Best Methods for Tracking Cognitive / Brain Health with Age?

This tweet got me thinking

which, if you see the actual post in twitter, shows this:

Most if us do a lot of testing to track our body’s physiological health status, but not so much our brain and cognitive heath over time. I would love to be able to track my brain, memory and cognitive health as well as I can track my cholesterol, or other blood-based measure, or even a functional measure like grip strength, VO2Max, etc… something easily tested and monitored over time that is reflective of fundamental biological processes in the brain that we are trying to maintain or improve.

I am wondering if people here have ideas on how we might track this… I’m not sure of the parameters or metrics we’d be looking at, but I assume we’d want to measure working memory and cognition at a minimum…

I was thinking maybe something like the double n-back testing apps that are widely available in the app stores, or here below some other ideas.

Do you have any ideas on this? Some measurements that might be a sort of BioClock for the brain, memory and cognitive function that is cheap, scientifically validated, and can be used to track status over time starting at age 30?

This below is sort of what i am thinking, but not so much focused on “older adults”…

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I believe I have a novel way of tracking cognitive performance. I play chess at club level and online you get an ELO score. This can vary by ±50 points week to week but a consistent downward trend would obviously suggest some degradation…

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According to the study you give on Dual N-Back, it seems that this game is hardly of any use:

Repeated measures multivariate analysis of variance failed to identify improvements across the three cognitive composites, working memory, processing speed, and fluid intelligence, after training. Follow-up Bayesian analyses supported null findings for training effects for each individual composite. Findings suggest that dual n-back working memory training may not benefit working memory or fluid intelligence in healthy adults.

What you seem to look for is rather a WASI. But it is a bit expensive and rather cumbersome, not something for a personal use. Or maybe IQ tests? There are free such tools online, like Accurate Online IQ Test [2022] | IQ Test Academy but I never used any I’m afraid.

And I would rather recommend real-world challenges like learning a new sport, a new hobby, a new language, a new skill, etc. The more physically active the better, for older people, I guess. The central point would be to face the unknown, to put yourself in a situation you definitely don’t master, that sends you back to the kind of challenges a young child has to overcome just for learning to get used to life. But that’s just my gut feeling, I actually don’t know.

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I wouldn’t trust any such tests because the definition of intelligence is so vague and brain functions so diverse. I’d guess that bioage clocks apply to the brain pretty well. I know that some clocks try to measure individual tissues. Do any measure markers for the brain?

Muhdo offers a “Memory Age” in their “DNA Transform” package:

Epigenetic memory age - Muhdo

Mine is healthy, that is, my memory, or more exactly, “the average methylation status of the genes associated with [my] memory” is younger than me, but not by much, some six years. You can do that once a year, for example, and have some sort of genetic check-up of your brain.

I don’t find anything specifically related to my brain or my memory in my TruDiagnostic results. But they say that

Epigenetic age acceleration, which is the change between epigenetic age and chronological age, captures the biological age of brain tissue. Alzheimer’s disease patients have biologically older brains than nondiseased individuals.

So your “TruAge” should reflect the age of your brain tissue and also can be used as a brain check-up.

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My radical lifestyle pivot, everything I do is cognitive focused. What defines us, what gives us “life/soul” is our brain. The body is just a shell carrying the brain around, supporting actor, but a critical “nurturer/guardian/epigenetic regulator”.

My mom has AD, my dad had PD…maybe some unknown wonky genes (hardware), that I need to epigenetically manage to side step. No family history mom side. Dad had two very old aged sisters (90+), but a third had AD. This is why I am here…prevention.

For example, my keto diet. Not for weight loss (although that was secondary and beneficial), but to be constantly bathing in ketones for brain uptake. As we age, our brains slowly loose the ability to uptake glucose (this is a hallmark signature decades before cognitive loss in say AD). Mitochondria, however, love to burn ketones (far more efficient, less ROS/inflammation than dirty glucose), and ketones bypass the blunted brain GLUT transporter, right into the cells to fuel the neuro/astrocyte machinery. When we fast, or in starvation, the body harnesses fats and other resources to generate ketones to fuel the brain (up to 60% fuel source) and stave off death. Evolutionarily conversed protective mechanism in humans. A ton of clinical research confirming this alternate fuel source for cognitive support. Ketones have also benefits in cancer prevention, tumour cells don’t like ketones, prefer glucose.

I’ve done some in depth cognitive baselining at 52 (now 57). I have a volumetric MRI (Neuroquant). Not very expensive given the deep anatomical insight and critical baselining, I think $500 USD

And a full day neuropsychological profiling (a large battery of tests evaluating all facets of cognitive function). My functional med doc was able to get me referred to a specialist, citing “family history”. I also got a SPECT scan (cerebral blood flow), also covered.

My hippocampi were 99 percentile (MRI), neuropsych normal, SPECT scan normal. Anecdotally from day to day interactions, my memory seems very good.

