Thursday, October 29, 2015

DG XXXVI: The National Institute for Health and Care Excellence versus Joe Verghese

Today’s post is going to involve a trip back to the future.

It’s a post in which we’ll see that when it comes to claims about the impact of playing chess on dementia, the age of the people playing the chess matters. By the time I’m done, I’ll  have suggested a path that the English Chess Federation - DG XXVII: The ECF vs Mrs Sally WilliamsDG XXVIII: The ECF vs The Daily ExpressDG XXXI: "many scientists", many claimsDG XXXII: Election Day - might follow if it's serious about being involved in the chess and dementia business.

First, though, we have a conundrum to solve.

As we saw earlier this week - DG XXXIV: A Message to the English Chess Federation; DG XXXV: The ECF vs the National Institute for Health and Care Excellence - the latest NICE guidelines for "mid-life approaches to delay or prevent onset" of dementia suggest a focus on

  • helping people stop smoking, be more active, reduce alcohol consumption, improve their diet and, if necessary, lose weight and maintain a healthy weight
  • reducing the incidence of other non-communicable chronic conditions that can contribute to onset of dementia, disability and frailty
  • increasing people's resilience, for example by improving their social and emotional wellbeing.

Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset [NG16], National Institute for Health and Care Excellence, 20 October 2015, page 4.

On the other hand, the (in)famous Verghese research, that is the the study that is commonly cited by people claiming that chess beats dementia (albeit they forgot to mention that Verghese’s work doesn’t actually mention chess) - DG III: Dogs That Don’t Bark; DG IV: After Six Years' Thought; DG V: In the News; DG VI: Doctor Susan - concludes,

Participation in leisure activities is associated with a reduced risk of dementia ... 
Verghese and others, The New England Journal of Medicine (2003)
(For the full reference and link to the original text see The Knowledge Pile)

That’s a bit of a discrepancy, no? How are we going to square this particular circle?

Actually it’s pretty easy.

So here’s the thing. The NICE guidelines are for people in "mid-life" and for the purposes of their report, NICE define that as people aged 40 to 64. The Verghese study, in contrast, focused on "subjects older than 75 ...."

Take a look at the other studies in The Knowledge Pile (where full references and links to the original text, where available, are given). The ages of the subjects of the research are always listed but the authors. For example, :-
  • Akbaraly: 65 and over;
  • Dartigues: 65 and over;
  • Hughes: 65 and over;
  • Sorman: 65 and over.

I think you see the point.

The NICE guidelines notwithstanding, cognitively-stimulating activities aren’t an irrelevance for those of us in mid-life who want to give ourselves the best chance of avoiding or delaying dementia. Reality is messy - DG XXX: The Ugly Truth - remember? Messages about health interventions don’t come in neat, unambiguous packages.

See, for example, The Guardian’s report on the publication of the NICE guidelines. At the end of the article, Jeremy Hughes, Head Honcho at The Alzheimer’s Society, says,

Nice rightly highlights the significance and evidence for cardiovascular risk factors, but this focus must not overshadow the additional importance of psychological and social risks, such as stress, depression, social isolation and lack of mental activity.
(my emphasis)

True enough. It’s just that for most of us in mid-life, the NICE guidelines suggest we think about starting elsewhere. In most cases stopping smoking, reducing alcohol intake, improving diet and losing weight is likely to be more helpful than setting up a chess set.

If the ECF are going to stick to the blanket claims about the effectiveness of chess in delaying Alzheimer’s with qualification with regard to age, they need to explain why they’re so out of step with the NICE guidelines. So why not do something else?

Given that associations have been found - again, see The Knowledge Pile for some relevant studies - between participation in cognitively stimulating activities and positive dementia outcomes when people over retirement age are studied, why not start there? Why not use that information to advocate for a programme aimed at encouraging older people to learn and play chess?

This is the future that I suggest for the ECF and its involvement with dementia. Go back to Doctor Coyle and the conclusion reached in this series a year and a half and 29 posts ago (DG VII):-

... participation in cognitively demanding leisure activities in late life may provide protection against dementia,
Determining the relative contributions of genes that confer risk and environmental factors such as effortful mental activity to the pathogenesis of dementia remains an important but unrealized goal in research on dementia. In the meantime, seniors should be encouraged to read, play board games, and go ballroom dancing, because these activities, at the very least, enhance their quality of life, and they might just do more than that.
Use it or Lose It - Do Effortful Mental Activities Protect against Dementia?

New England Journal of Medicine 2003; 348: 2489-2490

Chess and Dementia Index


Unknown said...

Has this paper been mentioned in the series? It won't show up in a PubMed search for chess or dementia, since it mentions neither, but it seems relevant to the topic.

Park, D. C. Park, Lodi-Smith, J. Drew, L., Haber, S., Hebrank, A. Bischof, G. N. and Aamodt, W. (2014) The impact of sustained engagement on cognitive function in older adults. Psychological Science, 25(1), 103-112.

There is a popular account of the research here:

The general conclusion is that learning a new skill (quilting and digital photography in the study) improves memory in older people. So it might be that learning to play chess would help, but simply continuing to play the game wouldn't.

Jonathan B said...

Has this paper been mentioned in the series?

Hello Ian. Thanks for the reference. No it hasn’t. Although it might well do shortly!

Jonathan B said...

Incidentally, from the study that Ian cites,

"Participants ranged in age from 60 to 90 ...."