Information

What science-based strategies can slow down dementia?

What science-based strategies can slow down dementia?



We are searching data for your request:

Forums and discussions:
Manuals and reference books:
Data from registers:
Wait the end of the search in all databases.
Upon completion, a link will appear to access the found materials.

What are some science-based strategies that could slow down dementia?

For example, do cognitive demanding tasks like solving crosswords, playing with the Rubic's cube, chess, or perhaps stuff like gardening help against dementia?


It depends on the disease that causes dementia. Dementia is a syndrome that has many causes. Some of them are treatable, such as metabolic/infectious diseases. Some are primary degenerative diseases of the nervous system, such as Alzheimer disease, Pick disease, and Huntington disease. Most diseases in the first category are treatable, many are curable. But most diseases in the second category are usually not amenable to treatment. They progress slowly but relentlessly despite any treatment.

Regarding non-pharmacologic treatments, including cognitive training or cognitive rehabilitation, they seem to have some roles in the management of dementia (H C Kales) but not have spectacular effects and still be inconclusive in improving or maintaining cognitive and functional performance of people with dementia (Diagnosis and Treatment of Dementia).


How Breathing Calms Your Brain, And Other Science-Based Benefits Of Controlled Breathing

The science of breathing stands on quite ancient foundations. Centuries of wisdom instructs us to pay closer attention to our breathing, the most basic of things we do each day. And yet, maybe because breathing is so basic, it’s also easy to ignore. A brief review of the latest science on breathing and the brain, and overall health, serves as a reminder that breathing deserves much closer attention – there’s more going on with each breath than we realize.

Controlling your breathing calms your brain.

While the admonition to control breathing to calm the brain has been around for ages, only recently has science started uncovering how it works. A 2016 study accidentally stumbled upon the neural circuit in the brainstem that seems to play the key role in the breathing-brain control connection. The circuit is part of what's been called the brain’s “breathing pacemaker” because it can be adjusted by altering breathing rhythm (slow, controlled breathing decreases activity in the circuit fast, erratic breathing increases activity), which in turn influences emotional states. Exactly how this happens is still being researched, but knowing the pathway exists is a big step forward. Simple controlled breathing exercises like the 4-7-8 method may work by regulating the circuit.

Breathing regulates your blood pressure.

“Take a deep breath” is solid advice, particularly when it comes to keeping your blood pressure from spiking. While it’s unclear whether you can entirely manage blood pressure with controlled breathing, research suggests that slowing your breathing increases “baroreflex sensitivity,” the mechanism that regulates blood pressure via heart rate. Over time, using controlled breathing to lower blood pressure and heart rate may lower risk of stroke and cerebral aneurysm, and generally decreases stress on blood vessels (a big plus for cardiovascular health).

Counting breaths taps into the brain’s emotional control regions.

A recent study showed that controlling breathing by counting breaths influences “neuronal oscillations throughout the brain,” particularly in brain regions related to emotion. Participants were asked to count how many breaths they took over a two-minute period, which caused them to pay especially focused attention to their breathing. When they counted correctly, brain activity (monitored by EEG) in regions related to emotion, memory and awareness showed a more organized pattern versus what’s normally experienced during a resting state. The results are preliminary, but add to the argument that controlling breathing taps into something deeper.

The rhythm of your breathing affects memory.

A 2016 study showed for the first time that the rhythm of our breathing generates electrical activity in the brain that influences how well we remember. The biggest differences were linked to whether the study participants were inhaling or exhaling, and whether they breathed through the nose or mouth. Inhaling was linked to greater recall of fearful faces, but only when breathing through the nose. Participants were also able to remember certain objects better when inhaling. Researchers think that nasal inhalation triggers greater electrical activity in the amygdala, the brain’s emotional epicenter, which enhances recall of fearful stimuli. Inhaling also seems linked to greater activity in the hippocampus, the seat of memory.

Controlled breathing may boost the immune system and improve energy metabolism.

While this is the most speculative of the study findings on this list, it’s also one of the most exciting. The study was evaluating the “Relaxation Response” (a term popularized in the 1970s book of the same name by Dr. Herbert Benson, also a co-author of this study), which refers to a method of engaging the parasympathetic nervous system to counteract the nervous system's “fight or flight” response to stress. Controlled breathing triggers a parasympathetic response, according to the theory, and may also improve immune system resiliency as a “downstream health benefit.” The study also found improvements in energy metabolism and more efficient insulin secretion, which results in better blood sugar management. If accurate, the results support the conclusion that controlled breathing isn't only a counterbalance to stress, but also valuable for improving overall health.


Can Learning a Second Language Delay Dementia?

Dementia is a syndrome (i.e. a collection of symptoms) that tends to affect those over 65. It is generally described as a global loss of cognitive ability, including language skills, memory, understanding and judgement. It can be a debilitating condition, frightening for both the sufferer and their family, and a growing concern in an aging population. A great deal of scientific effort is going into strategies to prevent the onset of dementia in the elderly.

What did the scientists say?

Previous studies have shown that the onset of dementia caused by Alzheimer’s disease can be delayed by as long as five years by multilingualism (i.e. being fluent in two or more languages). It is believed that the process of learning and using another language boosts the brain’s “cognitive reserve“, acting as a form of “brain training” to stave off the effects of Alzheimer’s disease dementia.

However, dementia is a condition with many subtypes, and before this study it was unclear as to whether learning another language would be beneficial in cases where dementia occurred due to another disease or mechanism. Also, the majority of studies were carried out in immigrant populations, which makes it difficult to tell whether the effect is truly biological, or simply a consequence of being in an environment where few people speak the patient’s native tongue. Also, studying immigrants can bias the sample of patients towards a certain culture or ethnic group.

In this study, the scientists try and circumvent this environmental problem by using Indian test subjects. India is a country of many languages, where locals switch languages mid-conversation speaking several languages is common even amongst those who cannot read or write! This makes it a valuable region for testing whether dementia is affected by bilingualism, especially as both the multilingual and non-multilingual patients in the sample can be drawn from the same population, and thus cultural and environmental biases can be removed.

The scientists used data from 648 patients in Hyderabad, all of whom were diagnosed with one of the following subtypes of dementia: Alzheimer’s Disease dementia, frontotemporal dementia, vascular dementia, dementia with Lewy bodies, and mixed dementia. Family members of the patients were interviewed to assess how many languages they spoke fluently, and at what age dementia developed. Around 60% of the patients spoke more than one language, and roughly the same proportion of both multilingual and non-multilingual patients eventually developed dementia.

The multilinguals developed dementia at an average age of 65.6 years, compared to 61.1 years for non-multilingual patients. The scientists showed that when controlling for a variety of factors, including urban or rural living, gender, education level, and others, this effect was preserved. In fact, when the scientists considered only illiterate patients, the effect increases – these multilinguals develop dementia around 6 years later than their single language counterparts. However, illiterates constitute 14% of the sample, so this figure is less robust than the others.

Most interestingly, this study is the first to demonstrate delay of frontotemporal and vascular dementia by multilingualism (dementia with Lewy bodies and mixed dementia did show a very small delay, but the effect was not statistically significant). The number of extra languages appears to be inconsequential to the effect.

The scientists do note a few shortcomings of the study. They rely on family members for determining at what age dementia develops, so it is unclear how much uncertainty this produces in the typical number of years delay produced by multilingualism. When the level of this effect appears to be similar to that achievable by drugs, we should be very careful that this effect isn’t overstated, for patients’ sakes. Also, how multilingualism is measured isn’t particularly precise, and it again relies on family member testimony. Precisely how early a patient should learn a language isn’t yet clear from this work, but the authors are keen to explore this question further.

What did the Media Say?

The BBC make it clear that only certain types of dementia are positively affected by a second language. They also note the advantages of this study’s unique sample of patients.

Livescience carry out an interview with Thomas Bak, one of the study’s co-authors. They discuss the applicability of the effect to, for example, United States nationals learning a second language in classes. Like the BBC, they correctly report some of the different subtypes of dementia in the study, but they do not report the lack of effect measured for other subtypes of dementia.

USA Today speak to other research groups interested in the same questions, to obtain perspective on this particular paper.

The Daily Mail’s headline emphasises the effect’s strength compared to drugs, which as I’ve already said we should be a bit more cautious about.

Generally speaking, this story is well reported, and the scientists’ desire to follow up these studies to determine whether these positive effects extend to Western citizens taking language classes is well expressed by most outlets.

