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Can We Pick Your Brain re. Cognitive Assessments?

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.

Thank you!

For a related article, you can read Alvaro’s Computerized Cognitive Assessments: opportunities and concerns.

Joshua Steinerman Einstein-Montefiore Brain Aging CenterDr. 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.

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12 Responses

  1. Hi Joshua,

    What you describe, and what it seems to me SharpBrains is a proponent of, is preventive care, be it in the form of education or checkups or early treatment. I am a big fan of preventive care, in general, because it can lessen the negative impact of the particular health issue in question.

    Specific to your three statements above:
    1–I would want to know if my cognitive abilities were declining so that I could have input into how my future plays out (in-home treatment, aide, nursing home, etc)

    2-It’s possible that any of the folks mentioned would treat me differently, but if I was engaged in the process of managing my care, I would include conversations with these folks (plus probably a social worker or someone skilled at helping people navigate such circumstances). I would definitely be concerned about the insurance aspect.

    3-Absolutely!

    Regards,
    Laurie

  2. Erin Matlock says:

    Thanks Dr. Steinerman for opening this discussion.

    Here are my answers.

    1) The knowledge would actually be empowering for me. It would spur me to take extra care of myself and be much more proactive about the activities and treatment I pursued.

    2) Friends – no.

    Family- I would want them to treat me differently by helping me make the transition and supporting the plan of treatment I chose.

    Physicians, employers and insurers – yes, for sure. I would be extremely concerned. I think it’s a natural reaction – and unfortunately, a part of aging that many people are currently going through.

    3)It would definitely be a serious motivator for me.

  3. Replies

    1> Not necessarily. Knowledge of a decline is an insufficient condition to cause worse off. However, couple that knowledge with a perceived inability to address the decline and yes, worse off conditions will follow.

    2> Concerned, no, because I’m quite comfortable that the presence of the knowledge would cause a change in a behavior through their altered expectations. And comfortable in my ability to address people with preconceived notions. Now if they have knowledge and I don’t, you may get a different answer.

    3> No. And for the general public a definite no. Strengths and weaknesses are not direct motivators of behavior change. By analogy, strengths and weaknesses relating to lack of physical activity are readily observed, yet the observations lack the “juice” to stimulate exercise. To motivate fitness program adherence, peer group appreciation, and positive expectation of results are needed.

  4. LifeGeeked says:

    Very interesting questions

    1- It is better to know and understand in order to be able to play my strengths and work on my weaknesses

    2- I would only be concerned about Employers

    3 – I would agree on what Mr Aaron Jackson Said, but I still find something motivating with knowing, maybe it is the self determination and will !

  5. Keith Rogers says:

    1. The effects of knowing I was suffering cognitive decline would be dependent on what else is happening in life at the time. Right now, I can say I would be very open to knowing where my abilities are suffering in hopes of making a change. But there have been times when that knowledge may have been depressing.

    2. I am not concerned how friends and family would treat me. Employer – yes, somewhat unless it was traced to a disability that could be “reasonably accommodated”. Insurer – excellent question. I don’t know how I’d feel about that.

    3. Absolutely! Even now, without knowing of any cognitive decline, I try to find ways to exercise my mental fitness. Just like I try to target areas of physical weakness with specialized focus, if I could know where I was “losing it”, I would focus on strengthening those areas. KR

  6. jairo obando says:

    thank for the space for participation.
    I give these answers:
    1) No, I would treat to recognize my new reality and to begin to look the causes and possible treatment.
    2)Sure. The people understant the situation of everyone and of this form treat you.
    3)Before that occur I will put in practice many advices that your and others give me .
    Its better prevent that to lament.
    Excellent web page.

  7. mk says:

    1) Even if my cognitive abilities were declining, knowledge of this would leave me worse off.

    Actually, this did happen to me a little over a year ago. I was losing my ability to think at work to an ever-increasing degree and, misunderstanding my doctor’s explanation, thought I had some form of dementia.

    2) I am concerned that family, friends, physicians, employers, or insurers would treat me differently if they found out I had cognitive decline.

