Effects of physical activity and exercise on the cognitive function of patients with Alzheimer disease: a meta-analysis

Exercise-Mediated Alteration of miR-192-5p Is Associated with Cognitive Improvement in Alzheimer's Disease

INTRODUCTION

Physical exercise is an important component of managing Alzheimer's disease (AD). miRNAs can be modulated by exercise intervention.

OBJECTIVE

The study explored the involvement and potential mechanism of miR-192-5p in the protective effect of physical exercise on AD.

METHODS

Ninety AD patients were enrolled, in which 45 cases accepted cycling training for continuous 3 months. The expression changes of miR-192-5p before and after exercise were analyzed by reverse transcription-quantitative PCR. 8-month-old APP/PS1 double Tg mice were used as the AD animal model. Mice in the voluntary exercise (VE) group received VE for 4 weeks. Morris water maze (MWM) test was used to evaluate the learning and memory function. Enzyme-linked immunosorbent assay was used to calculate the level of IL-1β, IL-6, and TNF-α.

RESULTS

AD patients showed elevated MMSE scores, decreased ADAS-cog and NPI-Q scores after 3 months of exercise. miR-192-5p was downregulated in the serum of AD patients and correlated with the levels of MMSE score, ADAS-cog, and NPI-Q score. A positive association was detected between serum miR-192-5p with TNF-α, IL-6, and IL-1β levels. MiR-192-5p is downregulated in the hippocampus tissues of mice after VE. Overexpression of miR-192-5p reversed the neuroprotective effect of exercise on AD in mice and promoted the inflammatory response of AD mice.

CONCLUSION

MiR-192-5p can be modulated by the exercise intervention and involved in the protective effect of exercise on AD.

Effect of Physical Exercise on Cognitive Function of Alzheimer's Disease Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trial

This review aims to systematically review the effects of physical exercise on the cognitive performance of patients with Alzheimer's disease (AD) and its mechanisms of action. Databases such as Web of Science, PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched until December 2021. A randomized controlled trial (RCT) to assess the effect of an exercise intervention (compared with no exercise) on patients with AD. The measures included cognitive function [Mini-Mental State Examination (MMSE), Alzheimer's Disease assessment scale-cognitive (ADAS-Cog), Montreal cognitive assessment scale (MoCA) and Executive Function (EF)]. The methodological quality of the included literature was assessed using the Physiotherapy Evidence Database (PEDro) scale. Twenty-two studies (n = 1647, mean age: 77.1 ± 6.3 years) were included in the systematic review, sixteen of which were included in the meta-analysis. A systematic review and meta-analysis revealed that physical exercise positively affects cognitive performance in older patients with AD. However, the positive effects of the intervention should be interpreted with caution considering the differences in methodological quality, type, frequency, and duration of exercise in the included studies. Future studies should consider the design rigor and specification of RCT protocols.

The Effects of Physical Running on Dendritic Spines and Amyloid-beta Pathology in 3xTg-AD Male Mice

Memory loss is the key symptom of Alzheimer's disease (AD). As successful drug treatments have not yet been identified, non-pharmaceutical interventions such as physical exercise and training have been employed to improve the memory function of people with dementia. We investigated the effect of prolonged physical running on hippocampal-dependent spatial memory and its underlying mechanisms using a well-established rodent model of AD. 3xTg-AD transgenic mice and non-transgenic mice were subjected to voluntary wheel running for 5 months (1 hour per day, 5 days per week), followed by spatial memory testing. After the behavioral testing, dendritic spines, synapses, and synaptic proteins as well as amyloid-beta (Aβ) pathology were analyzed in the dorsal hippocampi. Running improved hippocampal-dependent spatial memory in 3xTg-AD mice. This running strategy prevented both thin and mushroom-type spines on CA1 pyramidal cells in 3xTg-AD mice, whereas the effects of running in non-transgenic mice were limited to thin spines. The enormous effects of running on spines were accompanied by an increased number of synapses and upregulated expression of synaptic proteins. Notably, running downregulated the processing of amyloid precursor protein, decreasing intracellular APP expression and extracellular Aβ accumulation, and spatial memory performance correlated with levels of Aβ peptides Aβ_1-40 and Aβ_1-42. These data suggest that prolonged running may improve memory in preclinical AD via slowing down the amyloid pathology and preventing the loss of synaptic contacts.

Making the Best Out of IT: Design and Development of Exergames for Older Adults With Mild Neurocognitive Disorder - A Methodological Paper

Background: Utilizing information technology (IT) systems, for example in form of computerized cognitive screening or exergame-based (also called active videogames) training, has gained growing interest for supporting healthy aging and to detect, prevent and treat neurocognitive disorders (NCD). To ameliorate the effectiveness of exergaming, the neurobiological mechanisms as well as the most effective components for exergame-based training remain to be established. At the same time, it is important to account for the end-users' capabilities, preferences, and therapeutic needs during the design and development process to foster the usability and acceptance of the resulting program in clinical practice. This will positively influence adherence to the resulting exergame-based training program, which, in turn, favors more distinct training-related neurobiological effects. Objectives and Methods: This methodological paper describes the design and development process of novel exergame-based training concepts guided by a recently proposed methodological framework: The 'Multidisciplinary Iterative Design of Exergames (MIDE): A Framework for Supporting the Design, Development, and Evaluation of Exergames for Health' (Li et al., 2020). Case Study: A step-by-step application of the MIDE-framework as a specific guidance in an ongoing project aiming to design, develop, and evaluate an exergame-based training concept with the aim to halt and/or reduce cognitive decline and improve quality of life in older adults with mild neurocognitive disorder (mNCD) is illustrated. Discussion and Conclusion: The development of novel exergame-based training concepts is greatly facilitated when it is based on a theoretical framework (e.g., the MIDE-framework). Applying this framework resulted in a structured, iterative, and evidence-based approach that led to the identification of multiple key requirements for the exergame design as well as the training components that otherwise may have been overlooked or neglected. This is expected to foster the usability and acceptance of the resulting exergame intervention in "real life" settings. Therefore, it is strongly recommended to implement a theoretical framework (e.g., the MIDE-framework) for future research projects in line with well-known checklists to improve completeness of reporting and replicability when serious games for motor-cognitive rehabilitation purposes are to be developed.

Exercise Dosage in Reducing the Risk of Dementia Development: Mode, Duration, and Intensity-A Narrative Review

Senile dementia, also known as dementia, is the mental deterioration which is associated with aging. It is characterized by a decrease in cognitive abilities, inability to concentrate, and especially the loss of higher cerebral cortex function, including memory, judgment, abstract thinking, and other loss of personality, even behavior changes. As a matter of fact, dementia is the deterioration of mental and intellectual functions caused by brain diseases in adults when they are mature, which affects the comprehensive performance of life and work ability. Most dementia cases are caused by Alzheimer’s disease (AD) and multiple infarct dementia (vascular dementia, multi-infarct dementia). Alzheimer’s disease is characterized by atrophy, shedding, and degenerative alterations in brain cells, and its occurrence is linked to age. The fraction of the population with dementia is smaller before the age of 65, and it increases after the age of 65. Since women live longer than men, the proportion of women with Alzheimer’s disease is higher. Multiple infarct dementia is caused by a cerebral infarction, which disrupts blood supply in multiple locations and impairs cerebral cortex function. Researchers worldwide are investigating ways to prevent Alzheimer’s disease; however, currently, there are no definitive answers for Alzheimer’s prevention. Even so, research has shown that we can take steps to reduce the risk of developing it. Prospective studies have found that even light to moderate physical activity can lower the risk of dementia and Alzheimer’s disease. Exercise has been proposed as a potential lifestyle intervention to help reduce the occurrence of dementia and Alzheimer’s disease. Various workout modes will be introduced based on various physical conditions. In general, frequent exercise for 6–8 weeks lessens the risk of dementia development.

Exercise interventions in Alzheimer's disease: A systematic review and meta-analysis of randomized controlled trials

AIMS

To assess the potential multi-domain benefits of exercise interventions on patients with Alzheimer's disease (AD), as well as to determine the specific effects of different exercise modalities (aerobic, strength, or combined training).

METHODS

A systematic search was conducted in PubMed and Web of Science until March 2021 for randomized controlled trials assessing the effect of exercise interventions (compared with no exercise) on patients with AD. Outcomes included cognitive function (mini-mental state examination [MMSE] test), physical function (e.g., 6-minute walking test [6MWT]), functional independence (Barthel index), and neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI]). A random-effects meta-analysis was conducted.

