A I N H A Brain Health Guide H LA


HEALTHBRINPILLALTHS IXA Brain Health GuideAARS OF BRAINVisit us at: HealthyBrains.orgHE

YOU ARE YOUR BRAINYour brain determines every aspect of your life – yourthoughts, emotions, movement and memory. Your brainworks tirelessly for you 24 hours a day, 7 days a week.Keeping your brain healthy and sharp is essential to yourwell-being.Today we live longer and we live healthier. Our heart, ourjoints and the rest of our bodies can outlive our brain. Inother words, our life span may be longer than our brainspan. Brain disorders such as Alzheimer’s, Parkinson’s andstroke all become more common as we age. Maintainingbrain health can help to preserve memory and lower risk forbrain disease.Your lifestyle has a profound impact on your brain health.Unlike aging and genetics, you have control of yourlifestyle choices: what you eat and drink, how much exercise and sleep you get, the way you socialize and dealwith stress, the hobbies you develop and the medications you take to control your blood pressure or diabetes. All thesedecisions are critically important to helping you create a brain span that matches your life span. Learning, study, socialconnectedness, rest and relaxation contribute to cerebral reserve and help us thwart the effects of brain aging.We are proud to present Cleveland Clinic Lou Ruvo Center for Brain Health’s Brain Health Guide. This guide provides aroad map for your journey to brain health. Where supportive evidence is available, recommendations are based on themost current clinical, epidemiological and nutritional data. All recommendations are likely to evolve as scientific evidenceaccumulates over time.Read this guide and visit our website at healthybrains.org for a free brain health self-assessment. Learn about the sixpillars of brain health. Understand how to protect, maintain and boost your brain health.Read on, stay healthy, stay sharp!Jeffrey Cummings,JeffreC mmings MD,MD ScDDirectorCleveland Clinic Lou Ruvo Center for Brain HealthAbout Cleveland Clinic Lou Ruvo Center for Brain HealthCleveland Clinic Lou Ruvo Center for Brain Health provides state-of-the-art care for cognitive disorders and for the familymembers of those who suffer from them. The physicians and staff at the Lou Ruvo Center for Brain Health are devoted toexcellent patient care, support of caregivers and development of new treatments in clinical trials. The center offers a patientfocused multidisciplinary team approach to diagnosis and treatment, providing patients a complete continuum of care andintegrated research opportunities. The facility, designed by architect Frank Gehry, includes clinical resources, advancedbrain imaging, physical therapy, occupational therapy, clinical trials and the Keep Memory Alive Event Center. For moreinformation, please visit clevelandclinic.org/brainhealth.2

Physical ExerciseThe Six Pillarsof Brain HealthSocial InteractionMental FitnessSleep & RelaxationFood & NutritionMedical HealthTable of Contents4Brain Facts: The Three-Pound Universe6Physical Exercise: Get Moving8Mental Fitness: Stay Sharp10 Food & Nutrition: Eat Smart12 Social Interaction: Stay Connected14 Sleep & Relaxation: Rest Well16 Medical Health: Control Other Risks18 Healthybrains.org: Discover your BHI Score3

BRAIN FACTS“The chief function of the body is to carry thebrain around.” — Thomas EdisonBrain: The Three Pound Universe Weight: 3 lbs 300 mile/hour speed 100 billion neurons 70,000 thoughts per day 500 trillion synapsesIt’s a workhorseIt’s busyThe brain works 24 hours a day,7 days a week. Even whenyou sleep, it doesn’t.Whenever you dream, think, see or move,tiny chemical and electrical signals racealong billions of “highways” betweenneurons. In fact, neurons create andsend more messages than all of thephones in the world.It’s powerfulThe brain generates enough electricity topower a light bulb. It is the most powerfulsupercomputer ever created.It gets better with useWhen you learn something new, the structureof your brain changes. It continues to grow andchange throughout life. The more you use it,the better it gets.It’s amazingThe brain creates thoughts, drives emotions,stores memories, and controls your movementand behavior.4It’s resilientDue to its “neuroplasticity,” the brain isable to adapt and respond to changesand compensate for injuries and diseases.Neuroplasticity allows your brain to bejump-started, fine-tuned and remodeledthroughout your adult life.

