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Journal of Alzheimer’s Disease 20 (2010) 517–526 517
DOI 10.3233/JAD-2010-1391
IOS Press
Meditation Effects on Cognitive Function and
Cerebral Blood Flow In Subjects with
Memory Loss: A Preliminary Study
Andrew B. Newberga,b,∗, Nancy Winteringa,b, Dharma S. Khalsab,c, Hannah Roggenkampaand
Mark R. Waldmanb
aDivision of Nuclear Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
bCenter for Spirituality and the Mind, University of Pennsylvania, Philadelphia, PA, USA
cAlzheimer Research and Prevention Foundation, Tucson, AZ, USA
Accepted 12 January 2010
Abstract. This preliminary study determined if subjects with memory loss problems demonstrate changes in memory and cerebral
blood flow (CBF) after a simple 8-week meditation program. Fourteen subjects with memory problems had an IV inserted
and were injected with 250MBq of Tc-99m ECD while listening to a neutral stimulus CD. They then underwent a pre-program
baseline SPECT scan. Then subjects were guided through their first meditation session with a CD, during which they received an
injection of 925MBq ECD, and underwent a pre-program meditation scan. Subjects completed an 8-week meditation program
and underwent the same scanning protocol resulting in a post-program baseline and meditation scan. A region of interest (ROI)
template obtained counts in each ROI normalized to whole brain to provide a CBF ratio. Baseline and meditation scans and
neuropsychological testing were compared before and after the program. The meditation program resulted in significant increases
(p<0.05) in baseline CBF ratiosin the prefrontal, superior frontal, and superior parietal cortices. Scores on neuropsychological
tests of verbal fluency, Trails B, and logical memory showed improvements after training. This preliminary study evaluated
whether an 8-week meditation program resulted in improvements in neuropsychological function and differences in CBF in
subjects with memory loss. While the findings are encouraging, there are a number of limitations that can be addressed in future
studies with more participants and more detailed analyses.
Keywords: Cerebral blood flow, cognitive impairment, meditation, memory, single photon emission computed tomography
INTRODUCTION
The number of older Americans continues to grow
and with it the number who are thought to suffer from
cognitive impairment and Alzheimer’s disease (AD).
Among people aged 65, 2–3% show signs of AD, while
25–50% of people aged 85 have symptoms of AD [1].
∗Correspondence to: Andrew B. Newberg, M.D., Division of
Nuclear Medicine, Hospital of the University of Pennsylvania, 110
Donner Building, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Tel.: +1 215 662 3092; Fax: +1 215 349 5843; E-mail: Andrew.
newberg@uphs.upenn.edu.
An even greater number have some of the patholog-
ical hallmarks of the disease without the characteris-
tic symptoms. Until now, there have been few treat-
ment options for patients with early cognitive impair-
ment. Several medications and vaccine trials are un-
derway. However, a non-pharmacological approach
without side effects and without interfering with med-
ications would be very useful and cost effective in the
management of such patients without interfering with
any medical interventions. Initial studies have suggest-
ed that specific cognitive practice programs will help
improve memory [2,3]. Meditation has long been tout-
ed as a potential technique for improving memory and
lowering levels of stress, depression, and anxiety. This
ISSN 1387-2877/10/$27.50 2010 – IOS Press and the authors. All rights reserved
518 A.B. Newberg et al. / Meditation Enhances Cognitive Function
study was designed to explore the effects of a very spe-
cific form of meditation in patients with cognitive im-
pairment and to track potential changes with functional
brain imaging using single photon emission computed
tomography (SPECT).
Meditation, in general, is a complex neurocognitive
task that is often associated with alterations in brain
physiology and neuropsychological measures. Over
the past 30 years, there have been a number of studies
which have exploredthe physiological correlates of dif-
ferent types of meditation. It is important to note here
that meditation refers to a large variety of practices that
range from purely relaxation based techniques to those
performed with the goal of attaining intense spiritual
experiences. This variation, in itself, makes the study
of such practices difficult. However, we have tried to
find similarities among these practices, and since sub-
stantial prior studies have demonstrated improvements
in a variety of cognitive functionswith these practices,
it is worthwhile to continue to explore them.