Suvarna Alladi, DM, Thomas H. Bak, MD, Vasanta Duggirala, PhD, Bapiraju Surampudi, PhD, Mekala Shailaja, MA, Anuj Kumar Shukla, MPhil, Jaydip Ray Chaudhuri, DM and Subhash Kaul, DM (2013)
. “Bilingualism delays age at onset of dementia, independent of education and immigration status”. Neurology early online view: doi: 10.1212/01.wnl.0000436620.33155.a4


Interview with Dr. Heather Pedersen Brain–Health a Growing Concern as Boomers Age

The Center for Disease Control (CDC) announced their State and Local Public Health Partnerships to Address Dementia, The 2018- 2023 Road Map, as part of the CDC Healthy Brain Initiative. The Road Map helps chart a course for state and local public health agencies to prepare their communities to deal with the ever expanding need for brain-health concerns.

According to CDC and their Healthy Brain Initiative, there are at least five to six million people currently living with age-related dementias in the U.S. This translates into one out of every six women and one out of every 10 men, who live past the age of 55. As the population increases, and more Baby Boomers reach older ages, these numbers are expected to rise.

The CDC wants to stimulate changes in policies, systems, and environments. They convened experts who developed 25 actions for public health leaders to promote brain health, better care for people with cognitive impairment, increased attention to caregivers, and efforts to build public health capacity.

“Dementia is a devastating condition that impacts millions of people annually,” said Dr. Heather Pedersen, a board certified clinical neuropsychologist at the Algiers Neurobehavioral Resource, LLC, located in New Orleans.

“Dementia,” she said “is a generic term that refers to when an individual is experiencing cognitive problems––such as memory loss, difficulty with logic, or trouble with language––to such an extent that they cannot manage aspects of daily life.”

According to the CDC, while there are various forms of dementia, around 70 percent of cases are due to Alzheimer’s and the next most common type is vascular dementia. African Americans, Hispanics, and women are particularly at risk of developing Alzheimer’s and other dementias. More than 95% of people with dementia have one or more other chronic conditions. And, one in three Alzheimer’s caregivers report their health has become worse due to care responsibilities.

“There are many diseases and conditions that can lead to dementia,” Pedersen said, “with Alzheimer’s disease being the leading cause of dementia. Per the CDC, the number of adults with Alzheimer’s disease is expected to triple over the next 40 years. Alzheimer’s disease and other dementiacausing diseases impact individuals, families, friends, caregivers, health-care agencies, and communities in wide-ranging ways,” Dr. Pedersen said.

According to the CDC, they seek to promote the use of effective interventions and best practices to protect brain health, address cognitive impairment, and help meet the needs of caregivers for people with dementia. They aim to improve inclusion of healthcare quality measures that address cognitive assessments, improve the delivery of care planning to people with diagnosed dementia, and improve outcomes.

Another of the CDC’s goals is to educate public health professionals about the best available evidence on dementia, including detection. CDC Director Robert R. Redfield, MD, said. “Early diagnosis is key to helping people and their families cope with loss of memory, navigate the health care system, and plan for their care in the future.

“The importance of early detection and intervention for many dementia processes cannot be overstated,” Dr. Pedersen explained. “Some medications are more effective when started earlier and compensatory strategies can often be put into place so as to be more useful in the long run. However, in order to be able to put these interventions into place, an individual has to first be diagnosed with dementia.”

What are some of the benefits of early diagnosis of dementia?

“Early diagnosis of course allows for individuals to begin appropriate medication earlier on in the process, as there are medications for certain diseases, like Alzheimer’s, that can slow down the disease process. But, early diagnosis also allows for individuals and their families to begin to adjust and adapt their lives in ways to make good years last as long as possible,” Dr. Pedersen said. “By making slight changes to schedules, home management, or other systems, individuals can maintain independence for as long as possible.”

Can neuropsychologists’ findings help with treatments and/or treatment planning?

“Absolutely,” Pedersen said. “By helping with an accurate diagnosis, neuropsychologists can also help other providers make informed decisions about treatment options. Neuropsychologist evaluations also help by determining individual’s cognitive strengths and weaknesses,” she said.

“By maximizing strengths to compensate for weaknesses, neuropsychologists can help make suggestions to make tasks more efficient or easier to complete.”

Neuropsychologists can often help caregivers better understand issues for their loved ones and better cope with and adjust to the caring role.

“It is often very helpful for caregivers and other family members to understand the basics about what is causing the cognitive problems or dementia,” Dr. Pedersen explained. “As part of the evaluation process, clients and loved one’s are provided with feedback about what is likely causing their cognitive problems. We spend time discussing the causes, prognosis, treatments, and other strategies that might be helpful in maximizing the client to live their best life.”

In today’s medical culture, the approach is often the quick screening rather than the comprehensive assessment. Is this a concern? A quick screening may not be able to determine the cause of an individual’s cognitive problems, Pedersen explained.

“A comprehensive assessment is critical in the accurate diagnosis of dementia. There are many conditions that can masquerade as dementia and given the permanent, progressive nature of some dementias, it is vital that one isn’t falsely diagnosed,” she said. “There are many different diseases and conditions that cause dementia, some of which are treatable and some of which are not. Depression and some metabolic conditions can ‘look like’ dementia, but in fact are treatable conditions.”

The American Academy of Neurology (AAN) has recommended neuropsychological testing since 1996 for patients who may have experienced a traumatic brain injury, a stroke, Parkinson disease, multiple sclerosis, a neurotoxic exposure, or dementia. Neuropsychological testing “is particularly valuable in distinguishing between normal aging and mild dementias,” they AAN noted.

Dr. Pedersen, who earned her PhD from the University of North Dakota, and completed her postdoctoral fellowship in clinical neuropsychology at the Memphis Veterans Affairs Medical Center and UT Health Sciences Center Consortium, is licensed in Louisiana, Minnesota, and Arizona.

Among her training and research achievements, Dr. Pedersen has co-authored “The next major neuropsychological and neuropsychiatric breakthrough: Alzheimer’s disease,” for the Handbook of Neuropsychiatry Research. She also co-authored research on concussions for American Journal of Alzheimer’s Disease and Other Dementias, and co-authored “Later life health optimism, pessimism, and realism: Psychosocial contributors and health correlates,” published in Psychology and Health.

“Each person who walks through my door is a unique constellation of traits, strengths, and weaknesses, who is looking for some sort of assistance,” Dr. Pedersen said. “I find it very satisfying to come along side each client to work with them in their treatment goals.”

“That process of collaborating with my clients is a very enjoyable process for me,” she said.


The Baddeley-Hitch Model of Working Memory

The Baddeley-Hitch model of working memory suggests that there are two components of working memory:

  • Visuospatial Scratchpad- a place where you store visual and spatial information
  • Phonological Loop- a place where you record auditory information

A third part, the central executive, is the controller and mediator of these two different aspects of our working memory. According to Baddeley and Hitch, the central executive processes information, directs attention, sets goals, and makes decisions.


As research for a dementia cure continues, taking preventative measures to decrease the risk of developing dementia becomes crucial. Certain risk factors like age or genetic susceptibility cannot be changed or controlled, but there are many other factors that increase the probability of developing dementia. These factors include:

  • Drug or alcohol abuse
  • Cardiovascular factors, like high cholesterol, high blood pressure, diabetes, heart disease, stroke, atherosclerosis, hypertension, or obesity
  • Smoking
  • Mental health issues like depression
  • High estrogen levels in women
  • Head trauma
  • High homocysteine levels

Certain lifestyle changes and preventative measures decrease the risk of developing dementia. Research suggests that it may be beneficial to:

  • Stay physically active
  • Stay socially active
  • Participate in mentally stimulating activities, learn languages, or continue education
  • Drink moderately
  • Quit smoking and minimize drug use
  • Eat a healthy diet. Research has found that a mediterranean diet high in fish, nuts, whole grains, and plant-based foods may be the most beneficial for dementia prevention.
  • Adequately manage cardiovascular diseases like diabetes, high cholesterol, or high blood pressure

These measures aren't only for individuals who want to prevent dementia - these lifestyle changes are also beneficial for those who are already diagnosed, as positive changes can slow the progression of dementia.

