Alzheimer's: What You Can Do

(soft guitar music) >>It started where I would go out to the garage to get something.

And I forget, you know, what am I supposed to get?

So then I go back into the house and I think, and I think and I remember what I was supposed to get and I go back into the garage and get it.

And so when I went to my neurologist, I told her about it.

I was diagnosed with impaired cognitive development.

Did I get that right?

>>Mild cognitive impairment.

>>Mild cognitive...

I'm sorry.

Mild cognitive impairment.

That scared us because that's a precursor to Alzheimer's.

(soft violin music) >>Everyone is afraid of the A word.

It's a bad word, Alzheimer's.

And the story always is that there's nothing that can be done for Alzheimer's, nothing that can be done for dementia and that you're gonna just end up in a wheelchair in a nursing home.

There are many things you can do about dementia and Alzheimer's that are effective and available now to help change your life story going forward.

Yeah.

>>Dementia doesn't strip a person of their essential humanity.

There's so much more to who we are as human beings than our cognitive function.

And if people can embrace all of those other aspects of what it means to be a human being, I think they can more readily live well with dementia.

>>And I believe that one of the biggest and most ignored human rights for people living with dementia is the right to have hope, to be able to live life positively, meaningfully, as fully as possible.

>>We overmedicate all the time.

So we are a society... You know, it's all over the world who embrace getting medication for everything.

>>There is close to a billion dollars worth of expenditures every year for certain medications that are promoted for Alzheimer's.

And yet, as the research has demonstrated these pills don't work.

And now we know, not only do they not work but they're making people worse.

>>We have treated diseases as if we were stuck in the 20th century, by saying, just as we conquered pneumococcal pneumonia with penicillin, we're gonna find the penicillin for Alzheimer's disease.

But Alzheimer's disease is fundamentally different.

People say we don't know the cause.

Well, that's actually backwards.

We know a lot of causes.

The problem is it's not one.

There are many things that contribute.

>>Lifestyle matters and lifestyle matters massively.

When you institute intensive lifestyle intervention, and especially if you started earlier than that in midlife, we say that midlife is the formative period.

>>Absolutely.

>>If you institute the changes early enough, you can definitely maintain vibrant cognitive life well into your 80s, 90s, and beyond.

(upbeat violin music) >>Long time ago, my mentor and I were the first to find genetic markers in the human genome.

We found the Huntington's disease gene.

Then I decided that I wanted to build a full map of a chromosome.

That time this was a big deal.

It was before the Human Genome Project.

And so I picked chromosome number 21 because it's the smallest and I was a student and wanted to get done.

And I built the first genetic map of chromosome number 21, which happens to be the chromosome involved in Down Syndrome.

And then when I learned that Down Syndrome subjects inevitably by middle age get Alzheimer's pathology in their brain, I speculated it'd be an Alzheimer's gene.

It would be on chromosome number 21.

And I further speculated that it would be the gene for the amyloid plaque that accumulates in the brains of Alzheimer's patients.

These plaques are these sticky-like, boulder-like material that accumulate around nerve cells.

It's the first thing that happens in the brain of an Alzheimer's patient.

Sure enough, the gene that made the plaque was on chromosome 21.

And then that turned out to be the first Alzheimer's gene.

And it turned out to have the mutations in it that cause early onset Familial Alzheimer's disease.

It turns out that these really lucky people had tons of plaques and tangles and no neuroinflammation, were genetically protected.

We looked at their genomes and a bunch of them so far have had mutations in genes that protected them against neuroinflammation being triggered in the brain.

And we're learning from those genes about how to develop medicines to do that.

We already have one in a phase three clinical trial here in Boston.

The drug came out of what's called Alzheimer's in a dish, where we create Alzheimer's disease in a mini human brain, the size of a paper punch in a little well on a dish.

And we get that little brain and we actually get it to create plaques, tangles and neuroinflammation in one month.

>>We testing hundreds of brain at the same time.

>>And this makes drug discovery and screening a hundred times faster, a hundred times cheaper.

These sort of blue guys here are the microglial cells.

They're the ones that are cleaning your brain when you sleep.

But when they smell cell death 'cause there's plaques and tangles that's when they rush in and they killed the neurons and that's neuroinflammation, and that's what's happening in the Alzheimer's patients brain.

So once we learned from which genes protect the brain and make it resilient to neuroinflammation, we use those genes and put those into mini brains.

