May 15th, 2015
What is an “Older American?” Re-Envisioning Aging Beyond Gray Hair and Rocking Chairs

What defines an “older American?”

May marks “Older Americans Month.” While traditionally it has been a time for us to honor older generations and raise awareness around aging, over the years it has become clear that what it means to be “older” has changed dramatically. As the boomer generation moves into the ranks of those over 65, we are challenged not only to rethink our conceptions about what we mean by the term “older adults,” but also the kind of programming and services they seek and need.

Part of the challenge we face as a field comes from the limitations of categorizing those we serve simply based on years lived. There is tremendous diversity in the needs, wants and interests of individuals, regardless of their biological age. What does an 79-year old who still hikes, skis and runs his own business want and need versus his same-aged counterpart who has limited mobility due to chronic health issues and needs assistance with daily living activities, but loves to sing and visit with his grandkids? How do we plan in ways that serve both?

In addition, we need to re-imagine our vision of what older adults want to do. No longer are we developing programs and services for folks who are happy to simply reminisce or listen to travelogue lectures. A recent article in Geriatric Nursing showed that in fact older adults are most interested in activities that are actually quite – active! The study, which looked at data from over 5,000 community-dwelling, cognitive intact adults between the ages of 65 and 84, found that 4 out of the 5 most popular activities were very active, including walking/jogging, outdoor maintenance and playing sports.

This finding is spot on with our experience here at Total Brain Health — that active aging adults lead busy, fulfilling lives. When seeking brain fitness programs, they are not satisfied with cognitive fitness classes that do not actually reflect the science, challenge their abilities, feel stale or dumbed down. And why should they accept anything less? In response to their expectations (and yours) we strive to develop cognitive wellness opportunities that provide learning along the cutting edge spectrum of the brain science through programs that are appropriately engaging, varied, social and fun. For example, our TBH ACTIVITIES Toolkit program includes activities such as Ping-Pong, dance parties, and juggling games, as well as meditation, stress reduction exercises and innovative ways to build the skills we need to think clearly everyday. All of these activities tie to what the literature demonstrates supports our ability to stay sharp and to potentially lower our dementia risk.

So as we celebrate Older American’s Month, let’s re-envision aging beyond gray hair and rocking chairs. Set up the Ping-Pong tables and have a round robin tournament or hold a poetry slam. After all, age is just a number!

April 30th, 2015
TBH SCIENCE UPDATE: APRIL 2015

Diagnosing Alzheimer’s: Report Finds Fewer Than Half Told They Have Disease

What: A recent survey by the Alzheimer’s Association found that fewer than half of individuals diagnosed with Alzheimer’s disease are informed by their medical team of their diagnosis. The finding, shared in the association’s 2015 Alzheimer’s Disease Facts and Figures report, showed that while only 45% of affected individuals and their caregivers were informed of the diagnosis. By contrast, about 90% of patients suffering from the four most common cancers state that they were told their diagnosis.

Why This Matters:  Disclosing a serious diagnosis, like Alzheimer’s disease can be difficult. However, the diagnosis must be shared no matter how hard it is for the patient, family and the attending medical team. Knowing your diagnosis, or that of your family member, is critical information to have on many levels, including but not limited to pursuing proper medical treatment, opportunities to participate in future care decisions, and the dignity of self-determination. This finding shows not only the hesitancy on the part of the medical community to share the diagnosis, but also the bias of our culture regarding the disorder. While a definitive diagnosis of Alzheimer’s disease cannot be made without autopsy following death, studies show confirmation rates of clinical diagnosis during lifetime fall in the 90th percentile, suggesting that our current ability to accurately determine the disease based on clinical presentation is highly accurate. The comparison with cancer is apt, since it is only a few decades ago that providing a cancer diagnosis was similarly often not disclosed.

The Takeaway: This finding should help us all be more aware of the need to share a diagnosis of Alzheimer’s disease or other dementia with the affected individual and designated family members, as well as the need to ask if we or our loved ones are not given a clear, direct diagnosis over time.

