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Ma H, Mu X, Jin Y, Luo Y, Wu M, Han Z. Multimorbidity, lifestyle, and cognitive function: A cross-cultural study on the role of diabetes, cardiovascular disease, cancer, and chronic respiratory diseases. J Affect Disord 2024; 362:560-568. [PMID: 39019233 DOI: 10.1016/j.jad.2024.07.053] [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: 12/27/2023] [Revised: 06/18/2024] [Accepted: 07/12/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND The effect of lifestyle factors on cognitive function related to four major noncommunicable diseases (NCDs) including diabetes, cardiovascular disease, cancer, and chronic respiratory diseases, and the relationship between these NCDs and cognitive function have not been fully studied. We aimed to investigate the longitudinal associations between these NCDs and cognitive function in middle-aged and older people, and the combined effects of lifestyle factors. METHODS By employing the data from three large-scale cohort studies from the U.S. Health and Retirement Study (2010-2019), English Longitudinal Study of Aging (2014-2019), and China Health and Retirement Longitudinal Study (2011-2019), this study carried out a multi-cohort analysis to 77, 210 participants. Fixed-effects regression models were used to examine associations between NCD status and cognitive function. Margin plots were used to illustrate the effect of lifestyle factors. RESULTS Our findings revealed the dose-dependent association between mounting these NCDs and declining cognitive performance, ranging from one NCD (β = -0.05, 95 % CI: -0.08 to -0.02) to four NCDs (β = -0.51, 95 % CI: -0.75 to -0.28). Decline in cognitive function associated with NCDs was exacerbated with physical inactivity, current smoking status, and an increase in unhealthy lifestyle behaviors. LIMITATIONS The observational study design precludes causal interrogation of lifestyles and four NCDs on cognitive function. CONCLUSIONS An increasing number of these NCDs were dose-dependently associated with the decline in cognitive function score. Unhealthy lifestyle factors expedite decline in cognitive function linked to these NCDs.
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Affiliation(s)
- Huifen Ma
- School of Medical Management, Shandong First Medical University, Jinan, China
| | - Xiaomin Mu
- School of Healthcare Security, Shandong First Medical University, Jinan, China
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China
| | - Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China
| | - Min Wu
- School of Healthcare Security, Shandong First Medical University, Jinan, China
| | - Zhiyan Han
- School of Healthcare Security, Shandong First Medical University, Jinan, China.
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Quintas-Neves M, Teylan MA, Morais-Ribeiro R, Almeida F, Mock CN, Kukull WA, Crary JF, Oliveira TG. Divergent magnetic resonance imaging atrophy patterns in Alzheimer's disease and primary age-related tauopathy. Neurobiol Aging 2022; 117:1-11. [PMID: 35640459 DOI: 10.1016/j.neurobiolaging.2022.04.013] [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: 10/18/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
Our study compared brain MRI with neuropathological findings in patients with primary age-related tauopathy (PART) and Alzheimer's disease (AD), while assessing the relationship between brain atrophy and clinical impairment. We analyzed 233 participants: 32 with no plaques ("definite" PART-BRAAK stage higher than 0 and CERAD 0), and 201 cases within the AD spectrum, with 25 with sparse (CERAD 1), 76 with moderate (CERAD 2), and 100 with severe (CERAD 3) degrees of neuritic plaques. Upon correcting for age, sex, and age difference at MRI and death, there were significantly higher levels of atrophy in CERAD 3 compared to CERAD 1-2 and a trend compared to PART (p = 0.06). In the anterior temporal region, there was a trend for higher levels of atrophy in PART compared to Alzheimer's disease spectrum cases with CERAD 1 (p = 0.08). We then assessed the correlation between regional brain atrophy and CDR sum of boxes score for PART and AD, and found that overall cognition deficits are directly correlated with regional atrophy in the AD continuum, but not in definite PART. We further observed correlations between regional brain atrophy with multiple neuropsychological metrics in AD, with PART showing specific correlations between language deficits and anterior temporal atrophy. Overall, these findings support PART as an independent pathologic process from AD.
