Integrating Health Promotion Into Physical Therapy Practice to Improve Brain Health and Prevent Alzheimer Disease

Associations between baseline cognitive status and motor outcomes after treadmill training in people with Parkinson's disease: a pilot study

PURPOSE

To determine the effect of baseline cognition on gait outcomes after a treadmill training program for people with Parkinson's disease (PD).

METHODS

This pilot clinical trial involved people with PD who were classified as having no cognitive impairment (PD-NCI) or mild cognitive impairment (PD-MCI). Baseline executive function and memory were assessed. The intervention was a 10-week gait training program (twice-weekly treadmill sessions), with structured speed and distance progression and verbal cues for gait quality. Response to intervention was assessed by gait speed measured after week 2 (short-term) and week 10 (long-term).

RESULTS

Participants (n = 19; 12 PD-NCI, 7 PD-MCI) had a mean (standard deviation) age of 66.5 (6.3) years, disease duration of 8.8 (6.3) years, and MDS-UPDRS III score of 21.3 (10.7). Gait speed increased at short-term and long-term assessments. The response did not differ between PD-NCI and PD-MCI groups; however, better baseline memory performance and milder PD motor severity were independently associated with greater improvements in gait speed in unadjusted and adjusted models.

CONCLUSIONS

These findings suggest that memory impairments and more severe motor involvement can influence the response to gait rehabilitation in PD and highlight the need for treatments optimized for people with greater cognitive and motor impairment.IMPLICATIONS FOR REHABILITATIONCognitive deficits in Parkinson's disease (PD) could impact motor learning and gait rehabilitation, yet little is known about the effects of cognitive impairments on the response to rehabilitation in people with PD.This study demonstrates that the response to gait rehabilitation did not differ between people with PD who had no cognitive impairment and those with mild cognitive impairment.Across all participants, better baseline memory was associated with greater improvements in gait speed.Rehabilitation professionals should be mindful of PD severity, as those with more substantial memory and motor impairments may require additional dosing or support to maximize gait training benefits.

Concepts of dementia prevention in the health promotion among older adults: A narrative review

The number of older adults with dementia is predicted to markedly increase in the coming decades. A person suffers from dementia every 3 seconds globally, and one out of every 7 people suffers from dementia in Taiwan. The purpose of this narrative review is to integrate existing concepts of dementia prevention into health promotion and improve older adults' quality of life. This narrative review was performed using the PubMed database by searching for basic research and systematic reviews on dementia prevention and health promotion among older adults. We established a framework for dementia prevention and health promotion with regard to the physical, mental, spiritual, and social health aspects. We identified the following strategies related to older adults towards dementia prevention and health promotion in follows: Physical health promotion: cognitive activities, physical activities, body mass index, balanced diet, rainbow diet, Mediterranean diet, dietary approaches to stop hypertension diet, mind diet, no smoking and drinking, avoiding the "three highs" (i.e., hyperglycemia, hyperlipidemia, and hypertension), and head trauma; Mental health promotion: Positive thinking, Brief Symptom Rating Scale (BSRS-5), depression scale, and ascertained dementia 8 questionnaire (AD8) screening; Spiritual health promotion: religious beliefs, spiritual music, meditative activities, mindfulness, yoga, Qi-gong, Tai-chi, and Baduanjin; and Social health promotion: A supportive family system, socialization, social support, social networks, social interaction, and social participation. The conclusion of this narrative review was to integrate the concepts of dementia prevention and health promotion among older adults.

Exercise improves choroid plexus epithelial cells metabolism to prevent glial cell-associated neurodegeneration

