Enthusiasm Good for Brain

JAN 31, 2012

To Harness Neuroplasticity, Start with Enthusiasm

By: Dr. Helena Popovic

We are the archi­tects and builders of our own brains.

For mil­len­nia, how­ever, we were obliv­i­ous to our enor­mous cre­ative capa­bil­i­ties. We had no idea that our brains were chang­ing in response to our actions and atti­tudes, every day of our lives. So we uncon­sciously and ran­domly shaped our brains and our lat­ter years because we believed we had an immutable brain that was at the mercy of our genes.

Noth­ing could be fur­ther from the truth.

The human brain is con­tin­u­ally alter­ing its struc­ture, cell num­ber, cir­cuitry and chem­istry as a direct result of every­thing we do, expe­ri­ence, think and believe. This is called “neu­ro­plas­tic­ity”.  Neu­ro­plas­tic­ity comes from two words: neu­ron or nerve cell and plas­tic, mean­ing mal­leable or able to be molded.

The impli­ca­tions of neu­ro­plas­tic­ity are enor­mous: we have the abil­ity to keep our brains sharp, effec­tive and capa­ble of learn­ing new skills well into our 90s, if we pro­tect our brains from dam­ag­ing habits and give them ongo­ing stim­u­la­tion and appro­pri­ate fuel. One way to illus­trate this is to think of the brain and mind as a large boat, com­plete with cap­tain and crew, sail­ing the ocean blue.

The cap­tain makes the deci­sions and gives the orders, which the loyal crew fol­low. With­out a cap­tain, the boat would be direc­tion­less. With­out a crew, the day-to-day run­ning of the boat would be impos­si­ble. The crew know their role and don’t need the cap­tain to tell them how to do their job or to remind them of their job on a daily basis. They’re very well trained. The cap­tain only noti­fies the crew if he or she wants some­thing to change and takes charge when­ever lead­er­ship is required. As for the boat, it needs to be kept in good nick and fuelled on a reg­u­lar basis.

The cap­tain, the crew and the boat form a sin­gle, inter­de­pen­dent unit, each party influ­enc­ing the other two. If the cap­tain and crew don’t do their job prop­erly, the boat can get dam­aged and end up in dis­re­pair. If the boat is dam­aged, the jour­ney is more ardu­ous; in par­tic­u­lar, rough seas are more dif­fi­cult to han­dle. If the cap­tain is apa­thetic, incom­pe­tent or drunk, there is an absence of lead­er­ship. And if the cap­tain and crew are in con­stant dis­agree­ment, they won’t get very far.

How does this relate to the brain and mind? The cap­tain rep­re­sents the con­scious mind; the crew rep­re­sent the sub­con­scious mind; the boat is the brain; and the ocean is life.

The con­scious mind is the think­ing part of our­selves. It sets goals, makes deci­sions and inter­prets expe­ri­ences. The sub­con­scious mind is the part of our­selves beneath our con­scious aware­ness that keeps us alive and run­ning. It’s what keeps our hearts pump­ing, our lungs expand­ing and our hair grow­ing. We don’t con­sciously say to our­selves, “Pump, breathe, grow!”—these things are han­dled sub­con­sciously, through the auto­nomic ner­vous sys­tem. The num­ber one pri­or­ity of the sub­con­scious mind is our sur­vival: phys­i­cal, emo­tional and psy­cho­log­i­cal. This is why our sub­con­scious plays a pow­er­ful role in dic­tat­ing behav­iour. It pri­ori­tises our emo­tional well­be­ing over our con­scious wants. It’s why some­times we con­sciously think we want one thing, but still end up doing another. One rea­son that diets don’t work is they don’t address sub­con­scious issues that may be at play. We always sab­o­tage our efforts if the sub­con­scious pay-offs for not chang­ing over­ride the con­scious desire to lose weight. Finally, the brain is the ves­sel through which our con­scious and sub­con­scious minds operate.

Based on the anal­ogy of boat, cap­tain and crew, the fol­low­ing is an overview of how we can boost our brains.

1. Don’t dam­age the boat.
On day one in med­ical school, I was taught Pri­mum non nocere—“First do no harm”. No boat owner would know­ingly dam­age their boat, so it fol­lows that no human would know­ingly dam­age his brain. Apart from the obvi­ous injury caused by falling off lad­ders and falling into ille­gal drugs, things which harm the brain and reduce our cog­ni­tive abil­i­ties include smok­ing, stress, sleep depri­va­tion, soft drinks, seden­tary lifestyles, exces­sive alco­hol, junk food, high blood pres­sure, high cho­les­terol lev­els, obe­sity, lone­li­ness, pes­simism and neg­a­tive self-talk. Goal num­ber one is to avoid these dam­ag­ing entities.

