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Wuttke-Linnemann A, Henrici C, Skoluda N, Nater UM, Endres K, Fellgiebel A. Psychobiological Monitoring of a Home-Based Dyadic Intervention for People Living with Dementia and Their Caregivers: Added Value to Evaluate Treatment Success and Understand Underlying Mechanisms. J Alzheimers Dis 2022; 87:1725-1739. [PMID: 35527544 DOI: 10.3233/jad-210618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research concerning people living with dementia (PwD) and their informal caregivers (ICs) has recently begun to focus on dyadic aspects of psychosocial interventions. OBJECTIVE We adapted a dyadic psychosocial intervention and examined its effects on psychobiological stress in daily life. METHODS Twenty-four PwD-caregiver dyads were visited seven times at home by specialized nursing staff. Momentary subjective stress, salivary cortisol (sCort), and salivary alpha-amylase (sAA) were measured in PwD and ICs before and after each home visit as well as six times per day at two days each at the beginning and end of the intervention as part of an ambulatory assessment. Hair cortisol concentrations (HCC) were measured twice. RESULTS After each home visit session, ICs reported lower subjective stress. sCort was lower in both ICs and PwD, whereas sAA did not change. In daily life, area under the curve (AUCg) concerning sCort secretion indicated that PwD had lower sCort daily output at the end of the intervention, and AUCg concerning subjective stress indicated that both PwD and ICs reported lower subjective stress than at the beginning of the intervention. AUCg concerning sAA did not change over time in either group. HCC did not vary over time but increased with disease severity. CONCLUSION The psychosocial intervention reduced psychobiological stress but affected psychobiological stress measures differently in PwD and ICs. In particular, the discrepancy between subjective and physiological markers of stress in PwD emphasizes the added value to evaluate treatment success and understand underlying mechanisms as a complement to self-reports.
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Affiliation(s)
| | - Clara Henrici
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Nadine Skoluda
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria.,University Research Platform 'The Stress of Life - Processes and Mechanisms Underlying Everyday Life Stress', University of Vienna, Vienna, Austria
| | - Urs M Nater
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria.,University Research Platform 'The Stress of Life - Processes and Mechanisms Underlying Everyday Life Stress', University of Vienna, Vienna, Austria
| | - Kristina Endres
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Andreas Fellgiebel
- Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Mainz, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany.,Hospital for Psychiatry, Psychosomatic and Psychotherapy, Agaplesion Elisabethenstift, Darmstadt, Germany
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2
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Kim E, Bolkan C, Crespi E, Madigan J. Feasibility of Hair Cortisol as a Biomarker of Chronic Stress in People With Dementia. Biol Res Nurs 2022; 24:388-399. [DOI: 10.1177/10998004221090468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hair cortisol concentrations (HCC) are an innovative way to measure chronic stress relying on a small sample of hair. To date, there are no studies that have studied HCC as a biomarker of chronic stress in individuals with dementia. Given the vulnerability to chronic stress in people with dementia, using HCC as an objective measure of physiological stress in those with dementia has potential to enhance our understanding of this population. The goal of this exploratory, multidisciplinary, pilot study was to establish feasibility of HCC testing in people with dementia as a biomarker of chronic stress. HCC was examined over a 6-month period to assess physiological stress response during a transition to memory care. Newly admitted memory care residents ( n = 13, mean age = 82) were followed over 6 months. Residents’ hair samples and health information were collected at 3-month intervals. HCC levels significantly changed during the transition to memory care, which may reflect chronic physiological stress. Participants with frequent behavioral and psychological symptoms of dementia (BPSD) had significantly lower HCC at baseline and exhibited a blunted cortisol reactivity at follow-up. Based on detected changes in HCC, participants likely experienced stress reactions during the transition to memory care, providing preliminary evidence that HCC may be a useful, non-invasive measure of physiological stress in this population. This approach may also be applied to understanding the significance of person-centered care environments on minimizing chronic stress for people with dementia.
