The Heart-Brain Connection
By Robert A. Barnett  
Published 2/26/2013 
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It turns out that to keep your brain healthy, you need to take good care of your heart. Exercising regularly, eating right, managing stress, and practicing preventive medical care to control heart risk factors all play important roles in preventing Alzheimer’s and other forms of dementia.

“Cardiovascular risk factors are key to Alzheimer’s risk,” says Stephen M. Rao, Ph.D., director of the Schey Center for Cognitive Neuroimaging and a professor at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. “These include elevated cholesterol levels, hypertension, obesity, and diabetes. Each of these factors appears to elevate the risk of developing Alzheimer’s. No one is sure exactly why yet, but we know they do increase the risk.” Metabolic syndrome, a cluster of abnormalities that includes high blood pressure, low HDL (good cholesterol) levels, high trigylcerides and abdominal obesity, is also associated with a risk of cognitive decline, according to an expert panel convened by the National Institutes of Health.

The good news is that the same lifestyle choices that can protect your heart may also protect your brain. Preliminary research shows evidence that these lifestyle factors may decrease the risk of developing Alzheimer’s:

  • Regular aerobic exercise not only helps protect cognitive function overall, but it may be highly effective at preventing brain changes in people at high risk of Alzheimer’s. 
  • A Mediterranean-style diet that emphasizes consumption of fresh produce and omega-3-rich fish, with low intake of saturated fat, may decrease the risk of Alzheimer’s.
  • Don’t smoke. It affects your circulation everywhere, including the brain.

“There is a relationship to the whole vascular system — many of the factors that can lead to heart disease and stroke also seem to be involved in the development of Alzheimer’s disease, as well as other forms of dementia,” says David Frid, MD, who specializes in preventive cardiology at the Cleveland Clinic. “If we can change factors that damage the vascular system, we can have an impact on the development of Alzheimer’s disease and other forms of dementia.”

An Ounce of Prevention…

While it will take time to prove a causal connection between a healthy lifestyle and Alzheimer’s prevention, a new emphasis on metabolic prevention of Alzheimer’s disease is underway. The medical establishment recognizes that it’s all about prevention.  Previous approaches attempted to intervene too late in the process.

Alzheimer’s is associated with a buildup of two kinds of toxic protein fragments in the brain, beta-amyloid deposits and neurofibrillary tangles. Current clinical studies, including many expensive pharmaceutical trials, have focused on slowing down or even removing amyloid deposits, but “none of these has proven effective,” says Dr. Rao. Scientists are asking themselves if the amyloid deposits are a result of the disease or a cause. “The development of Alzheimer’s disease is a long chain of events, and these deposits and tangles may be the last stages of it,” he says. “The whole field is moving away from an emphasis on treating people only after they have been diagnosed. By then there is too much brain atrophy, too much amyloid, too many neurofibrillary tangles. That’s why we are doing prevention studies.”
One common pathway for the prevention of both cardiovascular disease and dementia may lie in protecting the health of the endothelial lining of the blood vessels. Smoking, high blood sugars, high blood pressure, high cholesterol, a diet low in antioxidants, and high levels of stress all damage endothelial functioning, causing increased rigidity and less responsiveness. How does this affect your brain health? Your blood vessels send oxygen and other nutrients to the brain, and they remove toxins. Bottom line: Keeping your blood vessels healthy and supple may help prevent the formation of amyloid deposits in the first place.

A Heart- and Brain-Health Action Plan

Although scientists and doctors continue to study the relationship between healthy lifestyle factors and Alzheimer’s, you can make your brain healthier starting today. The same lifestyle choices that can help prevent heart attacks, stroke, type 2 diabetes and other chronic diseases also play a role in keeping your brain healthy and functioning over the course of a lifetime. “Just as with heart disease, changes in the brain occur 10, 15, even 20 years before the emergence of Alzheimer’s disease,” says Dr. Rao. “If you can delay the onset of Alzheimer’s for five years, you can cut the number of people who get it in half. If you can delay it 10 years, you can practically wipe it out.”
“Look at lifestyle factors that you can control,” says Dr. Frid. Here’s how:

  • If you smoke, quit. “Some people can go cold turkey, while others need to slowly wean themselves, and others need support such as nicotine patches or other smoking cessation medication,” says Dr. Frid.
  • Exercise for 30 to 45 minutes, five or more days a week — at a minimum, three days a week.
  • If you are overweight, lose weight: Skip the fad diets and focus on a heart-healthy diet and an exercise program to achieve a healthy weight that you can maintain. 
  • Choose a heart-healthy diet: Eat plenty of fiber-rich fruits and vegetables, limit foods with added sugar, and keep sodium intake low. The Mediterranean diet has been shown to have a positive impact on cardiovascular risk, according to Dr. Frid. To learn more about how to eat the Mediterranean way, try the Cleveland Clinic online program Go! Foods for You.
  • Manage your stress: Too much stress can play a role in the development of heart disease. It can also cause you to smoke, overeat and skip exercise. The good news: Engaging in activities that reduce stress, such as yoga, exercise, stress management and relaxation techniques, can reduce your risk of heart disease.
  • Know your risk factors and control them. Get regular checkups, and learn how to manage your cholesterol, blood pressure or blood sugars.

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