Keep Your Brain Healthy
Dr. Nancy Hoffman
Dr. Hendler: Hello and welcome to KP Healthcast. I’m your host, Dr. Peter Hendler,
and our guest today is Dr. Nancy Hoffman who is a neuropsychologist at Union City
Kaiser. Dr. Hoffman did her doctorate in Clinical Psychology at the California Institute
of Integral Studies and did her postgraduate training at Kaiser. Welcome.
Dr. Hoffman: Thank you for having me.
Dr. Hendler: What kind of work, what is it that you do?
Dr. Hoffman: What I do is I see patients from all over the medical center that are having
difficulty with memory, with concentration, or attention, and I test them to try to find out
what might be wrong with their thinking.
Dr. Hendler: Okay, and did you want to start before my questions just giving us a little
background in keeping your brain healthy?
Dr. Hoffman: I did. I got interested in brain health because most people think about
health from the neck down, and if your brain is not healthy, it really doesn’t matter if
your body’s healthy, if your bank account is healthy. Everything we do really depends
on good brain health from thinking, feeling, working, playing, even sleeping is dependent
on good brain health. And now that 78 million of us baby boomers are aging, suddenly
we’ve got a lot of interest in keeping our brains healthy.
Dr. Hendler: Okay, people talk about staying mentally active. What do they mean?
Dr. Hoffman: Well, your brain works because you’ve got a hundred billion cells that are
connected to one another. Over time those cells, those connections start to fall apart as
part of normal aging, but if you learn something new, a new activity, new information, a
new language, your brain actually creates new connections to try to keep that information
flowing in your brain. So by staying mentally active, by learning new things, increasing
the connections in your brain, you can actually try to stave off dementia. Learning new
things actually increases those connections. So one of the things they have found in these
studies is that people with higher levels of education tend to have no outward signs or
fewer outward signs of Alzheimer’s disease even if they have the plaques and tangles that
other people have when they’ve actually had a diagnosis of Alzheimer’s. I’m not saying
that well-educated people don’t get Alzheimer’s, but the symptoms can appear much later
if you are mentally active.
Dr. Hendler: That’s very interesting. You’re saying that even though they have the
same abnormalities seen in the microscope in their brain, they somehow can get around
that by the exercise they’ve given their brain.
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Dr. Hoffman: That’s what appears to be, there was a nun study done in Minnesota by a
psychologist named David Snowdon, and he got a couple hundred of these nuns to donate
their brains to science, meaning that they are going to be autopsied at death, and one of
the things that they have found is that the better educated nuns, even though they have the
plaques and tangles in the brain on autopsy, never showed any outward signs of
Alzheimer’s dementia. So their speculating from this that education, learning new things,
creating new connections somehow protects your brain from dementia.
Dr. Hendler: Very good. What kind of things can people do to keep themselves
mentally active?
Dr. Hoffman: Anything that requires focused attention. You can take a class in
anything that interests you. Doing crossword puzzles is always something that can be
challenging for your brain. These new Sudoku puzzles that people are doing are really
helpful. There’s a New York Times website where you can play crossword puzzles and
these Sodoku games. Any game like that that improves your mental speed, watching
Jeopardy trying to guess the questions before the contestants. Nintendo has a game
called Brain Age that was actually designed by a Japanese neuroscientist, and it keeps
track of your progress so the idea is to try to bring the age of your brain down to
something a little bit lower. There’s a website called happyneuron.com where you can
play games on-line. You can go to lectures and plays. You can take classes at a
community college. Playing Bridge is good for your brain. Bill Gates and Warren Buffet
both play Bridge and they do all right.
Dr. Hendler: Well, as a matter of fact I do have a Nintendo DS and I do have Brain
Age.
Dr. Hoffman: Well good.
Dr. Hendler: And when I tried it the first time, my brain age was 84, and I practiced and
practiced and once after a long time when I got it down to 24, I quit and never opened it
again because I was afraid, you know, it could only go bad from there. But that’s a very
fun thing. It’s not one game. It’s many many different activities. Have you seen it?
Dr. Hoffman: Yeah, I have it actually and I do play it and I’m trying to get my brain
down past the 40s, cuz it was in the 70s.
Dr. Hendler: The only way I could get my score down is I actually had to go back to
multiplication flashcards.
Dr. Hoffman: Uh huh.
Dr. Hendler: After I did that a while I got it down.
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Dr. Hoffman: And see what happens is by doing that activity you’re creating more
connections, and you are actually creating an environment in your brain where
information can pass along those neurons, those brain cells much more quickly.
Dr. Hendler: Okay, now is watching TV a healthy mental activity?
