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Li Z, Guo H, Liu X. What exercise strategies are best for people with cognitive impairment and dementia? A systematic review and meta-analysis. Arch Gerontol Geriatr 2024; 124:105450. [PMID: 38692156 DOI: 10.1016/j.archger.2024.105450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/03/2024] [Accepted: 04/19/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Explore the types of exercise that are appropriate for people with dementia, as well as the intensity and frequency of exercise training that is appropriate for older patients to carry out. METHODS Cochrane Library, PubMed, Embase, Web of Science, Scopus databases were searched by computer to collect RCT studies that met the inclusion criteria of this article. The search time limit was until January 2024. Two reviewers independently screened literature, extracted data, and assessed the quality and risk of bias of the included studies. Then, meta-analysis was performed using RevMan 5.4 and Stata 15.1 software. RESULTS The results of our study showed that physical exercise improved patients' cognitive ability and walking ability, with aerobic and multicomponent training showing the best improvement, and that the number of training sessions should not be too high, with the experimental group showing the best results when the total number of interventions was less than 30. CONCLUSION We recommend long-term exercise training for middle-aged and elderly patients with dementia or those who are predisposed to dementia. The type of training we recommend is multi-component training and aerobic training, and we recommend 2-3 sessions of exercise per week for about 60 min each.
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Affiliation(s)
- Zecheng Li
- College of Sports Science, Harbin Normal University, Harbin, China
| | - Hongpeng Guo
- College of Sports Science, Harbin Normal University, Harbin, China.
| | - Xuebin Liu
- College of Sports Science, Harbin Normal University, Harbin, China
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Luo Q, Tian Z, Hu Y, Wang C. Effects of Aerobic Exercise on Executive and Memory Functions in Patients With Alzheimer's Disease: A Systematic Review. J Aging Phys Act 2024; 32:541-553. [PMID: 38521051 DOI: 10.1123/japa.2023-0292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/05/2023] [Accepted: 01/20/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Alzheimer's disease threatens the health of older adults, particularly by disrupting executive and memory functions, and many studies have shown that aerobic exercise prevents and improves the symptoms associated with the disease. OBJECTIVE The objective was to systematically review the effects of aerobic exercise on executive and memory functions in patients with Alzheimer's disease and to determine the effect factors and mechanisms of the design of aerobic exercise intervention programs. METHOD Relevant literature was searched in three databases (PubMed, Web of Science, and EBSCO) from January 1, 2014 to March 1, 2023, using a subject-word search method. Data on 10 items, including author and country, were extracted from the literature after screening. The quality of the literature was evaluated using the Physiotherapy Evidence Database scale, and a systematic review was performed. RESULTS Twelve papers from seven countries were ultimately included, embodying 11 randomized controlled trials and one study with a repeated-measures design. The overall quality of the studies was good as 657 study participants, aged 45 years and older who had varying degrees of Alzheimer's disease and significant symptoms, were included. Aerobic exercise was found to have a significant positive impact on executive and memory functions in people with Alzheimer's disease. CONCLUSION The effects of aerobic exercise on aspects of executive function were mainly characterized by improvements in inhibitory control, working memory, and cognitive flexibility, whereas the effects on aspects of memory function were mainly characterized by improvements in logical memory, situational memory, and short-term memory.
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Affiliation(s)
- Qiaoyou Luo
- College of Physical Education, Hunan University, Changsha, HUN, China
| | - Zuguo Tian
- College of Physical Education, Hunan University, Changsha, HUN, China
| | - Yuting Hu
- College of Physical Education, Hunan University, Changsha, HUN, China
| | - Chaochao Wang
- College of Physical Education, Hunan University, Changsha, HUN, China
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Liu S, Yang Y, Wang K, Zhang T, Luo J. A study on the impact of acute exercise on cognitive function in Alzheimer's disease or mild cognitive impairment patients: A narrative review. Geriatr Nurs 2024; 59:215-222. [PMID: 39053163 DOI: 10.1016/j.gerinurse.2024.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/28/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024]
Abstract
This narrative review follows the JBI approach and comprehensively explores the effects and mechanisms of acute exercise on cognitive function in Alzheimer's disease (AD) and Mild cognitive impairment (MCI) patients. The results showed that the combination of acute exercise and cognitive training improved the cognitive function of AD patients better than aerobic exercise or resistance training alone. For patients with MCI, moderate intensity acute aerobic exercise and resistance exercise were beneficial to enhance Inhibitory control (IC), but high-intensity acute exercise was adverse to improve IC; Brain-derived neurotrophic factor (BDNF) and Insulin-like growth factor 1 (IGF-1) may assume the potential mediating mechanism of acute exercise on cognitive function in AD and MCI patients, but more research is needed to further confirm this mechanism.
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Affiliation(s)
- Shiqi Liu
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, 400715, China
| | - Yi Yang
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, 400715, China
| | - Kun Wang
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, 400715, China
| | - Tingran Zhang
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, 400715, China
| | - Jiong Luo
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, 400715, China
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Wang M, Hua Y, Bai Y. A review of the application of exercise intervention on improving cognition in patients with Alzheimer's disease: mechanisms and clinical studies. Rev Neurosci 2024; 0:revneuro-2024-0046. [PMID: 39029521 DOI: 10.1515/revneuro-2024-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/08/2024] [Indexed: 07/21/2024]
Abstract
Alzheimer's disease (AD) is the most common form of dementia, leading to sustained cognitive decline. An increasing number of studies suggest that exercise is an effective strategy to promote the improvement of cognition in AD. Mechanisms of the benefits of exercise intervention on cognitive function may include modulation of vascular factors by affecting cardiovascular risk factors, regulating cardiorespiratory health, and enhancing cerebral blood flow. Exercise also promotes neurogenesis by stimulating neurotrophic factors, affecting neuroplasticity in the brain. Additionally, regular exercise improves the neuropathological characteristics of AD by improving mitochondrial function, and the brain redox status. More and more attention has been paid to the effect of Aβ and tau pathology as well as sleep disorders on cognitive function in persons diagnosed with AD. Besides, there are various forms of exercise intervention in cognitive improvement in patients with AD, including aerobic exercise, resistance exercise, and multi-component exercise. Consequently, the purpose of this review is to summarize the findings of the mechanisms of exercise intervention on cognitive function in patients with AD, and also discuss the application of different exercise interventions in cognitive impairment in AD to provide a theoretical basis and reference for the selection of exercise intervention in cognitive rehabilitation in AD.
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Affiliation(s)
- Man Wang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Road, Jing'an District, Shanghai 200040, China
- Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Yan Hua
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Road, Jing'an District, Shanghai 200040, China
| | - Yulong Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Road, Jing'an District, Shanghai 200040, China
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Venegas-Sanabria LC, Cavero-Redondo I, Lorenzo-Garcia P, Sánchez-Vanegas G, Álvarez-Bueno C. Efficacy of Nonpharmacological Interventions in Cognitive Impairment: Systematic Review And Network Meta-Analysis. Am J Geriatr Psychiatry 2024:S1064-7481(24)00385-3. [PMID: 39034265 DOI: 10.1016/j.jagp.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/26/2024] [Accepted: 06/28/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION There is currently no known cure for cognitive impairment, which highlights the need to explore other ways of managing this condition. This topic has recently become an area of active research. However, the availability of nonpharmacological options poses a challenge when trying to determine the best treatment for improving cognitive function. METHODS We conducted a systematic review and a Bayesian network meta-analysis to compare the effects of nonpharmacological interventions on global cognition in patients with mild cognitive impairment and dementia. The nonpharmacological interventions were classified as aerobic exercise, strength exercise, multicomponent physical exercise, other physical exercises, tai chi, mind-body exercises, traditional cognitive rehabilitation, computer-based cognitive rehabilitation, occupational therapy, music therapy, physical-cognitive rehabilitation, and reminiscence therapy. RESULTS Physical-cognitive rehabilitation emerged as the most effective nonpharmacological intervention for enhancing global cognition in patients with unspecified cognitive impairment and dementia, whereas occupational therapy focused on dual-task interventions was found to be the most effective nonpharmacological intervention for mild cognitive impairment. CONCLUSION These results underscore the importance of adopting a dual approach to managing cognitive impairment, integrating both cognitive and physical rehabilitation within the same intervention.
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Affiliation(s)
- Luis Carlos Venegas-Sanabria
- Health and Social Research Center, Camino de Pozuelo s/n (LCVS, ICR, PLG, CAB), Universidad de Castilla-La Mancha , Cuenca, Spain; Escuela de Medicina y Ciencias de la Salud (LCVS, GSV), Universidad del Rosario, Bogotá, Colombia; Hospital Universitario Mayor-Méderi (LCVS, GSV), Bogotá, Colombia.
| | - Iván Cavero-Redondo
- Health and Social Research Center, Camino de Pozuelo s/n (LCVS, ICR, PLG, CAB), Universidad de Castilla-La Mancha , Cuenca, Spain; Rehabilitation in Health Research Center (CIRES) (ICR), Universidad de Las Américas, Santiago, Chile; Facultad de Enfermería de Cuenca (ICR), Cuenca, Spain
| | - Patricia Lorenzo-Garcia
- Health and Social Research Center, Camino de Pozuelo s/n (LCVS, ICR, PLG, CAB), Universidad de Castilla-La Mancha , Cuenca, Spain
| | - Guillermo Sánchez-Vanegas
- Escuela de Medicina y Ciencias de la Salud (LCVS, GSV), Universidad del Rosario, Bogotá, Colombia; Hospital Universitario Mayor-Méderi (LCVS, GSV), Bogotá, Colombia
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Camino de Pozuelo s/n (LCVS, ICR, PLG, CAB), Universidad de Castilla-La Mancha , Cuenca, Spain; Universidad Politécnica y Artística del Paraguay (CAB), Asunción, Paraguay
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Akbuga Koc E, Yazici-Mutlu Ç, Cinar N, Sahiner T. Comparison of the effect of online physical exercise and computerized cognitive stimulation in patients with Alzheimer's disease during the Covid-19 pandemic. Complement Ther Clin Pract 2024; 57:101881. [PMID: 38959564 DOI: 10.1016/j.ctcp.2024.101881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/27/2024] [Accepted: 06/30/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION To investigate the effect of physical exercise alone and in combination with cognitive stimulation on cognition, physical function, and quality of life in patients with Alzheimer's Disease (PwAD). METHODS The study was a randomized controlled, single-blinded trial with pre-and post-treatment and follow-up assessments conducted at the private hospital and home environment in PwAD. Seventy-five (N = 75) participants diagnosed with AD were enrolled, but sixty (N = 60) participants (mean age 77.8 years, standard deviation (SD) 6.7) were randomized as physical exercise group (PEG) (n = 20), physical exercise and cognitive stimulation group (PE + CSG) (n = 20) and control group (CG) (n = 20). Participants in PEG and PE + CSG performed an online supervised physical exercise program (SPEP) given biweekly for 12 weeks. Additionally, the cognitive stimulation (CS) program was offered for at least three or five days for 12 weeks for PE + CSG. No treatment was given for the CG. The primary outcome measures were cognition, balance, functional mobility (FM), upper extremity muscle strength (UEMS) and lower extremity muscle strength (LEMS), and quality of life (QoL). Furthermore, depression, basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were measured secondarily. RESULTS PE + CSG demonstrated significant improvement in cognition, balance, FM, UEMS, IADL and reduction in depression compared to the CG (p < 0.05). Besides, participants in the PE + CSG had statistically superior QoL and IADL than the PEG (p < 0.05). CONCLUSIONS The addition of CS to the SPEP was a safe and effective method to gain statistically significant improvements in cognition, balance, FM, UEMS, IADL, and reduction in depression in PwAD.
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Affiliation(s)
- Ebru Akbuga Koc
- Yeditepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Çiğdem Yazici-Mutlu
- Yeditepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Nilgun Cinar
- Maltepe University, Faculty of Medicine, Department of Neurology, Istanbul, Turkey.
| | - Turker Sahiner
- Memorial Hospital, Department of Neuorology, Istanbul, Turkey.
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Wang Z, Xu X, Yang X, Wang SS, Zhou Y, Li Y. Effects of multicomponent exercise on cognitive function in persons with mild cognitive impairment: A systematic review and meta-analysis. Int J Nurs Stud 2024; 158:104843. [PMID: 39116586 DOI: 10.1016/j.ijnurstu.2024.104843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 06/05/2024] [Accepted: 06/11/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Multicomponent exercise has the potential to improve cognitive function in people with mild cognitive impairment. However, the effects of multicomponent exercise on specific cognitive subdomains in mild cognitive impairment and the optimal combination of exercise components remain unclear. OBJECTIVE This systematic review aimed to (a) investigate the effects of multicomponent exercise on different cognitive subdomains in people with mild cognitive impairment and (b) investigate the effects of different combinations of multicomponent exercise on global cognition in people with mild cognitive impairment. DESIGN A systematic review and meta-analysis. METHODS Six electronic databases, including PubMed, Medline, EMBASE, Web of Science, Cochrane Library, and CINAHL were systematically searched from inception to January 1st, 2023. Randomized controlled trials assessing the effect of multicomponent exercise interventions on cognitive function in people with mild cognitive impairment were included. The risk of bias was assessed using the Cochrane collaborative bias assessment tool. A random-effects model was used to calculate standardized mean difference. Subgroup analyses, meta-regression, and sensitive analysis were performed. If a meta-analysis was not feasible, studies were synthesized narratively. RESULTS Twenty studies were identified for systematic review and meta-analysis. Multicomponent exercise significantly improved global cognition [SMD = 1.04; 95 % confidence interval (CI): 0.53, 1.55], cognitive flexibility (SMD = -1.04; 95 % CI: -1.81, -0.27), processing speed (SMD = 0.43; 95 % CI: 0.04, 0.82), verbal fluency (SMD = 0.38; 95 % CI: 0.13, 0.63), attention (SMD = -0.90; 95 % CI: -1.68, -0.12) and memory (SMD = 0.36; 95 % CI: 0.04, 0.69) in mild cognitive impairment. The multicomponent exercise including cardiovascular (exercise that promotes cardiovascular health, such as endurance training or aerobic exercise) and motor (exercises that improve physical abilities, such as balance, coordination, agility, flexibility, etc.) components positively affected global cognition in people with mild cognitive impairment (SMD = 1.06; 95 % CI: 0.55, 1.57). CONCLUSIONS The findings of this study suggest that multicomponent exercise has a positive impact on various cognitive domains, including global cognition, cognitive flexibility, processing speed, verbal fluency, attention and memory in mild cognitive impairment. Specifically, the combination of exercises including cardiovascular and motor components was found to be effective in improving global cognition. However, further research is needed to investigate the optimal frequency and intensity of the multicomponent exercise intervention, and more detail about exercise combinations of the motor component (not classified in this study) for individuals with mild cognitive impairment. REGISTRATION The protocol was registered on PROSPERO (CRD42023400302).
