keeping your brain young abhilash k. desai m.d. associate professor, director center for healthy...
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Keeping Your Brain Young
Abhilash K. Desai M.D.Associate Professor, Director
Center for Healthy Brain AgingSaint Louis University School of Medicine
Characteristics of Aging Brain
Decline in function of attention (working memory). Decline in episodic memory (memory of events). Decline in speed of processing. Decline in multitasking capability. Semantic memory (memory of facts [e.g., address of ones
home, ones social security number]) does not decline except for memory of peoples names.
Procedural memory (memory of skills [e.g., riding bicycle, playing piano, shaving]) does not decline with age.
Capacity to recognize familiar routes, places and people does not decline with age.
Capacity to problem solve, think abstractly (executive function) does not change with age.
The evolutionary substrate of aging mind. Martin GM. Arch Neurol 2002;59:1702-1705. After the reproductive years, evolution has
not provided a great deal of protection for enhanced survival. As a result, aging produces a permissive biological environment, allowing opportunistic disease processes to develop, including Cerebrovascular disease, Alzheimer’s disease, Parkinson’s disease, and the Fronto-temporal dementias among others.
Alzheimer’s, dementia and aging
McNeal MG et al. Journal of Gerontology Biological Sciences. 2001;56A(7):B294-B301.
100 optimally healthy oldest-old (85 years and older) followed for 5.6 years on average. 34 subjects developed cognitive impairment, 23 progressed to Alzheimer’s disease. Thus, superior health at old age does not guarantee protection against cognitive decline.
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
Ferrucci L et al. Mapping the road to resilience. Mech Ageing Dev 2008; 129:677-679.
Aging has been conceptualized as declining efficiency of the mechanisms that maintain the homeostatic equilibrium, which is continuously challenged by destabilizing events (e.g., 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]).
Aging Mind
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.
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. Brain machinery wearing down due to genetic, environmental and lifestyle factors.
Centenarians and Supercentanarians
Perls TT. Dementia-free centenarians. Experimental Gerontology 2004;39:1587-1593. Conservatively, approximately 20% of centenarians are cognitively intact.
Wilcox DC et al. J Gerontol A Biol Sci Med Sci. 2008;63(11):1201-1208. 3 out of 12 supercentenarians (age 110 or more) developed dementia.
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).
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.
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.
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 bad habits are so difficult to break or “unlearn.” When we learn a bad 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.
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.
Meditation, Centering Prayer, Yoga, Tai Chi and Mindfulness practice are some of the best ways to improve attention.
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.
Basic Principles
As brain cells are trained and become more efficient, they can process faster.
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.
“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).
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.
Attunement to the needs and messages from our mind and body is key.
Understanding the root causes of “problems of the mind” is key to successful correction strategy.
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.
Brain Food!
“Let food by thy medicine, and medicine be thy food” – Hippocrates (460-377 BC).
Fotuhi M et al. Nat Clin Pract Neurol 2009. 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.
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).
Salt
50% of individuals with hypertension are salt sensitive (10%-15% of general population).
US Dietary Guidelines: age less than 50: 2.3grams/day. Age 50-70: less than 1.5grams/day. Age 70 or more: 1/2grams/day.
Average US salt consumption: 6-9grams/day. Most comes from processed food.
Average Asian salt consumption: 8-11grams/day.
Exercise
US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Washington. DC: US Dept of Health and Human Services; 2008. The Surgeon General recommends 150 minutes of moderate exercise per week, or 30 minutes of exercise 5 days a week to maintain health. However, in patients who are obese, more time should be spent exercising in order to lose weight, and physical exercise should be accompanied by proper diet to result in significant weight loss.
Good mind health advice!
Reeves et al. 2005. Four good health rules: don’t smoke, maintain
a normal weight, eat fruit and vegetables (5 servings a day) and get some exercise (30 minutes of moderate exercise 5 days a week).
Only 3% of US population followed all four!!!!
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.
References Weih M, Willtfang J, Kornhuber J. Non-pharmacologic prevention of
Alzheimer’s disease: nutritional and life-style risk factors. J Neural Transm 2007, DOI 10.1007.
Rabins PV. Do we know enough to begin prevention interventions for dementia? Alzheimer’s & Dementia. 2007; 3: S86-S88.
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.
Kramer AF, Erickson KI, Colcombe SJ. Exercise, cognition, and the aging brain. Journal of Applied Physiology 2006; 101: 1237-1242.
McEwen BS. Protective and damaging effects of stress mediators: central role of the brain. Dialogues Clin Neurosci. 2006; 8: 367-381.
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 Linder, MVD, Juillerat, A and Delbeuck X: Cognitive rehabilitation in mild
cognitive impairment and prodromal Alzheimer’s disease. Eds Gauthier, S., Scheltens, P., Cummings J.L. Alzheimer’s Disease and Related Disorders Annual 2004. Martin Dunitz, London and New York: pp 81-96.
Guerin, O and Vellas, B. Nutritional prevention in Alzheimer’s disease. Eds Gauthier, S., Scheltens, P., Cummings, J.L. Alzheimer’s Disease and Related Disorders Annual 2004. Martin Dunitz, London and New York: pp 161-172.
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 .
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
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. Healing Night. Rubin Naiman.
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.
