A vast and thought-provoking topic
The World Health Organisation (WHO) in its report Optimizing brain health across the life course: WHO position paper (2022) has outlined, in considerable detail, twenty-five determinants relating to brain health. These have been clustered under five categories, namely: (1) Physical health – seven determinants: Maternal health, intrauterine environment/ Genetic and epigenetic factors/ Nutrition/ Infections/ Noncommunicable diseases (NCDs)/ Health behaviours/ Traumatic injuries; (2) Healthy environments – six determinants: Safe use of chemicals/ Protection from radiation/ Healthy and safe workplaces and agricultural practices/ Air and water quality/ Stable climate/ Access to preserved nature and health-supportive built environments; (3) Safety and security – three determinants: Physical safety/ Financial security/ Humanitarian crises and emergencies; (4) Learning and social connection – five determinants: Education/ Lifelong learning/ Nurturing care/ Social connection, social isolation/ Social networks; (5) Access to quality services – four determinants: Integrated care at all health and social levels/ Skilled workforce and interdisciplinary teams/ Access to essential medicines, diagnostics and health products/ Carer support. The reader is referred to the publication itself for detailed comments concerning categories and determinants.
The WHO report outlines a complicated gamut of requirements concerning resources and improvements at local, national and global levels. The task of comprehensively addressing contemporary obstacles is truly immense. Additionally, when inadequacies occur, they very often are both concurrent and interlocked with the result that life-affirming assistance can be time-consuming, multi-faceted and expensive. Even so, depending on the circumstances and wellbeing of individuals and communities, such determinants are worthy of deliberation by governments when provision for brain health is being evaluated. This article is not intended in any way to address this myriad of challenges though it does touch on areas of innovations and developments – particularly regarding biological research, beneficial technologies, and lifestyles – which are highly relevant to many of them. An objective is to emphasise the advantages of covering all three of these subjects – asking for specialists’ opinions as necessary – when assessing and arranging well-targeted schedules for everyone with deteriorating cerebral conditions and their guardians.
Constructive steps onward in learning about the brain
“Sitting on your shoulders is the most complicated object in the known universe.” (Michio Kahu)
Scientific investigations have made remarkable progress in our comprehension and understanding of the human brain which controls essential key characteristics of daily living, for instance, thought processes, memory, language, emotion, movement, and decision-making. It contains billions of neurons and its neural networks are extremely intricate. Nonetheless, it is a relatively small organ, roughly around 1.4 cubic litres, but with substantial variations in volume. Its weight is approximately 1.3 to 1.4 kilograms, only around 2% of the total body weight, and it is generally larger and heavier among males. (As an aside, it may be pertinent to note that autopsy of Einstein’s brain indicated that it was smaller than average for men.)
Due to the complexity of the brain’s structure and operating mechanisms, it is not surprising to encounter both hindrances and limitations concerning medical exploration on how to extend our knowledge on different aspects of its performance. However, noteworthy insights have been made in comprehending features such as: its anatomy, lobes and their specific qualities; the key roles of neurons (for instance, their divergent ‘active’ or ‘inhibitory’ purposes in transmitting information); the significance of the supply of blood; the receiving and sending of signals from and to selected parts of the body; and, importantly, physical and mental failures associated with afflictions and debilities.
Taking positive action
Glitches and disorders within the brain are associated with common infirmities – dementia, Parkinson’s disease, motor neuron disease – and other less known disabilities. Fortunately, a great deal of attention is now being given to the development of treatments to slow down or alleviate neuro-progressive deficiencies. Research, through the likes of brain imaging, has made useful advancements in our understanding of progressive neurological maladies. Detailed studies of neural pathways or of the impact of specific substances (for example, nicotinamide (B3) in the treatment of Alzheimer disease; experimentation with poly ASP ribose polymerase inhibitors in understanding more about Parkinson disease; and lecanemab in slowing down decline on measures of cognition and function, particularly for some persons in the early stages of Alzheimer disease) posit helpful insights and a greater comprehension of how solutions might be found.
There can be little doubt that the standard and robustness of an individual’s bodily and mental wellbeing are all closely interlinked and that they rely on ‘good brain health’. Suffering and distress relating to ill health takes diverse forms and can arise through a range or combinations of personal, social and environmental concerns. The brain as a key centre for control may be in a malfunctioning mode and unable, at least temporarily, to resolve matters. There is genuine optimism that on-going studies will take forward the effectiveness of prescribed medicines. Nevertheless, debilities as anxiety, depression, and confusion (sometimes referred to as ‘brain fog’) often arise due to deleterious contexts which can be more fittingly resolved through engaging in alternative restorative activities – perhaps counselling, cognitive behavioural therapy, or mindfulness.
