Dr. Shehroo Pudumjee is a clinical psychologist specializing in neuropsychology. She earned her doctorate at Central Michigan University and completed her internship at the University of Florida. During a fellowship at Mayo Clinic, Minnesota, she focused on cognitive assessment in neurodegenerative conditions including Alzheimer’s disease and movement disorders. Her research interests span early detection of cognitive decline and examining and improving the efficacy of psychometric measures. She gave us a rundown on the brain and how it works.
Read the Q&A with Dr. Pudumjee below.
WAM: WHAT does the brain really do and what makes it so important to a woman’s overall health?
Dr. Pudumjee: The brain is a remarkable organ and makes us who we are – from processing the most basic stimuli in terms of light, sound, etc., allowing us to make sense of those stimuli, interact with our environment, using language and movement to do so, reasoning through situations, experiencing and expressing emotion, learning from our experiences and forming our own unique set of memories. In addition, the brain controls a lot of processes that go on outside of our awareness or deliberation. For instance, our flight or fight response, hunger, digestive processes, heart rate, etc. are often not processes we deliberately initiate. Given that the brain governs so many of functions and impacts nearly every aspect of our functioning, it is critical that we care for it over the life course.
WAM: HOW does the brain orchestrate all these disparate functions and signal the body to respond to orders like how to learn language, sleep and digest food?
Dr. Pudumjee: The brain is an incredibly complex and multifaceted organ that performs a variety of functions. Often a single brain structure can be involved in multiple networks and consequently can impact multiple functions/processes. At a cellular level, these networks are made up of bundles of nerve fibers, wherein electrical impulses are transmitted down the length of each neuron, and across the gaps between neurons facilitated by neurotransmitters. This firing of impulses happens very quickly – within a fraction of a second. Given this complex system, an interruption at any point can impact brain function such as processes related to learning, memory, attention, language, etc. Additionally, an interruption at one point in network can have downstream effects, wherein another part of the network can be affected by the “disconnection” from the rest of the network.
In the case of Alzheimer’s disease, for example, the buildup of amyloid and tau impacts neuronal integrity and connectivity. Typically, this shows early on as disruption in learning and memory processes and then progresses to include other, more diverse cognitive functions.
WAM: WHEN does the brain reach peak performance, and is it inevitable that it declines with age?
Dr. Pudumjee: Although there are individual differences in brain development and specific brain structures, typically, peak brain performance is achieved in one’s 20s-30s, with the frontal lobes, associated with executive functions such as complex reasoning, abstraction, planning, organization, inhibition, etc., being the last to complete development. It is important to recognize the impact of psychosocial and environmental factors on this process. For instance, if an individual experiences salient psychosocial stressors, emotional disturbances, medical complications, etc., these factors may impact their experience of cognitive efficiency and may alter when one perceives their peak cognitive functioning.
With regard to age related cognitive changes, as we age, we acquire new skills, learn new vocabulary, and gather wisdom. On the other hand, we may see some age related declines in functions such as cognitive speed, attention, our ability to grasp and learn new information. It is important to recognize that we may see minor, infrequent errors creep in and to a certain extent, these are normal. For instance, it may take one longer to complete tasks that were previously effortless or may require more deliberate effort when learning new information. Such changes are largely consistent with normal aging. However, if one starts to notice more significant, frequent errors, it may be worth investigating what is causing them.
WAM: WHO is most likely to develop Alzheimer’s and is it inevitable that we get this disease if we live long enough?
Dr. Pudumjee: Advancing age is the greatest risk factor for Alzheimer’s disease. Women are also more likely to develop Alzheimer’s disease and account for 2/3 of those with the disease. Additional risk factors involve family history and genetic markers (e.g., presence of the APOE ε 4 allele).
Further, cardiovascular/cerebrovascular conditions (e.g., stroke, hypertension, diabetes, etc.) raise the risk of future cognitive decline. Individuals with these risk factors face an increased likelihood of Alzheimer’s disease and related dementias. However, there is no clear indication that someone with these risk factors will “inevitably” develop Alzheimer’s disease.
Studies have shown that approximately 40% of Alzheimer’s diagnoses are preventable. Lifestyle modifications (e.g., improving exercise, adhering to a heart and brain healthy diet, addressing physical and mental health concerns, ensuring adequate sleep, etc.) have been found to reduce the risk of Alzheimer’s and also improve general wellbeing. Specifically exploring how these lifestyle changes may benefit women at risk for Alzheimer’s is a core goal of the Women’s Alzheimer’s Movement Prevention Center at Cleveland Clinic.