Five Factors for Better Brain Health

Dementia is on a lot of people’s minds these days. It’s a rapidly growing public health problem affecting around 50 million people globally (nearly 6 million in the U.S.). There are nearly 10 million new cases every year, a figure set to triple by 2050. 

Two-thirds of respondents to a recent survey conducted by MDVIP and IPSOS said they were concerned about dementia and Alzheimer’s disease, the seventh leading cause of death in America. Even though they’re worried:

• Only 41 percent feel they know the steps they can take to reduce risk of dementia or Alzheimer’s.
• Only 49 percent feel their doctor really knows them, and just over half feel their doctor has the knowledge and tools to help identify brain health issues.

Ironically, research shows that many people are afraid to talk about their brain health – even with their doctor. That’s not surprising. Brain health is a sensitive topic, and most primary care doctors in traditional practices have a hard time squeezing the topic into a standard 15-minute visit.

Before my affiliation with MDVIP, discussing brain health with my patients was somewhat challenging. At the time, I relied on observing changes in patients’ behavior, standard assessments and addressing occasional questions from patients.

Time to have a conversation
Today, in my smaller, more personalized MDVIP-affiliated practice, I have more time to get to know my patients, to go beyond their immediate needs and dig deeper into their concerns about cognitive health. The extra time, combined with advanced resources and tools now available to me, can help me identify risk factors and problems earlier, and because of the close relationships cultivated in my practice, starting the conversation is much easier.

And that’s important - having a knowledgeable conversation with patients about their cognitive health is huge. Patients often mistake deeper cognitive issues as “natural signs of aging.” But memory loss that disrupts daily life isn’t a natural sign of aging. While these signs or symptoms can actually represent serious neurological disease, it’s also possible they’re linked to manageable health problems like depression, anxiety, insomnia, sleep apnea, side effects of medication and nutritional deficiencies. 

These are things I consider when patients present with memory issues. I also look at relevant neurological family history, their history of concussions or other trauma. Catching something early can positively impact quality of life and it’s important for patient safety — as their doctor, I need to know that they can follow medical instructions appropriately. 

While talking about dementia may be scary for some patients, there’s a growing body of evidence and supporting data that show how some cognitive impairment can be improved and possibly prevented. I have dissected the data and created five guiding principles for better cognitive health in my practice which have shown positive results. 

Assessing Cognitive Health
Before introducing these principles to my patients, I first assess their brain health in depth through two main screening tools that help me identify at-risk patients. Your primary care doctor may use a different approach, but I use multiple screeners, because, in my experience, one measure can be adversely impacted by certain conditions like nervousness, jetlag, limited caloric intake, etc. In some cases, a second assessment may also be needed depending on the initial findings. 

My patients and I discuss the results of these screenings and next steps, which can range from simple diet change to referrals to specialists when something significant is noticed. I may also recommend a follow up visit with me to further assess and/or compare initial results. This additional visit enables me to use a second tool to look deeper into the main areas of the brain to determine functional impairment. Results are then presented and discussed with more solid and customized recommendations. And that’s when my five guiding principles come into play.

The principles – Fuel, Motion, Detox, Recovery and Rest - may appear pretty basic and can apply to most patients in some form. What sets them apart for members of my practice is that I am able to tailor these principles to each patient based on their medical history; current health status, including chronic conditions; medications; lab results; risk factors and other elements of their lives that can affect their heath, like stress and COVID-19. 

This customization is all possible due to the close relationships I am able to build and nurture with my patients. 

Five principles for better brain health

For both prevention and treatment, here my five guiding principles for improved cognitive health: 

Fuel - Diet is a key factor

• Keep vitamins at ideal levels
• Eat foods that promote good digestive health 
• Maintain brain derived neurotrophic factor (a key regulator of neural development) at high levels through a Mediterranean diet, which includes foods that increase omega levels but do not increase inflammation.

Motion - Involves physical and mental activity 

• Get cardiovascular exercise — 45 minutes per day at least 5 days of the week
• Get mental exercise, such as working or doing online brain activities
• Get social interaction. It’s hugely important, according to many studies. It is not good for the brain to be a “loner.” I know socialization is hard during COVID, so I suggest patients, especially to those who are shy or not that involved in the social scene, try to join a virtual group based on their particular interests. (I have hosted virtual meetings and events in my practice to help start social connections for some.)

Detox – Keeping things from harming your brain

• Maintain your dental health
• Don’t drink excessive amounts of alcohol 
• Stop smoking
• Decrease your stress levels
• Get rid of medications that are neurotoxic or decrease cognition (with your physician’s approval)
• Limit sugar, processed foods and caffeine

Recovery - Promote positive brain health 

• Participate in activities, such as Tai Chi, yoga and meditation.   
• Manage conditions that can adversely affect the brain, such as hypertension, diabetes, elevated cholesterol, anxiety, depression, autoimmune disease and chronic pain

Rest - Sleep is critical

• Get good quality sleep and plenty of it
• Adapt a consistent sleep routine – go to bed and wake up same time every day. Generally, aim for at least seven hours of sleep per night, a measure backed up by research.
• Treat and manage sleep apnea and insomnia. Both can help improve brain performance
• Prepare a consistent routine for taking care of pets. Believe it or not, many of my patients say their sleep in interrupted by taking care of pets. 

There is no cure for dementia but there are effective treatments for some forms and ways to help manage it. The most important thing you can do is to talk with your primary care doctor about your brain health and any issues - big or small - that you experience. 

Dr. Lara Hitchcock is a board-certified, MDVIP-affiliated family medicine physician in Orlando, Florida with special interests in brain health and women’s health. She earned her medical degree at the renowned Mayo Clinic Medical School and received her undergraduate degree in neurobiology at University of Florida. She is currently accepting a limited number of patients.