"7. Doctors and pharmacists will help patients navigate through the overwhelming range of available products and interpret the results of cognitive assessments. This will require significant professional development efforts, given that most doctors today were trained under a very different understanding of the brain than the one we have today."

The American Medical News, a weekly newspaper for physicians published by the American Medical Association, just published an excellent article along those lines:

Steps to a nimble mind: Physical and mental exercise help keep the brain fit
-- Neuroscience is uncovering techniques to prevent cognitive decline.

A few quotes:

- It's an example that highlights a wave of new thinking about the importance of brain fitness.

- Until recently, conventional wisdom held that our brains were intractable, hard-wired computers. What we were born with was all we got. Age wore down memory and the ability to understand, and few interventions could reverse this process. But increasingly, evidence suggests that physical and mental exercise can alter specific brain regions, making radical improvements in cognitive function.

- With nearly 72 million Americans turning 65 over the next two decades, physicians need the tools to handle growing patient concerns about how to best maintain brain health. Armed with this new brand of science, frontline physicians will be better equipped to address the needs of aging baby boomers, already in the throes of the brain fitness revolution.

- "Encourage them to exercise the brain in novel and complex ways," he says.

Full article: here

One of the physicians quoted in the article is Gary J. Kennedy, MD, Director of the Division of Geriatric Psychiatry at Montefiore Medical Center in NYC and a professor in the Dept. of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine.

To put the AMA article in better perspective for SharpBrains readers, we asked Dr. Kennedy a few follow-up questions. Below you have his questions.

Alvaro Fernandez (AF): Can you summarize how cognitive functions tend to evolve as we age?

Gary Kennedy (GK): As we age cognitive functions that rely on processing speed or reaction time decline, slow down.  Problem solving speed declines. This is in part the result of frayed neuronal insulation as the myelin sheath surrounding the axons wears thin with advanced age or illness. However it is possible to specialize and optimize some cognitive processes through experience, practice and planning. For example vocabulary can increase to age 90 provided there is ongoing stimulation and motivation to learn. And the growth and development of new brain cells can be augmented with the stimulating effects of physical exercise.

AF: Now, there are very significant cognitive differences among individuals of the same age, so age itself is not the main predictor. Can you explain what may be?

GK: Age also has the effect of amplifying differences between individuals. This is the result of variability in aging itself, freedom from or accumulation of illnesses and injury, and life style. The influence of genetics is largely exhausted by the 6 and 7^th decades of life which means that habitual activities and social relationships have a larger and larger impact resulting in greater and greater variability between individuals.

AF: Can you please explain the relationship between cognitive and emotional health (what we typically call "brain fitness")

GK: Cognitive health requires motivation to sustain it and motivation depends on emotion and social reinforcement. Emotional self-regulation is not simply self control. Rather it is the capacity to respond to an emotional stress without prolonged loss of equilibrium. And it is the capacity to modify emotional reactions to resonate with others in the environment. Thought and feeling when linked together can be a powerful stimulus for learning, both for better and for worse. A positive outlook with an active response style is more protective than a tendency toward negativism and withdrawal.

AF: What advice would you give to people who want to maintain their brain in top shape?

GK: Simply finding a partner for regular physical activity is one of the best prescriptions for improving brain function. Staying emotionally, intellectually and socially engaged is also good advice.  And the more the better. The brain is a muscle – use it or lose it.

AF: And what advice would you give to doctors and health professionals on how to help their patients?

Doctors and all health professionals need to know how to motivate their patients to make the changes in life style that will promote healthy aging. Small, meaningful changes are relatively easy to achieve if the professional simply asks. Two straightforward examples: “how often do you enjoy an alcoholic beverage?” and “how often do you get a half hour of physical activity, walking or exercising?” can help the older person to minimize alcohol and maximize exercise. Brief interventions work surprisingly well.

