Summary
People with subjective cognitive decline (SCD) are at increased risk of developing dementia. Because there is no cure for the disease, interventions that prevent cognitive decline are essential to help slow disease progression. But currently, our ability to accurately diagnose SCD and predict dementia risk are limited, which affects patient outcomes. Dr Tim Whitfield at University College London undertook a PhD that looked at predicting the onset of dementia in people with SCD and investigated how mindfulness may help prevent cognitive decline.
Our best performing model could predict dementia risk with 80% accuracy
Dr Tim Whitfield
Subjective cognitive decline (SCD) is a condition in which people experience worsening memory or cognitive abilities, and is often one of the first signs of dementia. To reduce dementia risk, there is a large emphasis on modifying lifestyle risk factors to improve mental and physical health.
Improving our understanding of whether certain interventions can slow cognitive decline and learning to better predict the onset of dementia could potentially help prevent SCD from progressing.
Mindfulness based therapy as a tool for slowing cognitive decline
Mindfulness is particularly good at improving executive function in older adults
Because of the well documented benefits of mindfulness for brain and mental health, we set out to investigate mindfulness based therapy (MBT) as an approach to slow cognitive decline and prevent the onset of dementia in older adults.
We performed a large meta-analysis, the first of this kind, that reviewed existing evidence on how mindfulness can improve the memory and cognitive abilities of adults under and over the age of 60. Our results show that MBT does provide cognitive improvements, particularly in people over 60, in comparison to doing nothing. In particular, the meta-analysis suggested that mindfulness is particularly good at improving executive function in older adults. This refers to a set of mental skills that enable us to identify goals, plan, focus attention, remember instructions and juggle multiple tasks successfully. However, we also found cognitive improvements are similar whether people take part in MBT or other types of interventions, such as a relaxation course or a healthy lifestyle workshop.
To investigate this further, we carried out a randomised controlled trial (RCT) to see if mindfulness had a positive effect on patients experiencing SCD. We designed an 8-week MBT course that was tailored for the needs of an older population. It included mindful activities such as gentle yoga, sitting mediations and body scanning, which involves bringing awareness to different parts of the body and tuning into any pain, discomfort or bodily sensations.
Similar to the meta-analysis, we found that MTB led to cognitive improvements in people with SCD, but that these benefits were not greater than those offered by an 8-week healthy lifestyle course.
Although our evidence is not strong enough to say for certain that mindfulness is effective at slowing dementia, it’s clear that it does offer some benefits and is worth considering as a tool to improve mental health in older adults.
Improving SCD diagnosis and predicting dementia risk
If we could get better at diagnosing subjective cognitive decline, we could give patients a more accurate prognosis
Another branch of my research was to examine how SCD is diagnosed, because mild memory problems are often not picked up in tests. We carried out an observational study in a memory clinic and found that different approaches for diagnosing SCD give different prognoses, which can be misleading for patients and negatively affect their outcome. This finding was exciting for us because if we could get better at diagnosing SCD, we could give patients a more accurate prognosis.
Building on this, we developed a model that could help predict which patients with SCD are at most risk of going on to develop dementia. Our best performing model could predict dementia risk with 80% accuracy. Again, this is extremely exciting because a tool like this would enable doctors to get a clearer understanding of a patient’s cognitive status. This information could then be shared with patients to help motivate them to focus on improving their cognitive health, as well as prepare them for what to expect in later life.
Validating our proof of concept work
I had an extremely positive experience working with the Dunhill Medical Trust, who were supportive and helpful throughout my PhD. They understand the long-term nature of some research questions like mine and are happy to fund them. What really impressed me was that they extended my funding by six months when my PhD was delayed due to the COVID-19 pandemic.
I am now planning on moving forward with the risk and prediction side of my research, and looking at using digital technologies such as Fitbits, wearables and smartphone apps to predict the risk of dementia. I’m also seeking further funding so that we can replicate our work on SCD diagnosis on a larger scale.
Find out more
You can read our meta-analysis on the effect of mindfulness programmes on cognitive function in older adults in Neuropsychology Review.
Our RCT investigating the impact of mindfulness based therapy and a healthy lifestyle intervention on older people with SCD is published in Alzheimer’s Research & Therapy.
