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. Khalsa b,c, Hannah Roggenkamp a and
Mark R. Waldmanb
a
Division of Nuclear Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
b
Center for Spirituality and the Mind, University of Pennsylvania, Philadelphia, PA, USA
c
Alzheimer 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 ratios in 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 An even greater number have some of the patholog-

ical hallmarks of the disease without the characteris-
The number of older Americans continues to grow tic symptoms. Until now, there have been few treat-
ment options for patients with early cognitive impair-
and with it the number who are thought to suffer from
ment. Several medications and vaccine trials are un-
cognitive impairment and Alzheimer’s disease (AD).
derway. However, a non-pharmacological approach
Among people aged 65, 2–3% show signs of AD, while without side effects and without interfering with med-
25–50% of people aged 85 have symptoms of AD [1]. ications would be very useful and cost effective in the
management of such patients without interfering with
any medical interventions. Initial studies have suggest-
∗ Correspondence to: Andrew B. Newberg, M.D., Division of
ed that specific cognitive practice programs will help
Nuclear Medicine, Hospital of the University of Pennsylvania, 110
Donner Building, 3400 Spruce Street, Philadelphia, PA 19104, USA.
improve memory [2,3]. Meditation has long been tout-
Tel.: +1 215 662 3092; Fax: +1 215 349 5843; E-mail: Andrew. ed as a potential technique for improving memory and
[email protected]. 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- course of their practice. Fewer studies have actually
cific form of meditation in patients with cognitive im- tried to evaluate the longitudinal effects of meditation
pairment and to track potential changes with functional over time. Davidson et al. showed that there were sig-
brain imaging using single photon emission computed nificant changes over time in the brain’s EEG when in-
tomography (SPECT). dividuals engaged in a daily 1 hour mindfulness based
Meditation, in general, is a complex neurocognitive meditation practice [12]. Moreover, no previous stud-
task that is often associated with alterations in brain ies have investigated the effect of meditation in patients
physiology and neuropsychological measures. Over with actual cognitive decline or AD. From the perspec-
the past 30 years, there have been a number of studies tive of improving memory using meditation, it is imper-
which have explored the physiological correlates of dif- ative to longitudinally study subjects before and after
ferent types of meditation. It is important to note here a meditation training program to determine if there are
that meditation refers to a large variety of practices that long term effects of such a program.
range from purely relaxation based techniques to those Therefore, the primary purpose of this study was
performed with the goal of attaining intense spiritual to investigate a particular type of meditation practice
experiences. This variation, in itself, makes the study called Kirtan Kriya (KK), in patients who presented
of such practices difficult. However, we have tried to with memory problems, before and after an 8-week
find similarities among these practices, and since sub- program. KK meditation is a simple technique that in-
stantial prior studies have demonstrated improvements volves the repetition of four sounds – SA TA NA MA.
in a variety of cognitive functions with these practices, While the person vocalizes these sounds, they sequen-
it is worthwhile to continue to explore them. tially touch their thumb to their index finger, middle
This is the first study to investigate potential im- finger, fourth finger, and then fifth finger. This is per-
provements in cognition in subjects with actual mem- formed out loud for 2 minutes, in a whisper for 2 min-
ory loss. utes, in silence for 4 minutes, followed by in a whisper
Studies utilizing positron emission tomography for 2 more minutes and finally out loud for the final
(PET), SPECT, and functional magnetic resonance 2 minutes. The total time is 12 minutes. Since this is
imaging (fMRI) have all demonstrated specific changes a simple and quick practice, it has the potential to be
in cortical and sub-cortical structures when subjects a very practical and low cost measure to help improve
were actively meditating [4–7]. There is a growing, memory. This also distinguishes this practice from a
although still relatively limited, number of studies that number of other meditation practices that require ex-
have evaluated the long-term effects of meditation prac- tended class sessions and long meditation practices that
tices. Specifically, these studies showed increased ac- may not be practical in an older population. This was
tivity in expert meditators in the frontoparietal regions, the purpose for the present study which was to evalu-
cerebellar, temporal, parahippocampal, and posterior ate the effects of performing daily KK meditation for
occipital cortex during meditation. These areas have 8 weeks on brain function and cognition and measure
also been implicated in a variety of memory tasks uti- changes in cerebral blood flow (CBF) utilizing SPECT
lizing fMRI [8]. Other studies have compared experi- imaging.
enced meditators to non-meditators with regard to brain We hypothesized that several structures would be
structure and function [9]. For example, a study by particularly affected by the KK meditation program.
