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Exercise prevents Alzheimer’s pathology

Exercise can prevent Alzheimer’s pathology in the brain

Age is considered the #1 risk factor for the development of Alzheimer’s Dementia (AD). The pathological changes in the brain of a patient with AD include abnormal beta–amyloid deposition in plaques and neurofibrillary tangles  resulting in neuronal loss and shrinkage of the brain. These changes, however, can be seen as early as 30 years before clinical symptoms occur but increase as we age.

As of yet there are not any drug or medical treatments that have been shown to prevent or reverse these changes in the brain of patients with AD. However, a recent study just published in the November 2014 issue of Neurology showed that exercise lessens these preclinical pathological biomarkers of AD.

Prior to this recent study, we had multiple studies that showed the following: (1) exercise can help to preserve memory as we age; (2) exercise has been shown to improve cognition in patients who already have Alzheimer’s and (3) exercise can improve brain volumes, most specifically, in the memory processing areas of the brain, the hippocampus. This is the first study that specifically looks at the pathological changes of AD resulting from exercise.

This study looked at late middle-aged adults (ages 40-65 at entry) who were cognitively normal but at high risk for AD. They investigated whether engagement in physical activity lessons age association alterations in beta-amyloid accumulation, cerebral glucose metabolism, hippocampal volume and cognitive function. Being physically active was based on the American Heart Association recommendation of 30 minute of moderate exercise 5 days a week.

The study found was that the physically active individuals had less beta-amyloid burden, improved glucose metabolism, hippocampal volume, immediate memory, and visuospatial ability compared to physically inactive persons.  This study provides more confirmatory support to the many other studies that show the beneficial effect of physical activity on the aging brain.

Since physical exercise has been shown to improve cognition, improve brain volumes and now decrease the age related disease markers of AD what are you waiting for? There is so much we do not have control over in our lives, but this is not one of them. You have the power to get and keep your brain fit and, potentially, prevent AD.  If you do not know where to start I would be happy to help find a program just for you.


Dr Deb

Works Cited:

Okonwo, O. e. (2014). Physical activity attenuates age-related biomarker alterations in preclinical AD. Neurology , 83, 1753-1760.


A Healthy lifestyle can reduce YOUR risk of stroke

How you can decrease your risk of stroke

As a neurologist, I see on a daily basis how devastating and debilitating a stroke can be. Unfortunately, the effects are typically irreversible. Therefore, prevention is of great importance. Controllable risk factors for stroke include hypertension, diabetes, high cholesterol, and smoking.   Thus, living a healthy lifestyle, which potentially would improve those risk factors, could decrease your risk for stroke.

Researchers in a recent study analyzed the combined effect of five factors that typically are associated with living a healthy lifestyle to see if living a healthy lifestyle would indeed decrease the risk of stroke. The 5 factors studied and recommended for a healthy lifestyle include: having a healthy diet, i.e., eating within the top 50% of a recommended foods, modest alcohol consumption (not greater than 3-9 drinks per week), not smoking, 40 minutes of being physically active per day and BMI of <25 kg/m2

The study found that women who had all 5 factors of healthy lifestyle compared with women with none had a 62% lower risk of ischemic stroke. All 5 components of the low risk lifestyle were inversely associated with the risk of ischemic stroke. The risk of stroke steadily decreased with each additional healthy lifestyle factor.

Once again research documents the importance of exercise as a part of a healthy lifestyle AND prevention of a devastating stroke. If you wish to add exercise to decrease your risk of a stroke but don’t know where to start, I would love to help you.


Dr Deb

Works Cited

Larsson, S. C. (2014). Healthy diet and lifestyle and risk of stroke in a prospective cohort of women. Neurology , 83, 1699-1704.


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Alzheimer’s Dementia

 What is Alzheimer’s Dementia and how can I prevent it?

As a neurologist I often get asked:  How can I prevent myself from getting Alzheimer’s?   My normal answer is to increase your physical and mental activity and keep yourself healthy and you will keep your brain healthy.  I will explain the reasoning below along with some basic information regarding Alzheimer’s dementia (AD)

What is Alzheimer’s Dementia?

Alzheimer’s dementia is the most common cause of dementia. Dementia by definition is a progressive decline in cognitive functioning.  It is a decline in thinking, remembering and reasoning to an extent that it interferes with a person’s daily life and activities.  Per estimates from the Alzheimer’s Association, 5.3 million Americans have AD. This number is estimated to triple in the next 40 years as the population continues to age and live longer.

How do you diagnosis AD?

