6 Steps to Improve Brain Vitality with Dr. Majid Fotuhi

Andrea Klemes (00:02):
Welcome everyone. I'm Andrea Klemes MDVIP's chief medical officer. We're pleased to connect virtually with all of you and over 10000 members who want to be in the know about brain health. MDVIP's purpose is to make healthier lives happen. We support this purpose in a couple of key ways. Of course, it starts with a close doctor-patient relationship you enjoy in the MDVIP model. We also believe in empowering people with valuable information to make healthy choices.

And that's why we're all tuned into this webinar to learn how to stay sharp as we age. As I've said, we're committed to educating you. And we recently partnered with a research firm to better understand consumer knowledge about dementia and Alzheimer's disease. We published the results from our nationwide study in September, which is recognized as World Alzheimer's Awareness month. Our survey included a brain health IQ quiz that many of you have taken on the MDVIP website.

Hopefully you scored better than the average American, is nearly half out. Yet 80% said they want to reduce the risk of cognitive decline. Not surprisingly, interest in this topic has attracted all of you submitted over 2500 excellent questions. Many of these will be addressed in today's discussion. If time permits, we may take a few additional questions that you can send to me using the chat box. If you're new to Zoom, simply hover your mouse at the bottom of your screen and click on the chat icon.

And now I'd like to tell you a little bit about our impressive guest speaker, Dr. Majid Fotuhi. As a Harvard and Johns Hopkins trained neurologist and neuroscientist, Dr. Fotuhi is one of the foremost authorities in the field of memory, Alzheimer's disease, brain vitality in older adults, concussion and ADHD. Through his 25 years of teaching clinical work in neuroscience research experience, Dr. Fotuhi has developed a multi-disciplinary approach to training brain function disorders.

In addition to treating patients in his current role as medical director of NeuroGrow Brain Fitness Center, Dr. Fotuhi conducts clinical research, writes books, gives public lectures about brain health and prevention of Alzheimer's disease and expanding brain capacity. Dr. Fotuhi, the stage is all yours.

Majid Fotuhi (02:31):
Thank you, Andrea. I really appreciate, um, this, uh, kind introduction. I am so excited to talk to you all about brain, brain health and how you can improve your brain function in a matter of three months. We have learned a lot in the past, uh, 20, uh, or 25 years about the brain and how we can improve our memory and defy aging. I hope to convince you by the end of this presentation, that there are a lot of things you could do to make yourself a little sharper in a matter of weeks.

So let me begin by, uh, showing you my slides. Six steps for enhancing your memory and brain vitality. Um, when I was a kid in Iran, my father always talked to me about our brain, about how our brain can change, how our brain can expand the way learning. He said, "Majeed, there is no limits in what your brain can do. If you want to learn several languages, if you want to become a doctor, if you want to write books, there's nothing that can hold you back. Your brain has a huge capacity and you can do that."

I became interested in brain and brain health, uh, since I was a teenager. In fact, I wrote a little book about these topics back then. It was never published. Um, and I went on to high school, thinking that I would go abroad one day and, uh, become a doctor or author, but unfortunately, things didn't work out that way. Uh, a revolution happened in Iran, Universities closed, and I had to actually scape from the country after living in the bathroom for two years.

So it was a rough path for me, but I did make it to Canada as a political refugee. And I started, um, my education at Concordia University and went on to study neuroscience. Um, I was always interested in neuroplasticity and how our brain can change and how we can tap into that, uh, brain's innate ability to function better. Our brain has this amazing capacity, but how can we tap into it? Um, I went to Johns Hopkins obtained my doctorate degree. I went to Harvard Medical School, got my MD, went back to Johns Hopkins for residency and I stayed at Hopkins.

And as, as, as an assistant professor of neurology, um, I continued my research published lots of studies, lots of papers and wrote three books. The book you see in the center is my most recent book, Boost Your Brain. You do not need to get this book. All you need to know about how it can boost your brain. Uh, you will learn today. I have also done lots of interviews with national media. I feel passionate about educating, uh, the public on, on how they can improve their memory and defy aging. And I think it's important that we convey the message to the public at large.

All right, now let's begin, uh, by me, uh, telling you the structure of what I'll be talking about. I'll begin by, um, reviewing a basic 101 anatomy of the memory parts of their brain. I will then review the effects of aging on your brain. Um, next I'll talk about the six ways that they can sharpen your brain. And at the end, ultimately about a program that I've put together based on my research and publications. All right, this picture shows a bird eye view of the brain.

The outer layer of the brain is called cortex. You can think of it as a blanket that covers all of the brain. Um, the, this part of the brain is important for long-term memory. So let me do a test with you. I want you to think of the house you lived in when you were in elementary school. Go ahead. I want you to envision the house when you were a kid, do you see the entrance? You remember your room, the kitchen, the front door. Do you see it? Isn't this incredible.

