Life Extension Magazine March 2008
Brave New World: Dr. Eric Braverman’s Path to Earlier Detection and Treatment of Cognitive Decline
Life Extension Magazine March 2008
For thirty years, Eric Braverman, MD, has been in the vanguard of a new breed of physicians, blazing a path towards a new paradigm for 21st-century medicine. Dr. Braverman founded his popular New York City practice, The Place for Achieving Total Health (PATH Medical), with the intention of integrating conventional and alternative medicine; and fulfilling an unmet medical need to merge neurology, psychiatry, internal medicine, and nutrition.
Along the way, he’s found time to publish some bestselling books, host a medical topics show on radio, and appear on national television sharing his medical insights recently with viewers of The Today Show and The Tyra Banks Show, among others. Dr. Braverman also directs the PATH Foundation, a nonprofit research organization dedicated to the diagnosis, prevention, and treatment of “all aspects of brain biochemical disorders, with specific focus on the impact of brain illness on overall health.”1
And that brain/body focus has been a central theme throughout his distinguished three-decade career so far. As the old saying goes, “A mind is a terrible thing to waste,” and Dr. Braverman would undoubtedly agree. As a leading integrative medicine practitioner, he’s worked tirelessly to investigate the intimate connections between mind and body, and to understand how brain function impacts every aspect of physical health.
His timing is excellent. As aging baby boomers reach retirement age, many are grappling with the effects of dementia and Alzheimer’s disease on their parents or partners as depicted in the recent feature film, Away From Her, starring Julie Christie, Gordon Pinsent, and Olympia Dukakis. In this poignant film, two aging couples struggle with the tragic effects of cognitive decline. It’s a story that’s all too familiar to Dr. Braverman.
In addition to the pain and struggle of watching loved ones succumb to this degenerative disease, unafflicted friends and family members are often left wondering if a similar fate awaits them. Fortunately, Dr. Braverman and colleagues have made huge strides towards harnessing their insights into the brain/body connection, using this knowledge to help prevent, diagnose, and treat the wasting away of minds which so often accompanies advancing age. And that’s good news for everyone.
AGE Statistics—and Hope for the Future
When it comes to aging’s toll on the mind, no one is safe. Statistically speaking, we’re all at risk of having our minds waste away as we age. And the decline in mental acuity occurs sooner than you might think.
“We’ve found that people start losing memory by age 50,” says Dr. Braverman’s colleague, Kenneth Blum, PhD, adjunct full professor in the Department of Physiology and Pharmacology at Wake Forest University, Winston-Salem, North Carolina. “Now that people are living longer, we’re seeing more dementias,” he adds. Dr. Blum, who is credited with discovering the “alcoholism gene,” is co-founder, with Dr. Braverman, of PATH Medical. In a scientific article they published recently in AGE: Journal of the American Aging Association, Drs. Braverman and Blum note that studies suggest 50% of people reaching the age of 80 will progress to advanced dementia. At that rate, says Dr. Braverman, “Everyone would end up demented if they lived long enough.” As it is, dementia is currently the eighth leading disability in the United States.2
Dr. Braverman believes that early diagnosis is critical because most forms of disease are examples of “accelerated aging.” Just as it’s possible to prevent fatal diseases, such as heart attacks and cervical cancers, with blood screening, MRIs, and Pap smear screenings, Dr. Braverman believes it is now possible to detect early signs of brain illness before it develops into intractable dementia or Alzheimer’s disease. “No one over 50 has to lose memory or attention as they age,” says Dr. Braverman.
A Looming Crisis
There is a veritable crisis our population faces as the huge cohort of baby boomers continues to age. What will happen when most aging boomers become cognitively disabled?
Fortunately, Dr. Braverman believes there are steps one may take to identify, and ideally slow or even reverse, the course of cognitive decline beginning at its earliest stages. For the past three decades, Dr. Braverman has focused his attention on the brain, with special emphasis in recent years on the problems inherent to aging brains.3,4 He’s come to view the brain as “the holistic organizer of the whole body’s health;” he sees the brain’s health as inextricably linked with that of the body, to an extent seldom fully appreciated by ordinary clinicians, who tend to treat individual organs or systems, rather than considering the ramifications of the complex interrelationships among organ systems.
