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Zhang Y, Chu M, Zheng Y, Zhang F, Yu H, Ye X, Xie H, Chen J, Qian Z, Zeng C, Chen W, Pei Z, Zhang Y, Chen J. Effects of Combined Use of Intermittent Theta Burst Stimulation and Cognitive Training on Poststroke Cognitive Impairment: A Single-Blind Randomized Controlled Trial. Am J Phys Med Rehabil 2024; 103:318-324. [PMID: 37792502 DOI: 10.1097/phm.0000000000002344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Poststroke cognitive impairment substantially affects patients' quality of life. This study explored the therapeutic efficacy of intermittent theta burst stimulation combined with cognitive training for poststroke cognitive impairment. DESIGN The experimental group received intermittent theta burst stimulation and cognitive training, whereas the control group only received cognitive training, both for 6 wks. The outcome measures were the Loewenstein Occupational Therapy Cognitive Assessment, modified Barthel Index, transcranial Doppler ultrasonography, and functional near-infrared spectroscopy. RESULTS After therapy, between-group comparisons revealed a substantial difference in the Loewenstein Occupational Therapy Cognitive Assessment scores ( P = 0.024). Improvements in visuomotor organization and thinking operations were more noticeable in the experimental group than in the other groups ( P = 0.017 and P = 0.044, respectively). After treatment, the resistance index of the experimental group differed from that of the control group; channels 29, 37, and 41 were activated ( P < 0.05). The active locations were the left dorsolateral prefrontal cortex, prefrontal polar cortex, and left Broca's region. CONCLUSIONS Intermittent theta burst stimulation combined with cognitive training had a superior effect on improving cognitive function and everyday activities compared with cognitive training alone, notably in visuomotor organization and thinking operations. Intermittent theta burst stimulation may enhance cognitive performance by improving network connectivity.
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Affiliation(s)
- Youmei Zhang
- From the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (Youmei Z, Hangkai X, Jing C, Chao Z, Jianer C); The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China (Youmei Z, Yanjun Z, Hangkai X, Jing C, Chao Z, Jianer C); Zhejiang Rehabilitation Medical Center, Hangzhou, Zhejiang, China (Feilan Z, Hong Y, Xiancong Y, Jing C, Zhiyong Q, Chao Z, Jianer C); Beihang University, Hangzhou Innovation Institute, Hangzhou, Zhejiang, China (Weihai C, Zhongcai P, Yue Z); and The Seconditions Hospital of Anhui Medical University, Hefei, An hui, China (Minmin C)
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Mitchell JJ, Blodgett JM, Chastin SFM, Jefferis BJ, Wannamethee SG, Hamer M. Exploring the associations of daily movement behaviours and mid-life cognition: a compositional analysis of the 1970 British Cohort Study. J Epidemiol Community Health 2023; 77:189-195. [PMID: 36690475 PMCID: PMC9933163 DOI: 10.1136/jech-2022-219829] [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: 09/15/2022] [Accepted: 12/08/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Movement behaviours (eg, sedentary behaviour (SB), moderate and vigorous physical activity (MVPA), light intensity physical activity (LIPA) and sleep) are linked to cognition, yet the relative importance of each component is unclear, and not yet explored with compositional methodologies. OBJECTIVE To (i) assess the associations of different components of daily movement and participant's overall cognition, memory and executive function, and (ii) understand the relative importance of each individual component for cognition. METHODS The 1970 British Cohort Study (BCS70) is a prospective birth cohort study of UK-born adults. At age 46, participants consented to wear an accelerometer device and complete tests of verbal memory and executive function. Compositional linear regression was used to examine cross-sectional associations between 24-hour movement behaviours and standardised cognition scores. Isotemporal substitution was performed to model the effect of reallocating time between components of daily movement on cognition. RESULTS The sample comprised 4481 participants (52% female). Time in MVPA relative to SB, LIPA and sleep was positively associated with cognition after adjustments for education and occupational physical activity, but additional adjustment for health status attenuated associations. SB relative to all other movements was robustly positively associated with cognition. Modelling time reallocation between components revealed an increase in cognition centile after MVPA theoretically replaced 9 min of SB (OR=1.31; 95% CI 0.09 to 2.50), 7 min of LIPA (1.27; 0.07 to 2.46) or 7 min of sleep (1.20; 0.01 to 2.39). CONCLUSIONS Relative to time spent in other behaviours, greater MVPA and SB was associated with higher cognitive scores. Loss of MVPA time, given its smaller relative amount, appears most deleterious. Efforts should be made to preserve MVPA time, or reinforce it in place of other behaviours.
