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Cognitive health

Healthy brain aging:

To help older adults protect
brain health and function,
add activities that ensure a
flow of novelty, variety and

why we need to retool challenge

by Álvaro Fernández, MA, MBA

‘Use it or lose it’ By now you have probably heard about

brain plasticity, the lifelong capacity of
the brain to change and rewire itself in
response to the stimulation of learning
and experience. The latest scientific
research shows that specific lifestyles and
actions can improve the health and level
of functioning of our brains, no matter
our age.

Of particular importance to maintaining

cognitive functioning through life are the
hippocampus (deep inside the brain, part
of what is called the limbic system),
which plays a role in learning and mem-
ory; and the frontal lobes (behind your
forehead), which are key to maintaining
decision-making and autonomy. Is there
a way to physically protect these parts of
the aging brain? Yes. But the right answer
is far from “do one more crossword puz-
zle” or “do more X” (whatever X is). The
key is to add significantly different activi-
ties to ensure a flow of novelty, variety
and challenge, combining physical and
mental exercise while not ignoring factors
such as stress management and balanced
nutrition.1

We need, in other words, to retool our

understanding and practice of “Use it or
lose it.” We must focus on the impor-
tance of getting out of our physical and
mental routines and activities to get the
benefits of real exercise—physical and
mental.
ICAA July-august-09 8/24/09 5:48 PM
Debunking 10 common
myths
The extensive research process we
undertook for our recent book, The
SharpBrains Guide to Brain Fitness,1 high-
lighted the need to debunk some popular
myths on brain health that may hinder
efforts in the right direction. These
include:
Myth 1. Genes determine the fate of
our brains.
Facts: Lifelong neuroplasticity allows our
lifestyles and actions to play a meaningful
role in how our brains physically evolve,
especially given longer life expectancy.
Myth 2. Aging means automatic decline.
Facts: There is nothing inherently fixed
in the precise trajectory of how brain
functions evolve as we age.
Myth 3. Medication is the main hope for
cognitive enhancement.
Facts: Noninvasive interventions can
have comparable and more durable
effects, side effect-free.
Myth 4. We will soon have a magic pill or
general solution to solve all our cognitive
challenges.
Facts: A multipronged approach is rec-
ommended, centered around nutrition,
stress management, and both physical
and mental exercise.
Myth 5. There is only one “it” in “Use it or
lose it.”
Facts: The brain is composed of a num-
ber of specialized units. Our life and
productivity depend on a variety of
brain functions, not just one.
Myth 6. All brain activities or exercises
are equal.
Facts: Varied and targeted exercises are
the necessary ingredients in brain train-
ing, so that a wide range of brain func-
tions can be stimulated.
Myth 7. There is only one way to train
your brain.
Facts: Brain functions can be impacted in
a number of ways, such as meditation,
cognitive therapy and cognitive training.
Myth 8. We all have something called
“brain age.”
Page 41
Facts: Brain age is a fiction. No two indi-
viduals have the same brain or expression Resource
of brain functions.
The SharpBrains Guide to Brain
Myth 9. That “brain age” can be reversed Fitness: 18 Interviews with Scientists,
by 10, 20, 30 years.
Practical Advice, and Product Reviews,
Facts: Brain training can improve specific
to Keep Your Brain Sharp
brain functions, but, with research avail-
able today, cannot be said to roll back Authors: Álvaro Fernández and
one’s “brain age” by a number of years. Elkhonon Goldberg, PhD
San Francisco CA: SharpBrains Inc.,
Myth 10. All human brains need the same May 2009
brain training. Paperback, 182 pages, $24.95
Facts: As in physical fitness, users must
ask themselves: What functions do I need
The SharpBrains Guide to Brain
to improve on? In what timeframe? What
is my budget? Fitness is the result of over a year of
extensive research including more
With these facts in mind, let’s delve into than 100 interviews with scientists,
different types of mental exercise and professionals and consumers, and a
how they benefit the brain. deep literature review. Among the
leading scientists interviewed, Arthur
Exercise requires cross-
Kramer explains the need for walking
training and challenge
book clubs and Yaakov Stern discusses
The most common enemies of novelty,
variety and challenge are routine and building cognitive reserve. There is an
doing things inside our comfort zones. accessible introduction to the brain
This is true for both physical and mental and brain fitness research combined
exercise. with over 100 references to peer-
reviewed scientific studies for deeper
Consider the type of mental exercise study. The resource also reviews 21
experienced daily by London cab drivers.
products for brain cross-training, tar-
Every new ride requires a complex men-
tal task to decide the most efficient route geted mental exercise, and emotional
to complete the continually novel chal- self-regulation.
lenge at hand. Contrast that with the
routine mental activity (we couldn’t really
call it “mental exercise”) undertaken by
There are four types of mental exercise
London bus drivers who, day after day,
with more supporting scientific evidence
follow a precise itinerary. Clearly, if you
that they can enhance specific brain
lived in London and wanted to protect
functions.1 They are:
and even grow your hippocampus, you
would choose to drive a cab, not a bus.
• Cognitive therapy (CT). The way we
perceive our experiences influences our
Of course, the brain has a variety of
