Alzheimer’s: The Bad News And The Good
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Dr. Devi’s Spectrum of Hope
This is Dr. Gayatri Devi. She’s a neurologist, board-certified in neurology, pain medicine, psychiatry, brain injury medicine, and behavioral neurology.
She’s also a Clinical Professor of Neurology, and Director of Long Island Alzheimer’s Disease Center, Fellow of the American Academy of Neurology, and we could continue all day with her qualifications, awards and achievements but then we’d run out of space. Suffice it to say, she knows her stuff.
Especially when it comes to the optimal treatment of stroke, cognitive loss, and pain.
In her own words:
❝Helping folks live their best lives—by diagnosing and managing complex neurologic disorders—that’s my job. Few things are more fulfilling! For nearly thirty years, my focus has been on brain health, concussions, Alzheimer’s and other dementias, menopause related memory loss, and pain.❞
Alzheimer’s is more common than you might think
According to Dr. Devi,
❝97% of patients with mild Alzheimer’s disease don’t even get diagnosed in their internist offices, and half of patients with moderate Alzheimer’s don’t get diagnosed.
What that means is that the percentage of people that we think about when we think about Alzheimer’s—the people in the nursing home—that’s a very, very small fraction of the entirety of the people who have the condition❞
As for what she would consider the real figures, she puts it nearer 1 in 10 adults aged 65 and older.
Source: Neurologist dispels myths about Alzheimer’s disease
Her most critical advice? Reallocate your worry.
A lot of people understandably worry about a genetic predisposition to Alzheimer’s, especially if an older relative died that way.
See also: Alzheimer’s, Genes, & You
However, Dr. Devi points out that under 5% of Alzheimer’s cases are from genetics, and the majority of Alzheimer’s cases can be prevented be lifestyle interventions.
See also: Reduce Your Alzheimer’s Risk
Lastly, she wants us to skip the stigma
Outside of her clinical practice and academic work, this is one of the biggest things she works on, reducing the stigma attached to Alzheimer’s both publicly and professionally:
Alzheimer’s Disease in Physicians: Assessing Professional Competence and Tempering Stigma
Want more from Dr. Devi?
You might enjoy this interview:
Click Here If The Embedded Video Doesn’t Load Automatically!
And here’s her book:
Enjoy!
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The Brain As A Work-In-Progress
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And The Brain Goes Marching On!
In Tuesday’s newsletter, we asked you “when does the human brain stop developing?” and got the above-depicted, below-described, set of responses:
- About 64% of people said “Never”
- About 16% of people said “25 years”
- About 9% of people said “65 years”
- About 5% of people said “13 years”
- About 3% of people said “18 years”
- About 3% of people said “45 years”
Some thoughts, before we get into the science:
An alternative wording for the original question was “when does the human brain finish developing”; the meaning is the same but the feeling is slightly different:
- “When does the human brain stop developing?” focuses attention on the idea of cessation, and will skew responses to later ages
- When does the human brain finish developing?” focuses on attention on a kind of “is it done yet?” and will skew responses to earlier ages
Ultimately, since we had to chose one word or another, we picked the shortest one, but it would have been interesting if we could have done an A/B test, and asked half one way, and half the other way!
Why we picked those ages
We picked those ages as poll options for reasons people might be drawn to them:
- 13 years: in English-speaking cultures, an important milestone of entering adolescence (note that the concept of a “teenager” is not precisely universal as most languages do not have “-teen” numbers in the same way; the concept of “adolescent” may thus be tied to other milestones)
- 18 years: age of legal majority in N. America and many other places
- 25 years: age popularly believed to be when the brain is finished developing, due to a study that we’ll talk about shortly (we guess that’s why there’s a spike in our results for this, too!)
- 45 years: age where many midlife hormonal changes occur, and many professionals are considered to have peaked in competence and start looking towards retirement
- 65 years: age considered “senior” in much of N. America and many other places, as well as the cut-off and/or starting point for a lot of medical research
Notice, therefore, how a lot of things are coming from places they really shouldn’t. For example, because there are many studies saying “n% of people over 65 get Alzheimer’s” or “n% of people over 65 get age-related cognitive decline”, etc, 65 becomes the age where we start expecting this—because of an arbitrary human choice of where to draw the cut-off for the study enrollment!
Similarly, we may look at common ages of legal majority, or retirement pensions, and assume “well it must be for a good reason”, and dear reader, those reasons are more often economically motivated than they are biologically reasoned.
So, what does the science say?
Our brains are never finished developing: True or False?
True! If we define “finished developing” as “we cease doing neurogenesis and neuroplasticity is no longer in effect”.
