As a person gets older, changes occur in all parts of the body, including the brain.
- Certain parts of the brain shrink, especially those important to learning and other complex mental activities.
- In certain brain regions, communication between neurons (nerve cells) can be reduced.
- Blood flow in the brain may also decrease.
- Inflammation, which occurs when the body responds to an injury or disease, may increase.
These changes in the brain can affect mental function, even in healthy older people. For example, some older adults find that they don’t do as well as younger people on complex memory or learning tests. Given enough time, though, they can do as well. There is growing evidence that the brain remains “plastic”—able to adapt to new challenges and tasks—as people age.
It is not clear why some people think well as they get older while others do not. One possible reason is “cognitive reserve,” the brain’s ability to work well even when some part of it is disrupted. People with more education seem to have more cognitive reserve than others.
(Source: National Institute of Aging)
Dr. Anne Foundas – The 3 M’s
Dr. Anne Foundas – Sleep and Aging
Dr. Heilman on Brain Health
Brain health can be influenced by lifestyle choices and other factors, including environmental stresses and traumatic brain injury. Lifestyle choices, such as the excessive use of alcohol, abuse of prescription pain medication, and the use of illegal drugs-of-abuse, can lead to disordered brain function and unhealthy brain aging. Brain disorders, such as multiple sclerosis, can produce brain injury that alters cognitive function and impacts brain health. Traumatic brain injury can impact the lives of children, adolescents, and adults. The Brain Institute of Louisiana is collaborating with local clinicians, scientists, and educators to improve access to care, and to advance science in order to improve brain health and these debilitating disorders.
ADDICTION: Alcohol & Substance Abuse
The National Institute on Drug Abuse defines addiction as a chronic and relapsing brain disease characterized by compulsive drug seeking and drug use, despite harmful consequences. Addiction disrupts the normal functioning of brain networks. Chronic exposure to addicting drugs, like heroin, amphetamines, and cocaine, can alter brain function. These drugs can mimic, disrupt, or amplify the brain’s own chemicals. Alcohol overuse, and prescription drug abuse can also lead to brain injury. These alterations in the brain impact behavior including how a person thinks, feels, and acts.
These brain changes can have a long-lasting impact, especially on the developing brain. It is important to know that the human brain continues to develop into adulthood with dramatic changes during adolescence. Adolescents who drink in excess, who abuse prescription pain medication, or who use other illegal drugs-of-abuse can become addicted and can develop brain changes. Scientists believe that these brain changes may explain the compulsive and destructive behaviors of addiction.
Addiction disorders can lead to brain injury directly through changes in brain networks. Addiction can also indirectly lead to brain injury because of associated high-risk behaviors. For example, a person may drive under the influence of alcohol and have a significant traumatic brain injury from a motor vehicle accident.
Prescription pain medications, like the opioid drug Oxycontin (Oxycodone HCL), have a high risk for addiction and dependence. Heroin has become a major drug-of-abuse with the current opioid crisis in America. These drugs can be overused and abused. Substance abuse leads to increased rates of suicide.
Alcohol can become habit-forming. Chronic overuse of alcohol is associated with loss of brain volume and disrupted brain function. Acute alcohol toxicity can lead to direct brain injury with life-threatening complications and long-term effects. Research shows that acute and chronic alcohol abuse can lead to shrinkage of the brain and to impaired memory, attention, and executive control.
All of these addiction disorders are associated with disrupted brain networks and unhealthy brain aging. Addiction disorders are preventable and treatable. If left untreated the problems associated with addiction can last a lifetime.
Source: National Institute on Drug Abuse
Stress-related Disorders & Posttraumatic Stress Disorder (PTSD)
Environmental stresses can lead to the development of posttraumatic stress disorder and other behavioral problems. These disorders can affect children, adolescents, and adults. Stressful events can have a major impact on an individual’s social, emotional, and cognitive development and can contribute to unhealthy brain aging.
Posttraumatic stress disorder or PTSD is a mental health problem that some people develop following a life-threatening event, like a natural disaster, a sexual assault, a car accident or military combat service. A critical factor in the development of PTSD is the exposure to an extremely threatening event. A person can either directly experience or witness this type of stressful event. Most people find it hard to fully resume normal activities after a major life stress. These individuals may feel on edge, have upsetting memories, or have trouble sleeping. The majority of these individuals will feel better in a few weeks or months without any long-lasting impact on behavior, emotions, memory or thinking.
