(Editor’s Note: what fol­lows is an excerpt from Dr. Gary Small and Gigi Vorgan’s new book, The Naked Lady Who Stood on Her Head: A Psychiatrist’s Sto­ries of His Most Bizarre Cases)

CHAPTER TEN

Brain Fog

Sum­mer 1990

Gigi and I had moved to Stu­dio City, about a forty-minute com­mute to UCLA. On week­ends, we often went to the movies at Uni­ver­sal City­Walk, a repli­ca­tion of Los Ange­les within Los Ange­les. Why peo­ple couldn’t just walk down the real streets of Los Ange­les made no sense to me, yet there we were, on a Fri­day evening, eat­ing ice cream and strolling down a sim­u­lated street.

We had just seen Total Recall, Arnold Schwarzenegger’s new sci­encefic­tion film about a con­struc­tion worker who under­goes a false mem­ory trans­plant that takes him on an imag­i­nary trip to Mars. But things go wrong, and when he comes out of it, he can’t tell what’s real and what’s imagined.

“When he first got back from Mars, there were so many signs that he was from the future that I believed it,” I said.
“But honey, before he had that mem­ory implant done, he was per­fectly happy liv­ing in the present—on Earth. Then he got all para­noid.”
“Of course he did. How do you know what’s real­ity if you can’t trust your mem­ory?” I asked.
“I don’t know; you’re the mem­ory expert. I want to go into this shop for a minute.” Gigi dis­ap­peared into a record store.

As I ate my ice cream and watched the crowds, I kept think­ing about those ques­tions. If two real­i­ties seem equally true, how would you know which ver­sion to believe? Many of my patients strug­gled with sim­i­lar issues, whether they were psy­chotic, demented, or sim­ply hav­ing mem­ory problems.

Over the past few years, I had begun to con­cen­trate a large part of my prac­tice on mem­ory issues—not just in older patients with Alzheimer’s dis­ease but in middle-aged peo­ple who were wor­ried about their increas­ing for­get­ful­ness. My research was also focus­ing on early detec­tion of demen­tia and age-related mem­ory decline, and I was devel­op­ing brain imag­ing as a diag­nos­tic tool.

Gigi came back with a bag of CDs and said Read the rest of this entry »

In a recently pub­lished sci­en­tific study (see Hall C, et al “Cog­ni­tive activ­i­ties delay onset of mem­ory decline in per­sons who develop demen­tia” Neu­rol­ogy 2009; 73: 356–361), Hall and col­leagues exam­ined how edu­ca­tion and stim­u­lat­ing activ­i­ties may inter­act to con­tribute to cog­ni­tive reserve. The study involved 488 ini­tially healthy peo­ple, aver­age age 79, who enrolled in the Bronx Aging Study between 1980 and 1983. These indi­vid­u­als were fol­lowed for 5 years with assess­ments every 12 to 18 months (start­ing in 1980). At the start of the study, all par­tic­i­pants were asked how many cog­ni­tive activ­i­ties (read­ing, writ­ing, cross­word puz­zles, board or card games, group dis­cus­sions, or play­ing music) they par­tic­i­pated in and for how many days a week. Researchers were able to eval­u­ate the impact of self-reported par­tic­i­pa­tion these activ­i­ties on the onset of accel­er­ated mem­ory decline in 101 indi­vid­u­als who devel­oped demen­tia dur­ing the study.

Results showed that for every “activ­ity day” (par­tic­i­pa­tion in one activ­ity for one day a week) the sub­jects engaged in, they delayed for about two months the onset of rapid mem­ory loss asso­ci­ated with demen­tia. Inter­est­ingly, the pos­i­tive effect of brain-stimulating activ­i­ties in this study appeared to be inde­pen­dent of a person’s level of education.

This is great news as it sug­gests that it is never too late to try to build up brain reserve. The more brain stim­u­lat­ing activ­i­ties one does and the more often, the bet­ter for a stronger cog­ni­tive reserve.

The cog­ni­tive reserve hypoth­e­sis sug­gests that indi­vid­u­als with more cog­ni­tive reserve can expe­ri­ence more Alzheimer’s dis­ease pathol­ogy in the brain (more plaques and tan­gles) with­out devel­op­ing Alzheimer’s dis­ease symptoms.