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Affiliation(s)
- John J Mitchell
- Primary Care and Population Health, University College London, London, UK
| | - Joanna M Blodgett
- Institute of Sport, Exercise and Health, University College London, London, UK
| | | | - Barbara J Jefferis
- Primary Care and Population Health, University College London, London, UK
| | - S Goya Wannamethee
- Primary Care and Population Health, University College London, London, UK
| | - Mark Hamer
- Institute of Sport, Exercise and Health, University College London, London, UK
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Zhao S. Influence of Aerobic Exercise Load Intensity on Children's Mental Health. Emerg Med Int 2022; 2022:7827980. [PMID: 35726303 PMCID: PMC9206579 DOI: 10.1155/2022/7827980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/13/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022] Open
Abstract
As people have become more aware in recent years, aerobic physical exercise plays an important role in alleviating people's mental health problems. However, traditionally, it is believed that young children do not have mental health problems. To help people change this fixed idea, and to study how to correctly adjust the load intensity of aerobic physical exercise under the condition of limited physical fitness of young children, and accurately help children's mental health development, this paper studies the influence of aerobic physical exercise load intensity on children's mental health. In this paper, the detection and tracking technology of video moving objects is used to analyze the data of the research object. This technique includes several commonly used and improved video analysis algorithms. The use of moving target and tracking technology and algorithms can completely extract moving targets, eliminate the phenomenon of void and nothingness, and improve data acquisition and analysis capabilities. The results show that taking part in aerobic exercise with appropriate intensity is beneficial to regulating children's emotional state, reducing their psychological burden, enhancing their negative energy resistance, and arousing their positive participation. Compared with before aerobic exercise, the learning efficiency was improved by 6.36%.
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Affiliation(s)
- Sihong Zhao
- School of Preschool Education, Xi'an University, Xi'an 710065, Shaanxi, China
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White D, John CS, Kucera A, Truver B, Lepping RJ, Kueck PJ, Lee P, Martin L, Billinger SA, Burns JM, Morris JK, Vidoni ED. A methodology for an acute exercise clinical trial called dementia risk and dynamic response to exercise. Sci Rep 2021; 11:12776. [PMID: 34140586 PMCID: PMC8211849 DOI: 10.1038/s41598-021-92177-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/04/2021] [Indexed: 01/21/2023] Open
Abstract
Exercise likely has numerous benefits for brain and cognition. However, those benefits and their causes remain imprecisely defined. If the brain does benefit from exercise it does so primarily through cumulative brief, "acute" exposures over a lifetime. The Dementia Risk and Dynamic Response to Exercise (DYNAMIC) clinical trial seeks to characterize the acute exercise response in cerebral perfusion, and circulating neurotrophic factors in older adults with and without the apolipoprotein e4 genotype (APOE4), the strongest genetic predictor of sporadic, late onset Alzheimer's disease. DYNAMIC will enroll 60 older adults into a single moderate intensity bout of exercise intervention, measuring pre- and post-exercise cerebral blood flow (CBF) using arterial spin labeling, and neurotrophic factors. We expect that APOE4 carriers will have poor CBF regulation, i.e. slower return to baseline perfusion after exercise, and will demonstrate blunted neurotrophic response to exercise, with concentrations of neurotrophic factors positively correlating with CBF regulation. Preliminary findings on 7 older adults and 9 younger adults demonstrate that the experimental method can capture CBF and neurotrophic response over a time course. This methodology will provide important insight into acute exercise response and potential directions for clinical trial outcomes.ClinicalTrials.gov NCT04009629, Registered 05/07/2019.
