Dharma Singh Khalsa, MD
Dharma Singh Khalsa, MD, founder of the Alzheimer’s Research & Prevention Foundation in Tucson, Arizona, and author of Brain Longevity. AlzheimersPrevention.org
Just as physical fitness is recognized for its ability to protect brain health, an active spiritual or religious life is known to reduce rates of mild cognitive impairment (MCI) and Alzheimer’s disease (AD).
These days, spirituality and religion are separate concepts. The word “spirituality” increasingly is used to represent a person’s search for a higher power or something sacred or divine within themselves. In recent years, many Americans have begun viewing themselves as spiritual but not necessarily religious.
Regardless of your views, engaging in some form of meditative thought— prayer, meditation, deep breathing or guided imagery—reduces activity in areas of the brain associated with stress while simultaneously enhancing cognition and focus. Stress is a risk factor for AD. The more stress you have, the more cortisol (a stress hormone) your body produces. Chronically elevated cortisol levels may promote brain shrinkage, inflammation and cognitive decline.
Spiritual fitness meditations, which involve focusing attention on a specific mantra, phrase, song or object, do more than reduce cortisol levels. They also lower heart rate and blood pressure, and enhance immune function by reducing stress, which is immunosuppressive. All of these have brain-protective effects— they reduce risk for heart disease, cancer and other chronic diseases, too.
Spirituality and religion also help people cultivate a sense of meaning or purpose in life, which, research suggests, independently helps slow AD.
Fascinating: In a study conducted by Rush University researchers, individuals who scored high on a “purpose in life” (PIL) assessment were 2.4 times more likely to remain free of AD than individuals with low PIL.
Spiritual fitness also may reduce depressive symptoms and engender positive emotions. And people who practice religion or spirituality are less likely to engage in unhealthy practices.
A 2019 study by Korean researchers published in American Journal of Alzheimer’s Disease & Other Dementias found that religious practice positively affects cognitive functioning. And when European researchers analyzed 51 studies exploring a link between religious practice, spirituality and AD, 50 of them yielded positive correlations. Many involved the benefits of spirituality on caretakers of those with AD or on helping patients with AD find meaning in their diagnosis. There’s even a research field called neurotheology that examines how various meditative practices affect the brain.
One type of meditation—Kirtan Kriya— shows promise in terms of counteracting the effects of stress on our brain. Practiced for thousands of years as part of the Kundalini yoga tradition, Kirtan Kriya involves singing a mantra of four sounds—Saaa, Taaa, Naaa, Maaa— while performing repetitive finger poses, or mudras. Traditionally practiced for 12 minutes a day, Kirtan Kriya has been shown to reverse memory loss, and neurological studies reveal it increases blood flow to, and activation of, anatomical areas important for memory function and emotional regulation. Research on Kirtan Kriya also suggests benefits related to anxiety, depression, sleep and mood.
How to do it: Sit up straight in a chair or on the floor. For two minutes, sing out loud Saaa, Taaa, Naaa, Maaa, which means “my truest self” in Sanskrit. As you sing, touch your thumb to each fingertip— Saaa (index to thumb), Taaa (middle finger to thumb), Naaa (ring finger to thumb), Maaa (pinky finger to thumb.) Repeat the practice for two minutes while whispering instead of singing. Next, spend four minutes repeating the mantra silently, followed by two minutes of whispering and two final minutes of singing. The fingertip mudras are performed the entire time. As you sing, try to imagine the sound flowing in through the tip of your head, sweeping through your brain and exiting through the forehead. End the practice with a deep, centering breath.
Recent finding: A new review published in Journal of Alzheimer’s Disease shows that Kirtan Kriya increases blood flow to key brain areas after a single session, with improvements building after eight weeks of daily practice.
Any type of meditative thought has the potential for stress reduction and improved brain function. But unlike, say, Transcendental Meditation, in which you silently focus on a mantra, Kirtan Kriya integrates singing and finger poses. It reduces cortisol levels and triggers the release of endorphins, which relieve stress, regulate mood and improve immune function… And, when the tongue touches the roof of the mouth while singing, it triggers the hypothalamus, key to maintaining hormone/chemical balance. The fingertip poses stimulate blood flow to the brain.
Recent study: My research team assigned 161 women, most of whom had reported cognitive decline or MCI, to one of two groups. One group performed Kirtan Kriya for 12 minutes a day for eight to 12 weeks. The other listened to music or underwent a memory-training program. Result: Those in the Kirtan Kriya group showed larger improvements in blood flow to the brain, cognitive functioning and markers of brain health. They also showed a greater increase in the length of telomeres—the caps at the end of chromosomes that prevent DNA from deteriorating. Shorter telomeres are associated with poor immune function, inflammation, accelerated aging and AD, while longer telomeres usually correspond to a longer life with a clearer mind. Women who began the study with the worst cognition experienced the most improvement in telomere length.
Spiritual fitness is just one spoke on the wheel of cognitive health. In 2014, the Finnish Intervention Study to Prevent Cognitive Decline and Disability showed that a brain-healthy lifestyle with specific dietary guidelines (heavy on produce, fish and whole grains)…physical activity (aerobic, strength and balance)… cognitive stimulation…social activity… and managing heart health—can slow cognitive decline.
At first blush, the FDA’s recent approval of the first treatment for early-stage Alzheimer’s disease (AD) since 2003 offers a glimmer of hope for the six million Americans with AD. Marketed under the name Aduhelm, aducanumab removes amyloid, a sticky compound often found in the brains of people with AD. Amyloid can clump and form plaques that disrupt cell-to-cell communication. Theory: By removing amyloid, you may be able to slow or reduce cognitive decline. Aducanumab is not a cure, and it cannot bring back lost cognitive function. One year of aducanumab, given intravenously every four weeks for 45 to 60 minutes at a time, costs $56,000.
Concerns: The new drug was approved via an accelerated approval pathway, meaning that despite uncertainty about its efficacy, the FDA wanted to provide access to a treatment that it believes is “reasonably likely” to help. This approval came after trials of the drug were initially halted because it seemed aducanumab wasn’t working as well as hoped. Subsequent reanalysis of the data suggested some potential, and, despite the FDA’s own advisory committee being against it, the accelerated approval happened.
Aducanumab has some side effects, including headaches, brain swelling and increased risk of falling. Note: The Cleveland Clinic and the Mount Sinai Health System do not plan to carry aducanumab due to safety and efficacy concerns.
Perhaps even more important is that more and more high-level AD researchers now suggest that amyloid deposits may not be the only cause of AD. Many patients live long, cognitively healthy lives despite having those plaques. Amyloid may be a marker of aging, but many holistic- and integrative-minded brain experts believe that AD results from lifestyle factors, including stress, poor diet, lack of exercise, lack of mental stimulation, lack of meditation and more.
