Kevin Y. Kawamoto
Special to The Hawai‘i Herald
How many people spend time intentionally and consistently taking care of their brain? The idea and practice of “brain health” is gaining traction in the United States and beyond, as populations are living longer and people are growing more concerned about preserving not only their physical abilities but also their cognitive skills for as long as possible.
Unfortunately there is no pill or potion that can magically keep our brains in perfect working order as we age, but scientific research has resulted in recommendations that may help to keep our brains active and healthy even later in life.
What is the Brain?
The average adult brain weighs about three pounds and is a complex organ that “controls thought, memory, emotion, touch, motor skills, vision, breathing, temperature, hunger and every process that regulates our body,” according to Johns Hopkins Medicine website. About 60% of the brain is fat, and the rest is a combination of water, proteins, carbohydrates and salts. It’s an organ, not a muscle, and contains blood vessels, neurons and glial cells.
The National Institute of Neurological Disorders and Stroke calls the brain “the crown jewel of the human body” because it is the source of “all the qualities that define our humanity.”
If you know someone who has had a brain disorder, like Alzheimer’s disease or who has suffered a serious injury or trauma to the brain, you know that the brain can affect so many different things that a person without experiencing trauma may take for granted. These include memory, language ability, attention/concentration, the ability to recognize familiar people or objects, motor skills, making complex decisions and understanding how to respond in social situations.
We’ve learned so much about how the brain works from people whose brain has been damaged in some way. We can compare how that person was before the damage with how that person is after the damage. But we’ve also learned that the brain has the ability to change and adapt, a concept referred to as neuroplasticity. In other words, another part of the brain might be able to help a person perform functions if one part of the brain is damaged.
One high-profile person we have learned from is former Congresswoman Gabby Giffords who was shot in the head in 2011 at a political event in Tucson, Arizona, and survived. The bullet passed through the left side of her brain from the front of her head and exited through the back of her skull. Although she has made a remarkable recovery in the years since the shooting occurred, it has been a long and arduous journey for her and her husband, Mark Kelly. The part of Giffords’s brain that was damaged affected her language and speech ability, a condition generally known as “aphasia,” and she had to re-learn how to put her thoughts into words again, an ability that most of us probably take for granted but is actually a complex process of thinking, proper breathing, control of muscles that enable speaking and vocal sound production.
In an interview she gave to PBS News Hour last April, she said, “Aphasia really sucks. The words are there in my brain. I just can’t get them out. I love to talk. I’m Gabby.” She understands what other people are saying to her, but she can’t always respond in the way that she wants to. Interestingly, music therapy has helped her regain her ability to communicate in words. The National Aphasia Association, a non-profit organization founded in 1987, suggests on its website that while it is not exactly clear why a person who has trouble speaking out words has an easier time singing the words of a familiar song out loud, this does seem to be the case in many people.
“One theory is that because music crosses the hemispheres of the brain, it creates new neural pathways for language,” according to an article on the organization’s website. “In addition, music is ripe with repetition and patterns, two things that aid memory.”
Another non-profit organization called Music Mends Minds uses music to bring joy and meaning into the lives of people with neurocognitive disorders like Alzheimer’s disease and Parkinson’s disease. Through live group sessions and virtual sessions (during the pandemic), music lovers gathered to play instruments and sing just for the enjoyment of it.
The organization was founded by Carol Rosenstein, whose husband Irwin was diagnosed with Parkinson’s disease in 2006. Carol observed that when Irwin played the piano, he “became more aware, responsive, confident, energetic, talkative and hopeful.” Carol founded Music Mends Minds in 2014.
Increasingly, the use of music to enhance the lives of older people with some level of cognitive decline, even in advanced stages, seems to have psychological benefits, improving mood and encouraging more social interaction. To help older people who are losing the ability to communicate in words, caregivers might try to find out what kind of music the older person would enjoy listening to. Music, like food, is a matter of taste after all. Familiar songs from the person’s past are likely to trigger the most positive reactions. The change in mood and ability to communicate after a positive musical experience can be dramatic in some persons.
