The document provides information on the aging brain including basic brain anatomy, the differences between normal aging, mild cognitive impairment, and dementia. It discusses factors that can affect memory and cognition with age as well as lifestyle habits and behaviors that can help maintain good brain health such as physical exercise, nutrition, sleep, and mental stimulation. The presentation outlines changes in memory and cognition that are normal with aging versus when further evaluation may be needed.

1. February
6th
,2016
The Aging Brain

2. Jonathan Artz, MD
-Union College NY (BS- Biological Sciences, PBK,MCL).
-Emory University School of Medicine- Class of 1993
-UNC- Chapel Hill- Internal Medicine and Neurology
-University of Virginia- Fellowship (Neurophysiology/Epilepsy)
-University of Pittsburgh (UPMC-Presbyterian)- Fellowship
Neurophysiology/Neuromuscular Disorders.
- Kaiser San Rafael- Staff Adult Neurologist since 2001

3. The Aging Brain- Objectives
1. Learn about basic adult brain anatomy and
Neurophysiology.
2. Understand the differences between normal
brain aging, mild cognitive impairment and
neurodegenerative dementia.
3. Understand the major factors that can affect a
person’s memory and cognition.
4. Recognize clinical factors that could require
additional medical or neurological
investigations.
5. Realize how you can main good brain health.
6. Have fun, get educated and not fall asleep !

4. Disclosers
1. All knowledge is from my own clinical
experience,education,review of the
literature (ie, Academy of Neurology),
Wilkepedia, CDC/NIH documents and
selected information from googling.
2. I have no financial relationships with any
pharmaceutical,nutriceutical, software or
technology company or other for- profit
ventures.

5. Housekeeping Rules
1. No I-phones,smart phones or other audio-
visual recording devices allowed during
presentation.
2. Pagers and other communication devices
should be adjusted to vibrate mode.
3. Bathrooms (upstairs and downstairs)- use
beforehand or sit in the back of room.
4. Lecture: 1 hour and 45 minutes followed
by 15 minutes (or so) for questions.
5. Save questions for end please.

7. The Brain’s Vital Statistics
ADULT WEIGHT about 3 pounds
ADULT SIZE a medium cauliflower
NUMBER OF NEURONS around
100,000,000,000 (100 billion)
NUMBER OF SYNAPSES (the gaps between
neurons) about 100,000,000,000,000 (100
trillion)

12. The general recollection network. The figure illustrates the
outcome of the contrast between accurately recognized test words endorsed as
‘Remember’ or ‘Know’ in an unpublished study (n = 19) of Wang and Rugg.
The words had been studied either as pictures or as words in the context of
two different encoding tasks. Regions are shown where recollection was
associated with enhanced activity at test regardless of the encoding condition.
Vilberg and Rugg. Current Opinions in Neurobiology, 2012, 23: 1-6.

13. The Brain Shrinks over time !
Based on MRI images-
Most tissue loss and changes seen in the:
The Frontal and Temporal lobes.

14. Neuroscientist Jeffrey Kaye of the Oregon Health and
Science University used MRI scans (like those below)
to track this process

17. Short Term Memory
1. Storing information temporarily and
determining if it will be dismissed or moved
to Long Term memory.
2. “Working” memory- the brain’s scratch
pad that keeps information (a number, a
name) on hand long enough to use it.

18. Long Term Memory
• Characteristics of this type of Memory:
1.Anything you remember over a few
minutes ago.
2.These memories are not of equal strength.
3. They are subject to change (ie, practice
and repetition can increase synaptic
connections and can improve this type of
memory).

19. Types of Long Term Memory
Explicit Memory
1.Requires conscious thought
2.Associative- Your brain links memories
together.
Examples:
A. Recalling who came to dinner last night.
B. Recalling what animals live in a Rain
Forest.

20. Episodic Memory
Autobiographical Information
1.Times
2.Places
3. Associated Emotions.
4. Who,What,When,Where Why Information
5. Collection of past personal experiences
that occurred at a particular time and place.

21. Semantic Long Term Memory
1. Textbook learning
2. General knowledge about the world
acquired over our lives.
Examples:
A.Enables us to say, without knowing when
and where we learned, that a zebra is a
striped animal or that Sacramento is the
capital of California.
B. It is better sustained over time (unlike
episodic memory)

22. Semantic vs Episodic Memory

23. Procedural Memory
Procedural learning
1. Repeating (practicing) a complex activity
over and over again until all of the relevant
neural systems work together to
automatically produce the activity.
2. Is essential for the development of any
motor skill or cognitive activity.

