Alzheimer's – Mistakes on the Journey to Nowhere

S3E12. The Leafy Greens Rabbit Hole

I’m not one to shy away from going down rabbit holes and this week found me tumbling my way down to Wonderland once again.

It all started with a report I read of a study published in Neurology this month that found (upon autopsy) that people who most closely adhered to the Mediterranean Diet had far fewer harmful plaques and tangles in their brains than those who did not.

What was surprising about the result, though, was that almost all of the benefit was found to be associated with consumption of leafy greens. I don’t want to get this wrong, so here is the finding verbatim: “People who ate at least seven servings of leafy greens per week had brains that looked 19 years younger than the brains of people who ate greens once a week or never.”

The authors, in typical researcher understatement, suggested that the findings are “enough for people to consider adding more of these vegetables to their diet.”

Duh! Ya think?

After reading that, I packed my bags for the rabbit hole!

First question: What are leafy greens?

A quick google search answered that pretty definitively: “Leafy greens include various types of lettuce (e.g., romaine, Bibb, butterhead, Boston, arugula, spring mix, red leaf, green leaf, etc.) as well as spinach, Swiss chard, watercress, collard greens, mustard greens, turnip greens, and kale.

Since I was headed down a rabbit hole, though, I asked which were the most beneficial in terms of nutrients. The ranking, from most to least, is: kale, microgreens, collard, spinach, cabbage, beet greens, watercress, romaine, Swiss chard, arugula, endive, bok choy and turnip greens. (Keep in mind that they are all good for you. This ranking is like seeding the Top 10 basketball teams in the country.)

I then got to thinking about the 7 servings part. That’s one serving per day. Since (1) I don’t consider leafy greens a breakfast food (and my breakfast granola is already a complete and completely filling meal) and (2) I don’t really eat a lunch, the math compels me to (3) get my one serving at dinner every night.

But what, I asked, is a serving of leafy greens?

Ladies and gentlemen…welcome to the leafy green rabbit hole!

Of all the options, spring mix with baby spinach is the one I most prefer. It frequently forms the base for a large salad with multi-colored peppers, red onions, mushrooms, avocado, tomatoes, salmon or anchovies, dulce and an olive oil dressing. (It’s also how I most often honor the research suggesting that brightly colored vegetables are better for you.)

But 7 nights a week? I don’t think so.

So exactly how much spring mix do I need to nibble to reach my daily quota?

Back to the google. Several reputable sites agreed that one serving was equal to 2 cups of loosely packed leafy greens.

‘Loosely packed,’ though, is not a clearly defined term, now, is it?

I tried putting spring mix into a measuring cup, but the act of grabbing the leaves and getting them into the cup inherently led to some amount of packing. When I poured it out into a bowl, it was definitely more than what I would consider a reasonably-sized serving, but I couldn’t see any way to pack it more loosely.

Come to think of it now, isn’t ‘loosely packed’ pretty much an oxymoron?

Then it occurred to me that I could look at my spring mix’s package for guidance. I knew there would be a nutrition label on it that indicated serving size and how many servings there were in the container.

Are you ready for this?

The label said that there was 1 serving per container.

Are you kidding me???

The label also told me that the contents weighed 5 ounces or 142 grams. So back to the google I went once again to see how much a serving weighed. The answer was a little ambiguous: 60-90 grams, depending on the vegetable. Using the midpoint of 75 grams would suggest that there are really 2 servings in that package, not 1.

Even if I went with that formula, though, it was still an impossible quota to meet.

It seemed that implementing the dormouse’s urging to ‘feed your head’ was not as easy as it ought to be!

Deep from within the recesses of my early memory banks, though, an image surfaced of Archimedes dropping objects into his bathtub and discovering that they displaced an amount of water equal to their volume.

‘Eureka!’ I cried.

I’ll empty out the container of leafy greens and fill it with water using a measuring cup. That will tell me exactly how many 2-cup servings there are in the container.

I’ve kept you guessing long enough. Four. There are exactly four servings in a 5 ounce package of loosely packed leafy greens.

And that amount meets the eye test. It looks like a reasonably-sized side salad.

I can handle that.

Needless to say, there are any number of ways to satisfy your leafy green requirement other than doing it all with spring mix. You can cook spinach, kale, mustard or collard greens, for example. But I’ll leave it up to you to figure out the serving size for each of those. 😀

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S3E8. A Most Unlikely Music Man

Have you ever thought about your relationship to music? I’ve been thinking about it a lot this week in the context of writing this blog episode. My intention was to write about the brain benefits of playing and listening to music, but I got seriously sidetracked.

If I had to pick one word to describe my lifelong dance with music it would be ‘inadequate.’

Although my parents didn’t listen to music at home, they offered music lessons to their children. My older sisters played the accordion and piano, but I quit the piano after just 3 lessons.

I’ve long regretted that decision for a number of reasons, but now you can add to that the fact that playing an instrument is correlated with a reduced risk of developing dementia later in life. The current thinking is that, like learning a second language, it develops a cognitive reserve that can be recruited when your primary circuits start to fail you. The good news is that you can still reap some of the benefits of learning to play an instrument at whatever age you decide to do it. For me, that was 70.

I’ve always envied those who could play an instrument and those who could sing. By elementary school, though, I knew that I couldn’t carry a tune. When Mrs. Wolfe, the music teacher, visited our classroom each week, I’d mouth the words to try to slip by unnoticed. Unfortunately, there was one day when she had everyone else stop singing so she could hear me. It was humiliating.

Even though I had no aptitude for music, my world was shaken when I was 10 and I went to the drive-in with my parents to see ‘West Side Story.’ I couldn’t get the tunes out of my head, I was in love with Maria and I started talking with a Puerto Rican accent!

Through my teens, though, my music insecurity increased (as did a boatload of other insecurities) as I realized that my friends all liked and had opinions about music but I did not. What was wrong with me?

Like all of my friends, I was captive to AM radio’s Top 10. We all had a bedside radio to play music to wake us up and to put us to sleep, and a transistor radio to keep us company the rest of the time. I pretty much didn’t like any new song when I first heard it and wondered why the DJs played songs like that, but then the more I heard them, the more I liked them.

I thought that that was a failing on my part, because I had friends who would get excited the first time a new song was played. In hindsight, I now know that what I experienced was pretty normal. It’s called ‘the mere exposure effect.’ Simply put, the more you see or hear something—unless there is something fundamentally offensive or odious about it—the more you like it.

Coming out of high school, I considered myself a soul man, happiest when listening to Motown artists like The Temptations, Four Tops, Diana Ross and the Supremes and Smokey Robinson. But I enjoyed the popular lineup of artists from that era, too: Beatles, Rolling Stones, Beach Boys, Four Seasons, Simon & Garfunkel, Mamas and the Papas, et al. I had also developed a fondness for the doo-wop sound of the 50s which is what Cousin Brucie and Scott Morrow played on WABC-AM as ‘oldies.’

In college, EVERYBODY had strong feelings about their music, except, it seemed, me. I clung to my R&B and resisted acid rock for a long time, but exposure to new music was inevitable as the occupants of every dorm room had record players which were blasted at all hours of the day and night.

Two doors down on my floor freshman year at Brown was a 6’9″ basketball player from western Pennsylvania coal country who loved Broadway musicals. I owe him a debt of gratitude for introducing me to ‘Hair.’

Sophomore year, three Canadian hockey players shared a suite next to the triple where I lived and played Crosby, Stills, Nash & Young’s ‘Helpless’ over and over again because they were homesick (‘There is a town in north Ontario…All my changes were there…’). Thank you.

I inhaled Janis Joplin, James Taylor, The Band, Led Zeppelin, Santana and—at long last—Cream. Sally brought me to her college’s library, sat me down in a listening room, placed earphones on my head and played ‘Abbey Road.’ OMG! Friends turned me on to Laura Nyro and Blood, Sweat & Tears. The only artist I ever ‘discovered’ by myself was Elton John. I had decided not to go home on winter break my junior year and was listening to the campus radio station WBRU one snowy night when ‘Your Song’ came on. I bought the album the next day.

Yet somehow, 4 years later, a guy who had no musical aptitude and whose musical tastes were dictated by his surroundings and who had never seen an opera or a symphony found himself the director of a 3,365-seat performing arts center that was the home of the New Jersey State Opera and New Jersey Symphony Orchestra. Talk about feeling inadequate!

I knew I was ignorant when it came to classical music so I decided to attend performances and sit in on rehearsals when I could, hoping to learn what all the fuss was about. What a rare and wonderful opportunity I had!

The problem, though, was that after settling into my seat, my mind would soon leave the music behind and think about anything and everything else. One night, I found myself composing a memo while I was supposed to be watching ‘Madame Butterfly!’

This inability to focus bothered me for years. What was wrong with me? Years later in graduate school, I learned that there were different attentional systems in your brain, some that attended to outside stimuli and some that attended to your internal dialog. I theorized that my internal attentional system must have been stronger than my external system. That would explain both my failure as a concert-goer and my ability to tune out distractions when studying. It certainly was a double-edged sword.

