Investing in Brain Health Pays Off Research Suggests There Is Much We Can Do to Decrease the Risk of Dementia By Roscoe Nicholson, MA, Senior Research Associate Mather LifeWays Institute on Aging
Investing in Brain Health Pays Off INTRODUCTION There is growing research that supports the use of brain fitness programs for people of all ages. Recent studies have confirmed the effectiveness of programs promoting lifestyle changes for brain health, and suggest that adopting certain lifestyle behaviors can help older adults maintain cognitive function and reduce the risk of Alzheimer s Disease or other cognitive decline. Prominent researchers in the area of brain health believe that the way people live their lives may account for as much or more of the risk for dementia than their genetic makeup. In fact, for the typical late-onset form of Alzheimer s Disease, genes seem to only account for about 30 percent of the risk (in contrast to the less common early-onset Alzheimer s, which occurs before age 65 and has a much stronger genetic component). 1 That other 70 percent is made up of a number of non-genetic influences, including a number of things we can control, such as the extent to which we participate in brain-healthy behaviors like physical and intellectual activity. Risk Factors for Late-Onset Alzheimer's Genetics 30% Non-Genetic Influences 70% Brain fitness programs can include a focus on encouraging a variety of lifestyle behaviors associated with brain health, cognitive training, or both. There is growing evidence to support the use of a number of these approaches. BRAIN HEALTH IS MALLEABLE Researchers are beginning to understand the mechanisms by which lifestyle and cognitive training seem to help our brains. One encouraging sign is research that has shown that we can grow new brain cells even late in life. In one early study that identified this phenomenon in humans, researchers studied the brains of cancer survivors who had undergone radiation treatment. 2 Radiation treatment changes some of the genetic information in the subject s cells, and by applying a special dye that is only attracted to cells with this new genetic data, the researchers could see which cells had formed after the cancer. They applied this dye to brain tissue on autopsy and were surprised to find cells in the brain that accepted the dye. This 2
Investing in Brain Health Pays Off meant that these cells had developed after the radiation treatment. Some of the people in this study were in their 80s when they received the cancer treatment, suggesting that new brain cells are growing well into later life. Since then, numerous other studies have confirmed this phenomenon. THE BENEFITS OF LEARNING NEW THINGS In addition to discovering the growth of individual new brain cells, scientists have demonstrated that entire brain regions can grow in adulthood. In a famous study of London cab drivers, researchers enlisted an elite group of taxi drivers who had to complete a three- to four-year apprenticeship to learn the intricate routes within the six-square mile area of central London. 3 At the end of the apprenticeship, the drivers had to take extremely difficult tests, and only about a quarter were able to pass. By using brain scans, researchers observed that the region of the hippocampus responsible for spatial relations had grown in those who completed the program. Cabbies who were not successful in the program failed to show any brain growth. This influential study provided us with strong evidence that certain types of experiences could actually grow parts of the brain in adulthood. COGNITIVE TRAINING Research also suggests that even a short-term course of cognitive training can have lasting effects. To date, the most comprehensive and welldesigned study of cognitive training is the Advanced Cognitive Training for Independent and Vital Elderly, or ACTIVE, Study. 4 Funded by the National Institutes of Health, the study s 2,832 participants had an average age of 73.6 when the study began. These participants were randomly assigned to one of three different cognitive training groups or a control group. For five or six weeks, the cognitive training groups practiced skills in either the areas of improving memory, strategic reasoning, or speed of processing. The study showed the following lasting effects: Five years after the training, researchers compared the participants within each group, and found that those individuals who received any type of training had improved cognitive function in the areas in which they received training. Interestingly, they also showed less difficulty with instrumental activities of daily living, such as cooking, driving, and managing finances. A full 10 years after the training, two of the three training groups (reasoning and speed of processing) continued to show improved performance in their specific areas. Most significantly, these two groups also showed greater maintenance of cognitive function 10 years later. Again, the benefits of cognitive training proved to be specific to the cognitive ability trained. However, all three training groups also continued to report less difficulty performing instrumental activities of daily living compared to the control group. 3
