Table of Contents
- The Alzheimer’s Risk Profile
- Identifying Your Personal Risk for Alzheimer’s
- Risk of Alzheimer’s – Denial is a Conspiracy
- What’s Your Real Brain Age? – Take the Alzheimer’s Risk Profile
- Test Your Real Brain Age: The Alzheimer Risk Profile
- Alzheimer’s Prevention – Balancing Your Hormonal Symphony
- The Nervous System
- The Anabolic and Catabolic Hormones
- Willpower and the Hormonal Symphony
In this article, you’ll find out your Real Brain Age by assessing your personal risk factors for Alzheimer’s disease. If the thought of taking a test or assessment increases your anxiety, please realize that this is not a “real” test. The assessment gives you a good idea of your risk for Alzheimer’s at this moment in time. This is not to say that you can greatly reduce this risk following the 4-step program (or greatly increase your risk if you ignore some health problems and allow them to continue).
Don’t be alarmed if your Real Brain Age is older than your chronological age. Once you determine problem areas in your diet, lifestyle, and health habits, you can make some dramatic changes using the 4-step Anti-Alzheimer’s Prescription and begin to plan for an active retirement with a bigger brain and increased memory.
The Alzheimer’s Risk Profile
“So . . . when will I get Alzheimer’s?” Susie’s anxiety was all too apparent when I explained that her chance of getting Alzheimer’s disease was higher than others because of her strong family history. I had diagnosed Susie’s uncle (her father’s brother) with Alzheimer’s disease in 2006 when he was 60. I then diagnosed her father with Alzheimer’s disease in 2007 at age 64. At 41, Susie knew how devastating the disease could be and dreaded each visit to the Alzheimer’s unit at a nearby nursing home where both her father and uncle now lived.
I have scores of patients — and relatives of these patients — who call me frequently and ask “when” they will get Alzheimer’s disease. Some want to get their affairs in order. Others want to have one last “hurrah” – a Baltic cruise or an African safari – before Alzheimer’s robs them of ability to be independent. You see, once this brain-robbing disease rears its ugly head in a family, a type of Alzheimer’s “fear factor” immediately permeates throughout its members — no matter what their age or health situation. I’ve witnessed highly successful men and women-doctors, police officers, attorneys, teachers, and corporate executives–who never once doubted their mental capabilities suddenly become neurotic, wondering “. . . if it’s Alzheimer’s” when they misplace their keys, forget an appointment, neglect to keep up with their bills or call a friend by the wrong name. Take it from me, watching someone you love undergo this unforgiving “brain meltdown” right before your eyes definitely gets your attention-and makes anyone question their own mental prowess. Nevertheless, when patients like Susie and others ask me “when” they will get Alzheimer’s disease, I immediately tell them two truths:
- Only God knows the future; and
- Only they can take charge of their future by first checking their brain age and then starting the 4-step Anti-Alzheimer’s Prescription to reduce-and even reverse-their chances of getting this horrific disease.
Identifying Your Personal Risk for Alzheimer’s
“It doesn’t seem fair,” Susie confided, “that I have so many risk factors for Alzheimer’s. I worry about my children and what will happen to them.”
Susie began to review the list of risk factors for Alzheimer’s, but had difficulty moving past her personal risk factor. “Genetics. Having one parent with Alzheimer’s disease increases your risk of getting the same by 10 to 30 percent; having two parents with Alzheimer’s raises the chance to 50 percent.”
As I explained a family history of Alzheimer’s disease is an intrinsic risk factor that you cannot change-that I cannot change. We cannot change genetics, no matter how much we’d like to. Age is another intrinsic risk factor that we cannot change. In addition, if you’ve had a heart attack or brain injury, you cannot erase either of these from your medical history, and both are thought to increase the chances of getting Alzheimer’s disease.
Still, we have to keep in mind the risk factors we can and must change: the two sentinel risk factors (sleeplessness and chronic stress) and the extrinsic risk factors that cause your brain to be much older than your real age.