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Affiliation(s)
- Zihan Wang
- School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Xinyi Xu
- School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Xinxin Yang
- School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Shan Shan Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Yi Zhou
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Yan Li
- School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, China; Neuroscience Research Center, Hebei Medical University, Shijiazhuang, Hebei, China; Hebei Key Laboratory of Neurodegenerative Disease Mechanism, Shijiazhuang, Hebei, China.
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Akalp K, Ferreira JP, Soares CM, Ribeiro MJ, Teixeira AM. The effects of different types of exercises on cognition in older persons with mild cognitive impairment: A systematic review and meta-analysis. Arch Gerontol Geriatr 2024; 126:105541. [PMID: 38981326 DOI: 10.1016/j.archger.2024.105541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/25/2024] [Accepted: 06/17/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE This systematic review with meta-analysis aims to analyze the effects of different types of exercise on cognition, neuroprotective and neuroinflammatory blood markers in older adults with mild cognitive impairment (MCI). METHODS Relevant studies were identified using PubMED, SPORTDiscuss, Web of Science, Scopus, and PsycInfo databases. Methodological quality assessment of the studies was done with modified Downs and Black checklist. Data obtained from the included studies was analyzed using Comprehensive Meta-Analysis 4.0 software and results were reported using the random effects method. RESULTS A total of twenty-three studies were identified. The findings were summarized as change in cognitive function after the exercise interventions in general and after each type of exercise. On average, the exercise intervention revealed an effect size (ES): 1.165; 0.741 to 1.589 (95% Confidence Interval (CI); p < 0.001); aerobic exercise ES: 1.442; 0.624 to 2.260 (95 %CI); p = 0.001; Multimodal ES: 0,856; 0.366 to 1.346 (95 % CI); p = 0.001 and resistance exercise ES: 1.229; 0.339 to 2.120 (95 % CI); p = 0.007. In addition, we observed significant small ES: -0.475; -0.817 to -0.134 (95 %CI); p = 0.006, I2= 0 %; τ2 = 0 of exercise effects on Tumor Necrosis Factor-α (TNF-α) and non-significant large ES:0.952; -0.238 to 2.142 (95 %CI); p = 0.117 on Brain Derived Neurotrophic Factor (BDNF) in persons with MCI. CONCLUSION The present study revealed the existence of a large positive effect of overall exercise intervention on cognitive function and a small effect on TNF-α in old people with MCI. Additionally, this study demonstrates that aerobic and resistance exercises had similar larger positive effects and were better than multimodal exercise on increasing cognition in older persons with MCI.
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Affiliation(s)
- Kaan Akalp
- University of Coimbra, Research Unit for Sport and Physical Activity(CIDAF -doi: 10.54499/UIDP/04213/2020), Faculty of Sport Sciences and Physical Education, 3040-248 Coimbra, Portugal.
| | - José Pedro Ferreira
- University of Coimbra, Research Unit for Sport and Physical Activity(CIDAF -doi: 10.54499/UIDP/04213/2020), Faculty of Sport Sciences and Physical Education, 3040-248 Coimbra, Portugal
| | - Carlos M Soares
- University of Coimbra, Research Unit for Sport and Physical Activity(CIDAF -doi: 10.54499/UIDP/04213/2020), Faculty of Sport Sciences and Physical Education, 3040-248 Coimbra, Portugal; University of Coimbra, Molecular Physical-Chemistry R&D Unit, Department of Chemistry, University of Coimbra, 3004-535 Coimbra, Portugal; Higher Institute of Educational Sciences of Douro, ISCE Research Center (CI-ISCE), 4560-708 Penafiel, Portugal
| | - Maria José Ribeiro
- University of Coimbra, CIBIT-ICNAS, Coimbra, Portugal; University of Coimbra, Faculty of Medicine, Coimbra, Portugal
| | - Ana Maria Teixeira
- University of Coimbra, Research Unit for Sport and Physical Activity(CIDAF -doi: 10.54499/UIDP/04213/2020), Faculty of Sport Sciences and Physical Education, 3040-248 Coimbra, Portugal
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Rehman MU, Sehar N, Rasool I, Aldossari RM, Wani AB, Rashid SM, Wali AF, Ali A, Arafah A, Khan A. Glymphatic pathway: An emerging perspective in the pathophysiology of neurodegenerative diseases. Int J Geriatr Psychiatry 2024; 39:e6104. [PMID: 38877354 DOI: 10.1002/gps.6104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 05/23/2024] [Indexed: 06/16/2024]
Abstract
The central nervous system (CNS) is widely recognized as the only organ system without lymphatic capillaries to promote the removal of interstitial metabolic by-products. Thus, the newly identified glymphatic system which provides a pseudolymphatic activity in the nervous system has been focus of latest research in neurosciences. Also, findings reported that, sleep stimulates the elimination actions of glymphatic system and is linked to normal brain homeostatis. The CNS is cleared of potentially hazardous compounds via the glymphatic system, particularly during sleep. Any age-related alterations in brain functioning and pathophysiology of various neurodegenerative illnesses indicates the disturbance of the brain's glymphatic system. In this context, β-amyloid as well as tau leaves the CNS through the glymphatic system, it's functioning and CSF discharge markedly altered in elderly brains as per many findings. Thus, glymphatic failure may have a potential mechanism which may be therapeutically targetable in several neurodegenerative and age-associated cognitive diseases. Therefore, there is an urge to focus for more research into the connection among glymphatic system and several potential brain related diseases. Here, in our current review paper, we reviewed current research on the glymphatic system's involvement in a number of prevalent neurodegenerative and neuropsychiatric diseases and, we also discussed several therapeutic approaches, diet and life style modifications which might be used to acquire a more thorough performance and purpose of the glymphatic system to decipher novel prospects for clinical applicability for the management of these diseases.
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Affiliation(s)
- Muneeb U Rehman
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Nouroz Sehar
- Centre for Translational and Clinical Research, School of Chemical & Life Sciences, Jamia Hamdard, New Delhi, India
| | - Iyman Rasool
- Department of Pathology, Government Medical College (GMC-Srinagar), Srinagar, Jammu and Kashmir, India
| | - Rana M Aldossari
- Department of Pharmacology & Toxicology, College of Pharmacy, Prince Sattam Bin AbdulAziz University, Al Kharj, Saudi Arabia
| | - Amir Bashir Wani
- Division of Biotechnology, Sher-e-Kashmir University of Agricultural Sciences and Technology-Kashmir, Srinagar, Jammu and Kashmir, India
| | - Shahzada Mudasir Rashid
- Division of Veterinary Biochemistry, Faculty of Veterinary Science and Animal Husbandry, SKUAST-Kashmir, Alusteng, Shuhama, Srinagar, Jammu and Kashmir, India
| | - Adil Farooq Wali
- Department of Pharmaceutical Chemistry, RAK College of Pharmaceutical Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Aarif Ali
- Division of Veterinary Biochemistry, Faculty of Veterinary Science and Animal Husbandry, SKUAST-Kashmir, Alusteng, Shuhama, Srinagar, Jammu and Kashmir, India
| | - Azher Arafah
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Andleeb Khan
- Department of Biosciences, Faculty of Science, Integral University, Lucknow, Uttar Pradesh, India
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García-Llorente AM, Casimiro-Andújar AJ, Linhares DG, De Souza Vale RG, Marcos-Pardo PJ. Multidomain interventions for sarcopenia and cognitive flexibility in older adults for promoting healthy aging: a systematic review and meta-analysis of randomized controlled trials. Aging Clin Exp Res 2024; 36:47. [PMID: 38386173 PMCID: PMC10884056 DOI: 10.1007/s40520-024-02700-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/08/2024] [Indexed: 02/23/2024]
Abstract
The global population is undergoing rapid aging, making physical activity a crucial element in preventing mortality and lowering the risk of Alzheimer's disease. Age-related declines in muscle mass and cognitive abilities significantly contribute to frailty and dependency. Thus, this study focuses on a meticulous analysis of the protective effects of multidomain interventions, an emerging resource combating age-related declines. It seeks to underscore their profound impact on cognitive flexibility and sarcopenia, highlighting their pivotal role in mitigating the adverse effects of aging. To identify relevant randomized controlled trials up to November 2023, we reviewed eight online academic databases, following PERSiST guidelines, PRISMA reporting system, and PICOs criteria. Meta-analyses on selected functional outcomes utilized a random-effects model, including the Timed Up and Go Test, Sit to Stand Test, Victoria Stroop Test, and Trail Making Test. Out of 2082 scrutinized articles, 17 were included in the systematic review, and 8 in the meta-analysis. Positive effects (p = 0.05, I2 = 57%; 95% CI - 0.63 to - 0.05) were observed in cognitive flexibility for certain interventions. Similarly, interventions addressing muscle strength demonstrated improvements in the Sit to Stand Test for the exercise group compared to the control group (p = 0.02, I2 = 0%; 95% CI - 0.63 to - 0.05). These findings underscore the importance of incorporating physical activity as a primary component of public health interventions for promoting healthy aging and reducing the burden of age-related diseases. Future interventions may explore more homogeneous approaches and evaluate the impact of thrice multidomain weekly sessions.
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Affiliation(s)
- A M García-Llorente
- SPORT Research Group (CTS-1024), Department of Education, CIBIS (Centro de Investigación Para el Bienestar y la Inclusión Social) Research Center, Area of Physical Education and Sport, University of Almería, Office 0.22, Building CITE III, Almería, Spain.
| | - A J Casimiro-Andújar
- SPORT Research Group (CTS-1024), Department of Education, CIBIS (Centro de Investigación Para el Bienestar y la Inclusión Social) Research Center, Area of Physical Education and Sport, University of Almería, Office 0.22, Building CITE III, Almería, Spain
- Department of Education, Faculty of Education Sciences, University of Almeria, 04120, Almeria, Spain
- Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes (CSD), Ministry of Culture and Sport of Spain, 28040, Madrid, Spain
| | - D G Linhares
- Universidade do Estado de Rio de Janeiro, Rio de Janeiro, BR, Brazil
| | - R G De Souza Vale
- Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes (CSD), Ministry of Culture and Sport of Spain, 28040, Madrid, Spain
- Universidade do Estado de Rio de Janeiro, Rio de Janeiro, BR, Brazil
- Laboratorio de Ejercicio y Deporte, Instituto de Educación Física y Deportes, Universidad del Estado de Rio de Janeiro, Rio de Janeiro, 20550-900, Brazil
| | - P J Marcos-Pardo
- SPORT Research Group (CTS-1024), Department of Education, CIBIS (Centro de Investigación Para el Bienestar y la Inclusión Social) Research Center, Area of Physical Education and Sport, University of Almería, Office 0.22, Building CITE III, Almería, Spain.
- Department of Education, Faculty of Education Sciences, University of Almeria, 04120, Almeria, Spain.
- Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes (CSD), Ministry of Culture and Sport of Spain, 28040, Madrid, Spain.
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Ayed IB, Aouichaoui C, Ammar A, Naija S, Tabka O, Jahrami H, Trabelsi K, Trabelsi Y, El Massioui N, El Massioui F. Mid-Term and Long-Lasting Psycho-Cognitive Benefits of Bidomain Training Intervention in Elderly Individuals with Mild Cognitive Impairment. Eur J Investig Health Psychol Educ 2024; 14:284-298. [PMID: 38391486 PMCID: PMC10887966 DOI: 10.3390/ejihpe14020019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Background: This study investigated whether combining simultaneous physical and cognitive training yields superior cognitive outcomes compared with aerobic training alone in individuals with mild cognitive impairment (MCI) and whether these benefits persist after four weeks of detraining. Methods: Forty-four people with MCI (11 males and 33 females) aged 65 to 75 years were randomly assigned to an 8-week, twice-weekly program of either aerobic training (AT group, n = 15), aerobic training combined with cognitive games (ACT group, n = 15), or simply reading for controls (CG group, n = 14). Selective attention (Stroop), problem-solving (Hanoi Tower), and working memory (Digit Span) tasks were used to assess cognitive performances at baseline, in the 4th (W4) and 8th weeks (W8) of training, and after 4 weeks of rest (W12). Results: Both training interventions induced beneficial effects on all tested cognitive performance at W4 (except for the number of moves in the Hanoi tower task) and W8 (all p <0.001), with the ACT group exhibiting a more pronounced positive impact than the AT group (p < 0.05). This advantage was specifically observed at W8 in tasks such as the Stroop and Tower of Hanoi (% gain ≈40% vs. ≈30% for ACT and AT, respectively) and the digit span test (% gain ≈13% vs. ≈10% for ACT and AT, respectively). These cognitive improvements in both groups, with the greater ones in ACT, persisted even after four weeks of detraining, as evidenced by the absence of a significant difference between W8 and W12 (p > 0.05). Concerning neuropsychological assessments, comparable beneficial effects were recorded following both training regimens (all p < 0.05 from pre- to post-intervention). The control group did not show any significant improvement in most of the cognitive tasks. Conclusions: The greater mid-term and long-lasting effects of combined simultaneous physical-cognitive training underscores its potential as a cost-effective intervention for the prevention and management of cognitive decline. While these results are valuable in guiding optimal physical and mental activity recommendations for adults with MCI, further neurophysiological-based studies are essential to offer robust support and deepen our understanding of the mechanisms underlying these promising findings.
