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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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