Dementia treatment versus prevention

Neurovascular coupling, functional connectivity, and cerebrovascular endothelial extracellular vesicles as biomarkers of mild cognitive impairment

INTRODUCTION

Mild cognitive impairment (MCI) is a prodromal stage of dementia. Understanding the mechanistic changes from healthy aging to MCI is critical for comprehending disease progression and enabling preventative intervention.

METHODS

Patients with MCI and age-matched controls (CN) were administered cognitive tasks during functional near-infrared spectroscopy (fNIRS) recording, and changes in plasma levels of extracellular vesicles (EVs) were assessed using small-particle flow cytometry.

RESULTS

Neurovascular coupling (NVC) and functional connectivity (FC) were decreased in MCI compared to CN, prominently in the left-dorsolateral prefrontal cortex (LDLPFC). We observed an increased ratio of cerebrovascular endothelial EVs (CEEVs) to total endothelial EVs in patients with MCI compared to CN, correlating with structural MRI small vessel ischemic damage in MCI. LDLPFC NVC, CEEV ratio, and LDLPFC FC had the highest feature importance in the random Forest group classification.

DISCUSSION

NVC, CEEVs, and FC predict MCI diagnosis, indicating their potential as markers for MCI cerebrovascular pathology.

HIGHLIGHTS

Neurovascular coupling (NVC) is impaired in mild cognitive impairment (MCI). Functional connectivity (FC) compensation mechanism is lost in MCI. Cerebrovascular endothelial extracellular vesicles (CEEVs) are increased in MCI. CEEV load strongly associates with cerebral small vessel ischemic lesions in MCI. NVC, CEEVs, and FC predict MCI diagnosis over demographic and comorbidity factors.

Effects of Transcranial Direct Current Stimulation on Cognitive Function in Older Adults with and without Mild Cognitive Impairment: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

INTRODUCTION

Noninvasive brain stimulation (NIBS) has shown benefits for cognitive function in older adults. However, the effects of transcranial direct current stimulation (tDCS) on cognitive function in older adults are inconsistent across studies, and the evidence for tDCS has limitations. We aim to explore whether tDCS can improve cognitive function and different cognitive domains (i.e., learning and memory and executive function) in adults aged 65 years and older with and without mild cognitive impairment and to further analyze the influencing factors of tDCS.

METHODS

Five English databases (PubMed, Cochrane Library, EMBASE, Web of Science, the cumulative Index to Nursing and Allied Health Literature [CINAHL]) and four Chinese databases were searched from inception to October 14, 2023. Literature screening, data extraction, and quality assessment were completed independently by two reviewers. All statistical analyses were conducted using RevMan software (version 5.3). Standardized mean difference (SMD) along with a 95% confidence interval (CI) was used to express the effect size of the outcomes, and a random-effect model was also used.

RESULTS

A total of 10 RCTs and 1,761 participants were included in the meta-analysis, and the risk of bias in those studies was relatively low. A significant effect favoring tDCS on immediate postintervention cognitive function (SMD = 0.16, Z = 2.36, p = 0.02) was found. However, the effects on immediate postintervention learning and memory (SMD = 0.20, Z = 2.00, p = 0.05) and executive function (SMD = 0.10, Z = 1.22, p = 0.22), and 1-month postintervention cognitive function (SMD = 0.12, Z = 1.50, p = 0.13), learning and memory (SMD = 0.17, Z = 1.39, p = 0.16), and executive function (SMD = 0.08, Z = 0.67, p = 0.51) were not statistically significant.

CONCLUSION

tDCS can significantly improve the immediate postintervention cognitive function of healthy older adults and MCI elderly individuals. Additional longitudinal extensive sample studies are required to clarify the specific effects of tDCS on different cognitive domains, and the optimal tDCS parameters need to be explored to guide clinical practice.