And then we screen every drug possible 'cause we can do it now.

But for most of us, you have to ask, how do I keep my brain resilient?

And the idea is to come up with drugs to treat the early pathology that triggers the disease and treat folks 10 years before they're gonna get the disease, 'cause we know when they're gonna get it.

You know, for most people you don't know.

You know, you might be able to look in the brain and say plaques and tangles are brewing based on brain imaging.

But I don't know for sure if they're gonna get the disease, some people get plaques and tangles and never get the disease.

Luckily only 2% or 3% of Alzheimer's is due to these mutations that cause early onset and 97%, 98% of cases of Alzheimer's, it's the interplay of genetic susceptibility, the DNA your parents gave you and your lifestyle.

(upbeat violin music) >>We decided to find a lifestyle model, meaning are there other diseases that are affected by lifestyle.

Heart disease, diabetes, cancers.

And so we looked around.

Where have they done lifestyle?

Well, everywhere we looked it turned back towards... Loma Linda.

>>Loma Linda, as the center of a lifestyle care, lifestyle medicine.

What we've seen here in Loma Linda Health, it's absolutely the cornerstone of preventive medicine.

It's who lives in Loma Linda.

It's the Seventh-day Adventist.

It's the fact that they live a certain way.

It's not like people don't develop dementia here, they do, but much later and in much smaller proportions.

>>You see people being engaged and connect in a deeper spiritual way.

And then right across the highway you see San Bernardino, which is unfortunately one of the unhealthiest places in the country.

We work at a community clinic in San Bernardino and it's very common to see men and women in their 30s and 40s coming in with strokes, with cognitive impairment, with diseases that you usually don't see until, you know people hit their 60s or 70s.

Why?

Because of lifestyle.

Because of unhealthy food, because of lack of exercise, because of stress.

>>So, we said, can this same thing be applied to brain health?

And what we saw was absolutely.

(electronic music) >>There are diseases where genes drive the disease.

And if you have that gene, you're gonna get the disease or Huntington's disease.

It's one gene.

If the father has it, the son's gonna get it.

The percentage of Alzheimer's that's driven by genes alone is 3%.

The other 97% is polygenetic.

The rest of the genes have to do with risk, not absolute outcome.

So the second group of genes that deal with Alzheimer's are the Apoe-4.

So a Apoe-4 gene is a higher risk gene.

Meaning that if you have one allele from one parent, your risk goes up four times.

If you have two, one from each parent, your risk goes up anywhere to 12 to 15 times.

Does that mean that if you have two genes, you're gonna get the disease?

You remember, this is one of the higher risk genes.

You know, 50% never developed a disease.

What happened?

Lifestyle.

>>I own a makeup, hair and skincare business.

So I do makeup and hair for brides and styling.

I do makeup and hair for headshots.

I had an appointment in my system and it said Stephanie makeup.

Stephanie showed up at my studio for her makeup.

And I could not remember what this appointment was all about.

And she sits down to do her makeup.

And I said, "So what are we doing your makeup for today?"

And she just looks at me and she goes, "Uh, my wedding."

I couldn't remember this wedding.

And so I'm kind of trying to cover and, but still sort of be my chatty self.

And I said to her, "So how long have you known your fiance?"

And she said, "You know, 10 years."

And I mean, it was just obvious that it was getting awkward.

And I probably wouldn't have figured it out for a while, except that night on Facebook, I saw her with my long time tennis coach, whom she married.

And I remembered at that point that just two weeks, not three weeks, not four weeks, not five weeks, just two weeks before that he had called me and asked me as a special favor if I would do Stephanie's makeup for their wedding as a gift to her.

I was so upset and frightened and thought like, this is not normal.

It's like a sheet gets pulled down and you just have a complete memory loss of something.

It's not that normal memory loss that we all have.

>>For a long time, we basically focused on the plaques in terms of trying to treat Alzheimer's.

We've tried many different drugs that stopped the plaques, and all of them in clinical trials failed to improve the learning and memory abilities of patients.

And many people said, "Well, it's the wrong thing to do?"

Well, it's not that simple.

What we've learned is the plaques come so early in the disease.

They come 20 years before symptoms.

By the time the brain has degenerated to the point of dysfunction, the plaques have done their job.

I like to say to plaques are like a match.

And they light a fire in the brain.

The fire is the other pathology called tangles and neuroinflammation.