 

Over 75 and Still on the Job? Keep at It, That May Be Keeping You Sharp

What: A study released online yesterday in Neurology reported that adults over 75 with cognitively complex work performed better over time than those in positions with less intellectual engagement. Researchers using data from approximately 1,000 subjects participating in the Leipzig Longitudinal Study of the Aged, looking at performance on a standard cognitive screening measure over an 8 year period. They found that a high level of cognitively demanding work was significantly associated with better performance on cognitive tests at baseline as well as with a lower rate of cognitive decline over time.

Why This Matters: Previous studies have found that our work environment can influence our risk for dementia later in life. However, this study is notable in that it looked at adults 75 and older and the impact of working conditions on their performance into older age, up to their early 80’s. The suggested association between demanding mental activity and preserved cognitive performance confirms what the science suggests to date regarding maintaining sharp thinking through continued use of intellectual skills, ongoing engagement and socialization.

The Takeaway: Keep working, keep volunteering, keep using your brain! It is interesting that this study comes from Germany, the country that first established a retirement age of 65 years. Perhaps it is time for a change?

 

April 15th, 2015
Bring On Spring! 3 Easy Spring-filled Activities to Boost Cognitive Wellness

Spring certainly has taken its time arriving on the East Coast this year. Only in just the past few day have we started to see hints of spring buds, green grass and some warmer days. After our long, cold winter, we are certainly anxious for spring to fully blossom!

We associate so many wonderful things with springtime – new beginnings, renewal of body and spirit, as well as reacquainting ourselves with the outdoors. It is often a time for special occasions as well, with many graduations, weddings and family reunions on the calendar between now and the beginning of summer.

For those of us planning activities, spring offers us many great opportunities to bring the lighthearted joy of the season to the clients and communities we serve. Here are some fresh ideas, like a poetry slam – and some innovative twists on tried and true ones – certain to spread the joyful spirit of springtime and activate everyone’s minds.

Spring Poetry Slam. April is National Poetry Month, and what better way to celebrate than to hold a Spring Poetry Slam? Poetry slams are events where participants come up with poems on the spot. They can write to a specific topic, word, or idea. Slams are timed, so that participants have an allotted period of time to write their verse. Often competitive, poetry slams are great for our brains. Why? First, these events challenge us to think creatively and out of our own “box,” supporting our brain’s plasticity and encouraging intellectual engagement. Second, because we have limited time to create our verse, we have the opportunity to challenge our thinking skills, especially those that can diminish with age such as attention, speeded and nimble thinking, as well as memory. Finally, this is clearly a social event, with tons of fun and a chance to mingle.

Holding a Spring Poetry Slam doesn’t require a lot of advance planning. Simply create your invitation and promote your event, using resources such as “A Brief Guide to Slam Poetry” from the American Academy of Poets or Power Poetry’s website. Decide on your judge’s panel, and  encourage folks to attend, even if they may not take part in the poetry competition (after all, every event needs an audience). While you might want to allow an older audience more time to create their poems for the competition, don’t make it too easy! For some springtime themes, keep the slam poetry topics seasonal, such as baseball, gardening, or rain. Be sure to plan for music and refreshments to really make your Poetry Slam a slammin’ (ha!) good time. Consider inviting a local poet, you may even have a published one in house or at a nearby university who might read their poems (and serve as a judge). Take a look at the great poster for this year’s National Poetry Month that you can order or even download and use as the prize for your winner.

“En Plein Air” Painting. “En plein air” or the act of painting outdoors, is a wonderful way to celebrate spring. Being outside can boost our mood, especially after a long winter spent indoors. The changing light and other environmental challenges make painting “en plein air” a twist on painting in the classroom, since we must adapt and adjust our perception and work accordingly.

Take your art class outside to a local flower garden, to your own community garden, or even to the park. Let everyone paint, color or draw to their own ability and desire. You can provide many different mediums (watercolor, pastels, colored pencils) and paper types and sizes. You will need support for their drawing (lap desks, easels or particle board), additional art supplies as well as clothespins to clip or weigh down paper to keep it from blowing in the wind. Consider sharing with your class famous En Plein Air works of art for inspiration prior to going. At the end of the event, why not plan an art show with all the wonderful pieces of art created during your outing? Finally, you can bring this activity to clients with greater cognitive challenge or who are house-bound by using flowering potted bulbs you can bring indoors and using simpler art supplies. such as crayons (which come in larger sizes and can be easier to hold).

