5/22/2013

1

Building the Brain’s 401K

Cate O’Brien, M.P.H., M.A.Mather LifeWays

Sherrie All, Ph.D.Chicago Center for Cognitive Wellness

2

Presenters

5/22/2013

2

3

I. Cognitive reserveII. How lifestyle factors effect the brainIII. Memory training strategiesIV. The Spencer Powell Brain Fitness Program

A. DevelopmentB. ImplementationC. Findings

V. Questions

Presentation Overview

4

Dementia is not inevitable

30%

70%

Risk for Alzheimer’s Disease(Late Onset AD after age 65)

Genes

Lifestyle,Environment andOther Factors

5/22/2013

3

5

Dementia

Diseases

• Alzheimer’s• Huntington’s• Parkinson’s• Pick’s

Vascular

• Silent Strokes• White dots

• TIA’s• Stroke

Infections

• HIV• CJD

• Human form of mad cow

Substance Abuse

• Alcohol• Sedatives• Anti-anxiety

medication• Toxins

6

Risk Factors are Interactive

Dementia

High Blood Pressure

Diabetes

Alzheimer’s

5/22/2013

4

7

Cognitive Reserve:Your Brain’s 401K Account

Low Reserve High Reserve

DementiaThreshold

8

Had Clinical Signs of AD No Clinical Signs of AD

Katzman et al. Annals of Neurology 25, 317-324, 1989

COGNITIVE RESERVE

Plump Healthy Brain

Unhealthy Looking Brains

5/22/2013

5

9

The Adult Brain Grows New Cells

Neurogenesis

Eriksson, et al. Nature Medicine 4, 1313 - 1317 (1998)

Region of the brain that forms new memories

Zoomed in on new brain cells that grew in the adult hippocampalregion

Hippocampus

10

Woolett & Maguire (2011) Curr Biol, 21(24-2):2109-2114.

NoseNose

Brain Structures Also Grow with Experience

5/22/2013

6

11

Brain Cells Form New Connections

• Pathways

• Synapses

• Brain Plasticity

12

Brain Plasticity

oPositive Plasticityo“Cells that fire together,

wire together”- Hebb’s Law

oNegative Plasticityo“Use it or Lose it”

5/22/2013

7

13

Minimize Losses

• Prevent or slow disease processes

• Avoid brain injury• Reduce stress

Maximize Contributions

• Maximize new brain cell growth

• Grow new connections between brain cells

Your Brain’s 401K

Your Lifestyle and Your Brain

5/22/2013

8

15

Lifestyle Factors and Brain Health

Physical Activity

Emotional

Nutrition

Spiritual

Intellectual

Social

16

Physical Activity

What we know about the cognitive benefits:• Participation in “leisure-time” physical activity lowers lifetime odds of developing Alzheimer’s disease• Exercise of 3x per week reduces the risk for dementia• Moderate levels of physical activity are enough to reduce the risk of cognitive impairment.• Those who walk more have greater protection from cognitive decline.

5/22/2013

9

17

Physical Activity and Cognitive Reserve

+2% hypocampal volumeBetter spatial memory

-1.4% hypocampal volume

(Erikkson et al., 2010)

18

How does physical activity prevent cognitive decline?

Physical Activity

Vascular Health

Cognitive Performance

5/22/2013

10

19

Chronic Stress is Toxic to the BrainStudies have also shown negative effects of cortisol on neurons (brain cells) and brain function. For example :

•Cortisol is toxic to brain cells. •Cortisol inhibits the birth of new brain cells

•Cortisol weakens synaptic connections and prevents the formation of new connections.

(Hanson, 2009; 1990; Sapolsky et al., 2004, Uno et al, 1994)

Emotional

20

Stress and Depression• Stress hormones have been linked to the brain chemicals

associated with depression

• Stress can make us more vulnerable to negative thoughts AND negative thoughts can trigger the stress response and keep it going

• Studies have shown that depression is linked with Alzheimer's disease and risk of dementia

Emotional

5/22/2013

11

21

Intellectual

What Sort of Intellectual Stimulation Seems Protective?Lifetime Activities• Reading

– Newspapers, Magazines, Books

• Writing Letters• Playing Games• Education• Stimulating

Professions• Hobbies

22

IntellectualACTIVE Study

Willis et al. (2006). Long-term Effects of Cognitive Training on Everyday Functional Outcomes in Older Adults. JAMA, 296(3): 2805-2814.

5/22/2013

12

23

Nutrition

• What we eat effects our brains• Obesity• Cardiovascular health• Diabetes• Chronic inflammation• Vitamins & Minerals

24

Feed Your Brain!

