August 31st, 2015

Sleep Problems May Be Early Indicator of Behavioral Health Distress in Older Adults

Margot Radding, TBH 2015 Summer Intern   Carleton College

What: A recent study by researchers in Canada observed the sleep problems encountered most often in older adults with and without anxiety or depression. Interviews that surveyed each participant’s sleep quality were given to over 2,500 subjects over 65 years of age. The results indicated that waking up frequently during the night, taking sleep medication, and lethargy during the day are associated with the distinct risk of meeting the criteria for a mood disorder. Only 4% of those without anxiety or depression struggled to stay awake during social activities, driving, or eating. This level was doubled for those with anxiety and depression. Of those without mood or anxiety disorders, 90% believed their quality of sleep was good. Conversely, more than 25% of those with depression rated their sleep as poor.

Why It Matters: Seniors suffering from mood disorders tend to self medicate to ameliorate their sleep problems. However, sleep medication is associated with the risk of suffering from a mood disorder. Trouble sleeping may be the first signs that a senior is not mentally healthy. Daytime sleepiness reduces the likeliness that seniors will engage in an active lifestyle, which may further contribute to depressed mood and anxious behaviors.

The Takeaway: Sleeping problems are part of a cycle that reduces the mental health of a senior. Low quality sleep leads to a low quality life; a non-active day leads to a sleepless night. Engaging in active programs, social groups, or exercise classes may be key to reducing depressive and anxious symptoms. In addition, professionals should be sensitive to changes in sleep patterns in their clients.


Want to Think Better? Take a Walk in the Woods

Maddie Snyder, TBH 2015 Summer Intern  Trinity College

What: A recent study out of Stanford considered the relative benefits of outdoor environments on cognition. Sixty randomly assigned subjects participated in a 50-minute walk in a natural area or an urban environment. Assessment of cognitive functioning was completed before and after the walk. Compared to the urban walk, the nature walk resulted in a significant decrease in anxiety, rumination, and increased working memory performance.

Why This Matters: These findings further the understanding of the influence of brief nature experiences on cognition. It also helped lay a foundation for future research on the mechanisms underlying these positive reactions to a walk in nature. It gives scientific evidence reassuring the health benefits of nature.

The Takeaway: This simple yet elegant study is a reminder of the value of spending time in a natural environment, only with a cognitive twist. Plan more activities for your community that offer the chance to get outside. On a personal note, consider moving your workout, lunch break or even your team meeting to the park or nearby garden. This time spent in nature not only boosts your physical health and mood, but also benefits your cognition.



July 28th, 2015

Brain Training Makes Safer Drivers: A Pilot Study

Aaron Sterling, College of Wooster

What: A recent study explored whether a computerized onboard cognitive training program was more effective in improving safe driving habits in older adults than other cognitive or driving training methods. Thirty-seven healthy elderly daily drivers were randomly assigned to one of three training groups: Training with a newly developed onboard cognitive training program, training with a similar program but on a personal computer, or training to solve a crossword puzzle. After 8 weeks of training, researchers found that those subjects trained via the onboard cognitive training program did significantly better on tests of processing speed, working memory, driving aptitude and on-road evaluations.

Why This Matters:  As the proportion of drivers over 65 increases, maintaining driver competence is fast becoming a significant public safety issue. Training programs to insure continued safe driving ability have shown promise in the past. This study, while small, suggests that there may be differential benefit depending on the program’s modality and delivery.

The Takeaway: The effectiveness of the onboard training system piloted in this study suggests that implementing a training system in the car may facilitate improved driver safety. We can probably look forward to future studies on a larger scale that consider the issue of best practices for delivering driver training in older adults.


Late Life Emotional Well-Being Linked to Early Childhood Familial Experiences

Margot Radding, Carleton College

What: A study out of the UK examined links between childhood experiences and adult well-being. 5,000 participants between the ages of 60 and 64 completed the Warwick Edinburgh Mental Well-being Scale (WEMWBS), a 14-part questionnaire that indicated, for instance, how often the subject “had been feeling close to other people.” Childhood environment was also assessed including factors such as socioeconomic circumstances, childrearing, parenting, family instability, parental health and adjustment, and child health and well-being. Of the indicators, the results revealed that childrearing, parental health, and childhood illness were related to WEMWBS scores. Participants born to teenage fathers had significantly lower WEMWBS scores than those born to fathers over 20. In addition, there was a suggestion that subjects with overprotective mothers were associated with lower WEMWBS. There was no evidence that socioeconomic circumstance was related to later well-being.

