This Week's Micro Resolution: Hearing Loss

 
Happy Monday, and welcome to your final micro resolution for the month of August: hearing loss!

As a reminder, our micro resolutions for the past month have been:

​It is estimated that 26.8% of adults over age 65 have hearing loss. Left untreated, hearing loss can lead to social isolation (a known risk factor for dementia), depression, anxiety, falls and reduced mobility. It has been estimated that eliminating hearing loss, a modifiable age-related condition linked to dementia, could reduce the risk of dementia in the general population by 9%.
 
In the 80s, it was learned that patients with Alzheimer’s Disease (a type of dementia) had twice the prevalence of hearing loss. Since then, studies continue to demonstrate the risk of dementia is higher in patients with hearing loss than compared to healthy controls, and greater hearing loss corresponds to a higher risk of cognitive decline. This has been observed in people as young as 55 years of age.
 
Exact pathophysiology is under debate, but current thinking is that hearing loss leads to structural and functional brain changes.  
 
Unfortunately, it is common for people to chalk up initial hearing difficulties to advancing age. The National Institute on Deafness and Other Communication Disorders (NIDCD) states, on average, people experience hearing loss for up to seven years before seeking treatment.
 

What can we do to prevent or address hearing loss?
 
You can start here with this NIH survey.
 
If the survey indicated a need for an evaluation OR if you have concerns about your hearing, contact your concierge physician and discuss the need for a hearing assessment. According to AARP, original Medicare will only cover an audiology evaluation if it is via referral.
 
You can locate an audiologist in your area by contacting the American Academy of Audiology.
 
Studies show higher scores on cognition tests after use of hearing aids. Fortunately, in 2022, the FDA created greater access to hearing aids by allowing them to be sold direct to consumers, in-stores or online. If it turns out you need hearing assistance, you can purchase hearing aids at your local pharmacy or even on Amazon, ranging in price from $99-$3,000. Unfortunately, original Medicare does not cover hearing aids or fittings.

This Week's Micro Resolution: Lifelong Learning

 
Happy Monday! This week, we're asking you to challenge yourself to rewire your brain by learning something new.

As a reminder, our micro resolutions for the month of August are:
​

​Stimulate Your Mind

When you laced your shoes this morning, did you think about it? When you cracked an egg this morning, did you bring awareness to it? How about when you zipped your jacket? Buttoned your shirt? Or how about when you put the car in reverse and pulled out of the driveway? Your answer is likely, no. You just did it because you know how and the act of doing it has become second nature, muscle memory. These are some examples of tasks in which we run on autopilot.

Can you think back to how challenging it was to learn these day-to-day activities? Maybe you even recall your own child or are now witnessing a grandchild learning something new every day! 

When we learn, the brain rewires itself. At the chemical, cellular and structural level this stimulation causes brain remodeling. The same would happen if there was an injury, such as a stroke. We have discussed this process before—called brain plasticity.

When we are young and everything is new, plasticity is high! Brain plasticity diminishes with advancing age because of that “autopilot” nature in which we complete everyday tasks. At some point you just know stuff and less is new to your brain.

There was a time when it was believed that brain plasticity wasn’t possible after a certain age but, now, thanks to the work of Dr. Marion Diamond, we know that is not true. The brain can be rewired in adulthood—it just requires that stimulation of learning something new and something sufficiently difficult for the learner.

​
​How about brain games?

The topic of lifelong learning would not be complete without addressing “Brain Games.” There is a plethora of options out there: from the basic crossword puzzle to mahjong to some fancy video games specifically designed to stall cognitive decline. There is also a significant debate in the scientific community about whether these games really work or are a gimmick. We have waded through the studies and have not come out on either side with a firm recommendation, except to say living a cognitively active lifestyle is a good idea.

If you enjoy crossword puzzles and Sudoku, keep it up! If you and your friends enjoy a weekly game of cards, keep it up. If you have disposable income and are curious about computer brain games, such as Luminosity, explore! Unfortunately, no, watching Jeopardy does not count! In fact, watching TV for 3.5 hours or more a day is associated with cognitive decline. 

This Week's Micro Resolution: Social Engagement

 As a reminder, we are tackling a different lifestyle modification each week of August. Last Monday, we examined engaging with art or music as two non-pharmaceutical interventions known to positively influence certain symptoms in neurodegenerative conditions, including: behavioral symptoms (agitation), and psychological symptoms (depression and anxiety), memory, and socialization. That last benefit, socialization, bridges the conversation to this week’s topic: isolation/loneliness.

 
As a reminder, our micro resolutions for the month of August are:

How Our Health May Suffer as a Result of Isolation and Loneliness

 Isolation is described as the objective reality of truly existing with a deficit of social bonds. Loneliness is described as the subjective experience where an individual may be surrounded by people but does not feel connected and supported. While the two may not be synonymous in the literature, both experiences negatively impact one’s mental health and overall health. Being or feeling disconnected has been equated with such negative consequences to health as smoking 15 cigarettes a day. A recent John’s Hopkins study found socially isolated adults have a 27% higher chance of developing dementia.

