COVER STORY

MIND GAMES: HOW MEDITATION AND YOGA  HELP FIGHT ALZHEIMER’S

By SHAGORIKA EASWAR

There are people who love television shows set in hospitals – St. Elsewhere, ER, Grey’s Anatomy... Who love books like Atul Gawande’s Being Mortal.

Why Buddha Never Had Alzheimer’s: A Holistic Treatment Approach Through Meditation, Yoga and the Arts by Dr Shuvendu Sen will no doubt appeal to all of them, but it is also sure to spike interest among everyone who has followed reports about how Alzheimer’s is reaching epidemic proportions.

Listed in All Time Best 100 Books on Alzheimer’s, it was an Amazon (US) bestseller that received the prestigious United States Nautilus Award (an award previously given to Nobel Peace Prize winner Desmond Tutu and the Dalai Lama). It has been translated into French by the famed Hachette Foundation.

It is full of profoundly moving case studies and packed with information, facts and figures.

The figures are frightening. Current research reveals that by 2025 the number of people aged 65 and over with Alzheimer’s in the US alone is estimated to reach 7.1 million. 

Dr Shuvendu Sen.

“It was probably always there, but didn’t get a chance to develop fully,” says Dr Sen. “We are facing the full wrath of the storm as we are living well into our 80s and 90s now. But then there is also early-onset. This is not a simple disease, it is not just about I-don’t-know-where-my-bathroom-is or just about loss of memory. It can be about loss of words. If someone says he’s having ‘breakfast’, the disease escapes detection because people around him may not realize he’s struggling to find the words for omelette or cereal. And because he might still be able to find his bathroom, we think all is fine. There can be personality changes as depression sets in due to the struggle inside to find the words.

“Think of how terrifying it must be for the person trapped inside that mind. They can’t talk, they can’t recognize loved ones. So you know what they do? They smile. The greatest smiles I have ever received have been from Alzheimer’s patients. They offer this smile and want nothing in return.”

In Alzheimer’s disease, the medical world is facing its hardest hour. Of all the diseases that continue to harass humanity, Alzheimer’s holds hostage the very fulcrum of human existence: its mind... The overwhelming fact remains that unless we have a deeper understanding of how the mortal mind works beyond the configuration of the brain’s anatomical landmarks, we will find it hard to tame a beast that revels in random invasions. In other words, unless we comprehend how we remember and relate, we cannot comprehend how we forget.

A diagnosis of Alzheimer’s is a death sentence since there is no known cure. While the prognosis is bleak for the patient, the disease also takes a toll on family members who have to watch the slow decline of their loved one.

Dr Sen wrote a screenplay to highlight the loneliness the patient and his family members experience. Between Raindrops was made into a Bangla movie, Sraboner Dhara, starring renowned actor Soumitra Chatterjee as an Alzheimer’s patient and released on December 6 last year.

I am reminded of a neighbour whose husband began forgetting how to perform routine tasks. He’d put a pot of water to boil for tea and forget to turn the gas off. Or he’d let the cat out, forget he’d done so, and get frantic looking for her. Tests confirmed her worst fears – Alzheimer’s. They tried to carry on as before at home, but when he began wandering out and losing his way, they put his name on a waiting list for a place where he could be looked after round-the-clock.

She agonized over the decision, feeling she was abandoning him, but it soon became impossible for her to look after him and when his turn came, he was moved there. I will never forget the look of devastation on her face one day when she returned from her daily visit.

“He doesn’t know who I am, and I am getting used to that,” she said. “But today he called me Ruth. I have no idea who Ruth is.”

It sneaks up on you, my neighbour had said when it began.

Mild Cognitive Impairment or MCI, writes Dr Sen, is the prelude to the ultimate tragic drama – a nascent, silent slide towards the inevitable. The fact that it can be indicative of everything from several neurodegenerative dementias other than Alzheimer’s and also non-neurodegenerative conditions like depression or the side effects of medicines makes things only that much more complicated.

Dr Sen writes about Mrs Wolfe, a patient of his who was diagnosed with Alzheimer’s and who struggled to recall his name on one of her visits.

“You have brown skin, doctor,” she said. “You must be an Indian.”

