nm n kirtan kriya meditation a promising technique for enhancing cognition in memory-impaired older...

7/28/2019 NM N Kirtan Kriya Meditation a Promising Technique for Enhancing Cognition in Memory-Impaired Older Adults

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419P.E. Hartman-Stein and A. La Rue (eds.),Enhancing Cognitive Fitness in Adults:A Guide to the Use and Development o Community-Based Programs,

DOI 10.1007/978-1-4419-0636-6_24, Springer Science+Business Media, LLC 2011

Abstract This chapter reviews some o the predictors and markers or Alzheimers,

ocusing on stress or the breadth o its impact and because it is an amenable target

or treatment. We then describe a low cost and easy to learn meditation technique,

Kirtan Kriya, that can not only lower stress, but preliminary evidence suggests it

also increases cognitive ability among those with incipient Alzheimers Disease.

Humankinds New Problem

Its easy to overlook the remarkableness o aging, exclaimed the renowned

gerontologist, Ken Dychtwald (2010). He pointed out that or 99% o the history o

humankind, average lie expectancy at birth was less than 18 years o age. Long

beore they reached what we would consider old age, people during that time died

rst o inectious diseases, accidents, or violence. Over the last thousand years, lie

expectancy climbed rom 25 years, reached 47 by the turn o the twentieth century,

sky-rocketed to 78 by the twenty-rst century, and is still climbing. Currently, the

age group with the greatest population increase is centenarians.

At the time that the Constitution o the United States was being ratied, arthritis,heart disease, and dementia were seldom, i ever problems that physicians were called

upon to treat, in part because liespan was too short or these conditions to emerge as

medical problems. Beginning o the last century, however, something unprecedented

has been happening. Advances in sanitation, public health, ood science, pharmacy,

medicine, and wellness-oriented liestyles, have resulted in an eleven-old increase in

the number o Americans o 65 years or older age, rom 3 to 33 million. The US

Census Bureau predicts that number will increase to 70 million by the year 2035.

D.S. Khalsa (*)Alzheimers Research and Prevention Foundation, Tucson, AZ, USA

Center or Spirituality and the Mind, University o Pennsylvania, Philadelphia, PA, USAe-mail: [email protected]

Chapter 24

Kirtan Kriya Meditation: A Promising

Technique for Enhancing Cognitionin Memory-Impaired Older Adults

Dharma Singh Khalsa and Andrew Newberg


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420 D.S. Khalsa and A. Newberg

While the increase in liespan enjoyed by many people is to be applauded,

increasing longevity brings with it a major problem: the dramatic increase in the

incidence o cognitive decline, dementia, and particularly, Alzheimers disease

(Alzheimers Association,2010). Today there are 5.3 million people with Alzheimers

disease in the United States with a price tag o $148 billion a year, not counting the

over ten million unpaid caregivers. Alzheimers is the sixth leading cause o death.

More telling however, is the act that Alzheimers disease is now the number one

worry o aging baby boomers, surpassing cancer and heart disease.

Predictors and Markers of Alzheimers

Age. The best predictor or Alzheimers disease (AD) is advancing age. As a per-son gets older, the probability o having AD increases. However, signicant cogni-

tive decline is not a normal part o aging.

Subjective cognitive impairment (SCI). SCI describes the experience o healthy

older adults who have the eeling that their memory is not unctioning as well as it

should, but or whom the subjective symptom cannot be veried objectively by

clinicians. Where clinicians used to dismiss this complaint, it has recently emerged

as an early marker or AD (Reisberg, Shulman, Torossian, Leng, & Zhu, 2010).

These researchers reported that, over a 7-year period, study participants who had

SCI progressed to mild cognitive impairment (MCI) and AD at a higher rate than

those who did not. O those without SCI at the start o the study but who did decline

to MCI or AD over its course, mean time to decline was 3.5 year longer than or SCI

subjects. In patients without pure cognitive complaints, such as those with multiple

sclerosis, there is a relationship between depression, atigue, SCI, and objective

neuropsychological unctioning (Kinsinger, Lattie, & Mohr, 2010).

