Can mindfulness-based interventions influence cognitive functioning in older adults? A review and considerations for future research

Mindfulness enhances cognitive functioning: a meta-analysis of 111 randomized controlled trials

BACKGROUND

Currently no comprehensive meta-analysis of MBI efficacy on global and unique cognitive subdomains exist.

METHOD

Examined the effects of MBIs on global cognition and 15 cognitive subdomains. Inclusion criteria: meditation naïve participants; randomized controlled trial; outcome included one objective or subjective cognitive functioning measure; primary focus was teaching mindfulness skills. Exclusion criteria: inadequate data; one-session ; control condition contained any MBI component. Robust variance estimation and moderator analyses controlling for presence of treatment fidelity were conducted.

RESULTS

One-hundred-and-eleven RCTs (n = 9,538) met eligibility criteria. MBIs had small-to-moderate significant effects on global cognition, executive attention, working memory accuracy, inhibition accuracy, shifting accuracy, sustained attention, and subjective cognitive functioning (vs. waitlist/no-treatment, g = 0.257-0.643; vs. active controls, g = 0.192-0.394). MBIs did not impact executive functioning (EF) latency indices, verbal fluency, processing speed, episodic memory, and cognitive error. Treatment effects were stronger for those with elevated psychiatric symptoms vs. healthy controls, and medical samples, studies with complete-case (vs. intention-to-treat) analysis, face-to-face (vs. self-guided) delivery, and non-standard (vs. standard MBI).

CONCLUSION

MBIs consistently yielded small-to-moderate yet practically meaningful effect sizes on global cognition and six cognitive subdomains that captured accuracy vs. latency-based indices of EF and sustained accuracy.

Effects of Mindfulness-Based Elder Care (MBEC) on symptoms of depression and anxiety and spiritual well-being of institutionalized seniors with disabilities: a randomized controlled trial

BACKGROUND

Despite the need to incorporate seniors from various settings into mindfulness-based empirical research, issues of geriatric frailties and non-compliance remain. This study aimed to evaluate the effects of a mindfulness-based elder care (MBEC) program on mental health and spiritual well-being among seniors with disabilities in long-term care residential settings.

METHODS

This single-blind, randomized controlled trial (RCT) randomly assigned seventy-seven participants into an MBEC group or control group of an eight-week MBEC program. Participants were assessed every four weeks at baseline (T0), mid-intervention (T1), post-intervention (T2) and follow-up (T3) using the Geriatric Depression Scale Short Form (GDS-SF), the State-Trait Anxiety Inventory (STAI) and the Spiritual Well-Being Scale (SWBS), respectively.

RESULTS

Linear mixed model (LMM) showed that MBEC participants' mental health improved significantly after completing the intervention; compared with controls, the MBEC group exhibited significantly lower anxiety (state-anxiety at T2; trait-anxiety at T2 and T3) and fewer depressive symptoms. Spiritual well-being was also significantly enhanced compared to that in the control group.

CONCLUSIONS

MBEC has positive effects on both mental health and spiritual well-being outcomes among seniors with disabilities. In long-term care facilities, seniors with abilities have the potential to adhere to and engage in activities of a mindfulness-based intervention. This low risk, easily accessible, and effective 8-week program is recommended to be integrated into regular long-term care institutional routines.

TRIAL REGISTRATION

This study was registered with Clinical Trial Registry (ClinicalTrials.gov - U.S. National Library of Medicine #NCT05123261. Retrospectively registered on 07/04/2021.). The CONSORT 2010 guidelines were used in this study for properly reporting how the randomized trial was conducted.

Meditation and Cognitive Outcomes: A Longitudinal Analysis Using Data From the Health and Retirement Study 2000-2016

Objective

We aimed to assess the association between meditation practice and cognitive function over time among middle-aged and older adults.

Method

We included Health and Retirement Study (HRS) participants assessed for meditation practice in the year 2000 as part of the HRS alternative medicine module (n = 1,160) and were followed up for outcomes over 2000-2016 period. We examined the association between meditation ≥ twice a week vs none/less frequent practice and changes in the outcomes of recall, global cognitive function, and quantitative reasoning using generalized linear regression models. Stratified analyses among persons with/without self-reported baseline depressive symptoms were conducted to assess the link between meditation and cognitive outcomes.

Results

Among our full study sample, meditation ≥ twice a week was not significantly associated with total recall [β ; 95% CI: -0.97, 0.57; p = 0.61], global cognitive function [β ; 95% CI: -1.01, 1.12; p = 0.92], and quantitative reasoning [β ; 95% CI: -31.27, 8.32; p = 0.26]. However, among those who did not have self-reported depressive symptoms at baseline, meditation ≥ twice a week was associated with improvement in cognitive outcomes such as total recall [β ; 95% CI: 0.03, 0.18; p = 0.01] and global cognitive function [β ; 95% CI: 0.05, 0.40; p = 0.01] over time.

Conclusions

Frequent meditation practice might have a protective effect on cognitive outcomes over time, but this protection could be limited to those without self-reported baseline depressive symptoms. Future studies could incorporate more precise meditation practice assessment, investigate the effect of meditation on cognitive outcomes over time, and include more rigorous study designs with randomized group assignment.

Pre-registration

This study is not preregistered.