It's been like five years since, uh, you've been there or maybe 10 years for some of you, it's been a while. Yet you can see the house. This is happening because your cortex is functioning. Cortex has other functions, such as navigation, calculation, planning, all the things we call higher brain function. Now the part of the brain that's important for short-term memory is called hippocampus. Hippocampus is a Greek word for seahorse.

Uh, the old anatomist who dissected the brain and saw this structure. Were not sure what to call it. And because they felt there was a resemblance to a sea horse, they picked the name hippocampus. Hippocampus is roughly the size of your thumb, you know, one on the right, one on the left. Now, if you slice the hippocampus and look under the microscope, you see this beautiful row neurons. Each of those little colorful dots is a brain cell and neurons. And these neurons are the brain cells that enable you to learn new things.

So I'm going to get your hippocampus to work. Are you ready for this? All right. I want you to memorize the spelling of my last name, which is not easy. My last name is Fotuhi. F as in Frank O-T-U-H-I and please don't write it down. Just memorize it Fotuhi. Those of you who will remember my name, the spelling of my name at the end of this presentation may get a check from Andrea as a reward. That's a joke, no check. Um, so, uh, hippocampus is ground zero for learning new things, such as what you do, names of people you meet and the books you read, the news you watch and everything else.

Now the hippocampus on top is important for long-term memory. When you memorize something, it gets packaged and goes into cortex for long-term storage. Now there's some good news about hippocampus and cortex, uh, and some bad news. Let me tell you the bad news first. With aging, hippocampus and cortex shrink faster than the rest of the brain. They atrophy by about 0.5% per year after age 50. This is why you may become more forgetful after you pass your '50s or for some of you, maybe '40s.

Uh, but memory is not the only thing that gets affected with aging. There's difficulty with sustained attention and processing information quickly. You'll find that your kids can do the modifications in their head or answer questions faster than you do. This is because there is a real life actual shrinkage that happen in your cortex and hipppocampus. So what is the big question? The big question is why? Dammit? Why? Why is it that these two brain structures that are so vital to everything we do shrink?

And this is what I've been studying for all these years. I've been wanting to figure out what accounts for the shrinkage in the brain when we get older. Now this slide summarizes what I've learned. It turns out that a lot of medical conditions such as insomnia, sleep apnea, obesity, smoking, diabetes, concussion, stress, and depression can shrink the brain in a dose dependent manner, which means the more insomnia you have, the more your brain will shrink. Now, if you ask an average person what causes memory loss in a 79 year old, their response would be Alzheimer's disease.

But what's Alzheimer's disease anyway? Alzheimer's is a disease in which certain proteins clump together. The proteins are usually soluble. They become insoluble like little piece of pebbles in the brain. They attract a lot of inflammation, which then kills brain cells. So those amyloid and tau, plaques and tangles are the insoluble clusters of proteins which attract inflammation, which then causes for their brain damage. But it turns out that Alzheimer's disease is really not the main culprit, the older we get.

So by the time you're in the 80s, how much plaques and tangles you have in your brain really doesn't matter as much. Is all these medical conditions affecting your brain over time causing in term shrinkage in the cortex and hippocampus, which accounts for why people become forgetful or they get confused, or they forget the names of their family members. These are very important concepts that are not fully appreciated by general public. And every month, there are new articles that say the same things because this is still news.

Now, what if you have multiple risk factors? What if you had insomnia sleep apnea, a lot of stress, uh, and obesity at the same time? Well, it makes sense that if you have multiple things wrong with you, your brain will shrink more than if you don't have so many things wrong with you. And let me tell you, when it comes to cognitive abilities and the memory, they depend on the size of cortex and hippocampus. And this is one situation where size matters.

Seriously, uh, the bigger the cortex and hippocampus are, the better it will be your cognitive capacity and cognitive endurance, which means for how long you will maintain your cognitive abilities. And if it shrinks, then your cognitive abilities will decay. Put it other way. If your hippocampus and cortex are strong, you will not get Alzheimer's disease. If you do have memory problems, let's say your '70s and '80s and your cortex and hippocampus are normal size, then you don't have Alzheimer's disease.

You may have depression, you may have other things that don't damage the brain. Um, and so it's not the Alzheimer's disease. Now, I'd like to show you a few slides to give you a taste of the scientific studies which have provided these compelling, um, findings for us. In this is study researchers wanted to know the duration of someone's and treated depression and the size of the hippocampus. So you can see the volume of, of hippocampus is normal, uh, is high. Shown on the left side.