RESULTS

28 studies (total n = 1337 participants, average age 79-90 years) were included in the systematic review, of which 21 could be meta-analyzed. Although considerable heterogeneity was found, exercise interventions induced several significant benefits, including in Barthel index (n = 147 patients, mean difference [MD]=8.36 points, 95% confidence interval [CI]=0.63-16.09), 6MWT (n = 369, MD=84 m, 95% CI=44-133)), and NPI (n = 263, MD=-4.4 points, 95% CI=-8.42 to -0.38). Benefits were also found in the MMSE test, albeit significance was only reached for aerobic exercise (n = 187, MD=2.31 points, 95% CI 0.45-4.27).

CONCLUSIONS

Exercise interventions appear to exert multi-domain benefits in patients with AD.

Nutrition, Physical Activity, and Other Lifestyle Factors in the Prevention of Cognitive Decline and Dementia

Multiple factors combined are currently recognized as contributors to cognitive decline. The main independent risk factor for cognitive impairment and dementia is advanced age followed by other determinants such as genetic, socioeconomic, and environmental factors, including nutrition and physical activity. In the next decades, a rise in dementia cases is expected due largely to the aging of the world population. There are no hitherto effective pharmaceutical therapies to treat age-associated cognitive impairment and dementia, which underscores the crucial role of prevention. A relationship among diet, physical activity, and other lifestyle factors with cognitive function has been intensively studied with mounting evidence supporting the role of these determinants in the development of cognitive decline and dementia, which is a chief cause of disability globally. Several dietary patterns, foods, and nutrients have been investigated in this regard, with some encouraging and other disappointing results. This review presents the current evidence for the effects of dietary patterns, dietary components, some supplements, physical activity, sleep patterns, and social engagement on the prevention or delay of the onset of age-related cognitive decline and dementia.

The Effect of Physical Exercise on Cognitive Impairment in Neurodegenerative Disease: From Pathophysiology to Clinical and Rehabilitative Aspects

Neurodegenerative diseases are a group of pathologies that cause severe disability due to motor and cognitive limitations. In particular, cognitive impairment is a growing health and socioeconomic problem which is still difficult to deal with today. As there are no pharmacologically effective treatments for cognitive deficits, scientific interest is growing regarding the possible impacts of healthy lifestyles on them. In this context, physical activity is gaining more and more evidence as a primary prevention intervention, a nonpharmacological therapy and a rehabilitation tool for improving cognitive functions in neurodegenerative diseases. In this descriptive overview we highlight the neurobiological effects of physical exercise, which is able to promote neuroplasticity and neuroprotection by acting at the cytokine and hormonal level, and the consequent positive clinical effects on patients suffering from cognitive impairment.

Disentangling Mitochondria in Alzheimer's Disease

Alzheimer's disease (AD) is a major cause of dementia in older adults and is fast becoming a major societal and economic burden due to an increase in life expectancy. Age seems to be the major factor driving AD, and currently, only symptomatic treatments are available. AD has a complex etiology, although mitochondrial dysfunction, oxidative stress, inflammation, and metabolic abnormalities have been widely and deeply investigated as plausible mechanisms for its neuropathology. Aβ plaques and hyperphosphorylated tau aggregates, along with cognitive deficits and behavioral problems, are the hallmarks of the disease. Restoration of mitochondrial bioenergetics, prevention of oxidative stress, and diet and exercise seem to be effective in reducing Aβ and in ameliorating learning and memory problems. Many mitochondria-targeted antioxidants have been tested in AD and are currently in development. However, larger streamlined clinical studies are needed to provide hard evidence of benefits in AD. This review discusses the causative factors, as well as potential therapeutics employed in the treatment of AD.

The Support Person's Preferences and Perspectives of Physical Activity Programs for Older Adults With Cognitive Impairment

Objectives: Physical activity (PA) is beneficial for older adults' cognition. There is limited research investigating perspectives of support persons (SPs) of next-of-kins (NOKs) with cognitive impairment. This exploratory study aimed to investigate perspectives of SPs of older adults with Alzheimer's Dementia (AD) or Mild Cognitive Impairment (MCI).

Methods: A telephone survey of 213 SPs of NOKs from the Australian Imaging, Biomarkers and Lifestyle Flagship Study of Ageing (AIBL) was undertaken to quantitatively assess SPs' beliefs and knowledge about PA benefits, current PA level of their NOK, and PA program preferences. The contribution of age, gender, diagnosis and mental health symptoms was assessed using multiple logistic regression analyses.

Results: Many SPs were aware of PA benefits for memory (64%) and believed it would help their NOK (72%). Older SP age was associated with less awareness of benefits (p = 0.016). SPs caring for male NOKs were more likely to believe that PA would be helpful than those caring for female NOKs (p = 0.049). NOK AD diagnosis (rather than MCI) (p = 0.014), older age (p = 0.005) and female gender (p = 0.043) were associated with lower PA levels. SPs were mixed regarding preference for their NOKs to participate in individual (45%) or group (54%) PA. Many SPs wanted to participate in PA with their NOK (63%).

Conclusions: The results highlight that SPs have high levels of awareness of the cognitive benefits of PA, and describe their preferences regarding PA programs. The findings provide new information to inform targeted public health messaging, PA prescribers and providers, and future research directions.

The effect of physical activity interventions on cognition function in patients with diabetes: A systematic review and meta-analysis

BACKGROUND

In recent years, studies have revealed that cognition may be impaired by glucose metabolism disorder. Meanwhile, physical activity has been demonstrated to maintain blood glucose. This meta-analysis was conducted to assess the effect of physical activity on cognition in patients with diabetes and provide evidence for the treatment of cognition impairment among them.

METHODS

We searched studies published in five databases from 1 January 1984 to 29 August 2020. A random-effect or fixed-effect meta-analysis was used to estimate the pooled effect of physical activity on the change of cognition throughout intervention duration and post-intervention cognition scores by standardized mean difference (SMD) and its 95% confidence interval (CI). We used funnel plots to evaluate the publication bias, I² statistic to evaluate the heterogeneity and did subgroup analysis stratified by sample size and follow-up time.

RESULTS

Five eligible studies involving 2581 patients with diabetes were included. The pooled effect of physical activity on cognition improvement in patients with diabetes was significant (SMD = 0.98, 95% CI: 0.34-1.62), while the effect on post-intervention cognition scores was not significant (SMD = 0.35, 95% CI: -0.04-0.73). In the subgroup analysis, the pooled effect was significantly higher in studies of follow-up time less than 1 year (SMD = 2.14, 95% CI: 1.63-2.64), while observing no significant effect in studies of follow-up time over 1 year (SMD = 0.10, 95% CI: -0.11-0.32).

CONCLUSIONS

Physical activity is beneficial to improving cognition in patients with diabetes. However, the long-term effect needs to be explored in future studies.

Mediterranean Diet and Physical Activity for Successful Aging: An Update for Nutritionists and Endocrinologists

The constant advancement in the medical field has allowed for the diagnosis and treatment of several health conditions. It has also contributed to increasing the average human lifespan, which is considered an outstanding achievement in history. Nevertheless, the impact of this in an ever-increasing aged population with chronic diseases and, most of the time, with limited and poor quality of life was not considered. Thus, it is imperative to establish strategies to age successfully. In order to do have a better understanding of this crucial issue, this review will analyze the endocrine changes in the elderly. It will present common conditions found in this population, chronic inflammation, and oxidative stress. Additionally, we will explain aging-related metabolic and physical performance decline related to hormone changes and lifestyle modifications. We will propose the Mediterranean diet and some specific guidelines about physical activity as part of the plan to have an active and successful aging process.

