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I would like to share with you this research report from Canada on exercise, cognitive training, and vitamin D *1. 175 people (mean age 73.1 years, 86 women) over the age of 60 with mild cognitive impairment (MCI) participated in this experiment. First, these participants were divided into five groups to examine the effects of exercise, cognitive training, and vitamin D over a 20-week period. Group 1 performed aerobic-resistance exercise, cognitive training, and vitamin D intake. Group 2 did aerobic-resistance exercise, cognitive training, and placebo vitamin D intake. Group 3 performed aerobic-resistance exercise, sham cognitive training, and vitamin D intake. Group 4 did aerobic-resistance exercise, sham cognitive training, and placebo vitamin D intake. The final group, Group 5, was the control group and performed balance-toning exercise, sham cognitive training, and placebo vitamin D intake. Participants were assessed for cognitive function three times: at baseline, 6-month point, and 12-month point. And of the 175 participants, 133 (76%) remained throughout the follow-ups. Participants in this experiment performed cognitive training with tablets for 30 minutes each time (real training or sham cognitive training) and 60 minutes of exercise (aerobic-resistance exercise or balance-toning exercise) in groups 3 times a week for a total of 20 weeks. All participants received either real or placebo vitamin D three times per week (10,000 IU). The real cognitive training was visual-motor training related to memory and attention, and the level of difficulty increased over time. Sham cognitive training was either touristic search or video watching. Aerobic-resistance exercises were programs specifically designed for older adults, with progressively increasing volume and intensity. The balance-toning exercises were a workout that did not progress in volume or intensity. Both types of training were properly supervised by instructors. As a result, groups that performed aerobic-resistance exercise had better cognitive function scores compared to Group 5, the control at 6 -month follow up. And what is even more interesting is that the groups that did both aerobic-resistance exercise and cognitive training (Group 1 and 2) had more clinically significant effects on cognitive function scores than the other groups. Groups 1, 2, and 3 did not revert to their pre-experimental levels when their cognitive function was reassessed at 12-month point. As for vitamin D intake, there was no effect at all. In short, this research report suggests that adding cognitive training along with aerobic-resistance exercise may improve cognitive function in older adults with MCI. More data is needed in the future, but if this program of physical exercise and cognitive training is firmly established, it is likely to be a safer and more reliable method than therapeutic drugs for older adults diagnosed with MCI or early Alzheimer's disease?! As I introduced in this blog before, various Alzheimer's drugs have been developed, but there are still problems (price, availability, side effects, etc.). Perhaps, as this research report shows, incorporating both aerobic-resistance exercise and cognitive training may offer new hope for both prevention and treatment of dementia!? We will see… By the way, I would like to talk about vitamin D, which was used in this study, in my next blog. Stay tuned!! *1 Montero-Odasso M, Zou G, Speechley M, et al. Effects of Exercise Alone or Combined With Cognitive Training and Vitamin D Supplementation to Improve Cognition in Adults With Mild Cognitive Impairment: A Randomized Clinical Trial. JAMA Netw Open.2023;6(7):e2324465. doi:10.1001/jamanetworkopen.2023.24465

