The Full Life Institute -the leading provider of concierge preventive Life Care for seniors in their home.

About The Full Life Institute

Aging is difficult to undergo and even understand. There is a built-in danger believing in the inevitability of the effects of old age which, if we give in to it, makes aging one of the most difficult periods of life, rather than one of the most satisfying. The whole concept of aging has changed in the past two decades. We hear that the new chronological age of OLD begins in the 80’s not the 60’s as used to be thought. It is now said that the danger of old age is that we may start acting old—not being old. In other words, the current view of aging is that it is a process that can be influenced by the personal decisions that we make.

The message delivered to the senior today is that we can live many more years than was originally thought just 10 years ago because the diseases that lowered life expectancy can be controlled. Dementia, heart disease, hypertension, diabetes, and other chronic diseases that wreak havoc on our bodies and minds can be countered with proper preventive treatment. As we move into the 21st Century, the scientific evidence is telling us that aging, in effect, is partly under our control and how we age is a matter of personal choice. The Full Life Institute has assembled a 21st Century team of medical professionals who treat disease by treating aging.

Dr. Peter Magaro, the President of The Memory Treatment Centers of America, and an acknowledged expert in the cognitive diseases related to aging, has developed an integrated protocol for the treatment of cognitive decline (www.memorytrainingcenters.com).

Dr. Peter Magaro

Aging is difficult to understand especially when you never gave it much thought until it crept up on you and you were there right dab in the middle of it. What Woody Allen said about death could just as well apply to dying, “I am not afraid of death. I just don’t want to be there when it happens.” When a person enters their senior years, they begin to understand that aging is a major pain; literally and figuratively. The question arises “Is this my new life? The answer can be “No”. The suffering of old age is not inevitable. We can influence the effects of aging and maintain our current lifestyle.

As I enter my 80’s and experience the many challenges of what has been called, the second middle age, I learned I had to be very proactive about making lifestyle choices that would affect my health. Medical choices were as much about Prevention as acute care. I saw that there is even a different vocabulary about aging. We now hear that the new chronological age of OLD begins in the 80’s not the 60’s. A new danger of aging is that we may start acting old—not being old.

Aging is now seen as influenced by personal decisions of what you will do with and to your body. The current scientific creed is that aging is a process that incorporates behavioral health decisions and as such we can make of it what we wish. The message being delivered is that the life span has increased because the diseases that have lowered that limit can be controlled through a behavioral health approach. Dementia, heart disease, hypertension, diabetes, and other diseases can be countered with proper preventive care. Aging is under our control and how we age is a matter of personal choice.

All these changes relative to our responsibility for our living and aging lead us to the most difficult conclusion. We can guide the process of health but we cannot do it without professional help. Due to the structure of the public health system, there are no programs that offer all the components that are necessary for an effective preventive program and are delivered in a manner that assured their use in the prescribed manner.

Even if they did exist, they would be too expensive for the public health system to bear.

I have spoken with many successful individuals who were ready to invest their time and energy in their health care to maintain their successful endeavors and, with some, their endeavors depend upon them being vital and active. They asked: “Where is the program designed for my social situation.”

The program you require now exists and is available for your use.

POSITION PAPER

FULL LIFE INSTITUTE

 AGING AND THE TREATMENT OF DISEASE

The questions answered in this white paper are WHERE, HOW and WHEN one should treat a disease.  Moreover, I will be addressing the CHRONIC DISEASES most often found with the ELDERLY.  I will be describing a comprehensive treatment protocol that can address the major problems of aging.  It would not be unfair to say that the COMPREHENSIVE treatment system offered here is the treatment of AGING rather than the treatment of DISEASE.

AGING AND DISEASE

It is possible, but rare, to age in relatively good health. For the majority of people, growing old is associated with an increased risk of developing a plethora of degenerative conditions and functional impairments Khaw (1999). The burden of disease is probably the most distressing aspect of old age often leading to depression and other secondary psychiatric disabilities and no one likes it.  When rated against the standard benchmarks a biological gerontologist would use to measure successful aging (maintenance of normal function, avoidance of disease and social engagement), only about 18% of people can be described as undergoing “successful aging” Bowling and Dieppe (2005)., From self-report surveys, anywhere between half and a quarter of elderly people do not consider themselves to be aging well. They are not happy and are probably not healthy either.  Unless improved treatment systems are applied, we may end up with a world in which we spend more money than ever before to keep more people more miserable. On the other hand, we know that better secondary prevention will postpone the age of onset of morbidity and that a comprehensive treatment model, available in a fixed location, is the best treatment available when the individual has ownership of the treatment and it becomes part of the person’s daily routine.  Certainly just seeing the usual activities of life becoming chores, reveals the everyday challenges presented by advancing years.

