View
213
Download
0
Category
Tags:
Preview:
Citation preview
Computers, treadmills and videogames: The new arsenal for late life brain training
Michael MarsiskeDepartment of Clinical & Health PsychologyApril 10, 2015
With thanks
College Local collaborators
Dawn Bowers Ron Cohen & program on Cognitive Aging and
Memory Institute on Aging
External collaborators ACTIVE coinvestigators and the National
Institute on Aging McKnight Brain Research Foundation, Santa
Fe Health Care, and The Village of Gainesville
Cognitive aging embodies PHHP
Health professions Assessment and psychodiagnosis Treatment Multidisciplinary (e.g., psychology and
occupational therapy and speech/language)
Public health Prevalence Prevention Population initiatives
Jill Pease asked a question
“I’m going to be running the story on the ACTIVE findings as the cover story for the next issue of PHHP News, our alumni and donor newsletter. I wanted to do a sidebar that addresses the “what can I do?” question that we seem to get a lot from consumers”
My answer
1. Continue your education. "Cognitive reserve" refers to the rich network of connections and knowledge that we build across a lifespan. People with more education and more complex jobs generally enter late life at a much higher level of mental functioning. Education can continue: take continuing education courses, read books in areas about which you know little, challenge yourself to learn new things.
My answer
2. Keep your brain healthy. "Brain reserve" refers to how much white and grey matter we're able to retain into the later years. Good health habits that may help to prevent heart attack/stroke, arthritis, cancer, and diabetes also help to maintain the brain: Aerobic exercise, strength training, good nutrition, control of blood pressure and cholesterol. It is never too late to begin healthier habits, and exercise training has boosted cognition even in the very old.
My answer
3. Spot-train your brain. There is growing evidence that cognitive training, like that used in ACTIVE, can help to improve performance in areas that tend to decline in late life. Even brief 10 week training programs can produce five-to-ten years of benefit in areas like memory, problem solving, speed, and attention. Excellent, clinically validated training programs are now available at low cost for computers, tablets and smartphones.
My answer
4. Combat negative mood. In general, older adults experience less major depression than younger adults, but depressive symptoms rise. Health challenges, activity restriction due to physical disability, retirement, financial concerns and losing loved ones are among factors that can increase anxiety and depression. Unfortunately, memory and other areas of mental functioning can be seriously compromised by mood disturbances. Seeking help with adjustment problems can be a potent way to guard against cognitive loss.
My answer
5. Engage. Participation in complex leisure activities that are new and interesting seems to confer benefits in terms of memory, problem solving, and mood. The benefits seem greatest when these activities are done socially. Tasks as diverse as learning to act, quilt, play piano, use an ipad, or master digital photography have all shown mental or brain activation benefits. Engaging in social leisure seems to have dual benefits: It minimizes negative mood (which can sap mental energy), and it provides a kind of "mental exercise" with complex tasks. The trick, however, seems to be to try something new -- something you've never done before.
The arsenal
Arsenal
Educate
Brain Health
Spot-trainMood
Engage
Let’s briefly begin with understanding cognitive aging
Many people have a preconception that late life is a time of decline
The story is far more nuanced and individuated.
Gains and losses
Schaie, 1994, 2008
Losses butA
ge
20
-34
Sta
nd
ard
Sco
re
GainsA
ge
20
-34
Sta
nd
ard
Sco
re
Dementia is the fear …
…but in fact
The majority of the population will not experience dementia (although rates will grow)
There are, however, significant functional consequences of normal cognitive aging in the absence of dementia that have been largely ignored Medication Finance
Plus prevention
What accounts for cognitive aging?
This is a detailed and evolving field, but at the risk of oversimplifying, there are four BROAD categories of explanation Neuronal/brain loss Reduction in neuronal/brain efficiency Growing interference Disuse atrophy (“sensory underload”,
“disengagement”)
Neuronal/brain loss
Neuronal/brain loss
Neuronal/brain loss
Neuronal/brain loss
Neuronal/brain loss
Neuronal/brain loss
Brain healthEngagementSpot training
Neuronal efficiency
Brain health
Growing interference
Growing interference
Growing interference
When w
il l I eat?
Wil l you take m
e to school
Have I done my homework?
Can I aff ord to get married?
Wil l I g
et a promotion?
Is m
y c
hi ld
health
y?
Wil l m
y chi ld succeed?How do we get both kids to two
diff erent soccer practices?
Have I taken my medication?
Does my mother need a nursing home?MoodSpot training
Disuse
EducateBrain healthSpot trainingMoodEngage
My program of research (and others)
In large measure, we’ve tried to chip away at normal cognitive aging, using the “arsenal”, more or less, as the conceptual framework for guiding our approaches.
