Cognitive Training or Gingko Biloba to prevent cognitive decline and dementia? New comprehensive report by the National Academies of Sciences, Engineering, and Medicine clarifies priorities for public health and for future research

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Evi­dence Sup­port­ing Three Inter­ven­tions That Might Slow Cog­ni­tive Decline and the Onset of Demen­tia Is Encour­ag­ing but Insuf­fi­cient to Jus­ti­fy a Pub­lic Health Cam­paign Focused on Their Adop­tion (Nation­al Acad­e­mies of Sci­ences, Engi­neer­ing, and Medicine):

“Cog­ni­tive train­ing, blood pres­sure man­age­ment for peo­ple with hyper­ten­sion, and increased phys­i­cal activ­i­ty all show mod­est but incon­clu­sive evi­dence that they can help pre­vent cog­ni­tive decline and demen­tia, but there is insuf­fi­cient evi­dence to sup­port a pub­lic health cam­paign encour­ag­ing their adop­tion, says a new report from the Nation­al Acad­e­mies of Sci­ences, Engi­neer­ing, and Med­i­cine. Addi­tion­al research is need­ed to fur­ther under­stand and gain con­fi­dence in their effec­tive­ness, said the com­mit­tee that con­duct­ed the study and wrote the report…

Over­all, the com­mit­tee deter­mined that despite an array of advances in under­stand­ing cog­ni­tive decline and demen­tia, the avail­able evi­dence on inter­ven­tions derived from ran­dom­ized con­trolled tri­als – con­sid­ered the gold stan­dard of evi­dence – remains rel­a­tive­ly lim­it­ed and has sig­nif­i­cant short­com­ings. Based on the total­i­ty of avail­able evi­dence, how­ev­er, the com­mit­tee con­clud­ed that three class­es of inter­ven­tions can be described as sup­port­ed by encour­ag­ing but incon­clu­sive evi­dence. These inter­ven­tions are:

  • cog­ni­tive train­ing – which includes pro­grams aimed at enhanc­ing rea­son­ing and prob­lem solv­ing, mem­o­ry, and speed of pro­cess­ing – to delay or slow age-relat­ed cog­ni­tive decline. Such struc­tured train­ing exer­cis­es may or may not be computer-based.
  • blood pres­sure man­age­ment for peo­ple with hyper­ten­sion – to pre­vent, delay, or slow clin­i­cal Alzheimer’s‑type dementia.
  • increased phys­i­cal activ­i­ty – to delay or slow age-relat­ed cog­ni­tive decline.

When fund­ing research on pre­vent­ing cog­ni­tive decline and demen­tia, the Nation­al Insti­tutes of Health and oth­er inter­est­ed orga­ni­za­tions should iden­ti­fy indi­vid­u­als who are at high­er risk of cog­ni­tive decline and demen­tia; increase par­tic­i­pa­tion of under­rep­re­sent­ed pop­u­la­tions; begin more inter­ven­tions at younger ages and have longer fol­low-up peri­ods; use con­sis­tent cog­ni­tive out­come mea­sures across tri­als to enable pool­ing; inte­grate robust cog­ni­tive out­come mea­sures into tri­als with oth­er pri­ma­ry pur­pos­es; include bio­mark­ers as inter­me­di­ate out­comes; and con­duct large tri­als designed to test the effec­tive­ness of an inter­ven­tion in broad, rou­tine clin­i­cal prac­tices or com­mu­ni­ty settings.”

The Report

Pre­vent­ing Cog­ni­tive Decline and Demen­tia: A Way For­ward (Nation­al Acad­e­mies of Sci­ences, Engi­neer­ing, and Medicine)

  • Sum­ma­ry: Indi­vid­u­als, fam­i­lies, and soci­eties around the world are con­cerned about demen­tia and the oth­er forms of cog­ni­tive impair­ment that affect many old­er adults. It is now known that brain changes typ­i­cal­ly begin years—if not decades—before peo­ple show symp­toms, which sug­gests that a win­dow of oppor­tu­ni­ty exists to pre­vent or delay the onset of these con­di­tions. Fur­ther, emerg­ing evi­dence that the inci­dence and preva­lence of demen­tia are declin­ing in high-income coun­tries offers hope that pub­lic health inter­ven­tions can be effec­tive in pre­vent­ing cog­ni­tive decline and demen­tia. Although the evi­dence base on how to pre­vent or delay these con­di­tions has been lim­it­ed at best—despite the many claims of suc­cess made in pop­u­lar media and advertising—a grow­ing body of pre­ven­tion research is emerg­ing. The Nation­al Insti­tute on Aging (NIA) ini­ti­at­ed this study with the Nation­al Acad­e­mies of Sci­ences, Engi­neer­ing, and Med­i­cine to take stock of the cur­rent state of knowl­edge on inter­ven­tions for pre­vent­ing cog­ni­tive decline and demen­tia, to help shape the mes­sages NIA con­veys to the broad­er pub­lic about these con­di­tions, and to inform future actions and research in this area.
  • To access the report: click Here

Key Take-Aways

The report clas­si­fied all the fol­low­ing inter­ven­tions into four cat­e­gories, accord­ing to the same pre­cise cri­te­ria based on all avail­able sci­en­tif­ic evi­dence. From high­er lev­els of evi­dence to low­er ones:

A. High­est Pri­or­i­ty for Future Research — Inter­ven­tions with encour­ag­ing but incon­clu­sive evidence

  • cog­ni­tive training
  • blood pres­sure man­age­ment for peo­ple with hypertension
  • increased phys­i­cal activity

B. Addi­tion­al Pri­or­i­ties for Future Research — Inter­ven­tions with insuf­fi­cient evi­dence but deserv­ing future research

  • new anti­de­men­tia phar­ma­co­log­i­cal treat­ments that can delay onset or slow dis­ease progression
  • dia­betes treatment
  • depres­sion treatment
  • dietary inter­ven­tions
  • lipid-low­er­ing treatment/statins
  • sleep qual­i­ty interventions
  • social engage­ment interventions
  • vit­a­min B12 plus folic acid supplementation.

C. Low­est Pri­or­i­ty for Future Research — No evi­dence of any ben­e­fit, and some evi­dence of lack of benefits

  • Acetyl­cholinesterase Inhibitor (AChEI) Anti­de­men­tia Drugs
  • Non­s­teroidal Anti-Inflam­ma­to­ry Drugs (NSAIDs)
  • Gingko Bilo­ba
  • Vit­a­min E
  • Hor­mone ther­a­py interventions

D. Inter­ven­tion with evi­dence sug­gest­ing detri­men­tal effects on cognition

  • Estro­gen-con­tain­ing Hor­mone ther­a­py interventions

The Report in Context