Promoting cognitive health in individuals with chronic stroke through enrichment

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Dr. Teresa Liu-Ambrose, PhD, PT, Associate Professor, is a Canada Research Chair and a Peter Wall Institute Scholar at the University of British Columbia, Department of Physical Therapy. She directs the Aging, Mobility and Cognitive Neuroscience Laboratory as well as the Vancouver General Hospital’s Falls Prevention Clinic. At the Centre for Brain Health and the Centre for Hip Health and Mobility, her research program focuses broadly on defining the role of lifestyle behaviours in promoting health and quality of life of older adults, with a focus on target populations at particular risk for both cognitive and physical decline. 

Michelle Munkacsy, MHK, is Study Coordinator for Dr. Teresa Liu-Ambrose.

More blog posts: Spark >> A BC Health Research Blog


300,000 Canadians report living with the effects of a stroke, according to Canada’s Centre for Chronic Disease Prevention and Control’s 2009 report. In addition, another 40,000 to 50,000 Canadians are hospitalized each year due to strokes.

Common consequences of strokes include both cognitive and motor deficits. In fact, having a stroke doubles the risk of developing dementia [1]. However, current stroke rehabilitation does not adequately deal with the cognitive consequences of stroke – memory disorders, impaired reasoning – especially for those who are in the chronic phase at least 12 months since their stroke.

Dr. Teresa Liu-Ambrose’s lab, which focuses on healthy aging, is studying ways to combat cognitive decline in this population.

Exercise training is a promising strategy to promote cognitive function. Past research, including our own, has shown that different types of exercise training can promote cognitive abilities of older adults [2-4].  However, there is insufficient quality evidence for stroke survivors. Furthermore, stroke survivors often have physical impairments that significantly limit their ability to exercise.

Current evidence suggests that that strong social networks and participating in strategic social activities, such as interactive games and volunteering, may be an alternative and effective way of promoting cognitive function in older adults, including those with have suffered a stroke [5-7]. The bottom line is that current evidence suggests that to maintain cognitive health, it pays to get up, move, and interact with the world and people around us. 

Until now, research in dementia prevention hasn’t focused on chronic stroke survivors, but our lab would like to change that. Over the next two years, we are conducting a randomized controlled trial to study how both an exercise program and a social and cognitive enrichment program may benefit cognitive function in this target population. This work builds on our earlier efforts which have provided preliminary evidence that both approaches have benefit for cognitive function in individuals with chronic stroke.

The proposed research is timely as there is an urgent need to reduce the burden of cognitive impairment and dementia in our aging population. Critically, if the onset and progression of dementia could be delayed by a modest one year, there will be nearly 9.2 million fewer cases of dementia in 2050. For the individual affected by stroke, reducing the severity of their cognitive deficits could promote functional independence and quality of life.

If you would like more information on our research, or would like to be a part of this study, please go to our lab’s website at http://cogmob.rehab.med.ubc.ca/research, or find the study at www.clinicaltrials.gov/ct2/show/NCT01916486.


References

  1. Kokmen E, Whisnant JP, O’Fallon WM, Chu CP, Beard CM.  Dementia after ischemic stroke: A population-based study in Rochester, Minnesota (1960-1984). Neurology. 1996: 46: 154-159.
  2. Colcombe S, Kramer AF.  Fitness effects on the cognitive function of older adults: A meta-analytic study.  Psychol Sci.  2003: 14: 125-130.
  3. Liu-Ambrose T, Nagamatsu LS, Graf P, Beattie BL, Ashe MC, Handy TC.  Resistance training and executive functions: A 12-month randomized controlled trial.  Arch Intern Med. 2010: 170: 170-178.
  4. Nagamatsu LS, Handy TC, Hsu CL, Voss M, Liu-Ambrose T.  Resistance training promotes cognitive and functional brain plasticity in seniors with probable mild cognitive impairment.  Arch Intern Med. 2012: 172: 666-668.
  5. Valenzuela MJ, Sachdev P.  Brain reserve and dementia: A systematic review. Psychol Me. 2006: 36: 441-454.
  6. Fratiglioni L, Wang HX, Ericsson K, Maytan M, Winblad B.  Influence of social network on occurrence of dementia: A community-based longitudinal study.  Lancet. 200: 355: 1315-1319.
  7. Rand D, Eng JJ, Liu-Ambrose T, Tawashy AE. Feasibility of a 6-month exercise and recreation program to improve executive functioning and memory in individuals with chronic stroke.  Neurorehabil Neural Repair. 2010: 24: 722-729.