Wednesday, February 29, 2012

Brain Exercise n Brain Health

Brain Exercise and Brain Health FAQs

Below you have a quick “email inter­view” we had yes­ter­day with a jour­nal­ist, it may help you nav­i­gate through this emerg­ing field. (if you want some brain exer­cise right now, you can check our Top 50 Brain Teasers).

1. Why is it so impor­tant to exer­cise our brains?

Our brains are com­posed of dif­fer­ent areas and func­tions, and we can strengthen them through men­tal exer­cise– or they get atro­phied for lack of prac­tice. The ben­e­fits are both short-term (improved con­cen­tra­tion and mem­ory, sus­tained men­tal clar­ity under stress­ful sit­u­a­tions…), and long-term (cre­ation of a “brain reserve” that help pro­tect us against poten­tial prob­lems such as Alzheimer’s).

2. What are 1 or 2 things that are guar­an­teed “brain drains”?

- high-levels of anx­i­ety and stress, that are guar­an­teed to dis­tract us from our main goals and waste our lim­ited men­tal energies.
- a very repet­i­tive and routine-driven life, lack­ing in nov­elty and stim­u­la­tion. We have brains to be able to learn and to adapt to new environments
The trick there­fore, is to take on new chal­lenges that are not way too difficult/ impos­si­ble, and learn how to man­age stress to pre­vent anx­i­ety from kicking-in.

3. What are three easy and quick men­tal exer­cises that every­one should be doing daily?

- For stress man­age­ment: a 5-minute visu­al­iza­tion, com­bin­ing deep and reg­u­lar breath­ings with see­ing in our mind’s eye beau­ti­ful land­scapes and/ or remem­ber­ing times in our past when we have been suc­cess­ful at a tough task
- For short-term mem­ory: try a series sub­tract­ing 7 from 200 (200 193 186 179…), or a series involv­ing mul­ti­pli­ca­tion (2,3 4,6 6,9 8,12…) or expo­nen­tial series (2 4 8 16 32 64…) the goal is not to be a math genius, sim­ply to train and improve our short-term mem­ory. Another way is to try and remem­ber our friends tele­phone numbers.
- In gen­eral: try some­thing dif­fer­ent every day, no mat­ter how lit­tle. Take a dif­fer­ent route to work. Talk to a dif­fer­ent col­league. Ask an unex­pected ques­tion. Approach every day as a liv­ing exper­i­ment, a learn­ing oppor­tu­nity.

4. Are cross­word puz­zles and sudoku really as great for exer­cis­ing our brain as they are reported to be? Why? And what about activ­i­ties like knitting?

Use it or lose it” may be mis­lead­ing if we think that “It” is just one thing. The brain is com­posed of many dif­fer­ent areas that focus on dif­fer­ent things. Doing a cross­word puz­zle only acti­vates a small part of the brain. The 3 key prin­ci­ples for good brain exer­cises are: nov­elty, vari­ety and con­stant chal­lenge. Not that dif­fer­ent from cross-training our bodies.
The first time we do a cross­word, or sudoku or knit­ting, that is great, because it forces us to learn. But when doing it is com­pletely rou­tine, the mar­ginal ben­e­fit is very lim­ited. Nowa­days neu­ropsy­chol­o­gists do not rec­om­mend paper-based activ­i­ties but computer-based brain exer­cise soft­ware pro­grams, since they can pro­vide a vari­ety of new activ­i­ties all the time, always tai­lored with a proper increas­ing level of challenge.

5. Any foods that increase our brain fitness?

The main prin­ci­ple is that foods that are good for our body are also good for our brain. omega-3 fatty acids, found in cold-water fish such as mack­erel, her­ring, salmon, and tuna, also have shown some ben­e­fits. There is con­tra­dic­tory data on Ginkgo biloba. The best “brain food” is, lit­er­ally, men­tal stimulation.