Visual Cognitive Assessment Test: Utility of the brief cognitive battery for early screening of cognitive impairment in Chongqing, China

OBJECTIVES

Early detection of cognitive impairment is essential for timely intervention. Currently, most widely used cognitive screening tests are influenced by language and cultural differences; therefore, there is a need for the development of a language-neutral, visual-based cognitive assessment tool. The Visual Cognitive Assessment Test (VCAT), a 30-point test that assesses memory, executive function, visuospatial function, attention, and language, has demonstrated its utility in a multilingual population. In this study, we evaluated the reliability, validity, and diagnostic performance of the VCAT for screening early cognitive impairment in Chongqing, China METHODS: A total of 134 individuals (49 healthy controls (HCs), 52 with mild cognitive impairment (MCI), and 33 with mild dementia) completed the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), VCAT, and domain-specific neuropsychological assessments. The diagnostic performances of MMSE, MoCA, and VCAT were evaluated using the area under the curve (AUC), sensitivity, and specificity. Construct validity of the VCAT was assessed with well-established domain-specific cognitive assessments. Reliability was measured using Cronbach's alpha.

RESULTS

The VCAT and its subdomains demonstrated both good construct validity and internal consistency (α = 0.577). The performance of VCAT was comparable to that of MoCA and MMSE in differentiating mild dementia from nondemented groups (AUC: 0.940 vs. 0.902 and 0.977, respectively; p = .098 and .053) and in distinguishing cognitive impairment (CI) from HC (AUC: 0.929 vs. 0.899 and 0.891, respectively; p = .239 and .161), adjusted for education level. The optimal score range for VCAT in determining dementia, MCI, and HC was 0-14, 15-19, and 20-30, respectively.

CONCLUSION

The VCAT proves to be a reliable screening test for early cognitive impairment within our cohort. Being both language and cultural neutral, the VCAT has the potential to be utilized among a wider population within China.

Biochemical analysis of methanolic extract from Evolvulus alsinoides

Evolvulus alsinoides is a medicinal plant in the Convolvulaceae family. Traditionally, it is used for different ailments in India and in several other countries. It has a variety of pharmacological qualities, including those that aid wound healing, hepato-protection, cardio-protection, anti-diabetic action, asthma, and epilepsy, memory and learning, and neuroprotection. The whole plant is utilized in Ayurvedic medicine to treat neurological disorders, including amnesia, and it is called the brain tonic by them. Therefore, the use of GC-MS in phytochemical research and chemotaxonomic investigations of medicinal plants containing physiologically active components is critical. Hence, the various secondary metabolites from the methanolic extract of E. alsinoides were analyzed using GC-MS technique. The methanolic extract of E. alsinoides yielded ten compounds. All ten compounds showed the highest number of hits. Those with the highest concentration were chosen to identify the qualitative compound. All compounds are non-toxic. Molecules with specific properties are capable of modulating a variety of proteins, including some enzymes. Thus, these molecules are potential hit-to-lead molecules in preclinical studies.

Nootropic activity of methanolic extract from Evolvulus alsinoides Linn. in mice with scopolamine-induced amnesia

Plants have been used as therapeutic agents in both un-ionized (Unani, Ayurveda) and unstructured forms since ancient times. Therefore, it is of interest to document the nootropic activity of methanolic extract from Evolvulus alsinoides Linn (Vishnukranthi) in mice with scopolamine-induced amnesia. Healthy male Swiss albino mice ranging between 25 and 30 g were used in the study. Scopolamine induced amnesia, the following two tests are performed, elevated plus maze test, passive avoidance test. The mean time spent in the open arm, closed arm, and central platform for each group of animals. The total transitions were 12.6±0.89 by GS group mice, 3.4±0.55 by GSP group mice, 7±0.71 by GSLD group mice and 10±0.71 by GSHD group mice. A significant difference was seen between GS and GSP group mice means. The mean time in the safe zone and shock zone for each group of animals when comparing to Group 2 Vs Group 3, 4 showed a statistical significance of p < 0.05. The findings of this study suggest that Evolvulus alsinoides may be a promising candidate for the development of new treatments for memory impairment and other cognitive disorders. It should be noted that more data is needed to confirm the safety and efficacy of Evolvulus alsinoides in humans and to investigate its long-term effects.

