The steep price of success

In a new study, we learn that working:

  • 41-48 hours is associated with a 10% greater risk of stroke.
  • 49-54 hours had a 27% increased risk of stroke.
  • 55 hours or more per week had a 33% greater chance of stroke.

The authors analyzed data from 17 studies on over 500,000 men and women from the US, Europe, and Australia.

The stroke findings were significant even after accounting for risk factors including smoking, alcohol use, physical activity, high blood pressure, and high cholesterol.

The study also showed working 55 hours or more per week was associated with a 13% greater risk of coronary heart disease.

Silent strokes, which neurologists see all the time and in abundance on brain MRIs, take a heavy toll on cognition as we get older.

Lancet article here



Concussions and Traumatic Brain Injury

People who’ve had TBI [traumatic brain injuries] have brains that appear older than their chronological age. In other words, TBI appears to accelerate brain aging.

Older brains have less gray and white matter. In other words, more atrophy.

Importantly, concussion is another name for mild TBI. Think about how many concussions kids and adolescents have growing up playing sports…

From the Annals of Neurology 2015

Is Dementia and Alzheimer’s Preventable?

To a large degree YES!

Which is very important, since there really is no cure at this point.

And the academic neurological community is beginning to recognize this. From a new article in the green journal, we find the conclusion:

This implies that preventative strategies for MCI [mild cognitive impairment] may need to begin in midlife and should persist throughout late life


The reality of the situation, however,  is that prevention should optimally not begin in midlife- but rather in childhood.

By reading through the items on this site, you will learn many of these strategies and techniques.


Some other interesting tidbits from the article:

  • Predictors of MCI [mild cognitive impairment] were APOE e4 allele, current depressive symptoms, midlife onset of hypertension, increasing number of vascular diseases
  • The risk of MCI was reduced in those who reported engaging in artistic, craft, and social activities


Neurology. 2015 May 5;84(18):1854-61


Air pollution linked to brain health

China Shanghai Pollutionnature paradise

For several decades, substantial evidence has accumulated that air pollution is bad for your cardiovascular system and lungs.  Since the brain is one of the most vascular organs in the body, it should not surprise us that air pollution is bad for it too. [Remember one of the tenets of brain health-keep the plumbing intact]. Research supporting this idea, however, has been slower to come to light. Recently, however, have noticed several news items showing how air pollution:

  •  Appears to affect development of childhood brains and lead to long term impairments in intelligence. Studies have found worse scores on tests of memory as well as verbal and nonverbal IQ. Studies have also uncovered more attention problems, and symptoms of anxiety and depression. Some studies have also found increased rates of suicide.
  • Can also affect adult brains by damaging arterial health, leading to poor circulation and stroke like changes.
  • Likely accelerates the aging of the brain and cognitive decline. Higher levels of air pollution were associated with the amyloid plaques and neurofibrillary tangles associated with Alzheimers disease. Some experts say that air pollution should be considered a risk factor Alzheimer’s disease and Parkinson’s disease!

The more I read about this issue, the more grateful I am that I don’t live in a badly polluted city like Beijing. Imagine all the hundreds of millions of people around the world who’s brain & health is declining at a more rapid pace, simply because of where they live? From merely economic perspective, you’d think there would be huge incentive to urgently finds ways to drastically curb pollution to 1) save massively on healthcare [less lung disease, heart attacks, strokes and 2) increase lifetime productivity of its citizenry. Unfortunately, no matter how little pollution gets generated where you live, it eventually all spreads and diffuses around the earth. Sooner or later, each and every one of us is affected.

In addition to smog and outdoor air pollution, indoor air pollution can also be bad for your brain. Keeping your house well ventilated can make a difference here, as can HEPA filters.

Some References:

Air Pollution during pregnancy and childhood cognitive and psychomotor development: six European birth cohorts. Epidemiology. 2014 Sep;25(5):636-47

Perera FP, Chang H-w, Tang D, Roen EL, Herbstman J, et al. (2014) Early-Life Exposure to Polycyclic Aromatic Hydrocarbons and ADHD Behavior Problems. PLoS ONE 9(11): e111670. doi:10.1371/journal.pone.0111670

Long-term air pollution exposure is associated with neuroinflammation, an altered innate immune response, disruption of the blood-brain barrier, ultrafine particulate deposition, and accumulation of amyloid beta-42 and alpha-synuclein in children and young adults. Toxicol Pathol. 2008 Feb;36(2):289-310

The Outdoor air pollution and brain health workshop, Neurotoxicology. 2012 Oct;33(5):972-84.



Keeping your brain active as you age

brain fitness old age senior

The latest research suggests that, even in late life  [80s and above],  the more you participate in mentally stimulating activities:

  • The slower your cognitive ability declines
  • The lower your risk for developing dementia [Alzheimer’s Disease, etc..]

In other words, use it or lose it. The brain appears to function similarly to muscles. Older folks who don’t regular exercise develop more muscle atrophy and decline than those who routinely workout.

Here is a list of some brain stimulating activities you can consider doing.

