Ward was a broad-shouldered, boisterous man in his early 70s who was visibly upset when he came into my office. A retired military man, Ward had a loud voice and a precise way of speaking. He was clearly anxious as he described several incidents in which he'd been "not up to par", as he put it: the other day when he couldn't remember the name of an old colleague; the evening when he forgot where he parked his car. And more and more often, he couldn't retrieve the right word on demand.
Even into his 60s, Ward had always felt as mentally sharp as the 30-somethings who worked with him. That began to change soon after he retired. He had been trying to do more crossword puzzles, but they didn't seem to help. A neurologist ran some tests and assured Ward that what he was experiencing was just normal, age-related cognitive decline, and said there wasn't much he could do about it. What most worried Ward were the Alzheimer's disease stats the neurologist shared with him: one in eight for people 65 or older, and over half for those over 85.
Ward had lived his life as a "beat the odds" kind of guy. He was born in a caravan and had worked two different jobs in high school to help his family and to save for university-the first of his family ever to attend. He was not a guy who was going to take old age lying down.
I quickly assured Ward that, although he was getting older, he didn't have to lose his edge and surrender to "senior moments". In fact, new research suggests memory loss may be reversible. The right diet and exercise could make a world of difference in clearing away his brain fog and promoting neurogenesis, the brain's ability to grow and change when presented with new challenges. Also, a simple memory game called 'n-back', the addition of an inexpensive spice into his daily diet and some new skills might provide Ward with the chance for his brain to stretch, grow and sharpen-and yours too.
What mild cognitive impairment means
Beginning in the late 1990s, the term 'mild cognitive impairment' kept popping up in medical journals and magazine articles. In 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association added 'mild neurocognitive disorder' to its list of official diagnoses.
All sorts of related terms-'age-associated memory impairment', 'subjective cognitive impairment' and my personal favourite, 'senior moments'-refer to that grey area between normal functioning and dementia or Alzheimer's disease. These recommendations don't just apply to the 65-and-over set, however. The time to take care of your brain starts much earlier.
Research shows your brain starts to noticeably slow down by your 40s, particularly if you do nothing to combat it. One study that tested over 7,000 people over the course of a decade found that all cognitive skills tested, except vocabulary, declined.1
If you work on sharpening your cognitive skills earlier in life, you will reap the benefits decades later.2 As Baby Boomers get older and our lifespans lengthen (and as we eat more processed carbs, move less and gain weight), mild cognitive impairment has seemed to take on epidemic proportions.
Up to 17 per cent of people over 65 may have some form of mild cognitive impairment, but what exactly is it?3 Signs of mild cognitive impairment include difficulty in the following:
o remembering names
o finding the correct word
o remembering where objects are located
Between 6 to 15 per cent of patients who meet criteria for mild cognitive impairment receive a diagnosis of dementia every year. After 10 years, up to 80 per cent of them will have or-if they've passed away-have had Alzheimer's.
And, as we know, Alzheimer's disease is challenging to treat, financially disastrous and, of course, emotionally devastating. It's already the sixth leading cause of death in the US and, in 2013, a new report from the journal Neurology warned that, by 2050, the number of Americans with Alzheimer's disease will triple from the five million currently to almost 14 million.
That said, if you're diagnosed with mild cognitive impairment, you are by no means doomed to an eventual Alzheimer's diagnosis. On the contrary, take it as all the more reason to go on the offensive. There are many things you can do to prevent and even reverse age-related types of cognitive decline. If your memory is going, you can fight to get it back.
One part of the brain involved in learning and memory, the hippocampus, is especially vulnerable to ageing: it produces less and less of the key protein RbAp48. In one study, inhibiting this protein in the brains of young mice made them forgetful in mazes. But when scientists increased this protein in old mice, their memories and cognitive performance were similar to those of young mice.4
While injecting this protein directly into our brains isn't an option for now, we certainly can employ neurogenesis-boosting strategies to keep the hippocampus fit, and potentially even reverse decline that's already occurring.
The study in young and old mice also provided evidence that age-related memory loss and Alzheimer's disease are two distinct conditions. Normal age-related decline targets the hippocampus, whereas Alzheimer's takes a different route, initially targeting a region of the brain called the 'entorhinal cortex'.
And though 'senior moments' and Alzheimer's are distinct conditions, you can slow down or even prevent both. Very few cases of Alzheimer's-only about 10 per cent-are inherited.
Taking charge of your ageing brain
The two primary brain structures to be targeted are the hippocampus and the prefrontal cortex, both of which are involved in learning as well as short- and long-term memory. When we strengthen these two areas, we go a long way towards fighting senior moments.
The hippocampus is the principal site of neurogenesis in the brain, which means we can actually grow new brain cells. We can also physically increase the thickness of the prefrontal cortex through meditation. (This is especially important as the prefrontal cortex begins to shrink in middle adulthood while it simultaneously loses dopamine.)
