From the College of Humanities and Social Sciences
Susan Mansfield

Susan Mansfield coaches seniors at the Uintah Basin Golden Age Center through an exercise testing cognition.

Salvaging the Mind

By Kristen Munson

Sharon Willer vowed to never own or learn how to operate a computer. She didn’t see how it could improve her life—she’d survived for seven decades without one.

“Never,” the 74-year-old repeated with an emphatic shake of her head.

But Willer changed her mind three years ago when she began having trouble recalling the names of people she knew. During a checkup with her physician she told him she suspected it was Alzheimer’s disease. He disagreed, but Willer was still rattled. She knew people with the disease and it scared her. Willer contacted the Uintah Basin Golden Age Center in Vernal where she heard about a computer program there that could help improve brain functioning. She decided to give technology a try.

“I didn’t even know how to turn the damn thing on when I stared,” she said. “It’s been wonderful. It seems like I can remember names longer now.”

Willer comes weekly and encourages all of her friends to go to the facility’s Brain Exercise Center to use the computers. She admits she comes to the senior center as much for the company as for the brain gym—a series of computer-based games that train and test cognition—but she believes she’s making progress.

“It’s fun to play the games,” Willer said. “Sometimes I get frustrated, but I would tell anyone who can’t remember, who doesn’t think their mind is working as it should, to come.”

That’s precisely what investigators of a new study on brain cognition want seniors in the community do. Derrik Tollefson, associate professor of social work at Utah State and the principal investigator of the study, partnered with graduate student Susan Mansfield, ’14, an intern at the Golden Age Center, to evaluate the brain training program at the facility. In August they will begin recruiting 100 healthy adults over 55 to participate in an 18-month study to test whether a commercial computer software program advertised to restore brain function actually helps stave off dementia. While several are on the market today, there are no longitudinal studies examining their effectiveness and few that determine the most effective type of training. The goal of Tollefson’s and Mansfield’s study is to determine whether or not the cognitive functioning of participants actually improves with their use.

The specific program targeted is developed by the company Scientific Brain Training. The series under evaluation is the company’s Aging Well Program, which consists of a series of 22 games that test an individual for memorization, visual and spatial abilities, executive function, attention, and language. A secondary component of the study is to determine if physical exercise and social interaction also affect cognitive functioning.

“We don’t know if it’s going to transfer over to real life,” Tollefson said. “We want to try and isolate as much as possible the effect of scientific brain training. I think the study we’ve designed will do that—if we find something that can maintain a person’s cognitive functioning that is great.”

The Brain Exercise Center opened in 2011—the same year the first of the Baby Boomers turned 65. The birthday used to signal retirement. However, nowadays it carries other connotations as well; many symptoms of Alzheimer’s disease manifest around this age. Vernal’s brain gym is the result of a $1 million gift from local resident Robert Williams who witnessed others live with Alzheimer’s. He funded the center to help salvage the minds of individuals with dementia. He passed away this spring.

“This program exists here because of his generous donation and his commitment to helping others who might be in this situation,” Tollefson said.

Susan Mansfield and Derrik Tollefson

Susan Mansfield is assisting Derrik Tollefson, associate dean of the Uintah Basin campus, with a study evaluating brain training computer programs.

The Silver Tsunami

Alzheimer’s disease is often called the long goodbye. Early symptoms typically present as memory impairment—forgetting words or repeating questions—and as the disease progresses, brain cells and brain function are destroyed. Eventually, individuals are robbed of their independence. Everyday tasks like eating and bathing may become impossible to accomplish. Language is lost. To date, there is no cure or pharmacological treatment to effectively prevent or treat the condition, and little can be done to alter its course. The physiological mechanisms that lead to Alzheimer’s remain unknown, but one fact is clear: the disease discriminates against age. Most cases occur in people aged 60 or older.

“The longer you live, the higher your risk is,” said Mansfield. “There’s more to Alzheimer’s than losing your memory, you lose your executive function.”

The portion of the brain in charge of decision making gradually atrophies. For example, deciding what to wear or what to watch on television becomes truly difficult. Mansfield first really appreciated the challenges of losing one’s executive function when her mother moved into her home a few years ago.

“I was not understanding the difficulty she was having,” she said from her office at the senior center.

If delaying the onset of Alzheimer’s is possible, the economic and social ramifications would be staggering. Nationwide, more than 5 million individuals are estimated to have Alzheimer’s and millions more family members and loved ones provide informal, unpaid care for them. In April, the New England Journal of Medicine published a report estimating the annual direct cost of care for Alzheimer’s patients in the United States is about $109 billion dollars—more than the amounts for cancer or heart disease. The figure balloons to nearly $215 billion when unpaid care is included in the tally. National health expenditures are projected to more than double by 2040 because of the nation’s aging baby boomer population. Demographers have referred to the wave as the “silver tsunami.”