2. Dock the boat in stim­u­lat­ing sur­round­ings.
Our brain func­tion improves in every mea­sur­able way when we find our­selves in envi­ron­ments that are men­tally, phys­i­cally and socially stim­u­lat­ing. Adven­ture pre­vents dementia!

3. Fuel it the finest.
Our dietary choices affect not only the health of our bod­ies but also the health of our brains. In fact our brains con­sume one fifth of all the nutri­ents and kilo­joules we ingest. What we eat has a sig­nif­i­cant impact on our neu­ro­trans­mit­ters (chem­i­cals that carry mes­sages between neu­rons across synapses), our alert­ness, our mood and our cog­ni­tive functioning.

4. Keep the cargo light.
Obe­sity is a major risk fac­tor for dementia.

5. Run the motor.
With­out phys­i­cal exer­cise our brains waste away as much as our mus­cles waste away. Exer­cise actu­ally induces the growth of new brain cells.

6. Learn the ropes and keep on learn­ing.
Hav­ing a good edu­ca­tion and engag­ing in life­long, active learn­ing help to pro­tect us from demen­tia and con­tribute to our devel­op­ing “cog­ni­tive reserve”. This reserve acts as a buffer against men­tal decline as we age.

7. Sail to new shores.
Bore­dom and monot­ony are poi­so­nous to our brains. We need to get out there, get explor­ing and get out of our com­fort zones. We need to sail to new shores to find riches out­side our usual bound­aries. We need to change our rou­tines, do things dif­fer­ently and give our­selves ongo­ing challenges.

8. Use it or lose it.
This applies to every func­tion of the brain and body, from study­ing to social­is­ing to sex. In order to main­tain our capac­ity for learn­ing new skills, we need to engage in learn­ing new skills on a reg­u­lar basis.  In order to become cre­ative, inven­tive and re-sourceful, we need to give our­selves tasks that require cre­ativ­ity, inven­tive­ness and resource­ful­ness. In order to have a good mem­ory, we need to make a con­scious effort to pay atten­tion. In order to remain socially adept, we need to remain socially active.

9. Train it and regain it.
If we lose a spe­cific brain func­tion, all is not lost. Pro­gres­sive, per­sis­tent, goal-focused prac­tice can help us regain the lost function.

10. Charge the bat­tery.
Still­ing the mind is as impor­tant as stim­u­lat­ing the mind. Get­ting ade­quate sleep and press­ing the pause but­ton on our mind chat­ter are essen­tial for peak per­for­mance on a day-to-day basis, as well as preser­va­tion of brain func­tion as we age.

11. Con­nect with fel­low trav­ellers.
Life­long social inter­ac­tion and mean­ing­ful con­nec­tion with oth­ers is vital for a healthy brain.

12. Choose the des­ti­na­tion.
The brain is a tele­o­log­i­cal device—it is fed by hav­ing goals to strive for and aspi­ra­tions to work towards. The clearer we are about where we want to go and what we want to achieve, the more effec­tive the brain is in accom­plish­ing the required tasks. This is anal­o­gous to the cap­tain giv­ing the crew clear instruc­tions about where they’re going and what is expected of them.

13. Com­mand the crew.
Hav­ing decided on what we want, we need to direct our self-talk to sup­port our goals. Our inter­nal dia­logue is a con­stant stream of instruc­tions to the sub­con­scious mind. Uplift­ing, solution-focused self-talk switches on brain cell activ­ity; neg­a­tive, dis­cour­ag­ing self-talk damp­ens it.

14. Com­mu­ni­cate grat­i­tude.
When we think about what we’re thank­ful for, we wire our brains to con­tinue find­ing things to be thank­ful for. Our brains are designed so that we see what­ever we’re look­ing for. We are never objec­tive, even when we make a con­certed effort to be so. Sub­jec­tiv­ity always enters our per­cep­tions. We don’t see things as they are; we see things as we are. There­fore, by reg­u­larly reflect­ing on things that we’re grate­ful for, we con­struct a fil­ter through which we see the world and we cre­ate more expe­ri­ences for which to feel grateful.

15. Prac­tise per­fectly.
When we prac­tise a skill in our imag­i­na­tions, the same neu­rons are fir­ing as if we were per­form­ing the skill in real life! If we see our­selves exe­cut­ing a task per­fectly in the mind’s eye, we become bet­ter at it in the real world because every men­tal rehearsal increases the effi­ciency of elec­tri­cal trans­mis­sions between the involved nerve cells. Men­tal prac­tice tur­bocharges our progress.

