S2E44. Greece!

We made it! We’ve spent the last several days island-hopping around Greece and as I write this we’re docking in Dubrovnik. I’ll be honest: I haven’t focused much (if at all) on brain health. I’ll assume you can understand why. Nonetheless, I’ll try to put together a few thoughts before heading out on our next excursion.

I felt I was prepared for the flight last Friday, having adjusted my sleeping and eating rhythms to accommodate 5 of the 7 hours we would cross during the flight. Serendipitously, Greece set its clocks back by one hour for daylight savings time the night we arrived, so I was gifted one more hour of transition time. What was left to absorb, then, was minimal: just 1 hour, or the equivalent of flying from Chicago to New York.

Unfortunately, I wasn’t able to get much sleep on the plane. I used a neck pillow, lavender oil, loose-fitting clothes, and I ate a banana, but all to no avail. The engine noise, fellow passengers conversing loudly, and the impossible task of getting comfortable all conspired against me. Consequently, I was not a happy camper the next morning when we landed in Athens.

The good news, though, is that I don’t think I felt any effect of the time zone changes. Once I caught up on my sleep, I was fine.

Sally, on the other hand—having not made any effort at all to prepare for the time-shift—was…fine!

It seems that for both of us, the quality of the previous night’s sleep was far more impactful than the 7 time zones we had crossed.

Traveling is a brain-healthy activity because it presents a variety of unique cognitive challenges. Going on a cruise provides those opportunities in spades.

First off, there’s getting oriented on the ship. It took me several days to figure out how to find the important locations: our room, the different restaurants, and the theater. Oh, you could find your way around by reading the signage, but I wanted to be able to do it on my own.

First, I figured out that the various restaurants, although they were on different decks, were all at the back of the boat while the theater and the main lounge were at the front. These landmarks replaced north (theater) and south (restaurants) in my personal navigation system. Then I noticed that the even numbered rooms were ‘west’ and they got higher as you traveled from ‘north’ to ‘south.’ So as long as I could keep an image in my head of where the theater was (‘north’), I could figure out where anything else was whenever I emerged from an elevator.

Conversely, after only 2 days, Sally just knew which way to turn to get to where we were going.

Then there are the excursions with guides who present volumes of information along the way, on-board lectures, adjusting to at least a dozen different accents spoken by members of the crew, and absorbing the sights and vistas themselves. Add to that sampling new foods and meeting new people and you’ve created an intense synapse-stimulating environment.

On the other hand, maintaining a brain-healthy diet just ain’t gonna happen! I’ve been like a kid in the proverbial candy store pigging out at the buffets on sweets, pastries, carbs, meat and more alcohol than I’d consumed in a very long time. Leafy green vegetables? Nope. On the positive side, I am eating a boatload of fish and I’m making an effort to dose myself with fruits every morning at breakfast. I’m not at all looking forward to stepping on the scale when we get home.

We walk a lot on our daily excursions. Even though I don’t find myself breathing hard, I’ll assume that I’m getting my 30-minutes of cardio every day. There is a ¼-mile jogging track around the boat and a fitness center with treadmills and resistance machines, but I’m tired enough at the end of the day without pushing my limits with intentional exercise.

So I hope you’ll excuse me if I leave it at that for now and get back to the task of thoroughly enjoying this trip. I know…it’s a tough job…but somebody has to do it!

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S2E38. Dementia Prevention: Brain Games

The notion that playing brain games on your computer can help prevent dementia is rooted in the research on neurogenesis and neuroplasticity.

Neurogenesis is the process whereby you can grow new brain cells at any age. Neuroplasticity is the process whereby you can grow new connections between neurons.

In theory, then, anything you do that (1) grows new brain cells, (2) increases the number of synapses between neurons, (3) strengthens cells and/or (4) protects them from harmful chemical interactions should all help slow down the process of cognitive aging. The recipe is pretty simple: bulk up your brain mass while minimizing the things that can cause it to atrophy. 

But it’s not just a theory. The research supports this view.

Exercise grows new cells, increases synaptic connections and strengthens the quality of transmission of electric impulses from cell to cell by thickening the axon’s myelin sheath.

A brain healthy diet provides nutrients that support neurogenesis as well as antioxidants that help clean up neuron-killing chemical detritus (e.g., beta amyloid and tau) that are residuals of your body’s immune response (i.e., inflammation).

Sleep expels toxins that accumulate on a daily basis and also increases the strength of neuronal connections (synapses) which form long-term memories.

When we engage in cognitively challenging activities—especially new and novel tasks—we create more connections. That is why reading a book, learning to play an instrument or to speak a new language, and navigating around a different environment (e.g., traveling) are all brain healthy activities.

But what about playing computer games? The evidence is spotty, but it seems that there might be something there. Enough, anyway, to justify millions of dollars of new research to try to nail down just what it can and can not do.

In S2E29: Brain Training Is Hard Work! I discussed the intense effort I expended during my first week of working with the BrainHQ program. Now, 9 weeks later, I have some data I can report.

First, let me say that I over-did it. Playing these games for an hour each day was exhausting. However, it did allow me to quickly work my way through all 29 tasks covering 6 different functions: attention, brain speed, memory, people skills, intelligence and navigation. After 5 weeks, I dropped down to 30-minute daily workouts, which was much more manageable.

So how did I do?

The program provides you with a percentile ranking that shows how your performance compares to others in your same-age cohort. After 9 weeks, my scores have leveled off and I’m not seeing any more improvement. I placed at the 89th percentile overall among 71-year olds, with individual domain scores that range from the 86th to the 94th percentile.

What is valuable about this is that I now have a baseline measure of my mental status. Going forward, if I maintain my 89th percentile ranking relative to my same-age peers, it will mean that I am aging normally. If that number drops, it will mean that my cognitive decline is a cause for concern. If it goes up, it will be a cause for rejoicing as it will suggest that I am not experiencing the expected pace of cognitive decline.

That information has practical value, too. It appears that measurable and accelerating cognitive decline starts to appear about 6 years before a diagnosis of dementia is usually made. If I continue to play these games on a regular basis over the coming years, my scores should serve as an early warning system of any emerging cognitive problems.

The alternative, of course, is to get a full neuropsychological workup every year. Playing computer games is a lot cheaper and more fun, though.

The knock on using brain games to promote brain health is that, although you can get better at the games, your new learning does not generalize to everyday life and so it has no clinical or practical significance, even if your scores continue to improve.

This past Sunday, though, I actually had a real-life experience for which I directly attribute my success to one of the games I’ve been playing. 

In this game, designed to enhance your speed of visual processing, the computer screen is divided into 8 pizza slice shaped segments. Images of 11 birds are then briefly flashed all at once around the periphery. One of the birds, however, is different from the rest. For example, it might have a white body instead of a rust-colored body, or a white wing instead of a black wing. The task is to click on the slice of the screen where the odd bird appeared.

The more I played this game, the better I got. After a while, I was stunned at how accurate I was with only the briefest glimpse of birds on the screen.

Which raises the logical question: So what?

I’ll tell you what! Last Sunday, we were having breakfast at the home of Sally’s son and daughter-in-law. Tammy mentioned that she had seen a bird fly away from their backyard bird house, but couldn’t tell if it was a blue jay or a bluebird. 

As we stood around talking in the kitchen, out of the corner of my eye through the sliding glass doors I saw the flash of a bird in flight. It was only a flash of color that lasted less than a second, but I was able to process its shade of blue and size, realizing immediately that it was a bluebird.

Impressive, huh?

Then we moved outside to eat breakfast. While we were seated around the table, Sally’s grandson Ryan (who recently graduated from college) brought out a bottle of champagne to make mimosas. When he popped the cork, it rocketed through a gap in a vine-covered fence and landed on the lawn beyond. I was the only one who saw where it went. 

Pretty cool, eh?

OK. So it’s no big deal…but it does suggest that something good is happening inside my head thanks to my computer game playing. 

 __________

S2E29. Brain Training Is Hard Work!

As I mentioned at the end of the last episode, my disappointment with my short-term memory led me to subscribe to ‘BrainHQ,’ a computerized cognitive training program. This past week was my first week using it and…man o’ man!!!…it’s hard work!

