Brain Fitness for Your Patients:

1. Brain Fitness for Your Patients: What you can encourage them to do about those ‘Senior moments’ Polk County Advanced Practice Nurses Association September 22, 2012

2. Our Agenda Today • How do you address your patients’ worry about their memory and their future due to their perceived memory loss? • The facts, like them or not: • Our brain function is less robust as we age • Lifestyle changes and brain exercises can improve our brain function Senior moments, brain farts, what fors, mental glitch, drawing a blank…

3. When is the brain fully developed? • Brain size: • a newborn's brain is only about one-quarter the size of an adult's; • about 80 percent of adult size by three years of age and 90 percent by age five • growth is largely due to changes in individual neurons, structured much like trees • Speed of neural processing: • newborn's brain slower than an adult's, transmitting information less efficiently • increases dramatically during infancy & childhood, maximum at about age 15 Synaptic development: # of synapses in the cerebral cortex peaks within the first few years, declines by about 1/3 between early childhood & adolescence From Zero to Three, National Center for Infants, Toddlers & Families

4. Brain development in babies • Does experience change the actual structure of the brain? • Brain development is "activity-dependent" • Every experience--whether it is seeing one's first rainbow, riding a bicycle, reading a book, sharing a joke--excites certain neural circuits and leaves others inactive • As neuroscientists sometimes say, "Cells that fire together, wire together."

5. Neuroplasticity • Visionary researcher Paul Bach-y-Rita “We see with our brains, not our eyes” • Today, Dr. Michael Merzenich - professor emeritus neuroscientist at the University of California, San Francisco • “The brain’s lifelong ability to change its structural and functional architecture in response to learning and experience.” Defined by Andreas Engvig, MD/PhD student

6. Research • http://www.cdc.gov/aging/healthybrain/research.htm • Examining the Impact of Cognitive Impairment on Co-occurring Chronic Conditions (2010–2012) • Examining the Prevalence of Chronic Health Conditions and Cognition (2010) • Understanding the Publics’ Perception of “Brain Health” (2005–2009) • New Research Explores Perceptions of Cognitive Health Among Diverse Older Adults [PDF-1.34Mb]Systematic Literature Reviews • Community-based Interventions to Improve Emotional Health in Older Adults (2007–2010). • Physical Activity Interventions Related to Cognitive Health (2007–2010). • Physicians’ Perceptions, Knowledge and Practice about Cognition (2008–2010). • Public’s Perceptions about Cognitive Health and Alzheimer’s Disease (2008–2009). • Assessing Perceptions, Knowledge and Beliefs About Cognition (2008–2010) • Research Meeting - the “Healthy Brain and Our Aging Population: Translating Science to Public Health Practice” (2006) • Alzheimer’s & Dementia: The Healthy Brain and our Aging Population: Translating Science to Public Health Practice. This special issue of Alzheimer’s & Dementia includes articles from presentations given at the 2006 research meeting about the “Healthy Brain and our Aging Population: Translating Science to Public Health Practice.” • Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (Ball et al., 2002; Willis et al., 2006), or the recent Nature Reviews article on cognitive interventions for Alzheimer’s disease (Buschert et al., 2010)

8. The Gerontologist: Promoting Cognitive Health in Diverse Populations of Older Adults. The Gerontologist Volume 49 Issue S1 June 2009

9. Cognitive Ability = Quality of Life • Staying Sharp • Staying Vital • Maintaining Independence Source: Posit Science Qualitative Study 9/04

10. Posit Science Normal Pathological Cognitive Function Age Brainspan Should Match Lifespan Brain Function Remains Robust “Normal” Age-Related Cognitive Decrease Pathological Cognitive Decrease

11. The Brain Changes Functionally With Age – Encoding and Processing Speed At age 75, it takes us more than twice as long to process information than when we were age 20

12. And this is why we all need to work on keeping our brain sharp…

13. Illustration: Immediate Memory Just for fun, I am going to give you an immediate memory test. No one else will know your results. Take out your pad and pen and wait until I finish reading the entire list. I will read you 16 words in total. Once I finish saying the 16 words, write down all the words you remember.

