electronic devices engage this attentional network and disengage the DMN, our “idling brain circuit,” which is involved in fostering creativity [73,74]. Biophilia exposure pro- motes revitalizing processes to the PFC attentional circuitry cortex that are taxed during multitasking activities (attention fatigue). This has been termed the attention restor- ation theory [75]. A biophilic exercise test used a specially designed Remote Associates Test (RAT) involving hiking in various western US wilderness regions. The test group recorded a 50 percent improvement in performance compared to a control group after the fourth day. The proposed mechanisms of influence pertaining to the natural environ- ment and brain health were the engagement of the DMN with introspection and positive emotions [76].
Another aspect of biophilic cognitive enhancement (improved cognitive scores, less anxiety and depression), as well as cardiovascular and immune benefits, was shown in people walking in Japanese forests. Immune effects included a ~40 percent increase of natural killer cell activity attributed to inhaling phytoncides (aromatic volatile substances released by trees) [77]; there was also decreased prefrontal cortical flow, as shown by near- infrared spectroscopy in the forest bathing group [78]. Japanese forest bathing or Shinrin- Yoku has accordingly been promoted within Japan since 1982 [79]. Other bio- phila studies, such as the one by MacKerron, used a GPS- based, mobile application called
“Mappiness” that tracked the location of people in natural surroundings. At specific intervals they recorded their status in questionnaires, graded from 1–100 for extent of happiness. Increased contentment occurred when outdoors [80]. Other proposed mech- anisms of biophilic engagement include epigenetic- related DNA methylation and altered gene expression [81].
Animal-Assisted Therapy and Animal- Assisted Intervention
Interacting or being associated with animals pays dividends in both health and illness. Pet interaction can lead to a decrease in anxiety, depression, and post- traumatic stress dis- order (PTSD), as well as facilitating sociality and emotional health of the owners [82–84].
In addition to the animal- assisted studies, a dementia study was conducted with robotic animals. A robotic seal was used in an Australian PARO study that was constructed to display emotion and be responsive to both touch and voice, with the benefit of practically no maintenance and improved safety [85]. Therapy trials using horses (equine therapy or hippotherapy) have been beneficial in those with PTSD and autism spectrum conditions and for people with musculoskeletal abnormalities such as paraplegia or hemiparesis.
In the Saratoga War Horse project, veterans with PTSD tested with the Beck Depression Inventory- II and PTSD checklist showed a significant 58 percent improvement. The neurobiological basis is attributed to oxytocin release as well as PFC activity modulation.
Oxytocin release occurs when petting a dog in both the humans and the petted dog, similar to studies in primates and rodents [86].
Meditation
People engage in stimulus- independent thought for a considerable part of their waking day, termed mind wandering, that includes contemplation of the future that is associated with DMN activity of the brain. The evolutionary perspective correlates this activity with capabilities of mental time travel, planning, reasoning, and various roleplay scenarios. An excess of such activity is presumed to be the cause of various neuropsychiatric conditions,
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including depression and anxiety; meditation is promoted as a possible attenuation of mind wandering, to help people “live in the moment.” This was supported by the study of Killingsworth and Gilbert that people with wandering minds were relatively less happy:
“A wandering mind is an unhappy mind” [87]. Several medical and neurological con- ditions reported benefits through mindfulness training, including anxiety, depression, PTSD, and chronic pain conditions [88–91]. Of specific interest is that mindfulness medi- tation was associated with an increased mononuclear cell telomerase activity, viewed as a measure of life expectancy and aging [92].
Meditation induces “brain building,” with experienced meditators showing neuro- imaging evidence for both increased gray and white matter within the medial fronto- polar cortex [93,94]. In addition, several other brain regions revealed volume increases, including the hippocampus, inferior parietal lobe, and posterior cingulate cortex [95].
Experienced meditators also have larger hippocampal volumes. Mindfulness training induces neuroplasticity within these brain regions and has been correlated with objective improvements in metacognition (Figure 10.1) [96,97].
Closely related to meditation is eudaimonia, a human characteristic that incorpor- ates intellectual activities, personal fulfillment, and virtuosity, in contradistinction to the concept of hedonic well- being. Eudaimonia has been correlated with lower risk of cardiovascular disease and depression [98]. A positive association was also been reported with eudaimonia, well- being, and right insular cortical gray matter volume [99]. On the contrary, a negative association has been noted with depression and insula volume [100].