And you can't put out a forest fire if it's raging by blowing out the match.

So that explains why so many Alzheimer's trials have failed.

So how does this really work?

Well, everything you experience creates memories.

Memories come in the form of sensations.

You see things, you hear things, and then memories become your context for the world.

So, when a baby sees a pair of red shoes, the infant doesn't know what red shoes are, it doesn't know it's for your feet.

It's like they're big things and they're bright and they got my attention.

But then you remember that mom put them on and walked around with them.

So now you have context.

Red.

They look like that.

They're shoes.

That person I really like who takes care of me wears them.

So all your life you're building this map in your neuro network, a hundred billion neurons, hundreds of trillions of connections that it's like a tapestry and Alzheimer's comes in and tears that tapestry apart, just basically tears apart thread-by-thread.

The thing about your brain is that tapestry is not fixed.

With neuroplasticity, every time you're learning something new, you're rewiring the brain.

Genes make things called RNA.

And they're like little factories.

Let's say you eat a lot of fatty junk foods.

Gene A may be making X amount of some protein.

And because you were eating junk food and that protein was causing inflammation in your body.

You change your habit to natural foods, and now Gene A is making Y amount, which is half of X.

And now all of a sudden, there's no inflammation.

Think about thousands of genes, all making proteins and RNAs at different levels.

And as you change habits, they adapt.

So just changing an eating habit can change a thousand genes.

And there's something called epigenetics.

Epigenetics is to genes as neuroplasticity is to the brain.

You'll rewire your brain and your habits with neuroplasticity.

They are then programmed in your genes by epigenetics.

So what will happen is 60 days goes by and you see some really greasy burger, between your genetic program and the new wiring in your newer parts of your brain, you're gonna say, "Ugh, how did I even eat that two months ago?"

So that's the power of epigenetics and neuroplasticity.

All it takes is repetition and changing habit, and it doesn't take long.

>>The pathology behind why the symptoms occur and when that pathology is starting, and it actually may be much earlier in life when you're 40, 50 years old, even depending if you have family history.

>>So many things have been backwards about the approach that people have taken to dementia, to this Alzheimer's disease.

And one of the things was well, since there's not much you can do about it, then just wait as long as you can.

That's the opposite of what should be done.

My research shows the very first step is actually prevention and for people to get into this before they get symptomatic and to understand that the process goes on for years and therefore you don't want to wait for symptoms.

And if you do develop symptoms, that's okay.

Get in as early as possible, and get on active prevention.

If I see people who are in early stages who have relatively early symptoms, they all get better when you do the right things.

So the earlier the better, which is true for virtually all chronic illnesses.

>>One of the diagnostic tests is MRIs and CAT scans that find out do you have the plaques and tangles that are associated with Alzheimer's in your brain?

And then people say, "Oh, my God, they've got that.

They're gonna get dementia."

One of the things that has been proven is that there are many elders who are dying and have a brain autopsy done.

They've never had dementia, but it turns out they've got plaques and tangles.

So there's not even a hundred percent connection between that physiological difference and getting dementia.

>>So the molecule at the center of Alzheimer's disease is APP, amyloid precursor protein.

That is the thing that gives rise to the amyloid that we vilified in Alzheimer's disease.

What we call Alzheimer's really means your brain has responded to a set of insults in a certain way, a protective response.

This is a network system that is in failure.

That is involuting.

When we looked at these larger data sets to look at what is driving this, we could immediately see that there are subtypes of Alzheimer's.

And there is a subtype that is mostly inflammatory, which we called type one, a subtype that is mostly atrophic, which we called type two, subtype that is mostly toxic, type three, vascular, type four and traumatic, type five.

And so we won't say anymore, "Oh, it's Alzheimer's."

We'll say, "Well, you're in this space, you have this profile, and we're now going to change that profile to a profile that's associated with excellent cognition."

People have thought, there's nothing you can do about it, therefore you better not check.

So my argument is why would you stick your head in the sand?

In fact, you should know your status and you should know your status not only genetically, but biochemically.

Most of it you can be done with blood testing.

It's very simple.

Some of them are urine tests.

If you have symptoms already, you want to include imaging, typically an MRI with volume metrics.

You also want to include functional testing, very simple online neuro-psychological quantitative assessment.

When you turn 45 or older, you should have a cognoscopy, and especially if there's any family history of cognitive decline.

We look at the status of your vascular system.

