Category Archives: risk factors

S2E51. Cholesterol? Bah! Humbug!

What kind of a Scrooge blogs about cholesterol on Christmas Eve eve when he should be decking the halls, harking the herald angels and making spirits bright?

Uh…that would be me!

I didn’t plan it this way, it’s just that I had my annual physical last week and my cholesterol is high, so my primary care provider put me on a statin. Some holiday gift, eh?

I’m a bit befuddled by it all. In my late 50s, my cholesterol numbers were good, but of late, they’ve been hovering at the high end of the safe zone or a little above. I have no idea what changed.

About 2 years ago, I tried taking a statin and it worked. Shortly thereafter, though, I began my quest to lose 40 pounds and to eat a brain healthy diet, which includes foods to help control cholesterol. So I came off the medication and did the experiment to see if weight loss, exercise and diet could bring my numbers into line.

I’ve been eating all the right things for about 18 months now: almonds, olive oil, asparagus, beans, blueberries, tomatoes, avocados, cacao powder, eggplant, apples, and salmon. And then last year, I added oats, oat bran and oatmeal to my daily regimen. On the flip side, I don’t eat fatty meats, full-fat dairy products, or junk food, all of which can raise LDL.

I worked out religiously and lost 40 pounds.

I was pretty sure my behavior had earned me a spot on the lipid screen Santa’s “nice” list, but instead, I got coal in my stocking. 

Since it didn’t work, I did a post-mortem.

Getting COVID last April definitely threw a wrench into the works. It left me weaker and unable to do the intensity of workouts I had been doing up until then. To make matters worse, I went off my diet during our cruise last month. I’ve gained back 12 pounds.

I decided to face reality and accept the fact that I probably needed the medication, but there were still a few things that were confusing me, and I wanted some answers.

In spite of the overall bad news, there were two bright spots in my blood work. First, it appeared that my efforts had paid some dividends in terms of raising my good HDL cholesterol level. I had succeeded in raising it to 60 mg/dL, which is very good. Consequently, my LDL/HDL ratio was also an excellent 2.4. 

So I could make the case that the reason my total cholesterol had moved into the danger zone (219) was that my HDL had increased…which is a good thing. 

So why did I need medication?

I asked my PCP about it when we met and she explained that the American Heart Association developed a formula for predicting the likelihood of heart and vascular disease emerging within the next 10 years. It takes into account factors such as age, gender, smoking history, blood pressure and total cholesterol levels. Their guideline is that your risk factor should be below 7.5%

She typed my numbers into her computer and swiveled her display around to show me the results. My risk factor was at 16.7%.

I felt like I had just been visited by the Ghost of Christmas Yet To Come.

That sealed the deal. I’m now taking a statin.

What made the decision easier was that I had checked out the research on statins before going for my check-up. For several years, there had been concern that taking a statin could have a side effect of reversible cognitive problems. On the other hand, there were studies suggesting it could provide protection against age-related cognitive decline. So which was it?

A recent study appears to have resolved the conflict: the negative side effect is more likely to appear in those under 45 while the protective benefits seem to accrue to those over 65. 

What a nice stocking stuffer!

So why does someone interested in brain health care so much about cholesterol anyway?

There are about 100,000 miles of blood vessels in your brain and their primary job is to provide oxygen and nourishment to each and every one of your 100 billion neurons and 1 trillion glial cells. So you want to do your very best to make certain that nothing impedes the ability of those arteries to deliver their precious cargo. Cholesterol is the grinch in this story that can gum up the works by sticking to arterial walls and restricting blood flow which, in turn, damages or kills cells.

So now you know what I know.

And on that note, I’ll close by wishing a Happy Christmas to all, and to all a good night!  

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S2E37. This Is Your Brain On Pot

In the interest of full disclosure:

I first tried pot at the end of my freshman year at Brown. The following semester was when I indulged the most. I was not considered a ‘head’ or ‘freak’ by any stretch of the imagination, but I would take a hit when offered and my longish hair and goatee fit the profile of those who merited an offer. 

I was terrified of getting busted, so I never bought any of my own, but always made contributions to the kitty. 

There was no real research about marijuana usage at the beginning of the 70s, just strong opinions based on folklore and urban legend. ‘Reefer Madness’ taught us that pot was a gateway drug to heroin, but whenever someone told me that junkies started with pot, I’d reply that pot users all started with milk. End of conversation!

I smoked enough to have a decent complement of weed stories to tell over the course of the coming decades, but I cut back dramatically during the second half of my sophomore year when I had a close encounter with depression and my therapist advised me to give it up.

I used pot sporadically over the course of my last two years at Brown as I settled on beer as my go-to party drug. In the 50 years since graduating, I think I’ve gotten high maybe 15 times, at most.

Which brings us from the 70s to my 70s where the marijuana world has changed dramatically.

Pennsylvania has legalized cannabis for medical use and so Sally got a prescription to treat her insomnia. For reasons unknown, edibles are not offered in PA, so we drive over to New Jersey where both medicinal and recreational pot is available, including edibles in the form of gummies. Would it surprise you to learn that we picked up some recreational edibles while we were there?

Getting high is different from what it was lo those many years ago. Don’t get me wrong. It’s still fun: music packs a strong emotional wallop, ripples on the surface of the pool are infinitely interesting, and the food is…well…you know!  Nonetheless, it’s different. It’s no longer part of a cultural movement. It doesn’t hold the same promise of self-discovery and revelation.

And some things just plain suck. For example, back in the day, you’d start to tell a story and then forget what you were going to say. That didn’t happen when you weren’t stoned and so it was really funny when it did. Now, though, I can lose my train of thought when I’m stone-cold sober, which is irritating enough, but when it happens while I’m trying to have a good time, it really pisses me off!

There was concern back in the day about possible long-term cognitive effects of regular marijuana use, but the research hadn’t been done yet. Fifty years later, there is still a dearth of information, but a few studies stand out.

Long-term chronic use is associated with reduced prefrontal brain volume. Heavy use has also been found to lower cognitive performance among teenagers several weeks after their last high. However, it appears that the effects of marijuana use among older Americans have been largely ignored. A 2019 review of the literature summarized the thin evidence this way:

“Marijuana (with chemical compounds THC and CBD) causes impairment in short-term memory; increases heart and respiratory rates, elevates blood pressure; and contributes a fourfold increased risk for heart attack after the first hour of smoking marijuana. These effects may be pronounced in older Americans with compromised cognitive or cardiovascular systems.”

These effects, though, are experienced while you are stoned. There is next to nothing to be found about long-term effects on the brain. Interestingly—and counter-intuitively—there was one study I came across suggesting that marijuana use might be helpful in recovering from brain injury, as it appears to have neuro-protective qualities!

Other articles mentioned the problem of driving under the influence because reaction times are impaired which leads to more accidents, as well as the respiratory problems associated with smoking pot which, while not as damaging as cigarette smoke, are still rough on your lungs.

So what’s a Baby Boomer to do? 

First, edibles appear to be easier on your body than smoking weed, but it will take a lot longer to get high, so be careful about dosing. 

Second, don’t drive or operate heavy machinery while stoned! 

(Learn more about these 2 points here: https://www.nytimes.com/2022/04/12/well/live/driving-while-high-marijuana.html )

Third,  although ‘chronic’ usage (apparently more than 16 times per month) has been shown to be harmful, there are no reported studies about occasional use. That doesn’t mean that it’s not bad for you, it just means that it hasn’t been studied. But if you have to choose between alcohol (which is a known neurotoxin) and marijuana (which isn’t), well, that appears to be a no-brainer. 

Of course, you always have the option of abstaining from mood-altering chemicals altogether, which is probably the safest position you can take when it comes to maintaining brain health.

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S2E36. Dodging Dementia Bullets

Dementia risk-management was not something that was on my mind when I was 20. Or when I was 30, 40, 50 or even 60, for that matter. Had it been, I would have been shit out of luck because the research had not been done yet and so there were no guidelines to work with.

Looking back at my life, though, it appears that I did a pretty good job of dodging high-risk dementia-related behaviors. Of course, I could not have done it intentionally because I didn’t know what those behaviors were, so basically, I lucked out. But as Pippin’s father Charlemagne told him: ‘It’s smarter to be lucky than it’s lucky to be smart!’

Here’s a partial summary of my smart luck. I’ve highlighted risk factors for dementia in bold.

Let me start with something that’s not a behavior at all: my genetic makeup. First and foremost, I was born a male. For reasons that are still not yet fully understood, women are at higher risk for developing dementia.

Secondly, it appears that I did not inherit the dreaded APOE4 gene which is linked to early onset Alzheimer’s. My mother demented at around the age of 83, but her sister was cognitively spry when she died at 94. Nobody on my father’s side lived long enough to find out if there was any dementia lurking there.

Like most boys growing up in the 50s and 60s, I played tackle football with pads after school every day in the fall. I was pretty small for my age, earning the nickname ‘shrimpotz’ in 4th grade, and I was still only 130 pounds when I got to my sophomore year of high school, so I figured playing football was hopeless and switched to running. The lucky thing here is that I was never knocked unconscious or had a concussion. Another risk factor averted. 

Not only did I dodge that bullet, but running became a lifelong habit. I was in the first cohort of joggers to take to the streets, back when it was considered cool for cars and trucks to try to run you off the road. Unknowingly, I had adopted one of the 5 core behaviors for reducing dementia risk…and I did it at a very early age.

I also lucked out when it came to education. I started school in Newark, NJ, where the quality of the education offered had already begun its decline from the system that produced Philip Roth in the 1940s to the one that failed and was taken over by the State of New Jersey in the 1990s. When I was about to enter 4th grade, my parents were able to move us to a town with some of the best schools in the state. I flourished there and wound up getting into Brown University.