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Affiliation(s)
- Miguel Quintas-Neves
- Department of Neuroradiology, Hospital de Braga, Braga, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Merilee A Teylan
- Department of Epidemiology, National Alzheimer's Coordinating Center, University of Washington, Seattle, WA, USA
| | - Rafaela Morais-Ribeiro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Francisco Almeida
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Charles N Mock
- Department of Epidemiology, National Alzheimer's Coordinating Center, University of Washington, Seattle, WA, USA
| | - Walter A Kukull
- Department of Epidemiology, National Alzheimer's Coordinating Center, University of Washington, Seattle, WA, USA
| | - John F Crary
- Neuropathology Brain Bank & Research Core, Department of Pathology, Nash Family Department of Neuroscience, Department of Artificial Intelligence & Human Health, Friedman Brain Institute, Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tiago Gil Oliveira
- Department of Neuroradiology, Hospital de Braga, Braga, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
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Klompstra L, Jaarsma T, Piepoli MF, Ben Gal T, Evangelista L, Strömberg A, Bäck M. Objectively measured physical activity in patients with heart failure: a sub-analysis from the HF-Wii study. Eur J Cardiovasc Nurs 2022; 21:499-508. [PMID: 34993536 DOI: 10.1093/eurjcn/zvab133] [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: 07/16/2021] [Revised: 11/29/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022]
Abstract
AIMS Physical activity (PA) is important in patients with heart failure (HF) to improve health outcomes. The adherence to PA is low, and therefore, novel approaches are necessary to increase PA. We aimed to determine the difference in PA in patients with HF who have access to exergaming compared to patients who received motivational support and to explored predictors of a clinically relevant change in non-sedentary time between baseline and 3 months. METHODS AND RESULTS In total, 64 patients (mean age 69 ± 9 years, 27% female) wore an accelerometer 1 week before and 1 week after the intervention. Data were analysed using logistic regression analysis. Patients spent 9 h and 43 min (±1 h 23 min) during waking hours sedentary. There were no significant differences in PA between patients who received an exergame intervention or motivational support. In total, 30 of 64 patients achieved a clinically relevant increase in non-sedentary time. Having grandchildren [odds ratio (OR) 7.43 P = 0.03], recent diagnosis of HF (OR 0.93 P = 0.02), and higher social motivation (OR 2.31 P = 0.03) were independent predictors of a clinically relevant increase of non-sedentary time. CONCLUSION Clinicians should encourage their patients to engage in alternative approaches to improve PA and reduce sedentary habits. Future exergaming interventions should target individuals with chronic HF who have low social motivation and a low level of light PA that may benefit most from exergaming. Also (non-familial), intergenerational interaction is important to enabling patients in supporting patients in becoming more active.
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Affiliation(s)
- Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Massimo F Piepoli
- UO Scompenso e Cardiomiopatie, Ospedale G da Saliceto, Piacenza, Italy
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden.,Department of Cardiology, Linkoping University, Linköping, Sweden
| | - Maria Bäck
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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Jaarsma T, Klompstra L, Strömberg A, Ben Gal T, Mårtensson J, van der Wal MH. Exploring factors related to non-adherence to exergaming in patients with chronic heart failure. ESC Heart Fail 2021; 8:4644-4651. [PMID: 35167729 PMCID: PMC8712787 DOI: 10.1002/ehf2.13616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/23/2021] [Accepted: 09/04/2021] [Indexed: 11/27/2022] Open
Abstract
AIMS This study aimed to explore factors related to non-adherence to exergaming in patients with heart failure. METHODS AND RESULTS Data from patients in the exergame group in the HF-Wii trial were used. Adherence to exergaming was defined as playing 80% or more of the recommended time. Data on adherence and reasons for not exergaming at all were collected during phone calls after 2, 4, 8, and 12 weeks. Logistic regression was performed between patients who were adherent and patients who were non-adherent. Secondly, a logistic regression was performed between patients who not exergamed at all and patients who were adherent to exergaming. Finally, we analysed the reasons for not exergaming at all with manifest content analysis. Almost half of the patients were adherent to exergaming. Patients who were adherent had lower social motivation [odds ratio (OR) 0.072; 95% confidence interval (CI) 0.054-0.095], fewer sleeping problems (OR 0.84; 95% CI 0.76-0.092), and higher exercise capacity (OR 1.003; 95% CI 1.001-1.005) compared with patients who were non-adherent. Patients who not exergamed at all had lower cognition (OR 1.18; 95% CI 1.06-1.31) and more often suffered from peripheral vascular disease (OR 3.74; 95% CI 1.01-13.83) compared with patients who were adherent to exergaming. Patients most often cited disease-specific barriers as a reason for not exergaming at all. CONCLUSIONS A thorough baseline assessment of physical function and cognition is needed before beginning an exergame intervention. It is important to offer the possibility to exergame with others, to be able to adapt the intensity of physical activity.
