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Rajab AS, Crane DE, Middleton LE, Robertson AD, Hampson M, MacIntosh BJ. A single session of exercise increases connectivity in sensorimotor-related brain networks: a resting-state fMRI study in young healthy adults. Front Hum Neurosci 2014; 8:625. [PMID: 25177284 PMCID: PMC4132485 DOI: 10.3389/fnhum.2014.00625] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 07/26/2014] [Indexed: 11/13/2022] Open
Abstract
Habitual long term physical activity is known to have beneficial cognitive, structural, and neuro-protective brain effects, but to date there is limited knowledge on whether a single session of exercise can alter the brain's functional connectivity, as assessed by resting-state functional magnetic resonance imaging (rs-fMRI). The primary objective of this study was to characterize potential session effects in resting-state networks (RSNs). We examined the acute effects of exercise on the functional connectivity of young healthy adults (N = 15) by collecting rs-fMRI before and after 20 min of moderate intensity aerobic exercise and compared this with a no-exercise control group (N = 15). Data were analyzed using independent component analysis, denoising and dual regression procedures. Regions of interest-based group session effect statistics were calculated in RSNs of interest using voxel-wise permutation testing and Cohen's D effect size. Group analysis in the exercising group data set revealed a session effect in sub-regions of three sensorimotor related areas: the pre and/or postcentral gyri, secondary somatosensory area and thalamus, characterized by increased co-activation after exercise (corrected p < 0.05). Cohen's D analysis also showed a significant effect of session in these three RSNs (p< 0.05), corroborating the voxel-wise findings. Analyses of the no-exercise dataset produced no significant results, thereby providing support for the exercise findings and establishing the inherent test-retest reliability of the analysis pipeline on the RSNs of interest. This study establishes the feasibility of rs-fMRI to localize brain regions that are associated with acute exercise, as well as an analysis consideration to improve sensitivity to a session effect.
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Affiliation(s)
- Ahmad S Rajab
- Department of Medical Biophysics, University of Toronto Toronto ON, Canada ; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute Toronto, ON, Canada
| | - David E Crane
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute Toronto, ON, Canada
| | - Laura E Middleton
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute Toronto, ON, Canada ; Department of Kinesiology, University of Waterloo Waterloo, ON, Canada
| | - Andrew D Robertson
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute Toronto, ON, Canada
| | - Michelle Hampson
- Department of Diagnostic Radiology, Yale University School of Medicine New Haven, CT, USA
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto Toronto ON, Canada ; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute Toronto, ON, Canada
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Middleton LE, Lam B, Fahmi H, Black SE, McIlroy WE, Stuss DT, Danells C, Ween J, Turner GR. Frequency of domain-specific cognitive impairment in sub-acute and chronic stroke. NeuroRehabilitation 2014; 34:305-12. [DOI: 10.3233/nre-131030] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Laura E. Middleton
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
- Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada
- Toronto Rehabilitation Institute, Toronto, Canada
| | - Benjamin Lam
- Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada
- Department of Neurology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Halla Fahmi
- Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Sandra E. Black
- Toronto Rehabilitation Institute, Toronto, Canada
- Department of Neurology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - William E. McIlroy
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
- Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada
- Toronto Rehabilitation Institute, Toronto, Canada
| | - Donald T. Stuss
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Psychology, University of Toronto, Toronto, Canada
- Rotman Research Institute of Baycrest, Toronto, Canada
| | - Cynthia Danells
- Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada
- Toronto Rehabilitation Institute, Toronto, Canada
| | - Jon Ween
- Rockwood Epilepsy and Stroke Center, Spokane, WA, USA
| | - Gary R. Turner
- Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
