Research Tends to Confirm The Importance of Patient Engagement For Patients To Be “Superagers”

The New York Times has an interesting article reporting research on the importance of engagement in helping people be “superagers.”  While I am not sure I like the phrase, with all its competitive implications, nonetheless the research is useful for those working to keep patients engaged not only with their own health situation, but also with institution and system improvement.

Specifically, the writer, Lisa Feldman Barrett, describes her imaging research into those with highest cognitive functioning in old age.

Our lab used functional magnetic resonance imaging to scan and compare the brains of 17 superagers with those of other people of similar age. We succeeded in identifying a set of brain regions that distinguished the two groups. These regions were thinner for regular agers, a result of age-related atrophy, but in superagers they were indistinguishable from those of young adults, seemingly untouched by the ravages of time.

What are these crucial brain regions? If you asked most scientists to guess, they might nominate regions that are thought of as “cognitive” or dedicated to thinking, such as the lateral prefrontal cortex. However, that’s not what we found. Nearly all the action was in “emotional” regions, such as the midcingulate cortex and the anterior insula.

My lab was not surprised by this discovery, because we’ve seen modern neuroscience debunk the notion that there is a distinction between “cognitive” and “emotional” brain regions.

But the most interesting part of the analysis is prescriptive:

Of course, the big question is: How do you become a superager? Which activities, if any, will increase your chances of remaining mentally sharp into old age? We’re still studying this question, but our best answer at the moment is: work hard at something. Many labs have observed that these critical brain regions increase in activity when people perform difficult tasks, whether the effort is physical or mental. You can therefore help keep these regions thick and healthy through vigorous exercise and bouts of strenuous mental effort. My father-in-law, for example, swims every day and plays tournament bridge.

The road to superaging is difficult, though, because these brain regions have another intriguing property: When they increase in activity, you tend to feel pretty bad — tired, stymied, frustrated. Think about the last time you grappled with a math problem or pushed yourself to your physical limits. Hard work makes you feel bad in the moment

One way of looking a this from a patient partnering point of view is that really engaging to improve the institution or the system can make you feel “tired, stymied, frustrated.”  But it is worth it in terms of maintaining capacity.  (The article makes clear that really vigorous exercise is also helpful, a lesson I am less willing to internalize — maybe extra blog writing will compensate for lack of exercise, I certainly prefer it!)

But the author is explicit:  “This means that pleasant puzzles like Sudoku are not enough to provide the benefits of superaging. Neither are the popular diversions of various “brain game” websites.

The article also links to a paper here, which, quoting the abstract, explains that:

Reviewing converging evidence from cybernetics, animal research, cognitive neuroscience, and social and personality psychology, we suggest that cognitive control is initiated when goal conflicts evoke phasic changes to emotional primitives that both focus attention on the presence of goal conflicts and energize conflict resolution to support goal-directed behavior. Critically, we propose that emotion is not an inert byproduct of conflict but is instrumental in recruiting control.

So, the complexities of true engagement would appear to be very good for the patient — and probably also for the professional care team.  Disagreement in the patient and professionals team is not a bad thing — unless it is not resolved in a positive and helpful way that includes improvement.

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