Pause to Consider the Aging Body and Mind
An integral part of Dr. Braverman’s forward-thinking approach includes the extension of the concept of menopause to include a variety of “pauses,” which affect both men and women throughout life. Among these is the “andropause,” which may already be familiar to some readers. Once controversial, it’s now widely recognized that, much like women undergoing the “change of life,” aging men also undergo significant changes in hormone levels.5-7 These changes may have wide-ranging effects on well-being. Steady declines in the male sex hormone, testosterone, are known to “alter mood, memory, ability to concentrate, and the overall sense of vigor and well-being that may interact with a host of other psychologic changes associated with aging.”5 Another example is the “adrenopause,” characterized by deficits in important hormones such as DHEA and pregnenolone.
Less familiar, but no less plausible, is the novel concept of “electropause,” or the gradual slowing of brainwave activity. The precise measurement of this activity forms the cornerstone of Dr. Braverman’s new approach to identifying and predicting early cognitive deficits. Other proposed “pauses” include the “psychopause,” which involves age-related changes in mood, personality, and anxiety levels, and the “somatopause,” which is related to declining levels of human growth hormone. Not coincidentally, assessment of growth hormone plays an integral role in both the early diagnosis and treatment of cognitive decline, according to Dr. Braverman’s brave new paradigm for brain health.
Diagnosing Early Cognitive Decline
In the AGE article,2 Dr. Braverman and colleagues describe a breakthrough in the diagnosis of early cognitive decline. If widely adopted, this simple and reliable procedure could transform the way men and women—and the physicians who care for them—approach aging. This simple new diagnostic procedure combines data from three sources:
A mathematical model integrates the data from these three sources, allowing clinicians to identify patients at risk of early cognitive decline potentially decades earlier than might otherwise be possible. This new prognostic method represents a significant achievement in anti-aging medicine. As Dr. Braverman wryly notes in his book, Younger You: Unlock The Hidden Power of Your Brain to Look and Feel 15 Years Younger, “By testing early and often, you can catch this disease while you can still remember to take the tests.”8
Zero to 100 in 100 Milliseconds
Every thought, every decision, every fondly recalled memory, or seemingly random impulse we experience, is the result of electrochemical activity in the brain. In fact, this activity is so fundamental to life that most nations now define death not by the absence of heartbeat or respiration, but by the absence of brain electrical activity.9
The BEAM (Brain Electrical Activity Mapping) electroencephalogram, developed about 15 years ago at Harvard and routinely used by Dr. Braverman, is a sophisticated, computerized, non-invasive instrument capable of measuring these impulses in order to detect early cognitive decline. Electrodes are placed at various points on the head. A series of stimuli, in the form of unexpected sounds or lights, are presented to the eyes or ears. Each stimulus elicits a wave (known as the P300 wave) of electrochemical impulses that travels from the relevant sense organ toward the back of the brain. As one scientist puts it: “The P300 wave shows the modifications in neuronal activity which take place during the cognitive process…”10 As such, it is a sort of snapshot of cognition in action.
Extensive research has shown that the latency (or lag time) between presentation of a stimulus —a bright light impinging upon the eye, for instance—and the brain’s reaction to that stimulus is 50 milliseconds (ms), or one-twentieth of a second. The brain reacts to sound in one-tenth of a second. Thought requires approximately 300 ms or about three-tenths of a second in healthy young adults. Although, to be more precise, latency usually equals 300 plus a subject’s age. Thus, a 50-year-old would be expected to register a P300 of about 350 ms. Essentially, the P300 is a measure of mental activity. Or to put it still more simply: three-tenths of a second represents the “speed of thought.”
“Keep in mind,” says Dr. Braverman, “we only have 100 ms to lose in the course of our lives. That’s just one-tenth of a second.” After a lifetime of illnesses, traumas, and other insults, processing speed declines (reflected by an increase in the P300 latency score), and the brain slows. A mere 100 ms of additional lag time between stimulus and reaction results in a fatally dysfunctional brain. “By the time thought takes four-tenths of a second, a person is demented,” Dr. Braverman observes. While it may not result in death, such a decline usually leaves a patient in a state that can be characterized as “the living dead—so demented they’re not really alive,” says Dr. Braverman.