Three potential neurovascular pathways driving the benefits of mindfulness meditation for older adults

Mindfulness meditation has been shown to be beneficial for a range of different health conditions, impacts brain function and structure relatively quickly, and has shown promise with aging samples. Functional magnetic resonance imaging metrics provide insight into neurovascular health which plays a key role in both normal and pathological aging processes. Experimental mindfulness meditation studies that included functional magnetic resonance metrics as an outcome measure may point to potential neurovascular mechanisms of action relevant for aging adults that have not yet been previously examined. We first review the resting-state magnetic resonance studies conducted in exclusively older adult age samples. Findings from older adult-only samples are then used to frame the findings of task magnetic resonance imaging studies conducted in both clinical and healthy adult samples. Based on the resting-state studies in older adults and the task magnetic resonance studies in adult samples, we propose three potential mechanisms by which mindfulness meditation may offer a neurovascular therapeutic benefit for older adults: (1) a direct neurovascular mechanism via increased resting-state cerebral blood flow; (2) an indirect anti-neuroinflammatory mechanism via increased functional connectivity within the default mode network, and (3) a top-down control mechanism that likely reflects both a direct and an indirect neurovascular pathway.

Association of nonpharmacological interventions for cognitive function in older adults with mild cognitive impairment: a systematic review and network meta-analysis

BACKGROUND

Understanding the effectiveness of nonpharmacological interventions to improve cognitive function in older adults with MCI and identifying the best intervention may help inform ideas for future RCT studies and clinical decision-making.

AIM

The main focus of this study was to assess the comparative effectiveness of nonpharmacological interventions on cognitive function in older adults with MCI and to rank the interventions.

METHODS

RCT studies until September 2022 were searched from six databases, including PubMed, the Cochrane Library, Embase, Web of Science, PsycINFO and CINAHL. The risk of bias in eligible trials was evaluated using the Cochrane Risk of Bias tool. Both pairwise and network meta-analyses were used, and pooled effect sizes were reported using SMD and the corresponding 95% confidence intervals.

RESULTS

A total of 28 RCT studies were included in this study, pooling 18 categories of nonpharmacological interventions. MBE (mind-body exercise) (SMD (standard mean difference): 0.24, 95% CI: 0.08-0.41, P = 0.004), DTE (dual-task exercise) (SMD: 0.61, 95% CI: 0.09-1.13, P = 0.02), PE (physical exercise) (SMD: 0.58, 95% CI: 0.04-1.12, P = 0.03) may be effective in improving cognitive function in older adults with MCI. Acupressure + CT (cognitive training) was the top-ranked intervention among all interventions. No greater benefits of MA (mindful awareness) on cognitive function were found.

CONCLUSIONS

Overall, nonpharmacological interventions significantly improved cognitive function in older adults with MCI. Acupressure + CT(cognitive training) was the most effective intervention for managing cognitive impairment. Future studies with high quality and large sample size RCT studies are needed to confirm our results.

A Randomized, Controlled Pilot Study of Mindfulness-Based Stress Reduction in Healthy Older Adults

OBJECTIVES

As the aging population increases, it is critical to find ways to sustain older adults' health and well-being. Mindfulness-Based Stress Reduction (MBSR) may be one approach, but its effects are difficult to discern because few studies have conducted randomized controlled trials with an active control group and blinded examiners. We begin to address these gaps with a pilot study examining the feasibility of conducting an MBSR intervention with an active control condition in healthy older adults.

METHODS

Participants were randomly assigned to one of two classes, MBSR or Brain Health education. Classes were matched for time, format, and instructor. The study examined acceptability, practicality, implementation, and preliminary efficacy using a range of participant questionnaires, instructor ratings, cognitive measures assessed by blinded examiners, and attendance.

RESULTS

Both MBSR and the Brain Health class evidenced high rates of recruitment, participant satisfaction, and retention. Implementation procedures were successful, and preliminary results revealed similar levels of efficacy across both classes.

CONCLUSIONS

This study demonstrates the feasibility of an MBSR intervention in healthy older adults.

CLINICAL IMPLICATIONS

MBSR, with its focus on improving stress and self-awareness, has the potential to be an approach that can improve aging adults' health and coping skills.

Facilitating Mindfulness-Based Interventions for Anxiety in Older People: History, Effectiveness, and Future Possibilities

The origins of mindfulness go back some 25 centuries to Eastern teachings, including Buddhism and Hinduism. Mindfulness-based interventions gained credence in Western mental health settings in the late 1970s through the work of medical researcher Kabat-Zinn, whose interest in Eastern meditation led him to develop a program for stress reduction. Since then, mindfulness-based interventions have been utilized for various populations, including older people with anxiety. Group mindfulness-based interventions have demonstrated benefits for older people with anxiety living in residential aged care and the community. In primary care settings, innovative delivery models for group mindfulness-based interventions could be facilitated by nurses to support older people with anxiety to age in place with dignity. The benefits of mindfulness-based interventions suggest the value of integrating ancient Eastern techniques with modern Western strategies to achieve better health outcomes for older people with mental health concerns.

The Effects of Mindfulness Interventions on Fibromyalgia in Adults aged 65 and Older: A Window to Effective Therapy

Pain usually receives insufficient attention by individuals due to the misconception that pain is a natural consequence of aging. For persons aged 65 and older, a disease requiring further research is fibromyalgia, characterized by chronic pain without clear pathology. Mind-body therapies like mindfulness are beneficial for this population as they affect psychological and biological aspects of pain. These therapies emphasize a nonjudgmental acceptance of thoughts and attention to the experience without attempting to resist or change them. Despite the potential benefits of mindfulness interventions for persons with fibromyalgia aged 65 and older, only few studies have examined the effects of these therapies, yielding conflicting findings. Importantly, no study has yet to be conducted exclusively on this population. This comprehensive review examined existing literature focusing on the effects of mindfulness-based interventions on the physical and mental well-being of persons with fibromyalgia aged 65 and older. It highlights the need for further research on the relationship between mindfulness, fibromyalgia, and gerontology, calling for a standard protocol of intervention.