Lazar and colleagues using structural MRI demonstrat- Specifically, attention focusing practices such as med-
ed that long-term meditators, practicing for approxi- itation have activated the attentional network in the
mately 1 hour a day, had thicker prefrontal cortexes than brain which includes frontal lobe structures as well as
non-meditators [10]. Additionally, Lutz and collabora- the anterior cingulate cortex [13,14]. We also hypothe-
tors using electroencephalography (EEG) showed that sized that structures such as the amygdala and thalamus
expert meditators were able to induce changes in their would be affected since these structures have shown
brain activity during meditation [11]. However, these changes in other studies of the long term effects of med-
studies did not determine if the findings were the result itation and are also part of the network of structures
of the meditation practices since these studies were not involved in the default network [15,16]. We have pre-
longitudinal. Thus, one possibility is that the individu- viously found changes in the temporal lobe associat-
als had brains that were fundamentally different which ed with verbal meditation practices and changes in the
predisposed them to such practices. A second possi- parietal lobe associated with altered spatial perceptions
bility is that the individual affected their brain over the 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 upon performance on the Logical Memory II subtest

of the Wechsler Memory Scale Revised, normal gen-
Subjects and imaging acquisition eral cognitive function, no impairment in activities of
daily living, and not sufficiently impaired to meet the
Fifteen subjects were recruited from local neurolo- NINCDS/ADRDA criteria for AD. The remaining sub-
jects were considered to have age-associated memory
gy clinics, local medical groups, and hospital based
impairment and were otherwise normal controls who
advertisements, who presented complaining of memo-
perceived their memory to be impaired. Each subject
ry problems ranging from mild age-associated memo-
had no significant experience with meditation or yoga.
ry impairment (n = 7), to mild cognitive impairment
Subjects were studied on their first KK training day and
(MCI) (n = 5), to moderate impairment with a diagno- then again after an 8-week self-directed training pro-
sis of AD (n = 3). The Mini-Mental Status Examina- gram. We excluded the data from the single AD patient
tion scores (MMSE) ranged from 16–30. There were 6 with a MMSE of 16 due to her inability to adequately
men and 9 women with ages ranging from 52–77 years perform the meditation.
with a mean age of 64 ± 8 years. The patients with AD On the first day of the study, after obtaining informed
were diagnosed on the basis of criteria established by consent (approved by the human subjects Institutional
the National Institute of Neurological and Communica- Review Board with the study protocol), a room was set
tive Disorders and Stroke/Alzheimer’s Disease and Re- up in the hospital to function as a meditation room. Ap-
lated Disorders Association (NINCDS-ADRDA) cri- proximately 20 minutes prior to the baseline scan, an
teria [17]. The MCI patients were diagnosed based intravenous canula (IV) was placed in one arm so that
upon criteria reported in Grundman et al. [18] which all injections could be performed without touching or
includes memory complaint, abnormal memory based 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 injection of approximately 925 MBq of 99m Tc-Bicisate
the remainder of the study. For the baseline scan, the though the IV while he/she continued to meditate for
subject was instructed to rest in the room with their approximately another five minutes. The subject was
eyes closed and listen to a general informational CD then scanned for 30 minutes using the same imaging
about the effects of meditation practices for approxi- parameters as for the baseline study. This scan was
mately 12 minutes. This CD was neutral in its con- labeled the “pre-program meditation” scan.