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Affiliation(s)
- Dreu White
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Casey S John
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Ashley Kucera
- American Academy of Family Physicians, Leawood, KS, USA
| | - Bryce Truver
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Paul J Kueck
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Phil Lee
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Laura Martin
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | - Jill K Morris
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Eric D Vidoni
- University of Kansas Medical Center, Kansas City, KS, USA.
- University of Kansas Alzheimer's Disease Center, 4350 Shawnee Mission Parkway, Fairway, KS, 60205, MS6002, USA.
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5
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Zhang J, Strand K, Totillo M, Chen Q, Signorile JF, Jiang H, Wang J. Improvement of retinal tissue perfusion after circuit resistance training in healthy older adults. Exp Gerontol 2021; 146:111210. [PMID: 33385483 DOI: 10.1016/j.exger.2020.111210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/15/2020] [Accepted: 12/10/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE To determine the retinal tissue perfusion (RTP) and its relation to cognitive function in healthy older people after an 8-week high-speed circuit resistance training program (HSCT). METHODS Eleven subjects in the HSCT group and seven age-matched non-training controls (CON) were recruited. The HSCT group trained 3 times per week for 8 weeks, while CON performed no formal training. One eye of each subject in both groups was imaged at baseline and at an 8-week follow-up, using a Retinal Function Imager to measure retinal blood flow (RBF). Retinal tissue perfusion (RTP) was calculated as RBF divided by the corresponding tissue volume. Cognitive function was assessed during both visits using the NIH Toolbox Fluid Cognition Battery. RESULTS RTP was 2.99 ± 0.91 nl·s-1·mm-3 (mean ± SD) at baseline and significantly increased to 3.77 ± 0.86 nl·s-1·mm-3 after training (P < 0.001) in the HSCT group, reflecting an increase of 26%. In the HSCT group, the Pattern Comparison Processing Speed Test (PAT) and Fluid Cognition Composite Score (FCS) were significantly increased after HSCT (P = 0.01). Furthermore, the changes in Flanker Inhibitory Control and Attention Test (FLNK) were positively correlated to increases in RTP (r = 0.80, P = 0.003). CONCLUSIONS This is the first prospective study to demonstrate that the increased RTP after HSCT was related to improved cognition in cognitively-normal elders, indicating RTP could be an imaging marker for monitoring cognitive changes due to physical activity in the elderly.
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Affiliation(s)
- Juan Zhang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Keri Strand
- Department of Kinesiology and Sports Sciences, University of Miami, FL, USA
| | - Matthew Totillo
- Department of Kinesiology and Sports Sciences, University of Miami, FL, USA
| | - Qi Chen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joseph F Signorile
- Department of Kinesiology and Sports Sciences, University of Miami, FL, USA
| | - Hong Jiang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jianhua Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
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Zwan MD, van der Flier WM, Cleutjens S, Schouten TC, Vermunt L, Jutten RJ, van Maurik IS, Sikkes SA, Flenniken D, Howell T, Weiner MW, Scheltens P, Prins ND. Dutch Brain Research Registry for study participant recruitment: Design and first results. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12132. [PMID: 33614897 PMCID: PMC7882519 DOI: 10.1002/trc2.12132] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/11/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The Dutch Brain Research Registry aims to facilitate online recruitment of participants for brain disease studies. METHODS Registrants were primarily recruited through an online social media campaign. The registration process included a short questionnaire, which was subsequently used in the prescreening process to match participants to studies. RESULTS In the first 18 months, 17,218 registrants signed up (58±11 years old, 78% female). Out of 34,696 study invitations that were sent, 36% were accepted by registrants, of which 50% to 84% were finally enrolled, resulting in 10,661 participants in 28 studies. Compared to non-participants, study participants were more often older, male, more highly educated, retired or unemployed, non-smoking, healthier, and more often had a family member with dementia. DISCUSSION The Dutch Brain Research Registry facilitates effective matching of participants to brain disease studies. Participant factors related to study enrollment may reflect facilitators or barriers for participation, which is useful for improving recruitment strategies.