5/22/2013

13

25

Alcohol

A Curvilinear Relationship

26

Spirituality

Brain Benefits of Spiritual Practice• Meditation increases the power

of brainwaves involved in higher-level mental activity

• Meditation improves attention, compassion, and empathy

• Preliminary evidence that mindfulness meditation practices may enhance cognitive functions such as working memory

• Religious practice and spirituality are associated with slower rate of cognitive decline

(Hanson, 2009; Chiesa et al., 2011; Carter et al, 2005; Tang et al, 2007; Lutz, Brefczynski-Lewis et al. 2008; Lazar et al, 2005; Kaufman, et al., 2007)

5/22/2013

14

27

Spirituality

It’s good for your brain because it’s good for your body

• Spirituality and religious practice have been linked to longer lifespan and positive health outcomes

• Church attendance and prayer are associated with lower blood pressure and better immune function

• Meditation has a wide variety of health and psychological benefits and has been shown to strengthen the immune system, decrease stress-related cortisol, and lower blood pressure

(e.g., Powell et al., 2003; Davidson et al 2003; Walsh and Shapiro, 2006; Tang et al 2007; Seeman, Dubin, and Seeman, 2003)

Reminder: high blood pressure can be bad

for the brain

Reminder: chronic stress and cortisol are

toxic to the brain

28

Social

1. Have better cognitive function

2. Experience less cognitive decline

3. Are less likely to develop Alzheimer’s disease and other dementias

4. Are less likely to develop disabilities

More socially active seniors:

5/22/2013

15

29

Why is social activity good for our brains?

1. Lowers stress, positive mood2. Provides social roles,

purpose in life3. Keeps seniors from

‘disengaging’4. Humans are ‘social creatures’5. Friends/family can notice

unhealthy symptoms and behaviors

6. Some social activities challenge us physically and mentally

30

Memory Strategy #1

• Look Up and Around• Put in the Effort

• Stay “Present”• Get your Hearing or

Vision Checked

Improve Memory by Improving Attention

5/22/2013

16

31

Improving Attention

• Manage Your Environment• Reduce Distractions and

Interruptions• Do One Thing at a Time

• Multi-tasking is a Myth!• Multi-tasking can be toxic to the

brain• Bribe yourself• Get Plenty of Rest

• May need to see a sleep doctor• Resting your when you’re awake

• Manage your Emotions

32

Attention Exercise

• Read the following number strings at a pace of one digit per second

• The person who goes second just reads the number strings in the reverse order (e.g.: Start with “4” on the first one – 493)

• 3 – 9 – 4 • 2 – 8 – 7 • 5 – 3 – 9

• 9 – 4 – 3 – 1 • 5 – 8 – 1 – 7• 7 – 3 – 5 – 9

• 7 – 4 – 5 – 6 – 1• 4 – 8 – 7 – 2 – 6• 5 – 3 – 8 – 9 – 2

• 8 – 9 – 2 – 3 – 7 – 6• 4 – 7 – 5 – 2 – 6 – 3 • 9 – 5 – 4 – 2 – 7 – 1

• 4 – 0 – 5 – 2 – 9 – 5 – 1• 7 – 3 – 9 – 2 – 6 – 4 – 0 • 3 – 8 – 2 – 9 – 1 – 7 – 4

• 4 – 7 – 9 – 5 – 2 – 8 – 3 – 5 • 9 – 4 – 3 – 7 – 6 – 2 – 4 – 8 • 5 – 1 – 8 – 6 – 3 – 4 – 9 – 2

5/22/2013

17

33

Memory Strategy #2

• Take mental snapshots

• Imagine the route you will drive or walk to get somewhere

Visualization

34

Memory Exercise

AKA:

• Method of Loci

– Translation: Putting things in locations

• Journey Method

Visualization: The Roman Room Method

5/22/2013

18

35

Brain Pathways Grew with Roman Room Method

Engvig et al. (2011). Human Brain Mapping. doi: 10.1002/hbm.21370

Connection Highways(in blue)

36

Memory Strategy #3

• Which is easier to remember?• 7329487589 or (732) 948-7589• 183457592 or 183-45-7592• 02282013 or 02/28/2013

Chunking

5/22/2013

19

37

Memory Strategy #3

ChunkingMaking use of Semantic Networks

RedRed

GreenGreen

YellowYellow

BlueBluePurplePurple

TreeTree

LemonLemon

LimeLime

OrangeOrange

OrangesOranges

GrapefruitGrapefruit

GrassGrass

BluegrassBluegrass

MusicMusic

CherriesCherries

PlumsPlums

38

Memory Exercise

Chunking

•Chunk this shopping list• Produce:

• Apples• Oranges• Lettuce• Carrots

• Dairy• Milk• Cheese• Eggs

• Packaged Foods– Juice– Cookies

• Baking– Salt– Flour– Sugar

• Household– Detergent

5/22/2013

20

39

Memory Exercise

• What were the categories?