While doing research for this blog episode, I discovered that my guess was on target. That internal attentional system focuses on what is now called ‘mind-wandering’ or ‘self-generated thought’ and it is believed to be your brain’s default system. This means you have to expend cognitive effort to focus on outside stimuli, thus consuming units of a limited amount of attentional resources. When your brain gets tired of sustaining its attention on something in the environment, it will revert to ‘listening’ to what you have to say to yourself.

Fast forward to the present.

My music exposure is way up since I re-connected with Sally who has a truly enviable and remarkable relationship with music. I’ve attended more concerts with her in the last 12 years than I had in my first 60! Earlier this month, we saw Mandy Patinkin in Wilmington and last night we saw a Linda Rondstadt impersonator at a community theater here in West Chester. Next month, we have tickets for Yo-Yo Ma in Philadelphia and in June we’re seeing Bryan Adams. In between, we’ll probably go to nearby restaurants a few times to hear Sally’s nephew Jake perform. (He’s really good. You can check out his latest single here.)

Going back to that Yo-Yo Ma concert in March, it will consist of Beethoven’s 4th symphony and his Archduke Trio. I’ve been listening to those pieces and having a fabulous time doing so. I’m hearing classical music like I’ve never heard it before, tracking the various instruments as they flit about one another, being tickled by the trills and thrilled by the crescendos. And now that I’ve heard each piece a number of times, I actually LIKE them! Admittedly, my mind drifts away periodically, but I seem to be better able to sustain my attention than in the past.

Inspired by that success, I decided to try to spend an hour each day listening to all 9 of Beethoven’s symphonies with the goals of staying focused and learning to like them.

As luck would have it, that decision makes brain-health sense. Sustained attention is an important cognitive function which has been linked to other cognitive functions like learning and memory. The research also tells us that listening to new music is protective against cognitive decline. I’m pretty sure, though, that you actually have to listen to it and not just have it as background music while your mind jogs off in other directions.

Now when you add an hour each day listening to Beethoven to the time I spend practicing the recorder and the time I’m listening to my playlist while working out on the treadmill, you get more than 2 hours each day when I’m immersed in music…and all of that time is challenging, interesting, fun and brain healthy.

And you know what else? I’m not feeling musically inadequate anymore! 😀

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S3E3. Brain Eaters

In this season’s first episode, I mentioned that I was in awe of the symbiotic relationship between microglia and neurons. I’m ready to explain why.

Let’s begin with the basics. We’re all familiar with neurons, the sexy cells that connect with each other, transmit electrical signals, store all of our memories and control our abilities to perceive and do things. We have about 86 billion of these cells and they form about a quadrillion (1,000 trillion) synapses with one another. And, yes, we use all of these cells, not just one-tenth of them.

There are about 100,000 miles of blood vessels providing oxygen and nutrients that enable them to work non-stop as long as you breathe.

Please take a moment to embrace the awe inherent in these numbers!

But neurons only comprise about half the cells in our brains. The rest are known as glia. Early on, these cells were just believed to provide a structure within which the neurons could function, like trellises for grape vines in a vineyard. But there are several different types of glial cells and they do a whole lot more than just provide the scaffolding and glue that hold the brain together:

Oligodendrocytes attach themselves to the long axons that stretch out from the neuron bodies and cover them with fatty tissue known as the myelin sheath. This is the brain’s white matter. It acts like insulation on a wire and improves the quality of the electrical impulses. If the myelin sheath breaks down and the signal is sufficiently compromised, that neuron may not be able to communicate with other neurons.

Astrocytes wrap around neurons and are involved in a variety of functions ranging from providing nutrients to enhancing synaptic activity to regulating blood flow to creating neurotransmitters to signaling the presence of invaders which triggers an immune response.

Pretty impressive, huh? Feel free to take another moment to let another wave of awe wash over you.

Then there are my favorites, the microglia. These cells have a variety of roles that change over one’s lifetime.

It turns out that you are born with way too many synapses and so you experience a period of synaptic pruning where inactive connections are eliminated by microglia who eat them.

Eat them!

Then as you mature, the microglia take on the role of janitor, cleaning up chemical garbage that accumulates between neurons, including the dreaded beta amyloid. They are also responsible for the primary immune response to local infection and injury. But that’s a two-edged sword: the inflammation caused by an immune response in your brain has been linked to dementia. They also eat damaged neurons as part of their protective role, but sometimes that process runs amok and they eat healthy neurons, as well.

Finally, the glymphatic system has a network of tubes that transports fresh fluid into your cranium, mixes it with the waste-filled fluid surrounding brain cells, and then flushes the solution out of your head and into your bloodstream where it can be excreted. All of this occurs during deep sleep.

The more I think about this elaborate, complex, elegant system, the more awestruck I am.

If any of these types of cells weren’t present, the entire system would break down pretty quickly. Or put another way, we wouldn’t exist if all of these tiny organisms hadn’t evolved together in their interdependent microscopic biome.

Try to imagine the process, played out over hundreds of millions of years, that led to this current iteration. How many combinations and permutations of chemicals stressed under different environmental conditions did Nature experiment with before stumbling upon one that would cause a cell to extend itself out from its body in search of similar cells, thereby giving birth to neurons?

And what does it take for a second…and a third…and a fourth type of cell to evolve that depends upon a neuron for its existence yet enhances the functionality of the host cell itself?

And how did they all come to coexist only inside a cranium?

And if what we see now is the culmination of a billion years of evolution, what will the next billion years bring?

Just thinking about the brain and how it works is truly mind-boggling!

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S2E42. Time Zones: Week 2

I’m sorry to foist this on you, but my experiment in preparing for a 7-hour time zone shift prior to our cruise is pretty much consuming my waking hours. And my sleeping hours, too, come to think of it.

This week was really rough on me. The good news is that I got into a rhythm of waking up at 4am as opposed to my normal 7:30am routine. But that was leaving me sluggish and pretty much wiped out during the day, even when I took a nap around noon.

It really had me perplexed because it was only 12 years ago that, following my first wife’s passing, I was on a regular schedule that had me getting up at 4:30am, working out on a treadmill and weight machine in my basement for an hour before showering and going to work. And I would feel physically fine and cognitively alert the whole morning (I had to be as I was a clinical psychologist on an acute care inpatient unit). Then I would take a nap in my office at noon and finish out the day, even putting in an extra hour or two at times.

So why was this so difficult? It appears that our circadian rhythms get a little cranky and less flexible as we age, but I didn’t think the difference between being 59 and 71 would have such a dramatic effect. Apparently, it does on me.

My new routine has me waking up at 4am and immediately walking for half an hour at a brisk pace. I moved my workout to first thing after waking up because I found I was too tired later on in the day to convince myself to do it.

Luckily for me, the new management company for our apartment building is renovating. They are painting the hallways a lighter color and changing the lighting so that it is like daylight out there…and early morning light is exactly what is called for when trying to fool your sleep-wake system into re-setting itself.

So my morning exercise of walking the halls (where 1 lap around is about 200 yards) is serving a dual purpose. If the hallways weren’t so fortuitously bright, I’d probably have to buy a light box and sit in front of it for a while after waking up. Thank goodness I lucked out and avoided that fate!

After my walk, I sit down with my computer, turn the brightness up full, and do The New York Times crossword puzzle, Spelling Bee, Wordle and Nerdle. It’s about then that Sally wakes up and I make her coffee and my tea to initiate our normal morning ritual. By then, the sky is starting to brighten and it feels like things are almost back to normal.

Sally is not all that enthusiastic about my attempt to prepare my body for Athens. Her natural rhythms would have her going to sleep around midnight, but she also likes to go to bed when I do, so my new hours have thrown a major monkey wrench into her routine. She reminds me that we went to Paris a few years back (6-hour time difference) and really didn’t do anything to fend off jet lag and neither of us can recall any severe effects. She has a point.

By 11am, I’m getting groggy and thinking about taking a nap. It takes me a while to appreciate the fact that I’ve already been up for 7 hours and I’ve worked out, so napping at 11am isn’t such an off-the-wall idea.

I’m eating dinner a little earlier than before (around 5:00pm instead of 6:30pm. After all, it’s not just your sleep but your hunger/digestive rhythms that need to adjust, as well.

Bedtime is the biggest problem. Early to bed means I can’t watch most of the Phillies games in the playoffs. Bummer! My compromise has been to get in bed around 9ish so I could at least watch a few innings. But that only left me the potential for 7 hours of sleep and, with the usual time it takes to fall asleep and the usual number of nighttime awakenings, I was only getting about 6 hours of actual sleep…and that just wasn’t enough for me, even with a mid-day nap.

So on Wednesday of this week, I moved my bedtime back to 8pm…and it worked like a charm! I got a good 7 hours of sleep and I felt fine the rest of the day. Now I know that I need to lock-in 8 hours in bed, no ifs, ands or buts!

As of today (Friday), I’ve got just 7 more days available to adjust. I’ve picked up half of the 7-hour transition I’ll be making, leaving a 3½-hour difference. I know I won’t be able to get all the way there, but I think I’d like to transition 1 more hour before we board the plane. That would be a 7pm bedtime and 3am awakening. Somehow, doing that never made it onto my bucket list!

