Will COVID-19 create more dementia? Dementia, Alzheimer's and the latest research

There are problems enough, but will COVID-19 lead to an upsurge in dementia and if so, what can be done about it? 

Here is the challenge. Given ICU can be a great place to be when you really need, recent research confirms what many have observed. One in four people had cognitive impairment a year after release from an ICU that was similar in severity to having mild Alzheimer’s, and 1-in-3 had cognitive impairment similar to that seen with moderate traumatic brain injury. 

So if someone ends up in ICU with COVID-19, and one imagines even more so if on a ventilator, the risks of developing dementia would be real. But there is hope, so this week we examine what mindfulness and meditation in particular have to offer – to anyone at risk of dementia, to those already affected by it, and their caregivers, but first

        Thought for the day

Meditation is all about the pursuit of nothingness. 

It is like the ultimate rest. 

It is better than the best sleep you have ever had.

It is a quieting of the mind. 

It sharpens everything, 

Especially your appreciation of your surroundings.

It keeps life fresh.

Hugh Jackman - long term meditator

The context

The world population is aging and the prevalence of dementia is increasing. By 2050, those aged 60 years and older are expected to make up a quarter of the population. With that, the number of people with dementia is increasing. Unfortunately, there is no current medical cure for dementia. The progression of symptoms with no hope of improvement is difficult to cope with, both for patients and their caregivers. 

Mindfulness training has shown to improve psychological well-being in a variety of mental health conditions. Research has shown preliminary but promising results for mindfulness-based interventions to benefit people with dementia and caregivers. So what follows are summaries quoting fairly directly from 4 key research papers that investigated what might be possible. The results are encouraging…

1. Review : Mindfulness, meditation, cognition and stress in people with Alzheimer's disease (AD), dementia, mild cognitive impairment and subjective cognitive decline – 2018. 

This study investigated how the use of meditation as a behavioural intervention can reduce stress and enhance cognition, which in turn ameliorates some dementia symptoms. Ten papers were identified and reviewed. 

There was a broad use of measures across all studies, with cognitive assessment, quality of life and perceived stress being the most common. Three studies used functional magnetic resonance imaging to measure functional changes to brain regions during meditation. 

The interventions fell into the following three categories: mindfulness, most commonly mindfulness-based stress reduction(MBSR) (six studies); Kirtan Kriya meditation (three studies); and mindfulness-based Alzheimer's stimulation (one study). Three of these studies were randomised controlled trials. 

All studies reported significant findings or trends towards significance in a broad range of measures, including a reduction of cognitive decline, reduction in perceived stress, increase in quality of life, as well as increases in functional connectivity, percent volume brain change and cerebral blood flow in areas of the cortex. 

Russell-Williams J, Jaroudi W et al. Mindfulness and meditation: treating cognitive impairment and reducing stress in dementia. Rev Neurosci. 2018;29(7):791-804. doi:10.1515/revneuro-2017-0066

2. Do adults with MCI have the capacity to learn mindfulness meditation? - 2019

High levels of chronic stress negatively impact the hippocampus and are associated with increased incidence of Mild Cognitive Impairment (MCI) and Alzheimer’s disease(AD). While mindfulness meditation may mitigate the effects of chronic stress, it is uncertain if adults with MCI have the capacity to learn mindfulness meditation.

Chronic stress negatively impacts the hippocampus, and high levels of chronic stress are associated with an increased incidence of MCI and AD. [6–8] Adults who are prone to high levels of psychological distress are more likely to develop dementia.[9] Animal research demonstrates that high levels of cortisol (the “stress hormone”) can damage the hippocampus[10], a key structure involved in memory processing that atrophies with Alzheimer’s disease. Thus, other stress-reducing interventions, such as meditation and yoga, might be helpful for adults with MCI.

Previous studies have shown that the hippocampus is selectively activated during meditation,[15–17] and experienced meditators have larger volumes and gray matter concentration in their hippocampi compared to matched controls.[18] In addition, research has shown that an eight-week MBSR class may increase gray matter density in the hippocampi of adults.[19] MBSR is thus a stress-reducing intervention that impacts the hippocampus and could potentially interrupt the progression of MCI through these effects. 

The period of time when an individual has MCI is transient and offers a rare window of opportunity prior to the development of dementia; finding an intervention that could help patients at this point of time could be invaluable. Since adults with MCI still have brain plasticity,[20] we hypothesized that adults with MCI would be able to learn and benefit from mindfulness meditation and yoga. 

What did the research find? Most adults with MCI were able to learn mindfulness meditation and had improved MCI acceptance, self-efficacy, and social engagement. So in summary, cognitive reserve may be enhanced through a mindfulness meditation program even in patients with MCI.

