here. - Calgary Association of Lifelong Learners

Promoting Healthy Brain
Aging
Dr. David B. Hogan
Professor & Brenda Strafford
Foundation Chair in Geriatric
Medicine
University of Calgary
1
Objectives
• Describe normal age-related changes in
cognition
– Contrast that with mild cognitive impairment &
dementia
• Review what can be done to promote
healthy brain aging and prevent dementia
– Don’t smoke, avoid excessive alcohol intake, keep active (physically, mentally & socially),
eat appropriate diet, & look after your health
2
A Few Points at the Start
• Aging is a continuous process
• Our “later” years (generally defined as 65+ or from retirement on) will last
30+ years for many of us
• Great variability between individuals
3
A Few Points at the Start
• What we see in later years are the
effects of the following:
– Aging (biological and social)
– Habits/ life-style
– The person’s life journey from birth
– Diseases and their therapies
4
A Few Points at the Start
• Brain
– “Control centre” of the central nervous system
• Mind
– All those cognitive (thinking) faculties that
enables consciousness, thinking, reasoning,
perception, and judgment
• Understanding the relationship between
the two is complex both philosophically
and scientifically but clearly there is a
strong one between the two
5
Changes in Thinking as We Age
• “Normal”
– Affects most of us as we age
– Can cope – might be viewed as an annoyance
• Disease
– Mild Cognitive Impairment (mild neurocognitive
disorder) – more than “expected” decline but modest
and does not prevent one from maintaining
independence (though may need more effort or
accommodation)
– Dementia (major neurocognitive disorder) –
significant decline that interferes with independence
6
Life Expectancy at Birth of
Canadians (3 years longer than
Americans)
Women
Men
At Birth
At Age 65
83.0 (72.9 in
1956)
21.3
78.3 (67.6)
18.1
Statistics Canada 2010
7
Brain Changes with Aging
• ↓ Brain weight:
By 5-10% at 80 compared
with younger adults
• Not the Same Everywhere:
Frontal and temporal lobes (front) by about
9-12% while parietal and occipital lobes
(back) show little loss; most occurs after
age 50
8
Changes in No. of Brain Cells
• By the age of 90, nearly 10% of the
average 20 billion neocortical neurons we
had are lost
– About 1 neuron per second (averaged over a
lifetime) - rate is greater with advancing age
– Neuronal systems most vulnerable to aging
are those in the outer layer (involved in higher
functions), the brainstem (movement), and the
front & bottom (memory/ learning) of the brain
– Loss of neurons is regional and preferentially
affects certain brain cells rather than global
9
We Can Tolerate and/ or
Adapt to These Changes
• Cognitive Reserve
• Plasticity
• Compensation and experience
(e.g., driving – decline in operational skills
but tactical and strategic compensations)
10
Cognitive Enrichment & Reserve
• Cognitive enrichment: earlier in life
appears to protect from the development
of age-associated cognitive decline (e.g.,
education, work, and/or leisure activities)
• Cognitive reserve hypothesis: more able to
compensate for any adverse changes
associated with aging
11
Plasticity
• The ability of the brain to change - can be in
response to being exposed to something new
and continues through life (experiences can
change our brain for the better)
• Older adults can improve their ability to solve
certain reasoning or memory tasks through
training, BUT
• Improvements seem to be specific to the trained
skill (little evidence of broad gains)
12
Ageism
• Negative/ positive stereotyping can
influence performance
– On a computer game during thirty-minute
exposure to the subconscious reinforcement of
either a positive or negative stereotypes of
aging
– Walking speed (significant increases in walking
speed of 9% were observed in subjects who
received positive reinforcement)
13
Common But Not Universal
Cognitive Declines With Aging
• Complex tasks that require taking in new
information and analyzing it may become
more difficult
– “Fluid intelligence” (the ability to think and
reason abstractly and solve problems)
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Common But Not Universal
Cognitive Declines With Aging
• Attention
– Difficulty focusing - more susceptible to being
distracted
• Processing speed
– Mental processing and reaction time become
slower with aging
• Memory
15
Memory
• Absent mindedness is common among all
of us –
– 189 people (avg. age 31/ range 19-60, 130
women) volunteered to keep a diary where
they counted examples of absent mindedness
