Physical activity and risk of cognitive impairment and dementia in elderly persons

Role of physical activity in ameliorating neuropsychiatric symptoms in Alzheimer disease: A narrative review

OBJECTIVE

Neuropsychiatric symptoms (NPs) affect almost all patients with Alzheimer disease (AD). Because of the complications associated with the pharmacological treatment, nonpharmacological treatment (such as physical activity) can be considered as an additional complementary treatment option for NPs. The aim of this review is to evaluate the impact of physical activity on NPs in patients with AD.

METHODS

We searched Pubmed and Google Scholar for potential eligible articles until March 1, 2018.

RESULTS

Although there are contradictory results showing the impact of physical exercise on NPs, most of them reported that it had a significant effect on depression and sleep disturbances in patients with AD. The beneficial effects could be explained through several mechanisms, including modulated production of neurotransmitters; increasing neurotrophins, such as brain-derived neurotrophic factor; reduction of oxidative stress and inflammation; elevation of cerebral blood flow; hypothalamic pituitary adrenal axis regulation; and support of neurogenesis and synaptogenesis. Physical activity can also improve cardiovascular risk factors, which may exaggerate NPs. There is limited evidence for other NPs such as agitation, disinhibition, apathy, hallucinations, and anxiety.

CONCLUSION

Physical activity may ameliorate depression and sleep disturbances in patients with AD. Therefore, physical activity can be a "potential" add-on treatment to drugs to reduce or prevent these symptoms onset and recurrence in patients with AD. However, further studies are needed to focus on relationship between physical activity and other NPs.

Physical therapy in patients with Alzheimer’s disease: a systematic review of randomized controlled clinical trials

ABSTRACT The objective of this study is to evaluate the effects of physical therapy on the cognitive and functional capacity of patients with Alzheimer’s Disease (AD). This is a systematic review of randomized or quasi-randomized clinical trials, using the descriptors: AD, dementia and physical therapy. Two studies were included with a total of 207 participants. In study 1, no statistically significant difference was found on the mini-mental state examination (MMSE) (MD 0.0, 95%CI −5.76 to 5.76), neuropsychiatric inventory (MD −4.50, 95%CI −21.24 to 12.24) and Pfeffer instrumental activities questionnaire (MD 0.0 95%CI −6.48 to 6.48). In study 2, there was no statistically significant difference on the MMSE (MD −1.60, 95% CI −3.57 to 0.37), clock-drawing test (MD −0.20, 95%CI −0.61 to 0.21) and Alzheimer’s Disease Assessment Scale - cognitive subscale (MD 1.0, 95%CI −2.21 to 4.21) after 12 months. There was no consistent evidence on the effectiveness of physiotherapeutic intervention in improving cognitive function and functional capacity of patients with AD. More studies should be conducted for better evidence.

Anhedonia and Dysphoria Are Differentially Associated with the Risk of Dementia in the Cognitively Normal Elderly Individuals: A Prospective Cohort Study

OBJECTIVE

We investigated the impact of depressed mood (dysphoria) and loss of interest or pleasure (anhedonia)on the risk of dementia in cognitively-normal elderly individuals.

METHODS

This study included 2,685 cognitively-normal elderly individuals who completed the baseline and 4-year follow-up assessments of the Korean Longitudinal Study on Cognitive Aging and Dementia. We ascertained the presence of dysphoria and anhedonia using the Mini International Neuropsychiatric Inventory. We defined subjective cognitive decline as the presence of subjective cognitive complaints without objective cognitive impairments. We analyzed the association of dysphoria and anhedonia with the risk of cognitive disorders using multinomial logistic regression analysis adjusted for age, sex, education, Cumulative Illness Rating Scale score, Apolipoprotein E genotype, and neuropsychological test performance.

RESULTS

During the 4-year follow-up period, anhedonia was associated with an approximately twofold higher risk of mild cognitive impairment (OR=2.09, 95% CI=1.20-3.64, p=0.008) and fivefold higher risk of dementia (OR=5.07, 95% CI=1.44-17.92, p=0.012) but was not associated with the risk of subjective cognitive decline. In contrast, dysphoria was associated with an approximately twofold higher risk of subjective cognitive decline (OR=2.06, 95% CI=1.33-3.19, p=0.001) and 1.7-fold higher risk of mild cognitive impairment (OR=1.75, 95% CI=1.00-3.05, p=0.048) but was not associated with the risk of dementia.

CONCLUSION

Anhedonia, but not dysphoria, is a risk factor of dementia in cognitively-normal elderly individuals.

Conhecimento de adolescentes acerca dos benefícios do exercício físico para a saúde mental

Resumo A adolescência é uma fase de várias transformações estruturais e funcionais. O exercício físico é capaz de promover plasticidade adaptativa sobre o sistema nervoso, reduzindo os riscos de futuras patologias psiquiátricas. Essa pesquisa teve como objetivo investigar o conhecimento dos adolescentes acerca dos benefícios do exercício físico sobre a saúde mental. Trata-se de um estudo transversal, realizado em uma escola estadual de um município do Centro-Oeste de Minas Gerais. Para coleta de dados, além de um questionário próprio desenvolvido para medir o conhecimento acerca dos benefícios do Exercício Físico sobre a Saúde Mental, foram utilizados o International Physical Activity Questionnaire, e o questionário socioeconômico da Associação Brasileira de Empresas de Pesquisa. Os dados foram analisados por meio de ferramentas de estatística descritiva e pelos testes de Kruskal-Wallis e de qui-quadrado, a um nível de significância de 5%. Verificou-se que indivíduos mais ativos possuíam maior conhecimento acerca dos benefícios do exercício físico para a saúde mental em relação aos indivíduos sedentários. Assim, o conhecimento pode ser um fator protetor contra o sedentarismo e a inatividade física, melhorando significativamente o aspecto relacionado à qualidade de vida do adolescente.

Screening older adults for amnestic mild cognitive impairment and early-stage Alzheimer's disease using upper-extremity dual-tasking

The purpose of the current study was to develop an objective tool based on dual-task performance for screening early-stage Alzheimer’s disease (AD) and mild cognitive impairment (MCI of the Alzheimer’s type). Dual-task involved a simultaneous execution of a sensor-based upper-extremity function (UEF) motor task (normal or rapid speed) and a cognitive task of counting numbers backward (by ones or threes). Motor function speed and variability were recorded and compared between cognitive groups using ANOVAs, adjusted for age, gender, and body mass index. Cognitive indexes were developed using multivariable ordinal logistic models to predict the cognitive status using UEF parameters. Ninety-one participants were recruited; 35 cognitive normal (CN, age = 83.8 ± 6.9), 34 MCI (age = 83.9 ± 6.6), and 22 AD (age = 84.1 ± 6.1). Flexion number and sensor-based motion variability parameters, within the normal pace elbow flexion, showed significant between-group differences (maximum effect size of 1.10 for CN versus MCI and 1.39 for CN versus AD, p < 0.0001). Using these parameters, the cognitive status (both MCI and AD) was predicted with a receiver operating characteristic area under curve of 0.83 (sensitivity = 0.82 and specificity = 0.72). Findings suggest that measures of motor function speed and accuracy within a more practical upper-extremity test (instead of walking) may provide enough complexity for cognitive impairment assessment.

Linking late life depression and Alzheimer's disease: mechanisms and resilience

Purpose of Review

This review summarizes recent literature linking Alzheimer's disease (AD) and late life depression (LLD). It describes shared neurobiological features associated with both conditions, as well as factors that may increase resilience to onset and severity of cognitive decline and AD. Finally, we pose a number of future research directions toward improving detection, management, and treatment of both conditions.

