Healthy aging:
Optimizing Your Brain
Health
Abhilash K. Desai M.D.
Associate Professor, Director
Center for Healthy Brain Aging
Saint Louis University School of Medicine
Disclosures
 None
Objectives
 Describe the impact of daily activities on brain
function.
 Discuss some daily practices to improve
brain’s resilience (i.e., its capacity to function
well despite diseases that damage brain cells
and brain connections).
Clinical vignette
 LM is a 58 year old woman, mother of 2 children and
1 grandchild, wife of 35 years and a school teacher.
She was diagnosed with Myasthenia Gravis 2 years
ago. She wanted to “fight” the disease and did not
want to rely on just drugs. She started going to Yoga
classes three times a week, swimming twice a week,
started practicing her piano five days a week and
writing her life-story to share with her grand child.
Over 18 months, her depression and anxiety resolved
and within first 3 months of initiating treatment she
noticed that MG has changed her perspective on life
itself.
Healthy Mind
 National Institute of Health commissioned
Cognitive and Emotional Health Project
defined successful cognitive and emotional
aging as “the development and preservation
of the multidimensional cognitive structure
that allows the older adult to maintain social
connectedness, an ongoing sense of
purpose, and the abilities to function
independently, to permit functional recovery
from illness or injury, and to cope with
residual functional deficits.”
Aging Mind
 Aging has been conceptualized as declining
efficiency of the mechanisms that maintain the
homeostatic equilibrium, which is continuously
challenged by destabilizing events (e.g., Alzheimer’s
disease, strokes, head injury, pollution, chronic
stress, chronic anxiety, poorly controlled
cardiovascular risk factors [e.g., obesity,
hypertension, diabetes, hyperlipidemia, low HDL,
smoking, sedentary lifestyle, sleep apnea, chronic
pain, chronic insomnia, chronic depression]).

Ferrucci L et al. Mapping the road to resilience. Mech Ageing Dev
2008; 129:677-679.
Aging Mind
 Alternative view: The downward spiral of
functional and structural decline might begin
from both, reduced brain activity due to
behavioral change and from a loss in brain
function driven by aging brain machinery.

Mahncke HW et al. Brain plasticity and functional losses in
the aged: scientific bases for a novel intervention. Prog Brain
Res 2006;157:81-109.
Basic Principles
 Our neglect of intensive learning as we age
leads the systems in the brain that modulate,
regulate, and control plasticity to waste away.
We rarely engage in tasks in which we must
focus our attention as closely as we did when
we were younger, trying to learn a new
vocabulary or master new skills. Anything that
requires highly focused attention will help.
Attention
 When we want to remember something we
have heard we must hear it clearly, because
a memory can be only as clear as its original
signal. Paying close attention is thus,
essential for good memory.
 Meditation, Centering Prayer, Yoga, Tai Chi
and Mindfulness practice are some of the
best ways to improve one’s ability to focus.
Basic Principles
 Plasticity (capacity of the brain to change in response
to experience) is competitive. There is an endless
war of nerves going on inside each of our brains.
Competitive plasticity also explains why our
unhealthy habits are so difficult to break or “unlearn.”
When we learn an unhealthy habit, it takes over a
brain map, and each time we repeat it, it claims more
control of that map and prevents the use of that
space for “good” habits. That is why “unlearning” is
often a lot harder than learning.
 Thus, if you want to change unhealthy habits,
stop engaging in it and replace it with healthy
habits.
Basic Principles
 Plastic change, caused by our experience, travels
deep into the brain and ultimately even into our
genes, molding them as well.
 Imagination: How thinking makes it so! We can
change our brain anatomy / structure simply by using
our imaginations! The plastic brain is like a snowy hill
in winter according to Pascual-Leone (an expert
neuroscientist). The mental “tracks” that get laid
down can lead to habits, good or bad!! Sometimes a
road block is necessary to help us change directions.
 Thus, visualization exercises may promote brain
health in a variety of ways.
Basic Principles
 As brain cells are trained and become more efficient,
they can process faster.
 “Reward” (fun!) is crucial to learning. Each time we
are rewarded, our brain secretes such
neurotransmitters as dopamine and acetylcholine,
which help consolidate map changes we have just
made (Dopamine reinforces the reward, and
acetylcholine helps the brain “tune in” and sharpen
memories).
 Thus, practicing skills that one retains on a daily
basis can improve speed of processing. Having
fun while practicing will speed up learning!
