(Editor’s Note: you may have read all the con­fus­ing –if not out­right mis­lead­ing– recent media cov­er­age on the effect of men­tal stim­u­la­tion on cog­ni­tive health and Alzheimer’s Dis­ease. To help clar­ify mat­ters, please find below part of the ongo­ing dis­cus­sion at Sharp­Brains’ group in LinkedIn, and keep tuned since in a few days we’ll be pub­lish­ing an analy­sis of the sci­en­tific study that, while bring­ing largely Good News, has been largely reported as Ter­ri­ble News.)

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Stu­art • I just came across this arti­cle in Med­ical News…Mental Stim­u­la­tion Delays The Decline In Think­ing Skills, But May Accel­er­ate Demen­tia Later On.…
It’s the first time I have seen an arti­cle talk­ing about the poten­tial down side of men­tal stim­u­la­tion in later life…I would be inter­ested in the views of the more qual­i­fied than myself in this area…http://tinyurl.com/22ovdfv

Jenny • I wouldn’t say I was more qual­i­fied. How­ever hav­ing read this arti­cle although ini­tially it would seem a dis­ap­point­ment that hav­ing done all that men­tally stim­u­lat­ing activ­ity to build one’s cog­ni­tive reserve to then be sub­ject to a rapid down­hill decline. But in fact I think the study is good news. Firstly it sup­ports the notion that by being engaged in men­tally stim­u­lat­ing activ­i­ties we can main­tain our cog­ni­tion as we age. Sec­ondly we may be on the way to devel­op­ing demen­tia but isn’t it bet­ter to delay or defer the onset fro as long as pos­si­ble? It may be by the time the symp­toms man­i­fest them­selves we have mean­while being enjoy­ing con­tin­u­ing to live normally.

In the Nun study the autop­sies of some of the nuns brains showed they were full of Alzheimer’s dis­ease yet clin­i­cally had shown no out­ward sign. I believe this study is very impor­tant in rein­forc­ing the mes­sage that we all ben­e­fit from keep­ing men­tally fit.

The other key point is that by defer­ring the onset of symp­toms the eco­nomic and social sav­ings to the health sys­tem and soci­ety will be huge.

And lastly. If I had the choice between liv­ing for longer symp­tom free of demen­tia and then going into a rapid decline I think I would choose that any day over the pos­si­bil­ity of devel­op­ing symp­toms ear­lier and liv­ing longer with the disease.

So I don’t see this arti­cle as hav­ing a down side. Being men­tally engaged and hav­ing a big­ger cog­ni­tive reserve, does not con­fer immu­nity against demen­tia and I don’t believe has ever pur­ported to do so. Maybe that has just been our wish­ful thinking.

Stu­art • Jenny.…..thank you for your com­ments, I recall read­ing the arti­cle on the Nun study which was very inter­est­ing in terms of their find­ings. I totally agree doing some­thing to remain men­tally active com­pletely out­weighs doing noth­ing, in addi­tion of course to exer­cise and good nutri­tion, if we take this approach we give our­selves the best chance.…this is what I am hoping !!

Alvaro • Jenny, excel­lent expla­na­tion! this is another exam­ple where it is key to under­stand that brain fit­ness is much more than the absence of Alzheimer’s plaques & tan­gles, it is the brain func­tion­al­ity that we can build through life in order to a) remain healthy and pro­duc­tive longer, every sin­gle day we live (objec­tive 1), b) com­press the poten­tial dis­ease time at the end of our lives (objec­tive 2).

Also, the talk about rates of cog­ni­tive decline can be very mis­lead­ing: if I have noth­ing to decline from, of course the rate of decline will be lower than if my start­ing point is higher and more func­tional. The rate of decline when I descend from the peak of Mt Ever­est is of course going to be higher than if I descend from my nearby lit­tle hill. The main point is: how long can I be over the thresh­old of required func­tion­al­ity to live and work well?

She­lah • After I read the arti­cle, I remem­bered a study I had read about in the 80’s, one which tracked retired nuns liv­ing in a con­vent in Min­nesota. Their par­tic­u­lar order’s vows empha­sized men­tal vigor, so these women were learn­ing new skills, e.g., paint­ing, vio­lin, bridge–even Chi­nese, in their 60’s, 70’s and 80’s.

The study con­cluded that the rate of Alzheimer’s dis­ease among the nuns was dra­mat­i­cally lower than in the gen­eral pop­u­la­tion; fur­ther­more, among those whose autop­sies con­firmed a diag­no­sis of Alzheimer’s Dis­ease, the tell­tale signs in the brain were much less advanced than sub­jects in a con­trol group who had had symp­toms of the dis­ease for an equiv­a­lent period of time.

I know that recent stud­ies are given more weight in many cases; per­haps, though, the two stud­ies are not mutu­ally exclusive.

Stu­art • She­lah .…I was inter­ested in your com­ments relat­ing to retired nuns, and the find­ings going back to the 80”, my own view would be that the two stud­ies, the one in the 80’s you men­tion, and the recent study men­tioned by Jenny, con­firm that brain health requires a holis­tic approach to life.