16. Bon voy­age!
Enjoy the jour­ney! Get excited about where you’re going. Pas­sion, enthu­si­asm and excite­ment are the most pow­er­ful brain fuels of all. The word enthu­si­asm comes from the Greek entheos, mean­ing “to be divinely inspired or pos­sessed by a god”.

Ralph Waldo Emer­son observed, “Noth­ing great has ever been achieved
with­out enthu­si­asm.”

– Dr Helena Popovic MBBS is an Australia-based med­ical doc­tor, researcher, fit­ness trainer, inter­na­tional speaker and author of In Search of My Father: Demen­tia is no match 

Lying to Patients

From Medscape Internal Medicine > Ethics: Today's Hot Topics

Lying to Patients: No Huge Ethical Failure, Says Bioethicist

Arthur L. Caplan, PhD

I am Art Caplan, and I am at the University of Pennsylvania in the Department of Medical Ethics and Health Policy. Today I would like to talk to you about a pretty thorny subject and one that is fascinating because it is so ethically rich: Should doctors ever lie to their patients?

The trigger for this discussion is a study that just came out that found that doctors do lie. In fact, the study found that 20% of more than 2000 doctors surveyed admitted that they had not told patients the truth when an error had taken place. They found out that more than 10% hadn't discussed financial conflicts of interest, and 15% said they gave a rosier picture about prognosis and risk and benefit with respect to a disease.

There has been a good deal of interest in this survey, and the public and some media reports are saying that this is shocking. We expect our physicians to always be truthful; this survey apparently shows that there is a considerable amount of lying going on, withholding of the truth, and not being forthright. What's wrong? Is there a huge ethical failure going on out there among doctors and medical practitioners?

The answer is no. It is inexcusable and not advisable to lie about an error. You may dodge a bullet on that one by having the patient not find out, but if it really affects their care, if they wind up harmed, if they wind up having to pay more and it comes out later that you didn't tell the truth or that there was an omission of the fact that an error occurred, you are going to get clobbered. I have seen it again and again in courtrooms. It may seem the easiest way out, to avoid telling the truth when an error takes place, but getting it out there and getting it over with early is the best protection in terms of malpractice associated with error. It isn't lying.

With respect to financial conflict of interest, patients have a right to know about it, and it should be brought up. But a lot of patients don't care, so you can get around that very quickly. You don't have to lie or withhold information. You can simply offer the patient the opportunity to know that you see a lot of drug representatives or that you went out to dinner and learned about this drug, and they probably will say, "Doctor, I don't care. What do you think is the right thing for me to do?" Making the offer is a better way to deal with something that a lot of patients don't think is all that important.

What about that circumstance in which a better prognosis is offered than is really the case for the patient? That circumstance, and a couple of other topics, are real ethical gray zones. It is not as clear that lying is always bad. Think about the use of a placebo. If you think that you can save a patient money and save them a lot of risk and side effects by giving them a placebo to see if it will calm their anxiety or help restore their sexual function, I am not sure that it is always wrong to prescribe a placebo. It is controversial, but I am not sure one is always wrong in trying to deal with a difficult or noncompliant patient, or one who has a bad, unhealthy lifestyle.

Is it wrong to "up the ante" a little bit and scare the patient more than you might otherwise about the consequences that might follow from their bad behavior? I am not sure that that is wrong either. The goal is good, and by being a little bit on the far end of the truth about what could happen to them, I am not sure that it isn't worth it. With respect to the "rosy prognosis," if someone has cancer or Parkinson disease or Alzheimer disease, I'm not sure that they want to hear in the first visit exactly what is going to happen to them or the grim nature of the statistics.

You might say that telling the truth is a noble thing to do, an important thing to do, and it is the way that we are going to keep patients trusting the doctor. At the same time, however, truth is not an event; it is a process. The survey may have failed to capture that insight. Telling the truth is important, but letting it come across in a humane way, letting it come across sometimes in "dribs and drabs" so that the patient can absorb it and not be psychologically devastated or emotionally harmed, is the right thing to do.

So, don't lie about mistakes, don't lie about conflict of interest, and be forthright when things go wrong. When there is a reason not to be trusted, let the patient decide how they want to manage that. Truth is a better policy. In some other areas, the truth, although it ought to come out eventually, is probably something that is more of a tool to be worked with in trying to help patients than it is an absolute necessity all of the time.

Education for Mental Fitness: “A Sharper Mind, Middle Age and Beyond”

JAN 19, 2012

By: Alvaro Fernandez

Kudos to Patri­cia Cohen for one of the best arti­cles I have read in The New York Times in a long time: A Sharper Mind, Mid­dle Age and Beyond, by Patri­cia Cohen. These are a few quotes — please do read the arti­cle in full, it is worth it.