But if somebody has, um, 1000 days of depression, the hippocampus is smaller. And if they have 3500 or 4000 days or 10 years of untreated, uh, depression, the hippocampus is much smaller. So if you're worried about getting Alzheimer's, I'm sorry to say, you're expediting the process. Now bigger belly is associated with a smaller hippocampus as well. The larger, the BMI gets, the smaller the cortex gets and this is the worst for people will have untreated diabetes. So I'm sorry to say, if you have untreated diabetes, any of you have obesity, you have one risk factor.

No there are, no, say 15 or 20 risk factors and everybody has something. Like for you, the risk factor is maybe the things that you can see by looking at someone, the stress and anxiety are also major killers of hippocampus. The stress hormone cortisol is literally toxic to the hippocampus. And studies have shown that the higher levels of cortisol literally shift the campus in a linear fashion. The worst, the cortisol levels, which means the worst the stress, the more the hippocampus shrinks.

I know many of you will have very active lifestyles. And I know that some of you thinking, "Oh my God, stress is not good for my brain." And I need to agree with you. You're right. Stress is terrible for your brain. Uh, insomnia is another factor that can increase your risk of Alzheimer's disease by shrinking the size of your hippocampus. If you've had, um, insomnia for one year, hippocampus volumes normal, but if you've had it for 20 years, if a campus is going to be much smaller. Or many people who say, 'Oh, I'm fine with sleeping five hours a day, five hours a night. And I don't have any symptoms."

That may be true for some people, but you need to sleep at least six hours there are committed sleeping hours for an average adult is eight hours. So someone has half an hour. Um, so if you sleeping fewer than, fewer than six hours, you are at risk for developing strokes, which are really bad for you. And you do not give your brain enough time to clean your brain at night. Um, it turns out that when you're sleeping, there's a lot of cleansing that happens to your brain. All of us could use a little bit of those amyloid and tau proteins in our brain, but the, the little proteins get washed and clean when you're sleeping at night

When you don't sleep enough at night, which means sleeping period, six hours, you're do not let your brain to clean the amyloid and the towel. And accumulate as if you have Alzheimer's. In fact, you have Alzheimer's because not only you will have indirect damage to your brain, perhaps, or other causes of insomnia, such as high blood pressure, high cortisol levels, but direct increase in plaques and tangles.

So lack of sleep literally generates Alzheimer's in the brain. And this is a new discovery in 2020, which is really interesting. The Alliance between what's Alzheimer's and what's medical conditions that to the brain shrinkage are merging because we are learning that some of those conditions, uh, literally increase the plaques and tangles, which we traditionally called as a disease by itself. Another bad factor for the brain over time is traumatic brain injury concussions. The more concussions you have, the smaller will be your court dates and hippocampus.

Now, at what age do these things become problem. It turns out that even college students who play football, experience a shrinkage and the size of their hippocampus if they have a lot of concussions, I want you to look at this slide carefully. This is a sideway view of the brain. Do you see the eyeball on the right eye socket? And you can see the top of the head and the back of the head, the colorful structure in the middle is hippocampus. Researchers in this study measured the average volume of hippocampus and a group of college students who did not play football you can see this on the left.

They also obtained MRIs from a group of college students who do play football and report the death that they have had several concussions. You see that on the right. Now I want you to look at these two structures, the one on the left and the one on the right, which one is smaller. They hippocampus in the group with no concussions or the one on the right, which is from football players who play concussion. You can see clearly that the one on the right is much smaller than the one on the left.

And, uh, it's no wonder that, um, adults who play football over time, experience a shrinkage in their brain, because you can see right here, hippocampus is much smaller than it would be. I had once a teenager who came to see me, a 16 year old, who was playing football and he obtain MRI and his hippocampus was at 10% for average size of the hippocampus for his age. And several studies have shown that the more concussions you get, the more hippocampus shrinks. And you have to also realize that hippocampus is connected to cortex and different parts of the cortex.

So memory is not the only thing that gets affected that will have difficulty with attention, regulation of behavior, anger management and a lot of other things that destroy your brain. So bottom line concussions are bad for the brain. Now, so we talk about a few of the medical conditions that can cause shrinkage of the cortex and hippocampus, now, we can talk about how you can reverse the process. I want to, uh, make, uh, one point clear. There are other things we didn't talk about because I can't talk about everything, uh, for example, smoking is bad for the brain.

Um, vitamin deficiencies are bad for the brain. Junk diet, uh, high in saturated fats. And, um, uh, the, the junk food is really, really bad. And those who have, um, a high consumption of, uh, junk food do have a small hippocampus. So let's say you have had your share of, uh, negative risk factors and now you want to reverse it. Is it possible? What do you think? Do you think that let's say the hippocampus has atrophied by 5% or 10% in the past 20 years, do you think it's possible to reverse the process? Regrow the brain?

