If you’ve never played Sudoku before, it really is fun- and simple. Rules: Put numbers in the squares so that 1-9 appear only once in each row, column, and 3×3 box.

The basic version of Smartkit Sudoku is free and can be played here.

The full version is $9.95 and can generate unlimited puzzles at 3 difficulty levels. There is a hint button and ‘Print’ ability so you can take & play your puzzles on the go. In addition to ‘pencil marks’, the full version has several additional nice features.

For short while, we’ll throw in our brand new PLEXUS puzzle ‘Medieval” when you purchase Smartkit Sudoku. (Click here to try our 1st PLEXUS puzzle- Olla Podrida).

Click here to try Smartkit Sudoku, and learn more about its features.

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New research adds further support to the idea that the higher your education level, the less likely you are to get Alzheimer’s disease and other forms of dementia.

The study found this to be the case even after adjusting for socioeconomic status and other medical diseases. [Education and dementia: what lies behind the association? 2007 Oct 2;69(14):1442-50. Neurology.]

The authors of the study conclude: “Higher educated persons may have a greater cognitive reserve that can postpone the clinical manifestation of dementia.”

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Note: The Mindfit software is currently available for purchase in the Smartkit Store here. Below you can read why the founder of the Smartkit website-a fellowship trained, board certified neurologist- decided to offer it for sale in the Smartkit store.

This article presents a review of Mindfit- a new computer program geared to train your brain. Many brain fitness programs have been released over the past year, and I have found this to be one of the most promising. As such, we’ve decided it’d be an appropriate addition to the smartkit store.

In a nutshell, Mindfit is a computerized brain gym designed to be used over an 8-12 month period of time (although you can still practice with the exercises after your training period is over).

It starts with several evaluation sessions, which are used to tailor the computer exercises to your specific abilities. The developers refer to this system as ITS- an Individualized Training System that adapts the difficulty level of the exercises to your abilities and performance as you advance.

After the evaluation session is complete, you train on Mindfit three times per week, 20 minutes a day, for 8 weeks. This process is repeated 3 times for a total of 3 rounds and 72 training sessions.

One important feature of Mindfit is that it continually provides feedback and analyzes your performance as you progress.

Another nice feature of Mindfit is that it tackles multiple cognitive domains. Many people think that by doing crossword puzzles every day (or more recently Sudoku puzzles), they’re doing a great job of exercising their brains. Unfortunately, this is just not true. To best train and sharpen your mind, you need to challenge it with lots of different puzzle types and activities. Novelty and challenge are crucial- otherwise you just won’t get the optimal benefit. Mindfit takes this into account, and features 14 skill areas that it goes to work on. These include:

• Working Memory
• Visual Short term memory
• Auditory short term memory
• Spatial Perception
• Planning
• Location Memory
• Naming
• Time estimation
• Inhibition
• Divided attention
• Hand-eye coordination

Is Mindfit for everybody? No. The exercises and overall difficulty level of the programs are mainly geared towards seniors, so I think those who are 50+ will find it most useful. However, because the software adapts to each individuals ability, even those younger can be challenged. Importantly, the developers have done an excellent job in making this software extremely easy to use. I suspect those who’ve never even sat down with a computer before will find it simple to set up and get started.

Over the last several years, quite a bit of research has come out showing that brain training exercises can in fact boost cognitive function (Click here to read about one of the most recent studies that appeared in JAMA, click here to read about a double-blind clinical trial that specifically showed MindFit improved short-term memory, spatial processing and attention/focus). For seniors looking to invest in a computerized brain gym, Mindfit represents a sophisticated piece of software that’s surprisingly easy to use.

Mindfit Demos:

Mindfit Demo #1: "Colored Walls"

Mindfit Demo #2: Picture Match"

MindFit Demo#3: Shape Arrangement"

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Last year I posted about the powerfully negative effects chronic stress has on your memory and brain. Now, a new study [Reference below] published in the June 12, 2007 journal of Neurology provides further evidence this is true by showing:

People who are chronically distressed are 40 percent more likely to develop Mild Cognitive Impairment (MCI) - a precursor to Alzheimer’s disease and other dementia syndromes.

These findings are consistent with dozens of earlier studies showing stress damages the hippocampus- the memory engine of the brain.