This is the first study to investigate potential im-
provements in cognition in subjects with actual mem-
ory loss.
Studies utilizing positron emission tomography
(PET), SPECT, and functional magnetic resonance
imaging (fMRI) have all demonstrated specific changes
in cortical and sub-cortical structures when subjects
were actively meditating [4–7]. There is a growing,
although still relatively limited, number of studies that
have evaluated the long-term effects of meditation prac-
tices. Specifically, these studies showed increased ac-
tivity in expert meditators in the frontoparietalregions,
cerebellar, temporal, parahippocampal, and posterior
occipital cortex during meditation. These areas have
also been implicated in a variety of memory tasks uti-
lizing fMRI [8]. Other studies have compared experi-
enced meditators to non-meditators with regardto brain
structure and function [9]. For example, a study by
Lazar and colleagues using structural MRI demonstrat-
ed that long-term meditators, practicing for approxi-
mately1 hour aday,hadthickerprefrontal cortexes than
non-meditators [10]. Additionally, Lutz and collabora-
tors using electroencephalography (EEG) showed that
expert meditators were able to induce changes in their
brain activity during meditation [11]. However, these
studies did not determine if the findings were the result
of the meditation practices since these studies were not
longitudinal. Thus, one possibility is that the individu-
als had brains that were fundamentally different which
predisposed them to such practices. A second possi-
bility is that the individual affected their brain over the
course of their practice. Fewer studies have actually
tried to evaluate the longitudinal effects of meditation
over time. Davidson et al. showed that there were sig-
nificant changes over time in the brain’s EEG when in-
dividuals engaged in a daily 1 hour mindfulness based
meditation practice [12]. Moreover, no previous stud-
ies have investigatedthe effect of meditation in patients
with actual cognitive decline or AD. From the perspec-
tive of improvingmemory using meditation, it is imper-
ative to longitudinally study subjects before and after
a meditation training program to determine if there are
long term effects of such a program.
Therefore, the primary purpose of this study was
to investigate a particular type of meditation practice
called Kirtan Kriya (KK), in patients who presented
with memory problems, before and after an 8-week
program. KK meditation is a simple technique that in-
volves the repetition of foursounds – SA TA NA MA.
While the person vocalizes these sounds, they sequen-
tially touch their thumb to their index finger, middle
finger, fourth finger, and then fifth finger. This is per-
formed out loud for 2 minutes, in a whisper for 2 min-
utes, in silence for 4 minutes, followed by in a whisper
for 2 more minutes and finally out loud for the final
2 minutes. The total time is 12 minutes. Since this is
a simple and quick practice, it has the potential to be
a very practical and low cost measure to help improve
memory. This also distinguishes this practice from a
number of other meditation practices that require ex-
tended class sessions and long meditation practices that
may not be practical in an older population. This was
the purpose for the present study which was to evalu-
ate the effects of performing daily KK meditation for
8 weeks on brain function and cognition and measure
changes in cerebral blood flow (CBF) utilizing SPECT
imaging.
We hypothesized that several structures would be
particularly affected by the KK meditation program.
Specifically, attention focusing practices such as med-
itation have activated the attentional network in the
brain which includes frontal lobe structures as well as
the anterior cingulate cortex [13,14]. We also hypothe-
sized that structures such as the amygdala and thalamus
would be affected since these structures have shown
changes in other studies of the long term effectsof med-
itation and are also part of the network of structures
involved in the default network [15,16]. We have pre-
viously found changes in the temporal lobe associat-
ed with verbal meditation practices and changes in the
parietal lobe associated with altered spatial perceptions
during meditation [6].
A.B. Newberg et al. / Meditation Enhances Cognitive Function 519
Fig. 1. This figure shows transaxial slices of SPECT scans (with CBF represented as red >yellow >green >blue) in the pre-program baseline
state and the post-program baseline state. The post-program baseline state shows that there is relatively increased activity in the right prefrontal
cortex (thick arrows) and anterior cingulate cortex (thin arrows) after the training program.