Related articles:

- Wellness Coaching for Brain Health and Fitness

- Build Your Cognitive Reserve-Yaakov Stern

Top 15 Brain Teasers and Games for Mental Exercise

1. Can you count?: Basketball attention experiment (Interactive).

2. Which way is the bus heading?.

3. Words in your brain: do you know where words are "stored" in your brain?.

4. Please Spot the Differences.

5. Do you think you know the colors?: Quick, try the Stroop Test.

6. Clinically proven Stress Management tip.

7. Riddle for the Whole Brain: The Blind Beggar.

8. What is going on with these pictures?.

9. Brain Teasers for the Weekend: a few challenges to exercise your attention and working memory.

10. Consider Linda's job prospects: riddle, or obvious?.

11. Count the Fs in this sentence.

12. Please find the missing number here.

13. How many... exercise your Frontal and Parietal lobes.

14. Mental Imagery and Spatial Rotation challenge.

15. Enjoy this Sunday Afternoon Quiz.

As a bonus, you can also try and write some Brainy Haikus. To inspire you, below you have a few haikus written by our readers (given that novelty, variety and challenge are important for our brains, writing haikus equals -for most of us who are not haiku specialists- another form of brain teasers to exercise our brains).

- Amit:

Love, college, career.
A new world of transitions.
Will I survive? Yes.

- Kathy:

My release technique,
Forgive, forget, love all,
Meditate on that!

- Alan:

Through the microscope,
slice of brain stains pink and blue,
the wonder of thought.

- Justin:

Justin the genieus
Must spell check the word genius
to post this Haiku

- GTB, the skeptic, says

Haiku's are easy
But sometimes they don't make sense
Refrigerator

Enough?

If you want more brain teasers and games, you can always visit our BrainTeasers page.

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.

-- Dr. 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.

Context: The Challenges of the Aging Society

The world is aging. This is occurring in two ways: through shifts in the age structure that will eventually lead to many more people reaching older ages than ever before, and through continued success in extending life. Less than 100 years ago, life expectancy was between 30 to 40 years. Today, close to 800 million citizens are 60 and over.

And aging in healthier ways. Aging has incorrectly been associated with decline and decay, when in fact many people live healthy into older ages. There has been a synchronous extension in life expectancy and quality of life - the average 65-year-old today is much healthier, physically and mentally, than the average 50-year-old of 100-150 years ago - when most existing institutions were envisioned and created.

Healthy life can be further extended with existing knowledge. The fact is the onset and progression of fatal and disabling diseases, disorders, and disability can be postponed using well-researched basic measures of public health, environmental and behavioural changes, and medical technology interventions. The same methods may be used to improve or maintain mental and physical functioning.

Our healthcare and retirement systems are on bankruptcy track - their premises are outdated. Existing institutions, policies and attitudes do not reflect the points outlined above, having been developed for a society that no longer exists. We need to get on the right track: aging populations represent potential resources that are currently untapped or underutilized.

The current disease-based research agenda compounds the problem: emerging biomedical research holds the promise of slowing down the biological processes of aging - thereby contributing to lower prevalence rates of a spectrum of diseases. Yet, given existing funding paradigms, there is not a well-integrated and funded research plan in place to drive the agenda.

Solution: Capturing the Longevity Dividend with a Healthy Aging Agenda

Getting our institutions and policies in the right track -given the growing extension of healthy life- can pay a series of economic, health, and other life course dividends. A course change can have a significant return on investment, and the absence of this course change will have a series of negative consequences globally. We need to capture the longevity dividend to benefit people of all ages, as well as older adults- stop thinking Burden, start thinking Human Capital to be maintained and deployed.

To capture this Longevity Dividend, we need to move the agenda forward in three complimentary areas:

1) Promote Healthy Lifestyles that help Maintain Physical and Cognitive Functional Abilities:

- Partner to Raise the Prevention Agenda: we need adopt a cross-sector life course approach to health promotion, engaging not only the health and insurance system but also the education system and the media sector. In healthcare, we need to integrate medical care and public health approaches to prevent and ameliorate chronic diseases and conditions - geriatric medicine offer a valuable template for health care redesign that would be beneficial for all.

- Invest in Lifelong Learning: investing in education at every point in the life course, encouraging life long learning.

2) Redesign Environments to Foster Health, Engagement and Financial Security:

- Redesign Retirement Policies: redesigning the current retirement paradigm through enhanced flexibility offers a win/ win/ win scenario - for employers, employees, and society at large.

- Provide opportunities for productive engagement: create new generative roles and a host of opportunities for productivity and engagement by elder adults. These would confer huge societal benefits on unmet global needs, and if designed correctly, will promote the health of an aging society. One example is the “experience corps” model.

