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.

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