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What Really Works to Help an Aging Brain

By Christie Aschwanden | March 7, 2021 | The Washington Post

When you reach a certain age, every lost key or hard-to-conjure word comes with a nagging question - is my mind slipping? The answer, unfortunately, is probably yes, but that doesn't mean that you're becoming senile or have something to worry about, says Denise Park, distinguished university chair in behavioral and brain sciences at the University of Texas at Dallas.

Most people experience a little bit of forgetfulness as they get older, particularly in their 60s and 70s, Park says, and this is the result of subtle changes in processing speed that begin in your 20s. Initially, these changes are too small to perceive, but eventually they become noticeable.

"It's like taking just a little bit of money out of your bank account each month. It won't seem like much at first, but eventually you'll notice you don't have as much money," Park says.

Requiring an extra moment or two to remember someone's name or having a little trouble keeping a lot of information in your head at one time or switching between focused tasks are normal parts of aging and not a sign that you're losing your mind, she says. "These changes are not threatening to your everyday life, as a general rule."

Your 60-year-old brain isn't going to function like it did at age 25 any more than your skin will look like it did at that age, but that doesn't mean you'll become senile. The brain's frontal cortex, which is used for problem solving and some aspects of word processing, shrinks with age, but it also shows more activity as you get older. "So maybe you have less real estate, but you use it more," Park says.

There's also evidence, she says, that older adults can create new brain pathways to cope with diminished ones and to increase their processing capability.

The value of exercise

Research has identified numerous ways to keep your mind healthy as you get older.

If you're a smoker, quitting the habit is the No. 1 thing you can do, says Elizabeth Zelinski, a psychologist at the Leonard Davis School of Gerontology at the University of Southern California. When it comes to cognitive decline, "Smoking is probably the No. 1 risk factor - it affects your nervous system and vascular system," she says, and detriments to either of those systems can accelerate memory problems.

Other risks for age-related cognitive decline include high blood pressure and diabetes, obesity and being sedentary, all of which affect your vascular system.

One of the most powerful ways to keep your mind healthy is with exercise.

Physical activity has been shown to promote neurogenesis - the formation of new neurons - and so it's not surprising that exercise would help keep your mind sharp. In 2012, Zelinski published a meta analysis on methods to improve cognition in older adults.

"What we found is that exercise was just as effective as doing any kind of cognitive training like brain games," she says. "Moderate exercise, even just walking, seems to be fine," Zelinski says.

An analysis from the Mayo Clinic Study of Aging found that moderate exercise in mid or late life was linked to a reduced chance of developing mild cognitive impairment. A review of 46 trials with more than 5,000 participants published last year concluded that exercise is associated with reduced cognitive decline and seems especially helpful for helping working memory. And a 2017 review of randomized, controlled trials concluded that in adults 50 and older, moderate intensity exercise (either aerobic exercise or strength training) was linked to improved cognitive function.

Pushing your brain

Just as you can train your body, you can also train your brain. "Cognitive training is very much like taking your brain to the gym," says Amit Lampit, a clinical neuroscientist at the University of Melbourne in Australia. The idea is to use highly structured exercises to practice cognitive processes so you can improve and maintain cognitive performance.

These exercises can improve performance on the cognitive tasks that they challenge, but the problem is that the improvements may not transfer to the things we really care about in real life. Does getting faster at a computerized memory test also make you faster at remembering someone's name? Right now, it's hard to say.

Numerous computerized brain training exercises are commercially available. While some studies have suggested these programs might be helpful, "there is currently little evidence that computerized cognitive training can delay or forestall dementia," Lampit says.

Computerized brain games are "what I like to think of as 'get smart quick' schemes," says Walter Boot, a psychologist at Florida State University. They are "something that you can sit down and do, and you can improve your performance and get better in a relatively short amount of time," he says, but ultimately they probably aren't making a meaningful difference in how your mind works as you age. Instead, he says, it's probably the lifelong things that you do, such as engaging with the world and being social, that matter.

Boot co-wrote a 2016 paper that reviewed the evidence on brain training interventions and concluded that there was "extensive evidence" that they improve performance on the trained tasks. There was less evidence that they improve performance on closely related tasks, and little evidence that they enhance performance on distantly related tasks. The researchers also found scant evidence that such training improves everyday cognitive performance.

