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The Guardian
30-04-2025
- Health
- The Guardian
The experts: neurologists on 17 simple ways to look after your brain
As we live longer, our risk of cognitive impairment is increasing. How can we delay the onset of symptoms? Do we have to give up every indulgence or can small changes make a difference? We asked neurologists for tips on how to keep our brains healthy for life. 'All of the sensible things that apply to bodily health apply to brain health,' says Dr Suzanne O'Sullivan, a consultant in neurology at the National Hospital for Neurology and Neurosurgery in London, and the author of The Age of Diagnosis. 'When you're 20, you can get away with absolute murder. You can not sleep for nights at a time and stuff like that. But you get away with nothing when you hit middle age. With every year that I get older, my lifestyle gets healthier.' All of her consultations will focus to some degree on lifestyle choices, she says: 'I work with a lot of people with degenerative brain diseases, and they are not caused by lifestyle. But everything is made better by having a moderate degree of exercise, eating healthily and sleeping well, whether it be bodily disease, brain disease or mental health.' 'If you want to damage your brain, smoke a lot,' says Tom Solomon, professor of neurology at the University of Liverpool. Likewise, 'a lot of alcohol is not good for you. A bit of alcohol seems to be OK. There is some soft data suggesting one to two units might reduce risks of cardiac disease in the elderly, but the evidence overall is that alcohol is harmful, especially to the brain.' Dr Faye Begeti, a neurologist and neuroscientist at Oxford University hospitals, takes a hard line: 'I find that people who are not alcoholics, but drink a small amount of alcohol every day over many decades, can still run into problems. With alcohol I have two rules for my patients: not out of habit, so only when celebrating; and not drinking daily.' There is a well-established link between physical activity and brain health, says Dr Richard Davenport, a consultant neurologist in Edinburgh and the outgoing president of the Association of British Neurologists: 'It works on many levels: psychological, metabolic, physiological.' 'Things that are good for your blood vessels are good for your brain,' Solomon says. 'A lot of dementia is because of damaged blood vessels. Physical activity is good for blood vessels as it keeps blood pressure down.' Solomon got a Guinness world record for running the fastest marathon dressed as a doctor in 2010, raising money for Encephalitis International, a brain inflammation charity. But you don't need to run marathons to keep your brain healthy, he says. Although, 'there is not much hard data telling you exactly how much exercise to do – in our headache clinics we say do 20-30 minutes of something that gets you at least a little bit short of breath two or three times a week, so running, swimming, cycling. They are very good for de-stressing, too,' he adds – another bonus for the brain. 'There are studies that show being active in every decade really helps with brain longevity,' says Begeti. 'I advise people to include single-leg exercises in their routine, because walking relies heavily on single-leg balance, and maintaining this becomes crucial as we get older. Aerobic exercise releases a brain-nourishing chemical called brain-derived neurotrophic factor that supports our neurons. A combination of that with resistance exercises that build up muscle is very important, as numerous studies have found greater muscle mass reduces cognitive decline, even in those who have already been diagnosed with dementia.' Opt for 'antioxidants and unsaturated fats, and not too much red meat', says Solomon. 'The biggest evidence is for the Mediterranean diet,' says Begeti, adding: 'I was born in Greece, so maybe I am biased.' She says the advice she often gives on this is simple: 'When you cook, your primary source of fat should be olive oil rather than butter. This is what I do and it is a really easy transition to make. You can have cakes with olive oil in; everything you fry should be in olive oil, rather than butter. I'm not saying you would never eat butter again, but that the primary source of fat is olive oil. And having some omega-3 with oily fish has really good evidence for brain health as well.' She says it is important for vegans and vegetarians to take vitamin B12 supplements. 'We see people who have simple or chronic headaches,' says Solomon. 'The things that reduce the risk of headaches are all very much the same. Regular exercise. Staying hydrated by drinking at least two litres of water a day. Stopping all caffeine. Not skipping meals. Getting to bed at a sensible time. We usually say to people: if you do this religiously for three months, headaches will reduce or come under control. And most of those things are also good for your general brain health, as far as we know.' 