Healthy aging:

Optimizing Your Brain

Health
Abhilash K. Desai M.D.
Associate Professor, Director
Center for Healthy Brain Aging
Saint Louis University School of Medicine

Disclosures
None

Objectives
Describe the impact of daily activities on brain

function.
Discuss some daily practices to improve
brains resilience (i.e., its capacity to function
well despite diseases that damage brain cells
and brain connections).

Clinical vignette
LM is a 58 year old woman, mother of 2 children and

1 grandchild, wife of 35 years and a school teacher.

She was diagnosed with Myasthenia Gravis 2 years
ago. She wanted to fight the disease and did not
want to rely on just drugs. She started going to Yoga
classes three times a week, swimming twice a week,
started practicing her piano five days a week and
writing her life-story to share with her grand child.
Over 18 months, her depression and anxiety resolved
and within first 3 months of initiating treatment she
noticed that MG has changed her perspective on life
itself.

Healthy Mind
National Institute of Health commissioned

Cognitive and Emotional Health Project

defined successful cognitive and emotional
aging as the development and preservation
of the multidimensional cognitive structure
that allows the older adult to maintain social
connectedness, an ongoing sense of
purpose, and the abilities to function
independently, to permit functional recovery
from illness or injury, and to cope with
residual functional deficits.

Aging Mind
Aging has been conceptualized as declining

efficiency of the mechanisms that maintain the

homeostatic equilibrium, which is continuously
challenged by destabilizing events (e.g., Alzheimers
disease, strokes, head injury, pollution, chronic
stress, chronic anxiety, poorly controlled
cardiovascular risk factors [e.g., obesity,
hypertension, diabetes, hyperlipidemia, low HDL,
smoking, sedentary lifestyle, sleep apnea, chronic
pain, chronic insomnia, chronic depression]).

Ferrucci L et al. Mapping the road to resilience. Mech Ageing Dev

2008; 129:677-679.

Aging Mind
Alternative view: The downward spiral of

functional and structural decline might begin

from both, reduced brain activity due to
behavioral change and from a loss in brain
function driven by aging brain machinery.

Mahncke HW et al. Brain plasticity and functional losses in

the aged: scientific bases for a novel intervention. Prog Brain
Res 2006;157:81-109.

Basic Principles
Our neglect of intensive learning as we age

leads the systems in the brain that modulate,

regulate, and control plasticity to waste away.
We rarely engage in tasks in which we must
focus our attention as closely as we did when
we were younger, trying to learn a new
vocabulary or master new skills. Anything that
requires highly focused attention will help.

Attention
When we want to remember something we

have heard we must hear it clearly, because a

memory can be only as clear as its original
signal. Paying close attention is thus,
essential for good memory.
Meditation, Centering Prayer, Yoga, Tai Chi
and Mindfulness practice are some of the
best ways to improve ones ability to focus.

Basic Principles
Plasticity (capacity of the brain to change in response

to experience) is competitive. There is an endless

war of nerves going on inside each of our brains.
Competitive plasticity also explains why our
unhealthy habits are so difficult to break or unlearn.
When we learn an unhealthy habit, it takes over a
brain map, and each time we repeat it, it claims more
control of that map and prevents the use of that
space for good habits. That is why unlearning is
often a lot harder than learning.
Thus, if you want to change unhealthy habits,
stop engaging in it and replace it with healthy
habits.

Basic Principles
Plastic change, caused by our experience, travels

deep into the brain and ultimately even into our genes,
molding them as well.
Imagination: How thinking makes it so! We can change
our brain anatomy / structure simply by using our
imaginations! The plastic brain is like a snowy hill in
winter according to Pascual-Leone (an expert
neuroscientist). The mental tracks that get laid down
can lead to habits, good or bad!! Sometimes a road
block is necessary to help us change directions.
Thus, visualization exercises may promote brain
health in a variety of ways.

Basic Principles
As brain cells are trained and become more efficient,

they can process faster.

Reward (fun!) is crucial to learning. Each time we
are rewarded, our brain secretes such
neurotransmitters as dopamine and acetylcholine,
which help consolidate map changes we have just
made (Dopamine reinforces the reward, and
acetylcholine helps the brain tune in and sharpen
memories).
Thus, practicing skills that one retains on a daily
basis can improve speed of processing. Having
fun while practicing will speed up learning!