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Affiliation(s)
- Marissa D. Zwan
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Wiesje M. van der Flier
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
- Department of Epidemiology and BiostatisticsAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Solange Cleutjens
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Tamara C Schouten
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Lisa Vermunt
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
- Department of Clinical ChemistryNeurochemistry LaboratoryAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Roos J. Jutten
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Ingrid S. van Maurik
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
- Department of Epidemiology and BiostatisticsAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Sietske A.M. Sikkes
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Derek Flenniken
- Center for Imaging of Neurodegenerative Diseases (CIND)San Francisco Veterans Affair Medical CenterSan FranciscoCaliforniaUSA
| | - Taylor Howell
- Center for Imaging of Neurodegenerative Diseases (CIND)San Francisco Veterans Affair Medical CenterSan FranciscoCaliforniaUSA
| | - Michael W. Weiner
- Center for Imaging of Neurodegenerative Diseases (CIND)San Francisco Veterans Affair Medical CenterSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Philip Scheltens
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
| | - Niels D. Prins
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamthe Netherlands
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da Costa Daniele TM, de Bruin PFC, de Matos RS, de Bruin GS, Maia Chaves C, de Bruin VMS. Exercise effects on brain and behavior in healthy mice, Alzheimer's disease and Parkinson's disease model-A systematic review and meta-analysis. Behav Brain Res 2020; 383:112488. [PMID: 31991178 DOI: 10.1016/j.bbr.2020.112488] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/28/2019] [Accepted: 01/16/2020] [Indexed: 12/12/2022]
Abstract
This systematic review and meta-analysis examines how exercise modifies brain and behavior in healthy mice, dementia (D) and Parkinson disease (PD) models. A search was performed on the Medline and Scopus electronic databases (2008-2019). Search terms were "mice", "brain", "treadmill", "exercise", "physical exercise". In the total, 430 were found but only 103 were included. Animals n = 1,172; exercised 4-8 weeks (Range 24 h to 32 weeks), 60 min/day (Range 8-120 min per day), and 10/12 m/min (Range 0.2 m/min to 36 m/min). Hippocampus, cerebral cortex, striatum and whole brain were more frequently investigated. Exercise improved learning and memory. Meta-analysis showed that exercise increased: cerebral BDNF in health (n = 150; z = 5.8, CI 3.43-12.05; p < 0.001 I2 = 94.3 %), D (n = 124; z = 4.18, CI = 2.22-9.12; p < 0.001; I2 = 93.7 %) and PD (n = 16 z = 4.26, CI 5.03-48.73 p < 0.001 I2 = 94.8 %). TrkB improved in health (n = 84 z = 5.49, CI 3.8-17.73 p < 0.001, I2 = 0.000) and PD (n = 22; z = 3.1, CI = 2.58-67.3, p < 0.002 I2 = 93.8 %). Neurogenesis increased in health (n = 68; z = 7.08, CI 5.65-21.25 p < 0.001; I2 17.58) and D model (n = 116; z = 4.18, CI 2.22-9.12 p < 0.001 I2 93.7 %). Exercise augmented amyloid clearance (n = 166; z = 7.51 CI = 4.86-14.85, p < 0.001 I2 = 58.72) and reduced amyloid plaques in D models (n = 49; z = 4.65, CI = 3.94-15.3 p < 0.001 I2 = 0.000). In conclusion, exercise improved brain and behavior, neurogenesis in healthy and dementia models, reduced toxicity and cerebral amyloid. Evidence regarding inflammation, oxidative stress and energy metabolism were scarce. Studies examining acute vs chronic exercise, extreme training and the durability of exercise benefit were rare. Vascular or glucose metabolism changes were seldom reported.