Mild cognitive impairment. Individuals with MCI have cognitive problems that exceed

what is expected or their age and background but are not severe enough to meet the

criteria or the diagnosis o dementia. MCI is a risk actor or developing AD or otherdementias and is oten considered a preclinical stage o dementia (see Chap. 21).

Medical conditions. Medical conditions that are high risk actors or AD include

cardiovascular disease, high cholesterol, Type 2 diabetes, high blood pressure,

smoking, and obesity. Many o these actors are modiable via medications and

liestyle changes; undertaking such modications may decrease the likelihood o

developing both heart disease and cognitive dysunction. Although epidemiologic

studies show associations with these actors and AD risk, randomized clinical trials

have not clearly demonstrated yet that odds o getting dementia actually decrease

with treatment or liestyle changes.

Stress. Stress occurs when a person is unable to cope with the demands placed

upon him/her. When his/her ability to perorm is exceeded by the demand, stress

ensues. Individuals have dierent levels o tolerance to stress, and dierent

responses at dierent times in their lives. Although well documented in the research


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42124 Kir tan Kriya Meditation: A Promising Technique or Enhancing Cognition

literature, the eect o chronic stress is an under-discussed and underappreciated

aspect o maintaining brain tness in an aging population. The next section oers

historical and recent research results that show why stress management is so impor-

tant to brain health.

Stress and the Brain

In the rst authors personal and clinical experience, chronic, unrelenting stress

may be near the top o the list o todays liestyle actors that impact the cause

and possibly the progression o AD. Why? Stress stimulates the adrenal glands to

release the hormone cortisol, which then fows throughout the blood stream.

Cortisol suppresses the immune system unction. Stein-Behrins and Sapolsky(1992) ound that illness and aging are times o decreased ability to handle stress.

Cortisol also shortens the liespan o cells and o the organism overall. The

liespan o a normal, healthy cell is controlled by its telomeres, a segment o DNA

at the tip o the chromosome. Telomeres are believed to have a protective unction,

like the plastic tip o a shoe lace that prevents the lace rom unraveling. Telomeres

prevent chromosomes rom losing genetic inormation needed in the replication

process. Each time the cell divides, the telomere is shortened, until at last the telom-

ere length is insucient or the cell to replicate itsel and it eventually dies. However,

there is an enzyme, telomerase, which can rebuild the DNA sequence at the end o

the chromosome and thus lengthen the telomere. Choi, Fauce, & Eros (2008)

ound that exposure to cortisol was associated with a reduction in telomerase activ-

ity in human T lymphocytes. By acting on telomerase, cortisol aects cell lie.

When cortisol reduces telomerase activity, the telomeres in the DNA shortened pre-

cipitously and, in turn, the shortened telomeres accelerate aging and illness. People

with both chronic stress and AD are in double jeopardy in regard to their cells, as

Lukens, Van Deerlin, Clark, Xie, & Johnson (2009) ound, because telomere length

in peripheral blood is already diminished in individuals who have AD.

O most interest here is the research into the direct role o stress and cortisol on

the development o dementia. Early lie stresses, such as abuse and neglect at a

young age, result in the development o infammation in the hippocampus, the brain

structure that is undamental to learning and commonly the site o initial deterioration

in AD. Although causal linking has not yet been established, this early-age infam-

matory process could potentially contribute to AD pathology (Anda et al., 2006;

Bornstein, Copenhaver, & Mortimer, 2006).

Newcomer et al. (1999) ound decreased memory perormance in healthy humans

who were injected intravenously with stress-levels o cortisol. In a longitudinal

study conducted over a period o 30 years, Crowe, Andel, Pedersen, and Gatz (2007)

ound a higher risk o dementia in individuals who reported a high incidence owork-related stress. Wilson et al. (2003) showed that Alzheimers disease is higher

in people with a stress-prone personality. Peavy et al. (2007) showed that stress

produced more reactivity and higher levels o cortisol with subsequent worse eects

on memory unction in older individuals who had a genetic risk or the development

o AD (i.e., ApoE4 positive).


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The hormone cortisol has been shown to kill brain cells in the hippocampus, the

brain structure undamental to learning and sometimes considered to be the memory

center o the brain (Sapolsky, 1992; McEwen & Sapolsky, 1992). Prolonged expo-

sure to stress leads to loss o neurons, particularly in the hippocampus (Lupien,

McEwen, Gunnar, & Heim, 2009).