Recent Findings

Epidemiological studies have consistently shown a significant relationship between LLD and AD, with support for depression as a prodromal feature of AD, a risk factor for AD, and observation of some shared risk factors underlying both disease processes. Three major neurobiological features shared by LLD and AD include neurodegeneration, disruption to cerebrovascular functioning, and increased levels of neuroinflammation. There are also potentially modifiable factors that can increase resilience to AD and LLD, including social support, physical and cognitive engagement, and cognitive reserve.

Summary

We propose that, in the context of depression, neurobiological events, such as neurodegeneration, cerebrovascular disease, and neuroinflammation result in a brain that is more vulnerable to the consequences of the pathophysiological features of AD, lowering the threshold for the onset of the behavioral presentation of AD (i.e., cognitive decline and dementia). We discuss factors that can increase resilience to AD and LLD, including social support, physical and cognitive engagement, and cognitive reserve. We conclude with a discussion of future research directions.

A 'Music, Mind and Movement' Program for People With Dementia: Initial Evidence of Improved Cognition

BACKGROUND

Music is being increasingly used as a therapeutic tool for people with dementia. Research has uncovered several qualities of music that are responsible for its beneficial effects. Based on the identification of seven therapeutic capacities of music, we devised the Music, Mind, and Movement (MMM) program and evaluated whether it had therapeutic benefit for people with dementia (various types) in the areas of cognition, mood, identity, and motor fluency.

METHODS

The MMM program involved seven 45-min weekly group sessions, and individual 15-min "booster" sessions. Twenty people with mild to moderate dementia participated. Group 1 (n = 10) completed the MMM program first and Group 2 (n = 10) acted as a wait list control for 7 weeks, receiving standard care and completing the MMM program after the first group. Assessments of global cognition (Addenbrooke's Cognitive Examination, ACE-III), mood (Geriatric Depression Scale short form), identity ('I am' task), and fine motor skills (9-Hole peg task) were conducted at baseline (T1), time 2 (T2, post treatment), and time 3 (T3, 1 month post MMM program).

RESULTS

Within group comparisons were conducted with 12 participants from the MMM program and 10 participants receiving standard care. Global cognition (total ACE-III score) improved in 8/12 participants after the MMM program, whilst it decreased in 8/10 participants after the period of standard care. MMM participants showed increases in ACE-III subdomain scores of attention (p = 0.007) and verbal fluency (p = 0.056).

CONCLUSION

Our preliminary findings suggest that the MMM program may improve cognition, particularly verbal fluency and attention, in people with dementia.

Controlled randomized trial of walking exercise with positive education on cardiovascular fitness and happiness in retired older adults

AIM

Regular walking exercise (RWE) is associated with increased cardiovascular fitness and might elevate subjective psychological well-being. Positive education links positive psychology concepts with self-efficacy through the curriculum, which helps foster well-being. This study examines if regular walking exercise with positive education has better effects on cardiovascular fitness and happiness than RWE alone in retired older adults.

METHODS

Three arms of experimental design were used: pedometer walking exercise training (PWET); positive education and pedometer walking exercise training (PEPWET); and pedometer walking exercise (PWE). Trained walking exercise was provided to the PWET and PEPWET groups by a walking exercise coach three times per week, for 45 min per session for 12 weeks. Positive education was designed and led by a licensed PhD psychologist every other week. Of 150 participants, 60, 60 and 30 were randomly assigned to PWET, PEPWET and PWE, respectively. Demographic information, Chinese Happiness Inventory, RWE, and 6-min walking distance were assessed before and after the intervention.

RESULTS

The percentage of participants who practiced RWE after 12 weeks was significantly higher in the PEPWET group (96.7%), followed by the PWET (75%) and PWE groups (40%). Cardiovascular fitness in the PWET and PEPWET groups was significantly better than in the PWE group. Chinese Happiness Inventory scores in the PWET and PEPWET groups were significantly higher than in the PWE group, and the PEPWET group also showed significantly higher Chinese Happiness Inventory scores than the PWET group.

CONCLUSIONS

In addition to RWE, the study findings show that positive education can be beneficial to promote older adults' RWE, cardiovascular fitness and happiness. Geriatr Gerontol Int 2019; 19: 879-884.

Fitness-Dependent Effect of Acute Aerobic Exercise on Executive Function

Cognitive gains are reported to be induced by acute aerobic exercise, but the role of fitness in the effect of acute aerobic exercise on executive function remains unknown. Therefore, we aimed to examine the effect of fitness on acute exercise-induced changes in executive function from neural mechanism approach. Twenty-four female college students were assigned to high-fitness or low-fitness groups based on their cardiovascular fitness level, and then underwent functional magnetic resonance imaging while performing N-back tasks before and after 30 min of acute exercise. The behavioral results revealed significant interaction effects of group by time in the 0-back and 1-back tasks, but not in the 2-back task. The accuracy was significantly higher in the high-fitness group than in the low-fitness group before exercise in the 1-back and 2-back tasks. At the neural level, significant interaction effects of group by time were observed in all tasks. The 0-back and 1-back tasks activated the right cerebellum while the 2-back task activated subcortical regions. Our findings suggest that fitness moderates the effect of aerobic exercise on cognitive function, and provide the first neural evidence to support the influence of fitness on exercise-induced cognitive performance.

A systematic review of existing peripheral biomarkers of cognitive aging: Is there enough evidence for biomarker proxies in behavioral modification interventions?: An initiative in association with the nutrition, exercise and lifestyle team of the Canadian Consortium on Neurodegeneration in Aging

Peripheral biomarkers have shown significant value in predicting brain health and may serve as a useful proxy measurement in the assessment of evidence-based lifestyle behavior modification programs, including physical activity and nutrition programs, that aim to maintain cognitive function in late life. The aim of this systematic review was to elucidate which peripheral biomarkers are robustly associated with cognitive function among relatively healthy non-demented older adults. Following the standards for systematic reviews (PICO, PRIMSA), and employing MEDLINE and Scopus search engines, 222 articles were included in the review. Based on the review of biomarker proxies of cognitive health, it is recommended that a comprehensive biomarker panel, or biomarker signature, be developed as a clinical end point for behavior modification trials aimed at enhancing cognitive function in late life. The biomarker signature should take a multisystemic approach, including lipid, immune/inflammatory, and metabolic biomarkers in the biological signature index of cognitive health.

Traumatic Brain Injury Modifies the Relationship Between Physical Activity and Global and Cognitive Health: Results From the Barcelona Brain Health Initiative

Physical activity has many health benefits for individuals with and without history of brain injury. Here, we evaluated in a large cohort study the impact of physical activity on global and cognitive health as measured by the PROMIS global health and NeuroQoL cognitive function questionnaires. A nested case control study assessed the influence of a history of traumatic brain injury (TBI) on the effects of physical activity since underlying pathophysiology and barriers to physical activity in individuals with TBI may mean the effects of physical activity on perceived health outcomes differ compared to the general population. Those with a history of TBI (n = 81) had significantly lower Global health (β = -1.66, p = 0.010) and NeuroQoL cognitive function (β = -2.65, p = 0.006) compared to healthy adults (n = 405). A similar proportion of individuals in both groups reported being active compared to being insufficiently active (X ( 1 ) 2 = 0.519 p = 0.471). Furthermore, the effect of physical activity on global health (β = 0.061, p = 0.076) and particularly for NeuroQoL (β = 0.159, p = 0.002) was greater in those with a history of TBI. Individuals with a history of TBI can adhere to a physically active lifestyle, and if so, that is associated with higher global and cognitive health perceptions. Adhering to a physically active lifestyle is non-trivial, particularly for individuals with TBI, and therefore adapted strategies to increase participation in physical activity is critical for the promotion of public health.

