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Notepad A tool to keep notes and your questions to the health professional
Close the notepadYour options according to your priorities
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Watchful Waiting
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Learn more about the studies
Studies descriptionStudies and references
Roberts et al. [2014]. Neurology, 82 (4), 317-325.
Design : Prospective cohort study; Participants: Individuals aged 70 years old or more; Follow-up duration: 5 years.
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Studies descriptionStudies and references
Kueider et al. [2012]. PloS One : 7 : pages e40588.
Design : Systematic literature review including 38 experimental studies ; Participants : 3,205 individuals aged 55 years old or more, presenting with mild cognitive impairment; Intervention : Computer-based cognitive training during 2-68 weeks, and from 20-120 minutes a day, depending on the study.
El-Khoury et al. [2013]. BMJ 2013, 347:f6234.
Design: Systematic review of 17 randomised controlled trials; Participants : 4 305 older people aged 60 years and more living at home; Intervention : Physical activity (eg. Tai chi, balance exercices, strength exercices) with the aim of preventing falls.
Russ et al. [2012]. Cochrane Database Syst Rev 9 : Cd009132.
Design : Systematic literature review including 9 randomized trials; Participants : 5,149 individuals aged 65 years old or more, presenting mild cognitive impairment; Intervention : Cholinesterase inhibitors. Length of follow-up: 24 weeks to 4 years.
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Studies descriptionStudies and references
Martin et al. [2011]. Cochrane Database Syst Rev 1: pages CD006220.
Design : Systematic literature review of 36 randomized trials, including 3 about people living with mild cognitive impairements; Participants: 2,229 people aged above 60 years, and presenting mild cognitive impairments; Intervention: Cognitive training; Follow-up duration: 1.5 to 9 months.
Hill et al. [2016]. Am J Psychiatry: Nov 14: pages appiajp201616030360.
Design: Systematic literature review including 11 randomized trials; Participants : 686 individuals aged 60 years old or more, presenting with mild cognitive impairment; Intervention : Computer-based cognitive-training; Length of follow-up: 8-48 weeks.
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Studies descriptionStudies and references
Roberts et al. [2010]. Neurology 5 : pages 425-431.
Design: Cross-sectional survey; Participants : 420 American neuropsychologists.
Kaduszkiewicz et al. [2014]. Ann Fam Med 2 : pages 158-165.
Design : Prospective cohort study, on the factors predicting progression of cognitive decline; Participants : 357 individuals aged 75 years old or more; Length of follow-up: 3 years.
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Brain Exercises
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this option -
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Studies description
Mental capacities improve for... 33% of older people
18% of older adults
15% of older adults
With Without Impact Studies and referencesJeong et al. [2016]. Psychother Psychosom 85: pages 198-207.
Design: Randomized trial in 3 experimental groups, i.e., group-based cognitive intervention, home-based cognitive intervention, and the control group; Participants: 293 persons age 50 to 85 with mild cognitive impairment: Targeted intervention for this Decision box: Home-based individual cognitive training 5 times a week or group-based cognitive training twice a week for 12 weeks; Follow-up: 6 months.
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Studies description
Working memory improves for... 78% of older adults
31% of older adults
47% of older adults
With Without Impact Studies and referencesMartin et al. [2011]. Cochrane Database Syst Rev 1: pages CD006220.
Design : Systematic literature review of 36 randomized trials, including 3 about people living with mild cognitive impairments; Participants: 2,229 people aged above 60 years, and presenting mild cognitive impairment; Intervention : Cognitive training; Follow-up duration: 1.5 to 9 months.
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Learn more about the studies
Studies descriptionStudies and references
Martin et al. [2011]. Cochrane Database Syst Rev 1: pages CD006220.
Design : Systematic literature review of 36 randomized trials, including 3 about people living with mild cognitive impairments; Participants: 2,229 people aged above 60 years, and presenting mild cognitive impairment; Intervention : Cognitive training; Follow-up duration: 1.5 to 9 months.
