Walking stabilizes cognitive functioning in Alzheimer's disease (AD) across one year

Biochemical Markers of Physical Exercise on Mild Cognitive Impairment and Dementia: Systematic Review and Perspectives

BACKGROUND

The cognitive effects of physical exercise in patients with dementia disorders or mild cognitive impairment have been examined in various studies; however the biochemical effects of exercise from intervention studies are largely unknown. The objective of this systematic review is to investigate the published results on biomarkers in physical exercise intervention studies in patients with MCI or dementia.

METHODS

The PubMed database was searched for studies from 1976 to February 2015. We included intervention studies investigating the effect of physical exercise activity on biomarkers in patients with MCI or dementia.

RESULTS

A total of eight studies were identified (n = 447 patients) evaluating exercise regimes with variable duration (single session-three sessions/week for 26 weeks) and intensity (light-resistance training-high-intensity aerobic exercise). Various biomarkers were measured before and after intervention. Seven of the eight studies found a significant effect on their selected biomarkers with a positive effect of exercise on brain-derived neurotrophic factor, cholesterol, testosterone, estradiol, dehydroepiadrosterone, and insulin in the intervention groups compared with controls.

CONCLUSION

Although few studies suggest a beneficial effect on selected biomarkers, we need more knowledge of the biochemical effect of physical exercise in dementia or MCI.

Brain activity during walking: A systematic review

BACKGROUND

This systematic review provides an overview of the literature deducing information about brain activation during (1) imagined walking using MRI/fMRI or (2) during real walking using measurement systems as fNIRS, EEG and PET.

METHODS

Three independent reviewers undertook an electronic database research browsing six databases. The search request consisted of three search fields. The first field comprised common methods to evaluate brain activity. The second search field comprised synonyms for brain responses to movements. The third search field comprised synonyms for walking.

RESULTS

48 of an initial yield of 1832 papers were reviewed. We found differences in cortical activity regarding young vs. old individuals, physically fit vs. physically unfit cohorts, healthy people vs. patients with neurological diseases, and between simple and complex walking tasks.

CONCLUSIONS

We summarize that the dimension of brain activity in different brain areas during walking is highly sensitive to task complexity, age and pathologies supporting previous assumptions underpinning the significance of cortical control. Many compensation mechanisms reflect the brain's plasticity which ensures stable walking.

Protective Effects of Physical Exercise in Alzheimer's Disease and Parkinson's Disease: A Narrative Review

Alzheimer's disease (AD) and Parkinson's disease (PD) are devastating, frequent, and still incurable neurodegenerative diseases that manifest as cognitive and motor disorders. Epidemiological data support an inverse relationship between the amount of physical activity (PA) undertaken and the risk of developing these two diseases. Beyond this preventive role, exercise may also slow down their progression. Several mechanisms have been suggested for explaining the benefits of PA in the prevention of AD. Aerobic physical exercise (PE) activates the release of neurotrophic factors and promotes angiogenesis, thereby facilitating neurogenesis and synaptogenesis, which in turn improve memory and cognitive functions. Research has shown that the neuroprotective mechanisms induced by PE are linked to an increased production of superoxide dismutase, endothelial nitric oxide synthase, brain-derived neurotrophic factor, nerve growth factor, insulin-like growth factor, and vascular endothelial growth factor, and a reduction in the production of free radicals in brain areas such as the hippocampus, which is particularly involved in memory. Other mechanisms have also been reported in the prevention of PD. Exercise limits the alteration in dopaminergic neurons in the substantia nigra and contributes to optimal functioning of the basal ganglia involved in motor commands and control by adaptive mechanisms involving dopamine and glutamate neurotransmission. AD and PD are expansive throughout our ageing society, and so even a small impact of nonpharmacological interventions, such as PA and exercise, may have a major impact on public health.

