Cognitive Stimulation, Music Therapy, and Cryostimulation to Improve Cognitive Function

In my book, How Not to Age, I discuss the role of drugs and supplements and focus on diet and lifestyle approaches to the prevention and treatment of cognitive decline, but there are a few common non-drug, non-supplement, non-lifestyle approaches to dementia treatment. For example, cognitive stimulation therapy, which typically involves group activities and social interaction. There have been at least 44 randomized controlled trials of cognitive stimulation including thousands of participants. ADAS-Cog, short for Alzheimer’s Disease Assessment Scale – Cognitive subscale, is the most commonly used measure of cognition in clinical trials of dementia treatment. A clinically relevant improvement is often defined as a reduction of four or more points on the ADAS-Cog measure. Regrettably, the attenuation of cognitive decline for most of the cognitive stimulation studies averaged only about two points.

You could argue any improvement is better than nothing, but unfortunately the cognitive effects don’t appear to generalize to helping with everyday life situations. You can train people to get better at a computerized “brain game,” but that doesn’t necessarily translate to other arenas. Also, the marginal improvements are temporary. They don’t appear to persist once the intervention period is over.

While cognitive stimulation therapy may have no significant overall effect on quality of life, any kind of group therapy has been shown to improve psychological well-being. As social creatures, social participation is important for mental health throughout the life course, but there is insufficient evidence that it can improve or prevent cognitive dysfunction. Dementia is associated with social isolation, but this may be reverse causation, where the dementia leads to social withdrawal, instead of the other way around.

The same issue comes up all the time with those advocating for “use-it-or-lose-it” mental stimulation to forestall decline. For example, this review in a peer-reviewed aging journal suggested that “if a person solves crosswords four times a week, they can reduce their risk of dementia by 47 percent.” Yes, doing frequent crossword puzzles is associated with lower subsequent dementia risk, but isn’t it more likely that those on the verge of a dementia diagnosis are less likely to be doing crossword puzzles, as a result of their declining cognitive abilities?

Music therapy presents a similar story of improving well-being without necessarily affecting cognition. Even in late stages of dementia, when verbal communication is lost, music can be enjoyed. However, it does not seem to improve brain function. Most (five out of seven) meta-analyses of the 40+ interventional clinical trials of music therapy for people with dementia found no cognitive benefits. And, the few studies that did found the effect was short-lived, disappearing after one to three months. Even though cognition doesn’t seem to be affected, there still may be positive effects in terms of reducing agitation and improving mood and socialization.

One of the kookiest treatments I ran across was cryotherapy, also known as cryostimulation. Those with mild cognitive impairment randomized to short-term exposures to extremely cold temperatures experienced a transient boost in general cognitive functioning (no longer apparent two weeks after daily sessions ended). Study subjects in shorts and a t-shirt were exposed to 58 degrees below zero for two minutes. No, wait, that was the placebo control group exposed to “noncryogenic” temperatures. How low did the experimental group go? Two minutes at more like 200 degrees below zero.