Wells RE, Kerr C, Dossett ML, et al. Can Adults with Mild Cognitive Impairment Build Cognitive Reserve and Learn Mindfulness Meditation? Qualitative Theme Analyses from a Small Pilot Study. J Alzheimers Dis. 2019;70(3):825-842. doi:10.3233/JAD-190191

3. Review of already well researched mindfulness techniques - 2018

Although there is a wide variety of interventions that include components of mindfulness (e.g., Acceptance and Commitment Therapy), this review focuses on the two programs with the largest evidence base, the mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). These group-based programs have been studied in healthy populations and in those with mental or physical disorders, showing satisfactory to good efficacy (Chiesa and Serretti, 2009; Hofmann et al., 2010; Hempel et al., 2014).

Although current research supports the rationale for MBI with persons with dementia and their caregivers, only few RCTs have been conducted and more research is necessary

What can be said is participants receiving MBSR showed greater improvement in memory, but not cognitive control. Moreover, the MBSR group improved on measures of worry, depression, and anxiety, and decreased cortisol level for those with high baseline cortisol.

Studies with persons with Mild Cognitive Impairment (MCI) or Severe Cognitive Impairment (SCD) have looked at the effect of Mindfulness Based Interventions (MBI). This is informative for dementia research, since individuals with MCI have an increased annual conversion rate of 5–17% to Alzheimer’s disease (Cheng et al., 2017), and approximately 60% over a 15-year period of persons with SCD will continue to develop Alzheimer’s disease (Reisberg et al., 2008).

Studies with persons with MCI or subjective memory complaints have looked at the effect of MBI. One pilot study found a trend toward improvement of cognition, quality of life, and well-being for people in the mindfulness condition (Wells et al., 2013). A RCT showed that the participants in the MBI group showed less memory deterioration and greater decrease in depressive symptoms compared to the control group (Larouche et al., 2016).

Although these studies demonstrate feasibility of MBSR with older adults with SCD and MCI, and preliminary evidence for memory improvement, more research is necessary to investigate whether MBI can influence cognitive decline.

Berk L, Warmenhoven F, van Os J, van Boxtel M. Mindfulness Training for People With Dementia and Their Caregivers: Rationale, Current Research, and Future Directions. Front Psychol. 2018;9:982. Published 2018 Jun 13. doi:10.3389/fpsyg.2018.00982

4. Mindfulness practice can improve health outcomes of MCI - 2017.

Growing evidence has linked mindfulness to cognitive and psychological improvements that could be relevant for mild cognitive impairment (MCI). This Australian study reported long-term mindfulness practice may be associated with cognitive and functional improvements for older adults with MCI. The researchers concluded mindfulness training could be a potential efficacious non-pharmacological therapeutic intervention for MCI.

Wong WP, Coles J, Chambers R, Wu DB, Hassed C. The Effects of Mindfulness on Older Adults with Mild Cognitive Impairment. J Alzheimers Dis Rep. 2017;1(1):181-193. Published 2017 Dec 2. doi:10.3233/ADR-170031

Finally, what might be possible?

It does need to be said that dementia is now well identified as another of the chronic degenerative diseases - like cancer, heart disease and MS. All these other known chronic degenerative diseases have been shown to be prevented by Lifestyle interventions. Once present, their symptoms have all been shown to be significantly lessened by Lifestyle interventions; and all have shown some signs – ranging up to major – of reversal through Lifestyle interventions. So why not dementia???

And what are Lifestyle interventions? The things you can do for yourself – like what you eat and drink, your exercise levels, relaxation, mindfulness and meditation. Many believe the mind-based interventions are key, both due to their direct effects and because the mind decides what we do with our lifestyle. Get the mind into a good state and everything else follows – we eat better, drink more wisely, are more inclined to exercise and so on.

RELATED BLOGS

Here are the links to 3 consecutive blogs that clarify just what dementia and Alzheimer’s are Alzheimer’s is the most common form of dementia), what the risks are and how prevention is possible; maybe even some recovery. Plus an intruiging post on the link between Alzheimers and impotence

1. Dementia, Alzheimer’s and other related conditions explained

2. The causes explained

3. One dozen proven things you can do to prevent dementia

4. Alzheimers and impotence – what is the link? Why is it so significant?

Purpose Built App – Allevi8

The new, free mindfulness/meditation based App I have been involved in developing – Allevi8 – has been specifically designed to assist people affected by chronic degenerative disease. We targeted 5 main issues – stress and mental health, emotional health, pain management, healing and finding meaning amidst adversity.

So while many others recognise the need for help with these areas – especially now in the era of the pandemic – it provide free access to specific techniques for people facing chronic degenerative disease. Dementia is one of those conditions.

Allevi8 is available via a simple search in your App store. Also, we do have a meditation session via Zoom that goes out live each Monday. This session is well attended and many report how helpful it is to receive practice tips and meditate in a like-minded community each week. To join us, simply download Allevi8 and the link will be sent by email. All of this is free, however, you might like to consider paying it forward – there is a secure donation facility on the App under “Gift”.