All of that was fortuitous because, as it turns out, attending a high quality elementary school and going to college are both protective factors. Again, lucky me!

But it didn’t stop there. When I was 44, I decided to become a psychologist and so I spent the next 6 years in graduate school, first at Marywood University in Scranton, PA, and then at the University of Connecticut. Once again, I didn’t do it to promote my long-term brain health, but we now know that that kind of intense cognitive challenge involving learning new skills and information is also one of the pillars of dementia risk-reduction.

Along those lines, I suppose it also helped that I changed careers every 10 years and that all of those careers were people-oriented.

With its heavy doses of sugar, refined flour, saturated fats, beef and fried foods, the American diet is a notorious contributor to dementia risk. For a long time, I ate with abandon in service to my taste buds, ignoring calories, cholesterol and fat content. Can you say “large pizza with extra cheese, sausage and pepperoni?” 

Fortunately, I did not have a sweet tooth and my metabolism did not lend itself to excessive weight gain. Thus I dodged two more dementia bullets in spite of myself: diabetes and obesity.

My worst period in terms of unhealthy eating was when we were running our B&B. I was the cook, serving up eggs, bacon and breakfast pastries every day. And every day I ate what I was cooking. By the end of that run, though, I realized that I needed to make some changes. There was a history of heart disease on my father’s side (it killed both him and his father when they were around 60), so I figured I better start eating a heart-smart diet. The research for that was plentiful, so I gave up red meat, began using low-fat products, and ate more vegetables, fish and pasta. As fate would have it, all those changes were helpful in maintaining brain health (and constitute another pillar of a brain-healthy lifestyle). I was in my 40s at the time.

I was never a big drinker. In fact, I was a cheap drunk, getting tipsy on just 2 beers. In college, I tried to become a ‘better’ drinker (you can imagine the peer pressure) and even managed to down a 6-pack of Schlitz one night before passing out. But excessive drinking was not in the cards for me. That doesn’t mean that I never got drunk because I did when the occasion merited it. But I never really liked the taste, whether it was beer, wine or hard liquor. Even now, it’s hard for me to drink a few ounces of red wine with dinner, but I do it for the purported brain-health benefits.

On the other hand, I never had any desire or interest in smoking. I hated it ever since I was in grade school and my parents used to light up at the dinner table at the end of the meal. I became an anti-smoking advocate at an early age, so much so, that people were astonished to learn that I had smoked pot! Oh, I suppose I took in my fair share of second-hand smoke (my first wife of 36 years was a smoker), but I think its safe to put this in the ‘dodged a bullet’ column, too.

There are a few other risk factors I haven’t covered here. You can see them all at this link to see how lucky you’ve been:

https://www.nhs.uk/conditions/dementia/dementia-prevention/

Finally, there is one risk factor I haven’t yet dodged, and it’s the biggest one: age. The older you are, the greater your chances of dementing. But dodging that bullet is a good thing, isn’t it?  🙂

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S2E22. An Abundance Of Caution

Every few days, it seems, a public figure issues a statement saying that although they are fully vaccinated, they just tested positive for COVID. And, although they are asymptomatic at this time, out of “an abundance of caution” they will quarantine for five days.

I just love the phrase “an abundance of caution.” Is that like a gaggle of geese? Or a congress of baboons? In any event, I appreciate the sentiment.

It is out of an abundance of caution, then, that I am switching to organic toiletries: soap, shampoo, hair conditioner, toothpaste, deodorant and shaving cream. The links between these products and dementia are weak at best, but I figure it can’t hurt, so why not?

Toothpaste

Gum disease and gingivitis are both risk factors for dementia. Daily brushing, therefore, is important. As the old Crest carton and tv ad reminded us: ‘…when used in a conscientiously applied program of oral hygiene and regular professional care.’

The primary concern about toothpaste seems to be the presence of fluoride. From what I can gather, though, the best documented effects involve embryonic neurodevelopment and young children. Deposits have also been found post-mortem in the brains of those with Alzheimer’s, but no correlational or causal links have been proposed.

Other ingredients in toothpaste (e.g., artificial sweeteners, artificial coloring, parabens, propylene glycol) might harm you in various ways, but my concern here is brain health. But…out of an abundance of caution…I made the switch. 

It appears that a solution of equal parts baking soda and water will work just fine as a daily toothpaste and it’s as inexpensive as it gets. Alternatively, there are a variety of organic toothpastes available online, although most are on the pricey side.

Shampoo and hair conditioner

Did you know that there are emissary veins in your scalp that provide a conduit into your brain? Their presence means that what you rub into your scalp has the potential to get into your brain…and that’s cause for concern.

A few chemicals in the United States have been banned from use in hair dyes for this reason, but there are many others that are suspect but for which there are inadequate studies to establish the danger. The European Union, on the other hand, has banned some 1,300 chemicals from cosmetics.

Since we massage shampoo and hair conditioner into our scalps on a regular basis, and the potential exists for it to be absorbed into our brains, then I think it makes sense to pay attention to what we’re using.

I used Pert shampoo with conditioner for years. It always burned my eyes, but I didn’t think anything about it. After all, at an early age we were taught to close our eyes when shampooing. Now, though, I figure that that isn’t such a good thing after all, and so I tried organic products and…lo and behold…no more eye irritation!

Soap

I’ve been using Zest for as long as I can remember, and, just like with my shampoo, the fumes burned my eyes. That was enough to get me to try an organic milled soap. And just like with the shampoo, the burning disappeared.

One theory about Alzheimer’s posits that an ineffective immune system can be responsible for the disease. The thinking behind it is somewhat counter-intuitive: we are so germ-conscious that we sanitize ourselves to the extent that our bodies don’t learn how to fight off a range of bacteria, and it is our under-developed immune systems that fail us when it comes to preventing dementia caused by bacteria.

One of the recommendations that this suggests is to stop using anti-bacterial soap. Fascinating!

In addition, chemicals can be absorbed through our skin, some of which can cross the blood-brain barrier, so it makes sense to pay attention to the ingredients in your soap…out of an abundance of caution!

Deodorant

The suspect chemicals to be avoided in deodorants are parabens, triclosan, phthalates, propylene glycol and aluminum. Their effects are linked to cancer more than dementia, but as long as we’re protecting ourselves, we might as well go all in.

It turns out I was already using a safe deodorant: unscented Arm & Hammer Essentials, so no need to change.

Shaving soap

The ill effects of the chemicals that might be found in shaving soaps are generally not too severe except for aerosols which may contain carcinogens. But just like with deodorant, we’ve come this far, so we might as well finish the job. In this case, too, I was already using a natural, unscented shaving soap.

So for me, it wasn’t that hard to make the switch to natural toiletries. The fact that I only use 6 items certainly helped! Did I really have to do it? No. Will it decrease my likelihood of getting dementia by a significant degree? Probably not. But out of an abundance of caution, I did it anyway.  😀

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S2E15. My COVID-19 Detour

I suppose I had been lulled into a false sense of security by all the public figures who have announced that, although fully vaccinated and boosted like me, they had contracted COVID and were either asymptomatic or experiencing only mild symptoms. 

When we got to Minneapolis last weekend, mask-wearing was optional in  both the hotel and the arena. Only a very few people were wearing them at either location…and that number did not include me. The first game was Friday night and by Monday morning I had a mild sore throat. So mild, in fact, that I didn’t even consider it was COVID-related, as the simpler explanation was that I had done a lot of yelling at the games.

Masks were required on Minneapolis public transit, at the airport, on planes, and during the Uber ride home.

On Tuesday morning, when I weighed myself on my fancy scale that records not only my weight but a dozen other biometric markers, I was surprised to see that my pulse had shot up to 86 beats/minute from its usual range of 55-65. That was odd and, I thought, bore watching.

I did all the things I normally do on Tuesdays and Wednesday (in this case, days  4 & 5 post exposure), only mildly inconvenienced by a sore throat and some noticeable body ache, but no fever (97.6). I was sticking to the yelling-irritated-my-throat hypothesis.

On Thursday night (day 6), we were scheduled to go out with some friends and so we self-tested at home. Both Sally and I were negative. With no reason to be concerned, we went out.

The next night, though, (Friday, day 7), I had a bear of a night trying to sleep. My sore throat worsened, my temperature rose to 99.6, and I had muscle pain in my back. I’d never had that kind of discomfort with either a sore throat or fever before. That sent me to the google to check on COVID symptoms and there it was: muscle ache was a symptom along with sore throat and fever. (I later learned that it is common for symptoms to worsen 5-7 days after they first appear. Apparently, I was on schedule!)

Since we were supposed to go out on Saturday night (day 8), too, we re-tested. This time, I generated a pretty pink positive line. Damn it to hell!

The good news was that Sally’s test was negative.

Right on cue, I developed the signature COVID cough. Now there, my friends, is a symptom brewed in the Devil’s own basement! It’s relentless. A sea of phlegm gurgles just beneath every breath you try to take. The constant coughing grates at your raw throat, making it scream over and over again. It gets to the point where you fear your next breath. It’s no way to spend an hour, much less a day or more.

I started a regimen of aspirin and cough suppressants. In doing so, though, we discovered that all of our flu/cold remedies were hopelessly past their expiration dates. The bottle of spray I use for sore throat pain, for example, had expired 11 years ago! Sally set about re-stocking our medicine chest with currently active remedies.

I wrote to my primary care physician to see if I needed to do anything else and I emailed the COVID reporting form to the Chester County Health Department.

