The Healthy Aging Brain…a Continuing Series

While exercise has an undisputed key role in maintaining brain health throughout our lives, promising new research points to a number of other factors that can spell the difference between thriving or just surviving the senior years. We checked in with Eric Terman, MD, personal physician and Assistant Professor of Internal Medicine and Geriatrics at Northwestern University for an informed view of the latest thinking on this topic…important not just for current seniors, but also for aging Baby Boomers and for younger 40-somethings just beginning the “aging” process.

 What are some of the key findings of current studies into how the mind ages?

Research shows that the brain continues to form new connections throughout life. This process, called adult neurogenesis, shows how plastic or structurally adaptable the brain is, even as we age. A combination of exercise, diet and stimulating environments can increase adult neurogenesis and improve cognitive functioning in young and old individuals. This has been documented in animals and we are seeing increasing evidence this occurs with humans too.

What role does exercise play?

We know exercise appears to increase the neurogenerative properties. While the cause is not clearly proven yet, there is little doubt that exercise benefits both body and mind in many ways. It is associated with reduced risk of dementia, and may actually be preventive. For these reasons, I almost always recommend a form of regular activity to my patients.

 Do you advise your older patients to consider retirement for reduced stress, more time for leisure activities, etc?

It’s critical to stay engaged in something you care about, whether or not you’re earning a significant salary. The brain stays sharp if you continually grapple with problems, find solutions and achieve positive outcomes.

Wouldn’t lifelong learning classes and lectures fill that void?

Sometimes listening to a lecturer can be barely better than watching TV in terms of passive versus active involvement of your brain. Unless you’re reading textbooks and writing papers, you’re better off with the type of engagement you receive from working. It’s the same reason the benefits of brain training games are unclear – problem solving for real world issues results in better cognitive capacity.

Can you explain mindfulness-based interventions and how these work to reduce the severity or risk of diseases such as Parkinson’s and Alzheimer’s?

High levels of stress are associated with increased risk of these diseases, and with mild cognitive impairment. Mindfulness-based interventions such as meditation and yoga are non-invasive stress reducers, and proven effective complements to treatments for anxiety, hypertension, chronic pain and insomnia too. Preliminary research is also showing that mindfulness-based interventions reduce atrophy of the hippocampus (a critical site of episodic memory), increase gray matter and improve functional connectivity in the neural networks of the brain most affected by the disease process of Parkinson’s and Alzheimer’s.

What is the best way to get started with this kind of program?

There are formal meditation programs and yoga training activities, as well as some excellent apps that take you through the process, such as Headspace.

What advice would you give seniors looking for ways to keep their brain and spirit vigorous as they age?

Find something to pursue that keeps you actively engaged and that you love to do if you formally stop working. Definitely, keep moving – I have patients who have started exercise programs in their 70s and they see significant differences in the way they feel. Modify your sleep behaviors if needed to ensure a good refreshing sleep, every night. And while the effect of a strong social network may be somewhat of a chicken-egg conundrum, there is increasing evidence that social and mental stimulation strengthen connections between nerve cells in the brain.

Breakthrough research sheds new light on Alzheimer’s disease

Numerous studies of Alzheimer’s disease, the leading cause of dementia that gradually erodes a person’s memory, thinking and ability to perform everyday tasks, are beginning to provide answers as to causes and possible targets for treatment. For instance, the link with cardiovascular disease has become increasingly evident. Several conditions known to raise the risk of cardiovascular disease, including high blood pressure, diabetes and high cholesterol, also increase the risk of developing Alzheimer’s – as many as 80 percent of individuals with Alzheimer’s disease also have cardiovascular disease, according to the Alzheimer’s Association. Experts have noted that while some people develop brain plaques and tangles seen in the disease, they do not suffer from the symptoms of Alzheimer’s unless vascular disease is also present.