- Redesign Cities: redesigning cities to support healthy aging and independence and engagement. One of the transitions that will take place is that a significant portion of future cohorts will live in cities. Hence, we need to create necessary environments and transportations that will accommodate this trend.

3) Develop an integrated Healthy Aging Research Agenda: the disease-specific model needs to be supplemented by advancing research design to slow the biological processes of aging. We need to raise and integrate resources to invest in research for innovation in new social experiments, retirement and pension policies that work, continuum of living circumstances that encourage living in place, development of enhancements that encourage physical and cognitive functioning, basic biological research on aging, all built on a strong social compact.

There are 2 promising areas to start moving this agenda forward:

1) Propose a new Millennium Development goal: Include these pressing issues as one of the Millennium Development Goals, optimizing a full healthy life course and harnessing the opportunities of an aging world, including building effective approaches.

2) Propose a Healthy Aging agenda for Global 2000 companies: in partnership with the appropriate Councils, suggest research-based practices and policies: - Health promotion in the work place.
- Flexible retirement policies.
- Defining new roles for older adults and civic engagement.
- Invest in life long learning.
- Develop new technologies, products and services for an underserved, and growing, market.

Now, your turn:  can you help define the challenges and outline the solutions?

Part of what makes Doidge’s writing so accessible is he tells stories, and his stories just happen to incorporate brain science. As a result, his book is easy to digest. The neuroscience behind Doidge’s book involves neuroplasticity, which is the brain’s ability to rewire itself. This means that the brain – our intelligence – is not something fixed in concrete but rather a changing, learning entity. On the face of it, this concept should not sound unusual, for it is what happens to individuals all the time as we go about the learning process, from infancy onwards.

What separates the stories in this book from daily learning is that the brains in question have been damaged in some form or other. Each tale is inspirational in that the individuals are able to overcome substantial, life-altering events, such as severe illness and stroke, in part thanks to the research of visionary scientists and doctors who developed methods and tools to facilitate neuroplasticity.

Neuroplasticity
The catchy phrase behind neuroplasticity is “neurons that fire together wire together”. The idea is that when two events (neurons firing) occur in the brain at the same time, the events (neurons) become associated with one another, and the neuronal connections (wiring) become stronger.

For many years, it was thought that each area of the brain had its own responsibilities; in other words, certain functions were localized or hardwired to certain brain areas. If something is hardwired then it is fixed and not capable of change.

However, while certain areas of the brain do tend to be responsible for specific functions, since the brain is plastic, areas overlap and even can co-opt one another’s functions. Initial maps drawn of our mental system turn out to be not as static as originally thought. If one pathway gets blocked, the brain is very good at finding alternative pathways.

As with any pathway, the more a particular path is used, the more ingrained it becomes, and pathways near one another become associated with each other. If a path is underutilized, over time it will be co-opted by other pathways that are branching out and need more space.

Hence, plasticity can be summed up in a few succinct statements all from chapter three – Redesigning the brain:

- Neurons that fire together wire together.

- Neurons that wire apart fire apart.
This is also stated as Neurons out of sync fail to link.

- Use it or lose it.

The Scientists
Doidge includes stories of the neuroscientists, among them Paul Bach-y-Rita, who pioneered the idea of “polysensory”. Polysensory refers to the sensory areas of the brain, which rather than only processing information from just the senses that normally report to those areas, are actually able to process information from any of the senses.

Michael Merzenich, a developer of the cochlear implant and founder of Posit Science, is another of the scientists noted by Doidge. Merzenich says that “You cannot have plasticity in isolation…it’s an absolute impossibility. (and Doidge continues) His experiments have shown that if one brain system changes, those systems connected to it change as well.”

Following on his heels is Edward Taub, who established constraint induced therapy, an alternative therapy for individuals felled by stroke. Taub’s research supported Merzenich’s findings that “when a brain map is not used, the brain can reorganize itself so that another mental function takes over that processing space.”

Alvaro Pascual-Leone’s experiments began with looking at what happens in the minds of those who read Braille, and transitioned to looking at how “our thoughts can change the material structure of our brains.” His goal was “to test whether mental practice and imagination in fact lead to physical changes.” This is, indeed, what happens when athletes use visualization to help prepare for sports trials.