Prevention is the Best Medicine
Research to develop a medication that can stop or reverse the effects of Alzheimer’s disease – the most common disease that results in symptoms of dementia – continues on, but more work needs to be done. There are various drugs being tested on people in “clinical trials,” which are carefully controlled studies done to examine the effectiveness and safety of specific drugs on humans, and perhaps one day a breakthrough in drug therapy will be announced. Existing drugs approved by the Federal Drug Administration may help treat symptoms of Alzheimer’s disease but do not cure it. Effectiveness of the drugs vary and should be prescribed and closely monitored by a qualified healthcare provider.
In 2021, the FDA approved a drug called aducanumab (brand name Aduhelm), which has been shown to reduce amyloid deposits in the brain. The buildup of amyloid deposits are thought to contribute to the development of Alzheimer’s disease. However, aducanumab’s FDA approval has been controversial due to questions about its effectiveness and safety. It is also extremely expensive to pay for out of pocket, and Medicare has restricted its coverage to people in approved studies. The use of drug therapy to treat any health problem must be done in close consultation with qualified medical professionals and with a full understanding of the potential risks and benefits.
Because there is no cure for Alzheimer’s disease and medications on the market have varying rates of success in managing the symptoms of the disease, it is especially important to focus on preventative measures that can help people with healthy brains keep their brains healthy for as long as possible.
Here are some tips for maintaining a healthy brain, tips that come from a variety of scientific brain research and brain experts:
First, maintaining good overall health is important. Keeping blood pressure, cholesterol and blood glucose in healthy ranges should have a positive impact on brain health. High-blood pressure (hypertension), high cholesterol and diabetes are harmful and are all risk factors for Alzheimer’s disease.
Second, get enough physical activity. For some, this may be working out at the gym. For others, this may involve doing regular housework and yard work. Others may only be able to engage in light physical activity. Some people do chair yoga, tai chi or safe stretching. Do what you can that is safe for your body and get professional advice from a physical therapist if you need it.
Third, hearing and visual impairments should be evaluated by a specialist who can suggest ways of improving those senses. If hearing loss and visual impairments limit physical and social activities, they could negatively affect cognitive health as well since positive social interactions are thought to be good for brain health.
Fourth, maintain a healthy weight. Obesity is a risk factor for Alzheimer’s disease and many other diseases, especially if obesity is the result of poor food choices and lack of portion control. It can also limit physical activity and movement, limiting social interactions and spending time outdoors.
Fifth, get help for psychological distress and mental health problems like depression and anxiety. Depressed and anxious people may lack the motivation to pay attention to their physical health, which could worsen overall health problems and affect their ability to find enjoyment in life and in being with others. Good coping skills should be developed and practiced, with attention to work/life balance. Admittedly, this can be difficult for caregivers who have little support from others. Joining a caregiver support group can be a lifesaver. There are a number of them in Hawai‘i.
Sixth, be aware of your excessive use of alcohol and other substances that can lead to chronic illnesses and other serious problems. The CDC lists these possible long-term effects from excessive alcohol use: “High blood pressure, heart disease, stroke, liver disease and digestive problems. Cancer of the breast, mouth, throat, esophagus, voice box, liver, colon and rectum. Weakening of the immune system, increasing the chances of getting sick. Learning and memory problems, including dementia and poor school performance. Mental health problems, including depression and anxiety. Social problems, including family problems, job-related problems and unemployment. Alcohol use disorders, or alcohol dependence.”
Seventh, get enough good quality sleep! Sleep experts agree that seven to nine hours of good quality sleep daily is essential for good health. There are things that can be done and doctors who specialize in diagnosing and treating problems that interfere with getting a good night’s sleep.
Eight, good nutrition is important for good health in general. One general recommendation that seems sensible is to mostly avoid fast food restaurants and cook more whole foods at home when possible.
Ninth, discontinuing cigarette smoking or not getting started to begin with is a universal recommendation for improving health outcomes. The CDC says that cigarette smoking is the leading cause of preventable death in the United States, more than HIV, illegal drug use, alcohol use, motor vehicle injuries and firearm-related incidents combined. Relatedly, dementia experts recommend reducing exposure to air pollution. Fortunately here in Hawai‘i, our industries and tropical tradewinds help keep our air relatively clean compared to other places resulting in poor air quality.
Tenth, “exercise” the brain by doing cognitively challenging tasks, playing games that require brain skills or engaging in real life activities that require planning, communication and decision-making (what is often referred to as executive skills). The adage “use it or lose it” applies here.