Why It Matters: This study suggests that initiatives to improve the nation’s mental well-being, particularly those focused on supporting families and children, may have benefits decades afterwards. These results stress the  importance of familial stability in childhood as the key to a healthy adulthood.

The Takeaway: We often focus on the impact of socioeconomic status on our general happiness. However, as these results reveal no evidence between childhood socioeconomic circumstances and WEMWBS scores, we may need to shift our views. As the state of our mental well-being is clearly vulnerable to early experiences, we should ensure our children grow up in families equipped to raise a mentally stable child.

June 30th, 2015

More Evidence Physical Exercise May Improve Thinking in MCI

Maddie Snyder, TBH Summer Intern (Trinity College)

What: A recent study looking at the effects of aerobic training on mild cognitive impairment (MCI) found that the training was associated with improvements on cognitive testing. The subjects, 40 older individuals diagnosed with MCI (MMSE mean score of 27.4), participated in a moderately intense aerobic exercise program twice a week for twenty-four weeks. After the intervention, subjects showed significant improvement on the Alzheimer’s Disease Assessment Scale – Cognitive (ADAS-C), a global measure of cognitive performance.

Why This Matters: This study shows that aerobic training may impact cognitive performance in individuals with mild impairment. This modest but consistent intervention of twice weekly exercise over a 6 month period is a very doable schedule for many of our clients, and it is helpful to see that such a program can demonstrate significant benefit. This finding adds to the literature on the potential benefits of aerobic exercise for the cognitively challenged population.

The Takeaway: All our clients, no matter their cognitive status, can benefit from regular aerobic exercise, even if it is just two days a week. It’s a great reminder to all of us that the next time we run or swim, we are not only working out our heart and lungs, but also our brains.


The “Cocktail Party” Effect in AD | Why A Crowded Room May be Different in Dementia

Margot Radding, TBH Summer Intern (Carleton College)

What: Researchers in the UK sought to explain why individuals suffering from Alzheimer’s disease may have a harder time distinguishing sounds in a noisy environment than cognitively healthy individuals of similar age. They examined functional neuroanatomical differences between those with healthy brains and patients with Alzheimer’s disease by using auditory stimulus testing, where the participant’s name is presented in the foreground or background (using the “cocktail party” effect, where their name is part of the general babble of the conversation). fMRI studies showed that while there was no difference in the part of the brain activated in both groups for the foreground trial, the Alzheimer’s subjects demonstrated significantly enhanced activation of a different part of the brain during the background trial, suggesting a diffusion of effort to interpret the sound.

Why This Matters: The enhanced and diffuse brain activation noted during the background trial in the Alzheimer’s group suggests that the activation is compensatory, such that the subjects in this group struggled more to understand while in the cocktail party environment. Though this compensatory activation is inefficient, it is the brain’s attempt at maintaining functionality. This study, though small, offers an interesting insight into the physiology of what we may observe in AD affected individuals as they work harder to follow conversations or seem to have difficulty processing information.

The Takeaway:  Individuals with Alzheimer’s disease may have greater difficulty understanding verbal communications or taking part in conversations under conditions similar to the “cocktail party” effect, where there is a great deal of background stimulation.

June 17th, 2015
Take the Purple Pledge! Join TBH this Month in Support of Alzheimer’s and Brain Awareness

The month of June marks Alzheimer’s and Brain Awareness Month. Alzheimer’s and related dementias affect millions throughout the U.S. According to the Alzheimer’s Association’s 2014 Facts and Figures Report, more than 5 million people currently live with Alzheimer’s disease. By 2050, this number is expected to skyrocket to as many as 16 million. Alzheimer’s is the 6th leading cause of death in the U.S. and is the only cause of death among the top 10 for which there’s no cure, or even a way to prevent or slow its progression. Finally, Alzheimer’s is currently the most expensive condition in the nation, costing us $214 billion in 2014. As the numbers grow, this impact on our economy will increase as well.

Even less appreciated by many is the devastating impact Alzheimer’s has on not only those caring for someone with the disease, as well as other family, friends and extended communities. Approximately 15.5 million people care for someone with Alzheimer’s in the U.S. today. Caregivers are at increased risk for poor health, emotional distress and social isolation. For many, there is little relief over the long hours of caregiving they provide.

As experts in the field of brain health, we witness on a daily basis the tremendous toll dementia takes on those diagnosed with a memory disorder as well as those caring for them. That is why TBH is pleased to join forces with the Alzheimer’s Association and our partner, NuStep, in efforts to raise awareness and support for those affected by Alzheimer’s disease.

