Brain Health Vital Signs

Extended Information Sheet

Additional Resources:

Sleep

Sleep is important for brain health because it allows you to form and maintain the pathways in your brain that help you learn and create memories.
A restful sleep is important for concentration and is overall especially important for cognitive function.
- Getting quality sleep has a positive impact on mood and stress, which can improve overall wellness and quality of life.
Less sleep can have an enormous impact on mood and memory. It can also make you vulnerable to health conditions, such as depression.
Goals
- Try to sleep at least 7+ hours a night.
- If you have sleep apnea or other sleep disorders:
  - It is highly recommended to seek treatment to ensure the highest quality of sleep possible.

Exercise

Exercise/physical activity helps improve your thinking, attention, and memory as well as your physical health.
Exercise increases blood flow to the brain, which is crucial towards optimal function and decreasing levels of stress.
- Regular exercise can also help with other factors that contribute to your overall health, such as managing weight, reducing chronic diseases, and strengthening your immune system.
- Minimal to no exercise can have a negative impact on managing stress and mental wellness.
Goals
- At least 150 minutes of light or moderate aerobic exercise per week is recommended.

- - - Can include running, walking, stretching, toning, swimming, etc.

At least 75 minutes of vigorous exercise per week is recommended.
Making small exercise goals every week is helpful because it can allow you to slowly get your body used to exercise, which makes it easier for it to become a maintainable part of your lifestyle.

Alcohol

Alcohol can interfere with the brain’s communication pathways. Heavy drinking for extended periods of time has a negative impact on the brain and can cause changes to brain structure and function.
- Newer research has shown that while there may be some overall health benefits to limited drinking of alcohol each week, daily consumption has more downsides than benefits.
- Heavy drinking can also cause serious liver damage, disrupt the growth of new brain cells, and interfere with your ability to form new memories.
Goals
- If you do not drink alcohol now, guidelines suggest that there are no reasons to start drinking alcohol.
- On days you choose to drink, intake should be limited to one drink or less for women, and two drinks or less for men.
- If you have a more severe problem with alcohol, there are many ways to seek help, including discussions with your medical providers and other community support services.

Mood/Stress

Stress can have negative effects on the brain and body. Chronic stress, which involves the long-term buildup of a hormone called cortisol in the brain, can lead to detrimental health issues.
- Elevated levels of cortisol can damage regions of the brain involved with memory and learning (including the hippocampus and prefrontal cortex), increase risk of developing cognitive impairment, and lead to the brain being less efficient when it comes to achieving necessary tasks.
- Prominent levels of cortisol and stress can also disrupt the way brain cells communicate with one another in a way that can directly impact one’s sociability and maintenance of healthy, positive interactions with others.
- Stress can additionally cause shrinking and death of brain cells, including the part of the brain most important to cognitive function (the prefrontal cortex, the part of the brain that is responsible for memory and learning).
- Stress increases one’s risk of worsening, or developing, other health conditions, such as diabetes, depression, digestive problems, and heart disease.
Goals
- People with depression, anxiety, and elevated levels of stress should seek help and treatment (e.g., therapy, medication, meditation, and other strategies).
- There are ways to reduce stress and prioritize your mental health and wellness, such as:
  - Exercise
  - Meditation and mindfulness practice
  - Being more social
  - Journaling
  - Making time for enjoyable activities, like reading or playing video games
  - Allowing for more personal time without distractions
  - Getting quality sleep
  - Eating well
  - Stretching