The other day I learned that vaccines for Alzheimer’s disease are possibly going to be available globally by the year 2030. Alzheimer’s Diseases International (ADI) *1. I recently attended a webinar that was primarily focused on this intriguing information *2. Both vaccines developed by AC Immune and Vaxxinity received FDA Fast Track designations *3. Both vaccines are immunotherapeutic vaccines, which target on amyloid beta. So, basically the vaccines teach our body’s immune system to attack aggregated amyloid beta *4&5. One notable aspect of this process is that AC Immune’s vaccine trial includes people with Down Syndrome as well as people with Alzheimer’s *5. Some people may not know the connection, but people with Down Syndrome are more likely to develop amyloid beta accumulation and Alzheimer’s disease. Therefore, this emerging vaccine is great news especially for people with Down Syndrome and their families. CEOs from these two companies mentioned that learning from the Covid pandemic, global access of the Alzheimer’s vaccine is possible. Their ultimate goal is for the general public to prevent Alzheimer’s disease. This is fantastic news for ultimately everyone if/when the vaccines are safe and people across the world have equal access to this global distribution. This exciting medical possibility makes me cautiously hopeful about the future of Alzheimer’s disease and other dementias!! This is a side note but I want to add one fact, which is that both CEOs driving these groundbreaking vaccines are female. It is extremely rare to see a female CEO in bio-pharmaceutical companies and at this corporate level of power and leadership! As a woman myself, it is exciting and encouraging to see that the face of advanced technology and innovation is someone like me, female! *1 ADI is the umbrella organization for Alzheimer’s Associations around the world. They directly work with WHO, and advocate for/with people living with dementia. They have been providing numerous informative webinars during the pandemic and beyond, which I have been enjoying and learning new knowledge, studies, and innovations regarding Alzheimer disease and other dementias. I would highly recommend these educational opportunities for people to check out their website if you are interested in learning about their work, Alzheimer’s, dementia, and more. Alzheimer's Disease International (ADI) *2　https://youtu.be/h7A93G0HVxU *3 Fast Track | FDA *4 https://ir.vaxxinity.com/news-releases/news-release-details/vaxxinity-receives-fda-fast-track-designation-ub-311-treatment/ *5 AC Immune Receives FDA Fast Track Designation for Anti-Amyloid-beta Active Immunotherapy, ACI-24.060, to Treat Alzheimer’s Disease | AC Immune SA

The long-term care insurance system was established in 2000 for the purpose of reducing the burden on family members and providing supportive care with the whole society. Long-term care insurance is a public insurance that pays the expenses for those who need nursing care. It is a system designed so that everyone bears the insurance premiums and pays them to those who need them most. After one reaches the age of 40, the long-term care insurance premiums will begin to be withheld from their salary. When one has retired from their lifetime of work, these premiums will be withheld from their pension. Therefore, it means that after one reaches the age of 40 in Japan, they will continue to pay the long-term care insurance premiums throughout the term of their life. The insured persons of long-term care insurance are divided into those who are 65 years old or older, and in addition, persons covered by medical insurance who are 40 to 64 years old. The former can receive long-term care services when they receive a certification of long-term care need or certification of needed support, regardless of the cause. The latter can receive long-term care services when they receive a certification of long-term care need (assistance) due to a disease associated with aging (specified diseases). Considering the sobering reality that Japan continues to grow as a 'super-aging' country*1, it becomes exponentially important for them (and other super-aging countries) to sustain and strengthen premium systems like the above mentioned one to truly create comprehensive support to families and communities. If you are interested in learning more about the long-term care insurance in Japan, you can check this; https://www.mhlw.go.jp/english/policy/care-welfare/care-welfare-elderly/dl/ltcisj_e.pdf *1 https://amp.kentucky.com/opinion/op-ed/article272316118.html

In my Japanese book, I mentioned the study regarding mortality of sedentary time *1. One of the most common sedentary behaviors is watching TV. You can probably easily imagine that watching TV is not good because it is a cognitively passive sedentary behavior. The study showed that time spent watching TV was associated with increased risk of dementia, irrespective of physical exercise, and time spent using a computer was associated with reduced risk of dementia *2. This study did not include tv viewing behavior during the pandemic period as part of their study data—which makes me wonder how many of us ended up with watching TV way too much for over last three years?? During the pandemic, my husband and I watched all the apps-Netflix, Hulu, HBO, you name it! We consumed lots of media content because we were sheltering at home like many other people across the globe. Binge watching has been the thing we do during the Covid outbreak!! We cannot take back the time we’ve lost already but we can change our behavior from this point onward. Since we are, at least for the moment safe and have some distance from the pandemic, it’s time for us to stop watching so much TV- if we want/need to stay sedentary, at least we should engage something cognitively active. A cognitively active sedentary behavior, such as using a computer, possibly can help stimulate our brains much better than passively viewing media content. After learning this new information about how unhealthy hours and hours of TV viewing can be, I may just have to break up with Netflix, Hulu, and Amazon Prime soon…”It’s not me, it’s you!” ＊１　Ekelund U, Tarp J, Fagerland MW, et al. Joint associations of accelerometer-measured physical activity and sedentary time with all-cause mortality: a harmonised meta-analysis in more than 44 000 middle-aged and older individuals. Br J Sports Med 2020;54:1499–1507 ＊２　Raichlen D A, Klimentidis Y C, Sayre M K, et al. Leisure-time sedentary behaviors are differentially associated with all-cause dementia regardless of engagement in physical activity. PNAS 2022; 119 (35). https://doi.org/10.1073/pnas.2206931119