tent. However, we would suggest that having content Subjects were discharged home with the medita-
on the CD that discusses meditation rather than a com- tion CD so that they could practice it at home. They
pletely neutral topic is appropriate to exclude any pos- were instructed to perform the practice every day for
sible expectation effect that might have resulted from 8 weeks. Subjects completed a log to record when
both conditions. The subject was injected through the they performed the meditation practice and their sub-
IV with 250 MBq of 99m Tc-Bicisate (Bristol-Myers jective experience of the practice and its effects. We
Squibb Medical Imaging, N. Billerica, MA), prepared contacted them at 4 weeks to remind them to continue
as specified by the manufacturer. The subject contin- practicing daily and to enquire as to their performance
ued to listen to the CD for another 5 minutes while of the meditation. We also directly interviewed sub-
the tracer uptake occurred in the brain. Approximately jects upon completion of the program to review their
15 minutes following the injection, the subjects under- progress. Upon completion of the 8-week meditation
went SPECT scanning for 30 minutes. This scan was training program, subjects returned to the University
labeled the “pre-program baseline” scan. of Pennsylvania Nuclear Medicine Department to un-
Projection images were obtained at three-degree dergo a second imaging day essentially identical to the
angle intervals on a 128 × 128 matrix (pixel size first. They received a “post-program baseline” scan in
3.56 mm × 3.56 mm) over 360 ◦ by rotating each head which they were injected with 99m Tc-Bicisate while
120◦ . These SPECT images were reconstructed in the listening again to an informational CD. After the base-
transaxial, coronal, and sagittal planes using filtered line scan, the subjects then performed the meditation
backprojection, followed by a low pass filter and 1st for the final time during which they were injected with
99m
order Chang attenuation correction (attenuation coeffi- Tc-Bicisate and underwent a “post-program med-
cient 0.11 cm −1 . The reconstructed slice thickness was itation” scan. We maintained the same order in the
4 mm with a spatial resolution of 8–10 mm. pre- and post-program imaging studies so that the ef-
Following this pre-program baseline scan, the sub- fect of doing the meditation would not interfere with
ject returned to the room for their first meditation ses- the baseline scans.
sion. Subjects initially viewed a 10 minute video with Although this was an open label study to assess effect
one of the investigators (DSK) showing how to perform as well as feasibility, we also recruited a small compar-
the Kirtan Kriya meditation. This video reviewed the ison group in which the KK meditation was replaced
phrases, the sounds, and demonstrated the manner of with a “music listening” task. Five subjects, two hav-
performing the meditation. It was explained to subjects ing MCI and three having age-associated memory im-
to focus on the sounds and finger movements. Subjects pairment (all women with a mean age of 65 ± 10 years
were not asked to do anything more than perform the and a range from 56 to 79 and mean MMSE of 29 ± 1),
task. Thus, there were no additional instructions re- were asked to simply listen to two Mozart violin con-
garding the state of mind that they should be in, any certos each day for approximately 12 minutes, the same
preparatory exercises, or any mindfulness exercises. At amount of time required for the KK meditation. The
the end of the video, the principal investigator answered subjects were asked to focus their attention on the mu-
any questions and then observed the subjects doing sic and to record their progress in a log book. Subjects
the meditation to make sure that it was done correct- underwent the same SPECT imaging procedures as the
ly. Subjects were instructed that they would perform KK group with listening to the music replacing listen-
the meditation while listening to a meditation CD that ing and performing KK meditation. The music group
guided them through the entire practice. The CD con- listened to the same neutral content CD to produce the
tains an individual performing the meditation practice same comparison state. A group listening to music for
in its intended manner with some background music to the same amount of time might provide an adequate
aid in the rhythm of the meditation. The subjects were comparison for the KK meditation program since sub-
then asked to perform the meditation for 12 minutes jects would undergo similar types of programs with the
the first time during which they would receive a second 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., and sensorimotor areas, as well as the precuneus, tha-
the music), we felt that the results would help reduce lamus, amygdala, and cingulate gyrus since these are
effects related to placebo and practice effects related to areas that have been found to be previously affected
repeated performance of the neuropsychological tests. during meditation tasks and also because these struc-
Furthermore, since some studies have suggested that tures subserve a number of cognitive processes. The
music might also improve cognition and mood, this location for each ROI was determined based upon MRI
comparison group might actually be more stringent in anatomy such that they could then be placed directly
terms of helping to observe an effect specifically from on functional SPECT scans [20]. Furthermore, each
the KK meditation. ROI fits within each specified region which helps to
Subjects in both groups were also evaluated on the ensure proper placement and to avoid problems with
first imaging day with a brief neuropsychological test partial voluming. The ROIs were placed on the ini-
battery (see Table 1) that was adapted from the bat- tial scan and then copied directly onto all subsequent
tery currently used by our Memory Disorders Clinic scans. This was possible because the images were al-
at the University of Pennsylvania and comprised of ready resliced into the same planes as described above.
a Category Fluency task in which subjects named as The count values for the baseline and meditation scans
many animals as possible in a 60 second time period, were obtained by determining the number of counts
the Wechsler Adult Intelligence Scale (WAIS) Digit in each ROI on the meditation scan and normalizing
Symbol Substitution Test, a Logical Memory task, and those counts to the whole brain activity. This provides
Trails A and B. These tests also were selected based a CBF ratio for each ROI compared to the whole brain.
upon other studies in which neuropsychological tests Since two SPECT scans were performed on the same
were used to evaluate changes in cognition associated day, the second scan had the decay corrected counts
with mental task interventions [19,20]. These same from the first scan subtracted out prior to analysis. We
tests were repeated on the 8-week follow up session. have previously validated this technique and show that
there is a high test-retest correlation with less than 6%
Image analysis and statistics variability [22].