Diet

Deprivation of proper nutrients can lead to injury of brain structures. Evidence shows that diets high in refined sugars (the “added sugars” on nutrition labels) are correlated with more impaired brain function compared to diets with natural sugars (found mostly in fruits, vegetables, and dairy).
- An example of an essential nutrient that keeps your brain healthy is omega-3 fatty acids, which fish is a major source of.
- A poor diet can lead to lower mood and energy and may make you more susceptible to conditions, such as depression, liver disease, dementia, and certain types of cancer.
- A healthy diet can lead to improved gut health, decreased inflammation, and a greater amount of nutrients to support the body’s functions and leave you in an overall better mood.
Goals
- Follow a Mediterranean style diet, as closely as possible.
  - Eat red meat at most twice a week, eat fish more than twice a week, eat veggies, fruits, nuts, and as little as possible processed foods and sweets.
- Setting small goals is a fantastic way to slowly change your diet so that your habits, food intake, and lifestyle more closely adheres to the Mediterranean diet style.
  - Slow changes tend to be a better way to maintain healthy eating as a part of your lifestyle.
  - Rapidly changing to a “stricter” diet will more quickly lead to burn-out, and not be beneficial to sticking to a healthy diet.

Purpose in Life

Having a “purpose in life” means that someone derives meaning from their life and experiences. When people have a sense of direction and meaning in their life, it is easier for them to set and achieve goals.
- People with a purpose in life tend to be more motivated and have less negative mood/stress impacts on their life. They are also typically more social and take better care of themselves (diet and physical activity).
Without a purpose in life, it is common to feel depressed, lonely, and without motivation, which are risk factors for cognitive impairment and dementia.
- When someone cannot identify meaningfulness in their life activities and as a result take less care of themselves, they are more likely to have deterioration of things like…
  - Physical health/activity
  - Mental well-being
  - Social connectedness
  - Cognitively stimulating activities
- Goals
  - Look for meaning in day-to-day activities.
  - Set goals and enjoy achieving small victories along the way.
  - Join community programs that participate in volunteer work.
  - Participate in spiritual or religious activities.
  - Make positive connections with people who empower you.
  - Seek help if you do not have a good support system, or need help finding a purpose/meaning in life (e.g., therapy, counseling)
    - If you do have a good support system, maintain healthy communication with them and receive help from those who provide encouragement.

Hearing

Hearing enables communication and fosters an understanding between people. As a result, struggling to hear during conversations can lead to frustration and can cause people to become less engaged and more withdrawn.
- Withdrawing socially and avoiding interactions can result in increased loneliness and not enough necessary social engagement and connectivity.
Difficulty hearing is a risk for developing impairments in cognition and learning.
- Hearing difficulties create barriers between the person with impairment and the environment and richness of an experience.
- As a result, the formation of memories and ability to learn from the environment and/or experience is significantly interfered with since our senses play a big part in memory and learning.
Goals
- Speak to your medical provider if you are having difficulties with your hearing.
- If your hearing is corrected (e.g., hearing aids), be sure to maintain and consistently use the corrective device.

Smoking

Smoking has been found to accelerate aging of the brain.
- People who have nicotine byproduct (found in cigarettes and cigars) in their blood tend to score lower on a brain function test than someone who does not.
The longer someone smokes, the more their brain tissue loses volume.
- Vital parts of the brain can start to shrivel up and lead to impairment.
Smoking significantly increases the risk of heart disease and stroke, which are both strongly linked to decline of brain health and cognition.
Goals
- Set small goals at a time to gradually break the smoking habit.
  - Quit smoking sooner rather than later.
- Talk to providers, family, or friends about receiving help and where to find resources to assist you in quitting.

Cognitive Activity

Incorporating cognitively stimulating activities into one’s lifestyle exercises and challenges the ability to think.
Learning new skills is important and can lead to memory improvements.
- Learning new things causes a physical change in your brain, due to neuroplasticity, which is the ability of to form and reorganize connections and neural networks in response to learning.
- Just like physical activity makes your muscles stronger, cognitive activity makes your brain stronger.
Keeping your brain active has benefits towards reducing decline and maintaining healthy cognition.
Goals
- Incorporate new cognitive activities into your daily lifestyle.
  - You can start slowly by learning one or two new skills or activities.
  - Once you become good at one activity, try to learn something else to continuously challenge your brain.
- Here are examples of activities to try:
  - Increased Reading
  - Card games
  - Word games
  - Drawing or other arts
  - Board games
  - Learning a new language
  - Learning to operate new technology.
  - Puzzles
  - Strategy games (e.g., chess)

