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The winter olympics that just ended have undoubtedly brought us a lot of surprises, moves and shocks.
Of course, there are also some small regrets (for example, not winning Bingdundun)
.
In addition, there are many anecdotes, such as Gu Ailing eating a leek box between competitions, foreign athletes learning Tai Chi in the Olympic Village,
etc.
Yes, you read that right, it is Tai Chi
.
Don't underestimate this sport, it was successfully applied for the World Heritage List at the end of 2020
.
In addition to effectively relieving joint pain, improving anxiety and depression, and reducing waist circumference in middle-aged and elderly people, Tai Chi also appears to be helpful in delaying cognitive decline
.
Professor Chen Shengdi's team from the Neurology Department of Shanghai Ruijin Hospital published important research results in the journal Alzheimer's & Dementia [1].
They found that for patients with chronic cognitive impairment (MCI), supplementing Tai Chi can significantly improve the effect of cognitive training
.
Cognitive training (120min/week) + Tai Chi training (120min/week) delays cognitive decline in MCI patients by at least 2 years.
This study also provides clinicians with prescribing the combined treatment of "cognitive training + Tai Chi" for MCI patients The program provides preliminary evidence
.
The dreaded Alzheimer's disease (AD) actually has a prodromal stage - mild cognitive impairment (MCI)
.
MCI is an important intervention window for AD.
If the progression of MCI can be delayed, the number of new cases of AD can be reduced, and the medical costs related to dementia can be reduced
.
Mild cognitive impairment (MCI): refers to the progressive decline of memory and other cognitive functions, but does not affect the ability of daily living, and has not yet reached the diagnostic criteria for dementia
.
Nearly half of MCI patients will progress to Alzheimer's disease (AD) in the following 4-5 years [2] Unfortunately, mild cognitive impairment ( MCI) special drugs
.
Moreover, AD treatment drugs are not often prescribed to MCI patients in clinical practice, because the guidelines point out that their preventive effect is limited [3]
.
Regrettably, so far, there has been no large-scale clinical study on drug intervention to delay the process of cognitive deterioration
.
At this moment, perhaps we have more hope for non-drug interventions
.
Nonpharmacological interventions include cognitive training, physical exercise, dietary optimization, and cognitive stimulation therapy [4-6]
.
An early randomized trial of 2832 older adults over the age of 65 (who did not experience significant cognitive decline at enrollment) using three cognitive training methods (information processing speed, memory, and reasoning)
.
The study found that each intervention successfully improved the corresponding ability of the subjects, and the effect lasted for 2 years [7]
.
In addition, remote computerized cognitive training should not be underestimated
.
A meta-analysis showed that computerized cognitive training had positive effects on overall cognition, specific cognitive domains, and psychosocial functioning in patients with mild cognitive impairment (MCI) [8-9]
.
In fact, Prof.
Chen's team has conducted online multi-model cognitive task training for patients with mild cognitive impairment (MCI) for 6 months
.
MCI patients showed significant benefits in memory, attention, and executive function
.
But with the extension of follow-up time, the training effect is no longer significant [10]
.
In addition to cognitive training, how does physical exercise help cognition? Taking Tai Chi, a household name and suitable for all ages, in addition to improving balance control, flexibility, and muscle strength, Tai Chi has great benefits on overall cognitive performance, delayed recall, and executive function [11-12]
.
Therefore, Professor Chen's team imagined that, perhaps, Tai Chi could further strengthen cognitive training and help delay cognitive decline in patients with mild cognitive impairment (MCI)
.
Of course, the long-term effects of Tai Chi on MCI patients remain to be explored
.
Professor Chen's team, who has been deeply involved in the field of MCI non-drug intervention research, has finally completed the enrollment of MCI patients after more than 3 years after multiple academic analyses such as small sample pre-test, Tai Chi program screening, and feasibility discussion of Tai Chi-cognitive joint training.
Group intervention and follow-up
.
Let's take a look at how this "protracted" study is carried out.
First, the included patients must meet the "MCI due to AD" criteria, which is established by the National Institute on Aging and Alzheimer's Association (NIA-AA) The proposed "AD-derived mild cognitive impairment" [13]
.
Subsequently, MCI patients were randomly divided into cognitive training group (CT), cognitive + Tai Chi training group (MixT) and control group
.
