Brain Health and Wellness:

Brain health and physical wellness are two tightly linked to each other. Most
recent neuroscience research indicates that at a number of health conditions and lifestyle
factors impact the size of the brain areas for learning and memory, called hippocampus.
The size of this brain structure can determine an individuals eventual risk for becoming
demented. Obesity, stress, high blood pressure, sleep apnea, concussion, and diabetes
shrink the hippocampus, while exercise, mental activity, treatment of sleep disorders, and
meditation have been shown to literally grow its size. An emphasis on brain health and
wellness in a unified program can produce remarkable results with regards to improved
memory and brain performance, better mood and a sense of quality of life, along with
successful aging with a fit body.
CONFIDENTIAL

Medical Conditions and Risk Factors Shrink the Brain,

Especially the Hippocampus
No
Risk Factors

Hippocampus

Multiple
Risk Factors

Hippocampus

CONFIDENTIAL

Exercise
Physical Fitness
Cognitive
Stimulation
Meditation

Diabetes
Hypertension
Obesity
OSA
Head Trauma
Stress
Genes

Dr. Majid Fotuhi, based on his 25 years of research, clinical work, and teaching in
neuroscience at Johns Hopkins and Harvard Medical School, has summarized this
literature in his scientific peer-reviewed articles (and books) and formulated a brain
fitness program to use effective behavioral modification techniques for enhancing
cognitive function. He served as the founder and chief medical officer for NeurExpand
Brain Centers where this program produced remarkable results in patients with memory
loss, post-concussive syndrome, and mild cognitive impairment.

Brain Fitness Program: Overview

Initial
appointment
with
neurologist

Brain Fitness
Program:
Diagnostics

Level 1
Level 2
Level 3

Follow-Up

The brain fitness program consists of a comprehensive brain health assessment

followed by a series of interventions designed to optimize memory and overall cognitive
performance.

Brain Fitness Program: Initial Exam

Psychology

Brain Fitness Program:

Comprehensive Diagnostic Tests
BrainMRI

CardiopulmonaryTes ng

Neurocogni veEvalua on

Caro dUltrasound
BrainMapping qEEG

BloodTest

SleepHealth
Assessment

Over a period of 12 weeks, patients first undergo a detailed neurological

evaluation to determine all of the potential causes for cognitive deficits and brain atrophy,
from head to toe, followed by a series of tests. They then start an intensive set of
treatment sessions that enhance cognitive function, reduce anxiety, improve sleep, and
focus on lifestyle factors that are shown to be critical for prevention of late-life dementia.

Brain Fitness Program:

A Personalized and Integrated Set of Interventions
BrainCoachingandCounseling

Brain-healthyDietCounseling

Cogni veSkillsTraining

ExerciseTraining

NeurofeedbackTraining

WeeklyMonitoring

The program consists of nine important interventions, starting with patients sense
of purpose in life and their desire for peak brain performance in order to achieve a
personal goal:
1
2
3
4
5
6
7
8
9

Setting specific goals for patients 12-week program, based on his/her purpose in life and
brain performance expectations
Fitness training and close monitoring to ensure progress
Neurofeedback training
Stress and anxiety reduction counseling
Meditation training
Cognitive Skills Training
Nutrition counseling for Mediterranean diet and taking omega-3 supplements (e.g. algal-DHA
900 mg/day)
Medical treatment of insomnia, sleep apnea, vitamin B12 or D deficiency, and depression, as
needed
Emphasis on brain training home assignments (homework), with increasing difficulty (e.g.
memorizing a list of 100 items)

Patients who enroll in the brain fitness program go through a formal step-by-step
program in order to establish their baseline level of brain performance and significantly
improve their cognitive function:
Step 1: Initial evaluation with neurologist
Check for all of the non-Alzheimers etiology for memory loss

Step 2: Diagnostic tests

Q-EEG (Brain mapping),
Complete neurocognitive evaluation
Brain MRI with NeuroQuant,
Fitness testing, blood tests, and/or other tests, as needed

Step 3: Follow up visit with neurologist

Discuss results of tests, determine eligibility for the program
Start treatment of medical conditions (e.g. sleep apnea) identified by tests

Step 4: Orientation to the program

Education regarding the scientific basis of the Brain Fitness Program
Establish purpose for starting the program
Set goals for the program and establish a strong commitment to achieve them