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Affiliation(s)
- Tiny Jaarsma
- Department of Medicine, Health and Caring SciencesLinköping UniversityLinköpingSweden
| | - Leonie Klompstra
- Department of Medicine, Health and Caring SciencesLinköping UniversityLinköpingSweden
| | - Anna Strömberg
- Department of Medicine, Health and Caring SciencesLinköping UniversityLinköpingSweden
- Department of CardiologyLinkoping UniversityLinkopingSweden
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Jan Mårtensson
- Department of Nursing, School of Health and WelfareJönköping UniversityJönköpingSweden
| | - Martje H.L. van der Wal
- Department of Medicine, Health and Caring SciencesLinköping UniversityLinköpingSweden
- Department of Cardiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
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Objectively assessed physical activity and sedentary behavior and global cognitive function in older adults: a systematic review. Mech Ageing Dev 2021; 198:111524. [PMID: 34181963 DOI: 10.1016/j.mad.2021.111524] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Both physical activity (PA) and sedentary behavior (SB) are important factors for healthy ageing. This systematic review aimed to determine the association of objectively assessed (instrumented) PA and SB with global cognitive function in older adults. METHODS PubMed, Embase, the Cochrane Library (via Wiley), CINAHL, PsychINFO, and SPORTDiscus (via EBSCO) were searched from inception to June 21, 2020 for articles that described associations of objectively assessed PA/SB with global cognitive function in older adults aged 60 years and older. Results were synthesized using an effect direction heat map and albatross plots portrayed estimated effect sizes (standardized regression coefficients (βs)), which were summarized in boxplots. RESULTS In total, 45 articles were included representing a total of 15,817 older adults (mean/median age ranged from 65 to 88 years; 49.5% female). Longitudinal studies (n = 7) showed that higher moderate-to-vigorous and light PA (MVPA and LPA, respectively) and lower SB were associated with better global cognitive function. Standardized βs of cross-sectional studies (n = 38) showed that lower SB (median [IQR], β = 0.078 [0.004-0.184] and higher LPA (β = 0.096 [0.046-0.188]), activity counts (β = 0.131 [0.049-0.224]), number of steps (β = 0.155 [0.096-0.246]), MVPA (β = 0.163 [0.069-0.285]) and total PA (TPA) (β = 0.174 [0.147-0.255]) were associated with better global cognitive function. CONCLUSIONS Higher PA and lower SB are associated with better global cognitive function in older adults. The greatest estimated effect sizes were found for moderate-to-vigorous and TPA, suggesting that greater duration of any PA, and high intensity PA could be most beneficial for global cognitive function.