'Good sleep starts at the beginning of the day,' says Begeti, 'rather than at night when you are stressing about not getting good sleep. Anchor your morning by getting up at roughly the same time each day. If you need more sleep at the weekends, then catch up with 60 to 90 minutes, or one sleep cycle extra. Don't make it too erratic, because then your brain doesn't know when to produce the right hormones.' 'We still don't exactly know what sleep is all about,' says Davenport, 'but increasingly, there is good evidence that sleep is allowing the brain some downtime to do a bit of tidying up, and in particular, tidying some of these dodgy proteins that ultimately may do bad things in terms of degenerative disease. In other words, getting decent sleep matters.' 'With insomnia, there can be a lot of worry when we hear that reduced sleep can give rise to disease,' says Begeti. 'I think it is about being able to do good things for your brain, but not being really stressed if you're not doing everything perfectly, because stress has really negative effects as well.' But, she concedes: 'It's easier said than done to say to somebody, 'Don't be stressed!'' 'There is evidence that people with perceived long-term stress are at increased risk of cognitive decline and dementia,' Solomon agrees. We are in the midst of a panic about what technology is doing to our brains, but as Begeti explains in her book The Phone Fix, the science does not confirm that we are addicted to our phones. That said, she limits checking her Instagram account to twice a day and mutes all WhatsApp groups. 'I suggest people try to develop a routine or a schedule of connection and disconnection that works for them. Distraction is a big thing when it comes to technology. I prefer people to use technology intentionally because they want to, rather than to avoid doing some difficult work or dealing with something, and instead using technology to fill that gap. When people use it as an avoidance tactic, I think that is when it can make them feel bad.' Does having so much information readily available online mean we are losing memory capacity? 'You may not be able to remember a phone number, but the brain is very adaptable,' says Begeti. 'It remembers things that you use and sidelines things that you don't. If you don't remember phone numbers daily, then your brain might not be accustomed to remembering them. It doesn't mean this ability has disappeared. It is more the brain is prioritising certain things that you do.' Maintaining social connections is crucial in helping to avoid dementia. 'Of course, there are problems associated with technology,' says O'Sullivan. 'There is some awful content on there. But I think we often forget the positive things it brings to our lives. For older people, who may not have great mobility, it is creating incredible connectedness.' Begeti adds: 'There are early studies with preliminary findings that show if middle-aged adults engage in social media, they have reduced incidence of dementia.' 'Brain and mind health is all about having ambitions and interests outside of yourself,' says O'Sullivan. 'I have so much work to do that my mind is kept well occupied, but my plan going forward is to do all the things I wish I had time to do now: go back to university, do art appreciation courses, and challenge myself in settings where I'll be mixing with lots of different people.' Find a 'magnificent obsession', says Dr Richard Restak, a professor of neurology at George Washington University hospital in the US and author of How To Prevent Dementia: An Expert's Guide to Long-Term Brain Health. 'Take up an interest, the earlier in life the better, and do a lot of mental work trying to learn more stuff. You can link it to social interaction, which is very important.' 'You need to exercise the brain every day, particularly with memory,' says Restak. At 83, he is still writing books. What is his secret? 'I think, in my case, it is mostly training the brain. I walk and have a sensible diet, but I'm not cultish about it. If my wife brings back some pastries, I will certainly have one.' What's his training? 'Every day I try to learn a new word,' says Restak. 'The word today is turveydrop – based on a character in [Charles Dickens's] Bleak House – and is someone who is just interested in looking important. If somebody calls you that, it's not a compliment.' He keeps lists of all his daily words to refer back to, if his memory fails him. But don't narrow your training too much, he adds. 'Remembering particular things is only good for the area in which they are applied, so that you become a good crossword puzzler or a great Scrabble player. I lose at Scrabble all the time. I think I've got a pretty good vocabulary, but Scrabble is its own world.' 'Learning is harder when you are older,' says Solomon, 'but it helps as you mature.' He played piano as a child, then took it up again 10 years ago. 'People who play musical instruments are less likely to have cognitive impairment because it is all about using the brain.' The same goes for learning languages. With both, 'You're using very different parts of your brain. If you don't do any of those things, there are whole chunks of your brain that are not really being used.' 