24. Procedural Memory and Anatomy
1. Basal Ganglia
-Linked to formation of motor behaviors and
habits.
2. Cerebellum
- Plays a role in correcting movement and
in fine-tuning the motor agility found in
procedural skills such as painting,
instrument playing and in sports such as
tennis.

25. Amygdala- Emotion and Memory

26. Amygdala
1. Involved in figuring out the emotional
significance of events and is responsible
for the influence of emotion on perception
of an experience.
2. This set of brain cells helps alert us to
notice emotionally significant events even
when we're not paying attention.
Examples: ?

31. Memory Lapses
• People commonly associate memory
lapses in their mid-30s, 40s, or 50s as a
sign of Alzheimer’s disease as they
approach later adulthood, but typically this
is not the case. Memory lapses can be
both aggravating and frustrating but they
are due to the overwhelming amount of
information that is being taken in by the
brain

32. Normal Age Related Effects in
Memory
1. Occasionally forgetting where you left things
you use regularly (keys,wallet,glasses).
2. Forgetting names of acquaintances or
infrequently forgetting an appointment
(date/time).
3. Having trouble remembering what you just read
or the details of a conversation.
4. Walking into a room and forgetting why you
entered.
5. Suboptimal retrieval of information “on the tip of
your tongue.”

33. Age and Short Term Memory
1. With aging, the amount of time our short
term memory can store information
becomes shorter and shorter.
2. With aging, there is time to move new
information to long term memory> making it
more likely to forget recent events.
3. Memory lapses are a normal part of
aging to a degree !

34. The Aging Brain and Cognition
As we age, difficulties are seen in the ability to
integrate, manipulate, and reorganize the contents
of working memory in order to complete higher
level cognitive tasks such as:
Problem solving
Decision making
Goal setting
Planning

35. Normal Aging and Memory
1. Episodic Memory is especially impaired
in “normal” aging.
2. More difficulty encoding new memories
for events or facts.
3. Source Information (where and when one
learned the information) declines with
age.
4. Degradation of white matter tracts linking
frontal-temporal-parietal lobes.
5. Hippocampus starts to shrink at age 30.

36. Age Associated Memory Changes
1. Able to recall and describe incidents of
forgetfulness.
2. Able to function independently and
pursue normal activities, despite
occasional memory lapses.
3. May pause to remember directions, but
does not get lost in familiar places.
4. No trouble holding or understanding a
conversation despite the occasional
difficulty finding the right word(s).

37. Types of Memory Spared in Aging
• Procedure Memory- minimal to no decline
with age.
• Semantic Knowledge (memory)- stable or
improves with age.

38. Mild Cognitive Impairment
Short term Memory and/or Cognition
that does not significantly impact daily
functioning.

39. Mild Cognitive Impairment
The diagnosis of Mild Cognitive Impairment
relies on the fact that the individual is able to
perform all their usual activities successfully,
without more assistance from others than
they previously needed.

40. Mild Cognitive Impairment
Memory or cognitive complaints:
1. Trouble remembering names of people
one met recently.
2. Trouble remembering the flow of
conversation and an increased tendency to
misplace things.
3. Person will often be aware of these
issues and will compensate (ie, note taking
and extra reliance on calendar use).

41. Mild Cognitive Impairment
1. There are no FDA approved treatments
(ginko,vitamins,Aricept,Exelon,galantamine
or Namenda).
2. The main goal is to identify risk factors
(High blood pressure, medications,
excessive alcohol use, poor sleep/insomnia,
mood related issues) and improve on them.
3. Physical Exercise is useful tool to better
control several of the risk factors above.

42. M.C.I. >> Dementia
Suspect an Early Stage of Dementia (most
common form being Alzheimer’s Type) if :
1.There is confirmation of significant
memory difficulties by a knowledgeable
informant (family member, close friend).
2. Any change in ability to perform daily
tasks such as hobbies,finances, or attending
to ones personal hygiene.
3. Poor performance on objective memory
Testing.

43. Dementia
1. Alzheimer’s Type (75% of all Dementias).
2. Vascular related (Stroke)
3. Alcoholism or other drug/toxin related.
4. Result of Head injury/Concussion.
5. Depression (“Pseudo” Dementia)
6. Prolonged Sleep Deprivation
7. Medication effects (anticholinergic drugs
and some sedatives).
8. Result of prolonged oxygen deprivation
despite Cardiac Resusitation (CPR).