THE AGING PROCESS
I would like to begin by fully adopting Michael Rae’s (2013) eloquent discussion of the aging process, age-related disease and how disease relates to aging

“We’ve all heard this language used by medical experts. But what do we mean by them? What is the mysterious connection between aging and the diseases of aging? ….While we sometimes prefer not to think about it, we all know that people lose their health as they age. Angina, Alzheimer’s, breast and prostate cancers, chronic kidney disease … With rare exceptions caused by birth defects, severe congenital mutations, or traumatic injury, these diseases are never present in young adults. Their first subtle hints crop up in the years between our forties and our seventies, accompanied by the weakening of our muscles (even in athletes), loss of cushioning in our joints, failing of the eyesight, and a generalized decay of the body’s resilience and health. Over time, the minor aches and vague malaise of middle age devolve more or less rapidly into clinical diagnoses, leaving us with a rising burden of disease, disability, and dependence. But why does this happen? What is it about these diseases that causes them to slowly creep into our bodies after decades of relatively healthy life, each joining and building on the others, as if they were so many poorly-coordinated orchestra musicians, playing at different speeds, starting at different times, and raising a cacophony that gets louder and louder until it reveals itself as a terrible, secret symphony? And what can the answers to those questions tell us about what to do about them?

Over the decades that you share life with friends and loved ones, you watch as the degenerative aging process gradually sets into young, healthy bodies, rendering them ever more fragile and riddled with age-related disease. Fundamentally, what you’re witnessing is the same thing that happens over time to a new car that isn’t optimally maintained. The immaculate finish of the new machine you drove home fresh off of the dealer’s lot slowly begins to lose its luster. Its upholstery fades. Its brakes slowly get soft. It develops leaks in the manifold gasket, and begins to exude the stench of a corrupted catalytic converter … and eventually, the engine seizes up.  So it is with our bodies. During our first two to three decades of life, developmental programs build up our growing bodies, laying down the cellular and molecular structures of our tissues in exquisite fidelity to the instructions carried in our genetic code. From form, flows function: the pristine condition of the microscopic machinery of life ensures its silent, unimpeded functioning, manifested in the health and vigor in youth. But like a car or any other ordered system, the components of that carefully-organized structure can be damaged — not just by blunt trauma, with its visible scars, but at the microscopic level, during the course of normal cellular operation. The business of life is carried out by intricate, interlocking, tightly-regulated cycles of biochemical reactions in our cells, which must respond with perfect elasticity to the constantly-shifting demands of everyday life, as we eat, drink, sleep, go hungry, walk to work, or make love. So minor biochemical “accidents” that cause microscopic damage to the structure of our cells and structural molecules are frequent and inevitable events.”

“Just like the wear on an engine, the damage occurs at such low levels that you don’t notice its effects at first: instead, it takes many decades for the damage to build up to the point where tissues begin to cease proper functioning. Thinning skin, clouding eyes, muscles sapped of strength, shortness of breath, failing memory … from minor malaise to crippling and life-threatening conditions, the diseases and disabilities of old age flow from the inexorable degradation of the integrity of the cellular and molecular machinery that carries out the essential functions of our tissues. And as some tissues stop functioning properly, other tissues that depend on their activity make increasingly-desperate attempts to repair, adapt to, or compensate for the rising tide of damage. As the originating organs continue to decay, these secondary effects become chronic and dysfunctional, leading to self-perpetuating inflammation, oxidative stress, and other metabolic aberrations that impair our health even more

So aging is nothing more or less than the integrated, whole-body picture of these myriad forms of damage, decay, and dysfunction accumulating in all of our tissues over the course of time, impairing the ability of our cells and organs to keep us alive and healthy. When we look at someone and can see that she’s old, what we are seeing is the sum of the outward ways that all of that damage has ravaged her body — her skin, and her hair, and her muscles — and the indirect signs, like the damage to her joints that shows itself when she struggles to button her coat, and the damage to subsets of nerve cells that surfaces in her trembling hand when she signs her name” (Rae, 2013).

