Does Mental Activity Accelerate Cogntive Decline?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Does mental activity accelerate cognitive decline for people with Alzheimer's disease? Of course not. But to read the headlines over the past two days, one could be excused for wondering.

Contradictory Study?
A study published yesterday in Neurology noted that, among demented subjects with AD, those who had a history of high cognitive activity like reading, doing crosswords, and visiting museums, declined at an accelerated pace. On the surface, this seems contradictory to the notion that exercising your brain preserves mental function. A closer look, however, reveals an obvious and consistent conclusion.

This study demonstrates that, most probably, maintaining a high level of mental activity allows subjects with progressing Alzheimer's pathology, to continue functioning at a high cognitive level, even as the lesions accumulate in their brains. This means that those who remain mentally active may not manifest symptoms until they have very extensive damage in their brains. If so, symptoms will first appear in these subjects at a later, more pathologically severe stage. As such, there is little wonder that the decline seems more rapid for these subjects.

Delay and Compression of Symptoms
A good way to look at it is this: We don't see an acceleration of decline, but rather, a delay and compression of decline, into the final stages of the disease.

To illustrate this point, consider a typical course of decline between a mentally active person and a mentally inactive person. The inactive person may show subtle symptoms for 5 years, moderate symptoms for five years, and severe symptoms for five years, across a 15-year disease course. The mentally active person might show no symptoms for the first ten years of disease and then degrade quickly to severe symptoms during the final five years. Both had a 15 year disease course but the mentally active person showed no symptoms for the first ten. That person appeared to decline more rapidly, but actually declined much slower (perhaps not at all) during ten of the 15 years. In the broad context, the active person was certainly far better off across the full course of decline.

Many of the headlines on this study are sensationalistic and misleading. I thought this coverage from Bloomberg/Business Week was well done and represented the facts quite fairly.

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