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Affiliation(s)
- Ines Ben Ayed
- Research Laboratory, Exercise Physiology and Physiopathology: From Integrated to Molecular "Biology, Medicine and Health", LR19ES09, Faculty of Medicine of Sousse, Sousse University, Sousse 4000, Tunisia
- Laboratory of Human and Artificial Cognition (EA 4004), Psychology UFR, University of Vincennes/Saint-Denis, 93200 Saint-Denis, France
- Research Laboratory, Education, Motricity, Sport and Health (EM2S), LR15JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia
| | - Chirine Aouichaoui
- Research Laboratory, Exercise Physiology and Physiopathology: From Integrated to Molecular "Biology, Medicine and Health", LR19ES09, Faculty of Medicine of Sousse, Sousse University, Sousse 4000, Tunisia
- High Institute of Sport and Physical Education of Ksar Saïd, University of Manouba, Mannouba 2010, Tunisia
| | - Achraf Ammar
- Department of Training and Movement Science, Institute of Sport Science, Johannes-Gutenberg-University Mainz, 55122 Mainz, Germany
- Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine of Sfax, University of Sfax, Sfax 3000, Tunisia
- Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS, UPL, Paris Nanterre University, 92000 Nanterre, France
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3029, Tunisia
| | - Salma Naija
- Neurology Department, University Hospital Sahloul Sousse, Sousse 4052, Tunisia
| | - Oussama Tabka
- Research Laboratory, Exercise Physiology and Physiopathology: From Integrated to Molecular "Biology, Medicine and Health", LR19ES09, Faculty of Medicine of Sousse, Sousse University, Sousse 4000, Tunisia
| | - Haitham Jahrami
- College of Medicine and Medical Science, Arabian Gulf University, Manama 293, Bahrain
| | - Khaled Trabelsi
- Research Laboratory, Education, Motricity, Sport and Health (EM2S), LR15JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3029, Tunisia
| | - Yassine Trabelsi
- Research Laboratory, Exercise Physiology and Physiopathology: From Integrated to Molecular "Biology, Medicine and Health", LR19ES09, Faculty of Medicine of Sousse, Sousse University, Sousse 4000, Tunisia
| | - Nicole El Massioui
- Laboratory of Human and Artificial Cognition (EA 4004), Psychology UFR, University of Vincennes/Saint-Denis, 93200 Saint-Denis, France
| | - Farid El Massioui
- Laboratory of Human and Artificial Cognition (EA 4004), Psychology UFR, University of Vincennes/Saint-Denis, 93200 Saint-Denis, France
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12
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Wang N, Wang L, Wang J, Chen R, Shi M, Liu H, Xu X. Effects of physical activity and depressive symptoms on cognitive function in older adults: National Health and Nutrition Examination Survey. Neurol Sci 2024; 45:299-308. [PMID: 38062279 DOI: 10.1007/s10072-023-07250-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND & AIMS Population aging is a growing phenomenon, with cognitive impairment becoming a prevalent issue among the elderly. This study aimed to investigate the impact of physical activity and depressive symptoms on cognitive function in older adults using a nationally representative data set of U.S. older adults aged ≥ 60 years. METHODS The study comprised 2713 participants aged ≥ 60 from the National Health and Nutrition Examination Survey 2011-2014. Participants were classified into two groups: Cognitive impairment and No-Cognitive impairment, determined by the results of the Digit Symbol Substitution Test (DSST). Physical activity (PA) was assessed using the Global Physical Activity questionnaire (GPAQ), while depressive symptoms were evaluated using the Patient Health Questionnaire (PHQ-9). Logistic regression analysis examined the relationship between physical activity, depressive symptoms and cognitive function. RESULTS Multifactorial logistic regression analysis showed that high levels of physical activity were found to be significantly associated with a lower risk of cognitive impairment compared to low levels of physical activity [OR = 0.789, 95% CI:0.632 ~ 0.986, P = 0.037]. On the other hand, the presence of major depressive symptoms was significantly associated with a higher risk of cognitive impairment compared to the absence of depressive symptoms [OR = 3.482, 95% CI: 2.278 ~ 5.324, P < 0.001]. Participants in the recreational physical activity group exhibited higher Cognitive scores (P < 0.001), indicating better cognitive functioning. CONCLUSION High levels of Physical activity were independently associated with a lower incident cognitive impairment. Additionally, the severity of depression was positively correlated with an increased risk of cognitive impairment.
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Affiliation(s)
- Na Wang
- General Practice, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Long Wang
- General Practice, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Jun Wang
- General Practice, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Rong Chen
- General Practice, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Menglian Shi
- General Practice, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Huanbing Liu
- General Practice, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Xinqun Xu
- General Practice, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China.
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Gelfo F, Petrosini L, Mandolesi L, Landolfo E, Caruso G, Balsamo F, Bonarota S, Bozzali M, Caltagirone C, Serra L. Land/Water Aerobic Activities: Two Sides of the Same Coin. A Comparative Analysis on the Effects in Cognition of Alzheimer's Disease. J Alzheimers Dis 2024; 98:1181-1197. [PMID: 38552114 DOI: 10.3233/jad-231279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Evidence in the literature indicates that aerobic physical activity may have a protective role in aging pathologies. However, it has not been clarified whether different types of aerobic exercise produce different effects. In particular, these potential differences have not been explored in patients with Alzheimer's disease (AD). The present narrative review has the specific aim of evaluating whether land (walking/running) and water (swimming) aerobic activities exert different effects on cognitive functions and neural correlates in AD patients. In particular, the investigation is carried out by comparing the evidence provided from studies on AD animal models and on patients. On the whole, we ascertained that both human and animal studies documented beneficial effects of land and water aerobic exercise on cognition in AD. Also, the modulation of numerous biological processes is documented in association with structural modifications. Remarkably, we found that aerobic activity appears to improve cognition per se, independently from the specific kind of exercise performed. Aerobic exercise promotes brain functioning through the secretion of molecular factors from skeletal muscles and liver. These molecular factors stimulate neuroplasticity, reduce neuroinflammation, and inhibit neurodegenerative processes leading to amyloid-β accumulation. Additionally, aerobic exercise improves mitochondrial activity, reducing oxidative stress and enhancing ATP production. Aerobic activities protect against AD, but implementing exercise protocols for patients is challenging. We suggest that health policies and specialized institutions should direct increasing attention on aerobic activity as lifestyle modifiable factor for successful aging and age-related conditions.
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Affiliation(s)
- Francesca Gelfo
- IRCCS Fondazione Santa Lucia, Rome, Italy
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
| | | | - Laura Mandolesi
- Department of Humanities, Federico II University of Naples, Naples, Italy
| | | | | | - Francesca Balsamo
- IRCCS Fondazione Santa Lucia, Rome, Italy
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
| | - Sabrina Bonarota
- IRCCS Fondazione Santa Lucia, Rome, Italy
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Marco Bozzali
- Department of Neuroscience 'Rita Levi Montalcini', University of Torino, Turin, Italy
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
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14
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Lv S, Wang Q, Liu W, Zhang X, Cui M, Li X, Xu Y. Comparison of various exercise interventions on cognitive function in Alzheimer's patients: A network meta-analysis. Arch Gerontol Geriatr 2023; 115:105113. [PMID: 37418819 DOI: 10.1016/j.archger.2023.105113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/31/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE Exercise helps enhance cognitive function in Alzheimer's patients, although the most effective forms of exercise remain unknown. METHODS This network meta-analysis was registered in INPLASY (INPLASY202330066). According to predetermined criteria, this investigation comprised randomized controlled studies involving exercise therapies in people with Alzheimer's disease. The exercise intervention was ranked using surface under the cumulative ranking curve (SUCRA) and mean ranking, with the critical goal outcomes being overall cognition, executive function, and memory function. RESULTS Resistance exercise is the most likely strategy to be beneficial for slowing down overall cognitive function loss in Alzheimer's patients (72.4%). Additionally, multi-component exercise was the most effective way to improve executive function (30.4%). The only type of exercise that significantly affects memory function is resistance exercise. Memory is the cognitive function that is least responsive to exercise. CONCLUSION Resistance exercise may be an efficient intervention for overall cognitive function decline in patients with Alzheimer's and conjointly for their memory function. Multi-component exercise is more effective in improving executive function in patients with Alzheimer's disease.
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Affiliation(s)
- Shi Lv
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
| | - Qian Wang
- Postdoctoral Workstation, Department of Central Laboratory, The Affiliated Taian City Central Hospital of Qingdao University, Taian 271000, China
| | - Wenxin Liu
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
| | - Xinlei Zhang
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
| | - Mengmeng Cui
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
| | - Xiubin Li
- Department of Neurology, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China.
| | - Yuzhen Xu
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China.
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15
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Andrade-Guerrero J, Rodríguez-Arellano P, Barron-Leon N, Orta-Salazar E, Ledesma-Alonso C, Díaz-Cintra S, Soto-Rojas LO. Advancing Alzheimer's Therapeutics: Exploring the Impact of Physical Exercise in Animal Models and Patients. Cells 2023; 12:2531. [PMID: 37947609 PMCID: PMC10648553 DOI: 10.3390/cells12212531] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
Abstract
Alzheimer's disease (AD) is the main neurodegenerative disorder characterized by several pathophysiological features, including the misfolding of the tau protein and the amyloid beta (Aβ) peptide, neuroinflammation, oxidative stress, synaptic dysfunction, metabolic alterations, and cognitive impairment. These mechanisms collectively contribute to neurodegeneration, necessitating the exploration of therapeutic approaches with multiple targets. Physical exercise has emerged as a promising non-pharmacological intervention for AD, with demonstrated effects on promoting neurogenesis, activating neurotrophic factors, reducing Aβ aggregates, minimizing the formation of neurofibrillary tangles (NFTs), dampening inflammatory processes, mitigating oxidative stress, and improving the functionality of the neurovascular unit (NVU). Overall, the neuroprotective effects of exercise are not singular, but are multi-targets. Numerous studies have investigated physical exercise's potential in both AD patients and animal models, employing various exercise protocols to elucidate the underlying neurobiological mechanisms and effects. The objective of this review is to analyze the neurological therapeutic effects of these exercise protocols in animal models and compare them with studies conducted in AD patients. By translating findings from different approaches, this review aims to identify opportune, specific, and personalized therapeutic windows, thus advancing research on the use of physical exercise with AD patients.
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Affiliation(s)
- Jesús Andrade-Guerrero
- Laboratorio de Patogénesis Molecular, Laboratorio 4, Edificio A4, Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla 54090, Mexico;
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Queretaro 76230, Mexico; (P.R.-A.); (N.B.-L.); (E.O.-S.); (C.L.-A.)
| | - Paola Rodríguez-Arellano
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Queretaro 76230, Mexico; (P.R.-A.); (N.B.-L.); (E.O.-S.); (C.L.-A.)
| | - Nayeli Barron-Leon
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Queretaro 76230, Mexico; (P.R.-A.); (N.B.-L.); (E.O.-S.); (C.L.-A.)
| | - Erika Orta-Salazar
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Queretaro 76230, Mexico; (P.R.-A.); (N.B.-L.); (E.O.-S.); (C.L.-A.)
| | - Carlos Ledesma-Alonso
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Queretaro 76230, Mexico; (P.R.-A.); (N.B.-L.); (E.O.-S.); (C.L.-A.)
| | - Sofía Díaz-Cintra
- Departamento de Neurobiología del Desarrollo y Neurofisiología, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Queretaro 76230, Mexico; (P.R.-A.); (N.B.-L.); (E.O.-S.); (C.L.-A.)
| | - Luis O. Soto-Rojas
- Laboratorio de Patogénesis Molecular, Laboratorio 4, Edificio A4, Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla 54090, Mexico;
- Red MEDICI, Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla 54090, Mexico
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16
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Lin JC, Chen IH, Cheng FY. Review articles (Meta-Analyses) effects of walking on cognitive function in individuals with mild cognitive impairment: a systematic review and meta-analysis. BMC Geriatr 2023; 23:500. [PMID: 37605156 PMCID: PMC10441758 DOI: 10.1186/s12877-023-04235-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 08/14/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) is the stage between the expected cognitive decline of normal aging and the more serious decline of dementia. Previous studies have shown that regular exercise can improve cognition and physical performance in older adults. Walking is a low-technology and low-cost exercise that has been proven to improve cognition and mobility in healthy elderly individuals. However, no systematic review or meta-analysis has explored whether walking can improve cognitive function in older adults with MCI. This study aimed to explore the effects of walking interventions on cognitive functions in individuals with MCI. METHODS In accordance with the PRISMA guidelines, MEDLINE, PubMed, SPORTDiscus, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, Airiti Library, and the National Digital Library of Theses and Dissertations in Taiwan were searched from inception to July 2023. Independent reviewers selected randomized clinical trials (RCT) that compared the effects of walking with no intervention or other exercises in individuals with MCI. The primary outcomes were cognitive functions, and the secondary outcome was walking endurance. Three reviewers independently conducted data extraction. The risk of bias was assessed using the Revised Cochrane Risk of Bias assessment tool. RESULTS Fourteen RCTs were included in this review. The quality of evidence in these studies was rated as good to excellent. The results of the meta-analysis showed that the individuals with MCI had no significant improvement in cognitive function but had significant improvement in the 6-min walk test (Mean Difference=23.70, p=0.008) after walking interventions compared to no intervention or other exercises. CONCLUSION Walking intervention has no significant improvement on cognitive functions in older adults with MCI. However, walking induces beneficial effects on aerobic capacity. TRIAL REGISTRATION This systematic review has the registration number CRD42021283753 on PROSPERO.
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Affiliation(s)
- Jia-Chi Lin
- MacKay Medical College, Institute of Long-Term Care, No.46, Sec. 3, Zhongzheng Rd, Sanzhi Dist, New Taipei City, 252, Taiwan
| | - I-Hsuan Chen
- Department of Physical Therapy, Fooyin University, Kaohsiung City, Taiwan
| | - Fang-Yu Cheng
- MacKay Medical College, Institute of Long-Term Care, No.46, Sec. 3, Zhongzheng Rd, Sanzhi Dist, New Taipei City, 252, Taiwan.
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Lopera F, Custodio N, Rico-Restrepo M, Allegri RF, Barrientos JD, Garcia Batres E, Calandri IL, Calero Moscoso C, Caramelli P, Duran Quiroz JC, Jansen AM, Mimenza Alvarado AJ, Nitrini R, Parodi JF, Ramos C, Slachevsky A, Brucki SMD. A task force for diagnosis and treatment of people with Alzheimer's disease in Latin America. Front Neurol 2023; 14:1198869. [PMID: 37497015 PMCID: PMC10367107 DOI: 10.3389/fneur.2023.1198869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/21/2023] [Indexed: 07/28/2023] Open
Abstract
Alzheimer's disease (AD) represents a substantial burden to patients, their caregivers, health systems, and society in Latin America and the Caribbean (LAC). This impact is exacerbated by limited access to diagnosis, specialized care, and therapies for AD within and among nations. The region has varied geographic, ethnic, cultural, and economic conditions, which create unique challenges to AD diagnosis and management. To address these issues, the Americas Health Foundation convened a panel of eight neurologists, geriatricians, and psychiatrists from Argentina, Brazil, Colombia, Ecuador, Guatemala, Mexico, and Peru who are experts in AD for a three-day virtual meeting to discuss best practices for AD diagnosis and treatment in LAC and create a manuscript offering recommendations to address identified barriers. In LAC, several barriers hamper diagnosing and treating people with dementia. These barriers include access to healthcare, fragmented healthcare systems, limited research funding, unstandardized diagnosis and treatment, genetic heterogeneity, and varying social determinants of health. Additional training for physicians and other healthcare workers at the primary care level, region-specific or adequately adapted cognitive tests, increased public healthcare insurance coverage of testing and treatment, and dedicated search strategies to detect populations with gene variants associated with AD are among the recommendations to improve the landscape of AD.