I shared the news on Facebook. Thank goodness for real and virtual friends and family! The speedy recovery wishes were overwhelming, along with suggestion about how to treat it. Here’s a summary:

  1. Get better.
  2. Get better fast.
  3. Drink lots of liquids and get lots of bed rest.
  4. Take lemon juice with honey and cayenne pepper.
  5. Homemade chicken soup.
  6. Open the windows in the apartment for ventilation.
  7. Buy and use a pulse oximeter.
  8. Ask my doctor for one of several antivirals now available.
  9. Nebulizing saline with hydrogen peroxide.

To the everlasting credit of all those who care about me and who I care about in return, please note that there was not a single recommendation to try Ivermectin or hydroxychloroquine.

My physician responded and suggested I go with #3 above, OTC products to treat symptoms, and a 5-day quarantine. She did not offer anything from #8.

Upon waking up Monday morning (day 10), I was delighted to see that my cough was gone. What a joy it was just to be able to take a deep breath! My pulse rate had also returned to a more normal level, so it seemed I might have turned the corner.

Thankfully, too, I never lost my sense of smell or taste, and my appetite was good. The biggest problem was getting things past my inflamed throat.

My throat was causing another big problem: a major communications breakdown.

I could talk with effort but could not project my voice at all. Sally’s difficulty in hearing me was compounded by the muffling effects of the KN95 masks we were both wearing all the time. Those masks also prevented any attempts at lip-reading. Bottom line: communication was farcical if not hopeless, even with Sally wearing her hearing aides. At one point, we seriously considered texting each other even though we were sitting only about 10 feet apart in the living room!

My brain fog lifted on Tuesday morning (day 11). I don’t think my temperature ever broke 100, but the mental dullness felt equivalent to a fever of about 102. I was glad to be able to think clearly and write again.

That was pretty much it. My pulse oximeter arrived on Tuesday afternoon and my oxygen level was at a healthy 96. Temperature was a normal-for-me 97. I took a shower and felt 1000% better.

On Wednesday, we tested again. Sally was negative but I was still positive. That was a huge disappointment, to say the least!

I’m feeling fine, though, with no symptoms, so I’ll continue to isolate and wear my mask and we’ll test again on Friday.

Looking back, if this was what a mild case of COVID feels like, then I’m eternally grateful for the vaccinations and booster that kept it from being the real thing.

The good news is that I escaped my close encounter with COVID.

The bad news is that I suspect that the week of COVID brain fog  inflammation has nudged up my risk of developing a dementia sometime down the road.

For now, though, I’m just happy to be able to take a deep breath again!

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S2E5. Glucose And Ketones And Insulin…Oh My!

I began the week with the goal of understanding why some researchers refer to dementia as ‘Type 3 Diabetes.’ I had seen the phrase often enough, but I hadn’t really wrapped my head around what it actually meant. But, like Dorothy in The Wizard of Oz, I wound up going on a wild detour en route to my destination. Let’s start at the beginning:

Type 1 diabetes occurs when your pancreas stops making enough insulin. 

Type 2 diabetes occurs when your cells become insensitive or resistant to using the insulin you do produce.

The Type 3 variant was proposed because it posits that insulin insensitivity in the brain is the cause of cellular malfunctions resulting in dementia. 

All of this raises the obvious question: what does insulin do that causes so many problems when it doesn’t do its job?

The answer introduces us to glucose. Glucose is a sugar that is the most plentiful source of energy for all of the cells in your body. It is floating around in your bloodstream all the time. You can increase your blood glucose very quickly by eating sweets or refined flours, or by drinking sugary liquids. Foods with complex carbohydrates will also be converted into glucose, but it takes a little longer.

The connection between insulin and glucose is that insulin binds to your cells and opens the door for the glucose to enter, thus providing the energy the cells need to conduct all of their functions. Needless to say, when that energy supply is disrupted, there are major problems throughout multiple systems in your body, including your brain.

If your production of insulin isn’t high enough to accommodate all of the energy demands from all of your cells, you have Type 1 diabetes. If your cells have developed a resistance to using insulin so they can’t get enough glucose to power them, then you have Type 2 diabetes.

As I understand it, then, it seems like Type 3 diabetes isn’t really a separate disorder, but more appropriately the way that Type 2 diabetes affects the brain, and this is why diabetes and dementia are strongly correlated. 

Enter ketones!

Ketones are compounds that are created when your body burns stored fat. There is a relatively low concentration of them floating in your bloodstream at all times and cells can use them instead of glucose to provide energy. In one sense, they seem to be a back-up energy source in case you don’t get or can’t process enough glucose. On the other hand, converting ketones to energy is more efficient and, if you raise your relative level of ketones enough, your body prefers to use them instead of glucose.

And now for that detour along the yellow brick road:

A theory has recently been offered suggesting that it is chronic energy deficiency in the brain that is the cause of the breakdowns in cellular functions that we see in dementia.* This is based, in part, on the observation that there are brain regions that are intensive energy consumers and that each type of dementia is associated with at least one of these areas whose breakdown results in the signature symptoms of that dementia. In Alzheimer’s, for example, it’s the hippocampus and pre-frontal cortex.

So if there is something impeding the flow of energy to the brain, then those areas which demand the most energy will be the first to experience problems. Insufficient energy availability, in turn, unleashes a cascade of events that lead to the accumulation of plaques and tangles, the loss of myelin in white matter, and synaptic degradation, to name just a few. And this is on top of the impairments that emerge because that region can’t do it’s job because it doesn’t have sufficient energy available to it.

All of which brings us back to insulin. Age is the biggest risk factor for dementia and we know that insulin production decreases with normal aging. This means that glucose metabolism drops off as we grow older, putting enormous stress on our high-energy brain centers. 

It’s a prescription for dementia.

To close the circle—and to offer a ray of hope—a number of studies have shown that burning more ketones can actually improve cognitive functions like memory, language and global functioning.** Although it’s way too early to draw any conclusions, it’s possible that increasing ketone utilization to offset deficits in available glucose just might be a protective strategy as we age.

I can’t wait for the research! 

P.S.: The above post is largely based on my reading of two recent journal articles (see footnotes). To be honest, I only understood a small percentage of what I read, as cell metabolism is a highly technical topic written in a language I barely understand! But I think I got the gist of them. Please feel free to correct anything that isn’t right, or expand on any of these topics. I’d appreciate it!

* Neurodegenerative Diseases: Is Metabolic Deficiency the Root Cause?Muddapu, Vignayanandam Ravindernath, Dharshini, S. Akila Parvathy, Chakravarthy, V. Srinivasa, Gromiha, M. Michael, Frontiers in Neuroscience, March 2020, Vol. 14

** Effects of Ketone Bodies on Brain Metabolism and Function in Neurodegenerative Diseases. Jensen, Nicole Jacqueline, Wodschow, Helena Zander, Nilsson, Malin, Rungby, JÃrgen. International Journal of Molecular Sciences, November 2020, Vol. 21

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S2E2. More Risk Factors

Ugh. Just what we needed: more things that increase the likelihood of our developing dementia.   😦

The upside of this, though, is that more and more research is being done and we’re moving towards getting a handle on what’s really going on in our brains as we age. And since forewarned is forearmed, this is a good thing, right?

The list of risk factors was already pretty extensive before the most recent studies came out: age, head injury, smoking, excessive drinking, high cholesterol, diabetes, high blood pressure, insomnia, air pollution, obesity, depression, social isolation, lack of physical activity, strokes, hearing loss and lack of education, to name those at the top of the list.

Here’s one I just learned about last week: infectious diseases. The suggestion has been around since Alzheimer’s was first identified, but it was considered a fringe theory and relegated to a backwater of research. Now it’s receiving more attention.

The identified possible culprits are herpes, Lyme disease, and gingivitis. Each is able to cross the blood-brain barrier and invoke immune responses and inflammation which leave beta amyloid and tau proteins as by-products of the process. Those chemicals, in turn, form the plaques and tangles associated with dementia.

It made me wonder if, in a decade, we won’t be looking at having had COVID as a risk factor. After all, symptoms of COVID include brain fog and loss of taste and smell, all of which are brain functions.

Apparently, though, COVID does not cross the blood-brain barrier, so it’s mechanism of action must be different from the others. It’s been suggested that it might weaken the barrier enough to let other microbes cross which then triggers the immune response. The research is ongoing. 

But infections aren’t the only newly-identified risk factors. It now appears that having cataracts is correlated with developing dementia, too.

In this case, it isn’t immediately apparent what the connection might be. How can having a cloudy lens in your eye impair cognitive performance?

Two possible pathways are suggested. First, having difficulty seeing might lead to more social isolation (e.g., not driving at night to be with friends). Alternatively, when your lenses are clouded, less light passes through them. This results in a drop in overall electrical stimulation to your brain.

These two ideas are roughly the same as those proposed for why hearing loss is a risk factor: (1) difficulty following conversations leads to withdrawal and social isolation and (2) reduced auditory stimulation leads to an overall decline in brain activity.

What do I make of all this? To me, there seems to be an overarching pattern here: whatever reduces brain activity increases the risk for developing dementia. Conversely, things you do that stimulate brain activity are protective.

If this is the case, then we can see why having cataract surgery, wearing hearing aids, listening to music, exercising, social engagement, reading books and learning new skills are all protective.

It really looks like we might be looking at a “use it or lose it” scenario. Or more accurately, “use it or lose it faster” because we will all experience declines in our cognitive performance as we age, so the goal is to slow down that process in order to live a long, healthy life and then die before we meet the criteria for dementia.

But this stimulation theory does not, of course, explain everything. Another group of risk factors appears to involve the ability to pump a steady supply of well-oxygenated blood to the brain. Just this past month, a study was released correlating higher resting heart rate with an increased risk of dementia. It’s no wonder that behaviors that are heart-healthy are also brain-healthy. 