– Occurred on average of 6-7 per week or once
daily (usually forgot something)
16
Memory
• Types of memory errors that increase as
we age
– Blocking
• Strong sense that the memory exists (tip-of-thetongue phenomenon); often with names & words
– Suggestibility
• Incorporating information from others into our own
recall;; the “Remember, I told you” scam
17
But …
• Many aspects of thinking can stay the
same or get better
– “Crystallized intelligence” (the knowledge and skills that we’ve accumulated;; based upon facts and rooted in experiences) continues to
accumulate
– Because of our experiences, we may be
better at making decisions
– Well-practiced skills and familiar information
are generally not affected by age
18
Overall
• While certain abilities may decline with
aging, this is generally mild and not
noticeable until we are 70+
– In one study by 81 only 30-40% had
demonstrable declines in certain aspects of
mental ability (2/3 of these were slight)
– While on average there are declines in certain
areas, there is a lot of variability
– We can compensate for the changes that
might occur with normal aging
19
Emotional Side
• Older adults typically report higher levels
emotional well-being than younger adults
• While still common (8-16%), severe
depressive symptoms less frequent (or no
more frequent) in later life than in midlife
• Why – ? More positive outlook more likely to live into
old age
– ? Harder to detect
– ? Less financial pressure/ fewer negative
interpersonal exchanges
– ? More resilient/ look at things differently
20
Looking at the Sunny Side
• The “Mellow Years”
• Generally we respond more to negative
information (media is aware of that)
• In a study, older people tended to respond
less to negative images than younger
persons
– Both responded the same way to positive
images
21
G8 Dementia Summit
• Hosted by the UK government in London
in December 2013
• Highlighted the importance of dementia in
an aging world
– More common as we age
• Projected global cost of $1.2 trillion US by 2050
– Develop new treatments for Alzheimer
disease and other dementias
– Focus on prevention
22
Prevention
• 2014 Blackfriars Consensus of Brain and
Dementia
– Action on behavioural risk factors (tobacco, poor diet,
physical inactivity) with reductions in raised BP &
cholesterol, obesity, and diabetes could prevent 320% of predicted new dementia cases in 20 years
– Gains likely greater if combined with action to protect
brain health throughout life
• Alcohol, substance abuse & head injuries
• Supporting lifelong learning and improved workplace health
• Improving social interactions, stimulation, & supportive care
in later life)
23
Prevention
• 2014 paper estimated the potential of
preventing Alzheimer’s disease
– About a third of cases worldwide might be attributable
to potentially modifiable risk factors
– Diabetes, midlife (35-64) hypertension, midlife obesity
(BMI > 30), physical inactivity (do not do either 20
minutes of vigorous activity on 3+ days per week OR
30 minutes of moderate on 5+), depression, smoking,
low educational attainment
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The Guardian (Apr. 19/15)
• Watch your weight (complicated relationship – being
overweight in mid-life probably increases risk but tend to
lose weight with a dementing illness)
• Regular exercise
• Intervene early (the process underlying dementia may
start 15-20 years before symptoms develop)
• Look after your heart
• Get an education when young (and can’t hurt when
older)
• Healthy, balanced diet (Mediterranean diet)
• Limit alcohol intake
25
Keeping Sharp at Any Age
– See your health professional regularly
• BP, cholesterol, diabetes, smoking, medications
(good and bad)
– Exercise
• 30+ minutes, 3-5 times a week or more (e.g., brisk
walk); some is better than none so do as much as
you safely can
– Get enough sleep – 7-8 hours of sleep per
night
26
Keeping Sharp at Any Age
– Avoid excessive stress
• Interferes with sleep, ability to concentrate, learn
and remember
– Think, think, think
• Read, puzzles, chess, go to a play, paint
– Socialize
• Church, club membership, volunteering, part-time
job
– Eat right
• Low fat, fruits/ vegetables/ B vitamins, fish - The
American Geriatrics Society Foundation for Health in Aging
27
What Comes First?
• Those who are more active tend to show
fewer changes in thinking as they age
– In one study, cognitively inactive person was
2-3 times more likely to develop Alzheimer’s disease
• But does:
– Reduced activity leads to cognitive decline?