Age-related diseases, in turn, are nothing more or less than the many particular ways that particular organs and tissues stop working properly as a result of their lifelong accumulation of the particular forms of aging damage that most impact their ability to carry out their function in the body. “Alzheimer’s disease” is just the name we give to a particular subset of the aging process that occurs in particular parts of the brain; “Parkinson’s” is just the name for another such subset. Becoming more farsighted with time, as well as cataracts and age-related macular degeneration (the number one cause of blindness in people over the age of 65) are the aging of different tissues in the eye. Atherosclerosis is one manifestation of the aging of the arteries; the stiffening or “hardening” of the arteries that causes our blood pressure to slowly rise with age (and the risk of stroke along with it) is another aspect. Frailty (a recognized medical syndrome of aging) is the terrible late stages of the aging of the muscles, the bones, and most likely the skin and other cells that support these tissues.

Individual Differences in the Aging process  But if all parts do not continue to function — the point, in other words, at which a particular age-related disease sets in — is determined by the sum of the multiple, largely independent sources of damage that occur in particular organs and tissues — and these multiple forces vary from one person to another of this aging is happening in all of our organs and tissues throughout adult life, then why does one person seem to age more slowly than another? And why do some people develop particular age-related diseases — chronic kidney disease, or chronic bronchitis, or glaucoma, or heart failure — at earlier ages than other people do, and even though that same person may not develop other diseases of aging for many years after? Because the point at which a given tissue or organ reaches a level of damage that is beyond its ability, get exercised or a brain that never gets challenged. And just as Range Rovers are built to last longer than Chryslers, people do vary to and in one tissue or organ and another within the same person. A given organ can be weaker than average at birth, because of unfavorable genes or it’s because its mother was missing essential nutrients in her diet. It can be injured in a car accidents or a skateboarding spill. Different organs can be particularly damaged by specific lifestyle exposures, like smoking (the lungs and circulation), or excessive alcohol (the liver and the brain), or overeating (the insulin-producing cells of the pancreas). It can atrophy for lack of use, whether it’s muscles and hearts that never a moderate extent in the rate at which even the most fundamental, inescapable aspects of aging occur. This is why longevity runs in some families: because of variations in genes that slow down the rate of cell growth, or regulate metabolic processes involved in driving particular forms of aging damage, members accumulate moderately less aging damage over time, and as a result are able to put off the diseases of aging into their eighties instead of their seventies.  It’s all of these things coming together that will determine when a given organ in a given person will cross over that critical threshold: when so many of its cellular and molecular structures have been disabled by damage, that it no longer has the functional reserve needed to carry out its role in the body in the face of the ordinary challenges of life. And once again: when that happens, we call it a disease.” (Rae, 2013)

In brief, the same aging mechanisms that contribute to age-related diseases also show themselves as features of aging which in the past were considered to be “natural changes” (e.g., the accumulation of senescent cells in the skin contributes to wrinkling, a “natural change” as well as to cardiovascular disease, an “age-related disease”).   We consider some aging process not diseases and not attempt a treatment while with others a treatment is critical. As we age, the cells become less able to ward off simple diseases, mutations, viral and bacterial invasions.  The chronic disease grows from these initial attacks.   Just as with our auto metaphor above, if we run the car too often with improper air in the tires, the tire will become flat while the properly filled tire will not have a flat until the rubber is more worn. The genotype was the same but the phenotype was very different. Taking care of the tires is the driver’s responsibility which includes going to the garage every few months to have them evaluate (diagnose) the tire.   If a year later, the tire ignorers finds themselves on a dark road with a flat, it is not the tire at that time which is at fault but also the lack of care of the tire a year ago.

“Possibly the most helpful way to think about what is being proposed here is to consider treatment as a risk factor that occurs at different levels of prevention.  Primary prevention aims to prevent disease or injury before it ever occurs. This is done by preventing exposures to hazards that cause disease or injury. Examples here involve public health legislation such as a ban on smoking. Secondary prevention, the main prevention method we employ, aims to reduce the impact of a disease or injury that has already occurred or is occurring This is done by detecting and treating disease before it becomes noticeable as soon as possible to halt or slow its progress, This prevention involves using personal strategies to prevent increase in the effects of the disease and return people to their original health and function. Examples include: regular exams and screening tests to detect disease in its earliest stages (e.g. mammograms to detect breast cancer; cognitive tests to detect Alzheimer’s disease) daily diet and exercise programs to prevent further heart attacks or strokes.  Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often-complex health problems and injuries (e.g. chronic diseases, permanent impairments) in order to improve as much as possible their ability to function, their quality of life and their life expectancy. Examples include using a cane or wheel chair for diabetes, arthritis etc.  Having a support group to share strategies for living well or vocational rehabilitation programs to retrain workers for new jobs when they have recovered as much as possible.  Our treatment protocol also includes these preventions.

