A combination of brain exercises and healthy lifestyle changes can improve memory performance in healthy elderly adults, new research suggests. In a sample study of 115 participants from 2 live-in retirement communities, those who underwent a new educational program (that included memory training, physical activity, stress reduction, and better diet) showed significant improvements on a variety of measures after just 6 weeks, including word recognition and recall.

"I was very pleased with these significant results in a sample that was not huge," Gary Small, MD, professor of aging at UCLA, told Medscape Medical News. He noted that the investigators wanted to test whether this intervention improved both objective and subjective memory performance. "Subjective memory is a person's self-perception of how they're doing, and objective is how well they do on a pen-and-paper test. It was gratifying to see that this program seemed to be helping people in day-to-day memory challenges."

Karen Miller, PhD, associate clinical professor at UCLA, said in a release that "it was exciting" to see the subjects' participation, as well as their improvements in the memory fitness program. The study demonstrates that it's never too late to learn new skills to enhance one's life."

The study was published online July 14 in the American Journal of Geriatric Psychiatry.

"Despite the effectiveness of memory training interventions in clinical trials, few community-based programs exist, and their effects have not been systematically tested," write the investigators.

The new memory training program uses a standardized curriculum consisting of brain exercises for association and visual imagery, education on a "healthy brain diet" and stress reduction, physical activity, and even assigned memory exercises to be performed at home. The investigators have previously offered this program in a number of settings, including the UCLA campus and senior centers. However, this is the first time it was offered in a retirement living community, which made participation easier because "users did not have to drive to a class off-site," said Dr. Small. "Our group tends to study memory training and healthy lifestyle techniques from the point of view of first developing a program that we think is user friendly and then testing it out. However, many times there's the approach where a scientific study is done first. So a program may be proven to be effective or not, but the question is: Will people use it? And will it be adaptable to a lot of communities?"

After testing, participants were randomly assigned either to undergo the memory fitness program, consisting of 12 twice-weekly, hour-long sessions (15 - 20 per class), or to be placed on a waiting list for the program and considered study controls. Objective cognitive measures during the pretesting phase, as well as at baseline and at study's end, assessed changes in immediate and in delayed verbal memory, retention of verbal information, memory recognition, and verbal fluency. Subjective measures evaluated domains of memory self-awareness, including frequency and severity of forgetting, mnemonics use, and retrospective functioning.

Results showed that the patients who underwent the memory fitness program showed significant improvements postintervention on recognition memory) and retention of verbal list learning. In addition, their retrospective functioning scores increased, "indicating a belief in having a better memory."

"These findings indicate that a 6-week healthy lifestyle program can improve both encoding and recalling of new verbal information as well as self-perception of memory ability in older adults," they write, noting that it may be generalizable to a real-world setting.
"As a community-based educational intervention, the program has the potential to meet the community's need for an affordable and sustainable memory program over time."

John Parrish, PhD, executive director of the Erickson Foundation, which oversees the retirement communities used in this study, said in a release that the foundation is now offering the program in all 16 of their communities across the country. "The study suggests that the memory fitness program may be a cost-effective means of addressing some memory-related concerns of healthy older adults," he said.

Dr. Small said that he hopes that clinicians will see from this study and others that mild, age-related memory complaints can improve with specific training. "There are a lot of ways to learn memory techniques. I think physicians should first ask people about their memory concerns and then try to refer them to get some help.It's important to empower people and teach them about healthy brain lifestyle. Although there's no absolute proof that you can prevent Alzheimer's disease, we know that physical exercise and healthy diet can prevent diabetes, which is itself a major risk factor for Alzheimer's. So it all seems to tie together."

Along with the beneficial effects of alcohol, here’s another health tidbit for you. In a presentation at the European Society of Cardiology (ESC) 2011 Congress, British investigators reported that individuals who ate the most chocolate had a 37% lower risk of cardiovascular disease and a 29% lower risk of stroke compared with individuals who ate the least amount of chocolate.

In the study, published online August 29, 2011 in British Medical Journal, Dr Adriana Buitrago-Lopez and colleagues state: “Although overconsumption can have harmful effects, the existing studies generally agree on a potential beneficial association of chocolate consumption with a lower risk of cardiometabolic disorders. Our findings confirm this, and we found that higher levels of chocolate consumption might be associated with a one-third reduction in the risk of developing cardiovascular disease.”