Dr. Braverman’s diagnostic procedure for early cognitive decline may help prevent such scenarios from becoming common as the “boomers” age. By combining information about changes in the P300 latency, growth hormone levels, and attention, he and his colleagues have shown that it is possible to reliably predict current and future decreases in cognitive function. The technology could serve as a tool that’s especially useful for frontline physicians, upon whom there is growing pressure to sound the alarm regarding early cognitive decline in their aging but otherwise healthy patients.
The Growth Hormone Connection
Most people are aware that a child’s normal growth is somewhat orchestrated by human growth hormone (HGH). But growth hormone supplementation between the ages of two and 18 years adds only about two to three inches of growth. Dr. Braverman is fond of pointing out that growth hormone is misnamed. For 80% of your life, you will produce growth hormone, he notes, despite the fact that you will have stopped growing at the usual time, somewhere around 18 years of age. “That is because the hormone is mislabeled,” he says. “It should be ‘repair hormone.’” While it’s true that growth hormone is responsible for growth, it also serves crucial health maintenance and repair functions throughout life. As one team of scientists noted in a recent journal article: “[H]GH also affects metabolism, cardiac and immune function, mental agility, and aging.”11 Moreover, declining levels of growth hormone have been associated with decreasing lean muscle mass and increasing adipose tissue mass (body fat), along with thinning skin in aging individuals.12 In essence, at least part of the age-related tendency to lose strength and to gain girth may be attributed to declining growth hormone levels.
Furthermore, growth hormone is intimately associated with a related hormone, insulin-like growth factor-1 (IGF-1), which, significantly, is capable of crossing the blood-brain barrier. Both are anabolic hormones. By definition, they stimulate the development of muscle mass, strength, and power. But their effects are more far-reaching than that. “Both GH and IGF-1 affect cognition and biochemistry in the adult brain,”13 wrote Swedish researchers recently. One of the mechanisms by which acetyl-L-carnitine helps protect against dementia is by boosting IGF-1 production.
In another recently published journal article, Dr. W.E. Sonntag, co-author of the AGE paper2 and a professor emeritus in the Physiology and Pharmacology Department at Wake Forest University School of Medicine, notes, “deficiencies in circulating GH/IGF-1 contribute to the genesis of brain aging.”14 Dr. Sonntag has studied growth hormone and IGF-1 for years, publishing numerous papers on their effects in the body and, in particular, their relationship to aging.
In an earlier paper, Dr. Sonntag and colleagues reported on experiments with growth hormone supplementation. “…Growth hormone administration to…humans raises plasma IGF-1 and results in increases in skeletal muscle and lean body mass, a decrease in [body fat], increased immune function, improvements in learning and memory, and increases in cardiovascular function.”15
Scientific understanding regarding growth hormone and IGF-1—and their complex inter-relationships with the brain, the body, and aging—continues to evolve. But Dr. Braverman is convinced that growth hormone holds one of the keys to restoring a degree of vitality and fostering repair in the aging body and mind. “I have seen astounding results with my patients’ use of growth hormone,” writes Dr. Braverman, in a handout provided to his patients, “including vigor, physical strength, and more confidence in approaching life’s most difficult task: aging gracefully.” Dr. Braverman believes that, combined with the bone density-enhancing drug, Forteo®, growth hormone represents the end of human frailty among thin, emaciated older people.
In keeping with his philosophy of treating the whole body and mind, “brain to toes,” Dr. Braverman tailors his treatment to an individual’s specific needs. Anti-aging therapies often include advice regarding improvements in nutrition, recommendations regarding suggested dietary supplements, and suggestions regarding appropriate lifestyle changes, including exercise regimens designed to improve overall heath. “The PATH to life extension is clear now that we know that we can sustain good brain function to the age of 100 and beyond,” Dr. Braverman says.
