Association between exercise and the risk of dementia: results from a nationwide longitudinal study in China

Effect of long-term physical exercise and multidomain interventions on cognitive function and the risk of mild cognitive impairment and dementia in older adults: A systematic review with meta-analysis

INTRODUCTION

Recent studies have suggested that sustained multidomain interventions, including physical exercise, may be beneficial in preventing cognitive decline. This review aims to assess the impact of prolonged physical exercise and multidomain strategies on overall cognitive faculties and dementia risk among community-dwelling older adults without dementia.

METHODS

We systematically searched PubMed, Web of Science, PsychInfo, and CINHAL databases from inception until April 1, 2024, for randomized controlled trials that investigated the effects of long-term (≥ 12 months) physical exercise or multidomain interventions on non-demented, community-dwelling older adults. The primary outcomes assessed were changes in global cognition and the risk of mild cognitive impairment (MCI) or dementia. Standardized mean differences (SMD) and risk ratios (RR) with 95 % confidence intervals were computed using a random-effects inverse-variance method with the Hartung-Knapp-Sidik-Jonkman adjustment for effect size calculation. The Cochrane Risk-of-Bias-2 tool (RoB-2) was used for bias assessment, and the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was applied to evaluate the certainty of evidence.

RESULTS

Sixteen trials, including 11,402 participants (mean age 73.2 [±5.5] years; 62.3 % female) were examined. The risk of bias was low. Moderate-certainty evidence indicated that physical exercise interventions had modest to no effect on cognitive function (k= 9, SMD: 0.05; 95 % CI: -0.04-0.13; p = 0.25), whereas multidomain interventions were significantly impactful (k=7, SMD: 0.09; 95 % CI: 0.04-0.15; p < 0.01). Physical exercise interventions did not alter MCI risk (k= 4, RR: 0.98; 95 % CI: 0.73-1.31; p = 0.79) or dementia onset (k= 4, RR: 0.61; 95 % CI: 0.25-1.52; p = 0.19), with very low-to low-certainty evidence, respectively.

CONCLUSIONS

Integrative multidomain strategies incorporating physical exercise may benefit the global cognitive function of older adults. However, long-term physical exercise alone did not yield any cognitive gains. The effectiveness of such exercise interventions to mitigate the overall risk of incident MCI and dementia warrants further research.

The effect of different exercise on physical fitness, cognition, and mental health in healthy older adults

Objective

This study aimed to examine the effects of different exercise programs on physical fitness, cognition, and mental health in healthy older adults.

Methods

A randomized controlled study was performed with 89 healthy older adults. They were separated into four groups: the control (Con; n = 20), physical activity (PA; n = 23), cognitive training (CT; n = 23), and physical activity coupled with cognitive training groups (PA + CT; n = 23). The subjects in PA, CT, and PA + CT groups received exercise programs that lasted 40 min daily, conducted at least three days a week for 20 weeks. The PA group received regular aerobic physical activity interventions, the CT group received cognitive training interventions, and the PA + CT group received physical activity combined with cognitive training interventions. Physical fitness (by chair stand, biceps curl, 2-min step, 8-step up and walk, and sit and reach tests), cognitive function (attention, simple reaction time, and spatial memory), and mental health (anxiety and depression status) were evaluated before and after 20 weeks.

Results

The body composition results reveal no significant effects among the four groups after 20 weeks before and after aerobic exercise interventions (p > 0.05). Compared with Con, the PA, CT, and PA + CT groups significantly improved physical fitness parameters (p < 0.05). The post-hoc analysis demonstrated that the PA and PA + CT groups had higher fitness levels than the CT group. Similarly, a significant difference was observed in the cognitive index among the four groups (p < 0.05). As determined by post-hoc analysis, attention and simple reaction time differed sequentially between the Con, PA, CT, and PA + CT groups. The spatial memory was superior in the PA, CT, and PA + CT groups compared to the Con group (p < 0.05), with the PA + CT group exhibiting the highest level of performance. However, there was no significant difference in the mental health parameters among all the groups (p < 0.05).

Conclusion

A 20-week intervention involving different exercise methods can enhance physical fitness, cognition, and mental health in older adults. These methods include physical activity, cognitive training, and a combination of physical and cognitive training. The combined physical activity and cognitive training interventions yielded more favorable outcomes than individual physical or cognitive training interventions.

