Nov 14, 2008
If you could, you would. You can, but prefer not to know it?
More than any other organ, your brain is up to you. You are what you think, not just what you eat. Here’s some food for thought:
Design your Mind
Setting cognitive and behavioral goals raises challenging and worthy questions: What do you want from your brain? Will you know it when you achieve it?
To attain the brain of our choosing, we must understand our selves and current abilities. Introspection and curiosity are helpful if they trigger and sustain the effort to enrich the mind. However, objective information which leads to informed assessment of brain function is often lacking.
Mind your Brain
Honesty. Openness. Self-awareness.
Irrefutable virtues, but in practice most people fall short. Few regularly appraise their brain skills; even so, the ability to accurately judge one’s own mental performance is not guaranteed. I believe the first step to minding the brain is shedding hang-ups while offering and soliciting frank feedback from family and close confidants. In the clinical setting, routine cognitive screening and “mental check ups” are not currently practiced, in part due to time constraints and limited utility of traditional paper-and-pencil tests. From a public health perspective, the U.S. Preventative Task Force reviewed available evidence and could not determine whether the benefits of screening outweighs the risks (link here).
There is great promise in using computer-based cognitive assessments and innovative memory tests which are based on contemporary concepts in cognitive psychology. Highly desirable research aims will be to demonstrate their ability to 1) reliably capture a person’s “baseline” cognitive abilities; 2) promptly detect intraindividual change; and 3) accurately predict risk of future decline.
Equally critical will be establishing public and professional buy-in to the notion that peeking at the brain is worthwhile. Complicating the situation, especially with aging, is a widespread ambivalence–even objection–to taking stock of our cerebrum. If cognitive decline or an Alzheimer’s diagnosis would be the outcome, there is a common and unfortunate preference “not to know” (See Early Alzheimer’s disease diagnostics: Wait! Wait! Don’t Tell Me) for a recent editorial addressing the research and public policy implications of such willful ignorance).
Mend your Mind
It is true that motivating people to seek ongoing assessment of their mental status will identify people who are experiencing signs of brain aging. The challenge will then fall to professional and research communities to demonstrate the benefits of early diagnosis and intervention. Delivering clinical excellence will require interdisciplinary innovation.
In establishing the Einstein-Montefiore Brain Aging Center in New York City, I prioritized two overlooked but essential modes of intervention: education and community outreach. The goals are to counteract a prevailing therapeutic nihilism which is no longer justifiable, and to mobilize communities to promote brain longevity. Such culture change will presage successful research and development of the therapies so desperately needed. Disease-modifying biotechnologies and astounding cognitive neurotechnologies may be on the horizon, but the time is now to pique your brain.
SharpBrains readers: I would like to pick your brains on this subject. Please post your comments and thoughts on the following provocative statements:
1) Even if my cognitive abilities were declining, knowledge of this would leave me worse off.
2) I am concerned that family, friends, physicians, employers, or insurers would treat me differently if they found out I had cognitive decline.
3) Understanding my cognitive strengths and weaknesses will motivate me to establish and adhere to a personalized brain fitness program.
For a related article, you can read Alvaro’s Computerized Cognitive Assessments: opportunities and concerns.
— Dr. Joshua Steinerman is Assistant Professor of Neurology at New York’s Albert Einstein College of Medicine, where he established the Einstein-Montefiore Brain Aging Center and directs the Neurodegenerative Disease Clinical Trials Program. He is also Founding Scientist at ProGevity Neuroscience.