Medication For Dementia

Medication for reversible dementias

Some reversible dementias exist: for example, vitamin B12 deficiency can cause pernicious anemia, leading to dementia that can be treated by addressing the deficiency. Medication and supplements that can completely cure reversible dementias include:

  • Vitamin B12 supplements for pernicious anemia
  • Hormonal supplements for hyperthyroidism, hypothyroidism, or other imbalances
  • SSRIs or other antidepressants for depression symptoms which may mimic dementia
  • Antibiotics or medications to treat brain infections like encephalitis or meningitis

Medication for managing dementia symptoms

When a dementia condition cannot be treated, slowed, or reversed, doctors and medical professionals focus on medications that can make living with dementia easier and more manageable. There are several classes of medications proven to work at treating symptoms and reducing the effects of dementia, which include:

  • Cholinesterase inhibitors: Aricept (donepezil), Razadyne (galantamine) and Exelon (rivastigmine). Cholinesterase inhibitors alleviate symptoms of Lewy-body dementia and Alzheimer's disease by slowing the breakdown of Acetylcholinesterase, which plays a role in learning, memory, and cognitive skills. Cholinesterase inhibitors decrease disorientation, confusion, and memory problems, but can present unpleasant side effects like dizziness, nausea, and vomiting.
  • Glutamate inhibitors: Namenda (memantine) prevents the harmful overproduction of glutamate that accompanies dementia. Glutamate overproduction leads to increased cell damage and neurodegeneration, so memantine works to treat moderate to severe Alzheimer's disease by preventing this damage.
  • Medications for managing mental health, mood, and behavioral issues: antidepressants, antipsychotics, and mood-stabilizing medications. Dementia causes mood swings and increased anxiety and agitation, so mood-stabilizing medications can be helpful for alleviating symptoms. A high percentage of dementia sufferers are afflicted by depression, so antidepressants are used to increase wellbeing and quality of life. Although antipsychotics are sometimes prescribed for those with hallucinations and paranoia, they present a risk of dangerous side effects and are used in moderation and under careful supervision.

Side effects of medications used to alleviate dementia symptoms include nausea, dizziness, vomiting, slowed heart rate and diarrhea. A doctor or healthcare professional can prescribe the medication that best fits an individual's condition and situation.

Therapy

Research has shown that therapy improves well being, day-to-day functioning, and overall mood in dementia sufferers. Dementia is correlated with increased anxiety and depression, so professional counseling and a strong support system are integral to maintaining and improving overall well being. Patients can choose from many different types of therapy, including therapies that align with their interests like music or art therapy.

Cognitive Stimulation Therapy

Also known as CST, cognitive stimulation therapy is clinically proven to help those with mild to moderate dementia and is the premiere therapy method for dementia patients. CST involves training memory, language ability, and problem solving skills in order to improve cognitive functioning, and can increase memory and reasoning skills without medication.

Behavioral therapy

Behavioral therapy is usually administered by qualified family or loved ones of dementia sufferers, or by the caregivers of afflicted individuals. This method is twice as effective as antipsychotics for treating symptoms like anxiety, aggression, depression, wandering, and insomnia. Behavioral therapy involves tackling the triggers or causes of unwanted behaviors like aggression or wandering in order to alleviate and provide outlets for these behaviors without medication. For example, a trained caregiver may find that feelings of restlessness or stress cause their patient to wander away from home, and can implement an exercise regimen to manage this restlessness.

Other dementia therapies can be beneficial based on the situation, and include:

Managing Dementia

Dementia hugely affects everyday functioning both for sufferers and for their loved ones, and coping with dementia can require major lifestyle and environmental changes. A comprehensive management system includes therapy and counseling to manage possible stress, anxiety, and depression. A patient suffering from more advanced stages of dementia may need a caregiver who can provide regular or semi-regular support.

Some tools that sufferers and caregivers can use to manage dementia include:


Contents

ADHD is the only disorder of attention currently defined by the DSM-5 or ICD-10. Formal diagnosis is made by a qualified professional. It includes demonstrating six or more of the following symptoms of inattention or hyperactivity-impulsivity (or both). [9] [10]

  • gives no close attention to details
  • has trouble holding attention on tasks
  • appears to not listen when spoken to directly
  • not following through on instructions
  • has trouble organizing tasks
  • avoids tasks requiring long mental effort
  • loses things necessary for tasks
  • easily distracted
  • forgetful in daily activities
  • fidgets or squirms
  • leaves seat inappropriately
  • runs or climbs inappropriately
  • unable to play quietly
  • "on the go" or "driven by a motor"
  • talks excessively
  • blurts out answers too early
  • has trouble waiting their turn
  • interrupts or intrudes on others
  • be age inappropriate,
  • start before age 12,
  • occur often and be present in at least two settings,
  • clearly interfere with social, school, or work functioning,
  • and not be better explained by another mental disorder.

Based on the above symptoms, three types of ADHD are defined:

  • a predominantly inattentive presentation (ADHD-I)
  • a predominantly hyperactive-impulsive presentation (ADHD-HI)
  • a combined presentation (ADHD-C)

SCT is proposed to be similar to the predominantly inattentive presentation (ADHD-I), but can be distinguished from it by the following symptoms: [11] [12] [4]

  • Prone to daydreaming
  • Easily confused or mentally foggy
  • Spacey or inattentive to surroundings
  • Mind seems to be elsewhere
  • Stares blankly into space
  • Underactive, slow moving or sluggish
  • Lethargic or less energetic
  • Trouble staying awake or alert
  • Has drowsy or sleepy appearance
  • Gets lost in own thoughts
  • Apathetic or withdrawn, less engaged in activities
  • Loses train of thought or cognitive set
  • Processes information not as quickly or accurately

As a comparison of both tables shows, there is no overlap between the official ADHD inattention symptoms and the SCT symptoms. That means that both symptom clusters do not refer to the same attention problems. They may exist in parallel within the same person but do also occur alone. However, one problem is still that some individuals who actually have SCT are currently misdiagnosed with the inattentive presentation. [4]

Social behaviour Edit

In many ways, those who have an SCT profile have some of the opposite symptoms of those with classic ADHD: instead of being hyperactive, extroverted, obtrusive, excessively energetic and risk takers, those with SCT are drifting, absent-minded, listless, introspective and daydreamy. They feel like they are "in the fog" and seem "out of it". [13]

The comorbid psychiatric problems often associated with SCT are more often of the internalizing types, such as anxiety, unhappiness or depression. [6] Most consistent across studies was a pattern of reticence and social withdrawal in interactions with peers. Their typically shy nature and slow response time has often been misinterpreted as aloofness or disinterest by others. In social group interactions, those with SCT may be ignored. People with classic ADHD are more likely to be rejected in these situations, because of their social intrusiveness or aggressive behavior. Compared to children with SCT, they are also much more likely to show antisocial behaviours like substance abuse, oppositional-defiant disorder or conduct disorder (frequent lying, stealing, fighting etc.). [8] Fittingly, in terms of personality, ADHD seems to be associated with sensitivity to reward and fun seeking while SCT may be associated with punishment sensitivity. [14] [8]

Attention deficits Edit

Individuals with SCT symptoms may show a qualitatively different kind of attention deficit that is more typical of a true information processing problem such as poor focusing of attention on details or the capacity to distinguish important from unimportant information rapidly. In contrast, people with ADHD have more difficulties with persistence of attention and action toward goals coupled with impaired resistance to responding to distractions. Unlike SCT, those with classic ADHD have problems with inhibition but have no difficulty selecting and filtering sensory input. [15] [8]

Some think that SCT and ADHD produce different kinds of inattention: While those with ADHD can engage their attention but fail to sustain it over time, people with SCT seem to have difficulty with engaging their attention to a specific task. [16] [17] Accordingly, the ability to orient attention has been found to be abnormal in SCT. [18]

Both disorders interfere significantly with academic performance but may do so by different means. SCT may be more problematic with the accuracy of the work a child does in school and lead to making more errors. Conversely, ADHD may more adversely affect productivity which represents the amount of work done in a particular time interval. Children with SCT seem to have more difficulty with consistently remembering things that were previously learned and make more mistakes on memory retrieval tests than do children with ADHD. They have been found to perform much worse on psychological tests involving perceptual-motor speed or hand-eye coordination and speed. They also have a more disorganized thought process, a greater degree of sloppiness, and lose things more easily. The risk for additional learning disabilities seems equal in both ADHD and SCT (23–50%) but math disorders may be more frequent in the SCT-group. [13]

A key behavioral characteristic of those with SCT symptoms is that they are more likely to appear to be lacking motivation and may even have an unusually higher frequency of daytime sleepiness. [19] They seem to lack energy to deal with mundane tasks and will consequently seek to concentrate on things that are mentally stimulating perhaps because of their underaroused state. Alternatively, SCT may involve a pathological form of excessive mind-wandering. [8]

Executive function Edit

The executive system of the human brain provides for the cross-temporal organization of behavior towards goals and the future and coordinates actions and strategies for everyday goal-directed tasks. Essentially, this system permits humans to self-regulate their behavior so as to sustain action and problem solving toward goals specifically and the future more generally. Dysexecutive syndrome is defined as a "cluster of impairments generally associated with damage to the frontal lobes of the brain" which includes "difficulties with high-level tasks such as planning, organising, initiating, monitoring and adapting behaviour". [20] Such executive deficits pose serious problems for a person's ability to engage in self-regulation over time to attain their goals and anticipate and prepare for the future.