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S2E40. Going Back To Sleep

It was just 9 weeks ago that I posted a blog about sleep (S2E31. Sweet Dreams Are Made Of This) in which I described my lifetime relationship with sleeping and napping.

I thought I had said all I needed to say about sleep’s importance as one of the five pillars of preserving brain health, but The Universe seemed to have a different idea. All of a sudden my inbox and social media feeds were full of articles about sleep and sleep hygiene…and it wasn’t even National Sleep Awareness Week!

So I played along and watched a webcast of an interview with Matt Walker, Ph.D., a sleep scientist at the University of California-Berkeley (you can watch the 1-hour event here: youtube.com/watch?v=ZaxGiYyUcyI).

A lot of the information he presented was new to me, so I read his book Why We Sleep.

WOW…was I ever impressed! It was a real page-turner! He keeps his use of jargon and scientific terminology to a bare minimum and has a knack for selecting just the right analogies to make the research he details come to life. But it’s the content he covers that is truly mind-boggling. It was humbling to discover how little I knew about sleep.

Did you know that all creatures who live more than a day sleep? Including insects and worms?

Did you know that only one side of a dolphin’s brain sleeps at a time because it has to stay awake to surface and breathe?

Did you know that just one hour of lost sleep can significantly impair your cognitive abilities and possibly even kill you? Apart from all the laboratory studies that demonstrate this, we have an unintended real-life experiment that is run every year. It turns out that the day after daylight savings time goes into effect (and we lose an hour of sleep by turning our clocks forward), there is a spike in the number of fatal heart attacks and car accidents. Conversely, when we turn our clocks back in the fall (and gain an hour of sleep), there is a corresponding drop in heart attacks and traffic accidents.

Fascinating!

Apart from fun facts to know-and-tell, the research he described was simply amazing. He would begin by asking what happens when we sleep, then progress to how it happens, and end up answering the ultimate question: why does it happen?

For the purposes of this blog, though, the meaty part of the book involves sleep’s effects on memory.

Dr. Walker explains that the hippocampus maintains traces of your experiences each day and then, during sleep, it empties itself by sending important information out to a variety of cortical areas where it is permanently stored in the form of memories. It’s kind of like downloading the contents of a thumb drive onto your hard drive and then erasing it from the thumb drive so it has its full capacity available for the next day. One stage of sleep is responsible for transmitting the data and a different stage of sleep takes on the task of cementing it in place by strengthening the synapses where the information is stored.

If your early sleep is disturbed enough, the information won’t be transmitted and you won’t remember much the next day. If your sleep later in the night is disturbed, the newly planted memory won’t be consolidated and you won’t remember much, either.

So if you want to be able to remember more about what happened today, you’ll need a good 7-9 hours of high-quality sleep tonight…and for the next couple of days, as well.

If you don’t get good early sleep, the hippocampus won’t empty out and it will have limited storage space available the next day. That’s part of the dullness you feel when you haven’t slept well and accounts for some of the difficulty you have learning new information that day.

Unfortunately, once we get into our 60s, our sleep patterns begin to change…and not for the better. We tend to sleep fewer hours and the quality of that sleep is compromised by more awakenings…all of which wreaks havoc on our memory, immune system, emotional reactivity and judgement.

It also compromises the nightly cleansing of the day’s chemical detritus which includes beta amyloid and tau particles, the accumulation of which are associated with Alzheimer’s pathology.

The take-home message here is that it’s not true that we need less sleep as we age. We need the same amount of sleep that we needed when we were younger to allow all of these crucial processes to be executed every night. The problem is that we don’t get the sleep we need as often as we should.

Putting all this together, it’s no surprise that getting fewer than the recommended number of hours of sleep on a regular basis is a risk factor for dementia. The relationship is so strong that researchers are now exploring whether sleep patterns can be used to predict whether or not you will develop a dementia a few years down the road.

Dr. Walker ends the book with a listing of things you can do to maximize your chances of getting the sleep you need (spoiler alert: taking sleep medication is not one of them). Here’s a link where you can review them: https://www.nhlbi.nih.gov/files/docs/public/sleep/healthysleepfs.pdf

The one change I made after reading the book had to do with my computer usage.

I’m usually on the computer right up until bedtime, but it turns out that that’s a terrible thing to do. You see, the LED screen of a computer emits strong light waves at the blue end of the spectrum. It is this wavelength of light that triggers your circadian rhythm which tells you when to wake up and when to go to sleep.

By bathing myself in blue light late at night, I was telling my brain that it was still daytime and so it delayed sending out the signal to initiate the sleep cycle until after I turned off the computer and went to bed.

I thought about changing my end-of-day routine, but realized I’m pretty much addicted to my computer use. Fortunately, the people at Apple have provided a solution. There is a program built into their computers and phones that will change the color emitted by their screens in the evening, going from blue-white to a soft yellow-amber. Problem solved! The program is called ‘Night Shift’ and you can find it by clicking on the ‘Display’ icon in System Preferences or Settings.

Alternatively, you can buy glasses that block the harmful wavelengths.

I’ll close with one more snippet from the book:

So, you ask, why is it that our circadian rhythm is triggered by blue light and not by full-spectrum sunlight?

You might recall that we are descended from fish and their aquatic predecessors. The circadian rhythm was an adaptation that evolved while we were living in water. But water filters out the other wavelengths of natural light leaving only the blues and greens. Eons ago, then, our evolutionary ancestors lived in a world that oscillated from darkness to blue and back again. And that’s the light pattern that controls your circadian rhythm to this very day!

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S2E39. The 50th Reunion

We were 21 and 22 years old. It was our last semester at Brown University. There were 7 of us: 4 girls and 3 guys. We shared the left half of a duplex at 43 East Manning Street in Providence, Rhode Island. It was 1972.

Five of us got together on Cape Cod this past weekend for our 50th reunion. We came from Oregon, California, Massachusetts, Connecticut and Pennsylvania. On Friday, we zoomed with the 2 missing classmates who live in New York and California. Although various combinations of us had gotten together over the years, this was the first time we had all been together since graduation day a little over half a century ago.

It was remarkably easy being together again in a shared living space. We brought photos and journals and letters we’d kept. We reminisced about how our group formed during the first 2 years at Brown, about our time on East Manning Street, and about the years since.

We shared memory after memory of our days together. Some of the stories were new to me. No one remembered everything. Some remembered more than others.

Some memories were pulled into consciousness from the deepest of slumbers. Others were made richer and more complete by hearing different perspectives of the same event.

There was one memory that only I of those who were there remembered. It was a sunny, crisp fall day during our sophomore year and we decided to walk to the Seekonk River which wasn’t very far away. On that afternoon, ripe milkweed pods were opening and the breeze was lifting the seeds out of their husks. Hundreds floated in the air all around us. It was snowing milkweed! I had never seen anything like that before, nor have I since.

I filled my pockets with the feathery fliers even though I didn’t know at the time what I would do with them. A few days later, I found a clear wine bottle and pushed them into it with a pencil. It was a sculpture…a work of art!

I kept that bottle through the years, brought it with me to the reunion, and told the story of how it came to be. As I sat looking at it, the Jim Croce lyric “If I could save time in a bottle” popped into my head and I realized that that is exactly what I had done.

I have no pictures from that period, so looking through the albums was, to me, astonishing. My visual memories were weak, faded, and in soft focus. Looking at those surprisingly unfaded color photos was like dusting off my own history, restoring it, and mounting it on the wall. I had forgotten how young we were.

Paraphrasing Hillary Clinton, it occurred to me that it takes a village to not only make a memory, but to preserve it.

In 2001—29 years after our time together and 21 years ago—I had occasion to try to capture our experience on paper. Here’s part of what I wrote:

“It was a time of passions expressed and passions denied; a time of independence, intimacy, intensity, and insufferable debate…but never, ever, indifference…Did any of us know that in that shortest of times we had permanently stitched ourselves into the fabric of each other’s lives?”

We toasted the good fortune that first brought our unlikely band together and we toasted the serendipity that allowed us to celebrate it a lifetime later. As we did so, we made more memories to carry with us to a future reunion: walking on the beach, avoiding poison ivy in the cranberry bog, making dinners, eating ice cream in an old schoolhouse, listening to oldies, doing a pot gummy, and visiting with 2 other classmates who were in the area.

And, of course, we took lots of pictures to share with the pair who could not attend and to fill an album that will help preserve these new memories for all of us.

I don’t think anyone wanted it to end. We joked about having a 75th reunion, but quickly realized we would be in our mid-90s, and so we decided we might want to do this again a little sooner than that.

In 1973, just one year after we graduated, Marvin Hamlisch wrote and Barbara Streisand sang ‘The Way We Were:’

“Memories

Light the corners of my mind

Misty watercolor memories

Of the way we were

Scattered pictures

Of the smiles we left behind

Smiles we gave to one another

For the way we were

Can it be that it was all so simple then?

Or has time re-written every line?

If we had the chance to do it all again

Tell me, would we?

Could we?

Memories

May be beautiful and yet

What’s too painful to remember

We simply choose to forget

So it’s the laughter

We will remember

Whenever we remember

The way we were

The way we were”

But we didn’t forget the painful parts. It was a unique combination of laughter and sadness and youth and intimacy and time and place that created the unbreakable bonds that we still feel so strongly today.

