Positive Aging and Brain Fitness

Freedom to Choose

I just finished reading an article in AARP’s newsletter about diagnosing Alzheimer’s disease. As I anticipated, the meat of the article did not live up to the headline. Oh, there has been
progress in a doctor’s ability to identify if the brain has “plaques and tangles.” For years, it was hypnotized that these plaques and tangles were the cause of Alzheimer’s; however, science has yet to explain why others with plaques and tangles had no noticeable symptoms. As Dr. Peter Whitehouse points out in the Myth of Alzheimer’s, it is more than one thing and brain aging playsa role.

Of course, the drug companies hope they will eventually find the cure, or a preventative, in the form of a new drug. Big Pharma is cheered on by consumers who have come to look for magic
bullets to solve all their problems. Perhaps, if we focused as much time andmoney on non- pharmaceutical interventions and more time promoting whole body wellness, we could significantly improve the overall quality of life, and maybe improve cognitive well being for millions. For several decades, we have been replacing purpose with pills, which has resulted in an increasingly medicated older population while encouraging learned helplessness. In fact, all too often, interaction between drugs (both prescription and nonprescription) can produce
symptoms mistaken for Alzheimer’s or other problems.

As a proponent of the 7 Habits of Highly Effective People, I learned that the ultimate human freedom is our freedom to choose. We can choose to be reactive or proactive; but it is up to us to make the choices. While we know that optimistic people outlive pessimists by over 7 years, this is seldom factored in when evaluating quality of life. We are too quick to blame others when in fact the only person controlling our feelings is us.

While it would be great if there were a pill that could prevent or delay the onset of dementia, there is an ever growing body of anecdotal evidence, much of which is supported by science, that a variety of activities and habits may delay the onset of dementia, improve processing speed and enhance one’s memory. We now know that what is good for the heart is good for the brain; but that is seldom mentioned in articles about the search for the cure.

Maybe we can’t prevent Alzheimer’s disease any more than we can prevent aging. However, like aging, there is a lot we can do to improve our quality of life and battle future memory loss just as we can battle diabetes, heart disease and lung problems with lifestyle changes. At NeoCORTA (www.neocorta.com), we have developed self-evaluation tools to help users identify and understand their risk factor and provide customized plans to improve cognitive well being, but a person must want to take charge of their future to benefit from those plans and
change their behavior accordingly.

I have come to believe that positive aging is well within everyone’s reach…Believe you can; believe you can’t and you are likely to be correct – your choice. Both attitudes can become a
self-fulfilling prophecy once you understand and respect the mind body connection…aging is just a series of many beginnings and we control the starting points for each pathway.

The Many Dimensions of Brain Fitness

Just as physical fitness is about more than the strength of your biceps, brain fitness is much more than just the strength of your memory. To help in the definition of personal performance targets, we need to develop a better vocabulary for describing the full breadth of key brain functions. In fact, understanding this breadth is a critical piece of the brain fitness puzzle.

“Cognition” describes our “thinking” abilities- it’s about processing, coordinating, strategizing and responding to information. This includes a range of critical brain functions such as the ability to remember, pay attention, and make decisions. While there are many ways to categorize the key areas of cognition, one useful approach is to focus on the following four areas:

1. Recall measures the strength of your memory. It includes the ability to remember specific information (e.g., facts, ideas, experiences, etc.) as well as how to perform tasks (e.g., opening a door, tying your shoes, etc.).
2. Attention measures your ability to focus or concentrate while ignoring distractions and irrelevant information. Attention is a fundamental brain process that enables you to perform a wide range of activities (e.g., driving a car). Many activities require a person to divide attention among many things, while others require a shift of attention quickly from one task to another.
3. Processing Speed measures the time it takes for your brain to process information and/or respond to it. An increase in processing speed can make you feel more alert and better able to react. A decline in processing speed can make you misunderstand what people are saying, or make it difficult to follow instructions.
4. Executive Function measures high-level thinking skills such as planning, making decisions, solving problems, and reasoning. Executive function skills are required for everyday activities such as setting goals, organizing events, and playing games.