Yes or no? Well, those of you who said, yes, you're right. And I'd like to tell you how you could do this. Our brain is made up of a lot of blood vessels. In fact, if you take a brain, uh, off someone who is deceased and then wash away, uh, the brain cells and then inject the dye that shows the blood vessels, this is what you will see. You will see a huge collection of blood vessels, uh, that, uh, filled up right? In fact, about a third of the brain is made up of blood vessels.

So anything that increases the blood flow and helps with the health of the blood vessels in the brain, is good for the brain and anything that harms the blood vessels that reduced blood flow is bad for the brain. For example, one reason people with hypertension or diabetes or obesity have brain problems is because the blood vessels are getting affected. Now one way to improve blood flow to the brain. In fact, the best way is to exercise. And it turns out that regular exercise literally grows your brain.

Let me give you some examples. In this study in Midwest, researchers wanted to know if walking three or four times a week can lead to increased in the blood of hippocampus. So they got a group of people in their '60s who had a sedentary lifestyle, and they put them in two groups. One group was told to walk initially, 15 minutes, maybe three times a week, and then 45 minutes, four times a week, uh, for one year. And the other group was told to do what they did before, you know, go the grocery shopping, but no do not necessarily start a new exercise program.

They were, uh, given information that exercise is good for them, but they were not necessarily pushed to exercise. The MRIs were obtained at baseline at six months and one year. I want you to look at the red line first. That red line shows how the hippocampus volume became smaller in one year in a group, uh, who had a sedentary lifestyle. This is a shrinkage that we've been talking about. The brain shrinks, the hippocampus and cortex shrink by about 0.5% per year. And this is what happened here.

But look at the blue line. That line demonstrates how the volume of the campus increase in a group that were just walking. Uh, they were not doing serious exercise. They were just walking. Um, so basically a simple matter walking can improve your brain function through increasing the volume of your hippocampus. And you can see it as clearly. Many other studies have shown similar results. But let's say you're interested in getting your hippocampus volume increase quickly. You don't have a year. You want to see results in three months.

Is it possible to increase the volume of hippocampus in three months with really vigorous exercise? Yes or no? What do you think? All right, let me show you. The answer is yes. Three months of vigorous exercise leads to a noticeable increase in the volume of the hippocampus. In this study, researchers put, uh, a group of volunteers into vigorous exercise, exercise for more than an hour, four times a week on a stationary bike, and they obtain MRIs at the beginning at the end, uh, this slide shows one of those MRIs.

Again, you can see your, eye on the right, top of the head on top. You can see a little bit of the nose. Uh, this person had average size hippocampus offline in blue. Um, and you can see it clearly. Now look at the same person's MRI three months after vigorous exercise, still the same eyes, the same optic nerve back there, but the long of the hippocampus is bigger, especially in the front you can see that the hippocampus has engorged is much bigger than it was three months before.

This is incredible. This is not your biceps we're talking about. This is someone's hippocampus. This is their brain that has grown in a matter of three months. And this is to me, one of the most exciting discoveries in neuroscience that our brain can increase to the extent that we can see it with naked eyes. When you exercise you increase blood flow to your brain, you literally increase the volume of the blood vessels in the brain. So you have more, uh, branches of blood vessels and people who exercise regularly versus those who don't exercise at all have 43% blood vessels in their brain.

I was not sure it was true when I saw the title of the study, but there are studies that have shown that fit people have a lot more blood vessels in the brain, which accounts to why not only they have better memory, but they feel sharper. Now, you don't have to necessarily do vigorous exercise every day to see the results. If you just walk one mile a day, you can reduce your risk of Alzheimer's disease by about 50%. So walking every day is one of the best things you can do to improve your brain health.

And of course the more vigorous you exercise, the better results you will see. Second in the list of things for you to do to improve your brain function with aging is eating a mediterranean diet. The important factor in Mediterranean diet is the fact that, uh, you eat fish and other, uh, items that are high in omega-3 fatty acids. There are multiple factors, in a mediterranean diet that's good for the brain, but omega-3 fatty acid. Is that one of the main reasons why the guide is good?

Of course, extra virgin olive oil is good, the blueberries and eating fruits and vegetables are good, but omega-3 fatty acids are particularly important for brain function. I believe that omega-3 fatty acids are the best brain vitamins. Um, one of the studies show that, uh, on average people have high levels of omega-3 fatty acids, which are EPA and DHA on average have a bigger hippocampus. So, uh, eating a healthy diet, a heart healthy diet is really good for the brain, but I do recommend taking omega-3 fatty acid supplements to my patients at a dose of 1000 milligrams per day.

I don't necessarily recommend any particular brands, uh, 1000 milligrams. What I take and my family takes. Third thing on the list is having an interest to learn new things. When you learn new things, you literally grow your brain, use it or lose it applies to your brain, just as much as it applies to your muscles. Um, in this study, researchers wanted to know, uh, what their medical students who are studying really hard for three months when they prepare for the final board exam, g- grow the size of the hippocampus. And they found out that they do.