Effects of Exercise on Progranulin Levels and Gliosis in Progranulin-Insufficient Mice

Loss-of-function mutations in progranulin (GRN) are one of the most common genetic causes of frontotemporal dementia (FTD), a progressive, fatal neurodegenerative disorder with no available disease-modifying treatments. Through haploinsufficiency, these mutations reduce levels of progranulin, a protein that has neurotrophic and anti-inflammatory effects. Increasing progranulin expression from the intact allele is therefore a potential approach for treating individuals with GRN mutations. Based on the well-known effects of physical exercise on other neurotrophic factors, we hypothesized that exercise might increase brain progranulin levels. We tested this hypothesis in progranulin heterozygous (Grn^+/−) mice, which model progranulin haploinsufficiency. We housed wild-type and progranulin-insufficient mice in standard cages or cages with exercise wheels for 4 or 7.5 weeks, and then measured brain and plasma progranulin levels. Although exercise modestly increased progranulin in very young (2-month-old) wild-type mice, this effect was limited to the hippocampus. Exercise did not increase brain progranulin mRNA or protein in multiple regions, nor did it increase plasma progranulin, in 4- to 8-month-old wild-type or Grn^+/− mice, across multiple experiments and under conditions that increased hippocampal BDNF and neurogenesis. Grn^−/−mice were included in the study to test for progranulin-independent benefits of exercise on gliosis. Exercise attenuated cortical microgliosis in 8-month-old Grn^−/−mice, consistent with a progranulin-independent, anti-inflammatory effect of exercise. These results suggest that exercise may have some modest, nonspecific benefits for FTD patients with progranulin mutations, but do not support exercise as a strategy to raise progranulin levels.

Interaction between therapeutic interventions for Alzheimer's disease and physiological Aβ clearance mechanisms

Most therapeutic agents are designed to target a molecule or pathway without consideration of the mechanisms involved in the physiological turnover or removal of that target. In light of this and in particular for Alzheimer’s disease, a number of therapeutic interventions are presently being developed/investigated which target the amyloid-β peptide (Aβ). However, the literature has not adequately considered which Aβ physiological clearance pathways are necessary and sufficient for the effective action of these therapeutics. In this review, we evaluate the therapeutic strategies targeting Aβ presently in clinical development, discuss the possible interaction of these treatments with pathways that under normal physiological conditions are responsible for the turnover of Aβ and highlight possible caveats. We consider immunization strategies primarily reliant on a peripheral sink mechanism of action, small molecules that are reliant on entry into the CNS and thus degradation pathways within the brain, as well as lifestyle interventions that affect vascular, parenchymal and peripheral degradation pathways. We propose that effective development of Alzheimer’s disease therapeutic strategies targeting Aβ peptide will require consideration of the age- and disease-specific changes to endogenous Aβ clearance mechanisms in order to elicit maximal efficacy.

Donepezil treatment in ethnically diverse patients with Alzheimer disease

OBJECTIVE

To compare the outcome of donepezil treatment in ethnically diverse Alzheimer disease (AD) patients with ethnically diverse AD patients who did not receive donepezil.

METHODS

Patients meeting NINCDS-ADRA criteria for probable or possible AD from a consortium of California sites were systematically followed for at least 1 year in this prospective, observational study. Their treatment regimens, including prescription of donepezil, were determined by their individual physician according to his or her usual criteria. Patients self-identified their ethnicity.

RESULTS

The 64 ethnically diverse AD patients who completed the study and received donepezil treatment had an average 1-year decline of 2.30 points (standard deviation: 3.9) on the 30-point Mini-Mental State Exam compared with a 1.70-point (standard deviation: 4.2) decline in the 74 ethnically diverse completers who received no donepezil or other anti-AD drugs during the study period. This difference was not statistically significant. The overall Cohen effect size of this treatment-associated difference was estimated at -0.15. After using propensity analyses and other techniques to assess factors that could bias prescribing decisions, the lack of benefits associated with donepezil treatment remained. The lack of donepezil benefits also remained when more traditional analyses were applied to these data.

CONCLUSION

Ethnically diverse AD patients in this study apparently did not benefit from 1 year of donepezil treatment. These unpromising results are in contrast to modest benefits of donepezil treatment measured in a directly comparable California study involving white non-Latino AD patients.

