by Bianca Garilli, ND
A Presidential Advisory on brain health was recently released by the American Heart Association/American Stroke Association in September 2017. The goals of the publication were to provide a definition of “optimal brain health” in adults, and guidance on how to maintain brain health through the years. From these data, the following 7 metrics were brought forward as steps to implement for improving brain health where ideal brain health was defined as “having an optimal capacity to function adaptively in the environment”:1
- Non smoking
- Physical activity at individualized goal levels
- Healthy diet consistent with current guideline levels
- Body mass index <25 kg/m2
- Untreated blood pressure at <120/<80 mm Hg
- Untreated total cholesterol <200 mg/dL
- Fasting blood glucose <100 mg/dL
The data to support these seven cognitive health metrics are abundant and many are related to reducing risk factors associated with cardiovascular disease (CVD) since the association between CVD and declining cognitive health is widely recognized. For the most part, these metrics can be categorized as “modifiable lifestyle behaviors” and several of these are discussed in more detail below:
Physical Activity and Brain Health
In a study looking at mild cognitive impairment and physical activity in people 65 years and older, it was found that participants who did not meet the minimum threshold of moderate-to-vigorous physical activity at 150 minutes of exercise per week had an increased risk for mild cognitive impairment.2
Healthy Diet and Brain Health
Evidence supports the link between certain dietary patterns, particularly those related to a Mediterranean style of eating, and reduced risk for many health conditions including dementia. Specific food groups seem to confer a protective role in reducing risk of and slowing the onset of cognitive decline; these nutrients include n-3 PUFA, polyphenols, vitamin D and B vitamins with some of the strongest data showing a supportive role for folate, riboflavin, and vitamins B6 and B12.3
Lifestyle Intervention and Brain Health
Results from the 2017 FINGER study demonstrated integrating a comprehensive lifestyle program including diet, exercise, cognitive training and vascular risk management reduced cognitive decline as compared with a control group who was given general health advice only. Two years after implementing a lifestyle intervention, participants experienced benefits related to reduced risk of cognitive decline. These data support a fully integrative lifestyle approach as a possible intervention in the elderly population who may be at increased risk for dementia.4
Optimal brain function is important as a person ages as it reduces the risk of a poor quality of life and increased mortality, both commonly associated with cognitive decline. Maintaining good cognitive health is also supportive of functional independence as well as lowering the risk for institutionalization.
Safe interventions that may extend the improved brain function should be considered as possible options for those at risk for cognitive decline. An integrative lifestyle modification approach which brings together many of the core “7 steps” noted above, is an excellent approach to this goal.
Why is this Clinically Relevant?
- Healthcare providers should discuss the relationship between cognitive decline and CVD risk in clinic visits
- Lifestyle interventions including dietary modifications, appropriate movement and exercise, and the other “7 steps” should be reviewed with all aging patients and their families and/or care providers
- Lifestyle modifications have the ability to reduce cognitive decline and should be implemented as early in life as possible
- Education on the importance of a Mediterranean food plan approach, routine exercise, non-smoking and other healthy lifestyle metrics should become part of every annual physical and health checkup
- Gorelick P, Furie KL, Ladecola C, et al. Defining optimal brain health in adults: A Presidential Advisory From the American Heart Association/American Stroke Association. Stroke. 2017;48(10):e284-303.
- Vancampfort D, Stubbs B, Lara E, Vandenbulcke M, Swinnen N, Koyanagi A. Mild cognitive impairment and physical activity in the general population: findings from six low- and middle-income countries. Exp Gerontol. 2017;100:100-105.
- Moore K, Hughes CF, Ward M, Hoey L, McNulty H. Diet, nutrition and the ageing brain: current evidence and new directions. Proc Nutr Soc. 2018;Jan 10:1-12.
- Sindi S, Ngandu T, Hovatta I, et al. Baseline telomere length and effects of a multidomain lifestyle intervention on cognition: the FINGER randomized controlled trial. J Alzheimers Dis. 2017;59(4):1459–1470.
Bianca Garilli, ND, USMC Veteran
Dr. Garilli is a former US Marine turned Naturopathic Doctor (ND). She works in private practice in Northern California as well as running a consulting company working with leaders in the natural and functional medicine world such as the Institute for Functional Medicine and Metagenics. She is passionate about optimizing health and wellness in individuals, families, companies and communities- one lifestyle change at a time. Dr. Garilli has been on staff at the University of California Irvine, Susan Samueli Center for Integrative Medicine and is faculty at Hawthorn University. She is the creator of the Veterans for Health Initiative and is the current President of the Children’s Heart Foundation, CA Chapter.