Do communication interventions affect the quality-of-life of people with dementia and their families? A systematic review

OBJECTIVES

Speech, language and communication difficulties are prevalent in all dementia subtypes and are likely to considerably impact the quality-of-life of people with dementia and their families. Communication interventions provided by trained professionals are recommended for this population, but little is known about their quality-of-life outcomes. This review aims to explore the quality-of-life outcomes of communication-related interventions for people with dementia and their families.

METHODS

Seven databases were systematically searched. Reference lists from included studies and relevant systematic reviews were also hand-searched. Primary research with quantitative quality-of-life outcomes were included. Narrative analysis was utilised to identify key intervention features and to describe quality-of-life outcomes.

RESULTS

1,174 studies were identified. Twelve studies were eligible for inclusion. Studies were heterogeneous in location, participant group, methodologies, interventions and outcome measures. Four studies reported increased quality-of-life for people with dementia following intervention. No studies reported increased quality-of-life for family members.

CONCLUSION

Further research is needed in this area. The studies which reported improved quality-of-life involved multi-disciplinary approaches to intervention, involvement of family caregivers, and functional communication intervention. However, data is limited so results should be interpreted with caution. The standardised use of a communication-focused quality-of-life outcome measure would improve sensitivity and comparability of future studies.

Effect of a Standardized Extract of Asparagus officinalis Stem (ETAS®50) on Cognitive Function, Psychological Symptoms, and Behavior in Patients with Dementia: A Randomized Crossover Trial

Dementia is a disease of substantial national concern in a superaging society in Japan. Thus, the treatments targeting this disease are of high priority. However, pharmaceutical treatments are under development and invasive. Hence, many alternative treatments, which are less invasive, are tried, and some of them are supposed to work for dementia symptoms. ETAS®50 is one of these treatments. ETAS®50, a standardized extract of the Asparagus officinalis stem with heat shock protein-inducing activity, is a functional food. ETAS®50 has antistress, autonomic nerve regulation, and sleep quality improvement effects in humans and could contribute to relieving dementia symptoms. This double-blind crossover pilot trial aimed to examine the effects of ETAS®50. A total of 27 patients with mild-to-moderate dementia between October 2018 and February 2020 were included in the trial. ETAS®50 was consumed for 12 weeks and then a placebo for 12 weeks. A significant difference in the mean score of the severity of symptoms in the Neuropsychiatric Inventory Questionnaire (NPI-Q-a) was observed between the ETAS®50 period (0.56 ± 1.72 points) and placebo period (-0.67 ± 2.34 points) (p=0.045). Between-group comparisons with respect to the items of NPI-Q-a also showed a significant decrease in symptoms in the ETAS®50 period compared with the placebo period (p=0.015 for agitation and p=0.045 for depression). In addition, we observed that scores for apathy tended to improve in the ETAS®50 period (p=0.058).

The Impact of Intradialytic Cognitive and Physical Training Program on the Physical and Cognitive Abilities in End-Stage Kidney Disease Patients: A Randomized Clinical Controlled Trial

BACKGROUND

Hemodialysis (HD) patients have lower cognitive functioning and reduced physical fitness than age-matched healthy individuals. Clinicians typically do not recognize the declining cognitive performance in these patients; therefore, cognitive impairment is greatly underestimated and not appropriately treated. This study aimed to evaluate the impact on cognitive function of combining cognitive training with physical exercise and physical performance in HD patients.

