Active Brains Slow Cognitive Decline

by Sheela Philomena on? July 04, 2013 at 10:30 AM Research News Keeping your brain mentally active could boost your brainpower in old age, suggests study.
Study author Robert S. Wilson, PhD, with Rush University Medical Center in Chicago, said that their study suggests that exercising brain by taking part in activities like these across a person's lifetime, from childhood through old age, is important for brain health in old age.

For the study, 294 people were given tests that measured memory and thinking every year for about six years before their deaths at an average age of 89.

They also answered a questionnaire about whether they read books, wrote and participated in other mentally stimulating activities during childhood, adolescence, middle age and at their current age.

After they died, their brains were examined at autopsy for evidence of the physical signs of dementia, such as lesions, brain plaques and tangles.

The research found that people who participated in mentally stimulating activities both early and late in life had a slower rate of decline in memory compared to those who did not participate in such activities across their lifetime, after adjusting for differing levels of plaques and tangles in the brain.

Mental activity accounted for nearly 15 percent of the difference in decline beyond what is explained by plaques and tangles in the brain.

The study found that the rate of decline was reduced by 32 percent in people with frequent mental activity in late life, compared to people with average mental activity, while the rate of decline of those with infrequent activity was 48 percent faster than those with average activity.

The study has been published in the online issue of Neurology, the medical journal of the American Academy of Neurology.

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Education may Influence Cognitive Decline in MS Patients

MS is a progressive immunologic brain disorder with neuropsychological deficits including selective attention, working memory, executive functioning, information processing speed, and long term memory. These deficits often impact daily life (ability to do household tasks, interpersonal relationships, employment, and overall quality of life).

In this study, investigators first assessed the role of cognitive reserve, the brain's active attempt to focus on how tasks are processed, in compensating for the challenge represented by brain damage. Earlier studies had reported that higher cognitive reserve protects MS subjects from disease-related cognitive inefficiency but in these studies cognitive reserve was mainly estimated through a vocabulary test. Here, investigators considered educational level and occupational attainment instead of vocabulary. They also evaluated both educational and occupational experience, hypothesizing that an individual's lifetime occupational attainment could also be considered a good proxy of CR, similar to the way in which higher occupational attainment reduces the risk of Alzheimer's disease.

The second aim of the study was to investigate the possible role of perceived fatigue. Fatigue can have a great negative influence on daily life, so that higher perceived fatigue might result in lower cognitive performance.

Fifty consecutive clinically diagnosed MS patients took part in the study. A control group included 157 clinically healthy subjects, with no psychiatric or neurological diagnosis. Individuals in both groups were, on average, of the same age, education level and gender. The mean age was 40.41years, with 12.37 years of education.

Cognitive performance was evaluated using the Paced Auditory Serial Addition Test (PASAT), in which a series of single digit numbers are presented and the two most recent digits must be summed. This test has high sensitivity in detecting MS-related cognitive deficits as it relies strongly on working memory and information processing speed abilities. Fatigue was evaluated through the Modified Fatigue Impact Scale (MFIS), which assesses the effects of fatigue in terms of physical, cognitive, and psychosocial functioning.

Of the 50 clinically diagnosed patients, 17 had less than 13 years of schooling, without obtaining any secondary level diploma, and 33 had received more than 13 years of schooling, leading to a diploma at university level. Both groups were administered a short neuropsychological battery including standardized tests for vigilance, alertness and divided attention. None of the tasks showed differences between the groups.

Patients were also classified using the US census categories into low occupations (student, housewife, unskilled/semiskilled, skilled trade or craft, clerical/office worker) and high occupations (manager business/government and professional/technical), where the occupational attainment categories are based on the cognitive complexity and cognitive effort needed to carry out the job efficiently. They were then further divided into three groups: low occupation and low education, low occupation and high education, and high occupation and high education.

The researchers found that high speed PASAT versions were more suitable for identifying compensatory capacities compared to low speed PASAT versions. MS patients with low education performed worse than matched healthy controls at faster PASAT speeds.

The study has been published in Restorative Neurology and Neuroscience.

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Cognitive Function of HRT for Women Ages 50 to 55 Years Studied

by Bidita Debnath on? June 25, 2013 at 6:06 PM Research News When given to women ages 50 to 55 years, postmenopausal hormone therapy with conjugated equine estrogens (CEEs) was not associated with overall sustained benefit or risk to cognitive function.
This is according to a report published Online First by JAMA Internal Medicine, a JAMA Network publication.

The Women's Health Initiative Memory Study (WHIMS) demonstrated that postmenopausal hormone therapy with CEEs, when prescribed to women 65 years and older, caused deficits in global and domain-specific cognitive functioning.

The Women's Health Initiative Memory Study of Younger Women (WHIMSY) tested whether prescribing CEE-based hormone therapy to postmenopausal women ages 50 to 55 years had longer-term effects on cognitive function. The study by Mark A. Espeland, Ph.D., of the Wake Forest School of Medicine, Winston-Salem, N.C., and colleagues presents primary findings from this study.

"Global cognitive function scores from women who had been assigned to CEE-based therapies were similar to those from women assigned to placebo," according to the study results. "Similarly, no overall differences were found for any individual cognitive domain."

The study included 1,326 postmenopausal women, who had started treatment in two randomized placebo-controlled clinical trial of hormone therapy when they were ages 50 to 55 years. The clinical trials the women participated in compared 0.625mg CEE with or without 2.5mg medroxyprogesterone acetate over an average of seven years.

"Our findings provide reassurance that CEE-based therapies when administered to women earlier in the postmenopausal period do not seem to convey long-term adverse consequences for cognitive function. Although we cannot rule out acute benefits or harm, these do not appear to be present to any degree a mean of seven years after cessation of therapy. One exception may be for minor longer-term disturbances of verbal fluency for women prescribed CEE alone; however this may be a chance finding," the authors conclude.
(JAMA Intern Med. Published online June 24, 2013. doi:10.1001/jamainternmed.2013.7727. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: An author made a conflict of interest disclosure. The study was supported by a National Institute on Aging contract. Other funding also was disclosed. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Commentary: Hormone Therapy in Younger Women, Cognitive Health

In an invited commentary, Francine Grodstein, Sc.D., of Brigham and Women's Hospital, Boston, writes: "Approximately 10 years ago, the Women's Health Initiative Memory Study (WHIMS) found that postmenopausal hormone therapy in older women caused nearly two-fold increases in dementia risk, worse rates of cognitive decline over time, and decreased brain volume on magnetic resonance imaging, compared with placebo treatment."

"In the article by Espeland et al, WHIMS investigators report new results from the Women's Health Initiative Memory Study in Younger Women (WHIMSY). The WHIMSY trial cleverly leverages 1,272 participants from the Women''s Health Initiative who were aged 50 to 55 years when they were originally assigned to hormone therapy or placebo and reports findings from cognitive assessments administered a mean 7.2 years after treatment was halted," Grodstein continues.

"In these younger women, reassuringly, cognitive function appears similar in those who had been given hormone therapy vs. placebo; that is, there is no evidence in WHIMSY of substantially worse cognitive function associated with hormone use at younger ages," Grodstein concludes.
(JAMA Intern Med. Published online June 24, 2013. doi:10.1001/jamainternmed.2013.6827. Available pre-embargo to the media at http://media.jamanetwork.com.)

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