Caroline Just, MD is a Neurologist in the Center for General Neurology at Cleveland Clinic. She spoke with us about the heart-brain connection and how you can lower your Alzheimer’s risk by protecting your heart.
Read the interview with Dr. Just below.
WAM: The link between heart health and cognitive function may surprise people. What does current research reveal about how these two systems influence each other?
Dr. Just: What’s good for the heart is good for the brain! Just like your heart health depends on the blood vessels that supply your heart being open and free of plaque, your brain health depends on the blood vessels in your brain being open and free of plaque.
WAM: High blood pressure is a risk factor for dementia and cognitive impairment. What mechanisms explain this relationship, and when in life should blood pressure management become a priority for brain protection?
Dr. Just: High blood pressure can lead to the blocking of tiny arteries in the brain. Although the arteries are tiny, this process can involve many different tiny arteries. When this happens, the arteries aren’t able to give blood to the surrounding brain cells, and brain cells can die. This is often experienced by patients as a slowness of processing and difficulty with attention. If you aren’t paying attention to something, you can’t remember it!
When should we start worrying about blood pressure? Age 30 or even earlier if there’s a family history. Some people have high blood pressure just because of a genetic risk factor. This can be the case even if they are not overweight and they exercise and eat well. It is important to have preventative health care because many patients have high blood pressure that can damage their organs without symptoms. We want to control blood pressure before it starts affecting their kidneys, heart, or brain.
WAM: How does exercise benefit both heart and brain health simultaneously? Are there specific types of exercise we should be focusing on for our brains?
Dr. Just: Cardio exercise, where your heart rate increases by about 30% to 50%, is really important for both heart health and brain health. We know that exercise lowers blood pressure. There are also benefits to mood. While you need some weight-bearing exercise like lifting weights for bone health and muscle health, the most important types of exercise for brain health are cardio exercises. The ideal is a moderate intensity for 150 minutes/week (like a brisk walk) or a high intensity (like running) for 90 minutes/week. However, if you can only get 10 minutes, that is infinitely better than 0.
WAM: What role does cholesterol play in brain health, and how do medications like statins factor into protecting against cognitive decline?
Dr. Just: Your “bad” cholesterols (LDL and VLDL) can injure your blood vessels on the inside and form plaques. These can cause a heart attack if they form in the arteries supplying the heart, or a stroke if this happens in the arteries supplying the brain. The plaque can also break off from another place in the body and end up in your heart arteries or brain arteries. Statins, as well as a diet high in whole grains and psyllium fiber, can reduce your bad cholesterol.
WAM: Inflammation seems to play a role in both heart disease and Alzheimer’s disease. What do we know about chronic inflammation as a common pathway, and can anti-inflammatory interventions protect both organs?
Dr. Just: We know that the inflammation leads to aging of our organs, including the heart and brain. However, “inflammation” is a very general term that just refers to our immune system being active. There are innumerable types of cells in our immune system that work on inflammation, but some inflammation is necessary to fight disease. We know that inflammation plays a role in the formation of neurofibrillary tingles and amyloid plaques. These structures are found in the brains of people with Alzheimer’s. There is some evidence that an anti-inflammatory diet (i.e., the Mediterranean or MIND diet) is associated with improved brain health.