prevention mental

This brain training program cuts dementia risk

  • A large 10-year study investigating the benefits of a brain training program for older adults found that training designed to improve processing speed & visual attention in particular reduced dementia risk.

Findings from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Study, which followed 2,802 healthy older adults for 10 years, has found that those who participated in computer training designed to improve processing speed and visual attention had a 29% lower risk of developing dementia compared to controls, with more training producing lower risk. Those who received instruction in memory or reasoning strategies showed no change in dementia risk.

Participants were randomly placed into a control group or one of three different cognitive training groups. One was instructed in memory strategies, another in reasoning strategies, and one was given individualized, computerized speed of processing training.

There were 10 initial sessions of training, each 60 to 75 minutes, over six weeks. Participants were assessed at the beginning of the study, after the first six weeks, and at one, two, three, five, and 10 years. Some of each group received four additional “booster” training sessions in months 11 and 35.

Among those who completed the most sessions (5 or more booster sessions), indicators of dementia were evident in 5.9% of the computerized speed training group; 9.7% of the memory strategy group; 10.1% of the reasoning strategy group. The control group had a dementia incidence rate of 10.8%.

14% of those who received no training developed dementia in the next 10 years, compared with 12.1% of those who received the initial processing speed training, and 8.2% of those who also received the additional booster training.

A decade after training began, the scientists found that 22.7% of people in the speed training group had dementia, compared with 24.2% in both memory and reasoning groups. In a control group of people who had no training, the dementia rate was 28.8%. This effect is greater than the protection offered by antihypertensive medications against major cardiovascular events.

It's suggested that some of the reason for this effect may be that the training builds up brain reserve, perhaps by improving brain efficiency, or in some way improving the health of brain tissue.

Some of the participants told researchers that the training encouraged them to enroll in classes at a local college or keep driving, and it’s possible that the motivational boost for continued social and intellectual engagement might also help explain the benefits.

Other research has found that processing speed training is associated with a lower risk of depression and improved physical function, as well as better everyday functioning.

The processing speed training was designed to improve the speed and accuracy of visual attention, with both divided and selective attention exercises. To perform the divided attention training task, participants identified a central object—such as a truck—while simultaneously locating a target in the periphery—the car. The speed of these objects became increasingly faster as participants mastered each set. In the more difficult training tasks, adding distracting objects made the task even more challenging, thus engaging selective attention.

The training program is available as the “Double Decision” exercise in the BrainHQ.com commercial product.

Of the 1220 who completed the 10-year follow-up, 260 developed dementia during the period.

http://www.futurity.org/speed-of-processing-training-dementia-1613322/

https://www.eurekalert.org/pub_releases/2017-11/uosf-ibf111417.php

https://www.theguardian.com/society/2017/nov/16/can-brain-training-reduce-dementia-risk-despite-new-research-the-jury-is-still-out

http://www.scientificamerican.com/article/brain-training-cuts-dementia-risk-a-decade-later/

Reference: 

[4490] Edwards, J. D., Xu H., Clark D. O., Guey L. T., Ross L. A., & Unverzagt F. W.
(2017).  Speed of processing training results in lower risk of dementia.
Alzheimer's & Dementia: Translational Research & Clinical Interventions. 3(4), 603 - 611.

Full text available at https://www.trci.alzdem.com/article/S2352-8737(17)30059-8/fulltext

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Keeping active in middle age tied to lower dementia risk

  • A very long-running Swedish study found that women with high levels of mental or physical activity in midlife were less likely to develop dementia.

A very long-running study, in which 800 Swedish women (aged 38-54) were followed for 44 years, found that women with a high level of mental activities in midlife were 46% less likely to develop Alzheimer's disease and 34% less likely to develop dementia overall, compared with women with the low level of mental activities. Women who were physically active were 52% less likely to develop dementia with cerebrovascular disease and 56% less likely to develop mixed dementia, compared with women who were inactive.

Mental activities included intellectual activities, such as reading and writing; artistic activities, such as going to a concert or singing in a choir; manual activities, such as needlework or gardening; club activities; and religious activity.

