OBJECTIVES Summarize and critically evaluate research on the effects of Tai Chi on cognitive function in older adults. DESIGN Systematic review with meta-analysis. SETTING Community and residential care. PARTICIPANTS Individuals aged 60 and over (with the exception of one study) with and without cognitive impairment. MEASUREMENTS Cognitive ability using a variety of neuropsychological testing. RESULTS Twenty eligible studies with a total of 2,553 participants were identified that met inclusion criteria for the systematic review: 11 of the 20 eligible studies were randomized controlled trials (RCTs), 1 was a prospective non-randomized controlled study, 4 were prospective non-controlled observational studies, and 4 were cross-sectional studies. Overall quality of RCTs was modest, with 3 of 11 trials categorized as high risk of bias. Meta-analyses of outcomes related to executive function in RCTs of cognitively healthy adults indicated a large effect size when Tai Chi was compared to non-intervention controls (Hedge’s g=0.90; p=0.043) and moderate effect size when compared to exercise controls (Hedge’s g=0.51; p=0.003). Meta-analyses of outcomes related to global cognitive function in RCTs of cognitively impaired adults, ranging from mild cognitive impairment to dementia, showed smaller but statistically significant effects when Tai Chi was compared to both non-intervention controls (Hedge’s g=0.35; p=0.004) and other active interventions (Hedge’s g=0.30; p=0.002). Findings from non-randomized studies add further evidence that Tai Chi may positively impact these and other domains of cognitive function. CONCLUSION Tai Chi shows potential to enhance cognitive function in older adults, particularly in the realm of executive functioning and in those individuals without significant impairment. Larger and methodologically sound trials with longer follow-up periods are needed before more definitive conclusions can be drawn.

MBSR is safe and feasible for adults with migraines. Although the small sample size of this pilot trial did not provide power to detect statistically significant changes in migraine frequency or severity, secondary outcomes demonstrated this intervention had a beneficial effect on headache duration, disability, self-efficacy, and mindfulness. Future studies with larger sample sizes are warranted to further evaluate this intervention for adults with migraines. This study was prospectively registered (ClinicalTrials.gov identifier NCT01545466).

The principle of informed consent obligates physicians to explain possible side effects when prescribing medications. This disclosure may itself induce adverse effects through expectancy mechanisms known as nocebo effects, contradicting the principle of nonmaleficence. Rigorous research suggests that providing patients with a detailed enumeration of every possible adverse event can actually increase side effects. Describing one version of what might happen (clinical “facts”) may actually create outcomes that are different from what would have happened without this information (another version of “facts”). This essay argues that the perceived tension between balancing informed consent with nonmaleficence might be resolved by recognizing that adverse effects have no clear black or white “truth.” This essay suggests a pragmatic approach for providers to minimize nocebo responses while still maintaining patient autonomy through “contextualized informed consent,” which takes into account possible side effects, the patient being treated, and the particular diagnosis involved.

Those with high baseline stress levels are more likely to develop mild cognitive impairment (MCI) and Alzheimer's Disease (AD). While meditation may reduce stress and alter the hippocampus and default mode network (DMN), little is known about its impact in these populations. Our objective was to conduct a “proof of concept” trial to determine whether Mindfulness Based Stress Reduction (MBSR) would improve DMN connectivity and reduce hippocampal atrophy among adults with MCI. 14 adults with MCI were randomized to MBSR vs. usual care and underwent resting state fMRI at baseline and follow-up. Seed based functional connectivity was applied using posterior cingulate cortex as seed. Brain morphometry analyses were performed using FreeSurfer. The results showed that after the intervention, MBSR participants had increased functional connectivity between the posterior cingulate cortex and bilateral medial prefrontal cortex and left hippocampus compared to controls. In addition, MBSR participants had trends of less bilateral hippocampal volume atrophy than control participants. These preliminary results indicate that in adults with MCI, MBSR may have a positive impact on the regions of the brain most related to MCI and AD. Further research with larger sample sizes and longer-follow-up are needed to further investigate the results from this pilot study.