Meanwhile, “emotional well-being” describes how you “feel”. Emotional well-being allows you to calmly handle day-to-day challenges, maintain a positive outlook, adapt to change, and understand and care for others. One way to make sense of emotional well-being is to break it into five key areas:

1. Anxiety is a feeling of fear or apprehension involving physical and/or mental experiences. Anxiety appears in the form of physical symptoms (e.g., sweating) or as a feeling of increased nervous energy. Moderate, short-term anxiety is a normal part of life, but it can cause physical and psychological problems if it’s chronic.
2. Stress is a response to demands or changes in one’s environment. It involves emotional, mental, and physical components that each serve to help meet challenges. Moderate stress can be positive; for example, it enhances alertness and motivation, which increases abilities. On the other hand, longer-term or high levels of stress can weaken emotional, mental, and physical capabilities.
3. Mood can be described as a predisposition, attitude, or state of mind. It can include positive emotions like happiness or enthusiasm for everyday life. It also includes more negative states such as sadness.
4. Emotional Control includes the ability to evaluate your feelings, manage negative emotions, and handle conflict.
5. Emotional Recognition enables you to pinpoint feelings (in yourself and others) and to understand the ways in which your behavior may affect the emotions of others. This skill helps you to connect with others and better engage in social interactions.

The brain fitness movement is still in its early stages. If we want to pursue and achieve truly meaningful improvements in our capabilities over time, we need to adopt a perspective that enables us to understand, discuss, and track the full range of important brain functions.

Key to Reversing Aging???

A member of the LinkedIn Changing Aging group asked me to comment on an August 23, 2010 article entitled, “Listening for the Key to Reverse Aging” by Jessica Hilo of Miller-McCune. The article is a perfect example of how the media dismisses positive news about aging – in this case by using analogies to sitcoms and condescension. Since the article demonstrates both the progress in brain research and the pervasiveness of ageism, I decided to post it here as well...

While the Neuroplasticity of the brain is now a generally accepted fact, it is not the key to "reversing aging;" nor is anything else. Aging is a biological process whereby an organism moves from a simple to a highly complex state. Physical and brain aging declines are both a part of this process; but not everyone ages the same. The problem is that way too many people age prematurely due to self inflicted physical deterioration, disease or the ravages of the "self-fulfilling prophecies" of aging that occur when adults accept and live out aging stereotypes.

My problem with the article is not with the content but the headline and conclusion. I am very familiar with the efficacy studies of the auditory cortex discussed. I did considerable research before investing in a computer program for an upscale community for older adults. We ultimately purchased the Posit Science program, which I have loaded on my personal computer and used. While we cannot reverse "aging," it appears we can reverse or delay cognitive loss by building a cognitive reserve and also increase the brain's processing speed. Posit’s research documents that use of their products can reverse the affects of cognitive decline by as much as ten years. Likewise, their programs that exercise the visual cortex have produced some impressive results. Like the body, you get the most from your brain by exercising it.

Just as it is improbable that we can "reverse aging," we can most definitely mitigate the impact of both physical and mental declines with fitness and wellness programs. I joined NeoCORTA because the company offered an affordable brain fitness assessment vehicle with which adults could evaluate their own brain fitness, identify risk factors that research indicates can result in cognitive decline and offer a holistic action plan to achieve comprehensive brain fitness. Whether or not it can be cured, wouldn't it be great if it could be delayed for 25 or 30 years? What would happen if we spent as much time and money on prevention as we did curing those things that are preventable?