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Affiliation(s)
- Francisco Lopera
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, Medellín, Colombia
| | - Nilton Custodio
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
| | | | - Ricardo F. Allegri
- Department of Cognitive Neurology, Instituto Neurológico Fleni, Buenos Aires, Argentina
| | | | - Estuardo Garcia Batres
- Geriatric Unit, New Hope, Interior Hospital Atención Medica Siloé, Ciudad de Guatemala, Guatemala
| | - Ismael L. Calandri
- Department of Cognitive Neurology, Instituto Neurológico Fleni, Buenos Aires, Argentina
| | - Cristian Calero Moscoso
- Department of Neurology, HCAM Memory and Behavior Unit, University of Hospital Carlos Andrade Marin HCAM, Quito, Ecuador
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Group, Faculty of Medicine, University of Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Juan Carlos Duran Quiroz
- Faculty of Medicine, Department of Functional Sciences, Physiology Division, Universidad Mayor de San Andres, La Paz, Bolivia
| | | | - Alberto José Mimenza Alvarado
- Memory Disorders Clinic, Neurological Geriatrics Program, Department of Geriatrics, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Ricardo Nitrini
- Cognitive and Behavioral Neurology Group, Department of Neurology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Jose F. Parodi
- Centro de Investigación del Envejecimiento, Facultad de Medicina, Universidad de San Martín de Porres, Lima, Peru
| | - Claudia Ramos
- Antioquia Neurosciences Group, University of Antioquia, Medellin, Colombia
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism (GERO), University of Chile, Santiago, Chile
| | - Sonia María Dozzi Brucki
- Cognitive and Behavioral Neurology Group, Department of Neurology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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18
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Wang YY, Wang XX, Chen L, Liu Y, Li YR. A systematic review and network meta-analysis comparing various non-pharmacological treatments for older people with mild cognitive impairment. Asian J Psychiatr 2023; 86:103635. [PMID: 37270875 DOI: 10.1016/j.ajp.2023.103635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Non-pharmacological therapy appeared to alleviate Mild Cognitive Impairment (MCI) symptoms and signs, according to systematic studies. This network meta-analysis aimed to assess the impact of non-pharmacological therapies on improving cognition in individuals with MCI and identified the most effective intervention. METHODS We reviewed six databases in search of potentially relevant studies of non-pharmacological therapies such as Physical exercise (PE), Multidisciplinary intervention (MI), Musical therapy (MT), Cognitive training (CT), Cognitive stimulation (CS), Cognitive rehabilitation (CR),Art therapy (AT), general psychotherapy or interpersonal therapy (IPT), and Traditional Chinese Medicine (TCM) (such as acupuncture therapy, massage, auricular-plaster and other related systems) and others. Excluded the literature such as missing full text, missing search results, or no reporting specific values and combined with the inclusion criteria and exclusion criteria in this article, the literature ultimately included in the analysis addressed the following seven non-drug therapies PE, MI, MT, CT, CS, CR, AT. Mini-mental state evaluation paired meta-analyses were undertaken by taking weighted average mean differences with confidence intervals (CI) of 95%. The network meta-analysis was conducted to compare various therapies. RESULTS A total of 39 randomized controlled trials, including two three-arm studies, with 3157 participants were included. PE was most likely to be the most effective intervention to slow down the cognitive ability of patients (SMD = 1.34, 95%CI: 0.80, 1.89). CS and CR had no significant effect on cognitive ability. CONCLUSIONS The non-pharmacological therapy had the potential to greatly promote the cognitive ability of the adult population with MCI. PE had the best chance of being the best non-pharmacological therapy. Due to the limited sample size, substantial variability among different study designs, and the potential for bias, the results should be regarded with caution. Our findings should be confirmed by future multi-center randomized controlled, high-quality large-scale studies.
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Affiliation(s)
- Yuan-Yuan Wang
- School of Public Health and Health Management, Anhui Medical College, Hefei City, Anhui Province 230061, China.
| | - Xiao-Xian Wang
- School of Public Health and Health Management, Anhui Medical College, Hefei City, Anhui Province 230061, China
| | - Lei Chen
- School of Public Health and Health Management, Anhui Medical College, Hefei City, Anhui Province 230061, China
| | - Yan Liu
- School of Public Health and Health Management, Anhui Medical College, Hefei City, Anhui Province 230061, China
| | - Ya-Ru Li
- School of Public Health and Health Management, Anhui Medical College, Hefei City, Anhui Province 230061, China
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Fonseca C, Ramos A, Morgado B, Quaresma P, Garcia-Alonso J, Coelho A, Lopes M. Long-term care units: a Portuguese study about the functional profile. FRONTIERS IN AGING 2023; 4:1192718. [PMID: 37214776 PMCID: PMC10192701 DOI: 10.3389/fragi.2023.1192718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023]
Abstract
Aim: In this study, we analyze the relationship between the functional profile of older people admitted to long-term care units in Portugal and some demographic variables such as education level, sex, and age as well as the emotional state of mind. Methods: A sample of 59,516 older people from the National Network of Integrated Continuous Care of Portugal were analyzed in this longitudinal study. All the retrospective data of the older people were collected during the period of hospitalization at the long-term care units. The database records of these units were analyzed, and a functional profile spanning the period of hospitalization was calculated. Results: Activities of daily living and cognitive states improved, in the first 90 days of hospitalization, while mobility and instrumental activities of daily living worsened for the same period of 90 days. Generally, there was a decline in all domains after 450 days of hospitalization. The older women that did not attend school, those over 85 years old, and those who suffered from anxiety were pre-dominantly placed in the group of those with greater dependence (severe/complete dependence). Conclusion: The participants hospitalized between 90 and 360 days presented the best results in the long-term care units of the National Network of Integrated Continuous Care of Portugal. With this study, we highlight the importance of evaluating the functional status of persons in long-term hospitalizations and the influence exerted by the level of education on the recovery and rehabilitation of dependence.
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Affiliation(s)
- César Fonseca
- São João de Deus Higher School of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
| | - Ana Ramos
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisbon, Portugal
| | | | - Paulo Quaresma
- Department of Computer Science, University of Évora, Évora, Portugal
- Centro de Investigação e Desenvolvimento em Ciências Humanas e Sociais (CIDEHUS), University of Évora, Évora, Portugal
| | - José Garcia-Alonso
- Department of Computer and Telematics Systems, University of Extremadura, Badajoz, Spain
| | - Anabela Coelho
- São João de Deus Higher School of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Manuel Lopes
- São João de Deus Higher School of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
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20
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Zeng Y, Wang J, Cai X, Zhang X, Zhang J, Peng M, Xiao D, Ouyang H, Yan F. Effects of physical activity interventions on executive function in older adults with dementia: A meta-analysis of randomized controlled trials. Geriatr Nurs 2023; 51:369-377. [PMID: 37127013 DOI: 10.1016/j.gerinurse.2023.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND To date quantitative meta-analysis with large samples to investigate the effects and potential moderators of physical activity (PA) on executive function (EF) in older adults with dementia is insufficient. Therefore, we conducted this meta-analysis. DESIGN Meta-analysis of randomized controlled trials (RCTs). PARTICIPANTS Old people with Alzheimer's disease (AD) or related dementia of varying types and severity as the primary diagnosis. METHODS PubMed, Web of Science, the Cochrane Library and Embase databases were searched for relevant studies published from 01 January, 2010 to 01 March, 2022. The results of executive function were reported in all RCTs. Random-effects meta-analysis was used to calculate the size of effects. Subgroup analyses of three moderators (including the specific sub-domains of EF, exercise prescription variables, and sample characteristics) were performed. RESULTS Eighteen RCTs were included with a combined sample size of 1366. Overall, PA interventions improved overall EF (standardized mean difference [SMD]=0.23, 95% confidence interval [CI] 0.05 to 0.41, p<0.05). The EF sub-domain "planning" was significant moderator (SMD=0.31, 95%CI 0.11 to 1.51, p<0.01), but inhibitory control, working memory and cognitive flexibility were not significant. Regarding exercise prescription variables, type of resistance training; moderate intensity; total duration ≤24 weeks and short (once or twice a week) frequency improved overall EF performance. Session length may be a moderator. Regarding sample characteristics, old-old, AD and both dementia and AD had significant benefits. CONCLUSIONS AND IMPLICATIONS EF in older adults with AD or related dementia benefited from physical activity, and the benefit was affected by the type, intensity, total duration, frequency of exercise. Physical activity can be an alternative intervention in aging patients with dementia, to improve EF performance or prevent or EF decline.
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Affiliation(s)
- Yuena Zeng
- School of Nursing, Jinan University, Guangzhou, Guangdong 510632, China
| | - Jinying Wang
- Department of Rehabilitation, Shenzhen Longgang District Maternity and Child Healthcare Hospital, Shenzhen, Guangdong 518172, China
| | - Xiaoyan Cai
- School of Nursing, Jinan University, Guangzhou, Guangdong 510632, China
| | - Xiaoying Zhang
- School of Medicine, Xizang Minzu University, Xianyang 712082, China
| | - Jiahui Zhang
- School of Nursing, Jinan University, Guangzhou, Guangdong 510632, China
| | - Mingmei Peng
- School of Nursing, Jinan University, Guangzhou, Guangdong 510632, China; Hemodialysis Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, China
| | - Duan Xiao
- Department of Rehabilitation, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, China
| | - Hui Ouyang
- Department of Rehabilitation, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, China.
| | - Fengxia Yan
- School of Nursing, Jinan University, Guangzhou, Guangdong 510632, China.
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21
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Formolo DA, Yu J, Lin K, Tsang HWH, Ou H, Kranz GS, Yau SY. Leveraging the glymphatic and meningeal lymphatic systems as therapeutic strategies in Alzheimer's disease: an updated overview of nonpharmacological therapies. Mol Neurodegener 2023; 18:26. [PMID: 37081555 PMCID: PMC10116684 DOI: 10.1186/s13024-023-00618-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/05/2023] [Indexed: 04/22/2023] Open
Abstract
Understanding and treating Alzheimer's disease (AD) has been a remarkable challenge for both scientists and physicians. Although the amyloid-beta and tau protein hypothesis have largely explained the key pathological features of the disease, the mechanisms by which such proteins accumulate and lead to disease progression are still unknown. Such lack of understanding disrupts the development of disease-modifying interventions, leaving a therapeutic gap that remains unsolved. Nonetheless, the recent discoveries of the glymphatic pathway and the meningeal lymphatic system as key components driving central solute clearance revealed another mechanism underlying AD pathogenesis. In this regard, this narrative review integrates the glymphatic and meningeal lymphatic systems as essential components involved in AD pathogenesis. Moreover, it discusses the emerging evidence suggesting that nutritional supplementation, non-invasive brain stimulation, and traditional Chinese medicine can improve the pathophysiology of the disease by increasing glymphatic and/or meningeal lymphatic function. Given that physical exercise is a well-regarded preventive and pro-cognitive intervention for dementia, we summarize the evidence suggesting the glymphatic system as a mediating mechanism of the physical exercise therapeutic effects in AD. Targeting these central solute clearance systems holds the promise of more effective treatment strategies.
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Affiliation(s)
- Douglas A Formolo
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, S.A.R, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong S.A.R, China
- Mental Health Research Center (MHRC), The Hong Kong Polytechnic University, Hong Kong S.A.R, China
| | - Jiasui Yu
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, S.A.R, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong S.A.R, China
- Mental Health Research Center (MHRC), The Hong Kong Polytechnic University, Hong Kong S.A.R, China
| | - Kangguang Lin
- Department of Affective Disorders, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
- School of Health and Life Sciences, University of Health and Rehabilitation Sciences, Qingdao City, Shandong Province, China
| | - Hector W H Tsang
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, S.A.R, China
- Mental Health Research Center (MHRC), The Hong Kong Polytechnic University, Hong Kong S.A.R, China
| | - Haining Ou
- Department of Rehabilitation, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Georg S Kranz
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, S.A.R, China
- Mental Health Research Center (MHRC), The Hong Kong Polytechnic University, Hong Kong S.A.R, China
- Department of Psychiatry and Psychotherapy, Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Vienna, Austria
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong S.A.R, China
| | - Suk-Yu Yau
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, S.A.R, China.
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong S.A.R, China.
- Mental Health Research Center (MHRC), The Hong Kong Polytechnic University, Hong Kong S.A.R, China.
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22
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Devanand D, Masurkar AV, Wisniewski T. Vigorous, regular physical exercise may slow disease progression in Alzheimer's disease. Alzheimers Dement 2023; 19:1592-1597. [PMID: 36722738 PMCID: PMC10101862 DOI: 10.1002/alz.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Mild to moderate exercise may decrease Alzheimer's disease (AD) risk, but the effects of vigorous, regular physical exercise remain unclear. METHODS Two patients with initial diagnoses of amnestic mild cognitive impairment (MCI) demonstrated positive AD biomarkers throughout 16 and 8 years of follow-up, with final diagnoses of mild AD and amnestic MCI, respectively. RESULTS Patient 1 was diagnosed with amnestic MCI at age 64. Neuropsychological testing, magnetic resonance imaging (MRI), fluorodeoxyglucose-positron emission tomography (FDG-PET), amyloid imaging PET, and cerebrospinal fluid (CSF) biomarkers during follow-ups remained consistent with AD. By age 80, progression was minimal with Montreal Cognitive Assessment (MoCA) 26 of 30. Patient 2 was diagnosed with amnestic MCI at age 72. Neuropsychological testing, MRI, FDG-PET, and amyloid imaging PET during follow-ups remained consistent with AD. At age 80, MoCA was 27 of 30 with no clinical progression. Both patients regularly performed vigorous, regular exercise that increased after retirement/work reduction. DISCUSSION Vigorous, regular exercise may slow disease progression in biomarker-positive amnestic MCI and mild AD.