Glossary:
- Neurogenesis: the process of creating new brain cells
- Neuroplasticity: the process of the brain adapting to changes by essentially rebuilding itself to suit our perceived current needs
We say “perceived” because sometimes neuroplasticity can do very unhelpful things to us (e.g: psychological trauma, or even just bad habits), but on a biological level, it is always doing its best to serve our overall success as an organism.
For a long time it was thought that we don’t do neurogenesis at all as adults, but this was found to be untrue:
How To Grow New Brain Cells (At Any Age)
Summary of conclusions of the above: we’re all growing new brain cells at every age, even if we be in our 80s and with Alzheimer’s disease, but there are things we can do to enhance our neurogenic potential along the way.
Neuroplasticity will always be somewhat enhanced by neurogenesis (after all, new neurons get given jobs to do), and we reviewed a great book about the marvels of neuroplasticity including in older age:
Our brains are still developing up to the age of 25: True or False?
True! And then it keeps on developing after that, too. Now this is abundantly obvious considering what we just talked about, but see what a difference the phrasing makes? Now it makes it sound like it stops at 25, which this statement doesn’t claim at all—it only speaks for the time up to that age.
A lot of the popular press about “the brain isn’t fully mature until the age of 25” stems from a 2006 study that found:
❝For instance, frontal gray matter volume peaks at about age 11.0 years in girls and 12.1 years in boys, whereas temporal gray matter volume peaks at about age at 16.7 years in girls and 16.2 years in boys. The dorsal lateral prefrontal cortex, important for controlling impulses, is among the latest brain regions to mature without reaching adult dimensions until the early 20s.❞
Source: Structural Magnetic Resonance Imaging of the Adolescent Brain
There are several things to note here:
- The above statement is talking about the physical size of the brain growing
- Nowhere does he say “and stops developing at 25”
However… The study only looked at brains up to the age of 25. After that, they stopped looking, because the study was about “the adolescent brain” so there has to be a cut-off somewhere, and that was the cut-off they chose.
This is the equivalent of saying “it didn’t stop raining until four o’clock” when the reality is that four o’clock is simply when you gave up on checking.
The study didn’t misrepresent this, by the way, but the popular press did!
Another 2012 study looked at various metrics of brain development, and found:
- Synapse overproduction into the teens
- Cortex pruning into the late 20s
- Prefrontal pruning into middle age at least (they stopped looking)
- Myelination beyond middle age (they stopped looking)
Source: Experience and the developing prefrontal cortex ← check out figure 1, and make sure you’re looking at the human data not the rat data
So how’s the most recent research looking?
Here’s a 2022 study that looked at 123,984 brain scans spanning the age range from mid-gestation to 100 postnatal years, and as you can see from its own figure 1… Most (if not all) brain-things keep growing for life, even though most slow down at some point, they don’t stop:
Brain charts for the human lifespan ← check out figure 1; don’t get too excited about the ventricular volume column as that is basically “brain that isn’t being a brain”. Do get excited about the rest, though!
Want to know how not to get caught out by science being misrepresented by the popular press? Check out:
How Science News Outlets Can Lie To You (Yes, Even If They Cite Studies!)
Take care!
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Compact Tai Chi – by Dr. Jesse Tsao
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A very frustrating thing when practicing tai chi, especially when learning, is the space typically required. We take a step this way and lunge that way and turn and now we’ve kicked a bookcase. Add a sword, and it’s goodnight to the light fixtures at the very least.
While a popular suggestion may be “do it outside”, we do not all have the luxury of living in a suitable climate. We also may prefer to practice in private, with no pressing urge to have an audience.
Tsao’s book, therefore, is very welcome. But how does he do it? The very notion of constriction is antithetical to tai chi, after all.
He takes the traditional forms, keeps the movements mostly the same, and simply changes the order of them. This way, the practitioner revolves around a central point. Occasionally, a movement will become a smaller circle than it was, but never in any way that would constrict movement.
Of course, an obvious question for any such book is “can one learn this from a book?” and the answer is complex, but we would lean towards yes, and insofar as one can learn any physical art from a book, this one does a fine job. It helps that it builds up progressively, too.
All in all, this book is a great choice for anyone who’s interested in taking up tai chi, and/but would like to do so without leaving their home.
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Healthy Brain, Happy Life – by Dr. Wendy Suzuki
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We talked about Dr. Wendy Suzuki’s research in the category of exercise and brain-benefits in our main feature the other day. But she has more to say than we can fit into an article!
This book chronicles her discoveries, through her work in memory and neuroplasticity, to her discoveries about exercise, and her dive into broader neurology-based mental health. So what does neurology-based mental health look like?
The answer is: mitigating brain-busters such as stress and anxiety, revitalizing a fatigued brain, boosting creativity, and other such benefits.