Running exercise protects spinophilin-immunoreactive puncta and neurons in the medial prefrontal cortex of APP/PS1 transgenic mice

The medial prefrontal cortex (mPFC) is thought to be closely associated with emotional processes, decision making, and memory. Previous studies have identified the prefrontal cortex as one of the most vulnerable brain regions in Alzheimer's disease (AD). Running exercise has widely been recognized as a simple and effective method of physical activity that enhances brain function and slows the progression of AD. However, the effect of exercise on the mPFC of AD is unclear. To address these issues, we investigated the effects of 4 months of exercise on the numbers of spinophilin-immunoreactive puncta and neurons in the mPFC of 12-month-old APPswe/PSEN1dE9 (APP/PS1) transgenic AD model mice using stereological methods. The spatial learning and memory abilities of mice were tested using the Morris water maze. Four months of running exercise delayed declines in spatial learning and memory abilities. The stereological results showed significantly lower numbers of spinophilin-immunoreactive puncta and neurons in the mPFC of APP/PS1 mice than in the wild-type control group. The numbers of spinophilin-immunoreactive puncta and neurons in the mPFC of running APP/PS1 mice were significantly greater than those in the APP/PS1 control mice. In addition, running-induced improvements in spatial learning and memory were significantly associated with running-induced increases in spinophilin-immunoreactive puncta and neurons numbers in the mPFC. Running exercise could delay the loss of spinophilin-immunoreactive puncta and neurons in the mPFC of APP/PS1 mice. This finding might provide an important structural basis for exercise-induced improvements in the spatial learning and memory abilities of individuals with AD.

Glutathione Peroxidase Activity Is Altered in Vascular Cognitive Impairment-No Dementia and Is a Potential Marker for Verbal Memory Performance

Background:

Coronary artery disease (CAD) increases risk for vascular cognitive impairment-no dementia (VCIND), a precursor to dementia, potentially through persistent oxidative stress.

Objective:

This study assessed peripheral glutathione peroxidase activity (GPX), which is protective against oxidative stress, in VCIND versus cognitively normal CAD controls (CN). GPX activity was also evaluated as a biomarker of cognition, particularly verbal memory.

Methods:

120 CAD patients with VCIND (1SD below norms on executive function or verbal memory (VM)) or without (CN) participated in exercise rehabilitation for 24 weeks. Neurocognitive and cardiopulmonary fitness (VO_2peak) assessments and plasma were collected at baseline and 24-weeks.

Results:

GPX was higher in VCIND compared to CN (F_1,119 = 3.996, p = 0.048). Higher GPX was associated with poorer baseline VM (β= –0.182, p = 0.048), and longitudinally with VM decline controlling for sex, body mass index, VO_2peak, and education (b[SE] = –0.02[0.01], p = 0.004). Only CN participants showed improved VM performance with increased fitness (b[SE] = 1.30[0.15], p < 0.005).

Conclusion:

GPX was elevated in VCIND consistent with a compensatory response to persistent oxidative stress. Increased GPX predicted poorer cognitive outcomes (verbal memory) in VCIND patients despite improved fitness.

Neuropsychiatric symptoms in early stage of Alzheimer's and non-Alzheimer's dementia, and the risk of progression to severe dementia

BACKGROUND

Neuropsychiatric symptoms (NPSs) in early dementia have been suggested to predict a higher risk of dementia progression. However, the literature is not yet clear whether the risk is similar across Alzheimer's dementia (AD) and non-Alzheimer's dementia (non-AD), as well as across different NPSs. This study examined the association between NPSs in early dementia and the risk of progression to severe dementia, specifically in AD and non-AD, as well as across various NPSs.

METHOD

This cohort study included 7,594 participants who were ≥65 years and had early dementia (global Clinical Dementia Rating [CDR] = 1). Participants completed Neuropsychiatric-Inventory-Questionnaire at baseline and were followed-up almost annually for progression to severe dementia (global CDR = 3) (median follow-up = 3.5 years; interquartile range = 2.1-5.9 years). Cox regression was used to examine progression risk, stratified by AD and non-AD.

RESULTS

The presence of NPSs was associated with risk of progression to severe dementia, but primarily in AD (HR 1.4, 95% confidence interval [CI]: 1.1-1.6) and not in non-AD (HR 0.9, 95% CI: 0.5-1.5). When comparing across various NPSs, seven NPSs in AD were associated with disease progression, and they were depression, anxiety, apathy, delusions, hallucinations, irritability and motor disturbance (HR 1.2-1.6). In contrast, only hallucinations and delusions were associated with disease progression in non-AD (HR 1.7-1.9).

CONCLUSIONS

NPSs in early dementia-especially among individuals with AD-can be useful prognostic markers of disease progression. They may inform discussion on advanced care planning and prompt clinical review to incorporate evidence-based interventions that may address disease progression.

Effects of Exercise in the Treatment of Alzheimer's Disease: An Umbrella Review of Systematic Reviews and Meta-Analyses

The authors aimed to provide an overview of the evidence on the effects of exercise in people with Alzheimer's disease through a comprehensive review of the existing systematic reviews and meta-analyses. A literature search was performed in CINAHL, Cochrane Library, EMBASE, PubMed, SPORTDiscus, Scopus, and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The AMSTAR-2-Tool was used for the quality assessment. Twenty-three reviews fulfilled the criteria. Most of the reviews investigated the effects of aerobic exercise on Alzheimer's disease symptoms. The largest effects of exercise were seen in terms of improved cognition by multiple exercises. The majority of the reviews were rated as being of moderate quality and none were classified as having high quality. Exercise is an effective way to treat Alzheimer's disease symptoms and has a low incidence of related adverse events. As most reviews were evaluated as low-moderate quality, caution is needed in the interpretation of the results.

Social Isolation in Dementia: The Effects of COVID-19

The aim of this literature review is to identify the effects of social isolation and lonliness on persons with dementia and to highlight interventions for private homes and long-term care facilities. It includes articles published in the last 5 years for a total of 45 articles. Social isolation and/or lonliness is linked to reduced quality of life, neuropsychiatric symptoms, and psychotropic drug use in people living with demential. Interventions, including physical activity, should be individualized and patient centered.

Rehabilitation in Dementia

Dementia is an eurodegenerative disorder, which causes significant disability, especially among the elderly population worldwide. The affected person shows a progressive cognitive decline, which interferes with the independence in performing the activities of daily living. Other than the cognitive domain, the patient tends to have neuropsychiatric, behavioral, sensorimotor, speech, and language-related issues. It is expected that the global burden of the disease will rise with more people entering the geriatric age group. By 2050 close, to 140 million people will be living with one or the other type of dementia. Alzheimer's disease contributes to more than 60% of cases worldwide, followed by vascular dementia. Pharmacotherapy has a limited role to play in the treatment, and at present, no drug is available, which can halt or reverse the progress of the disease. World Health Organization has mandated rehabilitation as a core recommendation in the global action plan on the public health response to dementia. Rehabilitation services are widely recognized as a practical framework to maximize independence and community participation in dementia care. The rehabilitation program is customized to achieve the desired goals, as each person has different experiences, preferences, motivations, strengths, and requirements based on type, course, and severity of the illness. It is an interdisciplinary-team approach with the involvement of several health care professionals. This article reviews the existing literature and outlines the effective rehabilitation strategies concisely in dementia care.

Aβ misfolding in blood plasma is inversely associated with body mass index even in middle adulthood

BACKGROUND

To understand the potential for early intervention and prevention measures in Alzheimer's disease, the association between risk factors and early pathological change needs to be assessed. Hence, the aim of this study was to determine whether risk factors of Alzheimer's clinical syndrome (clinical AD), such as body mass index (BMI), are associated with Aβ misfolding in blood, a strong risk marker for AD among older adults.

METHODS

Information on risk factors and blood samples were collected at baseline in the ESTHER study, a population-based cohort study of older adults (age 50-75 years) in Germany. Aβ misfolding in blood plasma was analyzed using an immuno-infrared-sensor in a total of 872 participants in a nested case-control design among incident dementia cases and matched controls. Associations between risk factors and Aβ misfolding were assessed by multiple logistic regression. For comparison, the association between the risk factors and AD incidence during 17 years of follow-up was investigated in parallel among 5987 cohort participants.

RESULTS

An inverse association with Aβ misfolding was seen for BMI at age 50 based on reported weight history (aOR 0.64, 95% CI 0.43-0.96, p = 0.03). Similar but not statistically significant associations were seen for BMI at baseline (i.e., mean age 68) and at age 40. No statistically significant associations with Aβ misfolding were found for other risk factors, such as diabetes, smoking, and physical activity. On the other hand, low physical activity was associated with a significantly reduced risk of developing clinical AD compared to physical inactivity.

CONCLUSIONS

Our results support that AD pathology may be detectable and associated with reduced weight even in middle adulthood, many years before clinical diagnosis of AD. Physical activity might reduce the risk of onset of AD symptoms.

