Delaying the onset of dementia, without pharmaceuticals?
Canadian researchers believe that combining exercising and brain training, in that order, can slow cognitive decline – and potentially even improve cognition – for older adults with mild cognitive impairment (MCI).
A multi-city clinical trial suggests that exercise and cognitive training together have a bigger impact than the sum of its parts and lead researcher Manuel Montero-Odasso, based out of London, Ont., says the results are clinically significant.
“Just to put this in perspective, if you want to get any medication for cognitive impairment or dementia approved by FDA (U.S. Food and Drug Administration) or Health Canada, you need to show at least a three-point improvement in the ADAS-COG, which is the scale we use. And we found just with this combination an improvement was -2.7 points, so very close to the three points,” he said.
“This improvement in this scale is much better than the improvement seen in the recent antibodies against amyloid trials. They are all in the news right now as a new drug to treat cognitive impairment of dementia.”
According to a study in the New England Journal of Medicine, the anti-amyloid trial Montero-Odasso is referring to resulted in an ADAS-Cog score of -1.44 (note that the study also included results from a different testing method, the CDR-SB or Clinical Dementia Rating sum of boxes score).
How do you measure improvements?
The ADAS-Cog, or Alzheimer’s Disease Assessment Scale-Cognitive Subscale, assesses the severity of cognitive symptoms of dementia through different criteria like word recall, naming objects, following commands, remembering directions and more.
The assessment was done at the beginning of the trial and at the sixth-month mark, with the scores addressing the difference. For example, if an activity took 50 seconds initially but 47 seconds after treatment, there would be a three-point improvement.
Montero-Odasso, who also serves as team leader at the Canadian Consortium on Neurodegeneration in Aging, says there is already evidence showing that exercise is good for the brain, but “this is one of the first trials, to my knowledge, that shows that when combining physical exercise with cognitive training the results are better than the mere sum of the parts.
“Our intervention, it seems, overall improves memory, attention and word recognition, which is important for dementia. Exercise alone improves more executive function.”
Previous research involved combining exercise with cognitive training at the exact same time but those results were “ambiguous.” Montero-Odasso believes that’s because it’s hard to focus when multitasking. Doing exercise right before cognitive training, however, appears to “galvanize” the brain to receive the training by improving blood circulation, Montero-Odasso theorizes.
What can you do from home?
The study, known as the Synergic Trial (Synchronizing Exercises, Remedies in Gait and Cognition), involved a specific cognitive training designed by Louis Bherer out of the Université de Montréal that is not publicly available, but Montero-Odasso says the “take-home message” is that exercising and stimulating your brain, however you can, is better than nothing.
“Try to do physical exercises at least three days per week and spend at least 40 minutes, but push yourself, pull your heart rate 20% higher than your base or basal heart rate. Try to sweat a little while you do the exercises; that means the exercise is meaningful. And right after the exercise, do a mental activity, play a chess game, get your mind active.”
The study split 175 Canadian adults aged 65 to 84 years into five different groups to try to compare the impacts of exercise, cognitive training and vitamin D; exercise, cognitive training and placebo vitamin D; exercise, sham cognitive training and vitamin D; exercise, sham cognitive training and placebo vitamin D; and a control group of balance-toning exercise, sham cognitive training and placebo vitamin D.
Cognitive training involved using a cloud program on an iPad that focused on switching attention and memory and would become progressively more difficult as participants showed improvement or easier if the participants were having difficulty. Sham cognitive training saw patients asked to find travel information online, for example, looking for flights and hotels for a trip to Paris, France between Sept. 2 and 9.
Montero-Odasso also noted that the trial found no clinical impact from the vitamin D, but the study participants had high levels of vitamin D to begin with so to truly know the impact they’d have to include people with low levels of vitamin D in the study. He says vitamin D levels are typically low in people over 65 but the people who got involved in the trial were more likely to be interested in improving their health.
“So they were already taking vitamin D a lot because vitamin D was a hot topic five, six years ago when we were conducting this trial,” he said.
“Perhaps the lack of effect of vitamin D is not a lack of real effect, but is the problem that the patients have a high level of vitamin D already.”
He added that a strength of the study is that participants were from five different cities – Vancouver, Montreal, London, Waterloo and Kitchener – which means that the result is not specific to one particular geographic area.
The next phase of trials, Synergic-2, will involve virtual, at-home interventions for 550 study participants with MCI. Those interested in taking part are encouraged to email info@gaitandbrain.com or call (519) 685 4292 ext. 42565.
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