Other new research is focused on the blood-brain barrier (BBB), a protective filter of the brain that becomes more damaged in patients with Alzheimer’s disease. At University of Southern California, neuroscientist Berislav Zlokovic and team found that the BBB becomes leaky with age, starting in the hippocampus, an area that is affected before the symptoms of Alzheimer’s disease are seen. He noted that specialized brain scans might help doctors diagnose the condition earlier. “Dr. Zlokovic’s advances bring us that much closer to a cure,” reports the chairman of the Cure Alzheimer’s Fund.

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Forget Me Not: Normal Aging, Mild Cognitive Impairment or Dementia?

We’ve all had the experience of frantically searching for car keys in the morning or walking purposefully into another room only to forget why we were going there, and as we age, it seems to occur with increasing frequency. Are these just signs of normal aging, or harbingers of a more serious condition? It’s a question more seniors and their families are asking, as awareness of progressive memory disorders such as Alzheimer’s disease grows.

The answers can be more reassuring than yo• may imagine. Many symptoms of memory loss are benign,or due to the aging process, and no further evaluation is needed (see the signs of normal aging, at right). Experts agree that most people who are aware of—and nervous about—their own declining memory, most likely do not have mild cognitive impairment or dementia.

However, it’s vital to know that if you do have symptoms of mild cognitive impairment (MCI), this may be due to underlying medical conditions that can be treated, such as thyroid dysfunction, vitamin deficiency, anxiety/depression, sleep disorders and uncontrolled chronic conditions such as diabetes.

You may want to consider seeking an evaluation if you experience increasing difficulty, compared to your past ability, over a range of everyday activities that include: remembering important details of things you’ve done in the past few weeks; completing complex tasks at work or home, such as keeping track of monthly bills; requiring personal assistance to remember family occasions or holidays; or having trouble finding your way around familiar environments.

Cognitive abilities are also affected by depression, so if you have experienced these feelings during the last month, further evaluation is recommended:

Felt that I cannot stop feeling “down” or “blue,” even with help from family or friends.

• Felt all pleasure and joy has gone from life.
• Felt hopeless about the future.
• Felt that everything was an effort.
• Felt low in energy or slowed down a lot.
• Did You Know?

150 minutes a week

Amount of exercise time needed to improve memory and reduce the risk of dementia. Source: Harvard Health

“Having memory loss does not necessarily mean yo• have Alzheimer’s disease (AD),” says neurologist William Rodman Shankle, MD, chair of California’s Memory and Cognitive Disorders Program at Hoag Neurosciences Institute. “In fact, there is a treatable cause in the majority of patients with cognitive impairment, provided it is detected early.”

Additionally, a rigorous combination of physical exercise, healthy diet, strict control of hypertension and diabetes, medication and ongoing social and intellectual stimulation, has proven highly effective in stopping or slowing down progression of all types of dementia, including Alzheimer’s.

Sources: Medical Care Corporation (www.mccare.com), Alz.org

Did You Know?

Learn, then sleep

While we sleep, memories are shifted to more permanent brain regions; studies have shown that sleeping shortly after learning new information can help retention in the long term. Source: The National Sleep Foundation

Signs of Normal Aging

• Forgetting the name of someone I know well, but remembering it later
• Forgetting what I was going to say in a conversation
• Forgetting what I was going to when going into another room
• Finding things I have recently put down
• Recalling a specific word I want
• Making occasional errors when balancing a checkbook
• Occasionally needing help to record a television show or adjust the microwave settings
• Getting confused about the day of the week but remembering it later
• Misplacing things from time to time, such as a pair of glasses
• Sometimes feeling weary of work, family and social obligations
• Becoming irritable when a routine is disrupted

Sources: mccare.com, Alz.org

Making Memories

• The creation of a memory begins with its perception, a quick sensation that is then stored in short-term memory, which lasts a few minutes to a few weeks before being erased. Strategies to enhance short term memory can be effective, such as dividing a 10-digit phone number into smaller chunks. Important information is gradually transferred from short-term into long-term memory.
• Working memory is the type most affected by normal aging. While a teenager will perform better on memory and word recall tests, a 70-year old can adapt by using associations to remember e.g. ‘Every Good Boy Does Fine’ for lines on a music staff.
• Long-term memory consists of procedural (knowing how to do things like ride a bike), semantic (knowledge of the world), and episodic (information about events you have personally experienced). Long-term memory decays very little over time, and can store a seemingly unlimited amount of information almost indefinitely.

