Our brain is a powerful tool that we should pay attention to, especially as we get older. Join us in conversation with Dr. Leslie Kernisan who shares her check list of important brain health practices we should all know about. Enjoy the show!
Margaret Manning:
My guest today is Dr. Leslie Kernisan. Leslie is a medical doctor with specialty in geriatrics. She has a fabulous website where she provides practical advise on how to deal with the aging problems that older adults face. It’s great to have you here, Dr. Leslie.
Dr. Leslie Kernisan:
Thank you.
Margaret:
I’m so happy that you are here discussing the topic of brain health. We know it’s important, and we sort of know what we have to do to stay healthy, but our knowledge is hardly systematic.
You have put together a fabulous check list as a guide to brain health, and you have come up with some really interesting angles on how to look at brain health. Can you please tell us about your check list?
Leslie:
It’s called How to Promote Brain Health. I created it because I realized that I often needed a place where to point my patients or my audience. It consists of my recommendations for optimizing your brain.
Because I’m a geriatrician, and so I mostly take care of people over 65. Many of them have cognitive difficulties or maybe even memory problems. I’ve realized that our suggestions for optimizing the brain function apply whether you are 60 or 85 with Alzheimer’s, because the core principles are the same.
I created that list, and I’d be happy to take you through it. I found that people have heard about several of the items because there has been a lot of interest in brain health and its pillars. However, two of those points most people don’t know about, so I try to focus on them.
Margaret:
On 60 & Me we have recorded a lot of videos on healthy ageing, and we know it’s really important to keep our brain healthy. We’re familiar with most information that is out there, which you also cover. But you have included some unique points that are really interesting, so please introduce us to your list.
Leslie:
The first item on my list includes the four types of medication to avoid if you are worried about memory loss. I’ve had older people who told me that they have noticed changes in themselves or were concerned about changes in their spouse.
They would all say, “What can you do? It happens,” and that’s when I think, “Oh my gosh, there are a lot of things you can do.”
One of the key steps to take, that people often don’t think about, is to identify and stop medications that we know dampen brain function. I’m often surprised that I don’t see this kind of information shared by the institutions that research brain health.
A few years ago, the National Academy of Medicine in the United States issued a groundbreaking report on cognitive ageing. In that report they gathered information about how the brain changes as it ages, and how we can maintain the best possible brain health.
They have prepared an action guide with six particular suggestions, and third on their list was managing your medications. That is one of the only places where I’ve seen medications brought up.
People are often surprised to find out that they are taking medications which dampen brain function or have been associated with developing cognitive impairment or even dementia. The ones to look out for are Benzodiazepines.
These are medications like Valium or Ativan—the generic name is Lorazepam or Xanax—which people take for anxiety or relaxing and often for sleep. Unfortunately, people who are already having any kind of memory difficulty get worse after taking these medications.
Some research studies associate Benzodiazepines with developing dementia or possibly accelerating it, but then other studies have contested the results. So, people don’t know whom to trust. But in geriatrics, we are very careful about spotting those medicines and encouraging people to taper off them if it all possible.
There is also an added problem: Benzodiazepines are terrible for balance, and they are associated with falls. By avoiding taking them, you are getting a double benefit as an older person.
People who are in their 50s and 60s should be aware of these side effects, because if you’ve been taking that medication for a few years, or even several years, which some people have, now is a great time to work on the process of tapering off and finding another way to manage insomnia or anxiety.
Otherwise, we end up with people who are in their 80s and starting to slip with their memory. When that happens it’s very hard to get them off the medication, because they get stressed and their memory gets worse. So, I encourage people to start early.
The other sedative medications, like Ambien, haven’t been around for as long, but I encourage people to minimize their use of that, too. We do know that people do less well on cognitive tests the next day after they have taken Ambien.
Nobody knows for sure what are the long term effects of Ambien, but there are safer ways to learn to sleep. People don’t realize that, but you can learn to sleep without sedatives.
Margaret:
I’d just like to mention that you are a fully accredited medical doctor, so you can make these claims. I encourage people who are listening, and maybe have questions or opposing views about the benefits/harms of Ambien, to go talk with their doctor, or do their homework and research the effects of these medications.
Leslie:
There is a wonderful geriatrician in Canada who did a study where she created a pamphlet about taking Benzodiazepines and other sedatives that gave people information on the risks, suggested a tapering schedule and encouraged them to read it and bring it to their doctor.
She did a randomized trial distributing the pamphlet to pharmacies and to people. One group didn’t want the pamphlet, but out of those people who received it, a surprising number were able to stop or reduce their dosage.
That was proof that giving people a really useful information tool could motivate them and empower them to go to their doctor and actually make a good change. I encourage people to take a look at that pamphlet. Always talk to your doctor before stopping this kind of medication as this is…