Uh, MRIs before studying, and after studying shows a clear d- uh, uh, difference was shown on the left with bright colors and on the right in the graph. Um, but it doesn't have to be in medical school, intensive learning that will grow hippocampus. If you learn a new language, you can grow your hippocampus. Even if you learn dancing steps, you can grow your hippocampus. In this study, researchers did MRIs before and after 18 months of studying and a yellow patch you see is a part of the hippocampus that has grown. Isn't that interesting?

You were just having fun dancing and you were doing this on a regular basis and your brain has improved and your hippocampus campus has grown so much so you can see, uh, with naked eyes on a brain MRI. Again, I would have expected that the changes we see with learning would be at the microscopic level. When I see these things, I find them quite striking because each one of those things we'll be talking about can grow the brain to the extent we can see with eyes. Now, I know some of you are interested in golf and you're wondering, well, what if I take 70 hours of golf lessons would that be good for my brain?

The good news is yes, playing golf is good for your brain. And especially learning to play golf seemed to be associated with the increase, the volume of cortex, the outer layer of your brain, uh, grows when you learn golf. In a study, researchers did MRIs at the beginning of a series of golf lessons. And after, uh, they finished a 70 hours of golf lessons. And when they compare to MRIs. They showed in color, which parts had grown. And it turns out the parts of the cortex that are important for eye-hand coordination, uh, grew the most. Not so much hippocampus, but this other brain area as a group.

Again, use it or lose. It applies to your brain just as much as it applies to your muscles. And the more you learn new things, the parts of the brain that are associated with subject matter grow. So if you learn how to play the violin, the part, our brain for music and learning, uh, your hand eye coordination grow, if play basketball, the parts of the brain that are important for coordination and balance grow, practice makes cortex. And, and so, and you can find something you enjoy and learn it, but you need to be consistent and keep at it.

We talk about how lack of sleep, uh, is terrible for the brain sleep apnea, which is a condition in which people snore at night, often have a big belly and feel tired during the day or they doze off during the day, um, is associated with a shrinkage by about 18%. But the good news is that if you treat the sleep apnea with the C-PAP machine to provide oxygen for the brain, um, the brain goes back. Again, in this slide summarizes that we're done before and after three months of a C-PAP and you can see that parts of the hippocampus have grown shown here in yellow.

Meditation is another important factor for, um, growing the size of your hippocampus. Um, when you meditate, you reduce the levels of cortisol. Cortisol is toxic for the brain. So not having cortisol is good for your brain. Meditation also increases blood flow to the brain. Um, for reasons that's not quite clearly identified when you meditate the improved blood flow from different parts of the brain, to the others. And this increased blood flow leads to an enlargement in the volume of the cortex and the hippocampus areas that are shown here in yellow and orange, are parts of the hippocampus that have grown after three months of daily meditation.

All right. Now, how about a sense of purpose in life? Would that make a difference in the size of the hippocampus? Surprisingly, it does. Researchers have been interested to know whether the brains of people feel passionate about what they do is different than those who just work because you have to pay the mortgages and take care of their, uh, presumed responsibilities. And if you know, if you are a person who, uh, feels passionate about what you do, you enjoy what you do, let's say, you know, you feel passionate about taking care of your children and grandchildren.

We feel passionate about your political affiliation and try to promote the ideas you believe in. Let's say you feel dedicated to your church and do volunteer work. Let's say you're a businessman and you feel passionate about making a lot of money. As long as you feel passionate about what you do. You seem to have a healthier brain. Um, this study recently showed that people who have a sense of purpose in life can have some degree of plaques and tangles in their brain and have no symptoms.

Yes, it is possible to have some degree of plaques and tangles your brain and have no symptoms. If your brain is as strong otherwise, um, in the study, uh, researchers look at plaques and tangles in two groups of, um, volunteers. And they realize that could the same moment, the plaques and tangles the group who had a sense of purpose in life did not have enough symptoms. So I would like you to think about what you do on a daily basis and pick on the things that you feel passionate about and pursue your dream, pursue the things that make you happy, not necessarily money all the time, but the things that make you happy from inside.

And if you can't because of your life circumstances and always do a hundred percent of time to things you enjoy. Make sure you do set aside time for doing the things you enjoy even if those things don't bring you much money. So what's the best age to start doing these things. What's the best age to eat a heart healthy diet, take supplements, learn new things, make sure you sleep well. Meditate. When? I think the best age is when you're a kid, we all know that if you brush your teeth you reduce the risk of cavities, when you get older. We know that if you have multiple negative risk factors, your brain will shrink and you will have atrophy when you're older.

