Transcript ppt-SHUBHADA-hyderabad - International Federation on Ageing

Talwadkar S, Jagannathan A, Nagarathna R
BACKGROUND
 Aging is associated with a gradual impairment of cognitive
functions
(Curr Neurol Neurosci Rep, 2004)
 Cognitive functions most affected by age are
 Speed of processing
 Memory
 Attention
 Executive function
 Spatial ability
 Reasoning
(Aging Health, 2010)
Treatment options for cognitive impairment Drug
 Activity
 Diet
 Cognitive interventions
 Tai chi
 Yoga
(Journal of the American Geriatrics Society, 2010; Dementia and Geriatric
Cognitive Disorders, 2010; Neurosci Biobehav Rev, 2012; Journal of the
South Carolina Medical Association, 2008)
 Trataka is one of the Shatkarmas (six cleansing processes)
(HYP)
 Looking intently with an unwavering gaze at a small point
until tears are shed is known as Trataka (HYP)
 Trataka practice makes eyes clear and bright. It improves
memory and helps to develop good concentration and
strong will power (Yoga publications trust, Munger, 2008)
 By practicing trataka, all the diseases of eyes are
destroyed
Samhita)
and
clairvoyance
is
obtained(Gheranda
 Trataka eradicates all eye diseases, fatigue and sloth and
closes the doorway creating these problems(Hatha yoga
pradipika)
 Combination of focusing and defocusing through yoga
reduces optical illusion more than focusing alone (Indian
Journal of physiology & Pharmacology, 1997)
 Jyotritrataka reduces intraocular pressure in normal
subjects (Thai Journal of Physiological Sciences, 2008)
 An increase in the CFF (perceptual accuracy) is seen
immediately after Trataka (The Journal of Alternative and
Complementary Medicine, 2010)
LITERATURE REVIEW
 Numerous studies looking at the effect of yoga on
cognition – in healthy young subjects
(Percept Mot Skills, 2007; Indian J Physiol Pharmacol, 2009; Front Integr
Neurosci, 2012 )
 Review study-15 studies with cognitively healthy elders, 8
studies with cognitive decline-Improvement in most of the
studies
(Clin J Sports Med, 2008)
 Review of nine studies including 3 RCTs, 6 NRCT’s-yoga
improved cognitive health of older adults
(Int J Yoga Therap, 2009)
 Relaxation response training improved attention, memory
in healthy elderly
(Compl Ther Clin Pract, 2006)
 Long term practitioners of Vihangam yoga in the geriatric
age group- better cognition
(Neuropsychol Cogn, 2012)
 Study in SVYASA-improvement in semantic, primary,
and working short term memory in healthy elderly
subjects
(SVYASA, 2005)
AIM & OBJECTIVES
 To study the effect of Trataka in the elderly on:
 Short term and working memory (digit span forward and
backward)
 Executive functions (Trail making test B)
METHODOLOGY
o Age & gender:- 60 to 80 yrs., Both males and females.
o Subjects:
Sample size:- n=60
Source of subjects:- Subjects were obtained from Old age
homes in Goa and from individuals staying in and around
Shantinagar and Margao areas in Goa.
 Inclusion Criteria:
 Healthy subjects
 Education: 5th Std. and above
 Willing to participate by giving a written informed consent.
 Those knowing Konkani, Hindi, English, Marathi.
 Exclusion Criteria :
 Those having neurological and psychiatric disorders
 Those who practiced yoga for the last 3 months.
DESIGN
 Randomized block design
 For the convenience of conducting the intervention, each
group was not more than 10 members – the groups were
randomized into Trataka or wait list control group.
Group A (trataka intervention)
Day1
TMT B, DS-F, DS-B
Day1(Immediately after intervention)
TMT B, DS-F, DS-B
Day 30
TMT B, DS-F, DS-B
Group B (Wait-list control)
Day 1
TMT B, DS-F, DS-B
Day 1 (After quiet sitting)
TMT B, DS-F, DS-B
Day 30
TMT B, DS-F, DS-B
ASSESSMENT
 Trail making test B-visual scanning, complex attention,
psychomotor speed mental flexibility,
executive
functions, working memory and task-switching ability.
 Digit Span forward and backward- evaluates short-term
memory and working memory.
DETAILS OF TRATAKA PRACTICE
DATA ANALYSIS
 Data was analyzed with the help of Statistical Package for
Social Sciences (SPSS) version 16.
RESULTS
Shapiro-Wilk test of normality
 Trail Making Test – Part B (TMT B) for both groups normally distributed (p > 0.05).
 Digit span test- not normally distributed (p<0.00). No
outliers in the data; however the data had distinct two peaks
at the higher and lower range of scores. Hence we used nonparametric tests.
 Due to multiple comparisons with baseline, Bonferroni
correction was conducted using the formula 0.05/n (where
alpha = 0.05; n = 3, as there were 3 pair wise comparisons).
 There were no group differences at baseline in all the
outcome variables.
Digit span test (Mann –Whitney Test)
 No significant difference between Trāṭaka and wait list
control group in digit span test scores - first follow up.