Dr. Braverman and colleagues are blazing a path to a brave new world in which advancing age need not be equated with inevitably failing memory, deteriorating brain power, and inexorable senescence. By diagnosing early cognitive decline through the assessment of changes in the P300 latency score, growth hormone levels, and attention, they’ve shown that it’s possible to take proactive steps to preserve one’s brain health before it’s too late.
“Early intervention by accurate diagnosis of cognitive decline in a clinical setting will reduce the incidence of dementia,” writes Dr. Braverman. “Accordingly, if interventions could be implemented that would delay the onset of dementia by two years, there would be two million fewer cases in 2047. The delay of symptoms by just one year would result in 800,000 fewer cases.”
Anyone who has ever been confronted with dementia in a loved one can undoubtedly attest to the fact that even one life saved from this awful disease would surely justify efforts at early diagnosis. In the Lionsgate film, Away From Her, the unafflicted partner in a loving couple stricken by the mind-robbing disease, Alzheimer’s, is told that watching the disease progress is like watching the lights go out one by one in the windows of a large house. Perhaps one day Dr. Braverman’s path will point the way to a brighter future, in which no one will be forced to watch the inner lights go out one by one.
If you have any questions on the scientific content of this article, please call a Life Extension Health Advisor at 1-800-226-2370.
1. Available at: http://www.pathmed.com/p/47.html. Accessed October 31, 2007.
2. Braverman ER, Chen TJ, Prihoda TH, et al. Plasma growth hormones, P300 event-related potential and test of variables of attention (TOVA) are important neuroendocrinological predictors of early cognitive decline in a clinical setting: Evidence supported by structural equation modeling (SEM) parameter estimates. AGE. 2007 May; 0161-9152 (Print) 1574-4647 (Online).
3. Braverman ER, Chen TJ, Schoolfield J, et al. Delayed P300 latency correlates with abnormal Test of Variables of Attention (TOVA) in adults and predicts early cognitive decline in a clinical setting.
Adv Ther. 2006 Jul-Aug;23(4):582-600.
4. Braverman ER, Blum K. P300 (latency) event-related potential: an accurate predictor of memory impairment. Clin Electroencephalogr. 2003 Jul;34(3):124-39.
5. Braverman ER. Break the cognition code for a younger, smarter you. In: Younger you: unlock the hidden power of your brain to look and feel 15 years younger. New York, NY: McGraw-Hill; 2007.
6. Mooradian AD, Korenman SG. Management of the cardinal features of andropause. Am J Ther. 2006 Mar-Apr;13(2):145-60.
7. Seidman SN. Testosterone deficiency and mood in aging men: pathogenic and therapeutic interactions. World J Biol Psychiatry. 2003 Jan;4(1):14-20.
8. Hochreiter WW, Ackermann DK, Brutsh HP. Andropause Ther Umsch. 2005 Dec;62(12):821-6.
9. Randell TT. Medical and legal considerations of brain death. Acta Anaesthesiol Scand. 2004 Feb;48(2):139-44.
10. Hansenne M. The p300 cognitive event-related potential. I. Theoretical and psychobiologic perspectives. Neurophysiol Clin. 2000 Aug;30(4):191-210.
11. Lanning NJ, Carter-Su C. Recent advances in growth hormone signaling. Rev Endocr Metab Disord. 2006 Dec;7(4):225-35.
12. Rudman D, Feller AG, Effects of human growth hormone in men over 60 years old. N Engl J Med. 1990 Jul 5;323(1):1-6.
13. Aberg ND, Brywe KG, Isgaard, J. Aspects of growth hormone and insulin-like growth factor-I related to neuroprotection, regeneration, and functional plasticity in the adult brain. Scientif World J. 2006 Jan 18;6:53-80.
14. Sonntag WE, Bennett C, Ingram R et al. Growth hormone and IGF-I modulate local cerebral glucose utilization and ATP levels in a model of adult-onset growth hormone deficiency. Am J Physiol Endocrinol Metab. 2006 Sep;291(3):E604-10.
15. Khan AS, Sane DC, Wannenburg T, et al. Growth hormone, insulin-like growth factor-1 and the aging cardiovascular system. Cardiovasc Res. 2002 Apr;54(1):25-35.