Adele Diamond postulated that the core cognitive deficit of those with ADHD-I is working memory, or, as she coined in her recent paper on the subject, "childhood-onset dysexecutive syndrome". [21] However, two more recent studies by Barkley found that while children and adults with SCT had some deficits in executive functions (EF) in everyday life activities, they were primarily of far less magnitude and largely centered around problems with self-organization and problem-solving. Even then, analyses showed that most of the difficulties with EF deficits were the result of overlapping ADHD symptoms that may co-exist with SCT rather than being attributable to SCT itself. More research on the link of SCT to EF deficits is clearly indicated—but, as of this time, SCT does not seem to be as strongly associated with EF deficits as is ADHD. [8]

Unlike ADHD, the general causes of SCT symptoms are almost unknown, though one recent study of twins suggested that the condition appears to be nearly as heritable or genetically influenced in nature as ADHD. [22] That is to say that the majority of differences among individuals in these traits in the population may be due mostly to variation in their genes. The heritability of SCT symptoms in that study was only slightly lower than that for ADHD symptoms with a somewhat greater share of trait variation being due to unique environmental events. For instance, in ADHD, the genetic contribution to individual differences in ADHD traits typically averages between 75 and 80% and may even be as high as 90%+ in some studies. That for SCT may be 50–60%.

Little is known about the neurobiology of SCT. But the SCT symptoms seem to indicate that the posterior attention networks may be more involved here than the prefrontal cortex region of the brain and difficulties with working memory so prominent in ADHD. This hypothesis gained greater support following a 2015 neuroimaging study comparing ADHD inattentive symptoms and SCT symptoms in adolescents: It found that SCT was associated with a decreased activity in the left superior parietal lobule (SPL), whereas inattentive symptoms were associated with other differences in activation. [23] A 2018 study showed an association between SCT and specific parts of the frontal lobes, differing from classical ADHD neuroanatomy. [24]

Recently a study showed a small link between thyroid functioning and SCT symptoms suggesting that thyroid dysfunction is not the cause of SCT. High rates of SCT were observed in children who had suffered prenatal alcohol exposure and in survivors of acute lymphoblastic leukemia, where they were associated with cognitive late effects. [25] [26] [27]

SCT is currently not an official diagnosis in DSM-5 and no universally accepted set of symptoms exists yet. But there are rating scales that can be used to screen for SCT symptoms such as the Concentration Inventory (for children and adults) or the Barkley Sluggish Cognitive Tempo Scale-Children and Adolescents (BSCTS-CA). [28] [12] The Comprehensive Behaviour Rating Scale for Children (CBRSC), an older scale, can also be used for SCT as this case study shows. [29] Additional requirements for a proposed SCT diagnosis (such as the number and duration of symptoms or the impact on functioning) are continuing to be investigated.

Although having no diagnostic code either, ICD-10 mentions the SCT group as a reason for why it did not replace the term "Hyperkinetic Disorder" with "ADHD". [30]

Other mental disorders may produce similar symptoms to SCT (e.g. excessive daydreaming or "staring blankly") and should not be confused with it. Examples might be conditions like depersonalization disorder, dysthymia, thyroid problems, [25] absence seizures, Bipolar II disorder, Kleine–Levin syndrome, forms of autism or schizoid personality disorder. [31] However, the prevalence of SCT in these clinical populations has yet to be empirically and systematically investigated.

Treatment of SCT has not been well investigated. Initial drug studies were done only with the ADHD medication methylphenidate (e.g. Ritalin®), and even then only with children who were diagnosed as ADD without hyperactivity (using DSM-III criteria) and not specifically for SCT. The research seems to have found that most children with ADD (attention deficit disorder) with Hyperactivity (currently ADHD combined type) responded well at medium-to-high doses. [21] However, a sizable percentage of children with ADD without hyperactivity (currently ADHD inattentive type, therefore the results may apply to SCT) did not gain much benefit from methylphenidate, and when they did benefit, it was at a much lower dose. [32]

However, one study and a retrospective analysis of medical histories found that the presence or absence of SCT symptoms made no difference in response to methylphenidate in children with ADHD-I. [33] [8] But these studies did not specifically and explicitly examine the effect of the drug on SCT symptoms in children. The medication studies who did this found atomoxetine (Strattera) to have significant beneficial effects that were independent of ADHD symptoms [34] and a poor response for methylphenidate. [5]

Only one study has investigated the use of behavior modification methods at home and school for children with predominantly SCT symptoms and it found good success. [35]

In April 2014, The New York Times reported that sluggish cognitive tempo is the subject of pharmaceutical company clinical drug trials, including ones by Eli Lilly that proposed that one of its biggest-selling drugs, Strattera, could be prescribed to treat proposed symptoms of sluggish cognitive tempo. [36] Other researchers believe that there is no effective treatment for SCT. [1]

The prognosis of SCT is unknown. In contrast, much is known about the adolescent and adult outcomes of children having ADHD. Those with SCT symptoms typically show a later onset of their symptoms than do those with ADHD, perhaps by as much as a year or two later on average. They have as much or more difficulty with academic tasks and far fewer social difficulties than do people having ADHD. They do not have the same risks for oppositional defiant disorder, conduct disorder, or social aggression and thus may have different life course outcomes compared to children with ADHD-HI and Combined subtypes who have far higher risks for these other "externalizing" disorders. [8]

However, unlike ADHD, there are no longitudinal studies of children with SCT that can shed light on the developmental course and adolescent or adult outcomes of these individuals.

Recent studies indicate that the symptoms of SCT in children form two dimensions: daydreamy-spacey and sluggish-lethargic, and that the former are more distinctive of the disorder from ADHD than the latter. [37] [38] This same pattern was recently found in the first study of adults with SCT by Barkley and also in more recent studies of college students. [8] These studies indicated that SCT is probably not a subtype of ADHD but a distinct disorder from it. Yet it is one that overlaps with ADHD in 30–50% of cases of each disorder, suggesting a pattern of comorbidity between two related disorders rather than subtypes of the same disorder. Nevertheless, SCT is strongly correlated with ADHD inattentive and combined subtypes. [37] According to a Norwegian study, "SCT correlated significantly with inattentiveness, regardless of the subtype of ADHD." [39]

Early observations Edit

There have been descriptions in literature for centuries of children who are very inattentive and prone to foggy thought.

Symptoms similar to ADHD were first systematically described in 1775 by Melchior Adam Weikard and in 1798 by Alexander Crichton in their medical textbooks. Although Weikard mainly described a single disorder of attention resembling the hyperactive-impulsive subtype of ADHD, Crichton postulates an additional attention disorder, described as a "morbid diminution of its power or energy", and further explores possible "corporeal" and "mental" causes for the disorder (including "irregularities in diet, excessive evacuations, and the abuse of corporeal desires"). However, he does not further describe any symptoms of the disorder, making this an early but certainly non-specific reference to an SCT-like syndrome. [40] [8]

One example from fictional literature is Heinrich Hoffmann's character of "Johnny Head-in-Air" (Hanns Guck-in-die-Luft), in Struwwelpeter (1845). (Some researchers see several characters in this book as showing signs of child psychiatric disorders). [41]

The Canadian pediatrician Guy Falardeau, besides working with hyperactive children, also wrote about very dreamy, quiet and well-behaved children that he encountered in his practice. [42]

First research efforts Edit

In more modern times, research surrounding attention disorders has traditionally focused on hyperactive symptoms, but began to newly address inattentive symptoms in the 1970s. Influenced by this research, the DSM-III (1980) allowed for the first time a diagnosis of an ADD subtype that presented without hyperactivity. Researchers exploring this subtype created rating scales for children which included questions regarding symptoms such as short attention span, distractibility, drowsiness, and passivity. [7] In the mid 1980s, it was proposed that as opposed to the then accepted dichotomy of ADD with or without hyperactivity (ADD/H, ADD/noH), instead a three factor model of ADD was more appropriate, consisting of hyperactivity-impulsivity, inattention-disorganization, and slow tempo subtypes. [43]

