Care Partner Training: Preventing Neurogenerative Decline

“Multi-domain brain training,” said Dr. Ellen Clarke, “can provide hope,” not just for dementia patients but for all aging adults.

Clarke, founder and chief scientist of Brain Evolved, was inspired by her grandmother Olive’s Alzheimer's disease diagnosis to research and develop practical cognitive training tools. Her recent presentation, sponsored by Insight Memory Care in collaboration with AARP Virginia, was part of Insight’s monthly Care Partner Training series.

Most adults prefer to age in place, and the average age at which older adults begin looking into assisted living is 75. “Loss of independence is the number one fear as we age,” said Clarke.

Clarke’s research found that providing brain training using proven intervention methods can add years to our functional lifespan. Use of these methods, said Clarke, “can potentially extend the threshold for seeking assisted living to age 95.”

Multi-domain brain training, in addition to the use of supplements, is the key. Many people may be familiar with cognitive games like those from Luminosity, but those provide singular domain training.

Multi-domain training integrates physical activity, cognitive games, social interaction, and stress relief to help extend brain health and independence.

In a recent two-year study using multi-domain training, participants increased overall cognitive function by 25%, executive function by 83%, and speed of processing by 150%.

A similar study was conducted with Alzheimer's patients, comparing use of medication, brain training, and medication plus brain training against a control group. While the groups using either just medication or just brain training showed slower cognitive decline than the control group, the group using both medication and brain training showed the slowest decline.

Clarke emphasized the use of intervention tools meant the dementia patients were “not getting better but declining more slowly.”

Assessment, in the form of screening and diagnostics, is the critical first step in beginning a multi-domain program. Medicare wellness checks are quick screenings to help doctors assess potential dementia and executive function issues.

The Montreal Cognitive Assessment test is a 10-minute, 15-question tool that helps provide early diagnoses of dementia, while the Brief Cognitive Assessment Tool is a 21-question test that helps determine the level of needed care. Neuropsych Battery tests are more extensive and help determine severity and type of cognitive impairment.

Program assessments are a series of tests given to ascertain a starting point and/or determine goals for a brain training program. These tests must be comprehensive.

Clarke gave an example of two subjects whose overall scores were similar, but whose sub scores varied significantly in areas such as focus, speed, strategy, and memory.

“These two would need vastly different brain training programs,” said Clarke.

Physical exercise is a crucial component, and, like any exercise program, must be cleared by a physician. Finding the right motivation is often difficult.

Clarke suggests seeking out an exercise buddy, setting goals, providing rewards and competitions, and trying different types of exercise.

“Combining mental and physical exercise can improve brain fitness better than either one alone – if done properly,” said Clarke.

Challenging the mind involves challenging the areas you need challenges, taking advantage of strengths, and engaging the brain. Clarke recommends looking for activities that include both crystallized intelligence (wisdom), and executive function, which includes strategy, planning, and multi-tasking.

Stress relief is important because stress is harmful to both the body and the brain. Signs of stress in a loved one can include mood swings, isolation, changes in sleeping or eating habits, physical manifestations, and increased brain power issues.

Suggestions to help reduce stress include meditation, exercise, going outdoors, engaging in a hobby, and social interaction with friends and family.

The importance of socialization is often overlooked. Socialization while eating is especially important for older adults, said Clarke, because they eat better and have better health, particularly if they are interacting with people they care about.

Some of the ways older adults can maintain social balance and stay engaged include clubs, volunteering, classes, regular phone calls including FaceTime, Zoom programs, texts, and games.

“Socialization is a paradox for many older adults dealing with brain fitness concerns,” said Clarke. If they notice they are having mental difficulties, they may withdraw from social activities in embarrassment, increasing their social isolation.

While there is no proven nutrient to improve brain health, experts agree that following the Mediterranean Diet, which focuses on seasonally fresh, locally grown produce with minimal processing, can be helpful for brain fitness.

Sleep is also important, and while a physician can prescribe medication, medication combined with a multi-domain approach that combines social interaction, exercise, set bedtimes, and stress reduction enhances the ability to get restorative sleep.

Clarke stressed that the multi-domain approach is not piecemeal but instead is a concentrated effort on all the things you need to do to build a better brain.

Clarke shared self-reported results from individuals who recently underwent brain fitness programs. A 72-year-old woman reported she felt less overwhelmed, had less brain fog, was more confident, and was no longer looking for senior living communities.

An early-stage male Alzheimer’s patient was more active in the community, able to operate technology better on his own, and had a more positive outlook.