Millions of Americans put cognitive decline at the top of their list of health concerns. Surveys have shown that a diagnosis of Alzheimer’s disease can strike greater fear than the prospect of developing cancer or having a stroke. Yet studies suggest that most people do not engage in brain health–promoting behaviors and activities, either because of a lack of knowledge or presumption that they cannot alter the course of aging and cognitive well-being. “The conventional wisdom was you got what you got. You would drain the cache of brain cells as you got older,” says Sanjay Gupta, MD, CNN chief medical correspondent. “It led to all these ideas that you really can’t do anything about your brain. It’s in this black box. You can’t measure it. It’s impenetrable.” What if you could not only maintain your brain’s health but actually build resilience against mental decline and disease? According to Dr. Gupta, a neurosurgeon and author of Keep Sharp: Build a Better Brain at Any Age, you can. “Most of us haven’t even begun to optimize our brains because we didn’t think it was possible,” he says. “It is.” Gupta points to research that began to correct misconceptions about our ability to preserve and sharpen our brain. “Ten years ago, all this interesting science was emerging from the neuroscientists and their labs and their clinical research,” he says. “What they were starting to learn was pretty transformative: You can grow new brain cells at any age. That sounds like a really simple statement. Actually, it was a big deal.” Translating those findings into practical information and actionable steps is what inspired Gupta to write Keep Sharp, which includes a questionnaire to help readers assess their risk factors for cognitive decline and a 12-week program of strategies to improve brain health. The book, he told Everyday Health in a recent interview, is “about this idea that no matter where you are today, you can be better tomorrow. There are ways to do it.” The following are some highlights from an edited transcript of that interview. Sanjay Gupta: This is a tough question to answer. You’ve got seven billion people living on the planet. Everyone is a bit different in terms of how they remember things, why they remember things, what inspires them to remember things. For the vast majority of people, when they start to have memory lapses, they start to question, “Is this the beginning of something that’s more serious, a more fundamental problem with my memory?” As a general rule, the idea that you misplace things, which is often what starts these conversations, is not typically because of an organic problem in memory for most people. When they misplace things, it’s an inattention issue. It wasn’t that they forgot where they put their keys. It was that they never truly remembered where they put their keys. Memory is an action. It’s not something that just happens automatically. You do have to encode something into your memory stores, and that does require a certain level of attention. We do so many things so mindlessly that we’re really doing these things inattentively. So it’s not that you’re forgetting. It’s that you’re never remembering some of these things in the first place. When it comes to misplaced keys, for example, that’s not so much a problem. If it takes you an extra beat to look at the keys and say, “What are these keys for?” that’s a bit of a concern. Then if someone cues you that those are for the car, how many cues does it take you to truly recall what the function of an object like that is? That gives you an idea of the types of memory problems that are more concerning and even an idea of how neuroscientists start to gauge the severity of those memory problems. GV: According to the Alzheimer’s Association, 1 in 10 seniors 65 and older has Alzheimer’s disease. But Alzheimer’s doesn’t tell the whole story when it comes to dementia. People often use these terms interchangeably. Can you talk about the distinction? SG: There are many types of dementia: Alzheimer’s, Lewy Body, vascular dementia. Alzheimer’s is the most common, but it is a form of dementia. Language matters. Words really do matter. And dementia is one of these words that I think we will look upon at some point from now and say, we need to get rid of that term. First of all, it’s not a very useful term. We can be more precise in terms of describing what’s happening to somebody. There’s also a pejorative sense of the word dementia. My kids pointed this out to me: The dementors in Harry Potter are these evil creatures. There’s this underlying pejorative sense about using the word for patients. I think that we should slowly move away from dementia, be more precise in the language, and understand the history of some of these terms. That’s the real distinction for me. GV: Normal aging is just one possible cause of cognitive decline. What are some other common circumstances that can cause the brain to “break”? SG: There are all sorts of reasons. Vascular problems, where you’re not getting enough blood flow to the brain, or you’re not getting enough blood being able to leave the brain. If there’s not enough blood flow getting to the brain, the brain can become starved of important nutrients. If not enough blood is leaving the brain, the brain can start to swell. The brain is the only organ that’s encased in something hard. Other organs swell, and it’s not good; but at least there’s room for them to swell. Not so with the brain. Traumatic brain injury is sort of the same thing. You get this significant cascade of inflammation, and that causes the brain to swell. Or brain tumors [and] strokes. Things like that. If someone’s showing up in the emergency room with difficulty thinking or remembering, you’ve got to go through a list of things that may have caused an organic problem for the brain to break, and then understand precisely what you’re dealing with. GV: In the book, you write about five pillars of brain health: move, discover, relax, nourish, and connect. How did you decide what should be on that list? SG: The way I approached it was to think, “How do I live? What is my way of life in terms of movement, in terms of rest, in terms of nourishment, in terms of connection, social connection with friends, in terms of my own purpose in life?” And within all those categories, the basic idea is that there is a best way to do those things for your brain. GV: What is the single best thing you can do for your brain if you have an hour? SG: Take a brisk walk with a close friend and talk about your problems. Movement is probably the most evidence-based way to actually stimulate that process of new brain-cell growth. Then there’s plenty of research around the value of connection. The opposite of that connection, loneliness, can be incredibly toxic, and that’s measurable. More than just the connection is the depth of that connection. GV: Connecting with others is especially hard these days, amid the pandemic and the need to maintain safe distance. How do we still connect with others in meaningful ways? SG: It can be different for different people, but a reliable way to do it is to go ahead and be vulnerable a little bit. Allow yourself to be vulnerable, ask for help, even talk about your problems. When I have conversations with my parents now, I’m often asking for little bits of help. I don’t even necessarily need it. But all of a sudden, I’m their son. They’re my parents. They want to help me. It adds purpose to our conversation and adds purpose to their overall interactions with me. I never really liked the term socially distant. I just felt that that wasn’t really what we were trying to say. It’s physically distant. There’s all sorts of ways to still stay connected. In fact, in some ways you can have very significant connections even through this COVID time. And there are some strategies to help. Like I just said, calling my parents and asking for help. We’re not in person, but we’ve had some really meaningful connections even during this time. GV: What would you say to someone who is fearful about the possibility of cognitive decline, for themselves or a loved one? SG: When someone starts to lose their memory, there’s no particular thing that you say. There’s no particular cure. There’s no vaccine. So I think that an acknowledgement of that is really important. What I think is crucially important right now, as we’re entering into this phase where so many more people are being diagnosed with dementia, is this recognition that there’s probably 40 to 50 million people out there right now who would have evidence of Alzheimer’s disease in their brain. If you were to look for objective evidence of plaques and tangles, you might find it. And those same people have no symptoms. They have no cognitive decline. That’s so crucially important because it basically means that the presence of these objective findings, these measurable findings in the brain, aren’t necessarily associated with symptoms. What I would tell people who are worried about this is that you’re not preordained to develop this. You may have increased risk because of certain genetic variants that you possess, but it’s not preordained.
