A multi-site collaborative study published in JAMA Psychiatry has demonstrated that a combination therapy can slow cognitive decline in older adults who are at risk for dementia. Cognitive decline is often the result of overlapping conditions which makes options such as combination therapies particularly pertinent as they can help to improve outcomes by targeting various disease pathways in a synergistic manner.
Collaboration to improve the mental health of older adults
This study led by the Centre for Addiction and Mental Health (CAMH), and with partnership across several Toronto Dementia Research Alliance (TDRA) sites – Baycrest, Sunnybrook Health Science Centre, Unity Health Toronto, and University Health Network focused on preventing cognitive decline in older adults with a condition that increases the risk for dementia: Major Depressive Disorder in remission (rMDD), Mild Cognitive Impairment (MCI), or both, and reports the primary results of the Prevention of Alzheimer’s dementia with Cognitive remediation plus transcranial direct current stimulation in Mild cognitive impairment and Depression (PACt-MD) study.
“Investing in long-term, comprehensive research like this is not only a commitment to science, but to the millions of individuals, families, and caregivers affected by dementia,” said the Honourable Mark Holland, Canadian Minister of Health. “This research contributes to advancing dementia care in Canada and improving quality of life for people living with dementia and caregivers.”
This randomized, controlled, and double-masked study involved 375 participants who received either a placebo control intervention or a combination of two active therapies: One involved a specially designed Cognitive Remediation (CR) technique designed to improve cognitive functioning and slow cognitive decline, such as puzzles and logic problems. The other was a transcranial direct current stimulation (tDCS) form of non-invasive brain stimulation. These therapies were delivered for 5 days per week for a period of 8 weeks, which was followed by 5-day “boosters” every 6 months, with assessments conducted at baseline, month 2, and yearly for three to seven years.
Combination therapy effective in slowing down cognitive decline
According to the researchers, those receiving the CR plus tDCS therapies experienced slower cognitive decline over a median follow-up of 4 years compared to those in the control group. Additionally, the beneficial effects were observed to be more prominent among those who had low genetic risks for Alzheimer’s disease, and those with rMDD, with/without MCI displayed better outcomes than those with MCI alone.
“We are very pleased to show, after seven years of close monitoring, that this combination of therapies is effective in slowing down cognitive decline for some of our most vulnerable populations,” said Dr. Tarek Rajji, lead author and one of the study’s Principal Investigators. “This study shows promise that multi-prong, non-pharmacological approaches for people with a high risk of developing dementia could help them live a more independent life for a longer time.” Dr. Rajji is a former CAMH Senior Scientist and now serves as Chair of the Department of Psychiatry at the University of Texas Southwestern Medical Center.
“While there are several presumed mechanisms underlying the increased risk for dementia in older adults with depression, impaired brain plasticity, or the ability of the brain to compensate for damage, is thought to be one common pathway. In this study we targeted the prefrontal cortex for treatment because this is believed to be an area of the brain that is highly adaptable to change and critical to executive functioning.” Dr. Mulsant is a Senior Scientist at CAMH, and the Labatt Family Chair for the Department of Psychiatry, Temerty Faculty of Medicine, at the University of Toronto,” explained Dr. Benoit Mulsant, senior author and research team lead.
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