A related post relates how stress is sticky, and where in the brain it settles.

[Reference]: Chronic distress and incidence of mild cognitive impairment. R. S. Wilson, J. A. Schneider, P. A. Boyle, S. E. Arnold, Y. Tang, and D. A. Bennett. Neurology 2007 68: 2085-2092

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Researchers in Ireland have found that brain exercises in the form of rote memorization of poems, articles, and short stories leads to memory improvement.

The study was done on healthy adults aged between 55 and 70. They underwent six weeks of intensive brain exercises involving rote memorization of a newspaper articles or poems of 500 words, followed by six weeks of rest.

Interestingly, the improvement was not seen immediately. When the study participants were tested 6 weeks later, however, a clear improvement in verbal and episodic memory was noted.

Furthermore, changes were actually detected in the hippocampus via high tech brain scans called Magnetic Resonance Spectroscopy (MRS).

Dr. Richard Roche, a co-author of the study from the Department of Psychology at National University of Ireland in Maynooth:

The brain is like a muscle that should be exercised through the retirement years as a defense against dementia, cognitive lapses and memory failure

You can read more about the rote memory training study here. For an earlier smartkit article that discusses how brain training exercises can improve memory and cognitive function, click here.

For computer software that can enhance cognitive function, check out this review of  Mindfit  

[Reference: McNulty, J,. Paul Brennan, M.D., Colin P. Doherty, M.D., D. McMackin, M.D., S. Sukumaran, M.D., I.H. Robertson, Ph.D., M.A. Mangaoang, Ph.D., S.M. O'Mara, D.Phil., Sinead L. Mullally, Ph.D., J. Hayden, B.A., J. Prendergast, B.Sc., and M. Fitzsimons, Ph.D.. The Identification of Neurometabolic Sequelae Post-learning Using Proton Magnetic Resonance Spectroscopy. Presented November 26 at the annual meeting of the Radiological Society of North America (RSNA)]

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From a recent update posted on the Medscape Neurology section:

Researchers at the American Academy of Neurology 59th Annual Meeting presented preliminary results from a study showing that long term exposure to secondhand smoke alone increases your risk for dementia by about 30%.

If you’re interested in learning more about the potential mechansim by which cigarattes destroy your brain, click here to read this earlier post. 

Reference: American
Academy of Neurology 59th Annual Meeting: Abstract S01.005. April 28 – May
5, 2007.

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It is commonly said that "elephants never forget". From the website Elephant Voices:

Based on the evidence available, elephants seem to remember for years other individuals and places and learned skills. In experimental trials involving a large set of visual symbols and acoustic tones or commands captive elephants show exceptional ability to learn and retain information over long periods. Accounts by practised observers indicate that elephants are able to remember the voices (and perhaps scents) o individual people for over 12 years

How to explain this phenomenon? Recently came across some interesting research out of Caltech that looked at elephant brains with MRI technology:

The elephant has an unusually large and convoluted hippocampus compared to primates and especially to cetaceans.( MRI image above comes from the John Allman Lab at the California Institute of Technology).

In humans and other mammals, the hippocampus is the brain structure largely responsible for memory formation.

Within 5-8 years, I suspect neuroimaging technology will be far enough advanced that a quick 5 minute human brain scan will be able to assess hippocampal anatomy & connectivity, and rate a person’s:

1. Natural ability to memorize various pieces of information (semantic, episodic, procedural, etc…)
2. Susceptibility to develop Alzheimer’s disease and other types of dementia- decades before actual memory impairment sets in

On a further note regarding elephant intelligence, a recent study [Reference below] reveals that elephants can recognize themselves in mirrors- a sign of self-awareness.

To date, only 3 other animals have shown themselves capable of this task:

• humans
• dolphins
• apes

Reference: Plotnik JM, de Waal FBM, Reiss D. Self-recognition in an Asian elephant. Proc Natl Acad Sci U S A. 2006 Nov 7;103(45):17053-7

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Is the brain like the muscles in your body? Can it be trained with cognitive exercises to improve mental agility and sharpness as you get older?

Quite a bit of research has come out lately indicating that the answer to this question is a resounding ‘Yes’.

