Computers, treadmills and videogames: The new arsenal for late life brain training

1. Michael Marsiske Department of Clinical & Health Psychology April 18, 2014 Computers, treadmills and videogames: The new arsenal for late life brain training

2. With thanks • College • Local collaborators • Dawn Bowers • Ron Cohen & program on Cognitive Aging and Memory • Institute on Aging • External collaborators • ACTIVE coinvestigators and the National Institute on Aging • McKnight Brain Research Foundation, Santa Fe Health Care, and The Village of Gainesville

3. Cognitive aging embodies PHHP • Health professions • Assessment and psychodiagnosis • Treatment • Multidisciplinary (e.g., psychology and occupational therapy and speech/language) • Public health • Prevalence • Prevention • Population initiatives

4. Jill Pease asked a question • “I’m going to be running the story on the ACTIVE findings as the cover story for the next issue of PHHP News, our alumni and donor newsletter. I wanted to do a sidebar that addresses the “what can I do?” question that we seem to get a lot from consumers”

5. My answer 1. Continue your education.  "Cognitive reserve" refers to the rich network of connections and knowledge that we build across a lifespan. People with more education and more complex jobs generally enter late life at a much higher level of mental functioning. Education can continue: take continuing education courses, read books in areas about which you know little, challenge yourself to learn new things.

6. My answer 2.  Keep your brain healthy.  "Brain reserve" refers to how much white and grey matter we're able to retain into the later years.  Good health habits that may help to prevent heart attack/stroke, arthritis, cancer, and diabetes also help to maintain the brain:  Aerobic exercise, strength training, good nutrition, control of blood pressure and cholesterol.  It is never too late to begin healthier habits, and exercise training has boosted cognition even in the very old.

7. My answer 3.  Spot-train your brain.  There is growing evidence that cognitive training, like that used in ACTIVE, can help to improve performance in areas that tend to decline in late life.  Even brief 10 week training programs can produce five-to-ten years of benefit in areas like memory, problem solving, speed, and attention. Excellent, clinically validated training programs are now available at low cost for computers, tablets and smartphones.

8. My answer 4. Combat negative mood. In general, older adults experience less major depression than younger adults, but depressive symptoms rise. Health challenges, activity restriction due to physical disability, retirement, financial concerns and losing loved ones are among factors that can increase anxiety and depression.  Unfortunately, memory and other areas of mental functioning can be seriously compromised by mood disturbances.  Seeking help with adjustment problems can be a potent way to guard against cognitive loss.

9. My answer 5. Engage. Participation in complex leisure activities that are new and interesting seems to confer benefits in terms of memory, problem solving, and mood. The benefits seem greatest when these activities are done socially. Tasks as diverse as learning to act, quilt, play piano, use an ipad, or master digital photography have all shown mental or brain activation benefits. Engaging in social leisure seems to have dual benefits: It minimizes negative mood (which can sap mental energy), and it provides a kind of "mental exercise" with complex tasks. The trick, however, seems to be to try something new -- something you've never done before.

10. The arsenal

11. Let’s briefly begin with understanding cognitive aging • Many people have a preconception that late life is a time of decline • The story is far more nuanced and individuated.

12. Gains and losses Schaie, 1994, 2008

13. Age 20-34 Standard Score Losses but

14. Age 20-34 Standard Score Gains

15. Dementia is the fear …

16. …but in fact • The majority of the population will not experience dementia (although rates will grow) • There are, however, significant functional consequences of normal cognitive aging in the absence of dementia that have been largely ignored • Medication • Finance

17. Plus prevention

18. What accounts for cognitive aging? • This is a detailed and evolving field, but at the risk of oversimplifying, there are four BROAD categories of explanation • Neuronal/brain loss • Reduction in neuronal/brain efficiency • Growing interference • Disuse atrophy (“sensory underload”, “disengagement”)

19. Neuronal/brain loss

20. Neuronal/brain loss

21. Neuronal/brain loss

22. Neuronal/brain loss

23. Neuronal/brain loss

24. Neuronal/brain loss Brain health Engagement Spot training

25. Neuronal efficiency Brain health

26. Growing interference

27. Growing interference

28. Growing interference Can I afford to get married? Is my child healthy? Will I get a promotion? Have I taken my medication? When will I eat? Will my child succeed? Will you take me to school How do we get both kids to two different soccer practices? Does my mother need a nursing home? Mood Spot training Have I done my homework?

29. Disuse Educate Brain health Spot training Mood Engage

30. My program of research (and others) • In large measure, we’ve tried to chip away at normal cognitive aging, using the “arsenal”, more or less, as the conceptual framework for guiding our approaches. • In general, the past five years have seen an explosion of research- and market-driven intervention approaches for cognitive aging

31. The arsenal

32. Educate

33. Educate Figure 1. Model estimated growth curves for 5-year cognitive change by racial group.

34. African American, Prompted African American, Unprompted White, Prompted White, Unprompted Educate (and support) unprompted With Kelsey Thomas

35. African American, Prompted African American, Unprompted White, Prompted White, Unprompted Educate (and support) Prompted “Can you look again? \ With Kelsey Thomas

36. The arsenal

37. Brain health • There is an extensive literature documenting that health issues of later life (especially cardiovascular, and especially hypertension) are destructive to cognitive functioning • Especially “executive functioning” • Ron Cohen, UF CAM director, and Catherine Price, CHP faculty member, have been leading contributors to understanding how vascular-related neuronal loss is directly associated with cognitive decline

38. Brain health • A now ten-year old meta-analysis clearly showed that exercise trials were very beneficial • Aerobic or aerobic + strength • Increase in grey and white matter • Increase in neurotrophic factors • Improvement especially in “executive control”

39. Brain health Dawn Bowers & Michael Marsiske

40. Brain health

41. Brain health

42. Brain health The gift that keeps on giving?

43. Brain health In moratorium, but forthcoming at the American College of Sports Medicine meetings Marco Pahor, PI (Institute on Aging) 1600 elders enrolled at 8 sites around the USA

44. Brain health Marsiske, Gogoi, Maye, McCoy, McCrae

45. The arsenal

46. Spot train • ACTIVE study • VITAL study • MEDLI study • Fitmind study

47. ACTIVE • University of Alabama-Birmingham Karlene Ball PhD • Hebrew SeniorLife BostonJohn Morris PhDRichard Jones ScD • Indiana UniversityFredrick Unverzagt PhD • Johns Hopkins UniversityGeorge Rebok PhD • Pennsylvania State UniversitySherry Willis PhD University of Florida/Wayne State UniversityMichael Marsiske PhD New England Research Institutes, Coordinating CenterSharon Tennstedt PhD National Institute on AgingJonathan King PhD National Institute of Nursing Research Susan Marden PhD

48. ACTIVE

49. ACTIVE

50. ACTIVE 10-year Trajectory of Memory, Separately by Training Group