Before I continue, let me reassure you that I am not shilling for BrainHQ. I chose it from the myriad of online cognitive training offerings because it is being used in a range of research programs and has some published studies to support it. Having said that, the data is mixed and the jury is still out as to whether or not this particular program (or any purported brain-enhancing program) generates any meaningful improvement in one’s life.

But—just as I decided that in regards to diet that if I’m going to put something in my mouth, then it might as well provide something that supports brain health—I came to the same conclusion about computer games. Instead of wasting an inordinate amount of time playing a mindless but addictive game like ‘Bubble Shooter,’ I might as well get some benefit out of that same block of time by playing games that just might provide some health benefit. 

To see if it was really worth doing, though, I spent time this week looking at some of the recently published research about the effects of cognitive training programs. One study that caught my eye was a meta-analysis (i.e., a study that analyzes the data from many studies all at once) of changes in brain connectivity attributable to cognitive training. 

You might recall from S2E23: Repaving Your Cognitive Infrastructure that our brains develop neural circuits that connect distant areas that are used simultaneously to complete tasks. As we age and our abilities start to decay, we recruit more areas to help perform the same functions. This is made possible by brain plasticity and is at the heart of cognitive resilience as a protective factor against dementia.

The meta-analysis I read combined data from a number of fMRI studies and revealed that computerized cognitive training changed these pathways and linkages. There were increases in activity in some areas and decreases in others. The overall pattern was to move in the direction of restoring the circuitry that existed before age-related attrition began. In effect, it (roughly) restored your brain to the way it was two years earlier. That’s pretty impressive, no?  

If I’m understanding it correctly, when your frontal lobes begin to atrophy, your brain recruits neurons from other more posterior regions to pick up the slack. But cognitive training strengthens your frontal lobes so they no longer need to use the support they had previously requisitioned. Thus the frontal areas showed more activation and the more posterior areas showed less. Fascinating!

So I jumped into my training with the fervor of a new convert and immediately set a goal of ‘working out’ for an hour every day. This, apparently, was considered a very aggressive plan of action as BrainHQ recommended 20 minutes/day at least 3 times a week as a good place to start.

The program allows you to target a variety of brain functions (e.g., attention, speed, memory) and so I went after memory instead of following the suggested general approach which covers all the bases. Was I in for a surprise!

It was really hard. The tasks included both audio and visual versions of the ‘N-Back’ card task that I described in last week’s episode (S2E28), as well as an audio version of the card game ‘Concentration.’ 

The program is designed to push you to a challenging level without frustrating you to the extent that you quit. So the exercises start off easy, progress until you fail, and then drop back to easier versions. The sweet spot is when you maintain an 80% correct response rate.

I struggled with the frustration, though. On the N-Back card task, I mustered up all the attention and focus I could to visualize the briefly-shown cards in an order that would help me identify the correct one when the time came….but I didn’t get very far.  😦

All of my best efforts not withstanding, my visualizations of the cards would disappear shortly after a few new cards were turned over. It was as if an evil magician was doing a disappearing act inside my head. Poof! Now you see it…now you don’t!

I beat up on myself because I knew that my performance represented a decline from my peak abilities. Yes, I know that this is true for all of us if we are fortunate enough to get to this age, but having it slap me in the face like that was a little hard to take.

About three days into my training, I recalled something I learned in graduate school. Your brain has a ready supply of neurotransmitters on call to maintain a high level of focused attention for about 45 minutes. After that, you can still focus, but your efficiency drops off. I used this fact when I was taking hours long exams by stopping every half hour and doing deep-breathing exercise for 3 minutes to restore my neurotransmitter reserve before returning to the test. It seemed to work then, so I applied the principle again now: I divided my hour of daily exercise into two 30-minute sessions several hours apart. I could feel the difference and see the improvement in my performance during the second half of the workout. 

(Come to think of it…45 minutes is about how long I can practice the recorder or read a book without losing focus. Interesting!)

The good news here is that, after a week of training, I can see that I’ve made progress on all of the tasks. Not a lot, but progress, nonetheless. Enough progress to keep me from quitting. But, damn…this is hard work!

__________

S2E28. Working Memory Workout?

A majority of the mistakes and cognitive errors that I have documented in this blog involve failures of working memory. Working memory is where we hold information online while we manipulate it and/or consider what to do with it. It’s where we hear our internal voice. It’s the central cog in our executive functioning network.

Consequently, it’s not pretty when you start to experience declines in your working memory abilities which, as it so happens, are usually the first to go as we get older.

So I was intrigued by an article in The New York Times last week that reviewed a new book (The Complete Guide to Memory: The Science of Strengthening Your Mind) by neuroscientist Dr. Richard Restak in which he asserts that exercising your working memory can forestall its decline and possibly even restore prior losses. The article covers his 7 key recommendations and you can read it here.

Regular readers of this blog know me well enough to figure out that I downloaded the book and read it this week. It reviews all the usual types of memory and he adds a few new ones of his own construction. He pays more attention to brain structures than most books of this type, but he keeps his narrative breezy and conversational, including examples ‘ripped from the headlines,’ as they say.

He recounts the usual litany of techniques you can use to better remember lists, but I was most intrigued by his lengthy discussion of working memory and exercises you can do to actually strengthen it.

One such exercise was to name all of the United States presidents in chronological order, beginning with FDR. Then do it in reverse order. Then do it alphabetically. Then do it in reverse alphabetical order. If you want to try this, I’ll give you a hint: there are 15 of them.

It took me a little while one sleepless night to master this task. As I did so, I felt like I could actually see the places where my working memory let me down and where answers were swimming nearby but just out of awareness.

He recommended making other lists that you can manipulate in similar ways, and to practice organizing them in your mind every day. 

He also recommended daily practice with what is known as the ‘N-back task.’ The easy-to-do-at-home version of this only requires a deck of playing cards. First, you select two cards that will be your ‘trigger’ cards, say a ten and a three. Then you turn over the cards one by one, look at them, and place them face down in a pile. When one of your trigger cards appears, you have to name the card that preceded it. This is the ‘1-back’ version of the task. After you’ve mastered it, you can make it more difficult by trying to name the card that was two cards before the current card, or ‘2-back.’ 

I immediately pulled out a deck of cards and tried it…and failed miserably at the 2-back version. I did alright with the 1-back version, actually having the most difficulty remembering which were my 2 trigger cards!

This piqued my interest in working memory tasks and so I googled it. I discovered quite a number of sites offering (for a subscription fee) computerized versions of a wide variety of working memory tasks. 

I tried a number of them and quickly discovered how limited my working memory is. I was especially bad at tasks that required me to remember visual images. In fact, I noticed that I retained virtually no memory of the images and had to resort to semantic memory to complete the task, i.e., naming the images that had flashed on the screen and remembering the names, not the pictures.

Neuropsychological tests are very good at isolating and identifying your weaknesses, and these were no exception.

Dr. Restak talked about my condition in his book. It’s called ‘hypophantasia’ which is the inability to retain fleeting visual images in your mind’s eye. Conversely, people who are exceptionally adept at doing this have ‘hyperphantasia.’ My first wife was such a person. She could walk through someone’s house once and later draw a diagram of all the rooms on every floor…to scale! Most of us have abilities that fall somewhere along this spectrum from hyper- to hypophantasia.

This experience alarmed me enough to want to initiate a structured workout routine to try to improve (or at least slow the deterioration) of my working memory. My recollection, though, was that—Dr. Restak’s exhortations notwithstanding—the research is mixed about whether computer games and tasks can actually improve your cognitive abilities. In most cases, it appears that you can get better at the computerized task, but that it doesn’t generalize to improve your ability to perform other tasks of daily living. What was I to do?

Right on cue, I received an email from one of my college roommates, Tom, with an article from The Boston Globe about several large-scale, age-related cognitive studies that are being launched in New England. Among the variables being tested are brain training techniques. The program offered by a company called BrainHQ will be used in these studies.

Well, if it’s good enough for the researchers, then it’s good enough for me! So I went to www.BrainHQ.com and subscribed for a year for $96.00. My intention is to do a 1-hour workout each day…if the frustration from getting too many wrong answers doesn’t overwhelm me.  

Wish me luck!