“Age is an issue of mind over matter. If you don’t mind,it does not matter.” — Mark TwainYour Brain: It’s AgingYour brain ages just like the rest of your body: it shrinks insize, slows down in speed, and becomes less able to adaptto change. As the years go on, your brain becomes moresusceptible to oxidative stress and more vulnerable to braindiseases such as Alzheimer’s and Parkinson’s.The aging brain may account for the “senior moment”:forgetting names or misplacing keys. However, getting olderdoesn’t have to mean you’re destined for a life of lost car keys.The brain cannot be transplanted.The memories you want areyour own.Advanced age and family history do increase your risk, butso do other factors such as diabetes, hypertension, obesity,high cholesterol, smoking, head trauma, stress, and lackof physical and mental activities. Your lifestyle plays asignificant role in your brain health. You can manage therisk and take control to stay sharp and keep memory alivewell into your golden years.Aging by the Numbers (USA)46 millionAmericans 65 and older in 201698 millionAmericans 65 and older in 2060600,000Americans will be 100 or older by 206024 percentAmericans will be older than 65 by 2060Healthyalthy BrainImage provided by Alzheimer’s Association alz.orgAdvancedAlzheimer’sAlzheimeAmericans with Alzheimer’s disease5.4 Million Americans with Alzheimer’s5.2 Million people are age 65 and older200,000 are under age 65 (younger-onset AD)5

PHYSICAL EXERCISEYour Body: Get Moving Walking Playing sports Gardening YogaKeep Track and MonitorWhat’s good for your heartis good for your brainPeople who exercise regularly mayhave a lower risk of developingAlzheimer’s. Exercise improves bloodflow and memory; it stimulateschemical changes in the brain thatenhance learning, mood and thinking.Building muscles, staying flexibleand practicing balance can improveposture and reduce the risk of falls.Exercise also helps to reduce stressand improve sleep quality, both ofwhich are important to your brainhealth.6 Use a fitness tracker Monitor your heart rate Track your progress Aim for 10,000 steps

“The only way you can hurt your body isif you don’t use it.” — Jack LaLannePump Up Your HeartYour target heart rate range for aerobic exerciseof moderate intensity should be:Age705030Heart rate range (beats per minute)75-12885-14595-162Just Get StartedExample Weekly Workout ScheduleEven if you have never exercised, any physical activity is betterthan none at all.Experts recommend you exercise using a combination aerobic,strength, flexibility and balance training as detailed below. As youcan see from the example workout schedule, you should alternateactivity so you do not work the same muscle groups two days ina row. Consult your doctor before beginning an exercise program,start slowly and gradually build frequency and duration.For additional tips, exercises and more, visit the NationalInstitute on Aging’s Go4Life website: https://go4life.nia.nih.gov/AerobicStrength 5 days a week 30 minutes a day of moderateintensity Moderate intensity means youcan talk but not sing whileexercising. Aim for your target heart rate(see box above) Walk, hike, bike, swim, dance,or just move 2 days a week 1 set per muscle group,with 8-12 repetitions per set Exercise all major musclegroups with a 2-day minimumrest in between. Squats, lunges, planks, bicepcurls, tricep press-down,shoulder press, etc.FlexibilityBalance 3-5 days a week 10 minutes each session Hold each stretch 30 to 90seconds Stretch muscles through afull range of motion Tai Chi, yoga, and stretching 2-3 days a week Sit to stand Stand with feet touching sideby side Stand heel to toe Walk backwards and sideways Walk on heels and toes Stand on one leg Yoga or Tai Chi anceSaturdayHikeBalanceStretchSundayRest7

MENTAL FITNESSYour Mind:Use It or Lose ItMental exercise is just as critical asphysical exercise in keeping your brainfit and healthy. Mental exercises mayimprove your brain’s functioning andpromote new brain cell growth, whichcould decrease your likelihood ofdeveloping dementia. As with muscles, youhave to use your brain or you lose it.8Build your brain reserveYou have something called “brain reserve,” which helps yourbrain adapt and respond to changes and resist damage.Your brain reserve begins to develop in childhood andgets stronger as you move through adulthood. People whocontinue to learn, embrace new activities, and develop newskills and interests are building and improving their brainreserve.