The most recent research I’ve come across is the ACTIVE study (Advanced Cognitive Training for Independent and Vital Elderly), published in the December issue of JAMA (reference below). The amazing findings indicate a mere 10 training sessions (each lasting 60-75 minutes) over a five week period was enough to significantly improve cognitive ability and brain power. Importantly, the brain boosting effect lasted more than five years.

The benefits were actually quite impressive. Dr. Sherry Willis, one of the chief authors of the study, notes: "The improvements seen after training roughly counteract the degree in decline in cognitive performance that we would expect to see over a 7-14 year period among older people without dementia".

The study included 2,832 participants over the age of 65.

For those over 50 looking for computer software that serves as a brain gym, check out our review of Mindfit brain trainig program.

JAMA. 2006;296:2805-2814. Long-term Effects of Cognitive Training on Everyday Functional Outcomes in Older Adults.

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Back in medical school, I remember a professor teaching us older patients tend to overreport memory problems and don’t really have much insight into the true status of their memory ability.

Now, a recent study published in the journal Neurology indicates that this may not be true.

The study looked at 40 people over the age of 60 who complained of memory problems but still had normal performance on detailed neuropsychological testing (i.e. cognitive and memory testing). Interestingly, the researchers found these patients actually had a significant reduction in brain gray matter in several regions:

• Bilateral hippocampal areas (the hippocampus is critical for memory function)
• Bilateral frontal regions
• Several other cortical and subcortical regions

In addition to enhancing the credibility of a patient’s insight when it comes to memory function, this study also raises another very important issue: Detailed memory tests may not be very sensitive at picking up organic memory impairment

Reference: Older adults with cognitive complaints show brain atrophy similar to that of amnestic MCI. NEUROLOGY 2006;67:834-842

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The headlines from the last few days would make you think so: “Folic Acid may boost brain power”, “Folic acid boosts minds of over-50’s”, “Folic acid improves memory in elderly”, “Folic acid boosts cognition in older adults”.

The truth, however, is that this new study published in The Lancet shows that folic acid provided cognitive benefits for those with high homocysteine levels. Patients (drawn from the Netherlands) that had normal homocysteine levels were not included in the study.

Is your homocysteine normal or elevated? If it is high, this study (along with several older studies) indicates your brain will likely benefit from folic acid supplementation.

Interestingly, however, there are many metabolic experts who believe that if your homocysteine level is at the upper limits of normal, there is still a benefit to be had from taking extra folic acid.

The metabolism of folic acid and homocysteine are closely intertwined. It has been shown that those who don’t consume enough folic acid will in turn have elevated homocysteine levels.

What are some good natural food sources of folic acid?

• Black-eyed peas, boiled, 1 cup: 210 mcg
• Lentils, 1/2 cup cooked: 179 mcg
• Beans, white, boiled, 1/2 cup 144 mcg
• Black-eyed peas, 1/2 cup cooked 120 mcg
• Broccoli, cooked, 1 cup 104 mcg
• Spinach, cooked, 1/2 cup 103 mcg
• Romaine lettuce, 1 cup 76 mcg
• Orange juice, 1 cup 75 mcg
• Wheat germ, raw, 2 Tbl 50 mcg
• Papaya cubes, 1 cup 53 mcg

[Source for Folate Food Content: Northwestern University]

The Lancet Folate study: Durga J, et al “Effect of 3-year folic acid supplementation on cognitive function in older adults in the FACIT trial: a randomized, double blind, controlled trial” Lancet 2007; 369: 208-216.

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A study which appears in the January issue of Neuropsychology indicates that a simple blood test- checking for uric acid levels- may help predict risk of cognitive impairment in older adults.

Patients with high-normal uric acid levels were found to have lower scores on tests of:

• mental processing speed
• verbal memory
• working memory

The question remains whether readily available drugs that reduce uric acid levels (i.e., allopurinol, probenecid, sulfinpyrazone) may benefit brain function in older adults with high uric acid levels.

Interestingly, a diet rich in purine rich foods is thought to elevate uric acid levels. Purine rich foods include animal meats- particularly beef, pork, and lamb. Shellfish is also thought to be a purine-rich food.