Secondary prevention places treatment of disease in the patient’s hands?  Agreed, the person needs help (instruction in the garage) how to keep themselves healthy (exercise or diet or training) as their cells become more susceptible to disease (chronological age).  We cannot control primary prevention factors; the physical environment outside the individual which contains tons of high risk factors to be avoided. Heart disease, for instance, has dramatically decreased from 1995 to 2005, the mortality rate diminished 26% and the stroke death rate fell 30%.  Primary prevention factors embedded in government policies and the Heart Association such the smoking ban, ads to give up fast food and Mayor Bloomberg’s effort to ban large cokes and salt in restaurants have made significant difference. Few new pharmaceutical or medical treatments have been applied.  Cancer is going through the same process of modifying concepts of the disease and eliminating primary prevention events with the same beneficial results. The rate of cancer survival has increased in the past 35 years from 49% to 68% and this is just not from better detection or treatment.  It is mainly due to eliminating Public Health risk factors.  Interestingly these primary prevention efforts have also reduced incidence of dementia although never considered as a goal.  Today, we are stressing the Second Level of Prevention as the place where The Person is Treating their own Self.  Now that the science of the aging process supports the aging process as the predominant treatment model. We visualize ourselves as having greater control of our own aging process.  We find personal control the main dynamic of the medically preferred treatment today.  It is this behavioral finance model that makes the Secondary Level of Prevention the preferred intervention.

A COMPREHENSIVE TREATMENT APPROACH TO AGING

“As we’ve said before, there are many different things that can contribute to the total burden of aging damage in our bodies, including our genes, our lifestyles, and things in our environment. Genes, the conditions in the womb, nutrition, lack of exercise, pollution … with all of the many factors that influence the onset of age-related disease, plus the side-effects of the very metabolic processes that give us life, you might think that completely preventing or curing those diseases would be a hopelessly complicated task. And indeed it would be, if your strategy were to try to hold back each and every one of those multiple causes of damage.”… (Rae, 2013)  The Intervention protocol offered by The Full Life Institute understands there are inherent links between all prevention levels and diseases in aging and treating one age related disease without treating the other may not be effective for either.  For instance, there would be no expectation to treat dementia without treating heart disease or vice versa.  For example in a recent John Hopkins study, the finding was that a midlife diagnosis of diabetes or prediabetes raises the risk of memory and thinking problems over the next 20 years.  Having diabetes in midlife was linked with a 19 percent greater decline in memory and thinking (cognitive) skills 20 years later, people with prediabetes, diabetes and poorly controlled diabetes had the higher risks of cognitive decline. The people with the worse cognitive decline were those with poorly controlled diabetes. In another study, blood pressure, diabetes, and smoking were found to be risk factors for Alzheimer’s disease and dementia. Obesity and sedentary behavior were also risk behaviors.

“But actually, what all of this complexity of diseases and aging reveals is the underlying simplicity of age-related diseases. Because while list of things that hasten the pace of age-related disease is long, they all contribute to the diseases of aging through the same critical intersection: each of them contributes damage to the cellular and molecular structures of our organs and tissues.” (Rae, 2013)

“The best evidence right now for the particular lifestyle factors that may reduce risk of Alzheimer’s and other chronic diseases is regular physical activity in combination with social and mental stimulation, and quitting smoking,” said Maria Carrillo, Alzheimer’s Association vice president of medical and scientific relations. “Other lifestyle activities that contribute to healthy-brain aging are eating a brain-healthy diet, being mentally active, and being socially engaged.”  These are the same treatments for heart disease but the focus here is on the most dangerous of the aging process, that of Alzheimer’s disease which is why we emphasize this disease in our aging program and will explore in more detail.  However we are aware that there are specific lifestyle factors that are integral to the aging process and thus each chronic disease.