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Affiliation(s)
- Thiago Medeiros da Costa Daniele
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Ceará, Fortaleza, Brazil; Sleep and Biological Rhythms Laboratory, UFC, Brazil; Universidade Federal do Ceará (UFC), Brazil; Universidade de Fortaleza (UNIFOR).
| | - Pedro Felipe Carvalhedo de Bruin
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Ceará, Fortaleza, Brazil; Sleep and Biological Rhythms Laboratory, UFC, Brazil; Universidade Federal do Ceará (UFC), Brazil.
| | - Robson Salviano de Matos
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Ceará, Fortaleza, Brazil; Sleep and Biological Rhythms Laboratory, UFC, Brazil; Universidade Federal do Ceará (UFC), Brazil.
| | - Gabriela Sales de Bruin
- Universidade Federal do Ceará (UFC), Brazil; Department of Neurology, Washington University in St Louis, United States.
| | - Cauby Maia Chaves
- Universidade Federal do Ceará (UFC), Brazil; Departamento de Clínica Odontológica, UFC, Brazil.
| | - Veralice Meireles Sales de Bruin
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Ceará, Fortaleza, Brazil; Sleep and Biological Rhythms Laboratory, UFC, Brazil; Universidade Federal do Ceará (UFC), Brazil.
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8
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Hooghiemstra AM, Leeuwis AE, Bertens AS, Biessels GJ, Bots ML, Brunner-La Rocca HP, Greving JP, Kappelle LJ, van Oostenbrugge RJ, van Rossum AC, van der Flier WM. Frequent Cognitive Impairment in Patients With Disorders Along the Heart-Brain Axis. Stroke 2019; 50:3369-3375. [DOI: 10.1161/strokeaha.119.026031] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background and Purpose—
Patients with cardiovascular disease are at increased risk for cognitive decline. We studied the occurrence and profile of cognitive impairment in 3 patient groups as exemplar conditions of hemodynamic disturbances at different levels of the heart-brain axis, including patients with heart failure (HF), carotid occlusive disease (COD), and patients with cognitive complaints and vascular brain injury on magnetic resonance imaging (possible vascular cognitive impairment [VCI]).
Methods—
In 555 participants (160 HF, 107 COD, 160 possible VCI, 128 reference participants; 68±9 years; 36% F; Mini-Mental State Examination 28±2), we assessed cognitive functioning with a comprehensive test battery. Test scores were transformed into
z
-scores. Compound
z
-scores were constructed for: memory, language, attention/psychomotor speed, executive functioning, and global cognitive functioning. We rated cognitive domains as impaired when
z
-score≤−1.5. Based on the number of impaired domains, patients were classified as cognitively normal, minor, or major cognitive impairment. We used general linear models and χ
2
tests to compare cognitive functioning between patient groups and the reference group.
Results—
Age, sex, and education adjusted global cognitive functioning z-score was lower in patients with COD (β [SE]=−0.46 [0.10],
P
<0.001) and possible VCI (β [SE]=−0.80 [0.09],
P
<0.001) compared with reference participants. On all domains,
z
-scores were lower in patients with COD and possible VCI compared with reference participants. Patients with HF had lower z-scores on attention/speed and language compared with reference participants. Cognitive impairment was observed in 18% of HF, 36% of COD, and 45% possible VCI. There was no difference in profile of impaired cognitive domains between patient groups. Memory and attention-psychomotor speed were most commonly affected, followed by executive functioning and language.
Conclusions—
A substantial part of patients with HF and COD had cognitive impairment, which warrants vigilance for the occurrence of cognitive impairment. These results underline the importance of an integrative approach in medicine in patients presenting with disorders in the heart-brain axis.
