September/October 2023

Brain Health: Brain Care for All
By Krystal L. Culler, DBH, MA; LeAnne Stuver, MEd, BSN; and Kali A. Sarver, MS
Today’s Geriatric Medicine
Vol. 16 No. 5 P. 8

Science Update: Why Investing in Brain Health Matters

Brain health is top of mind for many patients and health care providers. A recent report from the DANA Foundation highlights that more than eight in 10 Americans are directly affected by issues related to brain health, including depression, anxiety, seizures, learning disabilities, substance use/addiction, neurodegenerative diseases, and more. Public attention to brain health has dramatically increased in recent years in parallel to the appearance of the concept of brain health within the scientific literature.1

Across international and national surveys, adults consistently rank brain health as a top health concern. A growing number of adults report fearing a future decline in their brain health. Additionally, seven of 10 respondents from an international survey on brain health expressed motivation to change their lifestyles if they noticed concerns with their brain health, such as memory performance.2 However, few respondents report prioritizing their own brain health and are unsure how to maintain optimal brain wellness.2 There’s a great interest in patients receiving reliable research-informed information about brain health from trusted resources, including their health care providers.

Brain health is conceptualized as 90% lifestyle and 10% genetics, and fostering better brain health is of keen interest to patients, providers, health care systems, and societies. The research that is mounting across different areas of brain health science highlights how various aspects of our day-to-day life are interconnected and have a direct influence on our health. Investing in our most valuable asset—the brain—is imperative for all.

Defining Brain Health
Brain health is the key to optimal overall health. Similar to the World Health Organization’s definition of health, brain health encompasses physical, mental, and social well-being through continuous brain engagement and development.3 Yet, there’s no widely agreed upon or universal definition or conceptualization of brain health.

Most definitions lead back to the basic concepts of “thinking, feeling, and doing.” Many definitions focus on the performance of the brain when it’s challenged and functioning well. There are multiple definitions of brain health that encompass high-order cognitive processes such as the ability to learn, remember, plan, concentrate, solve problems, make decisions, and maintain a clear mind.

The World Health Organization embraces a holistic approach to brain health, defining it as “the state of brain functioning across cognitive, sensory, social-emotional, behavioral, and motor domains, allowing a person to realize their full potential.” Here brain health is defined as how we can optimize our brains to thrive at any age since we are constantly shaping our brains through our lifestyle, behavior, habits, and lived experiences. This broader view of brain health accounts for our environment and behaviors that directly influence our lifestyles and lifelong brain development.

Health still exists without the mere absence of disease or infirmity. The antiquated notion that brain health was only for healthy people excluded individuals living with neurodegenerative diseases or chronic/acute health conditions. By advocating, educating, and developing new ways to support brain care for all, every single person can live well with a brain-related diagnosis or health condition. Ultimately, brain health is for everyone, and investing in lifelong brain health matters.

Brain Health Risks
Brain health is commonly quantified by lifestyle risk factors or preventative factors that may delay cognitive decline and the onset of symptoms related to dementia and Alzheimer’s disease. Dementia is a term for declining cognitive ability that commonly affects complex tasks, memory, and behavior. While age, biological sex, and genetics are significant risk factors for neurodegeneration, there’s ample evidence that many other risk factors can be modified to reduce the risk of dementia later in life.4

Our brains undergo development until our early 20s, after which brain aging begins. Consequently, it’s crucial to engage in mental stimulation and intellectual challenges from a young age, such as seeking more education.5 Cultivating such habits throughout life enhances cognitive reserve in later years.

The recent Lancet Commission report outlines midlife risk factors, including hypertension and obesity. These become increasingly concerning due to their association with lower overall health outcomes and a heightened risk of late-life dementia. Traumatic brain injuries and excessive alcohol consumption are also significant risk factors, as they can lead to brain changes and cognitive impairment. Additionally, hearing loss plays a pivotal role in increasing the risk of dementia due to reduced social interaction and mental stimulation.5

In late life, attention shifts to factors such as harmful chemicals in air pollutants and smoking, which can expedite neurodegenerative processes, but quitting smoking has been shown to reduce dementia risk, even in older adults.5 Depression, social isolation, and physical inactivity also contribute to cognitive decline by depriving the brain of necessary mental and physical stimulation. Furthermore, there’s a positive correlation between dementia risk and diabetes, with an increase in risk corresponding to the duration and severity of diabetes.