__________

S2E14. Do Something Different

In terms of cognitive challenges to keep your brain healthy, games and puzzles are fun, but they don’t provide any added brain benefit. The more you engage in them, the better you get at doing them…but that doesn’t help preserve the abilities you need to live independently, like memory and executive functioning.

The recommendation, then, is to do something different to challenge yourself: learn a new language or learn how to play an instrument or go on a trip.

Go on a trip? You don’t have to ask me twice!

The NCAA Women’s Basketball Tournament was played over the course of the last month. I’ve been a fan of the University of Connecticut Huskies since I was a graduate student there from 1996-2001, and Sally caught the fever from me.

So three weekends ago, we made the 4 hour drive up to Storrs, CT, where the first 2 rounds were played on campus. When the Lady Huskies won those games, I went online to get tickets for the next 2 games which were being played in Bridgeport, CT, the following weekend. And when they won those 2 games we made the decision to do something we’d never done before: go to the Final Four in Minneapolis, MN!

This is where the cognitive challenge came in. We had 72 hours to figure out how to get tickets, book a flight, and get a hotel room. We started on the drive home from Bridgeport with me driving and Sally googling hotel rooms.

She found a hotel that was 3 blocks from the arena, so we booked it. When we got home, I searched for tickets online and learned that TicketMaster runs a brisk scalping business. I didn’t want to go all that way (about 1,000 miles) to sit in the nosebleed seats and watch the game on the giant monitor, so I took a deep breath and bought lower-level tickets for a price I never imagined I would pay for any event.

Finally, I went to the American Airlines site to book a flight and, hopefully, use my 65,000 frequent flyer miles. Not only were the available flights at lousy times, but they told me I needed to purchase an additional 200,000 miles at a cost of over $3,000 to get the seats!

That sent me over to Travelocity where I found non-stop flights between Philadelphia and Minneapolis at reasonable times and at an affordable $500 for the round-trip.

Planning done!

Last Friday, we took an Uber to the airport, arriving in plenty of time. After boarding the flight, though, we learned that there was a mechanical problem and we’d have to de-plane while they fixed it. That put us 2 hours behind schedule, so when we arrived in Minneapolis, we took a taxi to the hotel instead of taking the tram as we had originally planned.

We checked in and immediately left for the arena where the 2 semifinal games were being played. UCONN was in the 2nd game and we defeated Stanford. On to the championship game!

The next morning (Saturday), we were having breakfast in the hotel when an older woman approached us and asked if we wanted to buy her tickets for the final. She was a Stanford fan and she and her husband were going back to California instead of going to the game on Sunday. The tickets were in the first row behind the team bench!

Having paid as much as we did for our seats, my first reaction was: “Not interested.” But then I thought about it. First row! So I went over to talk with her and her husband. They wanted half of what they paid for the tickets which they bought directly from Stanford at face value. What the hell…you only live once!

Now we had to figure out how to consummate the transaction. I didn’t have any cash and the tickets were only accessible on a cell phone (apparently they don’t print tickets anymore. Who knew?).

I recalled seeing a ‘transfer tickets’ feature on the app we had to use to buy the tickets, so I knew how she could deliver the tickets to me. Luckily, she had a Venmo account and I was able to make the payment to her that way. 

The transaction was completed in less than 5 minutes. It must have been a sight, though, watching these 70+ strangers figure out the technology to make it work.

But I wasn’t done yet. I went back up to the room and went to the TicketMaster site to see if I could sell my original tickets and recoup a little of what I had paid, or at least get back what I just spent to upgrade my seats.

It is possible to sell your tickets there, but apparently you had to register with a bank account to do so, and I hadn’t done that. Damn!

But wait…I recalled seeing a ‘sell tickets’ menu button on the mobile ticket app and so back I went. Yup…there it was! 

Placing the tickets up for sale was easy enough, but how to price them was the challenging part. It was only about 32 hours until game time, so I needed to get this right. I figured that a lot of fans of the semifinal losers (Stanford and Louisville) would be trying to sell their tickets just like the couple we had just met. And there wouldn’t be a lot of demand for tickets since only people in or within a few hours drive of Minneapolis were likely buyers. So instead of going for a killing, I took a safer path and offered the pair for $500 (we had paid $300 for the first-row upgrade).

In about 2 hours, I received an email notification that the tickets had been sold!

On Sunday afternoon, we took a bus to the Minneapolis Institute of Art. It’s a beautiful facility and we spent our time in the Impressionism and Modern Art galleries. Directionally challenged as we are, finding the exit was an adventure, but we kept meandering until we got there…to discover that it was snowing outside! So instead of walking back to the bus stop, we called an Uber.

That night at the arena, the seats were great! The UCONN pep band was to our right, the cheerleaders directly in front of us and the team bench was on our left. It would have been perfect if we hadn’t gotten clobbered by South Carolina 64-49.  😦

The next day we took the tram from downtown to the airport. The connections were a little tricky, but we muddled our way through it. The flight was on time and we got an Uber from the airport. We were home by 7:30pm.

Once I finished licking my wounds from the defeat, I got around to thinking about all the cognitive challenges that this adventure entailed. Going to new places, orienting yourself, and figuring out how to get from point A to point B were at the top of the list. Then there was the task of mastering new technologies. And most of all, you have to react to a lot of unique decision-making inflection points. These are the things that are generalizable and help you preserve and grow vital brain circuits. 

And best of all, when all is said and done (and unlike doing Wordle, jigsaw puzzles and crosswords), you have a great story to tell when it’s over!

__________

S2E6. Real-Life Wordle

A week ago Thursday, Sally tried to print the New York Times crossword puzzle. Unexpectedly, the page that came out was blank, so she asked me if I could do it.

First, I tried to print it from my computer in order to rule out that the problem was with Sally’s MacBook Pro, but I got a blank page, too. Then I tried printing a different page from my computer to rule out that the problem was with the Times website.

Same result.

Then I turned the printer off and waited a minute before re-starting it. Another blank page emerged, so I knew the problem wasn’t with the printer’s software.

Next I tried to copy a page directly from the printer’s flatbed.

Whoa! It printed the colors but the black was missing. At that point it dawned on me that I had been getting blank sheets because the pages I had been trying to print were in black-and-white and the black ink wasn’t printing.

I checked the ink level and and, unexplicably, it showed the black cartridge was more than half-full. Odd…

But I replaced the cartridge anyway and…it printed perfectly!

A few hours later, it occurred to me that the process I used to solve the problem was a lot like playing Wordle. If you haven’t tried it yet, here’s a link that explains it.

Basically, the Wordle program selects a 5-letter word each day at random and you have 6 guesses to figure out what it is. You receive feedback after each guess telling you which letters (if any) are in the target word and whether you’ve guessed the right locations for any of those letters. You solve the puzzle by using the information you learn from each guess in order to make your next guess. I’ve been able to solve them all since I started playing and it usually takes me four guesses…but it’s the thinking it through that’s fun!

Can you see why fixing the printer reminded me of Wordle? Each attempt I made to print the crossword provided me with new information that I used to create the next attempt. With each try, I learned what was not the problem, thereby narrowing my remaining choices until I hit upon the solution.

(Yes, yes…I know…If I started out by trying to print a picture in color, I would have solved the problem in 2 tries instead of 5!)

So why am I writing about fixing printers and playing word games? Because they both rely on executive functioning, in this case, the ability to develop and implement a strategy and to learn from new information.

In dementia, it’s not just memory that goes. It also hits your prefrontal cortex and impairs your reasoning and ability to execute complex tasks. Typical symptoms are having trouble balancing your checkbook or following a recipe correctly. 

Having played it for a month now, I’m thinking that Wordle might be a good measure of executive functioning that could be used as an early warning sign for mild cognitive impairment. Here’s why:

For a simple game, it’s actually a pretty challenging cognitive task. You have to learn from each trial and apply that information to your next guess. You have to focus on—not only the letters that are part of the solution—-but on those that you have been told are NOT part of the solution. And you have to pay attention to location, as well. 

Because all the information from each guess is available to you on your device all the time, short-term memory is not a major contributor to solving the puzzle. The game really isolates two factors: your executive functioning and your ability to recall words. Both are affected in dementia.

