Brain games? Yoga? What slows mild cognitive impairment?
Randomized-controlled trial evaluated 5 interventions designed to improve function of affected people.
As we age, many of us experience minor changes to memory, language and decision-making. These changes may represent mild cognitive impairment (MCI), an intermediate stage between age-related cognitive changes and the more serious condition of dementia.
A number of behavioral interventions have shown promise to slow the advancement of MCI to dementia – such as physical exercise, mind-body awareness and memory training. But not much is known about the relative value of interventions.
In a study published May 17 in JAMA Network, researchers compared five interventions from the Mayo Clinic's Healthy Action to Benefit Independence and Thinking (HABIT) program, a 50-hour intervention delivered over 10 days and designed to improve function of people diagnosed with MCI. The five components include:
- Memory support: Calendar training for memory compensation.
- Cognitive exercise: Computerized brain games for concentration and thinking speed.
- Yoga: Chair-based physical activity and relaxation skills.
- Wellness education: Group classes that present scientific evidence around nutrition, sleep, future planning, emotional health, and how to make healthy changes.
- Support groups: Therapist-led emotional support with separate groups for participants and care partners.
The study was led by Melanie Chandler, a neuropsychologist and director of the HABIT program in Florida. Patients and caregivers helped design the study by identifying outcomes they rated as important. The study was novel in that it withheld one intervention.
The randomized, controlled trial included 272 patients at the University of Washington School of Medicine and three Mayo Clinic sites. Each group had one intervention withheld in random fashion. Researchers found no significant difference in effectiveness among the interventions for the study’s endpoint: improved quality of life. However, in two secondary measures, wellness education had a greater impact on mood, and yoga had a greater impact on memory-related activities of daily living.
At a 12-month follow-up, wellness education had the greatest impact on quality of life. Yoga and calendar training were also valuable for mood outcomes, and a support group positively affected participants’ ability to achieve goals.
“The take-home message is that a multi-component intervention benefits patients in a variety of outcomes,” said study co-author Pamela Dean, an assistant professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and clinical neuropsychologist at the VA Puget Sound. “It’s not any one thing. The study is really saying that people with MCI who are untreated may experience worsening functioning.”
The study had a number of limitations, chiefly that the study sample was small, the authors said. The study population also was highly educated and not diverse.
Dean said up to 20% of people age 65 and older have MCI, and about one-third of them will develop Alzheimer’s disease within five years. She said the interventions tested may not necessarily improve symptoms but could help a patient with MCI to remain stable.
Currently, the HABIT program is available only through the three Mayo Clinic locations: Jacksonville, Florida; Scottsdale, Arizona; and Rochester, Minnesota.
For people concerned about a change in their memory, speaking with their care provider is the best place to start, Dean said. “Early detection is really important so we can provide interventions and support for patients and their family members.”
The research was funded through the Patient-Centered Outcomes Research Institute (PCORI), whose goal is better-informed healthcare choices by patients and people who care for them.