A decade has passed since we published a comprehensive review in this journal addressing the topic of promoting successful cognitive aging, making this a good time to take stock of the field. Because there have been limited large-scale, randomized controlled trials, especially following individuals from middle age to late life, some experts have questioned whether recommendations can be legitimately offered about reducing the risk of cognitive decline and dementia. Despite uncertainties, clinicians often need to at least make provisional recommendations to patients based on the highest quality data available. Converging lines of evidence from epidemiological/cohort studies, animal/basic science studies, human proof-of-concept studies, and human intervention studies can provide guidance, highlighting strategies for enhancing cognitive reserve and preventing loss of cognitive capacity. Many of the suggestions made in 2010 have been supported by additional research. Importantly, there is a growing consensus among major health organizations about recommendations to mitigate cognitive decline and promote healthy cognitive aging. Regular physical activity and treatment of cardiovascular risk factors have been supported by all of these organizations. Most organizations have also embraced cognitively stimulating activities, a heart-healthy diet, smoking cessation, and countering metabolic syndrome. Other behaviors like regular social engagement, limiting alcohol use, stress management, getting adequate sleep, avoiding anticholinergic medications, addressing sensory deficits, and protecting the brain against physical and toxic damage also have been endorsed, although less consistently. In this update, we review the evidence for each of these recommendations and offer practical advice about behavior-change techniques to help patients adopt brain-healthy behaviors.

IntroductionIncreased physical exercise is linked to enhanced brain health and reduced dementia risk. Exercise intervention studies usually are conducted at facilities in groups under trainer supervision. To improve scalability, accessibility, and engagement, programs may need to be structured such that individuals can execute and adjust routines in their own homes.MethodsOne hundred eighty-three healthy older adults from two sites (the United States and Sweden) were screened. One hundred fifty-six subjects (mean age 73.2), randomly assigned to one of four interventions (PACE-Yourself physical exercise program, mindfulness meditation, or Cogmed® adaptive or nonadaptive computerized working memory training) began the study. All interventions were structurally similar: occurring in subjects' homes using interactive, web-based software, over five weeks, ∼175 minutes/week. In the PACE-Yourself program, video segments presented aerobic exercises at different pace and intensity (P&I). The program paused frequently, allowing subjects to indicate whether P&I was “too easy,” “too hard,” or “somewhat hard.” P&I of the subsequent exercise set was adjusted, allowing subjects to exercise at a perceived exertion level of “somewhat hard.” Program completion was defined as finishing ≥60% of sessions.ResultsA high percentage of participants in all groups completed the program, although the number (86%) was slightly lower in the PACE-Yourself group than the other three. Excluding dropouts, the PACE-Yourself group had a lower adherence rate of 93%, compared with the other three (∼98%). Over the five weeks, PACE-Yourself participants increased exercising at the highest intensity level, consistent with augmented aerobic activity over time. The number of exercise sessions completed predicted the postintervention versus preintervention increase in self-reported level of physical activity.DiscussionThis study supports the feasibility of a home-based, subject-controlled, exercise program in which P&I is regulated via real-time participant feedback, which may promote self-efficacy. Further study is needed to determine if similar results are found over longer periods and in more diverse populations.

IntroductionConverging evidence suggests that increasing healthy behaviors may slow or prevent cognitive decline.MethodsWe piloted a six-month, randomized, controlled investigation of 40 patients with mild dementia, mild cognitive impairment, or subjective cognitive decline. The intervention consisted of weekly motivational interviewing phone calls and three visits with a “Brain Health Champion” health coach, who guided participants to achieve personalized goals. Changes in behavior were measured using validated questionnaires.ResultsCompared with the standard-of-care control group, Brain Health Champion participants had statistically significant and clinically meaningful increases in physical activity (Cohen's d = 1.37, P < .001), adherence to the Mediterranean diet (Cohen's d = 0.87, P = .016), cognitive/social activity (Cohen's d = 1.09, P = .003), and quality of life (Cohen's d = 1.23, P < .001). The magnitude of behavior change strongly predicted improvement in quality of life.DiscussionOur results demonstrate the feasibility and potential efficacy of a health coaching approach in changing health behaviors in cognitively impaired and at-risk patients.