Moving Towards a Medicine of Dance: A Scoping Review of Characteristics of Dance Interventions Targeting Older Adults and a Theoretical Framework

Background

Dance combines cultural and aesthetic elements with behaviors important for brain health, including physical activity, social engagement, and cognitive challenge. Therefore, dance could positively impact public health given the rapidly aging population, increasing incidence of Alzheimer's disease and related dementias, and lack of uptake of exercise in many older adults. Despite a high volume of literature, existing literature does not support evidence-based guidelines for dance to support healthy aging.

Objective

To conduct a scoping review of the dance intervention literature in older adults and provide information to facilitate a more consistent approach among scientists in designing dance interventions for older adults that stimulate physical and neurocognitive health adaptations.

Methods

Study characteristics (sample size, population, study design, outcomes, intervention details) were ascertained from 112 separate studies of dance reported in 127 papers that reported outcomes important for brain health (cardiorespiratory fitness, balance and mobility, cognition, mood, and quality of life).

Results

High heterogeneity across studies was evident. Class frequency ranged from < 1 to 5 classes per week, class length from 30-120 minutes, and intervention duration from 2 weeks to 18 months. Studies often did not randomize participants, had small (< 30) sample sizes, and used varied comparator conditions. Over 50 tests of cognition, 40 dance forms, and 30 tests of mobility were identified.

Conclusions

Based on these results, important future directions are establishing common data elements, developing intervention mapping and mechanistic modeling, and testing dosing parameters to strengthen and focus trial design of future studies and generate evidence-based guidelines for dance.

Changes in physical activity and all-cause mortality in the oldest old population: Findings from the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

BACKGROUND

Insufficient or decreasing physical activity is common in older adults. Most studies on physical activity changes and mortality were conducted in adults younger than 80 years old in developed countries. We aimed to investigate the relationship between changes in physical activity and longevity in the oldest old (80 years or older) population using the Chinese Longitudinal Healthy Longevity Survey.

METHODS

Participants aged 80 or older at baseline were categorized into four groups: 1) remaining physically inactive (n = 14,287), 2) remaining physically active (n = 5411), 3) shifting from being inactive to active (n = 1364), and 4) shifting from being active to inactive (n = 1401). We fitted accelerated failure time Weibull survival regression models, adjusting for baseline sociodemographics, lifestyle factors and disease status. We further examined whether the associations differed by subgroups.

RESULTS

A total of 15,707 participants died during follow-up (median duration of follow-up = 3.0 years). Compared with participants who remained physically inactive, those who remained active (fully adjusted event time ratio (ETR): 1.14, 95%CI: 1.11-1.17) or shifted from being inactive to active (fully adjusted ETR: 1.14, 95%CI: 1.08-1.20) had statistically significant longer survival time. No significant association was observed between remaining physically inactive and shifting from being active to inactive. Subgroup analyses showed consistent associations in nearly all strata.

CONCLUSION

Maintaining frequent physical activity or shifting from being physically inactive to active was consistently associated with longer survival time in the oldest old population. Our findings provide evidence for encouraging older adults to regularly engage in physical activity to gain longevity benefits.

Lifestyle Changes Reduced Estimated White Matter Hyperintensities Based on Retinal Image Analysis

This study evaluates if there is an association between lifestyle changes and the risk of small vessel disease (SVD) as measured by cerebral white matter hyperintensities (WMH) estimated by the automatic retinal image analysis (ARIA) method. We recruited 274 individuals into a community cohort study. Subjects were assessed at baseline and annually with the Health-Promoting Lifestyle Profile II Questionnaire (HPLP-II) and underwent a simple physical assessment. Retinal images were taken using a non-mydriatic digital fundus camera to evaluate the level of WMH estimated by ARIA (ARIA-WMH) to measure the risk of small vessel disease. We calculated the changes from baseline to one year for the six domains of HPLP-II and analysed the relationship with the ARIA-WMH change. A total of 193 (70%) participants completed both the HPLP-II and ARIA-WMH assessments. The mean age was 59.1 ± 9.4 years, and 76.2% (147) were women. HPLP-II was moderate (Baseline, 138.96 ± 20.93; One-year, 141.97 ± 21.85). We observed a significant difference in ARIA-WMH change between diabetes and non-diabetes subjects (0.03 vs. -0.008, respectively, p = 0.03). A multivariate analysis model showed a significant interaction between the health responsibility (HR) domain and diabetes (p = 0.005). For non-diabetes subgroups, those with improvement in the HR domain had significantly decreased in ARIA-WMH than those without HR improvement (-0.04 vs. 0.02, respectively, p = 0.003). The physical activity domain was negatively related to the change in ARIA-WMH (p = 0.02). In conclusion, this study confirms that there is a significant association between lifestyle changes and ARIA-WMH. Furthermore, increasing health responsibility for non-diabetes subjects reduces the risk of having severe white matter hyperintensities.

