Researchers are developing new interventions that can help prevent, identify, and manage cognitive decline
By Ashley AbramsonDate created: January 1, 20248 min read
Vol. 55 No. 1
Print version: page 84
[This article is part of the 2024 Trends Report]
With an increasing percentage of Americans aging into the over-65 category, there is a growing need for science-based therapies to help slow, prevent, and treat the cognitive changes that can affect people’s aging brains. At the same time, geropsychologists, who specialize in treating older adults, are in short supply: APA estimates that the United States will need nearly 6,000 more of these specialists by 2030.
To support the expanding need to maintain and improve brain health, researchers are developing interventions that can help prevent, recognize, and treat mild cognitive impairment, dementia, and Alzheimer’s disease.
Here are four recent developments in the field of brain health that carry the potential to dramatically improve our quality of life as we age.
Slow-paced breathing interventions
Sympathetic nervous system activity, associated with the stress response, tends to be higher in older adults—and it’s linked with an increased risk of dementia. Researchers are studying how to help adults flip the nervous system’s switch from stress to relaxation.
Biofeedback exercises involving slow-paced breathing are one way to modulate heart rate and potentially prevent the sympathetic system from negatively impacting the brain, according to Mara Mather, PhD, a professor of gerontology, psychology, and biomedical engineering at the University of Southern California.
In a clinical trial, Mather and her collaborators studied breathing interventions in adults between 65 and 80 years old with the goal of increasing heart rate variability, a measure of parasympathetic activity. Those who practiced slow-paced breathing to a metronome until they achieved deep relaxation had lower rates of anxiety and depression than the steady breathing group. In their blood, they also had lower levels of amyloid-beta, a small peptide that can accumulate in the brain to form the amyloid plaque which is one defining feature of Alzheimer’s disease (Scientific Reports, Vol. 13, 2023).
While manipulating heart rate variability clearly impacts Alzheimer’s biomarkers outside of the brain, researchers do not yet know how it affects the brain itself. Mather’s lab is working on a second clinical trial exploring how manipulating heart rate variability can impact the brain itself through examining MRIs.
In the same study, older adults who participated in the slow breathing intervention also showed increased volume in subregions of the hippocampus, a part of the brain that is critical for memory processes and shows declines early in the Alzheimer’s disease process (Neurobiology of Aging, 2023). Mather’s work suggests that focusing on reducing stress through breathing could be an intervention to prevent or slow Alzheimer’s progression—and it’s something anyone can do.
“Slow-paced breathing may be able to slow the early stages of Alzheimer’s disease in adults who are still cognitively healthy,” said Mather. “If so, this simple relaxing technique could be a low-cost and low-risk way to reduce risk of the disease.”
Smartphone tools and training
As technology advances, so does evidence that effectively using it can help people cope with the impact of cognitive decline—and even help prevent it. Michael K. Scullin, PhD, associate professor of psychology and neuroscience at Baylor University in Waco, Texas, helped develop a behavioral randomized controlled trial to train people between 55 to 92 years old with mild dementia to use smartphones.
The researchers focused on helping participants set recurring appointment reminders as a way to improve quality of life. “People affected by dementia often have a challenge with prospective memory, or the ability to remember to do things in the future,” Scullin said. In his study, care partners—such as the participant’s spouse, adult child, younger relative, or hired nurse—reported that participants with cognitive decline had improved independent functioning across a month timespan (Journal of the American Geriatrics Society, Vol. 70, 2022).
Scullin’s team recently received funding for a Phase 2 trial of 200 participants over 6 months. Half of the participants are from digitally disadvantaged backgrounds, such as rural areas without internet access or homes without computers. “We want to know how to use these devices in a way that’s most effective at preserving daily functioning and overall health in individuals living with diseases,” said Scullin.
While Scullin’s work focuses on improving quality of life in those with impaired cognition, he theorizes using digital devices can also be a protective factor in cognitive health, contributing to a cognitive reserve in aging people—the more mentally active someone is, the more likely their cognitive abilities will be preserved (Wolff, J. L, et al., Journal of the American Geriatrics Society, Vol. 69, No. 7, 2021). Technology also encourages social connection, which can promote better cognition, and provides ways to better cope with daily difficulties, such as forgetting about appointments or medication.
Andrew Kiselica, PhD, assistant professor of health psychology at the University of Missouri, also studies smartphone use among aging people with cognitive impairment. He received a career development award from the National Institute on Aging to develop an intervention that helps patients and their caregivers access affordable technology and implement individualized technology-based solutions to reach care goals. To do so, the intervention includes occupational therapy strategies to help people choose, set up, and troubleshoot their technologies. In this way, caretakers can choose the technologies that best work for them. For example, caretakers might use a shared calendar with their loved ones to remind them of appointments, lightening their own caregiving load. The intervention can be delivered by any master’s-level behavioral or occupational health provider.
