Improve your BRAKES! Stay cognitively fit! The master of self-control!

Imagine yourself at a crossroads; you have to make a decision and choose one of the roads. Which road would you choose? Imagine yourself stuck in traffic. What prevents you from shouting and keeps you calm? Imagine yourself responsible for an important project. You have written your objectives and are trying to set a plan. What helps you to make that plan? Imagine yourself seeing a man dealing with people in a bad way. You judge this man as a rude person. What helps you make that judgment? Imagine yourself sitting in a restaurant. You looked at the menu and decided to order a medium-sized pizza with a big-sized iced lemon soda. What helped you make that decision? Imagine yourself in a difficult situation that forces you to save money. You set a goal to save $5000 over 5 months. What helps you set that goal?
You might be focused now trying to discover what I'm talking about. You might be tapping your finger on your forehead trying to think what your brakes would be. You have answered yourself. You are pointing to the right place! It's your prefrontal cortex!

At first, we have to discuss a term that will be mentioned repeatedly in this article, which is "executive function." 

Executive function is a mental process that helps you set your goals, manage your emotions, make plans, and solve problems. There are three main executive functions: 

1-Working memory:

Working memory holds and manipulates information (e.g., numbers, words, concepts) temporarily for immediate use for learning, reasoning, following instructions, and complex problem-solving. It is also crucial for reading, understanding language, learning new skills, and guiding goal-directed actions. Development of working memory starts during childhood, reaches its peak in early 30s, and starts to decline after middle age. 

2-Cognitive flexibility:

Cognitive flexibility helps you to adapt or adjust thinking or behavior in response to changes in a situation. It helps you change your plans if something goes wrong, switch between multiple tasks, and find alternative solutions to problems. It helps you to cope with changing situations to reduce anxiety. It is also involved in empathy (when you look at an issue from another person’s perspective). According to some experts, cognitive flexibility starts developing at age 3 and becomes complete at age 12. Other researchers suggest that its development continues until age 29. 

3-Inhibition control (inhibitory control):

Inhibitory control enables you to manage impulses, ignore distractions and irrelevant stimuli (e.g., background noise), get rid of unwanted thoughts, suppress automatic responses, and perform goal-directed actions. It enables you to think before you react. It is crucial for self-regulation, planning, focus, and resisting immediate urges or cravings (e.g., sticking to a diet despite cravings). It helps you to behave properly in social situations and events. A weak inhibitory control is observed in several disorders like Attention deficit hyperactivity disorder (ADHD) and addiction. Studies suggest that inhibitory control starts in infancy and begins to decline after the age of 60.
Poor executive function can affect your work, academic performance, daily tasks, and social interaction. 

In 1848, a rare accident happened to a respectable, loving husband and father, Phineas Gage, when an iron tamping rod pierced through the orbitofrontal lobe. After that accident, Phineas Gage became short-tempered, impulsive, and not able to make any plans. That accident helped scientists to understand the function and importance of the prefrontal cortex.
The prefrontal cortex (PFC) is considered the master of cognitive and executive function control, regulating behavior, thinking, and emotions. These functions help individuals with decision-making and problem-solving. It compares your past experience with the current situation and determines your reaction to them. Your PFC is your personality center; it is the part that makes us humans. Your prefrontal cortex is your character; it represents who you really are. Many neurological and psychiatric disorders are due to disorders of the prefrontal cortex, including depression, epilepsy, Obsessive compulsive disorder (OCD), and Attention deficit hyperactivity disorder (ADHD).
PFC is the last part to be completely myelinated (forming a sheath around the nerve fibers and neuronal axons) in the brain, usually in the mid-20s of age. Myelination helps faster signal transport between different parts of the brain. The prefrontal cortex helps you in everyday skills. Damage to your PFC affects your connection and interaction with the world.
PFC receives impulses from different regions of the brain through multiple connections in order to perform higher-order executive functions. These connections help you adapt to different situations and behave according to your perception at the moment. PFC helps to integrate information in order to interact with the social world, known as prosocial skills. PFC regulates emotions through its connection with areas releasing mood-altering neurotransmitters such as norepinephrine, dopamine, and serotonin. Decreased activity of the PFC has been reported in brain imaging of depressed and schizophrenic individuals. 

-Decision-making: regulating behavior and making choices.
-Emotional regulation: show empathy, understand feelings of yourself and others, and respond to rewards and punishments.
-Attention: ignoring distractions and being focused on tasks and situations.
-Self-control: controlling your actions and choosing better options.
-Setting goals: learning from your experience and setting your goals.
-Working memory: it functions as a short-term memory regulator.