The Grass is Always Greener. Here’s a simple and quick activity that will bring springtime right into your clients’ own homes. Invite members of your community to plant a container with grass seed. They can then take that container with them, water it and watch it grow over time. Some folks even “mow” or cut their grass as it grows (if they are able to use scissors safely), or place “lawn ornaments” in their container (you could even make miniature pink flamingos yard decorations by downloading and printing the images and putting them on toothpicks). This activity is easily adapted across the cognitive continuum, and offers a great, ongoing non-verbal modality for engagement with individuals with more significant cognitive challenge through senses of touch and smell. Consider offering this activity on Earth Day (April 22nd) as part of your community’s celebration or during an Earth Day Fair or other event.

March 31st, 2015
TBH SCIENCE UPDATE | MARCH 2015

Weighing In on Dementia Risk | Perhaps Midlife Obesity Doesn’t Matter

What: A study published online this month suggests that obesity at midlife may not be associated with increased risk for dementia. Researchers analyzed data from the AGES-Reykjavik Study, a large prospective study of cardiac function and aging, to determine the role weight at midlife plays in brain aging. Using a subsample of approximately 4,000 individuals followed over an average of 26 years, the researchers found no significant correlation between midlife adiposity and brain pathology, brain volume or dementia diagnosis when compared to midlife normal weight subjects. The study did not look at weight distribution at mid-life, specifically visceral body weight, which has been linked in other studies to increased dementia risk in later life.

Why This Matters: This study, which comes from a large, well-designed and highly respected research protocol, contradicts earlier findings which have suggested that weight at midlife may significantly increase late life dementia risk. These findings give pause to our understanding of the role weight may play in the risk for memory disorders.

The Takeaway: Research on the impact of lifestyle, such as body weight, on dementia risk is complex and relatively young when compared to lifestyle intervention science in other areas, such as cardiovascular health. However, even the researchers for this study warn that since maintaining a healthy weight has been strongly associated with overall well-being and successful aging, these findings should be considered in perspective. In other words, you should still stay away from those french fries.

 

Experimental Drug Shows Promise in Slowing Decline in Alzheimer’s Patients

What: Biogen, a pharmaceutical company, shared findings this month at the International Conference on Alzheimer’s and Parkinson’s Diseases and Related Disorders in Nice, France suggesting that an experimental medication may reduce significantly slow decline in Alzheimer’s patients. The drug, known as Aducanumab, is designed to reduce the presence of amyloid plaque, a known pathology of Alzheimer’s disease, in the brain. The Phase I trial, which focused primarily on safety of use, showed the drug could generally be tolerated, lowered amyloid plaque levels, and reduced the rate of cognitive decline in a small sample of 166 AD patients.

Why This Matters: To date there are few medications to treat Alzheimer’s disease, with many potential treatments failing in drug trials over the past several years. Finding a drug that significantly slows decline would be an enormous step forward in treating the disease (not to mention lucrative for the manufacturing pharmaceutical company and investors, who are very excited by this news).

The Takeaway: We have made little progress in developing effective pharmacological treatments for Alzheimer’s disease over the last decade, despite the dedicated efforts of some of the brightest research minds in the world and millions of invested dollars. Biogen’s findings, while quite early, are very promising. However, cautionary tales of other potential treatments that have fared well in early trials only to fail in larger studies abound (for example, IVIG treatment which last year failed in later phase trials after showing promise in early studies). Fingers crossed on this one.

March 30th, 2015
Dr. Green Delivers Opening Keynote Address to at Med In Israel 2015

Dr. Green delivered the opening keynote address, titled “Are You Ready for ‘The Brain Age’?: The Science, The Challenges and The Opportunities Ahead” at the 3rd Annual Med in Israel Conference in Tel Aviv on March 24, 2015. Dr. Green’s presentation to the international audience of 1,200 professionals from the medical and technology fields focused on the tremendous opportunities for innovative technological solutions to brain health challenges.

While in Israel, she was interviewed by the leading financial newspaper, Calcalist (the article is in Hebrew, but most internet browsers will have an option to view in English).

