Is brain health directly linked to physical and cognitive disability?
Brain health, physical and cognitive disability. Well, they’re kind of linked to each other, they go hand in hand, physical and cognition problems. The cognitive problems probably come a little bit earlier simply because we don’t test for them in clinical practice and so when you take people, even in very early stages of the disease when they don’t have physical problems and you send them off to a neuropsychologist who does these detailed neuropsychological assessments, you often find subtle abnormalities in cognition. Particularly around multi-tasking, shifting between sets, in other words, information loads, etc. And so… and we now know that people who have cognitive problems early on are much more likely to get physical disability. I think it’s just a sign of damage and the fact that the MS has been causing damage, that they’re linked to each other. But what about brain health?
Brain health is determined by two factors really; the size of the brain. So the bigger your brain the more likely you are to remain healthy. And also, what they call cognitive reserve. Now, cognitive reserve’s not necessarily linked to the size of the brain, it’s also linked to education and all the other factors that improve cognitive function. And so the two components of brain health really is brain size and cognitive reserve, and the question is, how do you improve both of those. In terms of brain size, is to make sure you get on to a therapy that renders your disease inactive. I think it’s quite clear now that all the more effective therapies, they slow down the brain loss because in people with MS, just remember that it’s also a normal process, we can’t stop it from happening, it’s going to happen anyway. And then how do we promote cognitive reserve? So there’s lots of things that promote cognitive reserve. Making sure you exercise, healthy diet, make sure you don’t get overweight, don’t drink too much alcohol, sleep well, avoid certain medications that can go into the brain and damage the brain. We also encourage people to stop smoking, we know that smoking’s not good for brain health. If you develop another disease like hypertension, diabetes, make sure that those are all controlled.
So there’s all these aspects of brain health that are not really linked to MS, just to lifestyle, that are really, really important. And those improve cognitive reserve. Because what cognitive reserve does, it allows you to live a normal life and when you get older, age normally – because that’s very, very important for people with MS to think about the future, and unfortunately, if I can just get sidetracked here, evolution never designed the brain to live to 80 or 90 years of age. In the past, in our ancestors, their life expectancy was less than 30, and so the fact that we’re now living in our seventies, eighties, nineties, is just not part of what evolution designed the human brain for. So that’s why almost everybody in society if they live long enough will have cognitive problems. And so what we’re trying to do with our Brain Health: Time Matters initiative, is to try and explain to people with MS that we need to optimise their brain health, not only because they’ve got MS right now, but what about when they’re older. We want to give them the best chance of having a healthy ageing as possible. So that’s kind of the long term view of brain health in MS.
This interview is part of an MS Reporters Sponsored Series on brain health, supported by Novartis.
MS Reporter: Cat
MS Expert: Prof Gavin Giovannoni works at the Blizard Institute, Barts and The London School of Medicine and Dentistry. Gavin is a Professor of Neurology, seeing MS patients and involved in clinical academic research.