Brain Exercises Better than Drugs in Preventing Cognitive Decline

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With an aging population, rates of dementia will only climb, yet doctors have few effective strategies for addressing the worst symptoms.

Mild cognitive impairment, in which older adults show lapses in memory and other mental functions that aren’t serious enough to impair their daily activities, affects about 10% to 20% of those over age 70. Each year, about 10% of these people will progress to develop dementia, a more serious form of impairment that can drastically affect their independence and ability to function. But despite the growing proportion of the population that may be affected by these conditions, an analysis published in the Canadian Medical Association Journal found that there are few effective options for treating the condition.

The researchers reviewed 32 randomized controlled trials, in which patients were randomly assigned to either an intervention such as drugs to control cognitive decline, herbal remedies, physical activity or mental exercises including crossword puzzles; or left to continue living their lives without any changes. By comparing the various methods of treating cognitive decline, the scientists hoped to come up with some ranking of how effective the various interventions were.

MORE: Heart Disease Test May Predict Dementia Better Than Cognitive Tests

They did not find strong evidence to support medications such as donepezil, a cholinesterase inhibitor designed to help brain chemicals keep neural circuits involved in cognition active. Studies have long hinted that such prescription drugs are only minimally effective in staving off the symptoms of dementia, but with so few medications to treat dementia available, many physicians continue to prescribe the medications since they can help some patients to improve recall.

There was also little evidence supporting the effectiveness of natural remedies such as the herbal supplement ginkgo, the  hormone dehydroepiandrosterone (DHEA), or vitamin B and omega-3 fatty acids. The majority of the studies found these remedies had little to no effect on improving scores on memory tests or other evaluations of cognitive functions.

(MORE: Brain Aging: What’s Nintendo Got to Do With It?)

Studies investigating the role of estrogen and testosterone therapy showed the hormone therapies may actually increase risk of cognitive decline; among more than 10,000 women, those taking estrogen therapy increased their risk of dementia after five years by 80% compared to the women not taking the hormone, and studies of men taking testosterone suggested that the hormone might hamper short term memory.

Because recent studies hinted that physical activity could improve cognitive function in the elderly, the researchers also evaluated trials that included resistance and balance training as well as aerobic activities and found that resistance training improved short and long term memory of some participants, while aerobic activities helped some executive functions such as planning and organizing, but not memory. Overall, the researchers write, “There is some evidence that physical exercise may have a positive benefit, and given its countless other medical benefits, it should be encouraged with all patients.”

By far the intervention that showed the most dramatic benefits among healthy elderly adults involved mental exercise. These trials involved participants learning computer-based training programs or performing memory, reasoning and speed-processing exercises. Those who were trained on these types of skills showed significantly better memory and attention skills than those who did not, and one trial even reported that participants retained improved memory at a five year follow-up.

(MORE: Exercise Trumps Brain Games in Keeping Our Minds Intact)

What are the best ways to engage the brain to reap these benefits? Anything that keeps thinking and organizational or memory circuits active can be helpful, according to recent studies. For example, last year, researchers from Tohoku University in Japan showed that elderly men and women could improve some of their declining mental abilities — at least in the short-term — by playing the game Brain Age, which quizzes users on a variety of topics and presents the queries in brain-teasing ways.

While it certainly can’t hurt to keep the brain active into old age, the researchers point out that it’s not clear whether intervening with crossword puzzles or daily sudoku can actually bypass mild cognitive impairment or steer an aging brain away from dementia. They note that many of the studies they evaluated involved a relatively small number of participants. But, the findings highlight the lack of effective strategies for addressing the growing prevalence of cognitive decline and dementia in the aging population. “Future studies should address the impact of cognitive training on the prevention of cognitive decline, and we encourage researchers to consider easily accessible tools such as crosswords puzzles and sudoku that have not been rigorously studied,” the authors conclude.


exercising is a natural and better way of keeping brain fit than pills.


What about headstands, shoulderstands and other inversions? See Light on Yoga, BKS Iyengar.


"  crossword puzzles?!?!? "

I despise crossword puzzles. At 57 ( I am approaching my mid 60's now ) I decided I was scientifically illiterate and went back to school to at least fulfill the lower division requisites for a BS degree ( I have a BA, weak though it is ) Rigor saves cognition and crossword puzzles are alright, I suppose, for those with humanities pretentions but this sharpens the aging mind;

Integrate (t^3e^t) dt



Pondering life is a never ending puzzle.


Sure brain exercises are useful and appreciate this this is a report of a study in CMAJ  but it it is not correct to say "there is little evidence supporting the effectiveness of natural remedies .......vitamin B" 

In fact there is an excellent positive trial of the benefits of high doses of B vitamins - 250+ people with mild cognitive impairment, RCT, followed for 2 years, significant slowing or stopping of brain shrinkage (as measured by MRI) Were it a drug it is pretty certain that you would know all about it and further trials would be under way. You don't and there aren't. Why is that do you think?

See  it here:

Read more:



Stop with the silly pharma conspiracies, it show your ignorance.  Once clinically proven, Pharma companies can and do patent natural items such as vitamins (e.g., statins were originally found in a food product, red yeast rice).  There are some pharma companies right now that are patenting highly purified omega-3 oils for cognitive decline.

Btw, this study has some concerns (e.g., 38% of the original enrollment dropped out before the final analysis was completed).  Study is far from conclusive (fyi, I personally do believe in the cognitive benefits of B vitamins, although preferably not from supplementation).