I’m seeing a third cluster that centers around the process of removing debris from your brain. It appears you need to provide the chemical building blocks your brain needs to clean up the mess left after an immune response has been triggered. This cluster includes doing things that can prevent the debris from forming in the first place, like managing stress and providing the opportunity for your brain’s maintenance system to do its job, i.e., getting a good nights sleep.

Given just this much information, it’s beginning to look a lot like dementia isn’t usually caused by just one thing. It’s more likely that it’s born of a lifetime of insults, from an assortment of causes whose effects lie latent for years and then emerge as we get older and reduce our daily activity level and the cognitive stimulation that comes with it. 

I’m starting to see something take shape out of this great fog of all we don’t yet know about dementia. True…it’s just a few broad brush strokes…but it’s beginning to make some sense.

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S1E50. An Early Present

I can’t recall ever being this eager (and anxious) about my annual physical and blood tests, but this year is different. My last check-up was in June, shortly after I began changing my diet and exercising on a regular basis. My blood sugar (A1C) was hovering around pre-diabetic levels, I was taking medicine (a statin) to lower my cholesterol, I was overweight at 180 pounds and I knew I had to do something about it. And so I did.

My expectations were pretty high this time around. I took myself off the statin about a month into the new regime. That was a pretty risky bet on my part because the numbers showed it was clearly doing a great job, with my cholesterol coming in lower than ever before. But I wanted to test the theory that I could control it with diet and exercise without exposing myself to potential side effects of a statin. I had worked into my diet pretty much every food identified as raising HDL (good cholesterol) and lowering LDL (bad cholesterol) and I was exercising an average of 60 minutes per day, 6 days per week. And as I’ve mentioned in previous posts, I had lost a shit-ton of weight!

The first thing I did in my new diet was to eliminate all added sugars. No more coffee with 2 teaspoons of sugar in the morning for me; I switched to tea. I carefully read labels on everything I bought and rejected anything with added sugar. By the time I finished, there were only 2 items I was eating with added sugar: herring in wine sauce and seaweed salad, but I figured the benefits they provided far outweighed the costs of ingesting the trace amounts of sugar I was getting in the quantities I was eating. When I did need to sweeten something, I used stevia, but that happened infrequently because I soon discovered that the natural sugars in the foods I was eating satisfied any cravings I had for sweets.

I also eliminated all refined flours which are quickly converted to sugar in your bloodstream. I was convinced that my glucose and A1C numbers would show significant improvement.

All these dietary changes did not come without a modicum of anxiety. Was it possible that I wasn’t getting enough of some essential vitamins or nutrients? I had no idea, so I was looking forward to seeing if things like my calcium and protein levels were holding up.

I had my physical last week and the results were good. My blood pressure was 116/64, my pulse was 57, my BMI (body-mass index) was 22.8 (down from the overweight range and squarely planted in the ‘normal’ zone), and my oxygen saturation level was 99%. I don’t recall ever having a resting heart rate below 60 beats/minute, and that oxygen reading is as good as it gets (also a personal best for me). I took all this to mean that my exercise program was working. In terms of brain health, it meant I was getting plenty of oxygen and my heart was supplying it with ease. I could scratch high blood pressure, anoxia and obesity/belly fat off my ‘eliminating dementia risk factors’ to-do list.

The results of my blood work came in on Wednesday. Logging in to my account and clicking through to the report felt like opening a present on Christmas morning!

I made a beeline for the glucose and A1C page…and wasn’t disappointed. My sugar numbers showed a dramatic drop, so much so that I had exited the pre-diabetic zone and entered the normal range for the first time in several years. The diet was working! 

Next I checked my cholesterol numbers. The good news was that they were all in the normal range, albeit at the high end. I was disappointed, though, to see a noticeable spike in my LDL without the medication. My HDL showed a substantial rise, too, which is a good thing. I was a bit befuddled, to say the least.

I did a little googling and found that the more meaningful metric is the ratio of total cholesterol to HDL, in which higher HDL generates a lower ratio and a lower ratio is better for you. Mine was not that much different from the one I recorded when I was taking the statin, and better than prior years’ readings. So something good was apparently coming from my lifestyle changes. Nonetheless, I decided right then and there to add oats back into my granola to try to knock down that LDL number.

I scratched off my list diabetes and high cholesterol as dementia risk factors.  😀

Finally, I looked at a variety of other indicators to see if I was lacking in anything. Potassium, protein and calcium were all fine. So were all the other readings, but to be honest, I have no idea what they measure. Bottom line: I’m not depriving myself of anything important.

The icing on the cake, though, arrived yesterday when my doctor followed up with this message:

“Hello Wayne,

I received your lab results…Overall, your labs are good…Your cholesterol and A1C were all within normal range…No indication to initiate any medications at this time…Keep up the great work!”

What a nice present.

Merry Christmas, everyone! 

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S1E49. Into The Homestretch

I had to reach deep into the back of the closet to snare the clothes bag that held my rarely-worn sport jackets and dress pants. I bought them shortly after moving in with Sally ten years ago because I needed something to wear for her niece’s wedding. I weighed 145 at the time.

Last month, while packing to attend the wedding of a friend’s daughter in North Carolina, I thought I might wear something from that bag, and I also thought that since I had lost 31 pounds and now weighed 155, they might fit.

WRONG!

The jackets fit fine, but it wasn’t even close when it came to buttoning the pants. The label said they were a 34″ inch waist, but if that was true, then I had a 37″ belly!

(It befuddled me because Sally had recently bought me some casual slacks (with elastic waists) that fit perfectly…and they were 34s. It’s a mystery I’ll have to solve another day.)***

Bottom line, though, was that I couldn’t wear those pants…and that pissed me off enough to motivate me to lose whatever weight necessary to get into them again…and to re-gain my boyish figure from when I was 60 and courting Sally.  😀

At that point, I had been dieting and exercising for six months and losing weight slowly but steadily. My weight had plateaued and so I needed to change something if I was going to drop another 10 pounds.

I couldn’t really eat less because I wasn’t eating all that much to start with. It’s not like I could give up Twinkies and brownies because I wasn’t eating anything with sugar or bad fats in it. And everything I was eating had a role to play in maintaining brain health, so there was nothing I felt comfortable cutting.

I was already using intermittent fasting as a weight-loss tool, so I couldn’t add that to my routine.

Since restricting caloric intake and intermittent fasting were not options, exercising more was the only path left open to me, so that’s what I did.

I had been jogging 11 miles/week and so I increased that to 21. 

I also added a set of exercises for my abdominals (a variety of crunches and planks). I figured that tightening up those muscles might pull my gut in without my having to hold my breath, and that could be worth a couple of inches right there. Make no mistake about it: it’s not that I covet 6-pack abs (which, by the way, I NEVER had). I just want to be comfortable in those pants.

Finally, I increased the weight on my strength training workouts in order to try to build a little more muscle mass. Muscles don’t just burn calories when you use them; they burn calories while resting, too, and that’s helpful. 

The science behind this is fascinating. It appears that your body will try to maintain a metabolism that fits your caloric intake while ensuring that you have enough stored fat to survive a period of food scarcity. 

You can see how this would have been adaptive during our specie’s hunter-gatherer millennia, but it’s a real pain in the ass today. When you burn off too much stored fat, your autopilot lowers your resting metabolism to conserve what’s left. That was the cause of the plateau I had hit at 155. Even though I was exercising to burn more calories, my resting metabolism slowed down to offset that, giving me a zero net change in weight.

By amping up my exercise routine and keeping my caloric intake constant, I would start to lose weight again. However, I only had but so much time to lose those 10 pounds before my metabolism adjusted once more. The race was on!

In the last 3 weeks, I’ve dropped another 5 pounds. I’m now in the homestretch: 36 pounds lost, 5 to go. The finish line is in sight, sometime around the middle of January.

Just for the hell of it, I tried those pants on again and…miracle of miracles…they fit just fine! So now I have clothes to wear for dressy occasions AND I’ve eliminated the belly fat risk factor for dementia.

*** It’s another day and I’ve solved the mystery! When I woke up yesterday morning, I recalled that those dress pants, although having a 34″ waist off-the-rack, had been custom tailored to fit my 32″ waist of 10 years ago. My new casual slacks, on the other hand, have a 34″ waist with the capacity to expand out to accommodate what was my 35″ waist in November. Voila! There’s the 3″ difference between the two pairs of pants and my (at the time) 35″ waist.

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S1E48. Winter Air

“Close the door! You’re letting all the heat out!”

I can hear my father’s words echoing down the decades. He’d chastise us like this on winter days whenever we came in to warm up from playing in the snow.

“In or out…make up your minds!”

There’s a fine line between cheap and frugal. In hindsight, I suppose he met criteria for frugal. I recalled his words this week as I wrestled with trying to regulate the air quality in the apartment.

If you’ve been following this blog for a while, you’ll remember from Episode 36 that I bought an air quality measuring device to see if there were any hidden environmental dangers in our new apartment.

Although I was able to take measurements, I didn’t see how I could improve the air quality if it was problematic, and so I decided to return the monitor the next day. Thankfully, I never did. By a process of trial and error, I learned to keep the air in the apartment pristine by leaving a window open to provide ventilation that flushed away elevations in formaldehyde and total volatile organic compounds (TVOC). And it seemed to work without running up a big air conditioning bill, too.

Now that we’re into the heating season, though, the problem has re-emerged.

Honoring my father’s wishes and respecting my own desire not to waste energy, I closed all the windows when it got cold outside. When I did, I saw that the air pollutants spiked as soon as the heat kicked on. It didn’t get up to dangerous or unhealthy levels, but the readings for both formaldehyde and TVOC were significantly higher.

