I have a wonderful opportunity to care for and to shape my brain for health.
Your brain is a highly dynamic and constantly reorganizing system capable of being shaped across your entire life span. Similar to animals, the human brain can generate new brain cells and respond to environmental input. Your goal is to expose your brain to enriched environments, to the novel and complex, and to grow your brain reserve!
As we discussed in the previous chapter, stimuli that are considered rote and passive to your brain are most likely not as health promoting. We learned from animal brain research that an enriched environment has three critical components: socialization, physical activity, and mental stimulation. It makes perfect sense to consider these same critical factors as important to the human brain, especially in light of research on humans suggesting their role in staving off the ravages of Alzheimer’s.
In addition to these three factors, I have included two new ones that are critical to promotion of brain health. The first is spirituality, which reflects the importance of reducing stress in our lives, slowing down, and appreciating the moment. The second is nutrition, which respects the fact that what we eat literally changes the physical and functional aspects of our body and relates directly to our overall health, including brain health. Each of these five factors of my brain health lifestyle is backed up by robust research to support its effectiveness. Most important, the lifestyle needs to be integrated, comprehensive, and proactive to be most effective for health and brain health. To recap, I have proposed a lifestyle that includes the following five areas critical to brain health:
• Socialization
• Physical activity
• Mental stimulation
• Spirituality
• Nutrition
Each of these factors is necessary to your brain health lifestyle, and together they form an integrated whole for you. The five factors need to be understood as one lifestyle and not separate entities. Remember, your goal is to adopt a proactive lifestyle for brain health that increases your brain reserve through exposure to the complex and novel. As with any lifestyle program, the journey can be challenging, but your brain health lifestyle is a lifelong journey toward wholeness and will require constant personal review and change. While adopting to any lifestyle change is not easy, the goal of a healthier and more challenged brain is worthwhile.
My healthy brain program is research-based, easily understood, and practical, as anyone can consider making changes to incorporate these activities into their own daily life. The other positive aspect of my lifestyle is that anyone can assess each of the five different lifestyle domains and understand which is a strength and which is a weakness, thereby providing a guide as to where the biggest change in behavior may need to occur. My program rests on the cognitive construct of brain reserve and the belief that neural plasticity affords the brain a wonderful opportunity to achieve health.
While my brain health lifestyle is developed from a sound understanding of brain and behavior, cognitive science, and clinical research, I realize that a practical way to apply the lifestyle is in many ways most critical—you’ll find all of the practical strategies to implement this lifestyle in the chapters ahead.
The brain health program that I offer you is unique in that it is lifestyle-based, comprehensive, and integrates many different research findings into one practical approach that is easy to adopt. My brain health lifestyle was applied recently as part of a small pilot investigation with healthy independent older adults. This work was done together with Emeritus Assisted Living (www.Emeritus.com) at a campus in the Boston region. I believe we were the first to launch a prospective lifestyle study on brain health (Dr. Nussbaum’s Brain Health Lifestyle) and the first to propose a lifestyle that was comprehensive (including all of the five critical areas of brain health and not just one).
In 2008, we designed our first prospective pilot study to measure the effects of the brain health lifestyle on older independent-living residents of Farm Pond at Emeritus Assisted Living. Farm Pond was a wonderful setting to create a brain health campus and to conduct the study. It is a self-contained campus with three components to the continuum of care, including independent living, assisted living, and memory-impaired living. Our study focused on the independent-living residents. The other important positive quality about Farm Pond is that it had good leadership to make sure the study protocol was followed properly.
Our goal for conducting this study was to find answers to the following questions:
• Does the brain health lifestyle help to enhance memory in the form of verbal recall?
• Does the brain health lifestyle improve quality of life as reported by the actual residents?
• Does the brain health lifestyle improve quality of life as reported by an independent third party who worked at Farm Pond?
• Did the residents know more about their brain and brain health by the end of the study?
Sixteen volunteers were randomly selected from the independent-living residents to participate in the brain health lifestyle for six weeks. This group represented our experimental sample, and they would follow a relatively strict protocol for the entire six weeks of the study. An additional and separate ten residents from independent living made up the control sample. These persons were not part of the brain health lifestyle protocol, and they simply continued to live their lives as usual at Farm Pond during the six weeks of the study. The residents in the experiment group and the control sample were not significantly different on variables of age, education, marital status, or gender.
Each resident in both the control sample and experiment group underwent a baseline assessment that included measures of mental status, verbal recall with measures of immediate and delayed recall and recognition memory, mood, and basic knowledge of brain health. Each resident then underwent a post-study assessment using the same measures. The same person conducted the two assessments to provide some control on the actual assessment process, and different forms of the memory tool were used to minimize practice effects. I developed a self-report and third-party report that gauged quality of life and was completed by residents in the experimental sample only at the post-study period.