As I do the puzzle each day, I have to take my time because I make a lot of mistakes. (Fortunately, a guess is not recorded until you hit the ‘return’ key, so you have time to correct errors.) I’ll get excited about a guess and then realize it uses a letter that I already know is not part of the solution. Or I’ll place one of the letters in the solution in a position that I know it can not occupy. Or worse yet, I’ll come up with a word that does not use all the letters I already know are part of the answer. 

Can you see how easy it is to make mistakes? Can you see how critical it is to check and double check your guesses before submitting them? Can you see how the errors you make in Wordle might translate into the kinds of real-life errors you make around the house?

I hope there are neuropsychologists out there running experiments to test whether performance on Wordle is correlated with cognitive decline. If so, I can’t wait to see the results!

__________

S2E1. Brain Resilience

Happy New Year and welcome to Season 2 of “Mistakes On The Journey To Nowhere!”

I thought I’d kick things off on a positive note with a discussion about brain resilience and cognitive reserve. The two terms are somewhat interchangeable and they both point in the same direction: factors that can protect us in the presence of dementia pathology.

There is a wealth of research associating the presence of beta amyloid and tau proteins with the occurrence of dementia. That is why many drug companies are searching for ways to remove these deposits as a way to slow down or eliminate them as a risk factor.

However, there is one finding that points in another direction. About 30% of those with high levels of these damaging chemicals (as determined by autopsy after their deaths) never developed dementia while they were alive. 

How can that be? Either the whole plaques/tangles/beta/tau hypothesis is wrong, or these folks possessed some quality that enabled them to function at a high cognitive level in spite of the damage that had been done to their brains. The latter appears to be the case.

So what is it that allows about ⅓ of us with dementia pathology to escape its ravages? As with most dementia research, the findings are correlational and not yet proven to be causal, but they all seem to lead in the same direction: it helps to grow lots of neurons and stimulate the production of synapses and neural networks throughout your lifetime. Later in life, then, when a given pathway is short-circuited by a chemical blockage, your brain is able to use an alternate route to complete the task. It’s a little like taking back roads when there is a car accident and traffic is backed up on the interstate.

The ability to do this is referred to as brain resilience or cognitive reserve.

As always, there seems to be a genetic component with some of us hard-wired to grow more connections and have larger brains. But, as always, a lot of it is environmental and behavioral, too.

Having gone to an academically stimulating elementary school is helpful. So, too, is having a college degree, as compared to those with only a high school education. Having a cognitively complex job (as opposed to performing manual labor or having a repetitive factory job) builds resilience. Learning new things at any age is protective.

Looking back over my life, it looks like I was very fortunate, indeed. I attended high-quality elementary and high schools and then received my undergraduate degree in Economics from Brown University. When I was 44, I returned to graduate school for my masters and Ph.D. in clinical psychology. That was 6 years of the most intense brain-stimulating work imaginable leading to a cognitively challenging career. 

In fact, I’ve re-trained 5 times over my life to pursue new careers (urban planner, performing arts center director, B&B host, clinical psychologist and political operative). And now I’m trying to teach myself how to play the recorder!

Let’s follow this building-more-brain-cells-and-connections path to promote resilience a little further. It’s not just lifelong learning that does it. It turns out that exercise also creates new connections in wide areas of the brain. Who knew? So it turns out that my running for 57 years probably also increased my cognitive resilience. Too bad it never made me any faster! 

BTW: exercise also helps promote the formation of the myelin sheath that protects the brain’s pathways which should, in turn, help reduce the short-circuiting we all experience from time to time because the electrical signal traveling down that pathway will have a greater likelihood of reaching its destination at full force.

(Caveat emptor: You might see ads for supplements intended to increase the production of Nerve Growth Factor (NGF) in order to facilitate these results. From what I can tell, the research is really preliminary on this and these products are jumping the gun a bit.)

So the very good news here is that the brain retains its ability to create new cells (neurogenesis) and to re-wire itself (plasticity) to the very end. By constantly seeking out new learning opportunities and exercising, we can increase our brain’s chances (resilience) of overcoming the insults we’ve inflicted upon it over the years.

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S1E41. A Brain-Healthy Lifestyle Is…

…a full-time job!

When I first started learning about brain health back in May, I would come across the phrase ‘lifestyle changes’ pretty often. It referred to the likelihood that if you were a typical American, you would probably have to adopt several changes to your current lifestyle if you wanted to ward off cognitive decline and dementia.

These were things like changing your diet to minimize intake of sugars and saturated fats, and getting off your butt and exercising several times each week.

I thought: “Piece of cake…I can do this!”

I’ve been implementing those ‘lifestyle changes’ for about six months now and…you know what? Those changes make up the better part of my day! Don’t get me wrong. I’m not complaining. I enjoy implementing the recommendations… but it’s turned into a full-time job.

Here is an accounting of what my new ‘lifestyle’ looks like from the perspective of the number of hours per day devoted to each of the five pillars of brain health:

1. Exercise: 1.7 hours. I’m working out six days each week. My workouts themselves take between 40-60 minutes, so I’m easily surpassing the 150-minutes/week brain health recommendation. But let’s add to that total my cool-down time (when I drink a pint of pomegranate juice mixed with filtered water) and the time it takes to shower. That gives me about 12 hours/week, or 1.7 hours/day devoted to my exercise regimen.

2. Diet:  2.0 hours. I’m still learning how to eat right which means that I’m still researching diet recommendations and recipes. Then there’s the grocery shopping, prep time (I’m now making my own granola and sauerkraut), cooking, and the actual eating. I’d say that this consumes an average of 2 hours each day.

3. Cognitive Challenge: 6.0 hours. I start my day by doing crossword and jigsaw puzzles. Figure 2½ hours there. I try to get half an hour of recorder practice in daily (but don’t always succeed) and then Sally and I listen to a vinyl album each night after dinner. Let’s call it 1 hour daily for music. Add another hour for reading books. I would like this to be a daily routine, but so far it’s more likely to be binge-reading the week before book club meets. I’ll add an hour for on-line activities like social media and reading the newspaper. Finally, I spend about half an hour each day thinking about, researching and writing this blog. If my math is correct, that adds up to 6 hours/day.

4. Social Engagement: 1 hour. This is my brain health weak spot. Compared to Sally who is out-and-about most of the day nearly every day, I am a veritable recluse. But I do manage to get together with others about twice each week. Although I work out in our apartment’s fitness center, there is rarely anyone else there. Same for when the pool was open. On nice days, my jogging path is the ⅓ mile loop around the building and I wave or say hello to everyone I see. On rare occasions, I will share the elevator with someone. None of this adds up to a ‘relationship,’ though, nor does it meet the criteria for ‘social engagement.’ So let’s be generous and round up to an average of 1 hour/day of ‘real’ social interaction with someone other than Sally.

5. Sleep: 9 hours. No…I don’t get 9 hours of sleep each night. It’s more like 7-8. But we do get in bed at 10:30pm and usually get up around 7:30am. This allows for time to fall asleep, wake up a few times in the middle of the night, lie awake for a little while in the morning before getting up, and still log the recommended 7-9 hours of solid sleep. It also facilitates our intermittent fasting schedule which has us stop eating at 7:30pm which is 3 hours before going to bed.

Here’s what it all adds up to:

1.7 Exercise

2.0 Diet

6.0 Cognitive Challenge

1.0 Social Engagement

9.0 Sleep

There you have it: 19.7 hours per day devoted to my newly-adopted brain healthy lifestyle. That leaves about 4 hours free for other pursuits. In the spirit of full disclosure, though, I’ll admit that I allocate about 1½ of them to my nap!

Now the question is: What will I do with all that free time?  😀

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S1E40. Road Trip

Growing up in the 50s, I knew the names of a number of famous people without knowing what it was they had done to earn such notoriety. Their names alone came to stand for excellence in their chosen fields: Enrico Caruso, Rudolph Valentino, Albert Einstein and Pablo Picasso, to name a few. The highest praise one could bestow on an aspiring singer would be to say: ‘He’s a regular Caruso.’ On the other hand, a common way to say someone wasn’t the sharpest knife in the drawer was to say: ‘He’s no Einstein!’

Frank Lloyd Wright was one of the names I learned without knowing anything about him other than that he was an architect. In fact, I still didn’t know much more about him until this past week. But that changed when we decided to combine our fall foliage viewing with the 4-hour trip to his most famous residence, Falling Water.