How does that work? Sci­en­tists are not sure but two pos­si­bil­i­ties are con­sid­ered.
1. One is that more cog­ni­tive reserve means more brain reserve, that is more neu­rons and con­nec­tions between neu­rons.
2. Another pos­si­bil­ity is that more cog­ni­tive reserve means more com­pen­satory processes (see my pre­vi­ous post “Edu­ca­tion builds Cog­ni­tive Reserve for Alzheimers Dis­ease Pro­tec­tion” for more details.)

Now, one may won­der about the dif­fer­ence types of men­tal stim­u­la­tion avail­able, includ­ing not only puz­zles and such, but struc­tured activ­i­ties such as brain fit­ness soft­ware and med­i­ta­tion. Do we exer­cise our brain every time we think about some­thing? What can one do to exer­cise one’s brain in ways that enhance capac­ity? Does aer­o­bic fit­ness train­ing also exer­cise one’s brain? What types of method­olo­gies and prod­ucts are avail­able? Do they “work”? Are all the same?

Those are the types of ques­tions we wanted to address in the book The Sharp­Brains Guide To Brain Fit­ness (avail­able via Amazon.com). We are proud of the recog­ni­tion the book has started to obtain, includ­ing endorse­ments by lead­ing scientists:

“The Sharp­Brains Guide to Brain Fit­ness is the only book that I know of that seam­lessly inte­grates lat­est infor­ma­tion about cog­ni­tive health across the lifes­pan, with inter­views with active researchers exam­in­ing cog­ni­tive main­te­nance and enhance­ment, along with reviews of com­mer­cial prod­ucts tar­geted to cog­ni­tive enhance­ment. The book should be very use­ful to any­one inter­ested in brain care, both health care pro­fes­sion­als and the pub­lic at large”.
— Arthur Kramer, Pro­fes­sor of Psy­chol­ogy at Uni­ver­sity of Illinois

“This Sharp­Brains book pro­vides a very valu­able ser­vice to a wide com­mu­nity inter­ested in learn­ing and brain top­ics. I found it inter­est­ing and help­ful“
- Michael Pos­ner, Emer­i­tus Pro­fes­sor of Neu­ro­science at the Uni­ver­sity of Ore­gon, and first recip­i­ent of the Dogan Prize

– Pas­cale Mich­e­lon, Ph. D., is Sharp­Brains’ Research Man­ager for Edu­ca­tional Projects. Dr. Mich­e­lon has a Ph.D. in Cog­ni­tive Psy­chol­ogy and has worked as a Research Sci­en­tist at Wash­ing­ton Uni­ver­sity in Saint Louis, in the Psy­chol­ogy Depart­ment. She con­ducted sev­eral research projects to under­stand how the brain makes use of visual infor­ma­tion and mem­o­rizes facts. She is now an Adjunct Fac­ulty at Wash­ing­ton University.

Ref­er­ences:

- Study: Hall C, et al “Cog­ni­tive activ­i­ties delay onset of mem­ory decline in per­sons who develop demen­tia” Neu­rol­ogy 2009; 73: 356–361

- Book: The Sharp­Brains Guide To Brain Fit­ness: 18 Inter­views with Sci­en­tists, Prac­ti­cal Advice, and Prod­uct Reviews, to Keep Your Brain Sharp

After about age 50, most peo­ple begin to expe­ri­ence a decline in mem­ory capa­bil­ity. Why is that? One obvi­ous answer is that the small arter­ies of the brain begin to clog up, often as a result of a life­time of eat­ing the wrong things and a lack of exer­cise. If that life­time has been stress­ful, many neu­rons may have been killed by stress hor­mones. Given the most recent sci­en­tific lit­er­a­ture, reviewed in my book Thank You, Brain, For All You Remem­ber. What You For­got Was My Fault, dead neu­rons can’t be replaced, except in the hip­pocam­pus, which is for­tu­nate for mem­ory because the hip­pocam­pus is essen­tial for mak­ing cer­tain kinds of mem­o­ries per­ma­nent. Another cause is incip­i­ent Alzheimer’s dis­ease; autop­sies show that many peo­ple have the lesions of the dis­ease but have never shown symp­toms, pre­sum­ably because a life­time of excep­tional men­tal activ­ity has built up a “cog­ni­tive reserve.

So is there any­thing you can do about it besides exer­cise like crazy, eat healthy foods that you don’t like all that much, pop your statin pills, and take up yoga?

Yes. In short: focus, focus, focus.

Chang­ing think­ing styles can help. Research shows that Read the rest of this entry »