Building a Better Older Brain

[[{"type":"media","view_mode":"media_crop","fid":"55805","attributes":{"alt":"© ALENA HOVORKOVA/SHUTTERSTOCK.COM","class":"media-image media-image-right","id":"media_crop_7276733826207","media_crop_h":"309","media_crop_image_style":"-1","media_crop_instance":"6994","media_crop_rotate":"0","media_crop_scale_h":"194","media_crop_scale_w":"200","media_crop_w":"319","media_crop_x":"18","media_crop_y":"10","style":"font-size: 13.008px; float: right;","title":"© ALENA HOVORKOVA/SHUTTERSTOCK.COM","typeof":"foaf:Image"}}]][Editor's note: This article is a summary of a presentation on this topic that Dr. Agronin gave at the 29th US Psychiatric & Mental Health Congress, held October 21-24, 2016 in San Antonio.]

Consider the following question: at what age do you think you made better decisions-at 18 or your current age?

Most people do not need to reflect long on their answer and choose their current age, since years of accrued knowledge and experience have brought them a more mature and wiser perspective.

But consider a follow-up question: do you think your decision-making will be better or worse when you are in your 80s and 90s?

On the one hand, our aging brains will not be as efficient or nimble in late life, since we all experience a modest decline in certain cognitive abilities. On the other hand, barring major brain damage, we might continue to grow and develop other cognitive powers because of and not in spite of aging. How can we understand and leverage this process in order to build a better older brain?

If we measure our cognition by looking at discrete neuropsychological abilities on standardized testing, we see 2 key trends emerging with age. Fluid intelligence-defined by problem solving, reasoning, logic, and pattern recognition-begins to decline in middle age and is characterized by slower processing speed, more frequent memory lapses, less efficient multitasking, and a decreased ability to suppress or inhibit distracting stimuli.¹ In contrast, crystallized intelligence-defined by knowledge, vocabulary, skills, and experience-remains stable or increases into late life, with a much later period when declines might occur.^2,3

These changes correspond to declines in neuronal metabolism and increasing neuronal death, yet at the same time neurons can continue to form connections and revise and reroute networks. The main tipping point for many individuals lies in the dramatically increased risk of Alzheimer disease and other neurocognitive disorders. Prevalence rates exceed 50% of the population aged 85 years and older. If we can avoid (and one day cure) dementia in late life, there is an opportunity to build a better brain through the ongoing development of several age-conferred strengths.

Elements of the better brain

There are 3 fundamental elements to a better older brain. The first is the protective base of skills and attributes that we build over time, our reserve. This includes our brain reserve that is the physical density of neurons and neuronal connections that set the threshold for the clinical expression of brain pathology, and our cognitive reserve that represents the abilities and skills that can compensate for brain damage. We also have reserves of ego strength, emotional maturity, motivation, and spirituality that can buffer cognitive decline. The second element of a better brain is our resilience in the face of adversity, enabling us to successfully cope and find ways to resume normal functioning. The third element is our ability to reinvent ourselves by finding creative solutions and novel, purposeful pursuits.

The process of resilience and reinvention is supported by psychologist Laura Carstensen’s⁴ socioemotional selectivity theory, which proposes that we tend to seek out more positive and meaningful activities in later life as our horizon of time looms closer. Put together, these 3 elements of the better older brain involve a maturing and integration of our life skills and experiences under what Gene Cohen⁵ labels our “developmental intelligence.”

Wisdom and creativity

Wisdom may be a cliché with multiple meanings, but generally it refers to being able to apply our accrued knowledge and experience in a balanced, pragmatic, empathic, and insightful way. Wisdom involves a process of reflecting on life experiences and making decisions that serve a higher purpose or virtue. It comes with age but does not depend on being old and has variations based on one’s background and culture.

In 2011, Cohen⁶ suggested that wisdom is based on postformal thinking, in which we mature beyond Piaget’s stage of formal operations (defined by abstract thinking, achieved by late adolescence) and are able to think more relatively, pragmatically, and less egocentrically. Cohen suggests that this wisdom provides a “developmental impetus” to boost our creativity and give us confidence to make necessary changes.

