A new kind of cognitive clinic, which opened 6 March in Santa Barbara, California, aims to help people stay mentally sharp by addressing mind, body, and soul.

After three years of development, Cognitive Fitness and Innovative Therapies (CFIT) opened its doors to a pilot group of clients this month. CFIT (pronounced “see-fit”) will help not only people who have cognitive impairment or Alzheimer disease, but also advise mentally fit clients on how to remain that way for as long as possible. “It is a new way of thinking about the whole person for their cognitive health,” said Debra Lieberman, a communications researcher at the University of California, Santa Barbara (UCSB), who is developing a virtual community for CFIT users. “You are not just a patient with diagnoses; all aspects of your daily life come into play.”

Ken Kosik, a neurologist at UCSB and executive director of CFIT, envisions the center as a place where people concerned about Alzheimer’s can get all the information and services they require in one location. Kosik is best known for his basic research on presenilin (Lemere et al., 1996), tau (Kosik et al., 1986), and RNA interference (Krichevsky and Kosik, 2002). The CFIT project is an addition to his ongoing research at UCSB (see ARF related news story and interview with Ken Kosik). CFIT has services for people who already suffer from cognitive impairment, but Kosik is excited to also assist people at risk for Alzheimer’s in staving off its approach. “We focus on people who may get it, before they get it,” Kosik said.

Studies have shown that staying physically fit, eating right, challenging one’s mind, and being social can all benefit cognitive health. CFIT aims to apply those data by designing personalized lifestyle programs for each client. “Their ability to bring together the state-of-the-art information in all arenas is unique,” said Rhonda Spiegel, executive director of the Alzheimer’s Association Central Coast Chapter headquartered in Santa Barbara, who is not involved with CFIT.

The center should be a fun place to go, Kosik said, and he plans that clients will use it on a weekly basis. To make the setting inviting, CFIT has decorated its suite, just outside a local hospital, in living room style, with tan couches and black leather chairs, sculptures, and a fountain to create a cozy, less clinical atmosphere. Users will have access to age-appropriate exercise equipment, including a reclined elliptical trainer and a Wii Fit so they can move their feet to the tunes of “Dance Dance Revolution.” A nutritionist will help clients assess their diet and may recommend supplements. The center offers computers that members can use for mind fitness games, such as programs that ask the player to decide which of two sounds lasted longer, or quickly identify the first letter of the word for a picture flashed on the screen. Kosik will start with a small pilot group of approximately 20 clients, who will use the center while CFIT refines its services. CFIT could eventually serve 700 users, Kosik estimates.

Also on offer are services to enhance social relationships among users. The center will assemble groups of clients that use the facilities simultaneously, so they get to know each other. “When people get social support, and have a circle of friends, they stay healthier,” Lieberman said. She and others are assembling an online social networking interface that will work in conjunction with Facebook. Users will be able to log on and record their diet and exercise habits—then see how their activities compare to those of others in their social network. Studies have shown that keeping tabs on what others are doing can promote healthy lifestyles, Lieberman said. In addition, Lieberman hopes to archive records from the social network that clinicians can then mine for data on how well the interventions work.

Kosik has assembled a team including medical doctors, a nutritionist, a social worker, and a chaplain. A unique position at CFIT is that of “navigator.” Tonya Kydland, a cognitive psychologist with experience in genetics, will help CFIT clients sift through the vast amount of information, some of it conflicting or misleading, that is available on the Internet. She can also help people understand how markers in their DNA contribute to a risk for Alzheimer’s. Kydland will assist patients in finding clinical trials if they wish to participate in one. That kind of informational service is not routinely available in a physician’s office. “Doctors only have a certain amount of time,” Kydland said. “I can sit with a client for two hours, if we want to.”

CFIT also plans to nurture the spirit, if clients feel they need it. Michelle Woodhouse, an Episcopal priest, described herself as the “director of spiritual care.” She will be available to counsel members of any faith, or no religion at all, on how to enrich their lives. “I’m interested in what are the important relationships in this person’s life.” she said. “Are there ways that an older person can enhance their quality of life?” That enhancement could take many forms: re-establishing a personal religion, reaching out to friends more, or finally planning that trip to Tuscany. Woodhouse can also help people plan end-of-life care and express their desires for a funeral service.

CFIT is partnering with community organizations, such as Life Chronicles, a Santa Barbara-based nonprofit that produces “memory” videos of people with terminal illnesses. A family may want a video, for example, to preserve a loved one’s character, spirit, and stories before a cognitive condition makes it hard for them to remember or communicate. In addition, such videos could be useful for professional caregivers who may not meet their patient until the person needs constant assistance. “Inside there’s still this person; you just can’t reach them anymore,” said Kate Carter, president of Life Chronicles. Viewing a memory video “helps the caregiver connect much better, which means better care no matter how you look at it,” she said.

The center will closely monitor the efficacy of its interventions, in order to measure if the approach works. While research studies typically focus on one particular intervention—following a Mediterranean diet, for example—Kosik and colleagues will analyze the effectiveness of CFIT’s recommendations as a whole. Kosik expects that people who follow the center’s guidance will, on average, maintain better cognitive health than a control group, including people from local assisted-living facilities, who don’t follow a program like CFIT’s.

It will be critical that CFIT show its model is cost-effective, Kosik said. For now, the center is funded by donations from the surrounding community. CFIT clients will have to pay for services—approximately $1,800 for an evaluation, and $4,000 for a year-long center “membership.” A high priority for Kosik is to show that the lifestyle intervention program lowers overall medical costs, and to seek additional funding so people who can’t afford the fees can still use the center. Armed with such data, he might even convince insurance companies to cover some costs in the future. “It’s very much my intention not to turn this into a boutique operation,” Kosik said.

If the program is proven effective, other communities could build similar centers. In addition, the CFIT model could be useful for other conditions, such as Parkinson disease. “This is the beginning of a major movement,” said Tom Harriman, chairman of the CFIT board.—Amber Dance.

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  1. I very much look forward to hearing updates about the progress of the center. I hope they will be able to produce quantifiable data of improved outcomes - quality of life, lowered medical costs, delay in nursing home placements, etc.

  2. A Mediterranean diet is difficult to follow in the U.S.

References

News Citations

  1. Garbage BAG2 Takes Out the Tau
  2. Amber Dance Interviews Ken Kosik

Paper Citations

  1. . The E280A presenilin 1 Alzheimer mutation produces increased A beta 42 deposition and severe cerebellar pathology. Nat Med. 1996 Oct;2(10):1146-50. PubMed.
  2. . Microtubule-associated protein tau (tau) is a major antigenic component of paired helical filaments in Alzheimer disease. Proc Natl Acad Sci U S A. 1986 Jun;83(11):4044-8. PubMed.
  3. . RNAi functions in cultured mammalian neurons. Proc Natl Acad Sci U S A. 2002 Sep 3;99(18):11926-9. Epub 2002 Aug 21 PubMed.

External Citations

  1. Cognitive Fitness and Innovative Therapies (CFIT)

Further Reading

Papers

  1. . Immediate and delayed effects of cognitive interventions in healthy elderly: a review of current literature and future directions. Alzheimers Dement. 2009 Jan;5(1):50-60. PubMed.
  2. . Lifestyle-related factors in predementia and dementia syndromes. Expert Rev Neurother. 2008 Jan;8(1):133-58. PubMed.
  3. . Non-pharmacologic prevention of Alzheimer's disease: nutritional and life-style risk factors. J Neural Transm. 2007 Sep;114(9):1187-97. PubMed.