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?

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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.

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 — almost a 50 percent lower risk over just two years. So, check your BP regularly, and if it’s high, find out how diet, exercise and medications can help reduce it.

Know your cholesterol level, and work on reducing it if it’s high. You should especially focus on the level of “bad” LDL cholesterol, and talk with your doctor about what changes you should make to what you eat, and whether you need medications. If you have too much cholesterol in your blood, it can build up inside your blood vessels, clogging the flow of blood and causing blood clots to build up. If a blood vessel in your neck or brain gets choked off by this kind of cholesterol-related narrowing, or if one of those clots breaks loose and travels into a smaller blood vessel, that can cause a major problem. If it happens in your brain, it’s a stroke. If it happens in your heart, it’s a heart attack and it can kill part of your heart muscle, which in turn can reduce the flow of blood to your body and brain.

Get regular exercise, even just a daily walk. There’s more and more evidence that regular physical activity, whether it’s walking, jogging, swimming, biking or some other active pastime, can help the heart and mind. Langa says he often tells his own patients about recent research showing that older people who walk regularly were less likely to get dementia, or to have their early forms of dementia get worse. Exercise gets the blood flowing and the heart pumping, which keep your muscles and blood vessels happy.

Stop smoking, and encourage your loved ones to quit too. Tobacco smoke, whether from your own cigarettes and cigars or from those smoked by people near you, can increase your blood pressure and decrease your “good” cholesterol levels, harm your blood vessels and increase the risk of blood clots that can cause strokes.

Eat healthy foods, and watch your weight. The foods you choose can affect your cholesterol and blood pressure, and the amount of food you eat has a lot to do with how much weight you gain. People who are overweight or obese, have a higher rate of heart problems, partly because carrying around all that extra weight can really stress the heart and blood vessels. Ask your doctor to advise you about safe and effective ways to lose weight slowly, rather than crash, fad or “yo-yo” diets. And remember the basic way to lose weight: Eat less, move more!

Pay attention to any special heart and stroke risks you may have: If you have diabetes, you’re automatically at higher risk for heart and blood vessel problems, including vascular dementia: Reduce this risk by keeping your blood sugar in control and sticking to diet and exercise plans. If you have a heart rhythm problem, such as atrial fibrillation, you’re at a higher risk for a stroke, and the dementia that can follow; talk to your doctor about medications that can help. If you’ve had a heart attack, a mini-stroke, severe chest pain or a diagnosis of coronary or carotid artery disease in the past, you’re at especially high risk for further problems that could affect your brain’s blood flow. Talk to your doctor about what you can do to reduce that risk.

There’s mounting evidence that all of this can really have an impact, says Langa. And even if there isn’t a specific study showing a direct connection for each of those factors, he says, it makes sense.

“The fact that vascular disease and vascular risk factors may be leading to both Alzheimer’s disease and vascular dementia opens up the possibility that if we do a better job of treating these risk factors, then we might be preventing dementia from ever starting, or perhaps preventing it from progressing among people who have it,” he says.

And that’s something that everyone can agree on with both their heart — and their mind!

Facts about vascular dementia:

• Vascular dementia is the term for memory and thinking problems that are caused by problems with blood flow to the brain. It’s the second leading cause of dementia; Alzheimer’s disease is the leading cause.
• Vascular dementia can be caused by anything that reduces blood flow to all or part of the brain: strokes, clogged blood vessels, or problems with blood pressure and blood vessels.
• As many as half of the 6 million Americans who have dementia may have vascular dementia, either alone or in combination with Alzheimer’s disease. This latter condition is often called mixed dementia.
• Dementia is particularly common in older people, and may occur in one in every 10 people over the age of 65, and one in every three people over the age of 80. But the factors that cause vascular dementia, and contribute to mixed dementia, start building earlier in life.
• If it’s bad for your heart, it’s probably bad for your brain: High cholesterol, high blood pressure, obesity, poor diet, lack of exercise, smoking, and uncontrolled diabetes can all harm your blood vessels and increase your risk of heart disease or stroke. And that sets you up for reduced blood flow to the brain, which causes vascular dementia.
• Study after study is beginning to show that controlling some of these risk factors for heart and vascular disease can also prevent or slow the progression of vascular dementia.

For more information, visit these web sites:

U-M Health Topics A to Z:
Alzheimer’s disease:
http://www.med.umich.edu/1libr/aha/aha_alzhdis_crs.htm

Stroke:
http://www.med.umich.edu/1libr/aha/aha_strnos_crs.htm

Controlling cholesterol:
http://www.med.umich.edu/1libr/guides/choles.htm

The Dementias: National Institutes of Health:
http://www.ninds.nih.gov/disorders/alzheimersdisease/detail_alzheimersdisease.htm

Written by Kara Gavin

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