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Affiliation(s)
- D.P. Devanand
- Area Brain Aging and Mental Health, Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain at Columbia University
| | - Arjun V. Masurkar
- Center for Cognitive Neurology, Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Thomas Wisniewski
- Center for Cognitive Neurology, Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
- Departments of Psychiatry and Pathology, New York University Grossman School of Medicine, New York, NY, USA
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23
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Ding Z, Leung PY, Lee TL, Chan AS. Effectiveness of lifestyle medicine on cognitive functions in mild cognitive impairments and dementia: A systematic review on randomized controlled trials. Ageing Res Rev 2023; 86:101886. [PMID: 36806378 DOI: 10.1016/j.arr.2023.101886] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
Mild cognitive impairment (MCI) and dementia are associated with lifestyle risk factors, making lifestyle medicine a potentially viable intervention for people with MCI and dementia. The present study aims to examine the effectiveness of lifestyle medicine on cognitive functions among people with MCI and dementia, by performing a systematic review and meta-analysis on randomized controlled trials (RCT). A systematic literature search was conducted to extract RCTs adopting lifestyle interventions of diet, exercise, and stress management or emotional well-being. Results showed that 65 studies were eligible. Exercise was the most promising lifestyle intervention that improved various cognitive functions among people with MCI and dementia, and was more effective in MCI than in dementia. Interventions on stress management or emotional well-being did not show a significant effect on people with MCI, and the evidence for people with dementia was insufficient to conclude. Similarly, due to the lack of RCTs on a healthy dietary pattern, the effectiveness of diet interventions was not examined. In conclusion, the exercise component of lifestyle medicine can be an effective and clinically significant intervention for protecting people with MCI and dementia against cognitive declines, especially when served as an early intervention at the stage of MCI.
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Affiliation(s)
- Zihan Ding
- Neuropsychology Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Pui-Ying Leung
- Neuropsychology Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China; Research Centre for Neuropsychological Well-Being, The Chinese University of Hong Kong, Hong Kong, China
| | - Tsz-Lok Lee
- Neuropsychology Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Agnes S Chan
- Neuropsychology Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China; Research Centre for Neuropsychological Well-Being, The Chinese University of Hong Kong, Hong Kong, China.
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24
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Luo G, Zhang J, Song Z, Wang Y, Wang X, Qu H, Wang F, Liu C, Gao F. Effectiveness of non-pharmacological therapies on cognitive function in patients with dementia-A network meta-analysis of randomized controlled trials. Front Aging Neurosci 2023; 15:1131744. [PMID: 36967820 PMCID: PMC10035791 DOI: 10.3389/fnagi.2023.1131744] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Objective Non-pharmacological therapies (NPTs) have received increasing attention from researchers as a category of treatment to improve cognitive impairment in patients with dementia because of their fewer side effects. In this study, photobiomodulation (PBM), enriched environment (EE), exercise therapy (ET), computerized cognitive training (CCT), and cognitive stimulation therapy (CST) were selected to compare the effects of NPTs that improve dementia by quantifying information from randomized controlled trials (RCTs). Methods We did a systematic review and network meta-analysis. We searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure Database, Wan Fang Database, Chinese Biomedical Literature Database, Web of Science, and VIP Database from the time of database creation to 1 August 2022. Two investigators independently screened the literature, extracted information, and assessed the RCTs' quality with the Cochrane Collaboration Network Risk of Bias 2.0. Network meta-analysis was performed using R language (X64 version 4.1.3) and STATA 17.0. Results We identified 1,268 citations and of these included 38 trials comprising 3,412 participants. For improving dementia, the results of the network meta-analysis showed that compared with the control group (CON), PBM (SMD = 0.90, 95% CI: 0.43-1.37), EE (SMD = 0.71, 95% CI: 0.02-1.41), ET (SMD = 0.42, 95% CI: 0.16-0.68), and CST (SMD = 0.36, 95% CI: 0.11-0.62) were significantly different (P < 0.05); There was no significant difference in CCT (SMD = 0.41, 95% CI: -0.07-0.88) (P > 0.05). The ranked results showed that PBM has more potential to be the best intervention (P = 0.90). In addition, there was a significant difference between PBM and CST in improving cognitive function (SMD = 0.54, 95% CI: 0.00; 1.08, P < 0.05). Conclusion In this study, NPTs have excellent potential to improve cognition in people with dementia, and PBM may have more significant benefits in improving cognition than the other four NPTs. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022363746.
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Affiliation(s)
- Guangxin Luo
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Junqiu Zhang
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Zeyi Song
- School of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Ying Wang
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Xiaojing Wang
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Haifeng Qu
- School of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Fang Wang
- Department of Psychology, The Fourth People’s Hospital of Wuhu, Wuhu, China
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People’s Hospital of Anhui Medical University, Anqing, China
| | - Fujia Gao
- School of Public Health, North China University of Science and Technology, Tangshan, China
- Hebei Province Key Laboratory of Occupational Health and Safety for Coal Industry, School of Public Health, North China University of Science and Technology, Tangshan, China
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25
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Liu X, Wang G, Cao Y. Association of nonpharmacological interventions for cognitive function in older adults with mild cognitive impairment: a systematic review and network meta-analysis. Aging Clin Exp Res 2023; 35:463-478. [PMID: 36607554 DOI: 10.1007/s40520-022-02333-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Understanding the effectiveness of nonpharmacological interventions to improve cognitive function in older adults with MCI and identifying the best intervention may help inform ideas for future RCT studies and clinical decision-making. AIM The main focus of this study was to assess the comparative effectiveness of nonpharmacological interventions on cognitive function in older adults with MCI and to rank the interventions. METHODS RCT studies until September 2022 were searched from six databases, including PubMed, the Cochrane Library, Embase, Web of Science, PsycINFO and CINAHL. The risk of bias in eligible trials was evaluated using the Cochrane Risk of Bias tool. Both pairwise and network meta-analyses were used, and pooled effect sizes were reported using SMD and the corresponding 95% confidence intervals. RESULTS A total of 28 RCT studies were included in this study, pooling 18 categories of nonpharmacological interventions. MBE (mind-body exercise) (SMD (standard mean difference): 0.24, 95% CI: 0.08-0.41, P = 0.004), DTE (dual-task exercise) (SMD: 0.61, 95% CI: 0.09-1.13, P = 0.02), PE (physical exercise) (SMD: 0.58, 95% CI: 0.04-1.12, P = 0.03) may be effective in improving cognitive function in older adults with MCI. Acupressure + CT (cognitive training) was the top-ranked intervention among all interventions. No greater benefits of MA (mindful awareness) on cognitive function were found. CONCLUSIONS Overall, nonpharmacological interventions significantly improved cognitive function in older adults with MCI. Acupressure + CT(cognitive training) was the most effective intervention for managing cognitive impairment. Future studies with high quality and large sample size RCT studies are needed to confirm our results.
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Affiliation(s)
- Xueyan Liu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Lixia District, Jinan, Shandong Province, China
| | - Guangpeng Wang
- Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan Province, China
| | - Yingjuan Cao
- Department of Nursing, Qilu Hospital, Shandong University, 107 Wenhuaxi Road, Lixia District, Jinan, Shandong Province, China.
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26
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Yang J, Dong Y, Yan S, Yi L, Qiu J. Which Specific Exercise Models Are Most Effective on Global Cognition in Patients with Cognitive Impairment? A Network Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2790. [PMID: 36833483 PMCID: PMC9957167 DOI: 10.3390/ijerph20042790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/22/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
(1) Introduction: Physical exercise interventions can impart significant cognitive benefits to older adults suffering from cognitive impairment (CI). However, the efficacy of these interventions can vary widely, depending on the type, intensity, duration and frequency of exercise. (2) Aim: To systematically review the efficacy of exercise therapy on global cognition in patients with CI using a network meta-analysis (NMA). (3) Methods: The PubMed, Embase, Sport Discus (EBSCO) and Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) on exercise for patients with CI from inception to 7 August 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. The NMA was performed using the consistency model. (4) Results: A total of 29 RCTs comprising 2458 CI patients were included. The effects of different types of exercise on patients with CI were ranked as follows: multicomponent exercise (SMD = 0.84, 95% CI 0.31 to 1.36, p = 0.002), short duration (≤45 min) (SMD = 0.83, 95% CI 0.18 to 1.19, p = 0.001), vigorous intensity (SMD = 0.77, 95% CI 0.18 to 1.36, p = 0.011) and high frequency (5-7 times/week) (SMD = 1.28, 95% CI 0.41 to 2.14, p = 0.004). (5) Conclusion: These results suggested that multicomponent, short-duration, high-intensity, and high-frequency exercise may be the most effective type of exercise in improving global cognition in CI patients. However, more RCTs based on direct comparison of the effects of different exercise interventions are needed. (6) NMA registration identifier: CRD42022354978.
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Affiliation(s)
- Junchao Yang
- School of Sport Science, Beijing Sport University, Beijing 100084, China
| | - Yunfeng Dong
- School of Sport Science, Beijing Sport University, Beijing 100084, China
| | - Shuting Yan
- School of Sport Science, Beijing Sport University, Beijing 100084, China
| | - Longyan Yi
- China Institute of Sports and Health, Beijing Sport University, Beijing 100084, China
| | - Junqiang Qiu
- School of Sport Science, Beijing Sport University, Beijing 100084, China
- Beijing Sports Nutrition Engineering Research Center, Beijing 100084, China
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Braz de Oliveira MP, Moreira Padovez RDFC, Serrão PRMDS, de Noronha MA, Cezar NODC, Andrade LPD. Effectiveness of physical exercise at improving functional capacity in older adults living with Alzheimer's disease: a systematic review of randomized controlled trials. Disabil Rehabil 2023; 45:391-402. [PMID: 35171074 DOI: 10.1080/09638288.2022.2037744] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To investigate the effects of physical exercise at improving functional capacity in older adults living with Alzheimer's disease (AD). METHODS Medline, Embase, Web of Science, The Cochrane Library, Lilacs, and PEDro were searched from inception until January 2021. Randomized controlled trials (RCTs) that reported functional capacity outcomes were included. The evidence was assessed using the GRADE approach. RESULTS Thirteen RCTs were included, involving 811 older adults living with AD. Multimodal exercise (ME), aerobic exercise (AE), and resistance exercise (RE) were used. The interventions were mainly supervised by caregivers. The evidence was low and with effect for activities of daily living (ADLs), moderate and with no effect for mobility and very low and with no effect for muscle strength, postural balance and flexibility after treatment with ME, moderate and with no effect for cardiorespiratory function and ADLs after treatment with AE. It was not possible to synthesize any type of evidence for RE. CONCLUSIONS Multimodal exercise promotes improvements in functional capacity (ADLs). Therefore, the practice of physical exercise can be recommended for older adults living with AD. The involvement of the caregiver in the physical exercises should also be considered, as it could enhance the benefits of exercise for these older adults.Implications for rehabilitationHealthcare providers with clinical knowledge regarding physical exercise should promote, prescribe and support the daily practice of physical exercises for older adults living with Alzheimer's disease (AD).The involvement of caregivers in home-based physical exercise programs should be considered, as it could enhance the benefits of such programs for these older adults.It is important to consider the degree of cognitive impairment in older adults living with AD when outlining goals for the improvement in functional capacity through physical exercise.Multimodal exercise involving aerobic training, postural balance, muscle strengthening, and flexibility is capable of promoting an improvement in functional capacity (activities of daily living) for these older adults.
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Affiliation(s)
- Marcos Paulo Braz de Oliveira
- Physical Therapy Department, Healthy Aging Research Laboratory, Federal University of São Carlos, São Carlos, Brazil
| | | | | | | | | | - Larissa Pires de Andrade
- Physical Therapy Department, Healthy Aging Research Laboratory, Federal University of São Carlos, São Carlos, Brazil
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28
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Braz de Oliveira MP, Moreira Padovez RDFC, Serrão PRMDS, Gomes Dos Santos J, Silva DCPD, Andrade LPD. Is physical exercise effective at improving body structure & function and activity outcomes in individuals with Mild Cognitive Impairment? a systematic review with quality of evidence assessment. Disabil Rehabil 2023; 45:575-587. [PMID: 35195496 DOI: 10.1080/09638288.2022.2040609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To investigate the effect of physical exercise on body structure & function and activity outcomes in individuals with Mild Cognitive Impairment (MCI). METHODS Six databases were searched from inception until January 2021. Randomized controlled trials (RCTs) comparing physical exercise with a control group were included. RESULTS Fourteen RCTs were included. Three types of physical exercise were identified: aerobic (AE), resistance (RE), and multimodal (ME). Regarding body structure & function outcomes, evidence for RE was very low and with effect for improvement in upper limb muscle strength and very low and without effect for lower limbs. For improvement in postural balance, evidence was very low and with effect with AE and very low and without effect with RE and ME. Evidence for cardiorespiratory function was very low and without effect with AE and RE. Regarding activity outcomes, evidence was low and without effect for mobility with AE and very low and without effect with RE and ME. CONCLUSIONS Physical exercise promoted improvements in body structure & function outcomes in individuals with MCI. Resistance exercise improvement upper limb muscle strength and AE enhanced postural balance. In contrast, physical exercise did not promote a significant benefit in activity outcomes.Implications for rehabilitationResults of this systematic review have shown that physical exercise promoted improvements in body structure & function outcomes in individuals with Mild Cognitive Impairment (MCI).Resistance exercise with elastic bands for approximately 60 minutes twice a week for a total of three months improved upper limb muscle strength.Aerobic exercise with walking for approximately 60 minutes twice per week for a total of six months enhanced postural balance.Considering the potential benefits identified in this systematic review, physical exercise can be recommended for individuals with MCI.We also highlight the importance of the use of the International Classification of Functioning, Disability and Health for rehabilitation planning.