Persons with Alzheimer's disease engage in leisure and mild physical activity with the support of technology-aided programs

Three studies were conducted to assess technology-aided programs to promote leisure engagement and mild physical activity in persons with Alzheimer's disease. Specifically, Study I assessed a program aimed at enabling three patients with mild or moderate Alzheimer's disease to choose among different music options and activate the preferred ones. Studies II and III were directed at patients in the low moderate or severe stages of the Alzheimer's disease who were no longer capable of ambulating and spent their time generally inactive, sitting in their wheelchairs. In particular, Study II used a program to help three patients exercise an arm-raising movement. Study III used a program to help three patients exercise a leg-foot movement. Each study was carried out according to a nonconcurrent multiple baseline design across patients. Results were very encouraging. The patients of Study I learned to choose and activate their preferred music pieces. The patients of Studies II and III enhanced their performance of the target movements and increased their indices of positive participation (e.g., smiles and verbalizations) during the sessions. The applicability of the programs in daily contexts and their implications for the patients involved are discussed.

Add life to years: psychosocial interventions for people with cognitive disorders

As population longevity increases, living with cognitive disorders during a significant part of the remaining lifespan becomes a strong possibility for the majority of older adults. Therefore, the development of treatment strategies to address the principal causes of cognitive and functional decline is a healthcare priority. The aims of medical and psychological therapies vary according to clinical severity. In the stages of mild cognitive impairment and early dementia, maintaining personal independence and enjoyment of life is a major objective from individual, societal, and economical perspectives (Neugroschl and Wang, 2011; Mokhtariet al., 2012). Current anti-dementia drugs contribute to this goal to a very limited extent. In individuals with mild cognitive impairment these compounds do not prevent the onset of dementia (Raschettiet al., 2007), and in those diagnosed with early dementia, these compounds delay the worsening of symptoms only for several months (Kurz and Lautenschlager, 2010). Drugs with novel mechanisms of action are being developed for Alzheimer's disease and other neurodegenerative conditions. These have the potential to slow down the progression of pathology and expand the number of years for which patients remain at mild levels of cognitive and functional impairment. It is less likely that these treatments will stop cognitive and functional decline completely (Kurz and Perneczky, 2011). Therefore, psychosocial interventions are urgently needed in addition to current and future pharmacotherapy. At any level of cognitive and functional impairment the role of psychosocial interventions is to strengthen and make the best use of preserved skills in order to attain or maintain optimal levels of activity, participation, and interpersonal relationships. In contrast to drugs, psychosocial treatments primarily operate at the behavioral level. Some attempt to restore functions through cognitive, social, or physical activity, while others attempt to minimize disability through compensatory cognitive, behavioral, or environmental strategies. Recent research has shown that psychosocial interventions may increase regional cortical thickness or modify the pattern of neuronal network activation (Draganski and May, 2008; van Paasschenet al., 2009; Vosset al., 2010; Ericksonet al., 2011). These neurobiological effects clearly demonstrate that brain plasticity persists into old age, but the relationship to behavioral gains and the importance for the prevention of cognitive decline (Lautenschlageret al., 2012; Steffener and Stern, 2012; Valenzuelaet al., 2012) are currently unclear.

Adaptation and sensitization to proteotoxic stress

Although severe stress can elicit toxicity, mild stress often elicits adaptations. Here we review the literature on stress-induced adaptations versus stress sensitization in models of neurodegenerative diseases. We also describe our recent findings that chronic proteotoxic stress can elicit adaptations if the dose is low but that high-dose proteotoxic stress sensitizes cells to subsequent challenges. In these experiments, long-term, low-dose proteasome inhibition elicited protection in a superoxide dismutase-dependent manner. In contrast, acute, high-dose proteotoxic stress sensitized cells to subsequent proteotoxic challenges by eliciting catastrophic loss of glutathione. However, even in the latter model of synergistic toxicity, several defensive proteins were upregulated by severe proteotoxicity. This led us to wonder whether high-dose proteotoxic stress can elicit protection against subsequent challenges in astrocytes, a cell type well known for their resilience. In support of this new hypothesis, we found that the astrocytes that survived severe proteotoxicity became harder to kill. The adaptive mechanism was glutathione dependent. If these findings can be generalized to the human brain, similar endogenous adaptations may help explain why neurodegenerative diseases are so delayed in appearance and so slow to progress. In contrast, sensitization to severe stress may explain why defenses eventually collapse in vulnerable neurons.

Effects of a single bout of walking on psychophysiologic responses and executive function in elderly adults: a pilot study

Background

The purpose of this study was to examine the effects of a single bout of walking on mood, psychophysiologic responses, and executive function in elderly adults.