Currently doctors can only diagnosis AD clinically, based on symptoms and excluding other causes of dementia that can be treated (vitamin deficiencies, hydrocephalus, tumors, depression etc). Unfortunately, the only way to confirm the diagnosis AD is by autopsy of your brain. The pathological changes that are seen in the brains of patients of AD include amyloid plaques (abnormal clumps of amyloid proteins) and neurofibrillary tangles (abnormal bundles of fibers).  It is unclear how or why these plaques and tangles form.  Once they are there, neurons in the brain lose their ability to function and communicate with each other.  Over time the neurons eventually die causing brain atrophy (shrinking of the brain). This process is thought to start up to 30 years before clinical symptoms develop.

What causes AD?

Scientists are not sure what causes AD.  It is most likely due to a combination of genetic, environmental and lifestyle factors. We do know some of the risk factors that can increase your risk of develop AD.  The more risk factors you have the more likely you are to develop AD.

What are the Risk Factors for Dementia?

  • The biggest risk factor for developing AD is age.  Currently the risk of AD doubles every 5 years after age of 65.
  • Genetics:  Genetics plays a big part in what is called “familial AD” which is a young onset AD (typically onset in the 40-50s). This type is autosomal dominant and has strong connection to genetics. This type of AD, however, only accounts for 5% of all AD.  The most common type of AD, “late onset AD” may be linked to an abnormal gene: the apolipoprotein E.  The linkage is not however 100%.  Thus not everyone who has this abnormal gene gets AD, and you may still get AD even if you don’t have the abnormal ApO E gene.
  • Diabetes (DM):   Studies have shown that people with DM are twice as likely to develop AD.  The good news is that people who are at risk for diabetes who changed their lifestyles could reduce their risk of DM by 58% over a 3 year period, thus possibly decreasing their risk for developing AD.   There may be several different reasons why people with diabetes are at an increased risk of dementia.
      • First of all they have an increased risk of having a stroke which itself increases the risk of dementia.
      • DM itself also causes micro-vascular disease which decreases blood flow into the brain thus increasing risk for dementia.
      • AD could be from a problem with the way the brain uses insulin. Nerve cells require a lot of energy; they get this energy from glucose and oxygen.  With diabetes cells lose their ability to respond to insulin, and brain is not able to use glucose properly.  (Think of it as DM of the brain).
      • Insulin also is known to regulate the metabolism of beta-amyloid and tau (the building blocks of the AD pathology) in the brain.
  • Depression:  A meta-analysis of 13 studies showed that people with a history of depression had almost a two times increased risk of dementia compared to controls without depression.
  • Cardiovascular disease:
    • Hypertension: Studies have shown people who have uncontrolled high blood pressure in midlife, are more likely to develop AD.  Hypertension also increases the risk for stroke.
    • High cholesterol: Cholesterol is felt to drive the production of beta amyloid.
    • Increased risk of stroke, patients with DM, hypertension, and high cholesterol are all associated with an increase of having strokes.  Having a stroke is felt to double your risk for dementia.
    • Belly fat:  Obesity has been associated with an increase risk of dementia.  The association between dementia and body weight appears to be most associated with a larger “waist to height” ratios than “body-mass index”.  The association is also greater for obesity during midlife instead of late life obesity.  A 2008 study in the journal “Neurology” found that people in their 40’s who have the highest amount of abdominal fat were more likely to have dementia when they reached their 70s. They found that those with the highest amount of belly fat were nearly 3 times more likely to develop dementia than those with the lowest amount of belly fat.
  • Head injury:  The best data to date show that people who have had moderate to severe traumatic brain injury have a 2-4 fold increase risk of dementia.  There is unclear association with mild head injuries or concussions.  More and more evidence is emerging regarding the risk of dementia after multiple head injuries as seen in boxers and professional football players (what is described in the literature as “chronic traumatic encephalopathy”)
  • Physical inactivity: A meta-analysis of 16 prospective studies and a systemic review of 24 longitudinal studies show that the lowest physical activity groups are associated with higher risks of developing AD.  The good news is that the risks of AD can be decreased with higher levels of physical activity as shown in a study reported in 2012.  Exercise has been shown to improve memory and to increase the size of the hippocampus (the area in the brain that works with memory), by 2% thus reversing age related volume loss by 1-2 years.
  • Cognitive inactivity and low education levels: Multiple studies have showed that the risk for dementia is lower in people who have higher education levels, intelligence, occupational attainment, and mentally stimulating leisure activities.  These studies are supported by randomized control studies, which reported cognitive interventions in healthy older adults are associated with improvement in cognitive function.

What can I do to prevent AD?