Creativity can also grow with age and does not depend on complete integrity of memory and other cognitive functions. Many older artists, such as the painter Henri Matisse and the dancer Martha Graham, were able to reinvent themselves after late-life health crises and channel their creativity into stunning pursuits. Creativity itself is not confined to artistic pursuits, however, but is a developing skill that can enhance relationships, responses to adversity, and intergenerational and community interactions.⁷

How to get there

There is no magic pill or fountain of youth that can build a better older brain, but there are several key strategies. Studies of centenarians and other long-lived persons from the so-called “blue zones” around the world emphasize the role of active physical and social lifestyles, being connected closely with other people and communal groups, a local and largely plant-based diet, and well-developed senses of purpose, gratitude, confidence, and tolerance.⁸

Physical activity does not need to involve intense body-building or marathon running but a more moderate approach such as walking, swimming, gardening, dancing, or other enjoyable activities several times a week. Aerobic activities provide the most benefit: improved cerebral blood flow, reduced cortical atrophy, and increased release of neural growth factors. Brain fitness may involve regular structured activities, including computerized modules, but may also involve regular, enjoyable intellectual pursuits that cross-train our mental abilities, such as learning a new language, starting a new hobby, or attending lifelong learning programs.

The Mediterranean diet maximizes brain-healthy foods (leafy green and other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil, and wine) and minimizes brain-unhealthy foods (red meats, butter and margarine, cheese, pastries and sweets, and fried and fast foods). The MIND diet combines a Mediterranean diet with the DASH diet (designed for lowering weight and blood pressure) and has been associated with a reduced incidence of Alzheimer disease.⁹

We must also keep in mind that our attitudes toward aging can influence our brain health. Psychologist Becca Levy’s¹⁰ stereotype embodiment theory posits that age stereotypes can become internalized and have an unconscious but truly negative impact on performance, health, and longevity. Ellen Langer’s¹¹ “counterclockwise” study of older men showed that immersion in an environment that reminded them of younger days and forced them to think and act like their younger selves had a significantly positive impact on their overall health and function in just a few weeks.

Together, these brain-healthy approaches will not only build a better brain, but may also reduce the risk or delay the onset of more serious cognitive decline. In his book The Memory Prescription, psychiatrist Gary Small¹² provides a simple 14-day plan to jump-start such an approach. In a later work he provides empirical evidence for the benefits of these factors, and suggests that long-term adoption of a brain-healthy lifestyle might be able to delay the development of dementia for 2 to 4 years.¹³

Ultimately, we increasingly have longer and healthier lives in which to realize a better older brain-and the tools we need are right in front of us.

Disclosures:

Dr. Agronin is a geriatric psychiatrist and Vice President of Behavioral Health and Clinical Research at the Miami Jewish Health Systems in Florida.

References:

1. Schaie KW. Developmental Influences on Adult Intelligence: The Seattle Longitudinal Study. New York: Oxford University Press; 2005.

2. Hendrie HC, Purnell C, Wicklund AH, Weintraub S. Defining and assessing cognitive and emotional health in late life. In: Depp CA, Jeste DV, eds. Successful Cognitive and Emotional Aging. Washington, DC: American Psychiatric Publishing, Inc; 2010:17-36.

3. Powell DH. The Aging Intellect. New York: Routledge; 2011.

4. Carstensen LL. A Long Bright Future. New York: Broadway Books; 2009.

5. Cohen GD. The Mature Mind. New York: Basic Books; 2005.

6. Cohen GD. The geriatric patient. In: Agronin ME, Maletta GJ, eds. Principles and Practice of Geriatric Psychiatry. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2011:15-30.

7. Cohen GD. The Creative Age: Awakening the Human Potential in the Second Half of Life. New York: Harper Collins; 2000.

8. Buettner D. The Blue Zones: 9 Lessons for Living Longer From the People Who’ve Lived the Longest. 2nd ed. Washington, DC: National Geographic Society; 2008.

9. Morris MC, Tangney CC, Wang Y, et al. MIND diet associated with reduced incidence of Alzheimer disease. Alzheim Dement. 2015;11:1007-1014.

10. Levy BR, Slade MD, Kunkel SR, Kasl SV. Longevity increased by positive self-perceptions of aging. J Pers Soc Psychol. 2002;83:261-270.

11. Langer EJ. Counterclockwise: Mindful Health and the Power of Possibility. New York: Ballantine Books; 2009.

12. Small G, Vorgan G. The Memory Prescription: Dr. Gary Small’s 14-Day Plan to Keep Your Brain and Body Young. New York: Hyperion; 2004.

13. Small G, Vorgan G. The Alzheimer Prevention Program: Keep Your Brain Healthy for the Rest of Your Life. New York: Workman Publishing Co; 2011.