METHODS
Subjects and imaging acquisition
Fifteen subjects were recruited from local neurolo-
gy clinics, local medical groups, and hospital based
advertisements, who presented complaining of memo-
ry problems ranging from mild age-associated memo-
ry impairment (n=7), to mild cognitive impairment
(MCI) (n=5), to moderate impairment with a diagno-
sis of AD (n=3). The Mini-Mental Status Examina-
tion scores (MMSE) ranged from 16–30. There were 6
men and 9 women with ages ranging from 52–77years
with a mean age of 64 ±8 years. The patients with AD
were diagnosed on the basis of criteria established by
the National Institute of Neurological and Communica-
tive Disorders and Stroke/Alzheimer’s Disease and Re-
lated Disorders Association (NINCDS-ADRDA) cri-
teria [17]. The MCI patients were diagnosed based
upon criteria reported in Grundman et al. [18] which
includes memory complaint, abnormal memory based
upon performance on the Logical Memory II subtest
of the Wechsler Memory Scale Revised, normal gen-
eral cognitive function, no impairment in activities of
daily living, and not sufficiently impaired to meet the
NINCDS/ADRDA criteria for AD. The remaining sub-
jects were considered to have age-associated memory
impairment and were otherwise normal controls who
perceived their memory to be impaired. Each subject
had no significant experience with meditation or yoga.
Subjects were studied on their first KK training day and
then again after an 8-week self-directed training pro-
gram. We excluded the data from the single AD patient
with a MMSE of 16 due to her inability to adequately
perform the meditation.
On the first day of the study, after obtaining informed
consent (approved by the human subjects Institutional
Review Board with the study protocol),a room was set
up in the hospital to function as a meditation room. Ap-
proximately 20 minutes prior to the baseline scan, an
intravenous canula (IV) was placed in one arm so that
all injections could be performed without touching or
disturbing the subject. The subjects reported minimal
520 A.B. Newberg et al. / Meditation Enhances Cognitive Function
discomfort from the IV that resolved prior to initiating
the remainder of the study. For the baseline scan, the
subject was instructed to rest in the room with their
eyes closed and listen to a general informational CD
about the effects of meditation practices for approxi-
mately 12 minutes. This CD was neutral in its con-
tent. However, we would suggest that having content
on the CD that discusses meditation rather than a com-
pletely neutral topic is appropriate to exclude any pos-
sible expectation effect that might have resulted from
both conditions. The subject was injected through the
IV with 250 MBq of 99mTc-Bicisate (Bristol-Myers
Squibb Medical Imaging, N. Billerica, MA), prepared
as specified by the manufacturer. The subject contin-
ued to listen to the CD for another 5 minutes while
the tracer uptake occurred in the brain. Approximately
15 minutes following the injection, the subjects under-
went SPECT scanning for 30 minutes. This scan was
labeled the “pre-program baseline” scan.
Projection images were obtained at three-degree
angle intervals on a 128 ×128 matrix (pixel size
3.56 mm ×3.56 mm) over 360◦by rotating each head
120◦. These SPECT images were reconstructed in the
transaxial, coronal, and sagittal planes using filtered
backprojection, followed by a low pass filter and 1st
order Chang attenuation correction (attenuation coeffi-
cient 0.11 cm−1. The reconstructed slice thickness was
4 mm with a spatial resolution of 8–10 mm.
Following this pre-program baseline scan, the sub-
ject returned to the room for their first meditation ses-
sion. Subjects initially viewed a 10 minute video with
one of the investigators(DSK) showing how to perform
the Kirtan Kriya meditation. This video reviewed the
phrases, the sounds, and demonstrated the manner of
performing the meditation. It was explained to subjects
to focus on the sounds and finger movements. Subjects
were not asked to do anything more than perform the
task. Thus, there were no additional instructions re-
garding the state of mind that they should be in, any
preparatory exercises, or any mindfulnessexercises. At
the end of the video, the principal investigatoranswered
any questions and then observed the subjects doing
the meditation to make sure that it was done correct-
ly. Subjects were instructed that they would perform
the meditation while listening to a meditation CD that
guided them through the entire practice. The CD con-
tains an individual performing the meditation practice
in its intended manner with some background music to
aid in the rhythm of the meditation. The subjects were
then asked to perform the meditation for 12 minutes
the first time during which they would receive a second
injection of approximately 925MBq of 99mTc-Bicisate
though the IV while he/she continued to meditate for
approximately another five minutes. The subject was
then scanned for 30 minutes using the same imaging
parameters as for the baseline study. This scan was
labeled the “pre-program meditation” scan.