Does she argue that exercise is a cure-all? No, not quite. Sometimes there are other things she’s recommending (such as in her chapter on challenging the neurobiology of the stress response, or her chapter on meditation and the brain).
The writing style is mostly casual, interspersed with occasional mini-lectures (complete with diagrams and other illustrations), and is very readable and informative throughout.
Bottom line: if you’d like the more in-depth details of Dr. Suzuki’s work, this book is a very accessible way to get 320 pages of that!
Click here to check out Healthy Brain, Happy Life, and give yours the best!
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Brazil Nuts vs Cashews – Which is Healthier?
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Our Verdict
When comparing Brazil nuts to cashews, we picked the cashews.
Why?
Looking at the macros first, Brazil nuts have more fat and fiber, while cashews have more carbs and protein. So, it really comes down to what you want to prioritize. We’d generally consider fiber the tie-breaker, making this category a subjective marginal win for Brazil nuts—and especially marginal since they are both low glycemic index foods in any case.
When it comes to vitamins, Brazil nuts have more of vitamins C, E, and choline, while cashews have more of vitamins B2, B3, B5, B6, B7, B9, and K, so while both are great, this category is a clear by-the-numbers win for cashews.
The category of minerals is an interesting one. Brazil nuts have more calcium, magnesium, phosphorus, and selenium, while cashews have more copper, iron, manganese, and zinc. That would be a 4:4 tie, but let’s take a closer look at those selenium levels:
- A cup of cashews contains 109% of the RDA of selenium. Your hair will be luscious and shiny.
- A cup of Brazil nuts contains 10,456% of the RDA of selenium. This is way past the point of selenium toxicity, and your (luscious, shiny) hair will fall out.
For this reason, it’s recommended to eat no more than 3–4 Brazil nuts per day.
We consider that a point against Brazil nuts.
Adding up the section makes for a win for cashews. Of course, enjoy Brazil nuts too if you will, but in careful moderation please!
Want to learn more?
You might like to read:
Why You Should Diversify Your Nuts
Take care!
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Visceral Belly Fat & How To Lose It
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Visceral Belly Fat & How To Lose It
We’ve talked before about how waist circumference is a much more useful indicator of metabolic health than BMI.
So, let’s say you’ve a bit more around the middle than you’d like, but it stubbornly stays there. What’s going on underneath what you can see, why is it going on, and how can you get it to change?
What is visceral fat?
First, let’s talk about subcutaneous fat. That’s the fat directly under your skin. Women usually have more than men, and that’s perfectly healthy (up to a point); it’s supposed to be that way. We (women) will tend to accumulate this mostly in places such as our breasts, hips, and butt, and work outwards from there. Men will tend to put it on more to the belly and face.
Side-note: if you’re undergoing (untreated) menopause, the changes in your hormone levels will tend to result in more subcutaneous fat to the belly and face too. That’s normal, and/but normal is not always good, and treatment options are great (with hormone replacement therapy, HRT, topping the list).
Visceral fat (also called visceral adipose tissue), on the other hand, is the fat of the viscera—the internal organs of the abdomen.
So, this is fat that goes under your abdominal muscles—you can’t squeeze this (directly).
So what can we do?
Famously “you can’t do spot reduction” (lose fat from a particular part of your body by focusing exercises on that area), but that’s about subcutaneous fat. There are things you can do that will reduce your visceral fat in particular.
Some of these advices you may think “that’s just good advice for losing fat in general” and it is, yes. But these are things that have the biggest impact on visceral fat.
Cut alcohol use
This is the biggie. By numerous mechanisms, some of which we’ve talked about before, alcohol causes weight gain in general yes, but especially for visceral fat.
Get better sleep
You might think that hitting the gym is most important, but this one ranks higher. Yes, you can trim visceral fat without leaving your bed (and even without getting athletic in bed, for that matter). Not convinced?
- Here’s a study of 101 people looking at sleep quality and abdominal adiposity
- Oh, and here’s a meta-analysis with 56,000 people (finding the same thing), in case that one study didn’t convince you.
So, the verdict is clear: you snooze, you lose (visceral fat)!
Tweak your diet
You don’t have to do a complete overhaul (unless you want to), but a few changes can make a big difference, especially:
- Getting more fiber (this is the biggie when it comes to diet)
- Eating less sugar (not really a surprise, but relevant to mention)
- Eat whole foods (skip the highly processed stuff)
If you’d like to learn more and enjoy videos, here’s an informative one to get you going!
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Why scrapping the term ‘long COVID’ would be harmful for people with the condition
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The assertion from Queensland’s chief health officer John Gerrard that it’s time to stop using the term “long COVID” has made waves in Australian and international media over recent days.