Stereological Investigation of the Effects of Treadmill Running Exercise on the Hippocampal Neurons in Middle-Aged APP/PS1 Transgenic Mice

The risk of cognitive decline during Alzheimer's disease (AD) can be reduced if physical activity is maintained; however, the specific neural events underlying this beneficial effect are still uncertain. To quantitatively investigate the neural events underlying the effect of running exercise on middle-aged AD subjects, 12-month-old male APP/PS1 mice were randomly assigned to a control group or running group, and age-matched non-transgenic littermates were used as a wild-type group. AD running group mice were subjected to a treadmill running protocol (regular and moderate intensity) for four months. Spatial learning and memory abilities were assessed using the Morris water maze. Hippocampal amyloid plaques were observed using Thioflavin S staining and immunohistochemistry. Hippocampal volume, number of neurons, and number of newborn cells (BrdU+ cells) in the hippocampus were estimated using stereological techniques, and newborn neurons were observed using double-labelling immunofluorescence. Marked neuronal loss in both the CA1 field and dentate gyrus (DG) and deficits in both the neurogenesis and survival of new neurons in the DG of middle-aged APP/PS1 mice were observed. Running exercise could improve the spatial learning and memory abilities, reduce amyloid plaques in the hippocampi, delay neuronal loss, induce neurogenesis, and promote the survival of newborn neurons in the DG of middle-aged APP/PS1 mice. Exercise-induced protection of neurons and adult neurogenesis within the DG might be part of the important structural basis of the improved spatial learning and memory abilities observed in AD mice.

Preventive approach for overcoming dementia

Dementia is used as a general term to describe chronic disorders of mental processes caused by the deterioration of cognitive functions to the extent that one's ability to perform daily activities is impaired. Currently, age is known to be the main risk factor for dementia, suggesting that the risk of being diagnosed with dementia significantly increases later in one's life. Therefore, there are two approaches one can take when confronting dementia: to cure it when it occurs in late adulthood or to prevent the onset of symptoms beforehand. Recently, the latter strategy of delaying and preventing Alzheimer's disease, the most prevalent form and most studied type of dementia, through both pharmaceutical and nonpharmaceutical interventions is becoming increasingly recognized. In this review, we discuss studies conducted in various fields that addresses nonpharmaceutical lifestyle interventions, including diet, physical activity, cognitive stimulation, and social engagement, and their effects in preventing and inhibiting dementia.

Self-Reported Physical Activity is Associated with Tau Burden Measured by Positron Emission Tomography

Numerous animal studies have reported exercise reduces the accumulation of Alzheimer's disease pathology, including amyloid-β (Aβ) and tau. Furthermore, we previously reported a relationship between higher levels of physical activity (PA) and lower brain Aβ burden in a human population. The recent advent of tau positron emission tomography (PET) tracers enables us to extend our investigations into the evaluation of the relationship between PA and brain tau burden. Utilizing data from the Australian Imaging, Biomarkers and Lifestyle (AIBL) study, we have examined the cross-sectional relationship between habitual PA and PET-quantified tau burden. Forty-three cognitively healthy older adults were categorized into low-moderate PA (LMPA; n = 16) or high PA (HPA; n = 27), based on self-reported PA levels. Tau PET imaging with the AV1451 tracer was conducted on all participants. The LMPA group had significantly higher neocortical tau burden (presented as a z-score; 1.22±1.98), compared to the HPA group (z-score: - 0.28±1.18). The difference between the LMPA and HPA groups was also evident when examining regional tau burden in the temporoparietal cortex and the prefrontal cortex. Our results suggest an association between self-reported PA level and brain tau burden. Future longitudinal and interventional studies utilizing larger samples sizes are vital to further investigate the nature of the relationship between tau and PA.

Assessment of the Mid-Life Demographic and Lifestyle Risk Factors of Dementia Using Data from the Framingham Heart Study Offspring Cohort

BACKGROUND

Dementia is the leading cause of dependence and disability in the elderly population worldwide. However, currently there is no effective medication for dementia treatment. Therefore, identifying lifestyle-related risk factors including some that are modifiable may provide important strategies for reducing risk of dementia.

OBJECTIVE

This study aims to highlight associations between easily obtainable lifestyle risk factors in mid-life and dementia in later adulthood.

METHODS

Using data from the Framingham Heart Study Offspring cohort, we leveraged well-known classification models (decision tree classifier and random forests) to associate demographic and lifestyle behavioral data with dementia status. We then evaluated model performance by computing area under receiver operating characteristic (ROC) curve.

RESULTS

As expected, age was strongly associated with dementia. The analysis also identified 'widowed' marital status, lower BMI, and less sleep at mid-life as risk factors of dementia. The areas under the ROC curves were 0.79 for the decision tree, and 0.89 for the random forest model.

CONCLUSION

Demographic and lifestyle factors that are non-invasive and inexpensive to implement can be assessed in midlife and used to potentially modify the risk of dementia in late adulthood. Classification models can help identify associations between dementia and midlife lifestyle risk factors. These findings inform further research, in order to help public health officials develop targeted programs for dementia prevention.

Sex differences in Alzheimer's disease: Understanding the molecular impact

Alzheimer's disease (AD) is a common neurodegenerative disorder that presents with cognitive impairment and behavioral disturbance. Approximately 5.5 million people in the United States live with AD, most of whom are over the age of 65 with two-thirds being woman. There have been major advancements over the last decade or so in the understanding of AD neuropathological changes and genetic involvement. However, studies of sex impact in AD have not been adequately integrated into the investigation of disease development and progression. It becomes indispensable to acknowledge in both basic science and clinical research studies the importance of understanding sex-specific differences in AD pathophysiology and pathogenesis, which could guide future effort in the discovery of novel targets for AD. Here, we review the latest and most relevant literature on this topic, highlighting the importance of understanding sex dimorphism from a molecular perspective and its association to clinical trial design and development in AD research field.

Does poor sleep impair cognition during aging? Longitudinal associations between changes in sleep duration and cognitive performance among older Mexican adults

Alterations in sleep patterns are common among older adults; further, short and long sleep durations have been linked with impaired cognitive performance in older individuals. Yet most research examining these relationships has been cross-sectional, limited to high-income nations, and has failed to consider how changes in sleep duration may impact cognitive decline. The present longitudinal study uses nationally-representative data to test whether changes in sleep length among "healthy" baseline sleepers are associated with reduced cognitive function in older Mexican adults (>50 years old) at follow-up. Data were drawn from the first and second waves of the World Health Organization's Study on global AGEing and adult health. Self-report data captured sleep duration over two nights, and five cognitive tests (immediate and delayed verbal recall, forward and backward digit span, and verbal fluency) were used to measure various cognitive domains and create a composite z-score of cognitive performance. Linear regressions were performed to assess associations between sleep length changes and cognitive decline, controlling for relevant lifestyle and health factors. Increased sleep durations at follow-up among individuals who reported intermediate sleep durations (6-9 h/night) at baseline were significantly associated with greater rates of decline in overall cognitive function. Longer sleepers also trended toward greater rates of decline for attention/working memory and executive function. This study suggests that long sleep durations are a risk factor for certain types of impaired cognition among older adults living in a middle-income country. These findings are clinically important given the growing rates of dementia and aging populations globally.

