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Medical reporter says lifestyle changes are key to resilience

by Sanjay Gupta, AARP, April 1, 2020

One evening several years ago, a 93-year-old man was brought into the emergency room where I was on call. When my chief resident told me about the patient, who was in serious neurological decline, his advanced age concerned me. I thought he would be too old to undergo an operation.

Learn more about Keep Sharp, an AARP-branded book based in part on the work of the Global Council on Brain Health.

A little while later, the CT scan showed a significant brain bleed that explained his symptoms, and I went to the man’s family, fully expecting them to tell me not to pursue an aggressive, risky operation.

I encountered a spry woman, his wife of 70 years. She was 94 and in perfect health; she took no medicines and had driven her great-grandkids to school earlier that day. She told me that her husband, my patient, was an avid runner and worked part-time as an accountant. His 63-year-old son called him “a whiz with numbers.” The man’s brain bleed occurred after he fell from his roof while blowing leaves. These nonagenarians were healthier than most of my patients — of any age.

I took the man to the operating room for a craniotomy. I drilled into his skull and used a sawlike device to remove a flap of bone. I removed the blood pool and coagulated small remaining bleeders. All that was left to do was to close the dura mater, reposition the bone flap and suture the skin.

Before I proceeded, though, I took a few moments to inspect his brain. What I saw surprised me. Given how sharp he was, how active and cognitively intact, I expected to see a large brain pulsating robustly and appearing healthy. But this looked like a 93-year-old brain. It was more shriveled, sunken with deep wrinkles indicative of his age.

7 Brain Health Myths

1. Myth: We use 10 percent of our brain.

Fact: Evolutionarily, it would make no sense to carry around surplus brain tissue. And let’s apply other logic here: If the 10 percent idea were true, it would make brain damage a lot less worrisome. Medical scans show that much of the brain is engaged during even simple tasks, and injury to small sections of the brain called eloquent areas can have profound consequences for language, movement, emotion or sensory perception.

2. Myth: Older people are doomed to forget things.

Fact: Yes, some cognitive skills do decline as you age, especially if you don’t employ strategies to pay closer attention and help you remember. But though you may have been quicker at picking up a new language or memorizing a list of random words when you were a youngster, you’re more likely to be superior with vocabulary and a good judge of character when you’re an older adult. You would score higher on tests of social communication and diplomacy, such as how to settle an argument or deal with a conflict. The other good news about aging is that, over time, we tend to improve at controlling our emotions, weathering stress and finding meaning in our lives.

3. Myth: Age inhibits learning.

Fact: Learning can happen at any age, particularly when you get involved in stimulating activities, like meeting new people or trying new hobbies. Yes, mastering some skills, such as a new computer program, may take an older person longer, but that doesn’t mean you can’t achieve it. Even people diagnosed with cognitive decline can continue to learn things.

4. Myth: Male and female brains differ in ways that dictate learning abilities and intelligence.

Fact: Differences do exist in the brains of men and women, though not necessarily to the extent that one is better “equipped” than the other. Scientists continue to study the brain to understand and learn more about any important differences between the brains of men and women — research is still emerging in the field of neuroscience. Another way to think about it more broadly: Each of us may be wired in our own unique way, though with a healthy brain we all have the capacity to learn, remember and make sense of the complex world around us.

5. Myth: A crossword puzzle a day can keep the brain doctor away.

Fact: Crossword puzzles flex parts of your brain related to word-finding ability, though they’re not a cure-all. While they might help you excel at that skill, it’s important to challenge your brain in a variety of ways.

6. Myth: You are dominated by your right or left brain.

Fact: Many people express and receive language more in the left hemisphere and experience their spatial abilities and emotional expression more in the right. But brain-scanning technology has revealed that the brain’s two hemispheres often work together in complex processing.

7. Myth: You have only five senses.

Fact: You know the basic senses: sight, smell, taste, touch and hearing. But other senses are processed in the brain: proprioception (where your body parts are and what they’re doing), nociception (feeling pain), thermoception (sensing temperature), chronoception (sensing the passage of time) and interoception (internal needs, such as hunger and thirst).

Now, if this sounds disheartening to you, it should not. In fact, it should sound just the opposite.

There is a truism in medicine: Always treat the patient, not the test results. If someone had described his brain to me before the operation, I probably would have been even less inclined to operate. But this was a reminder that it didn’t matter what his brain looked like — it mattered how it performed. The brain, perhaps more so than any other organ in the body, may reliably grow stronger in some ways throughout life and become more robust than in years past.

I won’t forget that experience. There seemed to be a total disconnect between the brain I was staring at and the man whose skull it inhabited. I was eager to see how he’d wake up from the operation and what his recovery might be like. Did I make the right decision? Had I prolonged his life or hastened his death?

As soon as I walked into his room, I knew the answer. I found the man reading his smartphone (without reading glasses, which I now need at age 50). He was following the recent election in western Africa, a place where he had spent time doing volunteer work just 10 years earlier. It was clear he was recovering well. I asked him how the whole event had affected him, wondering what he thought about mortality overall. He smiled and looked at me. “The biggest lesson in all of this,” he said, “is no more trying to blow the leaves off the roof.”

Continual improvement

I didn’t grow up with a deep-seated desire to be a doctor, let alone a brain surgeon. My earliest aspiration was to become a writer, likely triggered by a boyhood crush I had on a grade school English teacher.