• What was on the list?

Spencer Powell Brain Fitness StudyDevelopmentImplementationEvaluation

5/22/2013

21

41

Pilot Study Goals

The main goals of this study were to:• Determine the feasibility of implementing a new brain fitness program with older adults in different settings.• Examine data for potential associations between program participation and 1) increases in “brain-healthy” behaviors and 2) improvements in cognitive outcomes.• Identify needed revisions and enhancements to the existing program to inform program modifications that can maximize effectiveness in future dissemination and study.

42

Main Components

In the classroom:1. Education on how lifestyle

factors effect the brain2. Memory training

Online:3. Dakim BrainFitness

5/22/2013

22

43

Developing the Curriculum

• Guidelines• PowerPoint based training• Training manual• Computer-based training component

• Focus• Create a brain-health curriculum for residents and clients

of Mather, Mather Cafes, and Splendido that could be replicated and disseminated.

44

Developing the Curriculum

• 6 Dimensions of Wellness

5/22/2013

23

45

Developing the Curriculum

• Format• 8 week program• 1 week intro, 6 weeks content, 1 week closing• Self-paced computer program• 60-90 minutes per 1 week session• Train-the-trainer with instructors guide• Multiple formats: web, ppt, discussion guide

46

Developing the Curriculum

Theoretical grounding in Social Cognitive Theory (Bandura)• Self-regulation• Reciprocal determinism• Behavioral rehearsal / capability• Self-reflection / Reinforcements• Observational learning (modeling)

5/22/2013

24

47

Developing the Guide

48

Implementation

• Between 1 and 3 trainers at each of the sites implemented the program.

5/22/2013

25

49

Six training sites

• Three Mather’s More-than-a-Café locations• The Mather (CCRC)• Mather Place at Wilmette (Independent Living Community)• Splendido (CCRC)

50

Evaluation

Program Location EnrolledDid not

complete (n)Did not

complete (%)The Mather 21 2 9.5%

Mather Place at Wilmette 20 3 15.0%

Splendido 22 2 9.1%

Café on Higgens 17 4 23.5%

Café on Central 22 3 13.6%

Café at 83rd St. 20 6 30.0%

Total enrollment 122 20 16.4%

Enrollment and Attrition

5/22/2013

26

51

Dakim BrainFitness System Rating

On a scale of 1-5 where 1=Strongly Disagree, 2=Disagree, 3=Neutral, 4=Agree, 5=Strongly Agree

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

I will continue to use the Dakim program on my own

I was frustrated by other aspects of the Dakimprogram (non-technical)

I was frustrated by technical issues

Technical issues led me to stop using the program

I feel like the Dakim program challenged my brain

The Dakim program was easy to use

I enjoyed using the Dakim program

Mean rating

52

Course Evaluation

I feel I have achieved the following objective as a result of this class:Mean rating*

I understand how lifestyle affects my risk for dementia. 3.41I understand more about how the adult brain changes. 3.29I understand why staying mentally active can lower my risk for dementia. 3.70I understand how what I eat affects how my brain ages. 3.51I understand how managing stress can lower my risk for dementia 3.58I understand how being socially active lowers my risk for dementia 3.68I understand how physical exercise can help lower my risk fordementia 3.69I have made changes in my lifestyle to help lower my risk for dementia 2.75I plan to make even more lifestyle changes in the coming months to lower my risk for dementia 3.26On a scale of 1-4 where 1=Not at all, 2=to a slight extent, 3=to a moderate extent, and 4=to a great extent.

5/22/2013

27

53

Change in Brain Healthy Behaviors

** The nutrition scale asks about poor eating behaviors, thus a lower score indicates better diet.

-5

-4

-3

-2

-1

0

1

2

3

Treatment

Control

None of these effects reached statistical significance

54

Physical Activity: Meaningful Trend

Condition

Intervention

Control

Treatment Group Increased Physical

Activity by almost

2 hours per week

5/22/2013

28

55

Behavior Limitations

• Power

• Dose

• Duration

56

Change in Objective Cognitive Performance

The intervention group had better scores than the control group on 2 of the 3 memory-related tests.

-1.5

-1

-0.5

0

0.5

1

1.5

2

2.5

3

3.5

Treatment

Control

None of these comparisons reached statistical significance

5/22/2013

29

57

Effects Did Not Correlate With Dakim Use

58

Future Directions

Physical ActivityPhysical Activity

Emotional WellbeingEmotional Wellbeing

Intellectual EngagementIntellectual

Engagement

Enhanced Memory

Techniques

Enhanced Goal

Setting

Better Goal

Accountability

5/22/2013

30

59

Questions?