So I think you should do brain healthy things from the age that you start brushing your teeth. This picture shows my family and my daughter is in white, uh, uh, uh, Norah and Maya. This is a picture quite a few years ago when they were both in elementary school. And I talked to them about brain health issues, just like my father had talked to me about brain and brain health. But this time I'm more passionate than my dad. My dad knew these things because of his experience, but I know these things based on hardcore science, I can defend and say that exercise is critical for your brain health.

Not that I think that people who exercise are generally sharper. I know the MRI results. I know all the facts. In fact, my little girl on the left here, Nora is so interested about these things. She is writing a little book about brain health and my daughter on the right, Maya, who plans to be a lawyer always reminds me about how we need to be careful about our hippocampus and her hippocampus. In one occasion, I told her honey, um, your book review is due in two days and you haven't even started it.

And she said, "Dad, you're stressing me out. And that's not good for my hippocampus." Um, so I'm careful not to stress her because I don't want her to campus to be affected. But seriously, I think the evidence for things I've told you is really compelling and really must educate our children or grandchildren, our neighbors, our friends, our moms, everybody to do these things, just like we used to tell people to stop smoking because there was clear cut evidence for that.

All right. I would like to close my presentation with giving you some information about the brain fitness program I put together based on all the things I told you. Um, when I was learning these things, and when I wrote my book, I realized that we need to have a program where we make an inventory of each person's problems. Each person's risk factors, and it address them in a systematic way. It's not enough to tell someone, okay, make sure you eat right. You lose away weight, you make sure you sleep. Make sure your sleep has been checked, you don't have sleep apnea and make sure you meditate.

It's too much for any one person to take on. Just like the way you go to a gym. And you see someone who can train you to have stronger muscles and you see a dietician can help you eat better or lose weight. I thought we needed a brain coach had brain trainer who can help you address your risk factors, get brain training and, and have a better brain. So I put together a program called brain fitness program to do all those things. Um, I would like to tell you about one of my patients. Her name was Carol.

Um, she was 69 years old when she was brought to me by her sister. Her sister was convinced that Carol has Alzheimer's disease. For more than six months she was, she was sitting in front of a TV doing nothing every day. She wouldn't talk much, was confused. She wouldn't eat much. Um, and the family was concerned that she has Alzheimer's and this is the end of her. So they brought her to me to confirm a diagnosis of Alzheimer's disease so that they can have a power of attorney, uh, sell their house and use the money to pay for her nursing home.

But when I saw Carol, I realized she had a lot of treatable, risk factors. She, for example had back pain, which was severe and was on six different pain medications. Um, she had sleep apnea, she had depression and I realized that we can't just write her off. We need to know what's wrong with her. So we put it her in a program, which includes twice weekly treatments. Um, I, um, uh, reduce her pain, uh, pain medications. And I sent her for a sleep study. She has sleep apnea and, uh, help to, uh, have her get a CPAP machine.

And my staff, my brain coaches helped her with all the other things that we've been talking about. For example, she started to receive neurofeedback, which is a form of biofeedback to improve attention, memory, and sleep. Uh, we gave her brain training, not only with, uh, memorizing a list of words, you know, we often give our patients a list of hundred words to memorize, but also we hands-on, uh, brain games that would stimulate different parts of the brain.

We provide meditation training, nutrition counseling and exercise training. And we monitor our patients every week because we expect that, uh, each of our patients improves every week. For example, we give them a list of hundred words to memorize. And every week we give, 10 words and 10 words, and we expect them to work hard to improve their brain function. And these things happen to Carol as well. Uh, when I reduce her pain medications, she became more alert. She started to talk, which she didn't do initially. She had to come in a, on, on a wheelchair and was pretty much mute.

Um, but now she was talking, she was walking. Um, the sleep apnea treatment was giving her more energy, uh, halfway into program, uh, six weeks into it. She was already, um, exercising regularly was, had signed up for a gym. By the time she finished our program, she was looking for a job. Um, she was a very clever sharp person and I really enjoyed meeting her after she was alert and awake and interactive. She used to work as a manager and was supervising 50 people. And I could see why she was very smart.

She started checking her old friend. Um, it turned out that when she was in high school, she had a sweetheart, but for some reason they didn't get married. She married to someone else. Um, but her husband died a couple years earlier and now that she was more alert, decided to check out the old friend and it turned out that he was available to and they have never stopped loving each other. He was in California, she was in Baltimore. So they started commuting.

I mean, long-term distance and they will come see each other once in a while. And she was so happy. Um, when we did the MRI three months after she finished, uh, the program at the beginning, and after three months, when she had done our program, we saw that her brain had grown. Her hippocampus had literally grown in volume by 8.6%, which is equivalent to a brain. That's almost 17 years younger. Her cortex which you can see the outer layer on top had also filled up. So her brain had turned out to be a much younger brain.

