Genes, Lifestyle, Attitude Influence Longevity, Cognitive Health

A team led by Dr Gary Small, director of the University of California, Los Angeles (UCLA), Memory and Aging Research Center and assistant professor of psychiatry and biobehavioral sciences at UCLA's David Geffen School of Medicine, found that adults could improve their memory by making simple lifestyle changes.^4,5

In the 14-day study, 17 persons between 35 and 70 years of age (mean age, 53) with normal baseline memory performance scores were randomly assigned to an intervention group (n = 8) or a control group (n = 9).

Memory training involved the daily use of brainteasers, crossword puzzles, and memory techniques emphasizing verbal skills; the healthy diet involved eating 5 meals per day that were rich in omega-3 fats, low-glycemic index carbohydrates, and antioxidant foods; and the physical conditioning involved brisk daily walks and stretching exercises. Breathing and relaxation techniques were added to reduce stress, since stress causes the body to release cortisol, and chronically high levels of cortisol can impair memory and shrink memory centers in the brain, Small said in a news release.⁴

Participants in the intervention group agreed to follow the memory improvement plan and were minimally monitored, said Small.

The participants were given a prepublication copy of Chapter 3 of Small's The Memory Prescription,⁶ which contains specific daily recommendations on what to do and when and how to do it. Small explained, "For example, Monday morning instructs the volunteer to do a stretching exercise before a suggested healthy breakfast. Later in the morning, a memory technique is described. The exercises and meal menus are detailed each day of the week for 14 days." A research nurse reviewed the 14-day plan with the intervention group participants and answered their questions.

"We called them midway to make sure they were doing the program. We had them keep notes to make sure they understood and followed the program. . . . Our monitoring suggests that they made a reasonable effort," Small added.

Immediately before and after the 2- week program, brain function was assessed, using flurodeoxyglucose positron emission tomography (PET) scanning during mental rest, which measures regional rates of cortical glucose metabolism. Statistical parametric mapping analysis was used to determine the differences between the 2 groups.⁵

The short-term healthy lifestyle intervention program "had significant effects on brain function as measured by PET scans," Small told Psychiatric Times. Compared with controls, individuals in the intervention group experienced a "5% change in brain metabolism, not randomly throughout the brain, but in the left dorsolateral prefrontal cortex, which is an area of the brain that controls everyday working memory." The region of change involved a stretch of cortex in Brodmann areas 8, 9, and 10. In contrast, the control group showed no change in brain metabolism.

Small explained that the reduced glucose metabolic rates in the left dorsolateral prefrontal cortex suggest greater cognitive efficiency in that region of the brain and that the significant change observed in the left hemisphere is consistent with the verbal emphasis in the program's memory training exercises.

He added that the dorsolateral prefrontal cortex has been linked to anxiety symptoms, so stress reduction techniques might show some effect in that same brain region.

Future studies will involve determining specific effects of individual components of the program and testing the intervention program in different settings.

In the pilot study, Small said, "We threw in the kitchen sink, to see if we could see any kind of an effect. We don't know what part of that recipe changed the brain."

For the next study, Small said the investigators plan to focus on stress reduction and memory training. There would be a control group and 2 intervention groups—one in which participants receive memory training alone and another in which they receive both memory training and tai chi instruction. Why tai chi? Small explained that psychiatrist Michael Irwin, affiliated with UCLA's Norman Cousins Center for Psychoneuroimmunology, has conducted some studies on tai chi and found that it improves measures of immune function and is enjoyable for many older adults. Small added that the study will include a longer follow-up period to explore whether the effects, as measured by brain scans, are sustained.

The pilot study was funded by the Fran and Ray Stark Foundation Fund for Alzheimer's Disease Research, the Judith Olenick Elgart Fund for Research on Brain Aging, and the Parlow- Solomon Professorship on Aging; Small said he intends to seek government grants for the next study.