Modifiable Lifestyle Factors and Cognitive Function in Older People: A Cross-Sectional Observational Study

Background: The development of evidence-based interventions for delaying or preventing cognitive impairment is an important challenge. Most previous studies using self-report questionnaires face problems with reliability and consistency due to recall bias or misclassification among older people. Therefore, objective measurement of lifestyle components is needed to confirm the relationships between lifestyle factors and cognitive function. Aims: The current study examined the relationship between lifestyle factors collected with wearable sensors and cognitive function among community-dwelling older people using machine learning. Methods: In total, 855 participants (mean age: 73.8 years) wore a wristband sensor for 7.8 days on average every 3 months. Various lifestyle parameters were measured, including walking steps, conversation time, total sleep time (TST), sleep efficiency, time awake after sleep onset, awakening count, napping time, and heart rate. Random forest (RF) regression analysis was used to examine the relationships between total daily sensing data and Mini-Mental State Examination (MMSE) scores. Confounding factor analysis was conducted with models that were adjusted and unadjusted for demographic and vascular risk factors, and selected variables were assessed as risk and protective factors using partial dependence plots (PDPs). Results: Lifestyle data were collected for 31.3 ± 7.1 days per year using wristband sensors. RF regression analysis adjusted for age, gender, and education levels selected four variables, including number of walking steps, conversation time, TST, and heart rate. Moreover, walking steps, conversation time, and heart rate remained after RF regression analysis adjusted for demographic and vascular risk factors. Number of walking steps, conversation time, and heart rate were categorized as protective factors, whereas TST was categorized as a risk factor for cognitive function. Although PDPs of number of walking steps and heart rate revealed continuously increased MMSE scores, those of conversation time and TST and revealed that the tendency in the graph was reversed at the boundary of a particular threshold (321.1 min for conversation time, 434.1 min for TST). Conclusions: Lifestyle factors, such as physical activity, sleep, and social activity appear to be associated with cognitive function among older people. Physical activity and appropriate durations of sleep and conversation are important for cognitive function.

Associations Between Self-Reported Sensory Impairment and Risk of Cognitive Decline and Impairment in the Health and Retirement Study Cohort

Objectives

We aimed to determine whether self-assessed single (hearing or visual) and dual sensory (hearing and visual) impairments are associated with cognitive decline and incident possible cognitive impairment, no dementia (CIND) and probable dementia.

Method

Data were drawn from the 1996–2014 surveys of the Health and Retirement Study (HRS), involving 19,618 respondents who had no probable dementia and who were aged 50 years or older at the baseline. We used linear mixed models to test the association between self-assessed sensory impairment and cognitive decline followed by a Cox proportional hazard model to estimate the relative risk of incident possible CIND and probable dementia associated with the presence of sensory impairment.

Results

Respondents with self-assessed single and dual sensory impairment performed worse in cognitive tests than those without sensory impairment. The fully adjusted incidence of developing possible CIND was 17% higher for respondents with hearing impairment than those without hearing impairment. Respondents with visual impairment had 35% and 25% higher risk for developing possible CIND and probable dementia, respectively, than those without visual impairment. Respondents with dual sensory impairment at baseline were 38% and 26% more likely to develop possible CIND and probable dementia, respectively, than those with no sensory impairment.

Discussion

Self-assessed sensory impairment is independently associated with cognitive decline and incident possible CIND and probable dementia. Further studies are needed to identify the mechanism underlying this association and to determine whether treatment of sensory impairment could ameliorate cognitive decline and delay the onset of dementia among older adults.

Cognitive Performance, Aerobic Fitness, Motor Proficiency, and Brain Function Among Children Newly Diagnosed With Craniopharyngioma

OBJECTIVES

Craniopharyngioma survivors experience cognitive deficits that negatively impact quality of life. Aerobic fitness is associated with cognitive benefits in typically developing children and physical exercise promotes recovery following brain injury. Accordingly, we investigated cognitive and neural correlates of aerobic fitness in a sample of craniopharyngioma patients.

METHODS

Patients treated for craniopharyngioma [N=104, 10.0±4.6 years, 48% male] participated in fitness, cognitive and fMRI (n=51) assessments following surgery but before proton radiation therapy.

RESULTS

Patients demonstrated impaired aerobic fitness [peak oxygen uptake (PKVO2)=23.9±7.1, 41% impaired (i.e., 1.5 SD&lt;normative mean)], motor proficiency [Bruininks-Oseretsky (BOT2)=38.6±9.0, 28% impaired], and executive functions (e.g., WISC-IV Working Memory Index (WMI)=96.0±15.3, 11% impaired). PKVO2 correlated with better executive functions (e.g., WISC-IV WMI r=.27, p=.02) and academic performance (WJ-III Calculation r=.24, p=.04). BOT2 correlated with better attention (e.g., CPT-II omissions r=.26, p=.04) and executive functions (e.g., WISC-IV WMI r=.32, p=.01). Areas of robust neural activation during an n-back task included superior parietal lobule, dorsolateral prefrontal cortex, and middle and superior frontal gyri (p&lt;.05, corrected). Higher network activation was associated with better working memory task performance and better BOT2 (p&lt;.001).

CONCLUSIONS

Before adjuvant therapy, children with craniopharyngioma demonstrate significantly reduced aerobic fitness, motor proficiency, and working memory. Better aerobic fitness and motor proficiency are associated with better attention and executive functions, as well as greater activation of a well-established working memory network. These findings may help explain differential risk/resiliency with respect to acute cognitive changes that may portend cognitive late effects. (JINS, 2019, 25, 413-425).

Physical activity trajectories and subsequent fall risk: ARIC Study

To examine the impact of moderate to vigorous intensity physical activity (MVPA) trajectories during midlife and older adulthood with subsequent fall risk in later life. Cross-temporal analyses were conducted in 15,792 participants (27% black, 55% women) aged 45 to 64 years enrolled in the Atherosclerosis Risk in Communities (ARIC) Study. MVPA was collected at Exams 1 (1987-89), 3 (1993-95) and 5 (2011-13) using the ARIC/Baecke questionnaire. Latent class growth analysis was used to identify the MVPA trajectory groups. Reported falls outcomes were collected in 2013-14, 2015-16, and 2016-17. Generalized Linear Models were used to estimate associations of baseline predictors with trajectory class membership, as well as associations of trajectory classes with any falling (adjusted incident relative risks, aIRR) and with number of falls (adjusted relative rates, aRR). Four primary trajectory classes emerged, reflecting longitudinal patterns of maintained high (48%), maintained low (22%), increasing (14%) and decreasing (15%) MVPA. After adjustment for covariates, the decreasing MVPA trajectory group had a 14% higher risk of reporting any falling compared to the maintained high MVPA group [aIRR = 1.14 (1.01, 1.28)]. When compared to the maintained high MVPA group, the maintained low and decreasing group had a 28% [aRR = 1.28 (1.14, 1.44)] and 27% [aRR = 1.27 (1.17, 1.38)] higher rate in the reported number of falls, respectively. Findings support public health campaigns targeting habitual MVPA or exercise for fall prevention and suggest that interventions should be initiated in midlife; a time when individuals may be more able and willing to change behavior.

Physical Activity Alleviates Cognitive Dysfunction of Alzheimer's Disease through Regulating the mTOR Signaling Pathway

Alzheimer's disease (AD) is one of the most common aging-related progressive neurodegenerative disorders, and can result in great suffering for a large portion of the aged population. Although the pathogenesis of AD is being elucidated, the exact mechanisms are still unclear, thereby impeding the development of effective drugs, supplements, and other interventional strategies for AD. In recent years, impaired autophagy associated with microRNA (miRNA) dysfunction has been reported to be involved in aging and aging-related neurodegenerative diseases. Therefore, miRNA-mediated regulation for the functional status of autophagy may become one of the potent interventional strategies for AD. Mounting evidence from in vivo AD models has demonstrated that physical activity can exert a neuroprotective role in AD. In addition, autophagy is strictly regulated by the mTOR signaling pathway. In this article, the regulation of the functional status of autophagy through the mTOR signaling pathway during physical activity is systematically discussed for the prevention and treatment of AD. This concept will be beneficial to developing novel and effective targets that can create a direct link between pharmacological intervention and AD in the future.