Efficacy of mindfulness-based interventions in cognitive function in the elderly people: a systematic review and meta-analysis

OBJECTIVES

The main objective was to determine the efficacy of Mindfulness-Based Interventions in improving the cognitive function of older adults (healthy adults or adults with mild cognitive impairment).

METHODS

A search was conducted in 4 databases. The effect sizes were extracted to perform a meta-analysis of the cognitive functions, as well as subgroup meta-analyses according to each domain: attention, memory and executive function.

RESULTS

The meta-analysis of cognitive functions showed an average effect size of g = .07, 95% CI [-.013; .160], p = .09, with the following values for each domain: g = .02, 95% CI [-.167; .204] for attention; g = .06, 95% CI [-.148; .262] for memory; and g = .14, 95% CI [-.042; .329] for executive function.

CONCLUSION

The MBI had a null global effect. The attention and memory results showed a null effect size and a small effect size was found for executive function. The methodological quality of the studies, however, was poor, so the results need to be interpreted with caution.

Mindfulness-based cognitive therapy vs. a health enhancement program for the treatment of late-life depression: Study protocol for a multi-site randomized controlled trial

Background

Late-life depression (LLD) affects up to 18% of older adults and has been linked to elevated dementia risk. Mindfulness-based cognitive therapy (MBCT) holds promise for treating symptoms of depression and ameliorating cognitive deficits in older adults. While preliminary findings are promising, a definitive RCT investigating its effects on late life depression and cognition have not yet been conducted. We present a protocol describing a multi-site blinded randomized controlled trial, comparing the effects of MBCT and of an active control, a Health Enhancement Program (HEP), on depressive symptoms, executive functioning, and brain biomarkers of LLD, among several other exploratory outcomes.

Methods

Two-hundred and thirteen (n = 213) patients with LLD will be recruited at various centers in Montreal, QC, Canada. Participants will undergo stratified randomization to either MBCT or HEP intervention groups. We will assess changes in (1) depression severity using the Hamilton Depression Rating Scale (HAM-D17), (2) processing speed and executive functioning, (3) brain biomarkers of LLD (hippocampal volume, default network resting-state functional connectivity and executive network resting-state functional connectivity), and (4) other exploratory physiological and mood-based measures, at baseline (0 weeks), post intervention (8 weeks), and 26 weeks after baseline.

Discussion

The proposed study will assess the clinical potential of MBCT to improve symptoms of depression, as well as examine its impact on cognitive impairments and neurobiological markers, and thus inform its use as a promising adjunct in the treatment of LLD.

Clinical trial registration

www.ClinicalTrials.gov, identifier: NCT05366088.

The Effects of Mindfulness-Based Interventions on Couples in Later Life. A Mixed Methods Systematic Review

OBJECTIVES

To review current quantitative and qualitative evidence on the physical and mental health outcomes and participant experiences following mindfulness-based interventions (MBIs) for couples over the age of 65.

METHODS

The search strategy used PubMed; Web of Science; PsycInfo; The Dementia Evidence Toolkit; NIH RePORTER; NIH Clinical Trials.gov and Scopus databases and followed the JBI framework.

RESULTS

Four studies were included, of these, three were described as patient-carer dyads. Overall, the studies suggested that standardized, eight-week mindfulness interventions may be feasible for older adult independent couples and caregiving dyads, including people with cognitive decline, but the available evidence should be considered with caution.

CONCLUSIONS

Further high-quality studies investigating specific older adult dyads with sensitive and appropriate outcome measures are needed.

CLINICAL IMPLICATIONS

Whilst older adult mindfulness groups delivered to couples are feasible, conclusions about the effects of mindfulness on older adult caregiving and/or romantic couples are impossible to establish.

Cerebral Blood Flow and Brain Functional Connectivity Changes in Older Adults Participating in a Mindfulness-Based Stress Reduction Program

There is a growing interest in the potential beneficial effects of mindfulness meditation training in protecting against age-related physical, emotional, and cognitive decline. The current prospective, single-center, single-arm study investigated if functional magnetic resonance imaging-based changes in cerebral blood flow and brain functional connectivity could be observed in 11 elderly adults (mean age 79) after participation in a Mindfulness-Based Stress Reduction (MBSR) program. The results showed significantly (p < 0.05) altered cerebral blood flow and functional connectivity in the cingulate gyrus, limbic structures, and subregions of the temporal and frontal lobes, similar to findings of other meditation-related studies in younger populations. Furthermore, these changes were also associated with significant improvements in depression symptoms. This study suggests that the MBSR program can potentially modify cerebral blood flow and connectivity in this population.

Effectiveness of a mindfulness intervention for older adults to improve emotional well-being and cognitive function in a Chinese population: A randomized waitlist-controlled trial

BACKGROUND

To investigate the effect of a modified mindfulness-based stress reduction (mMBSR) program on mental well-being and cognitive function of older adults.

METHOD

Two hundred and fourty-six participants were randomly assigned to mMBSR (n = 120) group or waitlist control group which received mMBSR at 2-month (n = 123). Data collected at baseline, 2 and 4 months after recruitment.

PRIMARY OUTCOME

mental well-being: Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS).

SECONDARY OUTCOMES

Five Facet Mindfulness Questionnaire Short Form, Montreal Cognitive Assessment (MOCA), Verbal Fluency Test (VFT), international shopping list test, self-compassion scale, peace of mind scale, geriatric depression scale (GDS), and Pittsburgh sleep quality index (PSQI). In modified-intention-to-treat analysis, paired t-test for within group comparison, and ANCOVA to compare group differences at 2-months with adjustment of baseline values.