After 12 months of follow-up, the patients in MixT group were randomly divided into two subgroups.
Group A stopped training, and group B continued cognitive training and Tai Chi exercise
.
Trial Flowchart The research team used MMSE, ADAS-Cog to assess overall cognitive level, and AVLT, STT, CFT, SCWT and BNT to assess specific cognitive domains (memory, executive function, attention, language and spatial abilities)
.
The first question the researchers answered was: What is the immediate enhancement effect of Tai Chi after completing 12 months of training? Unsurprisingly, both the cognitive training group (CT) and the cognitive + Tai Chi training group (MixT) have significant advantages in overall cognition
.
At 12 months, the MMSE scores of patients in the control group decreased by 0.
75 SD, while those in the MixT and CT groups increased by 0.
33 SD and 0.
10 SD, respectively
.
In addition, compared with the CT group, the AVLT 5-minute recall (Auditory Vocabulary Learning Test-5-minute delayed recall) and AVLT 20-minute recall (Auditory Vocabulary Learning Test-20-minute delayed recall) scores were significantly higher in the MixT group.
Means Tai Chi training may help improve memory
.
The MixT group was also significantly better than the control group in terms of CFT recall and BNT~ So what about the long-term effects of Tai Chi? Take a look at the analysis at the 24th month follow-up
.
Obviously, the advantage of MixT group A who did not continue training from months 12-24 was diminished
.
The MMSE, AVLT 5-minute recall, and AVLT 20-minute recall scores of the MixT group B who continued the mixed training were significantly higher than those of the control group and MixT A group
.
Of course, its ADAS-Cog score was significantly lower than that of the control group and MixT A group.
After all, the higher the ADAS-Cog score, the more severe the cognitive impairment
.
Cognitive training + Tai Chi exercise can't be stopped~ In addition, functional neuroimaging assessment also found that 12 months after the start of the study, the neural activity of MCI patients in the cognitive training group and combined training group increased (ie, the low-frequency fluctuation amplitude ALFF signal increased) , the specific brain regions include bilateral medial temporal lobes, temporal poles, posterior cingulate cortex, and insular cortex
.
Bilateral temporal lobes (upper row black arrows), insula (upper row blue arrows), medial temporal lobes (lower row black arrows), posterior cingulate cortex (lower row blue arrows) In this study, the control group The annual conversion rate for Alzheimer's disease (AD) in the first 12 months was 7.
5% (4/53)
.
The CT group and MixT group had slightly lower annual conversion rates, 3.
9% (2/51) and 4.
2% (2/48), respectively
.
Although the AD conversion rates in both the CT and MixT groups were lower than those in the control group, unfortunately, the sample size was too small for its statistical power to demonstrate a significant difference between the groups
.
In the future, we still have to look forward to the study of large samples, but Qidian Cake should hurry up and synchronize with the uncle who loves to play Tai Chi.
Reference: [1] Li B, Tang H, He G, et al.
Tai Chi enhances cognitive training effects on delaying cognitive decline in mild cognitive impairment [published online ahead of print, 2022 Mar 15].
Alzheimers Dement.
2022;10.
1002/alz.
12658.
doi:10.
1002/alz.
12658.
[2] Gauthier S, Reisberg B, Zaudig M, et al.
Mild cognitive impairment.
Lancet.
2006;367(9518):1262-1270.
doi:10.
1016/S0140-6736(06)68542-5.
[3] Kasper S, Bancher C, Eckert A , et al.
Management of mild cognitive impairment (MCI): The need for national and international guidelines.
World J Biol Psychiatry.
2020;21(8):579-594.
doi:10.
1080/15622975.
2019.
1696473.
[4] Li BY , Wang Y, Tang HD, Chen SD.
The role of cognitive activity in cognition protection: from Bedside to Bench.
Transl Neurodegener.
2017;6:7.
Published 2017 Mar 28.
doi:10.
1186/s40035-017-0078-4.
[5] Olazarán J, Reisberg B, Clare L, et al.
Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy.
Dement Geriatr Cogn Disord.
2010;30(2):161-178.
doi:10.
1159/000316119.
[ 6] Yuan TF, Li WG, Zhang C, et al.
Targeting neuroplasticity in patients with neurodegenerative diseases using brain stimulation techniques.