Buschert et al. [2011]. J Alzheimers Dis 25 : 679-94.
Buschert et al. [2011]. J Alzheimers Dis 25 : 679-94. Design : Randomized trial; Participants : 43 people aged 50 years old or more presenting mild cognitive impairment or Alzheimer's disease (only the results pertaining to MCI are reported in this Decision Box); Intervention : Group-based cognitive training during 6 months (20 sessions of 2 hours each); Follow-up: 1-4 weeks.
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Learn more about the studies
Studies descriptionStudies and references
Gates et al. [2011], BMC Geriatrics 11.
Design : Systematic literature review including 10 randomized trials; Participants : 305 individuals aged 65 years old or more, presenting mild cognitive impairment; Intervention : Cognitive training; Length of follow-up: 3 to 6 months.
Bahar-Fuchs et al. [2013], Cochrane Database Syst Rev 6 : pages CD003260.
Design : Systematic literature review including 11 randomized trials; Participants : 675 individuals presenting with Alzheimer's disease or vascular dementia; Intervention : Cognitive training; Length of follow-up: 2-9 months.
Finn et al. [2011]. Brain impairment 12: pages 187-199.
Design : Randomized pilot study; Participants : 25 individuals aged 60 years old or more, presenting with mild cognitive impairment; Intervention : Computer-based cognitive training (30 sessions within 11 weeks); Length of follow-up : Measures were taken right after the intervention.
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Learn more about the studies
Studies descriptionStudies and references
Kueider et al. [2012]. PloS One : 7 : pages e40588.
Design : Systematic literature review including 38 experimental studies ; Participants : 3,205 individuals aged 55 years old or more, presenting with mild cognitive impairment; Intervention : Computer-based cognitive training during 2-68 weeks, and from 20-120 minutes a day, depending on the study.
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Brain Exercises on the Computer
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this option -
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Studies description
Mental capacities improve for... 56% of older adults
37% of older adults
19% of older adults
With Without Impact Studies and referencesMeta-analysis completed by the Decision Box team, based on the study of Hill et al. [2016]. Am J Psychiatry: Nov 14.
Design: Systematic literature review including 11 randomized trials; Participants : 686 individuals aged 60 years old or more, presenting with mild cognitive impairment; Intervention : Computer-based cognitive-training; Length of follow-up: 8-48 weeks.
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Learn more about the studies
Studies descriptionStudies and references
Klimova B. Computer-Based Cognitive Training in Aging. Frontiers in Aging Neuroscience. 2016;8:313.
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Physical Activity Tailored to Older Adults
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this option -
Learn more about the studies
Studies descriptionStudies and references
Strohle et al. [2015]. Am J Geriatr Psychiatry 23 : 1234-49.
Design : Systematic review of 6 randomized controlled trials; Participants : 6 443 people aged above 50 years, and presenting with mild cognitive impairment; Intervention : donepezil, galantamine, memantine, rivastigmine, Ginkgo Biloba, or physical activity during 24 weeks; Follow-up duration: variable depending on the study.
- reduced risk of chronic disease and premature death
- functional independence and mobility
- improved fitness and bone health
- reduced risk of cardiovascular disease
- improved mood and self-esteem
- reduced risk of falls
- improved sleep.
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Learn more about the studies
Studies descriptionStudies and references
Nelson et al. [2007]. Med Sci Sports Exerc;39(8):1435-45.
Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association.
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Learn more about the studies
Studies descriptionStudies and references
El-Khoury et al. [2013]. BMJ 2013, 347:f6234.
Design: Systematic review of 17 randomised controlled trials; Participants : 4 305 older people aged 60 years and more living at home; Intervention : Physical activity (eg. Tai chi, balance exercices, strength exercices) with the aim of preventing falls.
Liu, C.-j., & Latham, N. K. [2009]. Cochrane Database Syst Rev(3).
