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Vigorous Mind News

The National Institute on Aging awarded Vigorous Mind a second SBIR grant. This grant is to alleviate loneliness in older adults using the Vigorous Mind engagement, socialization and brain wellness platform. The study will be performed in collaboration with researchers from the Consortium on Technology for Proactive Care (CTPC) at Northeastern University. It will engage older adults at both senior living and senior centers that are customers of Vigorous Mind.

The first SBIR grant awarded to Vigorous Mind was to add physical exercise to the Vigorous Mind multidomain platform and to test usability and feasibility with older adults. The study was done in collaboration with the CTPC at Northeastern University and was completed successfully. Participants increased their engagement in physical activity and said that they would recommend Vigorous Mind to their friends.

The Science

A Non-pharmacological Multidomain Approach
 

The British Lancet Commission on Dementia Prevention, Intervention, and Care published in 2017 its
findings and said: "Acting now on dementia prevention, intervention, and care will vastly improve living and dying for individuals with dementia and their families, and in doing so will transform the future for society. ... Dementia is by no means an inevitable consequence of reaching retirement age, or event of entering the ninth decade. Lifestyle factors might reduce, or increase, an individual's risk of developing dementia. In some populations dementia is already delayed for years, while in others the number of people living with it has increased." (Livingston, 2017)

 

A large study of 196,383 individuals (mean age 64.1 years) without cognitive impairment or dementia at baseline were followed for an average of 8 years to investigate whether a healthy lifestyle is associated with a lower risk of dementia regardless of genetic risk. The researchers concluded that "a healthy life style was associated with a lower risk of dementia among participants with low of high genetic risk." (Lourida, 2019)

A large 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring in Finland (FINGER study) found that "a multidomain intervention could improve or maintain cognitive functioning in at-risk elderly people from the general population." (Nagandu, 2015)

A study of 1,995 older adults without dementia that looked at the effect of lifetime intellectual enrichment (education/occupation score and mid/late life cognitive activity) found that among carriers of the APOE4 gene (who are at higher risk of developing Alzheimer's disease), those with high lifetime intellectual enrichment (75the percentile), the onset of cognitive impairment was shown to be approximately 8.7 years later compared with low lifetime intellectual enrichment (25th percentile)." (Vemuri, 2014) 

Loneliness is associated with increased depressive symptoms, with risk for coronary heart disease and stroke and is a key predictor of depression, health deterioration, and death in older adults.
[Cacioppo, 2006, Valtorta, 2016, Singh, 2015, Perissinotto, 2012)

An active and socially integrated lifestyle in late life protects against dementia. More socially active older adults experience less cognitive decline in old age and better overall functioning.
(Fratiglioni, 2004, Bennett, 2006, Wilson, 2011, Fried, 2004)

The Vigorous Mind platform which includes cognitive training, physical exercise, stress reduction activities and socializing, was developed to facilitate living a healthy lifestyle and adopting the multidomain approach to reduce the risk of dementia and maintain brain health.  

Exercise and Cognitive Fitness

It used to be thought that after age 20, brain cells (neurons) began to die and were never replaced. Declining function was inevitable. This has since been proven wrong.

The great scientist and author Isaac Assimov wrote “the human brain is the most complicated organization of matter that we know”.  Significant research and effort have been devoted to gaining understanding how the brain functions.  Particularly, efforts have been focused on how brain functions change with aging.  As the aging population increases, concerns over the relationship of cognitive function and maintaining independence and quality of life in later years become increasingly important.   Cognitive and behavioral declines are not inevitable consequences of aging. Accumulating evidence shows that it is possible to ward off age related decline in cognitive function by means of regular mental exercise and physical activity.  Both of these activities increase blood flow to a variety of areas within the brain, and in doing so, encourage brain cell vigor and growth. Additionally, it has been shown that socialization, reduced stress, proper nutrition and adequate sleep help the individual bolster their functional abilities.

 

It used to be thought that after age 20, brain cells (neurons) began to die and were never replaced.  Declining function was inevitable.  This has since been proven wrong.   Today’s researchers have documented that our brains can grow and evolve even as we age.  Brain cells adapt to new stimuli.  It has been shown that mental exercising stimulates growth of new neurons and neuronal pathways and increases connectivity between neurons and between brain regions.   This form of stimulated growth and adaptation has been termed the development of a “Cognitive Reserve”, a sort of savings account for brain functionality, by scientists at Columbia University (Stern, 2006).  In addition, they believed that cognitive exercising increases the efficiency of connections between neurons, allowing the brain to function utilizing less resources. These biological processes may be responsible for preserved cognitive functioning and independence in the elderly even when biological markers of dementia or Alzheimer are present.