The relationship between physical activity, physical health, and mental health among older Chinese adults: A scoping review

The aging Chinese population is growing fast, and the proportion of the population aged 60 years old is projected to reach 28% by 2040, estimated 402 million. With increased life expectancy, the aging population tends to suffer from health risks and diseases, which create a burden on public health policy. Hence, it is essential to promote healthy and active aging, which includes improving older adults' physical and mental capacities and advocating for the achievement of a healthy life expectancy. Despite the rapidly growing aging population in China, there have been no reviews investigating the effect of physical activity on physical and mental health among older Chinese adults. Therefore, the current study aimed to review studies from the past 15 years that illustrate the effect of physical activity on physical and mental health among Chinese older adults. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR), this review addresses the associations between physical activity, physical health and mental health among older Chinese adults. A total of 371 studies were included in the scoping review, which covered the relationships between physical activity, physical health and mental health variables. The scoping review also revealed the impact of various kinds of physical activity affecting older adults' physical health, such as functional fitness, body composition, fall risk and balance, and mental health issues, such as depression, anxiety, cognitive function and quality of life. Moreover, studies have identified innovative forms of physical activity as emerging trends in physical activity interventions for older adults. To conclude, this scoping review captured the common effects between physical activity and overall wellbeing, including physical, mental, and cognitive health. Additionally, diverse forms of physical activity intervention, such as group-based and supervised individual interventions, should be supported, and cross-cultural exercise comparisons should be made in future explorations.

Effect of leisure activities on cognitive aging in older adults: A systematic review and meta-analysis

Abnormal cognitive aging in older adults is a growing public health problem. Previous studies showed inconsistent results pertaining to the effects of leisure activities on cognitive function in older adults. We conducted a systematic review and meta-analysis of published observational longitudinal studies to examine and synthesize the effects of leisure activities on cognitive function in older adults. MEDLINE, PubMed, EMBASE, PsycINFO (Ovid), CINAHL (EBSCO), and Web of Science databases were searched from January 2012 to January 2022. Relative risks (RRs) with 95% confidence intervals (CIs) were pooled using random-effects meta-analysis. Most studies found that leisure activities had a positive effect on cognitive function in older adults. The pooled RR for the effect of leisure activity on cognitive function was 0.77 (95% CI: 0.72-0.81, p < 0.01). The effects of leisure activities on cognitive function varied by different cognitive statuses in older adults, with RRs ranging from 0.55 (95% CI: 0.37-0.83) to 1.07 (95% CI: 0.95-1.22). Meta-regression analysis showed that compared with studies with percentage of female ≥50%, studies with female participant percentage <50% had significantly increased RR (p = 0.01). Moreover, studies conducted in European and American countries had significantly lower RR (p = 0.019), compared with those conducted in Asian countries. Our study revealed different effects of various types of leisure activities on different cognitive statuses in older adults. To make innovative recommendations for promoting cognitive function in older adults, more detailed observational longitudinal studies investigating the effects of different types of leisure activities on different cognitive statuses in older adults are needed.

Replacement of leisure-time sedentary behavior with various physical activities and the risk of dementia incidence and mortality: A prospective cohort study

BACKGROUND

Whether or not there is targeted pharmacotherapy for dementia, an active and healthy lifestyle that includes physical activity (PA) may be a better option than medication for preventing dementia. We examined the association between leisure-time sedentary behavior (SB) and the risk of dementia incidence and mortality. We further quantified the effect on dementia risk of replacing sedentary time with an equal amount of time spent on different physical activities.