Subjects were discharged home with the medita-
tion CD so that they could practice it at home. They
were instructed to perform the practice every day for
8 weeks. Subjects completed a log to record when
they performed the meditation practice and their sub-
jective experience of the practice and its effects. We
contacted them at 4 weeks to remind them to continue
practicing daily and to enquire as to their performance
of the meditation. We also directly interviewed sub-
jects upon completion of the program to review their
progress. Upon completion of the 8-week meditation
training program, subjects returned to the University
of Pennsylvania Nuclear Medicine Department to un-
dergo a second imaging day essentially identical to the
first. They received a “post-programbaseline” scan in
which they were injected with 99mTc-Bicisate while
listening again to an informational CD. After the base-
line scan, the subjects then performed the meditation
for the final time during which they were injected with
99mTc-Bicisate and underwent a “post-program med-
itation” scan. We maintained the same order in the
pre- and post-program imaging studies so that the ef-
fect of doing the meditation would not interfere with
the baseline scans.
Although this was an open label studyto assess effect
as well as feasibility,we also recruited a small compar-
ison group in which the KK meditation was replaced
with a “music listening” task. Five subjects, two hav-
ing MCI and three having age-associated memory im-
pairment (all women with a mean age of 65 ±10 years
and a range from 56 to 79 and mean MMSE of 29 ±1),
were asked to simply listen to two Mozart violin con-
certos each day for approximately 12 minutes, the same
amount of time required for the KK meditation. The
subjects were asked to focus their attention on the mu-
sic and to record their progress in a log book. Subjects
underwent the same SPECT imaging procedures as the
KK group with listening to the music replacing listen-
ing and performing KK meditation. The music group
listened to the same neutral content CD to produce the
same comparison state. A grouplistening to music for
the same amount of time might provide an adequate
comparison for the KK meditation program since sub-
jects would undergo similar types of programswith the
exception of not doing the active part of the meditation.
A.B. Newberg et al. / Meditation Enhances Cognitive Function 521
Table 1
Baseline characteristics of the KK and Music comparison groups
Baseline characteristics KK group Music group p
Age 64.0 ±8.0 65.0 ±9.9 N.S.
MMSE 28.1 ±0.7 29.0 ±1.0 N.S.
Category Fluency (Animals) 21.1 ±7.9 21.5 ±5.0 N.S.
Trails A 30.5 ±12.2 37.0 ±11.7 N.S.
Trails B 105.5 ±52.8 132.5 ±58.6 N.S.
Digit Symbols 63.7 ±25.3 67.6 ±21.7 N.S.
Logical Memory Delayed 10.6 ±5.2 12.3 ±6.5 N.S.
POMS 52.2 ±12.9 47.5 ±17.2 N.S.
Since the music group received an intervention (i.e.,
the music), we felt that the results would help reduce
effects related to placebo and practice effects related to
repeated performance of the neuropsychological tests.
Furthermore, since some studies have suggested that
music might also improve cognition and mood, this
comparison group might actually be more stringent in
terms of helping to observe an effect specifically from
the KK meditation.
Subjects in both groups were also evaluated on the
first imaging day with a brief neuropsychological test
battery (see Table 1) that was adapted from the bat-
tery currently used by our Memory Disorders Clinic
at the University of Pennsylvania and comprised of
a Category Fluency task in which subjects named as
many animals as possible in a 60 second time period,
the Wechsler Adult Intelligence Scale (WAIS) Digit
Symbol Substitution Test, a Logical Memory task, and
Trails A and B. These tests also were selected based
upon other studies in which neuropsychological tests
were used to evaluate changes in cognition associated
with mental task interventions [19,20]. These same
tests were repeated on the 8-week follow up session.
