Is it possible to delay the progression of cognitive decline through lifestyle interventions? It’s a question many people want to know and could shed light on needed therapies for dementia patients. We recently spoke to Glenn Smith, a neuropsychologist from the University of Florida about his study on behavioral interventions to help people with mild cognitive impairment (MCI). He is comparing the effectiveness of several behavioral interventions designed to prevent or slow dementia in patients with MCI.
- There’s a lot of research about how lifestyle influences your risk for developing dementia
- Neuroimaging sheds light on the way our brains process information
- Brain games can help both vision and hearing modalities -- helping to expand capacity to hold and process information
Watch the full interview
Being Patient: Is there a way to use neuroimaging to see if the memory of people suffering from mild cognitive impairment is actually improving?
Glenn Smith: When we do a neuroimaging study, there’s several different things we can look at. We can look at how good the blood flow to the brain is. We think [in] a lot of exercise trials that have shown some benefit on people’s cognitive function, the primary mechanism must be through making cerebral blood flow better. There’s the structure of the brain -- the brain is shrinking in Alzheimer’s disease, in certain key areas, and so we study that rate of atrophy through various physical or cognitive exercises. But then there’s also the circuits of the brain -- how are they organized? There are certain patterns of efficient brain processing we can see on what’s called functional neuroimaging, and so we study that imaging to see the effect of an intervention.
Being Patient: What are some of the most important lifestyle changes people can partake in now to help slowdown the decline of memory?
Glenn Smith: I think that there is very solid literature on three things that people should do as often as they can bring themselves to do them. The first is physical exercise -- we like yoga in our program because it’s very adaptable. Second is cognitive engagement -- we’re coming to understand it (learning) has to be novel. If you’ve always done crossword puzzles, doing one more crossword puzzle may not have the same positive impact as doing something totally novel, like learning a new language or trying to master a new skill. And the third thing is social engagement. There’s a fair amount of evidence that being around other people and being engaged socially helps through mechanisms for all of these things that we don’t fully understand, and yet the data from epidemiological studies is pretty compelling.
Being Patient: How do you know which brain games work and which ones don’t? A lot of those I could go on and I’ve never played them before. Is that good for my brain?
Glenn Smith: Most of these programs have been shown to improve your processing of information. It might help you see things in your environment more rapidly, or more clearly process things that are coming through your ears. Neuropsychologists like me describe this as improving processing to enhance working memory, or your ability to hold things in your mind and process it a little bit. If you’re engaging in those games because you want to be better at remembering your friend’s names in a social setting, I’m not sure they’ll deliver for you. But they do show positive impact on working memory, and working memory is something that is foundational to all other kinds of thought processes we engage in.
Being Patient: Is there a type of game that was particularly more impactful than another?
Glenn Smith: When you engage in these games you’re using one of two sensory modalities -- vision or hearing. The vision training has been shown to be most helpful with our ability, as we age, to look at the environment and notice details in it. That ability actually shrinks as we age. Our focus, not necessarily our vision, but our attentional focus, narrows. So this research on this aspect of processing we call ‘useful field of view’ has been shown, pretty routinely, to enhance our ability to notice more of the environment and process it better.
On the auditory side, there’s only so much information you can process and some you just have to let go of. That also shrinks as we age, so that when we’re young we can hold eight or nine or ten things in our mind and process it. By the time we get to be 65 or 70, that might shrink to four or five kinds of ideas or objects. So the processing training, just like it’s expanding the visual field, is expanding your capacity to hold and operate on information. Activities that do those two things, by giving you more and more information that you have to process more and more rapidly, that’s where the science is the best.
Being Patient: The behavioral research that you’re conducting on people who have MCI, what could that possibly do in the future for dementia or Alzheimer’s patients?
Glenn Smith: Two people may have the same amount of plaques and tangles in their brain from Alzheimer’s disease. One of them may have a whole lot of symptoms associated with that and one of them very little. We talk about this concept of reserve, which is the brain or the person’s ability to absorb brain insults and still function. What we’re trying to do through our behavioral efforts is enhance that reserve. Even if we can’t remove the plaques and tangles in your brain we can give you the capacity to continue to function better than you would have otherwise.