Adults with Mild Cognitive Impairment Can Learn – and Benefit from – Mindfulness Meditation

There’s currently no known way to prevent older adults with mild cognitive impairment (MCI) from developing Alzheimer’s disease.

But there may be a safe and feasible non-pharmacological treatment that may help patients living with MCI, according to a small pilot study in the current issue of the Journal of Alzheimer’s Disease led by a neurologist and researcher with Wake Forest Baptist Health.

“Until treatment options that can prevent the progression to Alzheimer’s are found, mindfulness meditation may help patients living with MCI,” said Rebecca Erwin Wells, M.D., M.P.H., associate professor of neurology with Wake Forest Baptist Health and associate director of clinical research for its Center for Integrative Medicine. “Our study showed promising evidence that adults with MCI can learn to practice mindfulness meditation, and by doing so may boost their cognitive reserve.”

Mindfulness means maintaining a moment-by-moment, non-judgmental awareness of thoughts, feelings, bodily sensations, and surrounding environment.

“While the concept of mindfulness meditation is simple, the practice itself requires complex cognitive processes, discipline and commitment,” Wells explained. “This study suggests that the cognitive impairment in MCI is not prohibitive of what is required to learn this new skill.”

Research has demonstrated that high levels of chronic stress negatively impact the hippocampus, a part of the brain involved in memory and learning, and are associated with increased incidence of MCI and Alzheimer’s. Other studies have indicated that non-drug interventions such as aerobic exercise can have positive effects on cognition, stress levels and the brain.

To test whether a mindfulness-based stress-reduction (MBSR) program could benefit adults with MCI, the study team enlisted 14 men and women between the ages of 55 and 90 with clinically diagnosed MCI and randomized them to either an eight-week course involving mindfulness meditation and yoga or a “waiting list” control group.

he researchers previously reported that the nine participants who completed the MBSR program showed trends toward improvements on measures of cognition and well-being and indications of positive impacts on the hippocampus as well as other areas of the brain associated with cognitive decline.

The newly published study adds context to those quantitative findings with a qualitative analysis of the MBSR participants’ responses in interviews conducted at the end of the eight-week course.

“While the MBSR course was not developed or structured to directly address MCI, the qualitative interviews revealed new and important findings specific to MCI,” Wells said. “The participants’ comments and ratings showed that most of them were able to learn the key tenets of mindfulness, demonstrating that the memory impairment of MCI does not preclude learning such skills.”

Those participants who practiced at least 20 minutes a day were most likely to have understood the underlying concepts of mindfulness, Wells noted.

The limitations of the study include the small sample size and that the results may not generalize to all patients with MCI, as two-thirds of the participants in this study had a college education or more. Additional research is needed to further test the preliminary hypotheses contained in this study.

Source: Wake Forest Baptist Health


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Measure of Belly Fat in Older Adults Is Linked With Cognitive Impairment

A new study using data from the Trinity Ulster Department of Agriculture (TUDA) ageing cohort study comprising over 5,000 individuals has found that a measure of belly fat (waist:hip ratio) was associated with reduced cognitive function in older Irish adults (>60 years of age). These findings have significant implications as the global prevalence of dementia is predicted to increase from 24.3 million in 2001 to 81.1 million by 2040.

Previous studies have found that people who are overweight do not perform as well on tests of memory and visuospatial ability compared to those who are normal weight. However, it is not well known if this is true in older adults. This is of concern within Ireland, as over half of the over 50s population is classified as being centrally obese, with only 16% of men and 26% of women reported to have a BMI (body mass index) within the normal range.

The researchers used data from the TUDA study, which is a cross-border collaborative research project gathering data from thousands of elderly adults in Northern Ireland and Ireland. They found that a higher waist:hip ratio was associated with reduced cognitive function. This could be explained by an increased secretion of inflammatory markers by belly fat, which has been previously associated with a higher risk of impaired cognition. On the contrary, body mass index (BMI) was found to protect cognitive function. BMI is a crude measure of body fat and cannot differentiate between fat and fat-free mass (muscle), thus it is proposed that the fat-free mass component is likely to be the protective factor.

