Exercise might slow rate of mental decline by 10 years for older people

\Mentally, we all slow down a little bit as we age. It gets harder to recall names, or we forget where we put our keys, or the car for that matter. Physically, an older brain doesn’t work as fast as it used to. But scientists think there might be one thing that could help slow down this natural aging process.

A study published online this week in Neurologyfound that older people who exercised regularly experienced a slower rate of mental decline.

In this study, 876 people at an average age of 71 who were a part of the Northern Manhattan Study, a group of people studied for stroke and for the potential to have a stroke, were asked how long and how often they exercised in the two weeks before their in-person interview.

Among the participants, 90 percent reported light exercise, such as walking and gardening, or no exercise at all. Those people were placed in the low activity group. The remaining 10 percent reported moderate to high-intensity exercise, such as running and aerobics, and were placed in the high activity group.

About seven years later, each person was given an MRI and a battery of tests that examined memory and thinking skills. Five years after that, participants took the memory and thinking tests again.

Researchers from the University of Miami and Columbia University found that people with no signs of cognitive impairment at the start of the research who reported low activity levels showed a greater decline in processing speed and episodic memory over five years. Their brains aged about 10 years more than the group that exercised.

“These results were not surprising because I think there is more and more evidence that more physical activity is good,” said Dr. Clinton Wright, an associate professor of neurology, public health sciences and neuroscience at University of Miami School of Medicine. “This is really building on evidence.”

Earlier studies have shown that exercise increases your gray matter in the areas that count for complex thought and decision-making.

Exercise is also a great stress reliever, which can protect the brain from damage caused by stress, which can cloud memory and slow thinking. Even something as simple as taking brisk walks can increase creative thinking, earlier studies have shown.

This study adds evidence that the opposite of an energetic lifestyle — essentially, being a couch potato — makes your brain sluggish, too.

“The effects that show low physical activity predicts cognitive decline over five years of follow-up are very strong and very robust and survived the adjustment for a large number of things that could influence results,” said Dr. Richard Lipton, a professor of neurology at the Albert Einstein College of Medicine in New York, who was not affiliated with this study.

Processing speed — how long it takes a person to complete tasks — deteriorates during the normal aging process. Declines in episodic memory — the ability to retain items in everyday life, such as a grocery shopping list –are one of the hallmarks of early Alzheimer’s disease, Lipton explained.

The study shows the effects on tests of very specific cognitive abilities, processing speed and episodic memory, which are important for everyday function, Lipton said.

What this study shows is that we need to keep active even long into old age if we want to keep our brains active.

Another strength of the research is the ethnic and racial diversity of the people it studied, Wright said.

“It’s probably one of the first that includes Latinos and African-Americans and whites in the same community,” Wright said.

Researchers are consistently pinpointing exercise as a significant factor related to cognitive health in older age. Another recent study showed that poor physical fitness in middle age might be associated with a smaller brain size later on, which could lead to dementia and mental decline.

“This (current) study is really exciting,” Lipton said. “It makes me feel really good about being on my elliptical right now. It contains the promise, the hint, the hope, that if people are more active that will protect their brains from aging and cognitive decline.”

What is colonoscopy?

PHILADELPHIA—Peg Bradford lost a grandmother to colon cancer, and knew her family was right when they nagged her to get checked. But she dreaded the unpleasant prep required for a colonoscopy and the slim possibility that her colon would be punctured during the procedure.

“I was a scaredy cat. I didn't want to deal with it,” Bradford said. “I built my own fears up and put it off.”

In December, shortly after turning 50, her South Jersey gastroenterologist discovered four polyps, fleshy growths sprouting from the walls of the colon that sometimes turn cancerous. He could remove only three. The last, a little over the diameter of a dime, was tucked in her cecum, the most distant portion of the bowel. She would need to see a specialist in Philadelphia for a second colonoscopy.

“I never expected this to happen,” said Bradford, who runs a Facebook group, Steps to Good Health, that has more than 20,000 members. “I was a wreck.”

Biopsies showed that all four polyps were benign, and she recovered without any problems. Bradford believes a colonoscopy was the right choice for her.

But colonoscopy—the most common and costly form of screening for colorectal cancer—isn't the only test available. It's often called the “gold standard,” and generally gets more publicity in March, the month designated for colon cancer awareness.

Even so, some public health officials say it shouldn't be the preferred option. In Canada last month, an independent task force came out against routine screening colonoscopies.

In the United States, several cancer experts said more Americans likely would get screened if their doctors offered them options.

The most commonly suggested alternative: a simple take-at-home stool test that might suffice for healthy people who have no family history of the disease and aren't suffering from irritable bowel syndrome.

