No simple solution to complex dementia

If you received a brain-training device in your Christmas stocking, enjoy it — but don’t expect it to cut your risk of getting dementia, despite what the marketing of such devices might lead us to believe.

Only a few months back, results from a University of South Florida study claimed that a brain-training computer game reduced dementia risk among 3,000 healthy older people who played it over five weeks in a classroom setting and who were assessed 10 years later.

The results, which were presented to the Alzheimer’s Association annual meeting in Toronto, suggested those who were assigned speed-processing training showed a 33% reduction in dementia or cognitive impairment compared to those who received no training.

The programme, called the Double Decision Exercise, is available online commercially where it’s claimed that using the speed processing training can “bring significant benefits to everyday life”, including improving cognitive function.

But can simply playing a brain training game regularly — which in this case, was only done in up to ten sessions for five weeks with four booster sessions for some participants — decrease your chance of developing cognitive impairment?

No, says Dr Rónán O’Caoimh, consultant geriatrician and senior lecturer in NUIG, who has a specialist interest in dementia.

It’s hard to believe that the very limited intervention delivered in this study — the process of engaging with some brain trainingm — would be enough to prevent what is essentially a biological, pathological process happening,” he says.

“What we know about cognitive training activities or brain training that is being used in popular culture, is there is some evidence suggesting that when used with other activities, it can potentially, especially with patients who have established cognitive decline, slow progression over time but has limited effect on daily activities.

“Another feature of this study is that there weren’t many follow up ‘booster’ sessions over the 10 years, people coming back again to re-engage with the brain training to maintain whatever benefits they got. There were many drop-outs”

The positive outcomes seen among the participants could be due to a lot of other potential reasons.

“It could be for instance, a case that for some of those patients who didn’t do as well as expected in the brain training, it woke them up to concerns that brought them down a different pathway towards improving their brain health, such as exercising more or going to their doctor more often for health checks. We don’t know though and there’s not enough evidence from the study to say that.”

O’Caoimh points to the FINGER study, research published recently in the Lancet journal, which found that there is some merit in brain training for slowing the onset of cognitive decline, particularly planning and reaction time rather than memory itself, in people already at risk, but only when it’s combined with other lifestyle and medical interventions.

Dementia is diagnosed when there are cognitive deficits during testing and functional impairment that interferes with people’s lives, such as not being able to carry out everyday activities. In the future, biomarkers such as blood, spinal fluid and PET brain scan protein tests will be used more. The clinical picture reflects a wide spectrum from mild to severe.

“Putting the picture together is challenging and for now it remains a clinical diagnosis. New biomarkers have potential to enhance this but their use is mainly in research settings and without better treatments they should be used carefully.

"There is a cohort of the older population who may have these abnormal proteins such a Amyloid-Beta but who never develop dementia and that’s the challenge,” says O’Caoimh.

“In NUI Galway we are working on several international drug trials — looking at medications designed to target the build-up of the proteins and the inflammation that surrounds them but nobody knows what the trigger is that causes the cascade.

“For some people there is no doubt that there is a genetic disposition with about 10% of cases familial and 90% sporadic but it varies depending on the dementia type. In some it’s just an ageing phenomenon — the brain is less able to clear the build-up of amyloid proteins driving inflammatory process and then it effectively snowballs.”

What many people dread most is the idea of losing control of their cognition and particularly memory, he says.

In that context, it’s not surprising that as we age we might reach out to brain-training exercises to do what we can preventatively.

“The idea that brain training alone would be enough to stop this protein deposition and inflammation, from a biological perspective isn’t plausible,” says O’ Caoimh. “But as part of a bigger lifestyle intervention it may help.

“There is a reason why things like higher socioecononic status and education, result in less dementia, not because people have more money, but because of all the other social and lifestyle factors that go with that,” he says.

“Perhaps those who engage in cognitive stimulation have more interest and resources to invest in their brain health.”


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