After enough years of these conversations, I have noticed that what people are actually afraid of comes down to two things. There is the sudden event, the heart attack or the stroke. And there is the slow one.
Many of my patients have watched a parent search for a grandchild’s name at the dinner table, and underneath the question they are asking me sits a quieter one. Is that road waiting for me too? It is a large part of why we built our metabolic program around early, movable risk.
What does my cholesterol have to do with my brain?
More than we used to think. The same small blood vessels we protect in the heart are the ones carrying blood to the brain. Blood pressure, lipids, and blood sugar have been treated for decades as heart numbers, but injury to those vessels shows up in the brain as well.
We have gotten reasonably good at talking about the fear of a heart attack. For most of my career, the honest answer to the fear of cognitive decline was some version of we do not really know what to do about that.
That answer is starting to change, and it turns out the two fears are far more connected than we once believed.
What did the Lund University study actually find?
Researchers at Lund University in Sweden followed roughly 500 adults with no memory problems, average age about 65, for four years with repeat brain scans. Smoking, cardiovascular disease, high blood lipids, and high blood pressure all tracked with injury to the brain’s small vessels and with white matter changes accumulating faster.
They wanted to know which of our risk factors leave marks on the brain, and what kind of marks they leave. The answer was clearer than I expected.
White matter is the wiring. It is the bundles of fibers that let one part of your brain talk to another, and it runs on a network of very small blood vessels.
Injure those vessels quietly, year after year, and the wiring frays. A good deal of what we casually call cognitive decline is that fraying.
Does treating my blood pressure protect my memory?
We cannot say that yet, and I will hold the science honestly. This was four years, in people who were still cognitively healthy, and it does not prove that treating blood pressure protects memory. But the risk factors leaving marks were the ones we already know how to measure and already know how to move.
The researchers concluded that working on vascular and metabolic risk may reduce the combined burden of several kinds of brain injury at once.
The estimate carried alongside their work is that close to half of dementia cases may be tied to risks we can change. That is not a small thing. It means a large part of what people fear most is, at least in part, negotiable.
Which numbers should I be checking early?
The most modifiable ones: cholesterol, early insulin resistance, and blood pressure. The point is to look for them while they are still quiet and still very movable, rather than waiting for them to announce themselves. Then build real coaching around the four things that actually move them.
Those four are nutrition, sleep, stress, and physical activity. None of them are new, and that is rather the point.
The goal is not only to prevent a heart attack or a stroke, although I very much want to do that for you. It is to protect the vessels feeding your brain at the same time. One kind of care, two kinds of protection.
That is the larger project, and it always was. Not only how long we live, but how well, and how many of those years we spend healthy and clear and present for the people we love.