Participants were given scores in each of the five areas based on how often they participated in mental activities, with a score of zero for no or low activity, one for moderate activity and two for high activity. For example, moderate artistic activity was defined as attending a concert, play or art exhibit during the last six months, while high artistic activity was defined as more frequent visits, playing an instrument, singing in a choir or painting. Low activity was defined as scores of zero to two and high activity as scores of three to 10 (44% and 56% of participants, respectively).

The physically active group ranged from light physical activity such as walking, gardening, bowling or biking for a minimum of four hours per week to regular intense exercise such as running or swimming several times a week or engaging in competitive sports. Most (82%) were in the active group.

Of the 438 women with the high level of mental activity, 104 (23.7%) developed dementia, compared to 90 (25.9%) of the 347 women with the low level of activity. Of the 648 women with the high level of physical activity, 159 (24.5%) developed dementia, compared to 35 (25.5%) of the 137 women who were inactive.

I note that distinction between those with high and low levels of activity seems very broad-brush. I don’t know why the researchers didn’t analyze the data in a more refined manner — comparing the most active with the least active would be more usual, and would be more likely to show a greater effect. But perhaps that's the point — showing that even with this smaller distinction, a significant effect is still found.

During the study, 194 women developed dementia. Of those, 102 had Alzheimer's disease, 27 had vascular dementia, 41 had mixed dementia, and 14 had other dementias. 81 (41.8%) of those with dementia also had cerebrovascular disease.

https://www.eurekalert.org/pub_releases/2019-02/uog-eai022419.php

Full text available at https://n.neurology.org/content/early/2019/02/21/WNL.0000000000007021

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Cognitive & motor training combined may slow progress of dementia

  • A very small study found that just 30 minutes of visually-guided movements per week could slow and even reverse the progress of dementia in those in the early stages of dementia.

Various forms of dementia, including Alzheimer's, involve brain network problems. Brain regions are not coordinating as well as they should; white matter is dysfunctional, impairing communications. It has even been suggested that problems in the default mode network (the "resting state" of the brain) may be the ultimate driver of the pathological characteristics of Alzheimer's, such as amyloid plaques, tau tangles, and brain atrophy. Regardless of the order of events, it does seem that network dysfunction is one of the big problems in dementia.

It's with this in mind that a pilot study has investigated the benefits of a program designed to simultaneously recruit networks involved in cognition and motor action.

37 elderly people were divided into four groups based on their level of cognition: 12 with normal levels of cognitive performance; 8 with below-average cognition; 6 with mild-to-moderate impairment; 11 with severe cognitive impairment. They completed a 16-week cognitive-motor training program that consisted of weekly sessions involving playing a videogame that required goal-directed hand movements on a computer tablet. Specifically, players had to slice moving objects by sliding their finger through it. Each object sliced earned a point, and bonus points were awarded for slicing multiple objects in a single movement. Each session lasted 20-30 minutes.

Cognition was assessed using the Dementia Rating Scale and the Montreal Cognitive Assessment questionnaire. Cognitive-motor functioning was assessed using the Brain Dysfunction Indicator. Tests occurred 2 weeks prior to training and 2 weeks after.

Two groups showed significant improvement in their cognitive scores after training: the sub-average group, and those with mild-to-moderate impairment. While those who were severely impaired showed no improvement, neither did they decline over the period.

It’s suggested that the communication between frontal lobe and motor control areas is a crucial factor in the program’s success.

https://www.eurekalert.org/pub_releases/2018-07/yu-cam072518.php

Full text available at https://www.karger.com/Article/FullText/490173

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Low social engagement linked to cognitive decline & dementia risk

  • A very large, very long-running British study found that higher social contact at age 60 was associated with a significantly lower risk of developing dementia.
  • A 3-year study of older adults found that lower social engagement was only associated with greater cognitive decline in those with higher amyloid-beta levels.

Socially active 60-year-olds face lower dementia risk

Data from the Whitehall II study, tracking 10,228 participants for 30 years, found that increased social contact at age 60 is associated with a significantly lower risk of developing dementia later in life. Someone who saw friends almost daily at age 60 was 12% less likely to develop dementia than someone who only saw one or two friends every few months.