METHODS

In the UK Biobank, 484,169 participants (mean age 56.5 years; 45.2% men) free of dementia were followed from baseline (2006-2010) through July 30, 2021. A standard questionnaire measured individual leisure-time SB (watching TV, computer use, and driving) and PA (walking for pleasure, light and heavy do-it-yourself activity, strenuous sports, and other exercise) frequency and duration in the 4 weeks prior to evaluation. Apolipoprotein E (APOE) genotype data were available for a subset of 397,519 (82.1%) individuals. A Cox proportional hazard model and an isotemporal substitution model were used in this study.

RESULTS

During a median 12.4 years of follow-up, 6904 all-cause dementia cases and 2115 deaths from dementia were recorded. In comparison to participants with leisure-time SB <5 h/day, the hazard ratio ((HR), 95% confidence interval (95%CI)) of dementia incidence was 1.07 (1.02-1.13) for 5-8 h/day and 1.25 (1.13-1.38) for >8 h/day, and the HR of dementia mortality was 1.35 (1.12-1.61) for >8 h/day. A 1 standard deviation increment of sedentary time (2.33 h/day) was strongly associated with a higher incidence of dementia and mortality (HR = 1.06, 95%CI: 1.03-1.08 and HR = 1.07, 95%CI: 1.03-1.12, respectively). The association between sedentary time and the risk of developing dementia was more profound in subjects <60 years than in those ≥60 years (HR = 1.26, 95%CI: 1.00-1.58 vs. HR =1.21, 95%CI: 1.08-1.35 in >8 h/day, p for interaction = 0.013). Replacing 30 min/day of leisure sedentary time with an equal time spent in total PA was associated with a 6% decreased risk and 9% decreased mortality from dementia, with exercise (e.g., swimming, cycling, aerobics, bowling) showing the strongest benefit (HR = 0.82, 95%CI: 0.78-0.86 and HR = 0.79, 95%CI: 0.72-0.86). Compared with APOE ε4 noncarriers, APOE ε4 carriers are more likely to see a decrease in Alzheimer's disease incidence and mortality when PA is substituted for SB.

CONCLUSION

Leisure-time SB was positively associated with the risk of dementia incidence and mortality. Replacing sedentary time with equal time spent doing PA may be associated with a significant reduction in dementia incidence and mortality risk.

The effect of two multi-component behavior change interventions on cognitive functions

Background

We previously reported the effects of two cluster-randomized 6-month multi-component workplace interventions, targeting reducing sedentary behavior or increasing physical activity among office workers, on movement behaviors and cardiorespiratory fitness. The primary aim of this study was to investigate the effects of these interventions on cognitive functions compared to a wait-list control group. The secondary aims were to examine if changes in cognition were related to change in cardiorespiratory fitness or movement behaviors and if age, sex, or cardiorespiratory fitness moderated these associations.

Methods

Both interventions encompassed multi-components acting on the individual, environmental, and organizational levels and aimed to change physical activity patterns to improve mental health and cognitive function. Out of 263 included participants, 139 (mean age 43 years, 76% females) completed a neuropsychological test battery and wore accelerometers at baseline and 6-month follow-up. The intervention effect (aim 1) on cognitive composite scores (i.e., Executive Functions, Episodic Memory, Processing Speed, and Global Cognition) was investigated. Additionally, associations between changes in movement behaviors and cardiorespiratory fitness, and changes in cognition were examined (aim 2). Moreover, age, sex, and cardiorespiratory fitness level were investigated as possible moderators of change associations (aim 3).

Results

Overall, cognitive performance improved from baseline to follow-up, but the change did not differ between the intervention groups and the control group. Changes in cardiorespiratory fitness or any movement behavior category did not predict changes in cognitive functions. The association between changes in time in bed and changes in both Executive Function and Global Cognition were moderated by age, such that a more positive relation was seen with increasing age. A less positive association was seen between changes in sedentary behavior and Processing Speed for men vs. women, whereas higher cardiorespiratory fitness was related to a more positive association between changes in moderate-intensity physical activity and Global Cognition.

Conclusion

The lack of an intervention effect on cognitive functions was expected since the intervention did not change movement behavior or fitness. Age, sex, and cardiorespiratory fitness level might moderate the relationships between movement behaviors and cognitive functions changes.

Trial registration

ISRCTN92968402. Registered 09/04/2018.

Home-dwelling older adults' attitudes and perceptions of dementia: A Q-methodological study in South Korea

AIM

Older adult attitudes and perceptions of dementia can have a major impact on early diagnosis, efforts to prevent and appropriately treat it, as well as being a family burden. The aim of this study is to explore attitudes and perceptions of dementia of home-dwelling older adults using Q-methodology.