behaviors, and we can learn cognitive
structures and functions to maintain,
skills to modify our thinking, resulting
well beyond the hippocampus, hence the
in actions. CT is commonly used in
need for cross-training. Not all mental
the context of anxiety and depression,
exercise is equal in terms of its structural
but its core principles and techniques
and functioning benefits—in the same
show promise in a variety of other
way that different types of physical fit-
applications such as healthy eating.
ness training bring different benefits.
• Meditation. This practice has been
Mental exercise strengthens the synapses
shown to improve specific cognitive
or connections between neurons (nerve
functions such as attention and emo-
cells), thus improving neuron survival
tional self-regulation.
and cognitive functioning. Remember
that “cells that fire together wire
together.” Continued on page 42
The Journal on Active Aging
July/August 2009 41
ICAA July-august-09 8/24/09 5:48 PM
Healthy brain aging: why we need
to retool ‘Use it or lose it’ Continued from page 41
• Biofeedback. A growing number of
relatively inexpensive devices can
measure and graphically display vari-
ous physiological variables such as
heart rate variability, so that users can
learn to self-adjust and identify and
manage emotions better.
• Brain Fitness Software. These fully
automated applications are designed
to assess and enhance specific cogni-
tive abilities. This is the area that has
exploded since 2007—and where we
observe the most confusion since dif-
ferent packages tend to target different
functions (e.g., working memory,
auditory processing, divided attention)
in ways that are not transparent or
understood by users.
Yet, even mental cross-training isn’t
enough on its own. What else is needed
to maintain the complex system of the
brain?
SharpBrains’ checklist for providers evaluating brain fitness programs
1. Target users: Who among your
clients is ready and willing to do the
program? How are they reacting to
the pilot testing of the activities?
2. Cognitive benefits: What are the
specific benefits claimed for using
each program? Under what scenario
of use (how many hours/week, how
many weeks)? What specific cogni-
tive skill(s) does the program train?
How will you measure progress?
3. Appropriate challenge: Do the exer-
cises adjust to the individual and
continually vary and challenge resi-
dents at an appropriate pace?
4. Scientific credentials: Are there sci-
entists, ideally neuropsychologists,
behind the program? Is there a
clearly defined and credible scien-
tific advisory board? Are there
42 The Journal on Active Aging
July/August 2009
Page 42
Brain-friendly living
Forget a magic pill. Healthy brain aging
requires a brain-friendly lifestyle, in addi-
tion to mental cross-training. This life-
style should at least include:1
• Balanced nutrition. As a general
guideline, what is good for the body
and heart is also good for the brain.
Gingko biloba and other supplements
do not seem to bring the benefits peo-
ple expect.
• Stress management. Chronic stress
reduces and can even inhibit neuroge-
nesis (the creation of new neurons)
and affects memory and other brain
functions. It is then important to
learn how to manage stress.
• Physical exercise. Physical exercise
improves cognitive functioning
through increased blood supply and
growth hormone levels in the brain.
Of all the types of physical exercise,
cardiovascular exercise that gets the
published, peer-reviewed scientific
papers?
5. Return on investment: What are
your key objectives, and how will you
independently measure the progress
due to this program to expand, main-
tain or change course?
6. Total cost of ownership: What may
be the total cost of ownership over
the next three to five years if you go
with different vendors: upfront fees,
ongoing fees, hardware, software,
training and support fees, cost of
additional modules and staff time?
How many clients will likely end up
using the system, and therefore what
is the cost of ownership per user?
7. Technical requirements: What are
the technical requirements needed to
successfully deploy and maintain the
heart beating has been shown to have
the greatest effect.
• Overall mental stimulation.
Cumulated mental stimulation
throughout our lives (via education,
jobs, leisure activities) can help build
a neuroprotective cognitive reserve
that can help delay the onset of
Alzheimer’s-related symptoms.
Healthy, active living—with a focus on
good health in all the dimensions of
wellness—is the kind of brain-friendly
lifestyle that can help protect cognitive
function across the life span.
Implications for active-aging
professionals
Active aging is one of the areas where
this type of brain research can make a
profound difference in years to come.
While much more research needs to be
done to identify the right type of cogni-
tive exercise to improve the daily func-
tioning of any given individual, it is
beyond reasonable doubt that novelty,
variety and challenge contribute to
healthy brain aging better than common
alternatives (more passive or repetitive
pastimes).
program? Does it require an
Internet connection? Who will
help solve potential glitches?
8. Staff training: What type of train-
ing will you and your staff need,
and who will provide it?
9. References: What similar organiza-
tions have used this specific pro-
gram? What proportion of their
clients use it regularly? What bene-
fits have they measured and ob-
served in their clients, and as an
organization? Is the use of the pro-
gram growing, or is it flat or
declining?
10. Product road map: What is the
product roadmap for this compa-
ny? What is the company develop-
ing and planning to offer next year,
and in two to three years?
ICAA July-august-09 8/24/09 5:48 PM Page 43