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Affiliation(s)
- Eunsaem Kim
- Mo-Im Kim Nursing Research Institute, Yonsei University Colleage of Nursing, Seoul, Korea
| | - Cory Bolkan
- Department of Human Development, Washington State University, Vancouver. WA, USA
| | - Erica Crespi
- School of Biological Sciences, Washington State University, Pullman, WA, USA
| | - Jennifer Madigan
- School of Biological Sciences, Washington State University, Pullman, WA, USA
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3
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D'Cunha NM, McKune AJ, Isbel S, Kellett J, Georgousopoulou EN, Naumovski N. Psychophysiological Responses in People Living with Dementia after an Art Gallery Intervention: An Exploratory Study. J Alzheimers Dis 2020; 72:549-562. [PMID: 31609692 PMCID: PMC6918920 DOI: 10.3233/jad-190784] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The use of existing public spaces by people living with dementia, such as museums and art galleries, are becoming popular due to their ability to facilitate programs which promote social engagement and inclusion. However, few studies have investigated physiological outcomes of art gallery-based programs. Using a quasi-experimental design, the present study aimed to investigate the levels of salivary biomarkers of cortisol and interleukin-6, quality of life (QoL), depressive symptoms, cognition, and wellbeing, after attending the National Gallery of Australia (NGA) Art and Dementia program. Twenty-eight people living with dementia, each supported by a carer or family member, were recruited for a six-week program and were followed up at twelve weeks. In total, 25 participants (17 female; mean age 84.6±7.27 years) completed the study, and 22 provided viable saliva samples. The waking to evening salivary cortisol ratio was higher post-intervention (p = 0.033), and returned to baseline levels at follow-up (p = 1.00), indicating a more dynamic salivary cortisol rhythm in response to the six-week program. Interleukin-6 levels remained unchanged (p = 0.664). No improvements in QoL (DEMQOL-Carer) were observed between baseline and post-intervention (p = 0.076). However, self-reported depressive symptoms decreased post-intervention compared with baseline (p = 0.015), and memory (immediate recall) (p = 0.009) and verbal fluency (p = 0.027) improved between the same timepoints. The NGA Art and Dementia program appears to have quantifiable benefits, including improved hypothalamic-pituitary-adrenal axis function, justifying a need for longer controlled trial inclusive of physiological outcomes.
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Affiliation(s)
- Nathan M D'Cunha
- Faculty of Health, University of Canberra, Kirinari Street, Bruce, Canberra, ACT, Australia.,Collaborative Research in Bioactives and Biomarkers (CRIBB) Group, Kirinari Street, Bruce, Canberra, ACT, Australia
| | - Andrew J McKune
- Faculty of Health, University of Canberra, Kirinari Street, Bruce, Canberra, ACT, Australia.,Collaborative Research in Bioactives and Biomarkers (CRIBB) Group, Kirinari Street, Bruce, Canberra, ACT, Australia.,Discipline of Biokinetics, Exercise and Leisure Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Stephen Isbel
- Faculty of Health, University of Canberra, Kirinari Street, Bruce, Canberra, ACT, Australia.,Collaborative Research in Bioactives and Biomarkers (CRIBB) Group, Kirinari Street, Bruce, Canberra, ACT, Australia
| | - Jane Kellett
- Faculty of Health, University of Canberra, Kirinari Street, Bruce, Canberra, ACT, Australia.,Collaborative Research in Bioactives and Biomarkers (CRIBB) Group, Kirinari Street, Bruce, Canberra, ACT, Australia
| | - Ekavi N Georgousopoulou
- Collaborative Research in Bioactives and Biomarkers (CRIBB) Group, Kirinari Street, Bruce, Canberra, ACT, Australia.,Australian National University Medical School, Australian National University, Canberra, ACT, Australia.,School of Medicine, The University of Notre Dame, Sydney, NSW, Australia
| | - Nenad Naumovski
- Faculty of Health, University of Canberra, Kirinari Street, Bruce, Canberra, ACT, Australia.,Collaborative Research in Bioactives and Biomarkers (CRIBB) Group, Kirinari Street, Bruce, Canberra, ACT, Australia
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4
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Ho RTH, Fong TCT, Chan WC, Kwan JSK, Chiu PKC, Yau JCY, Lam LCW. Psychophysiological Effects of Dance Movement Therapy and Physical Exercise on Older Adults With Mild Dementia: A Randomized Controlled Trial. J Gerontol B Psychol Sci Soc Sci 2020; 75:560-570. [PMID: 30496547 DOI: 10.1093/geronb/gby145] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Dementia interferes with older adults' functioning in cognitive, daily, psychosocial, and neuroendocrine domains. The present study examined the psychophysiological effects of dance movement therapy (DMT) and physical exercise for older adults with dementia. METHODS This randomized controlled trial recruited 204 older adults diagnosed with mild dementia into the DMT, exercise, or waitlist control group. Both DMT and exercise interventions had similar intensity and comprised 24 hr of intervention that spanned over 12 weeks. All participants completed self-report questionnaires on psychosocial well-being, daily functioning, neurocognitive assessments, and salivary cortisol measures at baseline and 3 follow-up measurements more than 1 year. RESULTS The DMT group showed significant decreases in depression, loneliness, and negative mood (d = 0.33-0.42, p < .05) and improved daily functioning (d = 0.40, p < .01) and diurnal cortisol slope (d = 0.30, p < .01). The effects on daily functioning and cortisol slope remained at 1-year follow-up. The exercise group of matched intensity showed no significant effects on the outcomes. DISCUSSION The study findings support the potential utility of DMT as a multifaceted intervention for improving various aspects of functioning in older adults with declining cognitive abilities. The lack of beneficial effects for our exercise intervention and long-term DMT effects highlights the need to maintain persistent levels of exercise with adequate intensity and duration.
