healthy aging
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Healthy AgingTRANSCRIPT
Healthy aging: Optimizing Your Brain Health
Abhilash K. Desai M.D.Associate Professor, Director
Center for Healthy Brain AgingSaint Louis University School of Medicine
Disclosures
None
Objectives
Describe the impact of daily activities on brain function.
Discuss some daily practices to improve brain’s resilience (i.e., its capacity to function well despite diseases that damage brain cells and brain connections).
Clinical vignette
LM is a 58 year old woman, mother of 2 children and 1 grandchild, wife of 35 years and a school teacher. She was diagnosed with Myasthenia Gravis 2 years ago. She wanted to “fight” the disease and did not want to rely on just drugs. She started going to Yoga classes three times a week, swimming twice a week, started practicing her piano five days a week and writing her life-story to share with her grand child. Over 18 months, her depression and anxiety resolved and within first 3 months of initiating treatment she noticed that MG has changed her perspective on life itself.
Healthy Mind
National Institute of Health commissioned Cognitive and Emotional Health Project defined successful cognitive and emotional aging as “the development and preservation of the multidimensional cognitive structure that allows the older adult to maintain social connectedness, an ongoing sense of purpose, and the abilities to function independently, to permit functional recovery from illness or injury, and to cope with residual functional deficits.”
Aging Mind
Aging has been conceptualized as declining efficiency of the mechanisms that maintain the homeostatic equilibrium, which is continuously challenged by destabilizing events (e.g., Alzheimer’s disease, strokes, head injury, pollution, chronic stress, chronic anxiety, poorly controlled cardiovascular risk factors [e.g., obesity, hypertension, diabetes, hyperlipidemia, low HDL, smoking, sedentary lifestyle, sleep apnea, chronic pain, chronic insomnia, chronic depression]). Ferrucci L et al. Mapping the road to resilience. Mech Ageing Dev
2008; 129:677-679.
Aging Mind
Alternative view: The downward spiral of functional and structural decline might begin from both, reduced brain activity due to behavioral change and from a loss in brain function driven by aging brain machinery. Mahncke HW et al. Brain plasticity and functional losses in
the aged: scientific bases for a novel intervention. Prog Brain Res 2006;157:81-109.
Basic Principles
Our neglect of intensive learning as we age leads the systems in the brain that modulate, regulate, and control plasticity to waste away. We rarely engage in tasks in which we must focus our attention as closely as we did when we were younger, trying to learn a new vocabulary or master new skills. Anything that requires highly focused attention will help.
Attention
When we want to remember something we have heard we must hear it clearly, because a memory can be only as clear as its original signal. Paying close attention is thus, essential for good memory.
Meditation, Centering Prayer, Yoga, Tai Chi and Mindfulness practice are some of the best ways to improve one’s ability to focus.
Basic Principles
Plasticity (capacity of the brain to change in response to experience) is competitive. There is an endless war of nerves going on inside each of our brains. Competitive plasticity also explains why our unhealthy habits are so difficult to break or “unlearn.” When we learn an unhealthy habit, it takes over a brain map, and each time we repeat it, it claims more control of that map and prevents the use of that space for “good” habits. That is why “unlearning” is often a lot harder than learning.
Thus, if you want to change unhealthy habits, stop engaging in it and replace it with healthy habits.
Basic Principles
Plastic change, caused by our experience, travels deep into the brain and ultimately even into our genes, molding them as well.
Imagination: How thinking makes it so! We can change our brain anatomy / structure simply by using our imaginations! The plastic brain is like a snowy hill in winter according to Pascual-Leone (an expert neuroscientist). The mental “tracks” that get laid down can lead to habits, good or bad!! Sometimes a road block is necessary to help us change directions.
Thus, visualization exercises may promote brain health in a variety of ways.
Basic Principles
As brain cells are trained and become more efficient, they can process faster.
“Reward” (fun!) is crucial to learning. Each time we are rewarded, our brain secretes such neurotransmitters as dopamine and acetylcholine, which help consolidate map changes we have just made (Dopamine reinforces the reward, and acetylcholine helps the brain “tune in” and sharpen memories).
Thus, practicing skills that one retains on a daily basis can improve speed of processing. Having fun while practicing will speed up learning!
