Light, physical activity reduces brain aging

Incremental physical activity, even at light intensity, is associated with larger brain volume and healthy brain aging, according to new research | JAMA Network Open | via scienceDaily

stretching-3098228_1920Considerable evidence suggests that engaging in regular physical activity may prevent cognitive decline and dementia. Active individuals have lower metabolic and vascular risk factors and these risk factors may explain their propensity for healthy brain aging. However, the specific activity levels optimal for dementia prevention have remained unclear.

The new 2018 Physical Activity-Guidelines for Americans suggest that some physical activity is better than none, but achieving greater than 150 minutes of moderate-to-vigorous (MV) physical activity per week is recommended for substantial health benefits.

Using data from the Framingham Heart Study, researchers found that for each additional hour spent in light-intensity physical activity was equivalent to approximately 1.1 years less brain aging.

According to the researchers, these results suggest that the threshold of the favorable association for physical activity with brain aging may be at a lower, more achievable level of intensity or volume.

Full story at ScienceDaily

Full article: Nicole L. Spartano | Association of Accelerometer-Measured Light-Intensity Physical Activity With Brain Volume. JAMA Network Open, 2019; 2 (4)

Staying fit and mentally active linked with reduced dementia risk

Researchers in Sweden have found that women who exercise and stay cognitively active during midlife have a reduced risk of dementia in older age | Neurology | via Alzheimer’s Research UK

In 1968, Swedish researchers began studying a group of 800 women in midlife, between the ages of 38 and 54, and measured the amount of time they spent doing cognitively stimulating activities, including reading books and writing. The team also recorded how much physical activity the women did including walking, and intense training like swimming.

The team followed the volunteers until 2012 to see if they went onto develop dementia. They found that those who were more engaged in physical activity and spent more time doing cognitive tasks had a lower risk of developing the condition.

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Abstract
Objective:  To investigate whether cognitive and physical activities in midlife are associated with reduced risk of dementia and dementia subtypes in women followed for 44 years.

Methods:  A population-based sample of 800 women aged 38–54 years (mean age 47 years) was followed from 1968 to 2012. Cognitive (artistic, intellectual, manual, religious, and club) and physical activity were assessed at baseline. During follow-up, dementia, Alzheimer disease, vascular dementia, mixed dementia, and dementia with cerebrovascular disease were diagnosed according to established criteria based on information from neuropsychiatric examinations, informant interviews, hospital records, and registry data. Cox regression models were used with adjustment for age, education, socioeconomic status, hypertension, body mass index, cigarette smoking, diabetes mellitus, angina pectoris, stress, and major depression.

Results:  We found that cognitive activity in midlife was associated with a reduced risk of total dementia and Alzheimer disease during follow-up. Physical activity in midlife was associated with a reduced risk of mixed dementia and dementia with cerebrovascular disease. The results were similar after excluding those who developed dementia before 1990, except that physical activity was then also associated with reduced risk of total dementia.

Conclusion: Our findings suggests that midlife cognitive and physical activities are independently associated with reduced risk of dementia and dementia subtypes. The results indicate that these midlife activities may have a role in preserving cognitive health in old age.

Full story at Alzheimer’s Research UK

Full reference: Najar, J. et al. | Cognitive and physical activity and dementia. A 44-year longitudinal population study of women | Neurology | First published February 20, 2019

 

Regular problem solving does not protect against mental decline

The well known ‘use it or lose it’ claim has been widely accepted by healthcare professionals, but researchers in the Christmas issue of The British Medical Journal find that regularly doing problem solving activities throughout your lifetime does not prevent mental decline in later life. However, the results suggest that regularly engaging in intellectual activities boosts mental ability throughout life and provides a “higher cognitive point” from which to decline.

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Abstract
Objectives:  To examine the association between intellectual engagement and cognitive ability in later life, and determine whether the maintenance of intellectual engagement will offset age related cognitive decline.

Design: Longitudinal, prospective, observational study.

Setting:  Non-clinical volunteers in late middle age (all born in 1936) living independently in northeast Scotland.

Participants:  Sample of 498 volunteers who had taken part in the Scottish Mental Health Survey of 1947, from one birth year (1936).

