Can mindfulness-based interventions influence cognitive functioning in older adults?

An increased need exists to examine factors that protect against age-related cognitive decline. There is preliminary evidence that meditation can improve cognitive function | Aging & Mental Health 

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However, most studies are cross-sectional and examine a wide variety of meditation techniques. This review focuses on the standard eight-week mindfulness-based interventions (MBIs) such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT).

We conclude that eight-week MBI for older adults are feasible, but results on cognitive improvement are inconclusive due a limited number of studies, small sample sizes, and a high risk of bias. Rather than a narrow focus on cognitive training per se, future research may productively shift to investigate MBI as a tool to alleviate suffering in older adults, and to prevent cognitive problems in later life already in younger target populations.

Full reference: Berk, L. et al. (2017) Can mindfulness-based interventions influence cognitive functioning in older adults? A review and considerations for future research. Aging & Mental Health. Vol. 21 (Issue 11) pp. 1113-1120

Daily crosswords linked to sharper brain in later life

Online trial finds that the more regularly people report doing word puzzles such as crosswords, the better their brain function in later life. |  Via ScienceDaily

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Image source: Jessica Whittle Photography – Flickr // CC BY-NC-ND 2.0

Experts at the University of Exeter Medical School and Kings College London analysed data from more than 17,000 healthy people aged 50 and over, submitted in an online trial.  The study, one of the largest of its kind, used tests from online cognitive test systems to assess core aspects of brain function. They found that the more regularly participants engaged with word puzzles, the better they performed on tasks assessing attention, reasoning and memory.

From their results, researchers calculate that people who engage in word puzzles have brain function equivalent to ten years younger than their age, on tests of grammatical reasoning speed and short term memory accuracy.

Read more at ScienceDaily

The effect of music therapy on cognitive functions in patients with dementia.

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Objectives: The aim of the present study was to meta-analyze the effect of music therapy (MT) on cognitive functions in patients with dementia.

Method: A systematic literature search was performed in Medline, PsycINFO, Embase, CINAHL and RILM up to 8 September 2016. We included all randomized controlled trials that compared MT with standard care, or other non-musical types of intervention, evaluating cognitive outcomes in patients with dementia. Outcomes included global cognition, complex attention, executive function, learning and memory, language, and perceptual-motor skills.

Results: From 1089 potentially relevant records, 110 studies were assessed for eligibility, and 7 met the inclusion criteria, of which 6 contained appropriate data for meta-analysis (330 participants, mean age range 78.8–86.3). Overall, random-effects meta-analyses suggested no significant effects of MT on all outcomes. Subgroup analysis found evidence of a beneficial effect of active MT on global cognition (SMD = 0.29, 95% CI 0.02 to 0.57, p = 0.04).

Conclusion: Despite the limited evidence of the present review, it is important to continue supporting MT as a complementary treatment for older adults with dementia. RCTs with larger sample sizes are needed to better elucidate the impact of MT on cognitive functions.

Full reference: The effect of music therapy on cognitive functions in patients with dementia: a systematic review and meta-analysis   | Aging & Mental Health | Published online: 10 Jul 2017

Vitamin D, cognitive decline and long-term risk of dementia

Hypovitaminosis D has been associated with several chronic conditions; yet, its association with cognitive decline and the risk of dementia and Alzheimer’s disease (AD) has been inconsistent | Alzheimer’s & Dementia

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Methods: The study population consisted of 916 participants from the Three-City Bordeaux cohort aged 65+, nondemented at baseline, with assessment of vitamin D status and who were followed for up to 12 years.

Results: In multivariate analysis, compared with individuals with 25(OH)D sufficiency (n = 151), participants with 25(OH)D deficiency (n = 218) exhibited a faster cognitive decline. A total of 177 dementia cases (124 AD) occurred: 25(OH)D deficiency was associated with a nearly three-fold increased risk of AD (hazard ratio = 2.85, 95% confidence interval 1.37–5.97).

Discussion: This large prospective study of French older adults suggests that maintaining adequate vitamin D status in older age could contribute to slow down cognitive decline and to delay or prevent the onset of dementia, especially of AD etiology.

Full reference: Feart, C. et al. (2017) Associations of lower vitamin D concentrations with cognitive decline and long-term risk of dementia and Alzheimer’s disease in older adults. Alzheimer’s & Dementia. DOI: 10.1016/j.jalz.2017.03.003

General practitioners’ practices when suspecting cognitive impairment

General practitioners (GPs) play a major role in the assessment of dementia but it is still unrecognized in primary care and its management is heterogeneous | Aging & Mental Health

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Objective: Our objective is to describe the usual practices, and their determinants, of French GPs in this field.

Results: Hundred two GPs completed the study. GPs were in majority men, working in urban areas. Mean age was 54.4 years old. GPs’ feeling of confidence and self-perception of follow-up of national recommendations is linked with their practices. Performing a clinical interview to assess cognitive impairment is linked with good communication skills. GPs feel less confident to give information about resources for dementia. The main reason alleged for underdiagnosis is the limited effectiveness of drug therapy.

Conclusions: This study underlines the importance of GPs’ feeling of confidence when managing cognitively impaired patients with dementia, and the need of increasing training in the field of dementia, which could improve the awareness of GPs about diagnosis and available resources.

