What is the #1 Predictor of Future Memory Problems?

Blood flow is essential to life. Blood brings nutrients to your cells and removes toxins. New research suggests that brain cells do not age as fast as we once thought; rather, it is the blood vessels that feed our neurons which age. That means if you want to keep your brain sharp and healthy for as long as possible, it is critical to protect your blood vessels. 

Since the brain uses 20 percent of the blood flow in your body, I have often said in lectures, “Whatever is good for your heart is good for your brain, and whatever is bad for your heart is also bad for your brain.” In 2007, when I wrote The Brain in Love, I realized I was missing a very important piece of the puzzle. Now I say, “Whatever is good for your heart is good for your brain is good for your genitals. And, whatever is bad for your heart is bad for your brain and bad for your genitals. It’s all about blood flow.” As erectile dysfunction (ED) is skyrocketing in men—just turn on the television and you’ll be bombarded with commercials for ED drugs like Viagra, Levitra and Cialis—so are brain problems. Blood flow goes down in both organs, not one or the other. Sexual dysfunction and low blood flow are also increasingly a problem in women.

If you have blood flow problems anywhere, it likely means you have them everywhere.

Forty percent of 40-year-old men have erectile dysfunction, according to the Massachusetts Male Aging Study, which likely means 40 percent of 40-year-old men also have brain dysfunction. With increasing age, the rate rises to a frightening level: The same study reported that 70 percent of 70-year-old men had erectile dysfunction, which likely means that 70 percent of 70-year-old men likely also have brain dysfunction.

Besides erectile dysfunction and a loss-of-oxygen experience, other vascular or blood flow risk factors include:

? Cardiovascular disease, including:

a. Atherosclerosis (hardening of the arteries)

b. High LDL or total cholesterol

c. Heart attack

d. Atrial fibrillation

e. Hypertension or pre-hypertension 

? Having a stroke or transient ischemic attack (TIA)

? Exercising less than twice a week and/or a slow walking speed. Ultimately, one of the most important reasons to exercise is that it keeps your blood vessels open and healthy.

The Blood Brain Barrier: Don’t Let Yours Leak

No discussion of blood flow to the brain is complete without mentioning the blood brain barrier (BBB), the protective membrane between blood vessels and brain tissue. The BBB acts as the gatekeeper, allowing nutrients like water, oxygen, glucose, vitamins and hormones to cross into brain tissue, and ushering out waste products like carbon dioxide. The BBB also protects the brain from toxins, infections and allergens. Although this protective layer is only a single cell thick, the cells forming it are tightly connected into a strong barrier. However, age, high blood pressure, trauma, inflammation, lack of oxygen and other assaults can fray or damage the cell connections, and when that happens—when they become “leaky”—disease is much more likely to occur because unwanted substances, like toxins, can cross into the brain.

Likewise, certain infections, such as syphilis and Lyme disease can cross the BBB, which may be why they often are associated with cognitive and emotional problems. There is also a suggestion that gluten and milk proteins can disrupt this barrier. As we age, the BBB first becomes leaky in the area of the hippocampus, which may be a big part of why memory issues are much more common with age. See Prescription for Better Brain Blood Flow for ways to help the BBB.

Cardiovascular Diseases

Given how important blood flow is to the brain, heart and blood vessel disease is a major risk factor for memory decline. Let’s look at each potential contributor.

Atherosclerosis, the main culprit behind cardiovascular diseases, is caused by a buildup of fatty deposits called plaques on the inside walls of arteries. As plaques get larger, arteries gradually narrow and can become clogged, restricting blood flow to areas that need it. Blood vessels also become less elastic (so-called “hardening of the arteries”), which raises blood pressure and makes them brittle, more likely to break (causing strokes). If you have the Apo E4 gene, there is an increased risk of coronary artery disease (in the arteries that feed the heart) and Alzheimer’s disease. 

The most common risks for developing atherosclerosis are high blood LDL cholesterol levels (see below), advancing age, being male (women are more often affected after menopause), high blood pressure, diabetes, smoking, obesity, physical inactivity and having close relatives who had heart disease or a stroke at a relatively young age. 

High levels of LDL cholesterol increase dementia risk, while high levels of HDL seem to lower it. In a four-year study of 1,037 women under 80 who had coronary artery disease, those who had elevated levels of LDL cholesterol had almost double the risk of memory loss, cognitive impairment or dementia. But lowering LDL cholesterol into the normal range eliminated this increase in risk. One caveat: Lowering total cholesterol below 160 mg/dL can increase the risk of depression and aggression, so don’t go too low. This is particularly important in people with an Apo E4 gene. 

Heart attack: And damage to the heart decreases its ability to pump blood. Having a heart attack significantly increases the risk for future memory problems.

Atrial fibrillation is a type of heart rhythm abnormality (arrhythmia) that reduces the amount of blood the heart can pump. This fluttering rhythm also allows blood clots to form, which are then pumped into the bloodstream. A-fib, as it’s commonly known, is a recognized risk factor for stroke and dementia.

Hypertension, or high blood pressure increases the risk of memory problems. Optimal blood pressure is critical for brain health. High blood pressure and even blood pressure at the higher end of the normal range (pre-hypertension) is associated with lower overall brain function and blood flow to the brain. According to the CDC about one-third of Americans have hypertension; and another one-third are pre-hypertensive. Being hypertensive is the second leading preventable cause of death and is associated with heart disease and stroke, other risks for memory problems. Chronically elevated pressure causes the blood vessel walls to enlarge and stiffen, making them more narrow and likely to break, much like atherosclerosis. Common causes of hypertension include genetic (runs in your family), being overweight, sleep apnea, kidney disease and as a side effect of oral contraceptive medicines.