“Every man can, if he so desires, become the sculptor of hisown brain.” — Santiago Ramón y CajalPlayDo crossword puzzles, play chess, card games oronline games. They stimulate the brain to producenew neurons and form new connections.Playing electronic “brain games” can help improveyour reaction time and problem-solving ability.It may also boost your attention span and helpmaintain your brain health.LearnTake up a new hobby or skill. Study a new language,learn a musical instrument or take woodworkingclasses. If you are right-handed, try using your lefthand more often. Novel activities help your brain formnew cellular connections and strengthen connectionsthat already exist.StudyGet educated. It can substantially increase your abilityto fight off mental decline. The same is true of workingat a challenging job. So go back to school, take classes, get a degree. You’re never too old to learn and yourbrain will thank you in the long run.9

FOOD & NUTRITIONEat Smart, Think BetterYou are what you eat. As you grow older, your brain is exposed to more harmful stress due to lifestyle andenvironmental factors, resulting in a process called oxidation, which damages brain cells. Rust on the handlebarsof a bike or a partially eaten apple gives you an idea of the kind of damage oxidation can cause to your brain.Food rich in antioxidants can help fend off the harmful effects of oxidation in your brain.The Mediterranean WayResearch shows that a Mediterranean-style diet rich in fish, whole grains, green leafy vegetables, olives and nuts helpsmaintain brain health and may reduce the risk of Alzheimer’s disease. Cook and eat fresh food, savor the taste, enjoydining with family and friends. A Mediterranean regimen is more than just a diet. It’s a lifestyle, a way of living well.Load your plate with fruitsand vegetables.Spinach, kale, broccoli and other leafy greenvegetables are rich in many brain-lovingnutrients. Blueberries, raspberries andblackberries are packed with antioxidants;they can potentially slow aging in the brainand elsewhere. Eat some every day.10Eat eggs in moderation.The protein and vitamins B, D and E in eggsand egg yolks may help to improve memory.You can reap the benefits of these vitaminswhile keeping your cholesterol to a minimum bymixing whole eggs with egg whites to roundout your omelet or scrambled eggs.Don’t forget fish.Eat plenty of whole grains.Fish is a great source of omega-3, the typeof fatty acid your body can’t produce, andit’s good for your brain. At least twice a week,eat five ounces of omega-3-rich fish, such assalmon, cod, haddock, tuna or halibut. Fishisn’t your thing? Try walnuts, flaxseeds orsoybeans instead.Whole grains — such as oats, barley andquinoa — are rich in many of the B vitaminsthat work to reduce inflammation of the brain.