But he also sets to rest doubts whether “forgetting a telephone number is the first slender hint of onrushing Alzheimer’s” by explaining the difference between explicit memory and implicit memory.

Factual happening or details such as names, places, dates, telephone numbers and social security numbers, etc., all fall under explicit or declarative memory. And explicit memory regresses with age, it’s part of a natural process.

Implicit memory, also called emotional memory, he writes, is reluctant to leave our minds. Thus even those who are unable to recall past events may retain the memory of the experience.

Presenting medical facts in a highly engaging manner, Dr Sen seamlessly weaves personal anecdotes with case histories and cutting edge advancements. He notes that researchers at Harvard Medical School, Johns Hopkins University and the Mayo Clinic have shown that contributing factors to Alzheimer’s (such as stress and hypertension) can be alleviated with holistic, alternate management approaches like meditation, yoga, music therapy and virtual reality therapy.

“How can meditation and yoga stop or even reverse Alzheimer’s?” he asks. “They set the mind on an inward journey, where the risk factors that precipitate the disease are formed. This bridging of the old and new creates an imperative paradigm shift in our perspective toward managing this disease.”

It sounds cliched, says Dr Sen, but the more he matured into his medical field, the more he was reminded of his grandmother Hiran Bala Sen.

She was an erudite, bookish woman he looked up to. A strong, feisty lady, she raised her family as a young widow on money she earned from writing books and poems. And yet one day, she went missing. She was eventually found close to midnight on a dark Calcutta street, in obvious distress, pacing back and forth, with no recognition of those who had searched so frantically for her.

“Diagnosis back then was sketchy, everything was clubbed under old-age or senile dementia,” says Dr Sen. “Years alter, as a physician, I found it hard to comprehend how someone with such a scholarly aptitude could turn into a vegetative state with no apparent warning signs.

“We have all those myths, the more you use your brain, the more you study, the less your chances of getting Alzheimer’s. To rest is to rust, and so on. But this beast of a disease is much more profound. There are hundreds of thousands of farmers in India for instance, who have never opened a book who don’t have Alzheimer’s. I wanted to write a user-friendly book, to present in a simple way what we know about the disease and what we can do to prevent it.”

He cites cases to show that contrary to popular belief, solving crossword puzzles or reading tons of books does not necessarily stave off Alzheimer’s. 

But the more languages you know, the more areas of your brain you use. Multiplicity helps, says Dr Sen.

“The more new words you use, the more new variables you use, the better it is, we think. Do we know this for sure? No, it is still all up in the air. There is evidence to show that there’s a lower incidence of Alzheimer’s in India, for instance, where many people are multilingual. On the other hand, there is also the belief that this is due to under-reporting.”

He makes an interesting point. In the good old days we used to remember the phone numbers of people we called often. The very act of recalling the number made us remember the person, our relationship with them, perhaps the last interaction... it was all unconscious and in the fraction of a second, but it reinforced a memory. Now we press the first letter of the person’s name on our phone and the computer makes the connection.

We have outsourced memory.

Having grown up in India, he was familiar with the concept and practice of meditation, but he didn’t make the connection to cognitive disorders until a friend was diagnosed with Alzheimer’s. Many years his senior, Neel Roy was a high-ranking audit officer with a wide range of interests encompassing classical music and politics. When he began forgetting common words, Dr Sen suggested everything from giving it time as it might be caused by anxiety to getting his thyroid checked. Having run out of tangible options, however, he asked him to try meditation.

Why, asked Roy.

“Well, at worst, it is a relaxing exercise. At best, it is not a drug and has no side effects.”

Today, 20 years later, Roy is approaching his 90s, his brain as alert and eager as that of a teenager.

De Sen cites the examples of the Beatles and Clint Eastwood, the best-known celebrity proponents of meditation and yoga.

Paul McCartney, who still practises meditation every day, says, “I think it’s always very good to get a sort of still moment in your day”.

And Clint Eastwood, who has been practising transcendental meditation or TM for almost 40 years now describes it as a great tool for anyone to have, “to be able to utilize as a tool for stress”.