As noted above, not every traumatized person develops short-term (acute) or long-term (chronic) PTSD. Symptoms of PTSD usually begin within 3 months of the traumatic event, but on occasion may not develop for many years. To make a diagnosis of PTSD disabling symptoms must last more than one month, and must be severe enough to interfere with work and/or relationships. A mental health professional, such as a psychiatrist or psychologist, can make the diagnosis.
The symptoms of PTSD are variable. Some symptoms include: re-experiencing the traumatic event, avoidance of situations that are reminders of the event, negative feelings and beliefs, and feeling keyed up or jittery with increased vigilance and arousal. Many people with a diagnosis of PTSD are treated for depression, alcohol, and drug abuse. Many people with PTSD have significant employment and relationship problems. Treatments for PTSD often target these related problems, and can improve long-term outcome.
Sources: National Center for PTSD – US Department of Veterans Affairs; National Institute of Mental Health
Multiple Sclerosis (MS)
Multiple sclerosis or MS is a demyelinating disorder of the brain and spinal cord that can lead to cognitive decline and disability. Demyelinating disorders, like MS, are associated with dysfunction in the immune system that leads to destruction of myelin. Myelin is the insulation that surrounds the axon of a nerve cell. Axons make up the white matter pathways that conduct neural signals throughout the nervous system. Destruction of white matter can lead to a variety of clinical problems depending on the location of the destructive “lesion.” Many people with MS have lesions in brain pathways with this destruction leading to cognitive problems including impaired attention, and learning and memory problems.
Guidelines published in April 2018 by the American Academy of Neurology (AAN) advise consideration of early treatment. The AAN recommends discussion of the benefits and risks of disease modifying treatment in adults who have had “a single clinical demyelinating event with two or more brain lesions that have imaging characteristics consistent with MS.” Disease modifying treatment should be considered in these patients who agree to this early treatment, and who do not have any contraindications to this treatment.
The goal of early treatment is to change or “modify” the course of the disease so that individuals with multiple sclerosis have fewer clinical episodes with less brain injury. This modification of the disease can lead to a better long-term prognosis with less cognitive decline and a reduction in disability.
Clinical relapses (i.e., recurrent clinical presentations) can leave a residual neurological deficit. For example, a patient may continue to have numbness or weakness following treatment. Over time relapsing disease may transition to a secondary progressive course with increased disability. Research has shown that disease-modifying treatment can improve long-term outcome in many people with a diagnosis of multiple sclerosis.
Longstanding MS can lead to whole-brain volume loss (i.e., atrophy). Brain atrophy can be associated with increased cognitive decline including changes in attention, executive and language function, and memory. MS patients may benefit from innovative treatments designed to enhance cognitive function.
Source: American Academy of Neurology (AAN)
Traumatic Brain Injury (TBI)
The Centers for Disease Control (CDC) defines a traumatic brain injury or TBI as a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury. Many people with a TBI experience changes in thinking, attention and memory. These changes can be short-lived or can evolve into a permanent pattern of deficit. TBI can occur in children, adolescents, and adults.
Those who survive a TBI may have memory loss, difficulty thinking, and feeling. Many people with TBI have behavioral, emotional, and physical disabilities that affect interpersonal, social, and vocational function. TBI can lead to maladaptive brain changes associated with lifelong cognitive, behavioral, and physical problems.
The severity of TBI is classified as: mild, moderate, and severe. The symptoms vary from person to person. Symptoms may resolve in one person and persist in another. The initial clinical presentation of a patient’s neurological signs and symptoms is important. The CDC estimates that TBI accounts for about 2.5 million emergency department visits, hospitalizations, and deaths annually in the United States. This number may underestimate the occurrence of TBI, as not all people seek urgent medical care. Of these patients with TBI reported by the CDC about 87% are treated and released, 11% are hospitalized and discharged, and 2% die.
An estimated 300,000 sports-related traumatic brain injuries occur in the United States each year. Most of these injuries are classified as a concussion. A concussion is defined as a temporary alteration of mental status as the result of head trauma. Most people with a concussion find that symptoms resolve over days or weeks. Symptoms are variable, and some people may have problems that persist for years. Symptoms include difficulty thinking and concentrating, feeling slowed down, and difficulty remembering new information. Recurrent concussions can lead to a more severe long-term problem with chronic brain changes and cognitive problems.
Many factors can influence long-term outcomes in TBI. The public health and economic burden of TBI is substantial; primary prevention remains the key public health strategy. A comprehensive and coordinated system of rehabilitation interventions is critical. Ongoing research and clinical trials with evidence-based guidelines should lead to improved quality of life for individuals and families.
Source: Centers for Disease Control and Prevention (CDC)