Juntendo
Forum Perspective
Juntendo Medical Journal
2017. 63 (5), 378-380

Cognitive Aging: Non-Pharmacological Interventions
YOSHIAKI FURUKAWA＊1) 2), ERI ARIKAWA-HIRASAWA＊2) 3), YUJI TOMIZAWA＊1) 2)＊1)Department of Neurology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan,＊2)Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan,＊3)Research Institute for Diseases of Old Age, Juntendo University, Tokyo, Japan

According to the literature, physical inactivity and lack of stimulating leisure activity are significantly important modifiablefactors for cognitive aging. In this perspective article, we have summarized recent findings of non-pharmacological intervention
effects on cognitive decline/dementia and have suggested that playing newly developed active video games, which cansimultaneously increase both leisure-time physical activity and cognitively stimulating leisure activity, may be a good preventive
measure against cognitive aging among the elderly. Public health interventions to promote lifelong leisure-time physical activity,
using advanced active video games (e.g., safe, pleasant, free-to-play, and cognitively stimulating smartphone games which canpromote not only leisure activity but also physical activity), could have the potential to decrease personal and social burdens
associated with cognitive decline/dementia in old age.
Key words: aging, cognition, dementia, interventions, perspective

Cognitive aging is characterized by a gradualage-related deterioration in brain function, whichleads to an increased risk of dementia among
elderly people. Dementia, a clinical syndrome, isdefined as the loss of brain capacity severe enoughto interfere with daily functioning. Neuropathological changes in Alzheimerʼ s disease (AD) andvascular dementia, the two main causes of dementia
in older adults, occur with age and dementia
prevalence is rapidly increasing due to the aging ofpopulations worldwide. Non-modifiable factors(age and genetic risk factors) and modifiablefactors (lifestyle and environmental risk factors)
contribute to dementia in old age. In the absence of
curative treatments for dementia, it is crucial todevelop non-pharmacological interventions thatwill slow down cognitive decline before the onset ofdementia.
Population-based community studies or survey
data in the US, Rotterdam in the Netherlands,
Stockholm in Sweden, and England have demon-

strated that age-specific prevalence or incidence
rates of cognitive impairment and dementia
decreased among people born later in the first halfof the 20th century 1). The improvements were
attributed to favorable changes in modifiablefactors (higher education levels, healthier lifestyle,and better control of vascular risk factors),suggesting that we could prevent cognitive impairment in later life by non-pharmacological interventions. In fact, in the Finnish Geriatric Intervention
Study to Prevent Cognitive Impairment andDisability (FINGER: the first large-scale, longerterm randomized controlled trial to assess amultidomain approach for reducing the risk ofcognitive decline), improvement in overall cognition after 2 years, which was measured throughcomprehensive neuropsychological test battery(NTB) total Z score, was 25% higher in theintervention group than in the control group; bothgroups improved in global cognition and the meanchange in NTB total Z score was 0.20 in theCorresponding author: Yoshiaki Furukawa
Department of Neurology, Juntendo Tokyo Koto Geriatric Medical Center
3-3-20 Shinsuna, Koto-ku, Tokyo 136-0075, Japan
TEL: + 81-3-5632-3111〔ReceivedFAX: + 81-3-5632-3728

Dec. 26, 2016〕〔Accepted

E-mail: furukawa@juntendo.gmc.ac.jp

June 5, 2017〕

Copyright © 2017 The Juntendo Medical Society. This is an open access article distributed under the terms of Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original source is properly credited.
doi: 10.14789/jmj.63.378

378

Juntendo Medical Journal 63 (5), 2017

intervention (diet, exercise, cognitive training, andvascular risk monitoring) group and was 0.16 in
the control (general health advice) group 2).
Although the extent of the beneficial effect in theFINGER trial was relatively small, it should be
noted that even a small reduction in the incidence ofcognitive decline/dementia is likely to have asubstantial effect on its prevalence and associatedpublic health burden. In an analysis of population-based data, Norton and colleagues examined
relative contributions of seven potentially modifiable risk factors (diabetes mellitus, hypertension,obesity, physical inactivity, depression, smoking,and low educational attainment) to AD 3). This
study indicated that the three most important
population-attributable risks of AD worldwide
were low educational attainment, smoking, andphysical inactivity. The contribution of low educational attainment was not as pronounced in the US,
Europe, and the UK and the largest proportion ofAD cases was attributed to physical inactivity inthese developed regions.
There is growing evidence that participation inleisure activities appears to be associated with areduced risk of late-life cognitive impairment anddementia 4)-9). In a French cohort study over a
4-year follow-up period, leisure activities wereassessed in individuals, aged 65 and over, without
prevalent dementia at baseline 6). This study has
shown that stimulating leisure activities (doingcrossword puzzles, playing cards, participating inorganizations, going to the cinema/theatre, andpracticing an artistic activity) were significantly
associated with a reduced risk of dementia. The
findings in this study suggest that the promotion of
cognitively stimulating leisure activities in elderlycommunity-dwelling populations seems to constitute a prevention strategy which could delay
dementia onset. It is a lot of fun participating instimulating leisure activities, such as board games
and video games, and these activities are more
likely to be sustained over time 4) 7) 10). Playing acustom-designed video game (NeuroRacer)
involved participants performing a perceptual
discrimination task while simultaneously performing a visuomotor tracking task 10). Multitasking
performance across the adult lifespan, as assessedwith this game, declined linearly from 20 to 79 yearsof age. However, following 12 hours of training, amultitasking training group (but not a single tasktraining group) demonstrated enhanced performance in elderly adults. This NeuroRacer investigation offers evidence of positive effects from video
game training on cognitive control abilities that areknown to be impaired in aging. Players of asomewhat similar game (Pokémon Go: a recently
developed smartphone game) are tasked withwalking around to find and catch ʻPokémonʼ bypointing their phone cameras and simultaneously
tossing ʻPokéballsʼ with their fingers 11). Pokémon Go
can increase outdoor activity and social interaction.
In this augmented reality game, players (spanningall ages) are usually required to walk 2-10 km toearn awards; substantial walking is known to havea good effect on the metabolic syndrome. A
prospective study, using data from the UK National
Child Development Study, revealed a significant
relationship between cumulative leisure-time
physical activity and cognitive functioning outcomes at 50 years of age 8). This cohort-based
investigation and other studies have suggested thatcognitive functioning in middle and old age could
benefit from participation in leisure-time physicalactivity 5) 8) 9).
Given that dementia is a multi-factorial disorder,
an intervention that can modify several risk factors
at the same time should be better able to obtain the
optimal preventive effect. As described above, inaddition to low educational attainment and smoking,physical inactivity and lack of stimulating leisureactivity are also significantly important modifiablefactors for cognitive decline/dementia; other majorrisk factors, namely, hypertension, diabetes, obesity,and hypercholesterolemia constitute the metabolic
syndrome and these vascular risk factors areclosely related to physical inactivity. These findings
suggest that playing advanced active video (smartphone) games, which increase both leisure-time
physical activity and cognitively stimulating leisureactivity, may be a good preventive measure against
dementia onset. There is a possibility that, throughhigher education levels (which can facilitate
healthier lifestyle, including a non-smoking environment) and future development of well-designed
cognitively stimulating active video games (which
can increase leisure and physical activities throughout life), we could slow down cognitive aging
among elderly people.

379Furukawa, et al: Cognitive aging

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