Friday, November 30, 2012

It's time to have "the talk"

Please enjoy this cuteness as a reward for reading this post
No, I'm not talking about the "birds and bees" talk. This "talk" is one you should have with your parents, or your partner, not your children. It's not an easy talk. You're not going to want to talk about it. They are not going to want to talk about it. But the discussion is important, and it should take place sooner than later. This "talk" is about advance health care directives.

Essentially, establishing "advance health care directives" (sometimes called a "living will") means deciding ahead of time how you want to be treated if you are no longer able to make decisions for yourself because you are ill (for example, with dementia) or incapacitated (for example, after a car crash). These decisions include things like whether you'd want to have a feeding tube, be treated with antibiotics, or be resuscitated with CPR if your heart fails (and many other decisions!). In general, people go about this in one of two ways: either by appointing someone to make decisions for them should it be necessary, or by writing down instructions for treatment, such as the kinds of treatments they would be ok with and the kinds they wouldn't want. Ideally, the advance directives should be a combination of both.

Now you're probably sitting there thinking "I'm way too young for this" (aren't we all), or "my parents are well, there's no need". And that's exactly the problem: by the time you need advance directives, chances are it will be too late. Our ability to make decisions for ourselves over our lifetime is like a bell curve: it's pretty low when we're young, still low-ish in our pre-teen/teenage years (hence the need for the "birds and bees" talk), then it peaks in adulthood, and starts declining again as we get older. So ideally we should start this discussion at our peak. I know I'm being a complete bummer suggesting we all sit down and talk about death and illness at our peak. But there's a good chance you'll thank me later.

I'm currently attending the Leadership Program for Physicians and Leaders in Long-Term Care in Vancouver (my talk is tomorrow and I should definitely be preparing for it instead of writing this!). There's a lot of discussion at the conference around advance directives. The main problem is that a lot of people don't have them!

There's some uncertainty over how much physicians actually follow advance directives. In some areas they have to and in others they don't. Really what it comes down to is everyone is better off if they have at least had the discussion - at the conference, one presenter mentioned how older adults who have advance directives tend to enjoy a better quality of life, and a better death. I know, I know. You're don't want to be reading about death on a Friday night. If you need a break, here are some kittens: click here.

As I said before, it's not an easy discussion. "Ah, ok, so, yeah, one day I might have dementia, or be in a car accident and suffer brain damage, and well I think I'd rather...". But hey, a lot of discussions are unpleasant ("Ah, ok, so, yeah, I dropped your brand new iPhone in the toilet"). So just do it. And don't just sit down and write this by yourself, either - speak to a loved one, or a relative, about what your thoughts are, and also involve your doctor - they can absolutely help with this, and may be able to provide you with useful tools. Advance directives should be an ongoing discussion, not a one-time thing - revisit your choices once in a while, and always keep someone in the loop.

I realize this isn't my most uplifting post, but as science moves forward, we face new choices that are important to talk about. So chatter away!

Thursday, November 15, 2012

Go lift some weights and call me in the morning

In my last post I told you that I would reveal the one thing you can do to have a significant, positive and lasting effect on your brain health as you get older. See if you can spot it in the following list:

a) Learn to dance Gangnam style
b) Join a choir
c) Catch a wave
d) Pump some iron

Ok, that was a trick question. All of these answers are somewhat correct, but I was looking for the "most" correct answer (flashbacks to undergrad, anyone?): Pump some iron.

I realize I sound like a broken record - I've already written about how aerobic exercise can promote healthy aging here and here, and I've even already written about resistance training, or lifting weights, here.

So why am I at it again? Because it's important!
I'm fresh out of the 2012 Aging and Society Conference, where researchers came together to discuss what works and what doesn't when it comes to healthy aging. It turns out everyone pretty much agrees that exercise is hands down the most effective intervention to keep your brain cells happy into old(er) age. All sorts of different types of exercise, ranging from simply walking to attending resistance training classes, are associated with different types of improvements in cognition, memory, and even brain size. 