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Affiliation(s)
- Rainbow T H Ho
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong.,Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong
| | - Ted C T Fong
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong.,Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Joseph S K Kwan
- Department of Medicine, The University of Hong Kong, Hong Kong
| | | | - Joshua C Y Yau
- Centre on Behavioral Health, The University of Hong Kong, Hong Kong
| | - Linda C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
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5
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François M, Bull CF, Fenech MF, Leifert WR. Current State of Saliva Biomarkers for Aging and Alzheimer's Disease. Curr Alzheimer Res 2020; 16:56-66. [PMID: 30345919 DOI: 10.2174/1567205015666181022094924] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/06/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Aging is the primary risk factor for major human pathologies, including cancer, diabetes, cardiovascular diseases, and neurodegenerative diseases such as Alzheimer's Disease (AD). AD is a progressive degenerative disorder of the brain and is the most common form of dementia. METHODS To-date no simple, inexpensive and minimally invasive procedure is available to confirm with certainty the early diagnosis of AD prior to the manifestations of symptoms characteristic of the disease. Therefore, if population screening of individuals is to be performed, easily accessible tissues would need to be used for a diagnostic test that would identify those who exhibit altered or aberrant aging profiles that may be indicative of AD risk, so that they can be prioritized for primary prevention. This need for minimally invasive tests could be achieved by targeting saliva, since it is now well recognized that many aging diseases including AD are associated with peripheral biomarkers that are not only restricted to pathology and biomarkers within the brain. RESULTS Therefore, the aim of this review is to summarize some of the main findings of salivary biomarkers of aging and AD; including various proteins, metabolites, and alterations to DNA and miRNA. The future of healthy aging resides in innovative platforms, biosensors and point-of-care devices that can extract real time information on the health status of an individual. Those platforms may be achieved through the development and validation of novel biomarkers of health using saliva which, although being the least explored for biomedical purposes, has the distinct advantage that it can be self-collected in a non-invasive manner.
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Affiliation(s)
- Maxime François
- CSIRO Health and Biosecurity, Future Science Platforms Probing Biosystems, Adelaide, South Australia 5000, Australia.,CSIRO Health and Biosecurity, Nutrition and Health, Adelaide, South Australia 5000, Australia
| | - Caroline F Bull
- CSIRO Health and Biosecurity, Nutrition and Health, Adelaide, South Australia 5000, Australia
| | - Michael F Fenech
- University of South Australia, Adelaide, South Australia 5000, Australia
| | - Wayne R Leifert
- CSIRO Health and Biosecurity, Future Science Platforms Probing Biosystems, Adelaide, South Australia 5000, Australia.,CSIRO Health and Biosecurity, Nutrition and Health, Adelaide, South Australia 5000, Australia
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6
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Sanchis-Soler G, Tortosa-Martínez J, Manchado-Lopez C, Cortell-Tormo JM. The effects of stress on cardiovascular disease and Alzheimer's disease: Physical exercise as a counteract measure. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2020; 152:157-193. [PMID: 32450995 DOI: 10.1016/bs.irn.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AD is a complicated multi-systemic neurological disorder that involves different biological pathways. Several risk factors have been identified, including chronic stress. Chronic stress produces an alteration in the activity of the hypothalamic pituitary adrenal (HPA) system, and the autonomic nervous system (ANS), which over time increase the risk of AD and also the incidence of cardiovascular disease (CVD) and risk factors, such as hypertension, obesity and type 2 diabetes, associated with cognitive impairment and AD. Considering the multi-factorial etiology of AD, understanding the complex interrelationships between different risk factors is of potential interest for designing adequate strategies for preventing, delaying the onset or slowing down the progression of this devastating disease. Thus, in this review we will explore the general mechanisms and evidence linking stress, cardiovascular disease and AD, and discuss the potential benefits of physical activity for AD by counteracting the negative effects of chronic stress, CVD and risk factors.