  • Reading the newspaper
  • Learning to play an instrument
  • Learning a new language
  • Solve puzzles & play brain challenging/thinking games
  • Writing letters/emails to keep up with friends/family
  • Learn to juggle
  • Travel
  • Read books & articles on topics that your find interesting
  • Volunteer at an elementary school
  • Take classes in acting
  • Socializing with friends
  • Playing card games with friends
  • Cooking complex recipes


Neurology 2012;78:1123-1129

How to Reverse Brain Atrophy

brain atrophy

As we age, our brains shrink in size due to loss of neural tissue. The term for this is ‘atrophy’, and it can be seen on MRI scans. Surprisingly, you don’t have to be old to have atrophy. In fact, the process of brain shrinkage probably begins in your 20s, and gets progressively more severe decade by decade.

Genetics and lifestyle factors primarily determine the rate at which your brain atrophies.

If you’ve been bummed out because your MRI shows significant atrophy, there is hope. To some extent, it can be reversed.

I was very excited to see a study published which indicated that exercise training increased brain volume. Specifically, this one study showed that moderate intensity aerobic exercise 3 days/week for year led to a 2% increase in hippocampal volume! This is very good news, since the hippocampus is felt to be the memory engine of the brain.

  • moderate intensity exercise for this study was defined as: walking for 40 minutes per session. Participants wore heart rate monitors and were encouraged to walk in their target heart rate zone, which in this study was 60-75% of the maximum heart rate.

After a bit of digging around, I found another study which showed aerobic exercise training increased brain volume of gray and white matter in the prefrontal cortex. This region of the brain, separate from the hippocampus as discussed above, plays a very important role in concentration, judgement, problem solving ability, social behavior. [more information about the prefrontal cortex can be found here]



Proc Natl Acad Sci U S A. 2011 Feb 15;108(7):3017-22.

J Gerontol A Biol Sci Med Sci (2006) 61 (11): 1166-1170




Mildly Elevated Blood Pressure

white matter disease changes small vessel chronic ischemic

High Blood Pressure, also known as Hypertension (HTN), is very, very bad for brain health.  It is a common condition that ruins the plumbing. Patients with a history of HTN typically have numerous lesions in their brain. These lesions commonly show up on MRI scans and are called ‘white matter lesions’, or ‘small vessel disease’, or ‘chronic ischemic change’.  Neurologists commonly find themselves explaining these MRI findings to patients. All of these terms basically mean the brain has suffered numerous small strokes. The longer you’ve had HTN, and the poorer controlled it has been, the more lesions you’ll probably have.

Of course, having a brain riddled with holes and looking like swiss cheese can’t be good. And what we find is that the more of these lesions you have, the more likely you are to have cognitive impairment.

Amazingly, I remember reading a recent article that suggested for every handful of white matter lesions seen on MRI [chronic ischemic changes, small vessel changes seen], there were hundreds if not thousands more present only detetable via microscope. This is an astounding piece of information.

Importantly, we are now learning that even mildly elevated blood pressure- in the normal range- can also be associated with these lesions. New lines of evidence suggest that low range pre-hypertension 120-129/80-84 probably is bad for your brain and ups your risk of small strokes accumulating over time.


Neurology March 12, 2014

Cholesterol ratio and Alzheimer’s

Having higher levels of “good cholesterol” HDL and lower levels of “bad cholesterol” LDL correlates with lower amounts of Alzheimer’s pathology in the brain [amyloid plaque].

Cholesterol measurements are important because they correlate with blood vessel health. As we reviewed earlier, keeping your pipes clean is incredibly important.

Since diet impacts your cholesterol level, this is yet another way you may modify your risk for getting Alzheimer’s disease.

From a recent JAMA article

Can Alzheimer’s symptoms be helped?


Above, a picture of a brain cell [source]

To an extent, Yes.

A key factor in this process involves plasticity- the brain’s innate ability to create new connections & rewire itself. At all ages, the brain remains plastic. It is highest during childhood, and diminishes as you get older. Plasticity is present to some extent, however, at all stages of life.

If we focus on increasing plasticity, Alzheimer’s symptoms can be improved. Especially if we can simultaneously diminish the rate of brain deterioration that is part of Alzheimer’s.

Scientists are hard at work uncovering the pathways that govern plasticity. Recently, a team has identified an important protein that plays a role: Reelin.  This protein has amazingly been shown to rescue the cognitive deficits in an Alzheimer’s animal model. [Here is a link to the study in Nature Communications]


Importantly, there is something you can do right now to safely, naturally, boost brain plasticity. It would be the trillion dollar drug if pharmaceutical companies could bottle it: Aerobic Exercise. While there are hundreds of studies that support this statement, here is one highly cited source: Exercise: a behavioral intervention to enhance brain health and plasticity.



Importance of Food Before Conception

diet baby brain development

“There is no escape-we pay for the violence of our ancestors”.- Frank Herbert, Dune

What a child eats will determine the health and strength of his or her brain as an adult.

What a mom eats during the 9 months of pregnancy will have a significant effect upon fetal brain development, which in turn plays a major role in shaping adult brain health and ability.

What a mom eats in the year before she conceives will also shape her child’s future adult brain.

And, surprisingly, we now have evidence that what the dad eats before conception also plays a very important role in shaping the child’s future intelligence & health.

You should realize it’s not just what you eat: tobacco, alcohol, and other drugs/toxins used by mom or dad before conception are bound to have a very negative influence on development!

Reference: “Low paternal dietary folate alters the mouse sperm epigenome and is associated with negative pregnancy outcomes,” by R. Lambrot, C.Xu, S. Saint-Phar, G. Chountalos, T. Cohen, M. Paquet, M. Suderman, M. Hallett, and S. Kimmins in Nature Communications, 2013.