A percentage change between the meditation and
The images of the pre- and post-program baseline baseline scans (for both the pre- and post-program ses-
and meditation scans were reconstructed and resliced, sions) was calculated using the equation:
using an oblique reformatting program, according to
(Meditation − Baseline)
the anterior-posterior commissure line so that the fi- %Change = × 100
nal two sets were aligned for analysis. A previously (Baseline)
validated template methodology consisting of regions Scan results were statistically evaluated using paired
of interest (ROI) corresponding to the major cortical t-tests comparing the pre- and post-program baseline
and subcortical structures was placed over the baseline scans, and also the change in activation between the
scan [21]. For the purposes of this study, we exam- baseline and meditation scans for both the pre- and post-
ined the CBF as measured in only a selected number program condition. Similarly, neuropsychological test
of ROIs which was hypothesis driven. The ROIs ex- scores were compared using paired t-tests. We cor-
amined included the inferior frontal, superior frontal, rected the CBF data analysis for multiple comparisons
dorsolateral prefrontal, orbitofrontal, inferior temporal, using the False Discovery Rate method [23]. A lim-
superior temporal, inferior parietal, superior parietal, ited number of Pearson correlations between changes
522 A.B. Newberg et al. / Meditation Enhances Cognitive Function

Table 2 Table 3
Comparison of the pre and post training program baseline scans Change in activation between pre and post meditation (or music lis-
revealing changes in CBF in the following structures (values are tening) scans (given as mean percentage change between the baseline
presented as mean ROI/whole brain ratios) and meditation states)
Structure Pre baseline Post baseline p Structure Pre-activation Post activation p
KK Group Kirtan Kriya
R Inferior Frontal 1.12 ± 0.10 1.19 ± 0.09 0.002∗ R DLPFC +0.9 −6.3 0.001∗
R Superior Frontal 1.12 ± 0.09 1.16 ± 0.08 0.007∗ R Superior Temporal +0.3 −5.7 0.005
R Superior Parietal 1.12 ± 0.07 1.18 ± 0.06 0.007∗ R Sensorimotor +2.4 −4.6 0.026
R DLPFC 1.10 ± 0.15 1.20 ± 0.15 0.007∗ R Precuneus −0.8 −5.8 0.042
R Sensorimotor 1.12 ± 0.08 1.18 ± 0.10 0.008∗ R Inferior Frontal −0.7 −6.3 0.049
R Posterior Cingulate 1.36 ± 0.16 1.28 ± 0.17 0.02 L Thalamus −0.2 +8.1 0.023
R Orbitofrontal 0.86 ± 0.24 1.00 ± 0.13 0.03 L Amygdala −2.1 −10.0 0.026
R Anterior Cingulate 1.15 ± 0.19 1.21 ± 0.13 0.05 Music
L Superior Frontal 1.11 ± 0.08 1.15 ± 0.10 0.006∗ R Thalamus +4.6 −7.3 0.03
L Thalamus 1.26 ± 0.09 1.18 ± 0.13 0.03 R Precuneus −5.6 +7.5 0.03
L Superior Parietal 1.12 ± 0.05 1.16 ± 0.09 0.02 ∗ Still
L Medial Frontal 1.17 ± 0.11 1.22 ± 0.11 0.05 significant when corrected for multiple comparisons.
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 the first meditation scan, but had significantly decreased
∗ Still significant when corrected for multiple comparisons. activity in the prefrontal cortex during meditation after
the training program. The music group showed no sig-
nificant differences in brain activation after correction
in neuropsychological test scores and changes in the
for multiple comparisons.
pre and post-baseline CBF were compared for select-
When neuropsychological test scores were compared
ed regions that were significant in the above analysis
between the pre and post training program sessions,
and known to be related to such parameters. Thus,
there were a several improvements observed in the KK
we compared prefrontal cortex and thalamic activity to
group (see Table 4). The KK group did significant-
tests of cognition and executive function such as the
ly better than the music group in Category Fluency –
Trails B, Digit Span Test, and the WAIS Digit Symbol
Animals (p < 0.05). However, several of the oth-
Substitution Test.
er neuropsychological tests demonstrated similar im-
provements between the KK and music groups even
RESULTS though the changes observed in the music group were
not significant.