Basic Principles
Brain derived neurotrophic factor (BDNF) is

crucial for memory and learning. BDNF turns

the nucleus basalis, the part of our brain that
allows us to focus our attention and keeps it
on, throughout the entire period of
experience. Once turned on, the nucleus
basalis helps us not only pay attention but
remember what we are experiencing. It allows
map differentiation and change to take place
effortlessly.
Exercise increases BDNF!!

Basic Principles
Our minds tend to process information in

specific contexts.
Our minds are NOT capable of doing several
things (doing them well) at once.
Thus, avoid multi-tasking and take time to
reflect on the context of any new
information one wants to remember /
learn.

Cognitive training
Attention training: mindfulness training,

Neuro-feedback.
Memory training: mnemonic strategies for
recall of word lists, sequences of items, texts,
stories (e.g., categorization, imagery).
Reasoning training: strategies to identify
patterns.
Speed of processing training: practice
increasingly complex tasks to identify and
locate visual information.

Stress and relaxation

Herbert Benson M.D., founder of the Mind-

Body Medical Institute in Chestnut Hill,

Massachusetts, Associate Professor of
Medicine at Harvard Medical School.
By completely letting go of a problem at some
point by applying certain triggers (e.g.,
relaxation exercises), the brain actually
rearranges itself so that the hemispheres
communicate better. Then the brain is better
able to solve the problem.

Stress and relaxation

Molecular studies have shown that calming response

releases little puffs of nitric oxide, which has been

linked to the production of such neurotransmitters as
endorphins and dopamine. These chemicals enhance
general feelings of wellbeing.
As the brain quiets down, another phenomenon that we
call calm commotion or a focused increase in activity
takes place in the areas of the brain associated with
attention, space-time concepts, and decision-making.

McEwen BS. Protective and damaging effects of stress

mediators: central role of the brain. Dialogues Clin Neurosci.
2006; 8: 367-381.

Nutritional strategies
Let food by thy medicine, and medicine be

thy food Hippocrates (460-377 BC).

Nutritional strategies such as Mediterranean
diet may have a significant effect in promoting
brain health, reducing risk of AD and slowing
progression of AD.

Morley. Nutrition and the Brain. Clin Geriatr Med 2010. In

Press.

Brain Food!
Systematic review: 11 observational studies

and 4 clinical trials. Conclusion: Existing data

favor a role for long-change omega 3 fatty
acids (fish or supplement) in slowing
cognitive decline in elderly individuals without
dementia, BUT not for prevention or
treatment of dementia.

Fotuhi M et al. Nat Clin Pract Neurol 2009.

Brain Food.
Mediterranean Diet. The New Mediterranean Diet Cook Book by

Nancy Harmon Jenkins (Bantam 2008).

Dash Diet (specifically for people with hypertension).
www.nhlbi.nih.gov/health/public/heart/hbp/dash/.
Turmeric (present in some curry powders, some yellow
mustard). Pills: Turmeric Force by New Chapter.
4-6 servings of vegetables and 3-5 servings of fruits per day.
Healthy fish: Pacific Herring (sardines), Sablefish (Black Cod),
European Anchovies, Spanish Mackerel, Wild Alaskan Sockeye
Salmon, Farmed Rainbow Trout, Albacore Tuna (Tombo). Visit
environmental defense fund for info on fish and mercury
(www.edf.org ).
Supplements: Omega 3 (molecularly distilled [e.g., Nordic
Natural] pills or liquid), Vitamin D (1,000-2,000IU), Vitamin B12
(500mcg-1000mcg), Zylfamend (has rosemary, turmeric, etc).

Physically active lifestyle.

Reduces risk of heart disease, cancer, diabetes,

strokes.
Linked to living longer and with less disability.
Recent studies also suggest reduce risk of
Alzheimers and slower progression of Alzheimers
disease.
Improved mood and reduced risk of depression.
Reduced risk of falls.
Improved capacity to pay attention (focus), problem
solve.
Improved sleep.

Physically active lifestyle

Improved blood flow to the brain
Reduced oxidation
Reduced inflammation
Reduced toxicity of misfolded proteins that are

thought to cause Alzheimers disease, Parkinsons

disease.
Improved neurogenesis (formation of new brain
cells) and synaptogenesis (formation of new brain
connections)

Kramer AF, Erickson KI, Colcombe SJ. Exercise, cognition, and the
aging brain. Journal of Applied Physiology 2006; 101: 1237-1242.