In this meta-analysis of six cohort studies and one cross-sectional study, overall chocolate consumption was reported, with investigators not differentiating between dark, milk, or white chocolate. Chocolate in any form was included, such as chocolate bars, chocolate drinks, and chocolate snacks, such as confectionary, biscuits, desserts, and nutritional supplements. Chocolate consumption was reported differently in the trials but ranged from never to more than once per day. Most patients included in the trials were white, although one study included Hispanic and African Americans and one study included Asian patients.

Overall, the pooled meta-analysis results showed that high levels of chocolate consumption compared with the lowest levels of chocolate consumption reduced the risk of any cardiovascular disease and stroke. There was no association between chocolate consumption and the risk of heart failure, and no association on the incidence of diabetes in women.

Personally, I’m waiting for chocolate martinis to have all my bases covered.

Yippee: Light to moderate drinking seems to reduce the risk for dementia and cognitive decline, according to a new study published in the August issue of Neuropsychiatric Disease and Treatment.

A meta-analysis of 143 studies on the effects of alcohol on the brain showed that moderate drinking, defined as no more than 2 drinks a day for a man and no more than 1 drink a day for a woman, reduced the risk for Alzheimer's disease and other forms of dementia by 23%. Light to moderate drinking conferred a similar benefit, but heavy drinking (more than 3 - 5 drinks/day) was associated with a nonsignificantly higher risk for dementia and cognitive impairment. Most of the studies did not distinguish between the different types of alcohol, but in a few studies, wine appeared to be more beneficial than beer or spirits. "It really seemed to
A number of explanations for the protective effect of moderate alcohol have been proposed. Some dementias are related to cardiovascular system problems, such as atherosclerosis, and alcohol may be protective because it raises the level of high-density lipoprotein (the good) cholesterol and might improve blood flow in the brain.

Medscape Medical News asked Anton P. Porsteinsson, MD, the William B. and Sheila Konar professor of psychiatry at the University of Rochester School of Medicine to comment on this study. "This is a well-done meta analysis. The findings are consistent with other meta analyses that have been done. Am I tremendously surprised at the findings? No, because they are looking at the same pool of studies," Dr. Porsteinsson said. "The fact that they approach it in slightly different ways and yet find similar outcomes makes me confident that this is what the data are actually signaling to us: that very modest alcohol consumption is protective," he said.

The next step is to figure out how moderate alcohol consumption exerts its protective effect.
"Is it some direct effect of the alcohol on the brain? Are people who consume moderate amounts of alcohol different in some way, in their diet, or their level of exercise? Are low concentrations of alcohol neuroprotective? Is it through some metabolic impact?" Dr. Porsteinsson said. Also interesting was that alcohol appeared to protect against all types of dementia, he said. "This makes it less likely to have a direct effect on beta amyloid or tau (a suspected cause of Alzheimer's Disease), but more of a global effect. It is an interesting review. They made it a pleasure to read."

Two new studies support the idea that regular exercise can cut the risk for subsequent cognitive decline and dementia risk.

In the first study, researchers used data from the Women's Antioxidant Cardiovascular Study (WACS), a cohort of women with prevalent vascular disease or 3 cardiovascular risk factors.
They report a significant trend toward decreasing rates of cognitive decline with increasing energy expenditure. Compared with women in the bottom forth of total physical activity, significant differences in the rates of cognitive decline were seen for those in the fourth and the fifth quintiles.

"This was equivalent to the difference in cognitive decline observed for women who were 5 to 7 years younger," the authors noted.

Specifically, regularly walking was "strongly related" to slower rates of cognitive decline. However, significant associations were seen only with the top quartile of walking, with a minimum of 30 minutes of walking daily. However, the benefit was not limited to vigorous exercise.

In a separate report, Laura E. Middleton, PhD at Sunnybrook Health Sciences Center, Toronto, Canada, and colleagues used data from the Health, Aging and Body Composition (Health ABC) Study to examine this same question. They looked at the relationship between exercise and incident cognitive impairment using activity energy expenditure (AEE), an objective measure. Physical activity questionnaires usually focus on moderate or vigorous activity related to exercise but don't capture other aspects of activity, such as moving around the house or even fidgeting, the authors note.

The authors report that after adjustment for baseline mental status scores and a variety of other factors, adults in the highest sex-specific third of AEE had lower odds of incident cognitive impairment than those in the lowest third.

In an interview, Dr. Middleton pointed out that there are now a number of studies that have confirmed this relationship, but the vast majority of those have used self-report of physical activity, an approach that carries inherent errors. Those with preclinical dementia may have issues with accurately recalling exercise, for example, and even those who have no such problems tend to over report how much they exercise.

