I was sitting in my GP’s office recently, being told something I didn’t want to hear. My blood pressure was too high and I needed to start medication with antihypertensives.

I didn’t want to have to take medication. I had always planned not to be on anything apart from fish oil and glucosamine supplements until I was at least 90 years old. I consider myself fit. I exercise daily, my weight is normal, I eat healthily, I don’t smoke and I keep an eye on how much wine I drink each week.

But my family history includes hypertension and stroke on both my mother’s and father’s side.
And I do recall a conversation with my obstetrician who was managing my pregnancy-induced hypertension a number of years ago. He said, “Jenny, you are likely to develop hypertension as you get older.” Harrumph. I heard, but didn’t want to listen. But who am I trying to kid?

I have what is called “essential hypertension”. The cause is as yet unknown.
I don’t like it. But I can deal with it and take my pills.
The reason why? Because I value my brain cells too highly not to. As a Doctor my medical training has taught me what the consequences of untreated hypertension are.

Hypertension has been described as a silent killer. You can’t feel if your blood pressure is too high. We rely on readings taken with a sphygmanometer to get an accurate idea of the state of our blood vessels.
The blood pressure reading essentially tells us the peak or systolic pressure our heart has to exert with each contraction to pump the blood around our body. The lower reading or diastolic pressure gives us the resting pressure of the circulatory system in between heartbeats.

If the readings are too high we run the increased risk over a period of time of blood vessel rupture causing a stroke or cerebrovascular accident. Other organs are affected as well, including the kidney, eye and heart. None of which is good news.

So, back to the brain and high blood pressure. Sure it’s good not to be at risk of stroke. But what about the effect of high blood pressure on memory and cognition?

Studies have shown that having high blood pressure can contribute to memory loss and other decline in brain function in people over the age of 45.

In one study of over 19000 participants aged 45 or older, they found that with each 10-point increase in diastolic pressure, the risk of cognitive difficulty increases by 7 points.

But how high is high?
We need to keep our diastolic pressure (the lower of the two reading indicating the pressure of the arterial system at rest) at below 90mmHg.

With around 25-30% of the Australia adult population having high blood pressure I am clearly not alone.
For the vast majority of people like myself we have “essential hypertension” where no specific cause is identified. However having high blood pressure causes problems by causing our arterial walls to thicken and lose their elasticity, leading to reduced blood flow and tissue death.

Having reduced blood flow to your brain becomes an issue when you need it to be working harder. For example when you want to be able to pay attention or work out a solution to a problem, the decrease of available blood flow to your brain leads to fewer brain cells being activated and an increased number of memory lapses happening as a result.

In older people, having high blood pressure can predict who is at risk of developing impaired executive function (organising, planning and decision making) and a greater risk of progressing to dementia. One study of 900 octogenarians showed that high blood pressure was associated with an increased risk of developing dementia when frontal lobe functioning was impaired

Because stroke and TIA are leading causes of risk of cerebrovascular disability followed by dementia, controlling hypertension is a simple and effective way to significantly potentially reduce the incidence of forecasted dementia in this group.

So attending to diagnosing and treating hypertension in midlife would appear to be essential to protect you from developing cognitive impairment further down the track.

If you are over 45 and haven’t had your blood pressure checked for a while, now would be a good time to make an appointment and get it checked by your GP.

If it is too high then some simple lifestyle changes could help:

• Keeping your weight in the healthy range
• Don’t smoke
• Reduce your alcohol consumption.
• Do some regular exercise
• Keeping your cholesterol in the normal range
• Eat less saturated fat.
• Use less salt in your diet.

Hypertension has no symptoms, but is easily managed and keeping it in the normal range could make a big difference to being able to save your brain.

References:
Shahram Oveisgharan; Vladimir Hachinski. Hypertension, Executive Dysfunction, and Progression to Dementia: The Canadian Study of Health and Aging. Arch Neurol, 2010; 67 (2): 187-192

JAMA and Archives Journals (2007, December 12). High Blood Pressure Associated With Risk For Mild Cognitive Impairment.

Radiological Society of North America (2007, November 29). High Blood Pressure May Heighten Effects Of Alzheimer’s Disease.

Over the centuries, meditation has been used to reduce stress, improve focus, attention and memory.

A few years ago when going through a period in my life that was proving to be somewhat stressful, I enrolled in a six-week meditation course.
And I have to say it was hugely beneficial.
Having to mentally and physically stop for that one brief hour each week, was very calming and it did help me cope.
I can’t say it was easy either. Being a person always on the go, never allowing myself the luxury to step back and stop the endless mind-chatter was quite a challenge and it took a while to get the hang of it.
But then I would start to look forward to that time, and little by little I did learn how to focus on the breath, to be more “present” and just take in the sounds around me with out allowing my thoughts to rudely intrude and distract.
I could actually just acknowledge them and let them float off somewhere else.