6. Does phys­i­cal exer­cise also exer­cise our brains?

In sum­mary, phys­i­cal exer­cise is impor­tant because it influ­ences the rate of cre­ation of new neu­rons in our brains. Men­tal exer­cise is impor­tant because it helps deter­mine how those new neu­rons are used-and how long they sur­vive. Stress can reduce both the cre­ation of new neu­rons and their life­time, so stress man­age­ment is impor­tant too.
7. Maria writes in her com­ment below “I read with great inter­est this post on brain-stimulating activ­i­ties. I was sur­prised that soft­ware with a chang­ing chal­lenge level was con­sid­ered the best stim­u­la­tion, since it’s a seden­tary activ­ity.Isn’t active learn­ing, that com­bines phys­i­cal and men­tal exer­cise, the best way to stim­u­late the brain? Thanks, and love your site!”
Answer: Great com­ment. We are talk­ing about 2 dif­fer­ent things here:
- Habits for long-term good brain health: we usu­ally men­tion the 4 pil­lars of nutri­tion, phys­i­cal exer­cise, stress man­age­ment and men­tal stim­u­la­tion. Yes, con­stant active learn­ing pro­vides great men­tal stim­u­la­tion.
– Short-term Train­ing and improve­ment of one spe­cific area (mem­ory,…): you need some­thing more direct and well-targeted train­ing expe­ri­ence such as that pro­vided by a computer-based pro­gram, that assesses where you are today and “stretches” that spe­cific capacity.
Both aspects are very impor­tant, in the same way that both walk­ing often and going to the gym to do tar­geted work­outs are com­ple­men­tary for phys­i­cal fitness.
Hope that helps-let us know any other question!

Brain Reserve N Exercise

Q&A with Yaakov Stern on Brain Reserve, Exercise, Cognitive Training, Angry Birds, YMCA and more