• “Some peo­ple are much bet­ter than their peers at delay­ing age-related declines in mem­ory and cal­cu­lat­ing speed. What researchers want to know is why. Why does your 70-year-old neigh­bor score half her age on a mem­ory test, while you, at 40, have the mem­ory of a senior cit­i­zen? If inves­ti­ga­tors could bet­ter detect what pro­tects one person’s men­tal strengths or chips away at another’s, then per­haps they could devise a pro­gram to halt or reverse decline and even shore up improvements.”
• “As it turns out, one essen­tial ele­ment of men­tal fit­ness has already been iden­ti­fied. “Edu­ca­tion seems to be an elixir that can bring us a healthy body and mind through­out adult­hood and even a longer life,” says Margie E. Lach­man, a psy­chol­o­gist at Bran­deis Uni­ver­sity who spe­cial­izes in aging. For those in midlife and beyond, a col­lege degree appears to slow the brain’s aging process by up to a decade, adding a new twist to the cost-benefit analy­sis of higher edu­ca­tion — for young stu­dents as well as those think­ing about return­ing to school.”
• “Many researchers believe that human intel­li­gence or brain­power con­sists of dozens of assorted cog­ni­tive skills, which they com­monly divide into two cat­e­gories. One bunch falls under the head­ing “fluid intel­li­gence,” the abil­i­ties that pro­duce solu­tions not based on expe­ri­ence, like pat­tern recog­ni­tion, work­ing mem­ory and abstract think­ing, the kind of intel­li­gence tested on I.Q. exam­i­na­tions. These abil­i­ties tend to peak in one’s 20s.”
• “Crys­tal­lized intel­li­gence,” by con­trast, gen­er­ally refers to skills that are acquired through expe­ri­ence and edu­ca­tion, like ver­bal abil­ity, induc­tive rea­son­ing and judg­ment. While fluid intel­li­gence is often con­sid­ered largely a prod­uct of genet­ics, crys­tal­lized intel­li­gence is much more depen­dent on a bou­quet of influ­ences, includ­ing per­son­al­ity, moti­va­tion, oppor­tu­nity and culture.
• “At a time when the prospect of a longer life is shad­owed by the fear of men­tal decline, the pos­si­bil­ity that the aging can have some con­trol over their men­tal fit­ness is an idea even William Osler would support.”

Full arti­cle: A Sharper Mind, Mid­dle Age and Beyond, by Patri­cia Cohen.

Build Your Cognitive Reserve

 sharpbrains » JUL 23, 2007

Build Your Cognitive Reserve-Yaakov Stern
By: Alvaro Fernandez

Dr. Yaakov Stern is the Divi­sion Leader of the Cog­ni­tive Neu­ro­science Divi­sion of the Sergievsky Cen­ter, and Pro­fes­sor of Clin­i­cal Neu­ropsy­chol­ogy, at the Col­lege of Physi­cians and Sur­geons of Colum­bia Uni­ver­sity, New York.
 He is one of the lead­ing pro­po­nents of the Cog­ni­tive reserve the­ory, which aims to explain why some indi­vid­u­als with full Alzheimer’s pathol­ogy (accu­mu­la­tion of plaques and tan­gles in their brains) can keep nor­mal lives until they die, while oth­ers –with the same amount of plaques and tan­gles– dis­play the severe symp­toms we asso­ciate with Alzheimer’s Dis­ease.
He has pub­lished dozens of peer-reviewed sci­en­tific papers on the subject.

 The con­cept of a Cog­ni­tive Reserve has been around since 1989, when a post mortem analy­sis of 137 peo­ple with Alzheimer’s Dis­ease showed that some patients exhib­ited fewer clin­i­cal symp­toms than their actual pathol­ogy sug­tested.
These patients also showed higher brain weights and greater num­ber of neu­rons when com­pared to age-matched con­trolls.
The inves­ti­ga­tors hypoth­e­sized that the patients had a larger “reserve” of neu­rons and abil­i­ties that enable them to off­set the losses caused by Alzheimer’s.
Since then, the con­cept of Cog­ni­tive Reserve has been defined as the abil­ity of an indi­vid­ual to tol­er­ate pro­gres­sive brain pathol­ogy with­out demon­strat­ing clin­i­cal cog­ni­tive symp­toms.