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MacIntosh BJ, Crane DE, Sage MD, Rajab AS, Donahue MJ, McIlroy WE, Middleton LE. Impact of a single bout of aerobic exercise on regional brain perfusion and activation responses in healthy young adults. PLoS One 2014; 9:e85163. [PMID: 24416356 PMCID: PMC3885687 DOI: 10.1371/journal.pone.0085163] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 11/24/2013] [Indexed: 02/03/2023] Open
Abstract
Purpose Despite the generally accepted view that aerobic exercise can have positive effects on brain health, few studies have measured brain responses to exercise over a short time span. The purpose of this study was to examine the impact within one hour of a single bout of exercise on brain perfusion and neuronal activation. Methods Healthy adults (n = 16; age range: 20–35 yrs) were scanned using Magnetic Resonance Imaging (MRI) before and after 20 minutes of exercise at 70% of their age-predicted maximal heart rate. Pseudo-continuous arterial spin labeling (pcASL) was used to measure absolute cerebral blood flow (CBF) prior to exercise (pre) and at 10 min (post-10) and 40 min (post-40) post-exercise. Blood oxygenation level dependent (BOLD) functional MRI (fMRI) was performed pre and post-exercise to characterize activation differences related to a go/no-go reaction time task. Results Compared to pre-exercise levels, grey matter CBF was 11% (±9%) lower at post-10 (P<0.0004) and not different at post-40 (P = 0.12), while global WM CBF was increased at both time points post-exercise (P<0.0006). Regionally, the hippocampus and insula showed a decrease in perfusion in ROI-analysis at post-10 (P<0.005, FDR corrected), whereas voxel-wise analysis identified elevated perfusion in the left medial postcentral gyrus at post-40 compared to pre (pcorrected = 0.05). BOLD activations were consistent between sessions, however, the left parietal operculum showed reduced BOLD activation after exercise. Conclusion This study provides preliminary evidence of regionalized brain effects associated with a single bout of aerobic exercise. The observed acute cerebrovascular responses may provide some insight into the brain’s ability to change in relation to chronic interventions.
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Affiliation(s)
- Bradley J. MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ontario, Canada
- * E-mail:
| | - David E. Crane
- Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Michael D. Sage
- Toronto Rehabilitation Institute, University of Toronto, Toronto, Ontario, Canada
- Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada
| | - A. Saeed Rajab
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Manus J. Donahue
- Department of Radiology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - William E. McIlroy
- Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Laura E. Middleton
- Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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Lam B, Middleton LE, Masellis M, Stuss DT, Harry RD, Kiss A, Black SE. Criterion and convergent validity of the Montreal cognitive assessment with screening and standardized neuropsychological testing. J Am Geriatr Soc 2013; 61:2181-2185. [PMID: 24320735 DOI: 10.1111/jgs.12541] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the validity of the Montreal Cognitive Assessment (MoCA) with the criterion standard of standardized neuropsychological testing and to compare the convergent validity of the MoCA with that of existing screening tools and global measures of cognition. DESIGN Cross-sectional observational study. SETTING Tertiary care hospital-based cognitive neurology subspecialty clinic. PARTICIPANTS A convenience sample of 107 individuals with mild Alzheimer's disease (AD, n=75) or mild cognitive impairment (MCI, n=32) from the Sunnybrook Dementia Study. MEASUREMENTS In addition to the MoCA, all participants completed the Mini-Mental State Examination (MMSE), the Mattis Dementia Rating Scale (DRS), and detailed neuropsychological testing. RESULTS Convergent validity was supported, with MoCA scores correlating well with the MMSE (correlation coefficient (r)=0.66, P<.001) and the DRS (r=0.77, P<.001) and the MoCA better associated with the DRS than did the MMSE. Criterion validity was supported, with MoCA subscores according to cognitive domain correlating well with analogous neuropsychological tests and, in the case of memory (area under the receiver operating characteristic curve (AUC)=0.86), executive (AUC=0.79), and visuospatial function (AUC=0.79), being reasonably sensitive to impairment in those domains. CONCLUSION The MoCA is a valid assessment of cognition that shows good agreement with existing screening tools and global measures (convergent validity) and was superior to the MMSE in this regard. The MoCA domain-specific subscores align with performance on more-detailed neuropsychological tests, suggesting not only good criterion validity for the MoCA, but also that it may be useful in guiding further neuropsychological testing.