But why, you ask, am I writing about Frank Lloyd Wright in a blog about dementia? Good question! It’s true that his best work was done when he was in his 80s, but that’s not why I’m writing about him.

One of the brain health findings I’ve come across is that travel to new places may be protective. It stimulates all your senses in a variety of ways which help stimulate brain cell growth. As we began planning our getaway, though, it occurred to me that you have to be functioning at a pretty high cognitive level in the first place to execute a road trip.

For starters, you have to have the desire and interest to go somewhere and not be overwhelmed by the logistics of actually doing it. In this case, the initiative came from Sally who said she wanted to do a road trip to see the leaves turn and I connected that with a suggestion some friends made a few years ago about going to Falling Water.

But it’s not like we can just get in the car and take off like we might have done in our teens and twenties. At this age, if we go somewhere on the spur of the moment without telling anyone, we might find our car make, model and license plate number flashing on the interstate in a ‘Silver Alert!’

Instead, we do our background research and make a plan. When will peak foliage occur? How long will it take to get to Falling Water? What days do we have free? Where will we stay? Do they have guided tours once we get there?

And there was one more big decision to make: which car would we take? My Volvo gets better gas mileage, but Sally’s Subaru has a much bigger windshield for viewing the scenery. We opted in favor of the view, but that introduced a layer of risk. She had run over a nail two weeks earlier and one tire was leaking air. She took it to the dealership and they put in a plug, but it didn’t stick. They had to re-do it twice. Was it really safe to drive? What if it went flat en route? We decided to roll the dice.

The weekend before our scheduled departure, I did a YouTube search and found great documentaries on the story behind the building of Falling Water and the life of Frank Lloyd Wright. On the eve of our departure, we watched Ken Burns’ 2-part biography of Wright on PBS. After 60 years, I finally now know why his name is synonymous with modern architecture.

Next up was finalizing the game plan: figuring out what time to leave in order to get to the first tour on time; packing (clothes appropriate for the forecast weather, medications, computers); turning off the air conditioning in the apartment; setting the alarm to wake up on time.

If you can do all of this planning and scheduling, your cognitive abilities are pretty much intact.

If you can shift your plans because you met someone on a tour who gave you a good recommendation, you are functioning well.

If you can keep your balance for two hours on a rock-strewn trail booby-trapped with tree roots hidden by fallen leaves, you are doing well.

If you can find your way back to the trailhead after missing a turn on your hike, you’re doing well.

If you can cut your stay short because it was impossible to sleep on your bed’s sagging mattress at the B&B, you’re functioning well.

Realizing that you miscalculated when the leaves would turn, if you can drive north in search of peak foliage without a map, keep moving in the right direction and find a hotel in Ebensburg, Pennsylvania, you are doing well.

If you can survive meals at local eateries like See-Mor’s All-Star Grill and Hoss’s Family Steak & Sea House, you can be thankful that you dodged a bullet.

If you can keep your sense of humor during all of this, you are doing extremely well.

But most importantly, if you can embrace with wide-eyed wonder and amazement a Frank Lloyd Wright designed home, you have much for which to be grateful!

Postscripts:

  1. That leaky tire didn’t give us a lick of trouble during our 500-mile adventure.
  2. Having travelled four hours west in search of foliage, we finally found it on the way home…2 hours north in the Poconos.

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S1E37. This Is Your Brain On Music

Music therapy has been used effectively for some time to treat agitation in dementia patients and to help surface personal memories. Its potential role as a protective factor in staving off cognitive decline, though, has been less well-researched, but there are indications that it might be useful.

A lower incidence of dementia has been found among professional musicians than the population in general. People who had some musical training in their lives experienced slower cognitive decline than those who did not. Listening to music, singing, and playing an instrument have all been linked to enhanced cognitive performance.

One of the 5 pillars of brain health is to engage in cognitive challenges. Learning to play a new instrument is often cited as an ideal undertaking. After all, playing music requires you to learn a new language that involves hand-eye coordination, short- and long-term memory, fine-motor control, and auditory and visual symbol discrimination. What more could you ask for?

So I decided to teach myself how to play the recorder. You know…the flute-like instrument we all played in 4th grade.

The problem, though, is that I have a less than intimate relationship with music. 

When I was 7 or so, I started piano lessons. I learned the notes pretty quickly, but I was completely flummoxed by the prospect of playing different notes with each hand at the same time. I quit after my third lesson.

In 5th grade, I used to lip-sync during group singing in Mrs. Wolfe’s music class because I knew I couldn’t carry a tune. As an adult, I have a singing range of about 6 notes that I can hit with any consistency.

When I started to listen to the radio, I was drawn to the doo-wop sound of the ’50s (oldies) and then Motown (The Temptations, Four Tops, Supremes and Smokey Robinson). Of course, I loved the Beatles, Four Seasons and Beach Boys. 

While in high school, I asked my parents for an electric guitar. It turned out I had no ear for music and couldn’t even tune the damn thing!

In college, I was pretty much a creature of my environment when it came to musical taste. If I heard a song enough times, I liked it. I depended on my dorm mates to buy the albums and do the playing. The only artist I ever discovered by myself was Elton John after I heard ‘Your Song’ for the first time.

When I was the Director of Newark Symphony Hall, I attended performances by the New Jersey Symphony Orchestra and New Jersey State Opera. But without any training or background in classical music, neither held my attention. I would drift off into my inner world until the applause at the end of a piece jolted me back.

The language of music is as foreign to me as the language of science is familiar. About 15 years ago, I bought a book called ‘Music Theory for Dummies.’ I didn’t get very far. 

So here I am, back at it, taking another shot at finding personal harmony with music. I bought a teach-yourself-recorder workbook that came with a CD so I can play along and check myself. So far, so good. I’ve learned 10 notes already and can play ‘This Land Is Your Land.’ I’m understanding full notes and half notes and rests and 3/4 time. I’ve even been introduced to F# and the key of G Major!

We’ll see how far I get, but it’s been a better-than-expected launch.

In addition to learning to play the recorder, I’m also listening to more music. When we moved, Sally and I made the decision not to throw out our vinyl, even though we hadn’t played any of the albums or 45s in more than two decades. Keeping them, though, came with a commitment to actually play them. Having set up a sound system and purchased a pair of awesome speakers the first month we were in the new apartment, we now set aside time after dinner each night to play an album from our combined collections. 

A lot of Sally’s music is new to me but I find I’m enjoying it on first hearing. When playing my music, I notice I’m picking up more of the words and hearing more instruments than I recall hearing before; it’s not so much a blur as it used to be. 

Apparently, something good is happening inside my brain!

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S1E34. The End Of Alzheimer’s Program

This week, I read the book so you don’t have to. Here are my take-aways:

Dr. Dale Bredesen is a leading advocate of a comprehensive approach to treating symptoms of dementia. The book The End of Alzheimer’s Program is an update of his 2017 publication The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline and includes lessons learned from 8 years of treating patients with the protocols he developed.

He rejects the notion of a single cause of Alzheimer’s and other dementias in favor of a holistic approach that focuses on the things your brain needs to function and the things that get in the way of its doing so. The program seeks to protect your brain and ward off cognitive decline by using diet and behavioral changes to support its essential activities while minimizing toxins that impair its ability to function properly.

He argues that the effort to find a drug that eliminates beta amyloid, for example, is misguided. You have to ask “How did it get there in the first place?” It turns out that beta amyloid is produced as part of the brain’s immune system to combat toxic invaders. So a remedy that is available to you right now is to identify the toxins (both chemical and biological, like rogue microbes that escape from you intestines and break through the blood-brain barrier) that are affecting you and eliminate them. Once you’ve done that, your brain’s immune response will not be triggered as often and you will not produce as much amyloid. It turns out you can manage a lot of this through diet.

Moreover, your brain has a natural way of removing beta amyloid after it has been created. It happens when you sleep. Therefore getting 7-9 hours of sleep each night can help ward off cognitive decline.

Bottom line: to a great extent, you can determine your own cognitive future by adopting a brain healthy diet and adding behavioral elements like exercise, sleep hygiene, stress management, cognitive challenge and social interactions.

Sound familiar?