Musicality
Rhythm is a key element of music but is also a feature in more fundamental human activities such as walking, running, and in tasks requiring complex coordination. The
Superior corona radiata Body of corpus callosum Genu of corpus callosum Anterior corona radiata
Figure 10.1 Meditation and brain building shown by MRI fractional anisotropic values for white matter connectivity in the anterior cingulate gyrus. The superior corona radiata (purple), body of the corpus callosum (red), genu of the corpus callosum (blue), and left anterior corona radiata (green) increased in efficiency and integrity.
Source: Tang Y- Y, Lu Q, Gen X, et al. Short- term meditation induces white matter changes in the anterior cingulate. PNAS 2010;107:15649–15652. Reproduced with permission.
origins of rhythmicity in the human brain may well be related to bipedalism in the Late Miocene period. Rhythm relies on motor and sensory frontoparietal circuitry that underlies efficient bipedalism. The augmentation of sensorimotor control for bipedal- ism requirements may have been an initial contributor to brain enlargement, with added prospects for involvement in other tasks such as foraging, language development, and social interaction.
In Mithen’s view, music and language evolved from the demands for vocal groom- ing that took over from tactile grooming of hominids, with their changes in social life and foraging and need for improved communication 6–7 mya. He postulated that gestures and music- like vocalizations would have increased and evolved into what he termed Hmmmm [101]. Extant primates today exhibit these fundamental aspects, with both geladas and gibbons referred to as “musical apes” as they synchronize their vocaliza- tions with others, using a variety of melodies and rhythms. Geladas have a lip- smacking activity (rapidly opening and closing their mouth). The facial movements involved in lip- smacking appear speech- like, suggesting that this may have been an early step toward eventual human speech evolution [102]. Together, these characteristics may be regarded as early precursors for language- like activity. Both apes use their musical communication for social interaction. Making music together may be viewed as a low- cost form of coop- eration that promotes social bonding and fosters group cooperation [103]. A common ancestral musical protolanguage evolved into the Hmmmm of Neanderthals, and in more separate circuitry for musicality and eventual language for more efficient communication of information and concepts among AMH ~200 kya [104]. Today, clinical studies reveal that the neural networks for language and music are relatively independent of each other and exhibit a degree of double dissociation. Musical ability or attributes can be “eroded”
to an extent by the demands of language acquisition [105]. Other clinical studies support rhythmic auditory stimulation therapy for people with stroke, Parkinson’s disease and TBI [106–108]. With aphasia, melodic intonation therapy (singing rather than speaking phrases and sentences) may work by decreasing the hyperactive right homologous Broca’s area, which could be causing inhibitory effects in the impaired left Broca’s region.
Insightful views by Tomlinson in his treatise of “A million years of music” reflected that the music neurobiological circuitry is relatively ancient, one of our newer cultural endowments, termed the “original human mental machinery,” long preceding language and evolving by technological and social forces. His sagacious premise was that techno- sociality formed the basis of musicality and was bound to early hominin experiences of both motion and emotion that enabled musical information to transmit emotive com- municative acts. This is turn led to more cognitive flexibility, increasing theory of mind, the capacity to think about others, and “thinking at a distance,” all of which evolved in a prelinguistic phase [109]. There is ample neurophysiological support for such obser- vations. Auditory processing emanates from a core superior temporal lobe area radiat- ing posteriorly to the parietal lobes and anteriorly to the temporal lobes. From there, bidirectional circuitry impinges on every prefrontal cortical area. This extensive circuitry allows auditory information to be integrated into memory systems and motor programs.
Particularly robust connections in the PFC are to the medial PFC (anterior cingulate cortex) and frontopolar cortex. Connections to the anterior cingulate cortex enable a synchronization of motor expression, attention and arousal, motivation, autonomic func- tions, memory circuits, emotion, and social engagement [110,111]. The anterior cingu- late cortex (ACC) has particularly robust affiliation with hippocampal, memory- related
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circuits, the amygdala, and the frontopolar cortex. Barbas et al. inferred that the FPC, auditory association cortical, and ACC connections may be the neurophysiological basis of using symbolic representations of internalized organized thought [112].
The basic emotions, whether considered in terms of four categories (anger, fear, sad- ness, joy), or six, seven, or eight do not always present as dramatic, intense, fully devel- oped responses. Much more frequent day-to-day emotional experiences are variations in degree of these basic emotions along intensity dimensions. This was encapsulated by Plutchik’s cone model of emotion, with the apex of the cone accommodating the lower- intensity emotions, indicating more subtle differences or less divergence, whereas the other end of the cone depicts the basic emotions at their highest intensities. The idea behind the cone was that music mostly elicits or augments the “partial” emotions rather than the extreme emotion subtypes [113,114].
