Brain Fitness For Positive Aging

Brain Fitness for Positive Aging
Ray Ownby, MD, PhD
Interprofessional Geriatrics
Training Institute
July 7, 2017
Positive Aging
Optimal Cognitive Function
Overview Optimal Physical Function
Absence of Disease
Cognitive
aging and
what we can
do about it. Brain Fitness
Brain structure
Brain function
2
C
B
Overview
Cognitive
aging and
what we can
do about it. A
3
Cognitive Aging
What changes with age
4
What causes the changes?
The science of memory and cognition
6
Structural and functional changes
Plaques and tangles
Risk factors
Cognitive
aging and
what we can
do about it.
8
Amyloid predicts cognitive decline
Donohue MC et al (2017). Association between elevated brain amyloid and subsequent

cognitive decline among cognitively normal persons. JAMA 317(22):2305-2316.
9
Nun Study
Cognitive
aging and
what we can
do about it.
10
Nun Study
Cognitive
aging and
what we can
do about it.
Riley KP et al (2002). Alzheimer's neurofibrillary pathology and the

spectrum of cognitive function: Findings from the Nun Study. Annals of
Neurology, 51, 567–577.
11
Cognition Pathology
Nun Study
~ 1/3
Cognitive
aging and
what we can
do about it.
Correlation = 0.57
What aboutsquared
Correlation the other 2/3?
= 0.32
About a third overlap
12
So what else causes cognitive aging?
13
Neuroinflammation
14
Differences in UFC/Cr level control and
future participants with AD controlling for
baseline age. *p < 0.05; UFC/Cr =
urinary free cortisol/creatinine.
Long-term cortisol measures predict Alzheimer disease risk.

Ennis, Gilda; An, Yang; Resnick, Susan; Ferrucci, Luigi; MD, PhD; OBrien, Richard; MD, PhD; Moffat, Scott Neurology. 88(4):371-378, January 24, 2017.
© 2017 American Academy of Neurology. Published by American Academy of Neurology. 3

What can be done?
18
What we can do about it
Overview • Exercise
• Diet
Cognitive • Stress management
• Mood
aging and
• Sleep
what we can • Purpose in life
do about it. • Social engagement
• Cognitive training
• tDCS
19
Risk factors
Cognitive
aging and
what we can
do about it.
National Academy of Sciences, June, 2017
Also see: Interventions to prevent age-related cognitive decline, mild

cognitive impairment, and clinical Alzheimer-type dementia. Agency for
Health Research and Quality, Comparative Effectiveness Report Number
188, March 2017.
20
Treatment
Cognitive
aging and
what we can
do about it.
NBC Nightly News with Lester Holt, June 22, 2017
Also see: Interventions to prevent age-related cognitive decline, mild

cognitive impairment, and clinical Alzheimer-type dementia. Agency for
Health Research and Quality, Comparative Effectiveness Report Number
188, March 2017.
21
Treatment? Highest priority areas:
Cognitive
Cognitive training
aging and Blood pressure management
what we can
do about it. Physical activity
Also see: Interventions to prevent age-related cognitive decline, mild cognitive

impairment, and clinical Alzheimer-type dementia. Agency for Health Research and
Quality, Comparative Effectiveness Report Number 188, March 2017.
22
Exercise
23
Meta-analysis of effects
Hillman et al., Nat Rev Neurosci, 2008 , 9, 58-65.

Issues
Promoting
brain health
Erickson KI et al. (2011). Proceedings of the National Academy of Sciences, 108, 3017-3022.
25
Diet
26
Mediterranean diet
 The Mediterranean diet
emphasizes olive oil,
fish, cheese and yogurt,
as well as fresh fruits and
vegetables
 Beans, legumes, and
nuts are important
 Whole grain breads and
pastas
Mediterranean
Diet
Risk of
cognitive
impairment
Psaltopoulou T et al (2013). Mediterranean diet, stroke, cognitive

impairment, and depression: A meta-analysis. Annals of Neurology, 74, 580-591.
What about exercise and diet?
29
Alzheimer Disease (AD) Incidence
in Individuals by No, Some, or
Much Physical Activity and Low,
Middle, and High Mediterranean-
Type Diet Adherence Scores
Scarmeas, N. et al. JAMA 2009;302:627-637.

Copyright restrictions may apply.
Cognitive training
Life moves pretty fast. If
you don’t stop and look
around once in awhile,
you could miss it.
--Ferris Bueller
31
Cognitive training
• Advanced Cognitive Training
Cognitive for Independent and Vital
Training Elderly (ACTIVE) study
• Six sites
Treatment
• 2,832 participants
• National Institute on Aging
• Key intervention:
• Speed of processing
• Useful Field of View
32
ACTIVE trial: 5 years later
Willis et al (2006). Long-term effects of cognitive training on everyday functional

outcomes in older adults. JAMA, 296, 2805–2814.
ACTIVE trial: 10 years later
Rebok et al (2014). Journal of the American Geriatrics Society, 62, 16-24.

