The prevention of neurological diseases could prevent more than 100,000 people from dying or living with a disability in Spain. These are data from the Spanish Society of Neurology, which recalls that, currently, more than 23 million people suffer from some type of neurological disease in our country. They estimate that in less than 15 years the number of stroke cases will increase by 35% and that in 25 years the cases of Alzheimer’s and Parkinson’s will triple.
In recent days, a bus has traveled through part of the country to raise awareness of prevention and give the population the option of taking tests to determine their cerebrovascular health, as well as their mental agility. What do these tests consist of? What are the keys to maintaining good brain health? Can we prevent our brain from shrinking as we age? We spoke with Javier Camiña, neurologist and communication member of the Spanish Society of Neurology.
Brain Week Bus of the Spanish Society of Neurology (SEN).
Simply repeating the same activity such as hobbies, when it is also often solitary, has little long-term benefit
My mother always makes word searches, crossword puzzles and sudoku puzzles because she says they are good for training the mind. Will she be more protected against possible mental illnesses?
The simple repetition of the same activity – as happens with these hobbies – when it is also usually solitary, has little benefit in the long term. They are intellectual activities that train some functions, but in prevention more complex tasks are preferable. So no word searches, no crossword puzzles, no sudokus. There are much more appropriate activities in long-term prevention.
We keep the hobbies. What do we do?
Learn something we don’t know. A language, an instrument, something creative. Any brain activity keeps neural circuits active. When we learn a new discipline, and we do not have any previous experience, the brain is forced to create new connections that favor circuits between various brain areas.
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People who consume more hours of television show a long-term reduction in gray matter
Let’s learn to play the piano, then?
It’s a good option. If I learn to play the piano, I need to reinforce the perception of the hands with respect to the key, I have to generate and improve the mobility of the hands. And coordinate the reading of the score with this mobility, which is why I favor visual-spatial coordination. I enhance the auditory cortex and sound management. And all this activates different areas of the brain.
And at night, what do we do? Many older people sleep only 4 or 5 hours because they do not have more sleep. I imagine that watching television is not a good plan…
Indeed. There are studies, including that from Johns Hopkins University, that show that those people who consume more hours of television have greater cognitive impairment than with other activities and have a long-term reduction in gray matter. It is an activity in which there is little decision, there is no participation. And the prefrontal cortex, in charge of these areas, shrinks or reduces its size. Other activities, such as browsing the Internet, for example, involve greater decision-making about what we search for and what we read.
It is especially after the age of 70 when the most (brain) mass is lost, because it atrophies.
But I have read that everyone’s brain shrinks. When does it start to happen?
Yes. At 25 years old there are still areas that are developing, but after 40 there are already small changes that affect us. Although it is especially after the age of 70 when it loses the most mass, because it atrophies, especially in relation to the loss of white matter as a result of the loss of connections between neurons. It is relevant to evaluate cerebrovascular damage, which generates cognitive impairment and accelerates or worsens other neurodegenerative diseases, such as Alzheimer’s disease.
I mean, the goal is to prevent it from shrinking too much, right? How do we achieve it?
The goal is to preserve brain activity in the best possible way. To do this, we must exercise regularly (at least 150 minutes per week), with a balanced diet, without alcohol or tobacco. And with quality sleep, this is essential.
The general sleep pass would imply a good number of hours (around 8 hours), with regular schedules, with a feeling of rest
But we have already said that many older people have enough sleep with 4 or 5 hours of sleep. Is this not true either?
Insomnia is a health epidemic. Although different stages of life have different needs, we should sleep at least 8 hours and have quality sleep. There are different maintenance processes that require deep sleep. And this has an impact on attentional performance and affects mood. It is linked to anxiety or depression. Even in young adults, not sleeping optimally affects short-term memory. Parents of young children who often sleep for long periods of time may be an example of this underperformance.
I have a smart watch that tells me how many hours I sleep, how many in REM phase, how many in deep sleep and how many in light sleep… How do I get the sleep pass?