Brain pathology and musical abilities may lead to a large variety of syndromes, from impaired musical emotion to newly acquired musicophilia, musical hallucinations, loss of musical abilities, or newfound expertise in music. Music therapy is based on the prem- ise that the modulation of attention, cognition, emotion, and behavior can improve both psychological and physiological well- being of people, whether afflicted by brain illness or not [115]. In Parkinson’s disease, for example, improvements may be induced due to music- evoked priming and arousal of the brain’s motor systems, mediated by auditory stimulation. This may be a function of entrainment of the motor circuitry by the music’s beat. Music therapy has also benefited people with Alzheimer’s disease, Tourette’s syn- drome, post- stroke visual neglect, memory, inattention, and working memory [115–117].
The postulated mechanisms include possible enhanced cerebral connectivity and activ- ation of motor cortical areas by processes such as entrainment, whereby one rhythmic frequency impacts another neuronal ensemble to a point of synchronization, or they influence each other [118]. It has been demonstrated that neurons fire in unison with musical input, and in that manner music modulates cerebral rhythms. Different types of music have been investigated from a therapeutic point of view, and the music of Mozart, in particular, has received much attention. Light and sound can entrain neurons, some- thing that can readily be seen on EEG recording with flashing lights, photic stimulation and entrainment, and in a pathological sense when one has photosensitive epilepsy [119].
Music can be regarded as a type of nutrient for the nervous system – the neurostimula- tion resetting the nervous system. The pioneering French doctor Alfred Tomatis, known for the sound stimulation program called the Tomatis method, referred to the importance of sound and music by saying “The ear is a battery to the brain.” Music can be uplifting by stimulating the dopaminergic reward system, and hypothetically music resynchronizes the brain through entrainment. Music is a high- value commodity across all human cul- tures due to the basic underlying reward system being stimulated with dopamine released by the striatal components, the caudate, and accumbens nuclei. Music as an abstract stim- ulus can initiate euphoria, shown by a PET brain study (using 11C-raclopride) of striatal dopamine release at peak emotional arousal [120]. In this regard, the so- called Mozart effect is sometimes referred to as a universal type of music that has not been influenced by individual linguistic and cultural rhythms. One of the reasons postulated is that Mozart started composing at the age of five, before his native German language was able to influ- ence his compositions to a significant degree. Many benefits of musical instrument play- ing have been claimed, many with scientific foundations, including the enhancement of working memory, mathematics, and verbal skills [121]. Importantly the transfer of the
music effect may be more generalized and apply to the domains of general attention, working attention, and executive function, all of which are impoverished after stroke, causing amusia, for example [122].
A Proposed Regimen For Cognitive Exercises and “Brain Building”
A long list of activities has been shown to be of benefit, and many others not mentioned may qualify:
1. computerized exercises such as BrainHQ, Cogmed, Posit, Lumosity, Brain Age.
These yield a number of different scores that can track improvement or worsening over time;
2. board games, such as chess and Stratego. These two in particular have inherent attributes that involve working memory by contemplating many moves ahead and their consequences. This specific ability may be one of the earliest indicators of incipient cognitive failure in people as they age;
3. card games;
4. sudoku;
5. book clubs and discussion groups;
6. learning a second language;
7. pursuing a qualification, diploma, or degree;
8. engagement in educational courses, such as the Great Courses program;
9. literary arts – reading, writing, poetry;
10. culinary arts – cooking or baking classes;
11. visual arts – viewing museum paintings or engaging in art production or therapy;
12. music – singing, instrument playing, performing, or passive listening;
13. biophilia, outdoor exercise, interaction with nature (Japanese forest therapy);
14. animal companionship and interaction;
15. meditation, spirituality. Meditation does not require monitoring. However, smart phone- based devices can be used to access services such as Headspace.com, and the Muse device (www.choosemuse.com), which can guide and monitor meditation.
Recommended Key Performance Indicators
Measuring and monitoring by you: brain activity quotient (AQ) with BrainHQ (www .BrainHQ.com) recommended for 0.5 hours, three times per week. You can also use com- puterized games and exercises that can track brain scores.
Measuring and monitoring by medical professionals: (1) computerized testing (CNS- VS) for working memory, speed of information processing, attention, executive function, per- ceptions of emotions (POET subtest), and inhibition; (2) King Devick test; (3) cerebro- vascular reserve (transcranial Doppler); (4) cognitive reserve (PET brain scan).