METHOD

A total of 42 adults, age 65 or over, who live in South Korea ranked 37 Q statements about their attitudes and perceptions of dementia into A Q sort table grid.

RESULTS

The following three distinct viewpoints were extracted: (1) it is my responsibility to prevent and to care about dementia (family-centered view); (2) there are no ways to treat dementia (despairing views); and (3) dementia is a national responsibility (nation-centered view).

CONCLUSION

Based on these results, central and local government and communities should work together with older adults to manage dementia and reflect these three viewpoints when developing systematic dementia management programs.

Trends in Cognitive Function Among Chinese Elderly From 1998 to 2018: An Age-Period-Cohort Analysis

Objectives: To investigate the effects of age, period, and cohort (APC) on trends in cognitive function among the Chinese elderly, and to explore how gender gaps in cognitive function change with age, period, and cohort. Methods: This study used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018, and included 90,432 participants aged above 65 years old. The measurement of cognitive function was the score of the Mini-Mental State Examination (MMSE). Cross-classified random-effect models were used to investigate age, period, and cohort trends in cognitive function. Results: Mini-Mental State Examination scores decreased with age at an increasing rate. While the cohort effect was nearly stable, the period effect demonstrated a downward trend from 1998 to 2002 followed by a nearly flat line. Females were associated with lower MMSE scores than males. When age increased, the gender gaps in MMSE scores further increased. The period-based gender gaps in MMSE scores diverged throughout the 20 years, while the cohort-based gender disparities in MMSE scores converged with successive cohorts. Conclusions: Age, period, and cohort had different and independent effects on cognitive function among the Chinese elderly. The effect of age was stronger than that of period and cohort. Gender disparities in cognitive function increased with age and period, and decreased with successive cohorts.

Sarcopenia and Mild Cognitive Impairment in Older Adults from Six Low- and Middle-Income Countries

BACKGROUND

Little is known about the relationship between sarcopenia and mild cognitive impairment (MCI) in low- and middle-income countries (LMICs).

OBJECTIVE

This study aimed to investigate this association among community-dwelling adults aged≥65 years from six LMICs.

METHODS

Cross-sectional, nationally representative data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. These data were obtained in China, Ghana, India, Mexico, Russia, and South Africa in 2007-2010. Participants were considered to have sarcopenia if they had low skeletal muscle mass (i.e., lower skeletal mass index) and a weak handgrip strength. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Multivariable logistic regression analysis was conducted to assess associations.

RESULTS

The final analytical sample consisted of 12,912 individuals aged≥65 years with preservation in functional abilities without stroke (mean [standard deviation] age 72.2 [10.8] years; 45.2% males). The overall prevalence of sarcopenia and MCI were 11.3% and 18.1%, respectively. After adjusting for potential confounders, there was a positive association between sarcopenia and MCI in all countries (i.e., odds ratio [OR] > 1) with the exception of South Africa, and the overall estimate was OR = 1.60 (95% confidence interval [CI] = 1.32-1.93) with a low level of between-country heterogeneity (I2 = 0.0%).

CONCLUSION

There was a positive association between sarcopenia and MCI in this sample of older adults living in LMICs. Causality should be assessed in future longitudinal research, while the utility of sarcopenia as a marker of MCI should also be investigated.

Age-Related Changes in the Association Between Traumatic Brain Injury and Dementia in Older Men and Women

OBJECTIVE

To investigate age-related changes in the association between traumatic brain injury (TBI) and dementia in older men and women separately.

SETTING

A total of 243 general practices in the UK.

PARTICIPANTS

This study included 4760 patients who received a first TBI diagnosis between 1995 and 2010 (index date), and 4760 patients without TBI who were matched to those with TBI by age, sex, index year, Charlson Comorbidity Index, alcohol dependence, and physician (index date: a randomly selected visit date).

DESIGN

Retrospective cohort study.

MAIN MEASURES

Incidence of dementia in the decade following index date.

