Stroke is the leading cause of disability worldwide and the second leading cause of death. Large and small strokes and disease of small cerebral blood vessels can lead to dementia, as well as milder degrees of cognitive deficit (vascular cognitive impairment). Strokes may be large or small and may occur with or without bleeding in the brain. The brain can also be damaged by a long-term lack of sufficient blood flow with loss of the axons, needed for neurons to communicate with each other. Attention to the four reserve factors (cognitive, physical, psychological, and social) can help to prevent stroke as well as improve recovery and diminish the effect of stroke on cognitive function. Cerebrovascular disease makes a very important contribution to cognitive impairment with aging. Recent studies have demonstrated several ways in which bacteria that reside in the mouth are involved in causing strokes. There are many modifiable risk factors for stroke including a high-fat diet, obesity, smoking, poor oral hygiene, physical inactivity, atrial fibrillation, alcoholism. Lifestyle factors play a large role in the risk of all forms of stroke

The neurodegenerative diseases Alzheimer’s, Parkinson’s, frontotemporal lobar degeneration, Lewy body disease, and amyotrophic lateral sclerosis are all age-related and caused by genes in only 1-10 percent of cases. Dementia describes a syndrome in which there are cognitive difficulties including impaired memory, judgment, planning, language, and other deficits. Alzheimer’s is the commonest cause of dementia. In the brain in neurodegenerative diseases there is abnormal folding of proteins creating thread-like filaments called amyloid. There is also abnormal activation of inflammation with free radicals and harmful cells. There are things we can do regarding diet and other actions that can lower the risk of developing neurodegenerative diseases with aging. High levels of physical and mental activity throughout life along with attention to a healthy plant-based diet can enhance our four reserves and diminish amyloid deposition and overactivity of the immune system. Lifestyle measures can also protect us from the effect of brain pathologies that may develop. There are many causes of memory loss other than Alzheimer’s disease which are completely reversible when properly recognized.

Humans are social beings and relationships with family and friends are critical for health at all stages of life. Studies have shown a higher risk of dementia in later life in individuals with poor social interactions. At all stages of life, it’s desirable for people to have healthy relationships with others. Maintaining a socially active lifestyle in later life enhances cognitive reserve and benefits cognitive function. The physical component of social interactions is also of value. Interpersonal experiences can influence the structure and function of the brain in both early and later life. Opportunities for interactions with other people enhances social reserve and improves cognitive, physical, and psychological reserves. Studies suggests that dementia is more common in those whose social engagement declines from mid- to late-life. Having stronger social contacts protects people from the manifestations of aging and age-related brain disease. Social interactions can be enhanced in aging through community organizations, social action groups, religious activities, and travel. Pursuing activities that help you find meaning will also help you make social connections.

There are several other important causes of dementia in younger and older persons. Normal pressure hydrocephalus is a condition with altered absorption of spinal fluid leading to cognitive losses, gait disturbances, and poor control of urination. It may be successfully treated with surgery. Creutzfeldt-Jakob disease is a rapidly fatal progressive condition caused by a potentially transmissible form of a prion, an abnormally folded protein. Bovine spongiform encephalopathy is another prion disease associated with eating infected cows. It is now recognized that small and large head injuries are bad for the brain and can cause serious cognitive and motor deficits, and progressive untreatable dementia. Repeated blows without visible immediate effect can lead to brain degeneration. A critical way to maintain cognitive reserve is to avoid all kinds of blows to the head. Excess consumption of alcohol is very damaging to brain function and can lead to dementia, as well as nerve damage and injury to several other parts of the body, such as the liver, heart and intestines. It is recommended that men should not consume more than two doses of alcohol a day and women not more than one.

Our ancestors had a vastly different diet than the one we have today. They had a much higher fiber content in their diet with less meat. This earlier human diet led to greater diversity of gut bacteria, which we now understand is important for health. Considerable research is being done worldwide about which bacterial populations will be best to consume as probiotics (live bacteria believed to aid health and enhance bacterial populations in the gut). Consumption of yogurt which has live bacteria is desirable, but don’t eat yogurt with a lot of sugar. Rather than eating yogurt with added fruit and sugar, it’s better to eat plain yogurt and add your own fruit. Prebiotics are non-digestible fibers that cannot be digested by people, which are designed for their ability to be metabolized by desirable gut bacteria. Consumption of high-fiber foods (including fruits, nuts, legumes, brown rice, beans, whole grains, vegetables, whole wheat bread) will have a similar effect on the microbiome as prebiotics. It is wise to avoid low-fiber foods such as red meat, which is high in saturated fat and provides little of the nutrition which is needed by our microbiota.

During stressful experiences the endocrine and brain systems involved have distinct neurochemical processes which enhance the power of the memory. Post-traumatic stress disorder is due not only to psychological factors, but neurochemical and evolutionary ones as well. It is valuable for people who have experienced stressful life events to realize that the power these memories have is not entirely psychological. It is in a deeply developed neural pathway created and preserved in the brain in a resilient fashion. Understanding that this is not a question primarily of “getting over It,” but rather “learning to live with it” may help. Stress has many effects on the brain and the body. Bolstering your physical reserves with physical activity, effective sleep, and a healthy diet enhances the ability to deal with stress. The experience of stress involves not only the brain, but also the body’s cardiovascular system and other parts. It is best if the work of dealing with stressful factors is accomplished early, before the achlyievement of great age. Several strategies can help to deal with stress: restful sleep, meditation, diet, cognitive and physical exercise, and avoidance of toxins.

Humans are born with 23 pairs of chromosomes and 20,000-25,000 genes. Genes are sequences of nucleotides (the basic structural unit of nucleic acids) that code for the amino acid sequence of proteins. It is important to know that the genetic information contained in the chromosomes does not directly determine what happens to us. Rather, the genes provide information about what can be done. What actually happens is an interaction between the genes and the environment. That is, how we live influences the action of our genes - the context is supreme. Genes are the cause of Alzheimer’s in only 1 percent of cases. A form of the apolipoprotein E gene called e4 increases the risk of getting Alzheimer’s by 2-10 times, depending on the dose of the gene (one or two copies). However, many persons with the risk form of the gene are not affected. In the majority of cases of Alzheimer’s there is a key interaction of genes and environmental factors which determines who becomes affected and at what age. Although genetic testing can be done to predict risk it is not currently recommended, as genetic tests are not needed to have commitment to preventive measures.

The results of the 10-week randomised trial were published in the Lancet in July 1988 (Tyrer, Seivewright, Murphy et al., 1988). The main findings at this point did not include any analysis of the general neurotic syndrome as this was not a term that would have been understood by the average reader and would have just led to confusion. The results were presented in a standard manner, focusing on the effects of the five treatments (Figure 4.1) and of the outcome of the three diagnostic groups (Figure 4.2).