Save Your Mind: Seven Rules to Avoid Dementia

By Antoine Hakim

This practical and informative book says that you can avoid dementia and the loss of control that accompanies this brain disease by following the author’s seven specific rules to exercise the brain and body. From the winner of Canada’s most prestigious science award, The Canada Gairdner Awards, this book also offers an authoritative and easy-to-understand explanation of how the brain works and what happens when dementia afflicts it. Author Dr. Antoine Hakim tells about some of the mind-blowing research that shows how elderly nuns maintained their cognitive abilities even though their brains displayed the physical signs of Alzheimer’s. He argues that you can build up a defensive system, a cognitive reserve, to protect your mind if you have a stroke. It’s even possible to reverse the early signs of dementia. Save Your Mind is an essential book for anyone who wants to take proactive steps to prevent dementia and the loss of mental control.

• Language: English
• Publisher: Barlow Publishing
• Release date: Aug 28, 2018
• ISBN: 9781988025322

Book preview

Advance Praise for Save Your Mind

With advice that is actionable, in language that is sharp, Dr. Hakim shows, explains, and sensitizes. As he uncovers the human dimensions of the disease and what can be done, he enables us to care better for ourselves, and others. This book is a gift, an invitation to the human spirit, a call to our formidable capacity to engage in combat and change course. Armed with love, determination, empathy, and the very memories that are under attack, everyone can take steps today so the future doesn’t take away the present, then the past. This book is for everyone who owns a brain.

— Michaëlle Jean, Secretary General of La Francophonie and

Governor General of Canada (2005 to 2010)

Dr. Hakim’s book shines a light on the critical importance of brain health: what we put in our heads helps protect us from both stroke and dementia. The book emphasizes the brain’s constant need for good blood supply, and describes how vascular risk factors such as high blood pressure can be managed through long-term regular physical activity, healthy eating, good sleep habits, avoiding loneliness, and exercising the brain by learning new activities. This book raises awareness around the risk of dementia and provides essential and practical information for anyone who wishes to reduce the risk for this awful condition.

— Dr. Patrice Lindsay, Director, Stroke, Heart & Stroke Foundation

Dementia is a huge problem, and this impressive book can help each one of us reduce our risk for it.

— Dr. Yves Joanette, Chair, World Dementia Council

When approaching middle or old age, who of us has not been afraid of the possibility of developing dementia? In a well-researched book, Dr. Hakim outlines seven practical measures each of us can take to prevent, or at least postpone, this unpleasant disease.

— François Mai, MD, FRCPC, FRCP (Ed), Adjunct Professor,

Faculty of Medicine, Queen’s University, and author of

Diagnosing Genius: The Life and Death of Beethoven

SAVE YOUR

MIND

Seven Rules to Avoid Dementia

Antoine Hakim, O.C., MD, PhD, FRCPC

Copyright © Antoine Hakim, 2017

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, without prior written consent of the publisher.

Disclaimer: Efforts have been made to ensure information is correct and accurate. The author and the publisher accept no liability for errors. We take no responsibility for loss or damage as a result of a person doing something or not doing something in accordance with the teaching in this book. The book is not providing legal, accounting, or lifestyle advice, and input from a competent professional should be sought.

Library and Archives Canada Cataloguing in Publication data available upon request.

ISBN 978-1-988025-21-6

ISBN EPUB: 978-1-988025-32-2

Printed in Canada

In Canada:

Georgetown Publications

34 Armstrong Avenue, Georgetown, ON L7G 49R

In the U.S.A.:

Midpoint Book Sales & Distribution

27 West 20th Street, Suite 1102, New York, NY 10011

For more information, visit www.barlowbooks.com

For my grandmother and parents, who despite forced migrations and extreme poverty remained committed to their children’s success and happiness.

For my wife and children, who lovingly understood and accepted my prolonged commitment to writing this book.

Contents

Introduction

Before the Rules, A Few Facts

Rule 1Grow Your Brain’s Capacity for Cognitive Functions

Rule 2Reduce the Debit Calls on Your Mind

Rule 3Monitor and Tame Your Blood Pressure

Rule 4Eat Right, Weigh Light, and Stay Bright

Rule 5Move Your Hind … To Save Your Mind

Rule 6Sleep Enough … If You Want to Think with Ease

Rule 7Socialize and Feel Useful: Loneliness and Depression Can Make You Crazy

Summary

Epilogue

References

About the Author

List of Figures

Figure 1MRI of a normal brain, showing white and grey matter structures

Figure 2Images of a hippocampus

Figure 3MRI Scans of a Normal Brain and a patient with Alzheimer’s Disease

Figure 4The Heart & Stroke Foundation FAST Assessment

Figure 5MRI Scan of a patient who has suffered a stroke that was not immediately treated

Figure 6MRI Scan of a patient who suffered covert strokes (mini-strokes)

Figure 7Percentage of strokes attributable to specific risk factors

Figure 8Diagram to summarize all the drivers and health consequences of obesity

Figure 9Why are these fitness fanatics using the escalator?