In “The sharp­brains guide to brain fit­ness” book, by Alvaro and Dr. Elkhonon Gold­berg, (which I think is great short ref. book on brain fit­ness) , they talk about the 4 pil­lars of brain health as being, 1. Bal­anced nutri­tion, 2. Stress man­age­ment, 3. Phys­i­cal exer­cise, 4. Men­tal stim­u­la­tion. When I think about it, if you project these 4 pil­lars onto what we under­stand to be the life style of a Nun, you can pretty much tick the box on all 4 points, in terms of how they live their lives.

Not sug­gest­ing we all need to live like nuns, but I can­not recall every see­ing a nun eat­ing a big mac or throw­ing a tantrum !!. .….… The more I read about brain health, and the con­tin­ued dis­cov­er­ies from neu­ro­science, the more I appre­ci­ate that brain health is not just about men­tal stim­u­la­tion, to opti­mize your brain health you need to try and fol­low the right life style.

Daniel • Alvaro is cor­rect that the “rate of decline” can be very mis­lead­ing. In dis­cussing this arti­cle, we have to keep this in mind, and find a good way to explain this to peo­ple. For exam­ple, if you knew you had a pro­gres­sive fatal con­di­tion (Alzheimer’s) that was def­i­nitely going to kill you in 10 years, then which of the fol­low­ing would you pre­fer:
1) Steady, grad­ual, pro­gres­sive dete­ri­o­ra­tion over 10 years, with death at that point (i.e. a slow rate of cog­ni­tive decline)
or
2) Symp­tom free life for 9 years, fol­lowed by rapid dete­ri­o­ra­tion in year 10 end­ing in death (i.e. an even­tual rapid cog­ni­tive decline, at the end stage of ill­ness).
Any­one in their right mind would choose option 2 over option 1.

Paula • Very con­cerned about the arti­cle and the rep­re­sen­ta­tion of infor­ma­tion about men­tal stim­u­la­tion. I am a Reg­is­tered Nurse spe­cial­iz­ing in the field of cog­ni­tive inter­ven­tions with indi­vid­u­als chal­lenged with early onset Alzheimer’s, early stage demen­tias, and any con­di­tion that exhibits cogn­tive decline. Much of our work has been focused on pro­vid­ing very spe­cial­ized inter­ven­tions and activ­i­ties for these indi­vid­u­als. With this rep­re­sen­ta­tion I fear that the per­cep­tion of the pub­lic would be that once diag­nosed with demen­tia that doing any cog­ni­tive inter­ven­tion or activ­i­ties would has­ten their decline. I would not ever believe this to be true. Pro­vid­ing oppor­tu­ni­ties for indi­vid­u­als to engage in cog­ni­tive and socially stim­u­lat­ing activ­i­ties will pro­vide for the oppor­tu­nity to pro­long inde­pen­dence, pur­pose and qual­ity of life. I would be inter­ested in addi­tional feed­back on how to bet­ter explain this research and findings.

Anne • Paula makes a good point regard­ing how peo­ple might receive this recent infor­ma­tion about men­tal stim­u­la­tion. For an exam­ple of how infor­ma­tion can be over sim­pli­fied visit WCTV.tv: http://www.wctv.tv/healthmatters/headlines/102387459.html

The report is titled ‘Health Mat­ters: Why you shouldn’t play men­tally stim­u­lat­ing games’

Erica • I would have pre­ferred to see the author posi­tion the title in this man­ner: Stud­ies have indi­cated that there will be peo­ple for which addi­tional men­tal stim­u­la­tion will effect a pos­i­tive delay in decline of think­ing skills to such a degree that they will suc­cumb to some­thing other than Alzheimer’s (regard­less of pathology).

The orig­i­nal arti­cle and sub­se­quent over sim­pli­fi­ca­tions are really salient exam­ples of how far we have come, yet how much fur­ther we have to go with regard to pub­lic edu­ca­tion on the sub­ject of brain fit­ness. I agree with Alvaro that an impor­tant aspect of edu­ca­tion with regard to brain fit­ness is func­tion­al­ity. The author posi­tions the study as a case of the cure being worse than the dis­ease which couldn’t be fur­ther from the truth. When parsed care­fully, as Jenny reflected above, the arti­cle is pos­i­tive. First, “men­tal stim­u­la­tion delays the decline in think­ing skills”, is cer­tainly encour­ag­ing and excit­ing on any level. Sec­ond, “…may accel­er­ate demen­tia later on”, that is if the symp­toms (regard­less of pathol­ogy) even man­i­fest in which case, I would agree with Daniel.

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The big pic­ture: “Indi­vid­u­als who lead men­tally stim­u­lat­ing lives, through edu­ca­tion, occu­pa­tion and leisure activ­i­ties, have reduced risk of devel­op­ing Alzheimer’s symp­toms. Stud­ies sug­gest that they have 35–40% less risk of man­i­fest­ing the dis­ease”- Dr. Yaakov Stern, Divi­sion Leader of the Cog­ni­tive Neu­ro­science Divi­sion of the Sergievsky Cen­ter at the Col­lege of Physi­cians and Sur­geons of Colum­bia Uni­ver­sity, New York. Read Full Inter­view Notes.

Resource: Brain Fit­ness Guide — Become your own Head Coach.

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