 2nd follow-up - When compared to wait list control group
Trāṭaka scores were higher and a possible trend towards
significance
INDEPENDENT SAMPLE T-TEST
 1st follow up-no significant difference in TMT B scores
between Trāṭaka group and Wait list control group.
 At the 2nd follow-up- trend towards significance and
possibly with a larger sample size we could have observed
a significant difference between the two groups
PAIRED SAMPLE T TEST-FOR
TRĀṬAKA GROUP
Mean (SD)
Variable
TMT B (Baseline – 1st
Mean (SD)
170.58(92.43)
follow-up)
TMT B (Baseline-2nd
follow-up)
170.58(92.43)
T
p-value
151.45(88.0)
-4.26 0.00*
111.27(71.63)
7.09
0.00*
PAIRED SAMPLE T TEST-FOR
CONTROL GROUP
Mean (SD)
Variable
Mean (SD)
T
pvalue
TMT B (Baseline – 1st
follow-up)
182.22(76.33)
191.70(91.98)
-1.10 0.28
TMT B (Baseline-2nd
follow-up)
0.04
179.38(76.65)
151.76(80.67)
2.17
 Wilcoxon Signed Ranks Test showed that there was no
significant change in the digit span test scores from baseline to
1st follow-up (p=0.06). But significant increase in scores was
seen from baseline to 2nd follow up (p = 0.001) and also from
1st follow up to 2nd follow up (p=0.002) in the trataka group.
 There was no significant changes in the digit span scores from
baseline to 1st follow-up/2nd follow-up (p>0.05) or from 1st
follow-up to 2nd follow-up in the control group.
SUB GROUP ANALYSIS
 The elderly from the old age home formed 2 blocks and
those from residential localities formed 2 blocksrandomized into any of the 2 interventions (Trātaka or
wait list control)
 Trataka group- 1 block-old age home
1 block- Elderly from Localities
 Wait-list control group1 block-old age home
1 block- Elderly from Localities
Trataka Group
1st follow
2nd follow
up
up
Mean
Mean
Mean
(SD)
(SD)
(SD)
268.57
(87.042)
228.14
(64.752)
199.29
(77.706)
Baseline
Variable
Old age
Digit span
home
Locality
Old age
TMT B
home
Locality
F
p-value
0.29
134.47
(65.031)
98.79
(47.989)
78.84
(31.489)
15.14
(3.024)
14.14
(1.773)
14.43
(2.070)
8.9
16.32
(4.137)
17.68
(4.877)
19.95
(3.979)
0.001
Wait-List control Group
1st follow
2nd follow
up
up
Mean
Mean
Mean
(SD)
(SD)
(SD)
Baseline
Variable
Old age
Digit span
home
Locality
Old age
TMT B
home
Locality
16.77
(2.555)
15.77
(3.345)
18.44
(4.693)
18.22
(6.667)
202.17
(81.658)
217.75
(99.649)
180.08
(85.373)
142.67
(68.440)
p-value
3.17
0.06
0.77
0.48
14.69
(3.011)
17.56
(5.126)
149.00
(60.858)
F
114.00
(58.643)
DISCUSSION
 Subjects were at a stage when cognitive decline was a




reality
Have never been exposed to Trāṭaka or any Yogā
intervention earlier
Scales used in this study were sensitive enough to tap the
cognitive improvement in the elderly
Prolonged duration of practice of Yogā/trāṭaka for
desirable effects
1 day of practice was not sufficient to produce changes in
the cognitive functions, whereas one month follow up
showed significant changes
 Trāṭaka- involves focusing and defocusing
 Focusing-Dharana
 Defocusing-Dhyana
 Dharana or focusing improves mainly concentrative
attention, enhances the stability of attention and reduces the
need to invoke executive skills that regulate the focus of
attention from moment to moment(decreased cognitive
efforts), improves the ability to remain vigilant and monitor
distractors without losing focus.
 Dhyana-the regulative attentional skills are invoked less
and less frequently, and the ability to sustain focus thus
becomes progressively “effortless”.
 Relaxation techniques have shown to reduce anxiety
and improve memory as well as attention. Reduced
anxiety can improve the performance on tasks
requiring attention and memory.
CONCLUSIONS
 Results establish that Trāṭaka can be used as a technique to
enhance cognition.
 Trāṭaka if provided to a group which is prone for cognitive
decline and to those who have not been exposed to any cognition
improving interventions, it can be helpful in improving their
cognition
 Long term practice of trāṭaka (according to this study an
optimum duration of one month) is needed to bring about the
required change in cognition.
 Trāṭaka improved memory scores of those living in residences
better than those living in old age homes shows that the place
where elderly age, has an impact on their cognition.
STRENGTHS & LIMITATIONS
Strengths:
 Randomized block design (RBD)
 Standardized neuropsychological tests with high reliability
and validity.
 Intervention was provided to the sample that needed the
intervention.
Limitations:
 Sampling was done only in 2 old age homes
 Sample size was small
 Only three outcome variables
FUTURE SUGGESTIONS
 Study with a larger sample
 Combinations of cognition enhancing Yogā techniques
 Subjects with cognitive deficits
 Combinations of Yogā and other cognitive interventions
 Mechanism of Trāṭaka practice
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Thank you
Dr Shubhada S. Talwadkar
E-mail [email protected]