What to do?

My first thought was that, since we want the bedroom relatively cool at night (~65 degrees) to promote a good night’s sleep, maybe I could open one of its windows and close the door to the rest of the apartment. This would give us clean air overnight air without triggering the thermostat in the living room.

Both of those goals were achieved, but at the cost of forfeiting our sleep: the second I opened the window, the din from the steady stream of cars on Route 202 flooded the room. I did my best to give it a fair shot, but I finally closed the window at around 3am after the driver of a car without a muffler gunned it when the light at the intersection turned green.

Hmmm…

This would be easy if my father hadn’t taught me so well.

This would be easy if I didn’t care about conserving energy.

I’d just open the window, crank up the heat, and pay the bloated electric bill each month.

But he did teach me well and I do care about energy conservation, so back to the drawing board I went.

I came up with the idea of leaving the bedroom window  open a little (~2 inches) during the day, from noon to 4pm when it’s as warm as it will get, and leaving the door into the living room open as well.

It worked. Air quality was good all day and the cold air flowing in from outside only triggered the heat once or twice. It remains to be seen, though, what will happen when it gets down into the teens during the day instead of the mid-40s that we had this week.

“What, are you crazy? Close the window…you’re letting the heat out!”

I went back to the bedroom problem and tried something a little different. I opened the window at 7:30pm (about 3 hours before our bedtime) and closed the door. I figured this would chill the room and lock-in good overnight air quality without triggering the thermostat.

Although it got a little too cold in there, the concept clearly worked. Over the next few days, I’ll play around with how long I refrigerate the bedroom before bedtime in order to get a good sleeping temperature.

My father would never have embraced the idea of opening a window in the winter with the heat on, not even for the worthy purpose of preventing cognitive decline. Knowing that I used an electric mattress pad to warm the bed in the room I just chilled would have driven him to distraction! 

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S1E46. I Am Not A Fanatic!

I’ve spent the last six months building a brain-healthy lifestyle by adjusting my diet, exercise and sleep routines, building cognitive challenges into each day, and trying to spend more time socializing. It came together bit-by-bit, day-by-day, until I had a system that pretty much governed every aspect of my existence, right down to monitoring and controlling the quality of the air I breathe in the apartment.

I’m more than happy to talk with people about what I’ve been doing and why (to whit, this blog), but I try really hard not to proselytize, for there’s nothing worse than the zealotry of a new convert who corners you in a conversation. So if I start going down that path, please let me know, as it is not at all my intention.

On the flip side of that coin, I’m uncomfortable when friends and family feel obligated to protect my journey by adjusting their behaviors to accommodate my lifestyle choices. I bristle whenever I hear, “Will there be anything you can eat if we go to that restaurant?” 

It’s not that I don’t appreciate their caring about me. I do. But I don’t feel as though I’ve earned their deference. It’s not as if I have a medical condition and will get sick if I go off my diet. It’s not a part of my religion, either. I won’t be denied entry into heaven if I eat a piece of cake. My body is not a temple and it will not be defiled no matter what I shovel into it.

I’m merely choosing to be a picky eater…and the consequences of that are 100% on me, along with the responsibility.

As far as I can tell, the downside of going off my diet is that I lose a little bit of time in the long-term project of cleaning the gunk out of my brain that can cause cognitive decline. I spent seventy years accumulating it, but I haven’t seen any research that quantifies how much time I have available to me to clean house.

So how much damage did I do over the last four days when I fell off the wagon? We went to the Bahamas to see the University of Connecticut women’s basketball team play in a tournament. I made a half-hearted effort to be faithful to my protocols, but staying at a vacation resort triggered a “you’re-on-vacation-go-for-it” reflex that had me making all sorts of unwise choices.

Alcohol is a no-no (except for about 5 ounces of red wine with dinner), but I couldn’t resist the allure of a Bahama Mama. Just one knocked me for a loop, but that didn’t stop me from trying a different restaurant signature cocktail each night!

Bread. I haven’t had bread in months except maybe to taste a sandwich that Sally had ordered. But there was no way I was going to say “no” to the breads and dipping oils that came with each meal. Same for pasta, which is the only thing I really miss in my new regimen.

Then there was the grotesquely sweet s’mores dessert with vanilla ice cream, chocolate fudge, marshmallow sauce and graham crackers. I’m surprised it didn’t trigger insulin shock in my sugar-deprived brain.

I didn’t observe my overnight fasting routine.

I had a rough night sleeping the night I had a Coke with dinner. In general, I’m pretty sure my increased sugar intake disrupted my sleep cycle big time.

In general, I over-ate, felt stuffed a lot and got hungry a lot sooner between meals.

Although we did a fair amount of walking, I didn’t really make an honest effort to try to exercise. The only time my heart got a workout was during the games which were all close and exciting.

Finding our way around the sprawling resort was quite the cognitive challenge, though. So was figuring out what to do when the air conditioning stopped working in our room. It took a while, but it dawned on me that perhaps the on-off switch is controlled by the doors to the balcony. Apparently, for the sake of energy efficiency, the air shuts off when you open the doors to the outside. It goes back on when you close them.

On the other hand, I didn’t realize until our third day there that all of our restaurant charges included a 15% gratuity. The wait staff must have laughed all the way to the bank each time I had added 20% to that!

So now I’m home and getting back into my routine. How much damage did I do? There’s no way to tell, but I doubt that I hurt my cause very much. It was interesting to see how quickly my body reacted to the changes…and not in a good way. It makes me more appreciative of the new path I am traveling.

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S1E44. Probiotics…really?

I have never been what the marketers call an ‘early adopter.’ In fact, I fit pretty solidly into the group of people they identify as ‘laggards:’ those who only purchase things after they are well-established.

I’m pretty skeptical about most new products and consider them fads until proven otherwise. Growing up, I rejected the hula hoop and Elvis Presley. More recently, I believed the cell phone would never catch on. (Who on earth would want to talk to people in the aisle of a supermarket where everyone could hear the conversation???)

My initial reaction when I first heard the word ‘probiotics’ was “Really?” I had never warmed to the idea of eating organic foods and considered it a fad popular among liberal elites (even though I am a card-carrying member of that group). Introducing probiotics to the equation was crossing too many lines for me.

So I paid little attention to it until I started my research into brain health. I bristled when it first came up in my reading. All my alarms were going off as I learned about the gut microbiome that contains thousands of different organisms that are essential for digestion and creating the chemical compounds that are vital to brain health. Conversely, a poorly-functioning microbiome can generate neurotoxins. 

That caught my attention.

But as I delved deeper, I wasn’t convinced that the research has yet advanced to the point where we can definitively say that enhancing a certain group of bacteria is beneficial. There are just too many different organisms and too many combinations and too many potential interactions to say for sure, IMHO. Then there is the testing that indicates a lot of products marketed as probiotic supplements don’t contain what they claim and, worse still, what they do provide is not absorbed by your gut.

As is my tendency, I backed off a few steps and looked for a level of engagement that matched my comfort zone, given the data. 

A simple guideline that made sense to me was that you should include some fermented foods in your diet as they contain naturally occurring beneficial probiotic organisms that have long been consumed in various cultures. 

I tried kimchi, but hated it. Then I made a batch of sauerkraut and loved it. (It’s easy to make: just massage some kosher salt into a bowl of shredded cabbage, weigh it down, cover, then let it sit on the counter until it tastes right. It’s a whole lot better than commercial sauerkraut. It’s now my go-to afternoon snack, mixed with a little seaweed salad.

But I didn’t stop there. A word kept cropping up in my reading that I didn’t recognize: kefir. I checked it out and discovered it was a fermented milk product (like yogurt) and generated a number of probiotic organisms. The problem for me, though, was that I had given up dairy.

After thinking about it for a while, I decided that the potential benefits outweighed the negative impact of milk and milk fat, especially in small quantities. I gave it a try and it was delicious.

Since I had made my own yogurt for ten years at our B&B, I knew that my next project would be to make it myself. I ordered a kefir maker from Amazon which was basically a 2-quart glass jar with a perforated lid to allow for air circulation. It came with a packet of ‘kefir stones’ which contain the microbes that convert milk fat into the beneficial probiotic organisms.

I discovered that there was a product called ‘A2 milk’ which is supposed to be a little healthier than regular milk, so I bought some to make my kefir. It’s pretty simple: pour the milk into the jar, add the kefir stones, and let it sit on the counter for about 24 hours. For flavor, I added a pint of pureed strawberries to a quart of kefir. (Somehow, I had dropped strawberries from my diet, opting for blueberries and raspberries, instead. This corrects that oversight.)

It turned out wonderfully! It’s a little tart, so I add a packet of stevia to ½ cup of my homemade strawberry kefir and drink it for dessert each night. 

It took less than a week before I noticed a healthy change in my digestion. Wow…color me surprised!

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S1E43. No Comment

“Pressured Speech” is a symptom of mania. It happens when your mind is racing at 100 mph and you feel the need to tell everyone all the epiphanies you’re having about how the universe works.

On the other end of the spectrum is “Poverty of Speech.” It’s one of the negative symptoms of schizophrenia and occurs when your brain grinds to a halt and you have very little to say. It also occurs in advanced dementia.

Most of us function somewhere between the two ends of that vast spectrum most of the time.

The reason I’m writing about this is that talking with people is the essence of social engagement, and social engagement is one of the five pillars of brain health.

As I mentioned in Episode 41, I think I’m knocking it out of the park on 4 of the 5 pillars, but that I need improvement in the social engagement domain. This past week, though, I found myself engaging with others on more days than not…and that gave me an opportunity to observe myself.