We look at your history of head trauma.

We look at your genetics.

So if you're gonna reverse that involution, you need to know what's causing the involution and then you need to optimize each of those factors.

You can do this directly online.

You can do this with a trained physician, or you can do this with your own physician, or you can look up and find a new physician who will do this.

(electronic music) >>People when they come here to finally get evaluated, there is a tremendous fear that this is their life story.

This is what's gonna happen.

Hi, there.

>>Hey.

>>How are you, French?

>>Good.

Good.

>>Good to see you.

>>Nice to see you.

>>Hi, Kristin.

>>Hello.

>>How are you?

>>Good, how are you?

>>Good.

Come on in.

>>Alrighty.

>>So our office, for example, is set up very much the way I want my doctor's office to be, which is it doesn't feel like an office, it feels like a home and that helps people feel more comfortable.

>>In mild cognitive impairment probably due to dementia and probably due to frontal, temporal, FTD, frontal temporal dementia.

>>Right, right.

When the person first comes in, I make sure that I spend time talking to that person, finding out what their risk factors are for developing memory problems, what their personal medical history is, what medications they're taking.

And then after that, I do a general medical exam.

I do a neurologic exam.

I also do a little bit of a psychiatric exam.

People question, they say, "Well, why do we need these tests?

Because if we do the test, nothing can be done anyway."

And I'm here to say that absolutely, there are things that can be done and they can actually change the trajectory of what your future looks like in a way that really makes a difference.

Even the most pessimistic people looking at dementia and Alzheimer's disease.

Everyone knows that there are simple things you can do, controlling your blood pressure, controlling risk factors for heart disease, exercising and socializing.

Everyone agrees across the board that these things will help make a difference in preventing even a person with Alzheimer's from getting to a nursing home.

But in order for these people who are suffering in this way to embrace those lifestyle changes, someone needs to be able to tell them.

>>At the same time that we are delivering a very disturbing diagnosis to people, we also need to inject a sense of hope moving forward that you can continue to live a meaningful life even though you have a progressive often and incurable disease.

>>There was a time when people would consider the brain a completely different organ, that, you know, it worked under different mechanisms and that it was almost, you know unknown how the brain actually worked.

But over the years, we actually look at the vasculature of the brain.

We look at the pathological mechanisms of disease and we now know that Alzheimer's disease and dementia is not one point.

It's not a disease.

There are multiple different mechanisms involved that end to the manifestation of the disease.

>>Imagine that you have a roof with 36 holes in it.

You got to patch all the holes to have a big effect.

So we're looking at dozens and dozens of things that actually need to be addressed.

And for each person we typically find between 10 and 25 abnormalities that need to be addressed.

And I would call our approach precision protocols because you're looking at a program, but it is precisely set up and personalized for why you got the cognitive decline.

You then say, okay, here are the things that are critical.

And then you translate that into a workable practical program.

Here's what you need to eat.

Here's what you need to do as far as sleeping.

Here's what you need to do for your stress level.

Here's what you need to do for your exercise.

Here are specific herbs and supplements and things like that, that you're going to take.

Here are appropriate pharmaceuticals that you need to do.

Here's appropriate brain training that you need and then here's appropriate follow-up because one of the things about this, you don't just treat and stop.

This is a multi-phasic approach and it takes additional steps because we want to address the things that are actually causing the problem.

And that's what's been published as getting the best results so far.

Some people, it may take all 36 to get over the threshold but for many people you don't have to address everything.

So you don't have to be perfect.

You just have to keep at it until you start seeing improvement and then keep tweaking and keep optimizing.

>>The reason the protocol works is because we cast such a wide net.

And you have to look at this as a puzzle with potentially lots of different pieces.

>>My brother-in-law said to me, "You need to watch this video series on Alzheimer's," which I did.

But it's the first time in watching this video series on Alzheimer's that I found out that there was hope.

There was a doctor on it, Dr. Hathaway, and I got on the computer and I Googled her and turned out she lived an hour from me.

I need to at least check it out.

>>You're making sure that you get eight hours of sleep every night.

>>Well, yeah.

I had 10 to 12 of those markers that were not in the optimal levels.

So I have to develop my own Liz protocol.

>>I don't have an answer to what people should be doing to find out what chance they have of getting dementia, or if they've already got it.

Now, if it's to change your life and eat better, sleep longer, have less stress, do more exercise and maintain purpose in your life, I'm all in favor.

