Healthy Brain Aging—Part 3

In Part 1 of Healthy Brain Aging, I shared material from Glenn Smith, Ph.D. of the University of Florida, who wrote the lead article in the May-June 2016 issue of American Psychologist. His article entitled, Healthy Cognitive Aging and Dementia Prevention will continue to be the basis of the Part 3 in this series.

In Part 1 we looked at the high numbers of dementia cases and the costs of those cases in America. We also noted the so-called Dementia Continuum, noting that dementia is not a black/white or have it/don’t have it phenomena.In Part 2 we had a brief discussion about Primary Prevention interventions. I mentioned how the risk factors for cerebrovascular disease (CVD) are among the most responsive to modification and effective treatment. Or as Dr. Smith states: There are a whole host of lifestyle (diet and obesity, physical activity, mental activities, alcohol and drug intake, smoking and social supports), mood, and physiological (blood pressure, lipids, inflammation, hyperglycemia, insulin resistance, metabolic syndrome, and diabetes) factors that impact vascular-related cognitive improvements and are amenable to treatment. In other words, for those willing to work for it…most are not doomed. That is good news. Primary Prevention is meant to help people avoid cognitive problems, while Secondary Prevention is aimed at those who already have symptoms.

Secondary Prevention

So Secondary Prevention is aimed at delaying or preventing progression of Preclinical States and Mild Cognitive Impairment (MCI) to dementia. Even after people become symptomatic, the same interventions used in Primary Prevention have been found to help slow the rate of cognitive decline and minimize disability when symptoms are actually “on board”.

In Secondary Prevention, Cognitive Rehabilitation approaches have been found to be helpful. This takes two general forms: a) restorative techniques, where the goal is to regain memory function through repetitive training procedures; and b) “memory compensation techniques”. In addition it is common that people with MCI and early Alzheimer’s Disease (AD) experience mood disorders like depression. In fact people with MCI and depression progress to dementia at a faster rate. Fortunately, cognitive-behavioral methods remain helpful even in mild forms of dementia.

An increasing trend in treatment of MCI is that of “multicomponent interventions”. These interventions typically include:

• Computer-based “attention” training (i.e., Fit Brains, Lumosity)
• Memory compensation training (i.e., using memory calendars)
• “New learning” practice (i.e. learning a new language or musical instrument)
• Stress management and relaxation training (i.e., yoga or Mindfulness Meditation)
• Mnemonic strategies
• Exercise (see below)
• Diet (i.e., low inflammation)
• Education
• Vascular risk monitoring
• Caregiver and patient support programs

The World Health Organization (WHO) recommends the following level of activity for helping adults remain healthy:

1. Adults aged 18–64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.

2. Aerobic activity should be performed in bouts of at least 10 minutes duration.

3. For additional health benefits, adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity.

4. Muscle-strengthening activities should be done involving major muscle groups on 2 or more days a week.

Finally, how do you know if the memory slippage you or your family has noticed is natural aging or beyond? The best way is to talk to your physician about your concerns and ask for a referral for formal neuropsychological testing. Yes, your doctor can give you a quick-and-dirty dirty memory screening evaluation, but unless you are already in the “dementia zone” you may not learn much from it. Certainly, we can learn about the health of our heart at the ER during a heart attack…or we can focus on prevention way before our ride in the ambulance.

As a psychologist, I have often said that I wish we all were required by Social Security to get a baseline cognitive/memory functioning evaluation before we could obtain Medicare. Unfortunately, the system is too shortsighted to do this. It appears they would rather pay $136 billion in AD treatment costs rather than spring for prevention, education, and training, which would save MILLIONS…and prevent untold heartaches.

Tim Berry