But before reporting findings, it’s important to establish my baseline because, as you will recall, dementia symptoms are measured against your previously normal behavior and abilities.

I’ve never really been a social person. I don’t think I’ve ever called anyone and said, “Hey, wanna hang out today?” On the other hand, I usually enjoy being with others when the opportunity presents itself.

I’ve never been comfortable meeting new people (is anyone?) and I never learned how to ‘work a room,’ even when my job description called for it. I never learned how to introduce myself to a stranger. I have a congenital disdain for ‘small talk.’

So how on earth did I ever have a career as a psychologist, you ask? No problem! In that role, it was understood that people would seek me out and they would do the talking while I listened… and I was a very good listener. 

Same for when we ran the B&B. My wife was the extrovert who would meet people upon arrival and have a glass of wine with them. By the next morning, after I had cooked and served them breakfast, they had a thousand questions for me which I was more than happy to answer.

On the other hand, when I do have something to say, you can’t shut me up! So much so that when I chaired meetings of the Kennett Area Democrats, Sally would frequently have to give me the pointer-finger-drawn-across-the-throat sign to let me know I needed to wrap things up.

So how did I do this week?

As is my style, I found myself more than happy to listen. I didn’t feel pressured to impress anyone or to say anything witty. I had no trouble following conversations, but neither did I feel compelled to compete for the floor. If the conversation moved on to another topic before I had a chance to say my piece, I just shrugged it off with an “Oh, well.”

Now that I’m reflecting upon it, though, it appears that throughout my life it wasn’t unusual for someone in a group discussion to say, “Wayne, you’ve been awfully quiet. What do you think?”

This past week, my mind was going all the time. I was thinking about what I was hearing and enjoying the company. I felt comfortable and relaxed. It’s true that I spoke less than the others in the room or at the table, but that was because I just didn’t have a lot to say.

Sally noticed and asked if I was feeling ok. That tells me I must have been talking even less than usual. I didn’t have a good answer for her. Was I tired from my workout or not getting my afternoon nap? Maybe. Is my cognitive processing speed slowing down so I’m not finding relevant content to offer in a timely fashion? Possible.

In any event, it bears watching.

So, with nothing more to say on the topic at this time (!), I’ll close with two tangentially related quotes that come to mind:

Better to remain silent and be thought a fool than to speak and remove all doubt. –Abraham Lincoln 

Talk less…smile more. –Aaron Burr in the musical ‘Hamilton.’

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S1E42. Smart…Not Brave

In your 20s, 30s and 40s, you were often rewarded for taking bold steps. If you failed, bouncing back was hard work, but nonetheless do-able.

My sense is that at 70, though, I don’t have a lot of room for error. As the old adage goes, I need to be measuring twice and cutting once. Sally and I have coined a phrase that we use to remind ourselves of our new status whenever we face a choice with a potentially steep down-side: “Smart…not brave.”

So I put on sneakers before I climb a ladder instead of going barefoot. I use a cart to bring in the groceries instead of trying to make a single trip carrying all the bags in my arms. Although I normally walk the three flights of stairs up to our apartment, I’ll take the elevator when I’m carrying a package. Get it? Smart…not brave.

But nowhere is my new age-appropriate approach more visible than in my exercise routine.

I’ve been running/jogging on-and-off since I was fourteen. Up until now, my goal was always the same: run farther faster. That meant pushing myself in my workouts, running at an ever faster pace, and running greater distances.

My event in high school was the 2-mile. I was never any good at it, but I worked hard and earned the respect of my teammates. I scored enough points in track meets to earn my varsity letter in my junior and senior years.

In those days, it was all about guts and glory. Pushing yourself to go beyond your limits. There was a phenomenon we called ‘the rigs’ (short for ‘rigor mortis’) which occurred during the sprint to the finish when you had already given your all. Your arms and legs would refuse to respond to your screams to go faster. It seemed like you were moving in slow motion. You were helpless as other runners passed you.

It was a state of oxygen deprivation. Your heart can only pump so much blood to your muscles, but you had exceeded its limit…and you still had 100 yards to go.

If I were to exert that kind of effort today, it would probably be the end of me! Fortunately, though, there is no need to try because my purpose in running has now changed dramatically. It’s no longer farther faster. I’m now running to live longer with a high-functioning brain. That makes all the difference in the world.

I no longer need to work out at my maximum heart rate. Twenty to thirty beats per minute below that will more than suffice to guarantee a free-running and fresh supply of blood to my brain and thereby reap the cognitive benefits of exercise.

Consequently, the toughest part of establishing my new routine is to resist the temptation to add distance or to run faster in each workout. I have to keep reminding myself to be smart, not brave, and that the new goal is 150 minutes/week of exertion…not running a new personal best. In essence, the goal is now the workout itself and not my running performance on race day.

The new approach spills over into my weight training, too. Up until now, the goal of lifting was to support my running. There were certain muscle groups (e.g., the ones you use in the motion to pump your arms and to run up hills) that I wanted to be bigger, stronger, and to have more endurance.

The goal of weight training in a brain-healthy lifestyle, however, is not bigger and stronger muscles. The goal is to engage more neurons and to develop more synapses. You do this, not by lifting more weight, but by doing a variety of different exercises at a challenging but comfortable weight. There’s actually a study that found this approach to be more supportive of brain health than the traditional muscle-building type of workout.

As luck would have it, the upper body resistance machines in our fitness center are all constructed so you can do each exercise with both hands or with either hand separately, and there are usually two different grips you can use.

I take advantage of this design feature in order to engage as much of my brain as possible. I’ll do one set of 15 repetitions using both arms, and then 1 set of 15 each using my left arm alone and then my right arm alone. I’ll also vary the grip.

I’ve now been doing weight training for six months and this past week was the first time I increased the resistance. Smart, not brave, as I can’t afford to pull, tear or injure any of my body parts. I don’t even want to think about how long the recovery period might be. The beautiful thing, though, is that I don’t have to push the envelope anymore.

My final concession to my ‘smart, not brave’ approach is to work out four days in a row and then take a day off to let my body recover. I’ll be honest, though: I have to keep reminding myself that the goal is 150 minutes/week and not exercising every day.

So far, it all seems to be working. Once I finish losing all the extra weight I’ve been carrying (30 pounds gone; 10 to go), I know I’ll start thinking about running some 5k races in the spring. It will be interesting to see how I handle it. I hope I’ll be smart…not brave!

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S1E41. A Brain-Healthy Lifestyle Is…

…a full-time job!

When I first started learning about brain health back in May, I would come across the phrase ‘lifestyle changes’ pretty often. It referred to the likelihood that if you were a typical American, you would probably have to adopt several changes to your current lifestyle if you wanted to ward off cognitive decline and dementia.

These were things like changing your diet to minimize intake of sugars and saturated fats, and getting off your butt and exercising several times each week.

I thought: “Piece of cake…I can do this!”

I’ve been implementing those ‘lifestyle changes’ for about six months now and…you know what? Those changes make up the better part of my day! Don’t get me wrong. I’m not complaining. I enjoy implementing the recommendations… but it’s turned into a full-time job.

Here is an accounting of what my new ‘lifestyle’ looks like from the perspective of the number of hours per day devoted to each of the five pillars of brain health:

1. Exercise: 1.7 hours. I’m working out six days each week. My workouts themselves take between 40-60 minutes, so I’m easily surpassing the 150-minutes/week brain health recommendation. But let’s add to that total my cool-down time (when I drink a pint of pomegranate juice mixed with filtered water) and the time it takes to shower. That gives me about 12 hours/week, or 1.7 hours/day devoted to my exercise regimen.

2. Diet:  2.0 hours. I’m still learning how to eat right which means that I’m still researching diet recommendations and recipes. Then there’s the grocery shopping, prep time (I’m now making my own granola and sauerkraut), cooking, and the actual eating. I’d say that this consumes an average of 2 hours each day.

3. Cognitive Challenge: 6.0 hours. I start my day by doing crossword and jigsaw puzzles. Figure 2½ hours there. I try to get half an hour of recorder practice in daily (but don’t always succeed) and then Sally and I listen to a vinyl album each night after dinner. Let’s call it 1 hour daily for music. Add another hour for reading books. I would like this to be a daily routine, but so far it’s more likely to be binge-reading the week before book club meets. I’ll add an hour for on-line activities like social media and reading the newspaper. Finally, I spend about half an hour each day thinking about, researching and writing this blog. If my math is correct, that adds up to 6 hours/day.

4. Social Engagement: 1 hour. This is my brain health weak spot. Compared to Sally who is out-and-about most of the day nearly every day, I am a veritable recluse. But I do manage to get together with others about twice each week. Although I work out in our apartment’s fitness center, there is rarely anyone else there. Same for when the pool was open. On nice days, my jogging path is the ⅓ mile loop around the building and I wave or say hello to everyone I see. On rare occasions, I will share the elevator with someone. None of this adds up to a ‘relationship,’ though, nor does it meet the criteria for ‘social engagement.’ So let’s be generous and round up to an average of 1 hour/day of ‘real’ social interaction with someone other than Sally.

5. Sleep: 9 hours. No…I don’t get 9 hours of sleep each night. It’s more like 7-8. But we do get in bed at 10:30pm and usually get up around 7:30am. This allows for time to fall asleep, wake up a few times in the middle of the night, lie awake for a little while in the morning before getting up, and still log the recommended 7-9 hours of solid sleep. It also facilitates our intermittent fasting schedule which has us stop eating at 7:30pm which is 3 hours before going to bed.

