很久没有来这里耕作了。谁知盘中餐（装修） 粒粒皆辛苦。

https://www.npr.org/sections/shots-health-news/2024/11/22/nx-s1-5050956/health-brain-dementia-sleep-diet-alzheimers

健康老龄化的关键之一是保持头脑敏锐。

而抵御痴呆症、中风甚至晚年抑郁症的一些最佳策略都归结于我们的日常习惯。

“你可以通过选择生活方式来大幅降低风险，”麻省总医院麦坎斯脑健康中心的神经学家兼联合创始人乔纳森·罗桑德博士说（says Dr. Jonathan Rosand）。

罗桑德和他的同事们开发了一种用 21 分量表来衡量和跟踪大脑健康的方法，称为大脑护理评分。该分数可以帮助人们了解日常习惯的重要性——例如睡眠、饮食和锻炼。 （你可以在大约五分钟内计算出你的分数。）

“我们所有人都有相当大的控制力【译者：即保护自己的健康】，”罗桑德说。

根据《柳叶刀》委员会的报告，通过解决 14 个可改变的风险因素，大约 40% 的痴呆症病例可以得到预防或延迟。甚至有遗传风险因素的人也可以从中受益。罗桑德经常被问到的一个问题是“医生，我该怎么做才能不像我的父亲或兄弟姐妹那样患上痴呆症？”

露丝·伯恩斯坦深知这种焦虑。伯恩斯坦说：“我们亲眼目睹祖母因阿尔茨海默病而失去基本生活能力。”现在，同样的事情也发生在她妈妈身上。“这真是令人震惊，”她说。

作为两个孩子的母亲，伯恩斯坦想尽一切办法保护自己的大脑，计算她的大脑护理分数帮助她了解了她可以做出的许多生活方式调整。“这非常有帮助，”伯恩斯坦说。“它真的激励了我，因为我明白这一切是如何累积起来的。”

伯恩斯坦发现自己正在查看评分清单上的项目：“我走路了吗？我的睡眠怎么样？我控制压力了吗？在最近的一次社交聚会上，她喝了一杯葡萄酒，但拒绝了第二杯。每周饮酒量限制在四杯以下可以获得更高的分数。

要计算你的大脑护理分数，你需要根据 12 种不同的风险因素对自己进行评分，包括饮食、饮酒、吸烟、睡眠、和运动量。你的血压、血糖、胆固醇和体重指数也被纳入其中。社会和情感因素也被纳入其中，包括目标感、压力管理和社交关系。每个回答都有一个分值，分数越高越好。

几项研究表明，高大脑护理分数与患病风险显著降低有关。例如，发表在《精神病学前沿》上的一项研究发现，大脑护理分数每增加五分，晚年抑郁症风险降低 33%，痴呆、中风和老年痴呆症的综合风险降低 27%抑郁症。

“令我们惊讶的是，它【即大脑护理】有多么强大，”耶鲁大学大脑和心智健康中心主任、最近这项研究的合著者凯文·谢思博士说。“对这种数量级产生影响是相当大的，”他说。

本月发表在《神经病学》杂志上的一项后续研究按遗传风险对参与者进行了分层，发现得分越高，患痴呆症和中风等脑部疾病的风险就越低，即使是在遗传了这些疾病的遗传风险较高的人群中也是如此。

“好消息是，如果你有健康的行为【习惯】，你对痴呆症的预防就会比不做这些事情要好得多，”这项研究的作者、布莱根妇女医院中风和脑血管病科主任克里斯托弗·安德森博士说。

“我们的想法是摆脱基因决定论的观念，”人们觉得他们对自己的风险无能为力，而是强调健康的选择有多么强大，安德森说。

耶鲁大学的凯文·谢思说，大脑评分研究对他自己的习惯产生了影响。他用水果代替了某些餐点中的含糖甜点，并在饮食中添加了更多的绿叶蔬菜和健康脂肪。“我很有动力，因为我了解数据，”他说。

提高大脑护理评分的另一种方法是控制高血压和糖尿病等慢性病。生活方式的选择可以有所帮助，但人们往往需要药物治疗。“如果我们能够消除高血压”，这只是评分的一个组成部分，“我们就可以大大减少痴呆症，”谢思说。他说，认识到人们在改变行为时可能面临的挑战也很重要。说到健康饮食，并不是每个人都能买得起大量新鲜水果和蔬菜。

罗桑德和谢思说，人们不应该把大脑护理评分看作一项你可能会失败的测试。“很少有人能得到满分，”谢思说。“我们的目标是获得尽可能高的分数，并随着时间的推移对其进行监控。”

该评分与美国心脏协会的《生命必需品 八 大指标》有很多相似之处，后者包括改善心脏健康的关键措施。加州大学洛杉矶分校老年综合精神病学家海伦·拉夫雷茨基博士说，这是有道理的，因为越来越明显的是，许多对心脏有益的东西对大脑也有好处。

而且，预防永远都不嫌早。“越早开始越好，”拉夫雷茨基说。

本文由简·格林哈尔格编辑。

You can reduce your risk of dementia. Here's how to get started

https://www.npr.org/sections/shots-health-news/2024/11/22/nx-s1-5050956/health-brain-dementia-sleep-diet-alzheimers

One key to healthy aging is to keep our minds sharp.