– Poorer cognitive functioning leads to reduced
activity?
– Both? Something else?
28
Keep Active
• Mentally, physically and socially
– Mental – take classes, read/ write, cross-word
puzzles, play music, explore community,
participate in games
– Physical – exercise
– Social – keep engaged; spend time with other
people, join a club, volunteer, try a part-time
job
– Combination better than one alone
• Fortunately can often combine them (e.g., dancing)
29
Knowing What Works Not New
• Hippocrates – “If we could give every individual the right amount of nourishment
and exercise, we would have found the
safest way to health.”
• Thomas Jefferson – “… a strong body makes the mind strong.”
• Your mother
30
Exercise
• Benefits in particular with “executive function”
– Umbrella term for thought processes that regulate
others like planning, attention, & problem solving
• Aerobic, strengthening, or both?
– Aerobic: 6 mth./3x wkly./40-45 min in sedentary
persons about 67 led to changes in brain activity and
improvements on testing requiring attention &
decision-making
– Progressive resistance training http://cogmob.rehab.med.ubc.ca/learn-more
31
How Does it Work?
• Not sure but likely some combination of
– Stimulation of growth of new brain cells
(called neurogenesis)
– Stimulation of growth of new blood vessels
(called angiogenesis)
– Higher levels of brain chemicals – one that
has attracted a lot of attention is BDNF (brainderived neurotrophic factor) that promotes
survival, growth and differentiation of brain
cells & their connections
32
Effects of Regular Exercise on Cerebrovascular
Reserve in Older Adults: Role in the Prevention
of Age-Related Cognitive Decline
Principal Investigator: Dr. Marc Poulin
Co-Investigators: Dr. Gail Eskes (Dalhousie
University), Dr. Christine Friedenreich, Dr. Michael
Hill, Dr. Eric Smith, Dr. David Hogan and Dr. Stewart
Longman
Collaborators: Dr. Todd Anderson, Dr. Richard Leigh,
Dr. Wayne Giles
Trainees: Dr. Margaret Davenport (HSFC PDF), Dr.
Genevieve Arsenault (AIHS PDF), Amanda Tyndall
(PhD student)
33
Brain in Motion Study
• 250 sedentary older (55-80) Calgarians
• Investigating relationship between
exercise, blood flow in the brain, and
thinking/memory skills
• Receive a free six-month membership to
the Fitness Centre at the University of
Calgary, an exercise “prescription” to walk or jog the track three days a week, and
support from the study’s fitness trainer 34
WHO Organization
• In order to improve cardiorespiratory and
muscular fitness, bone and functional health,
reduce the risk of chronic diseases, depression
and cognitive decline:
– Older adults should do at least 150 minutes of
moderate-intensity aerobic physical activity (PA)
throughout the week or do at least 75 minutes of
vigorous-intensity aerobic PA throughout the week or
an equivalent combination of both
– Aerobic activity should be performed in bouts of at
least 10 minutes duration
35
WHO Organization
• Continued
– For additional health benefits, increase moderateintensity aerobic PA to 300 min. per week, or 150
min. of vigorous-intensity aerobic PA per week, or an
equivalent combination of both
– If poor mobility, perform PA to enhance balance &
prevent falls on 3+ days per week
– Muscle-strengthening activities, involving major
muscle groups, should be done on 2+ days per week
– If cannot do the recommended amounts due to health
conditions, should be as physically active as their
abilities and conditions allow
36
Physical Activity
• Moderate – requires a moderate amount of effort
and noticeably raises the heart rate
– Brisk walking, dancing, gardening, housework,
traditional hunting & gathering, walking a pet/ playing
games with children
• Vigorous – requires a large amount of effort
causes shortness of breath and substantially
raises the heart rate
– Running, walking briskly up a hill, fast cycling,
aerobics, fast swimming, competitive sports, heavy
shoveling
37
Neurobics
• Neurobics: mental exercises, brain teasers
and puzzles that are believed by some to
enhance the brain's performance
• Term coined by late neurobiologist
Lawrence Katz (1956-2005) and Manning
Rubin (writer) to describe mental exercises
designed to keep the brain alert; term in
use since 1999
38
Neurobics
• Routine actions so automatic most largely
done unconsciously - require less brain
activity (i.e., less stimulation)
• Want to introduce novelty to your life
