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I have always been fascinated by the brain. When I started my job at the University I currently work for, I immediately took advantage of the employee benefit that covers tuition fees and took a few cognitive science classes like “Intro to brain and behavior”, “Chemistry of the brain” and “Drugs, brain and mind”. I became even more fascinated by everything that happens in our brains and by its potential, but I also learned about how many things can go wrong.

Unfortunately, I now have first hand exposure to one of my family members' cognitive decline and can say it's incredibly sad to see its progression.

There are a few key points I'd like to leave here with you, this is a very important one:

Cognitive decline does not happen overnight, but rather over many years, way before symptoms start to present.

I'd like to repeat this:

Cognitive decline does not happen overnight, but rather over many years, way before symptoms start to present.

This is why it's so important to start working on prevention today, while our brains are functioning well and we can understand what can be done to prevent damage.

Trust me, from my personal experience, once the cognitive decline gets to a certain point, it becomes extremely difficult to help the person experiencing it, because their level of comprehending things becomes seriously affected. Even if they are at a stage where the cognitive decline can be reversed or delayed, it's extremely difficult to make them understand what they can try to do to treat the decline at its roots.

There is no cure for Alzheimer's disease.

The medication that currently exists simply alleviate symptoms or at the most delays further decline. The medication does not reverse the existing damage.

Here are a few things you can expect when dealing with someone experiencing cognitive decline:

• Be prepared to say the same thing again and again. And again. Sometimes even during the same conversation. It can happen even a few minutes after you told them something, they will talk about that same thing again as if it's something completely new to them.
• Be prepared to have more patience than you ever thought you could have. They will need every ounce of compassion you can give.
• Be prepared to take over their tasks, initially complex tasks, until a point they will need help with basic simple tasks like personal hygiene. Not because they are weak or have a physical disability, but because they will get confused even when performing a basic task that they've done all their lives.
• Expect mood swings that are triggered unexpectedly by actions or words that are part of your routine and all of a sudden become irritating, offensive or threatening to them.
• Despite all the frustration you may feel, remember that it's not helpful to tell them they already told you something they are telling you for the 100th time, just listen like it was the first time. Be compassionate and understanding.

It's beyond sad.

Cognitive decline does have a genetic factor but genes are just one of the factors involved in developing Alzheimer's disease.

Apolipoprotein E (APOE) is the most common gene associated with late onset Alzheimer's disease.

There are 3 forms of the APOE gene:

APOE2 — the least common — appears to reduce the risk of Alzheimer's.

APOE4 — a little more common — increases the risk of Alzheimer's.

APOE3 — the most common — doesn't seem to affect the risk of Alzheimer's

We have two copies of the APOE gene, one inherited from our father and one from our mother. People that have two copies of the APOE4 gene have a greater risk of developing the disease.

The good news is that research has shown lifestyle plays a huge role in cognitive decline. Even people with two copies of the APOE4 gene may be more protected from developing Alzheimer's disease than those who have two copies of the APOE2 gene, depending on their lifestyle choices.

Some types of early stage cognitive decline can even be reversed.

But the reversal can happen only up to a certain stage, once the damage becomes extensive, it cannot be reversed anymore.

So let me go back to that phrase I repeated a couple times in the beginning of this article:

Cognitive decline does not happen overnight, but rather over many years, way before symptoms start to present.

What can we do? More than we think.

According to Dr. Dean Sherzai and Dr. Ayesha Sherzai, the NEURO plan can have a profound impact in preventing cognitive decline:

N – Nutrition: Adopting a balanced, plant-based diet leads to maximum mental proficiency.

E – Exercise: Daily exercise, simple movements and stretching increases life expectancy and boosts mood.

U – Unwind: Unwinding and developing ways to alleviate stress optimizes overall health.

R – Restore: Restorative sleep cleanses the brain of unhealthy chemicals and is vital to brain health.

O – Optimize: Optimize cognitive capacity by focusing on activities that are driven by your purpose.

I cannot recommend the Team Sherzai's book enough: The Alzheimer's Solution is one of those books that should be a required reading for everyone. On the book they talk about their journey as neurologists and explain how powerful our lifestyle choices can be when it comes to cognitive decline prevention. Obviously, for people already experiencing some decline, the lifestyle changes need to be more comprehensive but I encourage you to consider the changes you can incorporate into your lifestyle today as prevention, every little change counts!

They also have a very informative podcast: Brain Health and Beyond

Cognitive reserve:

By following the Team Sherzai's work, I learned about the concept of cognitive reserve, which is a fascinating concept where cognitive health is achieved by engaging in brain stimulating activities like learning to play a musical instrument or learning another language for example.

In simple words, when we build cognitive reserve, we build alternate routes to access the information stored in our brain. Cognitive reserve is something very important to have as we age and the brain starts to deteriorate, meaning if the main pathway to a certain information gets damaged, we may still be able to access that information via an alternate pathway. Think about when you're trying to travel by car and the road is damaged, if there is no alternate route you won't be able to get to your destination.

Challenge your brain, try learning new activities or try different ways to doing activities you already master so your brain is challenged in a healthy way.

My experience as a volunteer in a brain research study:

Last year I became a volunteer for a brain research study at the Women's Brain Initiative led by Dr. Lisa Mosconi:

“Of every 3 Alzheimer's patients, 2 are women. Even after accounting for women's greater longevity than men, women still outnumber men 2:1 in the Alzheimer's population. Our research is devoted to unraveling the causes of the increased risk in women. As a starting point, our brain imaging studies have demonstrated a link between estrogen declines and increased Alzheimer's risk in women. Our current NIH-sponsored brain imaging research builds upon those findings to further address the connections between female sex hormones, brain aging, and Alzheimer's risk.”

“As with any research study, only eligible participants can enroll. At the moment, we are enrolling women and men of age 40-65 years, with a family history of Alzheimer's, and no cognitive impairment or dementia.”

In August/2019, I spent a few hours at the Weill Cornell Medicine Neurology department in New York City, where I had blood work done and also a brain MRI.

From the blood work, I learned I have 2 copies of the APOE3 gene, which is the most common type of the APOE gene as I mentioned earlier in this article, I have the type that doesn't seem to affect the risk of Alzheimer's. Knowing which types of APOE gene you have is a personal decision, I thought very carefully whether I wanted to know or not. Some people prefer to know they have 1 or 2 of the APOE4 copies to serve as motivation to focus more heavily on their lifestyle choices, but others prefer to just focus on making lifestyle choices that will protect their brains no matter what, regardless of being more susceptible to developing cognitive decline.

My brain MRI came out normal, I have no signs of brain shrinkage or any other types of degeneration, which was also very encouraging. The brain MRI takes over an hour to be done, you have to remain as still as possible during the whole time, which is not very easy but I managed to relax and had no problem laying there still for the whole time.

They are also doing PET Scans of volunteer's brains but I didn't feel comfortable volunteering for those exams since they have quite an amount of radiation.

Dr. Mosconi's study has funding for some more years, not sure how many, but I have already agreed to go back so they can follow me as my brain ages.

My contribution is small but I feel very honored to be able to contribute in such a humble way, every tiny bit we can do to help fight this horrible disease is valuable.

I hope you find this article helpful and would like to finish with this reminder:

Cognitive decline does not happen overnight, but rather over many years, way before symptoms start to present.

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