 Key take-aways -
Life­time expe­ri­ences, like edu­ca­tion, engag­ing occu­pa­tion, and leisure activ­i­ties, have been shown to have a major influ­ence on how we age, specif­i­cally on whether we will develop Alzheimer’s symp­toms or not.
This is so because stim­u­lat­ing activ­i­ties, ide­ally com­bin­ing phys­i­cal exer­cise, learn­ing and social inter­ac­tion, help us build a Cog­ni­tive Reserve to pro­tect us.
The ear­lier we start build­ing our Reserve, the bet­ter; but it is never too late to start.
And, the more activ­i­ties, the bet­ter: the effect is cumulative.

The Cog­ni­tive Reserve
 Alvaro Fer­nan­dez (AF): Dear Dr. Stern, it is a plea­sure to have you here. Let me first ask you this: the impli­ca­tions of your research are pretty astound­ing, pre­sent­ing major impli­ca­tions across sec­tors and age groups. What has been the most unex­pected reac­tion so far?

 YS: well…I was pretty sur­prised when, years ago, a reporter from Sev­en­teen mag­a­zine requested an inter­view. I was really curi­ous to learn why she felt that her read­ers would be inter­ested in stud­ies about demen­tia. What she told me showed a deep under­stand­ing and insight: she wanted to moti­vate chil­dren to stay in school. She under­stood that early social inter­ven­tions could be very pow­er­ful for build­ing reserve and pre­vent­ing dementia.

 AF: That’s great…so let’s now fast for­ward, say, 60 years from our high-school years, and sup­pose that per­sons A and B both tech­ni­cally have Alzheimer’s (plaques and tan­gles appear in the brain), but only A is show­ing the dis­ease symp­toms. What may explain this discrepancy?

 YS: Indi­vid­u­als who lead men­tally stim­u­lat­ing lives, through edu­ca­tion, occu­pa­tion and leisure activ­i­ties, have reduced risk of devel­op­ing Alzheimer’s. Stud­ies sug­gest that they have 35–40% less risk of man­i­fest­ing the dis­ease. The pathol­ogy will still occur, but they are able to cope with it bet­ter. Some won’t ever be diag­nosed with Alzheimer’s because they don’t present any symp­toms. In stud­ies that fol­low healthy elders over time and then get autop­sies, up to 20% of peo­ple who did not present any sig­nif­i­cant prob­lem in the daily lives have full blown Alzheimer’s pathol­ogy in their brains.

 AF: What exactly may be going on in the brain that pro­vides that level of protection?

 YS: There are two ideas that are com­ple­men­tary. One idea (called Brain Reserve by researchers) pos­tu­lates that some indi­vid­u­als have a greater num­ber of neu­rons and synapses, and that some­how those extra struc­tures pro­vide a level of pro­tec­tion. In a sense, we have more “hard­ware”, pro­vid­ing a pas­sive pro­tec­tion against the attacks of Alzheimer’s.
The other the­ory (called Cog­ni­tive Reserve) empha­sizes the build­ing of new capa­bil­i­ties, how peo­ple can per­form tasks bet­ter through prac­tice, and how these skills become so well learned that they are not too easy to unlearn. Like devel­op­ing new and refined “software”.

 AF: But, both seem to go hand in hand, cor­rect? Neu­ro­plas­tic­ity means that what you call “hard­ware” and “soft­ware” are two sides of the same coin and they influ­ence each other, right?

 YS: Cor­rect. So these days we don’t make a sharp dis­tinc­tion, and are con­duct­ing more neu­roimag­ing stud­ies to bet­ter under­stand the rela­tion­ship between both.

 Build­ing Your Cog­ni­tive Reserve

 AF: OK, so our goal is to build that Reserve of neu­rons, synapses, and skills. How can we do that? What defines “men­tally stim­u­lat­ing activ­i­ties” or good “brain exercise”?

 YS: In sum­mary, we could say that “stim­u­la­tion” con­sists of engag­ing in activ­i­ties. In our research almost all activ­i­ties are seen to con­tribute to reserve. Some have chal­leng­ing lev­els of cog­ni­tive com­plex­ity, and some have inter­per­sonal or phys­i­cal demands.
In ani­mal stud­ies, expo­sure to an enriched envi­ron­ment or increased phys­i­cal activ­ity result in increased neu­ro­ge­n­e­sis (the cre­ation of new neu­rons).
You can get that stim­u­la­tion through edu­ca­tion and/ or your occu­pa­tion. There is clear research show­ing how those two ele­ments reduce the risk.
Now, what is very excit­ing is that, no mat­ter one’s age, edu­ca­tion and occu­pa­tion, our level of par­tic­i­pa­tion in leisure activ­i­ties has a sig­nif­i­cant and cumu­la­tive effect.
A key mes­sage here is that dif­fer­ent activ­i­ties have inde­pen­dent, syn­er­gis­tic, con­tri­bu­tions, which means the more things you do and the ear­lier you start, the bet­ter.
But you are never stuck: bet­ter late than never.