The commonality of individual behaviors that benefit so many diseases “suggests a new way to prevent and cure the diseases and disabilities of aging. Instead of fighting a hopeless battle to hold back all of the multiple, relentless metabolic forces that damage the cellular and molecular machinery of our bodies, what if we could repair the damage itself — even after it had already happened, and no matter what had caused the damage in the first place? Remember: the diseases and disabilities of aging are nothing more or less than the dysfunction that happens in our tissues when they accumulate too much of this damage to carry on their normal, youthful function. If we could remove, repair, replace, and render harmless the cellular and molecular damage that renders our living systems dysfunctional, then we could actually restore aging organs and tissues to youthful health and functionality, making them better and healthier than they were when we started treatment. The power of such an approach is that it would not merely delay the inevitable appearance of age-related disease: if it were done with zeal, and applied to the full range of the damage of aging, it would maintain our health and hold off the diseases of aging indefinitely.” (Rae, 2013)

While we are not as optimistic as Rae (2013), we do agree substantially with the underlying premise of a simplicity in the treatments with a complexity of the disease.  There are a fixed number of individual actions which seem to be related to modifying the structures underlying disease.  For instance, the recent concept of neural flexibility has encouraged new forms of stimulation of the brain to foster better associations between cells and greater learning in the elderly.

Treatment of Aging and Alzheimer’s disease

The prevalence of cognitive impairment in the older adult population and the need for proper psychological/medical evaluation and clinical treatment is striking. In a Mayo Clinic study of nearly 2000 subjects randomly tested in the 70-79 age group, 10% met criteria for a Mild Cognitive Impairment diagnosis; of the 80-89 year old group, the prevalence nearly doubled to just under 20%. Additionally, the results of a recent study in the Journal of the American Geriatric Society reported that almost 60% of Assisted Living residents suffer from cognitive impairment, with the vast majority not receiving any treatment. They also found that the staff surveyed estimated that only 34% had a cognitive impairment that would interfere with completing tasks necessary for daily living – an assessment that clearly underestimates the objective reports by more than half. (seniorjournal.com/NEWS/Alzheimers/6-04-05-CognitiveImpairiment.htm; The Mayo Clinic Study of Aging, Neurology, Sept., 2010; ‘Underrecognition of Cognitive Impairment in Assisted Living Facilities’, Magsi and Malloy, American Geriatrics Society, 26 JAN 2005 DOI: 10.1111/j.1532-5415.2005.53117)

The reported findings suggest that these older adults are not suffering from a severe dementia (at one end of the cognitive health continuum), and do not fall into the category of good-average cognitive functioning for their age (at the other end of the continuum). This 20% population of older adults, in general, and 60% of those living in Assisted Living communities, in particular, is the population in greatest need of a secondary prevention approach but may be the very population who rarely received it. There may be many actions one can take to minimize the risk of developing cognitive impairment such as intellectual tasks when young and a metetrainina diet, the greatest challenges today is providing available secondary prevention measures which have been shown to be effective.  There are appropriate treatments to serve the needs of older adults already experiencing symptoms of Mild Cognitive Impairment- symptoms of a condition requiring proper clinical evaluation and treatment.

Our primary treatment in the treatment of cognitive disabilities in aging is Memory Training.  The only treatment that the NIH ‘State of the Science Review’ reported as significant with a high degree of scientific strength to reduce the risk of cognitive decline is cognitive training. Furthermore, a recent report by the Harvard Medical School on cause and treatments of memory impairment affirms:  People with memory problems that are substantial enough to interfere with their daily lives are most likely to benefit from individual treatment, where their particular needs can be identified and addressed. If you are considering a memory-enhancement program, choose one that is run by a health professional with specialized training in cognitive rehabilitation. Beware of memory-enhancement programs that use computer games as a one-size-fits-all means of strengthening your memory. (Harvard Medical School 07.07 report on causes of and treatments for memory impairment; health.harvard.edu/special health reports/ improving memory)

Another recent review reported the effectiveness of cognitive training on aging, the ability of neuronal plasticity to allow changes in brain structure, and a delayed progression of cognitive decline, particularly with MCI patients.  The authors hypothesized that a cognitive treatment program could delay the effect of Alzheimer’s disease for 5 years, and overall prevalence could decrease by 50% due to a treatment of the aging structure.  These statistical probabilities suggest that with intervention (cognitive training), in 2020, the number of people age 65 and older with Alzheimer’s disease in the severe stage would drop from 2.4 million to 1.1 million. In 2050, the number of people in the severe stage would decline from an expected 6.5 million to 1.2 million. (Buschert, A.L., Bokde, L. W. and Hampel, H.  Cognitive Intervention in Alzheimer’s disease.  Neurology, Vol 6, 508-517.)

