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By Lawla Law

Cognitive impairment is a common problem in older adults, and one which increases in prevalence with age with or without the presence of pathology. Persons with mild cognitive impairment (MCI) have difficulties in daily functioning, especially in complex everyday tasks that rely heavily on memory and reasoning. This imposes a potential impact on the safety and quality of life of the person with MCI as well as increasing the burden on the care-giver and overall society. Individuals with MCI are at high risk of progressing to Alzheimer’s diseases (AD) and other dementias, with a reported conversion rate of up to 60-100% in 5-10 years. These signify the need to identify effective interventions to delay or even revert the disease progression in populations with MCI.

At present, there is no proven or established treatment for MCI although the beneficial effects of physical activity/exercise in improving the cognitive functions of older adults with cognitive impairment or dementia have long been recognized. Exercise regulates different growth factors which facilitate neuroprotection and anti-inflammatory effects on the brain. Studies also found that exercise promotes cerebral blood flow and improves learning. However, recent reviews reported that evidence from the effects of physical activity/exercise on cognition in older adults is still insufficient.

Surprisingly, studies have found that although numerous new neurons can be generated in the adult brain, about half of the newly generated cells in the brain die during the first 1-4 weeks. Nevertheless, research also found that spatial learning or exposure to an enriched environment can rescue the newly generated immature cells and promote their long-term survival and functional connection with other neurons in the adult brain

It has been proposed that exercise in the context of a cognitively challenge environment induces more new neurons and benefits the brain rather than the exercise alone. A combination of mental and physical training may have additive effects on the adult brain, which may further promote cognitive functions.

Daily functional tasks are innately cognitive-demanding and involve components of stretching, strengthening, balance, and endurance as seen in traditional exercise programs. Particularly, visual spatial functional tasks, such as locating a key or finding the way through a familiar or new environment, demand complex cognitive processes and play an important part in everyday living.

In our recent study, a structured functional tasks exercise program, using placing/collection tasks as a means of intervention, was developed to compare its effects on cognitions with a cognitive training program in a population with mild cognitive impairment.

Patients with subjective memory complaint or suspected cognitive impairment were referred by the Department of Medicine and Geriatrics of a public hospital in Hong Kong. Older adults (age 60+) with mild cognitive decline living in the community were eligible for the study if they met the inclusion criteria for MCI. A total of 83 participants were randomized to either a functional task exercise (FcTSim) group (n = 43) or an active cognitive training (AC) group (n = 40) for 10 weeks.

We found that the FcTSim group had significantly higher improvements in general cognitive functions, memory, executive function, functional status, and everyday problem solving ability, compared with the AC group, at post-intervention. In addition, the improvements were sustained during the 6-month follow-up.

Although the functional tasks involved in the FcTSim program are simple placing/collection tasks that most people may do in their everyday life, complex cognitive interplays are required to enable us to see, reach and place the objects to the target positions. Indeed, these goal-directed actions require integration of information (e.g. object identity and spatial orientation) and simultaneous manipulation of the integrated information that demands intensive loads on the attentional and executive resources to achieve the ongoing tasks. It is a matter of fact that misplacing objects are commonly reported in MCI and AD.

Importantly, we need to appreciate that simple daily tasks can be cognitively challenging to persons with cognitive impairment. It is important to firstly educate the participant as well as the carer about the rationale and the goals of practicing the exercise in order to initiate and motivate their participation. Significant family members or caregivers play a vital role in the lives of persons with cognitive impairment, influencing their level of activities and functional interaction in their everyday environment. Once the participants start and experience the challenges in performing the functional tasks exercise, both the participants and the carer can better understand and accept the difficulties a person with cognitive impairment can possibly encounter in his/her everyday life.

Furthermore, we need to aware that the task demands will decrease once the task becomes more automatic through practice. The novelty of the practicing task has to be maintained in order ensure a task demand that allows successful performance and maintain an advantage for the intervention. Novelty can be maintained in an existing task by adding unfamiliar features, and therefore performance of the task will remain challenging and not become subject to automation.