There were a number of significant changes in the pre In the KK group, there was a significant Pearson
program baseline and the post program baseline scans correlation between CBF in the right prefrontal cortex
in the KK group (see Table 2). In particular, structures versus the Trails B task (R = −0.61, p = 0.02) which
in the frontal lobe regions and right superior parietal was also significant after correction for multiple com-
lobe had significantly higher baseline CBF after the 8- parisons. There was a trend in the Pearson correla-
week training program (even after correction for mul- tions between the left thalamus versus the Trails B task
tiple comparisons). These findings were in contrast to (R = −0.62, p = 0.02), and the left thalamus versus
the baseline CBF values observed in the music com- the Digit Span Test (R = 0.56, p = 0.03), but these
parison group. The structures that had higher baseline were not significant after correction for multiple com-
CBF values after the 8-week music program were in the parisons. No significant correlations were observed in
amygdala and precuneus rather than the frontal lobes the music group.
(see Table 2). However, with the small sample size, Finally, it should be noted that the log books and
these changes were not significant after correction for exit interviews with the subjects revealed that the sub-
multiple comparisons. jects in general found the meditation practice enjoyable
We also compared how much the different structures and beneficial. The subjects were able to perform the
were activated (or deactivated) during the performance practice a mean of 75% of the days that they were in
of the meditation (or listening to music) both pre and the study. Most subjects reported that they subjectively
post training program (see Table 3). In the KK group, perceived that their cognitive function was improved
individuals mildly activated their prefrontal cortex in 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 narrower range with MMSE scores from 24 to 30. Most

subjects indicated that they perceived that their cogni-
The purpose of this pilot study was to determine for tive function was improved after the 8-week program.
the first time if a mind/body medical practice could Furthermore, the results of the imaging and neuropsy-
improve cognition in subjects with memory loss. In chological testing revealed that subjects did experience
this case a brief, simple, and low cost meditation prac- significant changes during the 8-week training period.
tice called Kirtan Kriya performed for only 12 min- In the study presented here, there were several sig-
utes daily over an 8-week period of time revealed posi- nificant changes in baseline CBF associated with the
tive results in both functional neuroimaging changes as 12 minute daily KK meditation training program. For
well as an improvement in cognitive function in people example, there were significant increases in CBF in the
with memory loss, including those with age-associated frontal cortex that aid in attention and executive func-
memory impairment and MCI. tion. This finding is particularly significant since these
Thus, this study was unique in attempting to mea- frontal lobe structures are not only important mediators
sure the longitudinal effects of meditation using func- of attention and executive function, but also appear to
tional brain imaging with SPECT in an older popula- be affected in patients with various dementia disorders
tion than previously studied, especially those patients as well as MCI [24–26].
already suffering from memory loss. It is important It is interesting that the changes in baseline and ac-
to note that the subjects in general found the medita- tivated states of the brain were in very different struc-
tion practice enjoyable and beneficial. The subjects tures in the KK group compared to the music group.
were compliant, performing the practice a mean of 75% This, of course, is consistent with the fact that the two
(range from 41% to 100%) of the days that they were in groups were doing different types of tasks. The activat-
the study, and indicating that they were able to perform ed states, in particular, were quite different with the KK
the practice successfully. However, the one AD patient group showing significantly decreased CBF in the pre-
with an MMSE of 16 had great difficulty performing frontal cortex during meditation after the training pro-
the meditation and when she returned for the 8-week gram. While the findings in the music group were not
follow up, was unable to perform the meditation prop- significant after multiple comparisons, the regions that
erly. While her data were excluded from the analy- were significant before correction, namely the amyg-
sis, it also raised an important issue that once subjects dala and the thalamus, have also been observed to be af-
become too impaired, meditation may not be possible. fected in research studies evaluating listening to music
For the remaining subjects, there was no clear relation- on the brain [27–29].
