The Older, Sometimes Better Brain

Dear Readers,

Like all other parts of the body, the brain ages. We forget people’s names, we lose stuff, we react more slowly. It’s not all bad, though: In some ways, the brain improves as it ages.

This month and next, we look at the older brain and its normal aging. First up this month, we look at how and why our thought processing changes, and habits that affect it. Next month, we’ll cover things that clearly are bad for your brain, what the older brain is good at and strategies you can use for optimal brain health.

Cognition: What’s Happening Here?

A recent report from the prestigious Institute of Medicine (a branch of the National Academy of Sciences), talks about what it called “cognitive aging” — the natural but variable process that affects memory, thinking and decision-making in all of us — and what we all can do to maintain brain health into old age.

AARP published a review of the IOM report. AARP found that most of us are very concerned about maintaining good brain health, but few know how to do it.

The IOM report recommends:

• exercise regularly;
• stay intellectually engaged;
• eat well;
• get sufficient sleep.

Dr. Ronald Petersen, director of the Mayo Clinic Alzheimer’s Disease Research Center, told AARP, aging doesn’t have to be a passive process. “We don’t have to just sit by and let time do ravages on us,” he said. “We can do something about cognitive aging, and we can have an impact on the rate at which we might experience these changes, perhaps postponing those ravages for extended periods of time.”

In addition to these basic keys, we’ll look at other factors that can affect how well you think and react as you grow old.

Exercise

What’s good for your heart is also good for your brain. High blood pressure, high cholesterol and diabetes — especially in midlife — are linked to poor brain health later in life. Controlling these problems through lifestyle habits and/or medication is key. According to Harvard Health Publications, “physical exercise is the best-documented way to preserve brain function. It helps you to lay down new memories and better focus on the tasks ahead of you.”

Another Harvard publication discussed studies that have linked regular aerobic exercise to reduced risk of dementia, and some that indicate that cardio workouts increase brain mass and improve reasoning ability.

The benefits accrue with only reasonable exertion — 30 minutes of moderate exercise most days. (See my newsletter, “The Nonexerciser’s Guide to the Why, How and What of Better Health.”)

Remarkably, Harvard noted that some trials of people with mild cognitive impairment showed that exercise was effective inarresting cognitive decline. And some evidence indicates that if you try a new, complicated physical regimen, like dance or sports, and show improvement, you’ll have greater brain benefits than following the same routine, like walking, all the time.

“What the studies haven’t determined,” according to the Harvard report, “is whether the benefits of exercise disappear when people become sedentary.”

If you need some inspiration working out in your later years, have a look at this YouTube video of a woman named Olga Kotelko. She died last year at 95, still a world-class track-and-field athlete who didn’t even take up the sport until she was 77. She won hundreds of medals in World Masters events, and was such a remarkable specimen that researchers at the Beckman Institute for Advance Science and Technology at the University of Illinoisstudied her brain to see what they could learn about the potential effects of exercise on cognition in the “oldest old.”

The analysis, published in the journal Neurocase, showed several interesting things.

Although the brain generally shrinks with age, Kotelko’s showed minimal shrinkage. Previous studies show that regular aerobic exercise can increase the volume of certain parts of the brain, including the hippocampus, which is important to memory. Kotelko’s hippocampus was smaller than the average younger person’s, but it was larger than expected for someone her age.

And other parts of her brain were comparable to those of women decades younger. Parts of the brain connecting the right and left hemispheres are responsible for engaging in tasks such as reasoning, planning and self-control. They decline the fastest in aging brains. But Kotelko’s were notably intact.

Although Kotelko performed worse on cognitive tests than younger women, she did better than adults her age who had been tested in an independent study, and her memory was considerably sharper.

Can we attribute Kotelko’s remarkable brain function to competition or exercise? No. But the association certainly provides reasons to pursue the science, as well as an active lifestyle to the degree an older person is able.

Intellectual Engagement

Anything that makes you think — reading challenging material, writing letters, learning a new language — helps preserve brain function. So do social activities: playing cards, discussing current events, volunteering in the community, attending worship services, and so on.  All require you to listen, think and engage, which is a pro-brain activity.

Some people believe that doing crossword or number puzzles like Sudoku keeps the intellectual muscle strong. You’ve probably heard about Lumosity and other online games that promise to improve your cognitive abilities. They’re heavily promoted, but do they work?

Maybe, but probably in only a limited way

Research, according to the IOM report, shows that computer and video game brain training can improve attention and memory during those activities, but few studies show that those skills carry over to other cognitive processes. In other words, doing puzzles and playing games helps you become a better puzzler and game-player, and have value as recreational pursuits that keep you engaged. But they’re not going to stave off dementia, or even help you remember that guy’s name you just can’t call up.

A recent story in the New York Times quoted a neuroscientist at the National Institute on Aging, who said that despite some evidence that doing crosswords might help to delay memory decline, they’re best done for pleasure, not brain health. “People who have done puzzles all their lives have no particular cognitive advantage over anyone else,” she said.

The Times was writing about a 10-year National Institute of Aging study. When it comes to brain-training games, “Unfortunately, few such … have been proven to have a meaningful, sustainable benefit beyond lining the pockets of their sellers. Before you invest in them, you’d be wise to look for well-designed, placebo-controlled studies that attest to their ability to promote a youthful memory and other cognitive functions.”