In both humans and animals, reactions to stress and also regulation o many

other body processes, including digestion, mood, immune unction, energy are

controlled by means o communications among a set o structures in the midbrain

called the hypothalamic-pituitary-adrenal axis, or the HPA axis. I the unctioning

o the HPA axis becomes impaired, the ability to regulate the body unctions just

listed is also impaired. A connection between cognition in the older adult and the

HPA has been ound. For example, MacLullich et al. (2006) showed that a smaller

anterior cingulate cortex (ACC) is associated with an impaired hypothalamic-

pituitary-adrenal axis (the HPA axis) regulation in healthy elderly men. The ACCplays an important role in rational cognitive unctions, including ocusing attention

and decision-making. It is a central station or processing stimuli and assigning

appropriate control to other areas in the brain. It is involved in learning and problem-

solving tasks. Hence, the Alasdair et al. nding associating diminishment o the

ACC to impaired stress regulation is especially signicant.

To summarize, chronic, unmanaged stress causes excessive cortisol release rom

the adrenal gland into the blood stream. This cortisol then travels to the hippocampus,

where it causes brain cell death and shuts o the inhibition o production o urther

cortisol rom the adrenal gland. The excess o cortisol causes infammation andhippocampal neuronal cell death, and also accelerates aging by decreasing telomere

length, which in turn may lead to more infammation, cardiovascular disease, cancer,

and Alzheimers.

Stress Response Versus Relaxation Response

Humans and most animals exhibit a stress response when acing a situation whosediculty is beyond their perceived ability. Humans also possess a counterbalancing

capability, the relaxation response. The main dierence between the two is that the

stress response may occur as a result o environmental stimulation, but the relax-

ation response requires the individual to take action.

The stress response and the relaxation response were rst demonstrated by Walter

Hess in 1949 by stimulating two discrete areas o the hypothalamus in the brain o

a cat. Table 24.1 shows that these two phenomena are opposites o each other.

The relaxation response was popularized by Benson in 1975. This is a relaxed,

sel-healing state, and requires positive action to experience. In addition to theeects listed in Table 24.1, it is said to activate the bodys natural healing mecha-

nism. There are our requirements to enter it (Benson, 1975):

1. A comortable position.

2. A quite environment.


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3. A tool or mental device.

4. A specic attitude.

The comortable position can be achieved by simply sitting on a chair, or on the

foor in a comortable, cross-legged posture. The environment should be quiet withan absence o distraction. The next two requirements to enter into a relaxation or

basic meditative state are perhaps the most important. The tool can be any thought,

sound, phrase, or object on which one ocuses. Examples include a chosen word

such as one, or peace, or an object such as the breath fowing in and out. The

attitude has to do with not becoming attached to any thoughts that enters conscious-

ness, but rather to acknowledge them and then go back to the chosen ocus. So it is

an attitude o accepting that ones mind will wander in spite o the desire to ocus,

and o not being harsh with onesel when it happens.

The relaxation response is a way to manage stress. Meditation is closely related tothis technique, sharing both the our requirements listed above and also outcomes in

regard to stress management. There are at least 13 physiological eects o basic medi-

tation that have been observed (Khalsa, 2001). In addition to the our listed in

Table 24.1, these include decreases in the stress hormones epinephrine, norepineph-

rine, and cortisol; decrease in lactic acid, which signies a decrease in anxiety level;

decrease in lipid peroxidase, which reveals a decrease in ree radical ormation; an

increase in the hormone DHEA; increase in the sleep and antiaging hormone, melatonin;

enhanced immune system unction, and a reduction in infammatory molecules.

Meditation is requently, i not always, associated with positive psychologicalchanges (See Kaszniaks review, chapter 5). These changes, in turn, are related to

telomerase activity in immune cells (Jacobs et al., 2011), which has the potential

to promote longevity in those cells, as explained above. Older adults who learned and

continued to practice Transcendental Meditation (TM) were indeed ound to have

the highest survival rates 3 years ater completion o a study that compared the eects

o TM, relaxation training, mindulness, and no treatment (Alexander, Langer,

Newman, Chandler, & Davies, 1989).