And to answer the song’s question, yes…I would do it all again. In a heartbeat!

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S2E38. Dementia Prevention: Brain Games

The notion that playing brain games on your computer can help prevent dementia is rooted in the research on neurogenesis and neuroplasticity.

Neurogenesis is the process whereby you can grow new brain cells at any age. Neuroplasticity is the process whereby you can grow new connections between neurons.

In theory, then, anything you do that (1) grows new brain cells, (2) increases the number of synapses between neurons, (3) strengthens cells and/or (4) protects them from harmful chemical interactions should all help slow down the process of cognitive aging. The recipe is pretty simple: bulk up your brain mass while minimizing the things that can cause it to atrophy.

But it’s not just a theory. The research supports this view.

Exercise grows new cells, increases synaptic connections and strengthens the quality of transmission of electric impulses from cell to cell by thickening the axon’s myelin sheath.

A brain healthy diet provides nutrients that support neurogenesis as well as antioxidants that help clean up neuron-killing chemical detritus (e.g., beta amyloid and tau) that are residuals of your body’s immune response (i.e., inflammation).

Sleep expels toxins that accumulate on a daily basis and also increases the strength of neuronal connections (synapses) which form long-term memories.

When we engage in cognitively challenging activities—especially new and novel tasks—we create more connections. That is why reading a book, learning to play an instrument or to speak a new language, and navigating around a different environment (e.g., traveling) are all brain healthy activities.

But what about playing computer games? The evidence is spotty, but it seems that there might be something there. Enough, anyway, to justify millions of dollars of new research to try to nail down just what it can and can not do.

In S2E29: Brain Training Is Hard Work! I discussed the intense effort I expended during my first week of working with the BrainHQ program. Now, 9 weeks later, I have some data I can report.

First, let me say that I over-did it. Playing these games for an hour each day was exhausting. However, it did allow me to quickly work my way through all 29 tasks covering 6 different functions: attention, brain speed, memory, people skills, intelligence and navigation. After 5 weeks, I dropped down to 30-minute daily workouts, which was much more manageable.

So how did I do?

The program provides you with a percentile ranking that shows how your performance compares to others in your same-age cohort. After 9 weeks, my scores have leveled off and I’m not seeing any more improvement. I placed at the 89th percentile overall among 71-year olds, with individual domain scores that range from the 86th to the 94th percentile.

What is valuable about this is that I now have a baseline measure of my mental status. Going forward, if I maintain my 89th percentile ranking relative to my same-age peers, it will mean that I am aging normally. If that number drops, it will mean that my cognitive decline is a cause for concern. If it goes up, it will be a cause for rejoicing as it will suggest that I am not experiencing the expected pace of cognitive decline.

That information has practical value, too. It appears that measurable and accelerating cognitive decline starts to appear about 6 years before a diagnosis of dementia is usually made. If I continue to play these games on a regular basis over the coming years, my scores should serve as an early warning system of any emerging cognitive problems.

The alternative, of course, is to get a full neuropsychological workup every year. Playing computer games is a lot cheaper and more fun, though.

The knock on using brain games to promote brain health is that, although you can get better at the games, your new learning does not generalize to everyday life and so it has no clinical or practical significance, even if your scores continue to improve.

This past Sunday, though, I actually had a real-life experience for which I directly attribute my success to one of the games I’ve been playing.

In this game, designed to enhance your speed of visual processing, the computer screen is divided into 8 pizza slice shaped segments. Images of 11 birds are then briefly flashed all at once around the periphery. One of the birds, however, is different from the rest. For example, it might have a white body instead of a rust-colored body, or a white wing instead of a black wing. The task is to click on the slice of the screen where the odd bird appeared.

The more I played this game, the better I got. After a while, I was stunned at how accurate I was with only the briefest glimpse of birds on the screen.

Which raises the logical question: So what?

I’ll tell you what! Last Sunday, we were having breakfast at the home of Sally’s son and daughter-in-law. Tammy mentioned that she had seen a bird fly away from their backyard bird house, but couldn’t tell if it was a blue jay or a bluebird.

As we stood around talking in the kitchen, out of the corner of my eye through the sliding glass doors I saw the flash of a bird in flight. It was only a flash of color that lasted less than a second, but I was able to process its shade of blue and size, realizing immediately that it was a bluebird.

Impressive, huh?

Then we moved outside to eat breakfast. While we were seated around the table, Sally’s grandson Ryan (who recently graduated from college) brought out a bottle of champagne to make mimosas. When he popped the cork, it rocketed through a gap in a vine-covered fence and landed on the lawn beyond. I was the only one who saw where it went.

Pretty cool, eh?

OK. So it’s no big deal…but it does suggest that something good is happening inside my head thanks to my computer game playing.

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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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S2E35. The Fog Of Memory

It was the spring of 1986. I had quit my job in Newark, NJ, and we had moved out to Tyler Hill, PA, where we were renovating an 1847 farmhouse with plans to open a B&B by the 4th of July weekend.

I was in one of the bedrooms on the 2nd floor where I was removing more than a century’s worth of floral print wallpapers. The work was slow and painstaking, first soaking small sections in a solution of vinegar and water and then scraping it carefully so as not to gouge the plaster beneath it.

It was also pretty mindless. After a while, I started to replay memories. I was 35 at the time, so my just-ended career in Newark, high school and college years, and growing up were not all that long ago.

I seemed to be watching the movie of my life playing in reverse. The farther back I went, the faster the reel seemed to spin, until I saw my baby pictures in my mind’s eye and the movie ended.

I felt inexplicably exhausted, so I lay down on the floor and closed my eyes…and a feeling of relief swept over me. Suddenly, I felt unburdened by my past and all the emotional baggage that came with it.

I soon realized that all those memories were no longer as close and vibrant as they had been just a few moments before. It was as if I had packed them all into boxes and moved them up to the attic.

Whatever happened that day was not intentional on my part, but it seems to have repeated itself every 10 years when I switch careers. It’s as if I hold on to a ton of potentially relevant information in case I need it, but then put it into long-term storage as soon as I don’t.

It happened again last year when I ended my 10-year career volunteering for the Democratic Party. No sooner had I quit as chair of the local organization than my memories of a decade’s worth of campaigning became remote. They had joined the previous sixty years worth of boxes in the attic of my mind, in a place that I refer to as ‘ago’ to differentiate it from the here and now.

I envy people who say they remember events as if they were yesterday. I have no such ability. When I rummage around in one of those boxes, my recollections appear as photographs, not movies. And they are definitely not high-def! Many have shifted perspective, so I have a bird’s eye view instead of my actual eye-witness perspective.

Many memories have been replaced by memories of the photographs of those events which I’ve viewed over the years. It’s a poor substitute, but it’s all I’ve got at this point.

Although I can’t conjure up strong visual images, I have detailed memories of the stories I’ve told about those long-ago events. My semantic memory (i.e., the facts surrounding events) is much stronger than my visual recollections. Auditory memory is pretty much non-existent.

Occasionally, strong emotional memories will surface. A feeling—sometimes triggered by a smell—will overwhelm me. I can’t always place it, but it’s familiar…and usually warm and pleasant.

I remember myself through a fog. I can still make out the shapes of my past, but they’re distant. I know that all of these things are part of me, but I just can’t see them all that well, even though I can describe them in great detail.

I have no idea whether this is normal or not. I don’t think it’s gotten worse with age. I think I’ve always been like this…but I’m not sure because I don’t think I thought about it when I was younger.

Which makes me wonder where it goes from here.

I’ve been watching a series of lectures on the ‘Joy of Mathematics’ from TheGreatCourses.com. I remember loving math classes in high school and being good at it. I remember the joy of solving equations. I graduated from Brown just 2 courses short of meeting the requirements for a degree in math.

Yet watching these lectures has shown me that the lion’s share of all that learning and studying is completely gone from my memory. I know: use it or lose it. But it still seems a shame. And it raises the specter of vast stores of memories falling into a black hole from which there is no recall.

That possibility makes even foggy memories look really good by comparison!

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S2E34. Uh-oh: Memory Failure!

(Theodore Ribot, in The Diseases of Memory published in 1881, pointed out that the first characteristic of amnesia in patients with dementia is the loss of memory for recently experienced events with relative preservation of remote events.)

I opened an email from Greg, a classmate at Brown some 50 years ago, that include a link to a recent article in The Guardian titled “Stop drinking, keep reading, look after your hearing: a neurologist’s tips for fighting memory loss and Alzheimer’s.”

I appreciated his thoughtfulness in sending it to me as I am always on the lookout for articles that might generate the inspiration for a blog episode. This article was an interview with Dr. Richard Restak and the occasion was the release of his new book The Complete Guide to Memory: The Science of Strengthening Your Mind.

I googled the book before I even finished reading the article, then downloaded the electronic version so I could scan its contents. A lot of the usual material was covered and I was struck by the fact that here was yet another neurologist covering a lot of the same material that is standard for this type of tome. It didn’t look like there was much that I hadn’t covered in prior posts.