When I chose medicine, I was 13 years old and my grandfather had just suffered a stroke. Witnessing his brain function change so quickly was jarring. He was suddenly unable to speak or write but seemed to understand what people said and could read without difficulty. I became fascinated by the intricate and mysterious functioning of the brain.

I spent a lot of time at the hospital and was that annoying kid who asked the physicians a lot of questions. I felt grown-up as they patiently explained what had happened. I watched as those doctors were able to return my grandfather to good health after opening up his carotid artery to restore the blood flow to his brain and prevent future strokes.

I started reading everything I could about medicine and the human body. Before long, I was fixated on the brain and, specifically, memory. It still astonishes me that our memories — the very fabric of who we are — can be reduced to invisible neurochemical signals between tiny areas of the brain. For me, those early explorations into the world of brain biology were at once demystifying and magical.

According to an AARP survey of Americans ages 34 to 75, nearly everyone (93 percent) understands the importance of brain health. But those same people don’t always know how to make their brains healthier. Some believe that this mysterious organ is a black box of sorts, untouchable and incapable of being improved. Not true.

I’ve now been a surgeon and health journalist for more than two decades, but what I’ve learned more recently, while researching this book, has shifted how I think about the brain and how to care for it. I am more convinced than ever that the brain can be constructively changed — continually enhanced and fine-tuned — no matter what your age or access to resources is.

For example, we are finding that changes to the brain that lead to diseases such as Alzheimer’s could begin there long before symptoms develop. This is critical information. There are people with a brain full of amyloid plaques — clumps of proteins that are the classic hallmarks of Alzheimer’s disease — who would never know it because they have no symptoms. What if they did know about it and took action?

As with my 93-year-old patient, it wasn’t about making the brain “look” better; it was about how the brain performed. Just like him, I cared more about preventing any crippling symptoms from developing. This is the biggest change in my thinking as a lifelong student of the brain. Focusing on that preclinical time could prove beneficial to patients. The message one day may be, “Yes, you have Alzheimer’s disease, but it will never cause you any symptoms.”

Mental resilience

A change I’ve made personally since turning 50 is working on building my brain’s resiliency. For example, I always thought of socializing as a fun diversion rather than a healthy brain-building activity. There is plenty of evidence, however, that strong and consistent relationships with family and friends pave the way for a more resilient brain.

Here’s how: The prefrontal cortex, where judgment and sound decision-making occur, is strengthened in response to personal human interaction. A more robust prefrontal cortex can decrease the amount of activity in the emotional centers of the brain, notably the amygdala. That means a challenging situation will be processed longer and stronger in the judgment areas of your brain, as opposed to the emotional centers.

I am more convinced than ever that the brain can be constructively changed — continually enhanced and fine-tuned — no matter what your age or access to resources is. Sanjay Gupta

By supporting your prefrontal cortex, you are less likely to see crises as insurmountable problems and accept that change is a normal part of living. That is resiliency in action.

People also develop more resilient brains by taking decisive action, instead of letting problems languish. They are consistently moving toward their goals, making even the small accomplishments count. They practice gratitude on a regular basis and consistently nurture a positive view of themselves. It is very hard to cripple a brain that is decisive and views itself favorably.

Another change I’ve made: I used to brag about my capacity for little sleep, but now I prioritize sleep. Scientists believe that sleep allows the brain to clear waste and organize memories. I also try to learn something new about myself every day. Self-discovery is one of the surest ways to develop a greater appreciation for your life — and to equip you with the means to enhance the good and mitigate the bad.

Remember, it all starts with the brain. Once you have strengthened your brain and made it more resilient, you will make better decisions about your health overall.

The ultimate health goal

In the late 1990s, I had a chance to spend a few days with Stephen Hawking. I was working at the White House and helped plan a series of evenings for President Bill Clinton and first lady Hillary Clinton. When we were thinking about how best to celebrate science, we unanimously agreed on having the famed theoretical physicist as our featured guest.

Because of his ALS, Hawking typed his entire talk into his computer and then played it after going onstage. We had even planned the question-and-answer part of the evening ahead of time. I knew that the audience would be engaged and entertained by his brilliance in the world of physics, but it was his life lessons that have stayed with me more than 20 years later.

Hawking’s disease slowly robbed him of his ability to walk, speak and participate in life the way most of us can, but he had a mind that nobody and nothing could take away from him. It remained sharp until his peaceful death, in 2018.

I once had a teacher who said to me (while pointing to his head), “They can take away everything you own, but they can never take away this.”

That statement has stayed with me ever since and continues to remind me that it’s up to me to protect and preserve my brain and its memories. All it really takes are some basic lifestyle strategies.

Adapted from Keep Sharp: Build a Better Brain at Any Age, by Sanjay Gupta, M.D. (Jan. 5, 2021), published by Simon & Schuster in partnership with AARP. Gupta is CNN’s Emmy Award–winning chief medical correspondent. He lives in Atlanta, where he is an associate professor of neurosurgery at the Emory University School of Medicine.

People who live with the everyday challenges of brain injury have unique and valuable knowledge to help guide human service system improvements. But some symptoms can make it difficult for people with brain injury to participate on the teams and work groups that meet to discuss and plan improvements. Those with and without brain injuries share the responsibility to make lived experience understandable and actionable.

The following are tips that professionals and people with brain injury can use to make the most of the lived experience of brain injury when collaborating on teams.

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