Computers, treadmills and videogames: The new arsenal for late life brain training

Michael MarsiskeDepartment of Clinical & Health PsychologyApril 10, 2015

With thanks College Local collaborators

Dawn Bowers Ron Cohen & program on Cognitive Aging and

Memory Institute on Aging

External collaborators ACTIVE coinvestigators and the National

Institute on Aging McKnight Brain Research Foundation, Santa Fe

Health Care, and The Village of Gainesville

Cognitive aging embodies PHHP Health professions

Assessment and psychodiagnosis Treatment Multidisciplinary (e.g., psychology and

occupational therapy and speech/language)

Public health Prevalence Prevention Population initiatives

Jill Pease asked a question “I’m going to be running the story on

the ACTIVE findings as the cover story for the next issue of PHHP News, our alumni and donor newsletter. I wanted to do a sidebar that addresses the “what can I do?” question that we seem to get a lot from consumers”

My answer

1. Continue your education.  "Cognitive reserve" refers to the rich network of connections and knowledge that we build across a lifespan. People with more education and more complex jobs generally enter late life at a much higher level of mental functioning. Education can continue: take continuing education courses, read books in areas about which you know little, challenge yourself to learn new things.

My answer

2.  Keep your brain healthy.  "Brain reserve" refers to how much white and grey matter we're able to retain into the later years.  Good health habits that may help to prevent heart attack/stroke, arthritis, cancer, and diabetes also help to maintain the brain:  Aerobic exercise, strength training, good nutrition, control of blood pressure and cholesterol.  It is never too late to begin healthier habits, and exercise training has boosted cognition even in the very old.

My answer

3.  Spot-train your brain.  There is growing evidence that cognitive training, like that used in ACTIVE, can help to improve performance in areas that tend to decline in late life.  Even brief 10 week training programs can produce five-to-ten years of benefit in areas like memory, problem solving, speed, and attention. Excellent, clinically validated training programs are now available at low cost for computers, tablets and smartphones.

My answer

4. Combat negative mood. In general, older adults experience less major depression than younger adults, but depressive symptoms rise. Health challenges, activity restriction due to physical disability, retirement, financial concerns and losing loved ones are among factors that can increase anxiety and depression.  Unfortunately, memory and other areas of mental functioning can be seriously compromised by mood disturbances.  Seeking help with adjustment problems can be a potent way to guard against cognitive loss.

My answer

5. Engage. Participation in complex leisure activities that are new and interesting seems to confer benefits in terms of memory, problem solving, and mood. The benefits seem greatest when these activities are done socially. Tasks as diverse as learning to act, quilt, play piano, use an ipad, or master digital photography have all shown mental or brain activation benefits. Engaging in social leisure seems to have dual benefits: It minimizes negative mood (which can sap mental energy), and it provides a kind of "mental exercise" with complex tasks. The trick, however, seems to be to try something new -- something you've never done before.

The arsenal

Arsenal

Educate

Brain Health

Spot-trainMood

Engage

Let’s briefly begin with understanding cognitive aging

Many people have a preconception that late life is a time of decline

The story is far more nuanced and individuated.

Gains and losses

Schaie, 1994, 2008

Losses butA

ge 2

0-34

Sta

ndar

d S

core

GainsA

ge 2

0-34

Sta

ndar

d S

core

Dementia is the fear …

…but in fact

The majority of the population will not experience dementia (although rates will grow)

There are, however, significant functional consequences of normal cognitive aging in the absence of dementia that have been largely ignored Medication Finance

Plus prevention

What accounts for cognitive aging? This is a detailed and evolving field,

but at the risk of oversimplifying, there are four BROAD categories of explanation Neuronal/brain loss Reduction in neuronal/brain efficiency Growing interference Disuse atrophy (“sensory underload”,

“disengagement”)

Neuronal/brain loss

Neuronal/brain loss

Neuronal/brain loss

Neuronal/brain loss

Neuronal/brain loss

Neuronal/brain loss

Brain healthEngagementSpot training

Neuronal efficiency

Brain health

Growing interference

Growing interference

Growing interference

When wil l I eat?

Wil l you take me to school

Have I done my homework?

Can I afford to get married?

Wil l I get a promotion?

Is my chi ld healthy?

Wil l my chi ld succeed?How do we get both kids to two

different soccer practices?

Have I taken my medication?

Does my mother need a nursing home?MoodSpot training

Disuse

EducateBrain healthSpot trainingMoodEngage

My program of research (and others) In large measure, we’ve tried to chip

away at normal cognitive aging, using the “arsenal”, more or less, as the conceptual framework for guiding our approaches.