This was described in the 2003 landmark longitudinal study by David Snowden, The Nun Study.  In this study, autopsies of the brains of individuals who lived well into their nineties or older and who showed no signs of mental functional decline, revealed that most exhibited significant changes in brain structures and biological markers usually associated with Alzheimer’s disease.  In spite of those changes, they did not show any behavioral changes.  Snowden concluded that continued mental exercising allowed for the development of alternate pathways that bypassed the diseased portions of the brain and that appeared to account for their preserved mental functioning.  

Researchers have acknowledged that brain exercise can have an effect on cognitive function.  However, the question remained as to whether the training had any long-term residual effect.  This question was addressed by a large study funded by the NIH and published in the Journal of the American Medical Association (the “ACTIVE” study) in December of 2006. The study followed 2,832 seniors in six cities for five years. They were divided into four treatment groups. Three groups received 10, one-hour cognitive training sessions (memory, processing speed, and reasoning) and one was the control group and received no training. Each training intervention improved the targeted cognitive ability compared to the individual’s base line after two years. Their final results after five years showed that training in ‘reasoning’ five years earlier showed significant carryover and resulted in less functional decline in those participants as measured by self-reported Instrumental Activities of Daily Living (IADL).  Thus, if ‘minimal’ training could have a carryover five years later, regular structured exercise could result in improved function over the course of one’s life.

This concept was amplified in a recent study by Jaeggi that was published in the Proceedings of the National Academy of Science in 2008.  Jaeggi's group concluded that it was possible to improve one’s ability to reason and solve new problems independently of previously acquired knowledge by training working memory.  The study demonstrated that the extent of improvement was critically dependent on the amount of training each participant received. Therefore, more frequent or longer training resulted in greater measurable gain in functionality.

 

Are cognitive exercise and cognitive activity important?  A recent study by Wilson in the journal Neurology in November of 2007 showed that people who are cognitively inactive are 2.6 times more likely to develop Alzheimer’s disease than cognitively active people. The researchers also found that frequent cognitive activity was associated with reduced incidence of mild cognitive impairment and less rapid decline in cognitive functions.   


Finally, in addition to the preventive and protective role of continued mental activity, some of the tasks in My Vigorous Mind have an immediate effect on daily functioning, as they practice vocabulary and refresh computation skills used in everyday life. My Vigorous Mind also provides opportunities to socialize and interact with others, reduce stress, and maintain a cognitively challenging lifestyle. Furthermore, My Vigorous Mind enables the user to experience progress and a sense of accomplishment. In doing so, it promotes a positive sense of well-being, a positive emotional state that enhances cognitive stability as one ages.

Brain Wellness and Science News

Food Combination and the Risk for Alzheimer Disease

Studying the effects of diet on the risk of getting Alzheimer Disease (AD) is a complex endeavor. Numerous studies focused on specific nutrients, such as minerals, vitamins, and fatty acids. However, examining specific nutrients without considering the individual’s entire diet does not provide the best estimate of the likelihood to show AD symptoms. Also some studies specified ahead of time which nutrients they focused on while others adopted an empirical approach, analyzing compounds in foods reported by study participants.  Each of these approaches has advantages and disadvantages. A recent study published by Gu and colleagues in April 2010 in the Archives of Neurology attempted to study the importance of dietary risk and protective factors in a more comprehensive way. The study examined combinations of foods comprising an entire diet. The study also integrated preexisting knowledge of nutrients-disease associations with data received from the study participants.

 

The study followed for four years 2,148 elderly New Yorkers (aged ≥65 years) without dementia.   Participants’ food intake was categorized into 30 food groups based on nutrient composition similarities (not including dietary supplements) and the interactions among food components were taken into account, yielding seven dietary patterns. The researchers then examined the association between these seven patterns and known dietary risks and protective factors for Alzheimer Disease. Saturated fatty acids are known to have negative effects on cognition, and monounsaturated fatty acids, Omega-3 polyunsaturated fatty acids, Omega-6 polyunsaturated fatty acids, vitamin E, vitamin B12, and folate are associated with better cognition. The effects of non-dietary risk factors such as chronic diseases were minimized using statistical methods in order to evaluate the unique contribution of the dietary patterns. 

The analysis of the data highlighted a dietary pattern that was strongly associated with lower risk for AD. It was characterized by higher intakes of salad dressing, nuts, fish, tomatoes, poultry, cruciferous vegetables, fruits, and dark and green leafy vegetables. It was also characterized with a lower intake of high fat dairy products, red meat, organ meat, and butter.  This diet pattern is rich in Omega-3 polyunsaturated fatty acids, Omega-6 polyunsaturated fatty acids, vitamin E, and folate and poor in saturated fatty acids and vitamin B12 (although vitamin B12 in isolation is not a risk factor). Although not identical, the identified dietary pattern is similar to foods typically consumed in Mediterranean countries.