As is the case with many adults, your Real Brain Age may be much older than your chronological age, depending on the risk factors you have for Alzheimer’s disease. For instance, if you are overweight, have uncontrolled hypertension and type 2 diabetes, get little sleep and feel stressed out most of the time, your Real Brain Age may be 10 to 15 or more years older than your chronological age. (If you are 50, your Real Brain Age could be 60 or 65.) Alternately, if you are at normal weight, eat a healthy diet, have normal cholesterol and blood pressure, and fill your free time with stimulating learning experiences, your Real Brain Age could be 10 years younger than your chronological age. (If you are 50, your Real Brain Age would be 40.) For the most part, you determine the real age of your brain by how you care for yourself-with your diet, exercise regimen, educational opportunities, and rest and relaxation (the four steps).
Risk of Alzheimer’s – Denial is a Conspiracy
Whereas Susie acknowledged her higher risk of Alzheimer’s disease and was ready to learn how to reduce her risk factors, so many men and women will not admit they are at a higher risk for Alzheimer’s. For this brain-robbing disease, the family conspiracy of denial is common. That’s because the essential diagnosis is known to be a fate worse than death. Sometimes it happens slowly, and the roles in a marriage or household change unnoticeably. Perhaps outsiders notice it most, for it’s like witnessing the alcoholic family trying to keep a much-known secret.
In my neurology practice, adult children who bring their parents often write me notes prior to the appointment. Many notes state, “Dr. Fortanasce, please don’t use the word ‘Alzheimer’s’. My mom (or dad) is not ready to hear this yet.” Other times the note might say, “My father does not know why he’s here. I told him it was about his heart-not his memory.” When Susie’s uncle was first thought to have symptoms of Alzheimer’s disease, she handed me a note at his evaluation, simply stating, “. . . I am so scared.” Then when her father had symptoms of Alzheimer’s disease a few years later, Susie handed me another note, saying, “Please help my family.”
In addition, so much confusion surrounds Alzheimer’s disease that almost all of my patients and their families are shocked when they first receive this diagnosis. They want to know exactly why their brains failed them. Most patients are surprised to learn that this disease did not happen over a few weeks or months but took many years to develop–years where there were no outward symptoms of brain disease yet their brain was prematurely aging inside. I remember when one patient, Kenneth, 71, was diagnosed with Alzheimer’s disease. Anne, his wife of 45 years, wanted to know what medication I could prescribe for Kenneth to eliminate Alzheimer’s disease quickly, like taking an antibiotic for a throat infection. Please realize:
“There is no magic pill to cure Alzheimer’s.”
What’s Your Real Brain Age? – Take the Alzheimer’s Risk Profile
As a neurologist, I’ve reviewed the latest, reliable research literature available. I’ve read up on every aspect of Alzheimer’s disease. I’ve studied the published opinions of a variety of experts, including psychiatrists, epidemiologists, geriatric experts, toxicologists, cardiologists, endocrinologists, and other neurologists, in order to learn all I can about how the Alzheimer’s brain is different from a healthy brain. I’ve assembled all of these pieces to form the most complete picture of the problem possible, linking the factors to the outcomes and allowing us to identify our specific risks of Alzheimer’s disease.
While it used to be thought that Alzheimer’s occurred “randomly” in the elderly population, we now know that the damage associated with Alzheimer’s disease begins decades before any symptoms appear-even while you’re at the top of your game at midlife!
I know for a fact that no single approach will solve the problem of Alzheimer’s disease. There’s no one approach that can make you think faster, be more productive, and compete in a youth-oriented society. What is called for is an individualized approach that considers all the personal risk factors of each of us.
To help you determine an individualized approach for you-and your loved ones-I’ve designed the following 25-item questionnaire-Test Your Real Brain Age– that analyzes your risk of Alzheimer’s disease. Once you’ve completed the Test Your Real Brain Age quiz, you can score the quiz.
