01.06.2009 Natural Health

Healthy Heart, Healthy Brain

Margaret Evans meets a dementia researcher whose message is one of empowerment rather than fear

Remember Ronald Reagan, the silky smooth "Great Communicator" whose last message to the world was to bravely share his devastating prognosis before slipping away from the international stage into the enveloping fog of dementia? Or our own Hazel Hawke, who, equally bravely, shared an insight into her diminishing world before she, too, retreated from the public gaze. Both had been given a diagnosis of Alzheimer's Disease, the most prevalent form of dementia in the developed world. The fact that it can strike down the rich and powerful, as well as our nearest and dearest, just adds to the fear that surrounds this incurable condition. Like all fear it's based in ignorance - we understand so little about it. As a case in point, how many of us have even heard of Vascular Dementia, a separate form that afflicts 20 to 30 per cent of people in the first year after a stroke?

But it seems we want to know more. It's Never Too Late to Change Your Mind, written by Sydney doctor and dementia researcher Dr Michael Valenzuela, has been an unlikely No I bestseller in ABC bookstores in recent weeks since its February release. Maybe it's the underlying message of the subtitle, "The latest medical thinking on what you can do to avoid dementia", that conveys a sense of empowerment that overcomes our deep seated fears. And that's exactly what 34 year old Dr Valenzuela is seeking to achieve.

He pulls no punches in describing the seriousness of the condition: "It's really a fundamental and massive problem in Australia . At the moment in terms of numbers, over 220,000 individuals are affected with dementia and about one in 10 knows someone affected by dementia. So the spread of the burden in the community is really quite massive." Beyond the current numbers there's the added factor of an ageing population, with the baby boomer cohort now coming into the age group at risk. Dr Valenzuela suggests the number of dementia sufferers could double in the next 20 years: "so it is a real, real cause for concern."

The CEO of Alzheimer's Australia (NSW) John Watkins has highlighted the looming risk as the equivalent of climate change for medicine.

The key message of his book and one that those early sales show readers seem ready to embrace is the importance of prevention. As he says, "A preventive approach is critical in dementia because there is no cure and no effective treatment. Prevention has to be a real priority."

Unlike heart disease or diabetes or cancer which are all freely open for discussion and are widely written about, dementia suffers in silence. It seems to be a combination of ignorance - what is it exactly? - and that pervasive fear that always surrounds something we don't understand, particularly something that strikes so directly at our sense of self. We fear being robbed of our personality, our dignity, our individual spark and left helpless and dependent on others.

"A preventive approach is critical in dementia because there is no cure and no effective treatment. Prevention has to be a real priority."

I've seen its tragic impact on my own family with no history of Alzheimer's Disease. My mother's death came with a sense of blessed relief, not least for her, after two years of decline following the trauma of "life saving" surgery, twice in just two days. Even so, she would sometimes remark on the "poor old dears" around her, with just a hint of that feisty humour that was her trademark. It's those memories we as a family treasure.

In his helpful and compassionate way, Dr Valenzuela even provides a succinct definition: "Dementia is a gradual decline of mental function to the point where you can't really do day to day activities. So it's a very general clinical concept and there can be a number of diseases to lead to that outcome, the main two being Alzheimer's Disease and Vascular Dementia. They're related, but distinct, ideas."

We all make the same joke that not being able to find our car keys is "a bad sign". Rather, it's simply being distracted and pulled in so many different directions, the malaise of our time. The really bad sign, suggests Dr Valenzuela, is not knowing what to do with the keys when you find them.

The message is crystal clear - we do have the capacity to reduce our risk of this debilitating condition and it is by no means inevitable that we will experience mental decline as we age.

Dr Valenzuela mentions the example of a person who died at the age of 115 with no clinical signs at all of Alzheimer's Disease. Cooking with aluminium pots and pans also has no impact whatsoever on increasing our risk - it's just another of those persistent myths that surround dementia but so strong that I, for one, threw mine out years ago.

The exciting and empowering revolution of the last decade (and the very cautious Dr Valenzuela is happy to use the term revolution) is the growing understanding that vascular disease is a direct risk factor for Alzheimer's and that there is "an incredibly close link" between vascular disease and all types of dementia. So what is bad for the heart can also be bad for the brain. Or, to put it the other way around, what's good for the heart is very likely to be beneficial for the brain as well. Therein lies both our hope and our challenge.

So what is bad for the heart can also be bad for the brain. Or, to put it the other way around, what's good for the heart is very likely to be beneficial for the brain as well.

The medical profession, says Dr Valenzuela, has often overlooked the role of vascular disease in older patients, making the assumption that Alzheimer's is the culprit. But vascular disease of the brain is "incredibly common" and post mortem examination of older people often shows the two diseases existing side by side.