I just had the chance to dis­cuss lat­est neu­ro­sci­en­tific research and think­ing with Dr. Yaakov Stern, one of the lead­ing sci­en­tists study­ing how to build a neu­ro­pro­tec­tive cog­ni­tive reserve across the lifes­pan. Dr. Stern leads the Cog­ni­tive Neu­ro­science Divi­sion at the Colum­bia Uni­ver­sity Sergievsky Cen­ter. What fol­lows is a Q&A ses­sion con­ducted via email over the last week.
Alvaro Fer­nan­dez: What do you make of the recent study “Asso­ci­a­tion of Life­time Cog­ni­tive Engage­ment and Low β-Amyloid Depo­si­tion”? 
Yaakov Stern: I find these results very intrigu­ing. The con­cept of cog­ni­tive reserve posits that var­i­ous life­time expo­sures such as edu­ca­tion, occu­pa­tion and leisure activ­i­ties may be related to dif­fer­en­tial sus­cep­ti­bil­ity to Alzheimer’s pathol­ogy once it occurs. This paper con­tin­ues a new, ongo­ing theme that cer­tain life­time clo­sures may actu­ally impact on the brain changes or patho­logic find­ings them­selves. While more work needs to be done to under­stand how life­time expo­sures may impact the devel­op­ment of Alzheimer’s dis­ease pathol­ogy, it is clear that both cog­ni­tive stim­u­la­tion and exer­cise help shape the brain through­out the lifes­pan. For exam­ple, ani­mal stud­ies indi­cate that both a stim­u­lat­ing envi­ron­ment and a aer­o­bic exer­cise are asso­ci­ated with neu­ro­ge­n­e­sis, the growth and uti­liza­tion of new neu­rons in the hip­pocam­pus. Thus, life events may con­tribute to what I have called “brain reserve,” but now brain reserve is a much more fluid con­cept than I orig­i­nally imagined.
AF: How do these find­ings link to your work?
YS: These types of obser­va­tions have con­tributed to the design of two inter­ven­tion stud­ies that I am cur­rently run­ning. One of them com­pares peo­ple who engage in a aer­o­bic exer­cise ver­sus stretch­ing and ton­ing for six months. We are com­par­ing these two forms of phys­i­cal exer­cise to see which is more ben­e­fi­cial. F. Before and after this exer­cise period, the par­tic­i­pants receive exten­sive cog­ni­tive eval­u­a­tion and neu­roimag­ing. The neu­roimag­ing stud­ies will help us under­stand what brain changes are asso­ci­ated with any cog­ni­tive improve­ment that we see. One unique aspect of this study is that it is enrolling younger peo­ple that have been included in pre­vi­ous stud­ies. We are recruit­ing indi­vid­u­als who are 30 – 45 and 50 – 65.
AF: What is the cur­rent under­stand­ing on what adults may need, and ben­e­fit from? are pri­or­i­ties and likely inter­ven­tions the same when we talk about younger vs. older adults?
YS: That is exactly what I’d like to find out. The ani­mal stud­ies and some stud­ies of younger adults sug­gest that exer­cise may impact both the cog­ni­tion and the brain across all ages. The goal of my study is to see whether it has sim­i­lar effi­cacy in younger and older indi­vid­u­als, whether the same cog­ni­tive processes are enhanced, and whether the neural basis for improve­ment is the same across these age groups. In the sec­ond ongo­ing study, we are look­ing at the rel­a­tive ben­e­fits of phys­i­cal and cog­ni­tive exercise.
AF: What is the cur­rent under­stand­ing on the rel­a­tive mer­its and short­com­ings of phys­i­cal and cog­ni­tive exer­cise? do you see them as some­how mutu­ally exclu­sive or as synergistic?
YS: My view is that they are syn­er­gis­tic. It makes sense to me that any improve­ments in “brain reserve” would heighten the abil­ity to develop a more “cog­ni­tive reserve.” To explain, we know that both exer­cise and cog­ni­tive stim­u­la­tion affects the brain itself. For exam­ple, they both up reg­u­late a chem­i­cal that is respon­si­ble for increased synap­tic plas­tic­ity. The advan­tage I see to cog­ni­tive train­ing is that it can enhance spe­cific cog­ni­tive func­tions. It may be that peo­ple will be ben­e­fit more from this cog­ni­tive train­ing when they exer­cise, since exer­cise may help the brain be more recep­tive to this train­ing. To test this idea, we are run­ning another study where par­tic­i­pants engage in both videogames designed to enhance cog­ni­tive func­tion (specif­i­cally, atten­tional allo­ca­tion), and also exer­cise. This study is open to peo­ple aged 60 and over. I must say that this study is more demand­ing because it requires both for vis­its to the gym a week and three vis­its to our lab to play the video game. One unique fea­ture of both of our stud­ies is that we have part­nered with all of the YMCAs in Man­hat­tan, so that par­tic­i­pants can con­duct their exer­cise ses­sions in any loca­tion that is con­ve­nient to them.
AF: Why did you select that par­tic­u­lar videogame and not, say, Tetris or Angry Birds?
YS: We are using the Space Fortress game because I believe that it may enhance atten­tional allo­ca­tion and exec­u­tive con­trol. I feel that these are very impor­tant cog­ni­tive func­tions and enhanc­ing them may directly impact on and improve the per­for­mance of many day-to-day activ­i­ties. We are com­par­ing the Space Fortress game with more stan­dard com­puter games, since it is quite pos­si­ble that they may be ben­e­fi­cial as well.
AF: So, your stud­ies will mea­sure the impact of mov­ing from a seden­tary lifestyle to exer­cis­ing at least 4 times a week. Would you expect the result­ing ben­e­fit to be more or less pro­nounced than if some­one already exer­cis­ing at four times per week increase to eight times per week?
YS: I am not sure what the answer to this is. Most exer­cise stud­ies begin with peo­ple who are not reg­u­lar exer­cis­ers because we believe that it will increase the chance that we can see an effect. My guess is that any increase in exer­cise may also be ben­e­fi­cial, but it would be harder to detect.
AF: The YMCA part­ner­ship is fas­ci­nat­ing, a very inno­v­a­tive way to do community-based research. How does it work? Who greets/ supervises/ sup­ports peo­ple? Was it dif­fi­cult to engage them? And, where do the com­put­er­ized cog­ni­tive work­outs take place?
YS: I agree that the part­ner­ship with the YMCA is very excit­ing. Peo­ple par­tic­i­pat­ing in our stud­ies get free access to the gym at any YMCA in Man­hat­tan. Our per­son­nel ini­tially meets par­tic­i­pants at the gym and ori­ent them to what they need to do. The gyms all have res­i­dent train­ers who know about the stud­ies and can give advice as needed. Right now the com­put­er­ized cog­ni­tive work­outs are done at our med­ical cen­ter. We are cur­rently work­ing on the tech­nol­ogy to allow peo­ple to play the games from their home in a way that we can directly mon­i­tor their per­for­mance. This should make it a lit­tle eas­ier for peo­ple to participate.
AF: Who is eli­gi­ble for your stud­ies and how can they sign up?
YS: As I men­tioned above, one study is recruit­ing peo­ple ages 30 to 45 and 50 to 65. The sec­ond, more inten­sive study is recruit­ing peo­ple age 60 and older. Both of these stud­ies are look­ing for indi­vid­u­als who are not reg­u­lar exer­cis­ers, because this should enhance our abil­ity to find an effect of exer­cise on cog­ni­tion. Our coor­di­na­tor can help answer ques­tions about whether you are eli­gi­ble or not. Any­one inter­ested poten­tially par­tic­i­pat­ing in one of these two stud­ies can con­tact Caitlin Slight: cbs2139 at