Social Engagement

Social engagement is believed to help “protect” against cognitive decline and prevent the negative effects of social isolation.
- Social isolation and loneliness can lead to a depressed mood and disrupted sleep, which are both risk factors for dementia.
Social engagement can activate and exercise the parts of the brain needed for recognition of faces and emotions, decision making, and for feeling fulfilled and rewarded, which are all significant in healthy cognition.
Goals
- Stay regularly connected with friends and family.
- Try to engage in social activities that you may enjoy, such as…
  - Clubs (e.g., gardening, book, language)
  - Community organizations (e.g., volunteering, activism for causes)
  - Classes
  - Social groups
  - Computer-based communication
  - Owning a pet

Vision

If the brain must use a lot of its resources trying to see the world more clearly because of changes in vision, its ability to function at an elevated level on other tasks will be limited.
Vision loss can cause people to decrease their physical activity, social activity, and cognitive activity (e.g., reading), which are all especially important for maintaining brain health.
Similarly, to hearing, vision is an important part of engaging with your environment and of the richness of one’s experiences. These are both crucial factors when it comes to learning and forming new memories.
- Our senses contribute to the formation and maintenance of memories.
Also, just like hearing impairments, having visual impairments makes it more probable that someone will withdraw from their environment due to frustration or embarrassment over the difficulties they face. This makes the person more likely to be socially isolated, which has negative effects on brain health.
Goals
- Talk to your provider about the necessary steps you may need to correct your vision.
- Improvements in visual acuity may require corrective lenses or cataract surgery.
- For corrective lenses…
  - Be consistent with your glasses or contact lenses and follow the provider’s advice.
  - Schedule regular visits to make sure glasses/contacts are up to date with the appropriate prescription.
    - Vision changes as you age and therefore your prescription may need to be changed too.

Cholesterol

Total cholesterol of 240 or above is considered a major risk for various health problems.
It is important to note that there are two types of cholesterol.
- HDL is known to be “good” cholesterol.

- LDL is known to be “bad” cholesterol.
When talking about cholesterol values, it is important to look at how much of this total is composed of “good” and “bad” cholesterol.
- We want lower amounts of LDL in our total cholesterol because “bad” cholesterol is linked with the formation of amyloid plaque in the brain, which is sometimes an indicator of Alzheimer’s disease.

Having a lot of “bad cholesterol” plays a significant role towards the buildup of a different kind of plaque in blood vessels, which leads to the clogging of arteries that can lead to a stroke and/or overall poor heart and blood vessel health.
- Strokes can have long lasting effects on cognitive function, and can also cause conditions like paralysis, trouble with speech or sight, brain damage, and even death in severe cases.

High LDL (bad cholesterol) also can lead to decreased density or strength of white matter, an element of our brain.
- White matter has a vital role in passing messages between different areas of the brain; therefore, decreasing its’ density leads to worse cognitive function.
HDL helps to remove excess of the other types of cholesterol from your blood, which helps to protect against the harmful effects of LDL.
It is ideal for total cholesterol to be composed of higher amounts of HDL and lower amounts of LDL.
Goals
- Total cholesterol less than 200 mg/dL.
- LDL cholesterol less than 100 mg/dL.
- HDL cholesterol 40 mg/dL or higher for men and 50 mg/dL or higher for women.
- Speak to you provider about important lifestyle and diet changes that can reduce LDL (bad cholesterol) and increase HDL (good cholesterol).
  - Important lifestyle changes that will do so include increasing physical activity, limiting alcohol consumption, quitting smoking, and losing weight.
  - Follow a diet low in saturated and trans fats, which are found commonly in dairy and meat, and replace them with healthier fats, found in foods like nuts, avocado, and fish.
    - A Mediterranean style diet is the most efficient to follow when trying to reduce your cholesterol levels.
- You may also speak to your provider about taking cholesterol lowering medications.