Basic Principles
 Brain derived neurotrophic factor (BDNF) is
crucial for memory and learning. BDNF turns
the nucleus basalis, the part of our brain that
allows us to focus our attention – and keeps it
on, throughout the entire period of
experience. Once turned on, the nucleus
basalis helps us not only pay attention but
remember what we are experiencing. It
allows map differentiation and change to take
place effortlessly.
 Exercise increases BDNF!!
Basic Principles
 Our minds tend to process information in
specific contexts.
 Our minds are NOT capable of doing several
things (doing them well) at once.
 Thus, avoid multi-tasking and take time to
reflect on the context of any new
information one wants to remember /
learn.
Cognitive training
 Attention training: mindfulness training,
Neuro-feedback.
 Memory training: mnemonic strategies for
recall of word lists, sequences of items, texts,
stories (e.g., categorization, imagery).
 Reasoning training: strategies to identify
patterns.
 Speed of processing training: practice
increasingly complex tasks to identify and
locate visual information.
Stress and relaxation
 Herbert Benson M.D., founder of the Mind-
Body Medical Institute in Chestnut Hill,
Massachusetts, Associate Professor of
Medicine at Harvard Medical School.
 By completely letting go of a problem at some
point by applying certain triggers (e.g.,
relaxation exercises), the brain actually
rearranges itself so that the hemispheres
communicate better. Then the brain is better
able to solve the problem.
Stress and relaxation
 Molecular studies have shown that calming response
releases little “puffs” of nitric oxide, which has been
linked to the production of such neurotransmitters as
endorphins and dopamine. These chemicals enhance
general feelings of wellbeing.
 As the brain quiets down, another phenomenon that
we call “calm commotion” – or a focused increase in
activity – takes place in the areas of the brain
associated with attention, space-time concepts, and
decision-making.
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McEwen BS. Protective and damaging effects of stress
mediators: central role of the brain. Dialogues Clin Neurosci.
2006; 8: 367-381.
Nutritional strategies
 “Let food by thy medicine, and medicine be
thy food” – Hippocrates (460-377 BC).
 Nutritional strategies such as Mediterranean
diet may have a significant effect in promoting
brain health, reducing risk of AD and slowing
progression of AD.

Morley. Nutrition and the Brain. Clin Geriatr Med 2010. In
Press.
Brain Food!
 Systematic review: 11 observational studies
and 4 clinical trials. Conclusion: Existing data
favor a role for long-change omega 3 fatty
acids (fish or supplement) in slowing
cognitive decline in elderly individuals without
dementia, BUT not for prevention or
treatment of dementia.
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Fotuhi M et al. Nat Clin Pract Neurol 2009.
Brain Food.
 Mediterranean Diet. The New Mediterranean Diet Cook Book by
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Nancy Harmon Jenkins (Bantam 2008).
Dash Diet (specifically for people with hypertension).
www.nhlbi.nih.gov/health/public/heart/hbp/dash/.
Turmeric (present in some curry powders, some yellow
mustard). Pills: Turmeric Force by New Chapter.
4-6 servings of vegetables and 3-5 servings of fruits per day.
Healthy fish: Pacific Herring (sardines), Sablefish (Black Cod),
European Anchovies, Spanish Mackerel, Wild Alaskan Sockeye
Salmon, Farmed Rainbow Trout, Albacore Tuna (Tombo). Visit
environmental defense fund for info on fish and mercury
(www.edf.org ).
Supplements: Omega 3 (molecularly distilled [e.g., Nordic
Natural] pills or liquid), Vitamin D (1,000-2,000IU), Vitamin B12
(500mcg-1000mcg), Zylfamend (has rosemary, turmeric, etc).
Physically active lifestyle.
 Reduces risk of heart disease, cancer, diabetes,
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strokes.
Linked to living longer and with less disability.
Recent studies also suggest reduce risk of
Alzheimer’s and slower progression of Alzheimer’s
disease.
Improved mood and reduced risk of depression.
Reduced risk of falls.
Improved capacity to pay attention (focus), problem
solve.
Improved sleep.
Physically active lifestyle
 Improved blood flow to the brain
 Reduced oxidation
 Reduced inflammation
 Reduced toxicity of misfolded proteins that
are thought to cause Alzheimer’s disease,
Parkinson’s disease.
 Improved neurogenesis (formation of new
brain cells) and synaptogenesis (formation of
new brain connections)
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Kramer AF, Erickson KI, Colcombe SJ. Exercise, cognition,
and the aging brain. Journal of Applied Physiology 2006;
101: 1237-1242.