Main outcome measures:  Cognitive ability and trajectory of cognitive decline in later life. Typical intellectual engagement was measured by a questionnaire, and repeated cognitive measurements of information processing speed and verbal memory were obtained over a 15 year period (recording more than 1200 longitudinal data points for each cognitive test).

Results:  Intellectual engagement was significantly associated with level of cognitive performance in later life, with each point on a 24 point scale accounting for 0.97 standardised cognitive performance (IQ-like) score, for processing speed and 0.71 points for memory. Engagement in problem solving activities had the largest association with life course cognitive gains, with each point accounting for 0.43 standardised cognitive performance score, for processing speed and 0.36 points for memory. However, engagement did not influence the trajectory of age related decline in cognitive performance. Engagement in intellectual stimulating activities was associated with early life ability, with correlations between engagement and childhood ability and education being 0.35 and 0.22, respectively.

Conclusion:  These results show that self reported engagement is not associated with the trajectory of cognitive decline in late life, but is associated with the acquisition of ability during the life course. Overall, findings suggest that high performing adults engage and those that engage more being protected from relative decline.

Full reference: Staff, R. et al. | Intellectual engagement and cognitive ability in later life (the “use it or lose it” conjecture): longitudinal, prospective study | BMJ | 10 December 2018

Related:

The effects of vitamin and mineral supplementation on cognitive function and the incidence of dementia in people with mild cognitive impairment.

This review investigated whether people with mild cognitive impairment can reduce their risk of developing dementia, or can prevent their memory or other thinking skills from deteriorating further, by taking vitamin or mineral supplements | Cochrane Database of Systematic Reviews

Vitamins and minerals have many functions in the nervous system which are important for brain health. It has been suggested that various different vitamin and mineral supplements might be useful in maintaining cognitive function and delaying the onset of dementia. In this review, the authors sought to examine the evidence for this in people who already had mild cognitive impairment (MCI).

The authors found eight randomised controlled trials (RCTs), which investigated four different types of vitamin or mineral pills by comparing them to a placebo (a dummy pill). The vitamins tested were B vitamins (vitamin B6, vitamin B12 and folic acid), vitamin E, and vitamin E and C given together. The only mineral tested was chromium.

However, the authors found the amount and quality of research evidence about vitamin and mineral supplements for treating MCI in people without nutritional deficiency is limited. They concluded that at the moment, it is not possible to identify any supplements which can reduce the risk of people with MCI developing dementia or which can effectively treat their symptoms.

Full reference: McCleery J, et al. |  Vitamin and mineral supplementation for preventing dementia or delaying cognitive decline in people with mild cognitive impairment |  Cochrane Database of Systematic Reviews | 2018, Issue 11.

Can museums help prevent dementia?

New study suggests visiting museums may be a promising psychosocial activity to support the prevention of dementia | The British Journal of Psychiatry | via The Mental Elf 

A study published in the British Journal of Psychiatry has revealed that people who visited museums often were less likely to develop dementia. In the research, a large cohort of people 50 years-old and older, as part of the English Longitudinal Study of Ageing (ELSA) was used as a sample and tracked across 10 years. The participants in the study did not show any clinical symptoms of dementia at baseline.

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Two main measures were used:

  1. Firstly, the participants had to complete a self-report scale regarding the frequency they were visiting museums and art galleries, varying from “never” to “twice a month or more”.
  2. Secondly, the incidence of dementia was based on a diagnosis of dementia or Alzheimer’s disease or on a score above 3.38 on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

The sample consisted of 3,911 adults, equally divided to males and females, and the mean age was 64 years-old. 6.3% developed dementia during the follow-up period. A third of participants indicated that they never visited a museum, but around 1 in 5 reported attending once or twice a year and a further 1 in 5 reported attending every few months or more.

The incidence rate of dementia was higher than average for people who never go to museums, lower than average for people who make a few visits per year, while the lowest rate was found for those who frequently visit museums.

Other cognitive activities were taken under consideration by the authors, but were not significantly associated with the occurrence of dementia. Thus, the effect of museum-attendance is thought to be unique and distinct from other activities that have been suggested.

