A growing body of research is providing evidence that exercising the brain can deliver benefits that are both cognitive and physiological. For seniors, these benefits can be combined with a multi-factorial approach to successful aging to deliver superior treatment outcomes. Here, we’ll look at a few studies, and consider how the results can be leveraged to help your aging patients achieve a greater quality of life.
Exercising the Brain?
Chances are, you had a teacher at some point in your academic career who loved to remind the class that brains were muscles. Without exercise, the trope goes, brains are doomed to become weak and unable to accomplish the most basic tasks. Hence, the teacher would insist, you must do your algebra homework.
Obviously, any description of the brain as a muscle is metaphorical in nature. But we’re now able to demonstrate that the dynamics surrounding both brain matter and muscle tissue are similar. Contrary to formerly held belief, brains do change over time and develop new neural pathways. Certain types of brain “exercise” can create conditions more favorable for such neurogenesis.
For older patients, remember that the mind and the body don’t typically slow down at the same rate. Getting the body active and in better health can improve the mind. Similarly, giving the mind a regular workout can help the body perform at a higher level. As you design interventions and care plans, don’t forget to look at bodies and brains – and remember that each has an impact on the other.
Watch the Buzzwords
Anytime new discoveries are made in medical science, entrepreneurs converge to take advantage of the minimal understanding of the new information that makes it into the public consciousness. Once vitamins were understood to be necessary for proper human function, vitamin supplements exploded onto the market, ostensibly providing all the benefits of a vitamin-rich diet. Studies of general vitamin supplement effectiveness, of course, remain unconvinced. Sellers of supplements depend upon consumers making the jump from the idea that vitamins are important to the idea that vitamin supplements will replace vitamins missing from the consumers’ diets.
Similarly, as the idea that brains can continue to change throughout the lifespan has taken hold in the popular consciousness, products have entered the marketplace promising to cultivate better and better “brain health.”
When evaluating such products, be aware of buzzwords incorporated in the marketing materials. “Neuroplasticity” is one such word. It simply refers to the capacity of brains to change over time (as opposed to existing in a static state), including employing new areas of the brain to take up tasks formerly handled by other areas. The concept is especially exciting for those seeking to understand and treat diseases of the brain. Whether or not a product is effective, or if its effectiveness depends upon neuroplasticity, you’ll be sure to see buzzwords used to market the product.
When considering what sorts of brain exercises to suggest, remember that something is better than nothing. The accumulation of a beta-amyloid plaque associated with Alzheimer’s disease was recently shown to be held at bay in study participants whose early and middle ages had been filled with reading, writing, game playing and puzzle solving.
Another earlier study done by the Albert Einstein School of Medicine looked only at memory loss associated with aging, and found that engaging in “cognitively stimulating leisure activities” had a demonstrable effect on the cognitive reserve, which “may delay the onset of the memory decline in the preclinical stages of dementia.”
The second study, interestingly, included a control measure of early life educational level achievement. That variable didn’t have an appreciable impact on the results. So, whether your aging patients are PhDs or high-school dropouts, getting them involved in cognitively stimulating activities can make a real difference.
A 2010 study looked at the way computerized “cognitive mediation” exercises impacted the gait speed that the sedentary participants were able to generate while walking. There were small but insignificant improvements in walking gait speed noted after an 8-week program of cognitive mediation compared with other study participants who’d been “wait-listed” for the computer training. When the researchers looked at the difference in gait speed during “walking while talking conditions,” they found that every participant who’d been a part of the intervention experienced statistically significant gains. The cognitive mediation seemed to benefit the body’s ability to multi-task its focus on walking and talking simultaneously.
There are several online “brain training” options available, including some that are accessed via smartphone or tablet apps. These may be easier for some patients to use, depending on the other conditions they’re facing. Keep in mind that while the “brain training” may or may not deliver the results promised by the site, your patients will nonetheless be working the brain “muscles” that promote memory, attention and cognition. Again – something is better than nothing.
