UAB experts help write healthy brain guidelines

An American Heart Association panel, including two experts from UAB, says the same healthy habits that can help ward off heart disease or stroke can also help prevent cognitive decline.

virginia howard 2017 2Virginia J. Howard, Ph.D., professor in the Department of Epidemiology, UAB School of Public Health.A healthy lifestyle benefits the brain as much as the rest of the body and may lessen the risk of cognitive decline (a loss of the ability to think well) as people age, according to a new advisory from the American Heart Association/American Stroke Association. The advisory was written by a panel of 19 medical experts convened by the AHA, including two from the University of Alabama at Birmingham

Both the heart and brain need adequate blood flow; but in many people, blood vessels slowly become narrowed or blocked over the course of their lives, a disease process known as atherosclerosis, the cause of many heart attacks and strokes. Many risk factors for atherosclerosis can be modified by following a healthy diet, getting enough physical activity, avoiding tobacco products and other strategies.

“Research summarized in the advisory convincingly demonstrates that the same risk factors that cause atherosclerosis are also major contributors to late-life cognitive impairment and Alzheimer’s disease,” said vascular neurologist Philip Gorelick, M.D., the chair of the advisory’s writing group and executive medical director of Mercy Health Hauenstein Neurosciences in Grand Rapids, Michigan. “By following seven simple steps — Life’s Simple 7 — not only can we prevent heart attack and stroke, we may also be able to prevent cognitive impairment.”

Life’s Simple 7 outlines a set of health factors developed by the American Heart Association to define and promote cardiovascular wellness. Studies show these seven factors may also help foster ideal brain health in adults.

The Life’s Simple 7 program urges individuals to:

  • Manage blood pressure
  • Control cholesterol
  • Keep blood sugar normal
  • Get physically active
  • Eat a healthy diet
  • Lose extra weight
  • Don’t start smoking, or quit

“We can gauge brain health by observing how well we function within our normal environment,” said Ronald M. Lazar, Ph.D., Evelyn F. McKnight Endowed Chair for Learning and Memory in Aging in the Department of Neurology and one of the UAB faculty on the writing group. “A healthy brain allows us to think, communicate, remember, problem solve, have mobility and regulate emotions. Cognitive impairment can affect any or all of those functions.”

lazar sizedRonald M. Lazar, Ph.D., Evelyn F. McKnight Endowed Chair for Learning and Memory in Aging in the Department of Neurology, School of Medicine.Lazar and Virginia J. Howard, Ph.D., a stroke epidemiologist and the other UAB co-author, say the advisory provides a foundation on which to build a broader definition of brain health that includes other influential factors such as the presence of atrial fibrillation, a type of irregular heartbeat that has been linked to cognitive problems; education and literacy; social and economic status; the geographic region where a person lives; and other brain diseases and head injuries.

Howard, professor in the Department of Epidemiology in the UAB School of Public Health, is the co-principal investigator of UAB’s long-running REGARDS study, a national effort to learn more about the factors that increase an individual’s risk for stroke and cognitive decline.

“Findings from REGARDS were important components in the deliberations that led to the advisory’s recommendations,” she said. “Equally important, our investigations while preparing the advisory showed areas where the body of knowledge is incomplete or where hypotheses have not been conclusively proved or disproved. This advisory should stimulate new avenues of collaborative research that can fill in the gaps of our understanding.”

The advisory, which is published in the American Heart Association’s journal Stroke, stresses the importance of taking steps to keep your brain healthy as early as possible, because atherosclerosis — the narrowing of the arteries that causes many heart attacks, heart failure and strokes — can begin in childhood.

“We cannot wait until we are seniors, in retirement or approaching retirement age, to begin focusing on brain health,” said Lazar, who is the director of the Evelyn F. McKnight Brain Institute in the UAB School of Medicine. “Some of the effects of cognitive decline are irreversible. Prevention is the key.”

The action items from Life’s Simple 7, which are based on findings from multiple scientific studies, meet three practical rules the panel developed in pinpointing ways to improve brain health — that they could be measured, modified and monitored.

“Life’s Simple 7 are easy concepts for the public to understand and follow, and easy for health care providers to monitor,” Howard said. “Blood pressure, for example, can be easily measured, and there are proven ways to positively affect blood pressure. And then, improvement can be measured over time.”

The advisory also recognizes that it is important to follow previously published guidance from the American Heart Association, Institute of Medicine and Alzheimer’s Association, which include controlling cardiovascular risks and suggest social engagement and other related strategies for maintaining brain health.

Dementia is costly to treat. Direct care expenses are higher than for cancer and about the same for heart disease, estimates from the AHA show. Plus, the value of unpaid caregiving for dementia patients may exceed $200 billion a year. As lives stretch longer in the United States and elsewhere, about 75 million people worldwide could have dementia by 2030, according to the advisory.

“Policymakers will need to allocate health care resources for this,” Gorelick said. “Monitoring rates of dementia in places where public health efforts are improving heart health could provide important information about the success of such an approach and the future need for health care resources for the elderly.”

The authors of the advisory reviewed 182 published scientific studies to formulate their conclusions that following Life’s Simple 7 has the potential to help people maintain a healthy brain throughout life.