Melanie Cole, MS (Host): Welcome to Back to Health, your source for the latest in health, wellness and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole. And joining us today is Dr. Matthew Fink. He's currently the Louis and Gertrude Feil Professor and Chairman of the Department of Neurology at Weill Cornell Medical College, and he's Neurologist-in-Chief at New York Presbyterian Hospital, Weill Cornell Medical Center. And we are here today to talk about keeping your brain healthy as you age.

Dr. Fink, it's always such a pleasure to have you join us. So, is memory loss a normal part of aging? Is this something that's inevitable? You and I were talking off the air a little bit about my dad and how long he kept his brain health. Is this just inevitable or not really?

Matthew Fink, MD: Well, first, Melanie, let me just say hello. It's good to be with you again. And I don't want to frighten any of our listeners, but problems with short-term memory are a common part of the aging process. And we know from studies that have been done in thousands of otherwise healthy people, beginning at age 35, our short-term memory begins to decline a little bit. It does not reach the point where it affects our ability to live our lives normally, but we will all develop problems as we get older with things like having trouble remembering people's names, you lose your keys, you forget where you parked the car, things like that. But that's not a disease and that's not something that people should really worry about.

Melanie Cole, MS: Well then, tell us a little bit about our brains and how they age. I mean, we think of brains as different than a muscle, but they really are a muscle, right? And we have to keep them active. Tell us a little bit about what happens?

Matthew Fink, MD: Sure. The brain is a complicated structure that is floating in a liquid bath inside the skull. It's protected from the environment in many ways. As you might imagine, it's surrounded by a hard, thick skull, that skull is there to protect the brain. And what happens with age is that the brain is a chemical, an electric organ. It operates by transmission of chemicals between brain cells and electrical discharges across brain cells, and that's what makes it all work. But it's also within a human body and, if the human body itself is not healthy and has other health problems, that is going to affect how the brain functions.

So, to preserve your brain and to keep it healthy until you're, you know, a hundred years old, the important thing is to keep the rest of your body healthy. And so, the first recommendation is good health habits. And what do we mean by good health habits? Good diet, regular exercise, stimulate your brain with lots of mental activity and lots of social interaction. Human beings are social beings. We're not supposed to be, you know, isolated. Social interaction is very, very important.

And then, there are other illnesses, which can really have a major effect, and I'll point out one, high blood pressure, what we call hypertension. There are repeated studies, multiple studies going back 50 years that show people who have high blood pressure that is treated will have a less chance of developing brain problems than people who have high blood pressure, which is not treated. And those brain problems are not just what we call dementia, but those include strokes, as we discussed earlier, with your father. I mean, high blood pressure is the number one risk factor for stroke. So, very important for all of us to keep track of our blood pressure and make sure it's treated. That one issue can make the difference between living a long and healthy life or developing dementia as you get older.

Melanie Cole, MS: You're just such an awesome guest, Dr. Fink. You explain everything in such an understandable way and things that we can take forward and use right away. Now, people hear brain health. Right away, everybody thinks of dementia and Alzheimer's. I'd like you to speak just a little bit about those two disorders and how they come into play and that they're not necessarily a done deal for us, right? As you talked about brain health and ways to keep ourselves strong of mind and body, speak about those two things. Really, what are they? Tell us a little bit about them.

Matthew Fink, MD: Glad to do that because a lot of people find it confusing.

Melanie Cole, MS: They do.

Matthew Fink, MD: So, dementia is a general term that describes people who have failing brain function to the degree where they are no longer able to manage their daily activities and they need help to do those things. That's what dementia means. It does not talk about what the cause is. But if you take a hundred people over the age of 65 who have dementia, meaning they need help with their daily activities. About half of them will have it from Alzheimer's disease, and I'm going to talk about that in a second, half will have Alzheimer's disease. About a quarter of them will have dementia due to a series of little strokes, which were not recognized as strokes, but which have caused progressive loss of brain function. And then, the other 25% have a whole variety of rare conditions that we could talk about at another time, but many, many rare conditions which can affect the brain as well. But the two biggest ones are Alzheimer's disease, which is the most common, and then what we refer to as vascular dementia, which is the second most common.