The expansion of practical diagnostic and tracking technologies to assess and monitor the changing needs of persons experiencing neuro-degenerative diseases has been immense in recent years. These technologies have an important purpose to undertake in providing feedback on the appropriateness and merit of strategic interventions. With regard to such procedures, it is essential that those being assessed and their caregivers are not voiceless but have an active, participatory role in decision-making. While diagnosis can postulate a starting standpoint for care and remediation, it will be of little value if suitable frameworks for on-going provision is not accessible.
Of course, at times, the brain displays an awareness of what a person should do but, due to a disability, the body is unable to act accordingly. Some technologies are aimed directly at reinforcing cognitive proficiency through stimulating memory, obtaining data and statistics, presenting suggestions for action, and offering solutions to overcome a difficulty. Consequently, they can endorse independence and enhance safety and security across a broad spectrum of personal, social and domestic activities – movement, time management, shopping and gardening – within commonplace environments. Exemplars include: information technology – programs and systems to entertain, coordinate biofeedback, and boost learning, knowledge and understanding; assistive technology – robotic aids, enlarged print for reading instructions, speech to print, ‘smart’ living quarters, etc. to ensure that messages from the brain can be carried out; adaptive technology – software and various types of equipment, artificial limbs, mopeds and so forth, to maintain or bolster transformative changes and functional competences for overcoming impediments and accomplishing tasks which previously would have been impossible; and rehabilitative technology to enable patients to recover from incapacities and illnesses as in the use of virtual reality for training in skills while feeling immersed within motivating surroundings.
Enjoyable and fulfilling lifestyles can do much to reinforce the effective working of the brain in relation to both corporal and mental health. Eight potential areas in which to foster personal wellbeing were outlined for consideration in a previous article on this website with particular attention to good practices relating to mental health. https://improvingcareand.education/home/good-mental-health/
In the course of day-to-day subsistence, these eight themes are prominent in the maintenance and promotion of a hale and hearty intellect. Very briefly summarised, they comprise: (1) Nourishing bodily intake– planning healthy eating; avoiding excess alcohol and medication; not smoking; not participating in harmful forms of ‘comfort eating’;) (2) Health and physical exercise – monitoring of eyesight, hearing and sleep habits; participating in relevant recreational endeavours as walking, cycling, and swimming; (3) Connectedness – safeguarding authentic interpersonal links and wellbeing; keeping in touch and appreciating constructive relationships with family, friends and neighbours; (4) Participation in groups – inclusion within supportive gatherings, hill walking, coffee mornings; (5) A fully balanced lifestyle– improving everyday work practices; attaining genuine job satisfaction; delivering well-organised caring programs; implementing sustainable coping strategies; (6) Involvement in therapeutic practices – participating in pursuits to enhance peace of mind, insightfulness and pleasure; learning new skills; (7) Self-compassion – being good to yourself; knowing that you matter (As the aphorism advises, “If you’re going to thrive, you must at first survive.”); (8) Requesting assistance – selecting a reliable person, or persons, capable of listening, understanding your lived experiences, and providing valuable advice and collaboration, and if necessary, also seeking professional guidance.
Maintaining good brain health in modern society is of the utmost importance. There is a need to regard its furtherance as a national priority. Effectual, long-term preventive and care approaches are required to ward off, or at least stall, present-day threats and hazards. A well-balanced combination of awareness-raising, advocacy and evidence-based action is desirable. On-going advancement in biological research and technology, along with personalised strategies for enriching individuals’ lifestyles, offer three promising, interrelated routes for achieving higher-quality social provision. Educational inputs across all ages can create a greater understanding of how genuine headway can be realised. When undertaking diagnosis and planning interventions relating to degenerative brain difficulties, caution is needed to ensure that a ‘one-size-fits-all’ stance is not adopted, not least because of the range and complexity of this discipline. Active, participatory involvement of those in need of help is essential. Due to acquired expertise and insights resulting from their personal narratives, based on past and current events, they have much to contribute.
Optimizing brain health across the life course: WHO position paper Geneva: World Health Organisation (2022)
My Brain Health Plan – Brain Health Scotland (hosted and supported by Alzheimer Scotland) has produced a booklet, entitled ‘My Brain Health Plan’, to help participants examine and identify characteristics and traits relating to their personal health. A key aim is to check factors and reduce risks of diseases which could be linked specifically with dementia (but which I feel also have much wider relevance). Positive recommendations, along with some examples, cover: taking exercise (brisk walking, gardening); eating well (vegetables, fish); staying connected (good company, group activities); reducing stress (stopping smoking, avoiding excess consumption of alcohol); switching off (relaxation, good quality sleep); and being aware (having regular check-ups, following medical advice). This booklet also provides a short, straightforward format for making and monitoring brain health pledges. The suggestion of jointly setting goals and sharing pledges is worthy of consideration. https://brainhealthplan.brainhealth.scot
Good Practices: Good Mental Health among Carers at: https://improvingcareand.education/home/good-mental-health/
Good Practices: Ten Things to be Getting On With? at: https://improvingcareand.education/home/ten-things-to-consider/