PFC lies in the anterior-most portion of the primate cerebrum. It receives its blood supply from the internal carotid artery (ICA) (ICA gives rise to anterior and middle cerebral arteries). The middle cerebral artery supplies the lateral and anterior aspects of the PFC and provides the prerolandic and orbitofrontal branches, while the anterior cerebral artery supplies the superior and medial surfaces and provides the orbital, frontopolar, and callosomarginal branches. PFC is drained through superficial cerebral veins, draining into the superior and inferior sagittal sinuses. Recently, it was found that the brain is drained by a lymphatic system known as the “glymphatic system” or “glial-related lymphatics," collecting glymphatic interstitial fluid within perivenous spaces and then following the meningeal sinuses, large deep veins, and lateral-ventral caudal rhinal veins draining into the cervical lymph nodes.  The PFC has connections with different areas of the brain through fasciculi (bundles of axons), including cortical, subcortical, and brainstem regions. Connections between the PFC and primary sensory and motor cortices are made through the superior and inferior occipitofrontal fasciculi, cingulum, and uncinate fasciculi. 

The prefrontal is divided into 5 parts: 

1-Dorsolateral prefrontal cortex (dlPFC): responsible for working memory, problem solving, planning, executive decisions, strategy, staying focused, and ignoring distractions. 

2-Anterior cingulate cortex (ACC): responsible for making choices, regulating emotions (e.g., regulating emotion when you are stuck in traffic, calming down during an argument), controlling autonomic functions (e.g., heart rate and blood pressure), and switching between tasks (e.g., switching from writing emails to answering phone calls). 

3-Orbitofrontal cortex (OFC): responsible for decision making, helps in judgement (linking outcomes and rewards of different things), controlling impulses (e.g., recognizing triggers, pausing before acting (deep breaths, counting), practicing mindfulness and emotional regulation), and inhibiting primal survival responses that arise from the primitive limbic system. 

4-Ventromedial prefrontal cortex (vmPFC): responsible for judging experiences as good or bad (labeling people/situations as inherently "good" or "bad").

 
5-Medial prefrontal cortex (mPFC): responsible for behavior adjustment according to the rules (using reinforcement and punishment) to shape actions, like giving a child a sticker for making their bed.

Lesions in the dorsolateral PFC cause working memory loss and impairment in memory recall and determining the context in which the memory was originally founded, leading to difficulty switching between tasks and dealing with rule changes. Lesions in the ventromedial PFC result in confabulation (memory error characterized by production of fabricated, distorted, or misinterpreted memories about oneself or the world), emotional lability (exaggerated changes in mood that happen rapidly), poor judgment, distractibility, and inappropriate affect (emotional expressions such as smiling, crying, or laughing that don't match the situation or a person's thoughts). 

The development of the PFC starts at week three of the embryologic life along with the remainder of the nervous system within the neural plate. The neural plate forms the neural groove that seals off from amniotic fluid, and then the neural tube is formed. In the fourth gestational week, a bulge from the prosencephalon is formed laterally out of the rostral neural tube, differentiating into the telencephalon, which becomes the cerebral cortex. Neurons and synaptic connections are formed intrauterine and during early childhood. The nervous system continues to develop and become more mature throughout life.
The prefrontal cortex keeps developing and becomes fully mature by early adulthood. Myelination, which helps faster signal transport and strengthens the connections of the brain, occurs late in the prefrontal cortex. As we mentioned before, the PFC becomes fully mature by the mid-20s for most people, helping them with judgment, planning, and self-control.
Early development of the PFC includes an increase in the volume of its regions due to dendritic arborization (expanding dendrites, portions of neurons, to enhance behavioral flexibility). These regions become smaller in volume near the start of adolescence due to pruning (loss of unneeded portions of neurons to increase behavioral efficiency). The OFC is not fully mature in adolescence. High emotional reactivity in some circumstances during childhood and adolescence is due to immaturity of cognitive control networks. Changes in the OFC and DLPFC are seen until age 25 in neuroimaging. 