 AF: Can you give us some exam­ples of those leisure activ­i­ties that seem to have the most pos­i­tive effects?
 YS: For our 2001 study we eval­u­ated the effect of 13 activ­i­ties, com­bin­ing intel­lec­tual, phys­i­cal, and social ele­menus.
Some of the activ­i­ties with the most effect were read­ing, vis­it­ing friends or rel­a­tives, going to movies or restau­rants, and walk­ing for plea­sure or going on an excur­sion.
As you can see, a vari­ety. We saw that the group with high level of leisure activ­i­ties pre­sented 38% less risk (con­trol­ling for other fac­tors) of devel­op­ing Alzheimer’s symp­toms.
And that, for each addi­tional type of activ­ity, the risk got reduced by 8%.
There is an addi­tional ele­ment that we are start­ing to see more clearly.
Phys­i­cal exer­cise, by itself, also has a very ben­e­fi­cial impact on cog­ni­tion. Only a few months ago researchers were able to show for the first time how phys­i­cal activ­ity pro­motes neu­ro­ge­n­e­sis in the human brain. So, we need both men­tal and phys­i­cal exer­cise.
The not-so-good news is that, as of today, there no clear recipe for suc­cess. More research is needed before we pre­pare a sys­tem­atic set of inter­ven­tions that can help max­i­mize our protection.

 AF: We typ­i­cally empha­size the impor­tance of a good nutri­tion, phys­i­cal exer­cise, stress man­age­ment and men­tal exer­cise that presents nov­elty, vari­ety and chal­lenge. What do you think of the rel­a­tively recent appear­ance of so many computer-based cog­ni­tive train­ing pro­grams, some more science-based than others?

 YS: Those ele­ments you men­tion make sense. The prob­lem is that, at least from the point of view of Alzheimer’s, we can­not be much more spe­cific. We don’t know if learn­ing a new lan­guage is more ben­e­fi­cial than learn­ing a new musi­cal instru­ment or using a computer-based pro­gram. A few of the cog­ni­tive train­ing com­puter pro­grams we have seen, like the one you dis­cussed with Prof. Daniel Gopher to train the men­tal abil­i­ties of pilots, seem to have clear effects on cog­ni­tion, gen­er­al­iz­ing beyond the train­ing itself. But, for the most part, it is too early to tell the long-term effects. We need bet­ter designed clin­i­cal tri­als with clear con­trols. Right now, the most we can say is that those who lead men­tally stim­u­lat­ing lives, through edu­ca­tion, occu­pa­tion and leisure activ­i­ties seem to have the least risk of devel­op­ing Alzheimer’s Disease.

 Research inter­ests
 AF: Tell us know a bit more about your cur­rent research
 YS: We are study­ing a num­ber of related areas, apply­ing neu­roimag­ing tech­niques to under­stand how exactly all these Cog­ni­tive Reserve con­cepts are imple­mented in the brain. One, we want to under­stand indi­vid­ual dif­fer­ences in how peo­ple approach tasks. We want to mea­sure their effi­ciency and capac­ity the brain net­works that medi­ate tasks per­for­mance with the idea that those with greater effi­ciency and capac­ity might cope bet­ter with age-related prob­lems.
For exam­ple, we can all under­stand that a com­pet­i­tive swim­mer is going to swim bet­ter than I would even if he has some weights in his legs, but we haven’t yet iden­ti­fied what exactly is the equiv­a­lent in the brain. Sec­ond, we want to under­stand how old peo­ple com­pen­sate for the areas of decline.
For exam­ple, do they begin to use new brain areas when the ones that are typ­i­cally used start to fail. Third, whether the Cog­ni­tive Reserve presents ben­e­fits beyond the pre­ven­tion of Alzheimer’s symp­toms. Does hav­ing a higher reserve result in bet­ter atten­tion, bet­ter exec­u­tive func­tions, more suc­cess­ful aging overall?

 AF: All very impor­tant top­ics. And I am sure every­one read­ing this inter­view will devour any new details on how to build our Cog­ni­tive Reserves. Thank you for your time, and please keep us informed.