To the best of the authors’ knowledge, this is one of the largest studies of older adults to report these findings. Given the high prevalence of overweight and obesity in the older population and the economic and social burden of cognitive dysfunction, the results suggest that reducing obesity and exposure to obeso-genic risk factors could offer a cost-effective public health strategy for the prevention of cognitive decline.

Clinical Associate Professor in Medical Gerontology at Trinity, Conal Cunningham, is the senior author of the study. He said: “While we have known for some time that obesity is associated with negative health consequences our study adds to emerging evidence suggesting that obesity and where we deposit our excess weight could influence our brain health. This has significant public health implications.”

Source: The University of Dublin


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Study: Smelling Dysfunction Found Associated with Impaired Cognition

In a large population-based study of randomly selected participants in Germany, researchers found that participants aged 65-74 years with olfactory dysfunction showed impaired cognitive performance. Interestingly, this strong association was not present in younger (55-64 years) or older (75-86 years) participants. Additionally, the effect was more present in women than men.

In neurodegenerative diseases like Parkinson’s and Alzheimer’s disease (AD), olfactory function is diminished. Further, olfactory dysfunction precedes the onset of cognitive impairment within AD, which highlights its potential as biomarker for early, preclinical diagnosis. Several studies suggest that olfactory dysfunction predicts progression from normal cognitive functioning to mild cognitive impairment and AD. There is little evidence for this association concerning different age stages and gender differences.

The Heinz Nixdorf Recall (Risk Factors, Evaluation of Coronary Calcium and Lifestyle) study is an observational, population-based, prospective study that examined 4,814 participants (baseline: 45-75 years; 50% men) in the metropolitan Ruhr Area. Participants returned for two examinations every five years. For this analysis, 2,640 participants from the third examination were divided into anosmics (lack of olfactory function), hyposmics (impaired olfactory function) and normosmics (normal olfactory function) according to their Sniffin’ Sticks Screening test scores. To examine age- and gender-specific associations, stratified analyses for gender and three age groups were conducted. Men and women differed significantly in their olfactory function. Women had higher scores on the olfactory test. Particularly, middle-aged anosmic male and female participants showed worst performance in several cognitive tests. No associations were seen in younger and older adults. There was a quantitative association in all age groups as anosmics performed worse than hyposmics and hyposmics performed worse than normosmics in all subtests.

The found association in the middle-aged group might occur because this age band between 65-74 years is critical for the onset of age-related cognitive and olfactory decline. Regarding the older age group, the association may be covered by other risk factors occurring in this age band like hypertension, diabetes or coronary artery disease. The pathology potentially causing olfactory and cognitive impairment mainly occurs after the age of 65. Thus, the young-aged groups are cognitively healthier and are less often anosmics. This might account for the missing associations in this age group. Nevertheless, cognitive performance was reflected by the decrement in olfactory function in all age groups. Participants with worst olfactory function showed worst cognitive performance and vice versa. More distinct effects were found for women compared to men. General differences in olfactory function between men and women can be the cause of this result. At this point we cannot conclude clinical implications regarding gender.

This is the first study reporting on age-specific associations of olfactory function and cognitive performance in the general population. Testing olfactory function is an easy and inexpensive way to detect dysfunctions and can help to identify individuals at risk of cognitive decline. Assessing olfactory function may be an appropriate marker to detect persons at risk of cognitive decline, especially in a crucial age stage between 65 and 74 years.

Source: EurekAlert!