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Affiliation(s)
- Marcos Paulo Braz de Oliveira
- Physical Therapy Department, Healthy Aging Research Laboratory, Federal University of São Carlos, São Carlos, Brasil
| | | | | | - Julimara Gomes Dos Santos
- Department of Physical Education, Federal Institute of Education, Science and Technology of Mato Grosso, Advanced Campus Diamantino, Diamantino, Brazil
| | | | - Larissa Pires de Andrade
- Physical Therapy Department, Healthy Aging Research Laboratory, Federal University of São Carlos, São Carlos, Brasil
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Joseph CR, Kreilach A, Reyna VA, Kepler TA, Taylor BV, Kang J, McCorkle D, Rider NL. Utilizing Reduced Labeled Proton Clearance to Identify Preclinical Alzheimer Disease with 3D ASL MRI. Case Rep Neurol 2023; 15:177-186. [PMID: 37901133 PMCID: PMC10603764 DOI: 10.1159/000530980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/02/2023] [Indexed: 10/31/2023] Open
Abstract
Addressing the seminal pathophysiology in Alzheimer disease (AD) is the next logical focus for effective intervention, given the initial disappointing and more recent possibly encouraging results of monoclonal antibody trials. Endothelial cell dysfunction-induced blood-brain barrier leak with associated prolonged capillary mean transit time (cMTT) and glymphatic outflow dysfunction is the most proximal events in the degeneration cascade. Sensitive and reproducible markers are required to both identify early disease and assess future treatment trial outcomes. Two participants, with mild cognitive impairment (MCI) and one with AD, were evaluated clinically prior to MRI in this small case series report. From seven 3D turbo gradient and spin echo (TGSE) pulsed arterial spin echo (PASL) MRI sequences six homologous region of interest in bitemporal, bifrontal, and biparietal lobes for each sequence were examined and plotted against time. By choosing late perfusion times during cMTT phase of perfusion linear analysis of signal decay could be utilized. A reference axial FLAIR sequence was also obtained. Slope of the linear analysis correlated to the rate of labeled proton clearance with reduced clearance occurring in AD participants compared to normal participants in our previous study. Whether similar differences in clearance rate extend to either MCI or early AD was investigated. Participants were categorized by clinical phenotype before MRI and compared to previously published phenotype cohorts: n = 18 normal/healthy, n = 6 AD, n = 3 MCI. Significant differences in labeled proton clearance rates between AD and MCI/control phenotypes within bilateral temporal lobes (left p = 0.004, right p = 0.002) and within bilateral frontal lobes AD versus controls (left p = 0.001, right p = 0.008) and AD versus MCI (left p = 0.001, right p = 0.001) were found. This noninvasive MRI technique has potential for identifying MCI transition to AD.
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Affiliation(s)
- Charles R. Joseph
- Department of Neurology, Liberty University College of Osteopathic Medicine (LUCOM) Lynchburg, VA, USA
| | | | | | | | | | - Jubin Kang
- LUCOM medical student, Lynchburg, VA, USA
| | | | - Nicholas L. Rider
- Department of Bioinformatics and Immunology, LUCOM, Lynchburg, VA, USA
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Steichele K, Keefer A, Dietzel N, Graessel E, Prokosch HU, Kolominsky-Rabas PL. The effects of exercise programs on cognition, activities of daily living, and neuropsychiatric symptoms in community-dwelling people with dementia—a systematic review. Alzheimers Res Ther 2022; 14:97. [PMID: 35869496 PMCID: PMC9306176 DOI: 10.1186/s13195-022-01040-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
The prevalence of dementia is expected to increase dramatically. Due to a lack of pharmacological treatment options for people with dementia, non-pharmacological treatments such as exercise programs have been recommended to improve cognition, activities of daily living, and neuropsychiatric symptoms. However, inconsistent results have been reported across different trials, mainly because of the high heterogeneity of exercise modalities. Thus, this systematic review aims to answer the questions whether exercise programs improve cognition, activities of daily living as well as neuropsychiatric symptoms in community-dwelling people with dementia.
Methods
Eight databases were searched for articles published between 2016 and 2021 (ALOIS, CENTRAL, CINAHL, Embase, MEDLINE, PsycINFO, PubMed, Web of Science). Randomized controlled trials evaluating the effects of any type of physical activity on cognition, activities of daily living, or neuropsychiatric symptoms in community-dwelling people with a formal diagnosis of dementia were included in this systematic review. Two authors independently assessed eligibility and quality of the studies. The methodology was in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.
Results
Eight publications covering seven trials were included in this review with the majority investigating either a combination of strength and aerobic exercise or aerobic exercise alone. This review revealed that there is no clear evidence for the beneficial effects of exercise on cognition. None of the included trials found an impact on activities of daily living. Although different randomized controlled trials reported inconsistent results, one trial indicated that especially aerobic exercise may improve neuropsychiatric symptoms.
Conclusion
Our systematic review did not confirm the impact of exercise on cognition and activities of daily living in community-dwelling people with dementia. The results suggested that aerobic exercise might be effective to reduce neuropsychiatric symptoms. Well-designed trials including only community-dwelling people with a formal diagnosis of dementia, large samples, long-term follow-ups, and detailed description of adherence to the intervention are needed to improve the scientific evidence on the best type of exercise modality.
Trial registration
PROSPERO, CRD42021246598.
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Menengi̇ç KN, Yeldan İ, Çınar N, Şahiner T. Effectiveness of motor-cognitive dual-task exercise via telerehabilitation in Alzheimer’s disease: An online pilot randomized controlled study. Clin Neurol Neurosurg 2022; 223:107501. [DOI: 10.1016/j.clineuro.2022.107501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/12/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022]
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Coutinho LA, Leão LL, Cassilhas RC, de Paula AMB, Deslandes AC, Monteiro-Junior RS. Alzheimer's disease genes and proteins associated with resistance and aerobic training: An in silico analysis. Exp Gerontol 2022; 168:111948. [PMID: 36087875 DOI: 10.1016/j.exger.2022.111948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Exercise appears to be a viable intervention for maintaining cognitive function and regaining functional autonomy, and perhaps even contributing to a slower progression of Alzheimer's Disease (AD). OBJECTIVE To explore different neuroplasticity pathways modulated by aerobic and strength training, determine whether signaling pathways overlapped for each specific training method (aerobic and strength training), and evaluate whether there is a functional relationship between APOE and APP gene expression with aerobic training modulated by BDNF; and strength training modulated by IGF-1. METHODS An in silico analysis was performed to analyze the connection between exercise types and neuroplasticity as a protective factor in AD. The platform provides a protein-protein interaction network translated into known and predicted interactions. A score > 0.70 was determined as high confidence and the network was considered significant when the Protein-Protein Interaction Enrichment was <0.01. RESULTS Multiple functional associations considered significant between the analyzed proteins. The results of our gene network model support that exercise, both aerobic and strength, can modulate genes that affect hippocampal neuroplasticity and neurogenesis, which may delay cognitive decline and Alzheimer's related symptoms. CONCLUSION The investigation about the functional association of aerobic training via BDNF in the modulation of APP, APOE, and MAPT genes in the hippocampus seems to be established, while strength training seems to induce the production of IGF-1 and IGF-1R, modulating AKT1.
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Affiliation(s)
| | - Luana Lemos Leão
- Postgraduate Program of Health Sciences, State University of Montes Claros, Montes Claros, MG, Brazil
| | - Ricardo Cardoso Cassilhas
- Physical Education Department, Federal University of the Valleys of Jequitinhonha and Mucuri (UFVJM), Diamantina, MG, Brazil; Multicenter Post Graduation Program in Physiological Sciences (PMPGCF), UFVJM, Brazilian Society of Physiology, Diamantina, MG, Brazil; Postgraduate Program in Health Sciences (PPGCS), UFVJM, Diamantina, MG, Brazil
| | | | | | - Renato Sobral Monteiro-Junior
- Physical Education and Sport Department, State University of Montes Claros, Montes Claros, MG, Brazil; Postgraduate Program of Health Sciences, State University of Montes Claros, Montes Claros, MG, Brazil.
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A Systematic Study into the Effects of Long-Term Multicomponent Training on the Cognitive Abilities of Older Adults with Neurodegenerative Disorders. PSYCH 2022. [DOI: 10.3390/psych4040056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Cognition includes all processes through which a person becomes aware of their situation, needs, goals, and necessary actions. Regular specialized cognitive and neuromotor simulation exercises have improved various cognitive processes, including memory, speed of reasoning, and problem-solving skills. This review focuses on understanding the efficacy of long-term multicomponent exercise interventions to mitigate and delay the effects on cognitive abilities in older adults with neurodegenerative disorders. The main criteria for final studies were randomised controlled trials with a minimum of a 24-week intervention. The Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, B-On, Sport Discus, Scielo, APA PsycINFO, Psychology and Behavioural Sciences, Academic Search Complete, Medline (PubMed), ERIC, and Google Scholar databases were checked. The search occurred between April 2022 and July 2022. A total of 19 studies were used in this review. The initial search identified 6.835 studies. In the first screening, a total of 6474 studies were excluded. After this, 361 studies were analysed by co-authors and did not meet the specific final criteria and were excluded. In total, 19 studies were included in the final analysis, and 14 papers met all requirements previously defined.
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Zhou Y, Li LD. Exercise training for cognitive and physical function in patients with mild cognitive impairment: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30168. [PMID: 36042589 PMCID: PMC9410583 DOI: 10.1097/md.0000000000030168] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND This systematic review evaluates the effect of exercise training in the treatment of patients with mild cognitive impairment (MCI). METHODS PubMed, Medline, EMBASE, Web of Science, and Cochrane Library databases were systematically searched up to Oct 2021 in order to identify randomized controlled trials (RCTs) which evaluated the effects of physical exercise in persons with MCI. Changes of cognitive and physical function were tested using pre- and postMMSE and TUG scores, and were compared with control intervention. RESULTS A total of 10 RCTs involving 635 MCI patients were included in the meta-analysis. Physical exercise improved MMSE scores (MD 0.71, 95 % CI 0.57 to 0.85, P < .00001, I2 = 95 %) and TUG performance (MD -0.82, 95 % CI -1.20 to -0.45, P < .00001, I2 = 12 %) in patients with MCI. CONCLUSIONS This meta-analysis demonstrated a positive effect of exercise training in people with MCI in relation to cognitive and physical function. These findings suggest exercise interventions be persistent, and reveal that more high-quality researches are needed.
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Affiliation(s)
- Yue Zhou
- Department of Neurology, The People’s Hospital Affiliated to Ningbo University, Ningbo 315040, Zhejiang Province, China
- *Correspondence: Yue Zhou (e-mail: )
| | - Liang-da Li
- Department of Neurology, The People’s Hospital Affiliated to Ningbo University, Ningbo 315040, Zhejiang Province, China
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Rondão CADM, Mota MPG, Esteves D. Development of a Combined Exercise and Cognitive Stimulation Intervention for People with Mild Cognitive Impairment-Designing the MEMO_MOVE PROGRAM. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10221. [PMID: 36011852 PMCID: PMC9408716 DOI: 10.3390/ijerph191610221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/13/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED Dementia patients are at high risk for the decline of both physical and cognitive capacities, resulting in an increased risk of the loss of autonomy. Exercise is regarded as a non-pharmacological therapy for dementia, considering the potential benefits of preventing cognitive decline and improving physical fitness. In this paper, we aim to describe the different design stages for an exercise program combined with cognitive stimulation for a population with mild cognitive impairment, i.e., the MEMO_MOVE program. METHODS The intervention design followed the Medical Research Council's guidelines for complex interventions and was structured according to the six steps in quality intervention development (6SQuID). The intervention was described considering the Template for Intervention Description and Replication (TIDieR). In order to establish the intervention characteristics, a literature review was conducted to collate and analyze previous work, which provided a summary the type of exercise that should be implemented among this population. RESULTS The MEMO_MOVE program was structured and described, regarding (i) inclusion of a cognitive stimulation component; (ii) the kind of cognitive stimulation; and (iii) the type of exercise, duration, frequency, intensity, and program length. CONCLUSIONS A systematic step-by-step process design was followed to create a specific intervention to promote physical fitness and cognitive stimulation in individuals with mild dementia.
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Affiliation(s)
| | - Maria Paula Gonçalves Mota
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
- Department of Sports, University of Trás os Montes e Alto Douro, 5000-801 Vila Real, Portugal
| | - Dulce Esteves
- Department of Sports, University of Beira Interior, 6201-001 Covilhã, Portugal
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
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Balbim GM, Falck RS, Barha CK, Starkey SY, Bullock A, Davis JC, Liu-Ambrose T. Effects of exercise training on the cognitive function of older adults with different types of dementia: a systematic review and meta-analysis. Br J Sports Med 2022; 56:bjsports-2021-104955. [PMID: 35577539 DOI: 10.1136/bjsports-2021-104955] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the effect of exercise training on the cognitive function of older adults living with different types of dementia, as well as potential moderators of exercise efficacy. DESIGN Systematic review and meta-analysis. DATA SOURCES Cochrane Central, PsycINFO, Embase, Medline and CINAHL. ELIGIBILITY CRITERIA Peer-reviewed, randomised controlled trials, in English (1990-present), which examined the effects of exercise training on the cognitive function of older adults living with dementia. STUDY APPRAISAL AND SYNTHESIS Risk of bias and study quality were assessed (Cochrane Risk of Bias Tool 2.0 and Physiotherapy Evidence Database Scale). We performed random-effects models using robust variance estimation and tested moderators using the approximate Hotelling-Zhang test. RESULTS Twenty-eight studies (n=2158) were included in the qualitative review and 25 in the meta-analysis. For all-cause dementia, a small effect of exercise training on cognitive function was observed (g=0.19; 95% CI 0.05 to 0.33; p=0.009). Type of dementia and exercise training characteristics did not moderate the effects of exercise training on cognitive function (p>0.05). Adherence to the intervention moderated the cognitive outcome effect size such that greater mean adherence was associated with greater cognitive outcome effect sizes (b=0.02; SE=0.01; p=0.005). CONCLUSION Exercise training showed small benefits for the cognitive function of older adults living with all-cause dementia. More research and standardised reporting of exercise training characteristics can strengthen the evidence for what works best for which types of dementia. PROSPERO REGISTRATION NUMBER CRD42020198716.
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Affiliation(s)
- Guilherme Moraes Balbim
- Department of Physical Therapy, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
| | - Ryan S Falck
- Department of Physical Therapy, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
- School of Biomedical Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Cindy K Barha
- Department of Physical Therapy, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Samantha Y Starkey
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexis Bullock
- Department of Physical Therapy, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
- Faculty of Management, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
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Mai Ba H, Kim J. The Effects of Combined Physical and Cognitive Interventions on Direct and Indirect Fall Outcomes for the Elderly with Mild Cognitive Impairment: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10050862. [PMID: 35628001 PMCID: PMC9140643 DOI: 10.3390/healthcare10050862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 01/04/2023] Open
Abstract
This review was intended to determine the effectiveness of physical and cognitive training (PCT) on falls and fall-related factors and cognitive function among community-dwelling elderly people with mild cognitive impairment (MCI). A systematic literature search was performed of the MEDLINE, CINAHL, Web of Sciences, Scopus, ProQuest, Embase, and Google Scholar databases for articles published from 2010 to 2020. The studies that combined PCT to assess their impacts on fall outcomes both directly and indirectly were included. Study quality was assessed using the standardized JBI Critical Appraisal Tool for RCTs. The standardized data extraction tool from JBI-MAStARI was used to extract data of included studies. Seven RCTs involving 740 participants were included. The overall fall incidence did not significantly decrease after the interventions. However, PCT significantly impacted the cognitive function and physical activities of elderly people with MCI, particularly improving their balancing ability, gait speed, muscular strength, and executive functions. This study indicated that combining PCT improves balance ability, gait speed, and executive functioning in the elderly with MCI, which may help to minimize fall occurrence.
