Our brain is a powerful tool that we should pay attention to, especially as we get older. Join us in conversation with Dr. Leslie Kernisan who shares her check list of important brain health practices we should all know about. Enjoy the show!
My guest today is Dr. Leslie Kernisan. Leslie is a medical doctor with specialty in geriatrics. She has a fabulous website where she provides practical advise on how to deal with the aging problems that older adults face. It’s great to have you here, Dr. Leslie.
Dr. Leslie Kernisan:
I’m so happy that you are here discussing the topic of brain health. We know it’s important, and we sort of know what we have to do to stay healthy, but our knowledge is hardly systematic.
You have put together a fabulous check list as a guide to brain health, and you have come up with some really interesting angles on how to look at brain health. Can you please tell us about your check list?
It’s called How to Promote Brain Health. I created it because I realized that I often needed a place where to point my patients or my audience. It consists of my recommendations for optimizing your brain.
Because I’m a geriatrician, and so I mostly take care of people over 65. Many of them have cognitive difficulties or maybe even memory problems. I’ve realized that our suggestions for optimizing the brain function apply whether you are 60 or 85 with Alzheimer’s, because the core principles are the same.
I created that list, and I’d be happy to take you through it. I found that people have heard about several of the items because there has been a lot of interest in brain health and its pillars. However, two of those points most people don’t know about, so I try to focus on them.
On 60 & Me we have recorded a lot of videos on healthy ageing, and we know it’s really important to keep our brain healthy. We’re familiar with most information that is out there, which you also cover. But you have included some unique points that are really interesting, so please introduce us to your list.
The first item on my list includes the four types of medication to avoid if you are worried about memory loss. I’ve had older people who told me that they have noticed changes in themselves or were concerned about changes in their spouse.
They would all say, “What can you do? It happens,” and that’s when I think, “Oh my gosh, there are a lot of things you can do.”
One of the key steps to take, that people often don’t think about, is to identify and stop medications that we know dampen brain function. I’m often surprised that I don’t see this kind of information shared by the institutions that research brain health.
A few years ago, the National Academy of Medicine in the United States issued a groundbreaking report on cognitive ageing. In that report they gathered information about how the brain changes as it ages, and how we can maintain the best possible brain health.
They have prepared an action guide with six particular suggestions, and third on their list was managing your medications. That is one of the only places where I’ve seen medications brought up.
People are often surprised to find out that they are taking medications which dampen brain function or have been associated with developing cognitive impairment or even dementia. The ones to look out for are Benzodiazepines.
These are medications like Valium or Ativan—the generic name is Lorazepam or Xanax—which people take for anxiety or relaxing and often for sleep. Unfortunately, people who are already having any kind of memory difficulty get worse after taking these medications.
Some research studies associate Benzodiazepines with developing dementia or possibly accelerating it, but then other studies have contested the results. So, people don’t know whom to trust. But in geriatrics, we are very careful about spotting those medicines and encouraging people to taper off them if it all possible.
There is also an added problem: Benzodiazepines are terrible for balance, and they are associated with falls. By avoiding taking them, you are getting a double benefit as an older person.
People who are in their 50s and 60s should be aware of these side effects, because if you’ve been taking that medication for a few years, or even several years, which some people have, now is a great time to work on the process of tapering off and finding another way to manage insomnia or anxiety.
Otherwise, we end up with people who are in their 80s and starting to slip with their memory. When that happens it’s very hard to get them off the medication, because they get stressed and their memory gets worse. So, I encourage people to start early.
The other sedative medications, like Ambien, haven’t been around for as long, but I encourage people to minimize their use of that, too. We do know that people do less well on cognitive tests the next day after they have taken Ambien.
Nobody knows for sure what are the long term effects of Ambien, but there are safer ways to learn to sleep. People don’t realize that, but you can learn to sleep without sedatives.