As expected from prospective studies, four residents from the experimental group and one resident from the control sample dropped out of the study prior to its conclusion. An analysis of the data indicated that the four who dropped out had lower mental status scores relative to those who remained in the study, suggesting that cognition may have been a variable predicting ability to sustain the six-week-long lifestyle. All residents were determined to be free of dementia, depression or other neuropsychiatric illness, substance abuse, uncontrolled hypertension or diabetes, and any uncorrected sensory deficit. The samples truly represented healthy, independent-living older adults.
Residents enrolled in the brain health lifestyle participated in one research-based activity within each of four domains of the lifestyle (physical activity, mental stimulation, spirituality, socialization), and they also consumed a special brain health diet. This occurred each day of the week for the entire six weeks. Examples of some of the activities within the physical activity domain included dance, walking, and aerobic exercise. Mental stimulation included sign language, Portuguese, discussion of the classics, and courses on the basics of the brain. Spirituality included prayer, meditation, and relaxation procedures. Socialization included field trips, recreational events, and games.
People who enrolled in the brain health lifestyle program from the experimental group demonstrated no significant differences on measures of mental status, mood, or level of knowledge on the human brain at baseline relative to the control sample. However, changes in scores measured at post-study testing compared to baseline revealed trends to significance on measures of mental status and memory. Most striking, when the data from the experimental group was analyzed as a within-group measure, significant improvements were found on delayed recall and knowledge of the brain. That is, residents who participated in the six-week brain health lifestyle were able to recall presented information after a twenty-minute delay period better than they could prior to the start of the study. This is an important finding and may be the first to show a positive effect of a comprehensive lifestyle approach on enhanced memory.
Residents who participated in the brain health lifestyle demonstrated the expected significant improvement in self-reported knowledge of the human brain and how to keep their brain healthy. Quality of life was measured using a special tool developed by my questions dealing with a variety of aspects of one’s life. Results indicate that the residents enrolled in the brain health lifestyle program reported positive sentiments about their life and mental and emotional functions after the study. They also expressed their belief that the brain health lifestyle was beneficial to them. They further expressed the belief that the brain health lifestyle is something that could be beneficial to everyone. Of equal interest were the results from the third-party ratings of quality of life. A designated person was asked to rate the resident’s function, demeanor, social, and cognitive abilities at the conclusion of the lifestyle program. Similar to the self-report measures, the third-party ratings reflected improved overall function and quality of life for those who participated in the lifestyle program.
There was no change between samples or within the experimental sample on general mental status or mood. As no resident was found to be depressed upon entering the study, the finding of no improvement in depression is not unexpected. Regarding general mental status, the measure simply reflects basic information processing, and all residents who participated in this study performed near the ceiling at baseline and did not have room to improve by post-study.
Upon completion of the study, I met with the residents who participated in the six-week lifestyle. Results were discussed, and the residents provided important feedback about their experience. What we learned from the residents may have been more important than the positive data on memory and quality of life. Residents stated the lifestyle programming was “life changing” and reported, “It saved me, as I was not living since the death of my spouse,” and “It brought me to life again and helped me get out of my room.” These testimonials provide strong support for the power of the brain health lifestyle, and Farm Pond is now working to extend the program to all residents in independent living. Indeed, the original residents of the study agreed to be the ambassadors and lead the program on their campus.
This pilot is a small study of a few residents, and results need to be interpreted with caution. However, the finding of improved delayed recall and positive ratings on quality of life at the conclusion of the study are significant and deserving of attention. There is real reason to believe that a sustained and proactive brain health lifestyle that is comprehensive and integrated has potential to enhance cognitive functioning and quality of life in healthy older adults. There is also reason to believe that such a lifestyle should have similar effects in younger and middle-aged adults. With some modest alteration, the brain health lifestyle can also be followed by those who may require some assistance during the day, and even with those who have mild dementia. These are empirical questions that can be answered with more study and research. The pilot study is the first, albeit modest, empirical measure of the benefits one can obtain from following a brain health lifestyle, an early glimpse into the program’s potential.
This study is a step that takes us beyond practical application of the brain health lifestyle to being able to cite empirical measures for its value. The next step is to replicate these early positive results with a larger and perhaps more diverse population. Ultimately, the brain health lifestyle should be a part of any prevention or wellness program, as the brain is the most important part of our being! Let’s take a look at the five critical areas of brain health.
The following provides a blueprint for the development of a brain health environment filled with the novel and complex. The brain health lifestyle incorporates five distinct but integrated components: socialization, physical activity, mental stimulation, spirituality, and nutrition. Each of these components, or “slices to the brain health pie,” encompasses research-based activities that have been documented to reduce the risk of dementia or to foster brain health. Together, these activities define the brain health lifestyle, which can be effectively applied in a culture committed to change.
The first critical area to think about in order to promote a healthy brain lifestyle is the area of socialization. Research in both animals and humans indicates socialization is important to health and for reducing the risk of dementia. It is important, therefore, to remain integrated in the community, to build a growing network of family and friends, and to always have a role and purpose for getting up each day. Retirement, as a national policy, does not make sense for a nation that prioritizes brain health for its citizens. Retirement promotes isolation and passivity, which reduces the likelihood of building brain reserve and drives a brain toward disease. Socialization is so vital to brain health that it will be the first of the five areas of brain health we will explore at length in the following chapters. However, I do not want to convey that one domain is more important than the other.