Test Your Real Brain Age: The Alzheimer Risk Profile
The best way to approach the Alzheimer’s Risk Profile is to take a piece of paper and to number it from 1 to 25, and then to record your answers (“T” or “F”), so that at the end you can easily compute your Actual Brain Age using the key. After you’ve scored the Alzheimer’s Risk Profile, give the test to family members, friends, and colleagues, and tally their scores. By following the proven solutions, safe strategies, and self-care recommendations that I teach you in Steps 1 – 4 of the Anti-Alzheimer’s Prescription you can develop a personalized program to dramatically reduce your risk of Alzheimer’s disease. Ultimately, you will greatly improve your quality of life and reduce your risk of many chronic diseases associated with aging.
On the separate sheet of paper, write True or False for each statement below. After you take the test, calculate your score using the scale on the following page. I will continue to address this profile throughout the book and teach you how changing your diet and lifestyle habits will decrease your chances of getting Alzheimer’s disease-give you a more youthful brain and increase your overall health and well-being.
True or False
- I get 7 to 8 hours (or more) of sleep each night.
- I eat at least 5 or more servings of fruits and vegetables high in antioxidants daily.
- I eat at least one serving of blueberries, raspberries, or blackberries daily.
- I eat baked or broiled fish high in omega-3 fatty acids (especially eicosapentaenoic acid and docosahexaenoic acid) at least three times a week.
- I take fish oil supplements high in omega-3 fatty acids or flaxseed supplements at least 5 times per week.
- I take folic acid supplementation with my daily multivitamin.
- I take a low-dose of aspirin daily.
- I drink red wine or grape juice at least 5 times a week.
- I exercise most days of the week for at least 30 minutes each time (total of three hours or more of strenuous exercise weekly).
- I read challenging books, do crossword puzzles or Sudoku, or engage in activities that require active learning, memorization, computation, analysis, and problem solving at least five times a week.
- My total cholesterol is less than 200.
- My LDL (“bad”) cholesterol is less than 110.
- I have “longevity genes” in my family, with members who lived to 80 and older without memory loss.
- I am not obese (less than 20 pounds overweight for a woman; less than 30 pounds overweight for a man).
- I eat a Mediterranean style diet (high in fruits, vegetables, whole grains, beans, nuts, and seeds, and olive oil as the source of fat; little red meat).
- I use olive oil and no trans-fat spreads instead of butter or margarine.
- I have never smoked cigarettes.
- I have normal blood pressure.
- I do not have diabetes.
- I do not have metabolic syndrome (high triglycerides, central obesity, and hypertension), also called insulin resistance syndrome.
- I do not have a sleep disorder such as snoring or obstructive sleep apnea or untreated insomnia.
- Daily uncontrolled stress is not a problem for me.
- I have a strong support group and enjoy many activities with friends, colleagues, and family members.
- I have no problems with short- or long-term memory.
- I’m ready to prevent Alzheimer’s and am willing to do whatever it takes.
Now please go back and count how many of the 25 statements you marked “True.” Write your score on a sheet of paper and then use the following key to determine your real brain age and risk of Alzheimer’s disease. Bear in mind that I’d have to meet with you individually to get all of the complex medical history necessary to give you a complete picture of your risk. Here, we’re aiming for a relatively simple means of tallying a score that will be easy to understand and apply to your diet and lifestyle habits.
23 – 25 Congratulations! You are aging well. Subtract 15 years from your chronological age for your Real Brain Age.
You are presently healthy with a youthful, productive mind. Following the 4-steps of the D.E.A.R. program will make your body, mind, and spirit even healthier. Unless things change in your life, your risk of Alzheimer’s disease is extremely low.
20 – 22 Not bad! Subtract 10 years from your chronological age for your Real Brain Age.
You are doing a lot to take care of your physical and mental health. Check the specific questions that you marked False – and be sure to pay attention to changes you need to make. Follow the 4-steps of my D.E.A.R. program to make your body, mind, and spirit even healthier.
15-19 OK. Your Real Brain Age is the same as your chronological age.
That said, you have a mild risk of Alzheimer’s disease, so pay attention. Carefully review the 4 steps to see what changes you need to make with your diet, exercise, mental stimulation or rest and relaxation.
12 – 14 – You have a moderate risk of Alzheimer’s Disease. Add 5 years to your chronological age for your Real Brain Age.
