Brain health in is a topic not discussed often enough, especially within the medical community. The conversation around mental health and access to mental health services has been increasing in recent years, however the aging brain is often left out of the conversation. There are so many questions left unanswered surrounding the decline of brain health associated with aging. The medical profession has made observations about those who ultimately experience brain atrophy and those who don’t, so we are slowly gaining clarity. However, there are still many questions left unanswered.
Research has identified some clear correlations and patterns in those who ultimately receive a diagnosis of dementia. Keep in mind, however, that correlation does not equal causation. We know that balance problems and risk of falls increase with increasing severity of cognitive decline. We know poor mental health increases the risk of developing dementia. We know that muscle weakness is associated with greater risk of dementia. What is not entirely clear is why.
This is the 2nd part in a series on the connection between the brain and body written from the prespective of a geriatric physical therapist (here is part one). I feel fortunate to have fallen into a profession where I work with older adults while still in my 30s. It provides me a unique perspective into my future and the future of my loved ones, leaving me in a unique position to try to put the puzzle of cognitive decline together and put forth my best effort to prevent it before it happens. Unfortunately, I often do not get referred to patients and their families until they are experiencing physical decline in conjunction with mental decline, leaving me in a position to trace backwards to form a clear picture of what that person was like before they had dementia.
In Part One in the series on Brain Health we covered the complex topic of chronic pain and it’s impact on the brain. The next topic in our series on movement and brain health is balance. We’ve heard the term “balance” used in several different contexts in recent years, but today we are here to talk about our physical balance.
Balance is a complex interaction between our brain, how we sense our environment, and how our brain communicates this information with our body. Our brain uses our senses, like sight, sound, and sensation, to form a map of our physical position in space. Using this information, our brain communicates with our muscular system to keep us upright as we move through our environment. A decline in any one or more of these systems leads to a balance issue (for more on the specifics of balance click here).
We can take a look at how balance changes with decreasing cognitive function and use this information to our advantage. Tapping into our balance systems gives a connection to the brain to keep us stimulated and engaged with our environment, which facilitates healthy processes of the brain. Keeping the brain stimulated regenerates the cells of the brain, which in turn helps our brain maintain a strong connection with the body.
First, we need to address the issue of falls. What is a fall anyway? Part of the problem in identifying falls is confusion surrounding what actually defines a fall. A fall is defined as any uncontrolled decent. Plopped into your chair? That was a fall. Trip but caught yourself on a piece of furniture? That was a fall too.
We all fall. Falling is a part of life as mobile human beings. It is when falls become to frequent or there is an inability to recover from falls that we realize balance has become problematic. Falling in older adults is a public health problem that has grown in awareness in recent years. However, there are many solutions available to be more proactive about balance long before falls become a problem! We will talk about developing awareness of your own balance after looking at the latest research regarding balance, walking, and brain health.
Research has found that the incidence of falls and balance problems increases with the severity of cognitive impairment. This is due to a variety of factors including impaired judgement of unsafe activities, perception of the environment, and delayed balance reactions. Even those with mild cognitive decline are starting to show a decline in balance.
Research has also found walking speed is a powerful early predictor of cognitive decline. Not only is walking speed an indicator of overall physical health but also of the effeciency of central nervous system processing. Walking speed has been found to decline even years prior to an onset of a decline in brain health.
In order to understand why this is happening, we need to talk about executive functions of the brain. Executive function is a set of mental skills that helps us plan and organize complex tasks throughout our day to day routine. Walking requires heavy involvement of the executive functions of the brain. For most of us, we don’t even give walking a second thought because the skill is so ingrained in our brain. It is not until something is going wrong that we become aware of how complex this automatic skill really is.
So why should we care about these research findings? The connection between our mobility and our brain health forms a cycle that feeds into itself. We can use this information to take action today to improve our physical health for the many benefits it provides to brain health.
To make this point more clear, we can take a look at childhood development to understand this connection between the brain and body. Child initially develop motor skills, like rolling, crawling, and eventually walking because they use their senses to observe their environment. Their curiosity drives their desire to explore the world around, which would not be possible without the ability to move in some way. Their ability to explore their environment in turn directly impacts the development of their brain. Without mobility, their learning ability may become impaired. This is why a delay in muscular development or the sensory system in children can turn into a developmental delay over time. In children this connection between mobility and brain development is a little more obvious than it is in adults, but the same principles still apply.
Sorting through the latest movement science research and turning into action is at the core of our jobs as therapists. So how can you turn this knowledge you have gained about balance, walking, and brain health into action? Just get moving! And challenge your senses while you are moving. Bring more mindfulness to your movement by exploring new environments to maximize the benefits to brain health. And if you are not feeling so confident about your movement, see a physical or occupational therapist for an assessment and customized plan.