Mindfulness May Be Helpful in Mild Cognitive Impairment

August 11, 2017

LONDON — Practicing mindfulness may reduce anxiety levels and slow cognitive decline in patients with mild cognitive impairment (MCI), new studies suggest.

The studies, presented at the recent Alzheimer's Association International Conference (AAIC) 2017,  are preliminary but encouraging, researchers said.

In one randomized study from Singapore, patients with MCI who underwent mindfulness training showed improvements in cognitive tests and reductions in the inflammatory biomarker C-reactive protein (CRP) compared with those assigned to an education program.

"We have shown proof-of-concept of this novel, low-cost, and self-directed mindfulness intervention in improving cognitive functions and ameliorating biomarker alterations in elderly with MCI," said Kheng Siang Ted Ng, BSc, National University of Singapore, who presented the study.

He suggested that the lowering of CRP levels indicated that mindfulness could be slowing a neuro-inflammatory component of dementia in that CRP modulates vascular pathology and could cause hypoperfusion of the brain, leading to increased white mater lesions and silent infarctions.

Commenting for Medscape Medical News, David Morgan, MD, professor of molecular pharmacology and physiology, University of South Florida, Tampa, chair of the session at which the study was presented, said, "I wouldn't say the results show an overwhelming success, but there is some indication that there may be some benefits. It is not clear if those are due to the mindfulness activities or to the socialization aspects — patients are being paid attention to — but even if that's the explanation that's still good news."

Dr Morgan, who was co-chair of the AAIC scientific program committee, added: "We gave this study an oral presentation to increase awareness of nonpharmacological approaches. We want to encourage these sorts of activities, especially as they are low cost."

In another study, presented as a poster, patients with MCI who underwent mindfulness training recovered more quickly after making an error in a test of concentration than did a control group that received education sessions.

"We found that patients with mild cognitive impairment could practice mindfulness successfully and it had a beneficial effect on the ability to stay on task when engaging in a test of attention and concentration," lead researcher, Eddy Larouche, BSc, Universite Laval, Quebec City, Quebec, Canada, told Medscape Medical News.  

"We believe the mindfulness may be helping by reducing reactivity and self-judgment," he added. "It is known that mindfulness can help in the capacity to control emotions — it has been shown to reduce anxiety and depression — and in this study it seems to be helping keep patients calm and on task."

While this study did not show any effect on memory or dementia, Larouche noted that stress has an important effect on memory and the progression of cognitive impairment. "To be able to continue performing tasks that require concentration is an important benefit when patients have mild cognitive impairment, and the benefit may possibly translate into delayed progression of cognitive decline," he said. "We would like to do a larger study to see if this is the case."

"There are not many mindfulness studies published in patients with mild cognitive impairment. It is encouraging that we saw some benefits in this population," he added.  

Randomized Study

Presenting the Singapore study, Ng explained that some studies have suggested a benefit of mindfulness in MCI, but these have been cross-sectional in design. Thus, it is difficult to prove a causal relationship.

His group conducted a study in which 55 patients with MCI living in the community in Singapore were randomly assigned to a program of mindfulness training or health education.

The sessions for both groups were held weekly for the first 3 months and monthly for the subsequent 6 months. Patients underwent blood and saliva collections to measure various cytokine and biomarker levels, and they also underwent neurocognitive tests.

Results showed that those who received mindfulness training had significantly decreased CRP levels at the 9-month timepoint. The mindfulness group also showed significant improvement in the attention and working memory domains at both 3 months (β = 1.29; P = .01) and 9 months (β = 2.02; P < .001).

The patients receiving mindfulness training also experienced significant improvement in long-term memory at 3 months (β = 1.41; P = .04). The other cognitive domains, hypothalamic-pituitary-adrenal -axis and cytokines biomarkers, had no significant changes.

Staying on Task

For the other study, Larouche and his colleagues randomly assigned 41 patients with MCI to mindfulness training or education sessions.  Both groups received 2.5-hour sessions once a week for 8 weeks.

The mindfulness training encompassed different exercises aiming at focusing attention on the present moment. These included attention on body parts, on specific tasks (such as breathing), and "soft yoga" (slow movements). Patients were also asked to practice the exercises for half an hour every day at home.

The education group received information about aging and how to manage life with memory impairments.

For the analysis, the mindfulness group was split in half according to the amount of mindfulness training they actually achieved. The higher-dose group achieved an average of 1277 minutes over the 8-week period and the lower-dose group achieved an average of 700 minutes.

Patients underwent various cognitive testing and the Five-Facet Mindfulness Questionnaire before and after the intervention and 3 months later.

Results showed that the mindfulness group had improvements on the capacity to keep on task on the Sustained Attention to Response Task (go/no-go task), a sustained attention test of concentration.  Specifically, patients showed lower posterror slowing (how long it takes to get back to normal performance after making an error) in the test that involved pressing a button in response to certain numbers being flashed on the screen. Two attitudes from the mindfulness questionnaire predicted lower posterror slowing: the decrease of reactivity and self-judgment.

"The task goes quite fast and it is common to make mistakes, but we found that the patients who practiced mindfulness were able to get back to the task quicker after making an error," Larouche explained. "This is a very sensitive measure of the capacity to reorganize after making a mistake and measures how much a person is overwhelmed by the mistake." 

He pointed out that patients with MCI often worry and exhibit a high degree of anxiety about their memory loss and the effects on everyday life. "In our study, those that practiced mindfulness at the higher levels had less posterror slowing compared to the education group," he said.

"This was only a 30-microsecond difference, but it remained significant after controlling for other factors," he added. "This is not a large effect but it opens up a path for future study." 

Alzheimer's Association International Conference (AAIC) 2017.  Abstracts DT-02-03 and P2-017. Presented July 17 and 19, 2017.

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