But I don't need to know I have a chance of dementia to do those five things, we should do those five things anyway.

And that's the best thing we have to put off dementia in the future and to live better with it, whenever it appears.

(electronic music) >>The genetics of Alzheimer's, we know fairly well now, what genes are involved in Alzheimer's.

What affects all these genes or the product of the genes.

Food is the most important.

The best studies show that if you eat well, plant-centered, your risk goes down as much as 53%.

Foods have to do with glucose dysregulation, foods have to do with lipid, Apoe-4 is the lipid transport gene.

You have a lot of garbage food, then if you have bad genes you won't be able to get rid of it.

You will develop disease.

Any food that you consume can add to that trauma or take away the trauma.

It's that significant.

It's poison versus medicine, that's food and its relationship to your brain.

>>Eat a lot of vegetables.

And by vegetables, we don't mean potatoes and cooked carrots.

You know, we mean all the cruciferous family, your broccoli, your leafy greens.

Eat fruit, but sparingly.

Try to eat organic as much as possible to reduce your pesticide and other toxin loads.

>>Water is really essential.

When we don't drink enough water, we actually can almost dry out the brain.

And dehydration actually can lead to things like urinary tract infections, especially in older patients and dementia patients, and they're already prone to that.

And that can contribute to this confusion that we see.

Really the best is drinking water, minimizing the coffee, teas and the sodas.

>>We learned that it's really important to keep your blood sugar in check.

And how do we do that?

Step one is to reduce your consumption of sugar.

That's how the sugar in your blood gets lowered.

Dietary meat should be restricted.

It should now be relegated to being a garnish and not the main event.

Generally we recommend meat each day about the size of a deck of cards or possibly a little bit more.

So many of us grew up in a time where we would gravitate in the grocery store to foods that were labeled low fat and no fat.

That meant that's for me, because of this messaging that we all receive that dietary fat was somehow threatening, that it would cause longterm issues.

Well we now recognize that humans have been eating a predominantly high fat diet for basically as long as we've walked this planet.

Fat is a good food to eat.

And we now recognize that having more dietary fat is powerfully associated with reduced risk for developing dementia.

It's why we see significant risk reduction for example, for dementia in people who have used what's called the Mediterranean diet.

We want good omega threes.

We want fats that are mostly monounsaturated fats that are unprocessed, like extra-virgin olive oil, the fats that we get from nuts and seeds.

So, it's good to think about welcoming fat back to the table.

Fat is back.

>>Changing food or changing dietary habits is probably the most difficult thing to do because food is not just food.

Food is culture.

Food is our stories.

Food is our memories of our grandma and our parents around the dinner table.

And people hold on to those memories dearly and they don't want to let go.

>>Changing my diet, I wasn't real happy about that 'cause I love my cheese and I love my hamburgers.

>>You missed your beer and wine.

>>Oh, yeah.

Well, I can't drink alcohol either.

I don't drink alcohol, because alcohol turns into sugar and Dr. Sherzai said that sugar's poison, it's poison for the brain.

>>Like it or not, I became plant-based too and it turned out it was so healthy.

I felt so good on it.

I was losing weight.

It was wonderful.

I know I'll never be anything but vegan again, ever.

And neither will he because I'm the cook.

(laughs) Plus he believes in it.

>>There's a lot of talk these days about the gut-brain connection, that somehow things going on in the gut might relate to the health and function of the brain.

The gut connection affects everything in the body.

The brain affects everything in the body.

The heart is involved with the brain and the kidneys and the pancreas and liver, you name it.

This is a holistic perspective.

Things that go on in the gut have a profound effect on what goes on in the brain.

The gut is where our bodies by and large manufacture what are called the neurotransmitters, serotonin and dopamine and norepinephrine, et cetera.

The gut manufactures many chemicals that are important for brain health and brain function and allowing the brain to be more resistant to disease.

We understand that the balance and diversity of organisms within the gut plays a very important role in the level of inflammation in the human body.

When we disturb our gut bacteria, primarily by eating inappropriately, but also by taking various medications including things like antibiotics, acid blocking drugs that are so commonly used, we open up the door to risk for altering how our gut bacteria function.

Our gut bacteria make B vitamins that are so important for brain health.

They manufacture a variety of metabolic products that have a huge play in terms of brain health.

They're involved intimately in detoxification of things to which we are exposed that can prove brain threatening.