Dr. Lawla Law is a practicing Occupational Therapist for more than 24 years, with extensive experience in acute and community settings in Hong Kong and Tasmania, Australia. She is currently the Head of Occupational Therapy at the Jurong Community Hospital of Jurong Health Services in Singapore and will take up a position as Lecturer in Occupational Therapy at the University of Sunshine Coast, Queensland, Australia in August 2014. Her research interests are in Geriatric Rehabilitations with a special emphasis on assessments and innovative interventions for cognitive impairment. Dr. Law is an author of the paper ‘Effects of functional tasks exercise on older adults with cognitive impairment at risk of Alzheimer’s disease: a randomised controlled trial’, published in the journal Age and Ageing.

Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.

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Image credit: Brain aging. By wildpixel, via iStockphoto.

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By Dario Salvucci

If the mind is a society, as philosopher-scientist Marvin Minsky has argued, then multitasking has become its persona non grata.

In polite company, mere mention of “multitasking” can evoke a disparaging frown and a wagging finger. We shouldn’t multitask, they say – our brains can’t handle multiple tasks, and multitasking drains us of cognitive resources and makes us unable to focus on the critical tasks around us. Multitasking makes us, in a word, stupid.

Unfortunately, this view of multitasking is misguided and undermines a deeper understanding of multitasking’s role in our daily lives and the challenges that it presents.

The latest scientific work suggests that our brains are indeed built to efficiently process multiple tasks. According to our own theory of multitasking called threaded cognition, our brains rapidly interleave small cognitive steps for different tasks – so rapidly (up to 20 times per second) that, for many everyday situations, the resulting task behaviors look simultaneous. (Computers similarly interleave small steps of processing to achieve multitasking between applications, like displaying a new web page while a video plays in the background.) In fact, under certain conditions, people can even exhibit almost perfect time-sharing – doing two tasks concurrently with little to no performance degradation for either task.

The brain’s ability to multitask is readily apparent when watching a short-order cook, a symphony conductor, or a stay-at-home mom in action. But our brains also multitask in much subtler ways: listening to others while forming our own thoughts, walking around town while avoiding obstacles and window-shopping, thinking about the day while washing dishes, singing while showering, and so on.

Multitasking is not only pervasive in our daily activities, it actually enables activities that would otherwise be impossible with a monotasking brain. For example, a driver must steer the vehicle, keep track of nearby vehicles, make decisions about when to turn or change lanes, and plan the best route given current traffic patterns. Driving is only possible because our brains can efficiently interleave these tasks. (Imagine the futility of only being able to steer, or plan a route.)

So how has multitasking earned such a negative reputation? In large part, this reputation stems from unrealistic expectations. The brain’s multitasking abilities – like all our abilities – come with limitations: when performing one task, the addition of another task generally interferes with the first task. For many everyday tasks, the interference is negligible or unimportant: your singing may affect your showering, or thinking about your day may affect your dish-washing, but likely not so much that you notice or care.

Other tasks, though, require every ounce of attention and can push past the limits of our multitasking abilities. In driving, the essential subtasks are demanding enough; additional subtasks – texting, dialing, even talking on a phone – increase these demands, and when controlling a 3000-pound vehicle at 65 miles per hour, even these minimal additional demands may lead to unacceptable risks.

Still other tasks do not have safety implications per se, yet most would consider them important enough that multitasking in those contexts is undesirable. A student in class is already multitasking in listening to the teacher, processing ideas, and taking notes. If this student is checking Facebook at the same time, this extra subtask drains mental effort away from the more critical subtasks and dilutes the learning experience.

The problem with multitasking thus lies not in our brain’s inability to multitask efficiently, but in our own priorities and decision-making. When we choose to multitask, we are deciding – consciously or not –