If you’re predisposed to say AD, it starts decades (amyloid/tau/loss in cerebral glucose uptake) before symptomatic. When you have symptoms, it’s TOO LATE.

I haven’t spent much time researching some of these web based cognitive function tools, I think they are getting better and better, and a lot of research is trying to connect them to actual clinical trajectories.

Hoping exercise and diet takes care of CVD.

Rapamycin for a pharma element (shows promise in AD mouse models, but they are sort of useless translating to humans).

Bottom line…we must push out all cause mortality, so you need to work on all the pathways.

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Very interesting stuff.
Give us an example of your day to day diet.

Basically, 20-25% protein, 70% plant fats, very little carbohydrates (only what comes from low carb vegetables). Only some low glycemic fruit sparingly (blueberries, blackberries), Of course, no typical carbs/sugar whatsoever. No bread, grains, pasta, dessert, etc

I fast for 24 hrs, eating only dinner. Only 3-4 cups black coffee in the AM until noon. I exercise daily just before dinner in my normal home routine. If travelling/vacation, I will exercise very early AM.

Protein: 50g of something wild animal protein (grass fed beef (anything wild), wild salmon, wild shrimp, eggs, skyr zero fat yogurt, some old hard cheese here and there). I don’t eat any large seafood (tuna, mahi mahi, etc), full of mercury. The wild salmon is ok. Even the wild sockeye salmon Costco sells, is ok.

Plant Fats: Avocado, EVOO, MUFA/PUFA nuts (macadamia, walnuts, pistacchio, pecans, pumpkin No cashews or peanuts)

Rest Vegetables: as much leafy green vegetables as I can stuff, nothing root (kale, spinach, asparagus, mushrooms, rapini, salad, peppers, zucchini, eggplant, etc…you get the idea, VERY low carb, no corn, carrots, potatoes)

Starting out, I would constantly check glucose/blood ketones (Freestyle Libre sticks) until I figured out the dietary window to be in a ketogenic diet (1st year or so). I don’t do that anymore, settled in. The OMAD (one meal a day) is to boost/extend the ketogenic state. I will be 1-2 mmol/L BHB in the afternoon.

Going on 6 years. It can be anti-social (no breakfast, lunch) and restaurant selection eating out is a bit more narrow. And you need to get past the constant hunger pangs starting mid morning all the way to dinner, great mental fortitude builder! I have come to completely ignore them now, it’s just a “state” I am in.

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from the first pdf:
A ketogenic diet extends longevity and healthspan in adult mice

It is often assumed that high-fat diets shorten lifespan since they have been shown to induce weight gain and obesity when fed ad libitum to C57BL/6 mice (Surwit et al., 1995). However, our results indicate that a calorie controlled LCD started in middle-aged mice does not have a negative impact on aging

The belief that high fat diet = unhealthy is still going strong in the mainstream.

There are lots of healthy ways to do keto. My macros are closer to 80/10/10, including plenty of animal fats, but everything else is similar to yours. I eat three meals and a snack, with a 12 hour eating window. On rapa, I’m getting less hungry and losing some weight as I eat less.

Great. I’ve done a good dive on animal vs. plant fats (eg. atherogenicity), and although I cannot say I came to a definite conclusion, I have tilted to plant fats as a safer bet. If I’m going to indulge in an animal fat, it’s most definitely some type of aged cheese and from Europe (grass fed). Otherwise, beef cuts are super lean.

I haven’t yet seen much impact Rapamycin yet, but I am still exploring/ramping dosing. I monitor my weight closely, my regiment is very controlled, so I should be able to see a signal.

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I started keeping track of my brain function years ago when I recognized that my ability to do crossword puzzles and sudoku seemed to reflect my brain function on that particular day.
I do NYT crosswords and hard to very hard sudoku. Anyone who is doing sudoku or crosswords at hard or higher levels has recognized what a good indicator of your present brain state they are. To anyone not familiar with sudoku, there is zero math involved only logic and visual concentration. If you are doing crosswords for a long time you will reach your personnel plateau and you will recognize when you are falling off. On my peak days, I feel I am as good as I ever was. However, I don’t have as many peak days in a row as I used to have.

Exactly… while they tend to go together, having a super healthy body without a healthy mind is far from optimal.

I have read and heard from friends with Alz family histories that try to follow Keto for precisely the reasons you mention… and the research looks good:

Thanks for the interesting measures of brain health - those sound really valuable, but obviously are difficult to track on a quarterly basis due to cost, and hassle factor. Someone like Peter Attia must have a protocol for measuring and tracking this in the short and longer term…

While things like chess, and puzzles, sudoku, etc. are good for exercising your brain I think, and perhaps in giving a general feeling for cognitive function, I’d like something with a very tangible, measurable / quantifiable end result that I can track like a blood glucose level to give me a good idea of short and long-term trends, and also to see if any inputs (e.g. Trehalose, rapamycin, etc.) make any difference over a 3 month to 12 month period.