Sleep
 Good sleep is necessary for memory
consolidation, for ability to focus and problem
solve the next day and for learning new skills.
 During sleep, processes involved in formation
of new brain cells and brain connections are
activated.
 Sleep is also important for creativity.
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Malhotra R and Desai AK. Healthy Brain Aging: What has
sleep got to do with it. Clin Geriatr Med 2010 In Press.
Good “Mind Health” Advice
 To keep mind alive requires learning something truly
new with intense focus.
 4 key steps for mind fitness include: understanding
how experience makes the brain grow; importance of
play and imagination in daily life; learning to live in
the “slow lane”; seeking novelty and innovation.
 Healthy brain cells need healthy nutrition, “reward”
neurotransmitters, BDNF, adequate blood supply,
protection from head injuries, protection from toxic
chemicals (e.g., pesticides, pollution).
 It is never to early, it is never too late.
Sleep N Pills
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S = Sleep. Adequate daily and lifelong quality and quantity of sleep is essential
for brain health.
L = Lose it or Use it. Be mentally active.
E = Exercise regularly (aerobic/endurance [e.g., swimming, treadmill, brisk
walking], strength training [e.g., Pilates], flexibility [e.g., Yoga], balance [e.g.,Tai
Chi]).
E = Excess disability (e.g., vitamin deficiencies, malnutrition, sleep apnea,
chronic pain, chronic stress, pollution, anxiety and depression, ADHD, obesity,
metabolic syndrome, smoking, drinking more than 2 alcoholic drinks / day,
poorly controlled hypertension, diabetes, hyperlipidemia ) needs to be
addressed.
P = Positive emotions (calm, peaceful, happy, optimistic, serene, joyful, relaxed,
in “flow,”) and Positive actions (altruistic, forgiving, kind, loving).
N = Nutrition (fruits [berries and cherries, avocados], vegetables [green leafy
vegetables, tomatoes], omega 3 rich food (especially fish), spices (especially
turmeric), whole grains, small amounts of olive oil or canola oil, very small
amount of nuts and red wine.
Pills (omega 3, B12, Vitamin D, Zylfamend, pills to treat cardiovascular
disorders, other conditions such as Alzheimer’s disease, ADHD, depression).
PSALMS – to become happier
 P: Engage in activities that generate
PLEASURE.
 S: Engage in activities that exercise our
STRENGTHS.
 A: APPRECIATE what you have. Wanting
what you have promotes happiness, not
having what you want.
 L: Cultivate capacity of LAUGH at your
imperfections. Capacity of listen up.
Checklist: A guide for clinicians
 1. Smoking cessation advice and guidance provided.
 2. Advice to follow guidelines proposed jointly by the American Heart
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Association and the American College of Sports Medicine regarding
daily physical activity provided.
3. Advice and guidance regarding healthy nutrition (e.g., Mediterranean
diet) provided.
4. Advice to engage in intellectually challenging and creative leisure
time activities provided.
5. Strategies to promote emotional resilience and reduce psychological
distress and depression (e.g., relaxation exercises, mindfulnessmeditation practices) provided.
6. Advice to maintain an active, socially integrated lifestyle provided.
7. Strategies to achieve and maintain optimal daily sleep provided.
8. Education about strategies to reduce risk of serious head injury (e.g.,
wearing seat belts, wearing helmets during contact sports, bicycling,
skiing, skateboarding) provided.
References
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Desai AK, Grossberg GT. Road Map to Healthy
Brain Aging. Clin Geriatr Med 2010. In Press.
Jedrziewski MK, Lee VM and Trojanowski JQ.
Lowering the risk of Alzheimer’s disease: Evidencebased practices emerge from new research.
Alzheimer’s & Dementia. 2005; 1: 152-160.
Fratiglioni L, Paillard-Borg S and Winblad B. An
active and socially integrated lifestyle in late life
might protect against dementia. The Lancet
Neurology 2004; 3:343-353.
Pasinetti, G.M. and Eberstein, J.A. Metabolic
syndrome and the role of dietary lifestyles in
Alzheimer’s disease. J Neurochem 2008; May 3
(epub ahead of print).
References on cognitive training
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Willis SL, Tennstedt SL, Marsiske M, et al. Longterm effects of cognitive training on everyday
functional outcomes in older adults. JAMA 2006;
296: 2805-2814.
Walker M. The role of sleep on cognition and
emotion. Ann NY Acad Sci. 2009;1156:168-197.