The other issue with self-report is that it doesn't capture activity that is not actual exercise, such as housework, "and in older adults that type of activity makes up a fairly large portion of your total physical activity, especially in someone who doesn't do purposeful exercise." When they did this comparison using only self-report, there was still a relationship, she notes, but it was much clearer using the objective evidence of total energy expenditure.

Bottom line? Keep moving.

The World Health Organization (WHO) announced yesterday that cell phone radiation can possibly cause cancer. The key word here is “possibly,” not probably. This announcement is based on an extensive review of studies on cell phone safety by a group of 31 scientists who meet regularly to evaluate the potential carcinogenic hazards from exposure to radiofrequency electromagnetic fields.

Some of the strongest evidence supporting a link between brain tumors and cell phone use comes from a series of Swedish studies, led by Lennart Hardell, MD, PhD, from the Department of Oncology, Orebro Medical Center. These studies showed that risk increased with the number of cumulative hours of use, higher radiated power, and length of cell phone use. The issue of cell phone safety was to have been settled once and for all by the huge 13-nation industry-funded Interphone study. But to date, the industry-funded Interphone studies found no increased risk for brain tumors from cell phone use, with only 4 exceptions. The findings contradicted the Swedish studies, which were independent of industry funding.

There is no consensus among physicians and scientists about the severity of risk, or if one even exists. One issue in attempting to evaluate the potential connection between brain tumors and cell phone use is the relatively short period of time that these devices have been heavily used in a large population and the long latency period for many tumors.

The National Cancer Institute, for example, has stated that although a consistent link has not been established between cell phone use and cancer, "scientists feel that additional research is needed before firm conclusions can be drawn." In a similar fashion, the American Cancer Society points out that even though the weight of the evidence has shown no association between cell phone use and brain cancer, information on the potential health effects of very long-term use, or use in children, is simply not available.

As Dr. Nancy Schneiderman, NBC Medical Correspondent pointed out last night, cell phone use had climbed over the past decade yet the incidence of glioma (the brain tumor alleged to result from exposure) has not.

So what should cell phone users do? Well, one thing is to restrict use if you’re worried.

In a recent Neurology article (2011;76:1395-1402) a study showed that the measurement of the thickness of several areas of the brain’s gray matter may predict who will develop and who will not Alzheimer’s disease (AD) years later and are presently cognitively normal. MRI scans were done on a series of patients, measurement made of various regions of their cortex, and followed for 10 year. 55% in the lowest third of cortical thickness developed AD dementia during follow-up. In contrast, no individual with the highest cortical thickness at baseline developed AD during follow-up.

" Richard B. Lipton, MD, of Albert Einstein College of Medicine in the Bronx, New York, who was not involved in the study, said, "The most interesting finding is that persons in the highest third of cortical thickness never developed AD. If these findings are replicated, this would mean that we can identify a sizeable group of older adults and reassure them that they are very unlikely to develop AD.

"In a world where fear of AD is an enormous problem, this kind of reassurance would be valuable to older adults and their families. In addition, these individuals could be excluded from studies of preventive intervention since it is impossible to improve on such low risk," Dr. Lipton said.

"The study is limited by the small sample size, but the results are exciting because of their strength and consistency," Dr. Lipton commented. "It is worth noting," he said, "that even in those with thinnest cortices, AD did not develop for 4 years. This is likely related to the rigorous exclusion of dementia in the sample, but it suggests that if the goal is short-term prediction of risk, for prevention trials, for example, this is not the way to go," he said.
Dr. Lipton also noted that cortical thickness could be a lifelong marker of brain reserve, a factor that protects against AD.

"Alternatively, cortical thinning could be a manifestation of unfolding disease, which could produce neuronal loss as illness develops, well before it becomes diagnosable," he said. "These 2 factors could each separately contribute to the findings."

Cell phones and brain tumors? There has been a great deal of debate in past years about a possible link between cell phone radiation and the development of brain tumors, or more specifically, acoustic neuromas – small tumors that develop on the nerve between the middle ear and the brain. I think it’s fair to say the jury is still out. One criticism is that many of the reports that claim cell phone use is not deleterious have been supported by the device manufacturers, which always creates the specter of conflict of interest.

A new study reported in this week’s Journal of the American Medical Association (JAMA) measured changes in PET scans immediately after subjects used a cell phone for one hour. The results showed and increase in glucose metabolism in brain areas adjacent to where the cell phone was held. Interesting. Because this shows a direct effect that may be due to the electromagnetic radiation from the phone’s antenna. What is not known at this time is whether this effect is good or bad. That remains to be seen and was not clarified by the study. So, until the association is either proven or disproven, it might be wise to use hands-free earphones.