RESULTS

Most participants were female (83.7%), living with others (67.0%), and married (50.7%). No significant difference of baseline characteristics except sleep quality. At 2 months, intervention group reported better mental well-being (0.9, 95%CI: 0.1-1.8, p = 0.025) and less depressive symptoms (-1.0; 95%CI: -1.7 to -0.3, p = 0.004). Within group at 2 months, intervention group had improvement in: mental well-being (SWEMWBS: 22.5-23.4, p = 0.011), cognitive function (MOCA: 24.6-25.8, p < 0.001; VFT: 38.7-42.1, p < 0.001), depressive symptoms (GDS: 4.1-3.1, p < 0.001), and sleep quality (PSQI: 8.3-6.7, p < 0.001). All these changes, except mental well-being, were sustained at 4 months.

DISCUSSION

Attrition rate was 14% and mindfulness intervention was found to be feasible and acceptable in older adults. Major limitation of the study was the absence of an active control group to control for non-specific effect.

BDNF mediates improvement in cognitive performance after computerized cognitive training in healthy older adults

Introduction

The often‐cited mechanism linking brain‐derived neurotrophic factor (BDNF) to cognitive health has received limited experimental study. There is evidence that cognitive training, physical exercise, and mindfulness meditation may improve cognition. Here, we investigated whether improvements in cognition after these three types of structured interventions are facilitated by increases in BDNF.

Methods

A total of 144 heathy older adults completed a 5‐week intervention involving working memory/cognitive training, physical exercise, mindfulness meditation, or an active control condition. Serum BDNF levels and Digit Symbol Test (DST) performance were measured pre‐ and post‐intervention.

Results

Linear mixed models suggested that only the cognitive training group demonstrated augmentation of BDNF and DST performance relative to the control condition. Path analysis revealed that changes in BDNF mediate intervention‐related improvement in task performance. Regression analyses showed that, across all intervention conditions, increased BDNF levels were associated with increased DST scores.

Discussion

This study appears to be the first to suggest that BDNF helps mediate improvements in cognition after working memory training in healthy older adults.

Highlights

Older adults were randomized to physical activity, mindfulness, cognitive training (computerized cognitive training (CCT), or control.

CCT, but no other condition, led to increased serum brain‐derived neurotrophic factor (BDNF) levels.

CCT led to improvement on the untrained Digit Symbol Test (DST) of speed/working memory.

Path analysis: increases in BDNF mediate intervention‐related improvement on DST.

Increases in BDNF associated with improved DST across all experimental groups.

The protective effect of mindfulness and compassion meditation practices on ageing: Hypotheses, models and experimental implementation

Alzheimer's disease (AD) represents a major health and societal issue; there is no treatment to date and the pathophysiological mechanisms underlying this disease are not well understood. Yet, there is hope that AD risk factors and thus the number of AD cases can be significantly reduced by prevention measures based on lifestyle modifications as targeted by non-pharmacological preventive interventions. So far, these interventions have rarely targeted the psycho-affective risk factors related to depression, stress, anxiety, and feeling of loneliness, which are all prevalent in ageing. This paper presents the hypothesis that the regular practice of mindfulness meditation (MM) and loving-kindness and compassion meditation (LKCM) in the ageing population constitutes a lifestyle that is protective against AD. In this model, these practices can promote cognition, mental health, and well-being by strengthening attention control, metacognitive monitoring, emotion regulation and pro-social capacities. Training these capacities could reduce the risk of AD by upregulating beneficial age-related factors such as cognitive reserve, and down-regulating detrimental age-related factors, such as stress, or depression. As an illustration, we present the Medit-Ageing study (public name Silver Santé Study), an on-going European project that assesses the impact and mechanisms of non-pharmacological interventions including meditation, in the ageing population.

Protocols for cognitive enhancement. A user manual for Brain Health Services-part 5 of 6

Cognitive complaints in the absence of objective cognitive impairment, observed in patients with subjective cognitive decline (SCD), are common in old age. The first step to postpone cognitive decline is to use techniques known to improve cognition, i.e., cognitive enhancement techniques.We aimed to provide clinical recommendations to improve cognitive performance in cognitively unimpaired individuals, by using cognitive, mental, or physical training (CMPT), non-invasive brain stimulations (NIBS), drugs, or nutrients. We made a systematic review of CMPT studies based on the GRADE method rating the strength of evidence.CMPT have clinically relevant effects on cognitive and non-cognitive outcomes. The quality of evidence supporting the improvement of outcomes following a CMPT was high for metamemory; moderate for executive functions, attention, global cognition, and generalization in daily life; and low for objective memory, subjective memory, motivation, mood, and quality of life, as well as a transfer to other cognitive functions. Regarding specific interventions, CMPT based on repeated practice (e.g., video games or mindfulness, but not physical training) improved attention and executive functions significantly, while CMPT based on strategic learning significantly improved objective memory.We found encouraging evidence supporting the potential effect of NIBS in improving memory performance, and reducing the perception of self-perceived memory decline in SCD. Yet, the high heterogeneity of stimulation protocols in the different studies prevent the issuing of clear-cut recommendations for implementation in a clinical setting. No conclusive argument was found to recommend any of the main pharmacological cognitive enhancement drugs ("smart drugs", acetylcholinesterase inhibitors, memantine, antidepressant) or herbal extracts (Panax ginseng, Gingko biloba, and Bacopa monnieri) in people without cognitive impairment.Altogether, this systematic review provides evidence for CMPT to improve cognition, encouraging results for NIBS although more studies are needed, while it does not support the use of drugs or nutrients.