Neuroimaging studies o meditators with such scanning techniques such as mag-

netic resonance imaging (MRI), positron emission tomography (PET), and single

photon emission computed tomography (SPECT) have provided evidence that

meditation has direct benets on the brain. These include increased activity in the

hippocampus (Lazar, Bush, Gollub, & Fricchione, 2000), increased cortical thickness

(Lazar et al., 2005), diminished loss o brain volume with age (Newberg et al., 2001)

and enhanced activity in the prerontal cortex (Newberg et al., in press). This last

nding is especially signicant because the prerontal cortex is associated with

attention, concentration, ocus, decision-making, and short-term memory.

Table 24.1 Walter Hesss (1968) discovery o the stress responseStress response Relaxation response

Blood pressure Increased Decrease

Pulse Increased Decrease

Respiratory rate Increased Decrease

MVO2

or oxygen demand Increase (rise) Decrease (drop)


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This extensive menu o benets rom meditation is available at a relatively low

cost (patients time) and generally no side eects, resulting in a high benet-to-cost

ratio, not only or the patient, but or society.

The orms o basic and more advanced meditation are legion, and some require the

investment o many years o practice to master. However, one orm o particular inter-

est is Kirtan Kriya (KK) meditation because it can be perormed even by those whose

memory has some impairment, and the benets accrue rom the very rst practice

session, based upon preliminary evidence rom our research. Beore describing the

research on which these claims are based, the next section describes the KK practice.

Kirtan Kriya Meditation

Kirtan Kriya is a 12-min singing exercise in the Kundalini yoga tradition that people

have been practicing or thousands o years. A kirtan is a song. Kriya reers to a

specic set o movements. In the Eastern meditation tradition, kriyas are used to help

bring the body, mind, and emotions into balance, thus creating healing. The Kirtan

Kriya orm o meditation is meant to be practiced or greater attention, concentration,

improved short-term memory, and better mood.

KK brings together several modalities o behavior: singing or chanting, nger

movements (mudras), visualization, and sequence tracking. Hence, it is a multiaceted,

multisensory exercise that engages several areas o the brain. The complexity o themethod thus absorbs attention to such a degree that the likelihood o distracting

thoughts entering the mind is greatly diminished. KK shares the our requirements

listed above or the relaxation response and basic meditation. It applies the standard

meditation behaviors or posture, eye direction, and breath as well. The technique is

described by Khalsa (2001).

Posture. The individual can sit comortably in a chair with their eet fat on the

foor. Alternatively, one can sit on the foor with legs crossed, although older adults

are not likely to choose this option. The essence o the posture is to be comortable

and sit with spine straight with only the natural curvature.

Breath. The practitioner simply breathes naturally as the meditation unolds.

Eyes. Eyes are closed.

The chant or mantra. The chant uses the sounds, Saa, Taa, Naa, Maa. These ancient

primal sounds rom Sanskrit, taken together, mean my true identity or my high-

est sel. The tune to which these sounds are sung is the rst our notes o the amil-

iar childrens song, Mary had a Little Lamb. That is, the notes are Mar-y had a.

See Fig. 24.1.The mudras or fnger movements. The thumb is touched to each o the other our

ngers in sequence. Both hands perorm the same mudra set simultaneously.

Figure 24.1 illustrates.


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On Saa, touch the index ngers o each hand to the thumbs.On Taa, touch your middle ngers to your thumbs.

On Naa, touch your ring ngers to your thumbs.

On Maa, touch your little ngers to your thumbs.

Always go orward in sequence: thumb to index nger, middle nger, ring nger,

and pinky; never go backwards.

The visualization. Visualize energy coming down rom above into the middle o

the top o the head, proceeding straight down into your brain, and then changing to

a lateral direction so that this orce comes out o your head at a point in the middleo your orehead, in the center lined up with the nose (the spot reerred to as the

third eye in some Eastern traditions). Hence, the energy is visualized as ollowing

the path o a capital letter L. One may think o this action as sweeping through like

a broom. See Fig. 24.2.

The sequence

1. Chant the sounds Saa Taa Naa Maa while also perorming the mudras with the

ngers o both hands. At the same time, visualize the L coming into and leaving

the head. With each syllable, imagine the sound fowing in through the top oyour head and out the middle o your orehead (your third eye point).