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Blomqvist A, Bäck M, Klompstra L, Strömberg A, Jaarsma T. Utility of single-item questions to assess physical inactivity in patients with chronic heart failure. ESC Heart Fail 2020; 7:1467-1476. [PMID: 32372549 PMCID: PMC7373918 DOI: 10.1002/ehf2.12709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/17/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022] Open
Abstract
Aim The purpose of this study was to explore the utility of two single‐item self‐report (SR) questions to assess physical inactivity in patients with heart failure (HF). Methods and results This is a cross‐sectional study using data from 106 patients with HF equipped with accelerometers for 1 week each. Two SR items relating to physical activity were also collected. Correlations between accelerometer activity counts and the SR items were analysed. Patients were classified as physically active or inactive on the basis of accelerometer counts, and the SR items were used to try to predict that classification. Finally, patients were classified as having high self‐reported physical activity or low self‐reported physical activity, on the basis of the SR items, and the resulting groups were analysed for differences in actual physical activity. There were significant but weak correlations between the SR items and accelerometer counts: ρ = 0.24, P = 0.016 for SR1 and ρ = 0.21, P = 0.033 for SR2. Using SR items to predict whether a patient was physically active or inactive produced an area under the curve of 0.62 for SR1, with a specificity of 92% and a sensitivity of 30%. When dividing patients into groups on the basis of SR1, there was a significant difference of 1583 steps per day, or 49% more steps in the high self‐reported physical activity group (P < 0.001). Conclusions There might be utility in the single SR question for high‐specificity screening of large populations to identify physically inactive patients in order to assign therapeutic interventions efficiently where resources are limited.
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Affiliation(s)
- Andreas Blomqvist
- Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health, Linköping University, 581 83, Linköping, Sweden
| | - Maria Bäck
- Department of Health, Medicine and Caring Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health, Linköping University, 581 83, Linköping, Sweden
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health, Linköping University, 581 83, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health, Linköping University, 581 83, Linköping, Sweden
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Influence of Previous-Year Physical Activity on the Cognition of COPD Older Patients During Exacerbation. J Phys Act Health 2020; 17:519-524. [PMID: 32234997 DOI: 10.1123/jpah.2019-0455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/28/2019] [Accepted: 02/25/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Growing evidence demonstrates the negative health impact of physical inactivity. Our aim was to examine the influence of previous-year physical activity (PA) on the cognition of chronic obstructive pulmonary disease (COPD) patients during exacerbation. METHODS Observational study. One hundred and fifty-one patients with COPD exacerbation were recruited over a period of 3 years and divided in 2 groups according to their previous activity level. Sociodemographic, anthropometric, and clinical variables were collected. Our main outcome measures were previous-year PA level, measured using the Modified Baecke Physical Activity Questionnaire and cognitive status measured using the Montreal Cognitive Assessment. RESULTS The cognitive variables that exhibited significant differences (P < .05) according to PA level were the visuoconstructional skills subscore, attention subscore, language subscore, orientation subscore, and Montreal Cognitive Assessment total score, with worse results in the sedentary group. Based on the relationships between total scores, the Baecke score was positively correlated with the Montreal Cognitive Assessment total score (r = .457). CONCLUSIONS The cognitive status of COPD patients during an exacerbation is related to previous-year PA level. Previous-year PA level should be taken into consideration when patients with a COPD exacerbation are evaluated.
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8
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The Effectiveness of Exercise on Cognitive Performance in Individuals with Known Vascular Disease: A Systematic Review. J Clin Med 2019; 8:jcm8030294. [PMID: 30832238 PMCID: PMC6463048 DOI: 10.3390/jcm8030294] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/23/2019] [Accepted: 02/24/2019] [Indexed: 12/11/2022] Open
Abstract
Patients with known vascular disease are at increased risk for cognitive impairments. Exercise has been shown to improve cognition in healthy elderly populations and those with mild cognitive impairments. We explored the literature to understand exercise as a modality to improve cognition in those with vascular disease, focusing on dose-responses. A systematic review was conducted through 2017 using Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Ovid Embase, and Ovid MEDLINE databases. Eligible studies examined effects of exercise on memory and cognition in cardiovascular (CVD) or cerebrovascular disease (CBVD). Data extracted included group characteristics, exercise dosage and outcomes measures employed. Twenty-two studies (12 CVD, 10 CBVD) met the inclusion criteria. Interventions included aerobic, resistance, or mixed training, with neuropsychological test batteries assessing cognition. In CVD populations, five studies demonstrated improved cardiovascular fitness and cognition with aerobic training, and another seven studies suggested a dose-response. In CBVD trials, four studies reported improved cognition, with no effects observed in the fifth study. Another study found enhanced cognition with resistance training and four demonstrated a positive association between functional capacity and cognition following combined aerobic and resistance training. Exercise is able to positively affect cognitive performance in those with known vascular disease. There is evidence to suggest a dose–response relationship. Further research is required to optimize prescription.