Transl Neurodegener.
2020;9(1):44.
Published 2020 Dec 7.
doi:10.
1186/s40035-020 -00224-z.
[7] Jobe JB, Smith DM, Ball K, et al.
ACTIVE: a cognitive intervention trial to promote independence in older adults.
Control Clin Trials.
2001;22(4):453-479.
doi: 10.
1016/s0197-2456(01)00139-8.
[8] Harvey PD, McGurk SR, Mahncke H, Wykes T.
Controversies in Computerized Cognitive Training.
Biol Psychiatry Cogn Neurosci Neuroimaging.
2018;3(11):907-915.
doi:10.
1016/j.
bpsc.
2018.
06.
008[9] Hill NT, Mowszowski L, Naismith SL,Chadwick VL, Valenzuela M, Lampit A.
Computerized Cognitive Training in Older Adults With Mild Cognitive Impairment or Dementia: A Systematic Review and Meta-Analysis.
Am J Psychiatry.
2017;174(4):329-340.
doi:10.
1176/appi .
ajp.
2016.
16030360.
[10] Li BY, He NY, Qiao Y, et al.
Computerized cognitive training for Chinese mild cognitive impairment patients: A neuropsychological and fMRI study.
Neuroimage Clin.
2019;22:101691.
doi:10.
1016/j .
nicl.
2019.
101691.
[11] Hong Y, Li JX, Robinson PD.
Balance control, flexibility, and cardiorespiratory fitness among older Tai Chi practitioners.
Br J Sports Med.
2000;34(1):29-34.
doi:10.
1136 /bjsm.
34.
1.
29.
[12] Takeshima N, Islam MM, Kato Y, et al.
Effects of 12 Weeks of Tai Chi Chuan Training on Balance and Functional Fitness in Older Japanese Adults.
Sports (Basel).
2017;5( 2): 32.
Published 2017 May 26.
doi: 10.
3390/sports5020032.
[13] Albert MS, DeKosky ST, Dickson D, et al.
The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease.
Alzheimers Dement .
2011;7(3):270-279.
doi:10.
1016/j.
jalz.
2011.
03.
008.
Responsible editor | Dai Siyu
Of course, there are also some small regrets (for example, not winning Bingdundun)
.
In addition, there are many anecdotes, such as Gu Ailing eating a leek box between competitions, foreign athletes learning Tai Chi in the Olympic Village,
etc.
Yes, you read that right, it is Tai Chi
.
Don't underestimate this sport, it was successfully applied for the World Heritage List at the end of 2020
.
In addition to effectively relieving joint pain, improving anxiety and depression, and reducing waist circumference in middle-aged and elderly people, Tai Chi also appears to be helpful in delaying cognitive decline
.
Professor Chen Shengdi's team from the Neurology Department of Shanghai Ruijin Hospital published important research results in the journal Alzheimer's & Dementia [1].
They found that for patients with chronic cognitive impairment (MCI), supplementing Tai Chi can significantly improve the effect of cognitive training
.
Cognitive training (120min/week) + Tai Chi training (120min/week) delays cognitive decline in MCI patients by at least 2 years.
This study also provides clinicians with prescribing the combined treatment of "cognitive training + Tai Chi" for MCI patients The program provides preliminary evidence
.
The dreaded Alzheimer's disease (AD) actually has a prodromal stage - mild cognitive impairment (MCI)
.
MCI is an important intervention window for AD.
If the progression of MCI can be delayed, the number of new cases of AD can be reduced, and the medical costs related to dementia can be reduced
.
Mild cognitive impairment (MCI): refers to the progressive decline of memory and other cognitive functions, but does not affect the ability of daily living, and has not yet reached the diagnostic criteria for dementia
.
Nearly half of MCI patients will progress to Alzheimer's disease (AD) in the following 4-5 years [2] Unfortunately, mild cognitive impairment ( MCI) special drugs
.
Moreover, AD treatment drugs are not often prescribed to MCI patients in clinical practice, because the guidelines point out that their preventive effect is limited [3]
.
Regrettably, so far, there has been no large-scale clinical study on drug intervention to delay the process of cognitive deterioration
.
At this moment, perhaps we have more hope for non-drug interventions
.
Nonpharmacological interventions include cognitive training, physical exercise, dietary optimization, and cognitive stimulation therapy [4-6]
.