Figure 10Diagram showing the mechanisms by which depression damages our brain leading to dementia

Figure 11Mpower for smokers

List of Tables

Table 1Dementia risk in 20 years, based on scores for risk factors in midlife

Table 2Factors contributing to dementia worldwide and in North America

Table 3Relative blood pressure impacts of some of the major lifestyle modifications

Table 4Patient Health Questionnaire

Table 5Scoring the PHQ-9

Introduction

Why You Need to Read This Book … and Follow Its Seven Rules

This book will help you keep your marbles!

We are all getting older, we’re living longer, and we’re terrified of losing our minds and having dementia. This book is written because I believe I have advice that will substantially reduce your likelihood of having dementia. The main lesson my 40 years of neurology practice have taught me is that vascular disease affecting the brain, combined with harmful behavioural patterns, contributed to dementia in the majority of cases. This combination usually led to sufficient damage to the brain’s structure and integrity that normal thinking and memory recall became difficult if not impossible.

This book is not intended only for the older citizen. It is now clear that the script for dementia is written very early, perhaps as early as our teenage years, so this book is written for everyone who cares about keeping the mind healthy. In my neurology practice, I have seen patients in their 40s who complained of brain fog and were clearly staring at the abyss of dementia. Some were able to reverse course and avoid that outcome while others continued their downhill path and over a few years became heavily dependent on their environment.

In the following pages, I will share with you knowledge I have gained from research done in Canada, the United States, and internationally on the topic of strokes and other vascular diseases that affect the brain. I will advise you especially on how to avoid them. I will also share with you knowledge on how to acquire some patterns of behaviour and avoid others in order to preserve your cognitive abilities. Lectures I have given internationally on the topic were always so popular that I decided to include in this book advice on how to maintain your ability to think and remember. You will learn how memory works in our brains and how to distinguish normal forgetfulness from more sinister possibilities.

The important message in this book is this: The risk of dementia is modifiable.

We do not have to acquire dementia as we age. There are lots of good examples of individuals, and even entire societies, where people remain intellectually sharp into very old age. I will give several examples of healthy minds in old age and extract from the accumulated studies advice you need to follow to stay sharp. To accomplish this, I have summarized current knowledge into seven rules to guide your future mental and cognitive health. These seven rules are based on my clinical experience, published research work, and voracious reading of the medical literature. The rules will benefit every person interested in preserving their mind and their ability to think and remember.

So read, enjoy, and get with the program.

Happy reading!

Before the Rules,

A Few Facts

We Are Living Longer, But We Also Want Good Life Quality

Dementia is by and large a disease that accompanies old age, and all of us are hoping, indeed expecting, that we will live longer than our parents did. Statistics confirm this expectation of longevity. They tell us that currently 50 million Americans are older than 65, and that in Canada 16% of the population is in that category. This demographic group is growing faster than any other. Not only that, but the rate of growth of this group is accelerating. Once Americans reach the age of 65, the average remaining life expectancy is still 20.4 years for women and 17.8 years for men.

It’s not just that we are living longer; our attitude towards old age is also changing. I saw an obituary recently that said, Jo Smith died unexpectedly at the age of 93. While we are of course delighted that life’s joys may be ours for longer than we anticipated, our fervent desire is not just to live long in years. We also want good life quality. And for most of us that means keeping our marbles and our independence as we age. We are aware deep in our souls that without the health of our brain and our mind, there is no health.

The statistics about life quality are daunting. Currently it is estimated, using different calculation methods, that more than 500,000 Canadians, 5 million U.S. citizens, and 44 million individuals worldwide suffer from dementia.¹ If you include individuals affected by milder forms of memory difficulty, not severe enough to qualify for dementia, these figures grow by about 50%. As if that was not bad enough, it is also estimated that every five minutes, one person somewhere is diagnosed with dementia.

And of course, those individuals afflicted with dementia are not the only ones affected by the condition. Every person with dementia requires a caregiver, frequently a family member whose chances of becoming depressed increase dramatically over time. Usually, both the affected individual and the care provider need to quit work, stop deriving income, and stop paying taxes. For this reason, there is increasing concern that what some refer to as the dementia time bomb will result in a severe fiscal squeeze: spending on age-related programs, including health care for seniors, will have to increase at a time when declining birth rates will result in diminishing revenues. This will force governments to increase taxes and modify health care systems to give priority to this debilitating condition, taking funding away from other projects and health care needs.

David Cameron, the former prime minister of the United Kingdom, called dementia one of the greatest enemies of humanity. Against this unsettling background, there is good news, and that is why this book was written.