While there’s not a lot of disparity between your Real Brain Age and your chronologic age, you need to really understand the risks you have that increase the chances of Alzheimer’s. It’s important that you review the quiz and circle any of the statements that indicate some work is needed. Talk to your doctor about your risk factors you have to see if treatment is indicated.
0 – 11– You have a high risk of Alzheimer’s disease. Add 10 years to your chronological age for your Real Brain Age.
Right now, call your doctor and talk openly about health problems you have. Ask if you’re doing all you can to manage these problems. In addition, read my book The Anti-Alzheimer’s Prescription and flag those pages that may help to decrease your risk of Alzheimer’s disease.
Alzheimer’s Prevention – Balancing Your Hormonal Symphony
Throughout my book the Anti-Alzheimer’s Prescription, I refer to your “hormonal symphony” from time to time, as a way to help you understand the physiologic and hormonal changes that occur with aging and how the 4-step program balances these hormones to prevent Alzheimer’s disease.
First, I need you to visualize a symphony orchestra. If you’ve ever heard a symphony orchestra, then you’ve heard the combination of many instruments making completely different sounds yet coming together in perfect balance to produce a melody that’s sensually pleasing. When watching a symphony orchestra play, the string instruments – the violins and cellos – are to the left of the stage; to the right are the bass and drums. Using smooth, graceful movements, the symphony conductor accentuates one section by raising a hand while diminishes another section by lowering a hand. In doing so, the symphony is in perfect harmony and you enjoy the pleasurable experience.
Your body also has a symphony-a hormonal symphony-that includes your hormones, neurotransmitters and nervous system that runs in conjunction with the hormones. In your body’s hormonal symphony, let’s say that insulin is the conductor. Most people understand that if insulin levels are balanced, there is harmony or health in the body, mind, and spirit.
The Nervous System
Now, the nervous system, vagal and sympathetic, is part of what we call autonomic or automatic, which simply means the nervous system is not under your conscious control. The nervous system carries messages to other neurons or body parts through the various neurotransmitters such as serotonin, dopamine, adrenaline, noradrenaline, and more. The vagal nervous system, in general, slows you down and causes a decrease in your pulse rate and blood pressure. The sympathetic nervous system revs you up and prepares you for the “fight or flight.”
The Anabolic and Catabolic Hormones
In your body, the anabolic hormones (growth hormones, testosterone, estrogen, and thyroid) and the neurotransmitters, dopamine and serotonin, together with the vagal nervous system represent the strings and the piano of your orchestral symphony. On the other side of the orchestra, representing the drums and the brass, you have your catabolic hormones namely cortisol and aldosterone. These hormones are associated with the neurotransmitters noradrenaline and adrenaline, and the sympathetic nervous system.
The anabolic hormones (violins and cellos) effect on the body is to increase lean body mass, muscle strength, and decrease fat. In your brain, the anabolic hormones act as antioxidants, wiping out free radicals (part of the body defense system), increasing the strength of the immune system, decreasing the release of cytokines (pro-inflammatory markers) and adding to endurance, positive mood, and a feeling of calmness and control via dopamine and serotonin. When the vagal nervous system is stimulated after exercise, it causes the body to go into a relaxation mode. When this occurs, your heartbeat slows, your skin feels warm and flushed, your pupils relax, and muscle tension diminishes. These are all the physical signs of the mystical Zen or the feeling of being calm, contented and in contact with nature.
Now when the catabolic hormones, together with adrenaline and noradrenaline, are excreted by the adrenals, it causes an increase in fat production, an increase in blood glucose, a decrease in lean muscle mass, and an increase in insulin. Insulin, the conductor of your hormonal symphony, tries desperately to control this catabolic response and must work overtime, increasing its levels as it frantically tries to rid the body of the glucose by storing it as fat. When glucose is not available through recently eaten food, cortisol breaks down protein to glucose, and, in doing so, reduces your much desired lean body mass. If glucose is produced in excess, insulin (your conductor) rids the body of it by storing it as fat (LDL or “bad”cholesterol). When the emergency threat remains for a prolonged time, the adrenal glands produce the stress hormone cortisol, allowing the body to prolong this emergency response. What is your body’s response? It is an increase in your heart rate, cardiac output, and pupil size. Your muscles tense and soon you have a headache, muscle aches, and even fibromyalgia with the deep muscle pain, insomnia, high anxiety, and depression. In the blood, there is a surge of glucose with insulin following to control it.
