A: The term “superfood” has become a pop­ular way to describe specific nutrient-rich foods that support brain function and other aspects of health. And while there is no food like Popeye’s spinach that provides instant ben­efits, there are certainly plenty of foods that contain vitamins, minerals, and other nutrients associated with better brain health. For exam­ple, cold-water fish such as salmon, mackerel, and tuna are rich in omega-3 fatty acids, which are nutrients associated with cognitive health. Fish can also be an excellent source of vitamin B12, which plays a role in the health of brain cells, nerve cells, and blood cells. Berries, including strawberries and blueberries, are also linked to better brain health. Berries are packed with antioxidants, which help prevent cell damage and reduce inflammation. The fiber in berries supports better gut health, which is also associated with healthy brain function. Other foods beneficial for your brain include beans, leafy greens, and whole grains.

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A: While many studies examining this ques­tion have been inconclusive, there is a sizable amount of research that suggests greater educational attainment is associated with lower risks of dementia. One study from a few years ago found that individuals who are illiterate are nearly three times as likely as their literate peers to develop dementia in their lifetime. There are a couple of possible explanations for this association. One is that more education contributes to a person’s cognitive reserve, the ability of the brain to adapt, improvise, and find new ways to solve problems or make deci­sions. Studies have shown that certain people with brain changes consistent with advanced Alzheimer’s disease showed few signs of dementia. Similar results were found among some individuals with brain changes associated with Parkinson’s disease and stroke. Cognitive reserve also appears to help people weather unexpected life changes, such as stress, chronic illness or surgery, and other health threats. In many cases, people who seemed to have a healthy cognitive reserve also had higher levels of education. Researchers also suggest that individuals with more education often achieve a lifestyle that affords them greater access to quality health care. Understand, though, that a lifetime of curiosity and self-directed learning, without a formal degree, can boost cognitive reserve. Anyone, regardless of their education, can follow a brain-healthy lifestyle.

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A: An estimated 10 to 20 percent of older adults have orthostatic hypotension, which is a drop in blood pressure when you go from sitting or lying down to standing. The sudden drop in blood pressure means less blood is flowing to the brain and muscles. Pos­tural hypotension increases fall risks. You can reduce that risk by taking your time shifting positions and holding on to something secure when you stand up. You may be able to increase blood flow before you stand up by moving your legs and feet and clenching your fists. Talk with your doctor about other steps that might be helpful. Unlike most of us, you may be encouraged to add more salt to your diet, as it can sometimes help raise blood pres­sure. If you have low blood pressure all the time, and not just when you rise, it may be that your “normal” blood pressure is just lower than what it is for others. Still, pay attention to signs that your blood pressure may need atten­tion or that you may have to adjust your activi­ties accordingly. If you frequently feel tired or weak, be sure to tell your doctor.

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A: Minor differences are quite normal and may be due to something as simple as the blood pressure cuff fitting a little differently around one arm compared with the other. Some people also experience a slightly higher blood pressure in their dominant arm. If you are right-handed, for example, your blood pressure reading may often be a little higher in that arm. If you use a home blood pressure monitor, it’s a good idea to periodically check both arms and try to be as consistent as possi­ble in how you measure the blood pressure in both arms. Larger discrepancies from one arm to the other, however, can indicate a problem such as a partially blocked artery in one arm. If you notice a difference in the systolic pressure of 20 mmHg or more or a difference in the diastolic pressure of at least 10 mmHg tell your doctor soon.

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A: As people get older, they can feel they have less control in their lives. Worries about health, money, and the passing of friends and relatives can trigger serious anxi­ety and depressive symptoms. So, it’s common for people to resist change more and more as they get older. Routines provide security and a level of comfort. Change introduces unpre­dictability into their lives and disrupts some of the things that give them peace of mind.

You can help by being understanding and reassuring that trying something new doesn’t mean giving up anything important in her life. Give your mother the space to feel how she feels, but don’t necessarily give up introducing new experiences into her life. Learning new things, seeing new places, meeting new peo­ple, etc., are all important for cognitive stimu­lation and mood enhancement. You may just need to start small. If she doesn’t want to go to a new restaurant in town, think about getting takeout from there so she can try a new dish in the comfort of her own home. If she likes it, she may be more willing to go to the restau­rant next time. If your mother’s resistance to change is accompanied by other concerning changes in memory or thinking skills, depres­sion or anxiety, or behaviors such as hoarding or diminished hygiene and self-care, then con­sider accompanying her to see her doctor or other medical professional and sharing what you have observed.