I’d just like to mention that you are a fully accredited medical doctor, so you can make these claims. I encourage people who are listening, and maybe have questions or opposing views about the benefits/harms of Ambien, to go talk with their doctor, or do their homework and research the effects of these medications.
There is a wonderful geriatrician in Canada who did a study where she created a pamphlet about taking Benzodiazepines and other sedatives that gave people information on the risks, suggested a tapering schedule and encouraged them to read it and bring it to their doctor.
She did a randomized trial distributing the pamphlet to pharmacies and to people. One group didn’t want the pamphlet, but out of those people who received it, a surprising number were able to stop or reduce their dosage.
That was proof that giving people a really useful information tool could motivate them and empower them to go to their doctor and actually make a good change. I encourage people to take a look at that pamphlet. Always talk to your doctor before stopping this kind of medication as this is very important.
The other medications that have been associated with cognitive decline comprise a whole broad group that’s called anticholinergic. Acetylcholine is a neurotransmitter in the brain and elsewhere in the body, and Alzheimer’s medication like Arisept is actually meant to increase it.
What people don’t realize is that lots of medications that are commonly used over the counter impair this neurotransmitter. In the United States these would be something like Benadryl or Dimenhydramine which is used for allergies or nausea, but a lot of people use it for sleep.
The sleeping agents included in over the counter medications like NyQuil or Tylenol PM are anti-histamines, which are anticholinergic. Certain medications for overactive bladder are also anti-cholinergic.
These are basically medications that make you drowsy and give you dry mouth as a side effect. Certain muscle relaxers fall into this category as well.
So this sums up medication. You’ve got a lot of resources and lists on your website on this and other topics, and people can look at those there. What else is on your check list that we need to consider for the aging brain?
The next item on my list often isn’t included elsewhere, but it’s on the tip sheet from the National Academy of Medicine on cognitive ageing—preventing delirium. Delirium is that condition of worse-than-usual mental function that happens to older people when they get sick.
It often happens when an older person is hospitalized. They may or may not have had surgery, and suddenly, they are totally confused. Their memory is terrible, or they are seeing things, or they are hallucinating. That is called delirium.
We know that people who developed delirium in the past have a higher chance of developing dementia later. If somebody has already had some memory problems or been diagnosed with Alzheimer’s or dementia, having episodes of delirium is associated with faster cognitive decline afterwards.
We believe that 40% of delirium cases can be prevented if you are a person who wants to take care of your brain health. Delirium often comes on at those times when people get very sick, and of course, there’s not much to do about that.
But you can have some control over planned hospitalization for surgery, like a joint replacement, or other procedures. You can actually try to take steps to reduce the chance that you will get into a state of delirium.
You can do one of two things. You can look for a hospital that has set up a special unit for older adults; they are called Acute Care for Elders Units. They are usually for people who have passed their 60s and are designed to provide older people with extra support.
One of the things that tip people into delirium is that the hospital is such a stressful, non-recuperative place: You get woken up in the middle of the night. They don’t get you out of bed early enough. They give you medications to help you sleep, like Benadryl, which actually provoke delirium in older people. Older people can become constipated. They may not have their glasses or hearing aids.
Hospitals have to develop ways to structure their environment so that it is more restorative, and people would be less likely to get delirium.
In being proactive, people can look for a hospital that has a special unit for older adults. They can also ask the surgeon or the hospital, “I’m very interested in preventing or reducing my risk of delirium. Do you have a program with your nurses and your hospital staff to help older people to avoid delirium? This is important to me.”
I also have a list of tips on what people and family members can do before the hospitalization, or during that stay, that can help minimize stress induced on the person.
That sounds really helpful. One of our bloggers has had a hip replacement and she wrote about it. The feedback that she got on that article was amazing. People shared how they had done almost all the things you have suggested to create for themselves a less stressful hospital environment.
They anticipated that their stay at the hospital might be traumatic, and so they took some favorite cuddly things they knew would help them cope, or packed pajamas that they felt comfortable in. They created their own world inside the hospital, which helped them reduce stress.