In his current role as Research Fellow in Regenerative Neuroscience at the School of Psychiatry at the University of NSW and a contributor to more than 30 research publications in this field, and perhaps even bestselling author, he is working with Alzheimer's Australia and the National Heart Foundation to promote a combined message, one that brings dementia within the framework of whole body health, what we recognise as a holistic paradigm.

The first and most important step, Dr Valenzuela suggests, is to maintain a healthy blood pressure level. "I rate it as the No 1 best thing that people can do, but people are always surprised and ask, 'What's blood pressure got to do with dementia?' But there is a lot of evidence linking those two things." There's a lot of ground to be made up as a recent survey revealed 80 per cent of Australians weren't aware of the link between high blood pressure and dementia.

In alarming fact is that rates of high blood pressure are increasing in older Australians, along with waistlines and the cardiovascular perils we readily associate with obesity and lack of exercise.

Dr Valenzuela believes we just haven't done enough as a community to prevent this fundamental risk factor for dementia and warns of the long term risks. High blood pressure left untreated in middle age (40s and 50s) can come home to roost in our 60s and 70s increasing our dementia risk by around 2.5 times.

He describes the whole body health awareness approach as "a call to arms" for people to take the initiative and take control of their own long term brain health. "If we lower or normalise our blood pressure, then I believe it can reduce our risk of dementia. So I believe it's really a time for people to take ownership of their own long term brain health because in the end it's what maintains our quality of life."

Hand in glove with blood pressure control is eating a good diet, one that as much as possible eschews highly processed and convenience goods high in poor quality fats and salt and devoid of the life sustaining nutrients and antioxidants of foods in their natural state. You read about such health giving food every month in NOVA.

Dr Valenzuela also comes out strongly in favour of oily fish rich in Omega 3 oils and a Mediterranean approach to alcohol, that is, drunk with meals and in modest regular amounts rather than a weekend binge, a trait still hanging on resolutely in our culture.

His second recommendation, one following the "use it or lose it" principle that covers everything from keeping moving to sex, is to exercise your brain as well as your muscles. Among some remarkable findings in the book, Dr Valenzuela includes a project he conducted with colleague Professor Perminder Sachdev in which they collated the findings of 22 studies tracking over 29,000 people for an average of seven years. The remarkable finding was that individuals with higher levels of lifetime mental activity had a 46 per cent lower chance of developing dementia. And this result seemed to stay consistent even in later life, providing the spark for the title of his book.

The author widens out this idea into what he calls the "Three Keys" of dementia prevention - maintaining mental, physical and social activity throughout our life. "If you do these three types of activities and ideally combine them, you can reduce your risk," says Dr Valenzuela.

Tai Chi, an activity he follows himself, is a "beautiful example" because of the mental stimulation it provides along with a surprisingly strenuous physical workout and breath control that is very good for health. Some styles require memorising very long sequences, up to 1000 separate movements, and all bring in the important socialising aspect. In fact, any activity that involves learning a new skill, engaging in physical exercise and doing it with other people is beneficial, advises Dr Valenzuela. Dancing, yoga, orienteering (also known as cunning running) and sailing are among other activities that he finds fit the bill.

The role of such activities in reducing the impact of stress is attracting wide interest in the dementia field and is a particular focus of Dr Valenzuela's own work and Australian research generally. Research is now pointing to the possibility of regenerating brain cells which, if it occurs in the hippocampus, a complex seahorse shaped structure deep in the brain that is critical to memory function, has major implications for dementia treatment. Neuroplasticity, the name given to promoting new brain cell growth and connections between brain cells, is enhanced by Three Key activities, says Dr Valenzuela. "The opposite, which is stress related cortisol in the brain, kills off neuroplasticity. So that's why long term chronic stress is so bad for our body health and our brain health."

While dementia may be hanging over our ageing society as a threat of climate change proportions, at least here in Australia we can take comfort from the realisation that our research is world's best. "Even though we have a lot of room for improvement, we're in much better shape than many other countries," says Michael Valenzuela.

And while his book is a fascinating insight into this devastating condition, its message is one of hope and empowerment. By integrating Three Keys style activities into our lifestyle, our cardiovascular fitness will improve and further lower our risk of dementia and allow us to continue enjoying life. To give Dr Michael Valenzuela the final word: "If there is a central message from this book, I hope it is a resounding call to begin to cultivate this virtuous cycle. This principle not only treats mind and body as one, but also acknowledges the unity of the brain and the heart".

It's Never Too Late to Change Your Mind by Dr Michael Valenzuela is published by ABC Books RRP $29.95

Margaret Evans

Margaret Evans has a background in teaching, journalism and publishing. She is the editor of NOVA Holistic Journal.