Lifestyle Influences Brain Health
Older adults who adopt brain-healthy behaviors can build cognitive reserve and delay the onset of Alzheimer's symptoms.
Brain health, or brain fitness, has become a hot topic among professionals working with older adults. Recent research seems to support the idea that brain fitness programs can benefit us—but how effective are the available programs, and can they work among the older adult population? This article provides insight on the topic along with findings from a study of one brain fitness program designed for older adults.
According to the Alzheimer's Association, approximately 5 million Americans over the age of 65, or one in 8.5 older adults, have Alzheimer's disease (AD) or other dementias. AD is the fifth leading cause of death in Americans aged 65 and older. As the baby boomer generation ages, the number of older adults with AD and other dementias is expected to increase substantially. Medical advances and improved social and environmental conditions have resulted in a greater number of Americans living into their 80s and 90s. This greater longevity is likely to result in significant increases in the number of individuals with the disease since the risk of AD increases with age; the number of people with AD doubles for every 5.5-year interval after the age of 65.1
Focus on Prevention
As part of the CDC initiative, the committee developed 10 priority actions for improving cognitive health. Two of the priority areas demonstrated increasing attention to lifestyle changes in order to reduce the risk of cognitive decline. Specifically, they included "help[ing] people understand the connection between risk and protective factors and cognitive health," and "conduct[ing] controlled clinical trials to determine the effect of reducing vascular risk factors on lowering the risk of cognitive decline and improving cognitive factors."
Brain injury is one such catalyst for new cell growth and restructuring. Numerous studies have explicated the brain's ability to change to compensate for injury, sometimes involving substantial rewiring of the brain's circuitry. Other nongenetic factors such as exercise can stimulate changes in the brain. For example, studies have demonstrated that exercise can increase the level of brain-derived neurotrophic factor (BDNF), a hormone that promotes growth of new brain cells. BDNF levels have also been associated with larger hippocampal volumes and better cognitive function in older age.2
The theory of cognitive reserve may help to explain why engagement in social and intellectual activities during leisure time is associated with a reduced rate of cognitive decline in cognitively normal older adults and possibly with a reduced risk of incident dementia. Functional imaging studies suggest that individuals participating in more leisure activities are not as susceptible to the onset of symptoms that typically coincide with AD pathology in the brain.5 Researchers have speculated that engagement in leisure activities may result in more efficient cognitive networks, providing a cognitive reserve that translates into a delay in the appearance of symptoms.
Focus on Brain-Healthy Lifestyles
Online Games' Benefits
The group's conclusion was that "claims promoting brain games are frequently exaggerated and at times misleading," and that "exaggerated and misleading claims exploit the anxiety of adults facing old age for commercial purposes." In the absence of the additional research the scientists deem necessary, the group recommends that "individuals lead physically active, intellectually challenging, and socially engaged lives, in ways that work for them." The researchers warn about brain games being viewed as a magic pill that comes with an opportunity cost, taking time and attention away from other preventive efforts that could be made. This message about the importance of lifestyle factors for brain health must not be lost among the many advertisements from groups wanting to sell brain games.
Boosting Brain and Memory
Next, the instructor plays a series of two or three short videos describing the benefits of a specific area related to brain health. These videos not only present recommendations for lifestyle change based on current research, but also present specific research studies and their findings, demonstrating the reasons supporting these recommendations. Following the presentation, the instructor leads participants in a discussion and brief activity related to the topic area, such as an in-class set of exercises in the physical activity session. Participants are also asked to set short-term goals related to increasing their activity in the area addressed.
Although the main focus of Boost Your Brain & Memory lies in the promotion of long-term cognitive health through lifestyle modifications, the program also provides a set of memory techniques that participants can use to increase their ability to remember tasks and lists. Such techniques are useful aides in recalling names, grocery lists, or the location of one's car in a parking lot. In addition to discussing lifestyle behaviors, the instructor presents information on each of the accompanying memory training techniques at the end of each of the lifestyle sessions. For example, one of the memory strategies is called Get Organized, or categorization, which involves grouping together similar items so that the conceptual group serves as a cue. The instructor discusses each of the strategies with the participants and encourages them to practice the strategy at home before the next class.
Evaluating the Program
This study used a randomized controlled trial design in which participants were assigned to either an intervention group or a wait-listed control group. The intervention consisted of three components: an eight-week educational initiative to promote cognitive health through adoption of behaviors thought to be associated with reduced cognitive decline, AD, or mild cognitive impairment; practice of memory training techniques; and use of the brain fitness system, an online cognitive training program. Results indicated positive trends in memory performance and behavior change; however, the sample size was not large enough to demonstrate statistical significance. The study provided both quantitative and qualitative data, which informed substantial program revisions, including a greater focus on principles of behavior change.
A second study was conducted to evaluate the revised program among continuing care retirement community residents. Thirteen communities from different regions of the country participated in the study and implemented the program for older adults at their locations. Similar to the first study, residents were randomized into intervention and wait-listed control groups. Dakim was not included as a component of the second study for several reasons, including cost, feasibility of implementation with a geographically dispersed sample, an interest in separating any effect due to lifestyle education from the possible effect of cognitive training, and recognition of the stronger evidence for lifestyle changes vs online training for long-term brain health. Pre- and postassessment surveys focused largely on changes in brain-healthy behaviors in three areas: physical activity, intellectual activity, and stress reduction. The intervention group reported greater behavior change than the control group on all items. These results were statistically significant on all except stress reduction. In addition, participants who had completed the course were more optimistic about maintaining memory compared with the control group. Taken together, these studies demonstrated the promise of educational interventions that present scientific research to motivate individuals to adopt lifestyle changes related to cognitive health.
Focus on Preserving Cognition
Currier continues, "Residents' two biggest fears are falling—and of course we have classes for that—and cognitive decline. We're a CCRC [continuing care retirement community], so [residents] see people with cognitive impairment all the time."
Laura Beyer, community relations coordinator at Clark-Lindsey in Urbana, Illinois, likewise sees increasing resident interest in strengthening cognitive skills. "Our residents are always pretty anxious about brain health—that is, about losing their brain health," she says. "So brain fitness is always one of our priorities."
As previously noted, there is substantial research to suggest that brain health is malleable, influenced by myriad factors, many of which can be controlled. Although the jury is still out on online cognitive training and brain fitness games, research into programs such as Boost Your Brain & Memory suggests that it is worthwhile to make concerted efforts to adopt and promote a brain-healthy lifestyle.
— Catherine O'Brien, PhD, is director of research at Mather LifeWays Institute on Aging, where she has been responsible for designing and overseeing large-scale multiyear evaluations for grant-funded projects relating to the field of aging.
— Roscoe Nicholson, MA, a senior research associate at Mather LifeWays Institute on Aging, is a PhD candidate whose graduate training has spanned psychology, sociology, anthropology, and neuroscience.
2. Middleton LE, Barnes DE, Lui LY, Yaffe K. Physical activity over the life course and its association with cognitive performance and impairment in old age. J Am Geriatr Soc. 2010;58(7):1322-1326.
3. Stern Y. What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc. 2002;8(3):448-460.
4. Katzman R, Aronson M, Fuld P, et al. Development of dementing illnesses in an 80-year-old volunteer cohort. Ann Neurol. 1989;25(4):317-324.
5. Scarmeas N, Stern Y. Cognitive reserve and lifestyle. J Clin Exp Neuropsychol. 2003;25(5):625-633.
6. O'Brien C. Testing a model of knowledge and lifestyle variables associated with cognitive health among older adults. Paper presented at: University of Illinois at Chicago; 2014; Chicago, IL.