Building the Brain s 401K

Transcription

1 Building the Brain s 401K Presenters Cate O Brien, M.P.H., M.A. Mather LifeWays Sherrie All, Ph.D. Chicago Center for Cognitive Wellness 2 1

2 Presentation Overview I. Cognitive reserve II. How lifestyle factors effect the brain III. Memory training strategies IV. The Spencer Powell Brain Fitness Program A. Development B. Implementation C. Findings V. Questions 3 Dementia is not inevitable Risk for Alzheimer s Disease (Late Onset AD after age 65) 30% Genes 70% Lifestyle, Environment and Other Factors 4 2

3 Dementia Diseases Vascular Infections Substance Abuse Alzheimer s Huntington s Parkinson s Pick s Silent Strokes White dots TIA s Stroke HIV CJD Human form of mad cow Alcohol Sedatives Anti-anxiety medication Toxins 5 Risk Factors are Interactive Diabetes Alzheimer s High Blood Pressure Dementia 6 3

4 Cognitive Reserve: Your Brain s 401K Account Dementia Threshold Low Reserve High Reserve 7 COGNITIVE RESERVE Plump Healthy Brain Had Clinical Signs of AD No Clinical Signs of AD Unhealthy Looking Brains 8 Katzman et al. Annals of Neurology 25, ,

5 The Adult Brain Grows New Cells Hippocampus Region of the brain that forms new memories Zoomed in on new brain cells that grew in the adult hippocampal region Neurogenesis Eriksson, et al. Nature Medicine 4, (1998) 9 Brain Structures Also Grow with Experience Nose Woolett & Maguire (2011) Curr Biol, 21(24-2):

6 Brain Cells Form New Connections Pathways Synapses Brain Plasticity 11 Brain Plasticity opositive Plasticity o Cells that fire together, wire together - Hebb s Law onegative Plasticity o Use it or Lose it 12 6

7 Your Brain s 401K Minimize Losses Maximize Contributions Prevent or slow disease processes Avoid brain injury Reduce stress Maximize new brain cell growth Grow new connections between brain cells 13 Your Lifestyle and Your Brain 7

8 Lifestyle Factors and Brain Health Physical Activity Social Emotional Intellectual Nutrition Spiritual 15 Physical Activity What we know about the cognitive benefits: Participation in leisure-time physical activity lowers lifetime odds of developing Alzheimer s disease Exercise of 3x per week reduces the risk for dementia Moderate levels of physical activity are enough to reduce the risk of cognitive impairment. Those who walk more have greater protection from cognitive decline. 16 8

9 Physical Activity and Cognitive Reserve +2% hypocampal volume Better spatial memory -1.4% hypocampal volume 17 (Erikkson et al., 2010) How does physical activity prevent cognitive decline? Vascular Health Physical Activity Cognitive Performance 18 9

10 Emotional Chronic Stress is Toxic to the Brain Studies have also shown negative effects of cortisol on neurons (brain cells) and brain function. For example : Cortisol is toxic to brain cells. 19 Cortisol inhibits the birth of new brain cells Cortisol weakens synaptic connections and prevents the formation of new connections. (Hanson, 2009; 1990; Sapolsky et al., 2004, Uno et al, 1994) Emotional Stress and Depression Stress hormones have been linked to the brain chemicals associated with depression Stress can make us more vulnerable to negative thoughts AND negative thoughts can trigger the stress response and keep it going Studies have shown that depression is linked with Alzheimer's disease and risk of dementia 20 10

11 Intellectual What Sort of Intellectual Stimulation Seems Protective? Lifetime Activities Reading Newspapers, Magazines, Books Writing Letters Playing Games Education Stimulating Professions Hobbies 21 ACTIVE Study Intellectual 22 Willis et al. (2006). Long-term Effects of Cognitive Training on Everyday Functional Outcomes in Older Adults. JAMA, 296(3):

12 Nutrition What we eat effects our brains Obesity Cardiovascular health Diabetes Chronic inflammation Vitamins & Minerals 23 Feed Your Brain! 24 12

13 Alcohol A Curvilinear Relationship 25 Spirituality Brain Benefits of Spiritual Practice Meditation increases the power of brainwaves involved in higher-level mental activity Meditation improves attention, compassion, and empathy Preliminary evidence that mindfulness meditation practices may enhance cognitive functions such as working memory Religious practice and spirituality are associated with slower rate of cognitive decline (Hanson, 2009; Chiesa et al., 2011; Carter et al, 2005; Tang et al, 2007; Lutz, Brefczynski-Lewis 26 et al. 2008; Lazar et al, 2005; Kaufman, et al., 2007) 13

14 Spirituality It s good for your brain because it s good for your body Spirituality and religious practice have been linked to longer lifespan and positive health outcomes Church attendance and prayer are associated with lower blood pressure and better immune function Meditation has a wide variety of health and psychological benefits and has been shown to strengthen the immune system, decrease stress-related cortisol, and lower blood pressure Reminder: high blood pressure can be bad for the brain Reminder: chronic stress and cortisol are toxic to the brain (e.g., Powell et al., 2003; Davidson et al 2003; Walsh and Shapiro, 2006; Tang 27 et al 2007; Seeman, Dubin, and Seeman, 2003) Social More socially active seniors: 1. Have better cognitive function 2. Experience less cognitive decline 3. Are less likely to develop Alzheimer s disease and other dementias 4. Are less likely to develop disabilities 28 14