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7
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Tortosa-Martínez J, Manchado C, Cortell-Tormo JM, Chulvi-Medrano I. Exercise, the diurnal cycle of cortisol and cognitive impairment in older adults. Neurobiol Stress 2018; 9:40-47. [PMID: 30450372 PMCID: PMC6234274 DOI: 10.1016/j.ynstr.2018.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 08/05/2018] [Accepted: 08/11/2018] [Indexed: 12/31/2022] Open
Abstract
Exercise has been shown to reduce the risk of developing Mild Cognitive Impairment and Alzheimer's disease as well as to improve cognition in healthy and cognitively impaired individuals. However, the mechanisms of these benefits are not well understood. The stress hypothesis suggests that the cognitive benefits attributed to exercise may partially be mediated by changes in the cortisol secretion pattern. Chronic stress may increase the risk of AD and exacerbate the cognitive deficits and brain pathology characteristic of the condition while physical activity has been shown to attenuate most of stress consequences and risk factors for AD. Initially, research on the effects of cortisol on cognition and physical activity focused on cortisol levels at one time point but the circadian pattern of cortisol secretion is complex and it is still unclear which aspects are most closely associated with cognitive function. Thus, the aim of this review was to analyze the exercise/stress/cognition hypothesis focusing on the effects of the diurnal cycle of cortisol on cognitive function and physical activity in older adults with and without cognitive impairment.
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Affiliation(s)
- J Tortosa-Martínez
- University of Alicante, Facultad de Educación, Carretera San Vicente del Raspeig s/n, 03690, San Vicente del Raspeig, Alicante, Spain
| | - C Manchado
- University of Alicante, Facultad de Educación, Carretera San Vicente del Raspeig s/n, 03690, San Vicente del Raspeig, Alicante, Spain
| | - J M Cortell-Tormo
- University of Alicante, Facultad de Educación, Carretera San Vicente del Raspeig s/n, 03690, San Vicente del Raspeig, Alicante, Spain
| | - I Chulvi-Medrano
- University of Alicante, Facultad de Educación, Carretera San Vicente del Raspeig s/n, 03690, San Vicente del Raspeig, Alicante, Spain
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8
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Abstract
PURPOSE OF REVIEW The endogenous circadian rhythms are one of the cardinal processes that control sleep. They are self-sustaining biological rhythms with a periodicity of approximately 24 hours that may be entrained by external zeitgebers (German for time givers), such as light, exercise, and meal times. This article discusses the physiology of the circadian rhythms, their relationship to neurologic disease, and the presentation and treatment of circadian rhythm sleep-wake disorders. RECENT FINDINGS Classic examples of circadian rhythms include cortisol and melatonin secretion, body temperature, and urine volume. More recently, the impact of circadian rhythm on several neurologic disorders has been investigated, such as the timing of occurrence of epileptic seizures as well as neurobehavioral functioning in dementia. Further updates include a more in-depth understanding of the symptoms, consequences, and treatment of circadian sleep-wake disorders, which may occur because of extrinsic misalignment with clock time or because of intrinsic dysfunction of the brain. An example of extrinsic misalignment occurs with jet lag during transmeridian travel or with intrinsic circadian rhythm sleep-wake disorders such as advanced or delayed sleep-wake phase disorders. In advanced sleep-wake phase disorder, which is most common in elderly individuals, sleep onset and morning arousal are undesirably early, leading to impaired evening function with excessive sleepiness and sleep-maintenance insomnia with early morning awakening. By contrast, delayed sleep-wake phase disorder is characterized by an inability to initiate sleep before the early morning hours, with subsequent delayed rise time, leading to clinical symptoms of severe sleep-onset insomnia coupled with excessive daytime sleepiness in the morning hours, as patients are unable to "sleep in" to attain sufficient sleep quantity. Irregular sleep-wake rhythm disorder is misentrainment with patches of brief sleep and wakefulness spread throughout the day, leading to unstable sleep and waking behavioral patterns and an entirely idiosyncratic sleep-wake schedule. SUMMARY Familiarity with these major circadian rhythm sleep-wake disorder phenotypes and their overlap with other neurologic disorders is essential for the neurologist so that clinicians may intervene and improve patient functioning and quality of life.