Effect Size = 0.36
Cognitive training in ACTIVE trial
Risk for dementia:

Cognitive • 331 participants developed dementia:
• Control: 14% in the control
Training • 10 or fewer sessions: 12.1%
• 11 to 14 sessions: 8.2%
Treatment
• Speed training reduced risk for dementia
by 8% per session
• HR, 0.52; CI 0.33 - 0.82; P = .005
Brooks M (2016). Brain training protects against cognitive decline, dementia. Medscape.
http://www.medscape.com/viewarticle/866577#vp_2 [Report of presentation at the Alzheimer Association
International Conference, 2016].
Edwards JD, Xu H, Clark DJ, Ross LA, Unverzagt FW. The ACTIVE study: What have we learned and what is next? Cognitive
training reduces incident dementia across ten years. ten years (2016). Presented at the meeting of the American Psychological
Association. July, Denver, CO. 38
Risk for dementia:

Treatment
by 8% per session
• HR, 0.52; CI 0.33 - 0.82; P = .005
Risk for dementia:

Treatment
by 8% per session
• HR, 0.52; CI 0.33 - 0.82; P = .005
Risk for dementia:

Treatment
by 8% per session
• HR, 0.52; CI 0.33 - 0.82; P = .005
Risk for dementia:

Treatment
by 8% per session
• HR, 0.52; CI 0.33 - 0.82; P = .005
Risk for dementia:

Treatment
• Speed training reduced risk for
dementia by 8% per session
• HR, 0.52; CI 0.33 - 0.82; P = .005
Cognitive
Training
Treatment
Anguera JA et al (2013).
Video game training enhances
cognitive control in older
adults. Nature, 501(7465), 97-
101.
NeuroRacer experimental conditions and training design.
JA Anguera et al. Nature 501, 97-101 (2013) doi:10.1038/nature12486

NeuroRacer multitasking costs.
JA Anguera et al. Nature 501, 97-101 (2013) doi:10.1038/nature12486

Can we enhance cognitive training?
47
Transcranial direct current
stimulation
tDCS • Application of a small current
across the scalp while doing a
Treatment mental activity
• Multiple studies suggest
enhancement of learning and
memory
• Potential for treating
depression
48
tDCS
Treatment
49
tDCS
Treatment
50
tDCS tDCS for cognition in older
persons with HIV
Treatment
• Pilot study
• Combined with speed of
processing cognitive training
• Results suggest enhancement
of learning and memory
• Pending funding from the
National Institute on Aging
51
GT Racing 2 – Gameloft, Paris
tDCS
Treatment
53
tDCS for cognition in older persons with HIV
tDCS
Treatment
Ownby RL, Acevedo A

(2016). A pilot study of
cognitive training with and
without transcranial direct
current stimulation to improve
cognition in older persons
with HIV-related cognitive
impairment. Neuropsychiatric
Disease and Treatment, 12,
2745-2754.
54
Will tDCS work in normal elderly?
Augmenting cognitive
training older adults: The ACT
tDCS trial
Treatment • Funded by National Institute on
Aging for 5 years
• Sites at University of Florida,
University of Miami, and
University of Arizona
• $5.7 million dollars
• Adam Woods, PhD, Principal
Investigator
• Status: Recruiting
55
Bottom line
56
• Diet
• Mood
aging and
• Sleep
• tDCS
57
• Diet
• Mood
aging and
• Sleep
• tDCS
58
• Diet
• Mood
aging and
• Sleep
• tDCS
59
• Diet
• Mood
aging and
• Sleep
• tDCS
60
No pill fixes cognitive aging,
and it doesn’t look like one is
Cognitive going to come along soon.
Aging
Treatment
61
Cognitive
Aging Specific types of diet, exercise
and cognitive training may
slow cognitive aging.
Treatment
62
Cognitive
Aging
Treatment
More research is needed.
63
Ray Ownby, MD, PhD, MBA
Psychiatry and Behavioral Medicine
Nova Southeastern University
ro71@nova.edu
Memory Disorders Program: 954-262-1481

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Brain Fitness for Positive Aging

Ray Ownby, MD, PhD

Donohue MC et al (2017). Association between elevated brain amyloid and subsequent

Riley KP et al (2002). Alzheimer's neurofibrillary pathology and the

Long-term cortisol measures predict Alzheimer disease risk.

© 2017 American Academy of Neurology. Published by American Academy of Neurology. 3

National Academy of Sciences, June, 2017

Also see: Interventions to prevent age-related cognitive decline, mild

NBC Nightly News with Lester Holt, June 22, 2017

National Academy of Sciences, June, 2017

Also see: Interventions to prevent age-related cognitive decline, mild

National Academy of Sciences, June, 2017

Also see: Interventions to prevent age-related cognitive decline, mild cognitive

Hillman et al., Nat Rev Neurosci, 2008 , 9, 58-65.

Psaltopoulou T et al (2013). Mediterranean diet, stroke, cognitive

Scarmeas, N. et al. JAMA 2009;302:627-637.

Willis et al (2006). Long-term effects of cognitive training on everyday functional

Rebok et al (2014). Journal of the American Geriatrics Society, 62, 16-24.

Risk for dementia:

Risk for dementia:

Risk for dementia:

Risk for dementia:

Risk for dementia:

Risk for dementia:

JA Anguera et al. Nature 501, 97-101 (2013) doi:10.1038/nature12486

JA Anguera et al. Nature 501, 97-101 (2013) doi:10.1038/nature12486

Ownby RL, Acevedo A

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