Of course, there are different levels of effort involved with different types of exercise, or even when talking about a single form of exercise. When my friend Jess asks me to go for a walk, she means a power walk: it usually involves going up hills, sweating like a pig (even though pigs, ironically, don't sweat much), and barely having enough breath for girl talk (though somehow we always seem to find it). When my friend Al and I go for a walk, what he means is a "mosey": we stop to look at the view, pet the dog, chit chat with strangers, and have more than enough breath for lengthy discussions about life, work, and the possibility of alien lifeforms. When it comes to brain health, whether you're walking or pumping iron, a little sweating and effort can go a long way. For example, resistance training has been proven to be most effective when the load, or how much weight you are working with, increases over time. So kick the intensity up a notch: there will still be plenty of time for chit chat around a post-exercise, antioxidant-rich mug of matcha (my new obsession - stay tuned).

Now that the obvious has been (re)stated, I want to take this opportunity to discuss the idea that perhaps lifestyle interventions such as exercise could be prescribed by your doctor. We know that exercise can improve cognition in aging but also conditions like depression. Should physicians prescribe lifestyle changes? Or are diet, exercise, and other lifestyle activities choices we should make ourselves? How would you feel if your doctor prescribed you exercise instead of pills? Would you be more motivated to exercise if the prescription came from your doctor instead of from your friendly Internet science blogger? Your thoughts in the comments!

Thursday, November 8, 2012

If only I had a (better) brain: Part II

Can we "train" our brains to be brighter, sharper, faster? 

A while back I wrote a post about a big study looking at "brain training". The researchers wanted to know whether training programs that look like video games (like Brain Age and Lumosity) could significantly improve brain performance on various tests. The results, in a nutshell, showed that while participants improved on the tasks they trained on (e.g., if the game involved ranking balls from smallest to biggest, the participants got *really* good at ranking balls from smallest to biggest), the improvement didn't carry over to general brain function.Turns out ranking ball sizes doesn't help you remember where you left your keys this morning.

Two years later, what's the word?

I'm going to shift a little from how I normally do things (review a single article) and tell you about findings I learned about at the recent Aging and Society conference. At the conference, several researchers talked about brain training in the context of aging. We know that as we get older our cognitive abilities decline - we forget names and words, misplace our shopping lists, and process information a little bit more slowly. Wouldn't it be fantastic if we could just spend ten minutes a day playing games on our iPad and successfully counter this decline? Of course it would be fantastic. Not just for us, but also for the companies who are trying very hard to convince us to buy their products to improve our cognition.

The problem is that skills are specific. If you want to become a fabulous jazz pianist, you have to play the piano (preferably jazz songs, too). If you want to become a star ballet dancer, you have to practice ballet. If you want to become a better mountain biker, you have to mountain bike - road biking will improve your leg strength and fitness, but ultimately it won't make you a better mountain biker. So why should things be any different for brain skills?

As it turns out, they aren't. Two years later, nearly all the research conducted in the field of brain training is turning up the same results: people only get better at the tasks they trained on - the improvement doesn't cross over to more general skills, different skills, or everyday life. In one study, a researcher compared a commercially available brain training program with what she called an "active control" - a group that simply played regular video games like Tetris. She found that the group who spent time on the commercially available brain training program actually saw some aspects of their cognition decline compared with the control group. Bummer.

Now don't throw out your Brain Age game yet - everyone at the conference agreed that engaging your brain in training programs is better than not doing anything. And most of the researchers felt that while the programs don't work now, it's not to say they'll never work. We are increasingly more knowledgeable about how the brain works, what happens when we get old, and what different training tasks do. So it's quite possible that sometime in the near-ish future (don't ask me when) we could see the advent of brain training programs that do have a significant and lasting impact on cognition.

Until then, there is one thing you can do to have a significant and lasting impact on your brain health... And I'll tell you in the next post.

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