Here’s what it all adds up to:

1.7 Exercise

2.0 Diet

6.0 Cognitive Challenge

1.0 Social Engagement

9.0 Sleep

There you have it: 19.7 hours per day devoted to my newly-adopted brain healthy lifestyle. That leaves about 4 hours free for other pursuits. In the spirit of full disclosure, though, I’ll admit that I allocate about 1½ of them to my nap!

Now the question is: What will I do with all that free time?  😀

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S1E40. Road Trip

Growing up in the 50s, I knew the names of a number of famous people without knowing what it was they had done to earn such notoriety. Their names alone came to stand for excellence in their chosen fields: Enrico Caruso, Rudolph Valentino, Albert Einstein and Pablo Picasso, to name a few. The highest praise one could bestow on an aspiring singer would be to say: ‘He’s a regular Caruso.’ On the other hand, a common way to say someone wasn’t the sharpest knife in the drawer was to say: ‘He’s no Einstein!’

Frank Lloyd Wright was one of the names I learned without knowing anything about him other than that he was an architect. In fact, I still didn’t know much more about him until this past week. But that changed when we decided to combine our fall foliage viewing with the 4-hour trip to his most famous residence, Falling Water.

But why, you ask, am I writing about Frank Lloyd Wright in a blog about dementia? Good question! It’s true that his best work was done when he was in his 80s, but that’s not why I’m writing about him.

One of the brain health findings I’ve come across is that travel to new places may be protective. It stimulates all your senses in a variety of ways which help stimulate brain cell growth. As we began planning our getaway, though, it occurred to me that you have to be functioning at a pretty high cognitive level in the first place to execute a road trip.

For starters, you have to have the desire and interest to go somewhere and not be overwhelmed by the logistics of actually doing it. In this case, the initiative came from Sally who said she wanted to do a road trip to see the leaves turn and I connected that with a suggestion some friends made a few years ago about going to Falling Water.

But it’s not like we can just get in the car and take off like we might have done in our teens and twenties. At this age, if we go somewhere on the spur of the moment without telling anyone, we might find our car make, model and license plate number flashing on the interstate in a ‘Silver Alert!’

Instead, we do our background research and make a plan. When will peak foliage occur? How long will it take to get to Falling Water? What days do we have free? Where will we stay? Do they have guided tours once we get there?

And there was one more big decision to make: which car would we take? My Volvo gets better gas mileage, but Sally’s Subaru has a much bigger windshield for viewing the scenery. We opted in favor of the view, but that introduced a layer of risk. She had run over a nail two weeks earlier and one tire was leaking air. She took it to the dealership and they put in a plug, but it didn’t stick. They had to re-do it twice. Was it really safe to drive? What if it went flat en route? We decided to roll the dice.

The weekend before our scheduled departure, I did a YouTube search and found great documentaries on the story behind the building of Falling Water and the life of Frank Lloyd Wright. On the eve of our departure, we watched Ken Burns’ 2-part biography of Wright on PBS. After 60 years, I finally now know why his name is synonymous with modern architecture.

Next up was finalizing the game plan: figuring out what time to leave in order to get to the first tour on time; packing (clothes appropriate for the forecast weather, medications, computers); turning off the air conditioning in the apartment; setting the alarm to wake up on time.

If you can do all of this planning and scheduling, your cognitive abilities are pretty much intact.

If you can shift your plans because you met someone on a tour who gave you a good recommendation, you are functioning well.

If you can keep your balance for two hours on a rock-strewn trail booby-trapped with tree roots hidden by fallen leaves, you are doing well.

If you can find your way back to the trailhead after missing a turn on your hike, you’re doing well.

If you can cut your stay short because it was impossible to sleep on your bed’s sagging mattress at the B&B, you’re functioning well.

Realizing that you miscalculated when the leaves would turn, if you can drive north in search of peak foliage without a map, keep moving in the right direction and find a hotel in Ebensburg, Pennsylvania, you are doing well.

If you can survive meals at local eateries like See-Mor’s All-Star Grill and Hoss’s Family Steak & Sea House, you can be thankful that you dodged a bullet.

If you can keep your sense of humor during all of this, you are doing extremely well.

But most importantly, if you can embrace with wide-eyed wonder and amazement a Frank Lloyd Wright designed home, you have much for which to be grateful!

Postscripts:

  1. That leaky tire didn’t give us a lick of trouble during our 500-mile adventure.
  2. Having travelled four hours west in search of foliage, we finally found it on the way home…2 hours north in the Poconos.

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S1E36. The Air, The Air Is Everywhere

Each morning, I scan the headlines on the digital version of The New York Times. I admit that I don’t read very many articles (apparently I’ve joined the Twitter generation that is easily satiated on 144 characters), but it does give me the feeling that I am generally in touch with what’s going on in the world.

Recently, they’ve added a section where they review home products and make recommendations. The other day they reviewed home air pollution monitors. Seeing that headline reminded me that there are pathogens floating around in the air that can affect brain function. It got me wondering if we made a mistake by moving into an apartment that’s about 100 yards from a busy highway. So I read the article…

…and I ordered the recommended device.

It arrived a day later and I eagerly scanned the simple directions that were offered in 5 different languages. I left it out on the balcony overnight, as instructed, so it could ‘calibrate’ itself, and then brought it inside the following morning and turned it on to get the verdict.

It happily flashed readings for four different categories of pollutants. An indicator light told me my status for each category: green for good air quality, yellow for passable (only people with breathing problems need worry), and red for unhealthy for everyone. Here were my results:

AQI: 20 – green

HCHO: .26 – yellow

TVOC: .91 – yellow

PM2.5: 5 – green

WTF?

It was somewhat comforting to know that we were not subjecting ourselves to dangerous levels of air pollution in our new abode, but what exactly were we measuring? And was there anything I could do about those yellow readings to get them down into the green range?

So I googled the letters and here’s what I found:

AQI: Air Quality Index. This is a number you’re likely to get in your daily weather report. Anything under 50 is good. It measures these chemicals:

* ground-level ozone

* particle pollution (including PM2.5)

* carbon monoxide

* sulfur dioxide

* nitrogen dioxide

So it looks like we have nothing to worry about from our proximity to the highway. Whew!

HCHO: Formaldehyde. Yup…it’s not just for preserving your frog in biology class. It’s found in a variety of construction products and is even used in clothing to create the permanent press quality. Under .1 milligrams per cubic meter is good; our reading of .26 put us at the high end of the passable zone which ran from .11 to .30. Using an air conditioner and dehumidifier can reduce harmful levels and effects.

TVOC: Total Volatile Organic Compounds. These include chemicals found in paints, solvents, cleaners, disinfectants, pesticides, air fresheners and other household items. The safe range is less than .6 milligrams per cubic meter. Our reading of .91 was in the passable range of .6 to 1.6. Interestingly, our own bodies give off high levels of these compounds. I scared the bejeezus out of myself when I was testing the air and the TVOC level shot up into the red zone. It  turned out that I had my finger on the air intake grid! I also noticed that the level skyrocketed when I was cooking dinner. It turns out that heated oils also give off a lot of volatile organic compounds. Not buying aerosols and good ventilation seem to be the best things you can do to offset their impact.

PM2.5: Fine Particulate Matter of 2.5 microns or less. Smokestack emissions, cars, fires and construction sites are the biggest sources of these and many EPA regulations are designed to reduce their release into the atmosphere. High PM2.5 levels have been linked to Alzheimer’s-like atrophy in the brain. 

Using a HEPA air purifier is one way to reduce your PM2.5 levels inside your home. We have two of them running all the time and our reading was a good 5. I did an experiment and turned the air purifier up to max output in the bedroom, closed the doors and let it run for 3 hours. It dropped the number from 5 to 2. Anything under 12 is in the good range.

I took the monitor outside to test ambient levels for all 4 measures, then brought it inside so I could compare the two. Perhaps not surprisingly, the two readings that had to do with particulates and air quality were better inside while the two readings that had to do with organic compounds and formaldehyde were worse on the inside.

So what have I learned?

I have a feeling that it won’t really do me much good to know the daily levels in the apartment as there is only so much I can do to better conditions on a day-to-day basis. I can be more aware when buying some household products, but it seems the formaldehyde levels are probably baked into the construction. And although our levels aren’t ideal, they don’t seem to be cause for alarm. When we see air quality alerts on tv, I suppose we can crank up the air purifiers if we want.

Bottom line: I think I’ll return the monitor on Monday.

PS: Drafting this post, I couldn’t help but be reminded of the song ‘Air’ from ‘Hair.’ Here it is for your listening enjoyment!

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S1E34. The End Of Alzheimer’s Program

This week, I read the book so you don’t have to. Here are my take-aways:

Dr. Dale Bredesen is a leading advocate of a comprehensive approach to treating symptoms of dementia. The book The End of Alzheimer’s Program is an update of his 2017 publication The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline and includes lessons learned from 8 years of treating patients with the protocols he developed.

He rejects the notion of a single cause of Alzheimer’s and other dementias in favor of a holistic approach that focuses on the things your brain needs to function and the things that get in the way of its doing so. The program seeks to protect your brain and ward off cognitive decline by using diet and behavioral changes to support its essential activities while minimizing toxins that impair its ability to function properly.

He argues that the effort to find a drug that eliminates beta amyloid, for example, is misguided. You have to ask “How did it get there in the first place?” It turns out that beta amyloid is produced as part of the brain’s immune system to combat toxic invaders. So a remedy that is available to you right now is to identify the toxins (both chemical and biological, like rogue microbes that escape from you intestines and break through the blood-brain barrier) that are affecting you and eliminate them. Once you’ve done that, your brain’s immune response will not be triggered as often and you will not produce as much amyloid. It turns out you can manage a lot of this through diet.

