Cognitive Exercise Key to Staving Off Mental Decline

Like many family physicians, Thomas Rosenthal, M.D., of Buffalo, N.Y., treats older adult patients, and he thinks family physicians are the go-to resource for cognitive issues among these patients. "We're the people most likely to hear the concerns from family members of patients who suffer cognitive decline," said Rosenthal.

Rosenthal evaluates older adult patients using simple cognitive tests. Initially, he tells a patient to remember three items. He immediately asks the patient to repeat those items and then to provide the date and year. After a moment, he again asks the patient to repeat the first three items. Patients who score poorly are further evaluated using the mini-mental state exam, or MMSE.

Research has found that performing cognitive exercises may make all the difference in whether older patients are able to live independently rather than in some sort of assisted care facility. According to the abstract for "Long-term Effects of Cognitive Training on Everyday Functional Outcomes in Older Adults," an article published in the Dec. 20, 2006, issue of the Journal of the American Medical Association, benefits from exercises employed in cognitive memory training sessions were still seen five years after the sessions took place.

In the study, participants were divided into three groups and took part in 10 exercise sessions aimed at improving reasoning skills, memory and mental processing speed. All participants showed improvement in the cognitive skill exercised. Additionally, participants who took part in additional memory skills sessions reacted three times faster than their counterparts who did not participate in the additional sessions. The increase was most apparent in everyday living activities, such as reacting to road signs, finding numbers in the phone book or checking ingredients on prescription medications.

More than 2,800 subjects with an average age of 73.6 years participated in the study. They were recruited from senior housing facilities, community centers, hospitals and clinics in Alabama, Michigan, Massachusetts, Maryland, Indiana and Pennsylvania.

Training for reasoning skills included teaching participants strategies for finding a pattern in a series of letters or words and identifying the next letter or word in the pattern. Memory training included using organization, visualization and association for remembering word lists and text, and mental processing speed training included having participants identify objects briefly exposed on a computer screen and then asking them to divide their attention between two search tasks.

Additional training sessions were conducted 11 and 35 months after the initial training sessions.

The authors found that the training sessions immediately improved cognitive ability among participants, and this improvement was retained during a five-year period. Five years after the initial training, participants who were available for evaluation reported less difficulty with activities of daily living than was reported by the control group.

Rosenthal agrees that cognitive exercise is key to avoiding mental decline as the body ages. "We've found that cognitive exercises are most effective for those who score 18 or better on the MMSE," said Rosenthal. He added that if a patient scores below 18, family physicians should look for coexisting disease, such as depression.

Finding patient exercises and resources can be as easy as typing "memory" into an online bookstore's search engine, said Rosenthal, adding that sending patients home with exercises could be as simple as encouraging them to do crossword puzzles.

He predicts that family physicians will see more patients with cognitive concerns in the near future. "Over the next five years, I think it will become a more and more important aspect of patient treatment," Rosenthal said. "It will become an additional challenge in taking care of multi-symptom patients. We'll want to screen them for cognitive decline for the same reason we screen for hypertension: because we can help."