In a small study evaluating Cytoplan’s Brain Health Programme, participants reported a significant reduction in symptoms of stress, anxiety, and overall psychological distress, as well as an improvement in cognitive health.
This blog has been written by Aurea Fellows who evaluated The Brain Health Programme as part of her MSc in Nutritional Therapy at the University of Worcester. Having worked as a professional business psychologist for over 20 years Aurea has always had an interest in mental well-being and particularly lifestyle interventions that can support an individual’s cognitive performance and overall brain health. Her research involved both a review of the existing literature and evaluating the outcomes for individuals who attended The Brain Health Programme.
Why is prevention important in relation to brain health?
Recent estimates suggest that mental illness, including dementia and depression, account for 13% of the global disease burden, exceeding both cardiovascular disease and cancer1. In 2016 dementia became England and Wales’ foremost cause of death2, and current estimates indicate that 850,000 people in the UK are living with dementia, with this figure forecasted to exceed 1 million by 20253. In the UK mental-health issues are currently estimated to effect 1 in 6 people4.
The scale of these illnesses creates a substantial social, economic and health burden. The estimated total cost of mental-health problems in England in 2009/10 was £105.2 billion5 and the estimated cost for dementia in the UK is £26 billion annually3. With these figures set to rise with an ageing population the World Health Organisation has recognised Alzheimer’s Disease as a global public health priority2.
Research commissioned by Alzheimer’s Research UK has shown that delaying the onset of dementia by five years would result in a third (666,000) fewer people with dementia by 2050. This would consequently reduce the cost to the economy by 36%, a saving of £21.2 billion, and require 566,000 fewer informal carers6.
The importance of prevention is amplified by the lack of disease-modifying treatments for dementia, the large-scale failure of pharmaceutical trials and the restricted effectiveness of conventional treatments for mental illness. Preventative measures in dementia are also important because associated neuropathological changes can precede diagnosis by more than two decades.
Consequently, attention is turning to non-pharmacological interventions and preventative strategies. The field of nutritional psychiatry is based on the growing evidence that diet and nutrition are associated with the prevention, development and management of mental illnesses. The importance of overall dietary patterns, key nutrients and the microbiota-gut-brain axis in mental health have all been highlighted by recent research1. Equally, modifiable risk factors, including diet and lifestyle, are estimated to account for 50% of the prevalence of Alzheimer’s Disease7. Studies also indicate a protective role for dietary patterns and certain nutrients in the prevention of cognitive decline and dementia8. Additionally, mental illnesses, such as depression and anxiety, are risk factors for dementia so intervention to improve mental health could reduce the risk of future cognitive decline.
What does the research tell us about the impact of preventative strategies?
A lot of the research into the relationship between lifestyle factors, including dietary patterns, and both cognitive and mental-health has been observational. Observational studies typically track changes in a cohort of individuals over time but are non-experimental in nature as they do not involve a specific intervention or a control group. However, a systematic literature review revealed a number of experimental studies, focused on the prevention of symptoms of cognitive decline or mental health, have taken place in recent years using interventions which simultaneously target a number of lifestyle factors such as diet, exercise and cognitive activities. The evidence from these studies suggests that such multidomain interventions can have a positive impact on the prevention of both depression and cognitive decline.
The inclusion criteria used for this MSc literature review were interventions that included diet or nutrition, plus another non-pharmalogical approach, in populations with no existing clinical diagnosis of mental illness or cognitive decline. Eight randomised controlled trials have taken place in recent years looking at the impact of multidomain lifestyle interventions on preventing cognitive decline9-16. Six of these trials showed significant improvement in cognitive outcome measures with intervention9-14. Although improvements were not seen in the other two trials15-16, subsequent analysis showed that the multi-domain intervention was effective for those with cardiovascular risk factors or evidence of brain pathology putting them at a higher risk for cognitive decline17.
Multidomain intervention studies in relation to mental health have focused on populations at higher risk of depression due to the presence or risk of other conditions such as type 2 diabetes or obesity. Six papers were identified in the literature review where the primary aim of the studies was the impact on other health outcomes rather than the prevention of mental health18-23. Four of these studies showed significant improvements in health-related quality of life and/or depressive symptoms with intervention18-21. Further analysis of another showed higher baseline depressive symptoms was associated with greater reduction following intervention22.
