June 28, 2017

Experts say more evidence needed on 3 brain boosting strategies

Daily Briefing

    Three key strategies aimed at preventing cognitive decline are supported by "encouraging," but not necessarily "high-strength evidence," according to a report from an expert panel assembled by the National Academies of Sciences, Engineering, and Medicine (NASEM).

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    According to the panel's report, while evidence supporting the strategies is encouraging, it's insufficient to support a public health campaign promoting the strategies as ways to keep the brain healthy. The three interventions are:  

    1. Cognitive training: The panel determined that evidence supporting dementia prevention strategies focused on programs that boost reasoning, problem-solving skills, memory, and processing speed is "low-to-moderate strength." According to the panel, some high-quality research suggested that the benefits were short-lived, lasting about two years before tapering at five or 10 years. And some of the studies were less rigorous, the panel said, leading NASEM to conclude that while brain training might slow age-related cognitive decline for a time, it doesn't appear to have an effect on Alzheimer's.  

    2. Controlling blood pressure: The panel said the evidence that managing hypertension, especially between the ages of 35 and 65, could delay or slow Alzheimer's was "sufficient," and should be included in public health messaging on the benefits of controlling blood pressure for cognitive function. But the experts said there's no strong evidence on the best way to reduce high blood pressure. Nonetheless, of the drugs designed to curb high blood pressure, angiotensin receptor blockers seem the best for cognition, the panel said. 

    3. Physical activity: According to the committee, "evidence is insufficient to conclude whether increasing physical activity" prevents or slows Alzheimer's. The panel explained that randomized controlled trials only occasionally suggested that exercise could help, and other types of studies indicated that while exercise could help stave off age-related cognitive decline, it wasn't helpful against Alzheimer's.

    Discussion

    According to STAT News' Sharon Begley, the panel's report follows a review last month that found none of the 105 experimental anti-Alzheimer's compounds currently in development are performing well enough for the United States to meet its goal of having a "meaningful" Alzheimer's therapy by 2025. "That makes the need for prevention strategies greater than ever," Begley writes.

    The panel called for further research on the strategies. And while the panel fell short of endorsing a public health campaign for the three strategies, it said the public should be aware of the assessed strategies. 

    Alan Leshner, committee chair and CEO emeritus of the American Association for the Advancement of Science, said, "Even though clinical trials have not conclusively supported the three interventions, the evidence is strong enough to suggest the public should at least have access to these results to help inform their decisions."

    Separately, Henry Mahncke—CEO of Posit Science, a brain-training company—criticized the committee for lumping together all different types of cognitive training.

    The Alzheimer's Association said it would stick with their "10 Ways to Love Your Brain," a broad approach that the association says helps reduce the risk of dementia, such as exercise, lifelong learning, and good sleep. "No one is promising this is going to prevent Alzheimer's," Niles Frantz, a spokesperson for the association, said, "but we think there is enough evidence to say it can reduce your risk" (Begley, STAT News, 6/22; Neergaard, AP/Sacramento Bee, 6/22).

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