Design: Systematic review of 121 randomised controlled trials; Participants: 6700 older people aged 60 years and more; Intervention: Progressive resistance strength training; Follow-up duration: Varied from the end of the intervention to 1 year.
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Learn more about the studies
Studies descriptionStudies and references
Strohle et al. [2015]. Am J Geriatr Psychiatry 23 : 1234-49.
Design : Systematic review of 6 randomized controlled trials; Participants : 6,443 people aged above 50 years, and presenting with mild cognitive impairment; Intervention : donepezil, galantamine, memantine, rivastigmine, Ginkgo Biloba, or physical activity during 24 weeks; Follow-up duration: variable depending on the study.
Watchful Waiting
Consists of keeping an eye on the evolution of your mental capacities without undertaking treatment or changing your lifestyle.
Among people who make changes to maintain or improve their mental capacities, a certain proportion will nonetheless develop more severe thinking or memory problems. They may be disappointed that the steps they took did not allow them to reach their goals.
Of 100 older adults with mild thinking or memory problems, approximately 20 will see their mental capacities improve on their own.
All the available options to improve mental capacities cause some inconveniences. These inconveniences are reviewed in the previous pages of this document. People who do not undertake any new treatment or change their lifestyle will not experience any of these inconveniences.
People who choose watchful waiting without making any changes are less likely to improve their mental capacities than those who do mental exercises or physical activity.
Failing to make changes to one's lifestyle or undertake treatment to prevent loss of mental capacities can lead to feelings of helplessness and distress.
Brain Exercises
Consists of doing activities and games that stimulate mental capacities, e.g., reading, crosswords, sudoku. These activities can either be done individually, or in a group under the supervision of a professional.
For every 100 older adults with mild thinking or memory problems who do brain exercises, 15 improve their mental capacities due to the exercises.
For every 100 older adults with mild thinking or memory problems who do brain exercises, 47 improve their working memory due to the exercises.
Current research does not show any effect of brain exercises on long-term memory or executive function of older adults with mild thinking or memory problems.
No negative side-effects of brain exercises done individually have been reported among older adults with thinking or memory problems.
Older adults may feel some anxiety to do well if brain exercises are done in a group.
Brain exercises can be done individually at home at limited costs. Supervised brain exercises can be accessed through local community health and services centers, or hospitals, but they require an external referral from an attending physician. There may be a waiting list to access these services. Private clinics allow easier access. In private memory clinics, costs are about $155 per hour.
Brain Exercises on the Computer
Consists of using the computer to do activities and games to stimulate mental capacities , e.g. video games. The computer can provide real-time performance feedback and can adjust to the person's ability level.
For every 100 older adults with mild thinking or memory problems who do computer-assisted brain exercises, 19 improve their mental capacities due to the exercises.
When they start doing computer-based brain exercises, some older people feel anxious about using an unfamiliar technology.
Computer-based brain exercises require access to a computer. The programs also need to be purchased: the costs are variable depending on the program.
Physical Activity Tailored to Older Adults
Physical activity programs can be adapted to older adults. They may include walking, water exercises, balance or flexibility exercises, and weight training. They can be done individually at home or with other people. The activities should produce a sensation of warmth, and make you breathe harder. You should be able to hold a conversation while exercising but be too short of breath to sing.
Older adults with mild thinking or memory problems who partake in regular physical activity improve their mental capacities compared to older adults who don't.
Regular physical activity has several additional benefits, for example:
Some older adults feel temporary muscle soreness after exercising. They can also experience muscle, bone or joint problems (for example minor strains, tendonitis, exacerbation of osteoarthritis, or joint pain).
In general, to experience positive impacts from physical activity, people must be physically active at least 3 weeks, either for 20 minutes 3 times a week, or for 2 hours once a week. Whatever the duration and frequency of the exercise, it takes time.
© Laval University, 2018 all rights reserved. - Conflicts of interest - Credits - References
Downgraded because of risk of bias.
Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.