November 16, 2017

expert reaction to brain training for dementia

A new study, published in Alzheimer’s & Dementia: Translational Research & Clinical Interventions, reports that computerised brain training may reduce the risk of dementia by 29%.

A before the headlines analysis accompanied this roundup.

Dr Sujoy Mukerjee, Consultant Psychiatrist (Old Age), West London MH NHS Trust, said:

“This is an important study with a relatively big sample exploring the possibility of preventing dementia by repeated use of a specific type of brain training and a 29% reduction in the incidence of dementia appears very promising. However, in my opinion the biggest drawback is that the diagnosis of dementia has not been confirmed by a robust clinical assessment backed by appropriate investigations.

“In the study participants who developed dementia during the follow-up were older, male, of nonwhite race, less educated, more likely non-drinkers, with more depressive symptoms, and more likely to have diabetes or CHF (Table 2).

“Patients from ethnic minorities, whose first language is not English and who has low education often do poorly in a cognitive screening like mini-mental state examination and over-representation of this group within the dementia-diagnosed population in this study raises legitimate question about accuracy of those diagnoses. There is a clear risk of over diagnosis of dementia in this group. Also, this group of patients would be less likely to complete or benefit from a computerised training programme.

“The authors have not offered any clear hypothesis why speed training should be so much better compared to other approaches like memory and reasoning training. They have raised the possibility of improving brain reserve. However, while brain reserve is correlated with broader variables like education, intelligence etc., it is unclear how that will explain supremacy of one cognitive training over another.

“Overall it is an important study that adds to the appeal of specific brain training that may contribute to primary prevention of dementia, possibly along with reductions of vascular risks and modifications of lifestyle but further rigorous research is necessary before the specific claim made by the authors could be substantiated.”

Prof. Peter Passmore, Professor of Ageing and Geriatric Medicine, Queen’s University Belfast, said:

“This is an interesting study looking at a specific type of cognitive training to see whether there is an impact on risk of dementia. However, the main problem here is in the definition of dementia. If I had been a referee I would have asked the authors to use the term ‘cognitive and functional decline’. The authors acknowledge this in their critique and say that dementia was not a primary outcome, the findings are from a secondary analysis. Thus there was not a clinical diagnosis of dementia and these results must be interpreted with caution as a result as they could easily be overstated.

“The findings may be regarded as hypothesis forming and the authors themselves state that a replication is needed using a clinical diagnosis of dementia as a primary outcome.”

Dr Doug Brown, Director of Research at Alzheimer’s Society, said:

“We expect over a million people across the UK to be living with dementia by 2021, therefore it’s vital that we see approaches, like brain training, being investigated that could potentially help reduce the risk of developing dementia.

“This study hints that a particular type of brain training may help people to ward off dementia, but due to limitations of the research, we can’t confidently conclude this.

“It’s positive that this study compared several types of brain training and was both long term and large scale in nature. However, as it relied on self-reporting of dementia in many cases rather than a robust clinical diagnosis, the results should be interpreted with caution.  Interestingly, only speed training but not memory or reasoning training showed any significant effect on the likelihood of developing dementia, meaning we can’t assume all brain training programmes will work in the same way.

“As computerised brain training has the potential to help a lot of people in a really cost-effective way, this area of research should remain a high priority. There are currently a number of studies looking at the effect of computer brain training on dementia, including a large UK study funded by Alzheimer’s Society. Combining these results with those from other studies should help us to have a clearer picture.

“Overall, the best way to reduce your risk is to take regular exercise, eat a healthy diet and avoid smoking.”

Prof. Rob Howard, Professor of Old Age Psychiatry, UCL, said:

“A large number of studies have looked at the effects of brain training interventions to improve cognitive functioning in people as they age. Generally, these have shown improvements in the narrow areas involved in the training without transfer to more general abilities and perhaps only modest impact on cognitive trajectory with increasing age associated with the most intensive interventions. The results reported here, of apparent reduction in risk of dementia after 10 years following only a few hours of cognitive training, are therefore rather surprising and should be treated with caution.

“I find it implausible that such a brief intervention could have this effect and it is worth bearing in mind that the results could have occurred by chance or as a consequence of uncontrolled confounding factors. On the basis of this study, I won’t be recommending speed of processing training to my friends or patients!”

Dr Rosa Sancho, Head of Research, Alzheimer’s Research UK, said:

“Dementia is our most feared medical condition, so there is a lot of interest in activities that could help maintain memory and thinking ability as we get older. We know that factors like diet and exercise can help to maintain a healthy brain, but there is growing evidence pointing to a role for mental stimulation and activities with less obvious physical benefits. While staying mentally active and socially engaged have been linked to a lower risk of dementia, evidence of the beneficial effect of brain training programmes has remained less clear.

“The association between speed of processing training and lower dementia risk in the study is on the very edge of statistical significance, so we need to be cautious about drawing too firm a conclusion from this finding alone. Dementia was not the primary outcome of this trial and so results are taken from a secondary analysis of the data. Although the study followed many volunteers for a long time, the researchers relied on participants to self-report their dementia diagnosis, a method that can be less reliable than clinical tests given as part of the study.

“The findings suggest a potential link between reduced dementia risk and a certain type of brain training in older healthy adults, but the mechanisms behind this association still needs exploring. The risk of developing dementia is down to a complex mix of age, genes and lifestyle, and research is unravelling how all these factors are linked so that people have the best advice on how to reduce their dementia risk. Remaining mentally active throughout life is an important part of a healthy lifestyle. A healthy balanced diet, not smoking, only drinking in moderation and keeping weight, blood pressure and cholesterol under control can all help maintain a healthy brain in later life.”

* ‘Speed of processing training results in lower risk of dementia’ by name of first author et al. published in Alzheimer’s & Dementia: Translational Research & Clinical Interventions on Thursday 16^th November.

Declared interests

Prof. Passmore: “No conflicts”

Dr Brown: “No interests to declare”

Prof.. Howard: “I have received research grants from the MRC, NIHR and Alzheimer’s Society.”

Dr Sancho: None received