Moreover, your brain has a natural way of removing beta amyloid after it has been created. It happens when you sleep. Therefore getting 7-9 hours of sleep each night can help ward off cognitive decline.

Bottom line: to a great extent, you can determine your own cognitive future by adopting a brain healthy diet and adding behavioral elements like exercise, sleep hygiene, stress management, cognitive challenge and social interactions.

Sound familiar?

He makes his case with meticulously documented references to the existing and emerging body of research and supplements it with case studies of people who were able to reverse their cognitive decline using his program. At times, it reads like an episode of “Grey’s Anatomy” or “House” where the doctors are unable to cure the illness until someone discovers that a rare toxin is causing the symptoms. They eliminate the toxin and the patient recovers.

As it pertains to dementia, the idea that you can reverse symptoms is pretty radical and flies directly in the face of the old notion that dementia is an unavoidable part of aging. As Dr. Bredesen documents, though, there are a large number of dementias that can be traced back to chemical, environmental or behavioral causes that can be rectified.

Which brings us to his program. It begins with an extensive battery of tests to identify the pathogens that might be affecting you as well as determining your levels of good chemicals and compounds. Once these factors are identified, you can design a diet that will correct imbalances and eliminate neurotoxins at their source. Progress is documented through ongoing testing and tweaks are made as you chart your reactions to the changes you have implemented.

Most of the book is spent going into great detail about how your diet affects long-term brain function. I’ll admit, I glazed over at the extended paragraphs laden with scientific terminology describing the chemical compounds and intra-cellular functions that were involved. Although he says he intends the book for consumers, it seems his real audience is physicians who he hopes will adopt his program. I can see how the book would be a great resource for someone who is guiding you through the process, but it definitely contains way too much information for most of us. Nonetheless, there are plenty of general recommendations and steps you can take to get started.

The chapters on exercise, sleep, stress management and cognitive challenge are informative, brief and a lot more digestible than the diet section!

Finally, Dr. Bredesen emphasizes that dementia is a process that takes years to develop. Your brain does its best to ward off attackers and to clean up the detritus after each daily battle. Over time, though, debris piles up and at some point the accumulation begins to take a toll on your cognitive functioning.

The good news is that most of this seems to be reversible if you start working on it soon enough.

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S1E32. The Fifth Pillar Of Brain Health

Different authors present the data and their conclusions about brain health research in a variety of ways, but they all pretty much cover the same material. What differs is the number of factors they identify. Since people can keep about 7 things (plus or minus 2) in short-term memory, I decided I’ll go with 5 so that 97.5% of us will have an easier time remembering them.

In previous posts, I’ve talked about 4 of the 5 pillars of brain health: diet, exercise, cognitive challenge and social engagement. In my way of looking at things, the fifth pillar is a twofer: sleep and stress.

We all know that we don’t function well and we make a lot of mistakes when we don’t get a good night’s sleep. Another way of describing that experience is to say that our brains are compromised when we don’t get adequate sleep and that is what causes the errors in our waking performance. 

A lot goes on in our brains when we sleep, including the cleaning up of chemical waste generated during the day, pruning of unnecessary synapses, and consolidation of long-term memory. Need I say more about the need to establish a healthy sleep regimen?

I used to teach sleep hygiene on the inpatient behavioral health units where I worked. As a cognitive-behavioral psychologist, I emphasized habits you could develop to help you get a good night’s sleep which is critical for those battling mental illness. I talked about no caffeine after 12 noon, setting a fixed time to get into bed each night, establishing a going to bed routine (e.g., reading or listening to music for half an hour before getting in bed), writing down everything you need to do the next day so you don’t think about it, etc.

I told my patients it was important to only use the bedroom for sleeping. The idea was that you would develop an association between the room and sleep and so just walking into the room at bedtime would trigger a sleep response. They would invariably ask about sex and I would tell them that if you really are having trouble sleeping, then move the sex to the living room or anywhere else other than the bedroom. That suggestion never failed to generate hoots and howls!

The brain healthy recommendation is 7-9 hours of good sleep. I’m not getting that consistently, so we’re trying a couple of things. We’ve set bedtime at 11pm. We don’t eat anything after 8pm (it turns out that this is really good for losing weight, too!). The recommendation for sleeping room temperature is 65-75, so I set the thermostat at 73 just before getting into bed. I just ordered blackout curtains from Amazon to try to help extend our sleep in the morning. As for bedroom sex…well, we’ll see how these other adjustments work out first!

The relationship between stress and brain health is a little more complicated. There’s good stress and bad stress. The good kind motivates you to achieve your goals. The bad kind triggers your fight-or-flight system and doesn’t feel good. Chronic bad stress releases cortisol which, over time, can be toxic to your brain, so you want to keep it at a minimum.

I used to teach stress management techniques several times each week in group therapy at the hospitals where I worked. The go-to skill that everyone should have is deep breathing. Back in 2006, I taped my presentation and put it on YouTube so patients could access it after they left the hospital. It’s been viewed nearly 139,000 times since then. You can check it out here. (Warning: I recorded this in one take and didn’t realize that there would be a ghostly ultraviolet glow once I turned out the light. You might want to watch it with your eyes closed!)

I can’t say that I’m experiencing much bad stress at all these days. So I’ll just leave it at that. Life is good!

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S1E31. There’s Hope For The Next 30 Years

Those who have followed this blog from the first post know that it started out as an effort to document my changing mental status over time. But over the course of the last month, it morphed into an account of my efforts to delay and (hopefully) prevent significant cognitive decline in the coming years. 

How did that happen? 

When I began writing last December, I assumed that dementia was something you were destined to develop. Either you had the gene or not. You were either lucky or you weren’t. But I soon learned that that was not the case. It turns out that, although there is no treatment or cure for dementia, you can do things to reduce your risk of developing it by 40%.

Bottom line: genetics is not destiny. You can get dementia without the gene and, conversely, not everyone with the gene develops it. The odds are just higher for those with the gene. Overall, about half of us will develop dementia after age 85 if we live that long and if we do nothing to protect ourselves. Making all the recommended behavioral changes lowers your chances of dementing after 85 from 50% to 30%.

Allow me to digress here for a moment to note how amazing it is to even be having this conversation. When I was in my early 20s, the average life expectancy for an American male was around 72. Now it’s over 85. Many of our parents are living into their 90s. It’s no longer unusual to read newspaper obituaries of centenarians. I would not be surprised if the final longevity calculation for my generation of baby boomers turns out to be over 100.

If that’s the case, then at 70, I may have 30 years ahead of me. Thirty years! I find that mind-boggling, don’t you? But all that extra time will be hell on earth if I dement. That’s a pretty strong motivator for changing one’s behavior, don’t you think?

So back to my main point…

There are 3 biological processes that make it possible to influence your cognitive future:

1. Epigenetics. Although your genes set the broad parameters of your life, you can influence how they are expressed, most importantly by controlling what you eat, how often you exercise, and the quality of sleep you get. So although I might be genetically programmed to live to be somewhere between 70 and 120, where I actually wind up will depend upon the lifestyle I assume on the way there. The same goes for brain function and cognitive decline.

2. Neurogenesis. Not that long ago, the common wisdom was that your brain developed until your mid-twenties and after that there was a long, inevitable process of cell loss. I used to joke about not holding in a sneeze because the spike in pressure would kill brain cells. Research in the last few decades, though, has demonstrated that we continue to grow new brain cells right up until we die. We just need to motivate our brains to do so by constantly challenging ourselves.

3. Neuroplasticity. Our brain is a mass of circuits formed by individual neurons connecting with each other. If there is damage to one part of our brain, there is the capacity (within limits) to re-wire ourselves to compensate. So even if a short-circuit develops because of some micro-damage, it’s possible to physically get around it. There’s a built-in resilience, if we can only tap into it. That may be the best news of all!

Those three things give me hope. We’re fortunate in that, just as we are living longer and finding ourselves at greater risk to develop dementia, research is discovering how to manipulate our biology to offer some protection.

And that is why I am changing my diet, exercising regularly, improving my sleep hygiene, doing crosswords and jigsaw puzzles, keeping my stress levels low and trying to socialize more.

While I catalog my behavioral changes to protect against dementia, I’ll try not to ignore the cognitive errors that keep cropping up. This week, for example, it became painfully apparent that I have pretty limited visual memory.  

I notice it when I do my daily jigsaw puzzle. I’ll study the picture before starting and describe it to myself verbally: “There’s a blue sky with clouds in the center, then a horizon line of mountains and a wheat field along the bottom, with dark green foliage on the right and light green foliage on the left.”

No sooner do I begin the puzzle, though, than the image of the whole picture disappears. Try as I might, I can’t conjure it up in my mind. I can recall the verbal description, but I can’t see it. Consequently, I match colors and shapes to complete the puzzle without having a sense of what the image is I’m creating. I’m surprised at the end when I see how it all came together!

Once I noticed this was happening, I tested myself by seeing if I could visualize the wall hanging we have of a Renoir painting. Nope. Couldn’t do it. I could clearly see portions of the painting like faces, hands, a hat and a dress, but I couldn’t see the whole thing all at once. There were several large features I didn’t recollect at all…and I’ve been looking at this painting every day for over a month now.

The good news is that I’m pretty sure this is baseline for me and does not represent a recent decline. 

When I was in graduate school, we would take the psychological tests we were learning to administer in order to better understand them. I recall doing well on the verbal portions of the Wechsler Memory Scale, but not so well on the visual tasks where you had to remember the items in a picture or a group of faces. How this plays out at a practical level is that Sally will ask me to describe someone I just met and I won’t be able to tell her the color of the person’s hair or eyes, or pretty much any other feature, for that matter.

I suppose I should keep track of this to see where it goes over the next 30 years.

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