- An example of learning something new and challenging – as well as culturally relevant – for someone in the Japanese American community is to study kanji, the Japanese writing system based on borrowed Chinese characters. This is no easy task, but it exercises different parts of the mind and body, including memory, translation, sight recognition, the fine motor skills necessary for writing, and so forth. Because there are thousands of kanji characters, a person can gradually build up skills from simplest to most complex or pursue the exercise to only a certain level of complexity. For adults with no or little background studying kanji, this activity could potentially last a lifetime.
- Another potentially new and challenging activity is to learn Japanese enka songs (or any Japanese language songs) and perform them using a karaoke machine. Again, this requires memory and translation, but it has the additional challenge of public performance. Moreover, enka songs tend to be emotion-laden ballads of some kind, so they provide an opportunity for emotional expression, especially for people who are more introverted and not accustomed to sharing their emotions off the karaoke stage.
- Other culturally relevant activities for stimulating the brain are writing haiku using the traditional Japanese syllabic structure (three lines total, five syllables in the first line, seven in the second line, and five in the third line). These can be written in English. Other forms of poetry also require deep thought, as does fiction, non-fiction and memoir writing.
Early Detection is Important
In Hawai‘i, it is estimated that 35,000 people will be living with Alzheimer’s disease by 2025. The Alzheimer’s Association has described signs of a potential problem that should indicate the need for professional consultation. These include: “Difficulty remembering recent conversations, names or events is often an early symptom; apathy and depression are also often early symptoms. Later symptoms include impaired communication, disorientation, confusion, poor judgment, behavioral changes and, ultimately, difficulty speaking, swallowing and walking.”
Like any health problem, the sooner you notice symptoms and call it to the attention of your doctor, the better. If there’s something that can be done early in any disease process to improve a patient’s health outcomes, early detection and diagnosis are essential. This also applies to the brain. Even though there is currently no cure for Alzheimer’s disease, there are people who are living with the disease and leading a meaningful life at the same time, often with the help of their support network. Support can be unpaid and informal – in the form of family, friends, neighbors, volunteers and so forth – or it could be paid caregivers and healthcare professionals.
It is important to note that cognitive concerns may be related to normal changes in the brain as one gets older, or it may be due to a disease. There are tests and assessments that can help healthcare professionals evaluate the problem and then suggest next steps based on the findings. These may involve drug and/or non-drug therapies, depending on each individual situation and help guide those who want to support the person experiencing these cognitive concerns.
Brain health, also known as cognitive health, seems to be receiving more attention these days as people become more aware of how important it is to take care of their brains, but there is much more that needs to be learned and done. The CDC has launched the Healthy Brain Initiative, a nationwide initiative that recognizes brain health as a central component of public health practice. One of the important goals of this initiative is to increase awareness of brain health. Developing policies, mobilizing partnerships, assuring a competent dementia-capable workforce and monitoring and evaluating the situation in each state are other goals of the initiative.
In Hawai‘i, there is much already happening to help raise public awareness and provide education about brain health to the public. The non-profit organization Catholic Charities has a publicly accessible archive of online videos related to dementia topics and caregiving, as well as ongoing online workshops in real time (which are later archived). The archive can be accessed at catholiccharitieshawaii.org/caring-for-persons-living-with-dementia-webinars-and-presentations/.
The Alzheimer’s Association Hawai‘i chapter is also a tremendous source of vital information and resources. Its website address is alz.org/hawaii. Project Dana has a caregivers support group in Honolulu and Waipahu as well as other services that can be found at projectdana.org. And finally, the Hawai‘i Aging and Disability Resource Center is a centralized source for information and assistance for older adults, individuals with disabilities, and family caregivers and can be reached by phone at 808-643-2372 or their website at hawaiiadrc.org.
Kevin Y. Kawamoto is a gerontological social work educator and a longtime contributor to The Hawai‘i Herald. He is interested in hearing from caregivers – past or present – of people living with Alzheimer’s disease and related disorders in Hawai‘i. What has your experience been like? What suggestions do you have to improve support for caregivers in Hawai‘i? What problems did you encounter or solutions to problems that you discovered as a caregiver? Please feel free to email Kevin with your thoughts at email@example.com.