Mindfulness Awareness

I would like to explore the idea of how to improve the cognitive function using simple tools that are available to us on an everyday basis. This week’s blog will have a focus on how to reduce the risk for developing neurocognitive disorders like dementia and Alzheimer’s disease (AD) using games.

Many of us have heard of AD before. It is a cause of progressive mental deterioration, due to degeneration of brain cells and tissue. It is a type of dementia that causes memory difficulties, impaired thinking, and disruption of behavior that slowly develops and worsens over time. Over 90% of occurrence of dementia is over the age of 65, where the prevalence is 6-10% in North America (1).

Two thirds of these dementia cases can be attributed to AD (2). Neurocognitive disorders can become severe enough to interfere with simple daily tasks and can have a devastating effect of the family and friends of people afflicted.

Pathophysiology

A hallmark of AD is the presence of neural debris found in the brain, particularly in the hippocampus, which is responsible for parts of our memory, personality, and task oriented functioning. This debris is composed of proteins such as neurofibrillary tangles (NFTs) and amyloid plaques (APs). When they accumulate they affect how neurons in the brain communicate, metabolize, and repair.

In effect this manifests as the symptoms that we see in Alzheimer’s such as memory impairment, personality changes, and the impact on the ability to perform simple daily tasks.There are a few risk factors associated with the development of AD. Some are genetic but most are modifiable, which means that there are things that we can do to prevent the occurrence of this disease: The following risk factors that have been identified are (3):

• Advancing age
• Family history
• APOE 4 Genotype: this is a gene on one of our chromosomes that helps with clearing some of the neural debris, APs and NFTs, that is found in AD. It also plays a role in brain cell communication. If this gene is defective there can be an associated 10-30x increased risk of developing AD.
• Down syndrome
• Obesity
• Insulin resistance
• Vascular dysfunction: this includes cardiovascular disease, and the functioning of our blood vessels
• Dyslipidemia
• Hypertension
• Inflammatory markers: this includes C-reactive protein, inflammatory cytokines, and other biomarkers that your doctor can detect to determine the level of systemic inflammation in your body.
• Traumatic brain injury

Brain Games

Within the scope of naturopathic medicine, we focus on interventions that stimulate the mechanisms of the body so disease has a formidable opponent to contend with. One of the components of prevention in neurocognitive disorders is to continuously stimulate and challenge the mind. The brain can be seen like a muscle and to keep it functioning optimally it can use a dose of exercise that activates different types of neural activity.

This doesn’t reflect on intelligence, rather a flexibility that is a key component to cognitive health. Think of this as brain yoga.Given that exercise and nutrition plans have been implemented, another good way that can be helpful in the prevention of diseases that cause dementia is the use of games. There is a growing body of researchers that believe with small doses of daily ‘brain games’, improvements in neurocognition in early forms of AD may be helpful (3,4,5).

With the accessibility of technology, most of us have smart phones, so I’ve compiled a list of my favorite brain apps that help exercise those neural connections.

1. Lumosity

Backed by clinical research in neuroscience, this application personalizes a cognitive training program. There are different sections that focus on memory, attention, speed, flexibility, and problem solving (6).

2. Cognifit

Another clinically researched resource, this application claims to improve daily task oriented functioning that could be beneficial in early cognitive impairment diseases (7).

3. Eidetic

This application is a bit different from other brain game apps, in the sense that it adds a context that may be more applicable when scribing things into memory. So learning phone numbers, bank account details, or favorite quotes are easier.

4. Elevate

This application is like a mental multi-vitamin. It has a concept of increased challenges that fosters a healthy self. Games are designed in 29 different training activities for improving cognitive skills.

5. Happify

Not a typical cognitive training game, this application focuses on the complex state of happiness. It features multiple activities that attempt to increase neuroplasticity and stretch those fibers that stimulate the sensation of happiness.

6. Mario Brothers

Finally, and my personal favorite, a classic game that can ‘grow’ your brain. While doggy-paddling through my swim in the literary research pool, I passed this interesting article that shows the gray matter in the brain can change resulting from playing Super Mario Brothers.

Although not specifically used in neurocognitive disorders I’d like to think that an occasional battle with Mario and Princess Peach can potentially reduce the devastating effects of AD (8).

Resources

1. Mathers C., Leonardi M. Global burden of dementia in the year 2000:summary of methods and data sources.

2. Serrano-Pozo A, Frosch MP, Masliah E, Hyman BT. Neuropathological alterations in Alzheimer disease. Cold Spring Harb Perspect Biol. 2011 Sep. 3(9):a006189.

3. Engvig, Andreas, et al. "Effects of cognitive training on gray matter volumes in memory clinic patients with subjective memory impairment." Journal of Alzheimer's disease: JAD 41.3 (2014): 779-791.

4. Kawashima, Ryuta. "Mental exercises for cognitive function: clinical evidence." Journal of Preventive Medicine and Public Health 46.Suppl 1 (2013): S22.

5. Rojas, Galeno J., et al. "Efficacy of a cognitive intervention program in patients with mild cognitive impairment." International Psychogeriatrics 25.05 (2013): 825-831.

6. Geyer J, Insel P, Farzin F, Sternberg D, Hardy JL, Scanlon M, Mungas D, Kramer J, Mackin RS, Weiner MW. (2015) Evidence for age-associated cognitive decline from internet game scores. Alzheimer’s & Dementia. doi: 10.1016/j.dadm.2015.04.002.

7. James Siberski, Evelyn Shatil, Carol Siberski, Margie Eckroth-Bucher, Aubrey French, Sara Horton, Rachel F. Loefflad, and Phillip Rouse - Computer-Based Cognitive Training for Individuals With Intellectual and Developmental Disabilities: Pilot Study - The American Journal of Alzheimer's Disease & Other Dementias 2014

8. Kühn, Simone, et al. "Playing Super Mario induces structural brain plasticity: gray matter changes resulting from training with a commercial video game." Molecular psychiatry 19.2 (2014): 265-271.