TBH Programs Improve Brain Fitness: Results of the ACAR Brain Health Intervention Study

Adults 65+ often experience changes in cognition, including memory. Longstanding evidence shows interventions such as lifestyle changes and memory training can improve thinking and cognitive vitality. However, most research has focused on longitudinal outcomes or laboratory-based interventions. There have been few naturalistic studies looking at the impact of cognitive wellness training in active aging communities. In addition, there is a lack of evidence for the value of sustainable, scalable interventions delivered in-place by existing staff to promote healthy cognition and wellbeing in this population.

Data is now available to fill that gap. The recently concluded ACAR Brain Health Intervention Study shows the robust, significant benefits of brain health training for adults in congregant living. The results demonstrate strong support for small group training designed to empower residents to be brain healthy, and to help them make meaningful changes for sharper thinking and better memory.

The ACAR Brain Health Intervention Study stemmed from a collaborative research partnership between Acts Retirement-Life Communities, researchers at the Alabama Research Institute on Aging, and Total Brain Health. Spearheaded by primary investigator Dr. Ian McDonough, associate professor of psychology at the University of Alabama-Tuscaloosa, the 2-year investigation enrolled residents from 23 Acts Retirement-Life Communities. All participants were 65+, resided in independent living, and without a previous diagnosis of memory disorder.

The study used Total Brain Health’s small group cognitive wellness programs as the primary training intervention. Designed especially for aging adults, TBH’s programs reflect a methodology grounded in wellness-based lifestyle interventions across body, mind, and spirit; Social-Based Brain Training that uses the power of social engagement for cognitive benefit; and experiential or “hands on” training.

549 Acts residents participated and were randomly assigned to either 1 of 3 active interventions groups or a waitlist control group:

TBH BRAIN WORKOUT Program Group. Led by Acts staff, participants learned about behaviors promoting cognitive (how to focus attention), physical (how to eat healthy), and socio-emotional (how to stay socially engaged) wellbeing.

TBH MEMORY Program Group. Led by Acts staff, participants learned how memory works, how wellbeing impacts memory, and how to use several practical memory strategies to enhance recall for names, conversations, and more.

The Book Club Group. Led by a peer facilitator, participants discussed brain health knowledge from a book on brain health each week.

Waitlist Control Group. Did not participate in any brain training during the study.

The 3 active groups met for 1-hour weekly for 8 sessions over a 2-month period. Participants completed a packet of self-report measures to assess wellbeing and brain knowledge before training began, immediately at the conclusion of the training classes, and 2 months later.

Analyses of the data was overseen by Dr. McDonough. The results showed that participants in the active intervention groups benefited significantly from the programs when compared to those in the waitlist control group. Furthermore, several of the improvements remained evident at the 2-month follow-up. Specifically, those in the intervention groups were:

Empowered with greater knowledge about how they can take care of their brains

Had greater confidence in their memory and brain fitness

Used more memory strategies than they had before the training

In addition, at the end of the 8-week training participants in both the TBH BRAIN WORKOUT Program and Book Club groups were significantly more likely than those in the control group to:

Make healthier lifestyle choices to support brain health

The results of the ACAR Brain Health Intervention Study offer a meaningful contribution to what we know about the benefit of brain wellness training in active aging settings. First, these outcomes show that such interventions can make a real difference for older adults, giving them the capacity to make brain healthier lifestyle choices, feel more secure in their ability to care for their cognition, and use techniques to improve their memory.

In addition, while independent living communities can play a key role in cognitive wellness research, there have been few meaningful partnerships between academics, communities, and cognitive program providers. The Acts Retirement-Life Communities Center for Applied Research (ACAR) is a forward-thinking model of how organizations can help foster collaborations to contribute knowledge about the benefits of communal settings for older adults. Acts staff were a key part of the research process, giving them the opportunity to gain meaningful professional experience. They were supported by the ACAR team as well as Acts corporate staff as they helped guide the investigation in their communities.

Perhaps most importantly, these findings clearly show that staff-led cognitive wellness training is clearly valuable and sustainable when delivered in ways that are affordable and scalable. As the Lancet Commission on Dementia Prevention, Intervention and Care (2017) charged, “(G)iving people information about how to prevent or treat dementia is an essential first step but is not enough. There is a responsibility, not just as professionals but as a society, to implement this evidence into interventions that are widely and effectively used … . Interventions have to be accessible, sustainable, and, if possible, enjoyable or they will be unused.” The ACAR Brain Health Intervention Study demonstrates that such interventions exist and can be robustly delivered in ways that help older adults thrive.

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October 2020 | Harvard Health  Can music really affect your well-being, learning, cognitive function, quality of life, and even happiness? A recent survey on music and brain health conducted by AARP revealed some interesting findings about the impact of music on cognitive and emotional well-being. Click here to read the full article. 