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Affiliation(s)
- Benjamin Lam
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laura E Middleton
- Heart and Stroke Centre for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mario Masellis
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Robin D Harry
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alex Kiss
- Clinical Epidemiology Unit, Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Sandra E Black
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Barnes DE, Santos-Modesitt W, Poelke G, Kramer AF, Castro C, Middleton LE, Yaffe K. The Mental Activity and eXercise (MAX) trial: a randomized controlled trial to enhance cognitive function in older adults. JAMA Intern Med 2013; 173:797-804. [PMID: 23545598 PMCID: PMC5921904 DOI: 10.1001/jamainternmed.2013.189] [Citation(s) in RCA: 244] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The prevalence of cognitive impairment and dementia are projected to rise dramatically during the next 40 years, and strategies for maintaining cognitive function with age are critically needed. Physical or mental activity alone result in relatively small, domain-specific improvements in cognitive function in older adults; combined interventions may have more global effects. OBJECTIVE To examine the combined effects of physical plus mental activity on cognitive function in older adults. DESIGN Randomized controlled trial with a factorial design. SETTING San Francisco, California. PARTICIPANTS A total of 126 inactive, community-residing older adults with cognitive complaints. INTERVENTIONS All participants engaged in home-based mental activity (1 h/d, 3 d/wk) plus class-based physical activity (1 h/d, 3 d/wk) for 12 weeks and were randomized to either mental activity intervention (MA-I; intensive computer) or mental activity control (MA-C; educational DVDs) plus exercise intervention (EX-I; aerobic) or exercise control (EX-C; stretching and toning); a 2 × 2 factorial design was used so that there were 4 groups: MA-I/EX-I, MA-I/EX-C, MA-C/EX-1, and MA-C/EX-C. MAIN OUTCOME MEASURES Global cognitive change based on a comprehensive neuropsychological test battery. RESULTS Participants had a mean age of 73.4 years; 62.7% were women, and 34.9% were Hispanic or nonwhite. There were no significant differences between the groups at baseline. Global cognitive scores improved significantly over time (mean, 0.16 SD; P < .001) but did not differ between groups in the comparison between MA-I and MA-C (ignoring exercise, P = .17), the comparison between EX-I and EX-C (ignoring mental activity, P = .74), or across all 4 randomization groups (P = .26). CONCLUSIONS AND RELEVANCE In inactive older adults with cognitive complaints, 12 weeks of physical plus mental activity was associated with significant improvements in global cognitive function with no evidence of difference between intervention and active control groups. These findings may reflect practice effects or may suggest that the amount of activity is more important than the type in this subject population. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00522899.
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Affiliation(s)
- Deborah E Barnes
- Department of Psychiatry, University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA.
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Middleton LE, Corbett D, Brooks D, Sage MD, Macintosh BJ, McIlroy WE, Black SE. Physical activity in the prevention of ischemic stroke and improvement of outcomes: a narrative review. Neurosci Biobehav Rev 2012. [PMID: 23201860 DOI: 10.1016/j.neubiorev.2012.11.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Physical activity is an integral component of stroke prevention. Although approximately 80% of strokes are due to cerebral ischemia, the mechanisms linking physical activity to the incidence of and recovery from ischemic stroke are not completely understood. This review summarizes evidence from human and animal studies regarding physical activity in the prevention of overt and covert ischemic stroke and associated injury. In cohort studies, people who are physically active have reduced rates of overt ischemic stroke and ischemic stroke mortality. However, few human studies have examined physical activity and the incidence of covert stroke. Evidence from animal models of ischemic stroke indicates that physical activity reduces injury after ischemic stroke by reducing infarct size and apoptotic cell death. Accordingly, physical activity may reduce the magnitude of injury from ischemic stroke so that there are fewer or less severe symptoms. Future research should investigate physical activity and incidence of covert stroke prospectively, ascertain the optimal dose and type of exercise to prevent ischemic injury, and identify the underlying neuroprotective mechanisms.
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Affiliation(s)
- Laura E Middleton
- Department of Kinesiology, 200 University Ave W, University of Waterloo, Waterloo, ON N2G 3G1, Canada.
