Projections to 2031 reveal an expected doubling of the proportion of the population over 65, from about 12% to 25% of Australians (Gridley et al., 2000), while projections for dementia disease onset approach 500,000 Australians by 2040, with an estimated health care cost increase from 1% to 3% of GDP (Access Economics, 2003). With this projected growth, identifying effective methods of alleviating the symptoms associated with mild cognitive impairment (MCI) and frontotemporal dementia (FTD) points to potential opportunity in the employment of contemplative techniques, with growing bodies of evidence for psychological benefits of meditation across cognitive, neuroscientific, social/relational and developmental realms (Walsh & Shapiro, 2006). Undertaking ground breaking research with meditation interventions inculcated in early dementia diagnosis may reveal clinical techniques worthy of endorsement not only in Australian but also in international psychological treatment communities.
Mindfulness and meditation have been researched as benefiting learning ability, short and long term memory recall (Cranson et al., 1991) and improved interoceptive awareness (Cahn & Polich, 2006) in cross sectional studies. Ageing has been shown to bring linear and lifelong decline in ability to encode new episodes in memory, in working memory and in the processing speed of cognition, accompanied by late life decline in short term memory and semantic and vocabulary ability (Hedden & Gabrieli, 2004). With aging, the chronic condition of MCI or ‘cognitive impairment no dementia’ has occurrence rates at between 33% – 56% of the population over 65, across two Australian studies, benchmarked by performance on memory tests at 1.5 SD below age norms (Low et al., 2004). MCI is a known precursor to both FTD and Alzheimers Disease (AD) in longitudinal studies (Lyketsos et al., 2002; Hedden & Gabrieli, 2004).
MCI is typically diagnosed with cognitive psychometric testing (Peterson et al., 1999), and recent neuroimaging study results correlate these results with grey matter deterioration in the entorhinal cortex (Dickerson et al., 2001) and the medial temporal lobe (Rusinek et al., 2003). A recent longitudinal controlled study of 25-55 year olds participating in an MBSR intervention program evidenced an increase in grey matter concentration in the hippocampus and entorhinal region, parts of the brain known to mediate stress and memory, supporting earlier studies finding increased cortical thickness for long-term meditators in the hippocampus (Lazar et al., 2005). Researching longitudinal outcomes for MBSR intervention employed at the point of early MCI diagnosis may also see retention of function in areas otherwise atrophying, such as the posterior cingulate, and left temporo-parietal junction as found in the Hölzel et al. (2011) whole brain study. These parts of the brain responsible for maintaining conscious experience of the self, autobiography and social cognition (Blanke et al., 2005; Van Overwalle, 2009), invaluable in MCI and FTD onset.
MBSR includes sitting meditation, body scan, and gentle yoga (Hölzel et al., 2011). Early intervention in MCI with yoga techniques thus potentially leverages the benefits of physical activity shown in large scale studies to be protective in onset of FTD and AD both neurobiologically – for example, improving chances of neurogenesis (Laurin, Verreault, Lindsay, MacPherson & Rockwood, 2001) and by preserving social-cognitive wellbeing and self-efficacy in ageing (Netz, Wu, Becker & Tenenbaum, 2005).
Neuropsychiatric symptoms such as depression, anxiety and agitation are co-morbid with FTD and MCI onset, with an occurrence rate of 30% of aged sufferers across each symptom (Lyketsos et al., 2002).
Alleviation of depression and anxiety with MBSR intervention is well established in the literature among the general population (Baer, 2003, Roemer et al., 2008), and modulation of neurotransmitters has been found to improve with greater grey matter concentration in the brain stem, leading to homeostasis of serotonin levels essential for mood regulation (Hölzel, et al., 2011), potentially neutralising tendency to agitation and aggression in MCI and FTD.
Finally gerotranscendence theory is a reformulation of developmental disengagement theory which proposes that it may be possible in older age to experience transcendent quiescence, with a sense of own life story dissolving into an awareness of participation in the larger human multi-generational story (Tornstam, 1989). The possibility of accentuating experiences of gerotranscendence appears well supported through the practice of non-judgemental awareness central to MBSR, with the ensuing plasticity of brain structure perhaps supportive of a shift, even in the stages of degeneration that mark the onset of chronic MCI & FTD, of the structures of the self to a possible and profound sense of wellbeing and generativity, even in what would perhaps otherwise be cast as a state of decline.
Researching both the developmental validity of the gerotranscendence construct, and establishing the efficacy of MBSR as an intervention in ageing based on the neuroscientific evidence seems imperative in we might afford that the suffering associated with the onset of neurodegenerative disease may be alleviated, halted, and perhaps even, turned around.
References:
Access Economics. (2003). The dementia epidemic: economic impact and positive solutions for Australia. Report prepared for Alzheimer's Australia. Canberra: Alzheimer's Australia.
Blanke, O., Mohr, C., Michel, C.M., Pascual-Leone, A., Brugger, P., Seeck, M., Landis, T., & Thut, G. (2005). Linking out-of-body experience and self processing to mental own body imagery at the temporoparietal junction. Journal of Neuroscience, 25, 550-557.
Cahn, R., & Polich, J. (2006). Meditation states and traits: EEG, ERP & neuroimaging studies. Psychological Bulletin, 132, 180-211.
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Low, L.F., Brodaty, H., Edwards, R., Kochan, N., Draper, B., Trollor, J., Sachdev, P. (2004). The prevalence of ‘cognitive impairment no dementia’ in community dwelling elderly: a pilot study. Australian and New Zealand Journal of Psychiatry, 38, 725-731.
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Netz, Y., Wu, M-J., Becker, B.J., Tenenbaum, G. (2005). Physical activity and psychological well-being in advanced age: A meta-analysis of intervention studies, Psychology and Aging, 20(2), 272-284.
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* this is 'the' paper. With warm and deep appreciation for the encouragement, wisdom and guidance of Niree, for the sense of connectedness and possibility that comes about when one soul really sees another.
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