Image analysis and statistics
The images of the pre- and post-program baseline
and meditation scans were reconstructed and resliced,
using an oblique reformatting program, according to
the anterior-posterior commissure line so that the fi-
nal two sets were aligned for analysis. A previously
validated template methodology consisting of regions
of interest (ROI) corresponding to the major cortical
and subcortical structures was placed over the baseline
scan [21]. For the purposes of this study, we exam-
ined the CBF as measured in only a selected number
of ROIs which was hypothesis driven. The ROIs ex-
amined included the inferior frontal, superior frontal,
dorsolateralprefrontal, orbitofrontal, inferiortemporal,
superior temporal, inferior parietal, superior parietal,
and sensorimotor areas, as well as the precuneus, tha-
lamus, amygdala, and cingulate gyrus since these are
areas that have been found to be previously affected
during meditation tasks and also because these struc-
tures subserve a number of cognitive processes. The
location for each ROI was determined based upon MRI
anatomy such that they could then be placed directly
on functional SPECT scans [20]. Furthermore, each
ROI fits within each specified region which helps to
ensure proper placement and to avoid problems with
partial voluming. The ROIs were placed on the ini-
tial scan and then copied directly onto all subsequent
scans. This was possible because the images were al-
ready resliced into the same planes as described above.
The count values for the baseline and meditation scans
were obtained by determining the number of counts
in each ROI on the meditation scan and normalizing
those counts to the whole brain activity. This provides
a CBF ratio for each ROI compared to the whole brain.
Since two SPECT scans were performed on the same
day, the second scan had the decay corrected counts
from the first scan subtracted out prior to analysis. We
have previouslyvalidated this technique and show that
there is a high test-retest correlation with less than 6%
variability [22].
A percentage change between the meditation and
baseline scans (for both the pre- and post-program ses-
sions) was calculated using the equation:
%Change =(Meditation −Baseline)
(Baseline)×100
Scan results were statistically evaluated using paired
t-tests comparing the pre- and post-program baseline
scans, and also the change in activation between the
baselineand meditation scansforboththe pre-and post-
program condition. Similarly, neuropsychological test
scores were compared using paired t-tests. We cor-
rected the CBF data analysis for multiple comparisons
using the False Discovery Rate method [23]. A lim-
ited number of Pearson correlations between changes
522 A.B. Newberg et al. / Meditation Enhances Cognitive Function
Table 2
Comparison of the pre and post training program baseline scans
revealing changes in CBF in the following structures (values are
presented as mean ROI/whole brain ratios)
Structure Pre baseline Post baseline p
KK Group
R Inferior Frontal 1.12 ±0.10 1.19 ±0.09 0.002∗
R Superior Frontal 1.12 ±0.09 1.16 ±0.08 0.007∗
R Superior Parietal 1.12 ±0.07 1.18 ±0.06 0.007∗
R DLPFC 1.10 ±0.15 1.20 ±0.15 0.007∗
R Sensorimotor 1.12 ±0.08 1.18 ±0.10 0.008∗
R Posterior Cingulate 1.36 ±0.16 1.28 ±0.17 0.02
R Orbitofrontal 0.86 ±0.24 1.00 ±0.13 0.03
R Anterior Cingulate 1.15 ±0.19 1.21 ±0.13 0.05
L Superior Frontal 1.11 ±0.08 1.15 ±0.10 0.006∗
L Thalamus 1.26 ±0.09 1.18 ±0.13 0.03
L Superior Parietal 1.12 ±0.05 1.16 ±0.09 0.02
L Medial Frontal 1.17 ±0.11 1.22 ±0.11 0.05
Music Group
R Amygdala 0.86 ±0.04 0.95 ±0.06 0.004
R Precuneus 1.23 ±0.02 1.11 ±0.07 0.02
∗Still significant when corrected for multiple comparisons.
in neuropsychological test scores and changes in the
pre and post-baseline CBF were compared for select-
ed regions that were significant in the above analysis
and known to be related to such parameters. Thus,
we compared prefrontal cortex and thalamic activity to
tests of cognition and executive function such as the
Trails B, Digit Span Test, and the WAIS Digit Symbol
Substitution Test.