    My son’s wedding was a few months away and I decided not to ask the doctor to go into detail, afraid I’d be crying all during the wedding. I didn’t confide in friends at the beginning, but did as I began making plans for retiring with a medical disability. I had to face the fact that if this was true, my place of employment would need a head’s up to replace me and my insurance would find out no matter how I tried to hide it. And yes, I was going to be broke and would shortly have to pay a fortune for insurance even though the company would not officially drop me (just increase my rates so astronomically I would drop myself). People did treat me differently. My friends were there for me, supportive, but not patronizing. Co-workers could be unthinkingly callous “Oh, she won’t be here next year anyway so we don’t need her input”. Or, they would go out of their way to talk with me and ask how I was, something they may not have done before. My employers themselves were wonderful. Even though I didn’t think I could continue on, they worked with me to alter my work environment, and lighten my load at great difficulty to themselves. The human resources department gave me enormous support as well. I was terrified at the thought of suddenly being unable to care for myself and not knowing whom I could trust to make decisions for me. Thank God for the Alzheimer’s Foundation who gave me much good advice, did a lot of legwork for me so I could make and take decisions, and called me to check up and see what I might need next. Now, recovering from my temporary cognitive impairment (temporary!!!), I have some idea of what to do should the need arise in the future.

    “Understanding my cognitive strengths and weaknesses will motivate me to establish and adhere to a personalized brain fitness program.” When you have cognitive weaknesses, you can lose the will to do anything. Having someone who will help you get started might be the thing to help me. Will power? No hope for the future = no will power for the present.

  8. As a person with MS, I am only too aware of cognitive deficits.
    1) I am better off knowing that my brain is on the decline.
    2) When friends and family are notified of this fact, I use it as an opportunity to educate them about MS and its effects.
    3) I am currently doing what I can to optimize my brain health through nutrition, exercise, and mental stimulation.

  9. Everyone, thank you very much for your generosity in sharing these thoughtful answers.

    Joshua, here you have mine

    1- Ignorance is what would leave me worse off, since it would preclude me from taking appropriate action. We also need to clarify that a) while some abilities tend to decline others tend to improve, b) there seems to be little inherently genetic in our individual cognitive trajectories, which emphasizes the importance of selecting our environments and our specific lifestyles/ actions in an informed manner.

    2- Only if there was some kind of stigma associated to the word “cognitive decline”. Which I hope doesn’t happen – for most people (we are not talking dementia, correct?), decline in some areas is part of the game, as is improvement in others.

    The only exception would be insurance companies – I would encourage them, as an industry, to have very strong privacy and non-discrimination safeguards before offering such assessments to consumers.

    3) Yes. That would be its main value.

  10. Elizabeth Smith says:

    Knowledge of cognitive decline is the only protection against its effects. It allows a person to adapt and change to circumstances.

    . My spouse’s experience has been that family and friends have adapted well to his cognitive decline. Employment and insurance are another matter because of liability and profit issues.

    Knowledge of cogitive decline would be a substantial motivator to maintain fitness but it is difficult to know how cognitive decline affects the ability to organize and adhere to a fitness regime.

  11. Nancy Scalise says:

    In answer to your questions. #1. I would definitely like to know if I have any cognitive decline. Knowledge is power and Power is knowledge.This knowledge would give me the empowerment to do what is necessary to cope and improve the situation. #2. i would definitely limit knowledge of cognitive decline to certain family members.I would want their help & support. Human nature being what it is,I definitely would be cautious with employers and insurers.
    #3.I had a brain tumor removed in may of this year. It was a benign occipital lobe miningioma. Without any cognitive testing before or after surgery I really didn’t know where i stood with those abilities. There was some memory loss but this is improving with time. Cognitive testing was suggested after surgery, but due to lack of medical insurance was not undertaken. I stumbled on the Happy Neuron at the Real Age website and was disappointed when it was no longer available there. You see it was playing those games that showed me that i was not up to speed. I had to do something to get myself going again. I then found the games again at the AARP website. I continue to play there and have decided that I should give myself a Christmas present and subscribe to the games. More so now than ever I am a very active participant in my medical care.
    Thank you for this opportunity to give my opinions. I hope it be of some use. I could go on with more but that is for another time.

  12. Joshua says:

    Thanks, all, for your thoughtful comments.

    Since there is a diversity of views, it is difficult to summarize. However, most responders emphasize that knowledge of one’s cognitive status is empowering, regardless of age, condition, or whether one’s cognition is improving or declining.

    I am in total agreement with this imperative to mind the brain, and understanding the many potential concerns that follow will allow our society to manage this information responsibly.

    An important caveat is that as SharpBrains enthusiasts, we are not representative of the prevailing opinions in most communities. We need better research to support this claim, but my impression is that many still view cognitive decline as inevitable and unmodifiable and would not be prepared to use objective feedback on their mental abilities to empower or motivate.

    Thanks to SharpBrains and a growing segment of the healthcare, private sector, and government universes, we are witnessing culture change and a shift toward preventative approaches.

    I know I don’t need to tell this community that successful brain aging is achievable, but each of us should consider how we can transmit this message to those around us.

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