Professor von Arnim, can we determine for ourselves how we age?
Christine von Arnim: I start with the bad news: We don’t know what triggers Alzheimer’s disease, one of the greatest bogeymen in old age. The condition is incurable, and, despite all the research, there is still no active ingredient.
I cannot avoid an enemy I do not know.
Yes and no. In medicine, we assume that two-thirds of the time, it is fate to get dementia.
What does fate mean?
First of all, the genes, protective genes, risk genes, and everything we do not know or understand.
And the last third?
These are risk factors that dementia researchers worldwide have identified in recent years. And that’s the good news now: risk factors can be, addressed.
Precisely, can we partly determine how we age?
Again and again. If I avoid what we have identified as a risk, it does not mean that I will gain a fixed number of healthy years of life or that I will never fall ill. It’s like crossing a street: I can be run over by a car even if I have looked exactly left and right. I experience a lot of bewilderment in my daily clinical routine. For example, my patients say: I have been doing sports all my life, have continued my education, and now you diagnose Alzheimer’s!
Then what do you answer?
That dementia is a disease whose cause is still unknown, and Even if I, Christine, turn all the knobs that I can influence and influence, I can lose my memory. Avoiding risk factors does not protect indiviPreciselyollectively.
You have to explain that.
International studies, for example, from the USA, Sweden, and the Netherlands, give hope. They show that new dementia cases decrease when a society lives “healthier in the brain.” Nevertheless, a woman who lives super healthy in the brain can fall ill, and another woman who whistles cannot. But precisely because we still don’t understand a lot, this is the pivotal point you shouldn’t whistle to. Recognized age experts estimate that the number of people with dementia worldwide could drop by one million if the risk factors are reduced by ten percent. Tempting.
Which twists and turns need to be turned for this?
Poison to the brain is everything that also triggers cardiovascular diseases, i.e., smoking, diabetes, obesity, high blood pressure, and physical inactivity. This causes vascular damage and affects the signaling pathways of the so-called insulin receptor. This receptor is linked to the metabolism and synapses in the brain. With the metabolic syndrome, i.e., the combination of overweight, high blood pressure, and elevated blood sugar levels, there are disorders of the mitochondria, which are the cells’ power plants. Here, too, we assume a direct connection to nerve cell damage, although much is still unclear. The relationship between heart and brain is secured and something that my team and I are researching intensively.
Do you get angry when someone smokes?
No, never. Who am I to judge myself? Smoking is an addiction, and obesity can have many reasons. But I am a missionary, if not towards the smoker in the supermarket car park. I strongly recommend an active lifestyle to my patients. It can also have a positive impact on the course of the disease.
Are there any other adjustments?
Social isolation, depression, and hearing loss also increase the risk of becoming demented. Current studies even suggest a connection with inflammation in the body, such as periodontitis. So it is not a good idea not to seek help for mental illnesses. And whoever celebrates and meets friends does something for the brain! Trauma and vision and sleep disorders also negatively affect, although the data is not as straightforward as other risk factors.
What do you do yourself to age healthy?
I have four children and a demanding job. Luckily I’m anything but socially isolated. Then I don’t smoke, I never smoke, and I go running.
Do you take vitamin D?
No. Various studies suggest that vitamin D may reduce the risk of dementia, but when my team and I looked into it, the effect was minimal. When it comes to healthy aging, nutrition is a factor. We know from many studies that Mediterranean food – lots of vegetables, fish, good fats, and little red meat – reduces the risk of dementia. From this, nutritional therapy in a vial was developed, which I have scientifically accompanied. The test subjects with mild dementia did indeed show effects, but these were minor. Based on the nutritional studies mentioned, we had hoped for a lot more.
How do you explain this?
Maybe there is a lot more to it. Sitting at the table together, talking to each other, and enjoying was not in the bottle. Perhaps that also plays a role in healthy aging. But now we are in a speculative area. What I can say for sure: The human body is just insanely complicated.
Do you have a different view of old age and aging than you did in your early years at work?
Today I think: A maximum memory in old age is, of course, an extreme one high value, there is no question about it, but it is not the only decisive factor for what can perhaps be called satisfaction. It is a bulrush, but I experience it with my patients: it also depends on the cooperation, which is around me, who am I, and how do we deal with each other? My work also includes training relatives, and a lot has happened in dealing with dementia patients in recent years. For example, we urge relatives not to improve people living with dementia if they say something wrong – for example, the weather is beautiful: “Today is winter.” It’s better to ask: “Are you cold?” Because sometimes, there is a message behind what is wrong. Maybe she also thinks of a winter day from her childhood. Then she should be able to tell you about it. Not improving does away with shame, anger, and annoyance on both sides. Besides, I no longer believe in the red button.