Irrespective of the life stage, certain modifiable risk factors can influence dementia risk. Inadequate sleep and heightened stress levels have detrimental effects on brain health, with these factors having particularly harmful health consequences.5 A diet rich in micronutrients and vitamins, such as the Mediterranean lifestyle or Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND diet), has been correlated with a decreased risk of neurodegenerative diseases in later life. Finally, practicing mindfulness and behavior change skills can promote sustained lifestyle changes for those with mild cognitive impairment.6

Fortunately, many risk factors for dementia can be modified through lifestyle changes. Engaging in regular exercise, adopting a healthful diet, eliminating unhealthful behaviors (eg, smoking and excessive alcohol consumption), and actively participating in social interactions can significantly reduce the likelihood of developing dementia. By making positive lifestyle changes, it is possible to decrease the risk of dementia by up to 40% and maintain a healthy brain for years to come.5

Putting It All Together
We are learning more about the importance of brain health in other disease states and health conditions, but the current leading reports tend to focus on dementia prevention. Modifiable risk factors have a cumulative effect across the lifespan related to differences in cognitive performance. A greater number of risk factors leads to poorer cognitive outcomes, and more protective risk factors boast better cognitive outcomes. The scientific evidence is mounting that highlights the importance of a brain-healthy lifestyle for individuals of all ages across the world.

A study that looked at the cumulative impact of a healthful lifestyle considered the following risk factors: nonsmoking, physical activity, limited alcohol consumption, diet (DASH), and cognitive engagement.7 Older adults who adhered to four to five healthful behaviors had a 60% lower risk of developing Alzheimer’s disease compared with individuals with zero to one such behaviors. Another study examined these five lifestyle factors plus social contact and genetic risk of APOE ε4, an established strong risk factor for Alzheimer’s disease. The study found that each healthful behavior was associated with a slower-than-average decline in memory over a decade, even for carriers of APOE ε4.8 Brain health science is revealing just how interconnected the components of brain health and genetics are today and in the future.

A Virtual Model of Brain Wellness
Worldwide technology is an underutilized solution that can promote brain health equity and community engagement.9 A Virtual Brain Health Center was created as an educational resource and health-fostering community for individuals and organizations seeking ways to understand the importance of brain health and to encourage brain health equity. The center serves as a connection to brain health educational services and curates reliable resources related to various aspects of science communication. It provides easy-to-understand brain health science information, including holistic brain health educational programs, topical infographics and blogs, and podcast interviews with leading experts.

While brain health research identifies risks, it involves personal choices for individuals.10 Everyone has a right to better brain health, and individual, modifiable risk factors are critical. The center has supported thousands of unique individuals and group members in the past 18 months spanning more than 70 different countries and growing. Individuals and groups have joined the center from across the world (Europe, Asia, Australia, South America, and Africa) and from low- and middle-income countries, including Malaysia, Indonesia, Philippines, and more, to take up the charge of better brain health. The majority of students join from across the United States, Canada, the United Kingdom, Australia, Israel, India, France, and Italy. The interest in brain health is global, and individuals are actively seeking ways to support their personal brain care.

Summary
The mounting scientific evidence highlights the importance of a brain-healthy lifestyle for individuals of all ages across the world. Understanding the role of lifestyle in disease maintenance and management is crucial for patients. In an international survey that represented 81 countries, respondents indicated that people trust brain health specialists (health care providers and experts) most, and only one-half trust their general practitioners.2 The necessity for health care providers to translate emerging brain health science for their patients into practical steps they can take in their daily lives is needed, and a virtual brain health center can be a valuable resource and support.