We invite you to join us as well! Here’s how:

  • Join or Donate to a “NuStepping to End Alzheimer’s Team” for The Longest Day ( This year, TBH has partnered with NuStep ( to design brain fitness programming for teams participating in The Longest Day through their NuStepping to End Alzheimer’s campaign. 76+ teams across the country will be working out with their bodies and their minds as they NuStep and take part in our “Step, Think, Give!” brain fitness program designed exclusively for NuStep’s event. You can join an existing team in your area, start a new team, or just show your support by donating to a NuStepping team or writing words of encouragement for on a team’s page.
  • Support our TBH Team! If you are unable to participate yourself but would like to share your support this month, consider supporting us! The TBH staff will be wearing purple and participating in the NuStepping to End Alzheimer’s event as our own team! We welcome you to donate to this great cause or offer us words of encouragement on our team page. 
  • Go Purple on June 21st! Join with us as we take the Purple Pledge and “go purple” for The Longest Day. We will be joining with the Alzheimer’s Association and others around the country on June 21st to raise dementia awareness and show our support for those affected, in particular those caregivers for whom every day is the longest day. 

Click here for more information about The Longest Day. To learn more about TBH’s customized brain fitness content and programming services, please contact at




June 1st, 2015

Moving News: Older Adults Love To Get Active

What: A study in the recent issue of Geriatric Nursing found that older adults are more likely to choose activities that are physically challenging. Using data from over 5,000 community-dwelling, cognitively healthy participants between the ages of 65 and 84 followed as part of the NHATS study, researchers found that 4 out of the 5 activities participants preferred included a good deal of physical engagement, including walking/jogging, outdoor maintenance and playing sports.

Why This Matters: Engaging the bodies, hearts and minds of adults over 65 requires us to understand what kinds of opportunities they seek. This very large study gives professionals great insight to the preferences of adults over 65, and suggests that opportunities to stay physically challenged are very welcome. This study may also reflect the impact of the “baby boom” generation on the desires of active agers, and our own need to shift expectations and – as a result – our strategy when planning activities. This study is especially of interest as other studies have documented a significant decline in physical activity engagement in adults 65+.

The Takeaway: We know that staying physically active is a critical way to promote brain health and successful aging. How great to know that many adults over 65 want those very activities? Look for even more ways to offer physically challenging activities to your active aging clients. For added brain challenge, try opportunities that require “thinking and moving” at the same time, like choreographed dance (ballroom, hip-hop or even an electronic dance game) or juggling.


Proof of Cognitive Reserve? Study Indicates Positive Effects on Age-Related Biomarkers  

What: A recent study published in JAMA Neurology found that individuals with higher cognitive reserve may have a lower susceptibility to age-related changes in key cerebrospinal fluid (CSF) biomarkers associated with Alzheimer’s disease risk. Researchers analyzed known CSF biomarkers in 211 cognitively healthy and 57 AD-affected individuals participating in the Wisconsin Registry for Alzheimer’s Prevention and the Wisconsin Alzheimer’s Disease Research Center. Cognitive reserve status (a theoretical concept suggesting that lifelong intellectual engagement creates a “buffer” against cognitive loss) was estimated based on years of education, with 16 plus years determined to confer high reserve. The study found significant benefit of higher cognitive reserve in reducing the effects of age on the measured CSF biomarkers. There was evidence as well for a dose-related response, where those subjects with more years of education demonstrated a progressively significant and positive effect on CSF biomarker status.

Why This Matters: While epidemiological studies have long shown potential benefits of cognitive reserve to delaying onset of cognitive change or lowering dementia risk, there have been few studies that have demonstrated biological evidence for intellectual engagement. This study also suggests a possible mechanism through which we can better understand the impact of cognitive reserve on risk for memory impairment. It is interesting to note that the study used years of education to estimate cognitive reserve. This could be a message that parents, educators and children need to hear early on. It would be helpful if future studies considered some of the many other factors commonly associated with higher educational status (such as higher lifetime SES, overall higher nutritional status, more frequent utility of healthcare, etc.) to determine their potential impact, as well as the impact of lifelong intellectual engagement as a measure of cognitive reserve.

The Takeaway: Lifelong intellectual engagement has been on everyone’s brain health “to-do” list for quite some time. This study may shed light on the way in which staying mentally active benefits our brains, only adding more reason why we should pursue things that engage our minds throughout our lifetime.

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

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

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.