So, let's talk about Alzheimer's disease. Alzheimer's disease was described a hundred years ago by a psychiatrist. And it was defined in a patient who developed dementia in her fifties. And at autopsy, her brain was examined and it showed certain changes, which became the hallmark of the disease. Those changes are plaques in the brain that contain a substance called amyloid and also a substance called tau. Now, what amyloid and tau refer to are misfolded proteins that deposit in the brain. They should not be there. In a healthy person, those deposits should not be there. They're deposited in the brain and they kill the brain cells. It's a process which develops over decades. We believe it takes 20 30 years, maybe longer, for these deposits to develop. And for that first 20 or 30 years, the person feels perfectly fine. But then, it reaches a level where enough of the brain cells are damaged that it interferes with brain function, and then we have what's called dementia.

Now, having a short-term memory loss and not being able to find your keys or forgetting where you parked your car, that is not dementia. That is not dementia. When we worry, it's when something happens where you don't know how to use your keys. Not only did you lose them, but once you have them, you don't know what to do with them. Or you forgot where you parked your car, but you actually forgot how to drive your car. That's when you have trouble, because it's interfering with your ability to manage your daily activities.

Melanie Cole, MS: Wow. This is just so interesting and so many things for us to think about. As we're thinking about ways that we can possibly prevent or delay, I'd like you to speak about red flags. You just mentioned the car and when it's really a little bit more scary, we all lose our keys and such. As you said, when we forget how to drive the car or why we're in the car, those are the kinds of things. What do we do next? If we see something like that, if we notice, or, you know, sometimes it's not us that notices, Dr. Fink, it's someone that loves us that notices those things, then what? What can we do? Are there things that we can do to help ward it off? And then, we're going to get into a summary of really the best brain health.

Matthew Fink, MD: Absolutely. And you're so right about that. People that have short-term memory impairments usually are not aware of it. They're not aware of the impairments. That's the nature of a memory impairment. So, it's always other people around them, family members, close friends, they're the ones that notice it and often urge the patients to seek some help.

So, what's the first thing to do? If a person or a family member thinks someone has a severe impairment. You want to start with your general physician, a primary care physician, for the following reason: there are a number of other medical problems that on a short-term can affect memory and can present as something that looks like dementia. And I'll give you a few examples.

One of the most common things are side effects from medications that people are taking. And this goes to what we can do to prevent it. The most common medication that can cause what appears to be dementia are sleeping pills. There is no such thing as a good sleeping pill. Whether you get them by prescription or you buy them over-the-counter, they all hurt your memory in one way or another. And depending on how often you take them and how strong they are, they can make you appear to have developed a dementia as a result of sleeping pills.

And then, there are other medical problems. An underactive thyroid, hypothyroidism, can cause the brain to malfunction and it looks like dementia. People that have liver disease, and the liver disease can be related to too much alcohol or there are other forms of liver disease that have nothing to do with alcohol, liver disease can cause a chemical to get into the blood that affects the brain. It can make someone appear to be demented, to have a dementia.

So, you want your primary care physician to check all those things out first. Second, there's a simple paper and pencil test that we can all do, all of the doctors use it. The one that I prefer is something called the Montreal Cognitive Assessment. We call it a MoCA, M-O-C-A. You can all look it up online. It's a test that takes 20 minutes to perform, pencil and paper. A doctor can do it in the office. It will give us a quantification of any cognitive problems that you might have. And it's not just memory, it also tells us about things like executive function, which means are you able to organize the events of your day. It looks at visual perception problems as well as memory. It looks at arithmetic issues. So, a 20-minute paper and pencil test can tell us a great deal about how well your brain is doing. And every doctor can do this. And so, we say start with your primary care doctor. You don't have to run off to a neurologist, but that's the first thing to do.

Melanie Cole, MS: Okay. So, how many of us are going to actually run off? I'm telling you right now that I am definitely going to do this test and it's called the MoCA test, everyone. So, write that down so that we can all see. That's so interesting, Dr. Fink. Now, you've talked about exercise. You've talked about maintaining a strong body as well. But we think of things like diet. I'd like you to touch on the other things that we can do. My parents always said, balance your checkbook, but kids don't balance their checkbook. People don't balance a checkbook. I mean, I still do. But diet, crossword puzzles, you know, there's all kinds of things now. Do these things have an effect? I'd like you to give us your best advice.

Matthew Fink, MD: Yes. Diet is extremely important. And it turns out that the American diet, for the most part, is about the worst thing you could do for your brain. And the reason is that we eat so much in the way of processed carbohydrates. When you walk in the store, bags and bags of stuff on the shelves, that's all processed carbohydrates. You need to avoid those things. You need to eat real food.