Sleep
Good sleep is necessary for memory

consolidation, for ability to focus and problem

solve the next day and for learning new skills.
During sleep, processes involved in formation
of new brain cells and brain connections are
activated.
Sleep is also important for creativity.

Malhotra R and Desai AK. Healthy Brain Aging: What has

sleep got to do with it. Clin Geriatr Med 2010 In Press.

Good Mind Health Advice

To keep mind alive requires learning something truly

new with intense focus.

4 key steps for mind fitness include: understanding
how experience makes the brain grow; importance of
play and imagination in daily life; learning to live in
the slow lane; seeking novelty and innovation.
Healthy brain cells need healthy nutrition, reward
neurotransmitters, BDNF, adequate blood supply,
protection from head injuries, protection from toxic
chemicals (e.g., pesticides, pollution).
It is never to early, it is never too late.

Sleep N Pills

S = Sleep. Adequate daily and lifelong quality and quantity of sleep is essential
for brain health.
L = Lose it or Use it. Be mentally active.
E = Exercise regularly (aerobic/endurance [e.g., swimming, treadmill, brisk
walking], strength training [e.g., Pilates], flexibility [e.g., Yoga], balance [e.g.,Tai
Chi]).
E = Excess disability (e.g., vitamin deficiencies, malnutrition, sleep apnea,
chronic pain, chronic stress, pollution, anxiety and depression, ADHD, obesity,
metabolic syndrome, smoking, drinking more than 2 alcoholic drinks / day, poorly
controlled hypertension, diabetes, hyperlipidemia ) needs to be addressed.
P = Positive emotions (calm, peaceful, happy, optimistic, serene, joyful, relaxed,
in flow,) and Positive actions (altruistic, forgiving, kind, loving).
N = Nutrition (fruits [berries and cherries, avocados], vegetables [green leafy
vegetables, tomatoes], omega 3 rich food (especially fish), spices (especially
turmeric), whole grains, small amounts of olive oil or canola oil, very small
amount of nuts and red wine.
Pills (omega 3, B12, Vitamin D, Zylfamend, pills to treat cardiovascular
disorders, other conditions such as Alzheimers disease, ADHD, depression).

PSALMS to become happier

P: Engage in activities that generate

PLEASURE.
S: Engage in activities that exercise our
STRENGTHS.
A: APPRECIATE what you have. Wanting
what you have promotes happiness, not
having what you want.
L: Cultivate capacity of LAUGH at your
imperfections. Capacity of listen up.

Checklist: A guide for clinicians

1. Smoking cessation advice and guidance provided.
2. Advice to follow guidelines proposed jointly by the American Heart

Association and the American College of Sports Medicine regarding

daily physical activity provided.
3. Advice and guidance regarding healthy nutrition (e.g., Mediterranean
diet) provided.
4. Advice to engage in intellectually challenging and creative leisure
time activities provided.
5. Strategies to promote emotional resilience and reduce psychological
distress and depression (e.g., relaxation exercises, mindfulnessmeditation practices) provided.
6. Advice to maintain an active, socially integrated lifestyle provided.
7. Strategies to achieve and maintain optimal daily sleep provided.
8. Education about strategies to reduce risk of serious head injury (e.g.,
wearing seat belts, wearing helmets during contact sports, bicycling,
skiing, skateboarding) provided.

References

Desai AK, Grossberg GT. Road Map to Healthy

Brain Aging. Clin Geriatr Med 2010. In Press.
Jedrziewski MK, Lee VM and Trojanowski JQ.
Lowering the risk of Alzheimers disease: Evidencebased practices emerge from new research.
Alzheimers & Dementia. 2005; 1: 152-160.
Fratiglioni L, Paillard-Borg S and Winblad B. An
active and socially integrated lifestyle in late life
might protect against dementia. The Lancet
Neurology 2004; 3:343-353.
Pasinetti, G.M. and Eberstein, J.A. Metabolic
syndrome and the role of dietary lifestyles in
Alzheimers disease. J Neurochem 2008; May 3
(epub ahead of print).