And importantly, our gut bacteria are involved in maintaining the integrity of the lining of the gut.

We should care about that because when the integrity of the gut lining is altered or threatened, then it becomes more permeable and things then get across that wall and enter the systemic circulation.

And that immediately amplifies the process of inflammation.

So this is a powerful connection between how we treat our gut bacteria and risk for Alzheimer's, diabetes, heart disease, cancer and so many inflammatory conditions.

(soft piano music) >>Stress is the major cause of inflammation in our bodies and inflammation in our bodies, when it gets to our brain makes the difference between mild cognitive impairment and more full-blown dementia.

>>Stress increases the production of a chemical called cortisol, which is over a long period of time, directly damaging to the brain's memory center called hippocampus.

Dissatisfaction with your job or being in a relationship that's causing you stress each day, watching the news each evening, or burying oneself on the internet and getting trapped in a rabbit hole of ever increasing stressful and threatening information.

What the research shows is as little as 12 minutes a day being involved in a meditation practicing, a mindfulness practice, or even religious prayer, you gain powerful brain benefits by engaging in this type of activity.

>>Meditation, we do it twice a day, every day for 20 minutes each time.

And I like doing that because it relaxes me.

It relieves any stress I have.

>>People say, "Well, I don't have time to meditate."

Well, anybody who says that needs meditation the most.

"And I don't know how to meditate."

And we have a very simple term, which is if you're meditating, you're doing it right.

You don't have to sit in Lotus position, sitting in a chair and just keep your spine straight, close your eyes, rest your hands on your lap, for thought or a feeling or a sensation will never enter your brain.

You just picture a breeze blowing and just gently float away.

We did a study where we had people intensively meditate for a week.

We looked at how all of their genes, 23,000 genes were being programmed that week by meditation.

And it was amazing.

Genes that cause Alzheimer's are going in the right direction.

Genes involving neuroinflammation we're going in the right direction.

All these genes that can cause problems completely chill out, just in one week.

>>In 2006, by accident I discovered the power of music for people in nursing homes.

I called up a nearby nursing home.

Then I said, "Music is your number one recreational activity but can we see if there's any added value if we were to totally personalize the music."

And I came in with my laptop and a few iPods, and it was just, you know an instant hit when people had their own music.

And then I wondered, well, how will this work for people with dementia?

And so people said, "Yeah, you know, we can try that."

This gentlemen, Henry who spent like 10 years in a nursing home with basically head down and nobody heard him say anything for years and years.

>>Let's try your music, okay.

>>But then when he had his music put on, come awake and he started talking a blue streak and it was amazing.

♪ I'm goin' up yonder ♪ I'm goin' up yonder >>Aah!

♪ To be with my lord >>When they have their music, there's a really good chance, they're gonna just light up and reconnect with themselves, feel good, communicate more.

We use over-the-ear headphones because people with Alzheimer's or other forms of dementia often lose the ability to filter out various audio streams.

Your ears.

When people have their own music, it improves their lives and improves their sense of wellbeing and improves a sense of self.

It helps calm them down.

In fact, it often can replace the use of anti-psychotic medications, anti-depressants, anti-anxiety medications and the research bears this out.

♪ Round, round, get around ♪ I get around ♪ Yeah, I get around ♪ Ooh, ooh, ooh, ooh ♪ I get around >>My plea based on 5,000 healthcare institutions we've trained in the US and 10 other countries, is that everybody consider this seriously at home or for those in their care.

♪ Round ♪ Get around, round, round >>Very nice to hear.

>>Okay, so those are tears of joy?

>>Yeah.

>>Okay.

Just want to make sure.

>>Oh, yeah.

>>Hey, you know, we haven't done today?

>>What?

>>We haven't played hide and seek.

Who wants to hide first?

>>It's not surprising that people, when they retire and they lose the purpose they had, many get sick or many die or many just get depressed and other things happen to them.

That's engagement.

So purpose and meaning is engagement.

I get engaged with life.

And engagement includes having a task you love, taking care of your home.

It includes caring for other people, arts and creativity, taking care of your body, and then creating a status in sociologists called a status, membership in a club and decision-making in a committee.

>>People living with dementia said that they can live well as long as they have opportunities to make a difference and continue to have purpose.

A real difference, real purpose, not like a fake purpose.

That sense of being in community with others is essential to their wellbeing.