14. How do we remember?A science perspective Hearing: Transform sound waves into neural signals

15. How do we remember?A science perspective Hearing: Transform sound waves into neural signals Encoding: Transform neural code from ear into neural code for brain

16. How do we remember?A science perspective Hearing: Transform sound waves into neural signals Encoding: Transform neural code from ear into neural code for brain Storage: Store neural circuit in memory-related brain structures

17. How do we remember?A science perspective Hearing: Transform sound waves into neural signals Encoding: Transform neural code from ear into neural code for brain Storage: Store neural circuit in memory-related brain structures Recall: Pull information out of storage for use

18. How do we remember?A science perspective Hearing: Transform sound waves into neural signals Encoding: Transform neural code from ear into neural code for brain Storage: Store neural circuit in memory-related brain structures Recall: Pull information out of storage for use High frequency hearing loss due to functional decline of inner ear “Fuzzy” encoding due to slow and inaccurate processing Poor storage due to lowered levels of key neurochemicals Decreased ability to recall information due to poor encoding and storage

19. Bad Good Great What Do People Do About Cognitive Decline? • Do nothing • Compensate • Crosswords, etc • Targeted Exercise

20. We have control over important causes of brain function decline Aging Machinery Noisy Processing Chemical Changes Negative Behavior Loss of hearing in the ear Shrinkage of brain “Fuzzy” input reduces accuracy and slows brain processing functions Lower levels of memory-enabling chemicals released “Do Nothing” and compensatory Habits lead to under use “Negative Plasticity” Within our control

21. Characteristics of Activities that Prevent and Reverse Brain Function Change Noisy Processing Chemical Changes Negative Behavior • Appropriately challenging • Repetitive and intensive • Frequently Rewarding • Attentionally demanding • Surprising • New • Demanding • Confronting Increase cognitive reserve? SCAT?

22. Learn something new - Sudoku

23. Dendrites • Treelike extensions of a neuron. • Most neurons have multiple dendrites: short & typically highly branched. • Dendrites are specialized for receiving information • They form synaptic contacts with the terminals of other nerve cells to allow nerve impulses (information) to be transmitted.

24. Grow Your Dendrites

25. Regular Exercise Sleep Stress Relief Socialization Diet Many Lifestyle Changes May Help With Brain Fitness …The Real Power is in targeting the root causes of brain function change

26. Designing a Program to “Really Use It” • Brain Plasticity-Based Workouts • Learn to play the violin • Learn Japanese • Learn to juggle • Learn to tango • Learn to use your “other” hand • Become an air traffic controller Use Programs Designed to Target the Root Causes of Brain Function Decline

27. IMPACTShows that the Right Kind of Cognitive Exercise Can Rejuvenate the Brain The researchers found that people using the Posit Science program: Best> Noticed benefits in their everyday lives CSRQ-64 Post-Only Measure (+/0/- scale) (higher is better) • Findings: • 3 out of 4 people self-reported positive changes in their everyday lives • Benefits ranged from remembering shopping lists, being more independent, feeling more self-confident and hearing conversations more clearly p = 0.003 ET AC

28. Illustration: Delayed Memory Take out your pen again On the back of your piece of paper, write down the words you now remember

29. How is this research helping? • The Benefits of DriveSharp Brain Fitness Training • Decades of research show the technology in DriveSharp: • Speeds up visual processing and increases "useful field of view" so drivers see more of the road with each glance • Decreases reaction time, so drivers can stop 22 feet sooner at 55 mph • Cuts at-fault crash risk by 50%

30. How brave are you? • http://www.positscience.com/testlets/jeweldiver/index.php?session=cbomppsn4i8ijpp1o50o9bfcp0

31. Just to get you started online: • http://www.sharpbrains.com • www.alz.org • http://www.marblesthebrainstore.com/visual.html • http://www.cognifit.com/ • http://www.lumosity.com/ • http://www.fitbrains.com/ • http://www.positscience.com

32. Resources

33. All About Aging, LLC Providing Solutions for Families

34. Barbara Herrington, M.A., C.M.C. • Professional Geriatric Care Management • Dementia Care Consulting * Brain Fitness • P. O. Box 2745, Winter Haven, FL 33883-2745 • Serving Polk & Highlands Counties • Phone 863-557-7604 • Barbara@allaboutagingllc.com • www.allaboutagingllc.com