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Affiliation(s)
- Astrid M. Hooghiemstra
- From the Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience (A.M.H., A.E.L., W.M.v.d.F.), Amsterdam UMC, location VUmc, the Netherlands
- Department of Medical Humanities, Amsterdam Public Health Research Institute (A.M.H.), Amsterdam UMC, location VUmc, the Netherlands
| | - Anna E. Leeuwis
- From the Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience (A.M.H., A.E.L., W.M.v.d.F.), Amsterdam UMC, location VUmc, the Netherlands
| | - Anne Suzannne Bertens
- Department of Radiology (A.S.B.)
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, the Netherlands (A.S.B.)
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center (G.J.B., L.J.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care (M.L.B., J.P.G.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | | | - Jacoba P. Greving
- Julius Center for Health Sciences and Primary Care (M.L.B., J.P.G.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - L. Jaap Kappelle
- Department of Neurology, UMC Utrecht Brain Center (G.J.B., L.J.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | | | - Albert C. van Rossum
- Department of Cardiology (A.C.v.R.), Amsterdam UMC, location VUmc, the Netherlands
| | - Wiesje M. van der Flier
- From the Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience (A.M.H., A.E.L., W.M.v.d.F.), Amsterdam UMC, location VUmc, the Netherlands
- Department of Epidemiology (W.M.v.d.F.) Amsterdam UMC, location VUmc, the Netherlands
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Mene-Afejuku TO, Pernia M, Ibebuogu UN, Chaudhari S, Mushiyev S, Visco F, Pekler G. Heart Failure and Cognitive Impairment: Clinical Relevance and Therapeutic Considerations. Curr Cardiol Rev 2019; 15:291-303. [PMID: 31456512 PMCID: PMC8142355 DOI: 10.2174/1573403x15666190313112841] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 12/19/2022] Open
Abstract
Heart failure (HF) is a devastating condition characterized by poor quality of life, numerous complications, high rate of readmission and increased mortality. HF is the most common cause of hospitalization in the United States especially among people over the age of 64 years. The number of people grappling with the ill effects of HF is on the rise as the number of people living to an old age is also on the increase. Several factors have been attributed to these high readmission and mortality rates among which are; poor adherence with therapy, inability to keep up with clinic appointments and even failure to recognize early symptoms of HF deterioration which may be a result of cognitive impairment. Therefore, this review seeks to compile the most recent information about the links between HF and dementia or cognitive impairment. We also assessed the prognostic consequences of cognitive impairment complicating HF, therapeutic strategies among patients with HF and focus on future areas of research that would reduce the prevalence of cognitive impairment, reduce its severity and also ameliorate the effect of cognitive impairment coexisting with HF.
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Affiliation(s)
- Tuoyo O Mene-Afejuku
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Monica Pernia
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Uzoma N Ibebuogu
- Department of Internal Medicine (Cardiology), University of Tennessee Health Sciences Center, Memphis, Tennessee TN, United States
| | - Shobhana Chaudhari
- Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Savi Mushiyev
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Ferdinand Visco
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States
| | - Gerald Pekler
- Division of Cardiology, New York Medical College, Metropolitan Hospital Center, New York NY, United States
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10
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Abstract
The number of adults with Alzheimer’s disease (AD) or related dementia is expected to increase exponentially. Interventions aimed to reduce the risk and progression of AD and dementia are critical to the prevention and treatment of this devastating disease. Aging and cardiovascular disease risk factors are associated with reduced vascular function, which can have important clinical implications, including brain health. The age-associated increase in blood pressure and impairment in vascular function may be attenuated or even reversed through lifestyle behaviors. Greater volumes of habitual exercise and higher cardiorespiratory fitness are associated with beneficial effects on vascular health and cognition. Exercise and cardiorespiratory fitness may be most important during midlife, as physical activity and cardiorespiratory fitness during the middle-aged years are associated with future cognitive function. The extent to which exercise, and more specifically aerobic exercise, influences the cerebral circulation is not well established. In this review, we present our working hypothesis showing how cerebrovascular function may be a mediating factor underlying the association between exercise and cognition, as well as discuss recent studies evaluating the effect of exercise interventions on the cerebral circulation.
