Today, I want to talk about a set of conditions known as neurodegenerative diseases. Now why are we talking about this today? Well as we are in the business of longevity and disease prevention, it is worth taking a look at what diseases commonly result in deaths.
The top 2 you may already be familiar with.
· #1 leading cause of death is ASCVD (or atherosclerotic cardiovascular disease)
· #2 is cancer
· #3 of course is neurodegenerative diseases.
Now the top 3 accounts for around 70% of all deaths, which is quite a sobering thought.
When we think about neurodegeneration, everyone thinks about Alzheimer’s disease. This is because it’s the most prevalent, and chances are you know somebody who was affected by this disease. But the other diseases that we’re going to talk about today are also very common, and you’ve probably never heard of them, but you should because there’s a reasonable likelihood that they will affect you at some point in your life or a loved one.
So let’s begin with a formal definition. Neurodegenerative diseases are a group of neurological disorders that cause progressive degeneration of the structure and function of the brain. These diseases are characterized by the gradual loss of neurons and neuron function, leading to mental and physical disabilities.
Common neurodegenerative diseases you may have heard of are Alzheimer's disease, Parkinson's disease, and Huntington's disease, just to name a few.
Symptoms of these diseases may include memory loss, impaired mobility, difficulty with speaking or understanding, and changes in behaviour or mood. Treatment options for neurodegenerative diseases are limited, but include…
1. Physical and Occupational Therapy: These therapies help to maintain physical functioning, address movement and balance issues, and develop strategies for managing activities of daily living.
2. Medications: Medications may be used to manage symptoms, support functioning, and slow the progression of neurodegenerative diseases.
3. Nutritional Therapy: Eating a healthy, balanced diet and supplementing it with vitamins, minerals and nutrients can help to support neurodegenerative disease, as well as overall health.
Now I believe we are still at an early stage of really understanding these conditions. Oftentimes, we discover that someone we know has this condition but since our diagnosis and understanding of these conditions are still at an early stage (and often made when the disease has already taken hold), the treatment options as mentioned are limited. This is akin to talking stage IV cancer (the most advanced stage). There is very little you can do at that point. We are not very good at detecting or understanding stages 1-3 of these neurodegenerative diseases, yet.
So a lot of efforts are obviously focused on early detection and understanding the causal relationships of various triggers for these diseases. With this framing in mind, I want to discuss 3 things that you may not be aware of, which are the early tell-tell signs that you may be at risk of developing these conditions.
1) disturbed REM sleep
2) impaired sensory inputs
3) dental hygiene.
Let’s tackle these one by one.
First let’s talk about disturbed REM sleep.
Actually the proper medical terminology is Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD) which is a sleep disorder characterized by acting out vivid, often violent dreams with vocal sounds and motor movements during a particular sleeping phase called REM sleep. Individuals usually seem to remain asleep throughout the event, and may not remember the episode upon awakening. It is estimated to affect 0.5–1% of the population and is more common in men. So why is it important to know why we have disturbed REM sleep? Well, research has shown that approximately 50% of patients with spontaneous RBD will convert to a Parkinsonian disorder within a decade. Ultimately, nearly all (81%-90%) patients with RBD develop a neurodegenerative disorder later in life.
If you are having difficulty concentrating, feeling excessively tired during the day, or having issues with memory, these may be signs that you have disturbed your REM sleep. Other signs may include waking up in the middle of the night, feeling irritable, or having a hard time falling asleep.
The easiest way to tell is if your partner tells you that you move a lot during sleep, and you start punching or kicking and acting out your dream. That is a sign that you may be having disturbed REM sleep.
If you notice any of these symptoms, it may be helpful to talk to your doctor. The most definitive test or the best way to monitor sleep stages is through an overnight sleep study. During a sleep study, your breathing, brain waves, and other body movements are monitored while you sleep. This allows a professional to determine which stage of sleep you are in and how long you stay in each stage. Your doctor may also recommend a wristwatch-like device called an actigraph, which is designed to measure your movements and determine when you are asleep or awake.
So let’s talk about the second point which is impaired sensory input. So what are we talking about here? We are talking about hearing loss or visual loss. Actually, although not a mainstream view, there are scientists that believe there is a causal link between hearing loss and certain neurodegenerative conditions. This is potentially important because it means that if we screen and detect hearing loss early and treat it aggressively, this could improve outcomes
What is definitely true and generally well accepted is that there are definitely very strong associations between hearing loss and/or visual loss, and sometimes later down the line, you are at a higher chance of developing these neurodegenerative conditions. Now you may wonder why this is. Well, we don’t know exactly, but the current thinking, which I like the most, is that if you have reduced sensory input, your brain has to devote more of its efforts to making sense of the inputs that are coming in, like for example, if your hearing is not good, then more work for the brain to engage and try to heighten the signal. This increases the so-called ‘cognitive load’ and because your brain is focused on trying to hear or trying to see, it’s using all of its power for that and diverting resources away from building memory which therefore could lead to reduced memory formation. I think over time (and we are talking over many years or decades) scientists think that this might have a compounding and detrimental impact. To put it more simply, you’re going to process information worse if you can’t hear. You’re going to process your environment worse if you can’t see. Over time this leads to a vicious cycle. You end up doing less and thinking less.
So I think a good thing to do is that if you have any sensory impairment such as hearing or visual loss, it is good to try to get this fixed so that you lessen the load on the brain daily working, or at least that is the rationale we have currently.
Lastly, we have to touch upon dental hygiene.
Good oral hygiene is important for preventing neurodegenerative diseases, as it helps to reduce the build-up of bacteria and plaque. Because of the proximity of your gums and teeth to your brain, any infection or inflammation here can lead to inflammation in the brain. And this does not have to be things like meningitis or encephalitis, but it could just be low-grade indolent infection. Scientists do not know if it’s the actual bacteria going to the brain that is the problem or the reactive/secondary inflammation that it causes. This is still an area of active research.
Additionally, poor dental hygiene has been linked with an increased risk for stroke, which can also cause neurodegenerative diseases. Regular brushing and flossing can help to keep inflammation at bay and reduce the risk of developing these diseases.
The good news is, there is a lot of exciting research being done on this topic, and I am optimistic, that in the next few years, we may understand these diseases a bit more, and we can get better at detecting early stages of diseases.
So what can you do right now, apart from the above things we mention? Well, there are actually a lot of the usual things that we suggest, which are going to have benefits. These are…
1. Exercise Regularly: Exercise helps keep your body and mind healthy. Regular physical activity can help maintain healthy blood pressure, blood sugar, and cholesterol levels. It also increases blood flow to the brain and strengthens the connections between brain cells.
2. Eat a Healthy Diet: Eating a balanced, nutritious diet is key to maintaining overall health. Make sure to include lots of fruits and vegetables, healthy fats, and whole grains. Avoid sugary and processed foods.
3. Get Enough Sleep: Make sure to get enough sleep. Even if you don’t have disturbed sleep, ensuring that you have enough REM sleep (in terms of hours) actually has a lot of benefits as well.