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Tan MKH, Wong JKL, Bakrania K, Abdullahi Y, Harling L, Casula R, Rowlands AV, Athanasiou T, Jarral OA. Can activity monitors predict outcomes in patients with heart failure? A systematic review. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:11-21. [PMID: 30215706 DOI: 10.1093/ehjqcco/qcy038] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/11/2018] [Indexed: 12/12/2022]
Abstract
Actigraphy is increasingly incorporated into clinical practice to monitor intervention effectiveness and patient health in congestive heart failure (CHF). We explored the prognostic impact of actigraphy-quantified physical activity (AQPA) on CHF outcomes. PubMed and Medline databases were systematically searched for cross-sectional studies, cohort studies or randomised controlled trials from January 2007 to December 2017. We included studies that used validated actigraphs to predict outcomes in adult HF patients. Study selection and data extraction were performed by two independent reviewers. A total of 17 studies (15 cohort, 1 cross-sectional, 1 randomised controlled trial) were included, reporting on 2,759 CHF patients (22-89 years, 27.7% female). Overall, AQPA showed a strong inverse relationship with mortality and predictive utility when combined with established risk scores, and prognostic roles in morbidity, predicting cognitive function, New York Heart Association functional class and intercurrent events (e.g. hospitalisation), but weak relationships with health-related quality of life scores. Studies lacked consensus regarding device choice, time points and thresholds of PA measurement, which rendered quantitative comparisons between studies difficult. AQPA has a strong prognostic role in CHF. Multiple sampling time points would allow calculation of AQPA changes for incorporation into risk models. Consensus is needed regarding device choice and AQPA thresholds, while data management strategies are required to fully utilise generated data. Big data and machine learning strategies will potentially yield better predictive value of AQPA in CHF patients.
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Affiliation(s)
- Matthew K H Tan
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Joanna K L Wong
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kishan Bakrania
- Diabetes Research Centre, University of Leceister, Leicester General Hospital, Gwendolen Road, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Gwendolen Road, Leicester, UK
| | - Yusuf Abdullahi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Leanne Harling
- Diabetes Research Centre, University of Leceister, Leicester General Hospital, Gwendolen Road, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Gwendolen Road, Leicester, UK.,Division of Health Sciences, Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, City East Campus, Adelaide SA, Australia
| | - Roberto Casula
- Diabetes Research Centre, University of Leceister, Leicester General Hospital, Gwendolen Road, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Gwendolen Road, Leicester, UK.,Division of Health Sciences, Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, City East Campus, Adelaide SA, Australia
| | - Alex V Rowlands
- Diabetes Research Centre, University of Leceister, Leicester General Hospital, Gwendolen Road, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Gwendolen Road, Leicester, UK.,Division of Health Sciences, Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, City East Campus, Adelaide SA, Australia
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Omar A Jarral
- Department of Surgery and Cancer, Imperial College London, London, UK
