Feb 20, 2008
Cognitive training (the basis for what we call “brain fitness” these days) has a wide array of applications. The most recent one, which is capturing public’s imagination, monopolizing media coverage, and creating certain confusion, is Healthy Brain Aging. We are fortunate to have Dr. Joshua Steinerman, one of our new Expert Contributors, offer today his great voice to this conversation. Enjoy!
Minding the Aging Brain
— By Joshua R. Steinerman, M.D.
Scientists, philosophers, artists, and experts from all fields of human endeavor lament: it ain’t easy getting older. It? Do they refer to frailty and disability? To bodily disease? To life at its essence?
It’s all in your head
The mind is not set in stone, but it is encased by bone. It’s really all about the brain, the hyphen in the mind-body conundrum. That squishy gray neuronal jungle is the interface between internal life and environmental sensations and stimulation. As expected, the brain shows signs of aging just as a wrinkled brow, a stooped posture, or an arthritic finger might. The most common brain changes observed in aging and in age-associated neuropsychiatric disease include:
* Brain atrophy (shrinking may be generalized or more pronounced in a particular lobe or brain structure, such as the hippocampus)
* White matter changes (degradation of the connections between brain regions, often attributed to diseased cerebral blood vessels)
* Plaques and tangles (accumulations of proteins and degenerated bits of nerve cells)
Going out of your mind?
There is no doubt that brain aging takes a toll on cognition and mental performance. Individuals vary in their ability to tolerate age-related brain changes before manifesting overt symptoms (see Alvaro’s interview with Yaakov Stern on the Cognitive Reserve). Nevertheless, there will always be a threshold beyond which signs of deterioration can be perceived. Often, the effects of brain aging are subtle and undetected. The cognitive declines commonly associated with aging are observed in the following domains:
* Processing speed and reaction times
* Cognitive control and Executive function
Some brains manifest accelerated or disproportionate changes. These are signs of pathological brain aging, and may take on the form or pattern of particular neurodegenerative diseases, such as Alzheimer’s disease. Concurrent brain pathologies, such as stroke or Parkinson’s-related changes, may act additively or synergistically. In these settings, cognitive symptoms may include profound memory loss and executive dysfunction, as well as language and visuospatial dysfunction. Behavioral symptoms can include depression, anxiety, apathy, agitation, or psychosis. When the ability to function independently is compromised, the term dementia may be used to describe this frightening mental state.
Getting into your brain
How do you think about your mind? Get cerebral and consider the possibility of successful cognitive aging. How do people envision such a prospect? A recent poll on Brain Health by the American Society on Aging/ Metlife Foundation reported the most common responses offered by Americans when asked to define brain fitness:
* Being alert/sharp
* Keeping your brain active/exercising the brain
* Good mental health/not senile
* Good memory
* Ability to function normally
* Ability to think clearly
* Not suffering from Alzheimer’s Disease
While these are all worthy goals, some cannot be empirically assessed. For example, with expertise, memory can be formally quantified, and Alzheimer’s Disease can be diagnosed with reasonable confidence. On the other hand: being alert, sharp, active, and thinking clearly are not only difficult to measure, they are closely coupled with self-perception and well-being. Such mental phenomena are not only of outstanding everyday relevance, they are sorely under-researched. Consequently, the scientific community may not have the necessary tools to study brain fitness interventions designed to achieve successful cognitive aging.
Brain training isn’t easy, either
In our initial forays into studying science-based cognitive training interventions, I propose that we have yet to apply the outcome measures of greatest interest. I believe there is a need to define and implement novel research outcomes for brain fitness research. These should be functionally-relevant, in that they reflect useful, everyday skills. They should be biologically-relevant, in that they track and distinguish normal and pathological brain aging. Many could be grounded in the largely-unexplored concept of positive cognition, much the way positive psychology energized a vision and research agenda for emotion and character.
Whether or not science-based mental fitness will make promoting brain longevity possible, it surely will not be easy. Establishing efficacy of the emerging technologies and techniques will require tremendous effort and investment. Motivating individuals to engage in brain-healthy activities may prove even more challenging than encouraging adoption of heart-healthy lifestyles. Ignorance will not yield bliss, and mental passivity can destroy. The challenge of minding and mending the aging brain must now be addressed head-on.
— Joshua Steinerman wrote this article for SharpBrains. Dr. Steinerman is a Postdoctoral Clinical Fellow in the Department of Neurology at Columbia University Medical Center. He is a Co-investigator on this Cognitive Training Clinical Trial, and looking for participants who are healthy adults between the ages of 60 and 75 living in New York City.