“Let food be thy medicine.” — HippocratesThe potential benefits of supplementsA combination of vitamins C (500 mg) andE (400 international units) have shown to bea potential benefit to brain health. Fish oilsupplements rich in DHA (up to 1,000 mg perday) are a good alternative for non-fish lovers.While thesefoods, drinks andsupplements have beenidentified as havingpotential benefits forbrain health, thesebenefits have not yetbeen scientificallyproven.Enjoy dark chocolate.Grab a cup of coffee or tea.Dark chocolate contains flavonoids, whichare strong antioxidants. They potentiallyimprove blood flow to the brain and reduceinflammation. Unsweetened cocoa powderoffers the greatest benefit, followed by darkchocolate with at least 72 percent cocoasolids.Coffee, one of the world’s most popular beverages,has been shown to improve memory and potentiallydecrease your risk of dementia. Up to three cups ofblack coffee a day are recommended. Black andgreen teas contain brain-boosting antioxidants; giveyour tea plenty of time to steep before you drink toget the maximum benefit your brain deserves.Toast to your good health.Spice up your life.Many herbs and spices — such as turmeric,cinnamon and ginger — are packed withantioxidants that may decrease harmful inflammationin the brain and elsewhere. The strong flavors and thebright, intense colors are clues to the benefits hidinginside your spice cabinet.Drink red wine in moderation.Resveratrol, found in red wineand the skin of red grapes, is apotent antioxidant. Resveratrolcan possibly reduce cell damageassociated with aging and mayprotect against the formationof damaging plaques in thebrain. Stick to the maximumrecommended daily amounts ofone glass for women and two formen. Not a wine drinker? Enjoy redgrape juice.11

SOCIAL INTERACTIONStay ConnectedLeading an active social life can protectyou against memory loss. Spending timewith others, engaging in stimulatingconversation, and staying in touch andconnected with family and friends are goodfor your brain health.A rich social network provides sourcesof support, reduces stress, combatsdepression and enhances intellectualstimulation. Studies have shown that thosewith the most social interaction within theircommunity experience the slowest rate ofmemory decline. Happy marriages or longterm relationships and having a purpose inlife have shown significant protective effectsagainst age-related cognitive impairment.12

“If you haven’t learned the meaning of friendship, youreally haven’t learned anything.” — Muhammad AliKeep in touch with family, maintain old friendshipsand work on new relationships. Here’s how:Branch outShared hobbies are a great way to meet like-mindedpeople. Get active in sports or cultural activities. Volunteeror join clubs. You’ll be surprised at how easy it is to talkto others in a relaxed setting that you both enjoy.Be interestedWhen you begin a friendship with someone, show agenuine interest in learning about the person and hisor her interests.Treasure your loved onesLive with purposeIt can be exciting to form new friendships, but rememberto cherish the friends you already have by spending timewith them.A life with purpose has been shown to reduce the risk ofAlzheimer’s. Volunteer, get involved, worship, help others.The Power of PetsPeople aren’t the only source of loving relationships.Animals have proven to be just as good for our brainhealth. If you can take on the responsibility, consideradopting a pet.Pets Keep us moving Calm us down Enhance our social life Boost our immunity Improve our heart healthJordan, our Cleveland Clinic Lou Ruvo Center for BrainHealth “pet therapist”: the greeter, the icebreaker, theelevator ride guide, the makes-you-feel-good companion13

SLEEP & RELAXATIONRest WellSleep energizes you, improves your mood and yourimmune system, and even reduces buildup in the brainof an abnormal protein called beta-amyloid plaque, whichis associated with Alzheimer’s disease. Try toget at least six hours of sleep a night.Keys to a good night’s sleepGet moving.Ditch the electronics.Exercise regularly. It makes it easierto get to sleep and improves thequality of your sleep.Clear your bedroom of TVs, computersand other electronics. These gadgetsemit blue light, which can disrupt thebody’s natural urge to sleep.Get some rays.Exposure to sunlight in the morningregulates your sleep/wake cycles.Keep the weight down.Sleep affects weight, and weight affectssleep. Insufficient sleep is a risk factor forovereating, while sufficient sleep helps tomodulate your food intake.Make it private.Make your bedroom a sanctuary. Keep itcool and comfortable. Darken your roomwith heavy shades and curtains or wearan eye mask to bed.14Trash the tobacco.Smokers spend less time in deep sleep andmore time in light sleep. They go throughnicotine withdrawal throughout the entirenight, which further disrupts their sleep.Stick to a routine.Develop a relaxing bedtime ritual thatyou perform every night before bed.Also, try to keep to the same sleep andwake time every night and morning —even on the weekends.