Step 5: Start the three main components of the program

Neurofeedback (two hours a week)
Cognitive Skills Training (two hours a week)
Brain Coaching/counseling (one hour a week)
Re
Step 6: Midway follow-up visit with the neurologist
Discuss treatment of medical conditions
Ensure making progress in the program and consider increasing the intensity of the training sessions

Step 7: Resume the three main components of the program

Neurofeedback (two hours a week)

Cognitive Skills Training (two hours a week)
Brain Coaching/counseling (one hour a week)
Re
Step 8: Repeat baseline tests
Q-EEG (Brain mapping)
Complete neurocognitive evaluation
Brain MRI with NeuroQuant,
Fitness testing, blood tests, and/or other tests, as needed
Re

Step 9: Follow-up appointment with the neurologist

Discuss post-program results

Establish goals for continuing with brain-healthy lifestyle

habits

Establish time for regular follow-up visits

The brain fitness program includes a cutting edge neurofeedback protocol,

which is based on using a patients brain wave activity (obtained from a standard EEG)
and providing feedback on how to move any abnormal activity (e.g. patterns associated
with anxiety, depression, or attention deficit) toward normal. In my practice,
neurofeedback is offered by one of the leading experts in this field, Mark Trullinger. He
served as the co-director of the brain fitness program at NeurExpand Brain Center and
has extensive experience in the field of quantitative EEG and behavior modifications
based on psychophysiological interventions.
The manuscript with results from patients who completed the brain fitness
program will be presented at the Alzheimers Association International Conference in
Washington DC, on July 18th, 2015. Below are the figures from this manuscript. They
show that 84% of patients experienced high-impact improvements in their cognitive
function, 97% had high-impact or moderate-impact improvements in their brain wave
normalization. Among those who had before-and-after brain MRIs, 65% had remarkable
reversal of atrophy (12%) or actual growth (53%) in the size of their hippocampus.
Percent of patients in the Brain Fitness Program (n=127) who had statistically significant
improvements in their cognitive function.

90
80
70
60
Percentage (%)

50
40
30
20
10
0

Low Impact

Moderate Impact

High Impact

Percent of patients in the Brain Fitness Program (n=127) who had statistically significant
improvements in the normalization of their brain wave activity on Q-EEGs.

Low Impact

Moderate Impact

High Impact

Percent of patients in the Brain Fitness Program who had before and after MRIs (n=17)
and had statistically significant changes in the volume of their hippocampus.

Normal Progression

Size Unchanged

Significant Growth

Cognitive results in one of the patients who completed the Brain Fitness Program shows
remarkable improvements in her executive function, memory, and language.

Patients baseline cognitive function is shown as percentile compared to others at

her age and gender. Post-program cognitive test showed significant improvements
in 9 of the 10 cognitive tests, with regards to executive function, memory, and
language. The only cognitive domain that did not improve was list-learning
delayed recall (not shown); it remained unchanged from baseline.
Brain mapping (Q-EEG) results in one of the patients who completed the Brain Fitness
Program shows significant reduction (lessen red areas) in abnormally slow (theta) brain
wave activity.

Q-EEG detects changes in a patients brain activity and compares it with a

normative set of data. Statistically significant higher than normal or lower than
normal EEG activities are shown in red or blue colors, respectively. Post-program
Q-EEG (B) in this patient showed significant improvement toward normal (46%)
from baseline (A), through a reduction in excessive levels of slow theta waves in
her right temporal lobe.

MRI results in one of the patients who completed the Brain Fitness Program shows
significant enlargement in the size of hippocampus.

Post-program MRI with NeuroQuant showed an 8.6% growth in the volume of

the hippocampus (HC). (A): Baseline Brain MRI. (B): Post-program Brain MRI.
(C): Higher magnification of baseline hippocampal volume. (D): Higher
magnification of the post-program hippocampal volume.
The brain fitness program has been modified to address the specific issues for
patients with post-concussive syndrome. These patients often suffer from persistent
dizziness, vertigo, headaches, irritability, poor sleep, imbalance, and neck pain. The
modified program, called concussion recovery program, has been remarkably effective
in this patient population. Dr. Fotuhi had completed a neuro-otology fellowship training
at Johns Hopkins for treating patients with dizziness and vertigo, and his expertise has
been critical to the success of this program.