Observing a decline in verbal expression or cognitive decline in a beloved family member, many worry whether it might be Alzheimer's disease. Indeed, modern medicine views these symptoms as important signs of neurodegenerative disease. Looking at the concepts of the heart and qi from Donguibogam through modern neurology, these two can be seen as closely connected to our brain function, blood flow, and metabolic activity, respectively.
First, the explanation in Donguibogam that the heart governs mental activity and cognitive function corresponds closely to the role of the cerebral cortex in modern neuroscience. In particular, Broca's area and Wernicke's area in the left cerebral hemisphere are critical regions related to language expression. Broca's area is responsible for assembling and articulating speech, while Wernicke's area handles understanding language. Connections between these regions must be smooth for us to find appropriate words for our thoughts, speak fluently, and accurately comprehend others' words. However, in neurodegenerative disease such as Alzheimer's disease, neurons in this cerebral cortex gradually become damaged and die, leading to brain tissue atrophy. During this process, abnormal protein deposits such as beta-amyloid plaque and tau neurofibrillary tangle accumulate, disrupting connections between neurons and triggering inflammatory responses. This inflammation creates a vicious cycle that gradually destroys the brain and makes signal transmission between neurons even more difficult. Consequently, the brain's information processing speed slows down, and language hypofunction—such as difficulty finding words (anomic aphasia), grammatical errors, and stuttering—becomes pronounced. While it may look like minor forgetfulness in early stages, as it progresses, using language becomes harder, and even understanding what others say can become difficult. In addition to Alzheimer's disease, frontotemporal dementia features prominent language hypofunction from early stages, impairing linguistic abilities in various forms such as fluent aphasia or nonfluent aphasia.
Donguibogam described qi as energy circulating throughout the entire body to sustain life activities. In modern medicine, this can be interpreted as adequate blood supply to the brain and energy metabolism within brain cells. The brain is an extremely active organ consuming more than 20% of the body's total energy. For the brain to function normally, it must be abundantly supplied with oxygen and glucose. However, if cerebral blood vessels become damaged or narrowed due to hypertension, diabetes, hyperlipidemia, or smoking, blood flow to the brain ceases to be smooth. This is termed cerebral ischemia, and chronic cerebral ischemia reduces the supply of oxygen and nutrients to brain cells, leading to neuron damage and cognitive decline. In vascular dementia in particular, brain tissue is damaged as cerebral blood vessel conditions such as cerebral infarction or cerebral hemorrhage recur, potentially causing rapid deterioration in cognitive function, language ability, and motor function. Furthermore, white matter hyperintensities resulting from microvascular disease also degrade brain connectivity, inducing overall cognitive decline and difficulty in language expression. These vascular factors also influence the progression of Alzheimer's disease, so cases where both types of dementia appear concurrently are not uncommon. Because maintaining brain cell function itself becomes difficult if the brain's energy metabolism is impaired, efficient glucose utilization and maintaining mitochondria function are crucial.
Even in normal aging, the brain atrophies to some extent, but neurodegenerative disease is far faster and more severe in rate and degree. Rather than simply dismissing these signs as mere aging, obtaining an accurate diagnosis and proper management when such symptoms appear is vital. Through consultation with a neurologist, imaging studies of the brain such as magnetic resonance imaging and computed tomography can verify the degree of brain atrophy or vascular lesions, and specialized imaging studies such as PET-CT or amyloid PET can check for deposition of causative substances of Alzheimer's disease. Additionally, objectively assessing changes in cognitive function through neuropsychological tests like the Mini-Mental State Examination or the Seoul Neuropsychological Screening Battery, as well as performing blood tests to exclude correctable causes such as vitamin deficiencies or thyroid gland dysfunction, is essential. Confirming an accurate diagnosis through such thorough evaluations and establishing a personalized treatment and care plan tailored to the individual is currently the best approach.
I deeply empathize with and understand your worry regarding changes in your beloved family member. Please remember that early detection and consistent management can greatly help slow the pace of these changes and maintain quality of life. The attention and support of family will be the greatest strength to warm an elder's heart and protect their brain health.