While previous studies have found a link between social contact and dementia risk, the long follow-up in the present study strengthens the evidence that social engagement could protect people from dementia (rather than precursors of dementia bringing about a decline in social engagement).

https://www.eurekalert.org/pub_releases/2019-08/ucl-sa6073119.php

Low social engagement plus high amyloid linked to cognitive decline

A three-year study of 217 healthy older adults (63-89) enrolled in the Harvard Aging Brain Study, has found that higher amyloid-beta levels in combination with lower social engagement was associated with greater cognitive decline over three years. Lower social engagement wasn’t associated with cognitive decline in those with a lower amyloid-beta burden.

https://www.eurekalert.org/pub_releases/2019-06/bawh-scl062819.php

Reference: 

Sommerlad, A., Sabia, S., Singh-Manoux, A., Lewis, G., & Livingston, G. (2019). Association of social contact with dementia and cognition: 28-year follow-up of the Whitehall II cohort study. PLOS Medicine, 16(8), e1002862. https://doi.org/10.1371/journal.pmed.1002862

Biddle, K et al, "Social Engagement and Amyloid-b-Related Cognitive Decline in Cognitively Normal Older Adults." American Journal of Geriatric Psychiatry. DOI: https://doi.org/10.1016/j.jagp.2019.05.005

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Rates of new dementia cases may be falling

  • Data from the very long-running Framingham Heart Study adds to evidence that, for those with at least a high school education, the rate of dementia is declining. Improved cardiovascular health and treatment appears to be an important factor in this decline.

As we all know, people are living longer and obesity is at appalling levels. For both these (completely separate!) reasons, we expect to see growing rates of dementia. A new analysis using data from the long-running Framingham Heart Study offers some hope to individuals, however.

Looking at the rate of dementia during four distinct periods in the late 1970s, late 1980s, 1990s, and 2000s, using data from 5205 older adults (60+), the researchers found that there was a progressive decline in the incidence of dementia at a given age, with an average reduction of 20% per decade since the 1970s (22%, 38%, and 44% during the second, third, and fourth epochs, respectively).

There are two important things to note about this finding:

  • the decline occurred only in people with a high school education and above
  • the decline was more pronounced with dementia caused by vascular diseases, such as stroke.

The cumulative risk over five years, adjusted for age and gender, were:

  • 3.6 per 100 persons during the first period (late 1970s and early 1980s)
  • 2.8 per 100 persons during the second period (late 1980s and early 1990s)
  • 2.2 per 100 persons during the third period (late 1990s and early 2000s)
  • 2.0 per 100 persons during the fourth period (late 2000s and early 2010s).

Part of the reason for the decline is put down to the decrease in vascular risk factors other than obesity and diabetes, and better management of cardiovascular diseases and stroke. But this doesn't completely explain the decrease. I would speculate that other reasons might include:

  • increased mental stimulation
  • improvements in lifestyle factors such as diet and exercise
  • better health care for infectious and inflammatory conditions.

The finding is not completely unexpected. Recent epidemiological studies in the U.S., Canada, England, the Netherlands, Sweden and Denmark have all suggested that “a 75- to 85-year-old has a lower risk of having Alzheimer’s today than 15 or 20 years ago.” Which actually cuts to the heart of the issue: individual risk of dementia has gone down (for those taking care of their brain and body), but because more and more people are living longer, the numbers of people with dementia are increasing.

http://www.futurity.org/dementia-rates-decline-1119512-2/

http://www.scientificamerican.com/article/is-dementia-risk-falling/

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Education gives an advantage that lasts a lifetime

A French study involving 36 healthy older adults (60-80), prescreened for amyloid deposits in the brain to exclude people who might have preclinical Alzheimer’s disease, has found a linear increase in gray matter volume in proportion to the number of years of education (7-20 years). Specifically, increases were seen in the right superior temporal gyrus, anterior cingulate gyrus, and left insular cortex, and metabolism also increased proportionately with years of education in the anterior cingulate gyrus, as did functional connectivity between anterior cingulate gyrus and the right hippocampus, left angular gyrus, right posterior cingulate, and left inferior frontal gyrus. This increased connectivity was associated with improved cognitive performance.