As I was moving it to the trash, though, I noticed that I had previously downloaded this very book!

Strange, I thought, that I hadn’t recognized the cover art. The name ‘Restak’ seemed familiar, but I couldn’t place it. Thinking logically, I realized that I must have read the book and, therefore, I must have blogged about it. So I scanned the titles of all my posts looking for one in which I might have written a review of the book. Since nothing jumped out at me, I began opening posts with potentially related titles and soon found it. It was S2E28: Working Memory Workout? published on July 15th.

That was only a month ago…and my memory of reading that book had all but evaporated!

What a kick in the pants! Here I was doing daily workouts to improve brain performance and I just had a major fail of episodic memory, the kind of memory malfunction that Ribot described back in 1881.

Episodic memory is our memory of what happens to us: what we do and what we experience. How could I not remember reading this book just a few weeks ago when I had obviously spent a lot of time reading it, thinking about it, and finally writing about it?

Forming an episodic memory has three stages. First you have to pay attention to the event. Basically, if it didn’t make much of an impression when you first experienced it, it’s unlikely that you will recall it later on.

Second, you need to encode it into memory. You do this by thinking about it, processing it, replaying it, and linking it to other experiences so it fits into a framework for remembering.

Finally, you need to be able to retrieve it. Recall memory is when you can retrieve it from your memory banks without any assistance. Recognition memory is when you need cues or hints in order to find it. Unsurprisingly, recognition is easier than recall. In either case, though, the memory must have been encoded for you to unearth it later on, with or without a little help from your friends.

So what had happened to cause my memory failure? I clearly had paid attention to the book and processed it more than enough to guarantee encoding. It would be easy to conclude that this was therefore a retrieval error…but maybe not. Why did it not come rushing back to me after seeing multiple cues, including the cover and table of contents? Alternatively, the breakdown could have been caused by a failure in any one or in any combination of the three functions.

I did a quick web search of articles about episodic memory and came across one that suggested you could improve it by watching a movie and then listing as many of the scenes as you could remember. It seemed to me that this could also serve as a reasonable test of your ability to recall episodic memories, so I tried it with a movie I had just watched the night before: ‘Hud’ starring Paul Newman.

I waited 5 days to give my brain a chance to consolidate the memory and, perhaps, even time enough to forget a little about it before attempting the task.

Now, obviously, I don’t know how many scenes there were nor how many scenes a brain-healthy 71-year old would remember, but I came up with 43.

I’ve got to believe that that’s pretty good. I’m pretty sure I didn’t miss much, so I’m going to put off worrying about any possible episodic memory failures for the time being.

But it is a little scary to see how it might sneak up on you.

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S2E33. How To Keep Your Brain Young

I stumbled across a book referenced in an article I was reading and was intrigued by the description of the author: “Professor Kerryn Phelps AM, Australia’s most trusted GP.”

Interesting! A book about brain health by a general practitioner and not a neurologist or neuropsychologist? A consumer of research instead of a creator of research? And from Australia? Because of these anomalies, I wondered if her perspective would differ from everything else I’ve been reading written by Americans with more traditional backgrounds…so I read her book, How To Keep Your Brain Young which was published last September.

Some differences were immediately apparent, such as the spelling of words like ‘foetus’ and ‘coeliac disease.’ When citing research studies, she tends to reference where the work was done instead of the authors’ names, so you come across things like, ‘in a study done at the University of Sydney…’ She seemed to prefer citing work done in Australia, and that was layered on top of references to Australian epidemiological studies and policies of Australian public health agencies. All in all, it was refreshing to see the view from down under.

The most striking thing about this book, though, is the range of topics covered. Although any book about brain health will necessarily cover dementia-related topics, Professor Phelps goes above and beyond in cataloguing the wide variety of things that can affect one’s brain health over one’s lifetime. You might expect a cradle-to-grave approach, but she goes beyond that, not just to pre-natal concerns, but all the way to pre-conception factors that might affect the brain-in-waiting!

Her thoroughness is carried throughout the book with an attention to detail that could only be rooted in the curiosity of someone who found every fact about the brain to be enormously fascinating. She begins with a description of the various brain structures, their functions and the neurotransmitters that drive the system. I have to admit that if I was not already well-versed in those topics, I would have found it very difficult to follow. It’s not that she uses a lot of technical jargon, but that she presents the information in a rapid, unadorned format. ‘Just the facts, ma’am,’ as Sergeant Joe Friday used to say. Her writing is unembellished. There are few anecdotes and personal reflections. There is no poetry in her prose. She writes like a GP speaks: ‘Here’s what the tests show and here’s what you can do about it. I’ve written you a prescription.’

Nonetheless, it’s riveting and breathtaking in its scope. There are short chapters about virtually all the things that can affect your brain in a lifetime, including alcohol, medications, chemotherapy, smoking, anesthesia, gluten, glucose, blood pressure, street drugs, menopause, stress, depression, your gut biome, stroke, brain injury and brain cancer. Factors that don’t merit their own chapters are covered in the chapter on dementia. Oddly, though, she doesn’t address air pollution, toxic chemicals or pesticides.

I thought the best line of the book came in her summary of the effect of using methamphetamines. After detailing all the different ways it kills neurons and affects brain function, she dryly remarks that ‘it really doesn’t have a lot going for it.’

After detailing what proper brain function looks like and inventorying all the things that can go wrong, she settles into a discussion of the things you can do to protect your most valuable organ throughout your lifespan, or as she puts it, ‘how to keep your brain young.’ There are chapters dedicated to cognitive challenge, exercise, diet, supplements, social connectedness, relationships, sleep and mind-body therapies. She also includes a chapter on the brain-enhancing properties of pets, which is something I hadn’t come across anywhere else.

Professor Phelps closes the book with a lifetime prescription for protecting your brain and preserving its performance. It comes down to avoiding brain injury, exercising, optimizing your diet, controlling your blood sugar, managing cholesterol, improving your gut health, controlling your blood pressure, building and maintaining social networks, sleeping soundly, stimulating your mind, taking care of your emotions, being cautious with prescribed medications, avoiding illicit drug use, not overusing alcohol, never smoking, and considering using supplements and herbs.

It seems like a lot until you realize that you’ve got a whole lifetime to figure it out. Obviously, the earlier you start, the better off you’ll be. Nonetheless, the research says that benefits will accrue no matter when you engage.

So, to answer my initial question, the view from down under is pretty much the same as it is from here in West Chester, PA!

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S2E31. Sweet Dreams Are Made Of This

When I was growing up, my mother valued her children’s sleep above all other bodily functions. When I was 12, I used that to my advantage when I wanted to play hooky from Hebrew school by staying up late the night before and then pretending not to wake up the next morning when she called me.

In college, a had a fierce bout of depression and found myself sleeping 12-16 hours every day. My therapist told me it was a defense mechanism whereby I tried to escape from reality. It sounded plausible at the time.

I used to wake up most nights at 3am. My best guess was that it was a little bit of residual trauma from when I was 6 or 7 and I was startled awake by the phone ringing. It was the hospital calling to tell us that my grandmother had died. My mother jumped out of her bed, wailing and crying hysterically. I glanced at the clock in my room and saw that it was 3am. Just recently, I learned that about 35% of us habitually wake up at 3am…and a related trauma is not a prerequisite at all.

In my early 30s, when I was the executive director of a performing arts center, I used to doze off in my office every afternoon. I fought it for a long time in the belief that I shouldn’t be sleeping on the job, but then I decided, screw it! As soon as I’d start to get drowsy, I would buzz my secretary and ask her to hold my calls, lean back in my chair and nod off.

My afternoon napping habit never left me. When my first wife and I ran a B&B in northeastern Pennsylvania, I would retreat to the rope hammock hung between a pair of birch trees or lie down on the porch swing on most days in the late spring, summer and early fall. Those were the best naps of my life!

Fifteen years later, as the staff psychologist on an inpatient behavioral health unit, I took my nap a little earlier to coincide with my lunch break. Without my asking, our director sent out a notice that staff should not disturb Dr. Braffman during lunch unless there was an emergency and a patient was in crisis. Now that’s how you value nap time!

In graduate school, I learned about the 4 phases of sleep. Later studies revealed that you cycle through these phases 4-6 times every night, and that you can dream at any time, not just during REM sleep.

New research published last month reported that there is a noradrenaline cycle that wakes you up as many as 100 times during the night. The awakenings are measured in milliseconds, so you are unaware of the vast majority of them.

Although we appear quiescent while we sleep, there’s actually a lot of important business going on under the hood. It’s the time when we consolidate memories and new learning and replenish our available stores of vital neurotransmitters. If you don’t sleep well or long enough, you’re going to have cognitive problems the next day, e.g., brain fog and you’ll be prone to making a lot of mistakes.

Another critical function of sleep is to clean up the chemical detritus left over from your brain’s daily activities. There is a whole separate network in your head that performs this task, running in parallel with the neural networks with which we are all so familiar. It’s called the brain’s glymphatic system.

It’s hypothesized that your brain’s ability to clean up the daily messes that it makes plays a critical role in preventing dementia. One way this might work would be by removing beta amyloid that is created as part of an immune response like a fever.