RESULTS

Within 10 years of index date, 8.8% of men with TBI and 4.8% of those without TBI were diagnosed with dementia, while the respective figures were 9.0% and 6.7% in women (P values < .01). There was a significant association between TBI and dementia in men (hazard ratio [HR] = 2.29, 95% confidence interval [CI]: 1.64-3.19) and in women (HR = 1.33, 95% CI: 1.07-1.64). Furthermore, the association between TBI and dementia was significant in men aged 60 to 70 (HR = 2.51, 95% CI: 1.27-4.96) and 71 to 80 years (HR = 3.00, 95% CI: 1.82-4.93), whereas the relationship was only significant and potentially unreliable in women aged 81 to 90 years (HR = 1.49, 95% CI: 1.03-2.14).

CONCLUSIONS

The age-related relationship between TBI and dementia differed between men and women. More research of a prospective nature and including behavioral data is needed to better understand these differences.

Poverty increases the risk of incident cognitive impairment among older adults: a longitudinal study in China

Objectives: With a longitudinal design, we aimed to investigate the relationship between poverty and the risk of incident cognitive impairment in China.Methods: We used three waves of the Chinese Longitudinal Healthy Longevity Survey (2008-2014). Cognitive impairment was assessed using the Chinese version of the Mini Mental State Examination. Poverty was measured according to the latest national poverty line settled at an annual per-capita income of 2300 yuan (approximately equivalent to 1.25 dollar/day) in 2011 in China. A marginal structural model was utilized to explore the association between poverty and the risk of incident cognitive impairment. The subgroup analyses were also conducted in this study.Results: The cumulative incidence of cognitive impairment over 6 years was 30.69% (1936/6309). Poverty increased 34% risk of incident cognitive impairment in the elderly (odds ratio = 1.34, 95% confidence interval (CI): 1.15-1.56) after controlling behavioral factors and health status covariates. Participants who were male (OR = 1.38, 95% CI: 1.08-1.76), lived in urban areas (OR = 1.55, 95% CI: 1.22-1.98), and were married (OR = 1.72, 95% CI: 1.28-2.32) had higher poverty risks on incident cognitive impairment in subgroup analyses.Conclusions: Our results provide empirical support for the ongoing discussion about how economic hardship impacts of cognitive functioning, and highlight the negative health risks that economically disadvantaged individuals may experience.

Dementia-Free Life Expectancy among People over 60 Years Old by Sex, Urban and Rural Areas in Jiangxi Province, China

Objective: To estimate and compare the dementia-free life expectancy (DemFLE) and age trends of the population over 60 in 2018 in Jiangxi Province, China, by sex and urban–rural areas. Methods: Based on the Summary of Health Statistics of Jiangxi Province in 2018 and the Sixth National Health Service survey of Jiangxi Province, the model life table is used to estimate the age-specific mortality rate by sex and urban–rural areas. DemFLE and its ratio to life expectancy (LE) were calculated using the Sullivan method. Results: In 2018, the DemFLE at age 60 was 18.48 years for men and 21.31 years for women, accounting for 96.62% and 96.67% of their LE. LE and DemFLE were higher for those in urban areas than in rural areas, except for men aged 90 and above; higher in women than in men, except for people in rural areas aged 90 and above. In urban areas, DemFLE/LE was higher for women than for men; the opposite was observed in rural areas. Urban women had a higher DemFLE/LE than rural women did, urban men had a lower DemFLE/LE than rural men did. Conclusions: With increased LE, DemFLE also increases, but with older age and over time, DemFLE/LE gradually decreases. The effect of dementia on elderly adults becomes more serious. It is necessary for the government to implement a series of prevention strategies to improve the quality of life and health awareness of the elderly. Elderly urban men and elderly rural women need more attention and health care.

Precision Medicine in Lifestyle Medicine: The Way of the Future?

Precision medicine has captured the imagination of the medical community with visions of therapies precisely targeted to the specific individual's genetic, biological, social, and environmental profile. However, in practice it has become synonymous with genomic medicine. As such its successes have been limited, with poor predictive or clinical value for the majority of people. It adds little to lifestyle medicine, other than in establishing why a healthy lifestyle is effective in combatting chronic disease. The challenge of lifestyle medicine remains getting people to actually adopt, sustain, and naturalize a healthy lifestyle, and this will require an approach that treats the patient as a person with individual needs and providing them with suitable types of support. The future of lifestyle medicine is holistic and person-centered rather than technological.

Late-Life Physical and Cognitive Activities Independently Contribute to Brain and Cognitive Resilience

BACKGROUND

Active lifestyles are related to better cognitive aging outcomes, yet the unique role of different types of activity are unknown.