March 18th, 2015
Time to Thank Your Brain! | 3 Things You Can Do In Honor of Brain Appreciation Week

What is indeed more miraculous than the human brain? This remarkable organ has evolved over time to become what is the defining feature separating humans from other animals. While it may weigh in at about 2% of our overall body weight, our brain holds everything that we are, from our basic physical functions of breath and balance, to our memories of playground games in school, to the strong sense of love we feel for our family and friends – even whether we see #thedress as white and gold or black and blue.

This March 16th – 22nd marks the 20th anniversary of Brain Awareness Week. This annual event, sponsored by the Dana Foundation, has grown over the years to reach an international audience and raise appreciation worldwide for brain science as well as for what we can do to boost brain wellness across the lifespan.

As passionate brain health educators, we love sharing new ways you can enhance your cognitive fitness. Here are some fun activities you can do join in on the Brain Awareness Week celebration:

Thank Your Brain! Our brains are responsible for everything from keeping us awake (and getting us to sleep) to maintaining our senses, helping us speak, letting us love, and giving us pleasure in the experience of new things.  As we grow older and worry about memory loss, we tend to lose sight of all of the amazing things our brains do on a daily basis. It’s important to take time to reflect on your brain’s strengths and think about what your brain does well. Try to list 10 ways in which your brain is totally awesome. We’ll bet it won’t take long at all!

Brain Fast Facts. Did you know that our brain has over 100 billion neurons? That contrary to popular belief, we “use” all of our brain most of the time? Or that each side of the brain controls the opposite side of our body, such that the left side of our brain controls the right side of our body and vice-versa? Why not increase your brain awareness this week by learning some fast facts? You can easily find some great information on sites such as www.brainfacts.org or this brain fact story on Viral Nova.

Sneak In Some Brain Appreciation! There are many activities you can do that are great brain boosters. This week why not take a lead from our TBH Blueprint and participate in a drawing class, friendly game of cards, or book club – it is good for your brain! And remember, its never too early to start thinking about next year’s Brain Awareness Week, scheduled for March 14th-20th 2016. Be sure to check out our books in the TBH Store, offering you some great, innovative ways to celebrate the brain, this week and all year long.

 

March 13th, 2015
Time to Thank Your Brain! 3 Last-Minute Ideas for Brain Appreciation Week

What is indeed more miraculous than the human brain? This remarkable organ has evolved over time to become what is the defining feature separating humans from other animals. While it may weigh in at about 2% of our overall body weight, our brain holds everything that we are, from our basic physical functions of breath and balance, to our memories of playground games in school, to the strong sense of love we feel for our family and friends – even whether we see #thedress as white and gold or black and blue.

This March 16th – 22nd marks the 20th anniversary of Brain Awareness Week. This annual event, sponsored by the Dana Foundation, has grown over the years to reach an international audience and raise appreciation worldwide for brain science as well as for what we can do to boost brain wellness across the lifespan.

As passionate brain health groupies, we love sharing new ways you can bring better cognitive fitness to your communities.  Here are some fun activities you can add to your schedule to join in on the Brain Awareness Week celebration:

Thank Your Brain! This activity, from our TBH FAIR Toolkit, is a great community-builder that gets everyone to give a quick “shout out” to their beautiful brains. Hang a large blank paper banner on the wall in the dining area, common room or lobby.  Have several poster pens, sharpies or other markers available, in a wide variety of colors.  Across the top, write in large letters “I THANK MY BRAIN FOR …”. Ask folks to participate by simply writing down how they might finish that sentence on the banner. At the end, you will be left with a rainbow array of brain appreciation statements that can be left up and shared over the remainder of the week.

Brain Fast Facts. Did you know that our brain has over 100 billion neurons? That contrary to popular belief, we “use” all of our brain most of the time? Or that each side of the brain controls the opposite side of our body, such that the left side of our brain controls the right side of our body and vice-versa? Why not raise a bit of brain awareness this week by sharing some fast facts about our brains in your morning bulletin, community meetings or even at the beginning of other activities this week? You can easily find a number of “brain fast facts” to share on the internet on sites such as www.brainfacts.org or this brain fact story on Viral Nova.

Sneak In Some Brain Appreciation! Chances are many of the activities you offer daily are great brain boosters. This week why not take a lead from our TBH Blueprint and make sure everyone knows that whatever the activity – a drawing class, friendly game of cards, or book club – it is good for their brain!