2. For 2 min, sing in your normal voice.

3. For the next 2 min, sing in a whisper.

Fig. 24.1 Tooch ngers on sequence as you sing the sounds

Fig. 24.2 Visualizethe sound entering thetop o the head andout the orhead


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4. For the next 4 min, say the sound silently to yoursel.

5. Then whisper the chant or 2 min, and then out loud or 2 min, or a total o

12 min.

6. To come out o the exercise, inhale very deeply, stretch your hands above your

head, and then bring them down slowly in a sweeping motion as you exhale.

The rst author has made a video demonstrating the KK meditation, which can

be seen by going to www.alzheimersprevention.org/kkmeditation.

Effect of KK Meditation on Brain and Cognition

According to Kundalini yogic tradition, there are several mechanisms by which

Kirtan Kriya conveys its benets. The use o the tongue in Kirtan Kriya during thechanting is believed to stimulate the 84 acupuncture meridian points on the roo o

the mouth in a certain permutation and combination that sends a signal to the hypo-

thalamus, as well as to the brain itsel. How this works on a chemical level is

theoretical, but the rst author conjectures that practicing KK may rejuvenate the

brain synapse by increasing important brain chemicals, such as acetylcholine.

The dense nerve endings in the ngertips, lips, and tongue are associated with a

high level o representation in the motor and sensory areas o the brain. Thereore,

when the practitioner utilizes the ngertips in conjunction with the sound, specic

areas in the brain, as seen on SPECT scans, are activated. Khalsa, Amen, Hanks,Money, and Newberg (2009) showed particular cerebral blood fow changes during

the practice o Kirtan Kriya. As shown in Fig. 24.3 the rontal lobes exhibited

Fig. 24.3 SPECT scan beore and ater Kirtan Kriya: brain healing in action


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increased cerebral blood fow. The posterior cingulate gyrus was activated (Fig.24.4).

This is signicant, because the posterior cingulate gyrus is one o the rst areas that

demonstrate decreased activity on a scan when one develops Alzheimers disease.

One might thereore conjecture that consistent practice o the KK meditation and

the concomitant activation o the posterior cingulate gyrus, potentially lead to a

decreased risk or cognitive decline and Alzheimers disease. Long-term studies

involving clinical outcomes as well as brain imaging will be needed to determine

whether this conjecture is true. At present, exploratory studies are showing someintriguing cognitive benets when Kirtan Kriya is practiced on a regular basis.

Newberg, Wintering, Khalsa, Roggenkamp, and Waldman (2010) described

positive eects o Kirtan Kriya on cognitive unction and cerebral blood fow in

subjects with memory loss. Signicantly, this is the rst study in which the KK

meditation has been explored in people diagnosed with memory impairment

although it is not the rst study o people with memory loss; Alexander, Langer,

Newman, Chandler, and Davies (1989) also included subjects with dementia in all

treatment groups, including the TM group. In our preliminary study, participants

who complained o memory loss symptoms were recruited, and either practiced KKor 12 min per day (the experimental group) or listened to music or an equal amount

o time (the comparison group). The 15 experimental participants ranged in age

rom 52 to 77 (mean 64, SD 8). Their MMSE scores ranged rom 16 to 30. Seven

had mild age-associated memory impairment (i.e., SCI), ve had MCI, and three

Fig. 24.4 Activation o the posterior cingulate gyrus (Source: Khalsa et al. (2009) unpublisheddata)


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had a diagnosis o AD and moderate impairment. However, one o those with AD,

whose MMSE score was 16, was ound to be incapable o ollowing the directions

or perorming the meditation, and her data was not included urther in the results.

Thus, 14 participants constituted the nal experimentation group, two o whom

had AD.

The experimental group participants were individually instructed in how to per-

orm the KK meditation. The training began with a 20-min video o one o the inves-

tigators explaining and demonstrating the technique. In this video and in urther

instructions to participants, the visualization component was not included. Then the

participant was told to perorm KK or a 12-min period while being supervised by

one o the researchers. Participants were told to perorm the 12-min KK practice

daily or 8 weeks, and provided a CD to help guide them. The CD was a recording o

the audible aspects, plus some background music as an aid in the rhythm.