In general, the past five years have seen an explosion of research- and market-driven intervention approaches for cognitive aging

The arsenal

Arsenal

Educate

Brain Health

Spot-trainMood

Engage

Educate

EducateFigure 1. Model estimated growth curves for 5-year cognitive change by racial group.

Educate (and support)

African American, PromptedAfrican American, UnpromptedWhite, PromptedWhite, Unprompted

With Kelsey Thomas

unprompted

Educate (and support)

African American, PromptedAfrican American, UnpromptedWhite, PromptedWhite, Unprompted

With Kelsey Thomas

\

Prompted

“Can you look again?

The arsenal

Arsenal

Educate

Brain Health

Spot-trainMood

Engage

Brain health There is an extensive literature

documenting that health issues of later life (especially cardiovascular, and especially hypertension) are destructive to cognitive functioning Especially “executive functioning” Ron Cohen, UF CAM director, and Catherine

Price, CHP faculty member, have been leading contributors to understanding how vascular-related neuronal loss is directly associated with cognitive decline

Brain health

A now ten-year old meta-analysis clearly showed that exercise trials were very beneficial Aerobic or aerobic + strength Increase in grey and white matter Increase in neurotrophic factors Improvement especially in “executive

control”

Brain health

Dawn Bowers & Michael Marsiske

Brain health

Brain health

Bird S

afari

Jewel

Diver

Master

Garden

er

Road T

our

Swee

p See

ker

GDIBD

I

Apath

yTE

PS-ATE

PS-C

SHPS

40.000045.000050.000055.000060.000065.000070.000075.000080.0000

Insight plus AerobicInsight plus WiiInsight onlyControl

Brain healthThe gift that keeps on giving?

Brain health

Marsiske, Gogoi, Maye, McCoy, McCrae

Memory

Speed

The arsenal

Arsenal

Educate

Brain Health

Spot-trainMood

Engage

Spot train

ACTIVE study VITAL study MEDLI study Fitmind study

ACTIVEUniversity of Alabama-Birmingham Karlene Ball PhDHebrew SeniorLife BostonJohn Morris PhDRichard Jones ScDIndiana UniversityFredrick Unverzagt PhDJohns Hopkins UniversityGeorge Rebok PhDPennsylvania State UniversitySherry Willis PhD

University of Florida/Wayne State UniversityMichael Marsiske PhDNew England Research Institutes, Coordinating CenterSharon Tennstedt PhDNational Institute on AgingJonathan King PhDNational Institute of Nursing Research Susan Marden PhD

ACTIVE

ACTIVE

ACTIVE 10-year Trajectory of Memory, Separately by Training Group

ACTIVE 10-year Trajectory of Reasoning, Separately by

Training Group

ACTIVE 10-year Trajectory of Speed of Processing ,

Separately by Training Group

ACTIVE 10-year Trajectory of Self-Reported IADL

Difficulty, Separately by Training Group

ACTIVE

State reported crashes over 10 years

Ross, Edwards & Ball, 2013

The arsenal

Arsenal

Educate

Brain Health

Spot-trainMood

Engage

UF Health Vitality Mind

UF Health Vitality Mind

The arsenal

Arsenal

Educate

Brain Health

Spot-trainMood

Engage

Engagement

Engagement

Engagement

Engagement

Engagement

Engagement

•150 older adults randomized to receive either • “Senior Odyssey”

• (n=87; teams solve long-term ill structured problems from the disciplines of literature, science and technology, civil engineering, and history, like building a structure out of balsa wood) or

• testing-only control (n=63)

EngagementUseful Field of View is improved by first-person shooter video games in college-aged players (but not by Tetris)

Engagement

Basak, Boot, Voss & Kramer (2009)

• Video game group: 23.5 hours of training (n=20)

• No contact control group

• Trained participants improved more than the control participants in executive control functions, such as task switching, working memory, visual short-term memory, and reasoning.

“The Videogame study”Computerized training Tetris Medal of Honor

“The Videogame study”

“The Videogame study”

Pretest Posttest0

102030405060708090

100

ComputerMedal of HonorTetrisControl

Div

ided

Att

enti

on T

ime

Going down = faster = improvement

“The Videogame study”

“The Videogame study”

RevivaWith Patricia Belchior

Crazy Taxi Computer trainingPosit Science Road Tour

Funded by the Robert Wood Johnson Foundation

Control

Reviva

Next steps

Submission of federal funding application(s) to understand Mechanisms of training-related

improvement Possible “effect modifiers”

▪ Mindfulness Community partnerships to

implement the ‘arsenal’ in community settings

UF Health Vitality Mind

Questions?

For further information, copies of reprints, or to request a copy of this talk Michael Marsiske marsiske@phhp.ufl.edu (352) 273-5097