Chicken or Egg?

C

Rose-tinted-odometer = ★

Brain Health is a major theme of this blog. Why? 


We think that to ‘maximise brain health for the life of a person with MS (pwMS)’ we need to manage MS actively and holistically and promote brain-healthy behaviours. The ‘we’ here is not only HCPs but you and society, which includes regulators, politicians, educationalists, pharma, etc.   

Another thing that people don’t get is that ‘life is a sexually-transmitted age-dependent neurodegenerative disease’ and that if we live long enough our nervous system fails. As MS reduces our reserve, by shredding axons, synapses and causing neuronal loss it brings age-dependent neurodegeneration forward. 

Early ageing and MS worsening overlap and we face a big challenge separating progressive MS from premature ageing. This is why when people state that treatment X, for example, HSCT, halts progression they are exposing their naivety and lack of understanding of MS. HSCT is not anti-ageing and hence that component of MS worsening can’t be altered. In the case of HSCT, it may hasten the ageing process as some of the chemotherapy agents used as part of HSCT are neurotoxic. 

HSCT supporters will typically point to the amazing EDSS data showing disease stabilisation and in some cases improvement. But MS is more than lower limb function and walking. What needs to be presented are multi-domain outcomes across multiple functional systems, in particular, cognition. MS is first and foremost a ‘preventable dementia’ and hence we need to monitor cognition over time and see what our treatments are doing to cognition.

The study below relates to ‘normal ageing’ but may be relevant to pwMS. It shows that playing analogue or board games reduces age-related cognitive decline. I suspect, based on the cognitive reserve hypothesis, these findings will apply to pwMS as well. Do you play board games? If you do you it may delay or slow down MS-related cognitive decline. Who would have thought of playing Monopoly as a potential DMT in MS?

Altschul & Deary. Playing Analog Games Is Associated With Reduced Declines in Cognitive Function: A 68-Year Longitudinal Cohort Study. The Journals of Gerontology: Series B, gbz149. Published 18-Nov-2019.

Objectives: Playing analog games may be associated with better cognitive function but, to date, these studies have not had extensive longitudinal follow-up. Our goal was to examine the association between playing games and change in cognitive function from age 11 to age 70, and from age 70 to 79.

Method: Participants were 1,091 non-clinical, independent, community-dwelling individuals all born in 1936 and residing in Scotland. General cognitive function was assessed at ages 11 and 70, and hierarchical domains were assessed at ages 70, 73, 76, and 79 using a comprehensive cognitive battery of 14 tests. Games playing behaviors were assessed at ages 70 and 76. All models controlled for early life cognitive function, education, social class, sex, activity levels, and health issues. All analyses were preregistered.

Results: Higher frequency of playing games was associated with higher cognitive function at age 70, controlling for age 11 cognitive function, and the majority of this association could not be explained by control variables. Playing more games was also associated with less general cognitive decline from age 70 to age 79, and in particularly, less decline in memory ability. Increased games playing between 70 and 76 was associated with less decline in cognitive speed.

Discussion: Playing games were associated with less relative cognitive decline from age 11 to age 70, and less cognitive decline from age 70 to 79. Controlling for age 11 cognitive function and other confounders, these findings suggest that playing more games is linked to reduced lifetime decline in cognitive function.

CoI: none

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

13 comments

  • Cryptic crosswords? I do at least one a day and have a weekly mega session with a friend where I emerge genuinely feeling as though the brain has had a big work-out.

  • I appreciate the study was on board games. However, I like to think that a blend of things to keep my brain active, in a sustained way, are key. Reading, thinking, crosswords, card games, intelligent discussion, learning something new etc are all valuable cognitive tools.

  • Board games? It is 2019 🤦‍♀️
    I like computer games.
    Not Too Hard
    Nor too easy.
    Mental distraction
    With a distracted brain.

  • What are your thoughts on millennials who rely on smartphones for all information recalling issues as opposed to remembering data?

    Will modern tech exacerbate cognitive decline in Gen-Y PwMS?

      • Me personally, after observing the way some of them are addicted to their smartphones, think it’s a disaster waiting to happen with regards to using their brains actively…that’s if they don’t get run down by a bus first cos they never lift their heads up.

        The amount of thinking we do these days is so, so much less than we did. Modern technology of course must have it’s place in the world, but the amount of youngsters who can’t work out a route, or work out how to find something without googling it is bad. I can still do both, the easy(techno way) and the “old” way. And I’m only 47!

  • I ensure that new grey matter is constantly replacing that is lost by ms atrophy. By weight training and increasing my strength and from memory exercises. I have currently memorised 370 names of famous actresses in alphabetical order. (errr its a guy thing).

  • I ensure new grey matter is constantly replacing that is lost by ms atrophy. By weight training and increasing my strength (physical exercise bas anti inflammatory effect and increases grey matter, as well as inducing repair mechanisms in the spine) and from memory exercises. I have currently memorised 370 names of famous actresses in alphabetical order. (errr its a guy thing).

  • As always one must be cautious not to confuse cause and effect.

    I think playing board games is probably good for people trying to keep their mind sharp and their social lives on track.

    But, it is equally likely that people with increasing brain deficits struggle more to play simpler board games.
    Perhaps at some point it is too painful for them to continue, even if they once enjoyed these kinds of diversions immensely.

    I really like board games, but find now with MS that they take much more concentration than they once did. For me, playing games earlier in the day is more fun than playing later at night. Trying to play any kind of board or card game that relies on speed has become embarrassingly non-competitive for me.

    I think there is some similar research into reading trends in those with declining mental acuity. People who were once voracious readers may find it too difficult to comprehend. If it becomes too hard it becomes less enjoyable.

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