In the 1990s, Weinberg and Brumback proposed a new disorder: "primary disorder of vigilance" (PVD). Characteristic symptoms of it were difficulty sustaining alertness and arousal, daydreaming, difficulty focusing attention, losing one's place in activities and conversation, slow completion of tasks and a kind personality. The most detailed case report in their article looks like a prototypical representation of SCT. The authors acknowledged an overlap of PVD and ADHD but argued in favor of considering PVD to be distinct in its unique cognitive impairments. [44] [45] Problematic with the paper is that it dismissed ADHD as a nonexistent disorder (despite it having several thousand research studies by then) and preferred the term PVD for this SCT-like symptom complex. A further difficulty with the PVD diagnosis is that not only is it based merely on 6 cases instead of the far larger samples of SCT children used in other studies but the very term implies that science has established the underlying cognitive deficits giving rise to SCT symptoms, and this is hardly the case. [8]

With the publication of DSM-IV in 1994, the disorder was labeled as ADHD, and was divided into three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined. Of the proposed SCT specific symptoms discussed while developing the DSM-IV, only "forgetfulness" was included in the symptom list for ADHD-I, and no others were mentioned. However, several of the proposed SCT symptoms were included in the diagnosis of "ADHD, not otherwise specified". [7]

Prior to 2001, there were a total of four scientific journal articles specifically addressing symptoms of SCT. But then a researcher suggested that sluggish tempo symptoms (such as inconsistent alertness and orientation) were, in fact, adequate for the diagnosis of ADHD-I. Thus, he argued, their exclusion from DSM-IV was inappropriate. [46] The research article and its accompanying commentary urging the undertaking of more research on SCT spurred the publication of over 30 scientific journal articles to date which specifically address symptoms of SCT. [7]

However, with the publication of DSM-5 in 2013, ADHD continues to be classified as predominantly inattentive, predominantly hyperactive-impulsive, and combined type and there continues to be no mention of SCT as a diagnosis or a diagnosis subtype anywhere in the manual. The diagnosis of "ADHD, not otherwise specified" also no longer includes any mention of SCT symptoms. [9] Similarly, ICD-10, the medical diagnostic manual, has no diagnosis code for SCT. Although SCT is not recognized as a disorder at this point, researchers continue to debate its usefulness as a construct and its implications for further attention disorder research. [7]

Significant skepticism has been raised within the medical and scientific communities as to whether SCT, currently considered a "symptom cluster," actually exists as a distinct disorder. [36]

Dr. Allen Frances, an emeritus professor of psychiatry at Duke University, has commented "We're seeing a fad in evolution: Just as ADHD has been the diagnosis du jour for 15 years or so, this is the beginning of another. This is a public health experiment on millions of kids. I have no doubt there are kids who meet the criteria for this thing, but nothing is more irrelevant. The enthusiasts here are thinking of missed patients. What about the mislabeled kids who are called patients when there’s nothing wrong with them? They are not considering what is happening in the real world." [36]

UCLA researcher and Journal of Abnormal Child Psychology editorial board member Steve S. Lee has also expressed concern based on SCT's close relationship to ADHD, cautioning that a pattern of over-diagnosis of the latter has "already grown to encompass too many children with common youthful behavior, or whose problems are derived not from a neurological disorder but from inadequate sleep, a different learning disability or other sources." Lee states, "The scientist part of me says we need to pursue knowledge, but we know that people will start saying their kids have [sluggish cognitive tempo], and doctors will start diagnosing it and prescribing for it long before we know whether it’s real. ADHD has become a public health, societal question, and it’s a fair question to ask of SCT." [36]

Adding to the controversy are potential conflicts of interest among the condition's proponents, including the funding of prominent SCT researchers' work by the global pharmaceutical company Eli Lilly [36] and, in the case of Dr. Russell Barkley, a leader in the burgeoning SCT research field, direct financial ties to that company (Dr. Barkley has received $118,000 from 2009 to 2012 for consulting and speaking engagements from Eli Lilly). [47] When referring to the "increasing clinical referrals occurring now and more rapidly in the near future driven by increased awareness of the general public in SCT", Dr. Barkley writes "The fact that SCT is not recognized as yet in any official taxonomy of psychiatric disorders will not alter this circumstance given the growing presence of information on SCT at various widely visited internet sites such as YouTube and Wikipedia, among others." [48]


The Baddeley-Hitch Model of Working Memory

The Baddeley-Hitch model of working memory suggests that there are two components of working memory:

  • Visuospatial Scratchpad- a place where you store visual and spatial information
  • Phonological Loop- a place where you record auditory information

A third part, the central executive, is the controller and mediator of these two different aspects of our working memory. According to Baddeley and Hitch, the central executive processes information, directs attention, sets goals, and makes decisions.


Interview with Dr. Heather Pedersen Brain–Health a Growing Concern as Boomers Age

The Center for Disease Control (CDC) announced their State and Local Public Health Partnerships to Address Dementia, The 2018- 2023 Road Map, as part of the CDC Healthy Brain Initiative. The Road Map helps chart a course for state and local public health agencies to prepare their communities to deal with the ever expanding need for brain-health concerns.

According to CDC and their Healthy Brain Initiative, there are at least five to six million people currently living with age-related dementias in the U.S. This translates into one out of every six women and one out of every 10 men, who live past the age of 55. As the population increases, and more Baby Boomers reach older ages, these numbers are expected to rise.

The CDC wants to stimulate changes in policies, systems, and environments. They convened experts who developed 25 actions for public health leaders to promote brain health, better care for people with cognitive impairment, increased attention to caregivers, and efforts to build public health capacity.

“Dementia is a devastating condition that impacts millions of people annually,” said Dr. Heather Pedersen, a board certified clinical neuropsychologist at the Algiers Neurobehavioral Resource, LLC, located in New Orleans.

“Dementia,” she said “is a generic term that refers to when an individual is experiencing cognitive problems––such as memory loss, difficulty with logic, or trouble with language––to such an extent that they cannot manage aspects of daily life.”

According to the CDC, while there are various forms of dementia, around 70 percent of cases are due to Alzheimer’s and the next most common type is vascular dementia. African Americans, Hispanics, and women are particularly at risk of developing Alzheimer’s and other dementias. More than 95% of people with dementia have one or more other chronic conditions. And, one in three Alzheimer’s caregivers report their health has become worse due to care responsibilities.

“There are many diseases and conditions that can lead to dementia,” Pedersen said, “with Alzheimer’s disease being the leading cause of dementia. Per the CDC, the number of adults with Alzheimer’s disease is expected to triple over the next 40 years. Alzheimer’s disease and other dementiacausing diseases impact individuals, families, friends, caregivers, health-care agencies, and communities in wide-ranging ways,” Dr. Pedersen said.

According to the CDC, they seek to promote the use of effective interventions and best practices to protect brain health, address cognitive impairment, and help meet the needs of caregivers for people with dementia. They aim to improve inclusion of healthcare quality measures that address cognitive assessments, improve the delivery of care planning to people with diagnosed dementia, and improve outcomes.

Another of the CDC’s goals is to educate public health professionals about the best available evidence on dementia, including detection. CDC Director Robert R. Redfield, MD, said. “Early diagnosis is key to helping people and their families cope with loss of memory, navigate the health care system, and plan for their care in the future.

“The importance of early detection and intervention for many dementia processes cannot be overstated,” Dr. Pedersen explained. “Some medications are more effective when started earlier and compensatory strategies can often be put into place so as to be more useful in the long run. However, in order to be able to put these interventions into place, an individual has to first be diagnosed with dementia.”

What are some of the benefits of early diagnosis of dementia?

“Early diagnosis of course allows for individuals to begin appropriate medication earlier on in the process, as there are medications for certain diseases, like Alzheimer’s, that can slow down the disease process. But, early diagnosis also allows for individuals and their families to begin to adjust and adapt their lives in ways to make good years last as long as possible,” Dr. Pedersen said. “By making slight changes to schedules, home management, or other systems, individuals can maintain independence for as long as possible.”

Can neuropsychologists’ findings help with treatments and/or treatment planning?

“Absolutely,” Pedersen said. “By helping with an accurate diagnosis, neuropsychologists can also help other providers make informed decisions about treatment options. Neuropsychologist evaluations also help by determining individual’s cognitive strengths and weaknesses,” she said.

“By maximizing strengths to compensate for weaknesses, neuropsychologists can help make suggestions to make tasks more efficient or easier to complete.”