An early randomized trial of 2832 older adults over the age of 65 (who did not experience significant cognitive decline at enrollment) using three cognitive training methods (information processing speed, memory, and reasoning)
.
The study found that each intervention successfully improved the corresponding ability of the subjects, and the effect lasted for 2 years [7]
.
In addition, remote computerized cognitive training should not be underestimated
.
A meta-analysis showed that computerized cognitive training had positive effects on overall cognition, specific cognitive domains, and psychosocial functioning in patients with mild cognitive impairment (MCI) [8-9]
.
In fact, Prof.
Chen's team has conducted online multi-model cognitive task training for patients with mild cognitive impairment (MCI) for 6 months
.
MCI patients showed significant benefits in memory, attention, and executive function
.
But with the extension of follow-up time, the training effect is no longer significant [10]
.
In addition to cognitive training, how does physical exercise help cognition? Taking Tai Chi, a household name and suitable for all ages, in addition to improving balance control, flexibility, and muscle strength, Tai Chi has great benefits on overall cognitive performance, delayed recall, and executive function [11-12]
.
Therefore, Professor Chen's team imagined that, perhaps, Tai Chi could further strengthen cognitive training and help delay cognitive decline in patients with mild cognitive impairment (MCI)
.
Of course, the long-term effects of Tai Chi on MCI patients remain to be explored
.
Professor Chen's team, who has been deeply involved in the field of MCI non-drug intervention research, has finally completed the enrollment of MCI patients after more than 3 years after multiple academic analyses such as small sample pre-test, Tai Chi program screening, and feasibility discussion of Tai Chi-cognitive joint training.
Group intervention and follow-up
.
Let's take a look at how this "protracted" study is carried out.
First, the included patients must meet the "MCI due to AD" criteria, which is established by the National Institute on Aging and Alzheimer's Association (NIA-AA) The proposed "AD-derived mild cognitive impairment" [13]
.
Subsequently, MCI patients were randomly divided into cognitive training group (CT), cognitive + Tai Chi training group (MixT) and control group
.
After 12 months of follow-up, the patients in MixT group were randomly divided into two subgroups.
Group A stopped training, and group B continued cognitive training and Tai Chi exercise
.
Trial Flowchart The research team used MMSE, ADAS-Cog to assess overall cognitive level, and AVLT, STT, CFT, SCWT and BNT to assess specific cognitive domains (memory, executive function, attention, language and spatial abilities)
.
The first question the researchers answered was: What is the immediate enhancement effect of Tai Chi after completing 12 months of training? Unsurprisingly, both the cognitive training group (CT) and the cognitive + Tai Chi training group (MixT) have significant advantages in overall cognition
.
At 12 months, the MMSE scores of patients in the control group decreased by 0.
75 SD, while those in the MixT and CT groups increased by 0.
33 SD and 0.
10 SD, respectively
.
In addition, compared with the CT group, the AVLT 5-minute recall (Auditory Vocabulary Learning Test-5-minute delayed recall) and AVLT 20-minute recall (Auditory Vocabulary Learning Test-20-minute delayed recall) scores were significantly higher in the MixT group.
Means Tai Chi training may help improve memory
.
The MixT group was also significantly better than the control group in terms of CFT recall and BNT~ So what about the long-term effects of Tai Chi? Take a look at the analysis at the 24th month follow-up
.
Obviously, the advantage of MixT group A who did not continue training from months 12-24 was diminished
.
The MMSE, AVLT 5-minute recall, and AVLT 20-minute recall scores of the MixT group B who continued the mixed training were significantly higher than those of the control group and MixT A group
.
Of course, its ADAS-Cog score was significantly lower than that of the control group and MixT A group.
After all, the higher the ADAS-Cog score, the more severe the cognitive impairment
.
Cognitive training + Tai Chi exercise can't be stopped~ In addition, functional neuroimaging assessment also found that 12 months after the start of the study, the neural activity of MCI patients in the cognitive training group and combined training group increased (ie, the low-frequency fluctuation amplitude ALFF signal increased) , the specific brain regions include bilateral medial temporal lobes, temporal poles, posterior cingulate cortex, and insular cortex
.
