Counter to guidelines, elderly men screened at high rates, even those with limited life expectancy.

Louise Walter

Veterans Affairs hospitals screen elderly men with limited life expectancies for prostate cancer at surprisingly high rates, even though guidelines recommend against such screening, according to a study led by a physician at the UCSF-affiliated San Francisco VA Medical Center (SFVAMC).

“Some VA hospitals are screening up to four-fifths of their very ill, very elderly patients, and some as few as one quarter, but none are targeting screening according to the men’s life expectancy,” said principal investigator Louise C. Walter, M.D., a geriatrician at SFVAMC and a professor of medicine at UCSF.

The study of 622,262 men at 104 VA medical centers around the country was published electronically in the Journal of General Internal Medicine on Dec. 17.

The authors found that, nationally, an average of 45 percent of men over age 85 or with four or more serious diseases were given a prostate-specific antigen (PSA) screening test. Screening rates at individual medical centers ranged from 25 percent to 79 percent.

The screening rate you would expect to see for men with limited life expectancy is zero to 20 percent,” said Walter. “No medical center we looked at was in that category.”

Walter noted that the latest guidelines from the U.S. Preventive Services Task Force recommend that men 75 years or older should not be given the PSA screening test because the harms, such as false positive results and unnecessary medical treatments, outweigh the benefits.

The study found that healthy older men with longer life expectancies were screened at the same rates as frail, ill men. “Low or high, a hospital’s screening rate had nothing to do with whether the men were sick or well,” said Walter. “As geriatricians well know, some elders are quite healthy and might benefit from screening, while others are quite ill and will not. Decisions about screening and other medical procedures for older patients need to be made on an individual basis.”

The study authors recommend new interventions at VA medical centers to reduce inappropriate PSA screening in elderly men, as well as new communication tools to help elderly men weigh the benefits and harms of screening.

Read more

The new medical center complements UCLA’s existing services.

Patients were moved Sunday from the nine-story Tower building that was part of the hospital to a new section.

The new UCLA Medical Center, Santa Monica officially opened its doors on Sunday as 125 adult and pediatric patients were carefully transported into new hospital buildings on the Santa Monica campus, as well as into the existing Merle Norman Pavilion.

Teams of doctors, nurses and moving specialists transported patients to ensure they were safely and efficiently relocated to the new hospital.  The move followed months of extensive planning to prepare the hospital for licensing and occupancy, and to orchestrate the extremely detailed sequence of patient relocations.

Part of a systemwide rebuilding project, the new Santa Monica campus features the UCLA Medical Center, Santa Monica; a branch of Mattel Children’s Hospital UCLA; the Los Angeles Orthopaedic Hospital; and the UCLA Rape Treatment Center. The new main entrance to the campus has returned to its former location at 1250 16^thStreet.

The new campus complements existing, world-class services provided by UCLA Health System facilities that include Ronald Reagan UCLA Medical Center, Stewart and Lynda Resnick Neuropsychiatric Hospital, Mattel Children’s Hospital, and more than 80 primary and specialty offices throughout greater Los Angeles.

“Every patient who comes to us deserves the best, and every one of them, when they leave us, should be an ambassador to tell others about the great care and service they received at UCLA,” said Dr. David Feinberg, president of UCLA Health System. “This wonderful new facility not only accommodates scientific and technical excellence, but also creates an environment that is healing.”

“Today’s move marks the final stage in the transformation of this hospital from a private community hospital to an academic-community hospital that delivers world-class UCLA care to every patient,” said Dr. James Atkinson, who oversaw the rebuilding project and serves as medical director at the Santa Monica campus.

He added that the campus will provide the full continuum of services, from neonatal intensive care to geriatric medicine, and serve as the inpatient home of UCLA’s highly regarded orthopaedic, geriatric and general medicine programs.

Read more

UC San Diego program has shown success in training health care, law enforcement.

