Maintaining our brains in later life is something we tend to start worrying about as we hit middle age. Now, a landmark clinical trial has provided some helpful clues about what we should be doing to prevent or delay cognitive decline.
Known as Maintain Your Brain, the trial involved 6000 participants, all of whom carried some of the common risk factors for dementia, and were aged 55-77.
“We reasoned this was the age at which people might start to be concerned about their cognition, but were not so old that they already had a lot of signs of disease in their brains,” says Henry Brodaty, co-director of the Centre for Healthy Brain Ageing at the University of New South Wales.
Half of the trial’s participants were supplied with information about lifestyle habits that could boost brain health. The other half were given more active coaching sessions. The entire intervention was delivered online.
At the end of year three, both groups showed some improvement in brain power, but the active coaching group improved almost three times as much as the information-only participants.
“You’d expect people aged 55 to 77 not to be improving in their cognition but to be stable or more likely showing a slight decline,” says Brodaty. “So, we’re very excited by this. If we can get people to do these things, it might not prevent dementia but it could delay the onset, which at a population level could have a major benefit.”
For the active coaching group, there were four modules, each lasting 10 weeks with boosters where necessary:
Physical activity: Participants were advised to do 300 minutes of moderate intensity exercise or 150 minutes of vigorous intensity exercise a week, as well as two days of moderate-vigorous intensity strength training a week, and daily balance training.
Nutrition: Participants were advised to follow a Mediterranean diet by consuming unprocessed plant foods including vegetables, fruits, legumes, grains, nuts/seeds and extra virgin olive oil, moderate amounts of fish and shellfish, and low intake of meat, dairy, eggs and animal fats.
Brain training: This targeted seven cognitive domains (verbal executive functioning, verbal memory, visual executive functioning, visual memory, visual attention, speed and working memory) and allocated three 45-minute sessions each week for 10 weeks then monthly sessions.
Peace of mind: Participants received training via This Way Up, a digital mental health programme based on the principles of cognitive behavioural therapy aimed at reducing or preventing depression and anxiety.
“We designed this trial in 2016,” says Brodaty. “If we do it again there are more risk factors we’d like to include. We’d like to have more collaboration with GPs and check blood pressure. Although we did tell people to stop smoking and give them Quitline numbers, we didn’t target it in coaching. And we’d try to do something about fostering social connectedness, which is hard to manage online while maintaining people’s privacy.”
The prevalence of dementia is expected to triple in the next 25 years, and Brodaty would like to see national prevention programmes similar to the Slip, Slop, Slap approach, which was targeted at reducing skin cancer, or smoking cessation campaigns.
“You don’t need an online programme. You could do all these things without any sort of intervention. But people aren’t like that as a whole. You can’t change eating or exercise habits very easily.”
At 77, Brodaty exercises for an hour every morning and follows a vegetarian Mediterranean diet. “I did it for my heart, because my father died young from a heart attack, but by fluke I’ve adopted a lifestyle that has been good for my brain as well.”
Though he says it’s never too late to improve lifestyle habits, the younger participants in the group did see the greatest benefits. “We’re not sure why; maybe they had more capacity to improve. We also found the women did better than the men, and again, we don’t know why.”
Brodaty is keen to repeat the project but this time include participants who had less formal education and from lower socio-economic backgrounds.
“We’d also like to increase the use of AI and computer power to personalise the intervention more, and partner with GPs, because they are good at prevention when they’ve got the right tools to give people.”