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Kure CE, Rosenfeldt FL, Scholey AB, Pipingas A, Kaye DM, Bergin PJ, Croft KD, Wesnes KA, Myers SP, Stough C. Relationships Among Cognitive Function and Cerebral Blood Flow, Oxidative Stress, and Inflammation in Older Heart Failure Patients. J Card Fail 2016; 22:548-59. [PMID: 27002943 DOI: 10.1016/j.cardfail.2016.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 03/10/2016] [Accepted: 03/15/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND The mechanisms for cognitive impairment in heart failure (HF) are unclear. We investigated the relative contributions of cerebral blood flow velocity (BFV), oxidative stress, and inflammation to HF-associated cognitive impairment. METHODS AND RESULTS Thirty-six HF patients (≥60 years) and 40 healthy controls (68 ± 7 vs 67 ± 5 years, P > .05; 69% vs 50% male, P > .05) completed the Cognitive Drug Research computerized assessment battery and Stroop tasks. Common carotid (CCA) and middle cerebral arterial BFV were obtained by transcranial Doppler. Blood samples were collected for oxidant (diacron-reactive oxygen metabolites; F2-isoprostanes), antioxidant (coenzyme Q10; CoQ10), and inflammatory markers (high-sensitivity C-reactive protein). Compared with controls, patients exhibited impaired attention (Cognitive Drug Research's Power of Attention domain, congruent Stroop) and executive function (incongruent Stroop). Multiple regression modeling showed that CCA-BFV and CoQ10 but not group predicted performance on attention and executive function. Additionally, in HF patients, CCA-BFV and CoQ10 (β = -0.34 vs β = -0.35) were significant predictors of attention, and CCA-BFV (β = -0.34) was a predictor of executive function. CONCLUSIONS Power of Attention and executive function is impaired in older HF patients, and reduced CCA-BFV and CoQ10 are associated with worse cognition. Interventions addressing these mechanisms may improve cognition in older HF patients.
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Affiliation(s)
- Christina E Kure
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia.
| | - Franklin L Rosenfeldt
- Cardiac Surgical Research Unit, Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne Australia; Department of Surgery, Monash University, Melbourne, Australia
| | - Andrew B Scholey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia
| | - Andrew Pipingas
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia
| | - David M Kaye
- Heart Failure Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Peter J Bergin
- Cardiovascular Medicine Services (Heart Centre), The Alfred Hospital, Melbourne, Australia
| | - Kevin D Croft
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Keith A Wesnes
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia; Department of Psychology, Northumbria University, Newcastle, UK; Wesnes Cognition Ltd, Streatley on Thames, UK
| | - Stephen P Myers
- NatMed-Research, Division of Research, Southern Cross University, Lismore, Australia
| | - Con Stough
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia
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11
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Argunova YA, Pomeshkina SA, Trubnikova OA. [Cognitive dysfunction after coronary artery bypass grafting]. Zh Nevrol Psikhiatr Im S S Korsakova 2016. [PMID: 28635728 DOI: 10.17116/jnevro201611691111-115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Despite the advances in surgical and anesthetic techniques for coronary artery bypass grafting (CABG), the incidence of neurological complications, including postoperative cognitive dysfunction (POCD), remains high. CABG is performed more often in elderly patients with severe comorbidities. However, comprehensive prevention measures and POCD rehabilitation have not yet been developed. Physical training is an effective and safe method for correcting endothelial dysfunction, severe systemic inflammatory response syndrome, lipid peroxidation, i.e. mechanisms contributing to the development and severity of POCD.