Dr. Hoffman: Unfortunately, no. But the average person watches over four hours a day
of television. The reason that television isn’t a mentally healthy activity is that you’re
very passive when you’re watching it. So if they hooked you up to some sort of a
machine, they would find that your brain waves were somewhat flat when you were
watching it as opposed to brain waves if you’re reading Shakespeare or attending a
lecture, and your brain has to be much more active to take in that information. So you
want focused attention unless of course you’re watching Jeopardy and trying to outguess
the contestants.
Dr. Hendler: Well, I would also like to add that I would at least think that computer
programming would keep your brain young.
Dr. Hoffman: We’ll see. How’s your brain?
Dr. Hendler: Well 84 but down to 24. Um, now you mentioned social activity. How’s
that good for your brain?
Dr. Hoffman: Well, they’re not completely sure how social activity is good for your
brain, but a study just came out that said lonely people are twice as likely to get
Alzheimer’s disease as people who have a very active social network. And by an active
social network they don’t necessarily mean that you have hundreds of friends but that you
perceive yourself as having a good strong support group. You could have two or three
very close friends, two or three very good relationships, and feel like you’ve got support
or you could have 200 friends and feel very isolated. So it’s not the number of people.
At the same time they don’t know which comes first in somebody with Alzheimer’s. Are
you developing Alzheimer’s and you tend to start to withdraw from social activities or is
there actually something in the social activity that keeps your brain young. One of the
things that socializing does is to reduce stress, and stress is really bad for your brain.
Dr. Hendler: Did you want to mention anything about animal studies?
Dr. Hoffman: Actually in animal studies that they’ve done because of course we can’t
do these studies on human beings, but on animal studies they’ve shown that animals that
are socially and cognitively living in enriched environments. So for animals it means
cages with lots of things to climb in or wheels to run around in or other animals to
interact with, that they actually have bigger cortexes, so the cortex is the outside part of
your brain, and more complicated circuitry. They have more brain connections than the
animals that are in cages by themselves with nothing to do. So they’re extrapolating from
animals to human beings that having an active social life, having a physically active life
is good for your brain.
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Dr. Hendler: The study I’d like to see is where the people play with the animals and the
animals play with the people and both of their brains get bigger.
Dr. Hoffman: Maybe get an innovations grant for that.
Dr. Hendler: Yeah, we’ll try for that. Um, why is stress bad for your brain?
Dr. Hoffman: Stress causes your body to release a hormone called cortisol, and cortisol
is like battery acid for your brain cells, especially the part of your brain that is responsible
for indexing and maintaining your memories. That’s your hippocampus, and the good
news is if you can reduce your stress, they’ve shown that the brain cells in the
hippocampus actually regenerate themselves. So by practicing stress reduction you can
actually make improvements in your ability to think and to remember to concentrate, and
if you’re a Kaiser member, you can find stress reduction classes in the Health Ed
Department that are either free or offered to members at a reduced rate. So stress
reduction is really important for brain health overall.
Dr. Hendler: Okay, so social activity is good for your brain. What about physical
activity?
Dr. Hoffman: Physical activity is actually really important for maintaining your brain
health, and part of it is because blood circulates throughout your brain carrying oxygen
and nutrients so the more you exercise, the better blood flow you have. And also this
blood flow seems to encourage the growth of new brain cells. So again, going to the
animal studies they put mice in cages with wheels and mice are notorious for loving to
run on these wheels. So they let them run as much as they wanted and found that they
doubled their brain size but only when they were allowed to run at will. When they
forced mice to run and there was probably some unpleasant consequence of not
continuing to run, they found that their brains actually shrunk, and the hypothesis there is
that the stress of being forced to run probably killed brain cells, but the enjoyment of the
exercise actually increased brain cells. And then of course if you exercise regularly and
live a healthy lifestyle, you’re going to have less of a chance of having a heart attack, of
having strokes, of having diabetes. Any of those illnesses are going to adversely affect
the health of your brain. So, and exercise also helps to combat depression and stress,
both of which we already know are bad for your brain. And if you do something, it
doesn’t necessarily have to be strenuous. You could walk 30 minutes a day, and if you
want to walk with a friend or with your partner, with one of your children, with your
neighbor, you’ve got the benefit of exercise combined with social interaction. One of the
things about exercise though is you don’t want to fall into a rut because you stop paying
attention to what you’re doing. If you learn a new activity, let’s say you usually walk but
you decide to take a tango class, the motor cortex in your brain, that’s the part of your
brain that controls your muscles, actually grows and changes. It has to change as you’re
learning new muscle skills, and they’ve done studies that show that people who are fit
have sharper brains. So you can start anytime. If you weren’t active in your 20s but you
want to get active now, it’s never too late to start. You might want to consult your doctor
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though if you’re older or if you have any health issues. And also when you’re exercising,
if you’re going to ride a bike or rollerblade or things like that, you’ll want to wear a
helmet because another tip to keeping your brain healthy is not to get a brain injury.
