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Mental Calisthenics Training Slows Cognitive Decline, Helps Seniors Stay Independent, Five-Year Trial Finds

ARTICLE IN BRIEF

  • ✓ A new study reports that a short program of progressively intense cognitive exercises — dubbed “neurobics” — can help seniors maintain higher levels of cognition and function better in their daily lives, and benefits continue for at least five years.

From crossword puzzles to memorizing poetry, seniors who continue to test their mental abilities seem to retain higher levels of cognition and remain independent longer than those who do not, studies show.

Researchers from Pennsylvania State University and from several geriatric institutions have documented for the first time that a short program of progressively intense cognitive exercises — dubbed “neurobics” — can help seniors maintain higher levels of cognition and function better in their daily lives, and that the benefits continue for at least five years.

Reporting in the Dec. 20 issue of the Journal of the American Medical Association, Sherry Willis, PhD, and colleagues confirmed these findings in a randomized, controlled, single-blinded study in 2,832 volunteers, with a mean age of 76 years. Seniors who completed the 10-session cognitive exercise program, 26 percent of them African-American, demonstrated better reasoning ability and cognitive functioning skills and were better able to perform activities of daily living than did non-participants, both immediately after taking classes and five years later (JAMA 2006;296:2805–2814).

“Although all of the subjects showed mental decline over the five-year period, the rate of decline was significantly less in the [cognitive] exercise groups,” noted study co-author Sharon Tennstedt, PhD, vice president of studies on aging at New England Research Institutes in Watertown, MA.

Mental exercises seem to enhance cognitive abilities in older adults and help offset the functional decline that accompanies aging, but until now that finding has not been documented in a randomized trial, she told Neurology Today in a telephone interview.

“We know you can improve cognition in laboratory experiments with this type of training, but we didn't know if it would translate into everyday living situations, let alone convey benefits that might last for years.”

ACTIVE SENIORS

The NIH-funded Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study was conducted between April 1998 and December 2004. Participants were divided into four groups, including a control group of subjects who did not participate in any training program. The other three groups attended two-hour training sessions of increasing difficulty for the first five weeks, and four remedial sessions at 11 and 35 months. One group trained in reasoning skills, such as identifying a missing letter or number in a sequence. A second group honed memory skills, and the third increased mental processing speed by identifying a brief computer image flashed on a screen while disruptive images were also displayed, she explained.

After five years, 67 percent of the volunteers were available for follow-up testing. The memory training group did 75 percent better than controls on memory tasks, the reasoning group outperformed controls by 40 percent, and subjects who worked to bolster mental processing speeds were 300 percent quicker than their untrained counterparts.

In addition, participants in all three intervention groups reported less difficulty in performing independent activities of daily living (IADL) compared with the control group. However, improvement was statistically significant only in the reasoning group. Daily living activities included tasks such as remembering directions, driving a car, balancing a checkbook, or following directions on medication labels.

Dr. Tennstedt noted that declining cognitive ability has been shown to lead to functional disability, the primary risk factor for loss of independence.

“The five-year results of the ACTIVE study provide limited evidence that cognitive intervention can reduce age-related decline in self-reported IADLs, the precursors of dependence and increased reliance on hospitals, outpatient assistance, home health care, nursing home services, and other related health care expenditures,” according to the researchers. However, given the lag in the relationship between cognitive decline and functional deficits, the full extent of intervention effects on daily function would take longer than five years to observe in a population that was highly functioning at enrollment, they noted in the paper.

Although there are many commercially available “mental exercise” games and learning tools online that claim to help improve memory, none have been rigorously tested, according to Dr. Tennstedt.

“The mental exercises we tested in the study involved person-to-person training and were very labor intensive. Can seniors do these activities on their own? That has yet to be determined, but clearly any type of memory or reasoning activity is going to be helpful. We consider this to be a breakthrough study, but clearly it deserves more investigation.”

She added that the researchers hope to get funding to study the possible benefits over a ten-year period.

In an editorial accompanying the study in JAMA (2006;296:2852–2854), Sally Shumaker, PhD, and colleagues at Wake Forest University Health Sciences, in Winston-Salem, NC, said the study's results “provide insights into the potential promise” of behavior-based interventions in helping seniors maintain cognitive ability and improving functional status.

Figure

Seniors who participated in mental exercize tasks had a significantly less rate of decline in cognitive functioning and independent living skills.

“The latest research suggests that mental training and physical activity both have promise for preventing declines in cognition,” said Dr. Shumaker, associate dean for research at the Wake Forest School of Medicine, in a phone interview. “It's possible to envision a future treatment approach that combines lifestyle and drug treatments to meet the specific needs of each individual.”

”The medications available today produce only low to moderate improvement in mental function,” the editorialists wrote. “And they can have adverse side effects. Showing that cognitive training can protect mental function means that individuals who cannot tolerate existing drugs would have additional treatment options.”

The authors say that matching cognitive training with an individual's risk factor profile is an intriguing possibility. For example, training that focuses on memory may be best for those at risk for Alzheimer disease.

”Once they are standardized and developed for mass markets, cognitive training programs might be available to seniors through churches, schools, and senior centers,” said Dr. Shumaker.

USE IT OR LOSE IT

Christopher M. Filley, MD, professor of neurology at the University of Colorado School of Medicine at Denver and Health Sciences Center, told Neurology Today in a telephone interview that the study supports what most neurologists already believe about the benefits of cognitive activity in aging seniors and, potentially, in those with early signs of dementia.

“This is interesting work, and I'm impressed by the size of the study,” he said.

Dr. Filley's work focuses on neurobehavioral deficits in cerebral white matter disorders, including neurobehavioral and neuropsychiatric syndromes.

“That normal elders can show improvement is encouraging, and the gist of it supports the idea that [such training] could be translated in seniors with dementia,” Dr. Filley said. “Starting with a normal population makes sense, and the findings are consistent with a lot of evidence that physical and cognitive exercise helps synaptic connectivity and reduces functional and cognitive decline,” he said.

“This study lends additional support to what neurologists can tell their elderly patients about the importance of engaging in cognitive, as well as physical, exercise to reduce age-related cognitive decline,” he continued. “The study makes these recommendations more legitimate and also suggests that developing some type of formal cognitive training program might be possible. But, of course the question is always who develops it and who pays?”

REFERENCES

• Willis SL, Tennstedt SL, Wright E, et al. for the ACTIVE Study Group. Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA 2006;296:2805–2814.
    • Shumaker SA, Legault C, Coker LH. Behavior-based interventions to enhance cognitive functioning and independence in older adults. JAMA 2006;296:2852–2854.