Will cognitive training prevent, delay or cure dementia?

This question keeps neurologists and other professionals busy these days. Dementia is described as: “the loss of cognitive functioning to such an extent that it interferes with a person’s daily life and activities”. Not only does it interfere with the person’s own life, but it also has a big impact on the life of family and friends. Worldwide there are over 50 million people with dementia. However, professionals still haven’t agreed on one corresponding answer to the question of which treatment or therapy prevents, delays, or cures dementia. Is cognitive training the answer to these questions?

Almost every person knows someone who is dealing with dementia. This could be a family member that is diagnosed with dementia or for example an acquaintance that is taking care of someone with dementia. However, did you know that dementia has many different causes and that every form has its own risk factors, etiology, and symptoms?  A few of the causes of dementia are:

  • Alzheimer’s disease
  • Vascular dementia
  • Lewy body dementia
  • Frontotemporal dementia
  • Creutzfeldt-Jakob disease

With Alzheimer’s disease being the most common form. Alzheimer’s disease is a neurodegenerative disease in which neuronal cell death plays a huge role. This neuronal cell death takes place because of an accumulation of neurotoxic amyloid plaques and neurofibrillary tangles consisting of the protein Tau. The neuronal cell death starts typically in the entorhinal cortex and the hippocampus. These parts of the brain are involved in, for example, memory. In a later stage, Alzheimer’s disease also affects other parts of the brain. Some pharmacological interventions known should tackle Alzheimer’s disease in theory. However, in practice, those interventions did not satisfactorily resolve the problem of dementia and in specific Alzheimer’s disease.  

In the past few years, some researchers have been evaluating what the effect of cognitive training is in people with dementia. Clare, L et al. conducted research on whether goal-oriented cognitive rehabilitation would increase goal performance and satisfaction in people with early-stage Alzheimer’s disease. The participants in this study were addressing personally meaningful goals while at the same time they performed tasks based on attention, concentration, memory, and stress management. Those participants were compared to a group of participants that received only relaxation training and a group of participants that did not receive any training at all. They found that personalized cognitive rehabilitation does improve the ratings of goal performance and satisfaction. These results were also partly supported by changes of the brain noticed on fMRI’s. After a six-month follow-up, they still found a significant difference in the MARS memory performance subscale scores between the group that received cognitive rehabilitation and the group that did not receive any training. This shows that cognitive training in a goal-directed manner can offer benefits for people with early-stage Alzheimer’s disease.

So goal-directed cognitive training might be beneficial for people with dementia, but how about a combination of cognitive and physical training? A meta-analysis by Karssemeijer et al. examined the positive effects of combined cognitive and physical exercise training on cognitive function in elderly with mild cognitive impairment or dementia. They stated that there was a significant positive effect of the combined training on global cognitive function in these populations. In the articles, they measured cognitive function using the well-known Mini-Mental State Examination and the Alzheimer’s Disease Assessment Scale-Cognitive Subscale. They also found a significant positive effect of the combined interventions on the activities of daily living. In Greece Bamidis, P.D. et al. conducted a study that also found that combined cognitive and physical training leads to gains in cognition. They conducted their research in individuals ranging from cognitively healthy to individuals with mild cognitive impairment or dementia (Figure 1). 

Figure 1: Effect of combined physical and cognitive training on global cognition in the intervention versus a passive control group of the Greece study of bamidis, P.D. et al.

Specifically, the improvement of the intervention group compared to the improvement of the control group was significantly higher for executive functioning and episodic memory. However, in this study, no significant effect was found in working memory between these groups. Overall, this study also had very interesting results for the future of cognitive training.

Aristotle Cognitive Training delivers a tool by which goal-directed cognitive training, as well as a combination of physical and cognitive training, can be given. Current research has already proven that these kinds of cognitive training can offer benefits for people with neurodegenerative disorders. Most of this research examined the effect of cognitive training next to physical training. Our tool can combine both disciplines into one training. In the future, we would like to explore what the benefits of our tool are for these populations and see what our contribution will be to tackle the terrible disease that dementia is. 

References

  • NIH national Institute on Aging. (2021). What is dementia? Symptoms, Types and Diagnosis. U.S. Department of Health & Human Services. URL: https://www.nia.nih.gov/health/what-dementia-symptoms-types-and-diagnosis
  • World Health Organization. (2020). Dementia: Key facts. URL: https://www.who.int/news-room/fact-sheets/detail/dementia
  • Emmady, P.D., Tadi, P. (2021). Dementia. StatPearls.
  • Kumar, A., Sidhu, J., Goyal, A., Tsao, J.W. (2021). Alzheimer Disease. StatPearls.
  • Bahar-Fuchs, A., Clare, L., & Woods, B. (2013). Cognitive training and cognitive rehabilitation for persons with mild to moderate dementia of the Alzheimer’s or vascular type: a review. Alzheimer’s research & therapy5(4), 1-14.
  • Karssemeijer, E. E., Aaronson, J. J., Bossers, W. W., Smits, T. T., & Kessels, R. R. (2017). Positive effects of combined cognitive and physical exercise training on cognitive function in older adults with mild cognitive impairment or dementia: A meta-analysis. Ageing research reviews40, 75-83.
  • Bamidis, P. D., Fissler, P., Papageorgiou, S. G., Zilidou, V., Konstantinidis, E. I., Billis, A. S., … & Kolassa, I. T. (2015). Gains in cognition through combined cognitive and physical training: the role of training dosage and severity of neurocognitive disorder. Frontiers in aging neuroscience7, 152.