ship between those with varying degrees of cognitive It is a particularly interesting finding that the areas
impairment, although these subjects were in a much activated by music (such as the limbic and posterior
524 A.B. Newberg et al. / Meditation Enhances Cognitive Function

structures) are different from those involved in the KK a placebo effect or a practice effect. It should also be
meditation (namely the frontal cortex and superior pari- stressed that a major limitation of this preliminary study
etal lobe). The initial hypotheses regarding KK medi- is the size of the music comparison group and future
tation is that it should have had its primary impact on studies evaluating music as well as other types of medi-
the frontal cortex. It is also interesting to note that tation might be useful in determining the most effective
the frontal lobes, superior parietal lobes, and posterior types of interventions. Thus, larger trials are necessary
cingulate are also part of the brain’s default network to determine whether music itself has a beneficial effect
and have been observed to be substantially different in on cognition, as well as recruiting intervention groups
patients with memory deficits associated with normal of more similar sizes. In particular, it will be important
aging, MCI, and AD [30,31]. This suggests the possi- to have more uniform groups, such as studying only
bility that the KK practice has an effect on this default patients with MCI, to help evaluate specific changes in
network over time. both brain function and neuropsychological status.
There were also improvements in cognitive function While it was also interesting to find a correlation
in the KK group as revealed by neuropsychological between the change in prefrontal cortex CBF and im-
testing. These changes were significant in verbal flu- provement in the Trails B test, the pilot nature of this
ency, although the KK group did not achieve results study limits any definitive statement about such a re-
that were statistically better than the music group in lationship. While such findings at least support the
the other neuropsychological tests. The KK group did notion that the physiological changes associated with
show trends in improvement in several other tests in- meditation may be related to improvements in cogni-
cluding the Trails B, WAIS Symbol Substitution Test, tion, larger studies will be necessary to confirm such
and Logical Memory Delayed task. correlations.
As this is a pilot study, there are many limitations As a pilot study, the data do provide important in-
that need to be considered and that will need to be ad- formation regarding general effect sizes and the stan-
dressed before being able to definitely state that med- dard deviation for CBF changes and neuropsycholog-
itation practices provide a cognitive benefit in older ical test changes associated with a meditation practice
individuals. For example, it could be argued that the that might have implications for powering future stud-
music group was also performing a “meditation-type” ies. Of course, an important issue would be what the
task and thus, might not have been as appropriate a primary outcome measure would be for future stud-
control group as possible. In fact, several studies have ies – imaging or neuropsychological outcomes. That
observed a beneficial effect of listening to music on the baseline brain activity, particularly in the frontal
cognitive function and our data show improvements al- cortex, was increased after eight weeks of meditation
though they were not significant, possibly because of practice supports the hypothesis that meditation may
the small sample size. Emery and colleagues showed affect brain function over longer periods of time. Of
that exercise plus music resulted in improved verbal course, it is also known that cognitive decline with ag-
fluency compared to exercise alone [32]. Another study ing or with MCI is slower than that for AD patients.
showed the music therapy resulted in improvements in Thus, the current study does not address whether medi-
verbal fluency in dementia patients [33]. Thus, it is tation will actually have long term benefits for slowing
possible that this music listening group might be con- that decline with either normal aging or MCI. On the
sidered an active intervention group as well, in which other hand, these findings provide a hypothetical basis
case both KK meditation and music resulted in im- for future studies exploring the effects of meditation
provements in cognitive function in these patients, but techniques on memory and cerebral activity by indi-
appeared to be associated with different physiological cating which brain structures are likely involved and
correlates. also provided information regarding the effect size and
It should be noted that determining the appropriate variability of specific measures.
control comparison group for meditation practices is al- We also recognize that the use of complementary and
ways a challenge since it is difficult to select a particular alternative medicine techniques in the management of
intervention (i.e., solving puzzles, doing spatial tasks, aging and dementia is still controversial. There have
reading, etc.) that would not have some component been few large scale studies and most data, including
of improving cognitive function. Furthermore, doing a the current study, must be viewed as preliminary. How-
simple test-retest group would not represent any inter- ever, we also hope that the results of studies such as
vention and thus might also not sufficiently control for 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 [10] Lazar SW, Kerr CE, Wasserman RH, Gray JR, Greve DN,
if techniques such as meditation prove to have only a Treadway MT, McGarvey M, Quinn BT, Dusek JA, Benson H,
Rauch SL, Moore CI, Fischl B (2005) Meditation experience
small value, their low cost and ease of use may make is associated with increased cortical thickness. Neuroreport
them a beneficial adjunct to the pharmacological arse- 16, 1893-1897.