 YS: My plea­sure. Thank you for your great edu­ca­tional initiative. ————————————

Sexual Activity n Heart cases

From Heartwire
 Lisa Nainggolan
 January 19, 2012 (Houston, Texas)

 New advice indicates that sexual activity is safe for the majority of heart disease patients and that doctors--as well as patients and their partners--should endeavor to bring up the subject of sex in discussions.
The guidance comes from the first-ever American Heart Association (AHA) scientific statement to address the issue, which is published online today in Circulation.
 Lead author Dr Glenn N Levine (Baylor College of Medicine, Houston, TX) told heartwire that the recommendations are probably the most comprehensive on the subject to date and have been compiled by experts from various fields, including cardiology, exercise physiology, sexual counseling, and urology. Physicians, patients, and partners are reluctant to talk about sexual activity, but it is something "that is important to quality of life for most people, and we would not want to see patients refraining from sex out of undue concern about precipitating a heart attack or sudden death," he observes.

 We would not want to see patients refraining from sex out of undue concern about precipitating a heart attack or sudden death.
 The only patients who should refrain from sex are those with unstable heart disease or severe symptoms; they should be assessed and stabilized with appropriate treatment before engaging in sexual activity, says Levine. And drugs that can improve cardiovascular symptoms or survival should not be withheld due to concerns that they may have an impact on sexual function, he notes.

 He also stresses that while use of phosphodiesterase-5 (PDE-5) inhibitor erectile-dysfunction drugs, such as sildenafil (Viagra, Pfizer) are generally safe for men who have stable cardiovascular disease, these agents are absolutely contraindicated in patients receiving nitrate therapy, either long-acting preparations or sublingual ones. Fear, Anxiety, and Depression Can Underlie Avoidance of Sex

 The AHA guidance gives general recommendations for sexual activity and CVD but also advice pertaining to patients with specific conditions: coronary artery disease; heart failure; valvular heart disease; those with arrhythmias and/or pacemakers or implantable cardioverter defibrillators (ICDs); congenital heart disease; and hypertrophic cardiomyopathy. And it covers cardiovascular drugs and sexual function as well as pharmacotherapy for sexual dysfunction.

 One of the main purposes of the statement "is to make physicians and healthcare providers aware that this is a real issue that is not appropriately addressed with the patient and partner and truly should be," says Levine. "

At the same time--because we are getting a lot of lay press attention to this issue--we hope to make patients and their partners aware that sexual activity is something they should feel free to discuss with their healthcare providers during an office visit or before hospital discharge.
 We hope to make patients and their partners aware that sexual activity is something they should feel free to discuss with their healthcare providers.
 "The important thing to emphasize is that the risk of heart attack with sexual activity is only extremely modestly increased during sexual activity and represents only a miniscule amount of a person's overall risk."
 Levine also wants to highlight the fact that anxiety and depression should be important considerations in patients with cardiovascular disease and can contribute to reduced or impaired sexual activity.
"Sexual counseling of CVD patients and their partners is an important component of recovery; unfortunately, it is rarely provided," he and his coauthors observe.
 Advice Should Help All Doctors to Advise CVD Patients on Sex The scientific statement has been published in a cardiology journal, Levine notes, because "the cardiologist is going to be asked to comment on this, and frequently the GP will often refer the patient to the cardiologist to address issues" relating to sexual activity, he notes.
For example, one subject he is frequently consulted about by other doctors is whether patients can use erectile-dysfunction drugs. Levine hopes, however, that the new recommendations will embolden other specialists to confidently advise patients: "One of the aims is to allow GPs, family doctors, and others to, at least for the majority of patients, give reasonable guidance." Another important consideration raised in the AHA statement--which is also endorsed by the American Urological Association, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association of Cardiovascular and Pulmonary Rehabilitation, International Society of Sexual Medicine, American College of Cardiology Foundation, Heart Rhythm Society, and Heart Failure Society of America--is that cardiac rehabilitation and regular physical activity can reduce the risk of cardiovascular complications in people with heart disease.
 Exercise testing can also provide additional information as to the safety of sexual activity in patients with indeterminate or unclear risk, the authors note.

 They conclude that further research is needed on sexual activity in specific cardiovascular conditions, particularly with regard to the effects in females and in older adults.
 Levine has reported that he has no conflicts of interest. Disclosures for the coauthors are listed in the paper.

