As a brain health coach, I often hear people say that they aren’t sure if what they are experiencing with their memory is “normal.” This is often said with a half-embarrassed laugh and question to the effect of, “Should I be worried?”
The reality is that even as doctors, we don’t have quick or easy ways to determine the state of brain health. We can get an idea of a patient’s heart health through biomarkers (e.g. cholesterol), through functional studies (e.g. treadmill testing), or through imaging tests (e.g. CT coronary scans). Such tests are just beginning to become available for determining brain health, but the most reliable assessment is often still your own subjective experience.
Defining brain health
I think of brain health as having two components (see Fig 1). There is a “Now” component, i.e. how well is your brain working at present? This includes all domains of current cognitive function, as well as mental and physical health, which of course influence our ability to think. And then there is the “Future” component, which comprises how well we are doing in terms of protecting our brains from degenerative changes and building cognitive reserve.
The elements of brain health can be organized as an upside-down pyramid. Our primary experience of our brains tends to revolve around executive functions and thoughts in our minds.
And unless we are paying attention, we may or may not be consistently aware of our emotions and energy, nor indeed of our physical health. And of course, we tend not to consider brain aging very often, even though it is both foundational and integral to our overall brain function.
Brain Health Index
I developed the Brain Health Index Quiz as a simple way for you to check in on your experience of current brain function, your own assessment of lifestyle habits, and your personal/family history. That initial version has since been renamed the Brain Health Check. The format was modified to a chatbox approach for ease of use, but the brain health assessment content and scoring are essentially the same.
We may or may not be consistently aware of our emotions and energy
It’s important to emphasize that there is no passing or failing grade for your Brain Health Index (BHI) Score. It’s actually just a snapshot of what is happening for you right now. Like most subjectively based assessments, it can and will fluctuate a bit from day to day, depending for example on your energy levels.
It’s not a report card, nor is it even an objective measure of performance. Your score mostly comprises subjective impressions, meaning that it represents how YOU are judging yourself. It’s often helpful to remind ourselves at this point that it’s human nature for most of us to be our own harshest critic.
I prefer to see these kinds of self-assessments as learning opportunities. We get to discover more about ourselves, and to decide if we are ready to take the next step in personal growth.
Your BHI Score places you in one of four stages in the journey to optimal brain performance. There is quite a bit of overlap between the stages, and I’ve been back and forth a lot myself between stages, but I’ve found the basic framework to be helpful in thinking through priorities.
Your score mostly represents how YOU are judging yourself
There are five actionable domains in the Brain Health Index (See Fig 3), mapping to the elements of brain health (Fig 1). This screening tool is intended to give you a big picture overview, to guide you to explore potential areas worth prioritizing.
Note that there is considerable overlap across many of these domains, and that this is by no means a comprehensive list of possible actions that could benefit brain health. And ultimately, how you choose to use this tool is entirely up to you.
Let’s take the example of Mina, whose Brain Health Index score was 38, placing her in the Freedom Fighter stage of her brain health journey. Let’s say that she has been diagnosed with many of the conditions listed such as diabetes, high blood pressure and hypercholesterolemia. She works full time, and takes care of her own teenagers, as well her elderly mom who has become increasingly frail over the past couple of years.
Mina often feels like she is running all day, barely able to keep her head above water, and stressed by work, finances, and an unhappy relationship. She stays up later than she would like, because it feels like late nights are the only time she gets to herself. She wishes she could spend more time exercising or preparing healthier meals, but feels guilty taking time for herself. She is so tired all the time, and feels like she is walking around in a fog most days.
Mina has noticed that her mom has been repeating the same question over and over again, when she goes over to visit. She is worried that Mom might be developing memory issues, but raising the question only makes her defensive. Mina has noticed that her own memory isn’t what it used to be, and worries about the fact that she hasn’t been able to get in for a check up in a while.
The main priority for Mina at the Freedom Fighter stage of her journey is to take tiny targeted action. What that looks like depends on what she feels most excited about. For example, she might feel like things would be so much better if she just wasn’t so tired all the time. And she knows that getting to bed at 1am isn’t great, when she has to be up for work at 630am to get her teen off the school.
So Mina could decide that she will try going to sleep 15 minutes earlier, at 1245am, Maybe she normally kind of falls asleep while watching TV or death scrolling on her phone. Her tiny targeted action could be to set an alarm at 12:45 am. That’s when she gets to turn off the lights and snuggle into bed. It doesn’t matter if Mina isn’t able to do this every night. The important thing is that she has set herself an attainable goal, and that she is paying attention to what she can learn from why it does or doesn’t happen.
Over time, Mina may decide that she likes feeling more in control of her bed time. She may even prefer to go to bed 30 minutes earlier, or wake up later - and allow her teenager to be responsible for getting herself ready for school. Because after all, she will be going to college soon.
Sleep is one of the Brain Health Multipliers, because it impacts brain physiology directly, by giving the brain sufficient time to clear up waste and toxins that build up during our waking hours. Sleep also correlates with our memory, attention and other cognitive functions, as well as having positive effects on our blood pressure, metabolism and blood sugar levels.
While dementia prevention may be a future goal, we actually get to experience the benefits of better brain health pretty quickly right away. That kind of immediacy is critical for building in that reward feedback loop that motivates us to keep going.
Mastering the Mind
Our most powerful weapon in the fight against dementia is actually housed within the brain itself. That is, our minds. In fact, only we can be the ones to harness the power of our own minds to foster healthy lifestyle habits, to cultivate thought patterns that serve us, and to build resilience to manage life’s many stresses.
However, our minds in default network or “monkey mind” mode also have the potential to undermine our best intentions. Research has shown us repeatedly that as humans, we are hard-wired to respond to threats by fighting, fleeing, freezing, or fawning.
In the modern world, our flee or freeze response can look like coping with stress through numbing behaviors like overeating, overdrinking, or watching TV. You can probably think of someone who seems to be caught in this kind of stress coping cycle that is ultimately a form of escape that keeps us stuck in inertia.
It wasn’t so long ago that I would turn on the TV as soon as I got home from work, eating goldfish crackers until dinner was served. And even after finishing my meal, I would keep grazing and snacking my way through different shows, telling myself that it was the best way for me to relax and unwind. But now I see that I had become addicted to over-eating and over-watching TV as a default mode of escape.
Our minds are the most powerful weapon in the fight against dementia
I would over-promise and over-work in order to gain approval, telling myself that I was being a hero by sacrificing my own needs. But actually, I was making myself a martyr. Martyrdom is immediately adjacent to victimhood, and of course we all want to escape when we are feeling like a victim. So really, I was perpetuating the cycle of “over-ing,” a stuck pattern so common that it is basically the norm for most of us.
What I have learned through coaching is that external validation and approval can never be enough to satisfy. Instead, I get to remind myself to have compassion and forgiveness for my own human failings. My own unconditional support and encouragement for myself does not always drown out my inner critic Milly’s commentary and scolding, but it helps to have a community of others with whom to share this work.
And the good news is that I am always finding more tools and ways to support my quest for better brain health. Whether it’s new and fun ways to move my body, or to get creative, I love the idea of being in a tribe of friends who will be celebrating our healthy minds and bodies together at our 100th birthday parties. I hope that you will join us.
Dr Em coaching tips
Take the free Brain Health Check on our home page.. Find out where you are in your brain health journey. Learn more about what affects our current brain function and risk for dementia.