Percent Showing Greater Cognitive Function Investing in Brain Health Pays Off ACTIVE Study: 10 Years After Training 80% 70% 60% 50% 40% 30% 20% 10% 0% Reasoning Group Processing Group Control Group LIFESTYLE AND BRAIN HEALTH Brain fitness is not just about what we think of as intellectual activity. In addition to cognitive stimulation, there are a number of lifestyle factors that affect brain health. For example, there is strong evidence to suggest that physical activity yields long-term benefits for the brain. Several observational studies have demonstrated that individuals who participate in regular physical activity reduce their risk of Alzheimer s Disease relative to individuals who are sedentary. In one such study, researchers found that subjects between the ages of 40 and 55 who participated in leisure-time physical activity (which could include simply walking) at least twice a week lowered their odds of developing Alzheimer s Disease by 60 percent. 5 Another study found that regular exercise was associated with a reduced risk for all types of dementia six years later. Similarly, a Finnish study found that an individual s amount of leisuretime physical activity in midlife was related to lower dementia risk 20 years later. In a recent update to this study, researchers found that, at a 28- year checkup (when participants average age was 79), a decrease in physical activity was associated with a greater risk of dementia. 6 Participants who maintained high levels of physical activity or who increased their physical activity levels had lower dementia risk than those who continued to have low physical activity at both time points. This data suggests that the window of opportunity for physical activity to positively impact cognitive health may extend from midlife to older ages. Other studies also support the idea that it is never too late to see brain benefits from exercise. 4
Change in Hippocampus Volume Investing in Brain Health Pays Off In addition to the observational studies mentioned above, several important intervention studies have produced additional evidence for the positive impact of physical activity on brain health. One such study of older adults demonstrated that aerobic activity can actually increase the size of the hippocampus, a crucial brain structure for memory. 7 In this study, researchers enlisted 120 healthy older adult participants in a fitness plan for one full year. Half were assigned to a group that walked three times per week and the other half were assigned to a stretching and toning class that also met three days a week. In the walking group, MRI brain scans showed an increase in volume in the hippocampus of two percent. This suggests that the walking program effectively reversed age-related loss in hippocampus volume by one to two years. The stretching and toning group showed a 1.4 percent loss of volume in the hippocampus a result on par with normal aging. 3% 2% 2% 2% 1% 1% 0% -1% -1% -2% -2% Walking Group Stretching Group -1.4% A similar study of older adults with mild cognitive impairment (MCI) showed the same general outcome: those who participated in a 12-week aerobic exercise program had significantly larger hippocampus volumes than the control group. 8 In additional to physical activity, evidence also supports the promotion of additional lifestyle factors in relation to brain health. These include: nutrition, social engagement, stress management, and intellectual habits (e.g., playing a piano or reading a book). Thus, a multifaceted approach wherein individuals address numerous different dimensions of wellness appears likely to yield the greatest benefit to their brains. 5
Investing in Brain Health Pays Off A PROVEN PROGRAM Mather LifeWays Institute on Aging has designed a multifaceted brain fitness program called Boost Your Brain & Memory. This evidence-based program provides a wealth of information and practical strategies for older adult participants. It is designed to be led by an instructor who is provided an easy-to-use DVD, reducing the need for a lot of teaching preparation. Additional activities also allow the instructor to engage participants in brain healthy behaviors and goal-setting. Participants receive a workbook with key concepts and targeted follow-up exercises. Mather LifeWays Institute on Aging conducted multiple studies of the Boost Your Brain & Memory program, and found that older adults who participated in the program reported greater positive behavior change than a control group in the following areas: Adoption of new brain-healthy behaviors Intellectual activity Participation in at least one activity that lowers the risk of Alzheimer s Disease Increased intensity, frequency, and time spent on physical activity The majority of these participants said they were optimistic about maintaining their memory, and believed they experienced an improvement in their memory. Altogether, 85 percent of participants said they had made changes to their lifestyle based on the program, and 84 percent said they planned to make even more changes in the coming months in order to reduce their risk of dementia. To learn more about Boost Your Brain & Memory or to purchase this program for your organization, visit www.matherlifewaysinstituteonaging/boostyourbrain. 6
END NOTES 1. Small G. The Alzheimer s Prevention Program. New York, NY: Workman Publishing Company, 2012. 2. Eriksson PS, Perfilieva E, Björk-Eriksson T, et al. Neurogenesis in the adult human hippocampus. Nature Medicine (1998); 4: 1313 1317. 3. Woollett K and Maguire EA. Acquiring the Knowledge of London s layout drives structural brain changes. Current Biology (2011); 21: 2109 2114. 4. Rebok GW, Ball K, Guey LT, et al. Ten-year effects of the Advanced Cognitive Training for Independent and Vital Elderly cognitive training trial on cognition and everyday functioning in older adults. Journal of the American Geriatrics Society (2014); Vol. 62(1): 16 24. 5. Kivipelto M and Solomon A. Alzheimer s Disease the ways of prevention. Journal of Nutrition & Healthy Aging (2008); 12(1): 89S 94S. 6. Tolppanen A-M, Solomon A, Kulmala J, et al. Leisure-time physical activity from mid- to late life, body mass index, and risk of dementia. Alzheimer s & Dementia. (2014). DOI: 10.1016/j.jalz.2014.01.008 7. Erickson KI, Voss MW, Prakash RS, et al. Exercise training increases size of hippocampus and improves memory. PNAS (2014); 108(7): 3017 3022. 8. Brinke LF, Bolandzadeh N, Nagamatsu LS, et al. Aerobic exercise increases hippocampal volume in older women with probable mild cognitive impairment: a 6-month randomised controlled trial. British Journal of Sports Medicine. (2014). DOI: 10.1136/bjsports-2013-093184 7