Small is also chief scientific and medical advisor for the Memory Fitness Institute, a for-profit company that helps people of all ages optimize their memory function and brain health,using state-of-the-art diagnostic, intervention, and prevention strategies. He explained that the Memory Fitness Institute has adapted the 14-day lifestyle intervention program for use in assisted living facilities and retirement communities and is testing the model in a realworld environment, a retirement community facility in Maryland.

"It will be a 6-week program, 2 days a week, taught by trainers there," Small said.

The program will screen participants in advance to ensure that they can perform the physical conditioning portion (walking) without hurting themselves; provide some education about a healthy diet; and introduce them to memory training exercises and stress reduction techniques.

Although brain scanning will not be part of the study, Small said, measures will be taken to systematically assess changes.

The Memory Fitness Institute has been developing some memory training programs based on Small's books, The Memory Prescription⁶ and The Memory Bible.⁷

"They have done some educational meetings, and they are testing out some of these programs at different sites to see what works and what doesn't," he explained.

On the nonprofit front, UCLA's Center on Aging, which Small directs, has just received a grant from the Archstone Foundation to support memory training. The Center has created a 5-week memory training program based on The Memory Bible. Volunteers teach the program, and so far about 1500 people have taken the course, Small said. It also has been licensed to the University of Texas and to a senior center in Chicago. Small also uses several memory and lifestyle approaches to help his own patients who complain of memory problems.

"I ask what their diet is like. . . . Are they exercising every day? What kind of stress are they under? I try to individualize a memory and brain health program for each of them," Small said. "These are things that will not only help their brain health but also their general health and their heart health." He also tries to live the lifestyle himself.

"I write these books with my wife, who is a professional writer, and we check things out in advance, so we try the recipes ourselves. We just finished a new book called the Longevity Bible, which will be out in June, that includes the four areas [diet, physical exercise, memory training, and stress reduction], but others as well, including relationships, positive outlook, the environment, medications, and supplements. So we try to live a healthy lifestyle as best we can."

In a related area, Small discussed his UCLA research team's use of a PET scan approach, in which "we can see the physical evidence of Alzheimer disease in a living patient." It uses a chemical marker injected into the vein to determine the localization and load of neurofibrillary tangles and -amyloid senile plaques in the brains of living patients.

"We can see a pattern of plaque and tangle deposition that is very consistent with what you see in autopsy studies. Our latest data are very promising that plaque and tangle PET scanning will be a useful approach to diagnosis and treatment monitoring. We published a study⁸ a few years ago with 16 subjects [9 with Alzheimer's disease], and now we have 60 subjects in followup, so we can be much more confident in the findings."

Eventually, Small hopes to place individuals whose PET scans show evidence of abnormal protein buildup on a healthy lifestyle regimen and to investigate how the intervention might modify the disease process.

While researchers define successful aging in various ways, few investigators have explored older adults' selfperceptions of successful aging. At the Stein Institute for Research on Aging at the University of California, San Diego, researchers led by Dilip V. Jeste, MD, professor of psychiatry and neurosciences and Estelle and Edgar Levi Chair in Aging, found that perceptions of the aging process depend not on disease or physical disability but rather on attitude and coping style.⁹

The researchers conducted a study involving self-rating of successful aging in more than 1200 community-dwelling residents between the ages of 60 and 99 years. The participants completed a detailed survey questionnaire on their medical history, health behaviors, quality of life, resilience, and cognitive performance, and rated themselves on successful aging. Nearly three fourths of the respondents felt they were aging well, often despite their having physical illnesses and some disability.¹⁰

"What is most interesting about this study is that people who think they are aging well are not necessarily the most healthy individuals," Jeste noted in a news release.⁹ "In fact, optimism and effective coping styles were found to be more important to aging successfully than traditional measures of health and wellness. These findings suggest that physical health is not the best indicator of successful aging— attitude is."

Another strong indicator of successful aging was the level of social and community involvement. Participants who spent time each day on hobbies, such as reading and writing, or socializing with other members of the community consistently gave themselves high scores, as did participants who had a paid job outside of the home.