Researchers Find Mental Activities May Protect Against Mild Cognitive Impairment

Mayo Clinic researchers have found that engaging in mentally stimulating activities, even late in life, may protect against new-onset mild cognitive impairment, which is the intermediate stage between normal cognitive aging and dementia. The study found that cognitively normal people 70 or older who engaged in computer use, craft activities, social activities and playing games had a decreased risk of developing mild cognitive impairment. The results are published in the Jan. 30 edition of JAMA Neurology.

Researchers followed 1,929 cognitively normal participants of the population-based Mayo Clinic Study of Aging in Olmsted County, Minn., for an average duration of four years. After adjusting for sex, age and educational level, researchers discovered that the risk of new-onset mild cognitive impairment decreased by 30 percent with computer use, 28 percent with craft activities, 23 percent with social activities, and 22 percent with playing games.

“Our team found that persons who performed these activities at least one to two times per week had less cognitive decline than those who engaged in the same activities only two to three times per month or less,” says Yonas Geda, M.D., psychiatrist and behavioral neurologist at Mayo Clinic’s Arizona campus and senior author of the study.

Researchers conducted a neurocognitive assessment at the time of enrollment in the study, with evaluations every 15 months. Following the assessment, an expert consensus panel at the Alzheimer Disease Research Center at Mayo Clinic made the classification of normal cognition or mild cognitive impairment for each study participant, based on published criteria.

“Our previous cross-sectional study had found an association between engagement in mentally stimulating activities in late life and decreased odds of mild cognitive impairment,” says Dr. Geda. “However, those findings were considered preliminary until confirmed by a prospective cohort study that we are now reporting in JAMA Neurology.”

Source: Mayo Clinic


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Canadian Task Force on Preventive Health Care Releases Updated Guideline for Cognitive Impairment Screening

For adults aged 65 years or older living in the community, there is no benefit to screening for cognitive impairment if they are asymptomatic, according to a new Canadian guideline published in CMAJ (Canadian Medical Association Journal).

“While the task force recommends against screening older community-living adults for cognitive impairment, physicians should investigate if patients or their family members express concern about possible memory loss,” states Dr. Kevin Pottie, chair of the Canadian Task Force on Preventive Health Care working group for the cognitive impairment guideline. “This recommendation is for adults without symptoms, not for people with concerns.”

The recommendation updates the task force’s previous recommendation that found insufficient evidence to recommend for or against screening, which was published in 2001. The current recommendation is based on a lack of evidence that screening is effective, a high rate of false-positive results for screening and the ineffectiveness of treatment for mild cognitive impairment. The task force found no clinical trials that evaluated the benefits or harms of screening for cognitive impairment, and instead looked at the effectiveness of treatment for mild cognitive impairment as indirect evidence to inform its recommendations on screening.

Cognitive impairment begins with normal age-related memory loss and may progress to mild cognitive impairment and possibly dementia. Although mild cognitive impairment is noticeable, it does not substantially affect daily living, unlike dementia. However, mild cognitive impairment can be a risk factor for later dementia, but it may not progress to that stage.

“Our assumptions were that, if clinicians are able to identify individuals with mild cognitive impairment early through screening and either slow down or stop its progression through effective treatment, the incidence of cognitive impairment (measured through cognition, function, behaviour and global status) may decline,” the authors state.

Key findings:

  • Cholinesterase inhibitors, a common treatment for Alzheimer disease, do not improve cognition in people with mild cognitive impairment.
  • Dietary supplements and vitamins did not improve cognitive function in people with mild cognitive impairment.
  • Nonpharmacologic interventions such as exercise and cognitive training may have some minor benefit, although the effect was not clinically significant.

The recommendation not to screen aligns with other national and international guidelines such as the United Kingdom’s National Institute for Health and Care Excellence (NICE) 2011 guidelines and the US Preventive Services Task Force 2014 guidelines.

“The task force’s findings have identified multiple opportunities for research,” states Dr. Pottie. “It is clear that we need more precise screening tools and treatments, including preventive approaches that improve outcomes for people with cognitive impairment.”

Source: EurekAlert!