And remember, its never too early to start planning for next year’s Brain Awareness Week, scheduled for March 14th-20th 2016. Our TBH Toolkits offer you some great, innovative ways to celebrate the brain, be sure to check them out!

February 26th, 2015
February 2015 | TBH Science Update

As we usher out Heart Awareness Month, here are two recent findings that further underscore the close relationship between heart health and brain fitness:

Mild Heart Dysfunction and Dementia: Findings Suggest Closer Monitoring Warranted

WhatAn investigation out of Iceland looked at the relationship between the range of cardiac function and brain physiology in older adults. The study considered a subset of older subjects who were part of the AGES-Reykjavik Study on aging, and found a significant and graded association between cardiac dysfunction and lower brain volume. In addition, these changes were linked to poorer performance on cognitive tests of processing speed and executive function.

Why It Matters: While the association of advanced heart failure with brain dysfunction is well established, less is known about the impact of more mild changes in cardiac hemodynamics on cognitive status. This finding suggests that the relationship of cardiac function to cognitive health develops gradually over time, suggesting that intervening to maximize cardiac function in older adults may reduce their dementia risk.

The Takeaway: Older patients with mild changes in cardiac hemodynamics should be monitored for changes in their thinking. This study also suggests that physicians should perhaps be more vigilant and consider earlier treatment for patients with such cardiac changes, as doing so may provide protection from dementia risk.

 

Do Blood Pressure Medications Reduce Dementia Risk?

What: Chronic high blood pressure during midlife has been previously associated with vascular dementia. The growing use of anti-hypertensive medications such as calcium channel blockers has raised questions regarding that class of medications possible impact on reducing dementia risk, including for Alzheimer’s disease. A new review study published online this month looked at over 38 published studies to examine this issue. The study found that antihypertensive drugs may indeed be of use in preventing cognitive loss.

Why it Matters: High blood pressure, long been associated with increase risk for stroke and dementia, is increasingly available to better control by lifestyle modifications and medications. Knowing whether the medications used for hypertension control may also lower dementia risk would be a key finding to determining other possible benefits of successful high blood pressure management.

The Takeaway: If past studies hadn’t already convinced you, here is a large, confirmatory finding that effectively managing your blood pressure is not only good for your heart but may also protect your brain. While the researchers call for further longitudinal studies where cognitive decline is a primary outcome measure to gain more insight into the mechanisms of this benefit, this and other studies continue to make it clear that managing your blood pressure should be a “no-brainer.”

February 16th, 2015
February 2015 | The Brain’s Favorite Valentine: 3 Ways to Share the Love for the Heart-Brain Connection

February is American Heart Month, and it’s a great time to once again take focus our thoughts on what is without doubt the brain’s favorite valentine, the heart.

Why does heart health matter so much to our intellectual wellness? The relationship between cardiovascular function and our brain health is well established. Numerous studies have shown over and again that the same factors known to impact cardiac health, such as physical activity, weight and stress, also play a significant role in determining dementia risk. The robustness of this relationship is strong and clear, and many of us know and teach that what is good for our heart is good for our brain as well.

What can we do to make sure everyone engages in the many health-boosting activities that benefit both heart and mind? Here are 3 heart — and brain! — warming activities across the Body|Mind|Spirit pillars of our TBH Blueprint you can use to share the love:

“Move to Your Heart’s Desire” Party. Physical activity is without a doubt one of the very best things we can do for both our hearts and our brains. Regular physical activity has been associated with sharper thinking and lowered risk for serious memory disorders, as well as better brain physiology, maintaining a healthy weight, reducing stress, and combatting emotional distress.

Why not give everyone a fun way to get their hearts and minds pumping this month with a fun and different improvised movement class? Have folks stand in a large circle. Begin by creating a large body movement (i.e., pumping your fists above your head in a victory move, swinging your arms in a large circle, swishing your hips back and forth, a pantomimed golf swing, cha-cha stepping into the circle and back, etc.) that you couple with a nonsense sound (i.e., “boom-boom,” “whish,” “cha-cha-cha”). Moving clockwise, have the person next to you repeat your moves and sounds, and then add their own. Keep moving around the circle, with each person repeating the moves and sounds of the classmate right before them and then adding their own. As the class becomes more comfortable with the activity, have everyone go a bit faster. Be sure to bring along some music to move along with to really keep the “party” going. Need to keep it simple? Have everyone in the group simply repeat the movement and sound that each class member comes up with, one at a time.

