HealthWatch: C-REM: Improve Your Gait And Your Brain

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Which comes first: does exercise lead to better brain health?  Or is it the other way around?  Can improving a senior’s mental capacity by playing brain games help increase his or her mobility?  
Seventy-three-year-old Marlene Ray knows all too well that aging is tough on the body and the mind.
Ray said, “My sister-in-law suffers with dementia, so I want to know what I can do to help anybody I can while my mind is still sharp.” 
Ray is one of more than 400 seniors being recruited by researchers at Albert Einstein College of Medicine for C-REM, the Cognitive Remediation to Improve Mobility study.
Joe Verghese, MBBS, MS, Professor of Neurology and of Medicine at Albert Einstein College of Medicine, Director of the Montefiore Einstein Center for the Aging Brain, Chief, Division of Cognitive & Motor Aging and Geriatrics at Einstein and Montefiore said, “It’s based on the idea that to walk in the real world you need to engage your whole brain.” 
Three days a week, for 45 minutes, half of the seniors in the study play computerized brain games that target the areas of the brain important to mobility and executive function, the prefrontal cortex, the basal ganglia, and the connections between. 
Participants then perform timed walking and cognition tests, seeing how long it takes to walk a runway, while reciting alternate letters of the alphabet. Or finding a way out of a floor maze, while keeping one foot on a yellow guideline. Ray, who performs with her church, says since beginning the program she’s seen big improvement in movement and memory.
Ray explained, “I did a show with my choir in December, and I had to remember 12 songs.” 
Verghese said, “We hope to see at the end of the trial we’ve reduced the amount of effort the brain has to do while walking, in other words, making the brain more efficient.” 
As part of the study, scientists are also using specialized scanners to measure brain activity. An earlier, small pilot program showed participants who played the brain games improved their walking. This large randomized trial is expected to run through 2020.
Contributors to this news report include: Cyndy McGrath, Field and Supervising Producer; Hayley Hudson, Assistant Producer; Kirk Manson, Videographer; Roque Correa, Editor.

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MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY

TOPIC:     C-REM: IMPROVE YOUR GAIT AND YOUR BRAIN
REPORT:    MB #4457

BACKGROUND: Cognitive impairment in older adults has a variety of possible causes, including medication side effects, metabolic and/or endocrine derangements, delirium due to intercurrent illness, depression, and dementia, with Alzheimer’s dementia being most common. Some causes, like medication side effects and depression, can be reversed with treatment. Others, such as Alzheimer’s disease, cannot be reversed, but symptoms can be treated for a period of time and families can be prepared for predictable changes. Many people who are developing or have dementia do not receive a diagnosis. One study showed that physicians were unaware of cognitive impairment in more than 40 percent of their cognitively impaired patients. Another study found that more than half of patients with dementia had not received a clinical cognitive evaluation by a physician.
(Source: https://www.nia.nih.gov/health/assessing-cognitive-impairment-older-patients) 

TREATMENT: People with cognitive impairment may require both drug treatment and other types of support. Ideally, a team approach integrating the services of physicians, nurses, other healthcare professionals, social workers, and community organizations may improve medical and behavioral outcomes for both the patient and caregiver. Suggest aids for daily functioning, such as to-do lists, a calendar, and other reminders. Technology for medication management, safety (e.g., emergency response, door alarms), and other care is also available. Regular physical activity, a healthy diet, social activity, hobbies, and intellectual stimulation may help slow cognitive decline.
(Source: https://www.nia.nih.gov/health/managing-older-patients-cognitive-impairment#references) 
 
NEW RESEARCH: Mobility disabilities represent the most prevalent disability among seniors. Emerging evidence indicates that executive functions play an important role in maintaining mobility. However, the use of cognitive remediation programs to enhance mobility has not been investigated in a full-scale randomized control trial. The CREM study is a single-blind randomized control trial to examine the effect of computerized cognitive remediation versus computer-based health education training on mobility in 420 seniors. The primary outcome is change in gait speed during normal walking and walking-while-talking conditions from baseline to post intervention. Secondary outcomes are changes in mobility, mobility-related cognitive processes and neuroplasticity. Results of this study will fill an important gap in the efficacy and feasibility of cognitive remediation to improve mobility in seniors.
(Source: https://www.futuremedicine.com/doi/abs/10.2217/nmt-2016-0034?journalCode=nmt) 

FOR MORE INFORMATION ON THIS REPORT, PLEASE CONTACT:


Elaine Iandoli, Science Media Relations Manager
718-430-4137
Elaine.iandoli@einstein.yu.edu 

If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know~to seek or change treatments, please let us know by contacting Marjorie Bekaert Thomas at mthomas@ivanhoe.com

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