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Are You Stressing Yourself Towards Alzheimer's Disease?

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Consider managing your stress before it manages you. Regardless of whether you've chosen your good stressor (planning a big party for someone special), keeping yourself in stress mode for weeks, months, or years at a time will do a number on your hippocampus that sets up vulnerability to Alzheimer's disease. Here's how it works:

When the brain perceives stress, it orders the adrenal glands to release cortisol. Cortisol is useful for getting us through brief and necessary rough patches of life, but chronically dosed from within, cortisol keeps blood pressure high, deposits fat around the waist, and promotes heartburn and gastric ulcers, and shuts gown the immune system.

Another adverse effect of the chronic release of cortisol, which is harder to see until it is too late, is shrinkage of the hippocampus, the part of the brain that we rely upon for the retention of new information. One of my favourite university professors spent decades studying the effects of stress on baboons. After observing East African baboon troop hierarchies and taking blood samples to characterize each baboon's stress hormone levels, he learned that high release of cortisol -- due to sitting at the bottom of the baboon pecking order -- can shrink the hippocampus. This happens in humans as well.

The hippocampus is the area of the brain, deep and on the underside, that serves as a filing system for incoming information. No hippocampus, no new memories. Imagine the mind being stuck at one point of a life history but living out each subsequent day fairly normally otherwise.

Alzheimer's disease destroys additional cognitive abilities besides short-term memory loss, but the hippocampi and its neighbours are the first brain locations where abnormal proteins collect. Whatever a person can do to protect the hippocampus from excessive stress and keep it robustly connected to the rest of the brain's memory processing hubs can help stave off Alzheimer's disease. Conversely, recurrent depression and post-traumatic stress disorder relate to hippocampal vulnerability, likely via cortisol levels.

We all require stimulation to enhance the brain's plasticity, but we need just the right amount of cortisol-inducing activity -- not too much. We all understand the risks of job burnout, but if my job were going to result in brain-out, it wouldn't be worth it.

Dr. Sapolsky has learned that lowering stress and corticosteroid levels allows the hippocampal region to recover size and function. "We are not getting our ulcers being chased by saber-tooth tigers, we're inventing our social stressors -- and if some baboons are good at dealing with this, we should be able to as well," he writes. "Insofar as we're smart enough to have invented this stuff and stupid enough to fall for it, we have the potential to be wise enough to keep the stuff in perspective."

This is where life balance proves to be a good long-term strategy. Dr. Sapolsky does not accept any invitations to speak at conferences unless he can be home in time to tuck his children into bed. He draws a thick line to let everyone know where his home life needs to be balanced against his professional life, and that's exemplary.

How do you know if you're in that stress mode? You can't manage your stress if you don't even realize you're in stress mode. Ask yourself today (and answer honestly!):

1. Do I feel safe?
2. Do I feel loved?
3. Do I feel healthy?
4. Do I feel happy?

The most important thing I've learned about loving kindness is that it begins with wishing oneself to be feeling safe, loved, and healthy, and living with ease. Much of today's stress is linked to the perception that only you can deliver the product or provide the service and that you must. My parents taught my brother and me to consider the needs of others first. Compassion is important, but it takes skill to stop short of overextending oneself.

When you're stressed moderately, you will not feel safe, loved, healthy or happy. Your balance has been upset, and, in my work at a clinic for dementia, most caregivers find too late that their own needs have not been met. Sometimes they intentionally put off the practice of loving kindness for themselves, holding their breath until the end of the dementia. But dementias can last for as long as 20 years, too long to delay gratification of one's needs. At worst, a caregiver will feel trapped and resentful of the patient and others who are not contributing to care. One of the major themes of education in our clinic is the idea of pacing -- making time for oneself amid the caregiving duties. This almost always requires that the caregiver share the experience with others.

In this lies the key to managing that stress. You often can't make the situation go away, but you can reconfigure how you address it and how you prioritize further action steps. It never fails to surprise me how so few caregivers feel that they deserve some respite or leisure time or even time to debrief with a friend. Leisure time is for managing stress, and it may be a crucial factor in the caregiver's own vulnerability to Alzheimer's or other dementias, like the type caused by stroke. While we cannot always avoid negative situations or harm, we can work on how that harm affects how we perceive the world and ourselves in it.

An example of shifting perception to reduce the stress of caregiving is that it is possible and even imperative for caregiver-patient interactions to be open and playful. But first it requires letting go of expectations of the patient's former abilities, letting go of the shared history that shaped those expectations over many years. I will not delude myself that this is easy to do, but I urge caregivers to make an effort to have one interaction like this each day with the patient, however brief. The idea is to have quality time together, to underscore or acknowledge that joy is an important part of life and is integral to the feelings of safety, health, and being loved.

Self-esteem is also linked to Alzheimer's risk. People experience a more beneficial cortisol production rate when self-esteem is high. That comfortable sense of self varies among individuals and is affected by life's experiences and by genetic make-up. Regardless of emotional or spiritual background, you can develop skills in appreciating the joyful aspects of life and practicing a compassionate outlook with equal concern for self and others. Your intentions may always be noble, but skill is what determines your level of stress. The good news is that the effects of cortisol are REVERSIBLE. Reducing your stress can re-inflate your hippocampi, so start managing that stress yesterday.

[Excerpted from The Memory Clinic]

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