– Non-routine sensory stimulation/
activities
– Carrying out a routine actions such as
dialling phone/ brushing teeth with nondominant hand
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Example of Memory Exercises
•
•
•
•
•
•
•
Pay attention
Rehearse/ repeat
Chunk
Use cues
Get organized
Mind your PQRST
Use external aids
National Institutes of Health
40
Memory Exercises
• Pay Attention – be deliberate; take a
second to actively pay attention (“I’m putting my keys in my jacket pocket”)
• Rehearse – you have a great idea in the
shower that you want to tell your partner;
repeat to yourself what you want to
remember
41
Memory Exercises
• Chunk – to remember a large number, break it
into chunks (3013661755 → 301-366-1755)
• Cues – mental picture (associate something you
want to remember with a picture – call someone/
face or telephone on your front door; sources of
folate - foliage); verbal elaboration (spring
forward, fall back; Great Lakes – HOMES for
Huron, Ontario, Michigan, Erie, Superior; PIN
number – change numbers to letters on a
phone; e.g., 3283 - DAVE)
• Organize – have fixed locations to store things
42
Memory Exercise
• PQRST – way to approach a text with a lot
of detail; P – preview (skim & identify main
points); Q – create questions to identify
what you want to learn; R –reread/ answer
your questions; S – study and understand
your answers; T – test yourself
• External aids – make notes, use memo
pad/ calendar, appointment book (be
organized)
43
Computerized Brain Training
• Includes various games for seniors such
as “Brain Age” and ‘Brain Weight”
• Based on the idea that regular mental
exercises can keep brains sharper
• There is no conclusive proof that these
mental games slow brain aging
• Most feel there is no harm other than
possibly to your pocketbook
44
A Consensus on the Brain Training Industry
from the Scientific Community
• “We object to the claim that brain games offer
consumers a scientifically grounded avenue to reduce or
reverse cognitive decline when there is no compelling
scientific evidence to date that they do. The promise of a
magic bullet detracts from the best evidence to date,
which is that cognitive health in old age reflects the longterm effects of healthy, engaged lifestyles. In the
judgment of the signatories, exaggerated and misleading
claims exploit the anxiety of older adults about
impending cognitive decline. We encourage continued
careful research and validation in this field.” (Max Planck
Institute for Human Development and Stanford Center on Longevity,
accessed May 19/15)
45
Mediterranean Diet
• Eating primarily plant-based foods, such as fruits
and vegetables, whole grains, legumes and nuts
• Replacing butter with healthy fats, such as olive
oil
• Using herbs and spices instead of salt to flavor
foods
• Limiting red meat to no more than a few times a
month
• Eating fish and poultry at least twice a week
• Drinking red wine in moderation (optional)
46
Stress
• Suggestion that chronic stress could
trigger the development of thinking
problems in later life
• Possible pathway
– Cascade of reactions involving stress
hormones (cortisol) that eventually leads to
shrinkage of the brain in critical areas
– Constant worry leads to excessive brain
activity
– Both might lead to and the development of
early changes of Alzheimer
47
Alcohol
• Excessive alcohol use includes binge and
heavy drinking
– Binge drinking? National Institute on Alcohol Abuse
and Alcoholism (US) defines it as a pattern of alcohol
consumption that leads to high blood alcohol
concentrations - usually corresponds to 5+ drinks on
a single occasion for men or 4+ drinks on a single
occasion for women (generally consumed within 2
hrs.)
– Heavy drinking? Defined as 15+ drinks per week for
men and 8+ drinks or more per week for women
48
Bundling
• FINGER Study
– 1260 people 60-77 at risk for dementia with average/
slightly impaired cognition
– 2-year multidomain intervention (diet, exercise,
cognitive training vascular risk factors) or general
advice (control group); adherent (85%+)
– Cognition improved in both groups but more likely to
maintain or improve general cognitive & executive
functioning and processing speed with intervention;
more adverse events (not serious) with the
intervention – 7% versus 1%, usually MSK pain
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Thank You for Your Attention
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