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Middleton LE, Poelke G, Santos‐Modesitt W, Yaffe K, Barnes DE, Goodson W. F1‐03‐03: Impact of a 12‐week exercise intervention on non‐cognitive outcomes in sedentary elders with cognitive complaints or mild cognitive impairment: Findings from the MAX Trial. Alzheimers Dement 2012. [DOI: 10.1016/j.jalz.2012.05.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Gina Poelke
- University of California San FranciscoSan FranciscoCaliforniaUnited States
| | | | - Kristine Yaffe
- University of California San FranciscoSan FranciscoCaliforniaUnited States
| | - Deborah E. Barnes
- University of California San FranciscoSan FranciscoCaliforniaUnited States
| | - William Goodson
- University of California San FranciscoSan FranciscoCaliforniaUnited States
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Abstract
OBJECTIVE To examine whether the association between clinical Alzheimer disease (AD) diagnosis and neuropathology and the precision by which neuropathology differentiates people with clinical AD from those with normal cognition varies by age. METHODS We conducted a cross-sectional analysis of 2,014 older adults (≥70 years at death) from the National Alzheimer's Coordinating Center database with clinical diagnosis of normal cognition (made ≤1 year before death, n = 419) or AD (at ≥65 years, n = 1,595) and a postmortem neuropathologic examination evaluating AD pathology (neurofibrillary tangles, neuritic plaques) and non-AD pathology (diffuse plaques, amyloid angiopathy, Lewy bodies, macrovascular disease, microvascular disease). We used adjusted logistic regression to analyze the relationship between clinical AD diagnosis and neuropathologic features, area under the receiver operating characteristic curve (c statistic) to evaluate how precisely neuropathology differentiates between cognitive diagnoses, and an interaction to identify effect modification by age group. RESULTS In a model controlling for coexisting neuropathologic features, the relationship between clinical AD diagnosis and neurofibrillary tangles was significantly weaker with increasing age (p < 0.001 for interaction). The aggregate of all neuropathologic features more strongly differentiated people with clinical AD from those without in younger age groups (70-74 years: c statistic, 95% confidence interval: 0.93, 0.89-0.96; 75-84 years: 0.95, 0.87-0.95; ≥85 years: 0.83, 0.80-0.87). Non-AD pathology significantly improved precision of differentiation across all age groups (p < 0.004). CONCLUSION Clinical AD diagnosis was more weakly associated with neurofibrillary tangles among the oldest old compared to younger age groups, possibly due to less accurate clinical diagnosis, better neurocompensation, or unaccounted pathology among the oldest old.
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Middleton LE, Manini TM, Simonsick EM, Harris TB, Barnes DE, Tylavsky F, Brach JS, Everhart JE, Yaffe K. Activity energy expenditure and incident cognitive impairment in older adults. Arch Intern Med 2011; 171:1251-7. [PMID: 21771893 PMCID: PMC3923462 DOI: 10.1001/archinternmed.2011.277] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Studies suggest that physically active people have reduced risk of incident cognitive impairment in late life. However, these studies are limited by reliance on self-reports of physical activity, which only moderately correlate with objective measures and often exclude activity not readily quantifiable by frequency and duration. The objective of this study was to investigate the relationship between activity energy expenditure (AEE), an objective measure of total activity, and incidence of cognitive impairment. METHODS We calculated AEE as 90% of total energy expenditure (assessed during 2 weeks using doubly labeled water) minus resting metabolic rate (measured using indirect calorimetry) in 197 men and women (mean age, 74.8 years) who were free of mobility and cognitive impairments at study baseline (1998-1999). Cognitive function was assessed at baseline and 2 or 5 years later using the Modified Mini-Mental State Examination. Cognitive impairment was defined as a decline of at least 1.0 SD (9 points) between baseline and follow-up evaluations. RESULTS After adjustment for baseline Modified Mini-Mental State Examination scores, demographics, fat-free mass, sleep duration, self-reported health, and diabetes mellitus, older adults in the highest sex-specific tertile of AEE had lower odds of incident cognitive impairment than those in the lowest tertile (odds ratio, 0.09; 95% confidence interval, 0.01-0.79). There was also a significant dose response between AEE and incidence of cognitive impairment (P = .05 for trend over tertiles). CONCLUSIONS These findings indicate that greater AEE may be protective against cognitive impairment in a dose-response manner. The significance of overall activity in contrast to vigorous or light activity should be determined.
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Affiliation(s)
- Laura E Middleton
- Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Research Institute, 2075 Bayview Ave, A421, Toronto, ON M4N 3M5, Canada.