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Affiliation(s)
- Hai Mai Ba
- Faculty of Nursing, Hue University of Medicine and Pharmacy, Hue University, Hue 49000, Vietnam; or
| | - Jiyun Kim
- School of Nursing, Gachon University, Incheon 21936, Korea
- Correspondence: ; Tel.: +82-32-820-4226
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Effects of Involuntary and Voluntary Exercise in Combination with Acousto-Optic Stimulation on Adult Neurogenesis in an Alzheimer's Mouse Model. Mol Neurobiol 2022; 59:3254-3279. [PMID: 35297012 DOI: 10.1007/s12035-022-02784-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 02/10/2022] [Indexed: 10/18/2022]
Abstract
Single-factor intervention, such as physical exercise and auditory and visual stimulation, plays a positive role on the prevention and treatment of Alzheimer's disease (AD); however, the therapeutic effects of single-factor intervention are limited. The beneficial effects of these multifactor combinations on AD and its molecular mechanism have yet to be elucidated. Here, we investigated the effect of multifactor intervention, voluntary wheel exercise, and involuntary treadmill running in combination with acousto-optic stimulation, on adult neurogenesis and behavioral phenotypes in a mouse model of AD. We found that 4 weeks of multifactor intervention can significantly increase the production of newborn cells (BrdU+ cells) and immature neurons (DCX+ cells) in the hippocampus and lateral ventricle of Aβ oligomer-induced mice. Importantly, the multifactor intervention could promote BrdU+ cells to differentiate into neurons (BrdU+ DCX+ cells or BrdU+ NeuN+ cells) and astrocytes (BrdU+GFAP+ cells) in the hippocampus and ameliorate Aβ oligomer-induced cognitive impairment and anxiety- and depression-like behaviors in mice evaluated by novel object recognition, Morris water maze tests, elevated zero maze, forced swimming test, and tail suspension test, respectively. Moreover, multifactor intervention could lead to an increase in the protein levels of PSD-95, SYP, DCX, NeuN, GFAP, Bcl-2, BDNF, TrkB, and pSer473-Akt and a decrease in the protein levels of BAX and caspase-9 in the hippocampal lysates of Aβ oligomer-induced mice. Furthermore, sequencing analysis of serum metabolites revealed that aberrantly expressed metabolites modulated by multifactor intervention were highly enriched in the biological process associated with keeping neurons functioning and neurobehavioral function. Additionally, the intervention-mediated serum metabolites mainly participated in glutamate metabolism, glucose metabolism, and the tricarboxylic acid cycle in mice. Our findings suggest the potential of multifactor intervention as a non-invasive therapeutic strategy for AD to anti-Aβ oligomer neurotoxicity.
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Liang YJ, Su QW, Sheng ZR, Weng QY, Niu YF, Zhou HD, Liu CB. Effectiveness of Physical Activity Interventions on Cognition, Neuropsychiatric Symptoms, and Quality of Life of Alzheimer’s Disease: An Update of a Systematic Review and Meta-Analysis. Front Aging Neurosci 2022; 14:830824. [PMID: 35309887 PMCID: PMC8926300 DOI: 10.3389/fnagi.2022.830824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/08/2022] [Indexed: 01/05/2023] Open
Abstract
The topic of physical activity interventions for the treatment of Alzheimer’s disease (AD) has been discussed for decades, but there are still inconsistent views on the effect of its intervention in different studies. With the increase in randomized controlled trials (RCTs), it is necessary to update newly published studies and systematically evaluate the effects of physical activity interventions. Scientific citation databases (e.g., PubMed, EMBASE, etc.) and registration databases (e.g., ISRCTN, CHICTR, etc.) were checked to screen RCTs and systematic reviews of physical activity interventions in AD. Then extract and review the intervention methods and their evaluation results in the included studies. Spearman correlation method was used to test the association between the mean difference (MD) of intervention results and activity time. The Hedges’g method was used to combine continuous data to analyze the standard MD (SMD) of different intervention types or time subgroups. The overall results show that physical activity intervention can improve the cognition, neuropsychiatric symptoms and quality of life (Qol) of AD patients, but the duration of the intervention significantly affected the outcome of the assessment. Subgroup analysis results showed that an intervention duration of 2–5 months had a significant advantage: cognitive function (Minimum Mental State Examination: SMD = 0.47, 95% CI = 0.33 ∼ 0.61, P < 0.01), neuropsychiatric symptoms (Neuropsychiatric Inventory: SMD = −0.48, 95% CI = −0.85 ∼−0.11, P < 0.01), and quality of life (Qol-AD: SMD = 0.47, 95% CI = 0.23 ∼ 0.71, P < 0.01). The systematic review and analysis results of updated RCTs suggested that short-term (2–5 months) physical activity interventions were more beneficial in improving cognitive function, neuropsychiatric symptoms and Qol in patients with AD. And there was no evidence of differences in the effectiveness of different physical activity interventions.
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Affiliation(s)
- Ya-Jing Liang
- Department of Nursing, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
- *Correspondence: Ya-Jing Liang,
| | - Qing-Wen Su
- Department of Health Management Center, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Zhi-Ren Sheng
- Department of Nursing, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Qiu-Yan Weng
- Department of Neurology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Yan-Fang Niu
- Department of Neurology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Hong-Di Zhou
- Department of Nursing, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Chun-Bo Liu
- Department of Nursing, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
- Chun-Bo Liu,
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Huang X, Zhao X, Li B, Cai Y, Zhang S, Wan Q, Yu F. Comparative efficacy of various exercise interventions on cognitive function in patients with mild cognitive impairment or dementia: A systematic review and network meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:212-223. [PMID: 34004389 PMCID: PMC9068743 DOI: 10.1016/j.jshs.2021.05.003] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/16/2021] [Accepted: 03/15/2021] [Indexed: 05/09/2023]
Abstract
BACKGROUND Exercise is a promising nonpharmacological therapy for cognitive dysfunction, but it is unclear which type of exercise is most effective. The objective of this study was to compare and rank the effectiveness of various exercise interventions on cognitive function in patients with mild cognitive impairment (MCI) or dementia and to examine the effects of exercise on the symptoms relevant to cognitive impairment. METHODS We searched PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, and PsycInfo through September 2019 and included randomized controlled trials that examined the effectiveness of exercise interventions in patients with MCI or dementia. Primary outcomes included global cognition, executive cognition, and memory cognition. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, and quality of life. Pairwise analyses and network meta-analyses were performed using a random effects model. RESULTS A total of 73 articles from 71 trials with 5606 participants were included. All types of exercise were effective in increasing or maintaining global cognition, and resistance exercise had the highest probability of being the most effective intervention in slowing the decrease in global cognition (standard mean difference (SMD) = 1.05, 95% confidence interval (95%CI): 0.56-1.54), executive function (SMD = 0.85, 95%CI: 0.21-1.49), and memory function (SMD = 0.32, 95%CI: 0.01-0.63) in patients with cognitive dysfunction. Subgroup analyses for patients with MCI revealed different effects, and multicomponent exercise was most likely to be the optimal exercise therapy for preventing the decline of global cognition (SMD = 0.99, 95%CI: 0.44-1.54) and executive function (SMD = 0.72, 95%CI: 0.06-1.38). However, only resistance exercise showed significant effects on memory function for patients with MCI (SMD = 0.35, 95%CI: 0.01-0.69). Exercise interventions also showed various effects on the secondary outcomes. CONCLUSION Resistance exercise has the highest probability of being the optimal exercise type for slowing cognitive decline in patients with cognitive dysfunction, especially in patients with dementia. Multicomponent exercise tends to be most effective in protecting global cognition and executive function in patients with MCI.
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Affiliation(s)
- Xiuxiu Huang
- School of Nursing, Peking University, Beijing 100191, China
| | - Xiaoyan Zhao
- School of Nursing, Peking University, Beijing 100191, China
| | - Bei Li
- School of Nursing, Peking University, Beijing 100191, China
| | - Ying Cai
- School of Nursing, Peking University, Beijing 100191, China
| | - Shifang Zhang
- School of Nursing, Peking University, Beijing 100191, China
| | - Qiaoqin Wan
- School of Nursing, Peking University, Beijing 100191, China.
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA
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Liu Y, Hu PP, Zhai S, Feng WX, Zhang R, Li Q, Marshall C, Xiao M, Wu T. Aquaporin 4 deficiency eliminates the beneficial effects of voluntary exercise in a mouse model of Alzheimer's disease. Neural Regen Res 2022; 17:2079-2088. [PMID: 35142700 PMCID: PMC8848602 DOI: 10.4103/1673-5374.335169] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Regular exercise has been shown to reduce the risk of Alzheimer's disease (AD). Our previous study showed that the protein aquaporin 4 (AQP4), which is specifically expressed on the paravascular processes of astrocytes, is necessary for glymphatic clearance of extracellular amyloid beta (Aβ) from the brain, which can delay the progression of Alzheimer's disease. However, it is not known whether AQP4-regulated glymphatic clearance of extracellular Aβ is involved in beneficial effects of exercise in AD patients. Our results showed that after 2 months of voluntary wheel exercise, APP/PS1 mice that were 3 months old at the start of the intervention exhibited a decrease in Aβ burden, glial activation, perivascular AQP4 mislocalization, impaired glymphatic transport, synapse protein loss, and learning and memory defects compared with mice not subjected to the exercise intervention. In contrast, APP/PS1 mice that were 7 months old at the start of the intervention exhibited impaired AQP4 polarity and reduced glymphatic clearance of extracellular Aβ, and the above-mentioned impairments were not alleviated after the 2-month exercise intervention. Compared with age-matched APP/PS1 mice, AQP4 knockout APP/PS1 mice had more serious defects in glymphatic function, Aβ plaque deposition, and cognitive impairment, which could not be alleviated after the exercise intervention. These findings suggest that AQP4-dependent glymphatic transport is the neurobiological basis for the beneficial effects of voluntary exercises that protect against the onset of AD.
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Affiliation(s)
- Yun Liu
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Pan-Pan Hu
- Jiangsu Province Key Laboratory of Neurodegeneration, Nanjing Medical University; Brain Institute, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Shuang Zhai
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Wei-Xi Feng
- Jiangsu Province Key Laboratory of Neurodegeneration, Nanjing Medical University; Brain Institute, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Rui Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Qian Li
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Charles Marshall
- College of Health Sciences, University of Kentucky Center of Excellence in Rural Health, Hazard, KY, USA
| | - Ming Xiao
- Jiangsu Province Key Laboratory of Neurodegeneration, Nanjing Medical University; Brain Institute, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Ting Wu
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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Zhou S, Chen S, Liu X, Zhang Y, Zhao M, Li W. Physical Activity Improves Cognition and Activities of Daily Living in Adults with Alzheimer’s Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031216. [PMID: 35162238 PMCID: PMC8834999 DOI: 10.3390/ijerph19031216] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022]
Abstract
Objective: The purpose of this meta-analysis was to examine the effects of physical activity (PA) on cognition and activities of daily living in adults with Alzheimer’s Disease (AD). Methods: Six electronic databases (MEDLINE, CINAHL, PsycArticles, SPORTDiscus, EMBASE and CNKI) were used to search for potential studies from inception until October 2021. Randomized controlled trials (RCTs) investigating the effect of physical activity (PA) on cognition and activities of daily living in AD patients compared to a control condition were included. The effect sizes were synthesized using a random effects model with a 95% confidence interval (CI). Results: Sixteen articles including 945 participants (aged 70 to 88 years, 34.6% male) met the inclusion criteria. The pooled effect sizes demonstrated that PA intervention was associated with significant improvements in global cognition (Standard Mean Difference (SMD) = 0.41, 95% CI [0.24, 0.58], p < 0.01) and activities of daily living (SMD = 0.56, 95% CI [0.32, 0.79], p < 0.01) in AD patients. Subgroup analyses suggested that PA for 3–4 times per week for 30–45 min for more than 12 weeks had a relatively strong effect on improving global cognition in AD patients. The sensitivity analysis showed robust results. Conclusions: The findings from the current meta-analysis suggested that AD patients can improve their global cognition and Activities of Daily Living (ADL) through engaging in aerobic and mixed exercise (aerobic and anaerobic exercise).