What I haven’t been able to find anywhere in the literature, though, is a description of the magnitude of this cleaning power. Can your brain completely clean house every day? Is there enough residual power to clean up festering messes that overwhelmed the system on earlier occasions? In other words, is it destiny that our brains eventually be overrun with chemical garbage? Or can we chip away at accumulations of waste products until all our neural pathways are functioning again? Or is breaking even on a daily basis the most we can hope for?

We don’t know the answer to those questions yet, but we do know that somewhere between 7-9 hours of restful sleep on a regular basis helps tremendously. And naps are good for you, too (thank you, lord!), so long as you don’t overdo it to the point where they start to affect your nighttime slumber.

The impact of consistently high-quality sleep on your brain’s health can not be overstated. If you aren’t sleeping well (i.e., less than 6 hours each night), you might want to consider implementing some behavioral changes now that will reduce your risk of dementia by 30-50% later on.

To sleep better, lay off the alcohol in the evening and no more caffeine after 12 noon. Set a fixed schedule for going to bed and waking up. Stow your electronic devices about an hour before bedtime. Make a list of all the things you want to do the next day so you don’t lie awake thinking about them. You might want to do a meditation/relaxation/deep breathing exercise just before bedtime. Make sure your bedroom is dark and the temperature is somewhere in the 60s.

If you do all of these things and still have trouble sleeping, it will be well worth your while to get evaluated. There are a range of products out there—both natural and pharmaceutical—that can offer you support, if you need it.

Pleasant dreams!

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S2E28. Working Memory Workout?

A majority of the mistakes and cognitive errors that I have documented in this blog involve failures of working memory. Working memory is where we hold information online while we manipulate it and/or consider what to do with it. It’s where we hear our internal voice. It’s the central cog in our executive functioning network.

Consequently, it’s not pretty when you start to experience declines in your working memory abilities which, as it so happens, are usually the first to go as we get older.

So I was intrigued by an article in The New York Times last week that reviewed a new book (The Complete Guide to Memory: The Science of Strengthening Your Mind) by neuroscientist Dr. Richard Restak in which he asserts that exercising your working memory can forestall its decline and possibly even restore prior losses. The article covers his 7 key recommendations and you can read it here.

Regular readers of this blog know me well enough to figure out that I downloaded the book and read it this week. It reviews all the usual types of memory and he adds a few new ones of his own construction. He pays more attention to brain structures than most books of this type, but he keeps his narrative breezy and conversational, including examples ‘ripped from the headlines,’ as they say.

He recounts the usual litany of techniques you can use to better remember lists, but I was most intrigued by his lengthy discussion of working memory and exercises you can do to actually strengthen it.

One such exercise was to name all of the United States presidents in chronological order, beginning with FDR. Then do it in reverse order. Then do it alphabetically. Then do it in reverse alphabetical order. If you want to try this, I’ll give you a hint: there are 15 of them.

It took me a little while one sleepless night to master this task. As I did so, I felt like I could actually see the places where my working memory let me down and where answers were swimming nearby but just out of awareness.

He recommended making other lists that you can manipulate in similar ways, and to practice organizing them in your mind every day.

He also recommended daily practice with what is known as the ‘N-back task.’ The easy-to-do-at-home version of this only requires a deck of playing cards. First, you select two cards that will be your ‘trigger’ cards, say a ten and a three. Then you turn over the cards one by one, look at them, and place them face down in a pile. When one of your trigger cards appears, you have to name the card that preceded it. This is the ‘1-back’ version of the task. After you’ve mastered it, you can make it more difficult by trying to name the card that was two cards before the current card, or ‘2-back.’

I immediately pulled out a deck of cards and tried it…and failed miserably at the 2-back version. I did alright with the 1-back version, actually having the most difficulty remembering which were my 2 trigger cards!

This piqued my interest in working memory tasks and so I googled it. I discovered quite a number of sites offering (for a subscription fee) computerized versions of a wide variety of working memory tasks.

I tried a number of them and quickly discovered how limited my working memory is. I was especially bad at tasks that required me to remember visual images. In fact, I noticed that I retained virtually no memory of the images and had to resort to semantic memory to complete the task, i.e., naming the images that had flashed on the screen and remembering the names, not the pictures.

Neuropsychological tests are very good at isolating and identifying your weaknesses, and these were no exception.

Dr. Restak talked about my condition in his book. It’s called ‘hypophantasia’ which is the inability to retain fleeting visual images in your mind’s eye. Conversely, people who are exceptionally adept at doing this have ‘hyperphantasia.’ My first wife was such a person. She could walk through someone’s house once and later draw a diagram of all the rooms on every floor…to scale! Most of us have abilities that fall somewhere along this spectrum from hyper- to hypophantasia.

This experience alarmed me enough to want to initiate a structured workout routine to try to improve (or at least slow the deterioration) of my working memory. My recollection, though, was that—Dr. Restak’s exhortations notwithstanding—the research is mixed about whether computer games and tasks can actually improve your cognitive abilities. In most cases, it appears that you can get better at the computerized task, but that it doesn’t generalize to improve your ability to perform other tasks of daily living. What was I to do?

Right on cue, I received an email from one of my college roommates, Tom, with an article from The Boston Globe about several large-scale, age-related cognitive studies that are being launched in New England. Among the variables being tested are brain training techniques. The program offered by a company called BrainHQ will be used in these studies.

Well, if it’s good enough for the researchers, then it’s good enough for me! So I went to www.BrainHQ.com and subscribed for a year for $96.00. My intention is to do a 1-hour workout each day…if the frustration from getting too many wrong answers doesn’t overwhelm me.

Wish me luck!

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S2E27. And The Diagnosis Is…

For the last year and a half now, I’ve been attempting to faithfully record the types of cognitive errors I notice myself making. At the same time, I’ve been researching the differences between normal aging, mild cognitive impairment, and dementia. So it’s about time I made the call and diagnosed myself, don’t you think?

Making a diagnosis like this isn’t a 1-time thing nor is it an all-or-nothing thing. It’s a snapshot of where I stand today. It’s not predictive of where I will be a year from now, or ten years from now. It’s more like an annual check-up than it is a definitive conclusion.

Before the ‘big reveal,’ though, I thought I’d summarize the range of mistakes I’ve previously documented in this blog. Here you go:

S1E2. Short-Term Memory Peek-A-Boo: walking into a room and forgetting why I went there; being able to hold fewer items in short-term memory (e.g., a 10-digit telephone number) than before.

S1E4. Mistakes On The Journey: doing things without intending to; tip-of-the-tongue word-finding problems; saying a word that isn’t the one I intended; not checking things after I’ve completed them so I don’t catch the errors I’ve made.

S1E5. Testy & Edgy: irritability; lowered frustration tolerance.

S1E6. Did I Do That?: Not remembering doing something right after I did it.

S1E8. Splotchy Thinking: more examples of doing unintended things; more examples of not remembering recent events.

S1E15. Vivid Memories That Aren’t: clear recollections of past events that turn out to be false.

S1E16. The Name Game: Not remembering the names of people I knew well years ago.

S1E18. 2 Runs, 4 Hits, 1 Error: Errors made in social situations.

S1E20. Dear Diary…: Errors in completing complex tasks.

S1E22. Making Coffee Isn’t Hard…Is It?: More problems with complex tasks and routines.

S1E24. Scary & Scarier: Breakdowns in implementing well-learned routines.

S1E28. Potholes On Open Highways: a variety of mistakes including memory, word-finding, and getting distracted.

S1E33. Poor Judgment: exactly what the title says!

S1E35. Mini-Miscues: A collage of errors, including visuo-spatial challenges.

S1E43. No Comment: Talking less in social situations.

S2E7. More Mistakes On The Journey: a grab bag of recent errors.

S2E12. When Your Fact-Checker Doesn’t: problems with executive function and meta-cognition.

S2E18. Subtle Symptoms?: Things that aren’t really problems now, but could become problematic if they worsen.

(You can read all of these episodes by going to the home page and scrolling down: www.MistakesOnTheJourneyToNowhere.com.)

Reviewing these episodes in order to write this post was pretty sobering. It seemed really bad at the time and I remember being nervous about all the ways I was failing. But I don’t feel that way anymore, even though I recognize that I am still committing most of these categories of errors. What changed?

For one thing, I realized that none of the mistakes that were dogging me had serious consequences. When playing schoolyard basketball, we used to say ‘No blood, no foul’ and these cognitive ‘fouls’ aren’t drawing any ‘blood.’

Secondly, I think I’ve become used to committing this range of errors. They were pretty shocking when I first focused my attention on them, but now, not so much. When I do a mental belly flop I’m more likely to react with a ‘Meh’ than an ‘OMG!’

Finally, I’ve gotten better at compensating for a wide variety of them. In most cases, the duration of a screw-up is very short (measured in just a few seconds) and quickly corrected.

So here’s my bottom line as of July 8, 2022 as I’m just a few days short of 71½:

I definitely don’t have dementia. This is primarily based on the fact that none of the errors I’m committing have serious consequences or affect my ability to live independently.