Full reference: Harmand, M.G-C. et al. (2017) Description of general practitioners’ practices when suspecting cognitive impairment. Recourse to care in dementia (Recaredem) study. Aging & Mental Health. Published online: 8 June 2017

The association between an inflammatory diet, cognitive function and dementia

The Mediterranean and Dietary Approaches to Stop Hypertension diets have been associated with lower dementia risk. We evaluated dietary inflammatory potential in relation to mild cognitive impairment (MCI)/dementia risk | Alzheimer’s & Dementia

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Method: Baseline food frequency questionnaires from n = 7085 women (aged 65–79 years) were used to calculate Dietary Inflammatory Index (DII) scores that were categorized into four groups. Cognitive function was evaluated annually, and MCI and all-cause dementia cases were adjudicated centrally. Mixed effect models evaluated cognitive decline on over time; Cox models evaluated the risk of MCI or dementia across DII groups.

Results: Over an average of 9.7 years, there were 1081 incident cases of cognitive impairment. Higher DII scores were associated with greater cognitive decline and earlier onset of cognitive impairment. Adjusted hazard ratios (HRs) comparing lower (anti-inflammatory; group 1 referent) DII scores to the higher scores were group 2-HR: 1.01 (0.86–1.20); group 3-HR: 0.99 (0.82–1.18); and group 4-HR: 1.27 (1.06–1.52).

Conclusions: Diets with the highest pro-inflammatory potential were associated with higher risk of MCI or dementia.

Full reference: Hayden, K.M. et al. (2017) The association between an inflammatory diet and global cognitive function and incident dementia in older women: The Women’s Health Initiative Memory Study. Alzheimer’s & Dementia. Published online: May 19 2017

Is making music associated with better cognitive functioning?

D. Mansens, D. J. H. Deeg, and H. C. Comijs. The association between singing and/or playing a musical instrument and cognitive functions in older adults. Aging & Mental Health. Published online: 19 May 2017
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Objectives: Cognitive decline happens to everyone when aging, but to some more than others. Studies with children, adults, and professional musicians suggest that making music could be associated with better cognitive functioning. In older adults however, this association is less well investigated, which is therefore the aim of this study.

Methods: In this cross-sectional study data from 1101 participants aged 64 and older from the Longitudinal Aging Study Amsterdam were used. Multivariable linear regression analyses were performed to test the association between making music and cognitive functioning and time spent making music and cognitive functioning. ANCOVA analyses were performed to differentiate between participants who made no music, only sang, only played an instrument or both sang and played an instrument in terms of cognitive functioning.

Results: Making music was significantly positively associated with letter fluency, learning and attention/short-term memory. Time spent making music yielded no significant results. The ANCOVA analyses showed higher scores for participants who only played an instrument compared to participants who made no music on learning, working memory and processing speed. For processing speed the instrument only group also had a higher score than participants who only sang.

Discussion: Making music at least once every two weeks and especially playing a musical instrument, is associated with better attention, episodic memory and executive functions. The results suggest that making music might be a potential protective factor for cognitive decline; however, to support this notion a longitudinal study design is needed.

 

Adequate vitamin D status in older age could delay or prevent the onset of dementia

Feart, C. et al. Associations of lower vitamin D concentrations with cognitive decline and long-term risk of dementia and Alzheimer’s disease in older adults, Alzheimer’s & Dementia | Published online: 15 May 2017

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Introduction: Hypovitaminosis D has been associated with several chronic conditions; yet, its association with cognitive decline and the risk of dementia and Alzheimer’s disease (AD) has been inconsistent.

Discussion: This large prospective study of French older adults suggests that maintaining adequate vitamin D status in older age could contribute to slow down cognitive decline and to delay or prevent the onset of dementia, especially of AD etiology.

Read the full abstract here

The Confusion Care Pathway

The Confusion Care Pathway has been developed by the dementia/delirium working group at London North West Healthcare NHS Trust as a guide to best practice in supporting people with dementia, delirium and/or cognitive impairment and their carers.

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The Confusion Care Pathway (CCP) starts with the need to recognise confusion. A confusion identifier (the symbol on the CCP) is applied to the medical notes and a magnetic identifier is applied above the bed. The CCP subsequently guides healthcare staff to assess the cause of the confusion in order to reach a cognitive diagnosis, to avoid moves unless in the patient’s interest and to focus on assessing the patient’s needs for care planning and discharge planning throughout the inpatient stay.

The CCP prompts healthcare staff to work in partnership with the patient and their carer from the outset of their admission by: exploring the patient’s needs and preferences via a document called ‘Important Things About Me’, as well as using the Carer’s Agreement and Carer’s Passport.

Aerobic and resistance exercises can improve thinking skills of the over 50s

Researchers reviewed 39 studies published up to the end of 2016 to assess the potential impact of varying types, intensities, and durations of exercise on the brain health of the over 50s | Alzheimer’s Society

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Dr Doug Brown, Director of Research at Alzheimer’s Society, said:

‘The benefits of regular exercise to keep a sharp mind are becoming clearer. Previous studies show that people who exercise are less likely to develop dementia, but more research is needed to find out exactly what type and how much exercise is best to help reduce your risk of the condition.’

‘In this study, researchers reviewed results from 39 trials of people in their 50s who were given supervised exercise programmes. Taking up moderate or vigorous exercise improved people’s performance on tests of thinking skills, but the study didn’t look at whether this reduced their likelihood of developing dementia.’

Read the original research article here