OBJECTIVE

To examine the independent contributions of physical (PA) versus cognitive (CA) leisure activities to brain and cognitive aging.

METHODS

Independent samples of non-demented older adults from University of California, San Francisco Hillblom Aging Network (UCSF; n = 344 typically aging) and University of California, Davis Diversity cohort (UCD; n = 485 normal to MCI) completed: 1) self-reported engagement in current PA and CA (UCSF: Physical Activity Scale for the Elderly and Cognitive Activity Scale; UCD: Life Experiences Assessment Form); 2) neuropsychological batteries; and 3) neuroimaging total gray matter volume, white matter hyperintensities, and/or global fractional anisotropy. PA and CA were simultaneously entered into multivariable linear regression models, adjusting for demographic characteristics and functional impairment severity.

RESULTS

Brain outcomes: In UCSF, only PA was positively associated with gray matter volume and attenuated the relationship between age and fractional anisotropy. In UCD, only CA was associated with less white matter hyperintensities and attenuated the relationship between age and gray matter volume. Cognitive outcomes: In both cohorts, greater CA, but not PA, related to better cognition, independent of age and brain structure. In UCSF, CA attenuated the relationship between fractional anisotropy and cognition. In UCD, PA attenuated the association between white matter hyperintensities and cognition.

CONCLUSIONS

Although their specificity was not easily teased apart, both PA and CA are clearly related to better brain and cognitive resilience markers across cohorts with differing educational, racial, and disease statuses. PA and CA may independently contribute to converging neuroprotective pathways for brain and cognitive aging.

Effect of Yoga versus Light Exercise to Improve Well-Being and Promote Healthy Aging among Older Adults in Central India: A Study Protocol for a Randomized Controlled Trial

Background: Aging is a natural process associated with many functional and structural changes. These changes may include impaired self-regulation, changes in tissues and organs. Aging also affects mood, physical status and social activity. There are adverse changes in cognitive behavior, perceived sensation and thinking processes. Regular physical activity can alleviate many health problems; yet, many older adults are inactive. Yoga is one of the scientific and popular lifestyle practice considered as the integration of mind, body and soul. Results of previous studies reported positive effects of yoga on multiple health outcomes in elderly. However, there is scarcity of scientific information where yoga’s effect is examined on over well-being and on multiple health outcomes simultaneously in elderly. This protocol describes methods for a 12-week yoga-based intervention exploring the effects of yoga on well-being in physically inactive elderly living in community. Methods and analysis: This two group parallel single blind randomized controlled trial that will be conducted at a designated facility of R.D. Gardi Medical College, Ujjain, Madhya Pradesh, Central India. A 12-week 60-min yoga intervention three times weekly is designed. Comparison group participants will undergo a 60-min program comprising light exercise focusing on conventional stretching to improve mobility. After screening, 144 participants aged 60–80 years will be recruited. The primary outcome is subjective well-being. Secondary outcomes include mobility, fall risk, cognition, anxiety and depression, mood and stress, sleep quality, pain, physical activity/sedentary behavior and cardio-metabolic risk factors. Assessments will be conducted at baseline (0 week), after the intervention (12+1 week) and at follow-up (36+1 week). Intention-to-treat analyses with mixed linear modeling will be applied. Discussion: Through this trial, we aim to determine whether elderly people in the intervention group practicing yoga show more favorable primary (well-being) and secondary outcomes than those in the light exercise focusing on conventional stretching group. We assume that yoga may be practiced to maintain health, reduce particular symptoms commonly associated with skeletal pain, assist in pain relief and enhance well-being. We anticipate that practicing yoga will improve well-being and mental health and may lead to significant improvement in depression, pain and sleep quality.Ethics and dissemination: This study is approved by the Institutional Ethics Committee of R.D. Gardi Medical College, Ujjain, IEC Ref No. 09/2018. All participants would be provided with written and verbal information about the purpose of the project and would be free to withdraw from the study at any time. Refusal to participate in the study would not have any negative consequences. Confidentiality of the information of each participant would be ensured. Knowledge obtained would be disseminated to stakeholders through workshops, meetings and relevant scientific conferences.Trial Registration: The trial is prospectively registered with the Indian Council of Medical Research Trial Registry CTRI/2018/07/015051.