Feasibility and Effectiveness of a Biography-Based Physical Activity Intervention in Institutionalized People With Dementia: Quantitative and Qualitative Results From a Randomized Controlled Trial

The objective of this multicenter randomized controlled trial was to evaluate the feasibility and effectiveness of a physical activity intervention for institutionalized people with dementia, individualized by capacity and biography. The intervention group (n = 34; age: mean = 86.09 years; 79.40% female; mean Mini-Mental State Examination value = 18.59) participated in a multicomponent training program, which included daily activities, dancing, gardening, and sports/games, twice weekly for 3 months. The control group (n = 29; age: mean = 86.34 years; 75.90% female; mean Mini-Mental State Examination value = 19.90) received standard care. Feasibility was evaluated by means of focus groups and feedback questionnaires. Functional performance (Short Physical Performance Battery and Timed Up and Go Test), activities of daily living, and gait were outcomes for effectiveness. A high adherence rate (80.46%) and uniformly positive feedback indicate that the piloted training program is feasible. The results show preliminary effectiveness on functional performance (Short Physical Performance Battery mean t0 = 3.15; mean t1 = 4.50; p = .006) and gait (e.g., velocity mean t0 = 46.97; mean t1 = 58.04; p = .007).

The Beneficial Role of Exercise on Treating Alzheimer's Disease by Inhibiting β-Amyloid Peptide

Alzheimer's disease (AD) is associated with a very large burden on global healthcare systems. Thus, it is imperative to find effective treatments of the disease. One feature of AD is the accumulation of neurotoxic β-amyloid peptide (Aβ). Aβ induces multiple pathological processes that are deleterious to nerve cells. Despite the development of medications that target the reduction of Aβ to treat AD, none has proven to be effective to date. Non-pharmacological interventions, such as physical exercise, are also being studied. The benefits of exercise on AD are widely recognized. Experimental and clinical studies have been performed to verify the role that exercise plays in reducing Aβ deposition to alleviate AD. This paper reviewed the various mechanisms involved in the exercise-induced reduction of Aβ, including the regulation of amyloid precursor protein cleaved proteases, the glymphatic system, brain-blood transport proteins, degrading enzymes and autophagy, which is beneficial to promote exercise therapy as a means of prevention and treatment of AD and indicates that exercise may provide new therapeutic targets for the treatment of AD.

Physical Activity Interventions and Their Effects on Cognitive Function in People with Dementia: A Systematic Review and Meta-Analysis

BACKGROUND

Physical activity (PA) has emerged as an alternative nonpharmacological approach to effectively address the effects of dementia. The primary aim was to identify and summarize PA interventions and their effects on cognitive function among persons with dementia (PwD).

METHODS

A systematic review was conducted with a meta-analysis using different electronic databases, such as PubMed, Embase, APA PsycNET, and the Web of Science. The identified and selected studies were randomized controlled trials (RCTs) that were written in English, published between 2000 and 2020, and implemented among PwD who received a PA intervention and whose cognitive function was measured at baseline and during a follow-up.

RESULTS

Twenty-two PA intervention studies met the eligibility criteria and showed a medium-size effect on the cognitive function of PwD, 0.4803 (95% CI = 0.1901-0.7704), with a high percentage of heterogeneity (I² = 86%, p ≤ 0.0001). Moreover, this review complements other reviews by including eight studies that have not previously been considered. Overall, studies have methodological limitations. However, six studies implemented in the past five years have shown more robust methodological designs, including larger sample sizes and more comprehensive measurement tools.

CONCLUSION

It is not yet possible to draw a conclusion on the ideal PA intervention for this population due to the high proportion of heterogeneity within the included studies. More emphasis is needed on the intensity of PA monitoring and adherence to such programs.

Dementia and COVID-19, a Bidirectional Liaison: Risk Factors, Biomarkers, and Optimal Health Care

Cognitive impairment following SARS-CoV-2 infection is being increasingly recognized as an acute and possibly also long-term sequela of the disease. Direct viral entry as well as systemic mechanisms such as cytokine storm are thought to contribute to neuroinflammation in these patients. Biomarkers of COVID-19-induced cognitive impairment are currently lacking, but there is some limited evidence that SARS-CoV-2 could preferentially target the frontal lobes, as suggested by behavioral and dysexecutive symptoms, fronto-temporal hypoperfusion on MRI, EEG slowing in frontal regions, and frontal hypometabolism on 18F-FDG-PET. Possible confounders include cognitive impairment due to hypoxia and mechanical ventilation and post-traumatic stress disorder. Conversely, patients already suffering from dementia, as well as their caregivers, have been greatly impacted by the disruption of their care caused by COVID-19. Patients with dementia have experienced worsening of cognitive, behavioral, and psychological symptoms, and the rate of COVID-19-related deaths is disproportionately high among cognitively impaired people. Multiple factors, such as difficulties in remembering and executing safeguarding procedures, age, comorbidities, residing in care homes, and poorer access to hospital standard of care play a role in the increased morbidity and mortality. Non-pharmacological interventions and new technologies have shown a potential for the management of patients with dementia, and for the support of their caregivers.

Computerized Cognitive Training (CCT) versus Yoga Impact on 12 Month Post Intervention Cognitive Outcome in Individuals with Mild Cognitive Impairment

There is currently limited and mixed evidence for the cognitive benefits of Computerized Cognitive Training (CCT) and yoga in persons with Mild Cognitive Impairment (pwMCI). The objective of this study was to investigate the benefit of computerized cognitive training (CCT) vs. physical (yoga) intervention on cognitive abilities. Participants in this study were part of the larger Mayo Clinic’s Healthy Action to Benefit Independence and Thinking (HABIT) program comparative effectiveness trial. The HABIT program is designed for pwMCI and their care partner and consists of five behavioral interventions: CCT, Memory Support System-Calendar (MSS-Calendar), wellness education, support groups, and yoga. The subtractive study design randomly withheld one of the interventions for a total of five study arms. Longitudinal mixed-effects regression models were used to investigate the hypothesis that CCT and yoga has a greater positive impact on psychomotor and basic attention abilities at 12 months post-intervention as compared to the other HABIT interventions. Findings showed CCT had a positive impact compared to yoga on the Cogstate psychomotor/attention composite at 12 months post-intervention (ES = 0.54; unadjusted p value = 0.007, adjusted p value = 0.021). The impact of yoga or combining CCT with yoga did not show statistically significant improvement. Continued CCT practice at home showed further benefit on psychomotor/attention at 12 months post-intervention. There was no significant benefit of CCT or yoga on Cogstate learning/working memory composite.

Comparison of exergames versus conventional exercises on the cognitive skills of older adults: a systematic review with meta-analysis

PURPOSE

To compare the effects of exergames versus conventional physical training on the cognitive skills of older adults.

MATERIALS AND METHODS

Scientific studies published in PubMed, Web of Science, and Cochrane Library databases were searched. Individual studies were assessed using the Cochrane Risk-of-bias tool for randomized trials (RoB 2). The quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE Pro). The cognitive outcomes were Trail Making Test (TMT)-A, TMT-B, Stroop Word-Color test, Mini Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA).

RESULTS

We identified 256 studies, in which 13 studies were included in the systematic review and 11 in the meta-analysis. The majority of the exergame interventions were based on the Xbox 360's Kinect, followed by the Impact Dance Platform, Nintendo Wii, and the Bike Labyrinth. We observed heterogeneity in the conventional exercise group and in the duration of training, which ranged from 12 to 52 sessions. There was no statistically significant difference between groups in TMT-A (p=0.083), TMT-B (p=0.122), and Stroop (p=0.191). There were differences in favor of exergames in MMSE (raw mean difference=-1.58, 95% CI: -2.87 to -0.28, p<0.001) and MoCA (raw mean difference=-1.22, 95% CI: -2.24 to -0.20, p=0.019).

CONCLUSIONS

Despite statistical differences in MMSE and MoCA, these results should be interpreted with caution due to methodological heterogeneity. Some studies reported possible neurophysiological benefits induced by exergames, which should be explored in future investigations.

Impact of various intensities and frequencies of non-occupational physical activity on the risk of dementia among physically independent older adults: the Japan Gerontological Evaluation Study

OBJECTIVES

The aim of this study was to investigate the association between different intensities and frequencies of non-occupational physical activity (PA) and the risk of dementia among Japanese older adults.

STUDY DESIGN

This was a prospective cohort study.