Physical activity relates to brain health because 25 percent of the blood, oxygen, and glucose from each heartbeat goes directly to the human brain. While the human brain weighs only two to four pounds on average, it demands more from each heartbeat than any other part of the body! It truly is the “central” nervous system. Knowing this simple fact, you can better appreciate why physical activity promotes brain health. The human brain consumes such a high level of glucose, oxygen, and blood because it cannot function without this energy source. Cells thrive from such blood flow and metabolize glucose for brain function, permitting rapid and efficient information processing. Even a brief period of slowed or no blood flow to a particular region of the brain can result in structural damage in the form of stroke, and this leads to loss of such functions as movement, language, and even personality change. You will learn much more about the crucial link between physical activity and brain health in Chapter 6.
We have learned that novel and complex environments help to activate the cortex and conscious information processing that promotes development of brain reserve. Our ability to engage our brain daily in the novel and complex fosters mental stimulation and promotes brain health. This includes new learning, which actually involves a neurophysiological event or series of events that change our neural systems, our neural chemistry, and our brain function. This process can also assist with new brain cell development, or neurogenesis.
Animal studies have demonstrated neurogenesis in rodents exposed to enriched environments that include novel and complex stimuli. Human neurogenesis was demonstrated in a publication in 1998, with the neuroanatomical structure critical to learning, the hippocampus, representing the site of neuro-genesis in both animals and humans. This supports the idea that the hippocampus and the role of learning are fundamental to our neural health and that our brains are agile and can adapt favorably in response to healthy stimuli. Environments that provide novel and complex stimuli are those most likely to be deemed “enriched,” with the greatest likelihood of promoting brain reserve. Brain reserve refers to the development of increased cellular connections (synapses) that help to defend against or delay the onset of neurodegenerative diseases such as Alzheimer’s.
A critical issue for everyone to remember is that the most sophisticated system for thinking, creating, problem solving, and basic academics is the human brain. It is critical for our society to turn inward for solving problems rather than relying only on gadgets or devices to do the work! Chapter 7 provides many specific ideas and suggestions for how you can enrich your own environment with the novel and complex.
We all lead very busy lifestyles, and surely, like many others, you feel the high stress of a fast-paced environment. It’s no wonder we’re doing so much damage to our own health because of it. This area, which I refer to as spirituality, addresses the need for all of us to slow down, to introspect, and to reduce stress in our lives. By engaging in a slower and more reflective life, we can impact our health and brains in a positive way.
Research indicates that animals exposed to environments that are too stimulating experience slowed brain development. Our own pace in life tends to be rapid and probably unhealthy. While most of us realize that we are going too fast and that we are involved in too many activities simultaneously, we have a hard time knowing how to slow down.
The brain demands stimulation, but it also can function best when it has rhythm and symmetry. Our hectic pace raises the probability of mental chaos, stress, and reduced cognitive efficiency. It also can lead to emotional breakdown. A brain health environment supports time for oneself, time to slow down, and time to keep the brain energized. I refer to this generally as spirituality. Of interest is the fact that an entire new field of study called neurotheology has emerged to study the relationship between spirituality, religion, and the brain. You will read more about neurotheology in Chapter 8 and also learn techniques for relaxation and stress abatement.
Food has the ability to alter thought processes, mood, and behavior. There is an entire new field of study called nutritional neurosciences that recognizes the impact of food on the function of the human brain. We also know that the human brain is 60 percent fat; indeed the brain is the fattest part of the body. It is believed that the lipid, or fatty, substance of the brain helps to insulate neural tracts, propelling information in a rapid and efficient manner. A brain that loses fat evinces slowed information processing, a maladaptive reality.
In recognition of this fact and our better understanding of the role of “free radicals” that originate as cellular breakdown with oxygen serving as a major catalyst, we can propose specific foods that supplement omega-3 fatty acids (good fat for the brain) and antioxidants that combat free radicals. In Chapter 9, a registered dietician discusses specific foods you can eat to get these healthy fats and other brain health foods.
Your brain reacts favorably to enriched environments that promote the novel and complex, and that life provides us teachings about our brain every day. This includes growth of new brain cells and an increase in your brain reserve. Now that you’ve taken the time to review your current lifestyle and have taken the brain health inventory in the Introduction, you should be empowered by your newfound knowledge about yourself and your brain. Armed with an honest assessment of your current brain health lifestyle, you are ready to learn specific activities to promote brain health through the five critical areas of a healthy brain lifestyle.
As you read the following chapters, it is important that you think about why such activities promote brain health and whether you have these activities in your current lifestyle. Most important, think about what you will need to change in your current lifestyle to include these activities in your daily life. Now let’s move ahead and take a more detailed look at each of the five areas that are critical to maximizing your brain health.