Based on the current research, providers can encourage patients to invest in their brain health in as little as 30 minutes a day with the following:

• five minutes for meditation/breathwork (start with short intervals—a few minutes per day);

• 10 minutes for brain fitness (create and maintain a mental fitness routine);

• 10 minutes for movement (five minutes of physical movement offers health benefits);

• five-minute brain breaks (take time to unwind throughout the day); and

• one minute for gratitude (take time to notice the positive and express gratitude).

While some brain-based conditions or diseases may still occur, individuals can continue to lead a brain-healthy lifestyle. Reframing how brain health is defined allows individuals to make the most of their capacity to thrive in life. Empowering patients with the straightforward knowledge and skills to build better brain health can influence individuals, families, and communities.9,10 Investing in brain health education matters for all, and health care providers have an influential role in providing brain care and resources for their patients. This encourages individuals and their communities to live brain-healthy lives today and in the future.

— Krystal L. Culler, DBH, MA, the founder of the Virtual Brain Health Center, is on a mission to revolutionize brain care for everyone. As a doctor of behavioral health and a holistic brain health expert, she brings nearly two decades of unparalleled expertise in working with individuals, families, providers, and advocacy organizations, specializing in brain-related diagnoses. With her groundbreaking work in translational and applied brain health science, she has garnered a collection of prestigious international and national awards.

— LeAnne Stuver, MEd, BSN, is the director of Lifelong Learning at the Virtual Brain Health Center. A registered nurse with a decade of hospital and homecare experience, she’s also an experienced health educator dedicated to revolutionizing the way we approach health education. With more than 25 years of expertise in the planning and implementation of adult education curriculum, she’s enlightened countless individuals through her diverse range of educational programs. Passionate about empowering individuals and communities, she strives to teach practical methods for supporting brain health and overall wellness.

— Kali Sarver, MS, is a doctoral student in the cognition and cognitive neuroscience area of psychology at the University of Michigan. She was a former intern at the Virtual Brain Health Center and is actively conducting research in the Cognitive and Affective Neuropsychology Laboratory. She studies brain aging, cognitive resilience and cognitive decline in older adulthood, and memory changes across the lifespan.

References
1. Chen Y, Demnitz N, Yamamoto S, Yaffe K, Lawlor B, Leroi I. Defining brain health: a concept analysis. Int J Geriatr Psychiatry. 2022;37(1).

2. How to promote citizens’ brain health? Insights from the Global Brain Health Survey on Citizen’s Perceptions of Brain Health Interventions. Lifebrain website. https://www.lifebrain.uio.no/news/lifebrain-report-v9-interactive.pdf. Published 2021. Accessed May 17, 2023.

3. Hachinski V, Avan A, Gilliland J, Oveisgharan S. A new definition of brain health. Lancet Neurol. 2021;20(5):335-336.

4. Niotis K, Akiyoshi K, Carlton C, Isaacson R. Dementia prevention in clinical practice. Semin Neurol. 2022;42(5):525-548.

5. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413-446.

6. Global Council on Brain Health. How to sustain brain healthy behaviors: applying lessons of public health and science to drive change. https://www.aarp.org/content/dam/aarp/health/brain_health/2022-03/gcbh-behavior-change-report-english.doi.10.26419-2Fpia.00106.001.pdf. Published 2022. Accessed May 17, 2023.

7. Peters R, Booth A, Rockwood K, Peters J, D'Este C, Anstey KJ. Combining modifiable risk factors and risk of dementia: a systematic review and meta-analysis. BMJ Open. 2019;9(1):e022846.

8. Jia J, Zhao T, Liu Z, et al. Association between a healthy lifestyle and memory decline in older adults: 10 year, population based, prospective cohort study. BMJ. 2023;380:e072691.

9. Lock SL, Chura LR, Dilworth-Anderson P, Peterson J. Equity across the life course matters for brain health. Nat Aging. 2023;3(5):466-468.

10. Friedman BB, Suri S, Solé-Padullés C, et al. Are people ready for personalized brain health? Perspectives of research participants in the Lifebrain Consortium. Gerontologist. 2020;60(6):1050-1059.