The comparison group comprised two people with MCI and three with age-associated memory impairment (SCI), or a total o ve participants who ranged

rom 56 to 79 years old (mean 65, SD 10). The mean MMSE score was 29 (SD 1).

They were to listen daily to a CD on which had been recorded 12 min o two Mozart

violin concertos.

The participants in the experimental group kept a practice log revealing a high

degree o compliance (75%, on average). Participants were scanned (SPECT) both

on the rst day at which they had been instructed, and at the ollow-up session ater

8-weeks o at-home practice. They were also given a battery o neuropsychological

tests on both occasions.The testing revealed a signicant improvement in scores on a verbal fuency test,

animal naming, and a test o divided attention, trailmaking, Part B. Both o these

neuropsychological tests tap into executive unctioning skills.

Subjectively, the experimental participants also reported improvement in their

overall memory unctioning. Given Reisberg et al.s (2010) ndings about SCI, this

may be signicant, as individuals with SCI may be at higher risk or progression to

MCI and later Alzheimers disease.

As stated above, this is the rst study o the eects o the Kirtan Kriya meditation

on people who are experiencing memory loss, and it revealed that KK had a positiveeect in enhancing cerebral blood fow and improving cognitive unctioning.

Previous studies o meditators using attention-ocusing practices other than KK have

revealed activations in brain structures in the rontal lobe and ACC. Previous studies

o meditators using mantras (not KK) have revealed changes in the temporal lobe.

As can be seen in the scans below in Fig.24.5, rom Newberg, Wintering, Khalsa,

Roggenkamp and Waldman (2010), KK practice produced a dierence in activation

in the rontal lobe, posterior cingulate gyrus, and anterior cingulate gyrus, both the

rst time the subjects practiced the meditation on the day o instruction, and more

prominently ater 8 weeks o doing the meditation only 12 min a day. MacLullichet al.s (2006) result reported earlier on the association between the ACC and the

bodys ability to regulate stress, we speculate that enhancing activity o the anterior

cingulate gyrus could improve hypothalamic-pituitary-adrenal axis unction, and

normalize the stress response so that not much o cortisol bathes the hippocampus.


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Conclusion

Mitigating the biochemical eects o stress on the body and brain is an important,

although rarely discussed, target o prevention or Alzheimers disease. Meditation

has been shown to be helpul in lowering anxiety and stress as well as a variety o

other positive health outcomes. However, some meditation techniques appear to be

unattractive to older adults and too complex to be utilized by those whose memory

is already compromised.This chapter described a orm o meditation, Kirtan Kriya, that has been success-

ully used in preliminary studies by this population at risk or Alzheimers disease.

Participants reported that it was enjoyable and subjectively benecial, including a

perception o improved cognition. Directed to practice it daily over a period o 8

weeks, participants did indeed practice it 75% o the days, on average. Newberg,

Wintering, Waldman, Amen, Khalsa and Alavi (2010) ound objective evidence o

cognitive benet as well. Hence, the Kirtan Kriya meditation appears to also improve

a number o aspects o psychological well-being.

Most noteworthy are the acts that this was a sel-directed training program usinga CD, ater only a brie one-on-one instruction; the amount o time necessary was

only 12 min a day or 8 weeks or these results to be observable; it is both a practical

and a low cost intervention; and it has no side eects, and does not interere

with medications. Our preliminary ndings suggest KK meditation is a promising

Fig. 24.5 Enhanced cerebral blood fow in the anterior cingulate gyrus


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intervention or enhancing cognition in older adults with mild memory impairment

that warrants urther research and possible inclusion in complementary treatment

protocols.

First Authors Final Comment

Yogi Bhajan, Ph.D., Master o Kundalini Yoga who brought KK to the West, was

once asked: Sir, does meditation prevent dementia? Not only does it prevent

dementia he replied, But it takes you to another dimension. In Khalsas opinion,

this other dimension is one where the regular practitioner o KK will discover optimal

health, psychological well-being, and brain longevity.

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nm n kirtan kriya meditation a promising technique for enhancing cognition in memory-impaired older...

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