Whilst there of a lot of awareness of the beneficial physiological changes associated with meditation for some time, it has only been over the last few years that scientific studies have been able to show more of what is going on in the brain when we meditate and the promise that further research may have, for future brain health benefits.

The brain itself actually undergoes physical change in response to meditation.
A study by Sara Lazar, research scientist from the Massachusetts Hospital Boston showed that regular meditation causes thickening of the cerebral cortex in those areas of the brain associated with decision-making, attention and memory.

The question arising from her study is: Would regular meditation slow the natural thinning of the cortex that occurs with age?

The cortex is associated with higher brain function. So, can meditation be shown to increase attention span, sharpen focus and improve memory?

The proponents of meditation say it can:

In 2007 a study by Amishi Jha and Michael Baine at Penn’s Stress Management Program at the University of Pennsylvania looked at how meditation affected the three separate components of paying attention ie:

• The ability to prioritise and manage tasks and goals.
• The ability to voluntarily focus on specific information.
• The ability to stay alert to the environment

They had two groups. The first group was new to meditation and undertook an 8 week course, which included 30 minutes daily meditation.
The second group was experienced in meditation and went on a full time one-month retreat.
Both groups underwent computer-based tests on response speeds and accuracy and both groups showed improved performance in attention and ability to focus. The experienced group did better overall but the new group demonstrated significant improvements over just a course of weeks.

The implications here suggested it would be worthwhile teaching employees to meditate, because even 30 minutes a day produced improved attention and focus.

Attention is the key to learning. So it would appear that meditation allows you to improve your attention and hence learning capacity.

The Deutsche Bank, Google and Hughes Aircraft now offer meditation classes for their workers because of the perceived benefits to their employees
with:

• Increased productivity
• Reduced stress related illness
• Reduced absenteeism
• Reduced number of errors or mistakes
• Improved recall and memory due to having a relaxed and clear mind.

Mental activity in meditation is wakeful and relaxed. Professor Jim Lagopoulos from Sydney University used EEG testing to look at the difference in the brain when mentally active, resting, asleep or meditating as the brain has some form of electrical activity in all of these.

What he found was that those engaged in non-reactive meditation produced more marked changes in electrical brain wave activity associated with wakeful relaxed attention, compared to those who were just resting without any specific mental technique.

What about meditation as a tool to prevent memory loss?

The results of a small pilot study into use of meditation to prevent memory loss was published in March 2010 by Dr Dharma Singh Khalsa and Andrew Newberg Associate Professor of Radiology Pennsylvania University School of Medicine

They had 15 subjects age 52 to 77 years. with known memory problems.
They undertook 8 weeks of Kirtan Kriya mediation for 12 minutes a day.

All the subjects underwent cognitive testing and brain imaging at the beginning and end of the 8-week period.

The meditation used was very simple.
The subjects had to repeat four sounds SA, TA, NA, MA while touching their thumb to index, middle, ring and little finger.

They had to perform this out loud for 2 minutes,
At a whisper for 2 minutes
In silence for 4 minutes
Then a whisper for 2 minutes
And finally out loud again for 2 minutes

They were all given a meditation CD to play at home.

In the control group with memory loss, they were asked listen to two Mozart violin concertos for 12 mins a day.

Of the 15 in the meditation group;
7 had mild age associated memory impairment
5 had mild cognitive impairment
3 had moderate impairment with Alzheimer’s disease.

Of the 5 in the control group;
2 had mild cognitive impairment
3 had age related memory impairment.

The results found that those in the meditating group showed increased blood flow to frontal and parietal lobes (areas associated with memory retrieval) on scanning. In cognitive testing they all had improved performance in general memory and attention.

Those who had listened to music, showed some increased blood flow in different areas of brain but of less significance and they showed no improvement in cognition.

The suggestion from the study is that meditation may be useful in those with mild memory impairment to slow down or inhibit progression of memory loss by “strengthening” the brain.

Whilst interesting, it has to be noted that this was an extremely small study, but certainly warranting further investigation with larger studies to see if this finding can be replicated.

Other researchers have also looked at the question of whether meditation can assist focus and thereby allow better memory

Dr Gary W Small, Director of Memory and Ageing Research Centre, University of California has found that exposing older people to technology such as the internet changed their brain activity in just one week. He found that the older subjects showed an increase in frontal lobe activity in their brains and where short term memory and decision-making is important.

Meditation appears to be a useful tool not only for the workplace but also to perhaps assist us to maintain our cognition, as we get older.
It may not be too long before meditation is offered more widely as a strategy to keep us brain fit.

It was like a scene reminiscent of a Dickensian novel.

Except Oliver Twist wasn’t asking for more. He was saying, “This doesn’t work!”

I had been given a heads up at the beginning of last week that a paper was about to be published on the effectiveness of brain training and that it was likely to engender significant media coverage.

They were not wrong. It certainly grabbed a lot of attention.

One friend came up to me and said “Jenny have you read the report that says brain training doesn’t work!”. “Yes” I said, “…….but have you read the feedback looking at the concerns about the methodology used and the generalisation of the conclusions reached?”
“Well, no I haven’t,” she said “But it was done using a very large number of people in the study and the researchers are from Cambridge, so it must be very valid.”