Linda Hill, UC San Diego

The University of California, San Diego, School of Medicine TREDS (Training, Research and Education for Driving Safety) program has been awarded a grant from the California Office of Traffic Safety to continue its work on driving safety in older adults. This team of experts, part of UC San Diego’s Injury Epidemiology, Prevention and Research Center, has been working to keep San Diego County’s highways and senior drivers safe since 2007.

“Both health care and law enforcement can play an important role in the identification and referral of drivers who may be at risk for a collision,” said Linda Hill, M.D., M.P.H., clinical professor in the Department of Family and Preventive Medicine at UC San Diego School of Medicine. “Physicians have knowledge of a patient’s medical history and the medications that can impact driving, while law enforcement witnesses and responds to unsafe driving first hand.”

Family members of older drivers often seek guidance from these professionals in an effort to keep their loved ones safe behind the wheel. TREDS educates health care providers on the American Medical Association’s screening guidelines that assess for vision, strength and cognitive impairment in adults over age 70. The focus of the law enforcement training is to increase recognition of medical conditions that can impact driving and referral resources.

“We have trained more than 1,000 health professionals and more than 700 law enforcement officers in Southern California counties. Now, these successful programs will benefit the most traffic-congested areas in the state, Los Angeles and Orange counties,” said Hill. “And soon health professionals throughout California will have the opportunity to receive the training online.”

Early identification of conditions is paramount to the continuation of safe driving. Treatment may be as simple as a new pair of glasses, some adaptive equipment for the car or physical therapy to improve range of motion. Training health care practitioners and law enforcement officials will better equip them to help older drivers maintain mobility for as long as safely possible.

“Older adults have positive driving attributes like experience, being more likely to follow laws and less likely to take risks; however, as a group, their rates of death per distance driven and per population is as high as that of teenage boys,” Raul Coimbra, M.D., Ph.D., FACS, chief of the Division of Trauma at UC San Diego Health System and founder of the UC San Diego Injury Epidemiology, Prevention and Research Center. “In addition, elderly drivers and their passengers are four times more likely to die than their 20-year-old counterparts in crashes of similar intensity.”

“The California Highway Patrol appreciates the training provided by the University of California, San Diego. This training has enabled our officers to better serve our older drivers by recognizing driving impairment and make referrals to community resources. We are grateful for the contributions senior drivers have made to our communities over the past decades and want to best serve them while they continue to enjoy their driving experiences,” said Chief Jim Abele of the California Highway Patrol.

“The goal of these programs is to improve driving safety in older adults by increasing awareness, education and management of the health-related impairments which result from the aging process,” explained Richard Kohr, senior driver ombudsman for the California Department of Motor Vehicles – Southern Region.

Funding for this program is provided by a grant from the California Office of Traffic Safety (OTS), through the National Highway Traffic Safety Administration (NHTSA). The DMV Senior Ombudsman Program and the San Diego Driver Safety Office collaborated with and support UC San Diego’s efforts to engage health professionals and law enforcement in this endeavor.

The grant team, led by Hill, includes Coimbra; Jill Rybar, M.P.H, project manager; and Tara Styer, M.P.H., training coordinator. For additional information or to schedule trainings, email TREDS@ucsd.edu or call (858) 534-9330.

Background
The AARP states that beginning in 2011, 8,000 baby boomers will be turning 65 each day and these projections are expected to continue for the next 18 years. The National Highway Traffic Safety Administration (NHTSA) estimates that by the year 2020, there will be more than 40 million licensed drivers over the age of 65, and 6 million drivers over 65 in California by the year 2030.

Older adults often experience a decline in cognition, vision and motor skills required to complete many tasks associated with driving. AAA reports that nearly 70 percent of older adults surveyed were using one or more prescription medications that could impair driving ability.

According to San Diego County, 1,408 individuals over 65 were involved in traffic crashes, accounting for 10 percent of all people injured and 16 percent of all traffic fatalities in 2008.

The Injury Epidemiology, Prevention and Research Center
The UC San Diego Injury Epidemiology, Prevention and Research Center is a combined effort of the Division of Trauma, Surgical Critical Care, and Burns with its Level-1 Trauma Center and the Regional Burn Center and the UC San Diego Department of Preventive Medicine to make our communities safer and to decrease the burden of injuries to our society.