RESULTS
There were a number of significant changes in the pre
program baseline and the post program baseline scans
in the KK group (see Table 2). In particular, structures
in the frontal lobe regions and right superior parietal
lobe had significantly higher baseline CBF after the 8-
week training program (even after correction for mul-
tiple comparisons). These findings were in contrast to
the baseline CBF values observed in the music com-
parison group. The structures that had higher baseline
CBF values after the 8-week music program were in the
amygdala and precuneus rather than the frontal lobes
(see Table 2). However, with the small sample size,
these changes were not significant after correction for
multiple comparisons.
We also compared how much the different structures
were activated (or deactivated) during the performance
of the meditation (or listening to music) both pre and
post training program (see Table 3). In the KK group,
individuals mildly activated their prefrontal cortex in
Table 3
Change in activation between pre and post meditation (or music lis-
tening) scans (given as mean percentage change between the baseline
and meditation states)
Structure Pre-activation Post activation p
Kirtan Kriya
R DLPFC +0.9 −6.3 0.001∗
R Superior Temporal +0.3 −5.7 0.005
R Sensorimotor +2.4 −4.6 0.026
R Precuneus −0.8 −5.8 0.042
R Inferior Frontal −0.7 −6.3 0.049
L Thalamus −0.2 +8.1 0.023
L Amygdala −2.1 −10.0 0.026
Music
R Thalamus +4.6 −7.3 0.03
R Precuneus −5.6 +7.5 0.03
∗Still significant when corrected for multiple comparisons.
thefirst meditation scan,buthadsignificantly decreased
activity in the prefrontal cortex during meditation after
the training program. The music group showed no sig-
nificant differences in brain activation after correction
for multiple comparisons.
Whenneuropsychological test scoreswerecompared
between the pre and post training program sessions,
there were a several improvements observed in the KK
group (see Table 4). The KK group did significant-
ly better than the music group in Category Fluency –
Animals (p<0.05). However, several of the oth-
er neuropsychological tests demonstrated similar im-
provements between the KK and music groups even
though the changes observed in the music group were
not significant.
In the KK group, there was a significant Pearson
correlation between CBF in the right prefrontal cortex
versus the Trails B task (R=−0.61, p=0.02) which
was also significant after correction for multiple com-
parisons. There was a trend in the Pearson correla-
tions between the left thalamus versus the Trails B task
(R=−0.62, p=0.02), and the left thalamus versus
the Digit Span Test (R=0.56, p=0.03), but these
were not significant after correction for multiple com-
parisons. No significant correlations were observed in
the music group.
Finally, it should be noted that the log books and
exit interviews with the subjects revealed that the sub-
jects in general found the meditation practice enjoyable
and beneficial. The subjects were able to perform the
practice a mean of 75% of the days that they were in
the study. Most subjects reported that they subjectively
perceived that their cognitive function was improved
after the 8-week program.
A.B. Newberg et al. / Meditation Enhances Cognitive Function 523
Table 4
Neuropsychological test score means (±SD) pre and post meditation training program
NP Test Pre Post % Change p
KK Group
MMSE 28.1 ±0.7 27.6 ±1.6 −2% 0.13
Category Fluency∗21.1 ±7.9 24.0 ±6.3 +14% 0.006†
Trails A (seconds) 30.5 ±12.2 33.6 ±20.5 −10% 0.18
Trails B (seconds) 105.5 ±52.8 84.6 ±50.6 +20% 0.05
WAIS Symbol Substitution Test∗∗ 63.7 ±25.3 67.6 ±21.7 +6% 0.05
Logical Memory Delayed∗∗∗ 10.6 ±5.2 12.4 ±6.5 +17% 0.05
Music Group
MMSE 29.0 ±1.0 29.0 ±0.82 0% 0.25
Category Fluency∗21.5 ±4.2 20.8 ±6.2 +3% 0.43
Trails A (seconds) 37.0 ±11.8 35.0 ±17.5 +5% 0.30
Trails B (seconds) 132.5 ±58.7 100.3 ±58.6 +24% 0.19
WAIS Symbol Substitution Test∗∗ 62.8 ±7.5 67.3 ±13.4 +7% 0.30
Logical Memory Delayed∗∗∗ 12.2 ±7.9 16.5 ±3.7 +35% 0.11
†Still significant after correction for multiple comparisons.