Current and past leisure time physical activity in relation to risk of Alzheimer's disease in older adults

INTRODUCTION

The associations between self-reported current and past leisure time physical activity (LTPA) and Alzheimer's disease (AD) incidence were determined using data from the multiethnic Washington/Hamilton Heights-Inwood Columbia Aging Project (WHICAP) study.

METHODS

The metabolic equivalent of LTPA energy expenditure was calculated for self-reported current and past LTPA for 1345 older adults. A Cox proportional hazard model was conducted to estimate the association between LTPA (low, middle, and high) and incident AD risk.

RESULTS

Comparing high to low level, current and past LTPA were both associated with reduced AD risk, with hazard ratio (95% confidence interval) = 0.39 (0.20-0.75) and 0.37 (0.18-0.75), respectively. Compared with "always low," "increased" and "always high" LTPA throughout life were associated with reduced AD risk, with hazard ratio (95% confidence interval) = 0.60 (0.36-0.99) and 0.28 (0.08-0.94), respectively. Light- and moderate-intensity LTPA were associated with lower AD risk.

DISCUSSION

LTPA both throughout life and later in life are associated with lower risk of AD.

Cognitive ageing trajectories and mortality of Chinese oldest-old

OBJECTIVE

This study aims to identify distinctive cognitive trajectories jointly with mortality probabilities and to explore factors related to the particular trajectories of cognitive ageing in China.

METHOD

6842 individuals aged 80 years and above from 7 waves of the Chinese Longitudinal Healthy Longevity Survey were assessed with the Mini-Mental State Examination for up to 16 years. A group-based trajectory model was used to jointly estimate cognitive ageing and mortality trajectories; and to explore the factors related to membership of the trajectory groups.

RESULTS

A four-group model best fit the data. For all groups, the cognitive function declined with age according to different rates. Group 4, 3, 2, and 1 showed slow (prevalence 52.8%), moderate (31.1%), progressive (12.6%) and rapid (3.5%) cognitive decline, respectively. Mortality probability trajectories followed a hierarchy in consistence with cognitive trajectories approximately. Females, illiteracy, and those born in rural areas were less likely to belong to the most favorable trajectory group.

CONCLUSIONS

The heterogeneity of cognitive ageing was identified among Chinese oldest-old. Childhood socioeconomic status, especially education, was associated with the rate of cognitive decline.

The Role of Genetics in Advancing Precision Medicine for Alzheimer's Disease-A Narrative Review

Alzheimer's disease (AD) is the most common type of dementia, which has a substantial genetic component. AD affects predominantly older people. Accordingly, the prevalence of dementia has been rising as the population ages. To date, there are no effective interventions that can cure or halt the progression of AD. The only available treatments are the management of certain symptoms and consequences of dementia. The current state-of-the-art medical care for AD comprises three simple principles: prevent the preventable, achieve early diagnosis, and manage the manageable symptoms. This review provides a summary of the current state of knowledge of risk factors for AD, biological diagnostic testing, and prospects for treatment. Special emphasis is given to recent advances in genetics of AD and the way genomic data may support prevention, early intervention, and development of effective pharmacological treatments. Mutations in the APP, PSEN1, and PSEN2 genes cause early onset Alzheimer's disease (EOAD) that follows a Mendelian inheritance pattern. For late onset Alzheimer's disease (LOAD), APOE4 was identified as a major risk allele more than two decades ago. Population-based genome-wide association studies of late onset AD have now additionally identified common variants at roughly 30 genetic loci. Furthermore, rare variants (allele frequency <1%) that influence the risk for LOAD have been identified in several genes. These genetic advances have broadened our insights into the biological underpinnings of AD. Moreover, the known genetic risk variants could be used to identify presymptomatic individuals at risk for AD and support diagnostic assessment of symptomatic subjects. Genetic knowledge may also facilitate precision medicine. The goal of precision medicine is to use biological knowledge and other health information to predict individual disease risk, understand disease etiology, identify disease subcategories, improve diagnosis, and provide personalized treatment strategies. We discuss the potential role of genetics in advancing precision medicine for AD along with its ethical challenges. We outline strategies to implement genomics into translational clinical research that will not only improve accuracy of dementia diagnosis, thus enabling more personalized treatment strategies, but may also speed up the discovery of novel drugs and interventions.