Genetic trigger discovered that makes the nose renew its smell sensors.

Elongated green cells are sensory neurons; cells labeled in red are immature cells

University of California, Berkeley, neuroscientists have discovered a genetic trigger that makes the nose renew its smell sensors, providing hope for new therapies for people who have lost their sense of smell due to trauma or old age.

The gene tells olfactory stem cells ‑ the adult tissue stem cells in the nose ‑ to mature into the sensory neurons that detect odors and relay that information to the brain.

“Anosmia ‑ the absence of smell ‑ is a vastly underappreciated public health problem in our aging population. Many people lose the will to eat, which can lead to malnutrition, because the ability to taste depends on our sense of smell, which often declines with age,” said lead researcher and campus neuroscientist John Ngai.

“One reason may be that as a person ages, the olfactory stem cells age and are less able to replace mature cells, or maybe they are just depleted,” he said. “So, if we had a way to promote active stem cell self-renewal, we might be better able to replace these lost cells and maintain sensory function.”

Gary K. Beauchamp, director of the Monell Chemical Senses Center in Philadelphia, who was not a member of the research team, noted that the olfactory system stands out for its ability to regenerate following injury or certain diseases

“This new paper … presents an elegant analysis of some of the underlying genetic mechanisms regulating this regeneration,” Beauchamp said. “It also provides important insights that should eventually allow clinicians to enhance regeneration, induce it in cases where, for currently unknown reasons, olfactory loss appears permanent, or even prevent functional loss as a person ages.”

The discovery may also help scientists harness olfactory stem cells and stem cells found in other sensory systems more generally, to recover sensory function following injury or degenerative disease, said Ngai, the Coates Family Professor of Neuroscience in UC Berkeley’s Department of Molecular and Cell Biology and director of the Helen Wills Neuroscience Institute and the QB3 Functional Genomics Laboratory.

Ngai, post-doctoral fellow Russell B. Fletcher and their UC Berkeley colleagues report their findings in the Dec. 8 issue of the journal Neuron.

Read more

UC Davis research aimed at understanding mechanism that allows tumor immortality despite telomerase-targeted therapy.

Lifeng Xu, UC Davis

The American Cancer Society has awarded UC Davis researcher Lifeng Xu a four-year, $720,000 grant to conduct research aimed at better understanding how some cancer cells manage to remain immortal. The work promises to improve the efficacy of cancer therapies currently in clinical trials that focus on blocking the activity of an enzyme called telomerase.

“Telomerase is activated in about 90 percent of tumors,” said Xu, a UC Davis assistant professor of microbiology.

Xu’s research focuses on what happens in the other 10 percent of cancer cells that manage to remain immortal without the presence of telomerase.

Telomerase is an enzyme that prevents the constant loss of specific DNA sequences from the tips of chromosomes, called telomeres, during cell division. Telomerase is found in embryonic stem cells, which allows these cells to divide over and over during development in utero. Adult, or somatic cells, only express telomerase at low levels and only at certain times in their life cycles.

Nearly all forms of human cancer, however, express telomerase, and have acquired the ability to replenish their telomeres to sustain unlimited cell proliferation, said Xu.

Because telomerase is not essential for normal cell function, scientists have homed in on this enzyme as an ideal target for treating a host of cancers. Telomerase inhibitors are now being tested for the treatment of brain and breast cancers, for example.

“But there are still some cancers that use other mechanisms to replenish telomeres and keep cells dividing,” said Xu. “Our goal is to understand these alternate mechanisms to design better drugs.”

Read more

UCSF-led analysis finds issues with low staffing, poor quality of care at 10 largest for-profit chains.

Charlene Harrington, UC San Francisco

The nation’s largest for-profit nursing homes deliver significantly lower quality of care because they typically have fewer staff nurses than nonprofit and government-owned nursing homes.

