Dr Gary Small director of the UCLA Longevity center and professor of psychiatry at UCLA's Geffen School of Medicine. Author "The Alzheimer's Prevention Program: Keep your brain healthy for the rest of your life."
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CAVANAUGH: This is KPBS. I'm Maureen Cavanaugh. We talked on the show last week about how the percentage of older people in California's population is expected to increase through the middle of this century. An older population means many good things for society, but one downside is the potential for a dramatic increase in Alzheimer's disease. Some doctors say we should expect an epidemic of Alzheimer's. Researchers are also learning new facts about dementia, and developing strategies. Doctor Gary Small is author of the best-seller, the memory Bible. He now offers ideas on how to delay symptoms of Alzheimer's in his new book, the Alzheimer's prevention program. Welcome to the program.
SMALL: Thank you.
CAVANAUGH: First of all, let me ask you about the focus on on delaying symptoms of Alzheimer's. Is it taken for granted that most older people will develop some form of dementia?
SMALL: We know that the risk for dementia and Alzheimer's increases with age. Age is the greatest risk factor by 65 or older, about 10% of people develop it. But by 85 or older, it's as high as 50%. And there's a belief that there's nothing I can do. That it's all genetics. And what we emphasize in the prevention program is that genetics are important but for the average person, they may be less important than non-genetic factors.
CAVANAUGH: When we say develop Alzheimer's, what do we mean? How long does the disease take to actually develop into a problem?
SMALL: We actually can see the disease in the brains of individuals years, sometimes decades before they have symptoms. So we know these tiny little protein deposits build up over many year, but it isn't until they reach a crucial level that people start having problems. And what makes it complicated is that we know as we age we have memory slips. It's very common to forget people's names or where we put things. And it's hard to differentiate even for the physician sometimes between normal aging, mild cognitive impairment, and Alzheimer's. It's usually when these impairments begin to interfere with everyday life that we are able to make a diagnosis.
CAVANAUGH: One of the reasons that you wrote the prevention -- this is the type of brain illness that they are going to develop as they get older and envision all sorts of bad things occurring from that. What does your book say that counters that idea?
SMALL: I think we try to help people with that fever by giving them the correct information. We update them on the latest research; we put it into perspective so people can understand it. And we also take it one step further. We provide practical strategies. We have a one-week jump start program. So people see how easy it is to start eating right, to start exercising, learning memory techniques, start noticing improvement, and they see the science that tells us that if we engage in this kind of lifestyle, there's a good chance that those symptoms that will impair our everyday life may be stayed off for several years.
CAVANAUGH: Do you have clinical support for many of the things you're suggesting people do in this book?
SMALL: Many of the strategies we offer we have tested in short-term studies. Others have tested is it in longer-term studies, in epidemiological studies, and clinical trials. With physical exercise, you probably have the strongest evidence there that cardiovascular conditioning is brain protectant. Mental exercise, the evidence is not as strong that it's going to delay the onset of Alzheimer's, but as far as memory techniques, it's very strong. You can see almost immediate results and you can have sustained improvement in your memory for many years.
CAVANAUGH: I'm speaking with Gary Small. Doctor, some of the strategies in your Alzheimer's prevention program might strike people as remarkably simple. For instance, tell us how can getting enough sleep help prevent or delay Alzheimer's?
SMALL: Well, we know that sleep is important to keep our minds fresh, to replenish our energy, and it's always kind of an anti-inflammatory strategy. A lot of what goes wrong in our brains as we age, our inflammatory system gets into high gear. We know that inflammation is important, it helps repair our body when we sprain or wrist or get infected. But as we age, those inflammatory cells are working too hard, and sometimes they attack normal cells. In fact, if you look inside an Alzheimer's brain, you can see evidence of inflammation. So getting a good night's sleep or eating omega 3 fats from fish or nuts or just physical exercise, these are all anti-inflammatory strategies that help protect the brain and help us feel better right away.
CAVANAUGH: Your prevention program is really made up of about four major elements. I think you mentioned some of them already. But just lay them out for us, if you would.
SMALL: We've talked about physical exercise. And you don't have to become a triathlete. You can just walk briskly 20 minutes a day. I've mentioned diet in addition to omega 3 fats. We want to eat antioxidant fruits and vegetables that protect our brain cells. Minimize the refined sugars, and the processed foods. Also try to manage our weight. Obesity and overweight is associated with a higher risk for Alzheimer's. We want to try to manage stress better, chronic stress is bad for our brain cells. It actually shrinks the memory centers of the brains. Different strategies to manage stress, and of course mental exercise, doing brain games stimulates our neural circuits but also the targeted brain games that help us with memory performance are critical.