The author of the article uses the analogy that this type of research is like the quest for the Fountain of Youth and so far has only benefited the "beloved aging lab rats." How sad that is the conclusion that can be drawn from such exciting research. Instead of celebrating advances in neurological research and memory, the media so long enamored with the youth culture tends to minimize the advances. Twenty years ago, the scientific and medical communities generally accepted that mental decline and memory loss was a "natural" part of the aging process. Just imagine what we may learn in the next twenty years now that we have data that dementia is not a "natural" part of brain aging.

Is Brain Fitness Bad for You?

There are times when I am convinced the media go out of their way to perpetuate aging myths and misconceptions of the aging process. Today a friend sent me a CNN article entitled, “Brain exercises delay, speed up dementia? The article related the results of a study of more than 1,100 participants aged 65 and older, none of whom had dementia when the research began.

The article reported that, “people who regularly engage in mentally stimulating activities such as reading, doing puzzles, and going to museums may stave off the onset of dementia longer than people who don't. This has been shown in several other studies in the past. But here's the flip side: Those who are cognitively active also decline more rapidly when they do develop symptoms of Alzheimer's disease, the new study in the journal Neurology found.”

So, is that a bad thing? Wouldn’t it be better to delay dementia for 20 years and be impacted for a few months or have dementia for 20 years? Seems like a no brainer.

All the research I have seen states that NEW learning and challenging activities are necessary for an effective brain fitness program. Numerous studies, such as the Nun’s Study, have documented that in fact there are numerous positive benefits from challenging the brain and having a positive aging self esteem, which this article totally ignored.

Generally, things like learning a new language, doing crossword puzzles and Sudoku, travelling, reading and attending classes are examples of being cognitively active. However for this study, "cognitively active" activities included going to a museum, watching television, listening to radio, reading newspapers, reading magazines, reading books, and playing games. Watching television? Listening to the radio? I’m not convinced that years of soap operas and game shows may not actually cause dementia.

Further, the article went on to report that “The researchers did not ask participants about whether they continued to be cognitively active after the initial assessment at the start of the study.” Wouldn’t that pretty much trash any assumption that what they found out really proved anything? Instead, the article reported that, “The National Institutes of Health delivered the grim news in April that evidence on preventing the onset of Alzheimer's disease continues to be fuzzy (evidently research methodology is a little fuzzy as well), and that there is no lifestyle modification a person can make that is proved to help.”

Both the headline and portions of the article imply that being cognitively active can be potentially harmful, which is exactly the type of uncertainty that can lead to inaction and fuel the self-fulfilling prophecy that dementia is just a natural part of aging and if you fight it you will lose. This is irresponsible as best.

Who's on First? Part Two

Everyone curious about brain fitness is eager to know what works, in the real world, for real people. What's needed in the industry is a more detailed, data-driven, long term analysis of the full range of products, activities, lifestyle factors, etc. etc. Much more focus needs to be given to studies on wellness rather than disease, which is the focus of the scientific/medical mainstream. New information needs to be interpreted for easy consumption by lay people. Ideally, we can move more quickly toward a system where this data can be used to define/predict benefits for individuals, since this specificity would be much more likely to motivate participation/commitment.

There is an overwhelming body of evidence, both quantitative and anecdotal, documenting that activities such as learning a new language, physical exercise, socializing with friends, working on challenging crossword puzzles, reducing stress and watching what you eat can improve both physical health and improve cognition. Multiple studies by thought leaders such as Rebecca Levy and Ellen Langer detail how a positive mental attitude, meaningful activities and respect impact memory. More recently some “brain fitness games” also claim to have a positive an impact on improving the brains processing speed and cognition.

Similarly studies found that a reduced risk of Alzheimer’s disease is associated with higher education or occupational levels, speculating that these individuals had a greater “cognitive reserve.” Additional findings have led to the theory that lifelong learning is more important for developing cognitive reserve than advanced education level alone.

Technology is also playing an increasing role. Millions of public and private funds have been devoted to efficacy studies on the documented benefits of brain fitness oriented computer games and exercises. This research has advanced the recognition that memory and other cognitive functions are “use it or lose it” skills.