That’s the finding of a new UC San Francisco-led analysis of quality of care at nursing homes around the country. It is the first-ever study focusing solely on staffing and quality at the 10 largest for-profit chains.

The article is published online in advance of print publication in Health Services Research.

“Poor quality of care is endemic in many nursing homes, but we found that the most serious problems occur in the largest for-profit chains,” said first author Charlene Harrington, R.N., Ph.D., professor emeritus of sociology and nursing at the UCSF School of Nursing. Harrington also is director of the UCSF National Center for Personal Assistance Services.

“The top 10 chains have a strategy of keeping labor costs low to increase profits,” Harrington said. “They are not making quality a priority.”

Low nurse staffing levels are considered the strongest predictor of poor nursing home quality.

The 10 largest for-profit chains operate about 2,000 nursing homes in the United States, controlling approximately 13 percent of the country’s nursing home beds.

In recent decades, nursing home chains have undergone a considerable expansion. A number of chains were publicly traded companies until the early 2000s, when five of the country’s largest chains went bankrupt. Following restructuring and ownership changes, as well as increases in Medicare payments, the largest chains became more financially stable. More recently, some of the largest publicly held chains were purchased by private equity investment firms, which invest funds received from investors, with whom they share profits and losses.

The researchers compared staffing levels and facility deficiencies at the for-profit chains to those at homes run by five other ownership groups to measure quality of care. The 10 largest chains were selected because they are influential in the nursing home industry and are the most successful in terms of growth and market share.

The study found that for-profit homes strive to keep their costs down by reducing staffing, particularly RN staffing.

Recent Medicare cuts in payment rates for nursing home residents — by 11 percent in October 2011 — may further jeopardize the health and safety of residents if the chains respond by reducing staffing and wages, Harrington said.

The 10 largest for-profit chains in 2008 were HCR Manor Care, Golden Living, Life Care Centers of America, Kindred Healthcare, Genesis HealthCare Corp., Sun Health Care Group Inc., SavaSeniorCare LLC, Extendicare Health Services Inc., National Health Care Corp. and Skilled HealthCare LLC.

From 2003 to 2008, these chains had fewer nurse “staffing hours” than nonprofit and government nursing homes when controlling for other factors. Together, these companies had the sickest residents, but their total nursing hours were 30 percent lower than nonprofit and government nursing homes. Moreover, the top chains were well below the national average for RN and total nurse staffing, and below the minimum nurse staffing recommended by experts.

The 10 largest for-profit chains were cited for 36 percent more deficiencies and 41 percent more serious deficiencies than the best facilities. Deficiencies include failure to prevent pressure sores, resident weight loss, falls, infections, resident mistreatment, poor sanitary conditions and other problems that could seriously harm residents.

The study also found that the four largest for-profit nursing home chains purchased by private equity companies between 2003 and 2008 had more deficiencies after being acquired. The study is the first to make the connection between worse care following acquisition by private equity companies.

The authors said that more study is needed on the subject. They also said that greater accountability and quality oversight mechanisms would help improve nursing home care, along with effective funding incentives and sanctions for low staffing and poor quality.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.

UCSF’s Cynthia Kenyon on the pursuit of a vibrant, longer life.

In 1993, UC San Francisco’ s Cynthia Kenyon, Ph.D., and colleagues discovered a gene that, when mutated, doubles the lifespan of the miniscule roundworm C. elegans. Today, her lab is investigating drugs in human cells that could extend the healthy, vigorous lifespan of people.

Kenyon discussed the state of the science at a TEDGlobal conference in Edinburgh last summer. The presentation, recently posted (see above), so far has received more than 103,000 hits, an indication that life – and lifespan – is of interest to many.

As seen on the big TED screen, C. elegans, formally known as Caenorhabditis elegans undergoes an aging process much like humans, if faster. As it approaches its thirteenth day, it is moribund, its formerly supple tissues deteriorating, its body static except for feeble motions of its head. Its mutated brethren, meanwhile, are supple, active and vibrant.