Taekwondo Enhances Cognitive Function as a Result of Increased Neurotrophic Growth Factors in Elderly Women

The purpose of this study was to investigate the effects of regular taekwondo (TKD) training on physical fitness, neurotrophic growth factors, cerebral blood flow (CBF) velocity, and cognitive function in elderly women. Thirty-seven women aged 65 or older were randomly assigned to either TKD (n = 19) or control (n = 18) group. TKD training was performed at 50⁻80% maximum heart rate (HRmax) for 60 min, five times per week for 16 weeks. All participants underwent the following examinations before and after the intervention: Senior Fitness Test; serum levels of neurotrophic growth factors, including brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and insulin-like growth factor-1 (IGF-1); systolic, diastolic, and mean blood flow velocity and pulsatility index of the middle cerebral artery using Doppler ultrasonography; Mini-Mental State Examination for dementia screening (MMSE-DS); and Stroop Color and Word Test (word, color, and color-word). In the TKD group, lower body strength and flexibility, aerobic endurance levels, BDNF, VEGF, and IGF-1 serum levels as well as the color-word test scores were significantly increased after as compared to before the intervention (p < 0.05). No statistically significant differences were found in cerebral blood flow velocities and the MMSE-DS score (p > 0.05). These findings suggest that regular TKD training may be effective in improving not only fitness but also cognitive function in elderly women. The latter effect may be due to increased neurotrophic growth factor levels.

Reversible predictors of reversion from mild cognitive impairment to normal cognition: a 4-year longitudinal study

BACKGROUND

Although previous studies have revealed many factors related to mild cognitive impairment (MCI) reversion, information about reversible factors related MCI reversion is limited, impeding the development of intervention strategies. The aim of the present study was to examine whether reversible factors such as lifestyle activities are associated with MCI reversion in elderly individuals using the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes database. A total of 396 community-living older adults (age ≥ 65 years) participated in the study. They were classified as reverters or non-reverters from mild cognitive impairment to normal cognition. We assessed lifestyle activities, potential confounding factors of cognitive decline, and reversion of mild cognitive impairment.

RESULTS

In a completed data set of 396 participants, 202 participants (51.0%) reverted from MCI to normal cognition. The reversion rate in participants for whom we imputed data was 34.3%. In the imputed group, a logistic regression model showed that the odds ratios (ORs) for reversion were significantly higher in participants who drove a car (OR 1.50, 95% confidence interval (CI) 1.41-1.60), used a map to travel to unfamiliar places (OR 1.12, 95% CI 1.06-1.18), read books or newspapers (OR 1.54, 95% CI 1.37-1.73), took cultural classes (OR 1.10, 95% CI 1.04-1.15), attended meetings in the community (OR 1.22, 95% CI 1.16-1.28), participated in hobbies or sports activities (OR 1.09, 95% CI 1.03-1.16), and engaged in fieldwork or gardening (OR 1.14, 95% CI 1.08-1.21). The imputed sample showed that non-reverters were more likely to discontinue fieldwork or gardening (11.0% vs. 6.1%) than reverters during the follow-up period.

CONCLUSIONS

Specific lifestyle activities may play important roles in MCI reversion in older adults. The longitudinal data indicate that it is reasonable to recommend that individuals continue to engage in fieldwork or gardening to increase their chance of recovery from MCI.

Health-Promoting Strategies for the Aging Brain

As the world's population ages and people live longer, the changes in the aging brain present substantial challenges to our health and society. With greater longevity come age-related diseases, many of which have direct and indirect influences on the health of the brain. Although there is some degree of predictable decline in brain functioning with aging, meaningful cognitive decline is not inevitable and is perhaps preventable. In this review, we present the case that the course of aging-related brain disease and dysfunction can be modified. We present the evidence for conditions and risk factors that may contribute to cognitive decline and dementia and for interventions that may mitigate their impact on cognitive functioning later in life, or even prevent them and their cognitive sequelae from developing. Although much work remains to be done to meet the challenges of the aging brain, strategies to promote its health have been demonstrated and offer much promise, which can only be realized if we mount a vigorous public health effort to implement these strategies.

Translational research on reserve against neurodegenerative disease: consensus report of the International Conference on Cognitive Reserve in the Dementias and the Alzheimer's Association Reserve, Resilience and Protective Factors Professional Interest Area working groups

BACKGROUND

The concept of reserve was established to account for the observation that a given degree of neurodegenerative pathology may result in varying degrees of symptoms in different individuals. There is a large amount of evidence on epidemiological risk and protective factors for neurodegenerative diseases and dementia, yet the biological mechanisms that underpin the protective effects of certain lifestyle and physiological variables remain poorly understood, limiting the development of more effective preventive and treatment strategies. Additionally, different definitions and concepts of reserve exist, which hampers the coordination of research and comparison of results across studies.

DISCUSSION

This paper represents the consensus of a multidisciplinary group of experts from different areas of research related to reserve, including clinical, epidemiological and basic sciences. The consensus was developed during meetings of the working groups of the first International Conference on Cognitive Reserve in the Dementias (24-25 November 2017, Munich, Germany) and the Alzheimer's Association Reserve and Resilience Professional Interest Area (25 July 2018, Chicago, USA). The main objective of the present paper is to develop a translational perspective on putative mechanisms underlying reserve against neurodegenerative disease, combining evidence from epidemiological and clinical studies with knowledge from animal and basic research. The potential brain functional and structural basis of reserve in Alzheimer's disease and other brain disorders are discussed, as well as relevant lifestyle and genetic factors assessed in both humans and animal models.

CONCLUSION

There is an urgent need to advance our concept of reserve from a hypothetical model to a more concrete approach that can be used to improve the development of effective interventions aimed at preventing dementia. Our group recommends agreement on a common dictionary of terms referring to different aspects of reserve, the improvement of opportunities for data sharing across individual cohorts, harmonising research approaches across laboratories and groups to reduce heterogeneity associated with human data, global coordination of clinical trials to more effectively explore whether reducing epidemiological risk factors leads to a reduced burden of neurodegenerative diseases in the population, and an increase in our understanding of the appropriateness of animal models for reserve research.

Activation of the Brain to Postpone Dementia: A Concept Originating from Postmortem Human Brain Studies

Alzheimer's disease (AD) is characterized by decreased neuronal activity and atrophy, while hyperactivity of neurons seems to make them resistant to aging and neurodegeneration, a phenomenon which we have paraphrased as 'use it or lose it'. Our hypothesis proposes that (1) during their functioning, neurons are damaged; (2) accumulation of damage that is not repaired is the basis of aging; (3) the vulnerability to AD is determined by the genetic background and the balance between the amount of damage and the efficiency of repair, and (4) by stimulating the brain, repair mechanisms are stimulated and cognitive reserve is increased, resulting in a decreased rate of aging and risk for AD. Environmental stimulating factors such as bilingualism/multilingualism, education, occupation, musical experience, physical exercise, and leisure activities have been reported to reduce the risk of dementia and decrease the rate of cognitive decline, although methodological problems are present.

The Role of Enhanced Cognition to Counteract Detrimental Effects of Prolonged Bed Rest: Current Evidence and Perspectives

Prolonged periods of physical inactivity or bed rest can lead to a significant decline of functional and cognitive functions. Different kinds of countermeasures (e.g., centrifugation, nutritional, and aerobic interventions) have been developed to attempt to mitigate negative effects related to bed rest confinement. The aim of this report is to provide an overview of the current evidence related to the effectiveness of computerized cognitive training (CCT) intervention during a period of complete physical inactivity in older adults. CCT, using a virtual maze navigation task, appears to be effective and has long-lasting benefits (up to 1.5 years after the study). Moreover, enhanced cognition (executive control) reduces decline in the ability to perform complex motor-cognitive dual-tasks after prolonged period of bed rest. It has been demonstrated that CCT administration in older adults also prevents bed rest stress-related physiological changes [these groups showed minimal changes in vascular function and an unchanged level of brain-derived neurotrophic factor (BDNF)] while control subjects showed decreased peripheral vascularization and increased plasma level of the neurotrophin BDNF during a 14-day bed rest. In addition, the effects of CCT are evident also from the brain electrocortical findings: CCT group revealed a decreased power in lower delta and theta bands while significant increases in the same EEG spectral bands power were found in control subjects. If we consider an increase of power in delta band as a marker of cortical aging, then the lack of shift of EEG power to lower band indicates a preventive role of CCT on the cortical level during physiological deconditioning induced by 2-week bed rest immobilization. However, replication on a larger sample is required to confirm the observed findings. Applications derived from these findings could be appropriate for implementation of hospital treatment for bed ridden patients as well as for fall prevention programs.