In the last quarter of Doidge’s book, which is equally interesting for the clarification of theories, he discusses the work of Eric Kandel, Sigmund Freud, Santiago Ramón y Cajal, Jordan Grafman, and several other scientists who are exploring neuroplasticity.

My Take-Aways
I see plasticity and metacognition as closely entwined. This combination of knowing that intelligence is not fixed and thus you can change it, and knowing how you learn, is immensely positive and powerful, and has huge implications for students of any age. I translate this to students who struggle with learning issues, and aging adults who fear their brains will fade. I also think it is important for teachers to understand the concept of brain plasticity, as a means for no longer pigeon holing students.

Of course, we take away from an author’s writing what we want or need to learn. As a provider of professional development to faculty, the final lesson I take from Doidge’s book is the power of multifaceted professional development to foster neuroplasticity in adults, and therefore enhance their creativity. I take the message that most of us have the ability to break out of habits and to learn something new, and each time we do this, it strengthens our ability to do it the next time!
Further Information
For more about Norman Doidge:

• interview on The Brain Science Podcast and Blog with Ginger Campbell

For more about some of the neuroscientists mentioned by Doidge:

• Edward Taub’s Revolutionary Approach to Stroke Rehabilitation – interview on the Brain Science Podcast
• Mixed Feelings – Wired Science’s video article on Paul Bach y Rita’s research
• Scientific American Frontiers: Changing Your Mind – The Sight of Touch story of Alvaro Pascual-Leone’s experiments

For more on brain plasticity and learning:

• Brain Plasticity: How learning changes your brain
• Neuroscience Interview Series: interviews with over 15 brain scientists on how to direct the property of neuroplasticity.

-- Laurie Bartels writes the Neurons Firing blog to create for herself the "the graduate course I’d love to take if it existed as a program". She is the K-8 Computer Coordinator and Technology Training Coordinator at Rye Country Day School in Rye, New York. She is also the organizer of Digital Wave annual summer professional development, and a frequent attendee of Learning & The Brain conferences.

Encephalon #58 (neuroscience and psychology), hosted by Walter at Highlight Health.
Hourglass #5 (biology  of aging), hosted by Laura at psique.

Enjoy!

You can read more about the main points of the Global Agenda Councils conversation here: Discussion Highlights. Below go some of my own still-jetlagged reflections.

The financial crisis has made obvious the obvious: that we live in a truly new and global world.

And that business as usual will lead to global disaster - we need new approaches to collectively adapt to and thrive in this new environment. The answer is not to go back to any old paradigm, which simply will not work in a new reality, but to imagine and build a better new way of doing things.

Some of the attendants urged us to “reboot” the system. I don’t think that a "reboot" is enough - we need to upgrade to a new operating system. We can call it Planet Earth 2.0.Based on the group discussion we had on Sunday morning, let me propose some of the architectural principles that should underlie any emerging Planet Earth 2.0 operating system. And let me present those principles using a “Yes We Can” value-based approach:

Yes
- From Business As Usual to Imagination-led Action.
- From Analysis to Synthesis.
- From Talk to Walk.

We
- From Financial Hegemony to Human and Natural Capital.
- From Us vs. them to Win-win Diversity.
- From Regulation/ Deregulation to Mindful Architecture.
- From Top-down Authority to Shared Responsibility.

Can
- From Selfish Genes to Committed to Improving the state of the world.
- From Accounting Rules to Values and Standards.
- From Being Stuck to Learn and Evolve.

Given that each of us are in fact part of that new operating system, we could start by pledging to live by principles like those. How can we refine them?

Needless to say, this new operating system upgrade would benefit from a new emphasis on cognitive health and performance, such as the one discussed in the proposal for a Global Consortium for Neurocognitive Fitness Innovation.

In short, no more Business as Usual. We need more Imagination, and Action. By each of us.