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Affiliation(s)
- Yu A Argunova
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - S A Pomeshkina
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - O A Trubnikova
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
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Abstract
Cognitive impairment in heart failure (HF) is believed to in part stem from structural brain alterations, including shrinkage of subcortical regions. Fortunately, neurocognitive dysfunction in HF can be mitigated by physical activity (PA), though mechanisms for this phenomenon are unclear. PA is protective against age-related cognitive decline that may involve improved structural integrity to brain regions sensitive to aging (e.g., subcortical structures). Yet, no study has examined the benefits of PA on the brain in HF and we sought to do so and clarify related cognitive implications. Fifty older adults with HF completed a neuropsychological battery and wore an accelerometer for 7 days. All participants underwent brain MRI. This study targeted subcortical brain volume given subcortical alterations are often observed in HF and the sensitivity of PA to subcortical structures in other patient populations. Participants averaged 4348.49 (SD=2092.08) steps per day and greater daily steps predicted better attention/executive function, episodic memory, and language abilities, p's<.05. Medical and demographically adjusted regression analyses revealed higher daily steps per day predicted greater subcortical volume, with specific effects for the thalamus and ventral diencephalon, p's<.05. Greater subcortical volume was associated with better attention/executive function, p<.05. Higher daily PA was associated with increased subcortical brain volume and better cognition in older adults with HF. Longitudinal work is needed to clarify whether daily PA can attenuate brain atrophy in HF to reduce accelerated cognitive decline in this population.
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13
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McCarthy M, Katz SD, Schipper J, Dickson VV. "I Just Can't Do It Anymore" Patterns of Physical Activity and Cardiac Rehabilitation in African Americans with Heart Failure: A Mixed Method Study. Healthcare (Basel) 2015; 3:973-86. [PMID: 27417807 PMCID: PMC4934625 DOI: 10.3390/healthcare3040973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/09/2015] [Accepted: 10/09/2015] [Indexed: 11/16/2022] Open
Abstract
Physical activity and cardiac rehabilitation (CR) are components of heart failure (HF) self-care. The aims of this study were to describe patterns of physical activity in African Americans (n = 30) with HF and to explore experience in CR. This was a mixed method, concurrent nested, predominantly qualitative study. Qualitative data were collected via interviews exploring typical physical activity, and CR experience. It was augmented by quantitative data measuring HF severity, self-care, functional capacity and depressive symptoms. Mean age was 60 ± 15 years; 65% were New York Heart Association (NYHA) class III HF. Forty-three percent reported that they did less than 30 min of exercise in the past week; 23% were told “nothing” about exercise by their provider, and 53% were told to do “minimal exercise”. A measure of functional capacity indicated the ability to do moderate activity. Two related themes stemmed from the narratives describing current physical activity: “given up” and “still trying”. Six participants recalled referral to CR with one person participating. There was high concordance between qualitative and quantitative data, and evidence that depression may play a role in low levels of physical activity. Findings highlight the need for strategies to increase adherence to current physical activity guidelines in this older minority population with HF.
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Affiliation(s)
| | - Stuart D Katz
- New York University Langone Medical Center, New York, NY 10016, USA.
| | - Judith Schipper
- New York University Langone Medical Center, New York, NY 10016, USA.
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14
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Alosco ML, Spitznagel MB, Cohen R, Sweet LH, Hayes SM, Josephson R, Hughes J, Gunstad J. Decreases in daily physical activity predict acute decline in attention and executive function in heart failure. J Card Fail 2015; 21:339-46. [PMID: 25573830 DOI: 10.1016/j.cardfail.2014.12.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/10/2014] [Accepted: 12/19/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Reduced physical activity (PA) may be one factor that contributes to cognitive decline and dementia in heart failure (HF). Yet, the longitudinal relationship between PA and cognition in HF is poorly understood owing to limitations of past work, including single-time assessments of PA. This is the first study to examine changes in objectively measured PA and cognition over time in HF. METHODS AND RESULTS At baseline and 12 weeks, 57 HF patients completed psychosocial self-report measures and a neuropsychological battery and wore an accelerometer for 7 days. At baseline, HF patients spent an average of 597.83 (SD 75.91) minutes per day sedentary. Steps per day declined from baseline to the 12-week follow-up; there was also a trend for declines in moderate-vigorous PA. Regression analyses controlling for sex, HF severity, and depressive symptoms showed that decreases in light (P = .08) and moderate-vigorous (P = .04) daily PA emerged as strong predictors of declines in attention/executive function over the 12-week period, but not of memory or language. CONCLUSIONS Reductions in daily PA predicted acute decline in attention/executive function in HF, but not of memory or language. Modifications to daily PA may attenuate cognitive decline, and prospective studies are needed to test this possibility.
