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‘Cognitive decline may start years before symptoms emerge’

In ‘Keep Sharp: Build A Better Brain At Any Age’, well-known neurologist Dr Sanjay Gupta provides valuable insight into the brain, and how and why it might start to go into a tailspin

A 30-year-old can be on the road to Alzheimer’s disease but not know it, writes Dr Gupta (Photo: iStock)

When my friend Sarah described to me her mother’s experience with cognitive decline over several decades that accelerated after she retired at the age of 62, I thought of my grandfather. I was immediately reminded of how agonizing it can be to watch someone wither away mentally—and emotionally. For many people, the downward slope is slow and steady, like a long-drawn-out illness, while for others it’s fierce and fast, like a traumatic accident…. When Sarah’s mother began to get lost while driving or routinely leave the car in parking lots because she couldn’t find it after shopping (or thought she had walked), the keys were taken away.

Her mood also changed. Her mother was always a bit depressive, which made Sarah wonder how much a lifelong bout with untreated depression contributed to her mother’s mental demise. Or was it the daily chardonnay habit that did it? The lack of sufficient exercise? The nutritional deficiencies from an eating disorder that began in her youth and never really went away—even with treatment? How much did not engaging in social activities, hobbies, and challenging work contribute to the acceleration of the disease? These are the questions millions of families ask themselves, and there are often few satisfactory answers.

Sarah’s story brings light to the fact that we often don’t and can’t know what triggers cognitive decline in the first place or what propels it over time. Multiple forces are likely in play, as there is no single culprit. Many theories exist, but we have no definitive answer yet. It is becoming abundantly clear, though, that the decline starts years, if not decades, before any symptoms emerge.

This is a crucial concept: A 30-year-old can be on the road to Alzheimer’s disease but not know it. People often don’t think or worry about dementia until after they turn 50, which is why it’s so important that younger generations heed the message and start thinking of habits that can help prevent decline.

While we have made so much progress in medicine, more than a century after the first description of Alzheimer’s disease by a German psychiatrist and neuropathologist whose surname is forever attached to the condition, researchers still cannot identify the precise cause or causes. It is a reminder that we humans are exceedingly complex organisms. It also means that what causes grave cognitive decline in person A will not cause it in person B, or C, or D, and so on. Sarah’s mother and my grandfather both received the diagnosis of Alzheimer’s disease, but probably for very different reasons. It’s like cancer: What causes breast or colon cancer in one individual will not always be the same for anyone else. There are myriad pathways to any particular type of cancer, and the same is true with dementia. Despite that, as we take a deeper look at the data, we realize there are still some excellent insights and strategies to reduce our risk for dementia.

Focus on your brain, and everything else will follow

When I interviewed top experts in brain health from a wide variety of professionals and pioneers in the field, one individual’s statement stood out from the rest. It came from Dr. Dan Johnston, a former lieutenant colonel in the U.S. Army who has served as a physician and researcher in the army from the Pentagon to Iraq and recently cofounded BrainSpan, a company and laboratory that develops products and programs to help people measure, track, and improve brain function. As a health care provider, his company delivers its products mostly through physicians.

To say Johnston’s goal is to optimize brain health and performance is an understatement. He aims to shift the way we think about health by “starting at the top,” as he puts it. When it comes to health, many of us immediately turn to things like weight, cholesterol levels, risk for cancer, blood sugar levels, and heart health, and we forget about the brain. Those other things are seemingly easier to grasp because the brain is encased in bone and has a mystical quality.

Keep Sharp: Build a Better Brain at Any Age by Dr Sanjay Gupta. (Headline/Hachette India,  <span class='webrupee'>₹</span>599)
Keep Sharp: Build a Better Brain at Any Age by Dr Sanjay Gupta. (Headline/Hachette India, 599)

he medical establishment has typically interfaced with the brain only when it is diseased or damaged. But here’s the key point: when you put your brain first, everything else health-wise falls into place. The brain is ground zero. Don’t forget that it is what makes you. Your heart ticks, yes, but it’s your brain that ultimately makes you tick and determines your quality of life. Without a healthy brain, you cannot even make healthy decisions. And with a healthy brain comes not only a healthy body, weight, heart, and so on, but also a stronger sense of confidence, a more solid financial future thanks to smart decisions, better relationships, more love in your life, and heightened overall happiness.

...Put the brain first. If you’re worried about something else—maybe those extra 20 pounds, the general aches and pains, the insomnia and chronic headaches—challenge yourself to make brain health a priority and watch what happens.

Excerpted with permission from Dr Sanjay Gupta's book Keep Sharp: Build a Better Brain At Any Age, published by Headline/ Hachette India, 599. Dr Sanjay Gupta is associate chief of the neurosurgery service at Grady Memorial Hospital in Atlanta, USA.

  • FIRST PUBLISHED
    04.02.2021 | 11:00 AM IST

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