Diet and Exercise
Giving the brain (or the body) a great workout is sure to have benefits. But focusing too much on exercise can neglect another major factor in brain health. Food. Brains (developing and aging brains in particular) can benefit from tailoring a diet to provide the nutrients that will be of most benefit.
A 2009 study appearing in The Journal of Neuroscience looked at research related to aging and nutrition. The study outlines a few specifics, including the positive impacts on motor and cognitive function of aging rats and older dogs brought on by the addition of berry fruit polyphenols and supplemental antioxidants, respectively. The authors concluded that “lifestyle changes involving caloric selection through alterations in berry fruit, nut, fish oil, and curcumin intake, and caloric restriction mimetics may provide beneficial effects in aging and prevent or delay the onset of neurodegenerative disease such as AD (Alzheimer’s Disease).”
Caloric selection was also considered in a July 2013 study published in Epidemiology. Here, the “Mediterranean diet” high in fish, vegetable and olive oil ingredients was examined. The literature review revealed that a “higher adherence to Mediterranean diet was associated with better cognitive function, lower rates of cognitive decline, and reduced risk of Alzheimer disease in nine out of 12 studies.”
Depending on the patient (and the circumstances surrounding the patient’s meal preparation), dietary and nutritional changes can be challenging to implement. Some care facilities elect to honor the unhealthy dietary desires of residents with the rationale that seniors should enjoy their remaining meals. When rich, high-calorie diets are fed to less and less active seniors, the results are often predictably unpleasant. Encourage your patients to take an active roll in their meal planning – and incorporate as many of the better options as possible.
Don’t Ignore the Body
Though some aging patients will be unable to participate in rigorous physical activity, you should encourage them to do as much as they are able. Not only will they realize gains in balance, mobility and agility, they may be doing their brain a favor as well.
Research offers mixed results on drawing a clear connection between increased physical exertion and decreased cognitive decline, but some studies do seem to indicate benefits are worth giving exercise a shot. Whether or not brain health is directly affected, patients can still experience the psychological benefits that come from feeling more physically independent. And that’s often enough to help improve a patient’s quality of life.
As a practitioner, it’s important to remember that the health of an aging patient’s brain is just one factor that impacts the patient’s ability “to achieve a sense of well-being, high self-assessed quality of life, and a sense of personal fulfillment even in the context of illness and disability.” This outlook, “a state wherein an individual is able to invoke adaptive psychological and social mechanisms to compensate for physiological limitations,” is described by Young, Fan, Parrish and Frick in a 2009 JAMDA Article. The results take into account that aging patients tend to value quality of life when evaluating how successful they are aging – even more than they value simply achieving advanced age.
Philips Lifeline’s eBook, The Changing Keys to Successful Aging (PDF), looks at the results of the study and offers an assessment tool to use with your patients. Understanding the interplay between the physiological, psychological and sociological domains will help you craft better care plans to get the best results for patients no matter their underlying health.
Here’s how it works:
Perhaps you are considering suggesting computer-based “brain training” to a patient who is confined to her bed. If she has a low score on the “engaging with life” section of the assessment, it may be better to involve her in similar mind-stimulating activities that also involve social interaction with her peers. Use the tool to identify areas you can target for improvement, and you’ll do a better job of hitting more birds with fewer stones.
A Quality Focus
Ultimately, quality of life is improved by having a healthy brain. Give your aging patients the opportunity to maximize their health by sharing the latest data on brain nutrition. Coach them to adopt a diet high in berries and antioxidants and to set aside foods high in cholesterol. After mealtime, suggest your patients give reading, writing, playing games and solving puzzles a try. Whether completed alone, on a computer, or with friends or family members, these types of mental challenges will help forestall cognitive decline. After game time, suggest some structured physical activity. The increased sense of independence that flows from confidence in one’s physical abilities will be an added benefit. Finally, spend adequate time on each of the three domains of successful aging. Working together, you’ll help your patients age well.