Stroke or Transient Ischemic Attacks: A stroke occurs when a blood vessel breaks or a clot chokes off blood supply to the brain, killing cells. The risk of developing dementia is six to ten times greater in a person who has had a stroke than in the general population. Even a stroke smaller than a pencil eraser increases your dementia risk. Having one or more strokes means your blood vessels are significantly more vulnerable. But the risk factors that lead to this single, damaging event—such as high blood pressure, smoking, heart disease and diabetes—develop over a long time, meaning you may have time to turn things around before it’s too late.

BE-FAST is a mnemonic (memory device) to remember the early symptoms of a stroke to get help as soon as possible, which is critical in stroke treatment. It stands for having problems with Balance, Eyes, Face, Arms, Speech ad Time.

Sometimes the warning signs of a stroke last for only a few minutes and then they disappear, but that does not mean the problem is resolved. You could have had a transient stroke, called a transient ischemic attack (TIA), and although it doesn’t last long, it is a symptom of a greater medical problem. Its disappearance only means that enough tissue has been repaired to resume normal function; it does not mean that all the damage has been reversed. A TIA is symptomatic of the final stage of damage to a brain circuit that tells us something is wrong. TIAs are a major warning sign of greatly increased risk for stroke and progressive memory problems. 

If you’ve had a stroke or a TIA and want to rescue your memory, you must be very serious about your health. I’ve seen significant improvement in people who have had a stroke when they put their brains in a healing environment—specifically, using hyperbaric oxygen therapy (HBOT), which helps boost blood flow in the area surrounding the stroke. 

Loss of Oxygen: Your brain is oxygen hungry, and anything that deprives it of oxygen prematurely ages and damages it. Sleep apnea can cut off oxygen (see Chapter XX), as can near drowning episodes, when your heart stops beating, or voluntary asphyxiation, which is more common than most people know. I’ve treated a number of patients who would hold their breath as long as they could underwater, and others who would knowingly engage in auto-erotic asphyxiation during sex, without knowing the damage they were doing to their brains. 

Limited or No Exercise: Not exercising is a major risk factor for memory loss, in large part because it fails to keep your blood vessels healthy. Exercise helps to boost a chemical called nitric oxide (NO), produced in the walls of blood vessels and helps to control their shape. If blood vessel walls do not receive pulses of blood flow on a regular basis from exercise, they begin to distort, flatten-out and limit blood flow overall. That means that the person’s tissues, including their brain, will not receive the nutrients it needs or have a good mechanism to get rid of the toxins that build up in the body. If the deep areas of the brain are starved of oxygen and glucose a person will have problems coordinating his or her limbs and processing complex thoughts, like having a deep conversation with your spouse or boss. Regular physical exercise is a major preventive strategy for memory loss, and you can start right now, whatever your age.  

Here are the reasons why physical exercise should be part of your everyday life: 

? Helps increase the size of the hippocampus,  the Holy Grail of any memory enhancement program.

? Protects the hippocampus from stress-related hormones, like cortisol, which normally shrink it. Even leisurely walking has been shown to increase the size of the hippocampus in women.

? Stimulates the production of growth factors, such as BDNF (brain-derived neurotrophic factors), which nurture stem cell production. 

? Stimulates “neurogenesis,” the ability of the brain to generate new neurons. In exercising laboratory rats, research shows that they generate new neurons in the frontal lobe and hippocampus, which survive for about four weeks and then die off unless they are stimulated. If you stimulate these new neurons through mental or social interaction, then they connect to other neurons and become integrated into brain circuits that help maintain their functions throughout your life. This is why people who go to the library or take music lessons after a workout are smarter than those who work out and then veg out.

? Decreases beta amyloid plaque formation.

? Improves cognitive flexibility.

? Improves mood and focus.

? Improves the heart’s ability to pump blood throughout the body and brain, which increases oxygen and nutrient delivery. 

? Boost nitric oxide production and the flexibility of blood vessels, which decreases the risk for high blood pressure, stroke and heart disease.  

? Enhances insulin’s ability to lower high blood sugar levels, reducing the risk of diabetes. 

? Helps you maintain coordination, agility and speed. 

? Improves levels of the hormone DHEA, which is critical to brain health.

? Improves blood pressure.

? Increases flexibility and agility.

? Allows for greater detoxification through sweat.

? Improves the quality of sleep.

“Yalla imshi.” I heard those two Lebanese words a lot as a child from my father. They mean, “let’s go” or “hurry up.” I am the third of seven children, and we were often in a hurry to get to school, pick someone up from baseball or buy shoes. I still hear them in my head and have used them once or twice with my own children. Little did my dad know how important those two words are. The faster we walk as we age, the longer we live and the sharper we think. An 80-year-old person who walks one mile per hour (mph) has only a 10 percent chance that he’ll live until 90. But, if you can get moving faster, say 3.5 mph, the 80-year-old person has an 84% chance of reaching 90. As walking speed goes down, so does executive function and decision-making skills. If you haven’t walked fast for a long time, start slow and work your way up safely. Falls are also a major cause of memory loss.

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About the Author:

Daniel Amen, M.D. is a double board-certified psychiatrist, professor and 10-time New York Times best-selling author. He is one of the world's foremost experts on using brain imaging tools to help optimize and treat patients. He is founder of Amen Clinics, which has the world’s largest database of functional brain scans relating to behavior.