44. When you should call your Doctor
1. Any progressive decline in short term
memory and/or cognitive functioning that
is affecting your daily functioning.
A. You are unable to recall circumstances where memory
loss caused problems.
B. You are getting lost or disoriented in familiar places.
C. You are unable to follow directions or multi-task
(cooking,cleaning,driving, during hobbies).
D. Your words are frequently forgotten or misused;
repeating phrases or stories in same conversation.

45. Identify Your Risk Factors

46. Functional Activities Questionaire
Pfeffer, RI (J Gerontology, 1982)
1. Writing checks and maintaining other
financial records.
2. Asembling tax or business records.
3. Shopping alone.
4. Playing a game of skill.
5. Making coffee or tea
6. Preparing a balanced meal.
7. Keeping track of current events.

47. Functional Activities Questionnaire
8. Attending to and understanding a
television program, book or magazine.
9. Remembering appointments,family
occasions and medications.
10. Traveling outside of neighborhood.
Score (0-3 for each above item):
a.0- independent.
b.1- mild difficulty
c.2- requires assistance
d.3- dependent
SCORE of > 8 equals functional impairment

48. Towards a Healthier Brain
1. Nutrition-Diet: low fat and sugar content
2. Weight : (linked with Diabetes risk)
-Goal BMI under 25 (normal 18-25).
3. Sleep Hygiene
4. Stress and Anxiety reduction (meditation).
5. Social Interactiveness
6. Mental Stimulation
7. Daily Aerobic forms of Exercise
8. Avoid smoking,excessive alcohol use

50. Brain Derived Neurotrophic Factor
(BDNF)
1. Found in Hippocampus and Frontal Lobe
(Pre Frontal Cortex) - areas vital to
learning, memory and higher level
thinking.
2. Parts of the adult brain retain the ability to
grow new neurons from neural stem
cells in a process called
NEUROGENESIS.

51. Neurobiological Effects of Physical
Exercise
Aerobic exercise- (30 minutes a day)
induces persistent beneficial behavioral and
neural plasticity as well as alternations of
gene expression in the brain.
A.Increased Neuron growth.
B. Improved declarative and working
memory.
C. Structural and functional improvements in
brain structures associated with cognitive
control and memory.

52. Aerobic Exercise
1. Running/Jogging.
2. Brisk walking.
3. Swimming
4. Cycling.
5. Rowing.
6. Skiing (especially cross country skiing)
7. Tennis

53. Structural Growth Effects of
Exercise on Brain MRI
Neuroimaging studies shows that consistent
aerobic exercise increased gray matter
volume in several brain regions associated
with memory,cognitive and motor control.
A.Prefrontal Cortex- required for cognitive control
of behavior, working memory,attentional control,
and cognitive flexibility.
B.Hippocampus- declarative and spatial memory.
C.Cerebellum- motor coordination and motor
learning.

54. Healthy Sleep Habits
1. Avoid caffeine, alcohol, nicotine and other chemicals
affect sleep.
2. Turn your bedroom into a sleep inducing environment.
3. Establish a soothing pre sleep routine.
4. Do not read in bed or watch TV in bed (the bed is for
sleeping !).
5. Keep a consistent sleep schedule.
6. Balance fluid intake- liquids cause urination !
7. Exercise early (not just before bedtime).
8. Keep naps short before (5 pm)
9. Finish dinner several hours before bedtime to avoid
indigestion.
10. Try and get consistent 7-8 hours of sleep each night.

55. Brain Healthy Nutrition
1. Diet low in processed sugars (under 30
grams a day).
2. Fruits and Vegetables stressed every
day.
3. Daily calories of between 1800 to 2000
unless lower amounts required for weight
loss or other medical need.
4. Avoid trans fats (unhealthy fats).
5. There is not a specific “Brain Diet”
known to work or be effective to

58. Kaiser Permanente Healthy Living
1. kp.org/healthyliving/nca (classes and
podcats).
2. kp.org/mydoctor (to choose a doctor).
3. San Rafael Medical Center and Novato-
Health Education Centers- 415-444-
2173.
4. Petaluma Health Education Center-

59. KP Preventative Care App-
(For I phone or Android compatible Smart phone)

60. Life Care Planning
• Who would speak for you if you were ever
unable to communicate for yourself ?
• Choose your healthcare agent now
and share with him or her what matters
most to you when it comes to health care.
kp.org/lifecareplan