Early in Nurturing the Older Brain and Mind, Pamela Greenwood and Raja Parasurman lay out evidence that age related cognitive decline and loss of plasticity are not universal. They pose the question, “Why do some individuals undergo cognitive decline late in life whereas others do not?” In asking this question, and in answering it, the authors push the field of neuropsychology down an important path: toward addressing critical questions of brain and cognitive health for patients and the general public.
In an intellectual endeavor reminiscent of Seligman's (Reference Seligman and Csikszentmihalyi2000) foray away from psychopathology and toward positive psychology, Nurturing the Older Brain and Mind draws our focus away from the more familiar terrain of diseases of cognitive decline toward factors influencing healthy cognitive outcomes in later life. Particularly in the context of healthcare reform, where our profession's relevance will depend, in part, on our ability to contribute to prevention and improve patient's health outcomes, Greenwood and Parasurman's book is particularly timely.
As it turns out, many of the same variables that positively influence cognitive outcomes in later life, such as exercise and low fat diets, also influence outcomes in the most common chronic diseases. As neuropsychologists educate patients who want to preserve their cognitive faculties (and who doesn't?) about pathways to healthy cognitive aging, such as those found in Nurturing the Older Brain and Mind, we could simultaneously assist our primary care colleagues in their efforts to lower healthcare costs by avoiding costly chronic disease complications. By incorporating this type of “neuroeducation” into our assessment process (and letting our primary care colleagues know that we are doing so) we may begin to shift the perception of the neuropsychological assessment procedure from a cost “increaser” in the healthcare system, to a potential cost “decreaser”.
Nurturing the Older Brain and Mind reviews literature demonstrating that three common myths of cognitive aging are untrue: the number of 1) neurons, 2) dendrites, and 3) synapses between neurons, all inevitably decline with age. Instead, the review demonstrates that age related changes are more subtle and localized, and can be reversed in certain circumstances.
Chapter 4 introduces a central concept of the book: the interaction of both brain plasticity and cognitive plasticity produces successful cognitive aging. Greenwood and Parasurman hypothesize that aging brains can be reorganized both by responses to subtle losses in neuronal function that may accompany aging, and also by new cognitive demands. The system works, though, only when neuronal plasticity mechanisms are in place. The authors identify five factors that influence outcomes of cognitive aging by enhancing the mechanisms of plasticity and address these in separate chapters: novel experiences in childhood, exercise, diet and nutrition, estrogen and cognitive enhancing drugs, and cognitive training/learning.
As likely for most readers of this book, I found that I engaged with the text on multiple levels: as a professional searching for information to help my patients, as a lifespan neuropsychologist fascinated by advances in our understanding of brain development and aging, and as a person whose own brain is aging over time. Chapter 6 is particularly compelling on all of these levels. It reviews the evidence that aerobic exercise can reduce or eliminate cognitive changes associated with healthy aging, and most particularly improve executive function. Chapter 7 addresses diet. The research on restriction of calories for cardiovascular health is compelling, if difficult to put into practice. High fat, high calorie diets have negative effects on cognition, while resveratrol (found in red wine) may have benefit similar to dietary restriction.
The writing style of Greenwood and Parasurman varies, at times dramatically, throughout the book. In an effort to make the book accessible to a broad audience, the authors helpfully end each chapter with a summary section, reiterating main points and conclusions. At times they offer assistance to lay readers as research is described, including explanations of basic terms within the text, such as “meta-analytic research study.” At many other points, though, the writing is accessible only to those with a neuroscience background. Readers are left to sort through dense sentences involving neuroanatomy, with little or no commentary or assistance. Non-specialist readers will have difficulty making their way though much of the text.
As a neuropsychologist, Nurturing the Older Brain and Mind, invigorated and expanded my ideas about how I can help my patients in the context of a traditional diagnostic practice: I read this book with a growing intention to use the information to educate patients and primary care colleagues about lifestyle factors and actions patients can take to make cognitive health a more likely outcome as they age. As a person who regularly sees the ravages of unsuccessful cognitive aging in my practice, and sometimes worries that this is where I too will end up, I read the book with an eye towards adjusting my own lifestyle factors. Much to their dismay, as the book addresses cognitive benefits of exercise and diet throughout the lifespan, including in childhood, my children's lifestyles have not escaped the effects of this book either. In writing this book, Greenwood and Parasurman take our field in a timely direction that will benefit our patients, our practices, and our own aging brains.