There are several effects on the brain when insulin goes above normal levels. To start, an enzyme produced by the brain to control insulin and reduce glucose comes into action. This is called the insulin-deleting enzyme (IDE). Problem is, the insulin-deleting enzyme is the one that also rids the brain of the toxic amyloid protein. When insulin and blood glucose levels are out of control, the insulin-deleting enzyme works overtime to remove the insulin-instead of removing the formation of amyloid, plaques, and tangles–the very pathology of Alzheimer’s disease. As insulin soars to high levels, it overwhelms the circuits in the brain, resulting in brain freeze. In psychology, we call this process “blocking.” The area of the brain most affected by brain freeze or blocking is the hippocampus, the learning and memory center of the brain. Finally, the increase in available amyloid protein releases the deleterious free radicals that attack neuronal cell membranes, the mitochondria (the energy engine), and the nucleus itself. This “brain” damage then provokes the brain’s own defense cells, the macroglia, to attack the damaged cells, thereby causing the loss of cells we see occurring in Alzheimer’s disease. As you’ll learn in Step 1, the Anti-Alzheimer’s Diet, the key to preventing the buildup of amyloid protein in the brain is to keep your levels of insulin balanced-and you can do that by following the prescribed diet.
Willpower and the Hormonal Symphony
Since our brain has both rational thinking and emotional components, we cannot dismiss either part. The control of the neocortex (thinking brain) over the emotional brain depends on the balance, harmony, and concert between our hormones (anabolic and catabolic), neurotransmitters (serotonin and dopamine), and autonomic nervous system. It is an understanding that we cannot succeed if our rational brain does not take care of our emotional needs. If the thinking brain can stay conscious and be in control of our limbic brain’s needs, we will be successful in preventing Alzheimer’s and living a long, healthy and bright life.
Problem is, as we age, our ability to maintain hormonal and neurotransmitter balance becomes increasingly difficult because of a natural loss of beneficial anabolic hormones and an increase in catabolic hormones. This is the physiological reason why our motivation wanes, our anxiety soars, and the ability for our cortical thinking brain to stay in control diminishes. Our ability to stay in control lessens. As we age, our brain’s control of sleep is disturbed and we have trouble getting enough sleep. Stress becomes an overwhelming daily issue because the brain cannot turn off its alarm (the cortisol hormone system). Then because we’re stressed, we feel fatigued. To boost our energy, we binge on simple carbohydrates -chips, cookies, and sugary drinks. Yet we neglect to exercise. All of these factors are cumulative and result in hormonal imbalance or dissonance in the hormonal symphony.
When the anabolic hormones are high, the catabolic hormones are controlled, and the serotonin and dopamine levels are high, our thinking brain –the neocortical brain — will stay in control. This is when we have willpower and can comply with a diet and lifestyle program.
On the contrary, when the anabolic hormones fall and dopamine and serotonin levels fall – it’s the limbic brain (emotional) that prevails. When the limbic brain rules, you’ll binge eat or drink, feel highly anxious or depressed, and have an inability to follow through. You’ll fall prey to addictions, as you seek ways to soothe the emotional brain’s needs. When the neocortex brain rules, you will stay in control, making choices that serve to keep you well.
The 4-step D.E.A.R. program method will help you maintain hormonal and neurotransmitter balance with insulin, the conductor of your hormonal symphony, balanced. As you do so, the neocortex(thinking) brain will make the decisions in your life-not your limbic or emotional brain. By making smart, conscious diet and lifestyle choices, you can slow the degradation of the brain. In effect, you can decrease your Real Brain Age (a younger brain is a more efficient, bigger brain!) and slow down your body’s biological clock. I truly believe this is an exciting promise-that we can actually choose to prevent Alzheimer’s and have a bigger, better brain.