∗Number of animals named in 60 seconds.
∗∗Number of correct answers in 120 seconds.
∗∗∗Number of correct details of a recalled story out of 25.
DISCUSSION
The purpose of this pilot study was to determine for
the first time if a mind/body medical practice could
improve cognition in subjects with memory loss. In
this case a brief, simple, and low cost meditation prac-
tice called Kirtan Kriya performed for only 12 min-
utes daily over an 8-week period of time revealed posi-
tive results in both functional neuroimagingchanges as
well as an improvementin cognitive functionin people
with memory loss, including those with age-associated
memory impairment and MCI.
Thus, this study was unique in attempting to mea-
sure the longitudinal effects of meditation using func-
tional brain imaging with SPECT in an older popula-
tion than previously studied, especially those patients
already suffering from memory loss. It is important
to note that the subjects in general found the medita-
tion practice enjoyable and beneficial. The subjects
were compliant, performing the practice a mean of 75%
(range from 41% to 100%) of the days that they were in
the study, and indicatingthat they were able to perform
the practice successfully. However, the one AD patient
with an MMSE of 16 had great difficulty performing
the meditation and when she returned for the 8-week
follow up, was unable to perform the meditation prop-
erly. While her data were excluded from the analy-
sis, it also raised an important issue that once subjects
become too impaired, meditation may not be possible.
For the remaining subjects, there was no clear relation-
ship between those with varying degrees of cognitive
impairment, although these subjects were in a much
narrower range with MMSE scores from24 to 30. Most
subjects indicated that they perceived that their cogni-
tive function was improved after the 8-week program.
Furthermore, the results of the imaging and neuropsy-
chological testing revealed that subjects did experience
significant changes during the 8-week training period.
In the study presented here, there were several sig-
nificant changes in baseline CBF associated with the
12 minute daily KK meditation training program. For
example, there were significant increases in CBF in the
frontal cortex that aid in attention and executive func-
tion. This finding is particularly significant since these
frontal lobe structures are not only important mediators
of attention and executive function, but also appear to
be affected in patients with various dementia disorders
as well as MCI [24–26].
It is interesting that the changes in baseline and ac-
tivated states of the brain were in very different struc-
tures in the KK group compared to the music group.
This, of course, is consistent with the fact that the two
groups were doing different types of tasks. The activat-
ed states, in particular, were quite different with the KK
group showing significantly decreased CBF in the pre-
frontal cortex during meditation after the training pro-
gram. While the findings in the music group were not
significant after multiple comparisons, the regions that
were significant before correction, namely the amyg-
dala and the thalamus, have also been observed to be af-
fected in research studies evaluating listening to music
on the brain [27–29].
It is a particularly interesting finding that the areas
activated by music (such as the limbic and posterior
524 A.B. Newberg et al. / Meditation Enhances Cognitive Function
structures) are different from those involvedin the KK
meditation (namely the frontal cortex and superiorpari-
etal lobe). The initial hypotheses regarding KK medi-
tation is that it should have had its primary impact on
the frontal cortex. It is also interesting to note that
the frontal lobes, superior parietal lobes, and posterior
cingulate are also part of the brain’s default network
and have been observedto be substantially different in
patients with memory deficits associated with normal
aging, MCI, and AD [30,31]. This suggests the possi-
bility that the KK practice has an effect on this default
network over time.
There were also improvements in cognitive function
in the KK group as revealed by neuropsychological
testing. These changes were significant in verbal flu-
ency, although the KK group did not achieve results
that were statistically better than the music group in
the other neuropsychological tests. The KK group did
show trends in improvement in several other tests in-
cluding the Trails B, WAIS Symbol Substitution Test,
and Logical Memory Delayed task.