It used to be thought that after age 20, brain cells (neurons) began to die and were never replaced.  Declining function was inevitable.  This has since been proven wrong.   Today’s researchers have documented that our brains can grow and evolve even as we age.  Brain cells adapt to new stimuli.  It has been shown that mental exercising stimulates growth of new neurons and neuronal pathways and increases connectivity between neurons and between brain regions.   This form of stimulated growth and adaptation has been termed the development of a “Cognitive Reserve”, a sort of savings account for brain functionality, by scientists at Columbia University (Stern, 2006).  In addition, they believed that cognitive exercising increases the efficiency of connections between neurons, allowing the brain to function utilizing less resources. These biological processes may be responsible for preserved cognitive functioning and independence in the elderly even when biological markers of dementia or Alzheimer are present.

This was described in the 2003 landmark longitudinal study by David Snowden, The Nun Study.  In this study, autopsies of the brains of individuals who lived well into their nineties or older and who showed no signs of mental functional decline, revealed that most exhibited significant changes in brain structures and biological markers usually associated with Alzheimer’s disease.  In spite of those changes, they did not show any behavioral changes.  Snowden concluded that continued mental exercising allowed for the development of alternate pathways that bypassed the diseased portions of the brain and that appeared to account for their preserved mental functioning.  

Researchers have acknowledged that brain exercise can have an effect on cognitive function.  However, the question remained as to whether the training had any long-term residual effect.  This question was addressed by a large study funded by the NIH and published in the Journal of the American Medical Association (the “ACTIVE” study) in December of 2006. The study followed 2,832 seniors in six cities for five years. They were divided into four treatment groups. Three groups received 10, one-hour cognitive training sessions (memory, processing speed, and reasoning) and one was the control group and received no training. Each training intervention improved the targeted cognitive ability compared to the individual’s base line after two years. Results after five years showed that training in ‘reasoning’ five years earlier showed significant carryover and resulted in less functional decline in those participants as measured by self-reported Instrumental Activities of Daily Living (IADL).  Thus, if ‘minimal’ training could have a carryover five years later, regular structured exercise could result in improved function over the course of one’s life. Ten years after results showed that participants who did processing speed training were 29% less likely to develop Alzheimer's disease compared with the control group. (Edwards, 2017)

 

This concept was amplified in a recent study by Jaeggi that was published in the Proceedings of the National Academy of Science in 2008.  Jaeggi's group concluded that it was possible to improve one’s ability to reason and solve new problems independently of previously acquired knowledge by training working memory.  The study demonstrated that the extent of improvement was critically dependent on the amount of training each participant received. Therefore, more frequent or longer training resulted in greater measurable gain in functionality.

 

Is cognitive exercise and cognitive activity important?  A recent study by Wilson in the journal Neurology in November of 2007 showed that people who are cognitively inactive are 2.6 times more likely to develop Alzheimer’s disease than cognitively active people. The researchers also found that frequent cognitive activity was associated with reduced incidence of mild cognitive impairment and less rapid decline in cognitive functions.   


Finally, in addition to the preventive and protective role of continued mental activity, some of the tasks in Vigorous Mind have an immediate effect on daily functioning, as they practice vocabulary and refresh computation skills used in everyday life. Vigorous Mind also provides opportunities to socialize and interact with others, reduce stress, and maintain a cognitively challenging lifestyle. Furthermore, Vigorous Mind enables the user to experience progress and a sense of accomplishment. In doing so, it promotes a positive sense of well-being, a positive emotional state that enhances cognitive stability as one ages.

Purpose in Life and the Risk of Alzheimer’s Disease and MCI

The study, therefore, provides evidence for purpose in life being a protective factor against MCI and AD and a modifier of cognitive decline in healthy older adults.

Although not a cure, in recent decades scientists found both risk and protective factors for Alzheimer’s disease (AD). Purpose in life is one such protective factor recently described by Drs Boyle, Buchman, Barns, and Bennett from the Rush Alzheimer’s Disease Center in Chicago. Purpose in life refers to the psychological tendency to derive meaning from life’s experiences. It also relates to the tendency to possess a sense of intentionality and goal directedness that guides behavior. Low levels of purpose in life, for example, is reflected in living from one moment to the next, not thinking about the future and in perceiving one’s daily activities as unimportant. Purpose in life has been previously linked to positive outcomes such as better mental health, happiness, and even to longevity. In their recent publication, Drs Boyle, Buchman, Barns, and Bennett examined whether purpose in life is also associated with reduced risk for AD and for Mild Cognitive Impairment (MCI).   


