Multiple factors can increase a person’s risk for dementia, including mild cognitive impairment.
Both
major depressive disorder in remission (rMDD) and mild cognitive impairment
(MCI) can increase a person’s risk for dementia.
Researchers
from the Centre for Addiction and Mental Health say a combination of two
“active” therapies may help slow cognitive decline in high-risk older adults.
Scientists
saw this decrease, especially in participants with rMDD and those at a low
genetic risk for Alzheimer’s disease.
Researchers
estimate that more than 55 million peopleTrusted Source around the world live
with dementia — a chronic condition negatively impacting a person’s memory,
concentration, and thinking skills.
Past
studies show that both major depressive disorder in remission (rMDD)Trusted
Source and mild cognitive impairment (MCI) can increase a person’s risk for
dementia.
“It
is important to slow cognitive decline to maintain independence in day-to-day
functioning and ultimately prevent dementia in older adults, especially those
at high risk of developing dementia, like in older adults with depression,”
Tarek Rajji, MD, chair of the Department of Psychiatry at the UT Southwestern
Medical Center and former senior scientist at the Centre for Addiction and
Mental Health at the University of Toronto explained to Medical News Today.
Rajji
is the lead author of a new study recently published in JAMA PsychiatryTrusted
Source that has found a combination therapy of computerized memory and thinking
exercises with non-invasive mild electrical stimulation may help slow cognitive
decline in high-risk older adults, especially those with rMDD — with or without
MCI — and those at a low genetic risk for a type of dementia called Alzheimer’s
disease.
A
combo of CR and tDCS therapies for dementia
For
this study, researchers recruited 375 older adults with an average age of about
72 years, who had either rMDD, mild cognitive impairment, or both.
Participants
either received a “sham” control intervention or the combination of two
“active” therapies — computer-based Cognitive Remediation (CR) techniques and a
type of non-invasive brain stimulation called transcranial direct current
stimulation (tDCS).
“CR
consists of computerized memory and thinking exercises that are meant to
improve these abilities,” Rajji said.
“The
way we delivered them was in a classroom-like setting where groups of six to
eight individuals were training on these exercises with the support of one or
two coaches. We administered the classes five days a week for eight weeks and
then five days a week every six months as boosters until the end of the study
or until an individual left the study or progressed from having normal
cognitive function to MCI or from MCI to dementia. In between boosters,
individuals were asked to exercise on their own at home online for 20 to 40
minutes a day,” he explained.
“tDCS
is a form of non-invasive mild electrical stimulation that is delivered by a
portable machine the size of a smartphone,” he continued. “It delivers a 2
milliAmp current to the frontal regionTrusted Source of the brain to enhance
brain plasticity, i.e. the brain’s ability to change and learn. We delivered it
for 30 minutes at the beginning of each class and while the individuals were
performing thinking exercises. The goal was to prime the brain and optimize the
ability to learn and benefit from the computerized exercises.”
“We
chose these two therapies because we thought that they have synergistic
effects. tDCS on its own was less likely to be effective but when combined with
another therapy like CR — which typically has had mild benefit — it would
increase its effect by priming the brain and increase its plasticity.” — Tarek
Rajji, MD
Combo
therapy slows cognitive decline compared to no therapy
Throughout
the study, researchers conducted participant assessments at the start of the
study, two months in, and then yearly for three to seven years.
During
these assessments, Rajji and his team found that participants receiving the
combination therapy experienced slower cognitive decline over an average
follow-up period of four years, compared to those receiving the “sham”
intervention.
“We
were very happy to see that our prediction was correct because, to date, no
other therapy has been shown to have such an effect in these patients,” Rajji
said.
Scientists
reported the benefits of the combination therapy was more notable in
participants with a low genetic risk for Alzheimer’s disease.
Additionally,
study participants with rMDD, with or without MCI, experienced better outcomes
than those with MCI only.
“Individuals
with low genetic risk for Alzheimer’s disease are likely to be ineligible for
the antibody intravenous infusion therapies so a therapy like ours could offer
hope to these patients,” Rajji explained.
“The
fact that we found the effect mainly in those individuals with remitted rMDD
irrespective of whether they also had MCI or not is very exciting because this
group has been consistently shown to be at double the risk of developing
dementia yet none of the current treatments for MDD reduce this risk. Our
treatment offers this possibility for these patients,” he said.
Cognitive
decline is multifactorial in nature
MNT
also spoke with David Merrill, MD, PhD, a board certified geriatric
psychiatrist at Providence Saint John’s Health Center in Santa Monica, CA, and
Singleton Endowed Chair in Integrative Brain Health, about this study, who
commented that this study highlights the potential benefits of combination
therapies in addressing the multifactorial nature of cognitive decline.
“Unlike
monotherapies that target isolated pathways, combination approaches recognize
that cognitive decline often results from an interplay of genetic, lifestyle,
vascular, and neuroinflammatory factors. Leveraging a combination strategy
could address these varied risk factors more effectively, potentially delaying
the onset of more severe cognitive impairment in at-risk populations. This
aligns well with preventative strategies we are increasingly exploring in
clinical practice, emphasizing early and multidimensional interventions.” —
David Merrill, MD, PhD
Building
on this research, Merrill said it would be beneficial to see larger-scale
studies that validate these findings across more diverse populations.
“Furthermore,
exploring the interaction between combination therapies and individual genetic
profiles — particularly among those with known risk factors such as the APOE ε4
allele — could illuminate how personalized interventions can be optimized.
Integrating digital health technologies and biomarkers for real-time tracking
of cognitive health and therapy efficacy would also be invaluable,” he said.
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