The institute sponsors scientific research about maximizing the brain’s lifelong ability to generate new cells and connections. One of its trials followed more than 2,800 cognitively healthy people 65 and older who were randomly assigned to training programs for memory, reasoning or speed of processing, or to a no-treatment control group.

After 10 years, according to The Times story, 6 in 10 people in the training programs, compared with 5 in 10 of the controls, had maintained or improved their ability to perform activities of daily living. And they all had improved the function they trained in. Those in the reasoning and speed-of-processing groups retained their benefits 10 years later, but the effects of memory training ultimately were lost. The difference between groups is not so impressive, but indicates that aging people who practice the training might be able to continue living on their own, the story suggested.

In a review of several studies, The Times reported, researchers at Johns Hopkins analyzed the cognitive training of older adults using computerized programs. They found that cognitively healthy people 55 and older didn’t have to be “technologically savvy in order to successfully complete or benefit from training”; that their results were as good as or better than more traditional pencil-and-paper training programs.

The takeaway here is that even older brains can learn new tricks.

Like the neuroscientist interviewed by The Times, the IOM advised consumers to beware of poorly tested products that claim to “prevent, slow or reverse the effects of cognitive aging.” Consumers should find out if the product promoted improved “performance on real-world tasks”? Are the claims supported by “high-quality research” that has been “independently verified”? And, how do the supposed benefits compare with the scientifically proven benefits of physical activity and social engagement?

Diet

There’s no specific food plan to boost or maintain brain health, but the Mediterranean diet, which I’ve championed, and the DASH (Dietary Approaches to Stop Hypertension) diet, which is similar, have been shown to help cognition in some studies, but not in others, according to the AARP story.

Some, but not much, alcohol (fewer than two drinks per day) — may be protective, but excessive alcohol is not your brain’s friend.

Like alcohol, a little dark chocolate — but not too much — might confer brain benefits on older folks. Several studies have shown that chocolate compounds called flavonoids (related to those in tea, red wine, grape juice and other plant foods)  might have promise. One study involved people over 65 with mild cognitive impairment. That condition causes memory problems more serious than those seen with normal aging, but less severe than dementia.

The subjects drank a daily cocoa beverage with varying levels of flavanols, a subclass of flavonoids. After eight weeks, the high-flavanol group did better on memory, verbal fluency and other cognition tests, and their blood pressure, blood sugar control and oxidative stress levels also improved. It’s unclear if flavonoids directly affected neurodegenerative processes, because the cognitive benefits were related primarily to better insulin sensitivity, which affects blood sugar control as well as brain function, and to more healthful blood pressure.

So, like exercise, what’s dietarily good for your heart is good for your brain.

Coffee and caffeine have been widely studied, with mixed results on cognition, but one review concluded, in part that “it appears that caffeine cannot be considered a pure cognitive enhancer. Its indirect action on arousal, mood and concentration contributes in large part to its cognitive enhancing properties.”

Dietary supplements, such as Luminene, ginkgo biloba and other potions widely promoted as brain boosters are pretty much a waste of money. And some might be harmful. And as AARP reported, there’s no good evidence that dietary supplements benefit specifically brain health.

In terms of vitamins and minerals, unless you’re consuming insufficient amounts in your diet, you’re not likely to benefit from supplementation. According to AARP, vitamin E doesn’t seem to help brain health and has been linked to a higher risk of death in large doses. Vitamin D deficiency has been linked to a decline in brain health, but taking vitamin D supplements hasn’t shown improved memory, motor speed or other cognitive benefit. And the IOM report said high levels of vitamin D are linked to attention problems and cognitive impairment.

Sleep

No matter how old you are, not enough sleep, or low quality sleep, is associated with cognitive impairment, and also a higher risk of developing Alzheimer’s disease.

But fractured sleep is a normal part of aging — older people simply don’t sleep as soundly as younger people. So how can any older person get enough sleep? Do they need to? To understand the nature of sleep, and to improve your chances of improved slumber, and therefore better brain function, see my newsletter,“The Struggle to Sleep.”

A study published in the Annals of Medicine showed that older people sleep less, but many report better quality sleep, and feel more awake during the day.

That study involved both subjective and objective evaluations of sleep, such as questionnaires and sleeping in a lab while being monitored for biophysical activity. Nearly 7,000 randomly selected subjects ranging in age from 35 to 75 were studied. People with declared sleep disorders were excluded.

The results showed that older people went to bed earlier and arose earlier than the younger folks, and that they didn’t sleep as long. Even so, according to the authors, “Older subjects complain less about sleepiness, and pathological sleepiness is significantly lower than younger subjects.” The researchers suggested that older people actually require less sleep.

Generally, it takes women longer to fall asleep as they age, but not so men. Both genders, however, generally are more restless and more likely to wake up than younger people, so maybe the reason the study participants didn’t complain about their changed sleep habits, the researchers surmised, was because they’ve adapted their sleep-quality expectations, or just adjusted to reality.

So if older people do complain about their sleep, something might be amiss, and there might be underlying causes worthy of investigation.

HERE’S TO A HEALTHY REST OF 2015!

Sincerely,

Patrick Malone
Patrick Malone & Associates