Gerrard’s comments were related to new research from his team finding long-term symptoms of COVID are similar to the ongoing symptoms following other viral infections.
But there are limitations in this research, and problems with Gerrard’s argument we should drop the term “long COVID”. Here’s why.
A bit about the research
The study involved texting a survey to 5,112 Queensland adults who had experienced respiratory symptoms and had sought a PCR test in 2022. Respondents were contacted 12 months after the PCR test. Some had tested positive to COVID, while others had tested positive to influenza or had not tested positive to either disease.
Survey respondents were asked if they had experienced ongoing symptoms or any functional impairment over the previous year.
The study found people with respiratory symptoms can suffer long-term symptoms and impairment, regardless of whether they had COVID, influenza or another respiratory disease. These symptoms are often referred to as “post-viral”, as they linger after a viral infection.
Gerrard’s research will be presented in April at the European Congress of Clinical Microbiology and Infectious Diseases. It hasn’t been published in a peer-reviewed journal.
After the research was publicised last Friday, some experts highlighted flaws in the study design. For example, Steven Faux, a long COVID clinician interviewed on ABC’s television news, said the study excluded people who were hospitalised with COVID (therefore leaving out people who had the most severe symptoms). He also noted differing levels of vaccination against COVID and influenza may have influenced the findings.
In addition, Faux pointed out the survey would have excluded many older people who may not use smartphones.
The authors of the research have acknowledged some of these and other limitations in their study.
Ditching the term ‘long COVID’
Based on the research findings, Gerrard said in a press release:
We believe it is time to stop using terms like ‘long COVID’. They wrongly imply there is something unique and exceptional about longer term symptoms associated with this virus. This terminology can cause unnecessary fear, and in some cases, hypervigilance to longer symptoms that can impede recovery.
But Gerrard and his team’s findings cannot substantiate these assertions. Their survey only documented symptoms and impairment after respiratory infections. It didn’t ask people how fearful they were, or whether a term such as long COVID made them especially vigilant, for example.
In discussing Gerrard’s conclusions about the terminology, Faux noted that even if only 3% of people develop long COVID (the survey found 3% of people had functional limitations after a year), this would equate to some 150,000 Queenslanders with the condition. He said:
To suggest that by not calling it long COVID you would be […] somehow helping those people not to focus on their symptoms is a curious conclusion from that study.
Another clinician and researcher, Philip Britton, criticised Gerrard’s conclusion about the language as “overstated and potentially unhelpful”. He noted the term “long COVID” is recognised by the World Health Organization as a valid description of the condition.
A cruel irony
An ever-growing body of research continues to show how COVID can cause harm to the body across organ systems and cells.
We know from the experiences shared by people with long COVID that the condition can be highly disabling, preventing them from engaging in study or paid work. It can also harm relationships with their friends, family members, and even their partners.
Despite all this, people with long COVID have often felt gaslit and unheard. When seeking treatment from health-care professionals, many people with long COVID report they have been dismissed or turned away.
Last Friday – the day Gerrard’s comments were made public – was actually International Long COVID Awareness Day, organised by activists to draw attention to the condition.
The response from people with long COVID was immediate. They shared their anger on social media about Gerrard’s comments, especially their timing, on a day designed to generate greater recognition for their illness.
Since the start of the COVID pandemic, patient communities have fought for recognition of the long-term symptoms many people faced.
The term “long COVID” was in fact coined by people suffering persistent symptoms after a COVID infection, who were seeking words to describe what they were going through.
The role people with long COVID have played in defining their condition and bringing medical and public attention to it demonstrates the possibilities of patient-led expertise. For decades, people with invisible or “silent” conditions such as ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) have had to fight ignorance from health-care professionals and stigma from others in their lives. They have often been told their disabling symptoms are psychosomatic.
Gerrard’s comments, and the media’s amplification of them, repudiates the term “long COVID” that community members have chosen to give their condition an identity and support each other. This is likely to cause distress and exacerbate feelings of abandonment.
Terminology matters
The words we use to describe illnesses and conditions are incredibly powerful. Naming a new condition is a step towards better recognition of people’s suffering, and hopefully, better diagnosis, health care, treatment and acceptance by others.
The term “long COVID” provides an easily understandable label to convey patients’ experiences to others. It is well known to the public. It has been routinely used in news media reporting and and in many reputable medical journal articles.
Most importantly, scrapping the label would further marginalise a large group of people with a chronic illness who have often been left to struggle behind closed doors.
Deborah Lupton, SHARP Professor, Vitalities Lab, Centre for Social Research in Health and Social Policy Centre, and the ARC Centre of Excellence for Automated Decision-Making and Society, UNSW Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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