Conway McLean, DPM, Journal columnist

How well do you think? Seems a strange question perhaps, but scientists are concerned with aging and the consequences thereof.

With our aging population come many health problems; time is unkind to the human body, the nervous system included. It should be obvious to most, the brain is an essential component of this part of the human body. And the evidence reveals tremendous variability in the functionality of our brains during our later years.

Within 20 years, about one in five Americans will be 65 or older. Part of aging is a degree of decline, be it physical or mental. Cognitive function, defined as the ability to think, to remember, to learn, naturally lessens with age.

In some, this process proceeds rapidly to the extent that it interferes with a person’s quality of life and activities. Unfortunately, we remain ignorant of the specifics: conjecture and theories rule the day.

As should be expected, these changes come in varied forms and different levels of severity. Mild cognitive impairment, designated as MCI, is the most common type and entails more benign symptoms, but can progress to true dementia in some.

Alzheimer’s is the most frequently seen type of dementia and is associated with significant progression, generally resulting eventually in death. Amongst the elderly, it is the fifth most common cause of mortality.

Mental decline is common, expected, another loss to the ravages of time. It’s one of the most feared consequences of aging. Every brain changes with age, and mental function changes along with it. Memory becomes faulty, unreliable. Decision making is more difficult, conversations harder to follow. An increased risk of depression has been noted. People with cognitive impairment lose their train of thought more often and more easily, as well as their temper. Anxiety occurs more frequently.

We know many factors come into play in the development of cognitive decline and dementia, some obvious and out of our control. Genetics is always a fundamental part of an individual’s health. But you can’t choose your parents while other components are very much under our control. The foods we eat, the substances we put into our bodies, how much we move (or don’t). But cognitive impairment is not inevitable; there are elements we can alter.

Surprising to many is the interaction between obesity and brain health. Some of the changes to the brain seen in Alzheimer’s can also be found in those with obesity. Diabetics with neuropathy, the nerve changes associated with this ubiquitous disease, are at increased risk of experiencing cognitive decline versus those who do not have diabetic neuropathy. Although we don’t understand the mechanism, even heart disease and hypertension seem to increase one’s risk.

But there is positive news on this topic. Evidence continues to grow that people can reduce their risk of cognitive decline by adopting certain lifestyle practices. Nutrition has been a hot topic in the discussion of brain health. Although our understanding of the role of diet in brain and neurologic health lags behind many specialties, study continues into this critical component of health.

Foods containing high-fructose corn syrup have been associated with impaired brain health and a higher risk of dementia. The list of these products includes many found on the shelves of your grocery store. An inspection of the ingredients in products such as breakfast cereals, fruit juices, sport drinks, and numerous others, will reveal the addition of this substance. Although the evidence is not yet definitive, gluten has also been linked to MCI and cognitive decline. This is a naturally occurring protein found in many grains, especially wheat products. Additionally, diets high in saturated fats possess a greater risk for dementia.

Various nutrients seem to reduce a person’s likelihood of these changes. Some examples include mega-3 fatty acids, plentiful in fish oil supplements. The B vitamins are vital to nerve health, as is D. Lutein is a plant pigment which aids in memory and learning. Protein levels also are beneficial to brain health. Foods high in flavonoids, which are powerful antioxidants assisting one’s immune system (plentiful in blueberries) appear able to boost memory and brain function.

Probably the safest approach nutritionally is to adhere to the principles of the MIND diet which, like the Mediterranean diet, rely on the consumption of fresh vegetables, legumes, nuts, and fish. Numerous studies continue to highlight the benefits of this approach. Not only has the evidence demonstrated a marked reduction in dementia risks but also improved heart and blood vessel health. Anything which helps your arteries is going to aid in dementia risk: what’s good for the heart is good for the brain.

As with most everything else in health and fitness, exercise has a strong association with brain health. Mental stimulation is also important, things like word games or learning a new language. Getting good sleep, of sufficient length on a regular basis, also reduces your risk of these degenerative changes.

Not surprisingly, cigarettes have been linked to an increased likelihood of cognitive decline. Maintaining a healthy blood pressure and optimal blood sugar levels, especially important for those with diabetes, are recommended. Limiting your intake of alcohol, even minimizing exposure to air pollution, seem helpful in preventing these brain changes. Reducing your risk of a head injury is recommended, with a recent study indicating that professional soccer players have a significantly greater risk of developing dementia.

From what we currently know about brain physiology and neurologic disease, measures such as these are highly recommended if one has a family history of dementia or Alzheimer’s, or even a suspicion of similar genetic traits. Absent such a history, following these dietary and lifestyle recommendations seem likely to reduce one’s risk of cognitive decline.

As of now, there are no pharmaceutical agents available for the treatment or prevention of cognitive decline, dementia, or Alzheimer’s. Regardless of the development of such a drug, a healthy approach, informed by the latest science, seems an effective way to maintain memory, cognition, and reasoning. A lifestyle encouraging brain health is a worthwhile investment in a fulfilling, enjoyable life well into your later years, however long they may be.

EDITORS NOTE: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.