The conclusion is that both the structure of the brain and its function in old age are increased in proportion to the number of years of education.

http://blogs.scientificamerican.com/mind-guest-blog/2013/07/03/school-work-prevents-senile-dementia/

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More evidence bilingualism protects against dementia

An Indian study involving 648 dementia patients, of whom 391 were bilingual, has found that, overall, bilingual patients developed dementia 4.5 years later than the monolingual ones. There was no additional advantage to speaking more than two languages.

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Less cognitive decline in Danish nonagenarians

A large Danish study comparing two groups of nonagenarians born 10 years apart has found that not only were people born in 1915 nearly a third (32%) more likely to reach the age of 95 than those in the 1905 cohort, but members of the group born in 1915 performed significantly better on tests of cognitive ability and activities of daily living. Additionally, significantly more members of the later cohort scored maximally on the MMSE (23% vs 13% of the earlier cohort).

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Purpose in life protects against Alzheimer's disease

June, 2012
  • New results from a longitudinal study add to evidence that having a purpose and finding meaning in life protects against the harmful effects of Alzheimer’s pathology in the brain.

Here’s a different aspect to cognitive reserve. I have earlier reported on the first tranche of results from this study. Now new results, involving 246 older adults from the Rush Memory and Aging Project, have confirmed earlier findings that having a greater purpose in life may help protect against the brain damage wrought by Alzheimer’s disease.

Participants received an annual clinical evaluation for up to 10 years, which included detailed cognitive testing and neurological exams. They were also interviewed about their purpose in life, that is, the degree to which they derived meaning from life's experiences and were focused and intentional. After death (average age 88), their brains were examined for Alzheimer’s pathology.

Cognitive function, unsurprisingly, declined progressively with increased Alzheimer’s pathology (such as amyloid plaque and tau tangles). But ‘purpose in life’ modified this association, with higher levels of purposiveness reducing the effect of pathology on cognition. The effect was strongest for those with the greatest damage (especially tangles).

The analysis took into account depression, APOE gene status, and other relevant medical factors.

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Cognitive stimulation beneficial in dementia

April, 2012

A review supports cognitive stimulation therapy for those with mild to moderate dementia.

A review of 15 randomized controlled trials in which people with mild to moderate dementia were offered mental stimulation has concluded that such stimulation does indeed help slow down cognitive decline.

In total, 718 people with mild to moderate dementia, of whom 407 received cognitive stimulation, were included in the meta-analysis. The studies included in the review were identified from a search of the Cochrane Dementia and Cognitive Improvement Group Specialized Register, and included all randomized controlled trials of cognitive stimulation for dementia which incorporated a measure of cognitive change.

Participants were generally treated in small groups and activities ranged from discussions and word games to music and baking. Treatment was compared to those seen without treatment, with "standard treatments" (such as medicine, day care or visits from community mental health workers), or with alternative activities such as watching TV and physical therapy.

There was a “clear, consistent benefit” on cognitive function for those receiving cognitive stimulation, and these benefits were still seen one to three months after the treatment. Benefits were also seen for social interaction, communication and quality of life and well-being.

While no evidence was found for improvements in the mood of participants, or their ability to care for themselves or function independently, or in problem behaviors, this is not to say that lengthier or more frequent interventions might not be beneficial in these areas (that’s purely my own suggestion).

In one study, family members were trained to deliver cognitive stimulation on a one-to-one basis, and the reviewers suggested that this was an approach deserving of further attention.

The reviewers did note that the quality of the studies was variable, with small sample sizes. It should also be noted that this review builds on an earlier review, involving a subset of these studies, in which the opposite conclusion was drawn — that is, at that time, there was insufficient evidence that such interventions helped people with dementia. There is no doubt that larger and lengthier trials are needed, but these new results are very promising.

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