In 2011, President Barack Obama signed the first national plan to combat Alzheimer’s disease. The National Alzheimer’s Project Act requires the coordination of research and services across federal agencies and the acceleration of treatments developed to prevent, stop, or reverse its effects by 2025. Treating and caring for the growing number of individuals with Alzheimer’s is a major public health concern. Nineteen states, including Utah, which has the highest prevalence of cases, have adopted measures from the national report and devised their own plans. The number of Alzheimer’s cases is expected to grow by 127 percent by 2025.

“With population growth, life expectancy, and retirees coming to the state, Utah is about to experience an aging tsunami in the next decade,” Utah’s 2012 report reads. “This unprecedented growth will have a marked impact on Utah’s healthcare system, not to mention families and caregivers.”

In Utah, families provide the bulk of the care for loved ones at an estimated cost of $1.8 billion annually, according to the state’s action plan. Among the strategies recommended in the report are to raise awareness about Alzheimer’s symptoms, treatment, and support for caregivers, as well as to promote a robust wellness agenda involving exercise, nutrition, and embracing initiatives that protect brain health such as the brain gym movement. Mansfield has advocated along with the Utah Chapter of the Alzheimer’s Association at the state capitol for funded programs. At this time, the Utah legislature has not yet funded any programs within the plan; however, she intends to continue the effort, she said.

Changing the course of Alzheimer’s

Next to Mansfield’s office a potential intervention may be plugged into the wall. About a dozen seniors face glowing computer screens and follow along as an instructor teaches a beginner course about using the Internet. After a few minutes it becomes evident some have departed the lesson in favor of playing brain training computer games. Across the hall in a pristine workout room, a man in a tracksuit performs quad exercises in the gym. Next door, two others play pool and lean against their cues chatting between shots.

“Baby boomers are more health conscious than other generations have been,” Mansfield said. “And their attitudes about aging are not complacent.”

Historically, they are a generation that demanded more from the government in terms of education when they were young and now require different types of services as they age. Their mindset about Alzheimer’s is different than in the past. Rather than viewing losing their memory as a fact of life, it’s a problem that needs solving, Tollefson said. “Their attitude is we don’t have to put up with this, we can change the course of this disease.”

That is the hope.

Autopsies of those with Alzheimer’s show amyloid plaques and neurofibrillary tangles in the brain. However, promising new therapies cannot be developed without first understanding what exactly causes neuron functioning in the brain to deteriorate. Current research suggests a host of factors may contribute to disease expression and progression. Several recent studies indicate a combination of genetic, environmental, and lifestyle factors may be at play.

Associations between Alzheimer’s and conditions such as heart disease, stroke, diabetes, and obesity have been found. Additionally, some studies suggest a lifestyle that includes a nutritious diet, exercise, education, and social and mental stimulation may reduce risk of Alzheimer’s. The National Institutes of Health held a summit in 2012 to identify research priorities and strategies for treating and preventing Alzheimer’s. The recommendations included pursuing clinical trials in asymptomatic and cognitively impaired adults to determine the effectiveness of interventions like physical exercise and cognitive training.

Utah State has tackled Alzheimer’s on several research fronts for decades.

In 2012, researchers of the Cache County Memory, Health, and Aging Study discovered a rare mutation in the TREM2 gene that was more likely to appear in people with Alzheimer’s. Earlier this year, JoAnn Tschanz, a psychology professor at USU, found caregiver coping mechanisms may play an important role in the progression of Alzheimer’s. For example, positive strategies such as seeking greater social support and counting blessings were associated with slower patient decline. The research was published in The American Journal of Geriatric Psychiatry in January. Tollefson and Mansfield’s study is the latest to assess factors contributing to the disease. The project is funded by grants from the Uintah Health Care Special Services District and the Uintah Impact Mitigation Special Services District.

The study is a new area of investigation for Tollefson. His research tends to focus on children and family violence issues rather than geriatric health. However, he has considerable experience evaluating social service programs for the state. He enlisted Mansfield to assist with monitoring the research after her field experience in the social work program brought her to the Golden Age Center. She aims to boost participation in services offered there such as the brain exercise center and field trips, but getting seniors in the door can be tricky, she said.

“Some don’t want to come to the Golden Age Center because they perceive it’s for old people—not them,” Mansfield said. “The actual purpose of senior centers is to keep people independent.”

She hopes that, in time, the center will become more of a community center where all people come to enjoy and benefit from its services. Last fall, she and Tollefson held a memory screening for the community to help educate it on the signs of normal aging. Through the study and beyond, Mansfield is committed to helping Vernal become what it needs to be for its aging population.

“I’ll be around for a while,” she said. “I want to see 10 to 15 years down the road what has happened.