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'Singing, Shopping, Schmoozing Lauded'
STEP Forum Outlines Successful Brain Aging

By Rich McManus

Photos by Bill Branson

On the Front Page...

The best way to enjoy "successful brain aging" — which was the theme of a STEP forum on Jan. 11 at Lister Hill Auditorium — is to keep the cart that holds the brain, namely the body, in good working condition. Oh, and it wouldn't hurt, in your later years, to take up a creative hobby like singing or art, or to indulge what one speaker called a hallmark of the sunset years — the urge toward autobiography. Swooned former acting NIA director Dr. Gene Cohen, now at George Washington University, "Language is like chocolate to the brain."

Continued...

While it is commonly held that "aging is not for sissies," it must have been something of a relief for the standing-room-only audience (and many more peering in via videocast) to learn from Dr. Marilyn Albert, director of the division of cognitive neuroscience at Johns Hopkins University's department of neurology, that the one activity that combines exercise, mental alertness, social stimulation — and perhaps a dandy new pair of pumps — is shopping. Perhaps aging baby boomers should adopt the mantra, "Shop, So You Don't Drop!"

The four-speaker panel reinforced with data what common sense has instructed humankind for millennia with respect to getting old. One speaker, Dr. Margie Lachman, who chairs the department of psychology at Brandeis University, even resorted to a quotation from Cicero, written in 44 B.C., to sum up her findings: "It is our duty, my young friends, to resist old age; to compensate for its defects by a watchful care; to fight against it as we would fight against disease; to adopt a regimen of health; to practice moderate exercise; and to take just enough food and drink to restore our strength and not to overburden it. Nor, indeed are we to give our attention solely to the body; much greater care is due to the mind and soul; for they, too, like lamps grow dim with time, unless we keep them supplied with oil."

Dr. Marilyn Albert

What kind of "oil" might Cicero have had in mind? According to Albert, a raft of large longitudinal studies that began in the mid-1980s underscore "the importance of vascular risk factors in maintenance of cognition." These include blood pressure, diabetes, cholesterol, weight and smoking. "If you have lots of risk factors," she noted, "it is likely that you will have damage to the large and small arteries in the brain."

Physical and mental activity also appear to be critical in maintaining mental ability, Albert said, though the exact mechanism by which these behaviors exert their beneficial effect is not yet known. She cautioned that many of her findings are the fruit of large observational or epidemiologic studies; the more authoritative clinical controlled studies have been few and small.

The attitude one brings to the march of years is also crucial in determining how successfully one negotiates them, suggested Brandeis's Lachman. She and her colleagues have studied the effect of "control beliefs" — those who embrace a sense of control over how life will turn out often see their optimism rewarded, in a sort of positive feedback loop. Contrarily, those who believe they are at fate's mercy tend to trend downward in measures of health.

Brandeis's Dr. Margie Lachman
makes a point.

"Attitudes and beliefs make a difference in whether or not we follow all the recommendations and prescriptions for activity and healthy diet," she explained. "Adaptive beliefs, including whether you can do something and whether it will make a difference, play a role in health promotion and successful aging."

According to a Pew Center Study published last summer, Americans lead the world in "get 'er done" optimism. A survey of 38,000 people in 44 countries asked respondents to agree or disagree with the statement, "Success in life is pretty much determined by forces outside our control." More than 60 percent of Americans disagreed. By contrast, only about 10 percent of respondents in Bangladesh disagreed.

"In the United States, there are products on the market that claim control over everything from allergies to zits — there's even a margarine called 'Take Control,'" Lachman observed. Products targeted specifically against the aging process represent a $40 billion-a-year industry, she said. But a robust sense of control is a good thing, she argued, not just empty Chamber of Commerce boosterism — it promotes behaviors leading to health and well-being, and offers compensation strategies once the handwriting has begun to show up on the wall. While it is true that the older Americans get, the more pared-away their sense of control becomes, there are nonetheless strategies we can employ to counter age-associated deficits, Lachman demonstrated.

Perhaps the poster child for an optimistic sense of robust, possibility-filled aging is GW's Cohen, who has made the later years of his own career (he spent 20 years at NIH in posts at both NIMH and NIA) more productive and enjoyable by finding not-so-rare examples of hearty aging, interviewing them and learning the keys to their success. In both anecdote and research paper, he showed that aging is often a time of ripe blossoming, of surpassing accomplishment, and perhaps not so incidentally, of deepening contentment.

