memory in elders: food for thought summary and comment by jonathan silver, md published in journal...
TRANSCRIPT
Memory in Elders: Food for Thought
Summary and Comment by Jonathan Silver, MD
Published in Journal Watch PsychiatryMarch 9, 2009
Education doesn't protect against memory loss, but eating less helps.
Copyright © 2009. Massachusetts Medical Society. All rights reserved.
Covering
• Wilson RS et al. Educational attainment and cognitive decline in old age. Neurology 2009 Feb 3; 72:460.
• Witte AV et al. Caloric restriction improves memory in elderly humans. Proc Natl Acad Sci U S A 2009 Jan 27; 106:1255.
Copyright © 2009. Massachusetts Medical Society. All rights reserved.
Background
• Two new studies look at preventing memory decline in elders.
Copyright © 2009. Massachusetts Medical Society. All rights reserved.
The Research
• The theory of cognitive reserve posits that having more intellectual capability enables one to better withstand an insult to the brain, whether from traumatic injury or dementia.
• Greater educational attainment has also been associated with lower risks for dementia.
• To learn whether educational attainment influences the rate of cognitive decline, researchers analyzed data on 6533 individuals (mean baseline age, 72; mean duration of formal education, 12.2 years) who underwent cognition tests every 3 years (maximum, 14 years).
• Overall, cognition declined at a gradually accelerating rate.
• More schooling was associated with higher baseline cognition but did not affect the rate of decline.
Copyright © 2009. Massachusetts Medical Society. All rights reserved.
The Research
• In an analysis excluding individuals with baseline cognitive impairment, greater education was associated with slightly less rapid decline early in follow-up, but with faster decline later.
• Findings did not vary by race.
Copyright © 2009. Massachusetts Medical Society. All rights reserved.
The Research
• Gingko biloba clearly does not prevent dementia.
• Might other interventions work — e.g., high intake of dietary unsaturated fatty acids (UFA) or, as in animals, caloric restriction (CR)?
• This research group randomized 50 healthy elders (mean age, 60; mean body-mass index, 28 kg/m2; 29 women) to CR by 30%, to UFA intake increased by 20%, or to no dietary change (controls).
• Adherence to diet was confirmed by nutritional diary.
• At 3 months, BMI, weight, fasting insulin levels, and high-sensitive C-reactive protein (CRP) levels decreased in the CR group, but not in the other two groups.
• Verbal memory significantly improved in the CR group (by 20%), but not in the UFA or control groups.
• Among the most adherent CR subjects (weight loss, >2 kg), decreased fasting insulin and CRP levels correlated significantly with improved memory.Copyright © 2009. Massachusetts Medical Society. All rights reserved.
Comment
• Although education does not protect against cognitive decline, it does delay the presentation of dementia.
• Then, when dementia is clinically apparent, it takes the typical progressive course.
• Patients in the second study were, on average, slightly overweight.
• Still, CR had impressive effects: A 20% improvement in verbal memory might be enough for FDA approval of a medication for cognitive enhancement.
• Regarding the findings with insulin and CRP levels, other researchers have linked diabetes to worse cognition.
Copyright © 2009. Massachusetts Medical Society. All rights reserved.
Comment
• Questions remain: Would only elders benefit from CR?
• Does this finding hold for all types of diets?
• Could CR mitigate cognitive problems arising from traumatic injury or neurological disorders?
• Clinicians should counsel their patients on the importance of diet and weight control, and that it may not only help their heart, it may help their brain.
Copyright © 2009. Massachusetts Medical Society. All rights reserved.
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Copyright © 2009. Massachusetts Medical Society. All rights reserved.