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Yaffe K, Middleton LE, Lui LY, Spira AP, Stone K, Racine C, Ensrud KE, Kramer JH. Mild cognitive impairment, dementia, and their subtypes in oldest old women. ACTA ACUST UNITED AC 2011; 68:631-6. [PMID: 21555638 DOI: 10.1001/archneurol.2011.82] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The population of oldest old is increasing, but the prevalence of cognitive impairment is not well characterized in this group. OBJECTIVES To determine the prevalence of mild cognitive impairment (MCI), dementia, and their subtypes in oldest old women and to examine whether some groups of oldest old women were more likely to have cognitive impairment. DESIGN Prospective cohort study. SETTING Women Cognitive Impairment Study of Exceptional Aging. PARTICIPANTS A total of 1299 oldest old (≥85 years) women. MAIN OUTCOME MEASURES All the women completed a neuropsychological test battery. Those who screened positive for possible cognitive impairment (n = 634) were further assessed for a diagnosis of dementia, MCI, or normal cognition. The remaining women (n = 665) were considered cognitively normal. Dementia and MCI subtypes were determined using standard criteria. RESULTS The women had a mean age of 88.2 years, and 27.0% were 90 years or older; 231 women (17.8%) were diagnosed as having dementia and 301 (23.2%) as having MCI, for a combined cognitive impairment prevalence of 41.0%. Clinical features consistent with Alzheimer disease and mixed dementia were most common, each accounting for 40% of dementia cases. Amnestic multiple domain and nonamnestic single domain were the most common MCI types, accounting for 33.9% and 28.9% of cases, respectively. Cognitive impairment was more frequent in women 90 years or older compared with those 85 to 89 years (dementia, 28.2% vs 13.9%, P < .001; MCI, 24.5% vs 22.7%, P = .02) and was more common in women with less education, a history of stroke, and prevalent depression. CONCLUSIONS In this large sample of oldest old women, 41.0% had clinically adjudicated cognitive impairment. Subtypes of dementia and MCI were similar to those in younger populations. Women in the fastest growing demographic, the oldest old, should be screened for cognitive disorders, especially high-risk groups.
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Affiliation(s)
- Kristine Yaffe
- Department of Psychiatry, University of California at San Francisco, 4150 Clement Street, San Francisco, CA 94121, USA.
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Middleton LE, Barnes DE, Lui LY, Yaffe K. Physical activity over the life course and its association with cognitive performance and impairment in old age. J Am Geriatr Soc 2010; 58:1322-6. [PMID: 20609030 DOI: 10.1111/j.1532-5415.2010.02903.x] [Citation(s) in RCA: 194] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine how physical activity at various ages over the life course is associated with cognitive impairment in late life. DESIGN Cross-sectional study. SETTING Four U.S. sites. PARTICIPANTS Nine thousand three hundred forty-four women aged 65 and older (mean 71.6) who self-reported teenage, age 30, age 50, and late-life physical activity. MEASUREMENTS Logistic regression was used to determine the association between physical activity status at each age and likelihood of cognitive impairment (modified Mini-Mental State Examination (mMMSE) score >1.5 standard deviations below the mean, mMMSE score</=22). Models were adjusted for age, education, marital status, diabetes mellitus, hypertension, depressive symptoms, smoking, and body mass index. RESULTS Women who reported being physically active had a lower prevalence of cognitive impairment in late life than women who were inactive at each time (teenage: 8.5% vs 16.7%, adjusted odds ratio (AOR)=0.65, 95% confidence interval (CI)=0.53-0.80; age 30: 8.9% vs 12.0%, AOR=0.80, 95% CI=0.67-0.96); age 50: 8.5% vs 13.1%, AOR=0.71, 95% CI=0.59-0.85; old age: 8.2% vs 15.9%, AOR=0.74, 95% CI=0.61-0.91). When the four times were analyzed together, teenage physical activity was most strongly associated with lower odds of late-life cognitive impairment (OR=0.73, 95% CI=0.58-0.92). However, women who were physically inactive as teenagers and became active in later life had lower risk than those who remained inactive. CONCLUSIONS Women who reported being physically active at any point over the life course, especially as teenagers, had a lower likelihood of cognitive impairment in late life. Interventions should promote physical activity early in life and throughout the life course.