METHODS

A total of 2194 participants aged ≥65 years from the Japan Gerontological Evaluation Study were followed up between 2010 and 2016. The standardised dementia scale of the long-term care insurance system was used to identify incident dementia, whereas non-occupational PA (<2 or ≥2 times/week on each intensity: light, moderate and vigorous) was assessed using a questionnaire. Cox regression was used to compute the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident dementia.

RESULTS

After adjustment for sociodemographic and medical characteristics, the following frequencies and intensities of non-occupational PA, compared with no non-occupational PA at all, were associated with a reduced risk of dementia: light PA ≥2 times/week (HR = 0.61, 95% CI: 0.38-0.97), moderate PA <2 times/week (HR = 0.46, 95% CI: 0.28-0.76), moderate PA ≥2 times/week (HR = 0.57, 95% CI: 0.36-0.91), vigorous PA <2 times/week (HR = 0.40, 95% CI: 0.21-0.74) and vigorous PA ≥2 times/week (HR = 0.29, 95% CI: 0.15-0.57). In the sex-specific analysis, moderate PA <2 times/week and vigorous PA ≥2 times/week were associated with a reduced risk of dementia in men, whereas light and moderate PA ≥2 times/week and all frequencies of vigorous PA were associated with a reduced risk of dementia in women.

CONCLUSIONS

Practicing non-occupational PA was associated with a reduced risk of dementia among Japanese older adults.

The effectiveness of Tai Chi Chuan on fear of movement, prevention of falls, physical activity, and cognitive status in older adults with mild cognitive impairment: A randomized controlled trial

PURPOSE

This study aimed to investigate the effectiveness of Tai Chi Chuan (TCC) on fear of movement, prevention of falls, physical activity, and cognitive status in older adults with mild cognitive impairment.

DESIGN AND METHODS

This controlled trial was conducted with 20 participants in the intervention group, and they did exercises for 35-40 min/session, twice a week for 12 weeks.

FINDING

The posttest scores of the scales indicated that the scores of cognitive adaptations, being observant, and changes in level subscales of the fall behavioral scale in the older adults who did Tai Chi exercise in the intervention group significantly increased (p < .01).

PRACTICE IMPLICATIONS

The nursing home provider can safely manage TCC exercise interventions for older adults with MCI.

Role of Adiponectin-Notch pathway in cognitive dysfunction associated with depression and in the therapeutic effect of physical exercise

A substantial percentage of late‐life depression patients also have an cognitive impairment, which severely affects the life quality, while the co‐occurring mechanisms are still unclear. Physical exercise can ameliorate both depressive behaviors and cognitive dysfunction, but the molecular mechanisms underlying its beneficial effects remain elusive. In this study, we uncover a novel adipose tissue to hippocampus crosstalk mediated by Adiponectin‐Notch pathway, with an impact on hippocampal neurogenesis and cognitive function. Adiponectin, an adipocyte‐derived hormone, could activate Notch signaling in the hippocampus through upregulating ADAM10 and Notch1, two key molecules in the Notch signaling. Chronic stress inhibits the Adiponectin‐Notch pathway and induces impaired hippocampal neurogenesis and cognitive dysfunction, which can be rescued by AdipoRon and running. Inhibition Notch signaling by DAPT mimics the adverse effects of chronic stress on hippocampal neurogenesis and cognitive function. Adiponectin knockout mice display depressive‐like behaviors, associated with inhibited Notch signaling, impaired hippocampal neurogenesis and cognitive dysfunction. Physical exercise could activate Adiponectin‐Notch pathway, and improve hippocampal neurogenesis and cognitive function, while deleting adiponectin gene or inhibiting Notch signaling blocks its beneficial effects. Together, our data not only suggest that Adiponectin‐Notch pathway is involved in the pathogenesis of cognitive dysfunction associated with depression, but also contributes to the therapeutic effect of physical exercise. This work helps to decipher the etiology of cognitive impairment associated with depression and hence will provide a potential innovative therapeutic target for these patients.

Post-COVID-19 Syndrome and the Potential Benefits of Exercise

The coronavirus disease (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, is leading to unknown and unusual health conditions that are challenging to manage. Post-COVID-19 syndrome is one of those challenges, having become increasingly common as the pandemic evolves. The latest estimates suggest that 10 to 20% of the SARS-CoV-2 patients who undergo an acute symptomatic phase are experiencing effects of the disease beyond 12 weeks after diagnosis. Although research is beginning to examine this new condition, there are still serious concerns about the diagnostic identification, which limits the best therapeutic approach. Exercise programs and physical activity levels are well-known modulators of the clinical manifestations and prognosis in many chronic diseases. This narrative review summarizes the up-to-date evidence on post-COVID-19 syndrome to contribute to a better knowledge of the disease and explains how regular exercise may improve many of these symptoms and could reduce the long-term effects of COVID-19.

MIND diet and cognitive performance in older adults: a systematic review

Cognitive decline is a rapidly increasing public health concern. A healthy diet has potential in preserving brain and maintaining cognitive health. This systematic review was designed to evaluate the relationship between Mediterranean-DASH diet intervention for neurodegenerative delay (MIND) diet and cognitive functioning in older adults. PubMed, SCOPUS, Embase, Cochrane Library, and Google Scholar databases were searched to extract original studies on humans published until July 2020, without date restrictions. Articles that evaluated the association between MIND diet and cognitive performance in older adults were included. Duplicated and irrelevant studies were screened out and data were obtained through critical analysis. Quality of the articles and risk of bias was assessed by Newcastle-Ottawa and Cochrane Collaboration's quality assessment tools. Of the 135 studies retrieved, 13 articles (9 cohort, 3 cross-sectional, and 1 RCT studies) were included in the final review. All of the included studies indicated that adherence to the MIND diet was positively associated with specific domains, but not all, of cognition and global cognitive function (78% of the studies) in older adults. MIND diet was superior to other plant-rich diets including Mediterranean, Dietary Approaches to Stop Hypertension, Pro-Vegetarian and Baltic Sea diets, for improving cognition. Adherence to the MIND diet may possibly be associated with an improved cognitive function in older adults. MIND diet may be superior to other plant-rich diets for improving cognition.

Associations of sarcopenia and its defining components with cognitive function in community-dwelling oldest old

BACKGROUND

This study aimed to investigate the associations of sarcopenia and its defining components with cognitive function in community-dwelling oldest old (over 80 years old) in China.

METHODS

Sarcopenia was diagnosed by the 2019 Asian Working Group for Sarcopenia (AWGS) criteria. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCA). Logistic and linear regression models were used to explore the associations of sarcopenia and its defining components with risk of mild cognitive impairment (MCI), and performance on multiple cognitive domains among 428 adults aged 80 years and older.

RESULTS

The overall prevalence of sarcopenia was 35.5%, with 40.34% for men and 32.14% for women. The prevalence of MCI was higher among sarcopenic oldest old than non-sarcopenic oldest old (28.95% vs. 17.39%, p = 0.005). Multivariate logistic regression analyses showed that sarcopenia [odds ratio (OR) = 1.86, 95% confidence interval (CI): 1.04-3.33], low handgrip strength (HS) [OR = 2.33, 95% CI: 1.40-3.87] and slow gait speed (GS) [OR = 2.31, 95% CI: 1.13-4.72] were significantly and independently associated with risk of MCI. Multivariate linear regression analyses showed that low HS was associated with worse performance in global cognitive function, visuospatial and executive function, naming and delayed recall.

CONCLUSIONS

Sarcopenia, low HS and low GS was significantly associated with MCI in community-dwelling oldest old. The associations between sarcopenia and its defining components with different cognitive subdomains could be further explored in the future.

Effects of Combined Physical Activity and Cognitive Training on Cognitive Function in Older Adults with Subjective Cognitive Decline: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background. Subjective cognitive decline (SCD) is recognized as the earliest prodromal stage of Alzheimer’s disease (AD). Emerging studies explored the effects of combined physical activity and cognitive training interventions on cognitive ability, psychological well-being, and emotion of older adults with SCD, but the results are now still controversial. Objective. This study systematically evaluated the enhancement effects of the combined physical-cognitive interventions on memory self-efficacy, objective cognitive function, psychological well-being, and emotion of older adults with SCD. Methods. Data sources PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang degree and conference papers database, Chinese Science and Technology Periodical (VIP) databases from their inception to 28 February 2020, the Cochrane Central Register of Controlled Trials (Cochrane Library, 2020, Issue 3), and the reference lists of all retrieved articles were searched. Data analysis and bias risk evaluation were conducted in 2020. Two reviewers (SG and YY) independently evaluated the risk of bias of the included studies using the RoB 2 tool. Results. Eleven RCTs involving 1713 participants with SCD (age 68.0 ± 6.1) were included for review and meta-analysis. The interventions in the included studies were physical activity combined with cognitive training. Multiple-modality exercise with mind-motor training, supervised strategy-based memory training sequentially after stationary cycling, Dejian Mind-Body intervention, and physical activity and cognitive stimulation were also practiced. Conclusions. Compared to the active or nonactive control groups, the combined interventions are effective in improving objective cognitive function in SCD which may show the potential value of combined physical-cognitive interventions in improving objective cognitive ability and preventing the conversion of SCD to MCI or AD and no adverse effects. However, owing to the limitations of the included studies, these findings should be interpreted cautiously.