As with many associations, the exact molecular mechanism is not well understood, but there are biological indicators worth examining in those who are less socially connected:

• The immune system is impaired
• Inflammatory biomarkers are higher 
• Abnormal brain structures have been noted
  
  

All these biological indicators are associated with cognitive decline and neurodegeneration.
Interestingly, research now believes this association may be bidirectional. Meaning lack of social connections/community may drive cognitive decline and cognitive decline may also drive social isolation. The thinking is that, with cognitive decline, comes with a lack of confidence in one’s ability to effectively communicate, thus leading individuals to wall themselves off from social interactions.
 
Access to technology has been found to reduce social isolation in the elderly. Churchgoers have also long been studied for their keen sense of social bonds.


How to Avoid Social Isolation or Loneliness
 
Many of our micro resolutions are tied to group activities which can foster a sense of community for an individual. They also involve learning something new, which we address next week. Examples of these include taking classes in exercise, cooking and art/music. However, it can be intimidating to take that first step, so this week our micro resolution isn’t something you do for yourself, it is something you can do for another person.
 
This week we ask you to consider the people you know who may be lonely or isolated, a person who recently lost a pet or spouse, a neighbor who lives alone, a quiet coworker, etc. and extend yourself to them.
 
Invite that person for a walk or a cup of coffee, drop off a home-cooked meal and chat a few moments, etc. When the holidays come or at your next gathering, maybe you’ll invite this individual. We are fairly confident this selfless act will be as beneficial for you as the person to whom you extend yourself.

This Week's Micro Resolution: Music & Art Therapy

Good morning and welcome to August!
 
We are taking a slightly different approach to our mini resolutions this month with four different brain brawn micro resolutions for the month—a new one in each week—instead of one overarching resolution!

(Do you recall April's Nature micro resolution?) 

​
​Our mini resolutions for the month of August will be:

A Music and Art Therapy Brain Brawn

 Music and art therapy are two non-pharmaceutical interventions with a long track record of positively influencing certain symptoms in neurodegenerative conditions.
 
Music and art therapy have been shown to improve behavioral symptoms, like agitation, and psychological symptoms, depression and anxiety, in addition to enhancing memory and encouraging socialization. These beneficial findings occur whether the patient is simply an observer OR holding a paint brush or musical instrument.
 
Music and art have been described as a scaffolding between the deteriorating areas of the brain and the preserved areas, which is quite remarkable and fascinating. Interestingly, a 2023 meta-analysis of studies involving music and neurodegeneration found that 93% of the 107 studies analyzed demonstrated at least one benefit of music on neurodegenerative conditions. While the exact molecular mechanism isn’t completely understood, a few things are established:
 
Music Therapy Mechanism of Action:

• Musical training can induce brain plasticity. In other words, in response to stimuli, adaptive structural and functional changes can be made to the brain. This can be as extensive as recovering from a stroke or simply learning something new. This connection between music and learning was tapped into by the Saturday Morning cartoon, Schoolhouse Rock.
• Listening to or playing music can stimulate the release of the neurotransmitter, dopamine, which helps regulate learning, memory processing and cognitive function.
• Music can stimulate autobiographical memory. Indeed, this connection is often resistant to decline.
• Music can even epigenetically influence genes! This is known as “sensogenomics,” meaning music can turn on certain genes. In this context, these genes may protect memory and cognition.

 
Art Therapy Brain Benefits:

• Enhanced memory recall (particularly through collage making)
• Reinforced sustained attention and intellectual engagement
• Encouraged bottom-up and top-down cognitive processing. These are two different theories about how the brain processes information delivered via the senses. Top-down processing is when the brain takes in the information as a whole and breaks it down to the smallest, minor aspects. Bottom-up processing refers to the idea that individual elements are taken in, one by one, and pieced together to create the entire structure as it is seen.

 
What does this mean for those of us wishing to ward off neurodegenerative conditions?
 
It means that enjoying the arts, either as a participant or an observer, may be beneficial for the structure and processing of the cognitive function of the brain. It also means we can potentially create a reservoir of memories accessible to us via the arts.
 
Let’s look at a few options and resolve to tap into just one of these ideas this month.

​But how do we connect music and art to our memories?
 
Make a collage. It has likely been a few decades since you used old magazines to create a vision board or a story about your life. But pull out the glue and glitter, old magazines and photos. Theme each collage about either a particular person or persons, or a memorable time in your life. Alternatively, you can make a memory jar with the collage on the exterior, with trinkets and tokens inside that remind you of the person or time in your life. Better yet? Make these in conjunction with the relevant individuals and share the stories, laugh and cry together enjoying the time and, all the while, deepening your memory reservoir.
 
Create playlists about a particular person/s or a time in your life. Journal your relevant thoughts to the selected music or use this playlist while making your collage.
 
On a side note, if you are a caregiver to someone with a neurodegenerative condition, you may wish to explore Meet me at MOMA. Note this is a program local to NY, but MOMA has a written program so that other museums may follow suit.