He makes his case with meticulously documented references to the existing and emerging body of research and supplements it with case studies of people who were able to reverse their cognitive decline using his program. At times, it reads like an episode of “Grey’s Anatomy” or “House” where the doctors are unable to cure the illness until someone discovers that a rare toxin is causing the symptoms. They eliminate the toxin and the patient recovers.

As it pertains to dementia, the idea that you can reverse symptoms is pretty radical and flies directly in the face of the old notion that dementia is an unavoidable part of aging. As Dr. Bredesen documents, though, there are a large number of dementias that can be traced back to chemical, environmental or behavioral causes that can be rectified.

Which brings us to his program. It begins with an extensive battery of tests to identify the pathogens that might be affecting you as well as determining your levels of good chemicals and compounds. Once these factors are identified, you can design a diet that will correct imbalances and eliminate neurotoxins at their source. Progress is documented through ongoing testing and tweaks are made as you chart your reactions to the changes you have implemented.

Most of the book is spent going into great detail about how your diet affects long-term brain function. I’ll admit, I glazed over at the extended paragraphs laden with scientific terminology describing the chemical compounds and intra-cellular functions that were involved. Although he says he intends the book for consumers, it seems his real audience is physicians who he hopes will adopt his program. I can see how the book would be a great resource for someone who is guiding you through the process, but it definitely contains way too much information for most of us. Nonetheless, there are plenty of general recommendations and steps you can take to get started.

The chapters on exercise, sleep, stress management and cognitive challenge are informative, brief and a lot more digestible than the diet section!

Finally, Dr. Bredesen emphasizes that dementia is a process that takes years to develop. Your brain does its best to ward off attackers and to clean up the detritus after each daily battle. Over time, though, debris piles up and at some point the accumulation begins to take a toll on your cognitive functioning.

The good news is that most of this seems to be reversible if you start working on it soon enough.

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S1E27. I’m Puzzled!

One of the 5 pillars for maintaining a healthy brain is to engage in daily challenges to your automatic, hum-drum, run-of-the-mill thinking, i.e., to exercise your brain as well as your body. 

For me, that includes researching & writing this blog and reading books. The experts in the field recommend big projects, too, like learning a new language or learning to play a musical instrument. They generally don’t recommend the commercially available cognitive training systems that claim to reverse or prevent cognitive decline. Those products appear to improve your skill at doing the computerized tasks without enhancing your performance in real-life situations.

One other recommendation, though, is to do various kinds of puzzles that force you to activate different brain regions and challenge your skills.

I’ve been doing the New York Times daily crossword puzzle for about ten years now, but my acquaintance with it goes back a long, long way.

My senior year in high school, John Lanterman would bring the puzzle into calculus class and four of us would sit in the back row and work on it while Mr. McGarry was solving equations at the blackboard. That was where I learned the word ‘ewer.’ 

When I tried to do it myself, though, I found it absolutely impossible. I gave up trying after a few futile attempts.

Six years later, out of college, I was living with my future wife and we would get the Times every Sunday and work on the puzzle together. It was a week-long project and we rarely completed it.

Now fast forward 40 years. I started doing the Times crossword puzzles online and found I could do them! I’m guessing it was the combination of their changing editors and my learning a lot of new words over the years. 

The Monday puzzle is the easiest and they get progressively harder through Saturday. Thursday’s is the most fun because it breaks the rules and requires a novel approach to solving it (e.g., putting 2 letters in a square instead of 1, or using the black squares to represent letters). The Sunday puzzle is bigger and not as hard as Friday’s or Saturday’s, but it has a theme built into it to make it more interesting.

Occasionally, there are clues that stump me (like who played a certain character on ‘Game of Thrones’) and so I’ll Google the answer. It’s nice to have the option to cheat. 😀

In terms of brain health and cognitive decline, what I’ll be looking for is the time when I’m cheating a lot more or when I just can’t complete the Friday and Saturday puzzles.

There is another New York Times word puzzle I’ve taken up in the past year called ‘Spelling Bee.’ In this one, they give you 7 letters including 1 designated letter that you must use to make as many words as possible. They assign points for each word and then rank your score from ‘Beginner’ to ‘Genius.’ As of now, I’m able to hit the ‘Genius’ level every day, so I’ll be watching to see if my scores drop into the ‘Amazing’ or ‘Great’ range in the years ahead.

In the past 3 weeks, at the suggestion of Sally’s friend Val, I’ve taken up doing jigsaw puzzles online. Now this is really something out of my comfort zone. I was never any good at it, watching others assemble them with great dexterity, matching piece after piece, while I looked on unable to place a single one. My color perception isn’t that great and I don’t have an eye for detail. I have great difficulty visualizing spatial tasks and rotating objects in my mind. In other words, I have no business trying to do jigsaw puzzles!

As it turns out, though, this site provides a format that makes them do-able for me. For starters, you can select how many pieces in the puzzle, from 40 to 216. But best of all, the pieces are presented in their proper orientation, so it’s a lot easier than doing an actual cardboard jigsaw.

I love doing them! It takes me about 2 hours to do a 216-piece puzzle, and I’m elated when I am able to discriminate among subtle gradations of color and match 2 pieces. I’m learning new strategies and I enjoy the intensity of the effort required to succeed.

Best of all, it’s changed how I view the real world. I’m now much more aware of shadows and shades. I see a hundred different greens in the wooded area outside our window and I zoom in on the branches and not just the leaves. Wherever I look, I envision my view as a jigsaw and think about how best to crop it to make a better puzzle. 

Over time, I’ll be watching to see if it starts taking me longer, of if I get frustrated and just can’t complete a 216-piece puzzle. In the meantime, though, I’m just enjoying my new-found skills and hobby!

All together, I would say I spend about 3 hours each day puzzling. Time will tell if that’s a good thing or not!

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S1E25. I Fixed It!

I’ve been remiss. In the introduction to this blog on my home page, I promised I would share my triumphs as well as my failures. I think I’ve done a pretty decent job sharing the failures, but no so much in reporting victories. Let’s fix that!

About eight years ago, Sally bought a funky clock that displays a set of moving gears and has no hands. What it does have is a black arrow that is fixed in its position pointing up towards the ceiling and a wheel with the hours marked on it (with 3 marks between each hour to denote 15-minute intervals) that makes a full rotation every 12 hours. 

(If you are reading this in an email, I strongly encourage you to go to the website here to see a picture of the clock, as my descriptive powers and your imagination will only carry us so far!)

Instead of two hands that move across the face of the clock in a clockwise direction, then, it has a clock face wheel (separate from the rest of the assembly) that is placed on one of the gears which moves it in a counterclockwise direction. To set the clock, you place the wheel on the gear so that the fixed arrow is pointing at the correct time. For example, if it’s 3:15, you would place the wheel above the arrow at the first hash mark between the 3 and the 4.

We hung the clock on the wall in the office but, to our dismay, it ran fast. So fast, in fact, that we would have had to re-set it every day if we wanted it to be of any use in telling time. Instead, we just left it in place and let time stop when the batteries died.

Fast forward to last month when Sally took the clock off the wall, packed it and brought it to our new apartment. There was a perfect spot for it and we were eager to hang it. To be honest, I had forgotten that it didn’t work, but it is such a cool design that I decided to spend a little time trying to figure it out before putting it up.

Looking at the control mechanism for the first time, I realized that all of the visible moving gears were for show. They had nothing whatsoever to do with rotating the clock face and, of course, there were no hands that needed moving. 

There were 2 hidden gears engaged in moving the time-keeping wheel, one larger than the other, and that was it. Fascinating!

On my next trip to the supermarket, I bought 2 D batteries. In a world dominated by AAA and dime-sized lithium batteries, I got a kick out of dropping these two big old clunkers into place. As soon as I did, all the gears went into motion.

I hung the base with all its moving parts on the wall and then settled the cogs of the clock face wheel onto the larger of the 2 drive gears…and waited.

The next morning, I awoke to find the clock was already half an hour fast. Bummer. After thinking about it for a while, it occurred to me that maybe it would slow down if I placed the wheel on the smaller of the 2 eligible gears. In fact, that was my only other option.

I tried to think through why that might work, but to no avail. I hadn’t ever tinkered with clocks and so I had no prior knowledge about gears to draw from. I never owned a 3-speed bike, either, and so I didn’t have the opportunity to learn about gears that way. I just couldn’t see why the smaller gear would turn the clock face wheel more slowly, but, hey, it couldn’t hurt to try, so I moved the wheel to the smaller gear…and waited.