This discovery, and subsequent findings in fruit flies, mice and humans, have revealed that genes regulate hormones that affect the rate of aging. The pathways these genes control have the ability to turn on or off a host of repair mechanisms that normally are inactive. One of the goals of Kenyon’s lab is to identify drugs that could turn on the proteins that control these processes to delay aging and age-related diseases.

“I’m really optimistic,” she said, “and it won’t be too long, I hope, before this age old dream begins to come true.”

The search for the fountain of youth.

The good news is we are living longer. The bad news is that we are not necessarily living better as age-related diseases often limit the quality of life. Studies of successful aging — physical and cognitive success — indicate that genetics account for only part of what determines how well we age. Thus, many experts encourage healthy lifestyle habits, including physical conditioning, diet, stress management and mental stimulation for better cognitive health and longer life expectancy. Noted expert, UCLA Dr. Gary Small, discusses the available methods for living longer in this UCTV program (see video above: first air date, Nov. 10, 57 minutes).

UCLA study has implications for humans.

David Walker, UCLA

UCLA life scientists have identified a gene that slows the aging process.

The biologists, working with fruit flies, activated a gene called PGC-1, which increases the activity of mitochondria, the tiny power generators in cells that control cell growth and tell cells when to live and die.

“We took this gene and boosted its activity in different cells and tissues of the fly and asked whether this impacts the aging process,” said David Walker, an assistant professor of integrative biology and physiology at UCLA and a senior author of the study. “We discovered that when we boost PGC-1 within the fly’s digestive tract, the fly lives significantly longer. We also studied neurons, muscle and other tissue types and did not find life extension; this is telling us there is something important about the digestive tract.”

The research appears in the current online edition of Cell Metabolism, the leading journal in its field, and will be published in an upcoming print edition. Co-authors are from Walker’s laboratory, the Salk Institute for Biological Studies in La Jolla, Calif., and the department of biology at UC San Diego.

“By activating this one gene in this one tissue — the intestine — the fly lives longer; we slow aging of the intestine, and that has a positive effect on the whole animal,” said Walker, a member of UCLA’s Molecular Biology Institute. “Our study shows that increasing PGC-1 gene activity in the intestine can slow aging, both at the cellular level and at the level of the whole animal.”

The biologists delayed the aging of the flies’ intestines and extended their lives by as much as 50 percent.

Fruit flies, or Drosophila melanogaster, have a life span of about two months. They start showing signs of aging after about one month, and they slow down, become less active and die, Walker said. They are a great model for studying aging, he said, because scientists know every one of their genes and can switch individual genes on and off.

What are the study’s implications for human aging?

“We all think about protecting the brain and the heart, but the intestine is a vital tissue type for healthy aging,” Walker said. “If anything goes wrong with the mitochondria in cells, the consequences could be devastating, and if anything goes wrong with our intestines, that may have devastating consequences for other tissue types and organs. Not only is the intestine essential for the uptake of nutrients that are a vital source of energy, but it is also an important barrier that protects us from toxins and pathogens in the environment. The intestine has to be well-maintained.

“No one yet knows what causes aging at the cellular or tissue level,” Walker said. “As we age, our mitochondria become less efficient and less active. That has far-reaching consequences, because if the mitochondria decline, then all of our cellular functions may be compromised. However, it’s a dangerous road to travel to say, ‘This is the cause of aging.’”

Read more

Treatment that might offer longer, better lives to children with progeria now in clinical trials.

Francis Collins

Aging of individual cells in the body leads to aging of the whole person. New evidence for this comes from studies of very rare children born with a genetic mutation that wrinkles, ages and kills them before they reach adulthood.

Thanks to research led by the director of the National Institutes of Health, Francis Collins, M.D., Ph.D., a treatment that might offer longer, better lives to children with Hutchinson–Gilford progeria syndrome now is in clinical trials.

The clinical trial and the research that led to it is stimulating scientists to think about ways to fight aging at the cellular level, similar to the way they already have begun to do battle against this most dramatic premature aging disease.

Children born with this form of progeria become strikingly wizened as they age without ever growing to adulthood. They die by about age 12 or so, usually due to heart disease.