References on cognitive training

Willis SL, Tennstedt SL, Marsiske M, et al. Long-term

effects of cognitive training on everyday functional
outcomes in older adults. JAMA 2006; 296: 2805-2814.
Walker M. The role of sleep on cognition and emotion.
Ann NY Acad Sci. 2009;1156:168-197.
Valenzuela M, Sachdev P. Brain reserve and dementia:
a systematic review. Psychol Med. 2006;36:441-454.
Valenzuela M, Sachdev P. Can cognitive exercise
prevent the onset of dementia? Systematic review of
randomized clinical trials with longitudinal follow-up.
Am J Geriatr Psychiatry. 2009;17:179-187.
Stern Y. What is cognitive reserve? Theory and
research application of the reserve concept. J Int
Neuropsychol Soc. 2002;8:448-460.

Suggested reading
The Healthy Brain Initiative. Centers for Disease

Control and Prevention and Alzheimers Association.

The initiative proposes 44 actions to maintain or
improve the cognitive performance of all adults.
Cognitive Fitness. Roderick Gilkey and Clint Kilts.
Harvard Business Review. November 2007.
AD Progress Report 2007.
www.nia.nih.gov/Alzheimers/Publications/ADProgress
2007.htm.
Yashodhara BM et al. Omega-3 fatty acids: a
comprehensive review of their role in health and
disease.

Suggested reading.
The Mindful Brain. Daniel Siegel.
Spark: The revolutionary new science of exercise

and the brain. John Ratey and Eric Hagerman.

Healthy Eating. A guide to the new nutrition. A
special report from Harvard Medical School.
Improving Memory. Understanding age-related
memory loss. A special report from Harvard
Medical School.
Anti-cancer. A new way of life. David Servan
Schreiber M.D.

Other resources.
Audio CD: Mindfulness for beginners. Jon Kabat

Zinn.
www.thememorypractice.com
www.sharpbrains.com/newsletter/expert-contributors
Posit Science website.
The Center for Healthy Brain Aging, Saint Louis
University School of Medicine Website
(http://neuroandpsych.slu.edu/healthybrain ).
http://bfc.positscience.com/resources/reading/thebrain-that-chages-itself-normal-doidge-01.php .

Checklist: Guide for clinicians

9. Education about strategies to reduce exposure to hazardous

substances 9e.g., wearing protective clothing during the administration

of pesticides, fumigants, fertilizers, and defoliants) provided.
10. Education and counseling provided regarding negative health
effects of alcohol consumption more than recommended as safe by the
National Institute of Alcoholism and Alcohol Abuse.
11. Education about importance of achieving and maintaining healthy
weight to promote overall health provided.
12. Strategies to achieve optimal blood pressure control instituted.
13. Strategies to achieve optimal control of dyslipidemia instituted.
14. Strategies to achieve optimal control of blood sugar / diabetes
instituted.
15. Advice regarding the risks and benefits of medications,
supplements, herbal remedies and vitamins to promote brain health
provided.
16. Secondary prevention of stroke strategies (e.g., daily baby aspirin)
implemented.

Suggested reading
The Brain That Changes Itself. Stories of personal

Triumph from the Frontiers of Brain Science.

Book by Norman Doidge M.D. Featured on PBSs
The Brain Fitness Program.
Why we make mistakes: How we look without seeing,
forget things in seconds, and are all pretty sure we
are way above average. Book by Joseph T. Hallinan.
Quiet! Sleeping Brain at Work. Robert Stickgold and
Jeffrey Ellenbogen. Scientific American Mind; 2008,
Vo. 19 Issue 4, p23-30.

Suggested reading
Stronger After Stroke. Peter Levine.
The Mind and the Brain: Neuroplasticity and

the power of mental force. Jeffrey M.

Schwartz MD
ADVANCE for physical therapists.
After a Stroke: 300 tips for making life easier
and striking back at stroke: A doctor-patient
journal. Cleo Hutton LPN.

Suggested reading
Are you working too hard? A conversation with

Mind/Body Researcher Herbert Benson. Harvard

Business Review November 2005; 53-58.
Dr. Andrew Weils guide to Heart Health. 2009.
The New Mediterranean Diet Cook Book. By Nancy
Harmon Jennkins. Bantam 2008.
Healing Night. By Rubin Naiman (addresses ways to
improve quality of sleep).
Aging Well. George Vaillant M.D.

Suggested websites
Santa Barbara, California center for Cognitive

Fitness and Innovative Therapies (CFIT).

www.sbcfit.org
www.worstpills.org Has list of 136 commonly
prescribed medications that are potentially
dangerous to seniors cognitive health. Some
of the pills listed here are good for you so
please review all medications with your health
provider before stopping them or reducing
their dose.

My contact info:
adesai@slu.edu