Even with the ones that show the most promising results, "what ends up happening is people find them hard and don't like doing them, so they drop out," Zelinski says.

This means it's important to find a cognitive challenge that you'll stick to. The problem with computerized brain training exercises, she says, is that when they work they feel effortful, and so people tend to stop. Park says the trick is to find something mentally difficult that's also engaging and that allows some room to progress. That could be learning a new language or musical instrument or even taking up quilting, which is a hobby that can require advanced spatial thinking.

Things you can do to stay mentally and socially engaged appear to be especially helpful. For instance, some evidence exists that people who retire, especially from low-level jobs, have relatively faster mental declines than people who keep working, Zelinski says. It doesn't mean don't retire, she says, but if you do, it's a good idea to find some other activities, such as volunteering, to keep you socially and mentally engaged.

Social connection and activities involving interactions with other people seem particularly helpful. "When you go to a party where you don't know anybody, you're actually engaged in a pretty complex cognitive task," Park says. "You're meeting new people, trying to remember their names and keep their stories straight," and that's a good way to exercise this kind of cognition.

The right diet

What you eat probably matters too, scientists say. A Mediterranean diet (high in fruits, vegetables, whole grains, nuts, seeds, fish and olive oil) may help keep your brain healthy, Zelinski says. Numerous studies have shown that diets that follow the Mediterranean pattern might help maintain good cognitive health. A study published in 2019 looked at more than 2,600 participants in a longitudinal study of aging and found that those who'd eaten a Mediterranean-style diet as adults had better cognitive performance in middle age.

But teasing out which components of diet might be important is tricky, and not every study has found an association between a Mediterranean diet and cognition. For instance, an examination of more than 6,000 participants in the large-scale and long-term Women's Health study found no relationship between a Mediterranean diet and cognitive decline.

The Mediterranean diet is often prescribed as a way to keep the heart and cardiovascular system healthy, and this may explain the association. Anything that impairs the vascular system increases the risk of cognitive decline, Zelinski says.

Vascular disease, which affects the body's circulatory system, is known to increase the risk of mini-strokes and other cardiovascular problems that can produce cognitive impairments. For this reason, controlling high blood pressure, diabetes and heart disease, whether through lifestyle measures, drugs or some combination of the two, can help your mind stay healthier, too.

No magic pill

One place you're unlikely to find cognitive enhancement is in a pill. Unless you have a documented vitamin or nutrient deficiency, it's unclear any vitamin or supplement will help your brain, Zelinski says. And, she adds, there's not enough evidence right now to recommend any "nootropic" supplements, which are heavily marketed for memory and brain function. The evidence that any of this stuff works is slim to none, says Pieter Cohen, a physician at Harvard Medical School and the Cambridge Health Alliance.

Cohen and his colleagues recently published an investigation of supplements claiming to improve memory or mental focus. Their study found five different unapproved and potentially dangerous pharmaceuticals, including vinpocetine, in some of these products. The Food and Drug Administration has warned that vinpocetine can cause miscarriage or harm fetal development. Cohen's group also found piracetam in some of these supplements, despite the FDA's rejection of attempts to market this ingredient in supplements.

A 1994 law allows supplements to be promoted as having a "structure/function" claim. "For practical purposes, it means that companies can sell products as if they do things like enhance cognitive function or maintain cognitive function without any evidence in humans," Cohen says. "In fact, you can have things that have been proven not to work."

As an example, he points to ginkgo biloba, where a large study sponsored by the National Institutes of Health showed that it did not prevent dementia or declines in memory.

"Even after strong data that something doesn't work, you can still market ginkgo biloba as enhancing memory," Cohen say. "The laws are crazy in terms of what's legally permitted for supplement advertisements."

Like so many other aspects of health, the secret to staying cognitively healthy as you age is pretty simple, and it's advice your mother probably gave you, Zelinksi says: "Eat right, exercise, stay engaged and socialize."

This content is licensed with permission. Read more in health and wellness at www.washingtonpost.com.

Christie Aschwanden
The Washington Post

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