Basic Principles
Brain derived neurotrophic factor (BDNF) is crucial for memory and learning. BDNF turns the nucleus basalis, the part of our brain that allows us to focus our attention – and keeps it on, throughout the entire period of experience. Once turned on, the nucleus basalis helps us not only pay attention but remember what we are experiencing. It allows map differentiation and change to take place effortlessly.
Exercise increases BDNF!!
Basic Principles
Our minds tend to process information in specific contexts.
Our minds are NOT capable of doing several things (doing them well) at once.
Thus, avoid multi-tasking and take time to reflect on the context of any new information one wants to remember / learn.
Cognitive training
Attention training: mindfulness training, Neuro-feedback.
Memory training: mnemonic strategies for recall of word lists, sequences of items, texts, stories (e.g., categorization, imagery).
Reasoning training: strategies to identify patterns.
Speed of processing training: practice increasingly complex tasks to identify and locate visual information.
Stress and relaxation
Herbert Benson M.D., founder of the Mind-Body Medical Institute in Chestnut Hill, Massachusetts, Associate Professor of Medicine at Harvard Medical School.
By completely letting go of a problem at some point by applying certain triggers (e.g., relaxation exercises), the brain actually rearranges itself so that the hemispheres communicate better. Then the brain is better able to solve the problem.
Stress and relaxation
Molecular studies have shown that calming response releases little “puffs” of nitric oxide, which has been linked to the production of such neurotransmitters as endorphins and dopamine. These chemicals enhance general feelings of wellbeing.
As the brain quiets down, another phenomenon that we call “calm commotion” – or a focused increase in activity – takes place in the areas of the brain associated with attention, space-time concepts, and decision-making. McEwen BS. Protective and damaging effects of stress
mediators: central role of the brain. Dialogues Clin Neurosci. 2006; 8: 367-381.
Nutritional strategies
“Let food by thy medicine, and medicine be thy food” – Hippocrates (460-377 BC).
Nutritional strategies such as Mediterranean diet may have a significant effect in promoting brain health, reducing risk of AD and slowing progression of AD. Morley. Nutrition and the Brain. Clin Geriatr Med 2010. In
Press.
Brain Food!
Systematic review: 11 observational studies and 4 clinical trials. Conclusion: Existing data favor a role for long-change omega 3 fatty acids (fish or supplement) in slowing cognitive decline in elderly individuals without dementia, BUT not for prevention or treatment of dementia. Fotuhi M et al. Nat Clin Pract Neurol 2009.
Brain Food.
Mediterranean Diet. The New Mediterranean Diet Cook Book by Nancy Harmon Jenkins (Bantam 2008).
Dash Diet (specifically for people with hypertension). www.nhlbi.nih.gov/health/public/heart/hbp/dash/.
Turmeric (present in some curry powders, some yellow mustard). Pills: Turmeric Force by New Chapter.
4-6 servings of vegetables and 3-5 servings of fruits per day. Healthy fish: Pacific Herring (sardines), Sablefish (Black Cod),
European Anchovies, Spanish Mackerel, Wild Alaskan Sockeye Salmon, Farmed Rainbow Trout, Albacore Tuna (Tombo). Visit environmental defense fund for info on fish and mercury (www.edf.org ).
Supplements: Omega 3 (molecularly distilled [e.g., Nordic Natural] pills or liquid), Vitamin D (1,000-2,000IU), Vitamin B12 (500mcg-1000mcg), Zylfamend (has rosemary, turmeric, etc).
Physically active lifestyle.
Reduces risk of heart disease, cancer, diabetes, strokes.
Linked to living longer and with less disability. Recent studies also suggest reduce risk of
Alzheimer’s and slower progression of Alzheimer’s disease.
Improved mood and reduced risk of depression. Reduced risk of falls. Improved capacity to pay attention (focus), problem
solve. Improved sleep.
Physically active lifestyle
Improved blood flow to the brain Reduced oxidation Reduced inflammation Reduced toxicity of misfolded proteins that are
thought to cause Alzheimer’s disease, Parkinson’s disease.
Improved neurogenesis (formation of new brain cells) and synaptogenesis (formation of new brain connections) Kramer AF, Erickson KI, Colcombe SJ. Exercise, cognition, and the
aging brain. Journal of Applied Physiology 2006; 101: 1237-1242.