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The Healthy Aging Brain: Making Strides by Taking Strides

“Walking is man’s best medicine.” Hippocrates
Put away the handheld brain games and turn your focus from lifelong learning to lifelong walking. The road to sustaining brain health is an active one and taking that first step, followed by thousands more on a daily basis, can make an enormous difference in quality of life in your later years. Arthur Kramer, PhD, director of the Beckman Institute for Advanced Science and Technology at the University of Illinois, has amassed decades of research that clearly points to the prescience of Hippocrates’s ancient wisdom. His studies have become a focus of public health policy as well, sparked by 10,000 Baby Boomers crossing the over-65 threshold each day for the next 15 years, each hoping to age with vigor and dignity intact. We checked in with Dr. Kramer for an update on how physical activity keeps the brain healthy over the lifespan.

What are the most striking results seen in your research?
Our 2006 study was one of the first to report actual increases in brain volume in the prefrontal and temporal cortices of seniors who participated in aerobic exercise. These areas of the brain normally decline with age, but in our group, significant improvements in cognitive performance and memory were noted.  We subsequently explored the impact of exercise on white matter, which allows information to be transferred within the brain, and found that connectivity is markedly improved, which is linked to more efficient memory, attention and decision making capabilities. All this points to the fact that age-related cognitive and brain changes are not inevitable, and can actually be reversed.

Why does exercise trigger these changes?
Several theories: increased blood flow, which improves cerebrovascular health; the release of proteins in the brain that stimulate the growth of new neurons; and the benefits of glucose and lipid metabolism which bring nourishment to the brain.

What type of exercise is most effective?
Only modest increases in physical activity are needed.  Walking 40 minutes three times a week for a year, at up to 70 percent of maximum heart rate, resulted in increased volume of the hippocampus, a part of the brain responsible for memory. You don’t have to run marathons – just walk, bike or swim at moderate intensity.

Tell us why you joined an international group of leading scientists who posted a strongly worded statement on the Stanford Center on Longevity website as to the unproven efficacy of ‘brain games.’
We felt that the scientific literature does not support claims made by the manufacturers of software-based brain games…that these can make people smarter, more alert, able to learn faster, and even prevent or reverse Alzheimer’s disease. What we discerned from the research was that when people practice a task repeatedly, they will get better at that task, but it is not necessarily applicable to real-world functions. The relationship between brain training games and real-world performance and cognition needs to be explicitly tested. Unfortunately, this is rarely done. Further, time spent on brain training can be better used for activities we know improve cognitive functioning – aerobic exercise, learning a new sport or a new language, staying socially connected. Our consensus was that the promise of a magic bullet detracts from the best evidence to date…cognitive health in old age reflects the long-term effects of healthy, engaged lifestyles.

As a contributor to the recent Institute of Medicine report on cognitive aging, what lifestyle modifications do you suggest?
Being physically active is unquestionably a top recommendation for enhancing cognition and longevity. We also noted the critical importance of reducing and managing cardiovascular disease risk factors; staying socially and intellectually engaged; getting adequate sleep and receiving treatment for sleep disorders as needed; and regularly reviewing health conditions and medications
that might influence cognitive health with a physician. What’s on your radar for future research? We are looking at what types of exercise lead to the largest cognitive and brain benefits. Dance is
particularly interesting because it’s physical, social and intellectually complex. Defining the optimal doses of exercise, and how these might differ with age, health and other factors are also a focus. We are working with children, who increasingly suffer from adult diseases like diabetes, due to obesity and inactivity. And we want to determine whether a combination of nutrition and exercise provides greater benefits than either of these factors alone. The definitive answers have not yet been found. We’ll continue to seek them out, to ensure we don’t just live long, but live well.

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