Progeria has often been portrayed as a “cartoon of aging,” from which little could be learned about normal aging, according to Collins, this year’s Charles J. and Lois B. Epstein Visiting Professor. He does not share this view. “I think we can counter that with molecular data,” he said during a talk at the UCSF Mission Bay campus on Oct. 3, part of a daylong symposium hosted by the Institute for Human Genetics.

The common culprit Collins has identified in normal and premature aging arises for different reasons. In normal aging, Collins suspects damage or loss of telomeres — protective DNA that caps genes at the tips of chromosomes within all our living cells.

Telomeres seem to be turning up everywhere in aging research. UCSF’s Elizabeth Blackburn, Ph.D., shared a Nobel Prize for the discovery of an enzyme that replenishes bits of telomeres that are lost every time a cell divides. Now she and her colleagues are finding links between telomere shortening and chronic diseases of aging. During his talk Collins served up another possible connection between telomeres and aging.

Collins and collaborators found the mutation that causes Hutchinson-Gilford progeria syndrome — a single-letter mistake in the genetic code. The mutation causes a splicing error in the genetic blueprint used to make one of the cell’s important structural proteins.  Instead the cell makes an abnormal protein — called progerin — that messes up the cell’s orderly structure, and the mess just gets worse every time a cell divides to make daughter cells.

In progeria, this happens in all cells. After several generations daughter cells become misshapen. Individual cells senesce faster than normal. The overall potential for cells to undergo cell division is abnormally limited.

Fortunately, Collin’s research team identified not only a cause, but also a treatment — an off-the-shelf drug developed to treat cancer but which was never successful for that purpose. Now a three-year clinical trial in which 28 children are being treated with the drug is ending, and during his symposium talk Collins said the yet-to-be published results are “encouraging.”

But in one of those expansive, “I hate to ruin your morning,” moments, Collins went on to present evidence that progerin is being made by a fraction of cells in all of us as we age, albeit in much less dramatic fashion.

Read more

The degenerative joint disease strikes half of Americans by the time they reach 70.

Sharmila Majumdar, UC San Francisco

How people walk, jump and run and how their knees look in an MRI scanner may hold the secret to predicting years or even decades in advance whether they will develop osteoarthritis, the common degenerative joint disease that strikes half of all Americans by the time they reach the age of 70.

Doctors today cannot look at a person’s gait, leap, stride or scan and tell you definitively whether or not they will develop osteoarthritis, but a new translational research center at the University of California, San Francisco, Medical Center and the University of California, Davis, seeks to change this.

Funded by a $6.3 million grant from the National Institutes of Health, the center will bring together radiologists, orthopedic surgeons, rheumatologists, laboratory scientists, mathematicians and physical therapists under one umbrella with a single purpose: finding new tools for predicting and preventing osteoarthritis in young people and improving care and outcomes for the tens of millions of American adults already suffering from the disease.

“Osteoarthritis is one of the major age-related illnesses of our times, and there’s no way to slow or reverse it once it starts,” said Sharmila Majumdar, Ph.D., UCSF Professor in Residence and vice chair of research in the Department of Radiology and Biomedical Imaging. “The diverse group of experts at the center will all be seeking to address this problem, but from different perspectives, integrating imaging, biomechanics and the symptoms of the individual.”

Nancy Lane, UC Davis

Specifically, these experts will combine advanced MRI imaging with sophisticated analyses of movement, clinical medicine, countrywide statistics and all the latest laboratory research on cartilage composition. They will seek to translate this research into clinical tools that can predict, prevent, and possibly slow damage to soft tissue in the joints.

“We’re very excited about this research because it will allow us to assess the progressive degeneration and risk factors in osteoarthritis of the knee, identify its association with hip osteoarthritis, and determine how changes in cartilage may be a predictor for the disease,” said professor Nancy E. Lane, M.D., who leads the UC Davis Musculoskeletal Diseases of Aging Research Group, is co-principal investigator of the project and will direct one of the four major projects funded by the new grant.