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Affiliation(s)
- Michael L Alosco
- Department of Psychological Sciences, Kent State University, Kent, Ohio
| | | | - Ronald Cohen
- Departments of Neurology Psychiatry and Institute on Aging, Center for Cognitive Aging and Memory, University of Florida, Gainesville, Florida
| | - Lawrence H Sweet
- Department of Psychology, University of Georgia, Athens, Georgia
| | - Scott M Hayes
- Memory Disorders Research Center, Veterans Affairs Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts; Neuroimaging Research for Veterans Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Richard Josephson
- Department of Medicine, University Hospitals Case Medical Center, Cleveland, Ohio; Harrington Heart and Vascular Institute, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Joel Hughes
- Department of Psychological Sciences, Kent State University, Kent, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, Ohio.
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15
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Galioto Wiedemann R, Calvo D, Meister J, Spitznagel MB. Self-reported physical activity is associated with cognitive function in lean, but not obese individuals. Clin Obes 2014; 4:309-15. [PMID: 25826160 DOI: 10.1111/cob.12071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/03/2014] [Accepted: 06/19/2014] [Indexed: 02/03/2023]
Abstract
Convergent evidence demonstrates that greater physical activity is associated with better cognitive functioning across many patient and healthy samples. However, this relationship has not been well examined among obese individuals and remains unclear. The present study examined the relationship between performance-based measures of attention/executive function and self-reported physical activity, as measured by the International Physical Activity Questionnaire, among lean (n = 36) and obese (n = 36) college students. Lean individuals performed better than obese individuals on measures of attention/executive function. No significant differences in self-reported physical activity emerged between weight groups. Higher self-reported physical activity was related to faster reaction time in lean individuals but slower reaction time in obese individuals. Additionally, in lean individuals, higher levels of self-reported physical activity were related to more errors on a task of speeded inhibitory control. The results are consistent with previous research demonstrating that greater physical activity is associated with faster attention and executive function abilities in healthy samples and highlight the importance of examining reaction time and accuracy indices separately on these measures. The lack of association among obese individuals may be due in part to inaccurate self-report in the current study. Additionally, the cognitive consequences of obesity may outweigh the benefits of physical activity in this group. Future work should investigate these associations in obese individuals using physical activity interventions, as well as a combination of self-report and objective measures to investigate discrepancies in reporting.
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16
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Hayes SM, Alosco ML, Forman DE. The Effects of Aerobic Exercise on Cognitive and Neural Decline in Aging and Cardiovascular Disease. CURRENT GERIATRICS REPORTS 2014; 3:282-290. [PMID: 25750853 DOI: 10.1007/s13670-014-0101-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Aging is characterized by a decline in cognitive functions, particularly in the domains of executive function, processing speed and episodic memory. These age-related declines are exacerbated by cardiovascular disease (CVD) and cardiovascular risk factors (hypertension, diabetes, obesity, elevated total cholesterol). Structural and functional alterations in brain regions, including the fronto-parietal and medial temporal lobes, have been linked to age- and CVD-related cognitive decline. Multiple recent studies indicate that aerobic exercise programs may slow the progression of age-related neural changes and reduce the risk for mild cognitive impairment as well as dementia. We review age- and CVD-related decline in cognition and the underlying changes in brain morphology and function, and then clarify the impact of aerobic exercise on moderating these patterns.
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Affiliation(s)
- Scott M Hayes
- Memory Disorders Research Center (151A), VA Boston Healthcare System and Boston University School of Medicine, 150 South Huntington Ave, Boston, MA 02130, USA; Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, MA, USA
| | - Michael L Alosco
- Memory Disorders Research Center (151A), VA Boston Healthcare System and Boston University School of Medicine, 150 South Huntington Ave, Boston, MA 02130, USA; Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Daniel E Forman
- Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Geriatric Cardiology Section, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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