And some of the best strategies to fend off dementia, stroke and even late-life depression come down to our daily habits.

"You can substantially reduce your risk through the lifestyle choices you make," says Dr. Jonathan Rosand, a neurologist and co-founder of the McCance Center for Brain Health at Massachusetts General Hospital.

Rosand and his collaborators have developed a way to gauge and track brain health with a 21 point scale called the brain care score. The score helps people understand the importance of daily habits — such as sleep, diet and exercise. (You can calculate your score in about five minutes.)

"All of us have a fair amount of control," Rosand says.

About 40% of dementia cases could be prevented or delayed by addressing 14 modifiable risk factors, according to a Lancet commission report. And even people who have genetic risk factors can benefit. A question Rosand is often asked is "Doctor, what can I do so I don't get dementia like my father or brother or sister?"

Ruth Bernstein knows the anxiety. "We watched my grandma be robbed of her identity" from Alzheimer's, Bernstein says. And now the same thing is happening to her mom. "It's truly devastating," she says.

As the mom of two kids, Bernstein wants to do all she can to protect her brain, and calculating her brain care score helped her understand the many lifestyle tweaks she can make. "It's been super helpful," Bernstein says. "It's really motivated me because I understand how it can all add up."

Bernstein finds herself going through a checklist of items on the score: "Have I got my steps in? How's my sleep? Am I managing my stress? At a recent social gathering she drank a glass of wine, but turned down a second. Limiting alcohol to fewer than four drinks a week leads to a higher score.

To calculate your brain care score, you rate yourself on 12 different risk factors ranging from diet, alcohol consumption, smoking, sleep and the amount of exercise you get. Your blood pressure, blood sugar, cholesterol and body mass index are also incorporated. Social and emotional factors are woven in as well, including sense of purpose, stress management and social connections. Each response is given a point value, and the higher your score the better.

Several studies show that a high brain care score is linked to a significantly lower risk of disease. For instance, a study published in Frontiers in Psychiatry, found that each five-point increase in a brain care score was associated with a 33% lower risk of late-life depression and a 27% lower composite risk of dementia, stroke and depression.

"What was surprising to us was just how powerful it was," says Dr. Kevin Sheth, the director of the Center for Brain and Mind Health at Yale University and a co-author of the recent study. "To have an effect on that order of magnitude is quite large," he says.

A follow-up study published this month in the journal Neurology, which stratified participants by genetic risk, found that a higher score was linked to a lower risk of brain disease including dementia and stroke, even among people who had inherited an increased genetic risk for these diseases.

"The good news is that if you engage in healthy behaviors, you are much more protected against dementia than if you do not do those things," says study author Dr. Christopher Anderson, chief of the Division of Stroke and Cerebrovascular Diseases at Brigham and Women's Hospital.

"The idea is to get away from the idea of genetic determinism," where people feel like there's nothing they can do about their risk, and instead emphasize how powerful healthy choices can be, Anderson says.

Yale's Kevin Sheth says the brain score research has had an impact on his own habits. He's swapped sugary desserts for fruit at some meals and added more leafy greens and healthy fats to his diet. "I'm motivated because I know the data," he says.

Another way to improve your brain care score is to manage chronic conditions, like high blood pressure and diabetes. Lifestyle choices can help, but often people need medication. "If we were able to eliminate high blood pressure," which is just one component of the score, "we could [reduce] dementia by orders of magnitude," Sheth says. He says it's also important to recognize the challenges people may face in changing their behaviors. When it comes to eating well, not everyone can afford to buy lots of fresh fruits and vegetables.

Rosand and Sheth say people shouldn't view the brain care score as a test that you can fail. "Very few people can have a perfect score," Sheth says. "The goal is to have the best score that you can and monitor it over time."

There's a lot of overlap between the score and the American Heart Association's Life's Essential 8, which includes key measures to improve heart health. This makes sense, says Dr. Helen Lavretsky, a geriatric integrative psychiatrist at UCLA, because it's increasingly clear that many of the things that are good for our hearts are also good for our brains.

And it's never too soon to focus on prevention. "The earlier you start, the better," Lavretsky says.

This story was edited by Jane Greenhalgh.