独特的脑部体能计画可以强化认知、脑容量


  【24drs.com】轻微认知障碍(mild cognitive impairment,MCI)的年长患者,完成12周跨科别脑部体能计画之后,认知表现有显著改善且海马回体积变大。
  
  马里兰州巴尔的摩约翰霍普金斯医学中心、维吉尼亚州McLean NeuroGrow脑部体能中心主席Majid Fotuhi博士表示,就我们所知,这是首度且唯一显示可以促进认知功能以及使海马回体积变大的计画。
  
  Fotuhi博士表示,这个计画超越病患医疗的关键介入措施之一,是强调生活的目的,提供了神经回馈与冥想训练,强调饮食、运动、omega-3脂肪酸的角色。
  
  他指出,这个计画可以在任何临床情况推广,整合医疗实务,集合一组神经科医师、心理学家、睡眠专家、营养师、运动生理学家,成为一个统一的团队。
  
  这篇研究发表于2015年阿兹海默氏症协会国际研讨会(Alzheimer's Association International Conference,AAIC)。
  
  Fotuhi博士解释,晚年时认知能力下降和脑萎缩,可能是因为诸多病症,如阿兹海默氏症、脑血管疾病、睡眠障碍、久坐生活型态、以及缺乏认知刺激等所引起之不同程度的病变。
  
  他表示,阿兹海默氏症不是认知衰退的唯一原因,有多种医疗情况会侵蚀海马回的体积;许多病患的记忆衰退原因有5或6种不同病因,我们应积极治疗所有的医疗状况。
  
  Fotuhi博士等人测试了127名轻微认知障碍(平均年龄70.7岁)成人,探讨进行集中式跨科别脑部体能计画的效果。
  
  这个计画聚焦在非阿兹海默氏症病因的评估与个人化治疗,病患接受了完整的医疗与神经评估,以确认可能造成认知衰退的所有因素,之后开始一项为期12周的计画,该计画包括每周5小时的一对一介入措施。
  
  他们每周接受2小时的认知刺激、2小时的神经回馈、1小时的谘商/脑部训练;这项计画包括认知技巧训练、正念冥想、运动建议、地中海式饮食、omega-3补充脂肪酸。
  
  在研究开始时与完成计画后,这些研究对象进行了量化脑波图(Q-EEG)以及MRI、神经认知测试量表。
  
  结果显示,完成脑部体能计画的病患,有84%在神经认知测试量表的10种组成中有至少3种感受到显著的改善(P < .05),例如:注意力、专注力、执行功能、解决问题、认知处理速度。
  
  完成计画之后进行的Q-EEG中,58%病患的脑波活性改善趋向正常化,平均而言,有41.4%回归朝向正常。
  
  完成计画之后有17名患者进行MRI,发现有65%经历了海马萎缩逆转或者体积比研究开始时成长。
  
  Fotuhi博士表示,有2名在完成计画之后1年进行MRI,海马回平均改善3%- 4%。整体而言,年龄较轻以及开始时的简易智能状态测验分数较高,与改善最多有关。
  
  洛杉矶加州大学Cyrus Raji博士对研究结果发表评论时表示,Fotuhi博士让有记忆丧失及失智的病患应用生活型态调整,借以停止他们的认知衰退。这个研究中,我特别注意到的是,他们使用量化MRI显示海马回体积有改善。
  
  Raji博士指出,在我的研究中,我探讨过生活型态对于脑部的影响,显示这类介入方式在流行病学大样本的好处。
  
  Raji博士表示,Fotuhi博士的研究令人震惊的是,他对社区中的病患实际地运用这个方法且显示出好处,如果有更多神经学家提供这种计画,可让病患有能力减少失智及认知衰退的风险。
  
  资料来源:http://www.24drs.com/
  
  Native link:Unique Brain Fitness Program Boosts Cognition, Brain Size

Unique Brain Fitness Program Boosts Cognition, Brain Size

By Megan Brooks
Medscape Medical News

WASHINGTON ─ Elderly patients with mild cognitive impairment (MCI) who completed a 12-week multidisciplinary brain fitness program saw marked improvement in cognitive performance and enlargement in hippocampal size.