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Affiliation(s)
- Laura E Middleton
- Heart and Stroke Foundation, Center for Stroke Recovery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
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Affiliation(s)
- Laura E. Middleton
- Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kristine Yaffe
- Department of Psychiatry, School of Medicine, University of California, San Francisco, CA, USA
- Department of Neurology, School of Medicine, University of California, San Francisco, CA, USA
- Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
- Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
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Rockwood K, Middleton LE, Moorhouse PK, Skoog I, Black SE. The inclusion of cognition in vascular risk factor clinical practice guidelines. Clin Interv Aging 2009; 4:425-33. [PMID: 19966911 PMCID: PMC2785866 DOI: 10.2147/cia.s6738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND People with vascular risk factors are at increased risk for cognitive impairment as well as vascular disease. The objective of this study was to evaluate whether vascular risk factor clinical practice guidelines consider cognition as an outcome or in connection with treatment compliance. METHODS Articles from PubMed, EMBASE, and the Cochrane Library were assessed by at least two reviewers and were included if: (1) Either hypertension, high cholesterol, diabetes, or atrial fibrillation was targeted; (2) The guideline was directed at physicians; (3) Adult patients (aged 19 years or older) were targeted; and (4) The guideline was published in English. Of 91 guidelines, most were excluded because they were duplicates, older versions, or focused on single outcomes. RESULTS Of the 20 clinical practice guidelines that met inclusion criteria, five mentioned cognition. Of these five, four described potential treatment benefits but only two mentioned that cognition may affect compliance. No guidelines adequately described how to screen for cognitive impairment. CONCLUSION Despite evidence that links cognitive impairment to vascular risk factors, only a minority of clinical practice guidelines for the treatment of vascular risk factors consider cognition as either an adverse outcome or as a factor to consider in treatment.
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Affiliation(s)
- Kenneth Rockwood
- Department of Medicine, Dalhousie University, Halifax, NS, Canada.
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Middleton LE, Mitnitski A, Fallah N, Kirkland SA, Rockwood K. Changes in cognition and mortality in relation to exercise in late life: a population based study. PLoS One 2008; 3:e3124. [PMID: 18769616 PMCID: PMC2518854 DOI: 10.1371/journal.pone.0003124] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Accepted: 08/08/2008] [Indexed: 11/24/2022] Open
Abstract
Background On average, cognition declines with age but this average hides considerable variability, including the chance of improvement. Here, we investigate how exercise is associated with cognitive change and mortality in older people and, particularly, whether exercise might paradoxically increase the risk of dementia by allowing people to live longer. Methods and Principal Findings In the Canadian Study of Health and Aging (CSHA), of 8403 people who had baseline cognition measured and exercise reported at CSHA-1, 2219 had died and 5376 were re-examined at CSHA-2. We used a parametric Markov chain model to estimate the probabilities of cognitive improvement, decline, and death, adjusted for age and education, from any cognitive state as measured by the Modified Mini-Mental State Examination. High exercisers (at least three times per week, at least as intense as walking, n = 3264) had more frequent stable or improved cognition (42.3%, 95% confidence interval: 40.6–44.0) over 5 years than did low/no exercisers (all other exercisers and non exercisers, n = 4331) (27.8% (95% CI 26.4–29.2)). The difference widened as baseline cognition worsened. The proportion whose cognition declined was higher amongst the high exercisers but was more similar between exercise groups (39.4% (95% CI 37.7–41.1) for high exercisers versus 34.8% (95% CI 33.4–36.2) otherwise). People who did not exercise were also more likely to die (37.5% (95% CI 36.0–39.0) versus 18.3% (95% CI 16.9–19.7)). Even so, exercise conferred its greatest mortality benefit to people with the highest baseline cognition. Conclusions Exercise is strongly associated with improving cognition. As the majority of mortality benefit of exercise is at the highest level of cognition, and declines as cognition declines, the net effect of exercise should be to improve cognition at the population level, even with more people living longer.