One study found that 45% of older patients who have had heart surgery developed delirium. Six months later, about 30–40% of those people hadn’t recovered to their previous cognitive baseline.
Do we need to call it delirium? It’s such a powerful word. Maybe we could just call it panic attack.
Delirium is the word older people should know. Hopefully, you won’t get it, but you’ll see an older relative get it, or you’ll have a friend get it, and you’d want to know. If you visit a friend in the hospital and they are very confused, you need to know to bring that up to the doctors, because often doctors don’t notice unless family brings it up.
Being prepared is a good way to preserve your brain health from the onslaught of delirium. Of course, if there’s an emergency and you get rushed to the hospital there’s seldom chance of any preparation. But in those cases where you have a choice, it’s good to take all the precautions you can think about.
Another item on my list of brain health factors is exercise. We all know how very important it is both for our body and our brain.
You should also avoid chronic sleep deprivation. Lots of older people have sleep difficulties, but you don’t want to turn right away to using one of those sedative medications. Instead, you want to make sure that your sleep problem is correctly diagnosed (I have an article on that called “Top Causes of Sleep Problems) and evaluated.
That’s what leads to right management. If what you have is just insomnia or anxiety there are non-drug ways to help you sleep that have shown to be effective. There is also cognitive behavioral therapy that’s now available online, and people can access it from their own homes.
You can also listen to audio books. They always put me to sleep. Simple meditation also works wonders. There are lots of practices that are free, don’t involve medication and actually do work.
There are so many easy ways. But the problem is, if people don’t realize that the easy approach the doctor gives you, that sedative pill, comes with a lot more risk, they may not make the effort to find another approach.
Finding ways to manage cognitive stress is really important. That’s where some of the lifestyle techniques that you mentioned come into play—Yoga, meditation, enough exercise.
I think managing cognitive stress is really important for those women who are caring for someone else. Caregiving comes with a lot of stress. Getting help with that, learning ways to cope, both with your stress in general or if you’re stressed because you are caring for someone with Dementia, is really important.
Learning some better techniques for managing difficult situations, getting treated if you have any anxiety or depression, is imperative. Unfortunately, a lot of people try to tough it out, and I think that’s not so great for the brain, and it definitely does not optimize your brain health.
I think a lot of it has to do with being a woman, too. We have learned to cope with things and manage on our own, and a lot of it comes from the fact that men die younger. So, a lot of women end up living by themselves. They say, “Oh, I’m okay, I’m fine,” but in their little heart of hearts they are not. They are struggling.
Yes, I think women often forget to take care of themselves. They are so busy taking care of others, or they feel like there are more important things to do at that moment. We often don’t perceive depression and anxiety as a current problem, but it is associated with developing cognitive problems later in life.
I think not everybody realizes that, but you want to take care of it. Don’t put it off for too long. Another thing you should do is address your cardiovascular risk factors. What is good for the blood vessels around your heart is also good for the brain, because the brain is nourished by blood vessels.
Addressing high blood pressure, if you have it, not smoking, taking care of your blood sugar, if that’s been an issue for you, maintaining a healthy weight, etc. are all super important as well.
You’ve given us so much information, Leslie. Thank you. With all the resources and lists on your website, women can really feel empowered to take care of themselves.
You should definitely make sure you are getting the best health care.
I want a doctor like you. Why can’t we have lots of doctors like you?
I would love to clone myself, but since I can’t, I feel like not only should all doctors and nurses know some geriatrics, but every person who is involved with the health of an older person.
If you are older, you are taking care of your own health, or you are often helping an older parent, older spouse, older friend. We could all benefit from knowing even just a little bit of geriatrics, and I want to share it with the world.
You are doing a great job.
Thank you for giving me this opportunity to share with your audience.
Thank you so much, Leslie. Take care.
Have you experienced a state of delirium? Do you think you take good care of yourself? What else do you think you need to improve on? Please share your thoughts in the comments below!
Tags Brain Health