Valenzuela M, Sachdev P. Brain reserve and
dementia: a systematic review. Psychol Med.
2006;36:441-454.
Valenzuela M, Sachdev P. Can cognitive exercise
prevent the onset of dementia? Systematic review
of randomized clinical trials with longitudinal followup. Am J Geriatr Psychiatry. 2009;17:179-187.
Stern Y. What is cognitive reserve? Theory and
research application of the reserve concept. J Int
Neuropsychol Soc. 2002;8:448-460.
Suggested reading
 The Healthy Brain Initiative. Centers for Disease
Control and Prevention and Alzheimer’s Association.
The initiative proposes 44 actions to maintain or
improve the cognitive performance of all adults.
 Cognitive Fitness. Roderick Gilkey and Clint Kilts.
Harvard Business Review. November 2007.
 AD Progress Report 2007.
www.nia.nih.gov/Alzheimers/Publications/ADProgres
s2007.htm.
 Yashodhara BM et al. Omega-3 fatty acids: a
comprehensive review of their role in health and
disease.
Suggested reading.
 The Mindful Brain. Daniel Siegel.
 Spark: The revolutionary new science of exercise
and the brain. John Ratey and Eric Hagerman.
 Healthy Eating. A guide to the new nutrition. A
special report from Harvard Medical School.
 Improving Memory. Understanding age-related
memory loss. A special report from Harvard
Medical School.
 Anti-cancer. A new way of life. David Servan
Schreiber M.D.
Other resources.
 Audio CD: Mindfulness for beginners. Jon Kabat
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Zinn.
www.thememorypractice.com
www.sharpbrains.com/newsletter/expert-contributors
Posit Science website.
The Center for Healthy Brain Aging, Saint Louis
University School of Medicine Website
(http://neuroandpsych.slu.edu/healthybrain ).
http://bfc.positscience.com/resources/reading/thebrain-that-chages-itself-normal-doidge-01.php .
Checklist: Guide for clinicians
 9. Education about strategies to reduce exposure to hazardous
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substances 9e.g., wearing protective clothing during the administration
of pesticides, fumigants, fertilizers, and defoliants) provided.
10. Education and counseling provided regarding negative health
effects of alcohol consumption more than recommended as safe by the
National Institute of Alcoholism and Alcohol Abuse.
11. Education about importance of achieving and maintaining healthy
weight to promote overall health provided.
12. Strategies to achieve optimal blood pressure control instituted.
13. Strategies to achieve optimal control of dyslipidemia instituted.
14. Strategies to achieve optimal control of blood sugar / diabetes
instituted.
15. Advice regarding the risks and benefits of medications,
supplements, herbal remedies and vitamins to promote brain health
provided.
16. Secondary prevention of stroke strategies (e.g., daily baby aspirin)
implemented.
Suggested reading
 The Brain That Changes Itself. Stories of personal
Triumph from the Frontiers of Brain Science.
Book by Norman Doidge M.D. Featured on PBS’s
The Brain Fitness Program.
 Why we make mistakes: How we look without seeing,
forget things in seconds, and are all pretty sure we
are way above average. Book by Joseph T. Hallinan.
 Quiet! Sleeping Brain at Work. Robert Stickgold and
Jeffrey Ellenbogen. Scientific American Mind; 2008,
Vo. 19 Issue 4, p23-30.
Suggested reading
 Stronger After Stroke. Peter Levine.
 The Mind and the Brain: Neuroplasticity and
the power of mental force. Jeffrey M.
Schwartz MD
 ADVANCE for physical therapists.
 After a Stroke: 300 tips for making life easier
and striking back at stroke: A doctor-patient
journal. Cleo Hutton LPN.
Suggested reading
 Are you working too hard? A conversation with
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Mind/Body Researcher Herbert Benson. Harvard
Business Review November 2005; 53-58.
Dr. Andrew Weil’s guide to Heart Health. 2009.
The New Mediterranean Diet Cook Book. By Nancy
Harmon Jennkins. Bantam 2008.
Healing Night. By Rubin Naiman (addresses ways to
improve quality of sleep).
Aging Well. George Vaillant M.D.
Suggested websites
 Santa Barbara, California center for Cognitive
Fitness and Innovative Therapies (CFIT).
www.sbcfit.org
 www.worstpills.org Has list of 136 commonly
prescribed medications that are potentially
dangerous to seniors’ cognitive health. Some
of the pills listed here are good for you so
please review all medications with your health
provider before stopping them or reducing
their dose.
My contact info:
 adesai@slu.edu