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Affiliation(s)
- Jill N Barnes
- Department of Kinesiology, Bruno Balke Biodynamics Laboratory, University of Wisconsin-Madison, Madison, WI, USA.,Department of Medicine, Division of Geriatrics and Gerontology, University of Wisconsin-Madison, Madison, WI, USA
| | - Adam T Corkery
- Department of Kinesiology, Bruno Balke Biodynamics Laboratory, University of Wisconsin-Madison, Madison, WI, USA
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11
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Cognitive Deficits in Multiple Sclerosis: Recent Advances in Treatment and Neurorehabilitation. Curr Treat Options Neurol 2018; 20:53. [PMID: 30345468 DOI: 10.1007/s11940-018-0538-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW This article highlights recent progress in research on treatment and neurorehabilitation of cognitive impairment in multiple sclerosis (MS) including pharmacological interventions, physical exercise, and neuropsychological rehabilitation, both in conventional and technology-assisted settings. RECENT FINDINGS The most consistent evidence in terms of improvement or preservation of circumscribed cognitive scores in MS patients comes from moderately sampled randomized clinical trials on multimodal approaches that combine conventional or computerized neuropsychological training with psychoeducation or cognitive behavioral therapy. Disease-modifying treatments also appear to have beneficial effects in preventing or attenuating cognitive decline, whereas there is little evidence for agents such as donepezil or stimulants. Finally, physical exercise may yield some cognitive improvement in MS patients. Despite substantial and often promising research efforts, there is a lack of validated and widely accepted clinical procedures for cognitive neurorehabilitation in MS. Development of such approaches will require collaborative efforts towards the design of interventions that are fundamentally inspired by cognitive neuroscience, potentially guided by neuroimaging, and composed of conventional neuropsychological training and cognitive behavioral therapy as well as physical exercise and therapeutic video games. Subsequently, large-scale validation will be needed with meaningful outcome measures reflecting transfer to everyday cognitive function and maintenance of training effects.
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Abstract
The term vascular cognitive impairment (VCI) was introduced around the start of the new millennium and refers to the contribution of vascular pathology to any severity of cognitive impairment, ranging from subjective cognitive decline and mild cognitive impairment to dementia. Although vascular pathology is common in elderly individuals with cognitive decline, pure vascular dementia (that is, dementia caused solely by vascular pathology) is uncommon. Indeed, most patients with vascular dementia also have other types of pathology, the most common of which is Alzheimer disease (specifically, the diffuse accumulation of amyloid-β plaques and neurofibrillary tangles composed of tau). At present, the main treatment for VCI is prevention by treating vascular diseases and other risk factors for VCI, such as hypertension and diabetes mellitus. Despite the current paucity of disease-modifying pharmacological treatments, we foresee that eventually, we might be able to target specific brain diseases to prevent cognitive decline and dementia.
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van der Flier WM, Scheltens P. Amsterdam Dementia Cohort: Performing Research to Optimize Care. J Alzheimers Dis 2018; 62:1091-1111. [PMID: 29562540 PMCID: PMC5870023 DOI: 10.3233/jad-170850] [Citation(s) in RCA: 196] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2017] [Indexed: 01/01/2023]
Abstract
The Alzheimer center of the VU University Medical Center opened in 2000 and was initiated to combine both patient care and research. Together, to date, all patients forming the Amsterdam Dementia Cohort number almost 6,000 individuals. In this cohort profile, we provide an overview of the results produced based on the Amsterdam Dementia Cohort. We describe the main results over the years in each of these research lines: 1) early diagnosis, 2) heterogeneity, and 3) vascular factors. Among the most important research efforts that have also impacted patients' lives and/or the research field, we count the development of novel, easy to use diagnostic measures such as visual rating scales for MRI and the Amsterdam IADL Questionnaire, insight in different subgroups of AD, and findings on incidence and clinical sequelae of microbleeds. Finally, we describe in the outlook how our research endeavors have improved the lives of our patients.