Historically, non-profit providers of aging services to include long term care have focused on treatment rather than prevention. With the growing aging population, providers have a responsibility to share information on the positive benefits of brain fitness with the clients they serve and their employees. In addition to caring for the afflicted or raising funds to find a cure, nonprofits providers should be offering programs that can be built in to the everyday office life of employees, especially those in the mature work force. This could include anything for computerized exercises to new and more challenging assignments.  Employment of such measures could benefit both employee health and retention.

The proliferation of brain fitness offerings has been beneficial, but can cause confusion and frustration among consumers who do not know where to begin. While worried about future memory loss, consumers do not know which products might help or if they are needed. While annual physical check examinations are common place, there is also a growing need for an annual brain check-up or examination, which NeoCORTA is now filling. An annual cognitive exam provides consumers with a current baseline for brain fitness and helps them create a plan to maintain and/or improve cognitive function. We are pleased to play the role of pathfinder in a growing industry.

Who's on First? Part One

Since President George Bush declared the 1990s the Decade of the Brain, we have learned a lot about the workings of the brain. In the last two decades, numerous research studies have validated the neuroplasticity of the brain and others detail how it may be possible to delay or even prevent cognitive loss. Since most active adults over age 50 fear cognitive loss more than they fear heart disease or cancer, a plethora of new products and services in the brain fitness category have flooded the market in response to the fear and growing numbers of older adults.

Many scientists once believed that as we aged the brain's networks cemented in place. But now an enormous amount of evidence uncovered in the past two decades finds that the brain never stops changing and adjusting. One line of research is showing that this flexibility can help maintain language processing even in the face of severe obstacles. Furthermore, some research suggests that special brain exercises can tap into the brain's adaptive capacities and help people overcome certain language and reading problems.

There is currently a lack of clarity/awareness around what "brain fitness" means (it's more than memory; it's even more than just cognition). More consensus building among thought leaders and more education for the general public is needed around its scope and goals. Brain fitness is less about avoidance of disease, and more about maintaining and improving the brain’s capability and potential.

The brain fitness industry is in its infancy. To date, there have been difficulties in reframing the use of brain science for both practitioners and consumers. With the projected rise in Alzheimer’s patients, there is more need than ever for medical treatment and expertise. However, there is also a need for appropriate nonmedical applications of brain science just as there have been in the physical fitness movement. For example, it's time to de-stigmatize and remove the fear factor from discussions about brain fitness. With more education and understanding, the consumer will be able to take control and make their own decisions based on their personal goals and preferences.  As the industry matures, new players and operating models will begin to deliver services rather than depending on doctors, neurologists, psychiatrists, and academic researchers. The American Senior Fitness Association is a great example of this trend. They now offer a course on the integration of brain fitness into physical fitness programs.

Alvaro Fernandez, co-founder and CEO of SharpBrains, a research and consulting company that recently published The State of the Brain Fitness Software Market 2008 report, predicts that within the next few years, the same thing that happened for physical fitness—increasing numbers of health clubs, trainers, coaches, and equipment variety—will also happen for the field of brain fitness. Cognitive training will be conducted much like physical fitness training.” In the near future, brain fitness products will be a must-have for facilities serving older adults. Based on their market research, SharpBrains estimatedthat approximately 400 to 500 facilities for older adults in the United States are now offering some kind of computerized brain fitness program to complement their other recreational and therapeutic activities. And, direct purchases by consumers for at-home use are increasing rapidly as well.  

For widespread adoption to occur, we need a whole ecosystem of new solutions and service providers that can help consumers and organizations pursue brain fitness. For the movement to become mainstream, we need to make brain fitness programs affordable, easy, accessible, scalable, and of course effective. An important part of this is making sure that individuals/organizations can easily embrace the movement and get results without having to become brain scientists themselves, drastically modify their existing infrastructure, or devote massive amounts of time and energy.