However the treatment of brain diseases in the Protracted Lifw Institute program is not limited to the preventive effects of our memory protocol.   The Protracted Life Institute program contains all of the following elements:

  • State–of-the-science Cognitive Health programs, provided by professionals, with only evidence-based technologies such as cognitive training, and more newly-developed technologies such as trans-cranial direct-current stimulation.
  • Electronic aids to monitor safety and capacities for independent function that can inform individualized plans of care and assist in maintaining one’s optimal level of independence.
  • Consistent compliance to the treatment protocol until it becomes part of the life style
  • A focused treatment philosophy that follows a highly developed protocol that is individualized for each patient.

Treatment Convenience: the Trick to Compliance

We are offering a comprehensive care model of treatment that is directed at those over 55 who are beginning to show signs of a chronic disease. The new generation of older adults are our potential clients and they are international.  They are looking for the comprehensive programming necessary to provide the supportive regimen in the most advantageous manner. In our treatment protocol, each client is assigned a cognitive psychologist, a trainer, a nutritionist, a social director and individual treatment manager. However all of this time, effort and cost is useless unless the patient participates. We expect the patient to receive cognitive training, mainly memory training, 2 to 3 times a week. The same with the exercise provided by the licensed trainer. The nutritionist and medical director must be available to the patient rather than the reverse as found with a customary treatment protocol. The treatment manager/social director is with the patient at least 4 hours a day.

Put in medical terms. To be compliant is to improve.  A non-compliant treatment is essentially a non-treatment. That is why we have a stringent selection criteria for acceptance into the program and are sure of our success.  The key to patient participation is to provide the comprehensive treatment program in the most convenient manner possible. Therefore, the ideal treatment location will located in a place where it will be fully utilized.  When they take ownership of the program, they will want to know they are in a place where they have total control over the elements. Rather than all the other issues that arise in going to a clinic for all these treatments, we offer the treatments in the patient’s home.  After all, this is not taking a pill once a day. Such a comprehensive treatment is exclusive and the cost can only be met by only the very few individuals who would be able to provide such personal care for their family.  However the goal here is reversing the effects of aging.  Cost is not the determining factor for our client.

REFERENCES
2015 Alzheimer’s Disease Facts and Figures.  Alzheimer’s and Dementia 2015; 11(3) 332Albert, M. S.

Changing the Trajectory of Cognitive Decline? August 2nd 2007; The New England Journal of Medicine, Volume 357:502-503, August 2, 2007, Number 5.

Assisted Living Facilities Business Report – U.S. SBA SBDC. “Retirement Communities in the US: 62331.” May 2009. IBISWorld. Santa Monica: CA. University of Texas at San Antonio, 02 Jul 2009.

Buschert, Verena, Arun L. W. Bokde & Harald Hampel. Cognitive intervention in Alzheimer disease. Nature Reviews Neurology 6, 508-517 (September 2010) | doi:10.1038/nrneurol.2010.113

Colby, Sandy L. and Ortman, Jennifer M.  The Baby Boom Cohort in the United States: 2012 to 2060 Current Population Reports Population Estimates and Projections. Issued May 2014 P25-1141.

Ghosh, Rajib et al. The New Era of Connected Aging: A Framework for Understanding Technologies that Support Older Adults in Aging in Place, 2014.

Hill, Jill, PhD., et al. Alzheimer’s disease and related dementias increase costs of comorbidities in managed Medicare. Neurology 8; 58(1):62-70.

Magaro, Peter A, Brotter, Bruce, Jalees, Mariyam. Nine Months of Memory Training Increases Cognistat Measured Memory in 70-89 Year-Old Mild Cognitively Impaired Individuals. Advances in Aging Research Vol. 04 No.03(2015), Article ID:56227,9 pages 10.4236/aar.2015.43010.

Mozaffarian, AS, et al. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation.2013: published online before print December 12, 2012, 10.1161/CIR.0b013e31828124ad.http://circ.ahajournals.org/lookup/doi/10.1161/CIR.0b013e31828124ad

Martin, Donel M., et al. “Can transcranial direct current stimulation enhance outcomes from cognitive training? A randomized controlled trial in healthy participants.” International Journal of Neuropsychopharmacology 16.9 (2013): 1927-1936.

Ortman, Jennifer M., Velkoff, Victoria A. and Hogan, Howard. An Aging Nation: The Older Population in the United States, Current Population Reports, P25-1140. U.S. Census Bureau, Washington, DC. 2014.

Pei-Jung Lin, and Peter J. Neumann. The economics of mild cognitive impairment. Alzheimer’s & Dementia Volume 9, Issue 1, January 2013, Pages 58–62U.S. Department of Health and Human Services- NIH. How to Prevent and Control Coronary Heart Disease. June 7, 2015.