Read more

The Berkeley Wellness Letter looks at brain-training programs.

As we grow older, we all worry about having “senior moments” that last more than a moment. That’s why brain-training programs have become a big business. Can mental workouts really “improve memory by 10 years” and prevent age-related cognitive decline and even dementia, as the programs claim?

Use it or lose it, maybe

Observational studies have consistently found that people with an active life — mentally, physically and socially — tend to be healthier and have a lower risk of mental decline and dementia as they age. No surprise there. But determining cause and effect is hard. Though researchers try to adjust for this in their studies, it could be that people who are mentally and physically healthy are better able to stay active.

A few years ago, one of the biggest and best randomized trials (called ACTIVE), sponsored by the National Institute of Aging, found that five weeks of a cognitive-training program helped older adults boost specific memory and problem-solving skills. The improvements were limited to the abilities trained, but did persist for five years, albeit modestly.

A 2011 Cochrane review of 36 studies found that people with mild cognitive impairment who undertook memory training, mostly group sessions with teachers, improved specific skills, but no more than people mentally active in other ways, such as those taking educational classes.

Despite some promising leads, as well as lots of wishful thinking and sales pitches for various programs, the research remains in its early stages.

Playing mind games

Many experts believe that simply doing activities that challenge your cognitive capabilities can help keep you sharp. There’s little doubt that learning a foreign language, playing bridge or chess, or solving puzzles (like Sudoku) is better for your brain than staring mindlessly at the TV. Several studies have found that even video action games can improve certain types of memory and other cognitive skills.

Other research suggests that commercial brain-training programs — often computer-based — target key cognitive skills better than, say, puzzles or classwork. These range from game-like products such as Nintendo’s Brain Age to expensive software such as Posit Science’s Brain Fitness Program.

Proving that mental workouts produce significant cognitive benefits in older people is difficult, largely because so many variables are involved. It’s much easier to do long-term clinical trials on drugs for dementia, for example (which, by the way, have not proven to be very effective).

And even when studies on the formal programs — usually sponsored by the companies that market them — find short-term improvements in some kinds of mental performance, so far no one knows if these translate into less overall cognitive decline long term or a reduced risk of dementia.

One difference between “natural” training (puzzles, games, learning new skills) and formal programs is that the former are complex tasks using everything from memory to visual attention, while formal programs tend to segregate the different tasks and skills. Formal programs may allow you to improve highly specific mental skills more easily, but you may not retain them as well as you would from a more natural process.

Even when you benefit from one kind of training, there may be no carry-over to other kinds of mental endeavors. For example, doing crossword puzzles, no matter how expert you become, may not help you remember names or balance your checkbook. That is, working on a brain-fitness program may not provide benefits beyond the particular skills learned.

What’s more, people who start out at high levels may profit more from the training. Those who already have cognitive problems may not benefit or may simply become discouraged. And, of course, we all know of people who developed Alzheimer’s or other forms of dementia who were highly educated and mentally active.

Plenty of reasons to flex your brain power

Even if it doesn’t reduce the risk of dementia, staying mentally active may delay its onset or slow its progression. Stimulating your brain can also enrich your life, banish boredom, help prevent or treat depression and be a way to make new friends.

You don’t need to invest in special games or training programs. Just do something challenging that you enjoy, so you’ll keep at it. You may find formal brain-training programs repetitive and boring, similar to being forced to run on a treadmill when you’d rather be hiking in the woods. Learning a new skill (such as a foreign language), taking classes in art history, playing strategic board or card games or doing volunteer work can be rewarding and fun as well as provide a sense of accomplishment.

If such endeavors also confer long-term mental benefits that stave off cognitive decline, so much the better.

Other steps to keep in mind: Physical exercise, controlling blood pressure and cholesterol, maintaining a healthy weight, preventing/controlling diabetes, treating depression, drinking alcohol in moderation (if at all) and having a heart-healthy diet are all good bets for brain health. In general, what’s good for your cardiovascular system is good for your brain.

Read more Berkeley Wellness Letter articles