Recent studies have shown that physical activities can prevent aging-related neurodegeneration. Exercise improves the metabolic landscape of the body. However, the role of these differential metabolites in preventing neurovascular unit degeneration (NVU) is still unclear. Here, we performed single-cell analysis of brain tissue from young and old mice. Normalized mutual information (NMI) was used to measure heterogeneity between each pair of cells using the non-negative Matrix Factorization (NMF) method. Astrocytes and choroid plexus epithelial cells (CPC), two types of CNS glial cells, differed significantly in heterogeneity depending on their aging status and intercellular interactions. The MetaboAnalyst 5.0 database and the scMetabolism package were used to analyze and calculate the differential metabolic pathways associated with aging in the CPC. These mRNAs and corresponding proteins were involved in the metabolites (R)-3-Hydroxybutyric acid, 2-Hydroxyglutarate, 2-Ketobutyric acid, 3-Hydroxyanthranilic acid, Fumaric acid, L-Leucine, and Oxidized glutathione pathways in CPC. Our results showed that CPC age heterogeneity-associated proteins (ECHS1, GSTT1, HSD17B10, LDHA, and LDHB) might be directly targeted by the metabolite of oxidized glutathione (GSSG). Further molecular dynamics and free-energy simulations confirmed the insight into GSSG's targeting function and free-energy barrier on these CPC age heterogeneity-associated proteins. By inhibiting these proteins in CPC, GSSG inhibits brain energy metabolism, whereas exercise improves the metabolic pathway activity of CPC in NVU by regulating GSSG homeostasis. In order to develop drugs targeting neurodegenerative diseases, further studies are needed to understand how physical exercise enhances NVU function and metabolism by modulating CPC-glial cell interactions.

Improvement of cognitive performance by a nutraceutical formulation: Underlying mechanisms revealed by laboratory studies

Cognitive decline, decrease in neuronal function and neuronal loss that accompany normal aging and dementia are the result of multiple mechanisms, many of which involve oxidative stress. Herein, we review these various mechanisms and identify pharmacological and non-pharmacological approaches, including modification of diet, that may reduce the risk and progression of cognitive decline. The optimal degree of neuronal protection is derived by combinations of, rather than individual, compounds. Compounds that provide antioxidant protection are particularly effective at delaying or improving cognitive performance in the early stages of Mild Cognitive Impairment and Alzheimer's disease. Laboratory studies confirm alleviation of oxidative damage in brain tissue. Lifestyle modifications show a degree of efficacy and may augment pharmacological approaches. Unfortunately, oxidative damage and resultant accumulation of biomarkers of neuronal damage can precede cognitive decline by years to decades. This underscores the importance of optimization of dietary enrichment, antioxidant supplementation and other lifestyle modifications during aging even for individuals who are cognitively intact.

Alzheimer's disease in elderly COVID-19 patients: potential mechanisms and preventive measures

Advanced age correlates with higher morbidity and mortality among patients affected with the novel coronavirus disease 2019 (COVID-19). Because systemic inflammation and neurological symptoms are also common in severe COVID-19 cases, there is concern that COVID-19 may lead to neurodegenerative conditions such as Alzheimer’s disease (AD). In this review, we summarize possible mechanisms by which infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, may cause AD in elderly COVID-19 patients and describe preventive measures to mitigate risk. Potential mechanisms include NLRP3 inflammasome activation and IL-1β release, renin-angiotensin system hyperactivation, innate immune activation, oxidative stress, direct viral infection, and direct cytolytic β-cell damage. Anti-inflammatory therapies, including TNF-α inhibitors and nonsteroidal anti-inflammatory drugs, antioxidants such as the vitamin E family, nutritional intervention, physical activity, blood glucose control, and vaccination are proposed as preventive measures to minimize AD risk in COVID-19 patients. Since several risk factors for AD may converge during severe SARS-CoV-2 infection, neurologists should be alert for potential symptoms of AD and actively implement preventive measures in patients presenting with neuropsychiatric symptoms and in high-risk patients such as the elderly.

Aerobic Exercise Sustains Performance of Instrumental Activities of Daily Living in Early-Stage Alzheimer Disease

BACKGROUND AND PURPOSE

Individuals with Alzheimer disease (AD) experience progressive loss of independence-performing activities of daily living. Identifying interventions to support independence and reduce the economic and psychosocial burden of caregiving for individuals with AD is imperative. The purpose of this analysis was to examine functional disability and caregiver time in individuals with early-stage AD.

METHODS

This was a secondary analysis of a randomized controlled trial of 26 weeks of aerobic exercise (AEx) versus stretching and toning (ST). We measured functional dependence using the Disability Assessment for Dementia, informal caregiver time required using the Resources Utilization in Dementia Lite, and cognition using a standard cognitive battery.

RESULTS

We saw a stable function in the AEx group compared with a significant decline in the ST group (4%; F = 4.2, P = .04). This was especially evident in more complex, instrumental activities of daily living, with individuals in the AEx group increasing 1% compared with an 8% loss in the ST group over 26 weeks (F = 8.3, P = .006). Change in memory was a significant predictor of declining instrumental activities of daily living performance (r = 0.28, 95% confidence interval = 0.08 ∞, P = .01). Informal caregiver time was not different between the AEx and ST groups.