'Deafness is one of the characteristics that the Lancet Commission has identified as being an important risk factor for dementia,' says Davenport. 'It's the same for vision. Anything that leads you to less interaction with the outside world is likely to be detrimental.' There is less evidence on the effects of reduced vision, he says, 'but if your vision deteriorates, you're going to stop driving, you may stop going out so much, and all of those things start to lead to social isolation, like deafness. Keep on top of your senses; make sure you can hear and see.' Interestingly, Davenport adds, 'sense of smell is often an early symptom of some of the degenerative diseases. No one is suggesting losing your sense of smell leads to them. It is probably just an early symptom, particularly in Parkinson's disease.' Davenport is a keen cyclist. Does he wear a helmet? 'Absolutely. There is good evidence that helmets do protect you.' He refers to the debate around the effect of repeated head injuries in sports such as rugby and football, and their role in neurodegenerative disease: 'There is still quite a lot to be unravelled about that, but it makes sense to try to protect your head from unnecessary injury. Where you need to be careful, of course, is that we know that physical exercise is very good for people, and therefore you don't want to stop kids playing football. But maybe easing up on heading the ball, which is already happening.' O'Sullivan points out that memory decline starts in your 30s. 'We all are increasingly forgetful over time,' Solomon agrees. Don't worry, he says, if, for example: 'You go upstairs for a jumper, and then you get upstairs and you can't remember what you've gone up there for. That's not a reason to see the doctor.' He says that the difference is obvious between patients who have dementia and those who are experiencing normal forgetfulness: 'When I say to these patients, 'Why have you come to see me?', they turn their head to look at the relative who is with them, because they have no idea why they are there.'
Hans India
24-04-2025
- Health
- Hans India
Brain implants that are helping people with Parkinson's
Although the brain is our most complex organ, the ways to treat it have historically been rather simple. Typically, surgeons lesioned (damaged) a structure or a pathway in the hope that this would 'correct the imbalance' that led to the disease. Candidate structures for lesioning were usually found by trial and error, serendipity or experiments in animals. While performing one such surgery in 1987, French neurosurgeon Alim-Louis Benabid noticed that the electrical stimulation he performed to locate the right spot to lesion had effects like the lesion itself. This discovery led to a new treatment: deep brain stimulation. It involved a pacemaker delivering electrical pulses via electrodes implanted in specific spots in the brain. This treatment has been used to treat advanced Parkinson's since the early 2000s. However, until today, the stimulator settings had to remain constant once they were set by a specialised doctor or nurse and could only be changed when the patient was next seen in the clinic. Accordingly, most researchers and doctors thought of stimulation as merely an adjustable and reversible way of lesioning. But these days the field is undergoing a revolution that challenges this view. Adaptive deep brain stimulation was approved earlier this year by the US and European health authorities. It involves a computer interpreting brain activity and deciding whether to adjust the stimulation amplitude up or down to achieve the best relief of a patient's symptoms. Parkinson's is a complex disorder with fluctuating symptoms that are greatly affected by the drugs a patient takes several times a day. While for some patients' constant stimulation does a good job controlling their symptoms, for others it is too strong some of the time and overly weak at other times. Ideally, the treatment should only kick in when it is most helpful. The discovery that made adaptive stimulation possible was made by scientists at University College London over two decades ago, around the time when the first patients with Parkinson's started getting electrodes implanted in the UK National Hospital for Neurology and Neurosurgery. When recording deep brain activity from these electrodes shortly after the surgery, the scientists noticed that a particular kind of brain wave appeared when a patient stopped medication, the symptoms worsened. The waves went away when the patients took their medication and started feeling better. It took a decade of further research before the same team of scientists first attempted to use the brain waves to control stimulation. The idea is akin to a thermostat controlling an air conditioner. When the waves (temperature) reach a certain threshold, an electronic control circuit turns the stimulator (A/C) on. This reduces the waves and when they go away the stimulation can be turned off for a while until the waves re-emerge. The original setup was bulky and could only be used in the hospital, and it took another decade to