If done annually, fecal immunochemical tests (FIT) have a strong track record for detecting hidden blood in the stool, an early sign of malignancy. A FIT doesn't require any inconvenient, uncomfortable preparation, anesthesia, or even a visit to a doctor's office. The completed test can be mailed to a lab. If it comes back positive—about 5 percent do—a colonoscopy is recommended to investigate further.

“We haven't done a good job telling people that there are two good, viable screening processes,” said Marcus Plescia, former director of the Division of Cancer Prevention and Control at the U.S. Centers for Disease Control and Prevention. “There's colonoscopy and fecal testing, and each one is a good approach.”

Last year, about 133,000 Americans were diagnosed with colorectal cancer. An estimated 50,000 died.

Early detection can prevent most deaths attributable to the disease, which is the second leading cause of cancer deaths among men and women combined in the U.S. The American Cancer Society strongly recommends screening for everyone between age 50 and 75. For patients such as Bradford with a family history of the disease, the ACS recommends screening starting at age 40.

In addition to colonoscopy and FIT, the U.S. Preventive Services Task Force suggests a third option, the rarely performed sigmoidoscopy, every 10 years with a FIT test.

“There is no empiric data to suggest that any of the recommended strategies provide a greater net benefit,” the independent group of experts stated in a draft of new guidelines released in 2015.

Most doctors agree that the best method is the one that gets done.

“Any form of colorectal screening that's been approved is reasonable,” said Mitchell Conn, a gastroenterologist at Thomas Jefferson University. “But someone who already has symptoms needs to have a more thorough procedure to evaluate the colon.”

Outside of the U.S., the fecal test is preferred. Last month, the Canadian Task Force on Preventive Health Care came out strongly against colonoscopy for routine screening, citing “the level of uncertainty over colonoscopy's effectiveness and harms.”

The statement riled the Ontario Association of Gastroenterologists.

“Colonoscopy is probably the best colon cancer screening test,” the group retorted. “It's just not proven yet.”

Four randomized controlled trials are underway, one in the U.S. by the Veterans Administration, but results aren't expected for several years. The USPSTF commissioned a review using existing observational data, which found all three strategies were effective and provided similar benefits.

While the jury is out, colonoscopy, as gastroenterologists are quick to point out, has its advantages. For starters, a patient needs only one every 10 years, unless polyps are found. The test, in which a thin, flexible tube is used to inspect the colon while the patient is under anesthesia, can spot most of the polyps that emerge from the colon wall or rectum, and remove them on the spot. Most will never become cancerous, but there's no way to know which will and which won't.

The procedure got a big public boost 16 years ago when TV journalist Katie Couric underwent one after her husband died of colon cancer. Still, a third of American adults have never had any kind of screening.

A campaign called “80 by 2018” aims to get 80 percent of adults screened during the next two years. The initiative is sponsored by the American Cancer Society, the CDC, and the National Colorectal Cancer Roundtable.

As Bradford's story shows, anxiety is one reason that people avoid testing.

“For some it's the ick factor; for others, it's true fear,” said Richard Wender, chief cancer control officer at the American Cancer Society. “One patient asked, “Why are you sticking something where the sun don't shine when you're feeling perfectly fine?'”

Time can also be a concern. For the popular “split-dose prep,” the first dose of the formula is taken at around 5 p.m. the day before the test, and can make for a sleepless night before the second dose early on the morning of the test. Patients are advised to take it easy for a day after the test, as it is done under general anesthesia. So it takes at least a day off work.

But the biggest barrier to screening is cost, said Wender, a physician at Thomas Jefferson University Hospital who also serves as the chairman of the National Colorectal Cancer Roundtable.

Without insurance, a colonoscopy with anesthesia can run several thousand dollars.

Screening colonoscopies are covered by most private insurance plans. But once a polyp is detected and removed, the screening becomes a diagnostic procedure and costs rise.

“People face an out-of-pocket expense if they're getting a colonoscopy. They also have to take a day off from work,” Wender said.

“You can afford a fecal blood test,” which runs $15 to $27.

Of course, if the fecal test suggests there is a problem, you need a colonoscopy, but 95 percent of fecal tests don't indicate a need for further testing.

Some people don't know about screening because their doctors fail to recommend it, Wender said. Others think they need to get screened only if they have symptoms or have a family history of colorectal cancer.

“The majority of people who develop colorectal cancer don't have a family history,” Wender said. “If you have a strong family history, screen earlier, but the absence of family history doesn't get you off the hook.”

Patients should be offered a choice of screening tests after a careful discussion with their doctor, said Minhhuyen T. Nguyen, director of clinical gastroenterology at Fox Chase Cancer Center.

“Screening rates are highest when patients self-selected a screening method,” she said. “If we can bring the screening rate way up, then it would be a win-win situation all around.”

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