Fix your brain-fog action plan
Here are some simple steps you can take to keep your brain in shape:
Never stop learning
The most reliable way to keep your brain sharp is to make learning a lifelong pursuit. Once you're done with school and are in your chosen career, keep on learning. Learning is especially important as you get older, especially after retirement, and is one of the best tools to protect the brain from cognitive decline and senior moments. It's why people with higher levels of education have fewer senior moments, and why people who speak only one language show symptoms of dementia four years earlier than bilinguals.5
Learning also increases your cognitive reserve-it builds neurons and connections in your brain. The more of these you have, the more you can spare. It's not just about preventing Alzheimer-causing plaques from building up by using strategies like sleeping eight hours a night. People who have built their cognitive reserves through learning can continue to function well even after plaques have started to develop. And whatever our level of education or our genetics, we all have the capability to grow more neurons and connections.
Staying engaged in leisure activities helps stimulate your brain. One famous study looked at almost 500 elderly people to examine the relationship between leisure activities and cognitive decline. Reading, playing board games and musical instruments, and dancing all reduced their risk of cognitive decline.6 Yet another study found that travelling, gardening and knitting also have protective effects.7
But notably, there was one activity that significantly increased the risk of cognitive decline: watching TV. While reading reduced the risk of cognitive impairment by about 5 per cent, watching TV increased the risk by 20 per cent.8 So, if you want to curtail senior moments, start by watching less TV and doing more gardening, card-playing and travelling.
Exercise is another fun activity that can protect your brain against cognitive decline. Aerobic activity has been shown to promote neurogenesis in the hippocampus,9 while just the simple act of walking every day might cut the risk of dementia in elderly people by half.10 Another study found that aerobic exercise in older adults led to increases in brain volume in areas associated with cognition,11 and still another study found that the more people walked, the bigger their brain volume (which is associated with a lower risk of mild cognitive impairment).12
Exercise is also important because it helps reduce belly fat-and carrying excess belly weight can spell bad news for the brain. In one study, people with the most belly fat were three times more likely to develop dementia than those with the least. Even those subjects who did not have excess belly fat but were overweight had an 80 per cent increased risk of developing dementia.13
What's more, exercise is an extremely effective natural antidepressant, which becomes doubly important as people get older, as prescription antidepressants can impair cognition.14 And because older people are more likely to be taking other medications-many of which are vital to their health-they should be all the more proactive about employing natural strategies to decrease the total number of pills they take for all conditions.
Do the n-back task
If you've ever played the childhood game Concentration, you've used a version of this task. And most brain-training systems and apps like Lumosity and Brain HQ use a version of this as well.
Unlike strategies that target crystallized intelligence-the knowledge and skills you acquire through life experiences (such as expanding your vocabulary through crossword puzzles)-the n-back targets your working memory, which tends to decline as you get older. Crystallized intelligence, on the other hand, increases throughout most of your life. You learn more facts and become better at Trivial Pursuit. But working memory is important because it allows you to hold information for a short amount of time while also being able to manipulate that information if necessary. Many of life's more complex tasks require you to tap into this type of memory.
For all its simplicity, the n-back task been shown to actually improve fluid intelligence, which is vital for learning and once thought to be fairly unchangeable. Because fluid intelligence generally declines after young adulthood, it's one of the most important kinds of intelligence to improve if you want to prevent further senior moments.
It doesn't take a huge commitment to see the gains either. You can improve your memory by doing the n-back task for just 25 minutes a day, or even less, for just a week, with even more gains after a few weeks (see pages 46 and 47).15 The n-back task even helped 80-year-olds improve their memory.16
Decreasing blood sugar spikes, shifting from omega-6 to omega-3 fats, moving from soybean to olive oil, and eating lots of vegetables and legumes high in B vitamins, including folate, will work wonders to prevent senior moments and other forms of cognitive decline.
My suggested diet-the Brain Fog Fix Programme-is, generally speaking, an amped-up version of the Mediterranean diet, which has been associated with a lower risk of mild cognitive impairment. For people who already have the condition, this diet will help prevent the transition from mild impairment to full-blown Alzheimer's disease.17
Build your diet around Mediterranean basics like fish and olive oil, and cut dramatically back on processed carbs, substituting organic and pasture-raised meats and dairy, and eating seven servings of vegetables and fruit every day.
Berries are truly a miracle food for your brain-high in flavonoids as well as fibre, which manages blood sugar spikes-not to mention being delicious. Eating berries regularly has been shown to slow the progression of cognitive decline by up to two and a half years, according to one study.18 Blueberries in particular might even help people overcome a genetic predisposition for Alzheimer's disease.19 Berries also may be able to reverse age-related brain decline.20
For breakfast, mix blueberries and raspberries into protein shakes made with organic milk or unsweetened almond milk, or eat them with stevia and plain Greek yoghurt.
