Aging and the Brain

New research on old age and the brain yields surprising results

A Q&A with Robert J. Dempsey MD, Manucher J. Javid professor and chair of the department of neurological surgery at UW–Madison

Q: In general, what changes does the brain go through as it ages?
A:
Several things take place. The vessels delivering nutrients may themselves age—they begin closing or get brittle—and then regions of the brain may lose nutrients they need to be plastic, nimble or, worse, alive. People may lose brain cells over time. Things like smoking can enhance that process, but eating and sleeping right can avoid aging of the brain.

My particular interest is ischemia, or stroke, with a secondary interest in brain tumors and other conditions of the brain. I look at injury by strokes as well as prevention, treatment and repair and trying to teach the injured brain to heal. A lot of the processes in which the brain ages are accelerated and cumulative, causing it to shrink and age prematurely.

We hope that changing this could be as simple as diet or medication. What we’re doing in our lab is looking at the process of atherosclerosis and how it may potentially signal that vessels throughout the brain are getting worse. We’re looking at studies with ultrasound tests to see if the vessels stiffen or get less supple with age and how this may predict stroke and premature brain aging.

Q: Why do some people age more successfully than others?  
A:
Cognitive independence and caring for yourself is how a lot of people would define [aging successfully]. Some were born with good longevity genes; they may have escaped the genetics that predispose a family to cancer or diabetes. There’s little doubt that all living things age. But there’s also little doubt that we have accepted normal aging when it may not have been. It may be premature to simply say that’s just life; many studies have suggested we should not be complacent, but vigilant.

Q: You are studying brain strokes. Why are these so important to look at?
A:
We now know that sub-clinical ischemia is more common than we thought, which are “silent strokes.” If you took a high-quality MRI scan of a person who had a minor stroke they may appear perfectly normal, but they might have had an area of their brain that died. The end result is premature vascular cognitive decline—people can lose their memory and the ability to care for themselves.

Atherosclerosis is a systemic disease and affects all blood vessels, but not all vessels equally. Our study suggests that atherosclerotic change in vessels is more important clinically than we thought. So [people should know] things like their cholesterol and blood sugar numbers and have these conditions treated if the numbers are abnormal. These are things we can all do now. It’s well worth it for heart attack and silent stoke prevention.

Right now we’re studying people who already have high-grade blocks in their carotid arteries. They may or may not know they had a little stroke, and we’re looking at their cognitive function. We’re looking at the bits of pieces of these blockages that get up to the brain, and removing those blockages to prevent this material getting up to the brain. Maybe that would improve one’s cognitive future.

There is some rather concerning speculation that this may be numbered in the millions as we look at a segment of the population with these new high-quality MRI scans.

Q: What does this mean for future treatment of the aging brain?   
A:
We look at the plasticity of the brain and its ability to repair itself. The brain does not stop growing. That’s in the lab right now and it’s promising and exciting, the process in which the brain tries to heal itself—can we accelerate that? We’re beginning to ask questions that could profoundly affect tremendous illnesses like vascular dementia, Parkinson’s and stroke.

Our research involves non-invasive ultrasound and cognitive testing. We’re using it to determine a decline in one’s memory or decision making, which could be the signal we’re looking for. So [extrapolate that] and this could be a part of [your yearly physical]. We want [these tests] to be applicable worldwide—not just at high-end research centers. We want to use tools that can be used in any doctor’s office. I do
medical missions around the world, and delivering care in a rational fashion is what I’m interested in.

Shayna Miller is associate and style editor of Madison Magazine.

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