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).
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which have neuroprotective, anti- inflammatory, anti- anxiety, and antidepressant effects.
Group membership makes us healthier and more resilient, and develops stronger immune systems. A study of prospective stroke studies (NOMASS) revealed that socially isolated people were twice as likely to have another stroke within five years compared to those in significant personal relationships [123]. Social isolation has also been reported in associ- ation with cardiovascular disease, rheumatoid arthritis, renal disease, cancer, and overall mortality [124–128]. The social brain circuitry includes lateral temporal, hippocam- pal, inferior parietal and prefrontal regions, with a critical hub in the CA2 region of the hippocampus [129,130]. Clinically, decreased inhibitory neuronal counts in the CA2 in people with bipolar disease and schizophrenia are findings supported by mouse data that are relevant to possible future treatment prospects for neuropsychiatric disease [131].
Oxytocin has been identified as a mediator of social neuroprotection after cerebrovas- cular ischemia, demonstrating both anti- inflammatory and antioxidant properties in rodent studies. At a molecular level, decreased neutrophil infiltration, decreased pro- inflammatory cytokines (interleukin 6), and lipopolysaccharide (LPS) and superoxide production by microglial cells have been documented [132]. Humans have been deemed super- cooperators by Nowak. The mechanisms responsible for the relatively advanced level of cooperation among humans stem from sociality, and several mechanisms have been identified as leading to the high level of cooperativity within our species. Assisting one another is referred to as direct and indirect reciprocity, as one favor may beget a reciprocal one; network reciprocity relates to advantages of groups, such as contiguously dwelling neighbors; kin selection relates to a preferred cooperativity with blood relatives, relative to strangers. Together these have made humans super- cooperators, which led Nowak to research future possibilities, such as curbing overexploitation of our current environmental resources. His intergenerational goods game suggested that decisions made by democratic group voting as opposed to individual decision- making tended to counter overexploitation of resources [133,134]. Further support for cooperating within a team structure comes from engineering, arts, science, humanities, patents, and manu- script publishing. Over a 50- year period, 2.1 million patents and 19.9 million manuscripts were reviewed by Wuchty et al., who found that team cooperativity dominated over single authorship and production [135].
Super-connectivity is also important with respect to optimal diversification of con- tacts. Networks or social organizations with a relative excess of strangers may impede exchange of new concepts or ideas, on the one hand, while networks dominated by a preponderance of personal friends may similarly stunt innovation. An optimal ratio was envisaged by Uzzin and Dunlap which explained success stories of cooperativity, such as their example of the famous musical West Side Story [136,137]. Social information is critical to survival and optimal interaction in groups. The inferential brain hypothesis, proposed by Koscik and Tranel, posits that human brains have progressed from primarily perceptual processing to inferential processing [138].
Looking further into the future, the trend of human evolution has been a progressive escalation in the networking domains. Initially our own brain sensorimotor networks and intracortical connectivity expanded and then evolved outside the brain to inter action with other minds, or intercortical connectivity, facilitated by the mirror neuron system.
Nowadays the brain–machine interface extends connectivity even further. Direct brain- to-brain communication, or the transmission of information between two humans not utilizing our sensory or motor networks, has been accomplished by the combination
of brain-to-computer interfaces using EEG encoding of binary (0,1) information bits.
The remote subject was stimulated by computer-to-brain communication (transcranial magnetic stimulation) that generated phosphenes which were also encoded in binary information bits [139].
The electronic age has certain social impediments. Many social media platforms exist, such as Twitter, Instagram, Snapchat, and Facebook, and these are manifestations of extended human sociality. However, there are limits to electronic communication.
Despite hundreds of millions of users, Facebook users, for example, have not developed group sizes any larger than our ancestral hunter- gatherer traditional group size of 100–
250 individuals. Pollet et al. noted that engaging in social network sites does not translate into greater “offline social network size” nor to emotionally closer friendships among offline network members [140].
Our social brain circuitry evolved to engage a polysensory input and multimodal output, fashioned over millions of years, that include components of communication such as:
1. numerous facial expression that impart subtle, covert, and other vital nuances to communication (Ekman claims over 10 000);
2. nonverbal communication relayed through body language such as stances and postures;
3. speech intonation or prosody that relays different, and at times even the opposite, message compared to spoken content [141,142].
Socialization and Brain Health Proposals
1. Socialize for brain development that has particular importance for children, teenagers, and young adults. The major fiber network for social and emotional competency, the uncinate fasciculus, continues to mature into the fourth decade.
2. Socialize for brain health as the process releases oxytocin, vasopressin, and endorphins, which have anti- inflammatory and neuroprotective properties.
3. Participation in group meetings, sport clubs, group discussion, dancing, group dinners, and performing arts.
4. Emphasize interpersonal face-to-face opportunities to benefit from communication mediated in the nonverbal domains, not captured by electronic communication devices.
5. Electronic communication nevertheless remains invaluable, but ancillary, facilitative, not a substitute for face-to-face interactions. It complements but should not replace face-to-face encounters.
Recommended Key Performance Indicators
Performance measures by you: Modified Social Network Index – participation once every two weeks with up to 12 different social groups (spouse, parents, child, neighbors, rela- tives, volunteers, work colleague, student, sport groups, social clubs, religious group, charity groups). Score out of 12 (maximum).
Measuring and monitoring by a medical team: CRP, interleukin- 6, brain network integ- rity by MRI brain scan fractional anisotropy [143,144].
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