Another friend simply expressed her relief at the headline she had heard.
“Thank goodness” she said, “Now I don’t have to worry about which game or training program I need to look at, because now it’s been shown they don’t make a difference”.

Oh no!

Now, while I am delighted that the topic of brain training is out at the forefront of people’s minds and that it has engendered a good deal of healthy debate, I have been dismayed at how one sweeping statement can colour people’s overall acceptance of what is the “truth”.

My concern is that for the vast majority of people, the only message they have heard is “Brain Training doesn’t work” Period. Without any exploration of what this study did or did not really demonstrate.

My first friend concluded that because the study is published in a respectable journal, because it involved a large number of study subjects (the largest of it’s kind to date) and it’s authors are academics from a well respected academic institution, that the findings therefore must be correct and to be taken note of.
My question to her, which she dismissed, was despite all that, is it not still possible to have produced a flawed study with an incorrect or overgeneralised conclusion?

Lets look at what all the fuss has been about.

The study was conducted by Jessica Grahn and Adrian Owen and others from the Cognition and Brain Sciences Unit in Cambridge UK, in conjunction with the BBC’s “Bang Goes The Theory” TV program.

11,430 participants were involved in the 6 week online study.
All were healthy adults aged between 18 and 60 years of age.

They were divided into three groups.

The first group undertook basic reasoning, planning and problem solving activities.
The second group undertook more complex activities more similar to computer brain training programs for exercise on memory, attention, maths and visual-spatial learning. The third group were asked to use the Internet to research answers to trivia questions.

All the participants had base line cognitive testing done before and after the study, using tests that are commonly used in looking at brain function in older adults who have sustained a brain injury or dementia.

The study’s finding reported that all three groups showed the same amount of minimal improvement which the authors put down to “practice making perfect” and then went on to say that that therefore brain training (while helping you by practice to improve a certain mental skill) does not translate into in to better overall improved cognitive functioning in every day life.

Looking a little closer at this study, the participants spent a grand total of 24 training sessions of 10 minutes each over the six week period.
240 minutes is not very long to look at how effective a training program is. I very much doubt that if I spent 3 to 4 hours over six weeks learning Japanese, I would have not learnt more than a few rudimentary words or sentences. Learning a new skill or undertaking training takes a lot of time, consistency, practice and effort.
Is their program actually a good example of brain training?

Other neuroscientists who have their own cognitive training programs have stated that in their programs participants are required to be spending a minimum of 30 minutes per brain training session and for a minimum of 15 hours in total to see any cognitive benefit.

The paper was also criticised in having poor quality control as all the subjects merely logged on to the study training program from their own homes with no regulation about what else was going on around them during the time of their “training”.
The gold standard for all studies involves adequate control of all variables.

Plus the cognitive tests they used on their healthy subjects, are usually used on people over the age of 60 with significant cognitive impairment. Would one expect any significant improvement then in healthy individuals with such minimal training?

So what can we take from this paper ?

With the huge amount of money being spent in the development and sales of brain training programs: $265 in sales in one year expecting to increase exponentially, we do need better assessments of the different brain training programs out there. We need a better idea of how effective they are and whether the results marries up with the promise. Are you paying for effective cognitive training or for simply a bit of fun and entertainment.

The Cambridge study used their own brain training program, which had a number of limitations and was clearly shown to be ineffective. But that finding on it’s own does not necessarily mean all the other programs are ineffective as well.

It is misleading for the results to be extrapolated to say that because their program was ineffective therefore all brain training programs are ineffective. There is a vast array of published research in the literature that reveal some very effective positive results from certain training programs. What about all the existing training programs that are used to assist people who are recovering from stroke for example? Is there anyone who would dispute their value in assisting people in recovery from their brain injury?

Just because one brand of whitening toothpaste doesn’t do a very good job doesn’t mean that all the other brands of whitening toothpaste don’t work as well.

My own sceptical mind also wonders about having a TV program involved with this study. Is there perhaps a little vested interest in getting people interested in watching the TV show? A bit like the newspapers who know that bad news sells. Will having a controversial headline produce the same effect?

What the paper maybe does highlight, is that there are no short cuts to maintaining your brain or trying to improve one’s mental cognition. And yes, I would certainly agree with that.
I also think we need to incorporate an array of initiatives to maintain or attempt to improve mental fitness. Brain training programs are only one facet.

There is plenty of evidence supporting the notion that managing other lifestyle factors including physical exercise, eating well, managing stress and getting enough sleep, will all help in our quest to stay mentally fit and optimise our brain health.

What I suggest now is for you to grab a cup of coffee and settle down for a bit of a read for yourself.
Here is the article from Nature magazine. Let me know what you think.
I do enjoy a bit of a debate.

Owen, A. M. et al. Nature advance online publication doi:10.1038/nature09042 (20 April 2010).