When we do this program for our patients, uh, the average increase in the volume of campus is about 3%, which is about 6%, six years younger in brain age. But for her given that she was really into exercising and have taken a new hobbies and she was meditating. She was really on top of it was much more than our average patient. So she came a year later. And said, "Dr. Fotuhi, I'm doing fine. I just, I'm just curious, did my hippocampus volume go back down again? I know that it had grown by 8.6%, but did it stay up or went down?"

We obtained another brain MRI and it showed that her brain volume had in fact increased one more percent in a time that she had stopped being a program. And this is because she had continued to exercise. She had continued to have new hobbies and she had continued to meditate, eat well and do all the other things that we talked about. We, uh, provided its program with 427 other patients with this condition called mild cognitive impairment. And we saw that 84% of our patients had a statistically significant improvements in objective testing that would be performed on these patients.

It wasn't that they told us they felt better. We had objective testing that showed they had indeed improved their attention, concentration, memory, executive function and overall, uh, brain health. We published, uh, his findings in the journal of provisional Alzheimer's disease. And this was later on featured in a four-page article in Time Magazine in 2016. Um, in more recent, uh, months, I have published another study where we provided this 12-week program for patients who have traumatic brain injury and have had post-concussive syndrome.

People who have had symptoms of concussion for three months or years. And we saw similar results in, uh, patients with traumatic brain injury. And we published that in their general uh, rehabilitation. So the program works and there is now compelling evidence that we can indeed defy aging. Much of what happens to our brain with aging has to do with our lifestyle choices, the way we choose to lead our lives, how much stress we choose to have, how much sleep we get, whether or not we have sleep apnea, whether we are overweight or obese.

Or we have diabetes that's treated or not treated, whether we have depression and whether it's treated or not treated and how many concussions we've had and what we've done about that to treat it. Now, you know, each person may have three of these risk factors. Have anywhere between one to 10 in severity. So if you have nine of them at, you know, 90% severity, then unfortunately you've had a lot of brain shrinkage, but if you had three of them at 10% severity good news is that you're good.

You don't have to worry too much about the shrinkage in your brain. And if you have had any degree of shrinkage, you can be proactive to literally grow your brain. Uh, you can do that by exercise. Vigorous exercise is better than mild exercise. High intensity interval training seems to be particularly good for the brain, but you have to be careful not to hurt yourself and always start and increase gradually under supervision of your doctors, make sure you sleep at least seven hours, seven or eight hours, ideally eight hours, um, you know, eat a heart healthy diet, take omega-3 fatty acids supplements about 1000 milligram a day.

Be curious. Learn new things, uh, if something's not working don't just kick it there just figured out how, what happened and try to fix it, learn new things. For example, learn the names of all the previous presidents, or try to memorize a list of a hundred words in my book was your brain. There are some memory tricks that you can learn. There are lots of other books and, and apps that we can use as well. Meditation is particularly, uh, powerful for improving blood flow to your brain to reduce cortisol levels and you can do five or 10 minutes a day.

Uh, also make sure that you follow, you pursue your dreams. You do something you feel passionate about. And just like multiple, uh, risk factors can have cumulative negative depending on the dose of each one. You can have, you can expect to have healthier brain based on the dose of the good things you do. So if you do physical exercise regularly, you don't stress too much. You're sleeping well regularly, you keep your brain active regularly. You meditate every day and you do more of the things you feel passionate about every day.

You can expect to go to your '70s and '80s and have only a minimal cognitive decline. Bottom line is you are responsible to what happens to your brain. You cannot blame other people. Often people wonder that, uh, they're at high risk because their parents or grandparents had Alzheimer's disease. The risk for Alzheimer's disease is high for adults who have parents who develop Alzheimer's disease in their '50s and '60s. If your parents or grandparents, uh, had Alzheimer's disease or other family members had Alzheimer's disease in their '80s, that is a minor increase in risk factor maybe 2%.

Whereas having multiple negative risk factors is a 16-fold increase. So 2% where it says 16 times to 32% increased risk. So you can't just worry about having bad genes. And even if you have genes for Alzheimer's disease, doing these things is a no brainer. There's no negative about the things we told you, I told you, and you really need to be proactive. Uh, in summary, uh, what people have told us for centuries is true, healthy body, healthy mind. If you try to reduce your stress and if you try to meditate, you'll have more motivation to exercise.

You will be more organized to take care of what you eat while you don't eat. When you eat a healthy diet. And when you exercise, you increase blood flow to your brain, which then makes your brain, a happier, healthier brain. You add more vitality to your brain when you exercise more. Well, if your brain is happier and more energetic, guess what? You are more energetic. You are more keen to smile, more exercise, more participate in social gatherings, do fun things, volunteer and really experience, uh, your life to the fullest.