Mindful walking and cognition in older adults: A proof of concept study using in-lab and ambulatory cognitive measures

Mindfulness practice and walking have been linked individually to sustain cognition in older adults. This early-phase study aimed to establish proof-of-concept by evaluating whether an intervention that integrates light-intensity walking with mindfulness practices shows promising signs of improving cognition in older adults. Participants (N = 25, Mage = 72.4 ± 6.45) were community-dwelling older adults who engaged in a supervised mindful walking program over one month (8 sessions total, 2 sessions per week, 30-minute slow walking containing mindfulness skills). They completed performance-based and subjective ratings of cognitive measures in field before and after two mindful walking bouts using a smartphone app. They also completed in-lab performance-based and self-report cognitive measures at baseline and after the entire program. Controlling for demographics, potential covariates, and time trends, short-term improvements in perceived cognition and processing speed were observed from pre- to post-mindful walking sessions (i.e., 30 min) across multiple ambulatory cognitive measures (Cohen's ds range = 0.46-0.66). Longer-term improvements in processing speed and executive function were observed between baseline and end of the program (i.e., one month) across various performance-based cognitive measures (ds range = 0.43-1.28). No significant changes were observed for other cognitive domains. This early-phase study (Phase IIa) provides preliminary support that mindful walking activity is promising for sustaining cognition in older adults. Our promising findings form the building blocks of evidence needed to advance this intervention to a fully powered randomized controlled trial that examines program efficacy with a comparator. Favorable outcomes will inform the development of this lifestyle behavioral strategy for promoting healthy brain aging in late adulthood.

Do group-based mindfulness meditation programs enhance executive functioning? A systematic review and meta-analysis of the evidence

Research examining the effects of group-based mindfulness interventions on executive functioning have yielded inconsistent findings, with some reports of enhanced performance and other reports of null findings. Inconsistencies in the literature may be due to methodological differences across studies, including the type of control group employed and sample characteristics (e.g., clinical vs. non-clinical samples). The current systematic review and meta-analysis examined the effect of group-based mindfulness programs on executive functioning in persons 18+ years of age. Following the standards for systematic review, a total of 29 studies were included in the meta-analysis, of which 21 comparisons contributed to the analysis of inhibition; nine to working memory; nine to attention shifting; and four to the analysis of verbal fluency. After removing outliers, random effects models suggested a small but significant synthesized effect of group-mindfulness training on overall executive functioning (95% CI = 0.256, 0.725). Examination of executive subdomains after removing outliers suggested a small, statistically significant effect for inhibition (95% CI = 0.055, 0.387), working memory (95% CI = 0.010, 0.437), and verbal fluency (95% CI = 0.071, 1.931). No significant pooled effects were found for attention shifting. A priori subgroup analysis by randomization, type of control group, and sample cohort revealed inconsistent results. Overall, the current review suggests that the effect of group-based mindfulness training on executive functioning is not robust.

The Effect of Mindfulness-based Programs on Cognitive Function in Adults: A Systematic Review and Meta-analysis

Mindfulness-based programs (MBPs) are increasingly utilized to improve mental health. Interest in the putative effects of MBPs on cognitive function is also growing. This is the first meta-analysis of objective cognitive outcomes across multiple domains from randomized MBP studies of adults. Seven databases were systematically searched to January 2020. Fifty-six unique studies (n = 2,931) were included, of which 45 (n = 2,238) were synthesized using robust variance estimation meta-analysis. Meta-regression and subgroup analyses evaluated moderators. Pooling data across cognitive domains, the summary effect size for all studies favored MBPs over comparators and was small in magnitude (g = 0.15; [0.05, 0.24]). Across subgroup analyses of individual cognitive domains/subdomains, MBPs outperformed comparators for executive function (g = 0.15; [0.02, 0.27]) and working memory outcomes (g = 0.23; [0.11, 0.36]) only. Subgroup analyses identified significant effects for studies of non-clinical samples, as well as for adults aged over 60. Across all studies, MBPs outperformed inactive, but not active comparators. Limitations include the primarily unclear within-study risk of bias (only a minority of studies were considered low risk), and that statistical constraints rendered some p-values unreliable. Together, results partially corroborate the hypothesized link between mindfulness practices and cognitive performance. This review was registered with PROSPERO [CRD42018100904].

Exploring Individuals' Willingness to Engage in Interventions to Improve Cognitive Health and Prolong Late-Life Independence: An Extension of Harrell, Kmetz, and Boot (2019)

Interventions designed to preserve cognition have become increasingly popular as our population ages. In exploring intervention effectiveness, however, researchers have often overlooked a potentially important factor: willingness to engage. Recent findings from Harrell, Kmetz, Boot (2019) showed that perceived cognitive deficits and perceived training efficacy were significant predictors of willingness to engage in a brain training intervention designed to preserve cognition. However, they did not explore another potentially important factor: anticipated intervention enjoyment. In the current study, younger, middle-aged, and older adults (N = 169) completed surveys that assessed their willingness to engage in different types of training (aerobic exercise, brain, meditation) to improve cognition and the extent that factors such as health, perceived cognitive deficits, belief in training efficacy, and personality contributed to willingness to engage. Participants reported being least willing to engage in meditation training and meditation training was rated by participants as the least likely to improve cognition. Anticipated training enjoyment was the overriding factor that predicted willingness. These findings provide additional insights into why, and for how long, individuals may be willing to engage in training to prolong independence and have implications for understanding intervention adoption and adherence.

Mindfulness and Cognitive Training Interventions in Mild Cognitive Impairment: Impact on Cognition and Mood

With the lack of disease-modifying pharmacologic treatments for mild cognitive impairment and dementia, there has been an increasing clinical and research focus on nonpharmacological interventions for these disorders. Many treatment approaches, such as mindfulness and cognitive training, aim to mitigate or delay cognitive decline, particularly in early disease stages, while also offering potential benefits for mood and quality of life. In this review, we highlight the potential of mindfulness and cognitive training to improve cognition and mood in mild cognitive impairment. Emerging research suggests that these approaches are feasible and safe in this population, with preliminary evidence of positive effects on aspects of cognition (attention, psychomotor function, memory, executive function), depression, and anxiety, though some findings have been unclear or limited by methodological weaknesses. Even so, mindfulness and cognitive training warrant inclusion as current treatments for adults with mild cognitive impairment, even if there is need for additional research to clarify treatment outcomes and questions related to dose, mechanisms, and transfer and longevity of treatment effects.