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A: Decision-making, focus, and planning are higher-level activities that help comprise the brain’s executive functions. While these functions also tend to suffer as a result of Alzheimer’s disease, those changes usually follow noticeable declines in memory, par­ticularly related to recent events and conver­sations. Frequently misplacing items or struggling to find the right words (or using the entirely wrong words to describe things) are also early Alzheimer’s symptoms.

Minor changes in executive function may be due to normal age-related brain changes. More frequent or difficult changes may indicate the presence of vascular cognitive impairment (VCI). In many cases, VCI is the result of cardiovascular disease, a history of transient ischemic attacks, diabetes, or other conditions that affect blood flow to the brain. You and your husband should consider talking with his doctor about executive function changes and whether an assessment of his cardiovascular and cerebrovascular health is appropriate.

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A: The reasons we forget some things and remember others, even when both bits of information seem to be similarly trivial, aren’t always obvious or easily understood. In general, though, it comes down to a “use it or lose it” dynamic. If information, such as what you have for lunch, isn’t repeated, thought about, written down, etc., you’re bound to forget a lot about that lunch within hours, let alone days. It’s not efficient for the brain to hold on to every shred of information and experience, so to make room for new memories, old ones (and often relatively new ones) have to go. If you’re wor­ried about not immediately remembering a recent meal you had or a movie you watched, you’re not alone. It’s a phenomenon that affects people of all ages and all levels of cognitive health.

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A: Getting a recommendation from someone you trust is a good place to start. Of course, you’ll want to make sure that this thera­pist accepts your mother’s insurance or charges a fee that can be paid without causing financial hardship. The other important consideration is whether a particular therapist is a good match, not just for your mother, but for her particular needs or concerns. While it’s not essential, a therapist with more experience working with older clients who have depressive symptoms may be more likely to effectively help your mother. Keep in mind that a mental health pro­fessional who comes highly recommended may simply not be a good match for everyone. Your mother should feel comfortable sharing her thoughts and feelings with her therapist and

feel like that person is responding in a positive and helpful way. Consider attending that first session or at least part of the session with your mother, as it appears you may be directly involved with her mental health care. And if it doesn’t seem like a good match, you can always try to find someone else.

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A:  Atrial fibrillation (A-fib) raises the risk of blood pooling in the heart and causing the formation of a blood clot. Anticoagulant medi­cations, such as dabigatran, apixaban, and oth­ers, reduce the risk of blood clot formation and therefore lower the risk of a clot making its way to the brain and causing a stroke. For that rea­son, taking a blood thinner if you have A-fib may be a life-saving decision. As you are also aware, blood thinners are associated with a greater risk of bleeding complications. Researchers have investigated whether blood thinners significantly raise the risk of hemor­rhagic strokes, and it appears that brain bleeds triggered by anticoagulation therapy are rare. However, if you do have a brain hemorrhage or any other type of bleeding event, being on an anticoagulant may make the bleeding worse. The key is to take your blood thinners exactly as prescribed. Taking them incorrectly may lead to potentially severe bleeding or clotting problems. It’s also important to report any unusual symptoms, such as nosebleeds or blood appearing in your urine or stool, to your doctor immediately. Because the ischemic stroke risk associated with A-fib is significant, while the risk of a blood thinner contributing to a hemorrhagic stroke is very low, you are better off taking the medication as long as you don’t have any concerning side effects. If you have any questions, ask your doctor. 

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A: Seasonal affective disorder (SAD) is a type of depression that usually starts in late fall and lasts through the winter. It tends to bring on feelings of sadness and lethargy. People who experience SAD often say they don’t feel like themselves and have trouble handling their daily activities. The consensus is that shorter days and reduced sunlight exposure in winter affects levels of the mood hormone serotonin, leading to depressive symptoms. People who experience SAD may also produce too much melatonin, a hormone that plays an important role in the sleep-wake cycle. Disruption in the hormones involved in the circadian rhythms that control sleep and other functions may be at the root of SAD symptoms.

As to your question, yes, “summer SAD” may also be a condition related to changes in sleep and mood hormones. While seasonal affective disorder in the summer months is less studied and not as well understood, some researchers suggest that the longer, sunnier days of summer may cause the body to produce such low levels of melatonin that insomnia or other sleep problems result. Insufficient sleep may cause depressive symptoms similar to those experienced by people who suffer from winter SAD.

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