Personalized treatment interventions: nonpharmacological and natural treatment strategies in Alzheimer's disease

Introduction: Alzheimer's disease (AD) is a slow, irreversible, progressive, complex, and fatal neurodegenerative disorder. Available pharmacological treatment, known for almost two decades, does not cure the disease, but only alleviates the symptoms, with various efficacy and different side effects. Therefore, there is an unmet need to find other person-centered or personalized approaches to treat AD.Areas covered: This article describes the application of precision medicine-like approaches utilizing nonpharmacological treatment strategies and the use of natural products in personalized care for patients with AD.Expert opinion: Due to the heterogeneity of disease symptoms, somatic conditions, and patient preferences, there is definitely no "one size fits all" intervention. Therefore, individualized treatment choice is based on dementia stage, medical and psychiatric comorbidity, leading symptoms, patient preferences, and remaining capacity of the patient. In the absence of disease-modifying agents, a patient-centered, multidisciplinary team approach appears to be the best option to alleviate the heavy symptomatic burden in this unfortunate population. Hence, appropriate interventions can be offered along the AD continuum, while a better understanding of personal characteristics might help in establishing optimal individualized treatment, as well as its duration and intensity, to deliver interventions in the most effective ways.

Multiple Roles in Neuroprotection for the Exercise Derived Myokine Irisin

Exercise has multiple beneficial effects on health including decreasing the risk of neurodegenerative diseases. Such effects are thought to be mediated (at least in part) by myokines, a collection of cytokines and other small proteins released from skeletal muscles. As an endocrine organ, skeletal muscle synthesizes and secretes a wide range of myokines which contribute to different functions in different organs, including the brain. One such myokine is the recently discovered protein Irisin, which is secreted into circulation from skeletal muscle during exercise from its membrane bound precursor Fibronectin type III domain-containing protein 5 (FNDC5). Irisin contributes to metabolic processes such as glucose homeostasis and browning of white adipose tissue. Irisin also crosses the blood brain barrier and initiates a neuroprotective genetic program in the hippocampus that culminates with increased expression of brain derived neurotrophic factor (BDNF). Furthermore, exercise and FNDC5/Irisin have been shown to have several neuroprotective effects against injuries in ischemia and neurodegenerative disease models, including Alzheimer's disease. In addition, Irisin has anxiolytic and antidepressant effects. In this review we present and summarize recent findings on the multiple effects of Irisin on neural function, including signaling pathways and mechanisms involved. We also discuss how exercise can positively influence brain function and mental health via the "skeletal muscle-brain axis." While there are still many unanswered questions, we put forward the idea that Irisin is a potentially essential mediator of the skeletal muscle-brain crosstalk.

The Effect of Eight Weeks of Endurance Training with Saffron on miR133bFC, miR29aFC in the Hippocampus Tissue and Depression in Rats with Alzheimer’s Disease

Background: Recent studies indicate that deregulation of microRNAs (miRNAs) expression is associated with neurological and cognitive disorders, but physical activity and medicinal plants have favorable effects on physiological and psychological factors in these patients. Objectives: Therefore, we aimed to investigate the effect of endurance training (ET) with saffron (S) on miR133bFC, miR29aFC in the hippocampus tissue and depression of rats with Alzheimer’s disease (AD). Methods: Forty AD rats with the mean age of eight weeks and mean weight of 250 ± 30.65 g were randomly divided into five groups of eight rats including: (1) control (C), (2) ET, (3) ET + S, (4) S, and (5) sham (normal saline) (Sh). During eight weeks, groups 2 and 3 ran on a treadmill for three sessions per week, each session lasting for 15 - 30 minutes, at a speed of 20 - 15 m/min, and groups 3 and 4 received 25 mg/kg daily aqueous extract of S peritoneally. Depression was evaluated by the forced swim test. Results: The levels of miR29aFC were higher in the ET + S group than in the C (P = 0.002), Sh (P = 0.003), ET (P = 0.003), and S (P = 0.001) groups. The levels of miR133bFC in the S (P = 0.02) and ET (P = 0.005) groups were lower than the C group. The mobility time in the ET (P = 0.001), S (P = 0.001), and ET + S (P = 0.001) groups was higher than the C group; in the ET + S group, the mobility time was higher than in the ET (P = 0.001) and S (P = 0.001) groups, and in the S group the mobility time was higher than in the ET group (P = 0.001). Conclusions: It seems that ET and S administration alone do not have favorable effects on miR29aFC and miR133bFC expression levels, but both can decrease depression; however, the simultaneous administration S and ET has interactive effects on improving miR29aFC expression and reducing depression.

Effect of physical exercise on cognitive function in older adults' carriers versus noncarriers of apolipoprotein E4: systematic review and meta-analysis

The presence of apolipoprotein (Apo) E4 is a genetic risk factor in cognitive impairment. Physical exercise contributes to slowing cognitive impairment in older adults, but little is known about the influence of exercise on ApoE4 carriers and noncarriers. The objective of systematic review is to study the role of physical exercise in older adults' ApoE4 carriers and noncarriers. A systematic literature search was carried out in five international databases: PubMed, Web of Science, PeDro, Scopus, and SPORTDiscus. A total of nine randomized controlled trials were included with a sample size of 2,025 subjects (901 ApoE4 carriers). The exercise reported a significant improvement on cognitive performance in older adults' ApoE4 noncarriers (standardized mean difference [SMD]=0.653; 95% confidence interval [CI], 0.29-1.00; chi2=35.36; degrees of freedom [df ]=7; P<0.0001; l 2=80%). It was also reported that a total program duration greater than 50 sessions generated different and significant effects on cognitive performance in older adults' ApoE4 noncarriers (SMD=0.878; 95% CI, 0.14-1.61; chi2=31.82; df=3; P<0.0001; l 2=91%). The results reported that high intensity generated a differential effect on cognitive performance in older adults' ApoE4 carriers versus noncarriers (SMD=0.963; 95% CI, 0.25-1.67; chi2=18.11; df=3; P<0.0004; l 2=83%). The effect of physical exercise on cognitive performance in older adults is conditioned by the presence or not of ApoE4.

Effects of acute interval handgrip exercise on cognitive performance

Previous studies have reported that even a single bout of dynamic exercise improves cognitive performance. However, the acute effect of the interval handgrip (HG) exercise protocol, which is effective in reducing resting blood pressure, on cognitive performance is poorly understood. Cognitive performance was assessed in 17 young healthy subjects before and after a resting control (e.g., time control) and the interval HG exercise (Exercise), which consisted of four trials of 2-min HG exercise at 25% of maximum voluntary contraction with 3-min recovery in between each trial. Mean arterial blood pressure (MAP) and middle cerebral artery blood velocity (MCA V) were measured continuously throughout the experiment. Memory recognition and executive function were assessed using memory recognition and Go/No-Go tasks, respectively. During interval HG exercise, MAP and mean MCA V increased from the resting baseline condition (both P < 0.049) and returned to the resting baseline levels during recovery after the interval HG exercise (both P = 1.000). The reaction time and performance accuracy of the memory recognition task did not change in either the time control condition or Exercise condition (P = 0.514 and P = 0.414 respectively). However, the changes in reaction time of Go/No-Go task from the baseline in Exercise condition was significantly shorter than that in time-control condition (P = 0.004) without affecting performance accuracy (P = 0.482). The results of the present study show that an acute interval HG exercise could improve the processing speed in executive function despite no post-exercise improvement in hemodynamic parameters in young healthy subjects. These findings suggest that the interval HG exercise is a useful exercise mode that can be expected to have a positive effect on the processing speed in executive function regardless of cardiovascular adaptation to exercise.

