Living with Mild Cognitive Impairment (MCI)
HABIT Healthy Action to Benefit Independence & Thinking™
Welcome to the HABIT page for people living with Mild Cognitive Impairment (MCI) and program participants. The HABIT Program is for individuals with MCI and their loved ones to learn the best strategies for adapting, coping, and living their best lives with MCI.
Follow the HABIT page to receive updates and information about adjusting to MCI and combating dementia. Our goal is to connect you with others and provide you with information and support.
Last week, I highlighted some research by the HABIT team evaluating the comparative impact of the 5 components of the HABIT program: Cognitive rehabilitation, cognitive training, yoga, support group, and wellness. We concluded that the topic is complicated and that no one intervention is "best." Multi-component interventions are likely to continue to be most helpful for patients with MCI. I did, however, mention that in evaluating the outcomes of quality of life, mood, anxiety, and self-efficacy, eliminating cognitive training did not negatively impact those outcomes.
Does this mean we think you can stop doing those brain games? Not so fast. I noted that we have not yet evaluated our cognitive outcome data to see if cognitive training may make a difference there. Because of this, I thought it an opportune time to highlight another recent study, this time from researchers in China, specifically evaluating the cognitive impact of cognitive training. Here are some details and summary, but you can read the study here if you like.
This study was conducted in patients diagnosed with "vascular cognitive impairment no dementia". This is essentially another way of saying Mild Cognitive Impairment (MCI) but with a known underlying etiology (cause) of vascular disease. As we discuss in HABIT, MCI is a syndrome that describes the loss of cognitive ability (memory, word finding, or executive functioning for example) but with relatively good day-to-day functioning. There are many diseases that may cause MCI. Alzheimer's disease is one, but vascular disease (i.e., small strokes or impaired blood flow in blood vessels of the brain) is another. In HABIT, we see patients with MCI with all etiologies and we may not even be sure of the disease. However, in this specific study, researchers limited the sample to patients with evidence of cognitive impairment (but not dementia) with evidence significant small vessel ischemic disease (i.e., vascular disease, primarily based on MRI scan--taking a picture of the brain and seeing evidence of small strokes).
Patients were randomly assigned to one of two possible interventions. The training group received a computerized, multidomain, adaptive training program for 7 weeks. They completed 30 minutes of training per day 5 days per week. When patients completed tasks with high accuracy, they upgraded to a higher difficulty level. The active control group received speed and attention tasks, also 30 minutes per day, 5 days per week for 7 weeks. In this group, they completed tasks at the same difficulty level throughout the study. This is a key difference between the interventions--the exercises got progressively more difficult as the participants got better at them in the training group.
The researchers collected data on measures of cognitive functioning (pencil and paper cognitive measurements) as well as measurements of brain functioning on brain scans (MRI and functional MRI). These measures are mean to evaluate changes in size of memory-important areas of the brain and evaluate the integrity and efficiency of the connections in the brain. They conducted these measurements prior to the intervention, at the end of the interventions, and 6 months later.
The found a significant improvement on pencil and paper cognitive measurements in the training group compared to the active control group. Unfortunately, this effect went away by 6 months after stopping the intervention. They did not find any change in the size of various brain structures with training compared to the active control, but the did see an increase in brain connections. Again, this improvement went away by 6 months after stopping the intervention.
Overall, I usually emphasize to my patients that we need to understand the benefits of cognitive exercise more. Ongoing research seems to suggest that cognitive exercises are not all created equal, and any potential benefits are only sustained with ongoing exercise. I'm optimistic enough about the benefits given studies like these, that we do routinely recommend brain exercise and help our patients create a habit during our treatment program. If you've been successful in creating a cognitive exercise habit, I'd love to hear more about what you are doing and how you maintain the habit!
Hi @joanamccormick and @jeanne51 – HABIT is definitely available at all of the Mayo Campuses. I've heard they are trying to make it available is some studies even off campus, but I'm just a volunteer so I will leave it to the experts to answer. Here is a video that might help answer some questions. Also, I'll tag @drmelaniechandler and @DrDonaLocke and @dranneshanderaochsner to see if we can get their insight. Meantime, I wanted to welcome you both to Connect and hope you can explore some of the helpful and interesting groups here.
Liked by Teresa, Volunteer Mentor, jeanne51
At present, HABIT is only available at one of the Mayo campuses (Arizona, Florida, or Midwest) and the University of Florida. It is our goal to help support providers at other institutions also launch HABIT programs, but that has not happened yet.
Liked by Debbra Williams, Alumna Mentor, jeanne51
Interesting this post is here when I finally get to check email. Denny just asked a few days ago if there is a class or something to help improve his memory.
Since technology is an issue "brain games" do not work for us. Have thought that maybe a part of the participants support group could be structured Brain exercises? But, since that is only once a month it may not be often enough.
While visiting the AZ Science Center today I picked up a book by Nancy Linde titled: 399 games, puzzles & trivia challenges specially designed to keep your brain young. "Organized on an increasing scale of difficulty…..all it takes is ten to fifteen minutes a day of playing the right games. (It's fun.)"
We are going to have a special "game" time every day together and check it out. So far I was impressed by the introduction from Professor of Psychiatry and Behavioral Sciences and Director of the Division of Psychology, U of Miami Miller School of Medicine which I read on the trip home via light rail.
Love this idea!
I would certainly be interested in purchasing this book for my own personal use. Where did you purchase it at? Thank you.
Liked by Dr. Dona Locke, HABIT AZ Director
Hi @bonniep! I like your alternative plan. Sounds like you've found something that will give Denny a challenge that will adjust over time. And I like that you guys are planning to do this together. We've started playing around with some board games like Boggle, Scattegories, and Telestrastions in our HABIT class. I'm not convinced that these have the same brain exercise impact as the processing speed based adaptive computer games, but these games do have some time pressure involved and can be a challenge. So, if brain games just aren't feasible these may also be some other options, but I don't have official data on that. But something is likely better than nothing!
@debbraw
Very interesting. Also, you did a great job of explaining why these brain exercises can still have great value in spite of whatever the results were from this particular study. Personally, I look forward to the morning newspaper just to do sudoku and the word jumble. And my husband, who was a patient in the HABIT program, enjoys doing a version of sudoku on his tablet where we can control difficulty level. The pleasure of this little morning ritual gives us plenty of value – whether it improves his brain – or mine – or not! I'm with you – let's stay optimistic about these exercises.
Liked by Teresa, Volunteer Mentor, lioness, jeanne51