The nature of the multi-domain intervention in the mental-health studies was predominantly diet and exercise with a focus on weight loss. Cognitive decline studies have typically used more varied interventions which have also included management of cardiovascular risk factors, as well as cognitive and social activities. However, most of the studies included just two or three elements to the intervention, very few of the studies included the breadth of domains that have been identified as important contributors to brain health and are included in precision medicine approaches to reduce dementia risk24 and the Bredesen Protocol™ for reversing cognitive decline. This protocol addresses the multiple physiological pathways potentially contributing to the underlying pathogenesis of cognitive decline, in order to achieve an additive effect, so it includes nutrition exercise, sleep, gut health, stress reduction, brain training and other interventions25.
What did the evaluation reveal about the outcomes of The Brain Health Programme?
The Brain Health Programme, developed by Cytoplan, is based on the diet and lifestyle elements of the Bredesen Protocol™. The programme comprises six interactive workshops, led by qualified Nutritional Therapists, which include talks, activities and discussion to show individuals how to make, and sustain, lifelong food and lifestyle choices to protect and promote the health of the brain. The workshops cover topics such as nutrition, optimising gut health, stress management, improving sleep, physical activity and brain training. The programme is aimed at individuals who want to optimise their brain health and reduce the risk of cognitive decline, potentially because they are experiencing a decline in concentration, focus, memory or mood.
The research study evaluated the outcomes of The Brain Health Programme using pre-and post- online questionnaires. The questionnaires contained questions relating to symptoms of mental well-being, cognitive health, gastrointestinal health and general well-being. The post-questionnaire also included questions regarding compliance to different elements of the programme and behaviour change strategies.
In total eleven participants took part in the study. They were all female and white, and aged 47- 74 years. Whilst the overall sample of participants was small, the study did reveal some encouraging preliminary results about the positive impact of The Brain Health Programme. Statistical analyses showed a significant reduction in symptoms of stress, anxiety, and overall psychological distress, as well as an improvement in cognitive health, following attendance at The Brain Health Programme. Further analysis revealed a strong correlation between an improvement in cognitive health and use of the behaviour change strategies embedded in The Brain Health Programme. Participants were also highly motivated to continue with the changes they had made to their dietary and lifestyle habits, with 100% of participants rating their motivation to maintain the changes as 50% or higher.
Therefore, the findings of this study add to a growing evidence base supporting the role of multidomain interventions in the prevention of cognitive decline and mental illness. Additionally, it shows a possible extension of application for such interventions to younger populations who are not necessarily at high risk due to other chronic conditions.
What does the future hold?
Clearly further research with a larger, more diverse sample, and ideally longer term follow up, is needed to build on these preliminary results. However, these findings in conjunction with the existing evidence, illustrate the potential benefits of a greater emphasis on prevention in relation to mental health and cognitive decline.
In the UK, we are spending £97bn of public money on treating disease and only £8bn preventing it. In November 2018 when announcing a green paper on prevention, the Health and Social Care Secretary Matt Hancock agreed the numbers don’t stack up when it comes to spending on prevention as opposed to treatment. The paper entitled ‘Prevention is better than cure’ argues for a shift towards primary and community care services to help people stay well. The paper states that there will be an extra £20.5 billion a year by the end of the next five years, offering an opportunity to change the focus of health and social care onto prevention.
The long-term strategy outlined in the paper includes ‘social prescribing’ which promotes a holistic approach to health and well-being. This approach enables healthcare professionals to refer people to a range of local, non-clinical services. Services include both lifestyle and social elements that support individuals in taking greater control of their own health and are seen as particularly relevant for individuals with mental health concerns26-27. Multi-domain lifestyle interventions such as The Brain Health Programme could therefore play a role in more holistic provision of healthcare services in the future.
Given the scale of the disease burden associated with mental illness, and the universality of the modifiable lifestyle factors, advancements in prevention have the potential to translate into large-scale gains at a population level. Gains not just in relation to the significant economic and social burdens but for enhanced quality of life for millions of people. However, there remains a continued need to raise public awareness about the benefits of prevention and for the availability of programmes to support lifestyle adjustment.
- The scale of mental illness in the UK affects the lives of millions of people and creates a substantial social, economic and health burden.
- The importance of prevention is amplified by the lack of disease-modifying treatments for dementia, the large-scale failure of pharmaceutical trials and the restricted effectiveness of conventional treatments for mental illness.
- Attention is turning to non-pharmacological interventions and preventative strategies for mental illness.
- The evidence from recent studies suggests that multidomain lifestyle interventions can have a positive impact on the prevention of both depression and cognitive decline.
- Preliminary positive findings from an evaluation of The Brain Health Programme add to this evidence base and show a possible extension of application for such interventions to younger populations.
- With increased funding for prevention services and social prescribing hopefully this will mean more services which target the root causes of poor health and promote the health of the whole individual including mental well-being.