The concepts of night and day do become challenging when working for a few days in a place with a 12-hour time difference with one's home base. Sleep is indeed very important to maintain top cognitive shape...which leads me to a fascinating news announcement:

Health insurance firms offering online cognitive therapy for insomnia (Los Angeles Times)

- "helping consumers get a good night's sleep has become a priority for most of the top-tier U.S. health insurance companies, including WellPoint, Aetna, Cigna, Kaiser Permanente and several Blue Cross plans. Their new programs don't involve sleeping pills. Instead, insurers are advocating the use of cognitive behavior therapy. Traditionally, the therapy has been done largely through face-to-face sessions, but many of the programs are now available online."

- "And use of sleeping pills has skyrocketed. A study this year in the journal Health Affairs found a 50% jump in sleeping pill use --- from 5,445 people per 100,000 in 1998 to 8,194 per 100,000 people in 2006. Though one version of Ambien, a popular sleep aid, is now available as a lower-cost generic costing about 50 cents per pill, newer drugs such as Rozerem and Lunesta cost about $4 and $5 per pill, respectively, or a minimum of nearly $1,500 per year for patients who take a sleeping pill every night. Online behavioral therapy programs cost less than $40 per user, and face-to-face counseling can range from about $300 to $1,800, depending on how many sessions a patient goes through and what level of specialist, from social worker to psychiatrist, provides the therapy."

- "Unlike sleeping pills, counseling is usually a one-time thing and costs do not continue year to year."

To read more on this trend - see The Future of Computer-assisted Cognitive Therapy

- In short, here we have a number of major societal problems (anxiety, depression...) that affect people of all ages, and an intervention that teaches people cognitive skills to be able to manage those related challenges better.  Talk about "teaching how to fish" vs. simply handing out fish (which we could argue is what antidepressant medications do).

- Why don't more people benefit today from that approach? A major problem, in my view, is the lack of a scalable distribution model. Meaning, using the traditional face-to-face approach, one needs to create, train, certify, ensure quality of, a very large  network of practitioners.

In other words, Applied Cognitive Engineering (ACE) and USA Hockey have partnered to bring to market a cognitive simulation game to improve the performance of ice hockey players - similar to what  ACE has been offering to professional and amateur basketball players.

ACE has raised $2.5M, and ACE and USA Hockey have received a joint $800k development grant from the BIRD Foundation for the co-development of a training system for Ice Hockey players. (The article mentions SharpBrains' Market Report as a sign of how the market is growing, since we cover ACE).

For more context on cognitive simulations, you will enjoy this Interview with Prof. Daniel Gopher:

Alvaro Fernandez: Tell us a bit about your overall research interests.

Daniel Gopher: My main interest has been how to expand the limits of human attention, information processing and response capabilities which are critical in complex, real-time decision-making, high-demand tasks such as flying a military jet or playing professional basketball. Using a tennis analogy, my goal has been, and is, how to help develop many “Wimbledon”-like champions. Each with their own styles, but performing to their maximum capacity to succeed in their environments.

What research over the last 15-20 years has shown is that cognition, or what we call thinking and performance, is really a set of skills that we can train systematically. And that computer-based cognitive trainers or “cognitive simulations” are the most effective and efficient way to do so.

This is an important point, so let me emphasize it. What we have discovered is that a key factor for an effective transfer from training environment to reality is that the training program ensures “Cognitive Fidelity”, this is, it should faithfully represent the mental demands that happen in the real world. Traditional approaches focus instead on physical fidelity, which may seem more intuitive, but less effective and harder to achieve. They are also less efficient, given costs involved in creating expensive physical simulators that faithfully replicate, let’s say, a whole military helicopter or just a significant part of it.

- "In a typical Montessori classroom, teachers use category-sorting exercises to help young students see patterns and connections. But the participants in this group were mostly in their 80s and on the other side of the cognitive development curve. They are residents at an assisted-living facility for people with dementia called Hearthstone at the Esplanade, which has six other homes in New York State and Massachusetts. Since July the residents have participated in a full-time program of Montessori-based activities designed for people with memory deficiencies."

- "A common misconception about people with dementia, Dr. Camp said, is that they no longer learn. But they do: residents learn to find their dining room table, for example, well after the onset of Alzheimer’s disease. And because they no longer have the higher brain function they had as adults, he reasoned, they are well suited to Montessori."

Full article: Coming Full Circle.

Related posts:

- Alzheimer's Risk and Prevention: the Cognitive Reserve

- Your comments on cognitive training, Posit Science, Alzheimer's Australia, gerontology, games