Kiselica is seeking funding for a feasibility trial to take place through the broader University of Missouri health system. He’s also working on a pilot study with collaborators from the University of Missouri Extension’s health and wellness program for older adults involving a tech-focused intervention that helps people glean cognitive benefits from smart technologies before they develop symptoms of cognitive impairment.
Virtual brain games
Adam Gazzaley, MD, PhD, founder of Neuroscape, a translational neuroscience center for technology creation and scientific research, sees technology as a form of medicine for cognitive decline. “We don’t have perfect drugs; some people don’t respond and they have side effects. My goal is to come up with [effective technologies] and validate them,” he said.
Gazzaley, a professor in neurology, physiology, and psychiatry at the University of California, San Francisco, focuses on creating and studying therapeutic tablet-based and virtual reality games that improve attention ability. Some studies focus on older adults, homing in on the evidence that games can improve cognitive function that often declines with age (Nature Aging, Vol. 2, 2022). The video games Neuroscape creates are adaptive, closed-loop games, which means the challenges and rewards adjust in real time based on ability according to user data, unlike most consumer games. If someone answers questions slowly, the games start out easier and progressively get more difficult. If someone needs more of a challenge, the game follows suit.
One game developed and studied at Neuroscape is Neuroracer, a video game that was shown to improve attention in older adults (Nature, Vol. 501, 2013). It is the first and only FDA-authorized treatment delivered through a video game experience. Some of Neuroscape’s games are in the research phase, but Gazzaley hopes to eventually scale them so medical providers can either prescribe them or patients can use them over the counter in tandem with psychological treatment. “We’ll have a whole set of technological tools that will complement standard approaches, like pharmaceuticals and behavioral therapy,” he said.
Digital cognitive assessments
Games can be useful to help preserve cognition, but some people may benefit more from nongamified cognition tasks. “For some people, games can provide motivational structure,” said Aaron Seitz, PhD, professor of psychology at Northeastern University in Boston and director of the Brain Game Center for Mental Fitness and Well-Being at the University of California, Riverside. “But for others, it may be overwhelming or distracting to see all these things happening on a screen, and then the game isn’t as helpful,” he added.
Seitz’s work focuses on creating digital apps that measure individual differences in cognition—for example, how well someone can accomplish tasks that involve distractions—and suggesting potentially beneficial interventions, games, or otherwise. His goal is to better understand how factors like cognition, lifestyle, cultural experiences, and overall health affect how people interact with different interventions. That way, he and his team can better predict the most useful individual treatments.
Seitz’s lab has created several games designed to address individual needs. One memory app he is currently studying is called Recollect, available for free in the Apple and Android app stores. Recollect requires users to employ their working memory to recall a series of colors presented on the screen. Another version of Recollect has the same premise, but it uses an astronaut collecting colored gems in space.
The lab has also created digital assessments that could be useful to psychologists and other clinicians, such as an app called PART (portable adaptive rapid testing) that evaluates focused attention and working memory. Rather than going to a clinic or hospital, people will be able to participate in cognitive testing at home on their devices. Currently, the app is available for free to researchers studying cognition, but Seitz hopes to share it publicly in the future.
This type of testing also allows clinicians to gain a deeper understanding of a person’s cognition because it tracks how long it takes for someone to answer a question and whether they change their response. “Digitizing assessments doesn’t just get rid of paper but also helps the clinician collect more useful data to help the person on an individual level,” said Seitz.
Given all the progress in research about cognition and the aging brain, there is reason to be hopeful about the future. These and other brain researchers are looking forward to fine tuning and scaling up their interventions so that more people can access resources that benefit their brain function before they develop cognitive impairment.
“Alzheimer’s pathology accumulates in a person’s brain for many decades, so it’s important to slow that down as much as possible,” said Mather. “Interventions that healthy people can do in their 50s or even earlier could be really beneficial and exciting.”
Further reading
Digital methods for performing daily tasks among older adults: An initial report of frequency of use and perceived utility
Benge, J. F., et al., Experimental Aging Research, 2023
Does ‘brain training’ actually work?
Jaeggi, S. M., et al., Scientific American, 2020
Integrated cognitive and physical fitness training enhances attention abilities in older adults
Anguera, J. A., et al., NPJ Aging, 2022
Leisure-time sedentary behaviors are differentially associated with all-cause dementia regardless of engagement in physical activity
Raichlen, D. A., et al., PNAS Psychological and Cognitive Sciences, 2022
The integrity of dopaminergic and noradrenergic brain regions is associated with different aspects of late-life memory performance
Dahl, M. J., et al., Nature Aging, 2023
SOURCE:
https://www.apa.org/monitor/2024/01/trends-brain-health-aging(accessed 24.1.24)
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