1. Michael Marsiske Department of Clinical & Health Psychology April 10, 2015

2.  College  Local collaborators  Dawn Bowers  Ron Cohen & program on Cognitive Aging and Memory  Institute on Aging  External collaborators  ACTIVE coinvestigators and the National Institute on Aging  McKnight Brain Research Foundation, Santa Fe Health Care, and The Village of Gainesville

3.  Health professions  Assessment and psychodiagnosis  Treatment  Multidisciplinary (e.g., psychology and occupational therapy and speech/language)  Public health  Prevalence  Prevention  Population initiatives

4.  “I’m going to be running the story on the ACTIVE findings as the cover story for the next issue of PHHP News, our alumni and donor newsletter. I wanted to do a sidebar that addresses the “what can I do?” question that we seem to get a lot from consumers”

5. 1. Continue your education. "Cognitive reserve" refers to the rich network of connections and knowledge that we build across a lifespan. People with more education and more complex jobs generally enter late life at a much higher level of mental functioning. Education can continue: take continuing education courses, read books in areas about which you know little, challenge yourself to learn new things.

6. 2. Keep your brain healthy. "Brain reserve" refers to how much white and grey matter we're able to retain into the later years. Good health habits that may help to prevent heart attack/stroke, arthritis, cancer, and diabetes also help to maintain the brain: Aerobic exercise, strength training, good nutrition, control of blood pressure and cholesterol. It is never too late to begin healthier habits, and exercise training has boosted cognition even in the very old.

7. 3. Spot-train your brain. There is growing evidence that cognitive training, like that used in ACTIVE, can help to improve performance in areas that tend to decline in late life. Even brief 10 week training programs can produce five-to- ten years of benefit in areas like memory, problem solving, speed, and attention. Excellent, clinically validated training programs are now available at low cost for computers, tablets and smartphones.

8. 4. Combat negative mood. In general, older adults experience less major depression than younger adults, but depressive symptoms rise. Health challenges, activity restriction due to physical disability, retirement, financial concerns and losing loved ones are among factors that can increase anxiety and depression. Unfortunately, memory and other areas of mental functioning can be seriously compromised by mood disturbances. Seeking help with adjustment problems can be a potent way to guard against cognitive loss.

9. 5. Engage. Participation in complex leisure activities that are new and interesting seems to confer benefits in terms of memory, problem solving, and mood. The benefits seem greatest when these activities are done socially. Tasks as diverse as learning to act, quilt, play piano, use an ipad, or master digital photography have all shown mental or brain activation benefits. Engaging in social leisure seems to have dual benefits: It minimizes negative mood (which can sap mental energy), and it provides a kind of "mental exercise" with complex tasks. The trick, however, seems to be to try something new -- something you've never done before.

10. Arsenal Educate Brain Health Spot- train MoodEngage

11.  Many people have a preconception that late life is a time of decline  The story is far more nuanced and individuated.

12. Schaie, 1994, 2008

13. Age 20-34 Standard Score

16.  The majority of the population will not experience dementia (although rates will grow)  There are, however, significant functional consequences of normal cognitive aging in the absence of dementia that have been largely ignored  Medication  Finance

18.  This is a detailed and evolving field, but at the risk of oversimplifying, there are four BROAD categories of explanation  Neuronal/brain loss  Reduction in neuronal/brain efficiency  Growing interference  Disuse atrophy (“sensory underload”, “disengagement”)

24. Brain health Engagement Spot training

25. Brain health

28. Mood Spot training

29. Educate Brain health Spot training Mood Engage

30.  In large measure, we’ve tried to chip away at normal cognitive aging, using the “arsenal”, more or less, as the conceptual framework for guiding our approaches.  In general, the past five years have seen an explosion of research- and market-driven intervention approaches for cognitive aging

31. Arsenal Educate Brain Health Spot- train MoodEngage

33. Figure 1. Model estimated growth curves for 5-year cognitive change by racial group.

34. African American, Prompted African American, Unprompted White, Prompted White, Unprompted With Kelsey Thomas unprompted

35. African American, Prompted African American, Unprompted White, Prompted White, Unprompted With Kelsey Thomas \ Prompted “Can you look again?

36. Arsenal Educate Brain Health Spot- train MoodEngage

37.  There is an extensive literature documenting that health issues of later life (especially cardiovascular, and especially hypertension) are destructive to cognitive functioning  Especially “executive functioning”  Ron Cohen, UF CAM director, and Catherine Price, CHP faculty member, have been leading contributors to understanding how vascular- related neuronal loss is directly associated with cognitive decline

38.  A now ten-year old meta-analysis clearly showed that exercise trials were very beneficial  Aerobic or aerobic + strength  Increase in grey and white matter  Increase in neurotrophic factors  Improvement especially in “executive control”

39. Dawn Bowers & Michael Marsiske

42. The gift that keeps on giving?

43. Marsiske, Gogoi, Maye, McCoy, McCrae Memory Speed

44. Arsenal Educate Brain Health Spot- train MoodEngage

45.  ACTIVE study  VITAL study  MEDLI study  Fitmind study

46. University of Alabama-Birmingham Karlene Ball PhD Hebrew SeniorLife Boston John Morris PhD Richard Jones ScD Indiana University Fredrick Unverzagt PhD Johns Hopkins University George Rebok PhD Pennsylvania State University Sherry Willis PhD University of Florida/Wayne State University Michael Marsiske PhD New England Research Institutes, Coordinating Center Sharon Tennstedt PhD National Institute on Aging Jonathan King PhD National Institute of Nursing Research Susan Marden PhD

49. 10-year Trajectory of Memory, Separately by Training Group

50. 10-year Trajectory of Reasoning, Separately by Training Group

51. 10-year Trajectory of Speed of Processing, Separately by Training Group

52. 10-year Trajectory of Self-Reported IADL Difficulty, Separately by Training Group

53. State reported crashes over 10 years Ross, Edwards & Ball, 2013

54. Arsenal Educate Brain Health Spot- train MoodEngage

57. Arsenal Educate Brain Health Spot- train MoodEngage

63. 150 older adults randomized to receive either “Senior Odyssey” (n=87; teams solve long-term ill structured problems from the disciplines of literature, science and technology, civil engineering, and history, like building a structure out of balsa wood) or testing-only control (n=63)

65. Basak, Boot, Voss & Kramer (2009) Video game group: 23.5 hours of training (n=20) No contact control group Trained participants improved more than the control participants in executive control functions, such as task switching, working memory, visual short-term memory, and reasoning.

66. Computerized training Tetris Medal of Honor

68. Going down = faster = improvement

71. With Patricia Belchior Crazy Taxi Computer training Posit Science Road Tour Funded by the Robert Wood Johnson Foundation Control

73.  Submission of federal funding application(s) to understand  Mechanisms of training-related improvement  Possible “effect modifiers” ▪ Mindfulness  Community partnerships to implement the ‘arsenal’ in community settings

75.  For further information, copies of reprints, or to request a copy of this talk  Michael Marsiske  marsiske@phhp.ufl.edu marsiske@phhp.ufl.edu  (352) 273-5097