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Through neuroimaging and genetic studies, researchers are looking for biological markers that will help to detect Alzheimer’s before major damage has occurred. But Dr. Small points out that for the majority of the population, nongenetic factors are more important to their brain health — and that lifestyle choices have a much greater impact than most people realize. For example, the widely cited MacArthur study on successful aging concluded that genetics accounts for approximately one-third of cognitive and physical success in aging. “That means two-thirds must be nongenetic,” says Dr. Small, who has written a number of books on the topic, most recently The Alzheimer’s Prevention Program: Keep Your Brain Healthy for the Rest of Your Life. “We are learning more and more about these nongenetic protective factors that might be under our control: nutrition, physical fitness, stress management and cognitive exercise.” In the area of nutrition, perhaps the most important strategy involves weight management. “We know that if you’re overweight, that doubles your risk for Alzheimer’s, and if you’re obese, it quadruples your risk,” Dr. Small says. “The good news is that new studies are showing that if you reduce your weight, you can significantly improve your cognitive performance.” As for what to eat, studies suggest a diet rich in omega-3 fatty acids and low in omega-6 fatty acids is healthier for the brain. Other brain-health strategies include consuming antioxidant fruits and vegetables and minimizing refined sugars and processed foods. Strong evidence supports the idea that physical fitness — particularly cardiovascular conditioning — can provide cognitive benefits, Dr. Small adds. “During exercise, the heart is pumping nutrients to the brain cells, and the body is producing brain-derived neurotrophic factor, which causes dendrites to sprout branches — the tentacles that connect brain cells,” he explains. Stress management is also believed to be important. Chronic stress in animals, for example, has been shown to lead to memory decline. Human studies have found that people who are prone to stress have higher rates of Alzheimer’s. Dr. Small and others have also reported findings indicating that mental stimulation, including memory training, improves cognitive performance and may lower the Alzheimer’s risk. Based on that evidence, the UCLA Longevity Center offers memory-related classes in more than a dozen states nationwide, tailored to different populations. Brain Boot Camp, a three-hour course, teaches lifestyle strategies for promoting brain health. Memory Training is a weekly program providing practical techniques for enhancing memory ability over the course of four weeks. Memory Fitness is designed for people in senior living, while Memory Care targets people experiencing mild memory loss and their caregivers. (Top) Image of FDDNP PET scan (left), MRI scan (middle) and FDG PET scan (right) of a patient with Alzheimer’s disease and a control subject. The FDDNP PET provides a measure of both amyloid plaques and tau tangles (warm colors) in the patient with Alzheimer’s disease. The FDG PET scan shows low metabolism (cool colors) in those same brain areas that control memory and thinking in the Alzheimer’s patient. “There is tremendous interest in these strategies,” Dr. Small concludes. “People want to know what they can do to take care of themselves. As physicians, we should be communicating that information and emphasizing that it’s never too early to start taking proactive steps to protect the brain.” 9 UCLA Physicians Update