Combination Therapy Slows Cognitive Decline in At-Risk Populations

 WHOM do we contact to get testing done in stroke survivors, since they are an at-risk population? With NO leadership anywhere in stroke, NOTHING WILL GET DONE!

Combination Therapy Slows Cognitive Decline in At-Risk Populations

Cognitive remediation plus transcranial direct current stimulation (tDCS) was effective in slowing cognitive decline in older adults with remitted major depressive disorder (rMDD), according to a study published in JAMA Psychiatry.

In the study of 375 participants with rMDD or mild cognitive impairment (MCI), those randomised to receive active cognitive remediation plus active tDCS experienced a slower cognitive decline over a median follow-up of 4 years than those randomised to receive sham treatments.

The effects were more prominent in patients with rMDD, with or without MCI, than in patients with MCI without rMDD.

“We are very pleased to show, after several years of close monitoring, that this combination of therapies is effective in slowing down cognitive decline for some of our most vulnerable populations," said Tarek K. Rajji, MD, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario. “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.”

Participants in the study were adults aged 65 years and older who had rMDD, with or without MCI, or MCI without rMDD aged 60 years and older. Assessments were made at baseline, month 2, and yearly from baseline for 3 to 7 years. Patients were randomised to cognitive remediation plus tDCS or sham plus sham 5 days a week for 8 weeks followed by twice-a-year 5-day boosters and daily at-home cognitive remediation or sham cognitive remediation.

The primary outcome was change in global composite cognitive score. Secondary outcomes included changes in 6 cognitive domains, moderating effect of the diagnosis, moderating effect of APOE ε4 status, change in composite score at month 2, and progression to MCI or dementia over time.

“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,” said Benoit H. Mulsant, MD, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health. “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.”

“The study showed that cognitive remediation plus tDCS, both targeting the prefrontal cortex, is efficacious in slowing cognitive decline in older adults at risk of cognitive decline, particularly those with rMDD and in those at low genetic risk for Alzheimer disease,” the authors concluded.  

Reference: https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2825463

SOURCE: Centre for Addiction and Mental Health