As we mentioned before, damage to the PFC affects your behavior, emotions, thinking, personality, judgment, planning, decision-making, adaptation, memory, focus, and actions. Symptoms that you might have include:

-Mood swings
-Impulsiveness
-Difficulty staying focused
-Difficulty with memory and planning
-Difficulty determining and setting long-term goals (e.g., saving money)
-Poor judgment
-Motivational loss
Dysfunction and dysregulation of neurotransmitters and their receptors within the PFC were found in multiple neuropsychiatric disorders, including depression, bipolar disorder, OCD, schizophrenia, ADHD, stroke, brain tumors, epilepsy, traumatic brain injury, substance abuse, and Parkinson’s disease. Exposure to stress in early childhood affects the prefrontal cortex. Using near-infrared spectroscopy and messenger RNA assays, down-regulation of glutamate transporter genes was found in depressed individuals. In schizophrenic individuals, functional magnetic resonance imaging (MRI) studies have shown reduced long-interval cortical inhibition and hypoactivity.

Many factors may contribute to cognitive health, including genetic, lifestyle, and environmental factors that may lead to a decline in performing everyday tasks. This decline may happen with aging; however, you can slow this process and improve your cognitive skills, as many of these factors may be changed.
You can change your prefrontal cortex through neuroplasticity. Neuroplasticity means building new pathways and strengthening the old ones through learning and practicing certain activities. These activities include learning a new skill, meditation and mindfulness, physical activity and exercise, and stress management. 

Methods to improve memory, attention, and performance! Keep your brain active and achieve better cognitive fitness!

According to researchers at Harvard Medical School, there are six cornerstones to staying cognitively fit. These 6 steps are
1-Eating a plant-based diet
2-Regular exercise
3-Managing stress
4-Getting enough sleep
5-Social contact
6-Brain Challenges
Using these 6 steps together can actually improve your brain function and health. We will discuss these steps and more.

1-Diet:

A healthy diet and cooking as a skill may help your brain to stay healthy and young. A balanced A healthy diet reduces the risk of chronic diseases and therefore reduces the risk of dementia. Eating a plant-based diet of vegetables, fruits, whole grains, and low-fat protein such as fish, skinless poultry, and beans may improve your memory. Limit refined and processed products as much as possible. You have to limit sugar and salt. Quit smoking and any nicotine products, such as chewing tobacco. Drinking water and fresh juice and avoiding alcohol and high-sugar drinks are also important. 

Types of diet that were proven by research to reduce the risk of cognitive decline include:

-A Mediterranean diet: it is a plant-based diet including fruits, vegetables, whole grains, beans, nuts, olive oil, moderate amounts of fish, poultry, and dairy, and very limited red meat. It is inspired by countries around the Mediterranean Sea. It was found to reduce the risk of dementia in Alzheimer’s.
-MIND diet: it is a combination of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. It focuses on plant-based food like leafy greens, berries, nuts, fish, olive oil, and whole grains, limiting red meat, sweets, cheese, butter, and fried foods. This diet is rich in antioxidants to fight oxidative stress and inflammation. Some studies showed that the MIND diet slows the cognitive decline and decreases Alzheimer’s risk. Further research is still needed.
In general, a balanced, healthy diet rich in vitamins, minerals, and fiber is essential for better brain health.
*I've written an article about corn as an example of a whole grain and another article about how plant-based diets help people live longer and healthier in "blue zones."

2-Physical activity:

Physical activity improves your blood circulation and blood flow to the whole body and your brain. According to the Department of Health and Human Services, it is recommended to perform at least 150 minutes of moderate aerobic activity weekly (e.g., brisk walking) or 75 minutes of vigorous aerobic activity (e.g., jogging). You can at least try walking at first for 15 minutes, for example, in a forest to enhance your mood, and then increase the duration and the exercise gradually until you reach the recommended daily activity duration. It is better to avoid any serious activity that may lead to brain injuries.

 Consistent aerobic activity may reduce neurodegeneration, improve your executive functions, strengthen your memory, and boost your performance.
A study involving late-middle-age participants with normal cognitive functions found that moderate levels of physical activity were associated with higher brain glucose metabolism (the brain's primary process for generating energy (ATP) from glucose), which in turn reduces the risk of developing Alzheimer’s. Another study found that the size of brain structure related to learning and memory could be increased through exercise, resulting in better spatial memory (your brain's ability to perceive, store, and recall information about locations, routes, and spatial relationships, which is crucial for navigation and orientation).