“Sleep is that golden chain that ties healthand our bodies together.” — Thomas DekkerManage StressStress is a given, and you will always have stress in yourlife. The question is not really whether you have stress, butrather, whether you’re riding the waves or they’re beatingyou up. Your own strategies for managing stress make a bigdifference in the health of your brain.How to de-stress Practice saying “no” to requests to take on projects you’dprefer to avoid. Focus on the present. Try not to worry about what maynever happen or what’s already in the past. Keep a list of what’s bothering you and schedule fiveminutes a day to review the list. Give your brain a 10-minute break each day by sitting ina quiet place and focusing on your breathing. Use imagery. Consider placing a photo of your favoriteMeditation andBrain Healthspot where you can easily see it. Whenever you feelstressed, you could look at that photo, imagining for amoment how it feels, looks, sounds, and even smells tobe there.Meditation is good for your brain health.Research shows that regular meditationhelps keep your brain happier andhealthier, hopefully for years and years tocome. Think positively. When you find yourself in a stressfulsituation, tell yourself: I can do this. I can figure this out.I’m going to be okay. Allow events to unfold naturally. This mindset may helpto reduce the anxiety that comes with high (sometimesunrealistic) expectations. Focus on the specific problem at hand to protectyourself from making it into a bigger issue than it actuallyis.“Practice makes progress; perfection is theenemy of progress.” — Roxanne B Sukol MD15

MEDICAL HEALTHA variety of medical conditions are strongly linked to the decline of brain function. Hypertension, diabetes,obesity, depression, head trauma, higher cholesterol and smoking all increase the risk of dementia. Keep yourblood pressure and weight at healthy levels, take medication as prescribed, cut down salt and sugar, keep activeand stay socially connected and positive. All of this can help you stay sharp, smart, and increase the vitalityand quality of life as you enter your golden years.RISK FACTORSKEEP IT IN CHECKHypertensionHigh blood pressure can causestructural damage in the brain,which later can develop intomental decline. Cut down on salt(less than one teaspoon a day). Check your blood pressure regularly. Keep active. Maintain a healthy weight. Take your medication. Aim to keep blood pressureunder 120/80 mmHg.Diabetes / ObesityOverweight people are morelikely to develop diabetes, anddiabetics have a much higherrisk of getting dementia. Avoid white sugar, white flour andhydrogenated fats. Eat more fiber. Eat some protein with every meal. Control portion size. Exercise for at least 30 minutes5 times a week.16

“How come every other organ in your body can get sickand you get sympathy, except the brain?”— Ruby WaxRISK FACTORSKEEP IT IN CHECKHigh CholesterolHigh cholesterol increases therisk of developing dementia. Take cholesterol-lowering medicationswhen prescribed. Control other risk factors like hypertension,diabetes, and obesity as advised by yourdoctor.Head InjuryResearch has shown aconnection between moderateor severe brain injury andthe risk of dementia orAlzheimer’s disease. Protect yourself from falls. Prevent injury from vehicle crashesby wearing your seat belt. Wear a helmet when biking orplaying sports.DepressionDepression is associatedwith increased risk forAlzheimer’s disease. Stay socially connected. Seek medical treatment.SmokingHeavy smokers have morethan double the risk of nonsmokers in developingAlzheimer’s disease. Quit. Cut down with a goal of quitting. Seek medical treatment or group support.17

BRINHEAHEALTHYBRAINS.ORGLTHAPIALTHS IXLLARS OF BRAINHEHealthyBrains.org is an innovative website and mobile app designed by Cleveland Clinic to engage, educate andempower all who are eager to maximize their brain health, minimize their risk of brain disorders and participate inthe discovery of new treatments that may prevent, treat, and cure Alzheimer’s, Parkinson’s and multiple sclerosis. How Does It Work?Signing up is completely voluntary. Use a computer,tablet, or smartphone to: Browse the HealthyBrains.org website Download the HealthyBrains app Register for a free, online self-administeredbrain checkupSigning up for a free brain checkup does not enroll youin any other research initiatives, but you can indicate aninterest in clinical trials. What is HealthyBrains.org?It’s a tool designed to engage, educate and empower allwho are eager to maximize brain health, minimize risk ofbrain disorders and participate in the discovery of newtreatments for Alzheimer’s, Parkinson’s and multiplesclerosisOn the HealthyBrains.org website or app, you can:18 Take a free self-administered brain checkup Get your Brain Health Index (BHI) score andreport Use your personal dashboard to trackprogress and get tips Test your memory as often as you’d like Elect to receive news trends in brain health Choose to learn about possible clinical trialsparticipationKnow your Brain Healt

