Cognitive functions decline with advancing age, specifically so-called executive functions, which are higher cognitive functions that include working memory, inhibition, and cognitive flexibility.

The Healthy Ageing study is looking for healthy volunteers over the age of 60 without a dementia diagnosis to investigate whether training of these functions in combination with electrical brain stimulation can improve cognition and whether such improvements are long lasting.

It is hoped the research will help in the future to tailor cognitive training strategies for the healthy ageing population with the aim of preventing cognitive decline and helping to develop treatment strategies for people with first signs of cognitive decline that are at a higher risk of developing dementia.

Katy Brem

Anna-Katharine Brem

Anna-Katharine Brem is the Chief Investigator for the study. She fills us in with more detail.

“The current study is a study with healthy, older people who are over 60 years old, and we are looking at how cognitive training in combination with brain stimulation can improve cognitive functions.”

What is meant by ‘brain stimulation’?

It’s non-invasive, electrical stimulation, which means that we apply a very low painless current to the brain. The current is delivered through electrodes that are attached to participants’ heads with the help of a cap. Some of the electrodes are used for stimulation and the rest of the electrodes are used for EEG acquisition (recording of brain activity).

EEGNHSchoicesv2The stimulation is a shorter period of time then the actual training, so after the end of stimulation, we can continue to collect EEG data. We record brain activity with EEG as this gives us information about which physiological processes are important for cognitive changes to take place. Furthermore, such changes might show us who can profit most from such an intervention.

What kind of brain training is involved?

trainingactivityIt is training higher cognitive functions such as working memory (i.e. the ability to maintain and manipulate information), inhibition and cognitive flexibility at the same time. The training integrates different functions, as this is thought to be closer to everyday tasks.

What’s the main aim of the study?

The main aim is to improve cognitive functions not only through training alone, but we hope to enhance training gains even more and over a longer time period by combining training with brain stimulation. The idea behind this combination is that if you do these kinds of training tasks by themselves, certain brain areas are activated, particularly in the frontal areas of the brain. This activation is produced internally by our brain when doing the training. We hope to support this activation by additionally stimulating the same areas with non-invasive brain stimulation. The stimulation therefore supports the brain in its natural activity pattern.

So it’s keeping your brain healthy?

MRi brain scan imageKeeping your brain active is just as important as keeping the rest of your body active. The motto is: “Use it or loose it”! Whenever we challenge our brains, it builds new connections between brain cells and improves and maintains existing connections. This helps different brain areas to communicate more efficiently with each other. So the idea behind brain training is that the brain remains fit. Combining brain stimulation with the training is thought to enhance these processes. You can compare this approach with training your muscles in the gym. Our training is 30 minutes long and consists of short training blocks that are preceded by instructions for each task.

What do you hope the outcome of the study will be?

The aim is that we can improve the brain’s functions. But we also hope that these improvements, if we find any, will last for a while. To investigate this, we do a follow-up one month later. As the training involves quite a bit of time investment, it is important that the benefits last for some time, otherwise it is not worth investing time and effort into it. Quite a few studies have shown that long-term changes can be achieved, at least in young people, and of course, we hope that this is also the case in older healthy people.

Can this training also be used for people with dementia?

Going forward, we would like to use this combined training and stimulation approach for people with first signs of cognitive decline that are at a higher risk of developing dementia. We hope that we can prevent cognitive decline or at least postpone it a little bit to improve quality of life for a period of time. Eventually, we would also like to explore whether this approach could be useful for people with dementia. A few studies already reported promising results, but more work is needed.

I have previously done work with people with Alzheimer’s,  where I combined cognitive training with transcranial magnetic stimulation (TMS), which is another noninvasive brain stimulation method. In that study we administered 6 weeks of daily training together with brain stimulation. We found improvements in addition to the medication effects and participants improved significantly on clinical scales. So that was extremely encouraging. For future studies I am interested in using electrical stimulation instead of TMS, because it is easier and cheaper to use, and in the future, could hopefully be used at home.


Eligibility

Healthy participants over 60 years old in the Oxford area.

Participant involvement

Participants visit Oxford University initially for a pre-test. This constitutes 2 ½ hours of cognitive testing; which is the baseline for further testing. Participants then visit the university for 5 consecutive visits of brain training and brain stimulation. These are usually 1 ½ hour visits, with 30 minutes of training itself. The training comprises short blocks of training, with new instructions given for each new activity.

Following the 5 days of training and stimulation, participants visit the university for a post-test. This is the same 2 ½ hour cognitive testing as the pre-test to re-evaluate the cognitive functions to assess whether there was a change. Follow-up testing is then completed one month later to see whether any improvements have remained.


About the researcher

Originally a Clinical Neuropsychologist, Katy worked with people who had experienced strokes or traumatic brain injuries, or people with chronic conditions such as Parkinson’s disease or Multiple Sclerosis. Working in a rehabilitation unit, she was responsible for cognitive testing, cognitive rehabilitation, and reintegration into work life.

“Cognitive rehabilitation is something that is not very common in the UK, but in Switzerland, where I worked previously, and Germany, it is a bit different. After a stroke, for example, people are assigned to go to a rehab unit, where they undergo an integrative and tailored rehabilitation programme, that may include physical therapy, occupational therapy, speech and language therapy, and cognitive rehabilitation. Cognitive rehabilitation uses computerised cognitive training programmes for people with cognitive impairment. With my research I would like to contribute in improving the outcomes of existing cognitive rehabilitation approaches and explore new means, such as the combination of training with brain stimulation. The aim is to not only improve cognitive functions, but to reach higher functional levels within a shorter time period. Given the pressure on public health institutions to reduce costs, a successful outcome of this research could help improve patient-centred care and reduce costs.”


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