CAVANAUGH: Yes, I want to talk more about that. We've been told for years that doing puzzles, learning new things will keep our brains healthy as we age. But it seems that you take a slightly different tack in this book. It all depends on what kinds of mental stimulation that we give our brains.
SMALL: Yeah. I encourage people to stimulate their minds, to enjoy it. You want to train but don't strain your brain. Have fun with it, because of the possibility that it keeps our brains healthy, and there's enough evidence there. I make the point and teach people in the book how to improve their memory performance. Part of the problem is this normal aging. And eventually it becomes no joke, and we need to learn how to compensate for that. And the book teaches people how to do that.
CAVANAUGH: So does strengthening your memory itself help the brain delay Alzheimer's?
SMALL: We don't know that. But it certainly delays -- whether it delays the physiological changes I don't know. But it certainly delays the symptoms. So you can overcome these age-related slips and perform better.
CAVANAUGH: How do you go about strengthening your memory skills?
SMALL: It's all really based on three simple strategies. We Call it look, snap, connect. Look is to focus attention. Snap is a reminder to create mental snapshots. Our brains are hardwired to remember visually. And connect is link knowing up those snapshots so it's meaningful and memorable.
CAVANAUGH: You've got brain exercises in this book to do just that.
SMALL: Yeah, and in the 7-day jump start program, we build up those skills over the week so people start learning look, snap, connect. They apply it to everyday memory change, and we focus on the most common problems. Names and faces, where you put things, remembering to remember so you don't run out of the house without your cellphone. And tip of the young where you can't think of that word, it just won't roll off the tip of your tongue.
CAVANAUGH: As part of this jump start program, there are also recipes in this book, right?
SMALL: Yeah, we want to make it fun and interesting. We want to show people that it's not so difficult to change. I can tell you the connection between brain health and your lifestyle. That's great. That'll motivate you. I can start you on a program, and that will help more because what is going to make a difference is not doing this for a week but changing the lifestyle so it becomes a habit. And our -- people who try it really find that it works.
CAVANAUGH: As the population ages, some doctors are saying Alzheimer's is poised to be the world's greatest epidemic. In light of that, do you agree with that, first of all?
SMALL: Well, it's possible. You look at the demographic, age is the greatest risk factor, and we’ve got a problem. People are living longer thanks to technology. The question is will they live better? There were a couple of scientists at UC San Francisco who recently looked at this question, and they looked at modifiable risk factors. And they estimated that in the U.S. there are 5.5 million people with Alzheimer's, worldwide about 34 million. And they projected if we could just have a 25% reduction in these different modifiable risk factors like not exercising, being overweight, smoking and so forth, 25% would mean three million fewer cases in the U.S., 17 million fewer cases worldwide. So I think if we can change how we live, we might be able to tackle this epidemic.
CAVANAUGH: So in light of that, do you think that doing this kind of brain health work, that kind of a program will become as important to medicine as the kind of tip you get from the doctor to maintain cardiovascular health?
SMALL: I'm hoping it will. People will say you can't really prevent Alzheimer's, and I would say if you equate prevention can cure, that's true. And yes, we need a 20-year framing study to absolutely prove that this makes sense. But in the meantime, we know that two of the key Alzheimer's prevention strategies, exercise and diet, will prevent diabetes. If you get diabetes, that doubles the probability you're going to get Alzheimer's. So frankly, I'm not willing to wait 20 years for somebody to tell me, hey, you should have been doing this.
CAVANAUGH: We talk a lot on this program and generally in this society about waiting for a cure for Alzheimer's disease, the same way we talk about waiting for a cure for cancer. Does it seem to be developing that what we really need to concentrate is preventing these or at least delaying these diseases in the first place?
SMALL: Well, I think that's what we can do right now. And if we can stave off symptoms long enough so people die from natural or other causes, that's about as close to a cure as we can get right now. And I think people need to realize that they have more control than they think. In addition to possibly staving off the symptom, they're going to feel better right away if they start living a healthier lifestyle.
CAVANAUGH: Doctor Gary Small will be in San Diego tomorrow to give a lecture at UC San Diego. The event will take place in the San Diego biomedical science medical at 5:30 PM on Wednesday. The lecture is free and open to the public. Thank so much for speaking with us.
SMALL: Thank you for your interest. I appreciate it.