Protocol for a Nested Randomized Controlled Trial to Evaluate the Feasibility and Preliminary Efficacy of the Mindfulness Based Health Promotion Program on the Quality of Life of Older Adults Assisted in Primary Care-"The MBHP-Elderly Study"

Introduction: Population aging is a global phenomenon that has grown rapidly and progressively all over the world. Interventions that promote health must be studied and implemented to make the aging process be with quality of life. Depression and anxiety are the most common mental health conditions that compromise the quality of life on the elderly and it can cause damage to the autonomy and activities of daily life. Mindfulness training has been shown to improve psychological health and quality of life on adults. Studies involving Mindfulness-Based Interventions (MBIs) with older people are scarce in the literature, but they have been increasing in recent years showing promising results for healthy aging. This trial will investigate the feasibility and preliminary efficacy of an MBI on the quality of life of elderly assisted in the Primary Care.

Materials and Methods: A cohort-nested randomized controlled trial with 3 assessment points (baseline, post-intervention and 1-year follow up) will be conducted to compare a MBI program (Mindfulness-Based Health Promotion) to a cognitive stimulation control-group in a Primary Care facility. One-hundred and two older adults will be recruited from a cohort of this facility and they will be randomized and allocated into an intervention group (N = 76) and the control group (N = 76). The primary outcome evaluated will be the improvement of quality of life assessed by the WHOQOL-BREF and WHOQOL-OLD. The secondary outcomes will be cognitive function, psychological health, sleep quality, self-compassion, and religiosity. Qualitative data will be assessed by focus group and the word free evocation technique. The feasibility of the program will also be evaluated by adherence and unwanted effects questionnaires.

Discussion: This cohort-nested clinical trial will be the first mixed-methods study with 3 assessment points which will study the feasibility and preliminary efficacy of a mindfulness-based program for older people in Latin America population. If the findings of this study confirm the effectiveness of this program in this population it will be possible to consider it as intervention that might be implemented as public policy addressed to older people in healthcare systems.

Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03048708. Registered retrospectively on October 11th 2018.

Quality of life in patients with mild Alzheimer disease: the mediator role of mindfulness and spirituality

OBJECTIVES

This study examined the mediator role of mindfulness and spirituality in the relationship between psychological morbidity, awareness of the disease, functionality, social support, family satisfaction, and quality of life (QoL) in patients with mild AD.

METHOD

The sample consisted of 128 patients who answered the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R), the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), the Hospital Anxiety and Depression Scales (HADS), the Satisfaction with Social Support Scale (SSSS), the Family Satisfaction Scale (FSS), the Spiritual and Religious Attitudes in Dealing with Illness (SpREUK), the Index of Barthel, and the Quality of Life-Alzheimer's Disease (QoL-AD).

RESULTS

Mindfulness and spirituality mediated the relationship between functionality, awareness of the disease, family satisfaction and QoL. Psychological morbidity had a direct negative impact on QoL and was negatively associated with awareness of the disease, family satisfaction and social support. Mindfulness was negatively associated with spirituality and the latter was negatively associated with QoL. More social support was associated with greater awareness of the disease and family satisfaction. More functionality, awareness of the disease and family satisfaction contributed to more QoL and this relationship was mediated by mindfulness and spirituality.

CONCLUSION

Interventions directed at the promotion of the QoL of patients with mild AD should focus on the promotion of mindfulness skills in AD patients, in addition to the reduction of psychological morbidity and the promotion of functionality, awareness of the disease, family relationships and social support.

Effect and Acceptability of Mindfulness-Based Stress Reduction Program on Patients With Elevated Blood Pressure or Hypertension: A Meta-Analysis of Randomized Controlled Trials

The mindfulness-based stress reduction program (MBSR) may reduce blood pressure (BP) in patients with hypertension or elevated BP. However, some important parameters (such as asleep BP) have not been investigated in previous reviews, and a well-conducted meta-analysis is lacking. This meta-analysis investigates the effect and acceptability of MBSR on patients with elevated BP or hypertension. Relevant articles were searched in multiple databases, including MEDLINE, EMBASE, and APA PsycInfo. Included studies were randomized controlled trials that involved patients with an elevated BP, had a control group, and investigated the effect of MBSR. The mean office and out-of-office (including 24-hour, daytime, and asleep) systolic BP and diastolic BP, psychological outcomes (depression/anxiety/stress), and dropout rate were compared between the MBSR arm and the control arm using a random-effects model. Quality assessment was conducted based on the Cochrane risk-of-bias tool. Twelve studies were included, and only one was considered having low risk of bias. MBSR decreased the office systolic BP and diastolic BP by 6.64 and 2.47 mm Hg at postintervention, respectively; the reduction in diastolic BP was sustained until 3 to 6 months after the recruitment. Our meta-analyses did not find a significant reduction in out-of-office BP after MBSR. MBSR reduced depressive, anxiety, and stress symptoms. The dropout rate from MBSR arm was 15% and was similar to that of control arm. The current evidence is limited by lack of high-quality and adequately powered trials with long-term follow-up. Furthermore, out-of-office BP was only reported by few trials.

Emerging Complementary and Integrative Therapies for Geriatric Mental Health

PURPOSE

The use of complementary and integrative medicine (CIM) is on the rise among diverse populations of older adults in the USA. CIM is commonly perceived as safer, less expensive, and more culturally acceptable. There is a growing body of evidence to support the use of CIM, especially mind-body therapies, diet and nutritional supplements used for mental disorders of aging.