The next day there was substantial improvement: the clock was only about 4 minutes fast, which was better, but not quite good enough. What now? I was out of gears to try.

I spent about half an hour at the kitchen table just looking up at the clock. It finally occurred to me that maybe if I added some weight to the bottom of the wheel it would slow it down because the battery would have to work harder to move the gear. Intuitively, it made sense.

A few minutes later, though, I realized I might be in trouble if I added weight to the bottom of the wheel because it would be out of balance as the wheel rotated and the weight was no longer directly under the gear. Hmmmm…

…but if I put weights at the 3, 6, 9 and 12-hour marks, then the wheel would be balanced throughout its rotation. Problem solved.

At that point, I don’t think it took me more than a minute to come up with the idea of using quarters as my weights. So I got out the duct tape and affixed two quarters to the back of the clock face wheel at each of the four locations, set the wheel back onto the smaller gear…and waited.

The next morning, I awoke to discover that the clock had kept perfect time! It’s now a week later and the funky mechanical analog clock is keeping the same time as my computer’s digital readout.

This was truly a high-five moment for me because I have next to no mechanical abilities at all. I just don’t have that gene. So to think something like this through and come up with a solution that worked was quite the cognitive victory.

But what about the thought process that led me to the answer? Was it just luck? Was I the proverbial broken clock that was right twice that day?

Reflecting back, I realized that most of what happened was intuitive. Or, at least, it seemed intuitive. At the time, I could not verbalize why the smaller gear would slow down the clock (although I did figure it out several days later). It seemed logical that weight would slow the turning of the gears. Did I have some long-forgotten experience that taught me that this was true? And the decision to use 2 quarters instead of 1 or 3? It wasn’t based on any kind of formula or algorithm; it just felt right.

All of which raises another question: Why ask why? What matters is that I fixed the clock and it was a nice victory. I’ll take it!

BTW: It’s now 8:30pm.  😀

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S1E16. The Name Game

No…not the Shirley Ellis 1964 version (“Nick, Nick, bo-Bick, bo-na-na fanna fo Fick…).

I created a new version after noticing I was blocking on names in everyday conversation. Although I clearly knew who I was talking about, when it came time to say their name, I would blank out and it would take me 5-10 seconds to retrieve it.

That got me thinking about remembering names in general. There are plenty of articles on the web about how to better remember names when you are first introduced, but I couldn’t find anything about how to recall names of people who were well known to you.

So I decided to test myself by trying to remember names of people who I hadn’t seen in years.

I started in 1972 (the year I graduated from Brown) and tried to recall names up to about 2011 when I left North Carolina to move to Pennsylvania to be with Sally. 

I had no trouble at all conjuring up mental images of their faces. After all, these were people with whom I had long-term relationships, like professors, co-workers and neighbors.

A few names appeared right away. For the most part, though, I had to work hard to find them. I would often get the first name fairly quickly, but it might take me 15 minutes or more to find their last name. Having done this for a week, I’ve successfully recalled dozens of names from my past, with only 2 remaining unidentified.

All of which got me wondering about what was going on in my brain. 

Memories of faces and memories of names are stored in different places in our brains. Designing and implementing a strategy for finding both and linking them takes place in another area altogether. And then there are the pathways that connect all three regions.

So what did I learn about myself by playing the game? First, I can recall a lot of faces. More accurately, I can recall important faces. There are hundreds of patients I saw as a psychologist and guests I hosted at our B&B who didn’t leave retrievable memory traces.

Second, although they are hard to find, my memory for names is pretty good, too. The memory of the name is intact as is the pathway connecting it to its face.

Third, my ability to create a task, develop a strategy and implement it is also working well. I tried multiple approaches when my initial search failed: going through the alphabet to test first letters (similar to how knowing the first letter of an answer in a crossword puzzle makes it easier to solve), trying to recall how many syllables were in the last name, replaying memories of my interactions with the person instead of just viewing their face in my mind’s eye. And then there were the times when I just gave up…and the name popped into my head ten minutes later!

But it wasn’t like I could go straight to the file folder where I knew the answer was. Most of the time I was staring into empty space, knowing that the answer was not where I was looking. I could feel when I was wrong and also when I was on the right path. When I did unearth the correct name, it was as if all the associated circuits lit up simultaneously and I instantly knew for certain that I was right.

So if I had to guess, I would say that my weakest link might be the pathways connecting the involved modules. It would make sense (to me, anyway) that they had atrophied over the years for lack of use.

But is this normal aging? I have no clue! In my brief web search, I couldn’t find any published research about this subject. The failure to connect faces with names and identities is well-documented in Alzheimer’s Dementia, but I couldn’t find anything about difficulty making those connections earlier in life being a risk factor.

So if you decide to play the game, please let me know how you make out. I’d love to hear about your experience.

In the meantime, feel free to reminisce a bit with Shirley Ellis’ memorable  lyrics:

The name game. Shirley! Shirley, Shirley

Bo-ber-ley, bo-na-na fanna

Fo-fer-ley. fee fi mo-mer-ley, Shirley!

Lincoln! Lincoln, Lincoln. bo-bin-coln

Bo-na-na fanna, fo-fin-coln

Fee fi mo-min-coln, Lincoln!

Come on ev’rybody, I say now let’s play a game

I betcha I can make a rhyme out of anybody’s name

The first letter of the name

I treat it like it wasn’t there

But a “B” or an “F” or an “M” will appear

And then I say “Bo” add a “B” then I say the name

Then “Bo-na-na fanna” and “fo”

And then I say the name again with an “”f” very plain

Then “fee fi” and a “mo”

And then I say the name again with an “M” this time

And there isn’t any name that I can’t rhyme

Arnold! Arnold, Arnold bo-bar-nold

Bo-na-na, fanna fo-far-nold

Fee fi mo-mar-nold. Arnold!

But if the first two letters are ever the same

Crop them both, then say the name

Like Bob, Bob, drop the “B’s”, Bo-ob

Or Fred, Fred, drop the “F’s”, Fo-red

Or Mary, Mary, drop the “M’s”, Mo-ary

That’s the only rule that is contrary

And then I say “Bo” add a “B” then I say the name

Then “Bo-na-na fanna” and “fo”

And then I say the name again with an “”f” very plain

Then “fee fi” and a “mo”

And then I say the name again with an “M” this time

And there isn’t any name that I can’t rhyme!

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–Wayne

S1E14. That Was Then. This Is Now.

I wrote this about my parents when I was 22:

‘They’ve been grandparents almost two years now. Grandparents twice over, that is, and a third expected momentarily. As I stepped through the doorway I was met by a heavy-sweet menagerie of home-cooked aromas. Outside, it was a crisp spring afternoon. Inside, it was a trifle too warm. They had both mellowed in recent years, but just now, for the first time, I felt as though I were entering a grandparents’ home. They’re growing old.’

When I wrote that closing line, I meant ‘old’ as a pejorative, not as a compliment.

My father was 52 at the time. He died at 60. My mother lived to be 85, developing dementia a few years before she died.

Paul Simon wrote this lyric into the song ‘Old Friends’ when he was 27 years old:

“Can you imagine us

Years from today

Sharing a park bench quietly?

How terribly strange

To be seventy”

Sally and I are 70. We quietly share park benches. It’s not strange at all.

On the other hand, Paul Simon will be 80 in October.

Our view of aging is curious, isn’t it? How must today’s 20-somethings view us? If we asked Paul McCartney today, would he say that 84 is the new 64? 

In any event, heading toward our ninth decade, the goal is to be active, engaged, wise and interesting…a group of adjectives we don’t normally associate with the degenerative effects of dementia. The good news is that there appear to be things we can do to increase our chances of achieving those goals and of sidestepping our worst nightmare. In fact, we can now reduce our risk of dementia by some 40% by adopting a brain-healthy lifestyle. We can fight back against the prejudices and preconceptions of our younger selves!