Neuropsychologists can often help caregivers better understand issues for their loved ones and better cope with and adjust to the caring role.

“It is often very helpful for caregivers and other family members to understand the basics about what is causing the cognitive problems or dementia,” Dr. Pedersen explained. “As part of the evaluation process, clients and loved one’s are provided with feedback about what is likely causing their cognitive problems. We spend time discussing the causes, prognosis, treatments, and other strategies that might be helpful in maximizing the client to live their best life.”

In today’s medical culture, the approach is often the quick screening rather than the comprehensive assessment. Is this a concern? A quick screening may not be able to determine the cause of an individual’s cognitive problems, Pedersen explained.

“A comprehensive assessment is critical in the accurate diagnosis of dementia. There are many conditions that can masquerade as dementia and given the permanent, progressive nature of some dementias, it is vital that one isn’t falsely diagnosed,” she said. “There are many different diseases and conditions that cause dementia, some of which are treatable and some of which are not. Depression and some metabolic conditions can ‘look like’ dementia, but in fact are treatable conditions.”

The American Academy of Neurology (AAN) has recommended neuropsychological testing since 1996 for patients who may have experienced a traumatic brain injury, a stroke, Parkinson disease, multiple sclerosis, a neurotoxic exposure, or dementia. Neuropsychological testing “is particularly valuable in distinguishing between normal aging and mild dementias,” they AAN noted.

Dr. Pedersen, who earned her PhD from the University of North Dakota, and completed her postdoctoral fellowship in clinical neuropsychology at the Memphis Veterans Affairs Medical Center and UT Health Sciences Center Consortium, is licensed in Louisiana, Minnesota, and Arizona.

Among her training and research achievements, Dr. Pedersen has co-authored “The next major neuropsychological and neuropsychiatric breakthrough: Alzheimer’s disease,” for the Handbook of Neuropsychiatry Research. She also co-authored research on concussions for American Journal of Alzheimer’s Disease and Other Dementias, and co-authored “Later life health optimism, pessimism, and realism: Psychosocial contributors and health correlates,” published in Psychology and Health.

“Each person who walks through my door is a unique constellation of traits, strengths, and weaknesses, who is looking for some sort of assistance,” Dr. Pedersen said. “I find it very satisfying to come along side each client to work with them in their treatment goals.”

“That process of collaborating with my clients is a very enjoyable process for me,” she said.


Can Learning a Second Language Delay Dementia?

Dementia is a syndrome (i.e. a collection of symptoms) that tends to affect those over 65. It is generally described as a global loss of cognitive ability, including language skills, memory, understanding and judgement. It can be a debilitating condition, frightening for both the sufferer and their family, and a growing concern in an aging population. A great deal of scientific effort is going into strategies to prevent the onset of dementia in the elderly.

What did the scientists say?

Previous studies have shown that the onset of dementia caused by Alzheimer’s disease can be delayed by as long as five years by multilingualism (i.e. being fluent in two or more languages). It is believed that the process of learning and using another language boosts the brain’s “cognitive reserve“, acting as a form of “brain training” to stave off the effects of Alzheimer’s disease dementia.

However, dementia is a condition with many subtypes, and before this study it was unclear as to whether learning another language would be beneficial in cases where dementia occurred due to another disease or mechanism. Also, the majority of studies were carried out in immigrant populations, which makes it difficult to tell whether the effect is truly biological, or simply a consequence of being in an environment where few people speak the patient’s native tongue. Also, studying immigrants can bias the sample of patients towards a certain culture or ethnic group.

In this study, the scientists try and circumvent this environmental problem by using Indian test subjects. India is a country of many languages, where locals switch languages mid-conversation speaking several languages is common even amongst those who cannot read or write! This makes it a valuable region for testing whether dementia is affected by bilingualism, especially as both the multilingual and non-multilingual patients in the sample can be drawn from the same population, and thus cultural and environmental biases can be removed.

The scientists used data from 648 patients in Hyderabad, all of whom were diagnosed with one of the following subtypes of dementia: Alzheimer’s Disease dementia, frontotemporal dementia, vascular dementia, dementia with Lewy bodies, and mixed dementia. Family members of the patients were interviewed to assess how many languages they spoke fluently, and at what age dementia developed. Around 60% of the patients spoke more than one language, and roughly the same proportion of both multilingual and non-multilingual patients eventually developed dementia.

The multilinguals developed dementia at an average age of 65.6 years, compared to 61.1 years for non-multilingual patients. The scientists showed that when controlling for a variety of factors, including urban or rural living, gender, education level, and others, this effect was preserved. In fact, when the scientists considered only illiterate patients, the effect increases – these multilinguals develop dementia around 6 years later than their single language counterparts. However, illiterates constitute 14% of the sample, so this figure is less robust than the others.

Most interestingly, this study is the first to demonstrate delay of frontotemporal and vascular dementia by multilingualism (dementia with Lewy bodies and mixed dementia did show a very small delay, but the effect was not statistically significant). The number of extra languages appears to be inconsequential to the effect.

The scientists do note a few shortcomings of the study. They rely on family members for determining at what age dementia develops, so it is unclear how much uncertainty this produces in the typical number of years delay produced by multilingualism. When the level of this effect appears to be similar to that achievable by drugs, we should be very careful that this effect isn’t overstated, for patients’ sakes. Also, how multilingualism is measured isn’t particularly precise, and it again relies on family member testimony. Precisely how early a patient should learn a language isn’t yet clear from this work, but the authors are keen to explore this question further.

What did the Media Say?

The BBC make it clear that only certain types of dementia are positively affected by a second language. They also note the advantages of this study’s unique sample of patients.

Livescience carry out an interview with Thomas Bak, one of the study’s co-authors. They discuss the applicability of the effect to, for example, United States nationals learning a second language in classes. Like the BBC, they correctly report some of the different subtypes of dementia in the study, but they do not report the lack of effect measured for other subtypes of dementia.

USA Today speak to other research groups interested in the same questions, to obtain perspective on this particular paper.

The Daily Mail’s headline emphasises the effect’s strength compared to drugs, which as I’ve already said we should be a bit more cautious about.

Generally speaking, this story is well reported, and the scientists’ desire to follow up these studies to determine whether these positive effects extend to Western citizens taking language classes is well expressed by most outlets.

Suvarna Alladi, DM, Thomas H. Bak, MD, Vasanta Duggirala, PhD, Bapiraju Surampudi, PhD, Mekala Shailaja, MA, Anuj Kumar Shukla, MPhil, Jaydip Ray Chaudhuri, DM and Subhash Kaul, DM (2013)
. “Bilingualism delays age at onset of dementia, independent of education and immigration status”. Neurology early online view: doi: 10.1212/01.wnl.0000436620.33155.a4


14 TIPS TO REDUCE YOUR RISK OF DEMENTIA AND ALZHEIMER’S DISEASE

Did you know that the overall volume of our brain already starts to shrink in our 30’s and 40’s, with the rate of brain shrinkage further accelerating around age 60?

The frontal cortex (the region involved in short-term memory and executive thinking) and the hippocampus (the brain region involved in memory) shrink the most as decades pass.

This brain shrinkage goes hand-in-hand with a slow, but steady decline in cognitive prowess.

We start to forget more. We find it more difficult to come up with words. We find it more difficult to put a name on a face.

The brain is the most valuable organ that we have, because it defines who we are. It stores our identity, our character, our memories.

A healthy lifestyle, including supplements, can significantly slow down the process of brain shrinkage and reduce the risk of Alzheimer’s disease.

So how can we protect our brain? How can we preserve our mental agility, thinking skills, and memories for longer?

We’ve taken the time to dig into all of the latest research into Alzheimer’s prevention and put together a nice overview on how you can keep your brain healthy for the longest time possible.

1. EAT A HEALTHY BRAIN DIET

Food is of course very important for your brain. Your brain uses ten times more energy than normal tissues, and needs large amounts of nutrients to function properly.

So it’s very susceptible to an unhealthy diet that provides too much, or the wrong fuel to your brain.

Also, the brain is very maintenance intensive. So it needs many building blocks to function properly, like magnesium, zinc, choline, omega-3 fatty acids, and many other substances.

Eating well will make you feel better, think better and stay better for longer, staving off not just Alzheimer’s disease but also depression and anxiety.

In fact, nutrition is the best technology we have to reduce the risk of Alzheimer’s disease.

These are some foods you need to eat to keep your brain at its best:

Blue and red fruit – but especially blue fruit

Blueberries, bilberries and blackberries are wonderful brain foods. They contain substances that protect the brain from damage, and can slow down aging, such as anthocyanidins.