Relationship between physical and cognitive performance in community dwelling, ethnically diverse older adults: a cross-sectional study

Background

Regular exercise training stimulates physiological adaptations to improve physical performance, reduce chronic disease risk, and slow age-related cognitive decline. Since the physiological mechanisms responsible for aging-associated cognitive decline are not yet fully understood, and training-induced physiological adaptations responsible for performance measure improvements are specific to the type (aerobic vs. strength) and intensity of training, studies are needed to assess the relationships between physical performance measures and cognitive performance in older adults. These results could be used to guide exercise prescriptions with the goal of improving age-related cognitive performance. The purpose of this study was to investigate the relationship between physical performance measures and cognitive performance in a population of community dwelling, ethnically diverse older adults.

Methods

The cognitive performance of ninety independent, community dwelling participants (69 female, 21 male), aged 75 ± 9.5 years (mean ± SD) was measured with the Modified Mini-Mental State Test (3MS), Trailmaking Tests A and B (TMT A & B), and the Animal Naming test. Sociodemographic (age, sex, ethnicity, medication use, years of education) and anthropometric data were collected, physical activity was assessed with the Physical Activity Scale for the Elderly (PASE), peak hand-grip strength, distance walked in the 6MWT, and heart rate pre-, during, and up to 5 min. post- 6MWT were measured. Forward stepwise multiple regression analyses were performed with each cognitive measure as a dependent variable.

Results and Discussion

Controlling for sociodemographic covariates, peak heart rate during the 6MWT (6MWT HR_PEAK) was positively correlated with performance in the 3MS (p < 0.017), and TMT A (p < 0.001) and B (p < 0.029). Controlling for sociodemographic covariates, PASE was positively (p = 0.001), and β-blocker use negatively (p = 0.035), correlated with performance on the Animal Naming test. Also, controlling for sociodemographic covariates, PASE was positively correlated with performance on the TMT A (p = 0.017). Here we show that higher peak heart rate during the 6MWT is positively correlated with cognitive performance in a population of community dwelling, ethnically diverse older adults (ages 60-95 years).

Conclusion

Higher peak heart rate during the 6MWT was found to be independently and positively correlated with cognitive function in community-dwelling older adults. Although additional work is needed, these results are promising and suggest that physicians, exercise professionals, and/or fitness/fall prevention programs may use peak heart rate during the 6MWT to easily monitor exercise intensity to support cognitive health.

A pilot programme evaluation of social farming horticultural and occupational activities for older people in Italy

The aim of this study was to evaluate a 1-year social farming programme conducted between 2014 and 2015, including horticultural and occupational activities on six agricultural farms for older people in good general health. Social farming is a practice that uses agricultural resources to provide health, social or educational services to vulnerable groups of people. Activity participation, social relationships, physical activity, and the quality of life of the participants were assessed using a pretest, posttest design. A total of 112 subjects were interviewed at baseline, though only 73 participants were retained through the end of the follow-up, resulting in a dropout rate of 34%. Data analysis revealed significant improvements in both social relationships and overall occupational engagement at the end of the programme, with significant increases in the frequency of contact with friends or relatives as well as the number of activities performed by the participants. This work adds to the literature on the effects of social farming and indicates that farming may provide opportunities for older people to engage in activities that stimulate social behaviours.

Efficacy and mechanisms of combined aerobic exercise and cognitive training in mild cognitive impairment: study protocol of the ACT trial

BACKGROUND

Developing non-pharmacological interventions with strong potential to prevent or delay the onset of Alzheimer's disease (AD) in high-risk populations is critical. Aerobic exercise and cognitive training are two promising interventions. Aerobic exercise increases aerobic fitness, which in turn improves brain structure and function, while cognitive training improves selective brain function intensively. Hence, combined aerobic exercise and cognitive training may have a synergistic effect on cognition by complementary strengthening of different neural functions. Few studies have tested the effects of such a combined intervention, and the findings have been discrepant, largely due to varying doses and formats of the interventions.

METHODS/DESIGN

The purpose of this single-blinded, 2 × 2 factorial phase II randomized controlled trial is to test the efficacy and synergistic effects of a 6-month combined cycling and speed of processing training intervention on cognition and relevant mechanisms (aerobic fitness, cortical thickness, and functional connectivity in the default mode network) in older adults with amnestic mild cognitive impairment. This trial will randomize 128 participants equally to four arms: cycling and speed of processing, cycling only, speed of processing only, or attention control for 6 months, and then follow them for another 12 months. Cognition and aerobic fitness will be assessed at baseline and at 3, 6, 12, and 18 months; cortical thickness and functional connectivity at baseline and at 6, 12, and 18 months; Alzheimer's disease (AD) conversion at 6, 12, and 18 months. The specific aims are to (1) determine the efficacy and synergistic effects of the combined intervention on cognition over 6 months, (2) examine the underlying mechanisms of the combined intervention, and (3) calculate the long-term effect sizes of the combined intervention on cognition and AD conversion. The analysis will use intention-to-treat and linear mixed-effects modeling.

DISCUSSION

This trial will be among the first to test the synergistic effects on cognition and mechanisms (relevant to Alzheimer's-associated neurodegeneration) of a uniquely conceptualized and rigorously designed aerobic exercise and cognitive training intervention in older adults with mild cognitive impairment. It will advance Alzheimer's prevention research by providing precise effect-size estimates of the combined intervention.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03313895 . Registered on 18 October 2017.

Effects of movement music therapy with a percussion instrument on physical and frontal lobe function in older adults with mild cognitive impairment: a randomized controlled trial

OBJECTIVES

We tested the hypothesis that performing a rhythmic physical task accompanied by a cognitive task, such as multitask movement music therapy (MMT) involving repetitive rhythmic movement with a musical instrument (the Naruko clapper), may improve pre-frontal cortex (PFC) function and cognitive performance.

METHOD

Forty-five older adult participants with MCI (74.62 ± 5.05 years) participated in this randomized, controlled, single-blind intervention trial. 35 were assigned to the MMT group and 10 to the control STT group. Before and after the 12-week exercise program, we administered six physical function tests, the Frontal Assessment Battery (FAB), and measured relative oxyhemoglobin concentrations using 45-multichannel functional near-infrared spectroscopy as a reflection of hemodynamic responses in the PFC.

RESULTS

We observed significant improvements in FAB scores only in the MMT group. Cerebral blood flow (CBF) in the PFC during the exercise was significantly increased in the MMT group compared with the STT group. The CBF increase was significantly correlated among various channels in the MMT group.

CONCLUSIONS

The MMT program appeared to stimulate the PFC and improve cognitive performance in our older adult participants with MCI, suggesting that the repetitive, rhythmic movements of MMT can activate the prefrontal area in older adults.

TRIAL REGISTRATION

Clinical Trial Registry Numbers: R000026130, UMIN000022671 (2016/06/08) [(University Hospital Medical Information Network (UMIN) Center] retrospectively registered.