>>Loneliness is a risk factor for Alzheimer's.

If you're lonely, it's a two-fold increased risk.

That doesn't mean being alone.

If you're alone and you like it, that's fine.

If you're alone and it stresses you out, that's loneliness.

Staying socially engaged with family and friends is good for your body, good for your brain.

(dramatic piano music) >>The journal "Neurology," it put out a study in 2017 where it looked at the various treatments that we as practicing neurologists should offer a patient who have early Alzheimer's or what is called mild cognitive impairment.

It looked at 12 to 14 different interventions, the various drugs that were being tried, et cetera.

And they came out with only one recommendation that I as a neurologist should use for a patient who's now developing mild cognitive impairment, which is the precursor to Alzheimer's.

And the recommendation was a drug called exercise.

Recommendations for adults in America are for 30 minutes of exercise each day.

>>There's two kinds of exercise that we really emphasize.

One is interval training, which means warming up then exercising as hard as you can for 20 to 60 seconds and then relaxing till you can do it again.

Strength training is important.

Loss of muscle mass is a very common problem as people age, and weakness and loss of muscle mass certainly contribute to all kinds of debility, falling because you don't have as good a balance, et cetera, et cetera.

>>It's not just because we know exercise does some things in the brain, amplifies the growth of new brain cells, amplifies the connection between brain cells called neurogenesis and neuroplasticity respectively.

There have been actual interventional trials that have demonstrated in one year comparing people who are given a fairly aerobic program in comparison to individuals who have been given a program to simply stretch.

Those individuals involved in aerobic exercise demonstrated three things that are very important.

Exercise, it changes the DNA expression in a person's body to turn on the production of something called brain derived neurotrophic factor or BDNF.

And why do we love BDNF?

We love BDNF because it turns on the growth of new brain cells, specifically where we need it most, in the hippocampus or the brain's memory center, which happens to be one of the early places of degeneration in Alzheimer's.

Our hippocampus declines in size as we age and by exercising, we stop the decline and it actually increases in size, who would not want that.

And finally, on memory performance testing, they were improved.

The data is absolutely profound in terms of how you build a better brain by simply engaging in mostly aerobic exercise.

THe benefits of exercise are across the board.

Good for your bones.

Good for your heart.

Good for your immune system, better sleep, better blood sugar control, you name it and reduced risk of Alzheimer's.

What's the downside of exercise?

I can't think of one.

(soft piano music) >>In Alzheimer's disease, What correlates with dementia is loss of synapses, the connections between the nerve cells.

So a hundred billion nerve cells, but tens, if not, hundreds of trillions, in some cases, a quadrillion synapses.

So every time you learn something new, you not only make new connections, but all learning is based on association with what you already knew.

So you reinforce the old connections to and create new pathways to recall information.

People ask about brain games.

I say brain games, if they teach you how to focus and pay attention that's good 'cause now you have a tool for learning, but it's only learning that's gonna protect your brain.

>>Challenging mental activity and challenging mental activities not Sudoku.

It's complexity.

Write a book.

>>Learn a new language.

>>Challenge it.

Push it.

That's where good stress and bad stress comes in.

There's the stress that's bad, that's driven by purposes that's outside of you.

And then there's the stress that's your story?

That has timelines, that has success points.

And that actually grows the brain.

>>When you're doing anything complex, you involve all of the brain.

(soft guitar music) >>Let's take a guitar.

When you're playing guitar, you're reading the notes.

That's your left hemisphere, the language centers being turned on.

You're looking at the notes and processing it visually.

That's your occipital lobe.

You're processing it as far as its context, it's your frontal lobe.

You're being creative, it's your right parietal lobe.

You're emotionally involved, it's your limbic system.

It's a brain on fire.

>>You're paying attention, so that's an extremely great exercise for your focus and attention.

You're processing all the information you're getting.

You're formulating your own thoughts.

Being completely, absolutely present sense-wise and attention-wise is an amazing activity for the brain.

>>That's a brain that's being challenged at the highest level.

And when you challenge it and push it, you make those connections.

That's the secret.

(ambient music) >>There's a strong correlation between not enough restorative sleep and risk for this disease.

Getting seven to eight hours each night of good restorative sleep, sleep that is characterized by both REM sleep and deep sleep.

So why not do everything you can to get a good night's sleep.