Introduction The often‐cited mechanism linking brain‐derived neurotrophic factor (BDNF) to cognitive health has received limited experimental study. There is evidence that cognitive training, physical exercise, and mindfulness meditation may improve cognition. Here, we investigated whether improvements in cognition after these three types of structured interventions are facilitated by increases in BDNF. Methods A total of 144 heathy older adults completed a 5‐week intervention involving working memory/cognitive training, physical exercise, mindfulness meditation, or an active control condition. Serum BDNF levels and Digit Symbol Test (DST) performance were measured pre‐ and post‐intervention. Results Linear mixed models suggested that only the cognitive training group demonstrated augmentation of BDNF and DST performance relative to the control condition. Path analysis revealed that changes in BDNF mediate intervention‐related improvement in task performance. Regression analyses showed that, across all intervention conditions, increased BDNF levels were associated with increased DST scores. Discussion This study appears to be the first to suggest that BDNF helps mediate improvements in cognition after working memory training in healthy older adults. Highlights Older adults were randomized to physical activity, mindfulness, cognitive training (computerized cognitive training (CCT), or control. CCT, but no other condition, led to increased serum brain‐derived neurotrophic factor (BDNF) levels. CCT led to improvement on the untrained Digit Symbol Test (DST) of speed/working memory. Path analysis: increases in BDNF mediate intervention‐related improvement on DST. Increases in BDNF associated with improved DST across all experimental groups.

No abstract

Background: Evidence suggests that engagement in cognitively stimulating activities may reduce risk of cognitive deterioration and dementia. Mechanisms underlying these observations remain to be determined. Animal research indicates that brainderived neurotrophic factor (BDNF) plays an important role in neural plasticity, neurogenesis, synaptic growth, and cognitive performance. Working under the assumption that augmented BDNF levels benefit brain function, investigations of human subjects have focused on determining whether physical or mental activities can increase BDNF levels. Surprisingly little research has been devoted to linking alterations in BDNF to changes in cognition. This study aimed to determine whether changes in BDNF contribute to the enhancement of cognitive performance after computerized cognitive training (CCT). We have demonstrated that five weeks of CCT emphasizing working memory (WM) was associated with improvement on an untrained test of WM/processing speed, the Digit Symbol Test. Here, we investigated whether this improvement was mediated by changes in BDNF levels. Method: Seventy-five older adults, ages 65-86, at two sites (USA and Sweden) were randomized to either Cogmed Adaptive (n=37) or Non-Adaptive (active control) (n=38) CCT. Under the adaptive CCT, task difficulty was revised on a trial-by-trial basis to create a consistently high level of challenge. Under the active control condition, task load remained at a constant, relatively low level. CCT was performed in the homes of participants, five days per week, over five weeks. Serum BDNF levels and performance on Digit Symbol were measured pre-and post-intervention. Result: Analysis using linear mixed models demonstrated an interaction between time and intervention group for Digit Symbol score (p=.036) and BDNF level (p=.013) Only the adaptive CCT group demonstrated an augmentation of BDNF level (p=.014) and improvement in Digit Symbol scores (p<.001) after training. Mediation analysis

Background: Evidence suggests that brain-healthy behaviors, such as exercise, a Mediterranean diet, and cognitive/social stimulation, help protect against the risk of cognitive decline and dementia. We have been studying two interventions (health coach vs. physician education) that promote brain-healthy behaviors in patients with mild dementia (MD), mild cognitive impairment (MCI), subjective cognitive decline (SCD), and those at-risk. When COVID-19 occurred, we became interested in deter-

Background Extensive evidence suggests that adherence to brain‐healthy behaviors can slow the rate of cognitive decline and decrease risk of dementia. We previously demonstrated that a health coaching intervention, including weekly phone calls, facilitated adherence to recommendations for brain‐healthy behaviors in older adults with mild cognitive impairment (MCI) or mild dementia. The current study extends this research to include cognitively normal, older adults at risk for dementia and adds a mobile health platform, two‐way texting, and wearable fitness trackers, to the health coaching intervention. Although subjects are still enrolling, the number of participants has increased substantially from our earlier report and data show promising trends. Method Participants, age 60‐79, with MCI or dementia risk factors are being randomized to the Brain Health Champion (BHC) intervention or a counseling and education (CE) control. In BHC, with guidance from a health coach, participants set personalized goals, reinforced by weekly video calls, mobile messaging, one dietitian consult, and 30‐minute in‐person or virtual visits every six weeks. In CE, educational materials sent every six weeks supplement usual care. Changes in physical activity, diet, social/cognitive engagement, neuropsychological test scores, and metrics of behavioral health are being measured over six months using questionnaires, wearable fitness trackers, and photographed food logs. Maintenance of behavior changes is also being assessed six months post‐intervention. Result Thirty‐four participants have enrolled in the study, with 27 (15 BHC, 12 CE) completers to date. All participants successfully operated the mobile technology by themselves or with caregivers’ assistance. Current trends show BHC participants increased participation in cognitive activities and adherence to a Mediterranean diet based on photographed food logs compared to CE. Participants in both arms show significantly increased scores on the composite neuropsychological assessment (pre‐ and post‐study), quality of life measures, and an increase in active minutes from pre‐ to post‐assessments. Conclusion Trends in the data indicate that the BHC program may be effective for promoting brain‐healthy behaviors, particularly increasing cognitive activities and Mediterranean diet adherence. Additionally, participating in a brain health study, regardless of intervention, may promote meaningful changes in quality of life and improved cognition.