Eat liberal portions of fish
We've already seen how the omega-3s in fish, DHA and EPA, can improve the functioning of our brain, and this becomes particularly important as we age. One recent study with adults aged 50 to 75 found that verbal fluency, visual tasks and reading ability all improved with a fish-oil supplement. The fish oil even helped to improve the structure of the brain itself.21
Another study showed that an omega-3 supplement may be able to improve working memory in older subjects.22 And fish isn't just prevention, but also a treatment. In a study of people who were already experiencing senior moments, the ones taking a DHA supplement showed improved verbal fluency after six months.23
In rural India, less than 1 per cent of seniors aged 65 and over have Alzheimer's disease, compared with about 13 per cent in the US. The reason for this discrepancy is shockingly simple: Indians eat lots of turmeric, a spice used in curry that contains curcumin, which has major anti-inflammatory and antioxidant properties.
Turmeric can also increase brain-derived neurotrophic factor, which enhances neurogenesis in the brain while fighting Alzheimer's disease-causing plaques. One study showed that turmeric helps the body clear brain-fogging plaques from the brain.24 Another found evidence of neurogenesis and enhanced cognition in older rats in as little as 12 weeks.25
In addition to making you think better, turmeric will make you feel better too, possibly by increasing serotonin in the brain.26 Aim to get a little of this magical spice regularly and not just once a month when you wind up at an Indian restaurant, as low doses of turmeric over a long period time are more effective than very occasional high doses in fighting Alzheimer's disease-causing plaques.27 And try to eat it with black pepper as Indians do in curry. That makes it even more powerful because this combo makes the turmeric more bioavailable.
The oily brain
DHA (docosahexaenoic acid), your brain's 'think better' omega-3, is found mostly in fish, seaweed and DHA-enriched milk. Associated with cognition, DHA can improve IQ scores and support neurogenesis, and is important for preventing brain fog, dementia and Alzheimer's disease. One large-scale study showed that people with the highest levels of DHA-they ate three servings of fish a week-were 47 per cent less likely to develop dementia and 39 per cent less likely to develop Alzheimer's than those with lower levels of DHA.1
EPA (eicosapentaenoic acid) is your brain's 'feel better' omega-3 which, like DHA, you can get mostly through seafood. (Most seafood has a little more DHA than EPA, but a few types have more EPA than DHA-see page 47). People with low levels of omega-3 are more likely to be depressed or even diagnosed with attention-deficit/hyperactivity disorder (ADHD).2
Boosting the brain's EPA levels can do wonders for improving mood, preventing depression and soothing anxiety. One study showed a link between people who ate a lot of fish and good mood.3 Another even larger study found that those taking an omega-3 fish-oil supplement were about 30 per cent less likely to exhibit depressive symptoms than those not taking one.4
Supplementing with fish oils with a high EPA-to-DHA ratio can lead to significant reductions in both depressive symptoms and anxiety.
A placebo-controlled double-blind study of stressed-out medical students facing frequent exams showed that omega-3 supplementation resulted in a 20 per cent reduction in anxiety symptoms while decreasing inflammatory factors.5
Your Brain Fog Fix diet
Favour seafood-based superfoods. These give your brain the most concentrated doses of the two types of omega-3s, DHA and EPA. Ideally you will have at least one serving of one of these fish every day for the first week, then about three times a week. Here's a sampling of healthier types.
o Albacore tuna, troll- or pole-caught, fresh or canned
o Arctic char, farmed
o Barramundi, farmed
o Black cod
o Dungeness crab, wild
o Longfin squid, wild
o Mussels, farmed
o Oysters, farmed
o Pacific sardines, wild
o Rainbow trout, farmed
o Spot prawns, wild
o Salmon, wild, any origin
Include other omega-3 superfoods. However, these vegetarian options contain high levels of ALA (alpha-linolenic acid), which your body must convert to DHA and EPA (see box, page 42) for you to think and feel better-but it doesn't do this very efficiently, especially in men. Vegetarian sources of ALA include:
o walnuts ( 1/4 cup)
o flaxseeds, ground (2 Tbsp) or oil (1 Tbsp)
o chia seeds (2 Tbsp).
Include seven servings of vegetables and whole fruit per day. Favour vegetables over fruit, berries among all fruits, and organic over conventionally grown, with a variety of vegetables and fruits to ensure you're getting the various vitamins that serve as cofactors and the different antioxidants that prevent inflammation. When eating fruit, ensure it's eaten whole or blended. Don't juice it.
Drink at least 10 8-oz servings of water each day.
Avoid processed grains, but have up to two cups a day of the following:
Brown rice, quinoa, barley, oatmeal, bulgur wheat, millet, couscous, spelt, flourless & sprouted grain bread, shirataki noodles (made from konjac root), pulses or beans. Cook and season with olive or coconut oil.
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