Full research: Fancourt, D., Steptoe, A., & Cadar, D. | Cultural engagement and cognitive reserve: Museum attendance and dementia incidence over a 10-year period |  The British Journal of Psychiatry | Volume 213, Issue 5 | November 2018 | pp. 661-663

Further detail at The Mental Elf

Future Alzheimer’s treatment

Report suggests joint actions and planning in Europe can help provide better coordinated and more timely care for Alzheimer’s patients | RAND Corporation

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  • The burden of Alzheimer’s disease in high-income countries is expected to approximately double between 2015 and 2050. Recent clinical trial results give hope that a disease-modifying therapy might become available in the near future. The therapy is expected to treat early-stage patients to prevent or delay the progression to dementia.
  • This preventive treatment paradigm implies the need to screen, diagnose, and treat a large population of patients with mild cognitive impairment. There would be many undiagnosed prevalent cases that would need to be addressed initially, and then the longer-term capacity to address incident cases would not need to be as high.
  • Researchers used a simulation model to assess the preparedness of the health care system infrastructure in six European countries — France, Germany, Italy, Spain, Sweden, and the United Kingdom — to evaluate, diagnose, and treat the expected number of patients.
  • Projected peak wait times range from five months for treatment in Germany to 19 months for evaluation in France. The first year without wait times would be 2030 in Germany and 2033 in France, and 2042 in the United Kingdom and 2044 in Spain. Specialist capacity is the rate-limiting factor in France, the United Kingdom, and Spain, and treatment delivery capacity is an issue in most of the countries.
  • If a disease-modifying therapy becomes available in 2020, we estimate the projected capacity constraints could result in over 1 million patients with mild cognitive impairment progressing to Alzheimer’s dementia while on wait lists between 2020 and 2050 in these six countries.

Recommendations

  • In addition to increasing specialist and infusion capacity in each individual country, joint actions and planning in Europe can help provide better coordinated and more timely care for Alzheimer’s patients.
  • A combination of reimbursement, regulatory, and workforce planning policies, as well as innovation in diagnosis and treatment delivery, is needed to expand capacity and to ensure that available capacity is leveraged optimally to treat patients with early-stage Alzheimer’s disease.

Full report: Assessing the Preparedness of the Health Care System Infrastructure in Six European Countries for an Alzheimer’s Treatment | RAND Corporation

A roadmap to advance dementia research in prevention, diagnosis, intervention, and care by 2025

Pickett JBird CBallard C, et al. | A roadmap to advance dementia research in prevention, diagnosis, intervention, and care by 2025 | International Journal of Geriatric Psychiatry  201817

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  • A broad-based taskforce of researchers, clinicians, UK funders of dementia research, people with dementia, and carer representatives was convened to generate consensus on research ambitions in prevention, diagnosis, intervention, and care for people with dementia.
  • Five goals and 30 recommendations that align with current national dementia strategies and plans were produced. A 10-point action plan was developed to support the delivery of these goals.

Abstract

Objective

National and global dementia plans have focused on the research ambition to develop a cure or disease-modifying therapy by 2025, with the initial focus on investment in drug discovery approaches. We set out to develop complementary research ambitions in the areas of prevention, diagnosis, intervention, and care and strategies for achieving them.

Methods

Alzheimer’s Society facilitated a taskforce of leading UK clinicians and researchers in dementia, UK funders of dementia research, people with dementia, and carer representatives to develop, using iterative consensus methodology, goals and recommendations to advance dementia research.

Results

The taskforce developed 5 goals and 30 recommendations. The goals focused on preventing future cases of dementia through risk reduction, maximising the benefit of a dementia diagnosis, improving quality of life, enabling the dementia workforce to improve practice, and optimising the quality and inclusivity of health and social care systems. Recommendations addressed gaps in knowledge and limitations in research methodology or infrastructure that would facilitate research in prioritised areas. A 10-point action plan provides strategies for delivering the proposed research agenda.

Conclusions

By creating complementary goals for research that mirror the need to find effective treatments, we provide a framework that enables a focus for new investment and initiatives. This will support a broader and more holistic approach to research on dementia, addressing prevention, surveillance of population changes in risk and expression of dementia, the diagnostic process, diagnosis itself, interventions, social support, and care for people with dementia and their families.

Full document: A roadmap to advance dementia research in prevention, diagnosis, intervention, and care by 2025