Healthy Heart, Healthy Mind?

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Prevent memory and thinking problems tomorrow by taking heart-healthy steps today, U-M expert says

ANN ARBOR, MI - You know that watching your weight, quitting smoking, cutting back on fatty foods and exercising regularly will help your heart. But did you know that these steps might also help your brain, and protect your memory?

In fact, doctors are beginning to realize just how connected the heart and brain really are. And that connection may help explain many of the severe memory and thinking problems that millions of people experience as they grow older.

Alzheimer's disease is still the top reason for such problems, which are often grouped together and called dementia. But factors related to the heart and blood vessels play a bigger role than doctors have often thought, says University of Michigan dementia expert Kenneth Langa, M.D., Ph.D.

It all comes down to blood flow. Your brain needs a lot of blood to function correctly, and to keep you on track with thinking, remembering, speaking and recognizing people. But if something happens to that blood flow, those abilities can suffer.

A stroke, high blood pressure, or clogged arteries can all rob your brain, or part of your brain, of its much-needed blood supply. This causes what experts call vascular dementia, which is dementia caused by a blood flow problem in or near the brain.

"Upward of 50 percent of people who have dementia, including many people with Alzheimer's disease, have some level of these problems going on," says Langa, a general internist at U-M and the VA Ann Arbor Healthcare System who has studied patterns of dementia in the elderly. "There's increasing evidence that Alzheimer's disease often exists along with vascular dementia, especially in people over age 75." Vascular dementia all by itself may account for 20 percent of all dementia cases.

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There is also growing evidence that taking steps to address the health problems that lead to vascular dementia may prevent Alzheimer's disease as well, says Langa. No matter how old you are, it's never too late to start.

"The main causes of vascular dementia are the risk factors that affect the blood vessels going to the brain. So strokes, which are the death of some brain cells due to blocked blood flow, are a major cause of vascular dementia, especially when they occur in the thinking parts of the brain," he explains. "And even if you don't have a stroke, just the presence of factors like high blood pressure and high cholesterol seem to cause slow damage to brain cells that can end up causing dementia."

Vascular dementia sometimes causes slightly different symptoms than Alzheimer's, which is caused by an abnormal protein that builds up inside the brain and triggers a cell-killing mechanism.

People with vascular dementia, for example, might have trouble planning ahead or processing complex information, leading to difficulty in cooking or balancing a checkbook, for example. They also might be more likely to have problems with balance and movement. Meanwhile, a person with Alzheimer's might have more problems with memory, such as recognizing the faces of loved ones or the function of objects such as keys, Langa explains.

But the boundaries between vascular dementia and Alzheimer's are blurry, and the two can occur at the same time in the same person.

There's also a lot of overlap between the factors that can cause vascular dementia and those that can cause heart attacks, strokes and other cardiovascular disease, Langa says. In addition to high blood pressure and high cholesterol, other factors include diabetes, lack of exercise and obesity.

There's even recent evidence that such factors are common among people with Alzheimer's disease, which adds to the argument that many of those people may actually have a combination of Alzheimer's and vascular dementia. This condition, called mixed dementia, was the subject of a research review in the Journal of the American Medical Association by Langa and his colleagues in the U-M Division of General Medicine and the VA Ann Arbor Healthcare System.

So what can you do to protect your brain, and your heart, at the same time? Here are some tips:

Know your blood pressure, and work with your doctor to reduce it if it's high. High blood pressure stresses the walls of your blood vessels, making them weak and more susceptible to leaking, bulging or even bursting. If this happens in one of the blood vessels in your brain, that can cause a stroke. There's even some evidence that the protein that builds up in the brains of people with Alzheimer's can invade the walls of brain blood vessels and make them weaker. And at least one study shows that people who control their blood pressure have less chance of developing dementia

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