Voluntary Wheel Running Did Not Alter Gene Expression in 5xfad Mice, but in Wild-Type Animals Exclusively after One-Day of Physical Activity

Physical activity is considered a promising preventive intervention to reduce the risk of developing Alzheimer's disease (AD). However, the positive effect of therapeutic administration of physical activity has not been proven conclusively yet, likely due to confounding factors such as varying activity regimens and life or disease stages. To examine the impact of different routines of physical activity in the early disease stages, we subjected young 5xFAD and wild-type mice to 1-day (acute) and 30-day (chronic) voluntary wheel running and compared them with age-matched sedentary controls. We observed a significant increase in brain lactate levels in acutely trained 5xFAD mice relative to all other experimental groups. Subsequent brain RNA-seq analysis did not reveal major differences in transcriptomic regulation between training durations in 5xFAD mice. In contrast, acute training yielded substantial gene expression changes in wild-type animals relative to their chronically trained and sedentary counterparts. The comparison of 5xFAD and wild-type mice showed the highest transcriptional differences in the chronic and sedentary groups, whereas acute training was associated with much fewer differentially expressed genes. In conclusion, our results suggest that different training durations did not affect the global transcriptome of 3-month-old 5xFAD mice, whereas acute running seemed to induce a similar transcriptional stress state in wild-type animals as already known for 5xFAD mice.

Physical Exercise and Alzheimer's Disease: Effects on Pathophysiological Molecular Pathways of the Disease

Alzheimer’s disease (AD), the most common form of neurodegenerative dementia in adults worldwide, is a multifactorial and heterogeneous disorder characterized by the interaction of genetic and epigenetic factors and the dysregulation of numerous intracellular signaling and cellular/molecular pathways. The introduction of the systems biology framework is revolutionizing the study of complex diseases by allowing the identification and integration of cellular/molecular pathways and networks of interaction. Here, we reviewed the relationship between physical activity and the next pathophysiological processes involved in the risk of developing AD, based on some crucial molecular pathways and biological process dysregulated in AD: (1) Immune system and inflammation; (2) Endothelial function and cerebrovascular insufficiency; (3) Apoptosis and cell death; (4) Intercellular communication; (5) Metabolism, oxidative stress and neurotoxicity; (6) DNA damage and repair; (7) Cytoskeleton and membrane proteins; (8) Synaptic plasticity. Moreover, we highlighted the increasingly relevant role played by advanced neuroimaging technologies, including structural/functional magnetic resonance imaging, diffusion tensor imaging, and arterial spin labelling, in exploring the link between AD and physical exercise. Regular physical exercise seems to have a protective effect against AD by inhibiting different pathophysiological molecular pathways implicated in AD.

Physical Activity and Redox Balance in the Elderly: Signal Transduction Mechanisms

Reactive Oxygen Species (ROS) are molecules naturally produced by cells. If their levels are too high, the cellular antioxidant machinery intervenes to bring back their quantity to physiological conditions. Since aging often induces malfunctioning in this machinery, ROS are considered an effective cause of age-associated diseases. Exercise stimulates ROS production on one side, and the antioxidant systems on the other side. The effects of exercise on oxidative stress markers have been shown in blood, vascular tissue, brain, cardiac and skeletal muscle, both in young and aged people. However, the intensity and volume of exercise and the individual subject characteristics are important to envisage future strategies to adequately personalize the balance of the oxidant/antioxidant environment. Here, we reviewed the literature that deals with the effects of physical activity on redox balance in young and aged people, with insights into the molecular mechanisms involved. Although many molecular pathways are involved, we are still far from a comprehensive view of the mechanisms that stand behind the effects of physical activity during aging. Although we believe that future precision medicine will be able to transform exercise administration from wellness to targeted prevention, as yet we admit that the topic is still in its infancy.

Physical exercise prevents amyloid β1-40-induced disturbances in NLRP3 inflammasome pathway in the hippocampus of mice

Amyloid beta (Aβ), one of the main hallmarks of Alzheimer's Disease (AD), may stimulate pattern recognition receptors (PRR) such as the NLRP3 inflammasome, inducing a pro-inflammatory state in the brain that contributes to disease development. Physical exercise can have multiple beneficial effects on brain function, including anti-inflammatory and neuroprotective roles. The objective of this study was to investigate the prophylactic effect of moderate treadmill exercise for 4 weeks on inflammatory events related to NLRP3 signaling in the hippocampus of mice after intracerebroventricular Aβ_1-40 administration. Our results show that Aβ_1-40 administration (400 pmol/mouse, i.c.v.) significantly increased the immunocontent Iba-1 (a microglial reactivity marker), NLRP3, TXNIP, and caspase-1 in the hippocampus of mice. However, physical exercise prevented the hippocampal increase in Iba-1, TXNIP, and activation of the NLRP3 inflammasome pathway caused by Aβ_1-40. Moreover, physical exercise per se reduced the TXNIP and caspase-1 immunocontent in the hippocampus. No alterations were observed on the immunocontent of GFAP, ASC, and IL-1β in the hippocampus after Aβ_1-40 and/or physical exercise. These results reinforce the role of NLRP3 inflammasome pathway in AD and point to physical exercise as a possible non-pharmacological strategy to prevent inflammatory events triggered by Aβ_1-40 in mice.

Effects of 6-Month Multimodal Physical Exercise Program on Bone Mineral Density, Fall Risk, Balance, and Gait in Patients with Alzheimer's Disease: A Controlled Clinical Trial

We aimed to determine the short- and medium-term effects of a multimodal physical exercise program (MPEP) on bone health status, fall risk, balance, and gait in patients with Alzheimer’s disease. A single-blinded, controlled clinical trial was performed where 72 subjects were allocated in a 3:1 ratio to an intervention group (IG; n = 53) and control group (CG; n = 19), where the IG’s subjects were admitted to live in a State Reference Center of Alzheimer’s disease, which offers the targeted exercise program, while the CG’s subjects resided in independent living. A multidisciplinary health team assessed all patients before allocation, and dependent outcomes were again assessed at one, three, and six months. During the study, falls were recorded, and in all evaluations, bone mineral density was measured using a calcaneal quantitative ultrasound densitometer; balance and gait were measured using the performance-oriented mobility assessment (POMA), the timed up and go test (TUG), the one-leg balance test (OLB), and the functional reach test (FR). There were no differences between groups at baseline for all outcome measures. The prevalence of falls was significantly lower in the IG (15.09%) than in the CG (42.11%) (χ² = 5.904; p = 0.015). We also found that there was a significant time*group interaction, with a post hoc Šidák test finding significant differences of improved physical function, especially in gait, for the IG, as assessed by POMA-Total, POMA-Gait, and TUG with a large effect size (ƞ²p = 0.185–0.201). In balance, we found significant differences between groups, regardless of time, and a medium effect size as assessed by POMA-Balance and the OLB (ƞ²p = 0.091–0.104). Clinically relevant effects were observed, although without significant differences in bone health, with a slowing of bone loss. These results show that a multimodal physical exercise program reduces fall risk and produces an improvement in gait, balance, and bone mineral density in the short and medium term in institutionalized patients with Alzheimer’s disease.

Exploring Effects of Aerobic Exercise and Mindfulness Training on Cognitive Function in Older Adults at Risk of Dementia: A Feasibility, Proof-of-Concept Study

OBJECTIVES

This study sought to explore feasibility, acceptability, and preliminary effects of aerobic training (AT), mindfulness training (MT), or both (MT + AT) on cognitive function in older individuals at risk of dementia.

METHOD

Participants were randomized to AT, MT, both, or usual care (UC). Z-scores of attention, verbal fluency, and episodic memory for non-demented adults (ZAVEN) were computed at baseline, end of treatment (EOT), and 6 months since baseline.

RESULTS

Of the 36 enrolled participants (12 M, 24 F, mean age = 70.1 years), 97% were retained in the study at 6 months. At EOT, MT had higher ZAVEN scores than UC (b = .43, P =.03) and AT (b = .26, P = .10), while no differences were seen with MT + AT. A similar pattern was observed at a 6 month follow-up (all P values = .10).

DISCUSSION

MT may improve cognitive function in older individuals at risk of dementia. These preliminary findings need to be confirmed in a fully powered RCT.