But also red fruit, like strawberries and raspberries, are very healthy for the brain.

Blue fruit contains a substance called pterostilbene that has beneficial effects on the aging process (learn more about pterostilbene here). The same for strawberries: they contain fisetin, which is a substance that can slow down aging. However, to achieve these lifespan effects you need much higher amounts than found in these fruits.

Blueberries and strawberries are not just healthy because of the pterostilbene or fisetin they contain, but also because of the many other flavonoids and substances.

Herbs

The powerful health benefits of herbs should not be underestimated. Oregano, rosemary, turmeric, ginger, sage, and many other herbs and spices reduce inflammation, and are able to protect the DNA from damage, an aging process the brain is very susceptible to.

Green leafy vegetables

Kale, cabbage, broccoli, spinach, and sprouts are leafy greens that have brain-protective effects.

For example, studies show that people who often eat leafy green vegetables have brains that were up to eleven years younger compared to people who did not eat a lot of green leafy vegetables (R,R).

Green leafy vegetables are full of important minerals, vitamins, and many other substances that the brain needs to stay healthy and function properly.

Also, vegetables don’t cause high glucose peaks in your blood (in contrast to potatoes, pasta and rice) so they are ideal substitutes for these starchy foods. The brain, given its reliance on glucose to function, is very susceptible to high glucose peaks. That’s the reason why some scientists call Alzheimer’s “type 3 diabetes”.

Omega-3 fatty acids

Omega-3 fats are very important for our health, especially for the heart, eyes and brain.

Omega-3 fats are an important component of the membranes of our cells, especially in the brain. There they make the cell membranes healthy and supple, ensuring proper communication between the brain cells.

Additionally, omega-3 fats carry out many other functions in the brain and body: they can reduce inflammation, improve metabolism and increase blood flow.

Reducing inflammation is especially important, because continuous low-grade inflammation damages the brain and accelerates aging (this is called “inflammaging”).

Omega-3 fats are found in animals and plants. Omega-3 fats are found in fatty fish, such as salmon, herring, anchovies, and mackerel. Plant-based sources of omega-3 fatty acids are walnuts, chia seeds and flax seeds, for example.

Dark chocolate (at least 70% cacao)

Dark chocolate is full of brain-healthy substances like flavanols that protect your brain and blood vessels and can slow down cognitive decline.

Dark chocolate can also boost cognitive performance, partly because it contains substances that widen the blood vessels so that more oxygen and nutrients make it to the brain cells.

Olive oil

Did you know that only 4 tablespoons of olive oil can reduce inflammation just as well as Ibuprofen, a strong anti-inflammatory drug?

Besides various anti-inflammatory substances, olive oil contains substances that have a range of other healthy benefits, like reducing protein accumulation, a process that plays an important role in aging. Examples of such substances are oleocanthal and tyrosol.

Tea and coffee

It’s well known that tea can reduce the risk of Alzheimer’s and Parkinson disease, and can reduce the risk of stroke. It can do this by reducing inflammation and keeping the blood vessels healthy.

Coffee has somewhat of a controversial reputation online, given many websites dissuade drinking coffee, claiming it’s unhealthy. However, if you look at the whole of scientific studies done with coffee, we see that coffee has more benefits than drawbacks. Coffee can reduce the risk of Alzheimer’s disease, Parkinson’s disease (and also type 2 diabetes, heart disease and various cancers).

However, don’t drink too much coffee. Keep it to a maximum of 3-5 cups per day, and ideally don’t drink coffee in the late afternoon or evening – otherwise you will have more difficulties falling asleep, which can have an unfavorable effect on Alzheimer’s of its own.

Reduce sugar and starch intake

Sugar damages your brain. It can do this by increasing inflammation in the brain, and causing aging-related crosslinks. Soft drinks, pastries, cookies, and other sweets cause your sugar levels to rise and can damage your brain (scientists often call Alzheimer’s disease “type 3 diabetes”).

But also eat less starchy foods such as bread, potatoes, rice and pasta. These foods are made up of starch, which are long chains of glucose. These starch products therefore also consist mainly of sugar, causing our blood sugar levels to rise.

There are also very few vitamins, minerals and other healthy substances in starch products (compared to, for example, vegetables).

Avoid unhealthy fats

These are trans-fats in fried food, junk food, cakes, cookies and pastries and ready-to-eat meals. Such fats are very bad for your brain.

Do not drink too much alcohol

Drinking too much alcohol damages the brain. In fact, alcohol is quite neurotoxic. Already regularly drinking more than two glasses of alcohol a day can damage your brain. Also, drinking once in a while five or more glasses in a few hours (binge-drinking) can exert very damaging effects on the brain.

Therefore, limit your alcohol consumption to one glass of alcohol per day, with ideally some alcohol-free days per week.

2. EXERCISE

Human bodies are literally made to move. Our brains need daily movement to keep themselves healthy.

Exercise releases all kinds of healthy substances in the brain, which keep your brain younger for longer, reduce the risk of dementia, and make you function better cognitively (R,R).

It’s never too late to exercise. A study showed that middle-aged people who went for a regular walk reduced their risk of Alzheimer’s by more than 45% (R).

Exercise can also improve your emotional state. Research found that regular exercise is at least as effective as taking antidepressants. Not only sports, but also dancing is very healthy for your brain (and your body).

3. CHECK IF YOU HAVE UNDERLYING MEDICAL PROBLEMS

Various diseases, some of which you might be unaware, can be detrimental for your brain health, especially in the long term, like high blood pressure, pre-diabetes, diabetes, atherosclerosis (the clogging up of your blood vessels), leaky gut, too much abdominal fat (“a beer belly”), low-grade systemic inflammation, and so on.

For example, hypertension and atherosclerosis damage the thousands of miles of blood vessels in your brain, and increase your risk of stroke and Alzheimer’s disease. Too much abdominal fat (having a “beer belly”) secretes substances in the bloodstream that reach the brain and cause inflammation there, increasing the risk of Alzheimer’s. (Pre)diabetes is also very unhealthy for our brain. That is why some researchers call Alzheimer’s disease “type 3 diabetes”, referring to the fact that insulin resistance of the brain can also significantly contribute to Alzheimer’s disease.

So get regular medical checkups to catch these problems as soon as possible.

4. CHECK WHICH DRUGS YOU TAKE

Some drugs can increase the risk of Alzheimer’s disease or cognitive deterioration, like specific sedatives, antidepressants or antihistaminergic drugs used to fall asleep or treat allergies. Many of these drugs are called “anticholinergics”, which might increase the risk of dementia in the long term.

5. BE SOCIAL

People need other beings to feel happy. We are social animals. Research shows that seeing people keeps your brain young.

Loneliness on the other hand is very bad for our brain, and health. Studies show that loneliness can even activate transcription factors in the brain.

Having little social contacts is unhealthy and increases your risk of dementia, heart disease and general mortality (R).

Therefore, go out with a friend, contact a former colleague or classmate, visit family, join an association, or become a volunteer.

6. RELAX!

If relaxation was a drug, it would be a billion-dollar blockbuster!

Relaxation, or meditation, is super healthy. When you relax, many substances are released that are healthy for your body and brain, such as endorphins. Your body also produces fewer substances that damage the brain, such as cortisol, a stress hormone that causes blood vessels to clog faster, increases blood pressure, and increases sugar levels.

Do meditation, yoga or breathing exercises. You can also do this online, or via meditation apps on your smartphone.

7. DON’T HIT YOUR HEAD

People who sustain head injuries have more risk of dementia. These head injuries can happen during exercising, playing, dancing, work, and so on. When you hit your head hard, brain tissue gets damaged each time. So next time when you want to headbutt a ball, use your head (only figuratively speaking!).

8. GET ENOUGH SLEEP

People underestimate the great importance of sufficient, regular sleep.

Sleep enables our brain needs to recover and repair itself.

Sufficient sleep keeps the brain healthy. People who sleep too little are more at greater risk for Alzheimer’s disease (and a lot of other diseases).

9. TAKE THE RIGHT BRAIN SUPPLEMENTS

Even if you follow a very healthy diet, it’s very difficult to get enough nutrients that are important for your brain. We explain why here.

There are various nutrients that are important for your brain, and of which many people of deficient. These are supplements like:

  • B vitamin complex (containing all B vitamins, like vitamin B12, B6, B3, B1, etc).
  • Zinc
  • Selenium
  • Vitamin D
  • Iodine
  • Omega-3 fatty acids

However, no supplement can provide the hundreds of other micronutrients that are important for brain health, and which you have to derive from a varied, healthy diet.

