\u201cI\u2019ve been talking about preventing Alzheimer\u2019s disease for more than 20 years,\u201d he told Deseret News, noting his first book came out in 2002. \u201cI want people to know that they play an important role in whether their brain stays healthy or whether it decays. And the other thing that\u2019s very important to know is that just because you have family members with Alzheimer\u2019s disease, it does not mean you will develop it.<\/p>\n
\u201cIt means that you can use that as a call to action and be more proactive about taking care of your brain.\u201d<\/p>\n
Perhaps those considered most at risk of developing Alzheimer\u2019s are people with one or two copies of the apolipoprotein E4 allele, which is a known risk factor for Alzheimer\u2019s, greatly increasing the likelihood of developing the disease.<\/p>\n
Fotuhi said even people with APOE4, as it\u2019s commonly called, who have an active lifestyle and exercise regularly have lower levels of Alzheimer\u2019s amyloid proteins in their brain. \u201cIn other words, exercise appears to negate the impact of the APOE4 gene on the brain,\u201d he said.<\/p>\n
Making your own difference<\/p>\n
Fotuhi notes there\u2019s \u201cno one magic exercise\u201d that\u2019s most effective and experts debate whether aerobic exercise is better than weight training, or vice versa.<\/p>\n
\u201cIn general, I recommend that people do a combination and that\u2019s what I do myself,\u201d he said. \u201cI usually do 45 minutes to an hour of cycling and then I do 30 to 40 minutes of weight training three times a week \u2014 and if I have time, maybe a fourth day.\u201d<\/p>\n
The key is improving your fitness, which he measures with basic questions: Can you walk three miles easily? Can you go up 10 flights of stairs? Nor is it a matter of being fit compared to same-age peers, he notes, because the average person these days is not fit. He suggests being fit compared to someone 20 years younger than you are.<\/p>\n
It\u2019s never too late, he adds, noting he\u2019s watched older patients get physically healthier and sharper mentally.<\/p>\n
\u201cI had many patients who were in their 70s and even early 80s who improved. And our brain does not stop growing; it doesn\u2019t stop changing just because we get older. Plus, related to this topic is a paper that was published recently in Nature. They found that individuals who are in their 70s and early 80s do have neurogenesis in their hippocampus,\u201d he said. <\/p>\n
\u201cNeurogenesis means the growth of new neurons, and hippocampus is a thumb-sized brain structure that\u2019s critical for learning and memory. With aging, usually the hippocampus shrinks, and when it shrinks a lot, people develop Alzheimer\u2019s disease symptoms.\u201d<\/p>\n
According to the research paper Fotuhi cited, neurogenesis doesn\u2019t stop as people age, but less occurs for those with Alzheimer\u2019s. He also noted that in those with the disease, the new cells don\u2019t mature normally. But exercise increases the brain-derived neurotrophic factor that\u2019s needed for cells to mature. Boosting that helps with both generation of new neurons and their maturation, he said.<\/p>\n
Brain \u2018super agers\u2019<\/p>\n
Brain \u201csuper agers\u201d \u2014 people in their 80s and older with brain function comparable to folks 20 or 30 years younger \u2014 have both more neurons and their neurons mature, per Fotuhi.<\/p>\n
\u201cThis study shows that whether or not you have Alzheimer\u2019s disease has to do with are you making enough new neurons and whether these new neurons are being matured. If you don\u2019t have enough new neurons and if the neurons are not mature, you get Alzheimer\u2019s disease. If you have plenty and they\u2019re very mature, you become a \u2018super-ager,\u2019 and if you\u2019re in between, you become an average aging adult,\u201d Fotuhi said.<\/p>\n
It\u2019s not just a matter of preventing damage, though that\u2019s crucial, he said. He\u2019s adamant that some damage can be reversed. Alzheimer\u2019s has stages and the first signs are often mild cognitive impairment, which in some people never progresses to actual Alzheimer\u2019s. He said early brain changes can be reversed.<\/p>\n
\u201cI have seen it firsthand in thousands of patients \u2014 not dozens or hundreds \u2014 thousands of patients in the past 20 years. You can reverse the effects of aging on the brain.\u201d<\/p>\n
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Drfotuhi.com Embracing 5 pillars of brain health<\/p>\n
He tells the story of a patient named Carol whose sister brought her to the doctor appointment because she was forgetful. The sister said Carol watched TV all day, sitting vapidly in front of the screen, something she\u2019d done for well over a year. The sister wanted a diagnosis of Alzheimer\u2019s so she could get power of attorney, sell Carol\u2019s house and use the money to pay for Carol\u2019s long-term care, Fotuhi said. <\/p>\n
He described Carol as well-dressed and quiet, but someone who engaged only minimally, answering questions with a word or two. Is something bothering you? \u201cNo.\u201d Why are you here? \u201cI don\u2019t know.\u201d<\/p>\n
Carol, it turned out, had medical conditions, including sleep apnea, diabetes and depression. Some of her medications were sedating. So he opted to tackle the medical problems first, focusing on changes that could increase neurogenesis. <\/p>\n
\u201cShe gradually woke up, literally,\u201d he said. \u201cShe started walking five minutes a day and then 10 minutes a day. By six weeks in the program, she was walking almost normally and she was interacting with our brain coaches and she was getting brain training.\u201d<\/p>\n
She was working on what he called the five pillars of brain health:<\/p>\n
ExerciseOptimal sleepMediterranean dietStress reduction\/meditationBrain training<\/p>\n
Those five things were the recipe he used to bring Carol back. \u201cShe was funny, she had multiple hobbies, she actually started looking for a job.\u201d He could also untangle her downward spiral: Pain medications sedated her and because of that, she was sitting all day and became depressed and stopped caring for herself and gradually she declined. <\/p>\n