1. Memory in Elders: Food for Thought Summary and Comment by Jonathan Silver, MD Published in Journal Watch Psychiatry March 9, 2009Journal Watch Psychiatry Education doesn't protect against memory loss, but eating less helps. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

2. Covering Wilson RS et al. Educational attainment and cognitive decline in old age. Neurology 2009 Feb 3; 72:460. Witte AV et al. Caloric restriction improves memory in elderly humans. Proc Natl Acad Sci U S A 2009 Jan 27; 106:1255. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

3. Background Two new studies look at preventing memory decline in elders. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

4. The Research The theory of cognitive reserve posits that having more intellectual capability enables one to better withstand an insult to the brain, whether from traumatic injury or dementia. Greater educational attainment has also been associated with lower risks for dementia. To learn whether educational attainment influences the rate of cognitive decline, researchers analyzed data on 6533 individuals (mean baseline age, 72; mean duration of formal education, 12.2 years) who underwent cognition tests every 3 years (maximum, 14 years). Overall, cognition declined at a gradually accelerating rate. More schooling was associated with higher baseline cognition but did not affect the rate of decline. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

5. The Research In an analysis excluding individuals with baseline cognitive impairment, greater education was associated with slightly less rapid decline early in follow-up, but with faster decline later. Findings did not vary by race. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

6. The Research Gingko biloba clearly does not prevent dementia. Might other interventions work — e.g., high intake of dietary unsaturated fatty acids (UFA) or, as in animals, caloric restriction (CR)? This research group randomized 50 healthy elders (mean age, 60; mean body-mass index, 28 kg/m2; 29 women) to CR by 30%, to UFA intake increased by 20%, or to no dietary change (controls). Adherence to diet was confirmed by nutritional diary. At 3 months, BMI, weight, fasting insulin levels, and high-sensitive C-reactive protein (CRP) levels decreased in the CR group, but not in the other two groups. Verbal memory significantly improved in the CR group (by 20%), but not in the UFA or control groups. Among the most adherent CR subjects (weight loss, >2 kg), decreased fasting insulin and CRP levels correlated significantly with improved memory. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

7. Comment Although education does not protect against cognitive decline, it does delay the presentation of dementia. Then, when dementia is clinically apparent, it takes the typical progressive course. Patients in the second study were, on average, slightly overweight. Still, CR had impressive effects: A 20% improvement in verbal memory might be enough for FDA approval of a medication for cognitive enhancement. Regarding the findings with insulin and CRP levels, other researchers have linked diabetes to worse cognition. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

8. Comment Questions remain: Would only elders benefit from CR? Does this finding hold for all types of diets? Could CR mitigate cognitive problems arising from traumatic injury or neurological disorders? Clinicians should counsel their patients on the importance of diet and weight control, and that it may not only help their heart, it may help their brain. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

9. About Journal Watch Journal Watch helps physicians and allied heath professionals save time and stay informed by providing brief, clearly written, clinically focused perspectives on the medical developments that affect practice. Journal Watch is an independent, trustworthy source, from the publishers of the New England Journal of Medicine. These slides were derived from Journal Watch Psychiatry.Journal Watch Psychiatry The best way to stay informed with Journal Watch, is through our alerts. To sign up, visit the My Alerts page.My Alerts page CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society