10. IMPROVE YOUR GUT

What’s in your gut has a great impact on your brain.

The 40,000 billion bacteria that live in your gut secrete thousands of different substances that can enter your bloodstream and impact how your brain works, and influence your cognitive abilities and even your feelings.

Scientists call this the “gut-brain axis”. The bacteria in your gut secrete substances such as neurotransmitters, neuropeptides and inflammatory molecules, which influence the brain.

If you eat unhealthy food, you have a gut microbiome that secretes unhealthy substances that make you feel bad and that can impair your thinking.

For a healthy microbiome it’s important to consume a lot of water-soluble fibers from vegetables, fruit, nuts, mushrooms and legumes.

Also eat less sugar and starch (including bread, potatoes, pasta and rice), since starch is made of glucose. Too much glucose can cause overgrowth of unhealthy bacteria in the gut (which love glucose).

Also important for proper gut health is preventing deficiencies of vitamin A, vitamin D, zinc, iodine and selenium: these vitamins contribute to a healthy, strong intestinal immune system. This immune system can keep the microbiome under control and well-balanced.

You can also take a probiotic, but make sure that it contains sufficiently different types of bacteria (not just lactobacilli). Everyone is different, and even more so their gut microbiomes, so while one brand can work for one person, it does not for another person. So try out different brands, and see which brand works best for you.

11. CHALLENGE YOUR BRAIN

Your brain likes being challenged. It’s like a muscle: you need to train it. If you don’t expose your brain to new things, it will wither away.

So instead of watching television passively or mindlessly browsing on Facebook, or gaming like a zombie, do things that engage your brain:

  • read a book or magazine
  • solve puzzles
  • play brain games (e.g. download brain training apps on your mobile)
  • learn a new language
  • play games like chess, checkers, mastermind, four-in-a-row, bridge…
  • learn a new hobby
  • try to learn as many things as possible by heart (such as phone numbers, quotes, songs…)
  • become a volunteer
  • learn to play an instrument
  • learn to dance
  • learn to paint or draw

Your brain loves new things. New experiences keep your brain sharp and healthy. Go on a journey, make new friends, learn a new hobby, read daily motivational quotes, download podcasts to learn things, read an interesting book, listen to an audio book, discover new music.

Be curious, inspired and motivated. There are so many ways to stimulate your brain, and at the same time keep it fit and young!

12. STOP SMOKING

We all know that smoking is not healthy. But it’s terribly unhealthy for your brain. Smoking damages and constricts the thousands of little blood vessels that run through your brain.

Smoking contains many substances that damage brain cells, increasing your risk of dementia and Alzheimer’s disease. And at the same time increase your risk of lung cancer, heart attacks, kidney cancer, wrinkles, strokes, emphysema, impotence and so on.

13. PRACTICE POSITIVE PSYCHOLOGY: BE HAPPY AND AVOID STRESS

A happy brain is a healthy brain. Stress damages the brain, increasing your risk of dementia. Try to learn to be happy. Yes, that’s possible! You can train your brain to be happy!

14. TAKE SUPPLEMENTS THAT SLOW DOWN AGING

One of our previous tips was to take supplements. These are supplements that your brain needs to function properly, like B vitamins, zinc and omega-3 fatty acids.

However, there are also supplements that aim to slow down aging itself.

These supplements contain substances that inhibit specific aging mechanisms, like protein accumulation, mitochondrial dysfunction, DNA damage, epigenetic changes, and so on.

These processes cause aging, but also greatly contribute to brain aging and dementia. In fact, we see that for example, accumulation of proteins, plays an important role in Alzheimer’s disease.

However, protein accumulation is also one of the reasons why we age, given protein accumulation happens in many other cells beyond just our brain cells.

Very few science-based supplements exist to slow down aging. That’s why we at NOVOS created NOVOS Core.


Evaluating the Latest Alzheimer's Disease Prevention Research

A recent review of research looked carefully at the evidence on ways to prevent or delay Alzheimer's dementia or age-related cognitive decline. Led by a committee of experts from the National Academies of Sciences, Engineering, and Medicine (NASEM), the review found "encouraging but inconclusive" evidence for three types of interventions:

The evidence for other interventions, such as medications and diet, was not as strong. However, scientists are continuing to explore these and other possible preventions.


How Breathing Calms Your Brain, And Other Science-Based Benefits Of Controlled Breathing

The science of breathing stands on quite ancient foundations. Centuries of wisdom instructs us to pay closer attention to our breathing, the most basic of things we do each day. And yet, maybe because breathing is so basic, it’s also easy to ignore. A brief review of the latest science on breathing and the brain, and overall health, serves as a reminder that breathing deserves much closer attention – there’s more going on with each breath than we realize.

Controlling your breathing calms your brain.

While the admonition to control breathing to calm the brain has been around for ages, only recently has science started uncovering how it works. A 2016 study accidentally stumbled upon the neural circuit in the brainstem that seems to play the key role in the breathing-brain control connection. The circuit is part of what's been called the brain’s “breathing pacemaker” because it can be adjusted by altering breathing rhythm (slow, controlled breathing decreases activity in the circuit fast, erratic breathing increases activity), which in turn influences emotional states. Exactly how this happens is still being researched, but knowing the pathway exists is a big step forward. Simple controlled breathing exercises like the 4-7-8 method may work by regulating the circuit.

Breathing regulates your blood pressure.

“Take a deep breath” is solid advice, particularly when it comes to keeping your blood pressure from spiking. While it’s unclear whether you can entirely manage blood pressure with controlled breathing, research suggests that slowing your breathing increases “baroreflex sensitivity,” the mechanism that regulates blood pressure via heart rate. Over time, using controlled breathing to lower blood pressure and heart rate may lower risk of stroke and cerebral aneurysm, and generally decreases stress on blood vessels (a big plus for cardiovascular health).

Counting breaths taps into the brain’s emotional control regions.

A recent study showed that controlling breathing by counting breaths influences “neuronal oscillations throughout the brain,” particularly in brain regions related to emotion. Participants were asked to count how many breaths they took over a two-minute period, which caused them to pay especially focused attention to their breathing. When they counted correctly, brain activity (monitored by EEG) in regions related to emotion, memory and awareness showed a more organized pattern versus what’s normally experienced during a resting state. The results are preliminary, but add to the argument that controlling breathing taps into something deeper.

The rhythm of your breathing affects memory.

A 2016 study showed for the first time that the rhythm of our breathing generates electrical activity in the brain that influences how well we remember. The biggest differences were linked to whether the study participants were inhaling or exhaling, and whether they breathed through the nose or mouth. Inhaling was linked to greater recall of fearful faces, but only when breathing through the nose. Participants were also able to remember certain objects better when inhaling. Researchers think that nasal inhalation triggers greater electrical activity in the amygdala, the brain’s emotional epicenter, which enhances recall of fearful stimuli. Inhaling also seems linked to greater activity in the hippocampus, the seat of memory.

Controlled breathing may boost the immune system and improve energy metabolism.

While this is the most speculative of the study findings on this list, it’s also one of the most exciting. The study was evaluating the “Relaxation Response” (a term popularized in the 1970s book of the same name by Dr. Herbert Benson, also a co-author of this study), which refers to a method of engaging the parasympathetic nervous system to counteract the nervous system's “fight or flight” response to stress. Controlled breathing triggers a parasympathetic response, according to the theory, and may also improve immune system resiliency as a “downstream health benefit.” The study also found improvements in energy metabolism and more efficient insulin secretion, which results in better blood sugar management. If accurate, the results support the conclusion that controlled breathing isn't only a counterbalance to stress, but also valuable for improving overall health.


Doing regular physical activity is one of the best ways to reduce your risk of dementia. It’s good for your heart, circulation, weight and mental wellbeing.

It’s important to find a way of exercising that works for you. You might find it helpful to start off with a small amount of activity and build it up gradually. Even 10 minutes at a time is good for you and try to avoid long sitting down for too long.

Aerobic activities

Each week, you should aim for either

  • 150 minutes of moderate aerobic activity, such as brisk walking, riding a bike or pushing a lawnmower, or
  • 75 minutes of vigorous aerobic activity, such as jogging, fast swimming or riding a bike up a hill.

You should also build in some resistance activities that require strength and work your muscles twice a week, such as

Alternatively, take part in activities that are both aerobic and resistance, such as football, running, netball or circuit training.

How much physical activity do adults aged 19-64 years old need to do to stay healthy?