Sleep
Good sleep is necessary for memory consolidation, for ability to focus and problem solve the next day and for learning new skills.
During sleep, processes involved in formation of new brain cells and brain connections are activated.
Sleep is also important for creativity. Malhotra R and Desai AK. Healthy Brain Aging: What has
sleep got to do with it. Clin Geriatr Med 2010 In Press.
Good “Mind Health” Advice
To keep mind alive requires learning something truly new with intense focus.
4 key steps for mind fitness include: understanding how experience makes the brain grow; importance of play and imagination in daily life; learning to live in the “slow lane”; seeking novelty and innovation.
Healthy brain cells need healthy nutrition, “reward” neurotransmitters, BDNF, adequate blood supply, protection from head injuries, protection from toxic chemicals (e.g., pesticides, pollution).
It is never to early, it is never too late.
Sleep N Pills S = Sleep. Adequate daily and lifelong quality and quantity of sleep is essential
for brain health. L = Lose it or Use it. Be mentally active. E = Exercise regularly (aerobic/endurance [e.g., swimming, treadmill, brisk
walking], strength training [e.g., Pilates], flexibility [e.g., Yoga], balance [e.g.,Tai Chi]).
E = Excess disability (e.g., vitamin deficiencies, malnutrition, sleep apnea, chronic pain, chronic stress, pollution, anxiety and depression, ADHD, obesity, metabolic syndrome, smoking, drinking more than 2 alcoholic drinks / day, poorly controlled hypertension, diabetes, hyperlipidemia ) needs to be addressed.
P = Positive emotions (calm, peaceful, happy, optimistic, serene, joyful, relaxed, in “flow,”) and Positive actions (altruistic, forgiving, kind, loving).
N = Nutrition (fruits [berries and cherries, avocados], vegetables [green leafy vegetables, tomatoes], omega 3 rich food (especially fish), spices (especially turmeric), whole grains, small amounts of olive oil or canola oil, very small amount of nuts and red wine.
Pills (omega 3, B12, Vitamin D, Zylfamend, pills to treat cardiovascular disorders, other conditions such as Alzheimer’s disease, ADHD, depression).
PSALMS – to become happier
P: Engage in activities that generate PLEASURE.
S: Engage in activities that exercise our STRENGTHS.
A: APPRECIATE what you have. Wanting what you have promotes happiness, not having what you want.
L: Cultivate capacity of LAUGH at your imperfections. Capacity of listen up.
Checklist: A guide for clinicians 1. Smoking cessation advice and guidance provided. 2. Advice to follow guidelines proposed jointly by the American Heart
Association and the American College of Sports Medicine regarding daily physical activity provided.
3. Advice and guidance regarding healthy nutrition (e.g., Mediterranean diet) provided.
4. Advice to engage in intellectually challenging and creative leisure time activities provided.
5. Strategies to promote emotional resilience and reduce psychological distress and depression (e.g., relaxation exercises, mindfulness-meditation practices) provided.
6. Advice to maintain an active, socially integrated lifestyle provided. 7. Strategies to achieve and maintain optimal daily sleep provided. 8. Education about strategies to reduce risk of serious head injury (e.g.,
wearing seat belts, wearing helmets during contact sports, bicycling, skiing, skateboarding) provided.
References
Desai AK, Grossberg GT. Road Map to Healthy Brain Aging. Clin Geriatr Med 2010. In Press.
Jedrziewski MK, Lee VM and Trojanowski JQ. Lowering the risk of Alzheimer’s disease: Evidence-based practices emerge from new research. Alzheimer’s & Dementia. 2005; 1: 152-160.
Fratiglioni L, Paillard-Borg S and Winblad B. An active and socially integrated lifestyle in late life might protect against dementia. The Lancet Neurology 2004; 3:343-353.
Pasinetti, G.M. and Eberstein, J.A. Metabolic syndrome and the role of dietary lifestyles in Alzheimer’s disease. J Neurochem 2008; May 3 (epub ahead of print).
References on cognitive training
Willis SL, Tennstedt SL, Marsiske M, et al. Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA 2006; 296: 2805-2814.
Walker M. The role of sleep on cognition and emotion. Ann NY Acad Sci. 2009;1156:168-197.