Active-aging organizations can easily pro-
vide quality information for staff and
clients and create a library of programs
and activities to assist each person in
finding an appropriate program—not
necessarily with budget implications.
Depending on the setting, older adults,
or their families, can buy the programs
based on the available information and
firsthand testing.
Finding the right mix between structure,
science and fun involves trying options.
There is no panacea, or program that
works best for everyone. Some people
prefer “fun games,” while others prefer
more structured sessions or a more sci-
ence-based approach.
Some options for mental exercise require
purchasing a device. Others require
installing software in PCs in existing or
new computer labs, or are fully available
online. And still others may be technolo-
gy-free, promising engaging combina-
tions of interactive, group-based activities
with pen-and-paper exercises.
How can you navigate this landscape? No
program available today currently offers a
dream combination of ideal characteris-
tics, so you need to take into account
your specific circumstances, priorities
and budget. That’s why we suggest you
launch a pilot and measure results in
objective, independent ways before
embarking on major rollouts. As you pre-
pare your business case, try using the
SharpBrains checklist on page 42 to
select and introduce a new toolkit for
cognitive exercise.
Ready for the future?
Based on our market research work, we
see clear signs of a growing “Culture of
Brain Fitness,” with a better integration
of physical and mental exercise and even
mainstream awareness and broad initia-
tives. Better tools to assess cognitive
functions and to improve brain functions
are underway. And more actors will take
brain fitness into consideration—think of
physicians, psychologists, insurance com-
panies, on top of residential communities
and seniors centers.
Can you, the ambassadors of active aging
and brain fitness, incorporate novelty,
variety and challenge into your work set-
tings, and help reshape and retool “Use it
or lose it” for your clients?
Álvaro Fernández, MA, MBA, recently
coauthored The SharpBrains Guide to
Brain Fitness: 18 Interviews with
Scientists, Practical Advice, and Product
Reviews, to Keep Your Brain Sharp, with
neuropsychologist Elkhonon Goldberg, PhD.
Fernández is the CEO of SharpBrains Inc.,
and a member of the World Economic
Forum’s Global Agenda Council on the
Aging Society. For more information about
SharpBrains, visit www.sharpbrains.com.
Reference
1. Fernández, A., & Goldberg, E. (2009). The
SharpBrains Guide to Brain Fitness: 18 Interviews
with Scientists, Practical Advice, and Product
Reviews, to Keep Your Brain Sharp. San Francisco
CA: SharpBrains Inc.

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The Journal on Active Aging
July/August 2009 43