While researchers don’t fully understand the underlying pathophysiology that may explain the correlation between high uric acid levels and impaired brain power, nonetheless, it is known that high uric acid levels do correlate with several dementia risk factors such as:

• type 2 diabetes
• high blood pressure
• atherosclerosis

Article: “Serum Uric Acid and Cognitive Function in Community-Dwelling Older Adults,” David J. Schretlen, PhD, Anjeli B. Inscore, PsyD, H. A. Jinnah, MD, PhD, Vani Rao, MD, and Barry Gordon, MD, PhD, Johns Hopkins University School of Medicine, Godfrey D. Pearlson, MD, Johns Hopkins School of Medicine, Hartford Hospital/Institute of Living, and Yale University School of Medicine; Neuropsychology, Vol 21, No. 1

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One of the most common reasons patients get upset with neurologists is when we tell them they should no longer drive. Most older folks are very independent, and when you take their car away from them, they are not happy. In fact, many become belligerent and act as if you’re personally out to get them.

The most common reasons for prohibiting driving include seizures, Parkinson’s disease, and dementia.

What is dementia? It is very broad term that encompasses all the hundreds of things that can lead to poor brain function. In addition to impairing memory and overall cognitive ability, dementia greatly diminishes reflexes and reaction time, visual-spatial processing, as well as hand-eye-leg coordination. And it is very common.

How common? It’s estimated that 5-10% of the population aged 65 years or older has it. My guess is that amounts to millions upon millions of unfit drivers.The scary thing, however, is that no one is doing anything about it.

The laws are incredibly strict when it comes to punishing and taking away licenses of people who get DUIs (driving under the influence of alcohol). And rightly so, of course. We don’t want them killing us or our children.
But what about the tens of millions of drivers over 65 that are demented? I believe they also represent a major road hazard, and need to have their licenses pulled.

Came across an article on physorg.com that recently notes:

Researchers at the Alzheimer’s Disease Research Center (ADRC) of Washington University School of Medicine in St. Louis and elsewhere have developed a three-hour workshop that trains health care providers to identify potentially unsafe drivers with dementia and to encourage appropriate retirement from driving.

This is all well and good, but the vast majority of primary care physicians are too busy taking care of medical issues to have to worry about this sort of thing, and many are not expert enough in neurological assessment to determine when “appropriate retirement from driving” should take place.

If a state can make laws prohibiting cell phone use while driving, why can’t they make laws subjecting everyone over 65 to another driving test?

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As strange as this may sound, currently, there is no good scientific test for Alzheimer’s disease. In other words, there is no specific blood test, spinal fluid test, or brain imaging study (MRI, CT, PET) that can definitely tell whether you have the disease or not.

The diagnosis mainly rests on the neurologist’s clinical impression, which is based on an interview, examination, as well as some blood tests and an MRI of the brain to rule out other conditions which may mimic Alzheimer’s. Many times, especially during the early stages of the disease, physicians are uncertain of the diagnosis. Families are told that more time is needed to observe the patient, to see how the disease process unfolds. This uncertainty can lead to frustration.

The only real way to be 100% certain of the diagnosis is to autopsy the brain, which of course is not a good option in a living person.

Things may have just changed though, as the UCLA School of Medicine has announced they’ve developed a PET scanning technique that seems to offer the promise of a definite answer.

While still experimental, the scan utilizes FDDNP, a radioactive tracer that binds to the plaques and tangles typically encountered in the Alzheimer brain. The PET technique then provides physicians an actual picture of how much and where this tracer shows up in the brain.

I’d say this is significant breakthrough, as we are now much closer to identifying which people are going to develop Alzheimer’s disease years before they become symptomatic (see a related post discussing the early signs of dementia).

Additionally, the new study will enable researchers to more rapidly develop effective treatments, since they’ll be able to more objectively see what drugs are effective and which ones aren’t.

The study was published in the New England Journal of Medicine, December 2006.

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People who regularly act out their dreams at night have a disorder called REM sleep behavioral disorder (RBD). Frequently, these patients can injure themselves or their spouses and not even realize it.

During normal REM sleep, the part of the brain that activates movement of the arms and legs is gated closed and silenced, so that your limbs are paralyzed. When this mechanism fails, RBD ensues.

A recent study done by the Mayo clinic indicates that a startlingly large number of people with RBD (two-thirds!) will, within 11 years time, go on to develop a synucleinopathy: a neurodegenerative disease like Parkinson’s disease or Lewy Body dementia.

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