In a recent systematic review (SR) and meta-analysis published in the journal Systematic review, researchers investigated claims that the Chinese martial art tai chi delays dementia progression and improves cognitive function in adults with mild cognitive impairment (MCI). They reviewed eight reviews and six randomized control trials (RCTs) and discovered a serious lack of formal tai chi research. Although available evidence suggests that tai chi can benefit the physical and cognitive health of the elderly, most studies focus on healthy adults and present inconsistent results.
Study: Effects and Mechanisms of Tai Chi on Mild Cognitive Impairment and Early Dementia: A Scoping Review. Image credit: Created with assistance from DALL·E 3
The mechanisms underlying the benefits of tai chi were explored, with findings showing increased regional brain activity and regional gray matter volume. This SR highlights the need for further research before tai chi can be clinically recommended as an MCI intervention.
Tai Chi and Mental Health
Tai Chi is an internal Chinese martial art that focuses more on spiritual, mental, and qi-related aspects than physical ones. Performed for both self-defense and its perceived health benefits, tai chi is growing in popularity worldwide as a form of gentle exercise and moving meditation. Unlike other martial art forms, Tai Chi consists of low to moderate intensity, slow, flowing movements, allowing even older adults to easily practice the art.
Tai Chi is promoted as beneficial for physical and mental well-being, with anecdotal reports of its ability to slow the progression of mild cognitive impairment (MCI) and delay the onset of dementia. However, these claims have never been scientifically validated, with existing studies presenting inconsistent, often contradictory results.
Dementia is a serious mental condition associated with numerous diseases in which cognitive impairment significantly impairs physical and social functioning. It has no cure, with current clinical interventions aimed at delaying its onset and progression. Dementia is a silent global epidemic and a growing concern – the current prevalence is 55 million, with the prevalence estimated to rise to 139 million by 2050. The onset of dementia is preceded by MCI and is characterized by a decline in cognitive ability without significant decline in daily functioning. . MCI increases the risk of dementia more than fivefold and is therefore the ideal stage for clinical interventions aimed at delaying dementia.
Some studies on positive associations between Tai Chi and MCI have identified improvements in cognitive function, learning, memory and visuospatial perception. Their results suggest that tai chi may act as a mind-body intervention, thereby reducing the risk of falls, stress, depression, and dementia in MCI patients. More recent research, however, has challenged these findings, finding no differences between depression levels and executive function in MCI patients and healthy controls following tai chi.
Furthermore, the mechanisms underlying the physical and neurological benefits of tai chi remain unclear. Elucidating the benefits of tai chi will allow clinicians and researchers alike to recommend the art form as an inexpensive, non-pharmacological, side-effect-free intervention to combat dementia risk in the future.
About the study
In the current review, researchers aimed to investigate the psychological, neurocognitive and physical effects of tai chi on patients with MCI and early-stage dementia. They sought to assess the safety of tai chi in this population and to uncover the neural mechanisms of the art’s popular benefits.
Data for this systematic review and meta-analysis were collected from multiple English and Chinese scientific databases. MEDLINE, PubMed, EMBASE, Cochrane Library, the Chinese Scientific Journal Database (VIP), the China National Knowledge Infrastructure (CNKI), Wanfang Database, and Sino-Med were queried from their inception to 4 December 2020. Inclusion Limits All studies conducted in adults over 50 included tai chi as an intervention, either independently or in combination with other interventions.
Data collected included bibliometric information, details of tai chi, demographic characteristics of participants, case-control interventions, and study outcomes. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. It employed the Measurement Tool for Assessment of Systematic Reviews (AMSTAR 2) software to assess data quality. For randomized controlled trials (RCTs), the Cochrane Risk of Bias Assessment Tool quality.
No statistical analysis was performed as part of this review, and the results were reported as a summary of the main study findings. Although a meta-analysis was initially proposed, insufficient qualitative studies made this unfeasible.
The database search identified 1,157 potential records, but quality assessment narrowed it down to eight SRs and six RCTs for efficacy outcomes, and five RCTs and four cross-sectional studies on mechanisms of tai chi. The included studies consisted of 5,054 individuals with study-specific sample sizes ranging from 11 to 1,061. Seven studies focused on MCI, while one focused on early stage dementia. Study participants ranged in age from 55 to 85 years. Four studies included a group of other interventions including tai chi, while the remaining four evaluated tai chi independently.
Tai chi interventions ranged from 30 to 120 minutes, one to six times per week, for eight to 52 weeks. The most commonly reported outcomes included global cognition, memory, perceptual-motor, and executive function. Two meta-analyses reported improved global knowledge in the tai chi intervention group compared to controls, but two other meta-analyses failed to find differences between these cohorts.
Of two meta-analyses exploring attention and executive function, one reported improvements associated with tai chi intervention, while the other was unable to find statistically significant differences between cases (tai chi) and controls. The visual effects of tai chi have been found to be positive, but results on memory, language, and motor function have been mixed or inconclusive across studies.
Tai chi has been found to have beneficial effects on depression levels in patients with MCI as measured by the Geriatric Depression Scale (GDS). Pain perception, especially as a comorbidity in patients with arthritis, was significantly improved in Tai Chi practitioners compared to controls. Similar improvements were reported for balance and fall risk reduction. Blood analysis showed that tai chi practitioners had significantly higher plasma brain-derived neurotrophic factor (BDNF) levels than controls, but other cytokine and interleukin levels were indistinguishable from non-practitioners.
“The Cornell Scale for Depression in Dementia (CSDD) score decreased by 49% for the intervention group (p = 0.02) in a per-protocol analysis, indicating a statistically significant improvement in depressive symptoms. At least 30 minutes per session at 1 year and at least three sessions per week After practicing tai chi for , tai chi was found to be superior to the control group (stretching and toning exercises) in slowing the progression of dementia identified by DSM. IV in people with amnestic MCI (p = 0.04).”
While there is some evidence of beneficial effects of tai chi on neurological function and dementia risk reduction, current research is inconclusive and, at times, contradictory in its verdict on tai chi as a clinically recommended intervention to delay the progression of MCI. from dementia
Clinical decision making requires more well-designed, large-scale, and transparently reported RCTs and meta-analyses for people with MCI or early-stage dementia.