Cognitive Interventions: Symptomatic or Disease-Modifying Treatments in the Brain?

Recent findings suggest that brain-stimulating activities may have beneficial effects on both Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD). However, whether cognitive interventions merely enhance cognitive reserve or truly attenuate, or even reverse, the disease's pathophysiology is still controversial. The aim of the present article is to discuss the potential for brain-stimulating activities, including cognitive stimulation (CS), cognitive rehabilitation (CR), and cognitive training (CT), to be symptomatic or disease-modifying interventions in the context of cognitive decline. While emerging evidence indicates that CT can enhance synaptic plasticity, suggesting a potential role in augmenting cognitive reserve, its impact on AD pathology remains uncertain. Small-scale studies suggest that CT and CS may slow down neurodegeneration in MCI patients and that multidomain interventions combining physical activity with CT may benefit Aß pathology. However, the considerable heterogeneity across studies limits the comparability of findings. It underscores the necessity for a more standardized approach to cognitive interventions in future guidelines for preventing and managing cognitive decline.

Relationship among Age, Education and Frailty in Older Persons.

Preliminary data suggest that frailty tend to increase with age and is associated with fewer years of formal education. However, it is still unclear whether age and education synergistically act in the definition of frailty. Aim of the study is to evaluate the interaction between age and education in defining frailty in community-dwelling older persons. We considered 911 community-dwelling older adults (mean age 79.5 years) who underwent a comprehensive geriatric assessment. Our results showed that education and age interact in the definition of frailty following an exponential-type relationship. Whereas age is a non-modifiable risk factor, much can be done to address the social component of frailty here represented by education. The reported interaction suggests that social interventions might be particularly effective at an older age, paving the way for multidisciplinary interventions beyond the clinical field.