CONCLUSIONS

Our analysis extends recent work by revealing specific benefits for instrumental activities of daily living for individuals in the early stages of AD and supports the value of exercise for individuals with cognitive impairment.

Validity of Instrumented 360° Turn Test in Older Adults with Cognitive Impairment

AIMS

To examine concurrent and construct validity of inertial sensor 360°turn measures in relation with motion capture and mobility assessments in cognitively impaired older adults.

METHODS

Data was collected in 31 participants, mean age 85.2 (SD 5.2), during clockwise (CW) and counter clockwise (CCW) 360° turns using (1) APDM body-worn inertial sensors and (2) Qualisys 8-camera laboratory-based motion capture.

RESULTS

Absolute agreement between inertial sensor and motion capture measures was excellent for turn duration and turn peak velocity (ICC = 0.96-0.98). Strong to moderate correlations were present between inertial sensor turn measures and performance on the Timed Up and Go, Short Physical Performance Battery and 90-s Balance Test. ROC curve analysis of CCW 360° turn duration and turn peak velocity distinguished higher risk versus lower risk for mobility disability.

CONCLUSIONS

Inertial sensor 360° turn measures demonstrated concurrent and construct validity in relation to motion capture and mobility assessments.

Physical Activity and Brain Health: An Analysis of Messages From Organizations and Caregiver Perceptions

Growing research suggests regular physical activity as a strategy for reducing risk of Alzheimer's disease (AD); however, there is little research available regarding public messages about the connection between physical activity and brain health. This study aimed to (a) examine the volume and content of regular physical activity and brain health messages being distributed by national organizations, and (b) explore how informal caregivers perceive and comprehend brain health messages. Methods included (a) a content analysis of 155 online documents related to physical activity and aging that were located on national physical activity organizations' websites, and (b) a thematic analysis of transcripts and observer notes from two focus groups with 10 informal caregivers recruited at a support organization for AD caregivers in the southeastern United States. Content analysis results revealed limited information about the physical activity and brain health connection. Focus group results revealed that caregivers had limited exposure to information about the physical activity and brain health connection and were concerned about the credibility of this information. Further research is needed regarding brain health and physical activity messages and the potential benefits of collaboration among physical activity organizations, researchers, and health care professionals in delivering consistent and credible messages to the public.

Fall risk in stroke survivors: Effects of stroke plus dementia and reduced motor functional capacity

BACKGROUND

Despite extensive research on falls among individuals with stroke, little is known regarding the impact of neurological conditions with comorbid diagnoses and motor functional capacity on the risk of falls in these individuals. Hence, the purpose of this study was to determine the fall risk and the contribution of reduced motor functional capacity to fall risk in individuals with stroke, dementia, and stroke plus dementia.

METHODS

Data from the National Health and Aging Trends Study (NHATS), a nationally-representative sample of Medicare beneficiaries, were analyzed for this cross-sectional study. The odds of self-reported falls within the past month in three subgroups of neurological conditions [stroke (n = 751), dementia (n = 369), and stroke plus dementia (n = 141)] were evaluated with a reference group of individuals with no stroke/dementia [i.e., controls (n = 6337)] using logistic regression models.

RESULTS

The prevalence of a recent fall was significantly higher (P < .05) in the three neurological disorder groups compared with controls. After adjusting for sociodemographics, mobility device use, and other comorbidities (i.e., chronic disease, vision impairment, and major surgery), the odds of a recent fall were significantly elevated in individuals with stroke (odds ratio [OR] = 1.45), dementia (OR = 2.45), and stroke plus dementia (OR = 2.64) compared with controls. After further adjustment for the lower motor functional capacity, the elevated odds in individuals with stroke were attenuated (OR = 1.16); however, the odds remained significantly elevated in individuals with dementia (OR = 1.67) and stroke plus dementia (OR = 1.82).

CONCLUSION

Findings indicate that the odds for falls in stroke survivors are elevated in the presence of comorbid dementia. Further, lower motor functional capacity accounted for increased likelihood of a fall in individuals with stroke, but it was not sufficient to account for the increased likelihood of a fall in individuals with dementia or stroke plus dementia. Thus, interventions focusing on secondary prevention of dementia and improving motor functional capacity may reduce fall risk in individuals with stroke.