Methods

Twenty healthy, elderly adults (10 women and 10 men; mean age 70.50 ± 3.4 years) participated in this study. Mood, as assessed by the Profile of Mood States, and salivary α-amylase activity were examined before and after walking. Executive functions were also evaluated by the Wisconsin Card Sorting Test.

Results

Negative feeling scores such as tension-anxiety, anger-hostility, and confusion significantly improved after walking. No significant differences were found for either salivary α-amylase activities or Wisconsin Card Sorting Test scores before and after walking. However, the changes in salivary α-amylase activity before and after walking correlated positively with the number of total errors and perseverative errors of Nelson in the Wisconsin Card Sorting Test.

Conclusion

These results suggest that moderate exercise, such as self-paced one-time walking, induces beneficial psychologic effects in elderly adults. Meanwhile, the significant increase in salivary α-amylase activity after walking might temporarily cause deterioration of executive function.

Aerobic exercise combined with antioxidative treatment does not counteract moderate- or mid-stage Alzheimer-like pathophysiology of APP/PS1 mice

AIMS

The present study evaluated the combined treatment effects of aerobic exercise and antioxidative stress on moderate-stage Alzheimer's disease (AD).

METHODS

Ten-month-old APP/PS1 mice were given antioxidative treatment with acetylcysteine, along with aerobic exercise for 6 weeks. Spatial learning and memory were tested using the Morris water maze, and β-amyloid (Aβ) plaque deposits in the forebrain were quantified by Thioflavin-S staining. Levels of soluble Aβ1-42, β-secretase enzyme, ү-secretase enzyme, oxidative and antioxidant stress markers nitrotyrosine and peroxiredoxin-1, glial markers glial fibrillary acidic protein and ionized calcium-binding adaptor molecule 1, and synaptic protein synaptophysin in the hippocampus were all measured by western blotting and/or immunohistochemistry.

RESULTS

APP/PS1 mice showed severe declines in spatial learning and memory compared with their wild-type littermates, which were not attenuated by aerobic exercise combined with antioxidative treatment. The pathologic analysis revealed that Aβ deposition and production, oxidative stress, glial inflammation, and synaptic loss were not mitigated in the brain of exercised APP/PS1 mice, compared with the sedentary APP/PS1 animals.

CONCLUSION

This study reveals that a combined treatment of aerobic exercise plus antioxidative stress does not counteract pathophysiology in the moderate- or mid-stages of AD.

Genetic determinants of voluntary exercise

Variation in voluntary exercise behavior is an important determinant of long-term human health. Increased physical activity is used as a preventative measure or therapeutic intervention for disease, and a sedentary lifestyle has generally been viewed as unhealthy. Predisposition to engage in voluntary activity is heritable and induces protective metabolic changes, but its complex genetic/genomic architecture has only recently begun to emerge. We first present a brief historical perspective and summary of the known benefits of voluntary exercise. Second, we describe human and mouse model studies using genomic and transcriptomic approaches to reveal the genetic architecture of exercise. Third, we discuss the merging of genomic information and physiological observations, revealing systems and networks that lead to a more complete mechanistic understanding of how exercise protects against disease pathogenesis. Finally, we explore potential regulation of physical activity through epigenetic mechanisms, including those that persist across multiple generations.

Amyloidosis in Alzheimer's Disease: The Toxicity of Amyloid Beta (A β ), Mechanisms of Its Accumulation and Implications of Medicinal Plants for Therapy

Alzheimer's disease (AD) is a progressive neurodegenerative disorder that leads to memory deficits and death. While the number of individuals with AD is rising each year due to the longer life expectancy worldwide, current therapy can only somewhat relieve the symptoms of AD. There is no proven medication to cure or prevent the disease, possibly due to a lack of knowledge regarding the molecular mechanisms underlying disease pathogenesis. Most previous studies have accepted the “amyloid hypothesis,” in which the neuropathogenesis of AD is believed to be triggered by the accumulation of the toxic amyloid beta (Aβ) protein in the central nervous system (CNS). Lately, knowledge that may be critical to unraveling the hidden pathogenic pathway of AD has been revealed. This review concentrates on the toxicity of Aβ and the mechanism of accumulation of this toxic protein in the brain of individuals with AD and also summarizes recent advances in the study of these accumulation mechanisms together with the role of herbal medicines that could facilitate the development of more effective therapeutic and preventive strategies.