Effect of Aerobic Exercise on Mental Health in Older Adults: A Meta-Analysis of Randomized Controlled Trials

Introduction: The recommendation of exercise programs in the senior population may benefit inactive and sedentary individuals and improve and help to treat specific health conditions. The purpose of this review is to summarize the published evidence from RCT studies of aerobic exercise interventions for mental health in older adults over the last 20 years. Methods: A literature search was conducted using electronic databases including Web of Science, PubMed/Medline, and ProQuest. Results: A total of 15 studies met the inclusion criteria. The subjects of these studies were aged 60 years or older and had various physical health statuses. In 15 studies, the mean effect size for the experimental outcome was 0.56 ± 0.39 (95%CI: 0.36-0.76). One-way ANOVA indicated no significant differences in the intervention duration [F _(2,15) = 0.919, p = 0.420], subject category [F _(2,15) = 0.046, p = 0.955], or measurement category [F _(3,14) = 0.967, p = 0.436]. However, there were significant differences in exercise frequencies [F _(2,15) = 6.03, p = 0.012]. Conclusion: The available evidence suggests that aerobic exercise is beneficial for improving the mental health of adults aged 60 years and older. The intervention effect can be achieved regardless of the type of subject and the duration of the intervention. Further, the present study indicates that low-frequency, long-term and regular aerobic exercise is more effective for older adults. Therefore, we recommend that older adults to exercise at a low frequency depending on their physical condition.

Dual-Task Training Affect Cognitive and Physical Performances and Brain Oscillation Ratio of Patients With Alzheimer's Disease: A Randomized Controlled Trial

This study aimed to investigate the effect of 12 weeks of dual-task training on cognitive status, physical performance, and brain oscillation of patients with Alzheimer's disease (AD). Twenty-six AD patients were randomly assigned to two groups, the training group (TG) and control group (CG). TG executed progressive combined exercises with visual stimulation twice a week for 12 weeks. Training included muscle endurance, balance, flexibility, and aerobic exercises with eyes closed and opened. Brain oscillation on electroencephalography (EEG) and a series of physical, cognitive, and mental tests were taken before and post-intervention. There was a significant improvement after training protocol in cognitive function, particularly in short-term and working memory, attention, and executive function (p < 0.01). Besides, there were substantial improvements in depression status (GDS scale), aerobic fitness (6 min walking), flexibility (chair sit and reach) functional ability (chair stand, timed up and go test), strength (knee extensions, preacher biceps curl, handgrip) in TG compared to CG. These signs of progress were associated with a significant increase (p < 0.05) in the frequency of brain oscillation and a decrease in the theta/alpha ratio. In addition to physical performance, the regular combined training with visual stimulation improves brain health as indicated by improving cognitive function and reducing the theta/alpha ratio. Clinical Trial Registration: Iranian Registry of Clinical Trials (IRCT) https://www.irct.ir/, identifier IRCT20190504043468N1-August 5, 2020.

Predicting the outcome of non-pharmacological treatment for patients with dementia-related mild cognitive impairment

Dementia is a progressive cognitive syndrome, with few effective pharmacological treatments that can slow its progress. Hence, non-pharmacological treatments (NPTs) play an important role in improving patient symptoms and quality of life. Designing the optimal personalised NPT strategy relies on objectively and quantitatively predicting the treatment outcome. Magnetoencephalography (MEG) findings can reflect the cognitive status of patients with dementia, and thus potentially predict NPT outcome. In the present study, 16 participants with cognitive impairment underwent NPT for several months. Their cognitive performance was evaluated based on the Mini-Mental State Examination and the Alzheimer's Disease Assessment Scale - Cognitive at the beginning and end of the NPT period, while resting-state brain activity was evaluated using MEG during the NPT period. Our results showed that the spectral properties of MEG signals predicted the changes in cognitive performance scores. High frequency oscillatory intensity at the right superior frontal gyrus medial segment, opercular part of the inferior frontal gyrus, triangular part of the inferior frontal gyrus, post central gyrus, and angular gyrus predicted the changes in cognitive performance scores. Thus, resting-state brain activity may be a powerful tool in designing personalised NPT.

From beta amyloid to altered proteostasis in Alzheimer's disease

Alzheimer's disease (AD) is an age related neurodegenerative disorder causing severe disability and important socio-economic burden, but with no cure available to date. To disentangle this puzzling disease genetic studies represented an important way for the comprehension of pathogenic mechanisms. Abnormal processing and accumulation of amyloid-β peptide (Aβ) has been considered the main cause and trigger factor of the disease. The amyloid cascade theory has fallen into crisis because the failure of several anti-amyloid drugs trials and because of the simple equation AD = abnormal Aβ deposition is not always the case. We now know that multiple neurodegenerative diseases share common pathogenic mechanisms leading to accumulation of misfolded protein species. Genome Wide Association studies (GWAS) led to the identification of large numbers of DNA common variants (SNPs) distributed on different chromosomes and modulating the Alzheimer's risk. GWAS genes fall into several common pathways such as immune system and neuroinflammation, lipid metabolism, synaptic dysfunction and endocytosis, all of them addressing to novel routes for different pathogenic mechanisms. Other hints could be derived from epidemiological and experimental studies showing some lifestyles may have a major role in the pathogenesis of many age-associated diseases by modifying cell metabolism, proteostasis and microglia mediated neuroinflammation.

The Relationship between Physical Exercise and Cognitive Function in Korean Middle Aged and Elderly Adults without Dementia

This study investigated the association between physical exercise and cognitive function in Koreans aged 45 years or above without dementia. Data from the 2006 to 2018 Korean Longitudinal Study of Aging (KLoSA) were used. The general characteristics of the study population were investigated using analysis of variance (ANOVA). The association between total exercise time per week and cognitive function, measured based on the Mini-Mental State Examination (MMSE) scores, was investigated using the generalized estimating equation (GEE) model. Subgroup analysis was conducted based on age, educational level, and marital status. A total of 8888 participants were investigated, of which 5173 (58.2%) individuals did not exercise regularly. Among participants who did exercise, 676 (7.6%) individuals were categorized into the Q1, 1157 (13.0%) into the Q2, 908 (10.2%) into the Q3, and 974 (11.0%) into the Q4 group. The mean MMSE score was 26.81 ± 3.17. Compared to the ‘no’ exercise group, better MMSE scores were found in the Q1 (β: 0.3523, p ≤ 0.0001), the Q2 (β: 0.2011, p ≤ 0.0001), the Q3 (β: 0.4075, p ≤ 0.0001), and the Q4 groups (β: 0.3144, p ≤ 0.0001) after adjustment. The magnitude of this association was stronger in participants aged 65 years or above and in single or separated individuals. The findings of this study confirm a positive association between physical exercise and MMSE scores in the middle aged and elderly.

Overview of Meta-Analyses of Five Non-pharmacological Interventions for Alzheimer's Disease

Background: Alzheimer's disease (AD) is a neurodegenerative disease characterized by progressive memory deficits, cognitive decline, and spatial disorientation. Non-pharmacological interventions to treat AD have been reported in many meta-analyses (MAs), but robust conclusions have not been made because of variations in the scope, quality, and findings of these reviews.

Objective: This work aimed to review existing MAs to provide an overview of existing evidence on the effects of five non-pharmacological interventions in AD patients on three outcomes: Mini-Mental State Examination (MMSE), activities of daily living (ADL), and Alzheimer's Disease Assessment Scale-cognitive section (ADAS-cog).

Methods: The databases PubMed, Cochrane Library, Embase, and Web of Science were searched to collect MAs of non-pharmacological interventions for AD. Two reviewers independently conducted literature screening, data extraction, and quality assessment. We assessed the quality of MAs with the Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 and assessed the evidence quality for significant outcomes using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

Results: We found 10 eligible MAs, which included between three (133 patients) and 15 randomized trials (1,217 patients), and five non-pharmacological interventions, namely, acupuncture therapy (40%), exercise intervention (30%), music therapy (10%), cognitive intervention (10%), and repetitive transcranial magnetic stimulation (rTMS) (10%). All the included MAs were critically low to low quality by AMSTAR 2. Acupuncture therapy and exercise intervention showed the preliminary potential to improve ADL and MMSE. rTMS and acupuncture therapy show benefits in decreasing ADAS-cog, and there were some evidence of improved MMSE with cognitive intervention. All these outcomes scored very low quality to moderate quality of evidence on the GRADE system.

Conclusions: Non-pharmacological therapy shows promise for the treatment of AD, but there is still a lack of high-quality evidence. In the future, the quality of the original research needs to be improved, and strictly designed MAs should be carried out following methodological requirements.