As this is a pilot study, there are many limitations
that need to be considered and that will need to be ad-
dressed before being able to definitely state that med-
itation practices provide a cognitive benefit in older
individuals. For example, it could be argued that the
music group was also performing a “meditation-type”
task and thus, might not have been as appropriate a
control group as possible. In fact, several studies have
observed a beneficial effect of listening to music on
cognitive function and our data show improvements al-
though they were not significant, possibly because of
the small sample size. Emery and colleagues showed
that exercise plus music resulted in improved verbal
fluency compared to exercise alone [32]. Another study
showed the music therapy resultedin improvements in
verbal fluency in dementia patients [33]. Thus, it is
possible that this music listening group might be con-
sidered an active intervention group as well, in which
case both KK meditation and music resulted in im-
provements in cognitive function in these patients, but
appeared to be associated with different physiological
correlates.
It should be noted that determining the appropriate
control comparison group for meditationpractices is al-
ways a challenge since it is difficult to select a particular
intervention (i.e., solving puzzles, doing spatial tasks,
reading, etc.) that would not have some component
of improving cognitive function. Furthermore, doing a
simple test-retest group would not represent any inter-
vention and thus might also not sufficiently control for
a placebo effect or a practice effect. It should also be
stressed that a major limitation of this preliminary study
is the size of the music comparison group and future
studies evaluatingmusic as well as other types of medi-
tation might be useful in determining the most effective
types of interventions. Thus, larger trials are necessary
to determine whether music itself has a beneficial effect
on cognition, as well as recruiting intervention groups
of more similar sizes. In particular, it will be important
to have more uniform groups, such as studying only
patients with MCI, to help evaluate specific changes in
both brain function and neuropsychological status.
While it was also interesting to find a correlation
between the change in prefrontal cortex CBF and im-
provement in the Trails B test, the pilot nature of this
study limits any definitive statement about such a re-
lationship. While such findings at least support the
notion that the physiological changes associated with
meditation may be related to improvements in cogni-
tion, larger studies will be necessary to confirm such
correlations.
As a pilot study, the data do provide important in-
formation regarding general effect sizes and the stan-
dard deviation for CBF changes and neuropsycholog-
ical test changes associated with a meditation practice
that might have implications for powering future stud-
ies. Of course, an important issue would be what the
primary outcome measure would be for future stud-
ies – imaging or neuropsychological outcomes. That
the baseline brain activity, particularly in the frontal
cortex, was increased after eight weeks of meditation
practice supports the hypothesis that meditation may
affect brain function over longer periods of time. Of
course, it is also known that cognitive decline with ag-
ing or with MCI is slower than that for AD patients.
Thus, the current study does not address whether medi-
tation will actually have long term benefits for slowing
that decline with either normal aging or MCI. On the
other hand, these findings provide a hypothetical basis
for future studies exploring the effects of meditation
techniques on memory and cerebral activity by indi-
cating which brain structures are likely involved and
also provided information regardingthe effect size and
variability of specific measures.
We also recognize that the use of complementary and
alternative medicine techniques in the management of
aging and dementia is still controversial. There have
been few large scale studies and most data, including
the current study, must be viewed as preliminary. How-
ever, we also hope that the results of studies such as
this one will help to foster a greater interest within the
A.B. Newberg et al. / Meditation Enhances Cognitive Function 525
medical community to explore such techniques. Even
if techniques such as meditation prove to have only a
small value, their low cost and ease of use may make
them a beneficial adjunct to the pharmacological arse-
nal currently being explored. Thus, we hope that future
studies with a larger population size, differentcompar-
ison groups, and a larger battery of neuropsychological
tests, would be able to advance the findings from this
initial study.
ACKNOWLEDGMENTS
We would like to thank the Alzheimer’s Re-
search and Prevention Foundation in Tucson, Arizona
(http://www.alzheimersprevention.org)for their gener-
ous support of this research project.
Authors’ disclosures available online (http://www.j-
alz.com/disclosures/view.php?id=282).
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