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Healthy aging: Optimizing Your Brain Health

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Title: Brain That Changes Itself Author: adesai Last modified by: Tor Holtan Created Date: 1/29/2009 10:01:42 PM Document presentation format: On-screen Show – PowerPoint PPT presentation

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Title: Healthy aging: Optimizing Your Brain Health


1
Healthy aging Optimizing Your Brain Health
  • Abhilash K. Desai M.D.
  • Associate Professor, Director
  • Center for Healthy Brain Aging
  • Saint Louis University School of Medicine

2
Disclosures
  • None

3
Objectives
  • Describe the impact of daily activities on brain
    function.
  • Discuss some daily practices to improve brains
    resilience (i.e., its capacity to function well
    despite diseases that damage brain cells and
    brain connections).

4
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.

5
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.

6
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.,
    Alzheimers 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 129677-679.

7
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 200615781-109.

8
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.

9
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 ones ability to focus.

10
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.

11
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.

12
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!

13
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!!

14
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.

15
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.

16
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.

17
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.

18
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.

19
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.

20
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/hea
    rt/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).

21
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
    Alzheimers and slower progression of Alzheimers
    disease.
  • Improved mood and reduced risk of depression.
  • Reduced risk of falls.
  • Improved capacity to pay attention (focus),
    problem solve.
  • Improved sleep.

22
Physically active lifestyle
  • Improved blood flow to the brain
  • Reduced oxidation
  • Reduced inflammation
  • Reduced toxicity of misfolded proteins that are
    thought to cause Alzheimers disease, Parkinsons
    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.

23
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.

24
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.

25
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 Alzheimers disease, ADHD,
    depression).

26
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.

27
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-meditatio
    n 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.

28
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 Alzheimers disease
    Evidence-based practices emerge from new
    research. Alzheimers 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 3343-353.
  • Pasinetti, G.M. and Eberstein, J.A. Metabolic
    syndrome and the role of dietary lifestyles in
    Alzheimers disease. J Neurochem 2008 May 3
    (epub ahead of print).

29
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. 20091156168-197.
  • Valenzuela M, Sachdev P. Brain reserve and
    dementia a systematic review. Psychol Med.
    200636441-454.
  • 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.
    200917179-187.
  • Stern Y. What is cognitive reserve? Theory and
    research application of the reserve concept. J
    Int Neuropsychol Soc. 20028448-460.

30
Suggested reading
  • The Healthy Brain Initiative. Centers for Disease
    Control and Prevention and Alzheimers
    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/Alzheimer
    s/Publications/ADProgress2007.htm.
  • Yashodhara BM et al. Omega-3 fatty acids a
    comprehensive review of their role in health and
    disease.

31
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.

32
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 .

33
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.

34
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
    PBSs 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.

35
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.

36
Suggested reading
  • Are you working too hard? A conversation with
    Mind/Body Researcher Herbert Benson. Harvard
    Business Review November 2005 53-58.
  • Dr. Andrew Weils 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.

37
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.

38
My contact info
  • adesai_at_slu.edu
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