In general, the past five years have seen an explosion of research- and market-driven intervention approaches for cognitive aging
The arsenal
Arsenal
Educate
Brain Health
Spot-trainMood
Engage
Educate
EducateFigure 1. Model estimated growth curves for 5-year cognitive change by racial group.
Educate (and support)
African American, PromptedAfrican American, UnpromptedWhite, PromptedWhite, Unprompted
With Kelsey Thomas
unprompted
Educate (and support)
African American, PromptedAfrican American, UnpromptedWhite, PromptedWhite, Unprompted
With Kelsey Thomas
\
Prompted
“Can you look again?
The arsenal
Arsenal
Educate
Brain Health
Spot-trainMood
Engage
Brain health
There is an extensive literature documenting that health issues of later life (especially cardiovascular, and especially hypertension) are destructive to cognitive functioning Especially “executive functioning” Ron Cohen, UF CAM director, and Catherine
Price, CHP faculty member, have been leading contributors to understanding how vascular-related neuronal loss is directly associated with cognitive decline
Brain health
A now ten-year old meta-analysis clearly showed that exercise trials were very beneficial Aerobic or aerobic + strength Increase in grey and white matter Increase in neurotrophic factors Improvement especially in “executive
control”
Brain health
Dawn Bowers & Michael Marsiske
Brain health
Brain health
Bird
Saf
ari
Jewel
Diver
Mas
ter G
arde
ner
Road
Tour
Swee
p Se
eker GDI
BDI
Apat
hy
TEPS
-A
TEPS
-CSH
PS40.0000
45.0000
50.0000
55.0000
60.0000
65.0000
70.0000
75.0000
80.0000
Insight plus AerobicInsight plus WiiInsight onlyControl
Brain health
The gift that keeps on giving?
Brain health
Marsiske, Gogoi, Maye, McCoy, McCrae
Memory
Speed
The arsenal
Arsenal
Educate
Brain Health
Spot-trainMood
Engage
Spot train
ACTIVE study VITAL study MEDLI study Fitmind study
ACTIVE
University of Alabama-Birmingham Karlene Ball PhD
Hebrew SeniorLife BostonJohn Morris PhDRichard Jones ScD
Indiana UniversityFredrick Unverzagt PhD
Johns Hopkins UniversityGeorge Rebok PhD
Pennsylvania State UniversitySherry Willis PhD
University of Florida/Wayne State UniversityMichael Marsiske PhD
New England Research Institutes, Coordinating CenterSharon Tennstedt PhD
National Institute on AgingJonathan King PhD
National Institute of Nursing Research Susan Marden PhD
ACTIVE
ACTIVE
ACTIVE 10-year Trajectory of Memory, Separately by Training Group
ACTIVE
10-year Trajectory of Reasoning, Separately by Training Group
ACTIVE
10-year Trajectory of Speed of Processing , Separately by Training Group
ACTIVE
10-year Trajectory of Self-Reported IADL Difficulty, Separately by Training Group
ACTIVE
State reported crashes over 10 years
Ross, Edwards & Ball, 2013
The arsenal
Arsenal
Educate
Brain Health
Spot-trainMood
Engage
UF Health Vitality Mind
UF Health Vitality Mind
The arsenal
Arsenal
Educate
Brain Health
Spot-trainMood
Engage
Engagement
Engagement
Engagement
Engagement
Engagement
Engagement
•150 older adults randomized to receive either • “Senior Odyssey”
• (n=87; teams solve long-term ill structured problems from the disciplines of literature, science and technology, civil engineering, and history, like building a structure out of balsa wood) or
• testing-only control (n=63)
Engagement
Useful Field of View is improved by first-person shooter video games in college-aged players (but not by Tetris)
Engagement
Basak, Boot, Voss & Kramer (2009)
• Video game group: 23.5 hours of training (n=20)
• No contact control group
• Trained participants improved more than the control participants in executive control functions, such as task switching, working memory, visual short-term memory, and reasoning.
“The Videogame study”
Computerized training Tetris Medal of Honor
“The Videogame study”
“The Videogame study”
Pretest Posttest0
10
20
30
40
50
60
70
80
90
100
ComputerMedal of HonorTetrisControl
Div
ide
d A
tte
nti
on
Tim
eGoing down = faster = improvement
“The Videogame study”
“The Videogame study”
Reviva
With Patricia Belchior
Crazy TaxiComputer training
Posit Science Road Tour
Funded by the Robert Wood Johnson Foundation
Control
Reviva
Next steps
Submission of federal funding application(s) to understand Mechanisms of training-related
improvement Possible “effect modifiers”
▪ Mindfulness Community partnerships to
implement the ‘arsenal’ in community settings
UF Health Vitality Mind
Questions?
For further information, copies of reprints, or to request a copy of this talk Michael Marsiske marsiske@phhp.ufl.edu (352) 273-5097
Recommended