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Cognitive Fitness: The Challenge of a Youthful Brain

21 March 2012 4,856 views

By James M. Ellison, M.D., M.P.H

Baby boomers approaching retirement age have perhaps the most defiant attitude in history. As a group, the baby boomers are proactive and instrumental in setting goals and achieving objectives. Thus, life changes associated with aging, and particularly the twin spectrums of cognitive and physical decline and disability, will be vigorously resisted by this population. This generation is also concerned with stress-related depression and how this affects memory.

From consumer evidence we know that baby boomers are more physically active than previous generations.  “Sixty is the new 40” is their slogan; and they are predicted to spend as much as $114 billion a year on anti-aging products and procedures by 2015. Among the factors contributing to their increased  physical activity: a  positive attitude toward aging, need to accommodate adverse economic forces by remaining in the work force longer, and plans to remain productive and engaged in work and leisure activities well past the age of 70.

 Lifestyle and depression

Middle-aged adults increasingly seek information about how to delay age-related (and stress related) cognitive and physical changes.   They maintain a health consciousness apparent in the profusion of media attention to the benefits of nutrition, exercise, and cognitive stimulation.   As such their focus is on staying healthy and guarding against the depression that may result from life changes.

Additionally, depression may be an exacerbating factor in cognitive impairment. Several epidemiologic studies show that those adults who have experienced a major depressive episode are subsequently at greater risk for developing dementia.

Among the possible reasons for this are that depressive symptoms may be an early manifestation of dementia – or that depression’s effects on metabolic functions and the immune system may increase the risk for dementia.

Dementia is an important cause of depression in later life – up to 50 percent of individuals with Alzheimer’s disease experience significant depressive symptoms.

From personal experience with aging family members, many harbor “forgetfulness” fears and the dreaded possibility of dementia.

Brain Fitness Has Grabbed the Public Interest

Among the many books that in recent years have touted various approaches to “brain fitness”, several are evidence-based and authoritative:  Positive Cognitive and Emotional Aging (Depp and Jeste), Keep Your Brain Healthy (McKhann and Albert), and The Memory Bible (Small).  They contain valuable advice for young and older adults.

Additionally, brain fitness training programs are beginning to spring up in California and in Washington, DC under the auspices of highly respected physicians.

Brain Fitness Software and Products

In addition to information about physical aging, cognitive aging, exercise, and nutrition, middle-aged adult populations around the world show have shown a great desire for software promoting cognitive stimulation.  This group is also seeking nutraceuticals and pharmaceuticals potentially capable of enhancing and/or preserving cognition.

Software packages already exist:  Posit Science’s Brain Fitness, Cogmed, and the Nintendo Brain Gym are only a few of many available options.  Websites such as Lumosity and My Vigorous Mind offer the alternative of signing onto a central server from any location. Then there are  multitudes of pharmaceuticals and nutraceuticals;  for example, the alleged cognition-enhancing prescribed medications (stimulants and modafinil), and nutraceuticals (DHA, citicoline, phosphatidyl serine, and various vitamin combinations).

But Where are the Consumer Guidelines?

Consumers have a limited awareness regarding the lack of evidence supporting computer programs and nutritional or “smart drug” approaches.  Most are unable to ascertain the potential adverse effects and/or drug interactions associated with their use.

Nonetheless, based on industry projections, consumers have a lively interest in age-defying products and will increase their consumption of nutritional supplements, software, exercise aids, and classes in yoga or other practices that offer guidance toward healthier aging.

Prevention, Assessment and Follow-through

Most of the active and potential consumers of these products have never received a valid individualized preventive assessment of their specific medical or psychological or neuropsychological condition or needs.  Nor has there been any instruction aimed at developing a balanced and comprehensive program for the personalized preservation of their cognitive and physical health.

For example, in the clinical world, once the presence of a Mild Cognitive Impairment or Dementia has been determined,  insurance does not  adequately cover the costs of health-enhancing services such as   psycho-educational counseling, nutritional guidance, exercise program planning, or the supervision of nutraceutical use. Pharmaceuticals that are covered can be beneficial, but often a limited degree.

Those physicians who wish to engage with families who need to or wish to actively participant in the client’s personalized cognitive preservation plan are hampered.

At one time sensitive family practitioners might have worked alongside psychiatrists to help families manage patients in cognitive decline. But with a shortage of family physicians and just 2 percent of graduating physicians are going into family practice — seeking more lucrative specialties — the shortages across the nation are dramatic.

Making the Choice for Preventive Medicine

A Cognitive Fitness Institute model that focuses core services on wellness to resist aging could serve as a preventive center for relatively healthy individuals.

By structuring organizations to focus on wellness, rather than disease, needs could be addressed in an organized and effective way by personnel teams of professionals to include social workers, occupational therapists, advanced nurse practitioners and clinicians, under the guidance of physicians and psychiatrists.

In an era that promises increased longevity and extended productivity it is incumbent upon the medical community find ways to improve the quality of life in the later years and alleviate the  caregiver burden shouldered by some 15 million caregivers who are providing 17 billion hours of unpaid care for demented older adults.   Given the technology and various methods to enhance brain function, it appears that the baby boomers’ quest to set back the clock on aging can become a reality through guidance in optimizing the new resources available.

Boston Brain Fitness 

With an expert team of specialists BBF is poised to provide:

  • A website which provides basic information about the  differences between normal cognitive aging and pathological aging
  •  Educational materials on the cognitive benefits of  nutrition, exercise, stress reduction, social connectedness, and nutraceuticals
  •  Software and other programs, educational materials, and videos/CDs available for purchase regarding cognitive stimulation, prescribed medications for cognitive preservation and/or enhancement (including authoritative reviews of products which help consumers plan a suitable individualized program.
  • Individual assessments of cognitive functioning to evaluate both strengths and areas of difficulty as well as how to best facilitate intervention.

In an era that promises increased longevity and extended productivity it is incumbent upon the medical community find ways to improve the quality of life for those who are over-stressed in their mid-years and for those in their senior years alleviate the concerns of mental decline.

Adapted from an article published and copyright on October 26, 2011

James M. Ellison, M.D., M.P.H, is clinical director of geriatric psychiatry at McLean Hospital in Belmont, Mass., and an associate professor of psychiatry at Harvard Medical School.

 Copyright 2011 James M. Ellison / All Rights Reserved


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