HbA1c

Hemoglobin A1c can assist in the diagnosis of diabetes.
- Hemoglobin A1c values ranging from 5.7 to 6.4 percent are considered to demonstrate an increased risk for diabetes, or what has been called “prediabetes”.
- Diagnosis of diabetes is established at a hemoglobin A1c that is greater than or equal to 6.5 percent.
- Diabetes has proven to be harmful and contributes to cognitive decline and risk of Alzheimer’s disease and/or dementia.
  - Diabetes leads to damage in blood vessels in our brains that carry oxygen.
  - When the brain does not receive enough oxygen, brain cells will die.
  - Death of brain cells can then cause significant memory and thinking deficits.
Goals
- Hemoglobin A1c less than 5.7 percent.
- Make suggested lifestyle changes, such as:
  - Increasing physical activity, which can lower blood glucose and improve you HbA1c.
  - Cut back on sugary and carbohydrate rich foods that increase your blood sugar levels and go for foods that are high in fiber.
  - Reduce stress.
  - Reduce alcohol consumption.
- Speak to your doctor about medications that can manage these levels if needed.

Body Mass Index

BMI is used to screen for being overweight or obese, using one’s height and weight.
- A BMI between 25 kg/m²and 29.9 kg/m²is classified as overweight.
- A BMI of 30 kg/m²or greater is classified as obesity.
- A BMI of 40 kg/m²or greater is classified as severe obesity.
A high BMI can lead to changes in the body that increase risk of Alzheimer’s and other forms of cognitive impairment.
- Damage in the brain’s blood vessels and the buildup of abnormal proteins are effects of high BMI.
- There is evidence that high BMI can also reduce blood flow to the brain and lead to shrinkage in volume of the brain.
Development of other risk factors, such as diabetes, hypertension, and heart disease, are likely to occur alongside a high BMI.
There is a lot of controversy surrounding BMI and how dependable of a measure it is.
- Recent studies display the importance of where fat is distributed.
  - Fat carried in the abdomen heightens one’s risk.
  - Fat carried in the hips and/or thighs are lower risk.
Goals
- BMI of 25 kg/m²or less.
- Decrease caloric intake by talking to a provider about a diet that works for you.
- Incorporate more exercise and movement into your day-to-day routine.
- Surround yourself with a dedicated support group and people with the same goals as you.
  - Examples of where you can find this support are weight loss programs and gym groups/classes.
- Speak with your provider about medications approved to assist in weight loss.

Blood Pressure

While target blood pressure differs across patients, a normal blood pressure for older individuals is categorized as a systolic blood pressure of less than 120 mmHg and diastolic blood pressure below 80 mmHg.
- Elevated blood pressure is categorized as systolic between 120 mmHg and 129 mmHg, with a diastolic of below 80 mmHg.
- Systolic of 130 mmHg or higher and diastolic of 80 mmHg or higher is where hypertension begins.
Hypertension (high blood pressure) damages blood vessels and is a substantial risk for strokes, which have lasting impacts on one’s cognitive function.
- There are distinct stages of hypertension with the lowest beginning at systolic of 130 mmHg and diastolic of 80 mmHg.
Damage can be caused to the brain by reduced or blocked blood flow, both results of high blood pressure.
- High force of blood pushing on arteries can lead to blood vessels that are scarred, narrowed, and/or diseased.
Goals
- Systolic blood pressure below 130 mmHg and diastolic below 80 mmHg.
  - This blood pressure goal may be lower depending on the individual but is used as a general recommendation to avoid hypertension.
- Monitor your blood pressure regularly so that you are aware of any changes.
- Make lifestyle changes to lower blood pressure, examples are…
  - Eating a well-balanced diet and decreasing salt intake.
  - Regularly exercising.
  - Managing stress through methods such as meditation, stretching, and any activity that you find personally relaxing.
    - Avoid doing too much.
    - Avoid stress triggers.
    - Make time every day for you to relax.
  - Limit alcohol intake and quit smoking.
  - Maintain a healthy weight.
- Speak to your provider about the possibility of blood pressure lowering medications.