“Memories: timeless treasures of the Heart”

 

Recently I watched a movie that won 2015 Oscar for Best Actress- Still Alice. Julianne Moore, as Dr. Alice Howard, honorably recreated the character Alice based on a bestselling novel by Lisa Genova. The movie takes twists and turns: when Alice’s initial diagnosis changes from mild cognitive impairment to an early onset of familial Alzheimer’s disease and when the family try to cope with the memory disruptions in a smart linguistic Professor at Columbia. The highlight was its ending which made warmth to an otherwise unhappy plot. In the last scene, after reading Angels in America to her mom, Alice’s daughter asked what that meant to her. Alice, who could barely think, contemplate, or hardly speak utter this beautiful four letter word: “Love”. Yes, it is all about love. The love and the compassion you show to the inflicted; the service you render to the patient and the peace that evolve from that relationship. It’s Alzheimer’s: a disease that eludes our efforts to stop, prevent or slow.

 

In a study reported in Nature genetics (September 2009- Fifteen years since the last discovery of its kind) scientists identified three new genes linked to the most common form of memory disorder, late-onset Alzheimer’s. We had 5.3 million Americans suffering from the disease and thought a cure for Alzheimer’s was near. Fast forward to six years - the direct cost for patient care per year is 226 billion dollars and would cost 1.1 trillion in 2050; 65 percent of the patients are women; since 2002 349 drugs failed in human trials. Everybody now praises the new drug in the pipeline (aducanumab developed by Biogen) as the Holy Grail of Alzheimer’s prevention. This is unheard in pharmaceutical industry which is driven by profit and competition. Failures in the past and a common cause seems to add synergy into a formidable attempt. Multiple targets (beta amyloid protein; tau protein; Apo lipoprotein E, which enhances the proteolysis cleavage of beta amyloid; and things we do not know) together with the time of intervention makes the drug development endeavor a daunting task. The path to "the patient has cognitive impairment" seems to be long.

 

From the experience with patients with cognitive impairment, (researchers feel) one way to reduce the progression is to keep the mind engaged and challenged - learn new things and use them. Exercise seems to enhance brain function; some results are documented and some are yet to get the blessings of our pragmatic scientific community. There is nothing wrong in trying to delay or fight the onset of such an inconvenience.

 

• Exercises indirectly delay the progression of cognitive impairment.  
• Aerobic exercises reduce the fasting plasma levels of insulin, cortisol and brain-induced neurotropic factors in women. It was strange to see that women benefits more from exercise for brain health than men. However, aerobic exercises increase the levels of Insulin-like growth factors in men, a negative factor for Mild Cognitive Impairment-MCI (Archives of Neurology, 67(1), Jan 2010).
• Any mild activity reduces the incidence of MCI by 30-40%. An exercise program combining strength training and aerobics is important for cognitive health. Cardiovascular exercises, 2-4 days/week, 30 min per session is beneficial. What is good for the heart is good for your Brain.
• Physical fitness and exercises were also found to improve spatial memory and increase the size of Hippocampus, a curved structure inside the brain. Higher the size of the Hippocampus, higher the ability of a person to store and process recent information. Other attributes to exercises: Increased blood circulation to the brain; change in brain metabolism; growth in new brain cells – neurogenesis (Proceedings of National Academy of Sciences, January 19, 2010).
• It is time for our fitness experts to add cognition to the exercise classes. Engage participants and challenge them. Yoga is an exercise modality where ancient gurus recognized the relevance of mind and spirit. They had modified some of the breathing techniques specifically for brain: for example- Kapalabhati (frontal brain purification). It is a pranayama. Science is yet to prove how headstand and inversions influence the flow of blood to the brain and its function. What about if we ask participants to use the brain and cognition in the head stand?  Allow them to contemplate on energy centers and locks. It is time for yoga community to add a fourth dimension to it and redefine yoga as a union of mind, body, spirit and cognition.
• Stress is a culprit. Stress triggers the release of stress hormones- norepinephrine, epinephrine and cortisol. Elevated cortisol is destructive. This catabolic hormone breaks down muscle; lower the ability to concentrate; reduce the activities of many important immune cells; and leads to cognitive disruption. Getting proper sleep is critical for optimal cognitive performance. Stress interferes with the ability of melatonin to induce sleep.
• Structured aerobic classes (cardio kickboxing, yoga, Pilates, step…) offer a challenge to brain and heart.
• Studies have found B vitamins - folic acid, Vitamin B6 and Vitamin B12 - could reduce the rate of MCI, a transitive stage between normal aging and dementia.
   
  Till we have a clear treatment for Alzheimer’s, it would be wise to be proactive. Remember: “Memories are the timeless treasures of the Heart” and we do not want to lose them.
   
  Healthy Regards,
   
  Jay