make it fit inside a device smaller than a matchbox that could be implanted in a patient's chest. New challenges While the option to make brain stimulation adaptive gives new tools to doctors and nurses to fit stimulation to a patient in the best possible way, it comes with new challenges. Even with the original fixed settings, there are many parameters that doctors must set to ensure effective treatment with minimal side-effects. Making stimulation adaptive adds another layer of complexity and puts extra demand on a clinical team's time and attention. In the case of Parkinson's, stimulation effects are almost immediate, so it is relatively easy to see how well particular constant settings work. But an adaptive setting must be tested over at least a few days to see how well it copes with the patient's daily routine and medication cycles. Adaptive stimulators also come with sensing abilities. They can record the harmful brain wave levels over days and weeks so that the clinical team can review them and see how well they are controlled. These possibilities are new in the treatment of Parkinson's, although similar implanted devices have been in use for years by cardiologists and epileptologists (neurologists who specialise in epilepsy). Studying brain waves recorded by the smart stimulators in Parkinson's patients opens new doors for understanding other diseases. Many patients suffer from problems such as depression and cognitive decline. Researchers could search for features in their brain signals that track the severity of these symptoms using AI tools to find relations too subtle or too complex for a human observer. A parallel branch of deep brain stimulation research is focused on precisely mapping out the brain circuits responsible for different neurological and psychiatric symptoms. Several recent studies reported successes in treating depression, OCD and severe headaches. Stimulating in the right place at the right time considering what the patient is doing is where the field is heading. With the basic technology now in place, progress could be rapid. (The writer is a Professor of Translational Neurophysiology, UCL)
The Guardian
20-03-2025
- Health
- The Guardian
David Landon obituary
My father, David Landon, who has died aged 88, was a pioneer in the use of high-resolution electron microscopes to improve the understanding of neuromuscular diseases such as multiple sclerosis, and established a state-of-the-art electron microscopy facility that provided diagnostic services for several London hospitals that ran from the mid-1970s onwards. Specialising in exploring the microscopic structure and function of nerves and muscles, his early published papers describing structures involved in nerve conduction called the nodes of Ranvier were the start of a fruitful research career that used electron microscopes in diagnostic services for neuromuscular conditions. Born in London, David was the son of the novelist and screenwriter Christopher Landon and his Australian wife, Isabella (nee Campbell). When the second world war broke out, Isabella took three-year-old David to Australia to escape the blitz, and they returned in 1945. Inspired by his biology teacher at Lancing college in Sussex, David developed a fascination with zoology, catching butterflies and watching birds as an escape from the tedium of boarding school and tensions at home in Norfolk following his parents' divorce. During medical training at Guy's hospital medical school in London, he met Karen Poole, a fellow student, and they married in 1960. After qualifying in 1959, David became a house physician and outpatients officer in the Guy's casualty department, senior house officer at Paddington hospital and then a lecturer in anatomy at Guy's before joining a new Medical Research Council research group in applied neurobiology at the National Hospital for Neurology and Neurosurgery in London. He intended to stay only a few years, but remained there for the rest of his professional life, and over the years held posts at the hospital as senior lecturer in applied neurobiology (1964-77), consultant in morbid anatomy (1974-2001), professor of neurocytology (1991-2001) and as dean of the Institute of Neurology (1987-95), an adjacent facility that stands within the faculty for brain sciences of University College London. His only diversions away from working at the National Hospital for Neurology and Neurosurgery came in 1975 when he spent three months setting up an electron microscopy facility at the University of Lagos in Nigeria, and in 1983 when he went to Bombay (now Mumbai), India, to train up 40 technicians on electron microscope use in relation to leprosy research. On his retirement in 2001 he was made a freeman of the Pewterers Company, in recognition of his work with the company's charitable trust. David was a generous mentor and a kind, loving family man. He loved his garden and developed a talent for silversmithing during retirement. He is survived by Karen, their three children, James, Christopher and me, five grandchildren, Heidi, Jack, Felix, Jason and Wilfred, and his brother, Nicholas.