The red button?
In my opinion, there are not individual buttons or even the one button that you have to press to stay healthy until old age. I have been working as dementia and senior researcher for 20 years. We have achieved a lot during this time.
For example, with research colleagues, you identified Alzheimer’s biomarkers, which reveal who will get Alzheimer’s dementia years before typical symptoms appear.
We know that dementias develop over decades, with obvious symptoms, many nerve cells have already died. In concrete terms, two proteins are deposited before the typical symptoms appear, amyloid and dew. Later, synapses disappear, and nerve cells go under. But even though we know that Alzheimer’s disease progresses in phases and we see the process, it is still unclear what causes dementia. I suspect that there is no one cause, but that we are dealing with different reasons. Maybe there have to be multiple hits for a person to get sick.
What are these hits?
Different factors that come together. Healthy aging is not necessarily an old free of memory disorders, even if Alzheimer’s is the horror scenario for many – because the disease destroys what defines us as human beings: our memory. It means aging that is as healthy as possible for the body and mind. And I find that very exciting now: The recommendations are incredibly similar. For example, what is good for the brain also lowers the risk of stroke.
You mentioned poor sleep as a risk factor. I have two children, four and eight, and – like many mothers – have slept little over the years. Do I have to worry?
A lot of research is currently being done on sleep. One hypothesis is that the brain is cleaned during sleep; the amyloid, deposited in Alzheimer’s disease, is removed. Another trace also suggests that rest should be given great attention: Researchers found individual dew deposits in adolescents’ brains, specifically in the brain area that is responsible for keeping watch and attention.
Can deposits already occur in adolescents’ form?
Yes, but it is unclear when and how it becomes Alzheimer’s – if it happens at all. But what I already think: how we live as babies, children, adolescents, and young adults, what we experience influences how we experience later in life. There are no moments at the push of a button in the sense of If you do x, y comes out. However, studies show that two active phases of life reduce the risk of dementia. We do not yet know whether this also applies to sleep or whether a lack of sleep in certain life stages – partying, children, shift work – can be compensated for at another time. By the way, too much sleep can also increase the risk of dementia.
Another I-have-to-worry-me question: At 40, I am in the middle of the so-called rush hour of life. In the madness of everyday life from an almost full job, the children, and what seems like a hundred appointments a day, I forget some things. Sometimes I speak to my son by the name of my daughter and vice versa.
After a hard night’s shift, I don’t even know the names of my children! (laughs) Stress and lack of sleep have an acute impact on memory, but this does not indicate dementia, nor is it a preliminary disease stage. If others approach you about forgetting and normal everyday routines no longer run smoothly, you should no longer listen to the here-I-always-buy supermarket’s cereal location.
Will my memory improve again as soon as I no longer have to think for three?
What you describe is an overload. The brain can be thought of as a network. More is not possible. So yes, as soon as the stress subsides, the memory works typically better.
Yes. This effect is confirmed for short phrases. But I can’t tell you if what we call the rush hour of life has a long-term impact. Women, especially mothers, probably have a higher mental load, and more women than men already have dementia today. Even if you calculate that women are getting older. It is suspected that the hormones have an impact. You also have to investigate the role a typical female lifestyle plays.
But research is at a dead end. The two most promising studies with an amyloid antibody failed. To put it merely: Researchers removed Alzheimer’s plaques, indissoluble deposits between the nerve cells, which in some cases succeeded – but the disease neither stopped nor slowed down. Are you discouraged?
I would be overjoyed if the studies were successful. That would have been a breakthrough. Amyloid has been very much in focus in recent years.
Difficult to say. The protein is Alzheimer’s identifier. Ignoring it would also have been wrong, and we learned a lot. I don’t believe in one cause, so it will probably need more than one active ingredient, and now we have to take other approaches, such as taking a closer look at sleep. Nevertheless, for people living with dementia, active ingredients will be found. One day dementia will be curable.
Are you afraid of old age?
No. I do what I can do. It is no longer in my hands.
The doctor Prof. Christine von Arnim, 48, is renowned dementia and senior researcher and owner of the newly created chair for geriatrics at the University Medical Center Göttingen.