Use a smartwatch To monitor sleep, it provides us with an approximate measure of the structure of sleep, with increasingly more information. The most relevant thing about its use is that the person who uses it shows interest in taking care of this aspect which, as we said previously, is very important. The general approval would imply a good amount of hours of sleep (around 8 hours), with regular schedules (without changing the times we go to bed and get up too much), with a feeling of restful rest when we get up and not having too many interruptions during the night.
If it affects the quality of sleep, couples, older and not just older, should sleep separately
Should older couples sleep separately?
If it affects the quality of our sleep, yes. And not just the elderly, but all couples. The message should be ‘let’s be selfish in seeking our best quality of sleep.’ We must look for appropriate comfort when going to bed, with the optimal temperature or level of darkness to guarantee rest, and with enough space on the mattress to feel comfortable. If we rest well as a couple, go ahead, because sleeping with someone also has positive emotional effects, improving our emotional well-being. But if one of the members of the couple snores, or has restless legs syndrome, it often affects the rest of the other person.
He was talking to me about exercising. Does it also directly improve the brain?
Physical exercise is beneficial from the vascular point of view and because it favors the connections between neurons, the synapses. Regular exercise in adults protects or even delays degenerative changes. It has been studied that 150 minutes a week of moderate physical activity has long-term benefits in neuroprotection, and should be done at all ages.
After the age of 50, a first episode of depression should be evaluated with caution, as it may be the precursor to a neurodegenerative disease.
Returning to the activities, I suggested learning a language.
Yes. And in this case there is an added value and that is that they are often studied in groups and social interaction has a positive impact on our brain. Unwanted loneliness is a risk factor for mental illness, depression and stroke. During the time of strict confinement, many people who lived alone had more rapid declines in their dementia. Depression predisposes to many neurological diseases, especially after a certain age. After the age of 50, a first episode of depression should be evaluated with special caution because it is likely to precede a neurodegenerative disease such as Alzheimer’s or Parkinson’s.
If we do everything he has told us, and also maintain a good diet… Do we have brains for years?
Longevity is complicated in the brain. Even if we live to be 120 or 130 years old, cognitive functioning would probably not be optimal. With age, there are neurodegenerative processes that are present. From the age of 90, 30 or 40% of patients have an accumulation of proteins that can lead to Alzheimer’s, even if you do not have symptoms yet. Our goal should be to take care of it in the best possible way, but not only seeking longevity, but also primarily quality of life.
Overweight or a sedentary lifestyle are very present in childhood and adolescence, two age groups where the prevalence of mental health disorders has worsened.
Currently, the prevalence of neurological diseases in Spain is 18% higher than the world average and also 1.7% higher than the average for Western European countries, mainly due to the aging of our population. But more and more we say that 50 is the new 40, and 40 is the new 30… Will this improve in a few years?
Forecasts for the coming decades suggest that our population pyramid will continue to age. Spain has one of the highest life expectancy in Europe and the world, but in terms of life expectancy in good health, Spain’s data are no longer so positive. This is influenced by the presence of diseases that minimize our abilities and well-being. And regarding those changes over the decades, our social perception of what we had preconceived that people would do at certain ages is changing. On the one hand, we have more adults or elderly people doing some sports activities with a regularity or demand that we did not usually see a few years ago. But we must also take into account that overweight or a sedentary lifestyle are very present in childhood and adolescence, and they are two age groups where in recent years the prevalence of mental health disorders has worsened significantly.
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These days, a bus from the Spanish Society of Neurology has offered the possibility in some parts of the country for the population to undergo brain health tests. What types of tests are performed?
The Brain Week that we have just celebrated is an activity to promote brain health that, fundamentally, aims to raise awareness in society that it must pay attention to everything in its power to promote brain health (healthy lifestyle, with balanced diet, physical exercise, adequate sleep, social and intellectual activities). Thus, the risk can be reduced or the onset of neurological diseases delayed.
The tests that are usually done on the bus are neurosonological studies to assess the possible presence of atherosclerosis in the carotid arteries and blood pressure measurements (such as stroke prevention), and various basic neuropsychological screening tests to evaluate the ability to pay attention and assistants’ working memory.
We agree that we will save the crosswords now, then?
Although they are not the best long-term activity, it is clear that it is preferable for you to do these hobbies than, for example, spend several hours watching television, which is a generally passive activity.