Transcendental meditation or TM is based on ancient Indian traditions and was popularized by Maharishi Mahesh Yogi, as Dr Sen reminds his readers. It involves the repetition of mantras – a sound or simple sentences – for 15 to 20 minutes with the eyes closed to help focus the mind. And studies conducted at Johns Hopkins Bloomberg School of Public health have shown that TM might be more effective in preventing dementia than current drug treatments.

It is different from Focused Attention (FA) meditation, which, in turn, is different from Open Monitoring (OM) meditation, but all offer very similar benefits, says Dr Sen. Some benefit from chanting a mantra, others by observing their breathing.

“Meditative pathways can differ based on individual choice,” says Dr Sen. “It’s about reaching a state of non-judgemental unawareness. In fact, just thinking that something will relax you, affects the brain in a positive way.”

He describes a presentation made by a German student in which she told 50 volunteers that they would be divided into two groups. One would meditate, the other would listen to relaxation tapes, with the volunteers getting to decide who was going to do what. After they chose either meditation or the relaxation tapes but – and here comes the oh, wow! moment – before they actually started, they were sent for MRIs which revealed that the areas in the brain that are hit by Alzheimer’s were sharper.

Just the act of choosing a calming activity had a calming effect.

Mind and brain. One is an actual, physical organ, the other isn’t. Is the mind, as some say, in every cell of our body? And is that why a holistic approach might work?

Why Buddha Never Had Alzheimer’s is published by HCI/Simon & Schuster, US$8.

Moving from consciousness, awareness, cognition and metacognition to motivation, intention, insight and free will, the brain and mind are seamlessly back and forth, exchanging each other’s position as cause and effect.

Research has revealed the existence of quantum energy in the tubules in our brains. If that energy can be concentrated through meditation, it could help combat Alzheimer’s, believes Dr Sen.

“I am not proposing meditation as a cure, but as prevention. The journey from Minor Cognitive Impairment or MCI to Alzheimer’s is whimsical, progressing at varying rates. What is of great interest is that sometimes, it also reverses. So meditation can be a valuable tool in helping with that reversal.”

He likens the mind to a lake, the surface of which is constantly ruffled by the slightest breeze.

This is our mind, helpless to the unending procession of our thoughts touching it from all around. The bed that lies at the very bottom of the lake is our unrealized self – completely unrecognized, covered and clouded by those ripples.

Yoga helps still those ripples.

Lowered blood pressure, cholesterol and blood sugar; increased muscle strength and flexibility and weight control are just a few of the many benefits of yoga. It also does something that most of us may be less aware of – focusing inward helps with a better body image as one becomes more satisfied and less critical of one’s body.

Dr Sen shares astounding case histories of his patients and family members, too.

Michael Wallace, a retired school teacher had begun to struggle with numbers and words – he had to strain to call a pen a pen. Diagnostic tests were inconclusive, he fell somewhere between early onset Alzheimer’s and unspecified dementia. When the multivitamins and  anti-anxiety medication that were prescribed were of little help, Wallace decided to explore mind-body wellness. He learned about meditation and yoga, but came to Dr Sen for a fourth opinion.

“I told him that when meditation is pursued in a simplistic way, it does not have adverse effects, resistance or tolerance, which are the three perils of modern medication. So why not try an age-old practice that has withstood the test of time?”

Wallace worked with a certified meditator and began showing improvement in his cognitive skills within six months.

Dr Sen’s father-in-law, Prasenjit Chaudhuri, was an active, healthy man with a keen intellect. He noticed a slowing of his gait when he turned 80. As the difficulty in moving increased, medication was prescribed for Parkinson’s disease. When that didn’t help, a slew of drugs were prescribed to combat possible Alzheimer’s-related depression and anxiety.

He swung between tears and anger. Some new meds were added, a few withdrawn, but he began hallucinating. The meds were changed again and an expressionless, but stable Mr Chaudhuri was sent home. Where he went back to meditation.

According to him, this is how he gets his “peace of mind”. Though a firm diagnosis remains elusive, he has recovered well since then and recently informed Dr Sen that he was reading and enjoying Hamlet all over again. 

Readers will learn that mindfulness, the much-used buzzword, is hardly new. TW Rhys Davids, the son of a clergyman from Wales, studied Sanskrit in the mid-1800s. He was the founder of the Pali Text Society and translated several early Buddhist texts.