For the same reason, I don’t think I meet the criteria for a mild cognitive impairment, either: there are no noteworthy consequences to my miscues. Even Sally, who is uniquely adept at spotting my screw-ups, would agree that they are mainly trivial in nature.

By process of elimination, then, it would appear that what I’ve been documenting is normal aging. Not only do my errors fall within a harmless range, but I’m maintaining pretty good executive functioning (e.g., writing this blog every week) and I am still able to find creative solutions to problems.

So that’s the diagnosis I’m going with for now: normal aging. And if I’m correct about that, then it’s both reassuring and terrifying to know that one’s brain circuits can misfire so frequently and you still get to call yourself ‘normal!’

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S2E26. Losing My Mind

“Every day is new now, with little remembrance of the day before, but with enough memory retained to know there was a yesterday. This is a new way to live and it takes getting used to.”

Thomas DeBaggio, author of the above quote, was diagnosed with early onset Alzheimer’s in 1997 at the age of 57. His book detailing the progression of the illness (Losing My Mind: An Intimate Look At Life With Alzheimer’s) was published in 2000. He went on to write another book in 2002 chronicling his life with dementia, and became a tireless advocate for Alzheimer’s research. He passed away in 2012.

Up until now, all of my posts have focused upon discerning the difference between normal age-related errors we all make and the more problematic mistakes associated with the onset of dementia, as well as preventative measures we can adopt to try to dodge the illness which affects about half of those who make it beyond the age of 85.

Reading this book last week, however, was my first road trip into the world of life with dementia…and it was sobering.

The book is presented as a braid of three interwoven threads. Fortunately for us, DeBaggio’s first love was writing. He was a journalist before settling into his career growing and selling herbs, which also led to his writing about that experience.

The book is not written in chapters. Instead, paragraphs alternate between the three threads. It’s a surprisingly effective technique that captures the essence of the relentlessly vanishing world in which he lived.

The first thread is his biography. Reading it, I wondered if he wanted to leave a trail he could follow to find himself once his memory of his own personhood failed him. A noble effort, for certain, but doomed to failure as the disease progresses inexorably through its mind-sucking stages which would ultimately rob him of the ability to understand that the story he had penned years before was about him.

The second thread is a description of his current status as it unfolds over the course of his first three years living with Alzheimer’s. At this point, he still has the introspective awareness to be able to recognize when he is making a mistake or losing a cognitive capacity or experiencing something new and unfamiliar. It is here that I am most thankful for his literary skills…which makes it all the more painful to travel with him as he loses access to his words and to the thoughts that he can’t pin down and retain:

“There is a dullness in my brain now to allow me to stare into silence without an idea or thought breaking the stillness.”

Juxtaposed against his past and his present (and looming future) is a summary of his research into Alzheimer’s disease circa 1999. He details the state of the research with excerpts from scholarly publications. It soon becomes frustratingly apparent that there has been very little progress in the past 22 years.

I’m glad I read this book as it helped better define for me the seamless spectrum that runs from the errors of normal aging to indications of cognitive decline to the early experience of dementia. It’s the transition from making errors that are irritating but readily resolved to awareness of problematic thinking that has real-time consequences to the loss of control of your inner dialogue.

Thankfully, I’m still in pretty good shape. When I woke up Thursday morning thinking about how I would end this episode, I was able to table my ideas and return to them after breakfast without any problem.

My thoughts don’t simmer in a quantum soup where they live lives measured in nanoseconds and their very existence is always uncertain.

My computer’s spell-check isn’t working overtime to try to figure out what it is I really meant to type.

I’m nowhere near traveling DeBaggio’s path, yet I am grateful to him for illuminating the way.

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S2E25. The 10 Warning Signs of Alzheimer’s

I’ve been blogging for a year and a half now and, surprisingly enough, have yet to delve into the early symptoms of dementia in their entirety. I’ll correct that oversight below, but before I do, I’d like to add a little perspective.

When you go through the list below, I think you’ll agree with me that there has already been a significant cognitive decline by the time you experience those kinds of problems. Given that we have no treatment that can reverse the effects of dementia, the primary value of diagnosis at that point would seem to be to initiate the transition to some form of assisted living, whether it be in a facility or via support provided by your family.

But there is another really good reason for getting checked out. It’s very possible that the cognitive mistakes you are making have a cause other than dementia. In particular, depression, sleep disturbance, stress and medication interactions can all generate symptoms that mimic dementia. There is great value, then, in ruling out these other causes before you start to fret over beginning your long goodbye.

Having said that, I hearken back to my original intent in writing this blog which was to try to identify indicators that you were slipping well before you get to the debilitated state described in the ‘warning signs’ below. My hope was that perhaps an extra year or two of awareness would give you time to make lifestyle changes that might slow the progression of the illness. What I’m searching for is cognitive errors (my ‘mistakes on the journey’) that are more worrisome than ‘normal aging’ yet not as debilitating as a ‘warning sign.’

As for now, it appears that dementia-related errors are (1) more frequent and (2) more disruptive than those found in normal aging. It’s a fine line, indeed.

With that in mind, I joined a webinar this past Tuesday presented by the Alzheimer’s Association (www.alz.org) titled ’10 Warning Signs of Alzheimer’s’ in hopes of hearing about more subtle indicators of an approaching dementia.

Spoiler alert: I was disappointed. The material covered was no different than that already posted on their website and, in fact, utilized the same slides. So rather than provide a summary of what I learned, it makes more sense for me to just present the information directly from their website, as I really don’t have anything to add. These are the best guidelines we as laypeople have to differentiate normal aging from dementia. The take-home message is this: If someone you know is exhibiting one or more of these symptoms, it’s probably time for a full diagnostic evaluation.

Here are the 10 warning signs:

1. Memory loss that disrupts daily life.

One of the most common signs of Alzheimer’s disease, especially in the early stage, is forgetting recently learned information. Others include forgetting important dates or events, asking the same questions over and over, and increasingly needing to rely on memory aids (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own.

What’s a typical age-related change?
Sometimes forgetting names or appointments, but remembering them later.

2. Challenges in planning or solving problems.

Some people living with dementia may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before.

What’s a typical age-related change?
Making occasional errors when managing finances or household bills.

3. Difficulty completing familiar tasks.

People with Alzheimer’s often find it hard to complete daily tasks. Sometimes they may have trouble driving to a familiar location, organizing a grocery list or remembering the rules of a favorite game.

What’s a typical age-related change?
Occasionally needing help to use microwave settings or to record a TV show.

4. Confusion with time or place.

People living with Alzheimer’s can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there.

What’s a typical age-related change?
Getting confused about the day of the week but figuring it out later.

5. Trouble understanding visual images and spatial relationships.

For some people, having vision problems is a sign of Alzheimer’s. This may lead to difficulty with balance or trouble reading. They may also have problems judging distance and determining color or contrast, causing issues with driving.

What’s a typical age-related change?
Vision changes related to cataracts.

6. New problems with words in speaking or writing.

People living with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have trouble naming a familiar object or use the wrong name (e.g., calling a “watch” a “hand-clock”).

What’s a typical age-related change?
Sometimes having trouble finding the right word.

7. Misplacing things and losing the ability to retrace steps.

A person living with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. He or she may accuse others of stealing, especially as the disease progresses.

What’s a typical age-related change?
Misplacing things from time to time and retracing steps to find them.

8. Decreased or poor judgment.

Individuals may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money or pay less attention to grooming or keeping themselves clean.

What’s a typical age-related change?
Making a bad decision or mistake once in a while, like neglecting to change the oil in the car.

9. Withdrawal from work or social activities.

A person living with Alzheimer’s disease may experience changes in the ability to hold or follow a conversation. As a result, he or she may withdraw from hobbies, social activities or other engagements. They may have trouble keeping up with a favorite team or activity.

What’s a typical age-related change?
Sometimes feeling uninterested in family or social obligations.

10. Changes in mood and personality.

Individuals living with Alzheimer’s may experience mood and personality changes. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, with friends or when out of their comfort zone.

What’s a typical age-related change?
Developing very specific ways of doing things and becoming irritable when a routine is disrupted.

If these are the 10 criteria by which we are to measure our cognitive health, then I passed my 71½-year check-up with flying colors!

The only item that is close to raising a warning flag is #9: Withdrawal from work or social activities. As Sally has pointed out, I’m not as talkative as I used to be and now have a tendency not to participate in conversations. But it’s not because I’m not following along or can’t find the words or put together a sentence. I would describe myself in those situations as being comfortable and attentive, albeit not actively engaged. To the extent that my silence might represent a precursor to the development of poverty of thought, though, it’s worth keeping on eye on.

So I’ll take my current mental status as a win…and continue to search for earlier warning signs of dementia.