People who have head injuries have increased risk of developing Alzheimer’s disease
later on.
Dr. Hendler: Well, now diet and exercise usually go together. Is there any research on
the effects of diet on your brain?
Dr. Hoffman: Actually there’s a lot of research on the effects of diet on your brain, and
a brain-healthy diet would be the kind of diet that would help to prevent strokes, heart
attacks, high blood pressure, or diabetes primarily because those illnesses are going to
lead to difficulty with thinking and memory and concentration later on. And also your
brain needs the right balance of nutrients to work well. So one of the first things that you
can do for yourself right away is to eat breakfast in the morning. Not doughnuts and
sugary cereals but eat something with protein with whole grains. Eat something healthy
so that your blood sugar levels are consistent throughout the day. And maintaining a
healthy weight is also important because they’ve shown that people who are obese in
middle age are twice as likely to develop dementia. Also if you have high cholesterol
and high blood pressure, you’re said to be six times as likely to develop dementia. So
one of the things that you hear with regard to diet and brain health is to know your
numbers. Know your blood pressure. Know your weight. Know your blood sugar.
Know your cholesterol. And if anything is high and especially if you’re a Kaiser
member, you can get a lot of help in lowering those numbers. You’d also want to eat
foods that are rich in antioxidants, and antioxidants are typically found in brightly colored
foods – rasberries, blueberries, beats, all the green leafy vegetables. You want to get
Omega 3s which are found in some fish, and part of the reason for that is that 60% of
your brain is made up of fat. They’ve also done studies that show that folate or folic acid
and B12 are good for your brain. And one of the studies came out of the nun study
because when they were doing the autopsies, they found that the higher the folate levels,
the less likely these nuns were showing symptoms of Alzheimer’s.
Dr. Hendler: Tell us a little bit about sleep and the brain.
Dr. Hoffman: Sleep is very important. If you are fatigued, it’s difficult to sleep clearly.
Excuse me...if you are fatigued, it’s difficult to think clearly, and obviously I’m a little bit
fatigued or I wouldn’t have said that. One of the things I just read is that if you are sleep
deprived for 21 hours or more, you are acting as if you’re drunk. It’s got the same effect
on your brain as if you were drunk. So a good rule of thumb to follow is that you need
one hour of sleep for every two hours of wakefulness. One of the things that wreaks
havoc on your memory and your ability to concentrate and pay attention is having a sleep
apnea, and I see a lot of patients who have memory difficulties because they have a sleep
apnea and they’re not taking care of it. And I happen to know that you have a podcast on
sleep apnea so I won’t go into the details here because people can listen to that. But a
sleep apnea is essentially when a person stops breathing momentarily at night, and
sometimes they themselves don’t know they have the sleep apnea but their bed partner
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will tell them. They may also snore excessively or find that they wake up with a
headache or they’re excessively sleepy during the day. And what’s happening with the
sleep apnea when you momentarily stop breathing, you’re depriving your brain of oxygen
over and over and over again, and depriving your brain of oxygen actually kills brain
cells. And a number of the patients that I see don’t use their CPAP machines. And if you
suspect that you have a sleep apnea, of course Kaiser has a sleep clinic where you can be
tested. But it’s really important if you do, that you use your CPAP machine every night
to avoid killing brain cells. It can also, a sleep apnea that’s untreated can lead to
hypertension, heart disease, and stroke which is very bad for your brain. You’re more
likely to have a car accident, and like I said if you develop a head injury for any reason,
that increases your likelihood of developing dementia later on. So if you drive, drive a
car with air bags and always use your seatbelt.
Dr. Hendler: I’ve heard that there’s a link between smoking and dementia. Is that true?
Dr. Hoffman: Well there seems to be. Studies that they’ve done lately have shown that
smokers tend to have greater mental decline than nonsmokers, and the number of years
that a person smokes happens to be important as well. They’re not really sure why that
is. It may be because damage to your arteries from smoking leads to increased risk of
stroke or blood clots, and then people who are in the early stages of COPD, so that’s
chronic obstructive pulmonary disease, often don’t know they have it, but they’re putting
their body in a chronic state of hypoxia. That means there’s consistently less oxygen
going to the brain than you need and that kills brain cells. And also smokers tend not to
exercise. So if you smoke and you want to keep your brain healthy, you should stop.