Let me start with a story from my own family. My father-in-law is 91 years old. He fought in the Second World War as an Air Corps gunner, and when he returned home he worked as a carpenter. He has always been physically active. He always lived in the countryside; built the houses that his family lived in; and still has a vegetable garden, cuts his own wood, carries it, and stacks it in a shed to be used for heating the house. Not only is the man on the move all the time, but he is also a voracious reader and active writer. Upon his return from the war, he got in the habit of writing a daily note, and I recently had the privilege of reading some of these journals, which spanned decades. He always starts his note with an observation on the weather, then a note on any wildlife he may have seen on his outings, a comment about what is going on in society around him, locally and nationally, followed by a personal note about what is going on with him and his family. The readings are fascinating because they cover so many years of personal, local, and national history. He still displays an impressively sharp mind. He is ready to engage me in discussion on any topic in the news or the family. The messages his life provides are captured in this book: Read. Write. Keep your brain active. Remain physically on the move.

The parents of a colleague live far from my father-in-law, on the island of Corsica, where the terrain rises sharply from the sea. My colleague’s aging mother has to climb several flights of stairs to get to her house and descend them if she needs to do any shopping. Recently it was suggested that she move households to a lower dwelling so she wouldn’t have to climb up and down so many stairs. She responded with wonderful insight and said, Going up and down all these stairs is what is keeping my body alive and my mind sharp.

Not only are there these notable individuals who have combined longevity of life with intellectual lucidity, but many studies of societies or groups of individuals have made correlations between mental abilities and lifelong activities and habits. My own observations, combined with the messages that have come to us from these studies, lead to a very clear message that was eloquently articulated by Dr. Robert Wilson, who led the Baltimore Longitudinal Study of Aging. He put it this way: The brain that we have in old age depends in part on what we ask it to do throughout life.²

That thinking changes things drastically. It used to be that when an older neighbour or friend had dementia, we thought they had Alzheimer’s disease, meaning there was not much they could have done to avoid that outcome. It was their fate. Now we know that Alzheimer’s disease is but one cause of dementia, and not the major one. In fact, we control a major part of how we age. And that is a good thing, because there is no consistent evidence of benefit from any pharmacologic agent in preventing or slowing cognitive decline due to Alzheimer’s disease. The best thing is to avoid the awful condition of dementia before it starts, or slow it down before it progresses too far—and you have the power to do that.

Your Brain Is Modifiable

In addition to individual stories like my father-in-law’s and my colleague’s mother, the conclusion that we can reduce our chances of having dementia is supported by several large and informative studies. The Scottish Lothian study tested 70,000 children at age 11 and followed them over the years. The Lothian study showed clear evidence, perhaps not surprisingly, that the more intelligent a child was at age 11 the more likely it was for his or her cognitive abilities such as memory to be preserved in old age.³ Genetics—who you picked for Mom and Dad—does play an important role, but that study also clearly showed that the participants’ scores on IQ tests at the age of 11 predicted their score in old age less than 50% of the time. Most of how well a participant functioned in old age depended on what he or she did with the brain qualities they were provided at birth. So your mental function in old age is not written in stone—it is written in brainpower you can boost or waste, confirming the important concept of brain plasticity, meaning that your brain is malleable and modifiable. In confirmation of that statement, the study suggests that regardless of how smart the young Scots were at birth, those who remained physically fit, maintained their bilingual backgrounds by nurturing their knowledge of both Gaelic and English, acquired more education, and did not smoke had better test scores in old age than would have been expected. In other words, the years will take a different toll on the brain depending on what you did with what you were given.

Closer to home in Baltimore, the Longitudinal Study of Aging has enrolled almost 1,000 people over the past 50 years. Every two years they are retested using a battery of cognitive and physical tests and answer questionnaires on their past and current intellectual lifestyle, including whether they read books or write letters. Their brains are also examined after death. The researchers recently concluded that the thinking, memory, and other cognitive abilities of those who kept their brains busy as they aged were more preserved than those who had not.⁴

Combined, the observations from these studies are answering the question of why some individuals seem not only to live long but also maintain their cognitive functions at a very sharp level throughout life, whereas others seem to complain of brain fog at a young age. What do you have to do to belong firmly in the first category? This book will be answering these questions for you.

How Do We Think and Remember?

The richness of the information each of the 100 billion neurons in our brain receives and sends out is to some extent predetermined—it’s inherited through genetics, which determine the number and quality of the neurons, other brain cells, and their connections, as well as the chemical environment they live in. So some of our cognitive and thinking abilities are not under our control, but the more important cues provided to the neurons in our brains are those acquired through our own activities and emotional environment. The trillions of contact points among the cells in the brain are known as synapses. At five months of gestation, the fetus has all the cells in the brain that he or she will have as an adult. The growth in the volume of the brain from then on is entirely due to the growth of the connections the neurons make on the receiving and outgoing ends. Keeping all these connections active and healthy is what provides us with the ability to think rapidly, calculate, recognize a familiar face, and remember an event, a date, or a place.

It is important to keep in mind something that has been known for a long time: that everything we do, or don’t do, affects the health of these cells and their connections.⁵ Their numbers and functions change with time but, more importantly, respond to the health