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Affiliation(s)
- Shengwen Zhou
- Department of Chinese Martial Arts, College of Sport Science, Hunan University of Science and Engineering, Yongzhou 425100, China;
| | - Sitong Chen
- Institute for Health and Sport, Victoria University, Melbourne 8001, Australia;
| | - Xiaolei Liu
- Chinese Traditional Regimen Exercise Intervention Research Center, Beijing Sport University, Beijing 100084, China;
| | - Yanjie Zhang
- Health and Exercise Science Laboratory, Institute of Sports Science, Seoul National University, Seoul 08826, Korea;
- Physical Education Unit, School of Humanities and Social Science, The Chinese University of Hong Kong—Shenzhen, Shenzhen 518172, China
| | - Mengxian Zhao
- School of Physical Education, Shenzhen University, Shenzhen 518060, China;
| | - Wenjiao Li
- Physical Education Unit, School of Humanities and Social Science, The Chinese University of Hong Kong—Shenzhen, Shenzhen 518172, China
- Correspondence:
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Barisch-Fritz B, Trautwein S, Scharpf A, Krell-Roesch J, Woll A. Effects of a 16-Week Multimodal Exercise Program on Physical Performance in Individuals With Dementia: A Multicenter Randomized Controlled Trial. J Geriatr Phys Ther 2022; 45:3-24. [PMID: 33813533 DOI: 10.1519/jpt.0000000000000308] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Dementia affects physical as well as cognitive performance. In individuals with dementia (IWD), decline in physical performance increases with disease progression and is associated with higher functional dependence and decreased quality of life. It is paramount to examine factors that potentially preserve physical performance in IWD, particularly in light of conflicting findings on the effectiveness of physical activity interventions on physical performance of IWD, mainly due to limited number of high-quality studies, large heterogeneity in methods used, or insufficient reporting of methods. The aim of this study was to investigate the effects of a 16-week multimodal exercise program (MEP) combining physical and cognitive tasks on physical performance in IWD, and to identify individual characteristics of MEP responders. METHODS A multicenter randomized controlled trial with assessment methods identified by an expert panel was conducted. We included 319 IWD of mild to moderate severity, older than 65 years, who underwent a standardized MEP specifically designed for IWD. At baseline and immediately after the MEP, we assessed physical performance (ie, mobility, balance, and strength) and function of lower extremities (primary outcomes). Potential effects of the MEP on physical performance were identified using 2-factor analyses of variance with repeated measurements within 2 samples (ie, intention-to-treat and per-protocol sample). Additionally, we compared characteristics related to physical performance between positive, non-, and negative responders. RESULTS AND DISCUSSION Neither analysis procedure revealed statistically significant time×group effects. However, 28% to 40% of participants were positive responders with regard to balance, and strength and function of lower extremities; and these persons had statistically significant lower baseline performance in the corresponding assessments. CONCLUSIONS This randomized controlled trial revealed no overall effects of the MEP on physical performance, probably due to high heterogeneity of the study sample. Findings in responder analysis showed that IWD with lower physical performance at baseline tended to benefit more than those with higher baseline performance. Thus, a higher degree of individualization of the MEP depending on baseline performance on IWD may improve overall MEP effectiveness.
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Affiliation(s)
- Bettina Barisch-Fritz
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Sandra Trautwein
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Andrea Scharpf
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Janina Krell-Roesch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
- Translational Neuroscience and Aging Lab, Mayo Clinic, Scottsdale, Arizona
| | - Alexander Woll
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
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Liu W, Zhang J, Wang Y, Li J, Chang J, Jia Q. Effect of Physical Exercise on Cognitive Function of Alzheimer's Disease Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trial. Front Psychiatry 2022; 13:927128. [PMID: 35782450 PMCID: PMC9243422 DOI: 10.3389/fpsyt.2022.927128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/19/2022] [Indexed: 12/31/2022] Open
Abstract
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.
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Affiliation(s)
- Wei Liu
- School of Physical Education, Xuzhou Kindergarten Teachers College, Xuzhou, China.,Institute of Motor Quotient, Southwest University, Chongqing, China
| | - Jia Zhang
- Qingdao Mental Health Center, Qingdao University, Qingdao, China
| | - Yanyan Wang
- Qingdao Mental Health Center, Qingdao University, Qingdao, China
| | - Junfeng Li
- Ministry of Sports, Shandong Technology and Business University, Yantai, China
| | - Jindong Chang
- Institute of Motor Quotient, Southwest University, Chongqing, China
| | - Qingyin Jia
- Financial Department, Shandong Sports University, Jinan, China
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45
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Nguyen SA, Oughli HA, Lavretsky H. Complementary and Integrative Medicine for Neurocognitive Disorders and Caregiver Health. Curr Psychiatry Rep 2022; 24:469-480. [PMID: 35962927 PMCID: PMC9411083 DOI: 10.1007/s11920-022-01355-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Integrative medicine is the practice of combining conventional medical treatments with "alternative" or "complementary" therapies. Integrative psychiatry is a holistic, person-centered approach to neuropsychiatric disorders that emphasizes a person's physical, emotional, interpersonal, behavioral, nutritional, environmental, and spiritual dimensions to achieve well-being. Older adults are more prone to physical injury, interpersonal loss, chronic illnesses, and physical and cognitive decline that can manifest as anxiety, depression, with functional decline and inability to care for self. Additionally, stress of caring for older adults with dementia can adversely affect caregivers' health. Although integrative approaches are perceived as safer and less stigmatizing, it is important to understand the risks and benefits of such therapies for older adults with neurocognitive disorders and their caregivers. RECENT FINDINGS Here, we summarize the results of the recent clinical trials and meta-analyses that provide evidence for integrative approaches to treating older adults with cognitive disorders and their caregivers which include the use of diet and supplements, and mind-body therapies. Dietary and mind-body therapies have become increasingly popular and show the strongest evidence of effectiveness for cognitive disorders and caregiver stress. Vitamins and supplements are the most popular integrative intervention, but there is mixed evidence supporting their use and the concern for herb (supplement)-drug interactions. While there is increasing popularity of integrative treatments, information to guide clinicians providing care for older adults remains limited, with variable scientific rigor of the available RCTs for a large number of commonly used integrative interventions particularly for cognitive disorders and caregiver stress and well-being.
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Affiliation(s)
- Sarah A Nguyen
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles; 760 Westwood Plaza, Los Angeles, CA, 90095, USA.
| | - Hanadi Ajam Oughli
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles; 760 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles; 760 Westwood Plaza, Los Angeles, CA, 90095, USA
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Kelty TJ, Mao X, Kerr NR, Childs TE, Ruegsegger GN, Booth FW. Resistance-exercise training attenuates LPS-induced astrocyte remodeling and neuroinflammatory cytokine expression in female Wistar rats. J Appl Physiol (1985) 2021; 132:317-326. [PMID: 34941437 DOI: 10.1152/japplphysiol.00571.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Neuroinflammation is an early detectable marker of mild cognitive impairment, the transition state between normal cognition and dementia. Resistance-exercise training can attenuate the cognitive decline observed in patients with mild cognitive impairment. However, the underlying mechanisms of resistance training effects are largely unknown. To further elucidate mechanisms of the known cognitive health benefits from resistance-exercise training, we tested if three weeks of resistance-exercise training could ameliorate lipopolysaccharide-induced neuroinflammation. Five-week-old female Wistar rats received intracerebroventricular injections of lipopolysaccharides to induce neuroinflammation and cognitive impairment. Rats then underwent three weeks of progressive ladder climbing to recapitulate resistance-exercise training in humans. Cognition was assessed towards the end of the training period by novelty object recognition testing. Neuroinflammation was measured one and 24-hours after the last resistance-exercise training workout. Resistance-exercise training ameliorated cognitive impairment, diminished lipopolysaccharide-induced neuroinflammatory cytokine expression, and attenuated astrocyte remodeling in the dentate gyrus 24-hours post exercise. Here, we provide evidence that the ladder-climbing model of resistance-exercise training in rats can improve cognition as early as three weeks. Additionally, these data support the hypothesis that resistance exercise can reduce lipopolysaccharide-induced neuroinflammation in the dentate gyrus.
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Affiliation(s)
- Taylor J Kelty
- Department of Biomedical Sciences, University of Missouri, Columbia, MO, United States
| | - Xuansong Mao
- Department of Biomedical Sciences, University of Missouri, Columbia, MO, United States
| | - Nathan R Kerr
- Department of Biomedical Sciences, University of Missouri, Columbia, MO, United States
| | - Thomas E Childs
- Department of Biomedical Sciences, University of Missouri, Columbia, MO, United States
| | - Gregory N Ruegsegger
- Department of Health and Human Performance, University of Wisconsin-River Falls, River Falls, WI, United States
| | - Frank W Booth
- Department of Biomedical Sciences, University of Missouri, Columbia, MO, United States.,Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, United States.,Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, United States.,Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, United States
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López-Ortiz S, Valenzuela PL, Seisdedos MM, Morales JS, Vega T, Castillo-García A, Nisticò R, Mercuri NB, Lista S, Lucia A, Santos-Lozano A. Exercise interventions in Alzheimer's disease: A systematic review and meta-analysis of randomized controlled trials. Ageing Res Rev 2021; 72:101479. [PMID: 34601135 DOI: 10.1016/j.arr.2021.101479] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/04/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Susana López-Ortiz
- i+HeALTH, European University Miguel de Cervantes, 47012 Valladolid, Spain.
| | - Pedro L Valenzuela
- Faculty of Sport Sciences, European University of Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - María M Seisdedos
- i+HeALTH, European University Miguel de Cervantes, 47012 Valladolid, Spain
| | - Javier S Morales
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Cadiz, Spain
| | - Tomás Vega
- Public Health Directorate, Regional Ministry of Health (Dirección General de Salud Pública, Consejería de Sanidad), Castilla y León, 47007 Valladolid, Spain
| | | | - Robert Nisticò
- Laboratory of Pharmacology of Synaptic Plasticity, EBRI Rita Levi-Montalcini Foundation, 00161 Rome, Italy; School of Pharmacy, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Nicola Biagio Mercuri
- Department of Experimental Neuroscience, IRCCS Fondazione Santa Lucia, 00143 Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Simone Lista
- Faculty of Sport Sciences, European University of Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; School of Pharmacy, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Alejandro Lucia
- Faculty of Sport Sciences, European University of Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; CIBER en Fragilidad y Envejecimiento Saludable (CIBERFES), 28029 Madrid, Spain; Research Institute of the Hospital 12 de Octubre ('imas12'), 28041 Madrid, Spain
| | - Alejandro Santos-Lozano
- i+HeALTH, European University Miguel de Cervantes, 47012 Valladolid, Spain; Research Institute of the Hospital 12 de Octubre ('imas12'), 28041 Madrid, Spain.
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Pisani S, Mueller C, Huntley J, Aarsland D, Kempton MJ. A meta-analysis of randomised controlled trials of physical activity in people with Alzheimer's disease and mild cognitive impairment with a comparison to donepezil. Int J Geriatr Psychiatry 2021; 36:1471-1487. [PMID: 34490652 DOI: 10.1002/gps.5581] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/09/2021] [Accepted: 05/17/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Physical exercise may benefit people with Alzheimer's disease (AD) and mild cognitive impairment (MCI). However, randomised controlled trials (RCTs) of exercise have shown conflicting findings and it is unclear if positive outcomes are comparable to a commonly used cholinesterase inhibitor, donepezil. METHODS Embase, Medline, PsycINFO, PsycARTICLES, SCOPUS were searched for RCTs of physical activity compared to a control condition, and donepezil compared to placebo in people with AD and MCI. Effect sizes were calculated from pre- and post-MMSE and ADAS-Cog scores and pooled using a random effects meta-analysis. RESULTS Ninteen RCTs were included in the exercise meta-analysis (AD, N = 524; MCI, N = 1269). Physical exercise improved MMSE scores in AD (Hedges' g = 0.46) and MCI groups (g = 0.63). For the MCI group, exercise appeared to have a stronger effect for those with lower MMSE scores at baseline (p = 0.022). 18 RCTs were included in the donepezil meta-analysis (AD, N = 2984, MCI, N = 1559). In people with AD, donepezil improved cognition (MMSE g = 0.23; ADAS-Cog, g = -0.17) but there was no evidence of improved cognition in MCI. CONCLUSIONS Physical exercise improved cognition in both AD and MCI groups. Where comparisons were possible, the effect size for physical exercise was generally comparable to donepezil. These results strengthen the evidence base for exercise as an effective intervention in AD and MCI, and future clinical trials should examine exercise type, intensity and frequency, in addition to cholinesterase inhibitors to determine the most effective interventions for AD and MCI.
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Affiliation(s)
- Sara Pisani
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Christoph Mueller
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jonathan Huntley
- Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
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The Use of Home-Based Nonimmersive Virtual Reality to Encourage Physical and Cognitive Exercise in People With Mild Cognitive Impairment: A Feasibility Study. J Aging Phys Act 2021; 30:297-307. [PMID: 34453024 DOI: 10.1123/japa.2021-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/30/2021] [Accepted: 05/18/2021] [Indexed: 11/18/2022]
Abstract
Individuals with mild cognitive impairment are at risk of cognitive and physical decline. Virtual reality (VR) exercise may provide beneficial physical and cognitive exercise. The objectives of this study were to assess the feasibility and safety of home-based VR exercise and to provide pilot data for physical and cognitive efficacy. Eleven individuals with mild cognitive impairment (seven males/four females, average 78 years old, and average 3 years since diagnosis) performed a 30-min home-based VR exercise program 5 days a week for 6 weeks. The VR platform was successfully installed in participants' homes, and all participants were able to learn the VR program and progress. Participants completed 99% of the prescribed exercise. There were no major adverse events. Most participants enjoyed the VR program and reported physical benefits; fewer reported cognitive benefits. No physical or cognitive outcome measures showed change after 6 weeks. Home-based VR exercise is safe and feasible in individuals with mild cognitive impairment.
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50
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Cezar NODC, Ansai JH, Oliveira MPBD, da Silva DCP, Gomes WDL, Barreiros BA, Langelli TDCO, de Andrade LP. Feasibility of improving strength and functioning and decreasing the risk of falls in older adults with Alzheimer's dementia: a randomized controlled home-based exercise trial. Arch Gerontol Geriatr 2021; 96:104476. [PMID: 34260986 DOI: 10.1016/j.archger.2021.104476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the effects of a Home-based multimodal exercise program for older people with Alzheimer's disease (AD-HOMEX) on muscle strength, mobility, the risk of falls and functioning. MATERIALS AND METHODS A trial with a blinded assessor was conducted involving 40 older people with mild to moderate AD randomized to an intervention group (IG) or control group (CG). The IG participated in a 16-week protocol with three 60-minute sessions per week. The sessions were performed at the participant's home by a physiotherapist and involved progressive individualized physical exercises. Muscle strength (5X Sit-to-Stand Test [5XSTS], 30-Second Chair Stand test, isokinetic and hand-grip dynamometer), functioning (DAFS-R and ADL-Q), mobility and the risk of falls (TUG) were assessed at baseline and after training. Intention-to-treat analysis was adopted. RESULTS There was a significant group-evaluation time interaction for the 5XSTS (p = 0.011). The IG demonstrated an improved performance on the 5XSTS (p = 0.020) and a reduced risk of falls (p = 0.000), whereas the CG exhibited a worse functional limitation (p = 0.008) after 16 weeks. The CG had an increased risk of falls (p = 0.006) and worse performance on the ADL-Q (p = 0.047) at the follow-up evaluation. An improvement in the IG and worsening in the CG were found regarding transition patterns between severity levels of functional limitation based on the ADL-Q. CONCLUSIONS Home-based physical exercise for older people with mild to moderate AD is an effective strategy that decreases the risk of falls and improves strength and functioning.
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Affiliation(s)
- Natália Oiring de Castro Cezar
- Department of Physical Therapy, Federal University of São Carlos; Department of Gerontology, Federal University of São Carlos.
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