The Efficacy and Underlying Mechanism of Moxibustion in Preventing Cognitive Impairment: A Systematic Review of Animal Studies

Cognitive impairment is age-related and manageable only with early diagnosis and prevention. Moxibustion is widely accepted in East Asia as useful for preventing cognitive impairment. This systematic review of animal studies was conducted to verify the efficacy of moxibustion in preventing cognitive impairment and to elucidate the underlying mechanism. Randomized controlled animal trials that established the efficacy of moxibustion in preventing cognitive impairment were included in the analysis. Results of behavioral tests and the signaling pathways elucidated were extracted and a meta-analysis was conducted with the behavioral test results. The risk of bias was evaluated using 9 items, and reporting quality was evaluated using the ARRIVE (Animal Research: Reporting In Vivo Experiments) Guidelines Checklist. Ten trials involving 410 animals met the inclusion criteria. All studies reported the benefit of moxibustion in preventing cognitive deficits caused by Alzheimer's disease (AD). Among five studies using the Morris water maze test, a significant effect of moxibustion in decreasing the escape time was reported in three studies, increasing the crossing times in four studies, and prolonging the dwelling time in two studies. The effects of moxibustion were demonstrated to be mediated by an increase in the activity of neurotrophins and heat shock protein, modulation of the cell cycle, and suppression of apoptosis and inflammation. However, considering the small number of included studies, the lack of studies investigating entire signaling pathways, and a high risk of bias and low reporting quality, our results need to be confirmed through more detailed studies.

Apparent Cognitive Decline as Revealed by an Executive Function Test within a Cohort of Elderly Individuals Self-Reporting Normal Cognitive Performance

Alzheimer's disease (AD) can be preceded by subtle memory decline that can last a decade or more before progressing to what would be diagnosed as the mild cognitive impairment stage. During this early stage of decline, individuals and even their caregivers can fail to perceive any serious difficulty or need to consult a physician. Herein, we present evidence in support of these concerns, and demonstrate how this can interfere not only with clinical trials of AD but also those involving cognitive performance of elderly individuals without intentional reference to AD.

Calcium Dysregulation in Alzheimer's Disease: A Target for New Drug Development

Alzheimer's disease (AD) is a devastating neurodegenerative disorder and the most common cause of dementia among aged people whose population is rapidly increasing. AD not only seriously affects the patient's physical health and quality of life, but also adds a heavy burden to the patient's family and society. It is urgent to understand AD pathogenesis and develop the means of prevention and treatment. AD is a chronic devastating neurodegenerative disease without effective treatment. Current approaches for management focus on helping patients relieve or delay the symptoms of cognitive dysfunction. The calcium ion (Ca²⁺) is an important second messenger in the function and structure of nerve cell circuits in the brain such as neuronal growth, exocytosis, as well as in synaptic and cognitive function. Increasing numbers of studies suggested that disruption of intracellular Ca²⁺ homeostasis, especially the abnormal and excessive Ca²⁺ release from the endoplasmic reticulum (ER) via the ryanodine receptor (RYR), plays important roles in orchestrating the dynamic of the neuropathology of AD and associated memory loss, cognitive dysfunction. Dantrolene, a known antagonist of the RYR and a clinically available drug to treat malignant hyperthermia, can ameliorate the abnormal Ca²+ release from the RYR in AD and the subsequent pathogenesis, such as increased β-secretase and γ-secretase activities, production of Amyloid-β 42 (Aβ 42) and its oligomer, impaired autophagy, synapse dysfunction, and memory loss. However, more studies are needed to confirm the efficacy and safety repurposing dantrolene as a therapeutic drug in AD.

Treating Alzheimer's Dementia With CT-Induced Low-Dose Ionizing Radiation: Problematic, Yet Potential for More Precise Inquiry

This commentary evaluates a recent single-case study by Cuttler et al that posits that a series of computerized tomographic (CT) scans ameliorated symptoms and signs of advanced Alzheimer's dementia in an elderly female patient. The report proposes that CT scanning delivered low-dose ionizing radiation (LDIR) that activated adaptive mechanisms in the brain to induce the effects observed and reported. However, the report evidenced methodologic problems that threaten the validity and value of its approach, stated results, and conclusions. We provide discussion of these issues, with view and intent toward developing more precise investigations of the potential mechanisms and utility of LDIR in treating Alzheimer's dementia and possibly other neurodegenerative disorders.