Act on Those Passions. Numerous studies have shown that staying intellectually engaged can reduce our dementia risk, in some cases by as much as 63%. Often changes in role such as retirement, relocation or health challenges can limit the degree to which we find ourselves exercising our minds. Have folks talk about something they are passionate about – it might be politics, cooking, childrearing advice or even the common area décor! Next, have them formulate some ideas on what they can do to engage more fully with their passions. It might be organizing a speaker, teaching a class themselves, writing an article, or even shooting a short video.  Finally, have them write out at least three steps they will take to fulfill their “Passion Plan.”

Pen a Heartfelt Wish. Nothing warms our hearts more that sharing our love or support with others.  But did you know that giving back or having a sense of purpose, not to mention being social, have all been linked to a reduced risk for memory loss? Here’s an activity that spreads the love in a social and community-building way. Have your group write anonymous “I wish for you” letters to share with others. These letters should be very general in tone, and include a kind or heartfelt positive wish or statement of support, such as “I wish for you a day filled with smiles” or “Here’s wishing you many simple pleasures today.” Address the envelopes to “The Person Who Finds This.” After everyone is done, go ahead and have the class hide the letters around the community for folks to find by chance. For more ideas similar to this, visit www.moreloveletters.com, which inspired this activity.

January 30th, 2015
Science Update | January 2015

Don’t Blame Mom! Twin Study Shows Exercise Reduces Dementia Risk Over Genetics

What: Finnish investigators reported this month in The Annals of Medicine that physical activity was associated with a significant reduction in dementia risk in a large group (21,791 subjects) of twins followed over a 29-year period. Using data from the older Finnish Twin Cohort, the researchers divided the subjects into categories based on their reported level of physical activity over time. They found that the twins who engaged regularly in vigorous exercise were half as likely to develop dementia as their less active twin.

Why It Matters: This study underscores once again the tremendous impact regular physical exercise may have on one’s risk for developing dementia. Twin studies provide one of the best ways to “control” for the influence of genetics on our risk for various diseases. These findings, from a very largest robust database following twins, strongly suggest that how we live matters very much to our dementia risk.

The Takeaway: Go for a walk, take a dance class, or swim. Do anything that gets your pulse pumping, and do it regularly and for many, many years. What you choose to do can really make a difference to your dementia risk. And spread the word – exercise really may be the best medicine!

 

Warning Label: Benzodiazepine Prescribing Increases With Age, Despite Known Risks

What: A recent study in JAMA Psychiatry  looking at patterns of prescribing for benzodiazepines in the U.S. found that this class of medications is increasingly prescribed with age, with a whopping three-fold increase in prescriptions from ages ages 18-35 years (2.6%) to folks ages 65-80 years (8.7%). Moreover, long-term use (defined as prescribed 120+ days) doubled with age, ranging from 14.7% in the youngest subset to 31.4% in ages 65-80 years. The study, using data from the 2008 LifeLink LRx Prescription database (IMS Health Inc.), confirmed the dangerous yet growing trend to prescribe long-term use of benzodiazepines for older adults.

Why This Matters: Doctors continue to overprescribe benzodiazepines for older adults, despite repeated warnings from experts against their use in this population. Prescribed primarily for anxiety and sleep disorders, benzodiazepines are known to significantly increase risk of confusion, falls, and impaired judgment (i.e., increased vehicular accident risks). The American Geriatric Society Beers Criteria for Potentially Inappropriate Use of Medications in Older Adults carries a warning level of “strong” against their use in this population. In addition, a study published in BMJ in September reported an associated increase in dementia risk in adults using benzodiazepines, with a noted increased associated risk tied to the length of time subjects were prescribed the medication, suggesting that exposure is linked to magnified risk for dementia.

The Takeaway: Any older adult – or any adult for that matter – should think twice or even three times before taking a benzodiazepine. There are proven alternative and effective treatments for sleep disturbance and anxiety without these associated risks, such as behavioral interventions and other classes of medication.  As a care professional, you can help educate your clients and their families regarding the risks of benzodiazepines and other medications for older adults.