Enjoy your life to the fullest. And this loop continues. The difficulty is for people to start this process because sometimes you're too tired or don't have time to exercise. The weight is too much, they don't have the energy and they don't exercise. They eat more because they don't have energy, eating more causes more sleep apnea because they get obese. And this cycle, the vicious cycle keeps going down.

You need to start the process and start an upward spiral where you walk more, you feel more energy, then you make better decisions about what you eat and you lose weight and you feel sharper and so on. I thank you for taking your time to listen to my presentation. I'll be happy to answer a few questions in the remaining time.

Andrea Klemes (51:13):
Thank you so much, Dr. Fotuhi, um, we do have maybe time for one or two, and I know I've been trying to answer some things as we've been going along. Um, but one thing that even you repeated the supplement suggestion about the omega-3s twice, and we still got, "Please, can you do it again like the third time?" So if you could maybe slowly so they can write it down, repeat it.

Majid Fotuhi (51:40):
So the omega-3 fatty acids are DHA and EPA. The preferred dose for the combination of these two, uh, is at least 1000 milligram. Between 1000 to 1500 milligrams. So I recommend people taking it at a dose of, you know, between a 1000 to 1500 milligrams. I don't recommend any brands. Uh, I think I haven't done a study to see which brand is better. I'll do tell you that I have one that I tell my patients, uh, I have no affiliation with this company and I don't want to think any, anything.

Uh, but, um, this is the one that I, coming to my patients. In case you want to know which one is called ultimate Omega by Nor- by Nordic natural, but by no means, uh, I'm not recommending, this is the best, but this is just a one product that has the enough, uh, VHA, APA. People need to read the fine print and add up DHA amount with the EPA amount and it should add up to 1000. Flaxseed, for example, has some of these omega-3 fatty acids, nuts have omega-3 fatty acids.

These days, a lot of eggs and milk are enriched with omega-3 fatty acids and they're all good, but there are 20 milligrams, 30 milligram. They're not a 1000 milligrams. And I did a study myself where we looked at the levels of omega-3 fatty acids in people's blood and the risk for Alzheimer's disease and people who have lower levels of fatty acids are more likely to Alzheimer's disease. So, uh, omega-3 fatty acids are by far the best brain vitamins.

Andrea Klemes (53:26):
Great. Thanks. Um, maybe, five minutes, maybe one more quick. There were a lot of, I mean, there were a lot of questions and a lot of things, obviously. Um, and you know, you mentioned golf and, and helping grow your brain at all. And there were other q- lots of questions about... You know, I'm, I'm reading down here that I wrote, bridge, chess, reading, one that I really want to know computer games like Candy Crush. If I'm playing strategically, is that helping my brain? So maybe a little bit more about, you know, what are those sort of fitness things that you can do to keep, like, what do we need to look for? Is it strategy? Is it just keeping your brain busy. What is it?

Majid Fotuhi (54:08):
Yes. That's an excellent question. I recommend brain games that are challenging to you. So if you're doing something you're not really trying hard, you're not stimulating that part of brain, and you need to be selective as to which part of your brain you want to, uh, activate. I happen to have a, a brain model in, in my office that I use for my patients and, and this part of the brain here in, in yellow is called temper lobe. And this is where the hippocampus sits.

Um, so if you want to not get Alzheimer's disease, you must have a healthy looking hippocampus. If you do the Candy Crush, you're not using you hippocampus, but if you're learning in your language, if you're reading something and you're memorizing something, you're challenging the learning part of your brain especially on things that require language, you particularly enhance the part of the brain or memory. And this is the part that gets affected more so than the part of our brain that's say, for being, having a quick reaction time.

So there's no harm in doing thing, I definitely do not recommend people sitting in front of a screen spending two hours on Candy Crush, um, I think it's better to do things that are hands-on, you know, volleyball or, or, or fishing, learn a new hobby that requires you to go birdwatching and things that require you to use your multiple senses are going to be more, uh, beneficial for stimulating different parts of your brain and giving you better results for the time that you have.

Andrea Klemes (55:39):
Great. Thank you. Thank you so much, Dr. Fotuhi, for this wealth of great information. I think here's my takeaway. We can defy aging. Great news is the six steps that you recommend for brain vitality are also heart-healthy and something that we focused on a lot at MDVIP, I challenge each of us to make brain fitness part of their personal wellness plan. And as Dr. Fotuhi said, it's never too early.

So if you haven't taken the brain health IQ quiz, please go to MDVIP.com/brainhealth to test your knowledge, share it with family and friends. There will be a link to the recording in the October MDVIP newsletter, that you can also share. So many questions on, uh, that came through the chat. And I tried to answer them, but there will be a link in the newsletter. Um, you can share that and talk about it with your friends. We can all get smarter and healthier together. So we're so glad everybody joined us, stay safe and enjoy your evening. Thank you.