Exercise-induced brain-derived neurotrophic factor expression: Therapeutic implications for Alzheimer's dementia

Emerging evidence indicates that moderate intensity aerobic exercise is positively correlated with cognitive function and memory. However, the exact mechanisms underlying such improvements remain unclear. Recent research in animal models allows proposition of a pathway in which brain-derived neurotrophic factor (BDNF) is a key mediator. This perspective draws upon evidence from animal and human studies to highlight such a mechanism whereby exercise drives synthesis and accumulation of neuroactive metabolites such as myokines and ketone bodies in the periphery and in the hippocampus to enhance BDNF expression. BDNF is a neurotrophin with well-established properties of promoting neuronal survival and synaptic integrity, while its influence on energy transduction may provide the crucial link between inherent vascular and metabolic benefits of exercise with enhanced brain function. Indeed, BDNF mRNA and protein is robustly elevated in rats following periods of voluntary exercise. This was also correlated with improved spatial memory, while such benefits were abolished upon inhibition of BDNF signaling. Similarly, both BDNF and cardiovascular fitness arising from aerobic exercise have been positively associated with hippocampal volume and function in humans. We postulate that exercise will attenuate cortical atrophy and synaptic loss inherent to neurodegenerative disorders - many of which also exhibit aberrant down-regulation of BDNF. Thus, the proposed link between BDNF, exercise and cognition may have critical therapeutic implications for the prevention and amelioration of memory loss and cognitive impairment in Alzheimer's disease and associated dementias.

Ideal Cardiovascular Health and Cognitive Test Performance: Testing a Modified Index of Life's Simple 7 Among Older Chinese Adults

Evidence suggests that cognitive decline in older adults is influenced by cardiovascular health (CVH), with metabolic and vascular mechanisms hypothesized to underlie the etiology of cognitive impairment. Research in high-income nations suggests that improved CVH is linked with decreased cognitive impairment risk, but it is unclear if this pattern is evident in low-income countries. Nationally-representative data collected in China were drawn from the World Health Organization's Study on global AGing and adult health Wave 1 (2007-2010; n = 11,295). Seven CVH factors were classified as "ideal" or "not ideal": smoking and drinking frequency, body mass index, physical activity level, blood pressure, diet, and self-reported anxiety. Additionally, scores from five cognitive performance tests (immediate and delayed verbal recall, forward and backward digit span, verbal fluency) were used to create a composite cognitive function variable. Linear regression analyses tested whether ideal CVH measures were associated with higher composite cognitive performance, controlling for sociodemographic factors. As hypothesized, ideal CVH was generally associated with higher cognitive performance. Low anxiety levels and reliable access to sufficient food (including produce) were particularly associated with higher cognitive function. These results suggest early detection and controlling modifiable CVH risks may protect aging individuals in China from cognitive decline.

Exercise as a therapeutic intervention for motor and non-motor symptoms in Parkinson's disease: Evidence from rodent models

Parkinson's disease (PD) is characterised by degeneration of dopaminergic neurons of the nigrostriatal pathway, which leads to the cardinal motor symptoms of the disease - tremor, rigidity and postural instability. A number of non-motor symptoms are also associated with PD, including cognitive impairment, mood disturbances and dysfunction of gastrointestinal and autonomic systems. Current therapies provide symptomatic relief but do not halt the disease process, so there is an urgent need for preventative strategies. Lifestyle interventions such as aerobic exercise have shown potential to lower the risk of developing PD and to alleviate both motor and non-motor symptoms. However, there is a lack of large-scale randomised clinical trials that have employed exercise in PD patients. This review will focus on the evidence from studies on rodent models of PD, for employing exercise as an intervention for both motor and non-motor symptoms.

Correlates of Cognitive Impairment among Indian Urban Elders

BACKGROUND

Cognitive impairment among elderly is increasing owing to increases in life expectancy globally. The problem is multifactorial. The objective of the present paper was to study the correlates of cognitive impairment in an urban elderly population in India.

METHODS

A cross sectional study was conducted among 100 randomly selected urban elderly population. Data was collected upon household visits using a predesigned pretested questionnaire administered by a trained investigator. Measurements included cognitive function assessment using Mini Mental State Examination, depression assessment using Geriatric Depression Scale, blood pressure measurement and anthropometry. Cognitive impairment was defined at MMSE score <24. Logistic regression was done to identify independently associated factors with cognitive impairment.

RESULTS

Prevalence of cognitive impairment among elderly was 10%. Women had a higher prevalence than men. Higher age, no schooling, living single, lower weight, lower waist and hip ratios, difficulty in activities of daily living, poor self-reported health, bedridden and depression significantly associated with cognitive impairment. The independently associated factors upon logistic regression were increasing age, no schooling and bedridden status for past six months.

CONCLUSION

Although the current prevalence of cognitive impairment among Indian urban elderly is low, several associated factors exist in this population that may increase the burden in future. Geriatric health policy should address the modifiable risk factors to manage the problem of cognitive impairment and its consequent outcomes.

Low Levels of Physical Activity Among Older Persons Living with HIV/AIDS Are Associated with Poor Physical Function

Antiretroviral therapy (ART) has prolonged lives of persons living with HIV/AIDS (PLWHA), resulting in greater incidence of aging-related diseases and disability. Physical activity (PA) is recommended for healthy aging, but little is known about PA in older PLWHA. The purpose of this study was to objectively assess PA levels in older PLWHA and the associations with physical function. Twenty-one PLWHA, ≥50 years old, on ART with undetectable HIV-1 viral loads, wore an accelerometer to assess PA, including number of steps, activity intensity, and energy expenditure over 7 days. A physical function performance battery assessing aerobic capacity, strength, and gait speed was also completed. Average age was 66, and 67% were male. An average of 3,442 (interquartile range: 4,613) steps were walked daily, with 254.9 kcals expended. Participants spent most waking hours (75%) sedentary, with minimal hours (24%) in light-intensity activity. Only 5 min per day (35 min per week), on average, were spent in moderate-to-vigorous physical activity (MVPA). Maximal gait speed and 6-min walk test significantly correlated (p < .05) with all PA outcomes. Usual gait speed significantly correlated with all PA outcomes, except for daily kcals and light-intensity activity. Greater PA was associated with better physical performance, while high sedentary time was associated with poorer performance. To our knowledge, this is the first study to objectively measure PA in older PLWHA. Our findings indicate that older PLWHA accumulate substantial sedentary time. Most (86%) do not achieve recommended MVPA levels. This activity profile was associated with poor physical function. Providers should promote PA among PLWHA.

Neuropsychological case report of MCI reversion at one-year follow-up

This report presents the neuropsychological profile of an older gentleman diagnosed with single-domain mild cognitive impairment (MCI) at baseline who reverted to normal cognitive functioning at 1-year follow-up. The case highlights important considerations for assessing and diagnosing MCI in clinical settings in the context of sizeable reversion rates that have been reported extensively in the literature. A 72-year-old gentleman presented to our Neuropsychology Clinic with subjective memory complaints. Per recommendation, the patient returned for follow-up testing 1-year later. A clinical interview, comprehensive battery of neuropsychological tests, and mood questionnaires were administered during both evaluations. At baseline, DSM-5 Mild Neurocognitive Disorder consistent with single-domain amnestic MCI was diagnosed based on several impaired scores on the California Verbal Learning Test, 2nd version (CVLT-II) and collateral report of subtle decline in functioning. At follow-up, all cognitive performances fell within normal limits. The patient no longer met criteria for Mild Neurocognitive Disorder. The present case study highlights important considerations when assessing and diagnosing MCI in the clinical setting. Repeat testing in clinical settings is underscored by the sizeable rate of MCI reversion reported in the literature. Important diagnostic and feedback considerations are discussed.

Effect of monosodium L-glutamate (umami substance) on cognitive function in people with dementia

Background/objectives

This study assessed the effect of continuous ingestion of monosodium l-glutamate (MSG) on cognitive function and dietary score in dementia patients.

Subjects/methods

This was a single-blind, placebo-controlled trial involving 159 subjects with dementia residing in a hospital or nursing home. We assigned the subjects to a group that ingested MSG thrice daily (0.9 g/dose) (MSG group; n = 79) or a group that ingested NaCl thrice daily (0.26 g/dose) (Control group; n = 80). This study consisted of a 12-week intake period, followed by a 4-week follow-up period without the ingestion of MSG or NaCl. We performed physical examination, cognitive symptom tests (the Touch Panel-type Dementia Assessment Scale (TDAS) and Gottfries–Bråne–Steen Scale (GBSS)), palatability and behaviour questionnaires, and blood tests before and after the intervention and after the follow-up period.

