CHAPTER 1

The Importance of Brain Health

Brain health and indeed the human brain is now securely positioned on the radar screen of the American psyche.

The belief that a proactive approach can help to reduce the risk of brain disease is the core principle of the brain health movement. While the focus of this book and my career is brain health, there remains a need to understand the consequences of brain disease. It is from this understanding of the devastation caused by brain disease that a strong energy to learn about and implement brain health emerges, not out of fear, but out of a motivation to build and preserve access to our own life story.

When thinking about brain health, we often think about brain disease. This makes sense, as disease in general has traditionally been the focus of our medical training and approach to health care. "Brain disease" refers to an array of conditions that negatively affect the function of the brain. Examples range from progressive neurodegenerative diseases, such as Alzheimer's, Parkinson's, and Lewy body dementia, to mental illnesses, such as depression, anxiety, bipolar disorder, schizophrenia, pervasive developmental disorders, and substance abuse, to trauma, such as closed head injury. Each of these conditions, and hundreds of others, impacts the structure and function of the brain, resulting in cognitive, emotional, and functional decline for the person. Such conditions and diseases also result in significant disruption of the family system and place a tremendous emotional and practical toll on the caregiver. Because the brain is so complex and we know so little about it, our interventions are symptom-based, not curative. When considering the brain, we tend to rely on the medical approach to the human brain that overly emphasizes disease, but we should strive to take on another perspective with an eye toward brain health, development, and growth rather than relying on reactive, quick, and invasive procedures only. Brain health is proactive and lifelong, with nothing quick about it. It's a lifestyle.

For many years we have believed that the brain is a fixed and rigid entity that has a limited window of opportunity to develop, the "critical period of brain development." Traditional thinking taught us that this critical period occurred early in life and new skill development could not happen beyond that time. Similarly, the ideas that brain disease is inevitable with advanced age and that once the brain is damaged it cannot be treated or healed were generally accepted. With our new understanding of the human brain, we have begun to challenge these ideas, and the new concept of brain health maintains that a proactive approach can be implemented at the earliest period of life and followed across the entire life span. Brain health further maintains the belief that we can shape our brains for health by exposing ourselves to a specific type of environment and by engaging in specific activities as often as possible.

Defining Dementia

Dementia is a clinical condition characterized by decline in overall intelligence relative to premorbid intellect, memory loss, personality change, and functional loss. There are nearly one hundred causes of dementia, and 95 percent of the causes of dementia are irreversible. Examples of the causes of dementia include Alzheimer's, Parkinson's, substance abuse, tumor, head injury, multiple strokes, and Lewy body. Most, though not all, types of dementia manifest in later life beyond age sixty-five. Examples of reversible causes of dementia include thyroid disorder, vitamin deficiency such as B₁₂ deficiency, and depression.

Alzheimer's disease is a progressive neurodegenerative disorder, the number one cause of dementia in the United States, accounting for 50 to 70 percent of all dementias, and is often used as the model of brain disease. The disease strikes specific regions of the brain and manifests in a predictable pattern of forgetfulness, loss of appreciation of space, personality change, and other deficits in thinking and function.

As a progressive disease, the course of Alzheimer's lasts on average ten or more years and cannot be reversed. Unfortunately, this horrific disease is the leading cause of dementia in the United States, presently affecting nearly five million persons, and is a major cause of dementia internationally. The number of Alzheimer's cases in the United States will increase to a staggering fifteen million or more by the middle of this century. Indeed, the United States presently spends over one hundred billion dollars annually on direct care of Alzheimer's, and corporate America loses over thirty billion dollars annually, as the employees, who are also caregivers of parents or loved ones with Alzheimer's or dementia, miss work and develop physical and mental illness themselves.

Alzheimer's disease is a deeply personal catastrophe that robs a family of their personal connection. For me, the ultimate question is, what is the dollar amount for the fact that somebody's father or grandmother has not been able to communicate with his or her grandchild during the past decade?

The essence of this question drives the motivation for my work in the area of brain health. There can be no greater loss than the inability to connect with one's own identity and further connect with the loved ones in our lives. It is the precise reality of the husband who entered my office so many years ago in a deep depression because he could no longer connect with his wife, who was suffering from dementia, and wanted her back with him.

Alzheimer's and other brain diseases are a fact of life and an unfortunate reality for too many families. Brain disease, like brain health, does not discriminate; it unites us in a common cause regardless of background. Our energy and resources are committed to finding cures for these diseases, but our incomplete understanding of the human brain most likely means a cure for dementia is not near. However, we can and should consider the behaviors and activities that relate to brain health as a viable and necessary path to follow now to forestall or reduce the risk of brain disease.

Degenerative and Other Types of Memory Loss

Brain dysfunction and disease can be caused in many ways. We have discussed dementia as a description of predominantly progressive forms of brain dysfunction. However, there are many other etiologies for brain dysfunction that may not be irreversible. In human brain function, so many processes need to be in balance or atypical or abnormal thinking...