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Affiliation(s)
- Wiesje M. van der Flier
- Department of Neurology, Alzheimer Center, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
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Hooghiemstra AM, Bertens AS, Leeuwis AE, Bron EE, Bots ML, Brunner-La Rocca HP, de Craen AJM, van der Geest RJ, Greving JP, Kappelle LJ, Niessen WJ, van Oostenbrugge RJ, van Osch MJP, de Roos A, van Rossum AC, Biessels GJ, van Buchem MA, Daemen MJAP, van der Flier WM. The Missing Link in the Pathophysiology of Vascular Cognitive Impairment: Design of the Heart-Brain Study. Cerebrovasc Dis Extra 2017; 7:140-152. [PMID: 29017156 PMCID: PMC5730112 DOI: 10.1159/000480738] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 08/18/2017] [Indexed: 12/13/2022] Open
Abstract
Background Hemodynamic balance in the heart-brain axis is increasingly recognized as a crucial factor in maintaining functional and structural integrity of the brain and thereby cognitive functioning. Patients with heart failure (HF), carotid occlusive disease (COD), and vascular cognitive impairment (VCI) present themselves with complaints attributed to specific parts of the heart-brain axis, but hemodynamic changes often go beyond the part of the axis for which they primarily seek medical advice. The Heart-Brain Study hypothesizes that the hemodynamic status of the heart and the brain is an important but underestimated cause of VCI. We investigate this by studying to what extent hemodynamic changes contribute to VCI and what the mechanisms involved are. Here, we provide an overview of the design and protocol. Methods The Heart-Brain Study is a multicenter cohort study with a follow-up measurement after 2 years among 645 participants (175 VCI, 175 COD, 175 HF, and 120 controls). Enrollment criteria are the following: 1 of the 3 diseases diagnosed according to current guidelines, age ≥50 years, no magnetic resonance contraindications, ability to undergo cognitive testing, and independence in daily life. A core clinical dataset is collected including sociodemographic factors, cardiovascular risk factors, detailed neurologic, cardiac, and medical history, medication, and a physical examination. In addition, we perform standardized neuropsychological testing, cardiac, vascular and brain MRI, and blood sampling. In subsets of participants we assess Alzheimer biomarkers in cerebrospinal fluid, and assess echocardiography and 24-hour blood pressure monitoring. Follow-up measurements after 2 years include neuropsychological testing, brain MRI, and blood samples for all participants. We use centralized state-of-the-art storage platforms for clinical and imaging data. Imaging data are processed centrally with automated standardized pipelines. Results and Conclusions The Heart-Brain Study investigates relationships between (cardio-)vascular factors, the hemodynamic status of the heart and the brain, and cognitive impairment. By studying the complete heart-brain axis in patient groups that represent components of this axis, we have the opportunity to assess a combination of clinical and subclinical manifestations of disorders of the heart, vascular system and brain, with hemodynamic status as a possible binding factor.
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Affiliation(s)
- Astrid M Hooghiemstra
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Anne Suzanne Bertens
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Anna E Leeuwis
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - Esther E Bron
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob J van der Geest
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jacoba P Greving
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wiro J Niessen
- Biomedical Imaging Group Rotterdam, Departments of Medical Informatics and Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.,Imaging Physics, Applied Sciences, Delft University of Technology, Delft, the Netherlands
| | | | - Matthias J P van Osch
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mat J A P Daemen
- Department of Pathology, Academic Medical Center, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center & Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands.,Department of Epidemiology, VU University Medical Center, Amsterdam, the Netherlands
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