Women in Leadership

Leadership Program for Women Targets Subtle Promotion Biases

Executive Summary:

Despite more women in the corporate work force, they still are underrepresented in executive officer positions. Professor Robin Ely and colleagues propose a new way to think about developing women for leadership. Key concepts include:
  • Despite more women in the corporate work force, they fill less than 15 percent of executive officer positions at Fortune 500 companies and make up just 3.6 percent of CEOs.
  • "Second generation" forms of subtle gender bias favor men for top leadership positions and create structural career blocks for women.
  • A new approach to women's leadership development helps participants internalize a leader identity and create an elevated sense of purpose.
  • Organizations must also take responsibility for giving equal opportunities to their employees.

About Faculty in this Article:

HBS Faculty Member Robin J. Ely
Robin Ely is the Warren Alpert Professor of Business Administration at Harvard Business School.

For the last quarter century, many fought hard to overcome gender discrimination in the workplace by raising awareness, strengthening antidiscrimination policies, and encouraging more women to enter the corporate world.
At first blush, that work appeared to pay off. After all, as of 2010, women made up 46.7 percent of the US labor force, and filled more than half of management, professional, and related occupations. If the strategy was to get more women in the workplace and let them naturally ascend to positions of upper management, it seemed the pump was well primed.
But even with increasing representation, women still fill less than 15 percent of executive officer positions at Fortune 500 companies and make up just 3.6 percent of CEOs.
The glass ceiling, it seems, moved higher up the organization, but was far from broken.
"Women's progress has really leveled off, and has been stuck for at least 10 years," says Robin J. Ely, the Warren Alpert Professor of Business Administration at Harvard Business School and senior associate dean for Culture and Community.
"Women's progress has really leveled off, and has been stuck for at least 10 years."
—Robin Ely
What went wrong? In their articleTaking Gender into Account: Theory and Design for Women's Leadership Development Programs, which appeared in the September 2011 issue of theAcademy of Management Learning & Education, Ely and coauthors Herminia Ibarra (INSEAD) and Deborah Kolb (Simmons School of Management) describe how previously identified "second-generation" forms of subtle gender bias have impeded women's progress. These practices and patterns, although unintentional, favor men and create structural career blocks for women.
The paper is believed to be the first to incorporate an understanding of second-generation bias into a new approach to women's leadership development, moving beyond traditional programs developed for men.
"Most leadership development for women is 'add women and stir'—basically, delivering to women what is delivered to men—or 'fix the women,' a strategy of training-up to be 'as good as' men," says Ely. "They don't take the systemic gender biases in organizations into account when educating women about how to move into and exercise leadership."

How people become leaders

The paper frames leadership development as "identity work" requiring the person to undertake two tasks: internalizing a leader identity (coming to see oneself and being seen by others as a leader) and developing an elevated sense of purpose.
Identity work is a process shaped by loops of action and feedback. For example, a person asserts leadership in an area, feedback affirms or disaffirms those actions, which builds or reduces confidence, in turn encouraging or discouraging further actions. "Through this back-and-forth, the would-be leader accumulates experiences that inform his or her sense of self as a leader, as well as feedback about his or her fit for taking up the leader role," according to the paper.
Furthermore, a leader's identity is tied to her or his sense of purpose. Leaders are most effective—both with themselves and with those they lead—when their personal values align with the work they are doing and connect to something that is larger than themselves.
But women doing the sort of identity work it takes to reach top-level positions in companies are often stopped in their tracks by subtle forms of gender bias, which are deeply ingrained in workplace culture and society at large. These biases can interfere with the dual requirements of internalizing a leader identity and developing an elevated sense of purpose.
First-generation biases, such as policies or actions that deliberately discriminate against women in hiring and promotion, have been largely wiped off the books. Second-generation biases, while unintentional, can have the same effect, blocking women from upper management.