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I’m now fairly cautious about egg consumption. There seems to be a cancer link especially when you hit 3-5/ week.

I’m a big salmon eater and have it almost daily as my main protein source. My blood free fatty acid analysis showed a high EPA level.
My only concern about this was a 2016 association study that showed high levels of omega 3’s in the blood of high grade prostate cancer patients. Other studies have shown a protective effect. There was never a clarification whether they were eating fish or taking supplements, or perhaps neither. Again, this wasn’t an RCT but still a little concerning since it was never explained.

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Exactly. The easiest person to fool is yourself, especially when it comes to intellectual and emotional states. I want something objective. I believe that keeping the brain intellectually active is helpful, but perhaps only for the specific skill being activated or learned.

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Different parts of the brain are associated with different cognitive function.

The neuropsych test I did covered the spectrum. I don’t know what these cost retail and/or if you could get them covered without some medical reason, but doing these every so often, gives you complete picture.

But 100%, if we could have a simple, real time, virtual implemented test with GOOD clinical translation…another markers tracking tool.

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Most of the apps / websites I see are focused on people who want to “train their brain” and improve function over time, in theory. I’m not looking for those - I just want to track some key metrics over time.

This group of apps identified below seem like something that might work, to test periodically, to check on cognitive function, that (I think) seem to have some scientific validation completed on them:

Alzheimer’s Disease Researchers at California based Leucadia Therapeutics released a panel of eight apps today to help people track memory and cognition. The new apps are ProCogny Memory Tracker, Infinite Mahjong, Iconic Sudoku, Word Recall, Connectors, Image Recall, Pattern Busters, and Speed Demon. The ProCogny Memory Tracker includes a non-clinical version of the proprietary Leucadia Memory Test. There are many digital trackers available to count steps and other measures of physical activity, but few apps track memory and cognitive function. The apps include games and puzzles that exercise different facets of memory such as word recall, reasoning, alternating tasks, matching, object recognition, pattern recognition, and spatiotemporal memory. The apps are available on Apple’s App Store and Google Play in 22 languages.

Download The Apps

ProCogny Memory Tracker, Infinite Mahjong, Iconic Sudoku, Word Recall, Connectors, Image Recall, Pattern Busters, and Speed Demon for mobile phones and tablets are available on Apple’s App Store and Google Play

Another App:

Savonix launches cognitive assessment app

San Francisco-based Savonix announced the global launch of their cognitive assessment app, Savonix Mobile. The app is accessible on any mobile device, and aims to eliminate the need for pen-and-paper exams to screen for cognitive function. The app was also created to serve as the vehicle for providers, patients and patients to easily incorporate the data into treatment planning and decision-making.

The company, which was founded in 2014, is made up of neuroscientists and gaming experts. The 30-minute brain training and testing app is based on existing clinical guidelines and procedures, but seeks to replace the costly, often time-consuming process that involves a clinician working with pen and paper to screen patients. The app is available internationally via healthcare licenses and third party partnerships.

“We are addressing a critical challenge in healthcare by solving how we assess mental health, specifically the cognitive and emotional function of patients on a large scale despite limited budgets and insufficient numbers of trained specialists,” said Savonix founder Dr. Mylea Charvat in a statement.

Charvat is a translational neuroscientist and entrepreneur with Ph.Ds from Stanford and Palo Alto University. She was inspired to move out of the clinical and academic setting in order to make cognitive screens easy and affordable.

“Traditional cognitive testing is a lengthy and inefficient process,” Dr. Dov Biran, CEO of Fitango Health said in a statement. “With Savonix we have found a simple and cost-effective way to gauge cognitive function as well as organize and store this data at the population level.”

Hmmm… seems like another Tech Startup casualty… no blog updates since October, 2021 … so they may no longer be a functioning company…

But - the app is still in the App Store, so I’m downloading it and going to be trying it out:

https://savonix.com/us/app-update/en/

… ok - downloaded, will report back on how all these apps work for my objective in terms of tracking.

Trying the apps from the first article above - they still seem to be alive and working.

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As a method to track of cognitive ability over time, something like these apps might prove useful. I hope they are not promoting them for practice and improving cognition, because improving on specific tests after practice might not reflect your brain health in general.

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@rapadmin One of the posters @Arg mentioned she was in an AD clinical trial.

Here are the eligibility requirements:

People who do not have amyloid build-up found in their brain are not able to join the AHEAD Study, but can track their own memory performance by joining in the Alzheimer Prevention Trials (APT) Webstudy. The “webstudy” is entirely online and for people over the age of 50

https://www.aptwebstudy.org/ (if less than 50, just fib your age…however, if the software is giving you a percentile, it’s relative to your age, so FYI)

I signed up, and took the test. It’s measuring reaction speed and short term memory, both very sensitive to memory decline signal.

THIS COULD BE A VERY GOOD REAL TIME TRACKING TEST.

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Great find! Thanks for adding this to the thread.