Results

There were no significant differences in the TDAS and GBSS total scores between the groups before and after the intervention. However, regarding the TDAS sub-items, “the accuracy of the order of a process” did not deteriorate in the MSG group compared with that observed in the Control group (p < 0.05). At the follow-up assessment, the TDAS total scores in the MSG group showed significant improvement compared with those reported in the Control group (p < 0.05). Furthermore, there was a correlation of changes from pre-intervention to post-intervention between the TDAS and enjoyment of the meal (r = −0.299, p = 0.049).

Conclusions

Our results suggest that continued ingestion of MSG has an effect on cognitive function. Furthermore, the patients with improved questionnaires about palatability survey showed greater improvement in cognitive function.

Mediterranean Lifestyle in Relation to Cognitive Health: Results from the HELIAD Study

Many lifestyle factors have been linked to cognitive function but little is known about their combined effect. An overall lifestyle pattern for people living in the Mediterranean basin has been proposed, including diet, but also physical activity, sleep and daily living activities with social/intellectual aspects. We aimed to examine the associations between a combination of these lifestyle factors and detailed cognitive performance. A total of 1716 participants from the Hellenic Longitudinal Investigation of Ageing and Diet (HELIAD), a population-based study of participants ≥65 years, were included in this analysis. Lifestyle factors were evaluated using standard, validated questionnaires and a Total Lifestyle Index (TLI) was constructed. Cognitive outcomes included mild cognitive impairment (MCI) diagnosis, a composite z-score (either continuous or with a threshold at the 25th percentile) and z-scores for five cognitive domains. A higher TLI was associated with 65% reduced odds for MCI in the non-demented individuals and 43% reduced odds for low global cognition when MCI participants were excluded, a risk reduction equivalent to 9 and 2.7 fewer years of ageing, respectively. Each lifestyle factor was differentially associated with domain-specific cognitive performance. Our results suggest that a TLI, more so than single lifestyle parameters, may be related to cognitive performance.

The provision of simple written material does not significantly improve physical activity rates in a population with musculoskeletal problems: a double-blinded randomised controlled trial

BACKGROUND

Physical activity has been shown to have significant health benefits to individuals, being effective in the treatment and prevention of multiple different conditions. However, despite these benefits, rates of physical activity remain low in the western world and less than 40% of people in the UK meet physical activity recommendations. Musculoskeletal pain can be a barrier to activity, and patients with pain can stop all activity out of fear of harm. This project seeks to see if simple written advice can influence activity rates and behaviors.

METHODS

A double-blinded randomized controlled trial was conducted to assess any impact of simple written material on physical activity rates in patients attending a single UK National Health Service (NHS) Sports Medicine Department. 546 consecutive patients with a range of musculoskeletal problems were randomised to either an "intervention group" (N.=235) or "control group" (N.=311). Patients in the intervention group received simple written material encouraging of the benefits of physical activity for general aspects of health, including practical steps to increase regular activity in daily life such as commuting, and work.

RESULTS

No significant difference in activity rates were seen between the members of the two groups in any of the outcome measures used. These measures included the short-form/7-day recall version of the International Physical Activity Questionnaire, the General Practitioner Physical Activity Questionnaire, and the "Vital Signs" questions. There were no differences seen in transport choices. Overall physical activity levels were low among both groups, with only one-third reaching national targets of 150 minutes of moderate-level physical activity per week, and one in five patients undertaking no regular physical activity.

CONCLUSIONS

The provision of simple written material does not significantly improve physical activity rates in patients referred to this NHS Sports Medicine Clinic in the UK. Consideration must be given to more tailored and individualized approached to physical activity promotion.

System biology approach intersecting diet and cell metabolism with pathogenesis of brain disorders

The surge in meals high in calories has prompted an epidemic of metabolic disorders around the world such that the elevated incidence of obese and diabetic individuals is alarming. New research indicates that metabolic disorders pose a risk for neurological and psychiatric conditions including stroke, Alzheimer's disease, Huntington's disease, and depression, all of which have a metabolic component. These relationships are rooted to a dysfunctional interaction between molecular processes that regulate energy metabolism and synaptic plasticity. The strong adaptive force of dietary factors on shaping the brain during evolution can be manipulated to transform the interaction between cell bioenergetics and epigenome with the aptitude to promote long-lasting brain healthiness. A thorough understanding of the association between the broad action of nutrients and brain fitness requires high level data processing empowered with the capacity to integrate information from a multitude of molecular entities and pathways. Nutritional systems biology is emerging as a viable approach to elucidate the multiple molecular layers involved in information processing in cells, tissues, and organ systems in response to diet. Information about the wide range of cellular and molecular interactions elicited by foods on the brain and cognitive plasticity is crucial for the design of public health initiatives for curtailing the epidemic of metabolic and brain disorders.

Muscle Thickness and Echo Intensity of the Abdominal and Lower Extremity Muscles in Stroke Survivors

Background and Purpose

This study compared the muscle thickness (MT) and echo intensity (EI) of the abdominal, thigh, and lower leg muscles between the paretic and nonparetic sides in chronic stroke survivors.

Methods

Thirty-two stroke survivors living in the community participated in this study. The MT and EI, which are indicators of muscle mass and intramuscular fat or connective tissue, were assessed in the rectus abdominis, external oblique, internal oblique, transversus abdominis, rectus femoris, vastus intermedius, vastus lateralis, vastus medialis, tibialis anterior, gastrocnemius, and soleus via transverse ultrasound imaging. In addition, a possible indicator of physical activity—the frequency of going out per week—was evaluated.

Results

All quadriceps muscles and the tibialis anterior were significantly thinner and the EI values of the vastus intermedius, vastus lateralis, vastus medialis, and soleus were significantly higher in the paretic limb than the nonparetic limb. The MT and EI values of abdominal muscles did not differ significantly between the two sides. The MT values of the paretic rectus femoris, vastus lateralis, and vastus medialis were significantly associated with the frequency of going out after adjusting confounding factors. The MT of the nonparetic vastus lateralis was significantly associated with latency from stroke onset after adjusting confounding factors.

Conclusions

Our results indicate that quantitative and qualitative changes on the paretic side in stroke survivors were the most robust in the thigh muscles, whereas such changes might not occur in the abdominal muscles.

Tea consumption is associated with cognitive impairment in older Chinese adults

OBJECTIVE

To explore the association between tea consumption and cognitive impairment (CoI).

METHODS

4579 adults (≥60 years) from the Weitang Geratric Diseases Study were assessed for characteristics of tea consumption and cognitive function by administering questionnaires and the Abbreviated Mental Test (AMT), respectively. We divided the subjects into normal cognitive function group (AMT score ≥8) and CoI group (AMT score ≤7).   The association between tea consumption and risk of CoI was determined by logistic regression models.

RESULTS

The least-squared means of the AMT scores for the subjects who seldom consumed tea were less favorable than those who habitually consumed tea. An inverse association was found between tea consumption (of any type) and prevalence of CoI (odds ratio = 0.74, 95% confidence interval = 0.57-0.98, P = 0.032). Interestingly, the protective correlation of tea was more obvious in never smokers (odds ratio = 0.63), but vanished in current/former smokers (odds ratio = 1.10). In never smokers, frequency of tea consumption was significantly associated with CoI (P for trend = 0.010).

CONCLUSION

Habitual tea consumption is suggested to be associated with a decreased risk of CoI among elders in Suzhou, and a higher frequency of tea consumption was associated with a lower prevalence of CoI among never smokers.