Recently, I read this interesting study, which reports that people with positive age beliefs recovered from MCI (mild cognitive impairment)*１. Researchers at Yale University conducted this study, involving 1716 participants with a mean (SD) age of 77.8 years from 2008 to 2020. They assessed participants‘ age-beliefs (such as “The older I get, the more useless I feel”), and divided them into two groups; positive age-belief group, and negative age-belief group. The positive age-belief group with MCI at baseline was likely to recover from MCI 30.2% greater than the negative age-belief group. Fascinating!! There is also a study that demonstrates how ageism affects older adults’ health *2. Negativity does harm us. We need to be mindful of what thoughts, beliefs, attitudes, we feed ourselves with. People tend to just think about food for our well-being but forget about integrating and internalizing healthy ideas/beliefs for our health. Don’t be discouraged even if you have MCI. It’s possible to reverse and transform it with developing a more positive mind. We cannot and should not underestimate the importance of our body- mind connection. *1 Levy BR, Slade MD. Role of Positive Age Beliefs in Recovery From Mild Cognitive Impairment Among Older Persons. JAMA Netw Open. 2023;6(4):e237707. doi:10.1001/jamanetworkopen.2023.7707 *2 Allen JO, Solway E, Kirch M, et al. Experiences of Everyday Ageism and the Health of Older US Adults. JAMA Netw Open. 2022;5(6):e2217240. doi:10.1001/jamanetworkopen.2022.17240

Recently, the US Food and Drug Administration (FDA) granted accelerated approval of Lecanemab, an anti-amyloid antibody for people with early Alzheimer's disease (mild cognitive impairment or mild dementia due to Alzheimer's disease). FDA will determine their full approval possibly in this summer. Lecanemab's 18-month clinical phase 3 trial demonstrated less cognitive and functional decline in the Lecanemab group, compared to the placebo group*1. Although they still have to examine its adverse events and safety of Lecanemab, maybe, this can be the drug that we have been waiting for a long time? If so, I hope that the US Centers for Medicare & Medicaid Services (CMS) revisit their decision of the coverage for the class of anti-amyloid monoclonal antibodies such as Lecanemab, limiting reimbursement only to people in clinical studies*2. This drug will cost about $26,500 a year*3. Yes, $26,500!! What is the point of developing a new drug that can possibly help so many people if you make it not accessible? *1. van Dyck CH, Swanson CJ, Aisen P, et al. Lecanemab in early Alzheimer’s disease. N Engl J Med. 2023;388(1):9-21. doi:10.1056/NEJMoa2212948 *2. Navigating Treatment Options | alz.org *3. Why It’s Hard to Get the New Alzheimer’s Drug Lecanemab | Time

A long time ago, when I was working as a therapist at an Alzheimer's residential facility in San Francisco, I met this 80 year old lady living with Alzheimer's, who was a Japanese-American, nisei (2nd generation). When she moved to the facility where most of the residents were white, it was clear that she was feeling very uncomfortable being around with White-Americans. I learned from her chart that during World War II, when she was small, she was forced away from her home to live in an assigned Japanese internment camp. As her dementia progressed, she started telling me that the white residents were watching us and we should be careful about who we talk to, in her Japanese language, to express her suppressed grief, anger, and hurt. Since her children didn’t speak Japanese, I was her main listener/witness/partner-in-crime to validate her experiences and feelings. Eventually, her family grew to understand her situation and decided to transfer her to another facility that would be emotionally healthier for her, where more Asian people resided and caregivers reflected her culture. Hanako was the first person who taught me the importance of understanding where my clients are from, their cultural and historical background, their mother tongue, and what the client’s and their family's values are. I will never forget the precious time Hanako and I shared together.