In this unprecedented time in which the discovery of the novel Coronavirus and the ensuing pandemic has captured the world’s attention and health, the global population’s day-to-day life has been temporarily but drastically altered. Our typical routine of leaving the house for eight hours to attend to our work or school duties has been replaced by the monotonous grind of homeschooling and trying to connect to Skype and Zoom conference calls. One easily slides into this new routine, exchanging formality for comfort. Monday through Friday is differentiated by the varying colors of comfortable workout. Instead of the clear delineations of work-home or school-home boundaries, these markers of time and space become indistinguishable as one moves back and forth from the bedroom to the makeshift home office at the kitchen table, moving aside homework worksheets or computer cables to make room for dinner. Social interaction has been reduced to waving at each other through the computer screen or limited to partners and children in the confines of home. All these dramatic changes can be sobering when one remembers the vibrant and dynamic social life and simple thrill in the change of scenery granted by work and school, but these changes are only made more depressing by the incessant, deafening background noise of negative media and economic predictions of recession.
One common concern heard in these difficult times is that when daily routine and level of engagement with the outside world is significantly limited, mental clarity can diminish as it lacks the constant influx of stimuli from change in environment and different interactions with a wide variety of people. The mind that was previously sharp and focused on each individual task has been dusted with cobwebs as the brain’s dynamic ability of receiving and adapting to new “inputs” lies dormant. How can we awake our minds from its current hibernation? Despite the current quarantine and self-isolation, all of us can develop a set of skills that can be utilized to maintain wellness no matter the external circumstances.
Current medical research has shed new opinions on the topic of strengthening the mind and preventing cognitive decline. Alzheimer’s disease and Parkinson’s disease are two of the most fear-inducing medical conditions and devastating for caregivers to witness in their previously strong and mentally astute loved ones. Naturally, we wonder how we can optimize our mental health, whether to stave off scary diseases or to simply maintain mental acuity and memory that seems to fog with every passing decade.
The market has been inundated with video games, computer games, and interactive apps with the promise of reducing cognitive decline. Even games like crossword puzzles, Suduko, and chess have become more popular as the elder generation seems to keep their minds sharp and the younger generations doggedly pursue them in order to reduce their chances of degenerative brain disease. While the medical literature lacks any guidelines on these topics, it is clear that these games and exercise do not seem to delay or prevent dementia. However, these games can help to exercise brain functions that can slow with age (such as processing speed, reaction time, decision making, and short term memory). They can also help to build up what scientists refer to as “cognitive reserve,” basically the brain’s innate ability to store “brain power” and utilize alternative mental functions if required, much like a mental emergency savings account.
So what is the medicine that our brain desperately requires to lift itself from grogginess and lack of use? The answer lies not in quick and fancy games and apps, but rather in ways that improve neuroplasticiticy, the remarkable ability for the brain to repair itself. Neuroplasticity is the reason why patients who have suffered devastating strokes can re-learn lost functions like movement and speech. In other words, it is the self-rehabilitation of the mind.
When neuroscientists, neurologists, and directors of anti-aging clinics are interviewed about neuroplasticity and what they would recommend to improve brain function, the verdict is clear… it involves the constant mental exercise that accompanies the challenge of learning something new. If one uses the same app or mindlessly and automatically plays a game of chess, there is no value in increasing neuroplasticity for the brain’s neurons are in “default” mode. To achieve a state of neuroplasticity and mental clarity, these neurons must change from “default” mode to “active mode” much like how we use physical exercise to engage new muscles. It is the mental equivalent of staying in one’s comfort zone all the time versus continually raising the level of difficulty and pushing our minds to be continually stimulated.
While there is no harm in doing crosswords and Suduko and brain-training apps, medical researchers and clinicians are much more likely to recommend focusing one’s attention and efforts on several domains currently being investigated by the Alzheimer’s Association and the American Association of Retired Persons. These domains may sound simplistic, but they hold the key to maintaining optimal brain wellness: physical activity, intellectual discovery, relaxation, nutrition, and social interaction.
For physical activity, it may please people to know that not only their waistlines will benefit from some exercise. Research has shown that 150 minutes of moderate intensity aerobic exercise per week can increase blood flow to the hippocampus (the brain’s memory storage region) and optimizes existing neural connections. While fitness centers and classes are closed at the present time, one can still run, bike, or swim outside while maintaining safe distances from other people or do high intensity interval exercises in the comfort of their own home.
Intellectual discovery can be thought of as the ability to learn a new skill and this is what the medical community strives to communicate amidst the focus on brain-training. The new skill doesn’t have to be expensive or technologically advanced…. Ideas range from learning a language or instrument, creative endeavors like painting or sculpting, or reading different books that offer a level of mental engagement rather than “tuning out” with each page. We must fight against the temptation to relax in front of endless Netflix shows or video games, effectively sedating ourselves amidst the tension and stress of the current situation.
We also cannot discount the effect of relaxation, which includes proper sleep hygiene. Mindfulness, meditation, journaling, prayer, and ensuring a full and deeply restful sleep are all essential in maintaining mental clarity. While we might be discouraged by the current lack of change in routine, it is paramount to continue to go to sleep at the same time and wake up at the same time every day, even if our only destination is the kitchen table to do a Skype meeting. It also bears keeping in mind that while we should continue to watch the news of the day to be informed of new governmental regulations, we should also limit the amount of news we consume and try not to do it right before bedtime as constant negative stimuli can adversely affect the quality of sleep.
Nutrition is also a challenge at this time. We are encouraged to limit how often we go grocery shopping and even the experienced cook might find it burdensome to create healthy meals from empty grocery shelves or when they are limited to nonperishable pantry items. In addition, being limited to the home can induce the urge to cook and bake comfort food. Despite this, we should all try to maintain the same eating schedule as we did in the times pre-Coronavirus. By continuing to plan our meals and snacks, we can avoid the temptation to succumb to impulsive eating and mindless snacking throughout the day.
And finally, social interaction, the direct opposite of the buzzwords of self-isolation and quarantine…we can choose to be mired in sadness as our only face-to-face interaction is reduced to the home, and we reminisce over former brunch dates, cocktails, and outings with friends and missed birthday parties with family members. In this aspect, we are lucky that we can still engage with other people through technology. Instead of a dinner party or birthday party, why not a virtual get-together where everyone invited eats dinner in front of the computer screen and sends birthday greetings at the same time? Virtual group fitness classes, book clubs, and even wine tastings have become the new and improved social interaction. Moreover, despite the buzz and hype of online interactions, one cannot discount the simple value of a text or phone call to check in on friends and family and offer mutual comfort in disparaging times.
Of course, the times governed by COVID-19 are frightening. The demands on our day-to-day life are unrecognizable and challenging and seem to forego our natural instincts to engage, to move, and to explore. I hope these simple recommendations on mental clarity can bring comfort and a sense of balance as we turn inwards to maintain health and wellness, and that we can emerge from these dark times with renewal and energy.
This blog was written by Dr. Shirin Karimi Hund, who is a Internal Medicine physician (General Practitioner). She graduated from the University of Connecticut School of Medicine where she was inducted into the Arnold P. Gold Humanism Honor Society for her contributions to medical humanities, and did her residency at Cambridge Health Alliance in Massachusetts (a Harvard Medical School affiliated program). During her residency, she was accepted to the Harvard Macy Institute for her work and interest in medical education. She is board certified in internal medicine and licensed in Connecticut.