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Hot Off the Press! Blood Test for Alzheimer’s Disease, Flu Vaccines Reduce Dementia Risk, and More: Research Highlights from the 2020 Alzheimer’s Association International Conference You Need to Know

Each July the Alzheimer’s Association International Conference offers a glimpse of the cutting-edge research on Alzheimer’s disease and related dementias. This year’s conference, held online, included many exciting advances in the science of dementia. Here are a few that you need to know about.

Coming Soon to Your Doctor’s Office? A Blood Test for Alzheimer’s Disease.  Several researchers reported significant progress towards an easily available diagnostic blood test for Alzheimer’s disease. Studies found that tests for abnormal versions of tau protein, specifically p-tau217, could potentially identify the disease with more specificity than current methods and in some cases even two decades before dementia symptoms occur. This finding is particularly exciting as early biomarkers have long been the “holy grail” of Alzheimer’s research. Currently diagnosis of dementia is made once clinical changes are evident and significant deterioration has already been established. Early biomarkers like a blood test would allow scientists to identify those with the disease or at risk before clinical changes have been established, making it easier to design effective interventions to delay or arrest the disease. A simple serum test would also be less costly and more accessible than current diagnostic tests. But don’t expect your doctor to have an Alzheimer’s test available anytime soon. While these findings are a huge step forward, research must continue with larger, confirmatory studies prior to available testing for the general public. Not surprisingly, the idea that a blood test for Alzheimer’s disease is within reach gained a lot of press. For a good overview of the research, see this article from the New York Times. 

Get That Vaccine! Flu and Pneumonia Vaccines Shown to Reduce Dementia Risk. Looking for something you can do right now to reduce your dementia risk? Get your vaccines! Research presented at the AAIC showed that getting even one flu vaccine could reduce your risk for Alzheimer’s disease by 17%, with more frequent flu vaccination adding another 13% reduction in risk. Other research found that the pneumonia vaccine offered even greater protection against Alzheimer’s dementia, reducing risk by up to 40% in those ages 65-75 years. As Maria Carillo, Chief Science Officer of the Alzheimer’s Association, shared “It may turn out to be as simple as if you’re taking care of your health in this way — getting vaccinated — you’re also taking care of yourself in other ways, and these things add up to lower risk of Alzheimer’s and other dementias.” Given that the seasonal flu and pneumonia already carry greater health risks as we age, these additional findings make getting your flu and pneumonia vaccines a “no brainer.” Here’s a great article covering the vaccine research from NPR. 

Even More Proof that It’s Never Too Early to Think About a Brain Healthy Lifestyle. AAIC presentations included several confirming that a brain healthy lifestyle from an early age essential to reducing dementia rates. Of particular note are studies showing cardiac risk factors such as obesity, high blood pressure and being overweight in teenagers and young adults are associated with a significant decrease in late-life cognition, particularly among African Americans. Other researchers reported a higher body mass index (BMI) in adolescence was associated with greater dementia risk in older adulthood, a risk that was even more significant for women. Finally, other research demonstrated that high-quality early education was associated with significantly improved cognition, memory and reduced dementia risk in later years. While these findings confirm earlier research, together they continue underscore the need for a strong public health approach to dementia prevention that stresses the importance of brain health at every age. Dr. Maria Carrillo, Chief Science Officer, Medical and Scientific Relations, at the Alzheimer’s Association, speak to CNN about this latest research here.

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Feb 2020 | Healthy Day. A breakthrough study has identified a class of natural gene variants that may protect against Alzheimer’s disease. Click here to read the article.

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WHAT. Researchers recently reported that Alzheimer’s disease (AD) may be additionally characterized by an arrest of maturation of new neuronal cells in the hippocampus. Using tissue samples and advanced processing methods, scientists in Spain were able to distinguish marked differences in neurogenesis, or the development and maturation of new neuronal cells, between neurologically healthy subjects and those with AD. These findings were significantly different up to the 9^thdecade of life with unaffected individuals showing continued evidence of neurogenesis, and those with AD showing progressive decline in the production and maturity of new neuronal cells.

WHY IT MATTERS. Demonstrating a decline in neurogenesis in AD may open a potential new avenue for therapeutic interventions for the disease. This study offers evidence for the role interventions that have been shown to boost neurogenesis may play in both slowing disease progression and potentially treating AD.

THE TAKEWAY. While this finding must be confirmed on a larger scale, it offers an intriguing potential explanation for the positive impact shown elsewhere between behaviors associated with both decreased dementia risk and improving daily well-being in persons living with dementia. individuals concerned about their dementia risk and those living with dementia may benefit from engaging robustly in the lifestyle interventions shown to support neurogenesis, including physical activity, intellectual engagement, and social interactions.

Moreno-Jiménez EP, Flor-García M, Terreros-Roncal J et al. Adult hippocampal neurogenesis is abundant in neurologically healthy subjects and drops sharply in patients with Alzheimer’s disease. Nat Med. 2019 Apr;25(4):554-560. doi:10.1038/s41591-019-0375-9

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