Tai chi may improve symptoms of mild cognitive impairment in the elderly

Two days ago, Halloween arrived at our house. It has been one of my favorite holidays since my own childhood, but now perhaps even more so, as we share in the excitement and joy with our grandchildren. All went well despite my concerns that I wouldn’t be able to participate. I carved a jack-o’-lantern with more dexterity than I expected. The mouth had an unexpected twist, but this only added to the gruesomeness. During the last year, I have noticed progression of my cognitive impairment due to Alzheimer’s. I am now clearly in the dementia stage of Alzheimer’s disease. Will I be able to carve a pumpkin next year? I already take the maximum dose of Aricept (donepezil). I strictly follow the MIND diet. I usually get my 10,000 steps every day walking with our dog Jack. I almost always get eight hours of sleep. I try to stay socially engaged, but honestly this is becoming more difficult. I also manage my high blood pressure and high cholesterol. Both are potent risk factors for Alzheimer’s dementia. What more could I do? On the advice of my geriatrician, I have added memantine, an NMDA-receptor blocker that suppresses the activity of glutaminergic neurons in the brain. And finally, I have followed her persistent advice to stop drinking alcohol. It will probably take several months to see benefits of these management upgrades, if any, although I must confess: I don’t miss the bottle of beer and glass of wine in the evening. I was surprised to find that non-alcoholic beer is actually quite tasty.

Another thing my geriatrician has been urging me to try is tai chi.  I admit to previously being a skeptic, but it turns out that multiple well-controlled studies have supported the use of tai chi as an adjunct to standard medical treatment for prevention and amelioration of several conditions associated with aging. I was most impressed by a recent study published in the Annals of Internal Medicine. Unfortunately, this paper appears to be hidden behind a paywall and may require an institutional license for viewing. A good open-access summary of the paper can be found at the National Institute of Aging web site. A total of 318 older adults with mild cognitive impairment (MCI) were randomly divided into three groups of approximately 106 subjects. The control group performed a set of routine stretching exercises for one hour semiweekly for 24 weeks. The second group received standard tai chi for one hour semiweekly for 24 weeks. The third group received cognitively enhanced tai chi consisting of cognitive challenges to solve while performing standard tai chi. Examples of these cognitive challenges include: “(a) verbally repeat, after the interventionist, the step-by-step movements in a form; (b) respond to or practice the intended form(s) while inhibiting or suppressing deliberate miscuing by the interventionist; (c) exercise recall of forms (either in a sequence or at random); (d) practice associating form names with form numbers; (e) perform forms without verbal or visual instructional cues; (f) perform side switching (alternating between lateral and bilateral sides), switch forms when given out of sequence, and vary form sequences (forward, backward, oddly or evenly ordered); and (g) perform forms with word spelling (forward and backward).” (See link to Annuals of Internal Medicine paper above for details.) The remarkable results of this study are summarized on the following figure. Keep in mind that a MOCA score of 26 to 30 is normal, 19 to 25 is consistent with MCI, 10 to 18 is consistent with moderate dementia, and less that 10 is suggestive of severe dementia. (Note that in this paper, the Chinese spelling of tai ji quan is used instead of the anglicized tai chi.)

This figure demonstrates that MCI subjects receiving tai chi had cognitive improvement at 24 weeks that on average raised the MOCA scores into the normal range. Those participating in the cognitively enhanced tai chi had even greater improvement of cognition, clearly into the normal zone. Stretching exercises had no benefit on cognition.  I know, I know, this is a single study and needs to be confirmed by other studies. Also, it is important to recognize there is no evidence yet that tai chi would benefit people in more advanced stages of dementia. It may or may not. Regardless of these caveats, it is important to realize that the findings of this study, if confirmed, suggest that tai chi may be more effective than any medication available today in improving cognition in MCI.  I’m now doing tai chi for 12 minutes every day, following the instructions on a YouTube video recommended by my geriatrician. I’ll keep you posted on how it goes.