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 Researchers reviewed 11,530 studies of so-called mild cognitive
impairment (MCI), to see how many older people are affected and
which interventions and lifestyle changes have been shown to improve
symptoms.
MCI becomes increasingly common at older ages and is characterized
by mild problems with thinking and memory that usually don’t
interfere with daily life or independent function. People diagnosed
with MCI are more likely, however, to go on to develop Alzheimer's
or other dementias than people without it.
Until now, said Ronald Petersen, the lead author of the new study
and American Academy of Neurology (AAN) treatment guidelines,
“Clinicians didn’t know what to do with these people. Now that we
know that it’s a burgeoning condition we need to pay attention when
folks come in and complain.”
Petersen, who directs the Mayo Clinic Alzheimer’s Disease Research
Center in Rochester, Minnesota, and his coauthors found that between
ages 60 and 64, 6.7 percent of people have MCI. In the 65-69 age
group, that rises to 8.4 percent, and about 10 percent at ages
70-74, nearly 15 percent at 75-79 and just over 25 percent at ages
80 to 84.
When they looked at the use of drugs, such as cholinesterase
inhibitors, they found “no high-quality evidence” that the
medications work, according to the report in the journal Neurology.
Their analysis of studies looking at the effects of physical
exercise on cognition did find a benefit, though. In one study
involving 86 women with MCI, 70 to 80 years old, researchers found
that twice-weekly resistance training for 26 weeks was more
effective than aerobic training over the same time period at
increasing what’s known as executive functioning. After completing
the exercise regimen, the women were better able to plan, manage and
organize their thoughts.
Based on their review, the authors updated a practice guideline for
MCI to include, for the first time, a recommendation that people
with the syndrome should exercise regularly as part of an overall
approach to managing their symptoms.
“This is a rich area of study. I don’t think you can say that if you
exercise 150 minutes a week you can push back cognitive decline a
certain number of years,” Petersen said in a telephone interview.
“We don’t know that for sure, but . . . physical exercise might be
beneficial in slowing down the rate of cognitive decline since it
has been shown to cause some stabilization or improvement of
cognition.”
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He thinks a combination of aerobic exercise and resistance training
is likely best for MCI patients, but the data about its long-term
effectiveness remains “scant.” He recommends that patients with MCI
try to work up a sweat by walking briskly for 50 minutes, three
times a week, because it might improve blood flow to the brain or
induce enzymes to break down proteins that can build up into brain
plaques.
Neurology researchers are hoping to develop more specific
evidence-based guidelines on how much exercise and what kind is
needed to potentially delay or prevent cognitive decline based on
ongoing clinical trials, he noted.
The new AAN guideline, which is endorsed by the Alzheimer’s
Association, also urges clinicians to discuss with their MCI
patients the diagnosis, prognosis, long-term planning and the lack
of evidence that drugs and dietary options, such as vitamins E and
C, homocysteine-lowering B vitamins and flavonoid-containing drinks,
are at all effective.
Petersen and his colleagues also analyzed five studies of
brain-training interventions and found “insufficient evidence to
support or refute the use of any individual cognitive intervention
strategy.” Nevertheless, they conclude that doctors may recommend
this approach because it might improve specific cognitive skills.
“Continuing to be cognitively and physically active is paramount for
overall brain health,” noted Dr. Neelum T. Aggarwal of the Rush
Alzheimer’s Disease Center in Chicago, who wasn’t involved in the
review or guidelines.
Some cases of MCI are associated with reversible causes of cognitive
impairment, including medication side effects, sleep apnea,
depression and other medical conditions, so it’s important for
patients to visit their healthcare provider at the first sign of
memory problems, he said in a phone interview.
SOURCE: http://bit.ly/2BV4fVp Neurology, online December 27, 2017.
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