Alzheimer's and cognitive impairment, six-week workout reduces risk in the over-65s

Want to try to reduce your risk of cognitive impairment and Alzheimer's disease? Put yourself in front of your PC or smartphone. And watch how 'fast' you are in the face of complex stimuli. As if it were a habit, almost an effortless exercise with ever-improving results in terms of reaction time, and the unconscious mind is in charge. With a general rule: it is never too late to 'compete' with oneself. Science reminds us of this. And it says, above all, that for those over 65, a five- to six-week 'training' programme that aims to bring processing speed up to its best, that helps people quickly find visual information on a computer screen and handle increasingly complex tasks in a shorter and shorter period of time would reduce the likelihood of encountering dementia in the next 20 years.

How to do it? It is necessary to focus on a customised cognitive training programme that adapts the 'gaming' to one's own day by day with tests that increase the level of performance over time. Recommending this strategy are the 20-year results of the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, the first and only one to evaluate the effects of this training modality on the onset of dementia of various origins. The latest results of the research, supported by the US National Institutes of Health (NIH) and coordinated by Marilyn Albert, head of the Alzheimer's Disease Research Center at Johns Hopkins Medicine, were published in Alzheimer's & Dementia: Translational Research and Clinical Interventions.

The investigation examined 2,802 adults from 1998-99 to assess the long-term benefits of three different cognitive training modalities - memory, reasoning and processing speed - compared to a control group that received no training. In the three training groups, participants received up to 10 sessions of 60-75 minutes of cognitive training over five to six weeks. Not only that: for half of the participants, again following a random pattern, four 'booster' sessions were added 11 and 35 months after the initial cycle. Analysing insurance data on 72 per cent of the patients over time (between 1999 and 2019), the experts found that 105 of the 264 (40 per cent) participants in the speed training group with booster received a diagnosis of dementia, a 25 per cent drop compared to 239 of the 491 (49 per cent) adults in the control arm, with no specific training.

It has to be said that the same statistically significant outcomes did not occur with regard to interventions aimed at reasoning and memory, and this remains to be understood. How so? It is precisely on this aspect that the experts focused their attention. The big difference lies in the fact that the proposed speed programme is individualised, with targeted management over time. In practice, the level of 'game' was always adapted to the individual response of each participant that day. People who were faster to begin with would quickly move on to more demanding and rapid challenges, while those who needed more time would start at slower levels. Memory and reasoning programmes, on the other hand, were not adaptive: everyone in the group learned the same strategies. Furthermore, speed training stimulates implicit learning (more akin to unconscious habit or skill), while memory and reasoning training stimulates explicit learning (more akin to learning facts and strategies). This matters, as implicit learning works very differently in the brain than explicit learning.

'The study clinically extends the observations of the ACTIVE trial published in 2002,' explains Vincenzo Andreone, Director of the Complex Operative Unit of Neurology and Stroke Unit of the AORN 'Antonio Cardarelli' in Naples, 'by showing that adaptive training of processing speed can reduce the risk of dementia diagnosis in the long term. The programme is based on a computerised test called UFOV (Useful Field of View), which measures how quickly a person can process visual information under attentional pressure. Initially, a central stimulus to be identified appears on the screen; then a peripheral element is added; finally distractors enter the scene, increasing the complexity of the task. The system progressively reduces the exposure time, expressed in milliseconds, adapting to the subject's capacity. The faster and more accurate the response, the greater the cognitive efficiency. 'It is not simply a matter of 'taking a test', but of real training repeated over time, built to stimulate attention and speed of processing,' reiterates the expert. And it is precisely this training, especially when reinforced with successive sessions, that has shown a significant reduction in the risk of being diagnosed with dementia over the next 20 years compared to the control group. The central point is that intervening on the efficiency of the cognitive response in old age can have lasting effects. We are not talking about a miracle cure, but about a possible delay in the clinical manifestation of the disease, and this can make a huge difference in public health'.