dementia in 2010, costing society an estimated $22 billion a year. Within a generation, those numbers will more than double.

On May 15, Small will be speaking in Toronto as part of the Ramsay Talks series. This is an edited version of a telephone conversation with the Star.

Q:Everybody thinks the moment they forget something, they’re getting Alzheimer’s. What’s that about?

A: There’s a lot of concern and anxiety about it. But the reality is that our brains age throughout life and, in fact, the science tells us that at age 45 we can measure cognitive and memory decline in the average person. There’s a steady gradual decline that continues.

One of the reasons that Gigi and I were motivated to write this book was to explain to people the truth about their brain aging and memory decline rather than living in fear that it’s Alzheimer’s dementia every moment.

Q:What’s the difference between Alzheimer’s and dementia?

A: The best way to define dementia is that it’s a cognitive impairment severe enough that you need help from others, that you really can’t be independent anymore.

People can get dementia from many different causes. You can have it from small strokes, you can have a reversible dementia as a drug side effect or a thyroid imbalance.

Alzheimer’s disease is the most common cause of dementia and, with Alzheimer’s, we see in the brain a buildup of small, sticky, waxy protein deposits called amyloid plaques and tau tangles. They accumulate in the memory and other cognitive areas of the brain. And they build up very gradually but, at some point, it reaches a threshold so that it’s impairing cognition and people need help and that’s when they have Alzheimer’s dementia.

Q:With the coming explosion in the aging population, thanks to the baby boom, aren’t the implications staggering?

A: Age is the greatest risk factor. By age 65 or older, your risk is about 10 per cent for Alzheimer’s dementia. By 85, it’s 40 per cent or more.

The implications are that we have a lot more people who have dementia and a lot more people concerned about developing it.

But our Alzheimer prevention program has a very positive message that empowers people. The studies of successful aging tell us that, when it comes to cognitive success or avoiding dementia or developing it, for the average person only a third of what determines that cognitive outcome results from genetics, from what we inherit.

Rarely there are families, less than 2 per cent of cases, with very strong genetic components; they have mutations that cause the disease very early in life. For the vast majority, the genetics are not as strong. They are a factor.

About 20 per cent of the population has this risk. It increases the likelihood of getting the disease and the likelihood of getting it at an earlier age but it’s not 100 per cent.

That means that two-thirds of the formula comes from non-genetic factors: the lifestyle choices we make every day have a major impact on how well our brains age.

Q: So those include what exactly?

A: Physical exercise, mental exercise, nutrition, stress management and other behaviours, like avoiding head trauma, not smoking and so forth.

Q: Exercise seems obvious.

A: Actually, it may not be completely obvious for people. They know there is a connection between exercise and physical health, exercise and avoiding heart disease. But not everybody is aware of the strong connection between physical exercise and brain health.

Getting a cardiovascular workout, your heart is pumping oxygen and nutrients to your brain cells. You’re secreting something called BDNF — brain-derived neurotrophic factor — which causes your brain cells to sprout branches and communicate more effectively. You do not have to become a triathlete to protect your brain. Studies have found that as little as 20 minutes of brisk walking a day will lower your risk.

Q: And nutrition?

A: Very important. If you are overweight, it doubles your risk for Alzheimer’s. If you’re obese, it quadruples your risk.

Nutrition involves omega-3 fats from nuts, flaxseed oil and fish. It involves eating antioxidant fruits and vegetables and trying to avoid refined sugars and processed foods.

Q: But as a society, we’re overweight, we’re eating junk, we’re battling diabetes, we’re sedentary. Aren’t we doomed?

A: I think we’ve got a big challenge. We have a huge number of people who are overweight or obese, who are still smoking, who are not exercising and we have to help them to change.

What we did in the Alzheimer’s prevention program was try to be mindful of the challenge of getting people to develop brain-healthy habits. The first element is to educate people to understand the connection between brain health and behaviour. The second is to show them that it’s not difficult.

We include a seven-day jump-start program in the book. It only takes half an hour a day, and they actually start noticing results. We include assessment tools so people can see improvement in memory and other measures after a week.

Now that’s important because, by observing that improvement, by getting that feedback, they are more motivated to continue those habits and those behaviours.

We’ve included self-rating assessments, simple tools that we have studied in our many research projects at UCLA looking at brain imaging and other indicators of cognitive health. There are objective measures where you time yourself to try to learn a certain number of words and then come back and see how many you know.

Q: What about mental exercise? I know people who do Sudoku because they’re convinced it will head off Alzheimer’s or dementia. Is there any point to that?

A: There have been a lot of studies showing a connection between mental stimulation and a lower rate of getting Alzheimer’s. But the evidence is not definitive. Having said that, we still encourage people to do these things and to have fun doing them, to try to train but not strain their brains. You can also cross-train your brain so you can do right-brain puzzles one day and left-brain puzzles the next day.

But more important than that are the memory training exercises that we include in the book. We know that people with normal aging and mild memory complaints can improve their memory in a very brief period of time and those benefits can be sustained for many years. We measured up to five years.

Q: Can’t early detection help?

A: We worked very hard on that for many years. We developed the first brain scan to visualize the physical evidence of Alzheimer’s disease. But one of the challenges with this approach is that we don’t have a specific drug linked to these scanning devices. What we have is something like a cholesterol test for the brain but we just don’t have the drug, like the statin drug for cholesterol and lowering risk for heart problems, to lower your risk for Alzheimer’s disease.

Q: And what about stress?

A: To some extent, a little bit of stress is a good thing. It keeps us motivated and doing things. The problem is too much stress is not good for the brain. Studies of laboratory animals find that when they’re under chronic stress, the hippocampal memory centres of their brains are smaller and they get lost in their mazes.

If you inject a human volunteer with the stress hormone cortisol, it temporarily impairs learning and recall. Chronic stress can also cause depression, which can impair cognitive ability.

So we can’t eliminate stress entirely but we can manage it better and provide simple exercises to help people. Our research group has done some studies recently with meditation and tai chi showing that better stress management improves your memory, improves your mood and, something else we get into in the book, chronic inflammation.

If you look inside those amyloid plaques you see evidence of inflammation and many of the Alzheimer’s prevention strategies are anti-inflammatory strategies, such as physical exercise and getting a good night’s sleep.

Q: So what do you do to stay healthy?

A: I get cardiovascular conditioning every day, I eat fish two times a week, I take fish oil capsules, I take smaller meals throughout the day because I think we were meant to be grazers, not stuffers. I try to take breaks from the Internet so I don’t get too stressed out. I try to monitor my multi-tasking. And whenever I can I break up my work day by stretching, walking, talking, relaxing.

You know, I think that after years of studying these issues, and seeing thousands of patients, actually seeing Alzheimer’s in my own family, I am living a much healthier lifestyle than I did 20 years ago. I feel pretty good.

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