With many thanks to Aurea for this blog; if you have any questions regarding the health topics that have been raised, please get in touch with Clare via phone; 01684 310099 or e-mail firstname.lastname@example.org
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- Alzheimer’s Society (2014). Dementia UK: Update. Available at: https://www.alzheimers.org.uk/info/20025/policy_and_influencing/251/dementia_uk
- McManus, S., Bebbington, P., Jenkins, R. and Brugha, T. (eds) (2014) Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital. Available at: http://content.digital.nhs.uk/catalogue/PUB21748/apms-2014-full-rpt.pdf
- Centre for Mental Health (CMH) (2018). Economic and social costs of mental health problems. [online] Centre For Mental Health. Available at: https://www.centreformentalhealth.org.uk/economic-and-social-costs
- Alzheimer’s Research UK (2014) The Trajectory of Dementia in the UK – Making a Difference. Available at: https://www.alzheimersresearchuk.org/wp-content/uploads/2015/01/OHE-report-Full.pdf
- Barnes, D. and Yaffe, K. (2011). The projected effect of risk factor reduction on Alzheimer’s disease prevalence. The Lancet Neurology, 10(9), pp.819-828.
- Otaegui-Arrazola, A et al. (2014). Diet, cognition, and Alzheimer’s disease: food for thought. European Journal of Nutrition, 53(1), pp.1-23.
- Clare, L. et al. (2015). The Agewell trial: a pilot randomised controlled trial of a behaviour change intervention to promote healthy ageing and reduce risk of dementia in later life. BMC Psychiatry, 15:25
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- Lee, K et al. (2014). Effects of a Multidomain Lifestyle Modification on Cognitive Function in Older Adults: An Eighteen-Month Community-Based Cluster Randomized Controlled Trial. Psychotherapy and Psychosomatics, 83(5), pp.270-278.
- Ngandu, T et al. (2015). A 2-year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. The Lancet, 385(9984), pp.2255-2263.
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- Andrieu, S et al. (2017). Effect of long-term omega 3 polyunsaturated fatty acid supplementation with or without multidomain intervention on cognitive function in elderly adults with memory complaints (MAPT): a randomised, placebo-controlled trial. The Lancet Neurology, 16(5), pp.377-389.
- van Charante, E. et al. (2016). Effectiveness of a 6-year multidomain vascular care intervention to prevent dementia (preDIVA): a cluster-randomised controlled trial. The Lancet, 388(10046), pp.797-805.
- Kivipelto, M., Mangialasche, F. and Ngandu, T. (2017). Can lifestyle changes prevent cognitive impairment? The Lancet Neurology, 16(5), pp.338-339.
- Faulconbridge, L. et al. (2012). One-Year Changes in Symptoms of Depression and Weight in Overweight/Obese Individuals with Type 2 Diabetes in the Look AHEAD Study. Obesity, 20(4), pp.783-793.
- Ibrahim, N. et al. (2016). Effects of a Community-Based Healthy Lifestyle Intervention Program (Co-HELP) among Adults with Prediabetes in a Developing Country: A Quasi-Experimental Study. PLOS ONE, 11(12), p.e0167123.
- Mazzeschi, C. et al. (2012). Mutual Interactions between Depression/Quality of Life and Adherence to a Multidisciplinary Lifestyle Intervention in Obesity. The Journal of Clinical Endocrinology & Metabolism, 97(12), pp.E2261-E2265.
- Ng, T et al. (2017). Multi-domains lifestyle interventions reduce depressive symptoms among frail and pre-frail older persons: Randomized controlled trial. The journal of nutrition, health & aging, 21(8), pp.918-926.
- Ruusunen, A. et al. (2012). How does lifestyle intervention affect depressive symptoms? Results from the Finnish Diabetes Prevention Study. Diabetic Medicine, 29(7), pp.e126-e132.
- Azar, K et al. (2016). The Electronic CardioMetabolic Program (eCMP) for Patients with Cardiometabolic Risk: A Randomized Controlled Trial. Journal of Medical Internet Research, 18(5), e134.
- Isaacson, R et al. (2018). The clinical practice of risk reduction for Alzheimer’s disease: A precision medicine approach. Alzheimer’s & Dementia, 14(12), pp.1663-1673.
- Bredesen, D. et al. (2018). Reversal of Cognitive Decline: 100 Patients. Journal of Alzheimer’s Disease & Parkinsonism, 08(05), pp.1-6.
- The King’s Fund (2017). What is social prescribing? Available at: https://www.kingsfund.org.uk/publications/social-prescribing
- NHS England (2018) Social prescribing. Available at: https://www.england.nhs.uk/personalisedcare/social-prescribing/
Last updated on 3rd November 2022 by cytoffice