RECENT FINDINGS

We summarize the results of the recent clinical trials and meta-analyses that provide the evidence for the role of CIM in treating older adults with mood or cognitive disorders that includes the use of diet and supplements, and mind-body therapies.

SUMMARY

Dietary and mind-body therapies have become increasingly popular and show the strongest evidence of efficacy for mood and cognitive disorders. Although the use of vitamins and supplements is the most popular CIM practice, only mixed evidence supports their use with additional concerns for herb (supplement)-drug interactions. Despite increasing use of CIM by the general population, information to guide clinicians providing care for older adults remains limited with variable scientific rigor of the available RCTs for a large number of commonly used CIM interventions for the mental health of older adults.

Episodic Memory in Later Life: Benefits of Prayer and Meditation

Purpose: To examine the effects of prayer and meditation on the episodic memory of older adults. Design: Secondary analysis of Health and Retirement Study (HRS). Method: Drawing from a subsample of HRS ( n = 1,135), this study utilized generalized estimating equation regression models to examine the effects of meditation and prayer on changes in episodic memory of older adults over time. Findings: Findings show a statistically significant positive effect of the use of prayer (0.50, p < .05) on episodic memory score at baseline. We also observed a slight gain in episodic memory over time for older adults who used prayer (0.04, p = .05). Meditation was not found to have a statistically significant effect on changes in memory in later life. Conclusion: This study illustrates the benefits of prayer in preserving memory and provides much needed empirical basis for community-level interventions to enhance memory in later life.

Cognitive Interventions in Parkinson's Disease: Where We Want to Go within 20 Years

 Today, meta-analyses demonstrate that cognitive training is safe and effective to enhance vulnerable cognitive functions in patients with Parkinson’s disease (PD), so that cognitive interventions can be regarded as a promising approach to treat or even prevent cognitive dysfunction in PD. However, many research gaps exist. Thus, this article aims to identify relevant research topics with regard to cognitive interventions in PD patients for the next 20 years. The most important to do's include the development of (non-digital and digital, maybe also artificial intelligence based) standardized cognitive interventions for PD patients in different cognitive stages and the conduct of large randomized controlled trials (RCTs) in these groups, also considering different patient profiles (e.g., motor subtypes) and the living setting (inpatient versus outpatient). The impact of cognitive and combined interventions in individuals with prodromal PD is of high relevance. Studies should elucidate underlying mechanisms of cognitive and neural plasticity induced by cognitive interventions and propose prediction models on which patients profit from which intervention. Health-economic analyses are also urgently needed. More generally, increasing the awareness of the concept of cognitive reserve and possibilities for the prevention of cognitive dysfunction is an important goal.

Translational research on reserve against neurodegenerative disease: consensus report of the International Conference on Cognitive Reserve in the Dementias and the Alzheimer's Association Reserve, Resilience and Protective Factors Professional Interest Area working groups

BACKGROUND

The concept of reserve was established to account for the observation that a given degree of neurodegenerative pathology may result in varying degrees of symptoms in different individuals. There is a large amount of evidence on epidemiological risk and protective factors for neurodegenerative diseases and dementia, yet the biological mechanisms that underpin the protective effects of certain lifestyle and physiological variables remain poorly understood, limiting the development of more effective preventive and treatment strategies. Additionally, different definitions and concepts of reserve exist, which hampers the coordination of research and comparison of results across studies.

DISCUSSION

This paper represents the consensus of a multidisciplinary group of experts from different areas of research related to reserve, including clinical, epidemiological and basic sciences. The consensus was developed during meetings of the working groups of the first International Conference on Cognitive Reserve in the Dementias (24-25 November 2017, Munich, Germany) and the Alzheimer's Association Reserve and Resilience Professional Interest Area (25 July 2018, Chicago, USA). The main objective of the present paper is to develop a translational perspective on putative mechanisms underlying reserve against neurodegenerative disease, combining evidence from epidemiological and clinical studies with knowledge from animal and basic research. The potential brain functional and structural basis of reserve in Alzheimer's disease and other brain disorders are discussed, as well as relevant lifestyle and genetic factors assessed in both humans and animal models.

CONCLUSION

There is an urgent need to advance our concept of reserve from a hypothetical model to a more concrete approach that can be used to improve the development of effective interventions aimed at preventing dementia. Our group recommends agreement on a common dictionary of terms referring to different aspects of reserve, the improvement of opportunities for data sharing across individual cohorts, harmonising research approaches across laboratories and groups to reduce heterogeneity associated with human data, global coordination of clinical trials to more effectively explore whether reducing epidemiological risk factors leads to a reduced burden of neurodegenerative diseases in the population, and an increase in our understanding of the appropriateness of animal models for reserve research.

Differential Effects of Physical Exercise, Cognitive Training, and Mindfulness Practice on Serum BDNF Levels in Healthy Older Adults: A Randomized Controlled Intervention Study

Previous studies have indicated that an active lifestyle is associated with better brain health and a longer life, compared to a more sedentary lifestyle. These studies, both on human and animal subjects, have typically focused on a single activity, usually physical exercise, but other activities have received an increasing interest. One proposed mechanism is that physical exercise increases levels of brain-derived neurotrophic factor (BDNF) in the brain. For the first time, the long-term effects on serum BDNF levels were compared in persons who engaged in either physical exercise training, cognitive training, or mindfulness practice during 5 weeks, and compared with an active control group. Two cohorts of healthy older individuals, one from the Boston area in the US and one from the Växjö area in Sweden, participated. A total of 146 participants were randomly assigned to one of the four groups. All interventions were structurally similar, using interactive, computer-based software that directed participants to carry out specified activities for 35 minutes/day, 5 days per week for 5 weeks. Blood samples were obtained at baseline and soon after the completion of the 5-week long intervention program, and serum BDNF levels were measured using a commercially available ELISA. Only the group that underwent cognitive training increased their serum BDNF levels after 5 weeks of training (F1,74 = 4.22, p = 0.044, partial η2 = 0.054), corresponding to an average 10% increase. These results strongly suggest that cognitive training can exert beneficial effects on brain health in an older adult population.