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9
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Kwan RYC, Leung MCP, Lai CKY. A Randomized Controlled Trial Examining the Effect of Acupressure on Agitation and Salivary Cortisol in Nursing Home Residents with Dementia. Dement Geriatr Cogn Disord 2018; 44:92-104. [PMID: 28768251 DOI: 10.1159/000478739] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Acupressure has been used to manage agitation in people with dementia because it is safe and inexpensive. However, its effect on agitation and at the biochemical level is uncertain. METHODS This randomized controlled trial examined the effect of acupressure on agitation, as measured by the Cohen-Mansfield Agitation Inventory (CMAI); and on salivary cortisol, as measured at baseline (T0) and in the 3rd (T1), 5th (T2), and 8th (T3) weeks. There were 119 agitated residents with dementia randomized into 3 groups: acupressure (n = 39), sham (n = 41), and usual-care group (n = 39). RESULTS A downward trend in agitation over time was noted in the acupressure group, which almost reached a level of significance in interaction effects between groups and time points (p = 0.052). Post hoc pairwise tests in the acupressure group showed that acupressure significantly reduced agitation at T2 (mean difference -6.84, 95% CI -10.60, -3.08) compared to baseline. Significant interaction effects between groups and time points were observed on the level of salivary cortisol (p = 0.022). CONCLUSION Acupressure is a multicomponent intervention that can reduce agitation. Acupoint activation may not be a significant component in reducing agitation, although this result may have been limited by the inadequate sample size. Acupressure is effective in reducing salivary cortisol in people with dementia.
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Affiliation(s)
- Rick Yiu Cho Kwan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR, China
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10
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Effect of cortisol diurnal rhythm on emotional memory in healthy young adults. Sci Rep 2017; 7:10158. [PMID: 28860606 PMCID: PMC5579256 DOI: 10.1038/s41598-017-10002-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 07/28/2017] [Indexed: 01/21/2023] Open
Abstract
Few studies have investigated the relationship between cortisol diurnal rhythm and cognitive function in healthy young adults, especially for emotional memory. To address this deficiency, this study examined the effect of diurnal cortisol slope (DCS) and heart rate variability (HRV) on emotional memory. Participants included healthy volunteers (44 men and 23 women; mean age 20.60 yrs). Participants were shown emotionally arousing slides and were asked to return to the laboratory one week later where they were given a "surprise" memory test to examine their emotional memory retention. Participants were asked to collect saliva samples at four time points (08:00, 11:00, 15:00, and 20:00) on the experimental days; these samples were used to calculate the DCS. Moreover, HRV was measured during the experiment. The multiple linear regression analysis revealed that declarative memory ability, sleep duration, and the DCS were the final significant determinants for emotional memory enhancement (B = -20.41, 0.05, -48.20, ps < 0.05), with participants having flatter cortisol slopes showing reduced or absent emotional memory enhancement. These findings are discussed in reference to the possible effects of diurnal rhythm mechanisms of the hypothalamus-pituitary-adrenal axis and the autonomic nervous system on emotional memory.
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11
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Ho RTH, Cheung JKK, Chan WC, Cheung IKM, Lam LCW. A 3-arm randomized controlled trial on the effects of dance movement intervention and exercises on elderly with early dementia. BMC Geriatr 2015; 15:127. [PMID: 26481870 PMCID: PMC4615324 DOI: 10.1186/s12877-015-0123-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/15/2015] [Indexed: 11/10/2022] Open
Abstract
Background Dementia is characterized by a progressive decline and deterioration of brain regions such as memory, spatial navigation and language, along with disturbances in daily functioning. Non-pharmacological interventions that offer a holistic approach by targeting cognitive functioning, prognosis and the psychological and social effects of dementia require rigorous investigation. The well-established benefits of physical activity for cognitive functioning and psychological support in dementia have been observed with dance-movement intervention. There is substantial evidence that dance-movement interventions provide emotional and social advantages. Thus, a randomized controlled trial (RCT) is planned to investigate the positive effects of a dance movement intervention, compared with mild physical exercise, on the physical and psychological well-being of elderly Chinese individuals with early dementia. Methods/Design A 3-arm RCT with waitlist control design will be used in this study. Two hundred and one elderly participants with very mild to mild dementia will be screened and randomized into the following groups: (i) dance movement based intervention, (ii) stretching and exercise intervention and (iii) no intervention waitlist-control group. The two intervention groups will receive a 1-h intervention, twice a week, for 12 weeks. The participants will be assessed four times over the course of 12 months: baseline before randomization, post-intervention (3 months), 6 months from baseline and 12 months from baseline. The primary outcomes will be compared between assessment points and between groups on neuropsychiatric symptoms, psychosocial well-being and cognitive and daily functioning. Secondary outcomes will assess the changes in salivary cortisol levels and their relationships with the primary outcome measures. Discussion This study will provide substantial evidence of the efficacy of a dance-movement-based intervention in slowing down dementia progression, due to its ability to act as a buffer against decline and improve areas affected by dementia. We also anticipate an association between cortisol levels and the outcome measures. The further development of this intervention into a structural program may be warranted for early psychosocial support among elderly populations. Trial registration The trial has been registered in the Chinese Clinical Trial Registry (ChiCTR-IOR-15006541).
