Minding the Aging Brain

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!

- Alvaro
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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

* Mem­o­ry

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.