15 Why is social activity good for our brains? 1. Lowers stress, positive mood 2. Provides social roles, purpose in life 3. Keeps seniors from disengaging 4. Humans are social creatures 5. Friends/family can notice unhealthy symptoms and behaviors 6. Some social activities challenge us physically and mentally 29 Memory Strategy #1 Improve Memory by Improving Attention Look Up and Around Put in the Effort Stay Present Get your Hearing or Vision Checked 30 15

16 Improving Attention Manage Your Environment Reduce Distractions and Interruptions Do One Thing at a Time Multi-tasking is a Myth! Multi-tasking can be toxic to the brain Bribe yourself Get Plenty of Rest May need to see a sleep doctor Resting your when you re awake Manage your Emotions 31 Attention Exercise Read the following number strings at a pace of one digit per second The person who goes second just reads the number strings in the reverse order (e.g.: Start with 4 on the first one 493)

17 Memory Strategy #2 Visualization Take mental snapshots Imagine the route you will drive or walk to get somewhere 33 Memory Exercise Visualization: The Roman Room Method AKA: Method of Loci Translation: Putting things in locations Journey Method 34 17

18 Brain Pathways Grew with Roman Room Method Connection Highways (in blue) Engvig et al. (2011). Human Brain Mapping. doi: /hbm Memory Strategy #3 Chunking Which is easier to remember? or (732) or or 02/28/

19 Memory Strategy #3 Chunking Making use of Semantic Networks Lime Tree Yellow Lemon Green Grass Music Red Grapefruit Orange Cherries Purple Blue Bluegrass Oranges 37 Plums Memory Exercise Chunking Chunk this shopping list Produce: Apples Oranges Lettuce Carrots Dairy Milk Cheese Eggs 38 Packaged Foods Juice Cookies Baking Salt Flour Sugar Household Detergent 19

20 Memory Exercise What were the categories? What was on the list? 39 Spencer Powell Brain Fitness Study Development Implementation Evaluation 20

21 Pilot Study Goals The main goals of this study were to: Determine the feasibility of implementing a new brain fitness program with older adults in different settings. Examine data for potential associations between program participation and 1) increases in brain-healthy behaviors and 2) improvements in cognitive outcomes. Identify needed revisions and enhancements to the existing program to inform program modifications that can maximize effectiveness in future dissemination and study. 41 Main Components In the classroom: 1. Education on how lifestyle factors effect the brain 2. Memory training Online: 3. Dakim BrainFitness 42 21

22 Developing the Curriculum Guidelines PowerPoint based training Training manual Computer-based training component Focus Create a brain-health curriculum for residents and clients of Mather, Mather Cafes, and Splendido that could be replicated and disseminated. 43 Developing the Curriculum 6 Dimensions of Wellness 44 22

23 Developing the Curriculum Format 8 week program 1 week intro, 6 weeks content, 1 week closing Self-paced computer program minutes per 1 week session Train-the-trainer with instructors guide Multiple formats: web, ppt, discussion guide 45 Developing the Curriculum Theoretical grounding in Social Cognitive Theory (Bandura) Self-regulation Reciprocal determinism Behavioral rehearsal / capability Self-reflection / Reinforcements Observational learning (modeling) 46 23

24 Developing the Guide 47 Implementation Between 1 and 3 trainers at each of the sites implemented the program

25 Six training sites Three Mather s More-than-a-Café locations The Mather (CCRC) Mather Place at Wilmette (Independent Living Community) Splendido (CCRC) 49 Evaluation Enrollment and Attrition Did not Did not Program Location Enrolled complete (n) complete (%) The Mather % Mather Place at Wilmette % Splendido % Café on Higgens % Café on Central % Café at 83 rd St % Total enrollment % 50 25

26 Dakim BrainFitness System Rating Mean rating I enjoyed using the Dakim program The Dakim program was easy to use I feel like the Dakim program challenged my brain Technical issues led me to stop using the program I was frustrated by technical issues I was frustrated by other aspects of the Dakim program (non-technical) I will continue to use the Dakim program on my own On a scale of 1-5 where 1=Strongly Disagree, 2=Disagree, 3=Neutral, 4=Agree, 5=Strongly Agree 51 Course Evaluation I feel I have achieved the following objective as a result of this class: Mean rating* I understand how lifestyle affects my risk for dementia I understand more about how the adult brain changes I understand why staying mentally active can lower my risk for dementia I understand how what I eat affects how my brain ages I understand how managing stress can lower my risk for dementia 3.58 I understand how being socially active lowers my risk for dementia 3.68 I understand how physical exercise can help lower my risk fordementia 3.69 I have made changes in my lifestyle to help lower my risk for dementia 2.75 I plan to make even more lifestyle changes in the coming months to lower my risk for dementia 3.26 On a scale of 1-4 where 1=Not at all, 2=to a slight extent, 3=to a moderate extent, and 4=to a great extent

27 Change in Brain Healthy Behaviors Treatment Control ** The nutrition scale asks about poor eating behaviors, thus a lower score indicates better diet. None of these effects reached statistical significance 53 Physical Activity: Meaningful Trend Condition Intervention Control Treatment Group Increased Physical Activity by almost 2 hours per week 54 27

28 Behavior Limitations Power Dose Duration 55 Change in Objective Cognitive Performance Treatment Control The intervention group had better scores than the control group on 2 of the 3 memory-related tests. None of these comparisons reached statistical significance 28

29 Effects Did Not Correlate With Dakim Use 57 Future Directions Enhanced Memory Techniques Physical Activity Enhanced Goal Setting Intellectual Engagement Emotional Wellbeing Better Goal Accountability 58 29

30 Questions? 59 30