Dr. Deborah Barnes from University of California, San Francisco looked at seven potentially modifiable risk factors for AD: diabetes, midlife hypertension, midlife obesity, smoking, depression, cognitive inactivity, and physical inactivity.  She estimates that up to a half of all the AD cases worldwide might be attributable to these risk factors.  She states that if risk factors prevalence were decreased by 25% then prevalence of AD could potentially be lowered by over 3 million cases worldwide.

Out all of the risk factors, the one that has the largest impact on AD prevention in the US is physical inactivity.  It is estimated that if 25% of sedentary people start exercising, potentially 230,000 cases of AD in the US could be avoided.  Low education potentially contributed to the largest proportion of AD cases worldwide; thus with a 25% reduction in low education and cognitive inactivity could potentially lower AD prevalence by 1.375 million worldwide and 91,000 cases in US.

Are there any medical treatments to prevent AD?

Currently there are NO medications that have been shown to decrease your risk for AD.  There are 4 medications that have been approved by the FDA to treat AD: Aricept, Exelon, Razadyne, and Namenda.  These medications provide modest benefit in slowing the rate of cognitive decline, but they do not change the underlying disease process.

“So how can I prevent AD from occurring?”

The corner stone of dementia prevention, until disease-modifying agents are available, is risk factor modification.  Thus you should try to decrease the bad things that may increase your risk for dementia: midlife obesity, midlife high blood pressure, diabetes, strokes, and tobacco use. Then you need to work on improving the things that have been shown to decrease your risk for dementia: increasing mental activity, regular exercise, remaining socially active, and have a healthy diet.

This site is purely informative and should not be considered medical advice. It is not intended to be used to diagnosis or treat any disease.  Please consult your physician before starting any fitness program or new supplement.



Amen, D. Use Your Brain to Change your Age.

Barnes, D. E. (2011). The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurology , 819-828.

Buchman, A. B. (2012). Total daily physical activity and the risk of AD and cognitive decline in older adults. Neurology , 13231329.

Desai, A. K. (2010). Healthy Brain Aging: A Road Map. Clinical Geriatric Medicine , 1-16.

Erickson, K. I. (2011). Exercise training increases size of hippocampus and improves memory. Proceeding of the National Academy of Sciences , 3017-3022.

Paturel, A. (2009, July/August). Your Heart, Your Belly and Alzheimer’s: People with so-called metabolic syndrome may be at a higher risk of developing Alzheimer’s dementia. Neurology Now , pp. 18-25.

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Exercise to prevent your migraines


Exercise can prevent your migraines!


Did you know that exercise can prevent migraines?  Well, it is true, and there is a recent study that proves it.  As a headache specialist, I always try to encourage my migraine patients to start a regular exercise program as a conservative way to decrease their migraine headaches, but up until now, we did not much scientific evidence to show that it actually helped.

Individuals with migraines and other headaches have been shown to be less physically active than those without headaches.  One of the reasons is that individual with migraines, that their headaches often worsen during physical activity. This is actually one of the major criteria on which migraines are diagnosed.  However, it is unclear if the lack of exercise in individuals with migraines is the cause or effect of having migraines.

The reason why exercise may decrease the frequency of migraine headaches is unclear.  Some of the things that we do know are that exercise can increase the natural endorphins (feel-good chemicals) in our brain.  Exercise can also decrease migraine triggers such as anxiety and stress.  Additionally, your sleep pattern is improved with regular exercise, which may then result in less frequent migraines.  Other risk factors for migraine headaches such as obstructive sleep apnea, hypertension, and obesity are also improved with regular exercise.

In a randomized, controlled trial of adults with migraines where patients were randomized into three groups; an exercise group, a relaxation training group, or a group that received the preventive medication topiramate (Topamax).  The exercise group exercised three times a week for 40 minutes.  The study looked at how frequent migraines occurred compared to their baseline migraine frequency. The study lasted three months.  What was found was that there were no significant differences between the groups, all decreased the frequency of migraines compared with the baseline. No adverse effects were reported in the exercise or relaxation groups.  Adverse effects were reported in 33% of the participants in the topiramate group. Restated, participants in this randomized controlled study who exercised regularly (3 times a week) experienced an improvement in the frequency of their migraine attack that was not significantly different from the participants who received drug preventive medication topiramate.1

Now I am not saying that routine exercise will prevent all migraines.  However, neither does medications.  So wouldn’t you rather try something that is good for you anyway either in addition to or instead of medications?

For more information on the causes and ways to prevent migraines see my Migraine Headache post.

As always please discuss with your physician before starting any strenuous physical activity. Also, please do not suddenly stop any of your medications without discussing with your physician first.  

Sites Referenced:

1Emma Varkey, A. C. (2011). Exercise as migraine prophylaxis: A randomized study using relaxation and topiramate as controls. Cephalagia, 1428-1438.