And you should try to eat as much in the way of plants as possible, green plants or plants of every different color. If you go into a store and you look at all the vegetables and fruits, they're all different colors. Those different colors are what are called antioxidants in the plants, and they're all different antioxidants, and they are all extremely healthy. And antioxidants taken on a regular basis in your diet can prevent your brain from getting worse. They really work. So, diet is extremely important. Eating mostly carbohydrates, all those bags of chips and crackers and pretzels and cookies, those are literally poison for you and you just want to avoid those. So, a diet should be mostly plants, if you can. People talk about olive oil, which is a great way to get oil into your system. Small amounts of meat, chicken, fish, whatever. People always ask me, "Well, how much should I eat?" A four-ounce portion of protein, four-ounce portion. That could be a four ounce portion of steak or chicken or fish is all you need. You don't need to eat more than that. And the rest of your food should be plants and fruits and vegetables. That's what you should focus on. It's not really complicated. You don't have to read a bunch of books about this. It's pretty simple. Some people like to follow what's called the Mediterranean diet, which is great, and the reason it's great is the food tastes so good. It's not anything bad, it's a wonderful diet. It's a Mediterranean diet. But it's really fruits and vegetables, plants, a little bit of meat, olive oil, lots of wonderful seasonings that make everything taste great. And that's really main thing with diet.

Let's talk about exercise. The reason exercise is so important is that there's a direct connection between exercising your muscles and keeping a healthy brain. When you exercise, your muscles release a chemical into your blood that goes to your brain and helps your brain to function better. It's not a hocus pocus concept. It's a real physical thing. So, regular daily exercise, very important. It doesn't matter what kind of exercise you do. You could be walking, swimming, using a rowing machine, an elliptical machine. Whatever it is that is good for you and you have access to, you should try to do.

Now, when we talk about supplements, if there is a deficiency of some sort that you have in your diet, the most common in the United States, actually, is vitamin D. We are pretty much all deficient in vitamin D, because we don't spend much time outdoors in the sun. So, if there's a deficiency, you definitely want to make up for that and take vitamin D supplements. But additional supplements, things like fish oil or resveratrol, which is a derivative of blueberries, there's no evidence that taking those supplements are going to make you any better unless you have a deficiency in your diet. So, I tell my patients, "Don't take fish oil capsules, eat fish." There's good evidence that eating fish two or three times a week will really reduce your risk of developing dementia, but there's no evidence that taking a fish oil capsule will do that. So, you might ask, "Well, why is that?" Well, food is much more complex than taking a supplement in a capsule. And the complexity of the food is what really makes a difference for you.

Now, I'll make one exception to my statement. A study was just published, which I think is a wonderful study, that's showing that people who take a multivitamin, which is something that contains, you know, a little bit of all of the vitamins and minerals, a multivitamin every day, those people have a lower risk of developing dementia as they get older. So, I tell most people, you know, if you want to do something, take a multivitamin, but don't take large amounts of supplements. Many of the supplements can also have side effects and make you sick in other ways. They're very expensive as well. You can spend an awful lot of money buying and taking supplements that don't really help you in any way.

Melanie Cole, MS: This is a masterclass in brain health, Dr. Fink, and you are just an amazing educator. Final thoughts for the listeners of what you want us to know. You have given us so much to think about, things that we can actually do right now to help our brain health. So, finish it off for us. Give us your best advice as we wrap up this absolutely amazing episode.

Matthew Fink, MD: I'm going to run through a list of things, a checklist for all of you to think about. Make sure you are keeping track and treating high blood pressure. Avoid getting injuries to your head. Get regular exercise. Eat a healthy diet. Try to maintain your ideal weight. And that doesn't mean being skinny. We all have a range of weight. You don't want to get too fat. You don't want to get too thin. You want to maintain your ideal weight. Watch your blood sugar. Blood sugar elevations can be a real problem. And visit your regular doctor on a regular basis. And if you have any concerns, discuss it with your doctor because we can very quickly and easily find problems that can be corrected and do everything possible to make sure you have a long and healthy wonderful enjoyable life.

Melanie Cole, MS: Rock on Dr. Fink. What a great episode this was. So much information packed into one amazing podcast. And that's what these are all about. Thank you so much, sir, for joining us. You are just an awesome guest.

And Weill Cornell Medicine continues to see our patients in person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Back to Health. We'd like to invite our audience to download and subscribe, rate, and review Back to Health on Apple Podcasts, Spotify, Google Podcasts. And for more health tips, please visit weillcornell.org and search podcasts. And parents, definitely don't forget to check out our Kids Health Cast, so many great podcasts there. I'm Melanie Cole. Thanks so much for joining us today.

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