3-Managing stress:
Chronic stress may impair attention, memory, and decision- and plan-making as it affects the hippocampus (a crucial brain structure in the temporal lobe essential for memory, learning, and emotional regulation) and prefrontal cortex. Chronic stress can lead to poor memory as it impairs memory retrieval and consolidation, impaired focus, poor judgement, increased impulsivity, more mistakes and poor decisions, and decreased ability to switch between tasks. Chronic stress may disturb neurotransmitters, affecting cognition and mood. It may also change the brain structure, especially in the hippocampus and prefrontal cortex. Mindfulness, meditation like yoga, and regular exercise are good options to relieve stress and improve your mood.

4-Getting enough sleep:

Getting enough amount of good quality sleep is important for your memory. Adults should have 7 to 9 hours of sleep a night on a regular basis. 9 hours of interrupted sleep won't help your memory. Remember, quality of sleep matters. Try to get rid of distractions around you; choose a calm room with a comfortable bed to sleep in. If you have any sleep problems like insomnia or snoring, you have to consult a doctor. 

5-Social contact:

Social contact helps to relieve stress and negative emotions. There are multiple ways through which you can increase your social contact, such as volunteering in a community group, attending meetup events, meeting with friends, having social contact with neighbors, attending cultural meetings, and many other ways. A study including more than 7,000 participants age 65 and older found that participants with higher social contact, such as visiting with neighbors and volunteering, had better cognitive health. Social engagement improves your mood and attitude and is an opportunity to increase your knowledge and learn new skills.

6-Challenge your brain:

Memory games are like when cards with different objects are mixed and arranged in rows, and you have to match the pairs correctly. This game enhances your memory and could be a good brain exercise. Math challenges, Sudoku, word games and mnemonics, gardening, writing calligraphy, and jigsaw puzzles are other examples. Brain training may help to reduce the symptoms of ADHD. These games are not only good ways to improve your memory and knowledge but also enable you to have fun while doing brain training. However, there is not enough evidence suggesting that computer-based brain training can actually improve your cognitive function. The aim of these games is to keep your brain engaged. 

Learning new skills such as playing a musical instrument, creative writing, theater, a new hobby, dance, or new languages can improve your self-esteem, reduce stress, increase social interaction, improve your memory, and keep your brain engaged and active. A study found that older individuals who learned digital photography had more memory improvement compared to those who did fewer cognitive activities. The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial is a large randomized controlled trial that assessed the effect of daily cognitive training on cognitive function, such as memory and reasoning, over a period of 10 years. The trial proved that appropriate cognitive training and practice can improve cognitive functions significantly in healthy older adults. Challenge your brain with different activities. 

7-Stay positive:

Negative emotions like anger, fear, hatred, self-pity, envy, grief, depression, and anxiety affect your overall performance and decrease your attention. Meditation and mindfulness practices improve memory, attention, cognitive flexibility, and speech and may help you to get rid of negative emotions and improve your mental state. 

8-Stay organized:

An organized environment helps your brain to stay focused and perform better. Use to-do lists to write your tasks. Organize your room and workplace and keep them tidy and clean. Limit distractions as much as possible. 

9-Manage your health problems:
Many chronic diseases, such as diabetes, high blood pressure (HTN), depression (which is associated with confusion and attention problems and is related to dementia), and obesity, may affect your brain health. Managing these conditions and taking medicine as prescribed are essential to keep your brain healthy. Research showed that high blood pressure from the 40s to the early 60s increases the risk of cognitive dysfunction later in life, as high blood pressure can literally affect any organ of your body, especially the heart and brain. 

A study found that reducing systolic blood pressure to lower than 120 mmHg in people aged 50 years and older can reduce the risk of mild cognitive dysfunction and therefore decrease the risk of dementia. It is important to do an annual screening, especially if you have a risk factor such as high cholesterol in blood, if you are diabetic, if you have a family history of high blood pressure, or even without a risk factor. Some studies found that obesity is a risk factor of heart disease as well as dementia. Maintaining body mass index (BMI) within the normal range through regular exercise is necessary. 

10-Medications:

Some medications may have side effects that affect memory, sleep, and cognitive function. Examples of these side effects are delusions, hallucinations, confusion, and memory loss.  Note that many drugs may have interactions with other drugs and even with diet. These interactions may affect your brain and cognition. Examples of these drugs are antipsychotics, antihistamines for allergies, muscle relaxants, sleep aids, and anticolic medicine. With the aid of your doctor, ensure that any medicine you take regularly is not the cause of your cognitive decline.

If you have trouble with memory and attention, and you find it very difficult to do daily tasks, it is better to consult your doctor to determine any investigations or cognitive tests that you might need if any health problem is suspected. 

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