Enhancing Cognitive Fitness in Adults

Abstract

To one degree or another we all face changes in our cognitive and emotional capacities as we age. As human beings and as professionals, we have a responsibil- ity for thinking deeply and acting honestly to assist those who seek out our care for these challenges. Certainly we bring the power of our expertise to the therapeutic relationship but also our deepest human compassion. The first editor of this volume, Dr. Paula Hartman-Stein, has exemplified these capabilities for me in our personal and professional relationships. She and her coed- itor, Dr. Asenath La Rue, have assembled a group of experts to publish a most timely volume. The world of cognitive aging is changing radically as the challenges to the dominant medical models of brain aging mount, and the need for more posi- tive, community-based approaches is recognized ever so more clearly. This volume addresses this need well. As a geriatric neurologist, psychologist, cognitive neuroscientist, and environmental ethicist, I tried to take a broad perspective on how individuals, communities, and society at large should address the problems and opportunities of adult development and cognitive aging. It is a time to expand our horizons and cure our addiction to biological and medical approaches. The very survival of our species depends on framing problems correctly, creating opportunities together, and developing new sources of hope that draw us into the future. Paula asked me to address in this foreword, which I am honored to contribute, why pills are not the answer to brain health. We see the crumbling of the pharmaceu- tically driven process of defining memory loss and cognitive decline as medical problems to be fixed. Yes, doctors can assist in assessing people as to whether medical conditions are contributing to loss of intellect. But their control over the full range of aging challenges is an example of the overreach of medicalization of social ills. The term Alzheimer’s disease provokes fear and a longing for simplistic solu- tions to what can no longer be viewed as a molecular problem waiting for its magic solution. Few honest people are willing to claim that Alzheimer’s disease is a singu- lar condition. The heterogeneity at genetic, pathological, and clinical levels has become ever more evident. Many now share the skepticism that Dr. Alois Alzheimer himself demonstrated about what he described as being a single separate disease. Moreover, the intimate links between the biology of aging processes themselves and so-called Alzheimerization of the brain are apparent. Changes in synapses and neu- rons occur with age. Plaques and tangles are no longer seen as the specific character- istic of the single disorder. The medical establishment has pushed recently for expensive biologically-based diagnostic tests whose reliability and validity have not been established. The emphasis on developing biomarkers is a result of desperation to better characterize Alzheimer’s disease in life and create the probably unrealistic hope of discovering specific sub- types of disease hidden among the enormous clinical heterogeneity. Ever more expansive labels of unclear utility outside a limited research framework are being applied to the continuum of aging so that now we not only have early and late forms of mild cognitive impairment but subjective cognitive impairment as well. These efforts have been linked to the promise that effective therapies, which will prevent, slow the progression of, or even cure Alzheimer’s disease, are just around the corner. Yet unfortunately, the number of failed therapeutic trials continues to grow. This is not surprising if one sees AD as a much more complex process intimately related to aging. Prominent CEOs of drug companies, molecular biologists, and even pioneers such as Robert Butler came to recognize the overly simplistic nature of our consid- ering Alzheimer’s as a single process. However, the domination of reductionistic molecular approaches to chronic disease persists, in particular with the notion that genes hold the answers to most, if not all, health problems. Scientific leadership at the highest levels is obsessed by genes as causes and potential targets for therapy while relatively ignoring environmental science, public health, and prevention efforts. This is most evident in the pharmaceutical industry. Some physicians have allowed the pharmaceutical industry to not only manipulate them to prescribe new and often more expensive and less safe drugs and to invent entirely new categories of drugs and diseases to promote a sense of progress which is increasingly being seen as an illusion. In my opinion, the promotion of “anti-aging medicine” represents the most malignant form of quackery yet seen in the long history of the attempts of healers to take advantage of those they strive to serve. We are moving towards an integrative health approach but are not yet there as we do not understand adequately what binds the healing traditions together. In my opinion, we need to focus on a personalized health approach not based on genes but on narrative. Every healer needs to co-create a healing story with the person suffering and seeking assistance. Moreover, this nar- rative needs to include greater attention to the relationships between the person and his social community and natural environment. We need to work with nature in our communities to foster healthy aging in all of us. Perhaps we need modern day shamans attentive to the interrelationships among individual, family, community, and envi- ronmental health! Drs. Hartman-Stein and La Rue offer us a feast of authors and ideas under the title Enhancing Cognitive Fitness in Adults: A Guide to the Use and Development of Community-Based Programs. They focus on improving thinking and emotional life rather than treating disease. The editors recognize that most of the strategies outlined in the book should be implemented in community-based settings. No longer will the hospital or the doctor’s office necessarily be seen as the exclusive locus of health. Rather we must embed health throughout community organizations, includ- ing schools as I will return to at the end of my foreword. The beginning part of the book focuses on research foundations. The book strives for a balanced approach to brain versus cognitive fitness. Merely promoting concepts such as neuroplasticity or neurogenesis is not a game changer. Brain scientists must be challenged to improve our cognitive functioning and well-being in safe ways and help to bridge scientific discoveries with practical, humanistic interventions. Part I of the book points out that exercise and cognitive engagement deserve a prom- inent place on the list of activities to do to keep the brain healthy. The editors have added a chapter that includes information about the role of meditation in not only improving cognition but also increasing compassion in caregivers of frail older adults. Increasingly, information technology will play a greater role than biotechnology in improving our cognitive functioning. However, we must go beyond computer games to fully embracing the power of social networks and multimedia. It is not so important that we develop artificial intelligence in computers, but rather we should focus on how computers and other digital devices can help humans think and remem- ber better as friendly aids to our cognition. The second part of the book introduces us to some of the most successful community- based programs in the country. Multifaceted programs will likely be the most successful as they embrace the diversity of learning styles. My own particular interest is an intergenerational learning that fosters the greatest opportunities for co-creation of narratives that promote long-term thinking and valuing in human beings. Whether it be reading or writing poetry or prose, the power of story is gaining appropriate increased attention as a vehicle for promoting healthy individuals and communities. The role of competitive intellectual programs such as Odyssey of the Mind and an old fashioned spelling bee is also highlighted in this part of the volume. The final chapter in the second part focuses on nutrition, increasingly recognized as an impor- tant element of general and brain health. Part III pays attention to creative artistic programming such as acting, creative dance, music composition done in groups, and viewing museum art work in small groups–all designed to enhance cognition in frail adults but perhaps more impor- tantly, to enhance life’s quality for the individuals and those who care for them, both paid caregivers and family. Part IV of the book concentrates on wellness interventions for adults with cogni- tive impairment including biofeedback strategies for “brain brightening.” My own attitude is that we should develop wellness approaches for learners of all ages that respect developmentally appropriate differences. In older adults these differences can be associated with loss of memory and ability to multitask. But just as with adults whose cognitive functioning is healthy, we need to look for opportunities for positive growth in those with dementia. This section of the book features community- based programs that strive to accomplish just that. Positive psychology and positive aging have appeared on the scene as a counter- balance to the often negative language of clinical psychology and gerontology.Yet a true wisdom of aging represents the need to balance the negative and positive aspects of aging. In fact, recognition of the limits of our individual human abilities as well as our life span is perhaps, etc. one of the sources for the kind of integrative knowledge that wisdom represents. We should not view wisdom as a rare occur- rence in human society but rather see that each one of us has a little bit of wisdom that can be enhanced by working collectively with others. The final chapters refer to two programs that focus on intergener