"There's no denying the problems associated with aging," he began, "but what has been denied...is the potential."

What the seniors among us have, Cohen argued, is access to long-accumulated masses of information, and a rich trove of experiences both inner and outer. Combined in the form of a whimsical equation, C (creativity) equals M (mass of info) E (experience) squared — which inverts Einstein's famous finding. Einstein, he noted, had an unusually high volume of glial cells (the "soup" that nourishes neurons, or brain cells), upon autopsy. Modern neuroscience, Cohen said, has shown that the greatest increase in the number of dendrites in the brain occurs between the early fifties and late seventies, and that enriched, stimulating social environments contribute to brain plasticity. While the maxim "use it or lose it" is generally true with respect to human faculties, Cohen said, "It's never too late to 'use it' in order to alter [age-associated] losses."

Cohen described an especially hopeful study by Dr. Thomas A. Glass and colleagues showing that, with respect to health outcomes, couch potatoes who have lively social outlets do as well as active seniors who make fitness a priority.

He noted that "there has been very little work elaborating psychological development in the latter half of life," but has made the study of human potential in those chapters his research focus. Among his findings: seniors who actively pursue creative expression (singing, painting artworks, for example) suffer less depression, need fewer doctor visits and require less medication than age-matched controls who don't avail themselves of such outlets; and, for elders who use their twilight years to "sum up" their lives autobiographically, rarely is language more appreciated than at this stage of life. "Language is like chocolate to the brain in humans," he said.

That hankering for chocolate in an "aging" brain can begin as soon as the early twenties, said Dr. Gary Small, director of the UCLA Center on Aging; even at that tender age, there begin to be age-associated decrements in cognition. And there better be plenty of Hershey's to go around: between 40 and 50 percent of the U.S. population report some age-associated memory impairment, he said.

Guest speakers at the STEP forum on brain maintenance were (from l) Dr. Gene Cohen, Dr. Gary Small, Albert, and Dr. Margie Lachman.

There really isn't any getting around it — whether you're a rodent, a monkey or a man, if you get older, you lose a few marbles, noted Johns Hopkins' Albert. "These losses aren't necessarily associated with any disease, it's just a normal decline," she said. And it's not that we in the animal kingdom lose brain cells by the boatload as we age, she explained, but that somehow there are changes in mechanisms that modulate brain function.

UCLA's Small offered some strategies for improving memory and decelerating brain aging. For those at increased genetic risk of Alzheimer's disease (as marked by the ApoE4 gene, or as suggested by PET or MRI scan, or by neuropsychological profile), he showed that early detection and early intervention are important. Cholinergic treatment with the drug galantamine can delay the deterioration seen in AD patients.

For those aging normally, some brain fitness strategies include: use of medications that have shown some protective effect such as antihypertensives, statins and anti-inflammatory drugs; avoidance of too many medications, which might interact negatively; stress reduction (proneness to stress doubles the risk of AD, Small said); physical activity (echoing both Dr. Albert and Cicero of antiquity); healthy lifestyle choices; healthful diet and mental activity. Like GW's Cohen — who recommended activities "that make your brain sweat a little" — Small noted that "leisure activity involving mental effort is associated with lower dementia risk for seniors."

Small described a "healthy brain diet" as suggested by observational studies: moderate caloric intake to avoid the ailments associated with obesity; antioxidants consumed as food (prunes, raisins, blueberries, plums, broccoli) or vitamins (E and C); omega-3 fatty acids (fish, olive oil, avoid animal fats); and low glycemic index carbohydrates such as apples, apricots, cherries, fettucine and nonfat yogurt.

He showed study results suggesting that any kind of mentally challenging activity might be protective, including doing crossword puzzles, learning languages, reading novels and completing jigsaw puzzles. Small also reviewed studies demonstrating that memory training can improve memory performance and brain efficiency, and that such benefits persist over time.

As in 44 B.C., so in 2005 A.D. — try to keep your stress level low, stay in good physical shape, eat right and keep your mind creatively engaged. As Small pointed out, all of these have potential benefit, and all have minimal risk.

To see the complete STEP presentation, visit www.videocast.nih.gov.
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