"To my knowledge, it is the first and only program that has been shown to enhance cognitive function and grow the volume of hippocampus," Majid Fotuhi, MD, PhD, chairman, NeuroGrow Brain Fitness Center, McLean, Virginia, and Johns Hopkins Medicine, Baltimore, Maryland, told Medscape Medical News.

"One of the key interventions in this program, above and beyond treatment of a patients' medical conditions, providing neurofeedback and meditation training and emphasizing the role of diet, exercise, and omega-3 fatty acids, is an emphasis on purpose in life," Dr Fotuhi told Medscape Medical News.

"This program can be replicated in any clinical setting with access to integrated medical practice where a group of neurologists, psychologists, sleep specialists, dieticians, and exercise physiologists can work together as a unified team," he added.

The study was presented here at the Alzheimer's Association International Conference (AAIC) 2015.

Brain Changes

Cognitive decline and brain atrophy in late life can be due to a variety of different pathologies secondary to varying loads of Alzheimer's disease, cerebrovascular disease, sleep disturbances, sedentary lifestyle, and lack of cognitive stimulation, Dr Fotuhi explained.

"Alzheimer's is not the only cause of cognitive decline. Multiple medical conditions can erode the size of the hippocampus and cause cognitive decline. Many patients have five or six different etiologies for a decline in their memory, and we should treat all those medical conditions aggressively," he said.

Dr Fotuhi and his team tested the effectiveness of an intensive multidisciplinary brain fitness program in 127 adults with MCI (average age, 70.7 years).

The program focuses on evaluation and personalized treatment of non-Alzheimer's etiologies. Patients received a full medical and neurologic evaluation to determine all potential contributing factors to their cognitive decline and then started a 12-week program that includes 5 hours a week of one-on-one interventions.

Each week, they received 2 hours of cognitive stimulation, 2 hours of neurofeedback, and 1 hour of counseling/brain coaching. The program includes cognitive skills training, mindfulness meditation, advice on exercise, and the Mediterranean diet, including supplementation with omega-3 fatty acids.

Participants underwent quantitative electroencephalography (Q-EEG) and MRI and a battery of neurocognitive tests at baseline and after completion of the program.

Results showed that 84% of patients who completed the Brain Fitness Program experienced statistically significant improvements in at least three of the 10 components of the neurocognitive test battery (P < .05), such as attention, concentration, executive function, problem solving, or speed of cognitive processing.

On the postprogram Q-EEG, 58% of patients had improvements toward normalization of their brain wave activity. On average, there was a 41.4% regression toward the norm.

MRI conducted in 17 patients after the program found that 65% experienced a reversal of hippocampal atrophy or growth above baseline volume.

"Two patients who underwent MRI a year after the program, and the improvement in the hippocampus is on average 3% to 4%," said Dr Fotuhi. Overall, younger age and higher baseline Mini–Mental State Examination score correlated with the most improvements.

"Astounding" Results

Commenting on the results for Medscape Medical News, Cyrus Raji, MD, PhD, from the University of California, Los Angeles, said, "Dr Fotuhi is applying lifestyle modifications in patients with memory loss and dementia to stop their cognitive decline. What I find particularly notable about this work is his demonstration of improvement of hippocampal volumes on quantitative MRI."

"In my work, I have studied the effects of lifestyle on the brain and demonstrated the benefits of such interventions in large epidemiological samples," Dr Raji added.

"What Dr Fotuhi has done that is astounding is he is actually applying this approach to 'real world' patients in the community and showing benefits. This provides patients the ability to one day go to a growing number of neurologists like him for programs to reduce risk for dementia and cognitive decline. This work is of considerable value," Dr Raji said.

The study had no funding. Dr Fotuhi has disclosed no relevant financial relationships.

Alzheimer's Association International Conference (AAIC) 2015. Abstract 4331. Presented July 19, 2015.

    
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