Dr. Hendler: I recently read something about positive attitude and brain health. Is there
a connection there?
Dr. Hoffman: Well there seems to be. The New York Times just published an article
that telling yourself that you can’t remember or you won’t remember seems to be a selffulfilling prophecy. So what they did in this study was they had people try to remember
something, telling themselves they wouldn’t remember and another group of people
trying to remember something, telling themselves they would. The people who
consistently told themselves that they don’t remember things, consistently don’t
remember things. So there seems to also be, with positive thinking, a sense of
effectiveness in your life. You can roll with the problems that life offers you. You don’t
feel overwhelmed all the time. You feel like you do have some control. And for some
reason that seems to protect your brain.
Dr. Hendler: Is there a relationship between depression and memory problems?
Dr. Hoffman: There is. Actually depression is very much like stress in that your body
releases cortisol, and it eats away at the cells in your hippocampus – the part of your
brain that’s responsible for your memory, and it begins to shrink so they’ve done
autopsies on people who suffered from depression and found that their hippocampuses
were actually much smaller than people who weren’t depressed. The good news is that
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the brain has plasticity. That means it can grow and change so if you’re depression is
treated, your hippocampus can regenerate. You can regain your memory. There’s
actually something called pseudodementia which is a term that was used for people who
were excessively depressed and began to look like they were demented. So treating your
depression will actually help your neurons or your brain cells to regenerate.
Dr. Hendler: Finally, do you have any tips for improving memory and overall brain
health for all of us?
Dr. Hoffman: Lots of tips. You can play the Nintendo Brain Age game we were talking
about. You can do all kinds of little things in your daily life like when you go to the
grocery store, organize your grocery list by sections of the grocery store. It will help you
when you’re in the store to remember what your looking for and you can make it into a
memory game for yourself. You can learn a new language. Learning a new language
actually creates a lot more connections in your brain and it’s fun, and you can travel.
Traveling is very good for your brain. You can put your new language to use. Use all
your senses when you’re trying to remember something. If you’re trying to remember
the name of a dog, visualize the feel of the dog’s fur, get a sense of the smell of that dog,
hear the sound of his bark. That will help you to remember, and the more that you
remember things like a dog’s name, the more positive your attitude and also again it
becomes a memory game or a memory trick. Something else you can do is when you’re
trying to calculate numbers, try to do it in your head before you pull out your calculator,
or don’t let your computer remember your passwords. You could force yourself to try to
remember them. If you’re reading something, you can use a highlighter to try to
remember key information. Read something different. They did a study when people
were reading Shakespeare, it actually helped to create new connections in their brain
because Shakespeare uses the language in a way that’s not common so you actually have
to work hard to understand it. Reading poetry is the same way. You can learn a new
skill, take a cooking class, take up ping pong, play bridge, take dancing lessons, garden.
Another thing you can do is to try to use your other hand – your nondominant hand to
open a drawer or open a door or if you’re going to the grocery store or driving to work,
take a route that’s unfamiliar so that you have to think about what you’re doing. Part of
what you really want to do is to learn to pay attention because it’s good for your brain.
Dr. Hendler: You know, getting back to what you said about Shakespeare. I just read
something about Shakespeare’s language, and I thought that that’s how everybody talked
back then, but apparently even back in that time his language was unusual, that he would
change the orders of like the subjects and the verbs on purpose to get people’s attention.
Dr. Hoffman: Oh that’s very interesting.
Dr. Hendler: Right.
Dr. Hoffman: And it’s kept our attention for hundreds of years.
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Dr. Hendler: So it’s now doubly hard because it was hard then and now it’s much
harder.
Dr. Hoffman: But much better for your brain.
Dr. Hendler: Yeah, if you can understand it. Well, there’s always Cliff Notes.
Dr. Hoffman: That’s true.
Dr. Hendler: Thank you Dr. Hoffman for being with us here today.
Dr. Hoffman: Thank you for having me.
Dr. Hendler: That was very interesting. I’d also like to thank our audience for being
with us today. KP Healthcast is created by the people at Kaiser Permanente in Fremont,
Hayward, and Union City, California. These podcasts are for general information only.
They’re not intended to be used as a substitute for medical advice given to you by your
personal physician. If you or a family member have any of the conditions discussed in
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personal physician because every case is different, and your physician is in the best
position to know what’s best for you. You can find all of our podcasts on our home page
at http://www.kphealthcast.org. You can e-mail us at [email protected].
We’d love to hear from you. Check our home page regularly for new topics and, as
usual, be on the lookout for new ways to THRIVE.
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