From the original Buddhist word sati was coined this giant of a word that, in the eyes of scores of scholars, has struggled to find the right home. Variously called or thought of as “possessing a good memory”, “full of care”, “heedful”, “thoughtful”, and “being conscious or aware”, mindfulness was finally wrapped up in 2001 by the Oxford English Dictionary as “the meditative state of being fully aware of the moment”.

Studies have found that not only does mindful meditation help with better concentration, focus and memory, it also helps decrease risk factors such as high blood pressure, high cholesterol, stress and obesity that “have all been implicated in the establishment of full-blown Alzheimer’s”. Dr Sen quotes studies which showed that a combination of meditation, body awareness and yoga resulted in increased grey matter in the left hippocampus, a brain area strongly involved in learning and memory.

Is meditation the answer to all modern ailments, then?

Dr Sen certainly makes a strong case for it.

Everything, he says, does not need high-powered drug intervention, sometimes a very basic step can help prevent the spread of disease.

He points to signs we see in hospitals about the importance of washing hands. Epidemics can be started through bacterial contamination from direct contact – and thus be largely prevented by the simple act of washing hands.

So, discuss with your physician, check out meditation, and above all, keep an open mind. President Ronald Reagan famously said, and Dr Sen quotes him, “Trust, but verify!”

Which leads to the question that has to be asked: How do we know Buddha never had Alzheimer’s?

Dr Sen says he took a very informal survey of religious leaders across all religions. He studied Christian, Jewish, Muslim and Hindu holy men and leaders.

“I was amazed to discover that almost all of them lived beyond 80. And all of them died young. As in with complete activity of their brains retained. A few died very young, Swami Vivekananda at 32, but of diabetes. Everyone dies, eventually, but these men died of bodily reasons, their brains as sharp as ever. Buddha was 82 when he died, his brain like that of a child. There is empirical confirmation of this which proves that whoever they were, they followed lives of quiet contemplation and such people universally tend not to have Alzheimer’s.

Is Alzheimer’s hereditary? With his grandmother’s and his father-in-law’s case histories, are he and his wife more at risk? Is it a double whammy for his kids, with cases on both sides of their family?

These are difficult questions to ask but Dr Sen addresses them in a matter-of-fact manner.

“One school of thought holds that it could be hereditary, another that it doesn’t have to be. Neurological disorders tend to walk a line. But there’s also atavism, in which they skip a generation. Just goes to show the lack of information on the subject, how much we still don’t know.”

So what, if anything, can one do to prevent Alzheimer’s?

“There’s a strong school of thought, scientifically validated, that diabetes, high blood pressure and high cholesterol are the causes of all the inflammation in the body,” says Dr Sen. “Since Alzheimer’s is also an inflammation, it is believed that if you can take care of diabetes, high blood pressure and high cholesterol, you can take care of Alzheimer’s. To me, that is too cute an explanation.

“Studies done in Canada show that stress is a major culprit. When a person is stressed out, the damage in the brain is exactly where Alzheimer’s hits. Stress is the number one point of entry. Which brings us back to the best way to unstress – meditation. It’s an inward, quiet journey. I tell my patients, I tell myself, that it doesn’t have to tie you down to a routine, it doesn’t have to be done at 5 am every morning. A few minutes whenever, wherever, can work miracles.”

As Dr Sen writes, it’s time to prescribe meditation.

• Named to America’s Best Physicians, Dr Sen is director, Medical Education and associate program director, Internal Medicine Residency Program at Raritan Bay Medical Center, Meridian Hacken-sack University and the recipient of many prestigious awards for his research work. He serves on and has been involved in advisory capacities in many leadership committees including the Alzhemeir’s Association. He has been invited to address United Nations officials, the New Jersey Senate, and Harvard University. 

• Why Buddha Never Had Alzheimer’s: A Holistic Treatment Approach Through Meditation, Yoga and the Arts is published by HCI/Simon & Schuster, US $8. Available from Amazon and Barnes & Noble. www.amazon.ca/Why-Buddha-Never-Had-Alzheimers/dp/0757319947.