Even Mild Dehydration May Cause Emotional, Physical Problems

From WebMD Health News Denise Mann January 20, 2012 Even mild dehydration may affect our moods and ability to concentrate. In a new study of 25 healthy women, mild dehydration dampened moods, increased fatigue, and led to headaches. The women in the study were aged 23, on average. They were neither athletes nor couch potatoes. Women participated in three experiments separated by 28 days. In two of these, dehydration was induced via walking on a treadmill with or without a diuretic pill. These pills encourage urination, and can lead to dehydration. The women were given a battery of tests measuring their concentration, memory, and mood when they were dehydrated and when they were not. Overall, women’s mental ability was not affected by mild dehydration. But they did have an increase in perception of task difficulty and lower concentration. But “women were more fatigued and this was true during mild exercise and when sitting at a computer,” says researcher Lawrence E. Armstrong, PhD. He is a professor of environmental and exercise physiology at the University of Connecticut's Human Performance Laboratory in Storrs, Conn. The findings appear in The Journal of Nutrition. Armstrong and colleagues previously looked at the effects of mild dehydration in men. Although men did experience some subtle mental difficulties when dehydrated, the risks were pretty similar between the sexes. The message is clear, he says: “We should focus on hydration and continue to drink during meals and when we are not at meals.” Avoid Dehydration: Drink More Water You are often already dehydrated once you become thirsty, but subtle cues like a headache and/or fatigue can be your body’s way of telling you to drink more water, Armstrong says. The new study should serve as a reminder for healthy, young women who frequently exercise to drink water, says Robert Glatter, MD. He is an emergency medicine physician at Lenox Hill Hospital in New York City. “Consume moderate quantities of water both during and after exercise in order to avoid mild dehydration, which may lead to headaches, fatigue, and difficulty concentrating,” he says in an email. “Just a small change in state of hydration was enough to affect mood, ability to concentrate, and lead to development of headaches.” It is unclear if these findings apply to other populations at risk for dehydration, such as the elderly, people with diabetes, and children, Glatter says. The best way to avoid becoming dehydrated is to drink an adequate amount of water. Olveen Carrasquillo, MD, agrees. He is the chief of the division of general internal medicine at University of Miami Miller School of Medicine. So, how much water do we need? “For most healthy people, six to eight glasses of 8 ounces of water a day is what we recommend,” he says. The effects of even mild dehydration are likely to be even more pronounced in high-risk groups, such as the elderly and young children. Knowing the signs of dehydration can also keep you out of the danger zone. Another sign is dark urine. “Your urine should be a light yellow color,” Glatter tells WebMD. Not everyone needs to drink this much water. “People with congestive heart failure and people with certain kinds of kidney disease may want to limit their fluid intake, and should talk to their doctor about how much water they should drink,” he says. SOURCES: Armstrong L.E. Journal of Nutrition, 2102.

Physical Activity Yields Better Academic Performance in Children

From Medscape Education Clinical Briefs News Author: Larry Hand CME Author: Penny Murata, MD 01/10/2012 Clinical Context The evidence for a relationship between physical activity and academic performance is not conclusive. A review by Trudeau and Shephard in the February 25, 2008, issue of the International Journal of Behavioral Nutrition and Physical Activity found a positive link between physical activity and academic performance, based on cross-sectional studies. A review by Taras in the August 2005 issue of the Journal of School Health reported possible acute benefits of physical activity on academic performance. This systematic review by Singh and colleagues assesses the longitudinal relationship between physical activity and academic performance in children. Study Synopsis and Perspective Concerned that physical activity times in schools might be cut back to make room for more academic study to improve test scores, researchers in the Netherlands conducted a systematic review of published studies and found that moderate to vigorous physical activity may actually improve academic performance in children and adolescents. In an article published in the January issue of the Archives of Pediatrics and Adolescent Medicine, researchers led by Amika Singh, PhD, from the Vrije Universiteit University Medical Center at EMGO Institute for Health and Care Research in Amsterdam, the Netherlands, write, "According to the best-evidence synthesis, we found strong evidence of a significant positive relationship between physical activity and academic performance." After searching 4 databases, the researchers screened 844 potentially related articles and determined that 14 qualified as relevant to their hypothesis. Of those 14 studies, 12 were performed in the United States, 1 was Canadian, and 1 was South African. Sample sizes ranged from 53 to 12,000 individuals aged 6 through 18 years, and follow-up duration ranged from 8 weeks to more than 5 years. The researchers rated only 2 of the 14 studies as having high methodologic quality. One of those studies was observational and the other was interventional. "[B]oth high-quality studies supported our hypothesis of physical activity being positively related to academic performance in children," they write. The studies they reviewed measured physical activity based on school athletic participation, self-reported physical activity questionnaires, or in the case of intervention studies, increased physical activity in schools during the study period. The studies measured academic achievement by self-reported grades, by cognitive test scores, or by both. The academic areas included reading, math, world studies, and history. The researchers concluded that although few published studies have assessed the link between physical activity and academic performance, enough evidence exists to report that "physical activity is positively related to academic performance in young people." They call for more high-quality studies to explore the mechanisms of such a relationship and to explore more physical activities than just school sports participation. The authors have disclosed no relevant financial relationships. Arch Pediatr Adolesc Med. 2012;166:49-55. Abstract