nal currently being explored. Thus, we hope that future [11] Lutz A, Greischar LL, Rawlings NB, Ricard M, Davidson
studies with a larger population size, different compar- RJ (2004) Long-term meditators self-induce high-amplitude
gamma synchrony during mental practice. Proc Natl Acad Sci
ison groups, and a larger battery of neuropsychological USA 101, 16369-16373.
tests, would be able to advance the findings from this [12] Davidson RJ, Kabat-Zinn J, Schumacher J, Rosenkranz M,
initial study. Muller D, Santorelli SF, Urbanowski F, Harrington A, Bonus
K, Sheridan J (2003) Alterations in brain and immune func-
tion produced by mindfulness meditation. Psychosom Med 65,
564-570.
ACKNOWLEDGMENTS [13] Frith CD, Friston K, Liddle PF, Frackowiak RS (1991) Willed
action and the prefrontal cortex in man. a study with PET. Proc
R Soc Lond 244, 241-246.
We would like to thank the Alzheimer’s Re- [14] Posner MI, Petersen SE (1990) The attention system of the
search and Prevention Foundation in Tucson, Arizona human brain. Ann Rev Neurosci 13, 25-42.
(http://www.alzheimersprevention.org) for their gener- [15] Pagnoni G, Cekic M (2007) Age effects on gray matter vol-
ous support of this research project. ume and attentional performance in Zen meditation. Neurobiol
Aging 28, 1623-1627.
Authors’ disclosures available online (http://www.j- [16] Hölzel BK, Ott U, Gard T, Hempel H, Weygandt M, Morgen
alz.com/disclosures/view.php?id=282). K, Vaitl D (2008) Investigation of mindfulness meditation
practitioners with voxel-based morphometry. Soc Cogn Affect
Neurosci 3, 55-61.
[17] McKann G, Drachman D, Folstein M, Katzman R, Price D,
REFERENCES Stadlan E (1984) Clinical diagnosis of Alzheimer’s disease:
report of the NINCDS-ADRDA Work Group under the aus-
[1] Hebert L, Scherr P, Bienias J, Bennett D, Evans D (2003) pices of Department of Health and Human Services Task Force
Alzheimer disease in the US population: prevalence estimates on Alzheimer’s disease. Neurology 34, 939-944.
using the 2000 census. Arch Neurol 60, 1119-1122. [18] Grundman M, Petersen RC, Ferris SH, Thomas RG, Aisen
[2] Mahncke HW, Connor BB, Appelman J, Ahsanuddin ON, PS, Bennett DA, Foster NL, Jack CR Jr, Galasko DR, Doody
Hardy JL, Wood RA, Joyce NM, Boniske T, Atkins SM, R, Kaye J, Sano M, Mohs R, Gauthier S, Kim HT, Jin S,
Merzenich M (2006) Memory enhancement in healthy old- Schultz AN, Schafer K, Mulnard R, van Dyck CH, Mintzer
er adults using a brain plasticity-based training program: a J, Zamrini EY, Cahn-Weiner D, Thal LJ; Alzheimer’s Disease
randomized, controlled study. Proc Natl Acad Sci USA 103, Cooperative Study (2004) Mild cognitive impairment can be
12523-12528. distinguished from Alzheimer disease and normal aging for
[3] Willis SL, Tennstedt SL, Marsiske M, Ball K, Elias J, Koepke clinical trials. Arch Neurol 61, 59-66.
KM, Morris JN, Rebok GW, Unverzagt FW, Stoddard AM, [19] Talassi E, Guerreschi M, Feriani M, Fedi V, Bianchetti A, Tra-
Wright E; ACTIVE Study Group (2006) Long-term effects of bucchi M (2007) Effectiveness of a cognitive rehabilitation
cognitive training on everyday functional outcomes in older program in mild dementia (MD) and mild cognitive impair-
adults. JAMA 296, 2805-2814. ment (MCI): a case control study. Arch Gerontol Geriatr 44,
[4] Lazar SW, Bush G, Gollub RL, Fricchione GL, Khalsa G, 391-399.
Benson H (2000) Functional brain mapping of the relaxation [20] Belleville S (2008) Cognitive training for persons with mild
response and meditation. Neuroreport 11, 1581-1585. cognitive impairment. Int Psychogeriatr 20, 57-66.