Second-generation bias

For example, women are ascribed to be friendly, emotional, and unselfish, attributes that seem inconsistent with larger societal beliefs about what a leader must be, such as assertive, self-confident, and entrepreneurial (which are traditionally seen as masculine traits.) Furthermore, women who do display those behaviors can be seen as abrasive instead of assertive, arrogant instead of self-confident, and self-promoting instead of entrepreneurial. These perceptions can hold women back.
"We cannot just tell women that if they want to take their place at the top of their organizations, they need to follow the patterns of their male colleagues," says coauthor Kolb.
And without women in high places, younger women lack the role models and mentors to help them succeed. It seems the organization is signaling that being female is a liability, discouraging talented women from working toward top positions.
Second-generation gender bias also manifests itself in organizational practices that fail to take women's lives into account, hinder their ability to develop powerful networks, and create excessive performance pressure on women.

A fresh approach

The solution offered by traditional leadership development programs for women has been to teach them the established rules so they could be effective players in a masculine culture.
By contrast, Ely, Ibarra, and Kolb propose a new set of principles to drive women's leadership programs (WLPs):
  1. Situate topics and tools in an analysis of second-generation gender bias. Participants receive a nuanced understanding of second-generation bias and how it may impact their own career development and the career development of other women in their firms.
  2. Create a holding environment to support women's identity work. The programs create a safe environment and peer networks that support participants in understanding and shaping who they are and who they can become.
  3. Anchor participants on their leadership purpose. WLPs redirect the participants away from a single-minded focus on career advancement and managing other people's perceptions of them as leaders, and toward identifying larger leadership purposes and the actions they need to undertake to accomplish them.
These programs help participants build skills around networking, negotiation, leading change, and managing career transitions. "We raise women's consciousness about how subtle forms of gender bias can get in their way and in other women's way, while giving them tools for addressing these problems and thus imparting in them a sense of agency," Ely says.

Negotiation and networking

One important technique women must master to create change in their organizations is negotiation, but research shows that women who negotiate hard for themselves experience backlash, says Ely. "They're evaluated negatively. Oftentimes, it's not that they don't know how to negotiate or don't want to negotiate. It's that they're trying to avoid the negative evaluation that comes along with being a hard negotiator as a woman."
The authors recommend that WLPs use a "shadow negotiation" framework that focuses on strategic "moves and turns" to give women tools to negotiate over potentially controversial issues and decisions.
"We cannot just tell women that if they want to take their place at the top of their organizations, they need to follow the patterns of their male colleagues"
—Deborah Kolb
In this process, the negotiator must come to see her own value and find ways to make it visible, gain from the experience of others in similar circumstances, explore various alternatives to agreement, learn to quickly regain one's footing when challenged, and develop an appreciation for why her request might be resisted.
These negotiations entail skill not only at assessing which options might lead to mutually acceptable agreements but also at enlisting support—women's negotiations often require raising awareness of and pushing back on gendered structures and work practices.
Another way women can gain access to leadership opportunities is through more effective networking. And since there are myriad differences between the way men and women network, and the networks themselves, WLPs must do more than teach traditional networking skills. They should, for example, address the issue of authenticity: women tend to see the sort of networking men do as inauthentic; they feel as if they're using people.
Vital networks can begin to form as soon as WLP participants walk in the door. "You bring senior women together from around the company, and it's the first time they've been in a room with that many women at their level, because they're in all different divisions, different parts of the world…It's powerful…it's something they've really been missing," says Ely. "And a lot of them don't even realize they've been missing it because they've never had it."
In the authors' experience, the networks formed within WLPs carry on well beyond the programs themselves and expand to create mentor relationships that help other women move up the corporate ladder.
When WLP attendees return, they are prepared to "catalyze change" in their companies that will help them and other women advance."

Organizational accountability

Organizations must also take responsibility for giving equal opportunities to their employees.
"What would help is for organizations to examine some of the assumptions they make about who is an 'ideal worker,' how they judge commitment, and what they look for in leaders," says Kolb. "If work cultures enabled both men and women to have full work and personal lives, it might help to level the playing field." 

Tuesday, February 28, 2012

Enthusiasm Good for Brain

To Harness Neuroplasticity, Start with Enthusiasm

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 

Wednesday, February 15, 2012

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.