Bilateral temporal lobes (upper row black arrows), insula (upper row blue arrows), medial temporal lobes (lower row black arrows), posterior cingulate cortex (lower row blue arrows) In this study, the control group The annual conversion rate for Alzheimer's disease (AD) in the first 12 months was 7.
5% (4/53)
.
The CT group and MixT group had slightly lower annual conversion rates, 3.
9% (2/51) and 4.
2% (2/48), respectively
.
Although the AD conversion rates in both the CT and MixT groups were lower than those in the control group, unfortunately, the sample size was too small for its statistical power to demonstrate a significant difference between the groups
.
In the future, we still have to look forward to the study of large samples, but Qidian Cake should hurry up and synchronize with the uncle who loves to play Tai Chi.
Reference: [1] Li B, Tang H, He G, et al.
Tai Chi enhances cognitive training effects on delaying cognitive decline in mild cognitive impairment [published online ahead of print, 2022 Mar 15].
Alzheimers Dement.
2022;10.
1002/alz.
12658.
doi:10.
1002/alz.
12658.
[2] Gauthier S, Reisberg B, Zaudig M, et al.
Mild cognitive impairment.
Lancet.
2006;367(9518):1262-1270.
doi:10.
1016/S0140-6736(06)68542-5.
[3] Kasper S, Bancher C, Eckert A , et al.
Management of mild cognitive impairment (MCI): The need for national and international guidelines.
World J Biol Psychiatry.
2020;21(8):579-594.
doi:10.
1080/15622975.
2019.
1696473.
[4] Li BY , Wang Y, Tang HD, Chen SD.
The role of cognitive activity in cognition protection: from Bedside to Bench.
Transl Neurodegener.
2017;6:7.
Published 2017 Mar 28.
doi:10.
1186/s40035-017-0078-4.
[5] Olazarán J, Reisberg B, Clare L, et al.
Nonpharmacological therapies in Alzheimer's disease: a systematic review of efficacy.
Dement Geriatr Cogn Disord.
2010;30(2):161-178.
doi:10.
1159/000316119.
[ 6] Yuan TF, Li WG, Zhang C, et al.
Targeting neuroplasticity in patients with neurodegenerative diseases using brain stimulation techniques.
Transl Neurodegener.
2020;9(1):44.
Published 2020 Dec 7.
doi:10.
1186/s40035-020 -00224-z.
[7] Jobe JB, Smith DM, Ball K, et al.
ACTIVE: a cognitive intervention trial to promote independence in older adults.
Control Clin Trials.
2001;22(4):453-479.
doi: 10.
1016/s0197-2456(01)00139-8.
[8] Harvey PD, McGurk SR, Mahncke H, Wykes T.
Controversies in Computerized Cognitive Training.
Biol Psychiatry Cogn Neurosci Neuroimaging.
2018;3(11):907-915.
doi:10.
1016/j.
bpsc.
2018.
06.
008[9] Hill NT, Mowszowski L, Naismith SL,Chadwick VL, Valenzuela M, Lampit A.
Computerized Cognitive Training in Older Adults With Mild Cognitive Impairment or Dementia: A Systematic Review and Meta-Analysis.
Am J Psychiatry.
2017;174(4):329-340.
doi:10.
1176/appi .
ajp.
2016.
16030360.
[10] Li BY, He NY, Qiao Y, et al.
Computerized cognitive training for Chinese mild cognitive impairment patients: A neuropsychological and fMRI study.
Neuroimage Clin.
2019;22:101691.
doi:10.
1016/j .
nicl.
2019.
101691.
[11] Hong Y, Li JX, Robinson PD.
Balance control, flexibility, and cardiorespiratory fitness among older Tai Chi practitioners.
Br J Sports Med.
2000;34(1):29-34.
doi:10.
1136 /bjsm.
34.
1.
29.
[12] Takeshima N, Islam MM, Kato Y, et al.
Effects of 12 Weeks of Tai Chi Chuan Training on Balance and Functional Fitness in Older Japanese Adults.
Sports (Basel).
2017;5( 2): 32.
Published 2017 May 26.
doi: 10.
3390/sports5020032.
[13] Albert MS, DeKosky ST, Dickson D, et al.
The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease.
Alzheimers Dement .
2011;7(3):270-279.
doi:10.
1016/j.
jalz.
2011.
03.
008.
Responsible editor | Dai Siyu
