In “The Naked Lady Who Stood on Her Head: A Psychiatrist’s Stories of His Most Bizarre Cases” (William Morrow, $25.99), Dr. Gary Small and his wife, Gigi Vorgan, detail therapeutic challenges Small has encountered throughout his career as well as incidents from his personal life. In the final chapter, “Sigmund Fraud,” the book touches on aging by recounting what happened when Small’s friend, also a psychiatrist, started developing Alzheimer’s.
“It was an unusual situation because my own mentor came to me for help,” Small said. “It was daunting. ... Even when we’re middle-aged, there’s a part of us that looks to others as mentors. So the idea of someone like that coming to me for help was challenging.
“Here I am, an expert in Alzheimer’s, [but] I didn’t recognize it as quickly as I should have because it was someone I was close to. I think it’s a very painful disease to recognize when it’s someone you’re close to because you feel a sense of helplessness.”
Small is the Parlow-Solomon Professor on Aging at the David Geffen School of Medicine at UCLA, director of UCLA’s geriatric psychiatry division and heads several institutes that study aging and memory. He has written a number of books on the topic, including some with Vorgan, like New York Times best-seller “The Memory Bible.”
“I don’t know if we can prevent [Alzheimer’s] altogether,” Small said. “I think the strategy is the lifestyle approach, trying to protect and help the brain rather than repair it.”
The reason lifestyle changes are important, Small says, is that genetics contributes only a third of what determines how long and how well we age. That remaining two-thirds can be affected by making the right choices.
“There is a lot of scientific evidence supporting [the idea] that many different lifestyle choices that protect the brain [can] stave off Alzheimer’s disease and improve memory,” Small said.
In the course of writing books on healthy aging and memory improvement, Small and Vorgan have identified four important lifestyle areas over which people have some control: mental exercise, physical training, stress reduction and healthy diet.
“There have been a lot of studies showing an association between mental stimulation and lower risk for developing diseases like Alzheimer’s, but a definitive cause and effect has not been proven. Some studies have found that animals with interesting and stimulating toys in their cages have better memory. They don’t get lost in the mazes,” Small said.
He says that it’s important for people to find their own interesting toys: mental challenges, like crossword or Sudoku puzzles, which are neither too hard nor too easy. Also, be sure to cross-train the brain by doing a jigsaw puzzle or trying to solve a maze puzzle, which uses the right side, and a crossword puzzle or a word scramble, which uses the left, he says.
“I instinctively do that myself. One day I’ll do a Sudoku puzzle, the next day a crossword puzzle, to shake things up,” Small said.
“There are other exercises,” Vorgan added, “other ways to tweak your brain, such as brushing your teeth with the other hand.”
“Another kind of specific brain exercise is learning memory techniques,” Small said. He and Vorgan call one method Look, Snap, Connect.
“ ‘Look’ reminds us to focus our attention. The biggest reason we don’t remember is that we’re distracted and not paying attention. ‘Snap’ means to create a mental snapshot or visual image of the information. And ‘Connect’ reminds us to figure out a way to give the information meaning and link it up with something we will remember,” said Small, who credits the method’s name to Vorgan.
Small’s memory-improvement techniques are aimed at the four most troublesome areas: names and faces; perspective memory (which happens when you say to yourself, Did I leave the stove on?); misplacing items; and the “tip of the tongue” phenomenon: you should know the word or name but can’t remember it.
Small said that physical exercise is also important in “protecting the brain.”
“One study found that a 10-minute brisk daily walk can lower your risk for Alzheimer’s disease,” Small said. “With regular exercise, you not only increase the blood flow to your heart, you also increase the blood flow to your brain. You’re reducing your risk for a number of age-related illnesses like diabetes, high cholesterol, hypertension — and these conditions are not good for your brain.”
Small and Vorgan recommend following a healthy brain diet, which features four components. The first is to eat moderately to avoid weight-related illnesses like diabetes or hypertension, which can lead to small strokes in the brain that affect memory. The second is not to eat too much fat, but to emphasize healthy fats in the diet, such as the omega-3 fatty acid from fish and olive oil, which are brain-protective, anti-inflammatory and anti-oxidant. The third is to eat fresh fruits and vegetables for anti-oxidant properties. And, finally, try to avoid processed foods, such as crackers and chips.
The final area for improving memory and staving off Alzheimer’s is stress management.
“A lot of studies show that stress is not good for the brain,” Small said. “I’ve seen a lot of benefit in my patients when they start using simple techniques to lower their stress level. ... You can take a yoga class, learn to meditate, learn breathing exercises. ... It’s important that people try different techniques. Not everything works for everybody.
“A wonderful way to manage stress and get your physical exercise is to take a walk with someone who’s part of your life and talk about your day at the same time. So you get the exercise and the social connection. The social connection is very important: Talking about what’s bothering you relieves stress.”
Small said that religious services might also provide stress relief.
“There’s a study that found that attending church or synagogue ... once a week is associated with a seven-year greater life expectancy,” he said. “Now, it’s not proof of cause and effect,” Small said. But he speculates that attending a synagogue could reduce stress because one spends time with “like-minded people who can offer support.”
Small added that when people combine all four — mental exercise, physical training, healthy diet and stress management — the whole is more than the sum of its parts.
“I think that in the not-too-distant future we’ll deal with Alzheimer’s disease in the way we deal now with high cholesterol. ... We’ll do a brain-check, and there will be a medicine or vaccine that will stave it off.” He said that “good tools” are being developed that will identify a potential problem years in advance and provide medical intervention.
“If we could delay the onset of the disease for just five years, that would have a significant impact on people’s lives,” he said.