Spoiler alert: I’m not one for miracle cures or for buying into ‘secret information that you can’t find anywhere else.’ As a former psychologist and researcher, I trust the science and want to see multiple studies heading in the same direction before I accept a conclusion as valid. So here are 4 recommendations for which there is a body of evidence supporting their efficacy:

  1. Take care of your heart. Your brain depends upon blood flow to provide nutrients and remove debris. There are 400 miles of blood vessels in your brain. You want every inch of them pumping at peak efficiency to prevent neuron damage and maintain synaptic connections. Adopt a heart-healthy diet; keep your stress levels in-bounds; keep your blood pressure and cholesterol levels in check.
  1. Exercise. The current guideline is about 150 minutes of ‘huffing & puffing’ each week (e.g., 30 minutes/day x 5 days). Walking is fine, but you need to work up a sweat and breathe hard. Obviously, this is good for your heart, but I also suspect that its moderating effect on cognitive function is also related to the fact that it engages so many areas of your brain.
  1. Challenge yourself cognitively. Read books. Learn new skills. Change your routine. Solve puzzles. Take on-line courses or, better yet, once we are COVID-clear, take courses in person. There seems to be a ‘use-it-or-lose-it’ aspect to how well our brains age, so try to be open to new experiences and challenges.
  1. Socialize. We are social animals and engaging with others engages our brain in ways well beyond any other activity. Just take a moment to think about all the ways you use your brain when sitting down for a meal with a group of friends. The complexity of negotiating a social context is stunning, invigorating, challenging…and fun! 

That’s roughly where the research stands today. You can reduce your risk of developing dementia by about 40% if you adopt a lifestyle that also happens to be associated with increased longevity. You get double the bang for the buck: more years and better years.

Bottom line: We don’t have to accept the dire predictions of our younger selves. We can marshal the resources that got us this far to get us through the final years of our journey in good stead. It’s definitely worth a shot.

All of which gives a brand new meaning to Bob Dylan’s 1964 lyric:

“…I was so much older then

I’m younger than that now.”

__________________


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S1E10. How It All Fell Apart

In March of 2019, I was on track to be the next chair of the Chester County (PA) Democratic Committee. Two years later, I’m not even a member of the organization. How did that happen?

More importantly: Why did it happen? The answer to that question makes a big difference.

Up until now, I’ve explored specific mistakes related to specific brain networks such as memory and language. But there are also global effects related to an oncoming dementia that can generate errors on a grander scale.

As our processing speed slows or as specific deficits develop, it takes more effort to attend to business as usual. The effects can be very subtle. We might get frustrated more easily, or feel more fatigued more often. Some of us will lose interest in things we’ve long enjoyed, while others will start to withdraw from social activities.

Now let’s take a look at what happened to me over the course of the past two years.

In March of 2019, I had a falling out with the Chair of the County Democratic Committee and resigned my position on the executive board. This was not planned and it immediately ended any chance I had to be elected County Chair.

Surprisingly, however, I felt relieved. I realized that–for the first time in my life–I had taken on more than I could comfortably handle. In retirement, I was feeling more stressed by my volunteering obligations than I ever had as a full-time employee or business owner!

Two months later, I resigned my seat on the Kennett Square Borough Council. The reason was pretty straight-forward: Sally and I were planning to travel a lot in the second half of the year and I wouldn’t be around to do my job. I thought it only fair to resign so that my fellow Council members could appoint someone to complete the 8 months remaining in my term who would take over my workload.

Again, I felt immediate relief after my resignation, even though relief was not my goal.

(By the way, Sally and I thoroughly enjoyed our trips in the second half of the year!)

At this point, having resigned two positions, I was still Chair of our local Democratic committee, the Kennett Area Democrats, and I was still a committee person responsible for my precinct.

In January of 2020, instead of further lightening the load, I took on a new assignment when I became the campaign chair for our candidate for State Representative. Once again, I was a full-time volunteer.

I thoroughly enjoyed the work, embraced it and learned a great deal from the experience. I was busier than ever, but not feeling the pressure.

My job as campaign chair ended on election day in November.

In December, I resigned my position as the Chair of the Kennett Area Democrats. It had been my intention ever since I was first elected three years earlier to guide the organization through the 2020 election and then step down. And so I did.

Let me pause here for a moment to provide some important context. As I’ve explained in earlier posts, cognitive impairments are defined as declines from previous levels of functioning, so it’s important to know a little something about my history.

Interestingly–or maybe ‘strangely’ is a better word–my life pattern has been to change my career (not just my job) every ten years. It seems my interest and enjoyment have an expiration date assigned to them. My careers as the manager of a performing arts center, as a B&B owner, and as a clinical psychologist all lasted just about 10 years, more or less. 

Each time I shifted, I embraced my new life with all my heart and soul and never looked back, never regretted the change, and lost interest in the old job. Now it appears to be happening again as I transition out of my career as a political activist, which began in October of 2010, a month after the death of my first wife.

The final separation came this past week when I resigned as the committee person for my precinct. During recent Kennett Area Democrats’ monthly ZOOM meetings, I realized I was losing interest in the organization. And then when a motion I offered was defeated, I thought: ‘I don’t need this aggravation and I don’t have the fire in my belly anymore to fight for this stuff. I’m done.’

Other than Sally, writing this blog is now my only passion.

So…what do you think? Does what I’ve described sound reasonable? Or is it a series of rationalizations to mask what’s really happening to me? Am I experiencing signs of cognitive decline on the journey to dementia? Or am I just beginning my 5th career?

Time will tell.

________________

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S1E9. When Words Hide

I was 45 and they were 22 the first time I met informally with my 6 new classmates in the clinical psychology Ph.D. program at the University of Connecticut. They were all incredibly bright and I couldn’t help but marvel at how fast they talked. For the first time in my life, I had to concentrate to follow the conversation…and I frequently discovered that they had moved on to a new topic by the time I had formed a thought I wanted to express.

It was my first encounter with the normal decline in brain processing speed as one ages. I, of course, attributed it to my having so many more experiences and neural connections than they did so that it took my brain longer to sort through all the information I had stored up before responding. 

That was a soothing theory to which I clung, but the fact is that our processing speed slows down as we age.

Fast forward 25 years. I no longer have to compete with 22 year olds in the classroom, but I’m sure my processing speed has continued to slow. There are some television shows where the rapid-fire dialogue is a challenge. I’m convinced they are written for a younger demographic.

Even among my peers, there are times when I listen and follow the conversation, but nothing witty or relevant occurs to me that is worth sharing. 

On the road to nowhere, this subject is known as ‘verbal fluency’ and it is one of the abilities that is measured to test for problems with language, 1 of the 6 domains in which impairment may be the basis for a diagnosis of mild neurocognitive disorder or dementia.

We all know its most common symptom: difficulty with word-finding. You know what you want to say, you can see it in your mind’s eye, you can recall any number of facts about it, but the word eludes you.

If you pause in mid-sentence while you search (which is uncomfortable for everyone), someone invariably tries to fill in the blank. Or worse yet, a guessing game erupts!

Or you don’t pause and instead try to work your way around it: ‘You know, that thing you hit with a stick at a party and candy comes pouring out.’

Worst of all, though, is when you just try to muscle your way through and the wrong word comes out: pinball; pintail; pintata.

There are simple tests that have been developed to detect problems with verbal fluency. In general, you are given a short period of time (e.g., 1 minute) to come up with as many words as possible that meet a certain criteria, such as names of animals or words that start with the letter ‘y.’ 

I just gave myself 1 minute to list words that begin with ‘y.’ Here’s what I came up with:

Yacht, yen, yin, yang, yank, yankee, yawl, yam, yak, young, youth, yap, yahoo, yard, yardarm, yikes, yipes, yarmulka.

As I took this make-believe test, I noticed that I began quickly with several words at the ready, but then my production tapered off. By the end of the minute, I was staring at an empty room in my brain. 

It’s now several minutes later and a few additional words have come out of hiding: yarrow, yes, yell, yellow, year, yearling, yield.

If I were being evaluated, the psychologist would compare the 18 words I found with the number found by 70 year old men with more than 16 years of education. If my score was below the average range, I would be on my way to meeting one of the criteria for a diagnosis.

But I’m not ready to take the test just yet.

Post script:

I went for a walk and came up with: you, your, yourself, yeti, yoga, yogi, yogurt, yew, yenta, yearly, yearn, yearning, yore, yurt… Where were all of these words when I needed them? Where were they hiding?

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