>>How many people does anybody know who says, "I know I'm supposed to get seven to eight hours of sleep, and that means I gotta get to bed at 10:00 and get up at 6:00 or get up at 5:00, and I've got to make sure I learn how to do that.

I'm not gonna read the news on my phone.

I'm not gonna watch television for an hour or two before I go to sleep.

I'm definitely not gonna have a cup of coffee after noon."

Those are all sleep hygiene.

We've got the data, we know it's gonna keep us healthy.

>>The brain needs sleep.

It needs high quality sleep.

We need deep sleep.

We need REM sleep in order for the brain to function well.

If you don't have that, your brain is gonna continue to be compromised.

We occasionally have a person who gets diagnosed with sleep apnea.

They start using a C-PAP or some other kind of device to correct and boom, their cognition comes back.

Sometimes that is the thing that is causing people to be cognitively impaired.

>>Well, sleep is super important because it allows the body to repair, restore itself and reset itself.

But in the context of memory, it gives the brain a chance to reboot.

>>As importantly, during deep sleep, you are cleaning your brain.

I call it mental floss, because it's all this debris that accumulates in your brain especially after 40 years old, like plaques.

And during deep sleep, you're actually get rid of them.

So you need as much sleep as possible to clean your brain.

'Cause we don't clean your brain, that debris will someday at some point go on to cause neuroinflammation.

And that's when you go down the slippery slope.

That's when ten to one hundreds of times more nerve cells start to die, and Alzheimer's initiating pathology plaques and tangles get going.

Sleep helps to deal with those.

So we say seven to eight hours of sleep.

And people say, "I can't get that.

You know, I'm lucky I get five or six."

Well, if you get six hours of sleep, take an hour nap.

>>My father says we have to be good to our bodies while we're young so that our brain will continue to last for us as our bodies age.

>>The story that Alzheimer's is inexorable and progressive is untrue.

We have patients with Alzheimer's who have been stable for 10, 12 years.

I have lawyers with Alzheimer's.

I have physicians with Alzheimer's.

I have hedge fund managers with Alzheimer's.

Most patients will do well with treatment.

>>So I'm on the ketoFLEX 12/3 diet.

I'm trying to get 45 minutes of cardio exercise a day.

I'm trying to get a full eight hours of sleep a night.

And I'm managing my stress through meditation and some other things.

I then took kind of three months to really hone in on each one to bring it into my life because this is a daily thing that's gonna be for the rest of my life.

I have so much energy now.

The brain fog is gone.

I'm able to recall that this is a chair very quickly.

(Liz laughs) This is a watch, you know.

So I feel much better.

And I think that I'm on the right track.

>>There were at various times in history, scourges of leprosy, a scourge of polio, a scourge of syphilis, a scourge of tuberculosis.

You didn't wake up this morning worrying about whether you're going to die of polio, nor did I. Alzheimer's is going the same direction.

It will be a past scourge.

And just as we had a global vaccination program for polio.

We now need to have a same sort of global program for neurodegeneration, starting with global program to reduce dementia.

We're seeing unprecedented improvements in this untreatable illness.

We can make this a rare disease.

>>I'm all for being realistic about what our priorities should be.

And they should be about living well.

And living well, it doesn't mean free of disease or having the right pills.

Living well means having a meaningful life.

Living well means engaging with the world in ways that matter to you, to do things that give you a sense of purpose every day, that give you a reason to get out of bed in the morning.

These are the things that people deserve.

>>I was diagnosed about two and a half years ago.

The first six months I can... were very, very hard.

>>Tell me why.

Tell me why.

>>It was like a death sentence.

They said, get your affairs in order and enjoy your life.

So for the next six months, we got our affairs in order and it was, it was truly depressing.

My goal, and I believe our goal was to help me to live for the first few years better than I would have lived if I didn't come here.

And it's a couple of years later and we certainly are.

>>He definitely has something wrong.

And over time, we'll figure out exactly what it is but you need to live through it.

And that's what we're doing.

You know, we live a very simple, quiet life and it works for us.

But the truth is we have a wonderful life and it's not a death sentence.

This is the precious time because he's not progressing like what everyone thought he would progress.

So, I'm okay with this right now.

(soft violin music) >>So the question is, why do this in the first place?

And the first answer, maybe a spiritual one, which is why are we here on this earth other than to give people a quality of life?

What is our responsibility to young people, to older people, to everybody, to give them a life worth living.

(soft violin music) (electronic music)

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