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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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S2E21. A Brain Healthy Bibliography

Over the course of the last year and a half, I’ve relied upon a wide variety of resources to help me prepare these blog posts. At times I’ve identified them and provided links; at other times, not so much. To remedy that, I thought I’d dedicate this episode to putting all of those resources at your fingertips. There are movies, videos, lectures, websites and books in the following list, just in case you feel compelled to take a deeper dive into the data:

Movies:

‘The Father’ starring Anthony Hopkins

‘Still Alice’ starring Julianne Moore

Books:

The End of Alzheimer’s by Dr. Dale Bredesin (see S1E34)

Remember: The Science of Memory and the Art of Forgetting by Lisa Genova (see S2E4)

In Love: A Memoir of Love and Loss by Amy Bloom (see S2E16)

Lecture Series:

The Aging Brain from The Great Courses (see S2E9, S2E10, S2E11)

Video:

Can Alzheimer’s Be Stopped? – PBS NOVA

Determined: Fighting Alzheimer’s – PBS NOVA

What You Can Do To Prevent Alzheimer’s – Ted Talk with Lisa Genova

Links:

Alzheimer’s Association

Being Patient

WebMD (search ‘dementia’, ‘Alzheimer’s,’ and ‘aging’)

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S2E20. Brain-Healthy Menu Plan

I’ve written often about your diet’s effect on your brain’s health, but it occurred to me that I haven’t yet put all the pieces together to demonstrate that it’s possible to incorporate this kind of diet into a daily routine. I’ll try to do that now.

One of the things that has always bothered me about diet recommendations is the idea that you have to have X many servings of various foods every day or week. I just don’t have the patience to measure things out to see if I’ve got enough to meet the criteria for a ‘serving,’ nor do I possess the discipline to keep track of all of those servings to see if I’ve met the goal.

Working that hard can take all the joy out of eating!

Instead, I’ve developed a practical approach (some would call it a rationalization!) toward eating. Here are the 3 key points:

1. You can only eat but so much in a day or a week, so eat when you’re hungry and eat things you like that fit your diet plan. I have faith that your body will figure out how to maximize the benefit from the selection you offer it as long as you provide it with a buffet that covers all the basic areas, like Omega3 fats, antioxidants, etc. A little of something good is better than none at all, and it’s probably good enough when you just can’t work the recommended volumes into your plan.

2. Except for #3 below, everything you put in your mouth should provide some nutrient that is protective of your brain.

3. There is no such thing as cheating. So what if you eat something you shouldn’t every so often? What’s the big deal? Maintaining brain health is a long-term project that plays out over decades. The more days I eat all the right things, the better off I am. But it’s not fatal if I have a piece of cake or a hamburger once in a while. It might set my project back a day or two, but that’s not so terrible and it’s more than offset by the soul-satisfying lift I get from eating something that’s taboo. Bottom line: your eating lifestyle should be guilt free!

Let me offer one disclaimer before showing you what I eat:

I’m not recommending that you adopt my diet. I’m just trying to demonstrate that a brain-healthy diet is do-able. Only you can decide what will work for you: what times of the day, how often, and what you like to eat. So I’m not going to give you a ‘meal plan,’ per se. It’s more like an outline to help get you started.

The diet that emerged for me was the result of my researching brain health in order to write this blog. As I learned about foods that contained important nutrients and compounds, I tried to add them to my diet. Having eaten this way for nearly a year now, I don’t remember what foods provide what benefits, but I can tell you that everything I swallow has a purpose based on the research.

Finally, before showing you what I eat, it’s important to show you what I don’t eat: products with added sugars of any kind, rice, grains (except for oats), dairy (except for kefir), refined flour, bread, fried foods, white potatoes, beef and pork. It sounds pretty restrictive, but it’s actually not all that bad.

Oh yeah…I almost forgot…the goal is to use all organic ingredients.

Here’s what my diet looks like:

Morning Tea: I try to do a 14-hour overnight fast each day, so I stop eating at 7:30pm the night before and have breakfast at 9:30am the next morning. Since I wake up hungry, though, I have 2 cups of tea at around 8:00am to hold me over. Decaf green tea is preferred, but I don’t like the taste all that much, so I mix ½ tablespoon of green tea leaves with an equal amount of mint leaves and then add ½ teaspoon of mixed turmeric, cumin, cinnamon, ginger and black pepper.

Breakfast: It’s the same thing every day: homemade granola with fruit. And it never gets old! It’s now my favorite meal. I linger over and savor every mouthful. Here are the ingredients: oats, chopped walnuts, pecans and almonds, turmeric, ginger, cumin, cinnamon, nutmeg, cocoa, flaked coconut, flax seed, chia seed, oat bran, figs, prunes, apples, raspberries, blueberries, strawberries, and grapes, with flax milk.

(I added oats to the mix after I wrote ‘A Granola Ritual’ because I wanted help in lowering my LDL (bad) cholesterol.)

As you can see, I pack a ton of brain-healthy goodies into this one meal.

Lunch: Well…not really. I get hungry between noon and 2:00pm, but I don’t prepare anything that could legitimately be called ‘lunch.’ More accurately, I nosh…usually standing up. I know, I know…I should sit down when I eat…but I’m hungry!

I hope this doesn’t gross you out, but my go-to noshes are pickled herring, homemade sauerkraut and seaweed salad. Hummus with vegetables, guacamole, and a few mouthfuls of dinner leftovers are also on the noshing menu. So are oranges and almonds.

Post-workout hydration: 1 pint pomegranate juice made with 1 part juice and 2 parts filtered water.

Dinner: One of the joys of adopting this food lifestyle is trying out new recipes…and being surprised that things taste as good as they do! Here is a list of the items that have become staples of my evening meals: salmon, chicken, shrimp, eggs, kale, quinoa, roasted vegetables (eggplant, acorn squash, sweet potato, Brussels sprouts, carrots), mackerel salad with celery, grapes and walnuts, spinach, asparagus, salad (spring mix, grape tomatoes, onions, sweet peppers (red, yellow, orange & green), mushrooms, anchovies, avocado, parsley, olive oil, balsamic vinegar, lemon juice), red lentil pasta, and 4 ounces of organic pinot noir.

Although garlic isn’t mentioned above, it, too, is a staple. You’re not doing it right if you’re not mincing garlic every day!

Dessert: This is the same every night: a half cup of homemade banana-strawberry kefir with a quarter cup of oat milk, a few dashes of cinnamon and nutmeg, and some stevia to make it sweet enough to pass as a dessert.

Bon appetit!

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S2E16. Dementia & Suicide

Tell the truth: you’ve thought about what you would do if you were ever diagnosed with dementia, haven’t you?

You’re not alone.

The topic came up again this past week when Sally and I watched a PBS NOVA episode about long-term Alzheimer’s research being done at the University of Wisconsin. One of the cases presented was a 73-year old woman with end stage dementia. She couldn’t talk or feed herself and her muscles constantly twitched and cramped. The story line followed her husband and children as they tried their best to make her last days comfortable.

“Don’t ever let me get like that…”

Sally didn’t need to finish the thought. We’ve talked about it before (S1E13), but we’ve never really come up with a plan.

This week, thanks to a new book written by Amy Bloom titled In Love, I learned that there is a path forward. The book is a memoir about her husband’s decision to suicide after being diagnosed with Alzheimer’s.

The path leads to Zurich, Switzerland, where there is a non-profit company, Dignitas, that will work with you. What makes Switzerland’s approach different from assisted suicide available in America is the conditions under which you are eligible to be helped.

In the 10 states in the U.S. that have some form of assisted suicide, the eligibility requirements are intentionally excruciatingly narrow. You’ll need to be diagnosed with a terminal illness with less than 6 months to live AND you’ll have to have all your faculties about you, be able to rationally discuss your decision, prove you are not depressed, and be physically able to self-administer your own lethal dose when the time comes.

That pretty much rules out anyone with dementia. If you still have your wits about you, no doctor will certify that you are within 6 months of death.

Clearly, the notion of a right to death with dignity for those with dementia has not yet reached our shores.

In Switzerland, though, they’ve eased the restrictions by eliminating the 6-month life expectancy condition. You still have to be diagnosed with a terminal illness (which dementia is) and you still have to be mentally and physically competent to implement the plan (i.e., drink the sodium pentobarbital solution) on your own. That’s why they call it ‘attended’ suicide over there instead of ‘assisted.’ The final act must be yours and yours alone.

Reading about that process, though, shook up my thinking. In my previous imaginings (it seems wrong to call them ‘fantasies’) about a post-diagnosis suicide, I envisioned milking my good days for as long as I could and then pulling the plug when I stopped being me (however I might define that). From another point of view, if I were the one to assist Sally after her diagnosis, the timing would be when she was no longer herself and had lost the ability to marvel at the world of children and ask questions about everything.

In either case, the timing would be tricky, as there is no paper-and-pencil test one can administer to determine that the time has come. You just know it. At that moment, it should be a pretty clear moral choice, especially if you are (as I am) unencumbered by any religious prohibitions against ending a life in this situation.

In Amy Bloom’s case, however, her husband Brian makes the decision to suicide almost immediately after learning his diagnosis. In hindsight, it is clear that he has been symptomatic for several years, but he is still quite capable of enjoying a good meal at a restaurant, traveling and fishing, and he is cognitively strong enough to meet the criteria for mental competence.

That’s pretty brave. Although his journey on the road to nowhere is clear, he is still very much Brian, both to himself and to Amy. There is no waiting, there is no ‘making sure,’ there is no milking the last drop of pleasure from life.

It’s going to take me a little while to wrap my head around that.

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