“May your brain span match your life span.”— Larry Ruvoalth Index (BHI) Score Get Informed Access up-to-date scientific informationand resources Provide your email to receive current news,articles and recommendations Stay informed on brain health news andcommunity events Join Our Community Become a citizen scientist Learn about and access clinical trials Join the HealthyBrains community ofresearchers, doctors, caregivers and peoplejust like you Together we will reduce the risk, advancescience and find cures for brain diseasesLeave a legacy. Keep Memory Alive.Want to Learn More?HealthyBrains.org/hbghealthybrains@ccf.orgGet a FREEbrain checkupHealthyBrains.org/hbg19

RESOURCESMany resources are available to helpyou learn and do more to maintain thehealth of your brain. Here are just afew recommended by Cleveland ClinicLou Ruvo Center for Brain Health.WebsitesAARP Brain Health Centeraarp.org/health/brain-health/Brain health material spanning brain games, exercises,lifestyle, diet choices and more.Administration on Aging (AOA) Resource Centersacl.gov/Get Help/Funded Resource Centers/AoA.aspxResource centers providing information and services forolder adults, including the National Alzheimer’s Call Center.Alzheimer’s Associationalz.orgA resource and education center for Alzheimer’s diseaseand dementia.Alzheimer’s Drug Discovery rces on prevention, health management andnutritional supplements that improve brain health.Cleveland Clinic SitesCleveland Clinic Lou Ruvo Center for Brain Healthclevelandclinic.org/brainhealthLearn about brain diseases, treatments and clinical trials.Cleveland Clinic Wellness Institutemy.clevelandclinic.org/wellnessPrograms to prevent illness and foster health throughnutrition, exercise and stress management.Keep Memory Alivekeepmemoryalive.org/socialservicesIncreases awareness and raises funds for the researchand treatment of brain disorders and sponsorseducational programs at Cleveland Clinic Lou RuvoCenter for Brain Health in Las Vegas.Healthy Brains by Cleveland ClinicHealthyBrains.org/hbgAn interactive platform that provides unique brain healthassessment tools and much more.ProductsCleveland Clinic Shop Wellness nts.aspxA variety of products for a brain-healthy lifestyle.Alzheimer’s Foundation of Americaalzfdn.orgResources on prevention, early detection andbrain health.American Brain Foundationamericanbrainfoundation.orgA resource center for brain diseases.Center for Disease Control and tiative.pdfThe public health road map for state and nationalpartnerships: Healthy Brain Initiative.National Institute on Aging Alzheimer’s DiseaseEducation and Referral Centernia.nih.gov/alzheimersAlzheimer’s related news, publications and currentclinical trials.NIHSeniorHealthnihseniorhealth.govHealth and wellness information for older adults.See especially the Memory and Mental Health sections.Contact UsCleveland Clinic Lou Ruvo Center for Brain Health888 West Bonneville AvenueLas Vegas, NV e.orghttps://healthybrains.org/hbgFor information on brain health and clinical trials,please contact healthybrains@ccf.org or855.LOU.RUVO (855.568.7886).Want to receive daily health tips via email?Learn more at clevelandclinicwellness.com.20

Your brain determines every aspect of your life – your thoughts, emotions, movement and memory. Your brain works tirelessly for you 24 hours a day, 7 days a week. Keeping your brain healthy and sharp is essential to your well-being. Today we live longer and we live healthier. Our heart,