Valenzuela M, Sachdev P. Brain reserve and dementia: a systematic review. Psychol Med. 2006;36:441-454.
Valenzuela M, Sachdev P. Can cognitive exercise prevent the onset of dementia? Systematic review of randomized clinical trials with longitudinal follow-up. Am J Geriatr Psychiatry. 2009;17:179-187.
Stern Y. What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc. 2002;8:448-460.
Suggested reading
The Healthy Brain Initiative. Centers for Disease Control and Prevention and Alzheimer’s Association. The initiative proposes 44 actions to maintain or improve the cognitive performance of all adults.
Cognitive Fitness. Roderick Gilkey and Clint Kilts. Harvard Business Review. November 2007.
AD Progress Report 2007. www.nia.nih.gov/Alzheimers/Publications/ADProgress2007.htm.
Yashodhara BM et al. Omega-3 fatty acids: a comprehensive review of their role in health and disease.
Suggested reading.
The Mindful Brain. Daniel Siegel. Spark: The revolutionary new science of exercise
and the brain. John Ratey and Eric Hagerman. Healthy Eating. A guide to the new nutrition. A
special report from Harvard Medical School. Improving Memory. Understanding age-related
memory loss. A special report from Harvard Medical School.
Anti-cancer. A new way of life. David Servan Schreiber M.D.
Other resources.
Audio CD: Mindfulness for beginners. Jon Kabat Zinn.
www.thememorypractice.com www.sharpbrains.com/newsletter/expert-contributors Posit Science website. The Center for Healthy Brain Aging, Saint Louis
University School of Medicine Website (http://neuroandpsych.slu.edu/healthybrain ).
http://bfc.positscience.com/resources/reading/the-brain-that-chages-itself-normal-doidge-01.php .
Checklist: Guide for clinicians 9. Education about strategies to reduce exposure to hazardous
substances 9e.g., wearing protective clothing during the administration of pesticides, fumigants, fertilizers, and defoliants) provided.
10. Education and counseling provided regarding negative health effects of alcohol consumption more than recommended as safe by the National Institute of Alcoholism and Alcohol Abuse.
11. Education about importance of achieving and maintaining healthy weight to promote overall health provided.
12. Strategies to achieve optimal blood pressure control instituted. 13. Strategies to achieve optimal control of dyslipidemia instituted. 14. Strategies to achieve optimal control of blood sugar / diabetes
instituted. 15. Advice regarding the risks and benefits of medications,
supplements, herbal remedies and vitamins to promote brain health provided.
16. Secondary prevention of stroke strategies (e.g., daily baby aspirin) implemented.
Suggested reading
The Brain That Changes Itself. Stories of personal Triumph from the Frontiers of Brain Science. Book by Norman Doidge M.D. Featured on PBS’s The Brain Fitness Program.
Why we make mistakes: How we look without seeing, forget things in seconds, and are all pretty sure we are way above average. Book by Joseph T. Hallinan.
Quiet! Sleeping Brain at Work. Robert Stickgold and Jeffrey Ellenbogen. Scientific American Mind; 2008, Vo. 19 Issue 4, p23-30.
Suggested reading
Stronger After Stroke. Peter Levine. The Mind and the Brain: Neuroplasticity and
the power of mental force. Jeffrey M. Schwartz MD
ADVANCE for physical therapists. After a Stroke: 300 tips for making life easier
and striking back at stroke: A doctor-patient journal. Cleo Hutton LPN.
Suggested reading
Are you working too hard? A conversation with Mind/Body Researcher Herbert Benson. Harvard Business Review November 2005; 53-58.
Dr. Andrew Weil’s guide to Heart Health. 2009. The New Mediterranean Diet Cook Book. By Nancy
Harmon Jennkins. Bantam 2008. Healing Night. By Rubin Naiman (addresses ways to
improve quality of sleep). Aging Well. George Vaillant M.D.
Suggested websites
Santa Barbara, California center for Cognitive Fitness and Innovative Therapies (CFIT). www.sbcfit.org
www.worstpills.org Has list of 136 commonly prescribed medications that are potentially dangerous to seniors’ cognitive health. Some of the pills listed here are good for you so please review all medications with your health provider before stopping them or reducing their dose.