[5] Lou HC, Kjaer TW, Friberg L, Wildschiodtz G, Holm S, [21] Resnick SM, Karp JS, Tretsky BI, Gur RE (1993) Comparison
Nowak M (1999) A 15O-H2O PET study of meditation and of anatomically defined versus physiologically based regional
the resting state of normal consciousness. Human Brain Mapp localization: Effects on PET-FDG quantitation. J Nucl Med
7, 98-105. 34, 201-208.
[6] Newberg AB, Alavi A, Baime M, Pourdehnad M, Santanna [22] Newberg AB, Saffer J, Farrar J, Pourdehnad M, Alavi A (2005)
J, d’Aquili EG (2001) The measurement of regional cerebral Stability of cerebral blood flow measures using a split-dose
blood flow during the complex cognitive task of meditation: A technique with 99mTc-exametazime SPECT. Nucl Med Comm
preliminary SPECT study. Psychiatr Res Neuroimaging 106, 26, 475-478.
113-122. [23] Benjamini Y, Hochberg Y (1995) Controlling the false discov-
[7] Herzog H, Lele VR, Kuwert T, Langen, K-J, Kops ER, Feinen- ery rate: a practical and powerful approach to multiple testing.
degen LE (1990-1991) Changed pattern of regional glucose J R Stat Soc Series B Stat Methodol 57, 289-300.
metabolism during Yoga meditative relaxation. Neuropsy- [24] Jauhiainen AM, Kangasmaa T, Rusanen M, Niskanen E, Ter-
chobiology 23, 182-187. vo S, Kivipelto M, Vanninen RL, Kuikka JT, Soininen (2008)
[8] Wager TD, Smith EE (2003) Neuroimaging studies of working Differential hypometabolism patterns according to mild cog-
memory: a meta-analysis. Cogn Affect Behav Neurosci 3, 255- nitive impairment subtypes. Dement Geriatr Cogn Disord 26,
74. 490-498.
[9] Cahn BR, Polich J (2006) Meditation states and traits: EEG, [25] Pereira FS, Yassuda MS, Oliveira AM, Forlenza OV (2008)
ERP, and neuroimaging studies. Psychol Bull 132, 180-211. Executive dysfunction correlates with impaired functional sta-
526 A.B. Newberg et al. / Meditation Enhances Cognitive Function

tus in older adults with varying degrees of cognitive impair- related content. Cereb Cortex 17, 2828-2840.
ment. Int Psychogeriatr 20, 1104-1115. [30] Damoiseaux JS, Beckmann CF, Arigita EJ, Barkhof F, Schel-
[26] Staffen W, Schönauer U, Zauner H, Spindler I, Mair A, tens P, Stam CJ, Smith SM, Rombouts SA (2008) Reduced
Iglseder B, Bernroider G, Ladurner G (2006) Brain perfu- resting-state brain activity in the “default network” in normal
sion SPECT in patients with mild cognitive impairment and aging. Cereb Cortex 18, 1856-1864.
Alzheimer’s disease: comparison of a semiquantitative and a [31] Sorg C, Riedl V, Mühlau M, Calhoun VD, Eichele T, Läer L,
visual evaluation. J Neural Transm 113, 195-203. Drzezga A, Förstl H, Kurz A, Zimmer C, Wohlschläger AM
[27] Saito Y, Ishii K, Yagi K, Tatsumi IF, Mizusawa H (2006) (2007) Selective changes of resting-state networks in individ-
Cerebral networks for spontaneous and synchronized singing uals at risk for Alzheimer’s disease. Proc Natl Acad Sci USA
and speaking. Neuroreport 17, 1893-1897. 104, 18760-18765.
[28] Satoh M, Takeda K, Nagata K, Hatazawa J, Kuzuhara S (2003) [32] Emery CF, Hsiao ET, Hill SM, Frid DJ (2003) Short-term
The anterior portion of the bilateral temporal lobes participates effects of exercise and music on cognitive performance among
in music perception: a positron emission tomography study. participants in a cardiac rehabilitation program. Heart Lung
Am J Neuroradiol 24, 1843-1848. 32, 368-373.
[29] Eldar E, Ganor O, Admon R, Bleich A, Hendler T (2007) [33] Brotons M, Koger SM (2000) The impact of music therapy on
Feeling the real world: limbic response to music depends on language functioning in dementia. J Music Ther 37, 183-195.