Community-dwelling, 951 participants, with mean age of 80 years completed a Purpose in Life questionnaire. For the following seven years their physical and cognitive health were examined annually. The association between the clinical examination findings and their reported sense of purpose in life were analyzed. The researchers found that a person with a high level of purpose in life was approximately 2.4 times more likely to remain free of AD and 1.5 time more likely to remain free of MCI than was a person with a low score on purpose in life. Furthermore, for persons that did not develop dementia during the follow up years, initial higher levels of purpose was associated with slower rate of cognitive decline, most notably in semantic memory (i.e., knowledge, including language and facts). However, slower rates of decline were also found in episodic memory (i.e., memories of events and the time they occurred, which is the hallmark of AD), working memory, and perceptual speed. These findings persisted after taking into account interfering factors such as level of education, initial cognitive abilities, gender, social connectedness, and mood.

 

The study, therefore, provides evidence for purpose in life being a protective factor against MCI and AD and a modifier of cognitive decline in healthy older adults. These findings have practical implications for interventions. Helping older persons identify personally meaningful activities and engage in goal directed behaviors may translate into increased sense of intentionality and usefulness and result in health benefits. 

We at Vigorous Mind have seen numerous examples among our clients where sense of purpose has made a difference in residents’ lives: In two assisted living facilities when participants in a knitting club learned that their gloves and hats will be sent to soldiers in Afghanistan, participation in the club grew four fold, the hours that the residents spent getting the gloves and hats ready were extended dramatically and pictures of soldiers wearing their gloves were hung and shown proudly to every visitor by club members.

In another facility the activity director who is a retired art teacher encouraged the residents that they should prepare an exhibition of their art for their families which they did with great success.   

 

Boyle P, Buchman A, Barnes L, and Bennett D (2010). Effects of a purpose in life on risk of incident Alzheimer disease and Mild Cognitive Impairment in community- dwelling older persons. Archives of General Psychiatry, 67, 304-310     

Social Engagement and Cognitive Decline

In September 2009 the journal “Experimental Aging Research” published an article by researchers at the Rush Alzheimer’s Disease Center in Chicago titled: “Social Engagement and Cognitive Function in Old Age”. The study was led by Dr. Kristin Krueger.  The researchers wanted to find out if maintaining social connections and participating in social activities benefit cognitive functioning. They wanted to learn in greater specificity which aspects of socializing behavior are more significant. The team examined the contribution of three aspects of social engagement separately in order to learn about their unique contribution to mental acuity;  (a) size of the social network (b) frequency of participation in social activities, and (c) how satisfied people were with the quality of their relationships. The size of the social network was assessed with questions about the number of children, family, and friends participants had and had seen at least once a month. For the frequency measure, participants were asked how often they engaged in activities that involved social interactions, such as going to restaurants and sporting events, going on trips, engaging in volunteer work, visiting friends and relatives, and engaging in group activities. Perceived social support was assessed through participants’ ratings on statements such as, “There is a special person who is around when I am in need. “  These questions were examined with a group of 838 persons without dementia and with average age of 80 years. The team found that only the frequency of social engagement and the perceived quality of relationship mattered. Individuals high on these two also scored higher on cognitive measures of memory, thinking speed, and visual-spatial thinking; and they also tended to maintain an active life-style. In summary, it is not how many people you have on your network, but how often you engage in social interactions and how close and supportive your relationships are that matters.

Changes in Cortical Dopamine D1 Receptor Binding Associated with Cognitive Training

In February 2009 the journal “Science” published an article by researchers at the Karolinska Institutet in Stockholm, Sweden titled: “Changes in Cortical Dopamine D1 Receptor Binding Associated with Cognitive Training”. It demonstrated for the first time how training working memory affects the biochemistry of the brain. Working memory is the ability to retain information for short periods of time and it affects many of our cognitive abilities. Working memory capacity is reduced with normal aging and it is associated with neurological and psychological disorders. In this study thirteen healthy males age 20-28 performed challenging working memory training for 35 minutes a day, five days a week for five weeks. Five computerized working memory tests (three visuospatial and two verbal) were used to test the participant’s working memory capacity before and after the training. The participants showed a significant improvement in their working memory capacity. Using functional MRI which allows researchers to view the brain “in action” the researchers focused on five areas in the brain where changes in the biochemistry of the brain (“plasticity”) could be seen. This is an important finding for the brain fitness industry.