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Affiliation(s)
- Rainbow Tin Hung Ho
- Centre on Behavioral Health, The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong, China. .,Department of Social Work and Social Administration, The University of Hong Kong, Room 534, Jockey Club Tower, Centennial Campus, Hong Kong, China. .,Sau Po Centre on Aging, The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong, China.
| | - Jacob Kai Ki Cheung
- Centre on Behavioral Health, The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong, China.
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, 2/F, New Clinical Building, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
| | - Irene Kit Man Cheung
- Centre on Behavioral Health, The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong, China.
| | - Linda Chiu Wah Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Tai Po Hospital, G/F Multicentre, Tai Po, Hong Kong, China.
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Johar H, Emeny RT, Bidlingmaier M, Lacruz ME, Reincke M, Peters A, Heier M, Ladwig KH. Lower morning to evening cortisol ratio is associated with cognitive impairment in men but not women: An analysis of 733 older subjects of the cross-sectional KORA-Age study. Psychoneuroendocrinology 2015; 51:296-306. [PMID: 25462902 DOI: 10.1016/j.psyneuen.2014.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 10/10/2014] [Accepted: 10/10/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND A dysregulated hypothalamic-pituitary-adrenocortical axis (HPA) is thought to play a role in the pathophysiology of cognitive impairment. Surprisingly, little agreement exists on the association of cortisol and cognitive impairment. Thus, we sought to examine the association between cognitive function and salivary cortisol levels in a representative sample of older men and women. METHODS A cross-sectional analysis was conducted among 733 study participants (65-90 years old, mean age=74.9) of the population-based KORA (Cooperative Health Research in the Region of Augsburg)-Age study. Associations were examined between cognitive function (determined by telephone interview for cognitive status-modified, TICS-m) and salivary cortisol measured upon waking (M1), 30min after awakening (M2), and in the late evening (E). RESULTS In a dose response manner, lower morning (M1 and M2), and increased evening levels were observed in participants with probable dementia (4.5%, N=33) and slightly increased in those with mild cognitive impairment (MCI) (13.8%, N=101) compared to healthy individuals. Higher morning to evening ratios were associated with reduced odds of cognitive impairment, even after adjustments for important confounders (M1/E ratio: OR=1.50, 95% CI=1.08-2.07, M2/E ratio: 1.41, 1.01-1.95, per 1 standard deviation (SD) increase). However, the significant association of an increased risk for cognitive impairment was observed among men (M1/E: OR=1.94, 95% CI=1.24-3.02; M2/E=1.74, 1.12-2.71) but not women (M1/E: OR=1.11, 0.69-1.78; M2/E=1.09, 0.67-1.77). CONCLUSION Our findings suggest that dysregulated HPA axis reactivity, evidenced by blunted diurnal cortisol responses, are associated with impaired cognitive function in an aged population.
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Affiliation(s)
- Hamimatunnisa Johar
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Rebecca T Emeny
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Martin Bidlingmaier
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Maria Elena Lacruz
- Institute of Clinical Epidemiology, Martin-Luther University Halle, Halle, Germany
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Margit Heier
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Karl-Heinz Ladwig
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre for Environmental Health, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Langerstr. 3, Munich, Germany.
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Yevchak AM, Steis MR, Evans LK. Sundown Syndrome: A Systematic Review of the Literature. Res Gerontol Nurs 2012; 5:294-303. [DOI: 10.3928/19404921-20120906-04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 01/20/2012] [Indexed: 11/20/2022]
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