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Affiliation(s)
- Laura E. Middleton
- Geriatric Medicine Research Unit, Centre for Health Care of the Elderly, Halifax, Nova Scotia, Canada
| | - Arnold Mitnitski
- Geriatric Medicine Research Unit, Centre for Health Care of the Elderly, Halifax, Nova Scotia, Canada
| | - Nader Fallah
- Geriatric Medicine Research Unit, Centre for Health Care of the Elderly, Halifax, Nova Scotia, Canada
| | - Susan A. Kirkland
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Geriatric Medicine Research Unit, Centre for Health Care of the Elderly, Halifax, Nova Scotia, Canada
- * E-mail:
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Middleton LE, Kirkland SA, Maxwell CJ, Hogan DB, Rockwood K. Exercise: a potential contributing factor to the relationship between folate and dementia. J Am Geriatr Soc 2007; 55:1095-8. [PMID: 17608885 DOI: 10.1111/j.1532-5415.2007.01238.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate whether exercise confounds the relationship between folate and cerebrovascular events, all-cause dementia, and Alzheimer's disease. DESIGN Prospective cohort study. SETTING Multiple centers in Canada. PARTICIPANTS In the Canadian Study of Health and Aging, 466 people reported exercise levels, had folate measurements, and were not demented at baseline. After 5 years, 194 had adverse cerebrovascular events, and 65 had dementia (Alzheimer's disease in 47). MEASUREMENTS Associations between folate and cerebrovascular outcomes were examined using logistic regression in the presence and absence of exercise and other confounders. RESULTS Folate was associated with greater risk of Alzheimer's disease (odds ratio (OR)=2.12, 95% confidence interval (CI)=1.01-4.54) and cerebrovascular outcomes (OR=2.05, 95% CI=1.11-3.78) in adjusted analyses before the inclusion of exercise and neared significance with all-cause dementia (OR=1.80, 95% CI=0.94-3.45). After the inclusion of exercise, the association between folate and dementia and Alzheimer's disease was 29% and 25% lower, respectively, and neither association was any longer significant (Alzheimer's disease: OR=1.91, 95% CI=0.89-4.11; all-cause dementia: OR=1.62, 95% CI=0.84-3.15). Exercise was a significant confounder in the relationship between folate and Alzheimer's disease (P=.03) and dementia (P=.003) but not cerebrovascular outcomes (P=.64). Unlike folate, exercise was significantly associated with Alzheimer's disease (OR=0.43, 95% CI=0.19-0.98) and dementia (OR=0.35, 95% CI=0.17-0.72) in adjusted analyses. CONCLUSION Exercise seems to account for much of the relationship between folate and incident dementia and Alzheimer's disease.
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Affiliation(s)
- Laura E Middleton
- Division of Geriatric Medicine, Dalhousie University, Halifax, Canada
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Middleton LE, Black SE, Herrmann N, Oh PI, Bechard L, Middleton L, Lanctot KL. P2‐538: VALIDITY OF PHYSICAL ACTIVITY SCALE FOR THE ELDERLY AMONG PEOPLE WITH MCI OR MILD DEMENTIA. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2018.06.1232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Sandra E. Black
- Sunnybrook Research InstituteUniversity of TorontoTorontoONCanada
| | | | - Paul I. Oh
- Sunnybrook Health Sciences CentreTorontoONCanada
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Abstract
Game sport and training require repeated high intensity bursts. This study examined differences between high intensity, intermittent work in two phases of the menstrual cycle. Six physically active young women (age 19-29) performed 10 6-s sprints on a cycle ergometer in both the mid-follicular (FP) (days 6-10) and late-luteal phases (LP) (days 20-24) of the menstrual cycle. Work, power, oxygen intake (VO2) parameters, and capillarized blood lactate were measured. Data are analyzed using the Friedman and Wilcoxon matched pairs tests. There was no difference between menstrual phases in peak 6-s power (6.8(0.6) W kg(-1) in FP, 6.9(0.6) W kg(-1) in LP), the drop off in work (1.2(3.5) J kg(-1) in FP and 1.0(2.7) J kg(-1) in LP), or in the sprint VO2 (23.7(1.5) mL kg(-1) min(-1) in LP and 24.3(2.4) mL kg(-1) min(-1) in FP). Capillarized blood lactate was also similar in both phases of the menstrual cycle both at 1 min (9.2(2.7) mmol L(-1) in FP, 9.2(3.1) mmol L(-1)) and at 3 min (9.0(2.2) mmol L(-1) in FP, 9.2(2.2) mmol L(-1) in LP). However, the average 6-s work was greater in the LP (39.3(3.4) J kg(-1)) than during the FP (38.3(3.1) J kg(-1)) (P=0.023). The recovery VO2 was also greater in the LP than the FP (26.3(2.4) mL kg(-1) min(-1) in LP, 25.0(2.6) mL kg(-1) min(-1) in FP, P=0.023). Average work over a series of sprints and the VO2 consumed between sprints may be slightly greater during the LP than the FP of the menstrual cycle.
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Affiliation(s)
- Laura E Middleton
- Dalhousie University, 5955 Veteran's Memorial Lane, Suite 1306, Halifax, NS, Canada, B3H 2E1.
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