Cross-sectional white matter microstructure differences in age and trait mindfulness

The process of aging can be characterized by a decline in cognitive performance, which may be accompanied by deterioration in specific structural properties of the brain. In this study we sought to investigate to what extent mindfulness changes over the aging process, and which alterations in brain structure can be associated to aging and concomitant changes in mindfulness. We collected Mindful Attention Awareness Scale questionnaire data to assess trait mindfulness and acquired diffusion-weighted imaging data fitted to the diffusion tensor model (DTI) in a group of 97 middle-aged to elderly participants. Our results showed that trait mindfulness increased with age. In terms of white matter structure our results suggested that there was a general increase of omnidirectional diffusion, which favored radial over axial diffusivity, leading to a decrease in fractional anisotropy (FA) in older participants. We further showed that trait mindfulness mediated the FA-age effect in a localized area consisting of the internal and external capsule, as well as the corona radiata. The implication of this mediation analysis is that trait mindfulness may deter age-associated neurocognitive decline, perhaps by preventing age-associated microlesions specifically in cortico-subcortical white matter tracts. This study can be considered a pioneer of using DTI studies to investigate the relationship between age and trait mindfulness.

Mindfulness-based stress reduction in middle-aged and older adults with memory complaints: a mixed-methods study

OBJECTIVES

In a rapidly aging world population, an increasingly large group faces age-related decline in cognitive functioning. Cognitive complaints of older adults are often related to worries and concerns associated with age-related functional decline. Mindfulness-Based Stress Reduction (MBSR) can successfully target stress, worry and ruminative thinking, but the applicability of this method in middle-aged and older adults with memory complaints is unclear.

METHOD

Patients of a university hospital memory clinic (n = 13), aged 45-85 years, with memory complaints but no diagnosis of cognitive disorder, participated in a standard 8-week MBSR program, consisting of weekly group meetings and a one-day silent retreat. After completion, semi-structured qualitative interviews were conducted. Questionnaires (administered before, one week after and five weeks after the intervention) assessed quality of life, psychological distress (stress, anxiety and depressive symptoms), mindfulness, self-compassion, and subjective memory functioning. Neurocognitive functioning was assessed online, before and after the intervention.

RESULTS

The qualitative analysis showed positive effects of the training (e.g. increased serenity), many participants worrying less about memory complaints. The self-reported measures were in line with the results of the qualitative analysis.

CONCLUSION

This exploratory mixed-methods study suggests that MBSR is feasible and well received among older individuals with cognitive complaints.

Why could meditation practice help promote mental health and well-being in aging?

Psycho-affective states or traits such as stress, depression, anxiety and neuroticism are known to affect sleep, cognition and mental health and well-being in aging populations and to be associated with increased risk for Alzheimer's disease (AD). Mental training for stress reduction and emotional and attentional regulation through meditation practice might help reduce these adverse factors. So far, studies on the impact of meditation practice on brain and cognition in aging are scarce and have limitations but the findings are encouraging, showing a positive effect of meditation training on cognition, especially on attention and memory, and on brain structure and function especially in frontal and limbic structures and insula. In line with this, we showed in a pilot study that gray matter volume and/or glucose metabolism was higher in six older adult expert meditators compared to 67 age-matched controls in the prefrontal, anterior and posterior cingulate cortex, insula and temporo-parietal junction. These preliminary findings are important in the context of reserve and brain maintenance as they suggest that long-term meditation practice might help preserve brain structure and function from progressive age-related decline. Further studies are needed to confirm these results with larger samples and in randomized controlled trials and to investigate the mechanisms underlying these meditation-related effects. The European Commission-funded project Silver Santé Study will address these challenges by studying 316 older adults including 30 expert meditators and 286 meditation-naïve participants (either cognitively normal or with subjective cognitive decline). Two randomized controlled trials will be conducted to assess the effects of 2-month and 18-month meditation, English learning or health education training programs (versus a passive control) on behavioral, sleep, blood sampling and neuroimaging measures. This European research initiative illustrates the progressive awareness of the benefit of such non-pharmacological approaches in the prevention of dementia and the relevance of taking into account the psycho-affective dimension in endeavoring to improve mental health and well-being of older adults.

Mindfulness Training for People With Dementia and Their Caregivers: Rationale, Current Research, and Future Directions

The world population is aging and the prevalence of dementia is increasing. By 2050, those aged 60 years and older are expected to make up a quarter of the population. With that, the number of people with dementia is increasing. Unfortunately, there is no cure for dementia. The progression of symptoms with no hope of improvement is difficult to cope with, both for patients and their caregivers. New and evidence-based strategies are needed to support the well-being of both caregiver and patient. Mindfulness training is a body-mind intervention that has shown to improve psychological well-being in a variety of mental health conditions. Mindfulness, a non-judgmental attention to one's experience in the present moment, is a skill that can be developed with a standard 8-week training. Research has shown preliminary but promising results for mindfulness-based interventions to benefit people with dementia and caregivers. The aim of this review is (a) to provide a rationale for the application of mindfulness in the context of dementia care by giving an overview of studies on mindfulness for people with dementia and/or their caregivers and (b) to provide suggestions for future projects on mindfulness in the context of dementia and to give recommendations for future research.