METHODS

Using a randomized, single-blinded control design, forty-four HD patients were recruited and randomly assigned to either an intradialytic physical exercise and cognitive training program (EXP group; n = 22; 54% male; 65.7 ± 9.7 years; 77.1 ± 21.9 kg; body mass index 26.8 ± 6.0) or a standard care control group (CON group; n = 21; 77% male; 67.2 ± 12.5 years; 74.2 ± 14.3 kg; body mass index 25.9 ± 3.8). The EXP group performed intradialytic cycling and cognitive training three days per week for 12 weeks. Study outcomes were assessed by the Symbol Digit Modalities Test (SDMT), Montreal Cognitive Assessment (MoCA), 10-repetition sit-to-stand test (10-STS), handgrip strength test (HGS), and stork balance test.

RESULTS

The results showed a significant time*group interaction effect for SDMT (p < 0.001; η2 = 0.267) and MoCA (p < 0.001; η2 = 0.266). Moreover, no significant interaction was observed for 10-STS, HGS, and stork balance test (p > 0.05).

CONCLUSIONS

Our findings suggest that incorporating intradialytic cognitive and physical exercise training could help to improve the functional status of HD patients. The innovative, nonpharmacological, bimodal intervention is cost-effective, safe, and easy to implement during the intradialytic period and offers a potential impact on patients' quality of life and well-being.

An Exploratory Study of Nutrition Knowledge and Challenges Faced by Informal Carers of Community-Dwelling People with Dementia: Online Survey and Thematic Analysis

Nutrition knowledge is a primary factor influencing food choices and the ability to identify nutritional risk for carers of people with dementia. Acquiring nutrition knowledge helps carers monitor changes in food intake and micronutrient intake, and whether a healthy and balanced diet is being consumed. This study aimed to assess the nutrition knowledge of carers in the Australian community and their experiences with nutrition education. Using a mixed-methods approach, the nutrition knowledge of informal carers was assessed using the revised General Nutrition Knowledge Questionnaire (AUS-R-NKQ), and interviews of informal carers were used to explore the perspectives in a sub-sample. A total of 57 carers (44 females; mean age of 63.0 ± 13.1) completed the survey, and 11 carers participated in follow-up interviews. The total sample scored 22.9 (±4.57) out of 38 on the AUS-R-NKQ, suggesting basic nutrition knowledge. The interviewed carers acknowledged the importance of healthy nutrition but viewed the provision of a healthy diet for a person with dementia as challenging. In both the survey and interviews, carers reported limited use and availability of dementia-specific nutrition resources. Carers were unsatisfied with the advice and number of referrals provided to improve the nutrition of the person with dementia and desired less confusing nutrition education materials adapted to their level of knowledge. The present study highlights the need for informal carers to be supported to acquire adequate nutrition knowledge.

Alzheimer's disease: using gene/protein network machine learning for molecule discovery in olive oil

Alzheimer's disease (AD) poses a profound human, social, and economic burden. Previous studies suggest that extra virgin olive oil (EVOO) may be helpful in preventing cognitive decline. Here, we present a network machine learning method for identifying bioactive phytochemicals in EVOO with the highest potential to impact the protein network linked to the development and progression of the AD. A balanced classification accuracy of 70.3 ± 2.6% was achieved in fivefold cross-validation settings for predicting late-stage experimental drugs targeting AD from other clinically approved drugs. The calibrated machine learning algorithm was then used to predict the likelihood of existing drugs and known EVOO phytochemicals to be similar in action to the drugs impacting AD protein networks. These analyses identified the following ten EVOO phytochemicals with the highest likelihood of being active against AD: quercetin, genistein, luteolin, palmitoleate, stearic acid, apigenin, epicatechin, kaempferol, squalene, and daidzein (in the order from the highest to the lowest likelihood). This in silico study presents a framework that brings together artificial intelligence, analytical chemistry, and omics studies to identify unique therapeutic agents. It provides new insights into how EVOO constituents may help treat or prevent AD and potentially provide a basis for consideration in future clinical studies.

Effects of enriched environment on the expression of β-amyloid and transport-related proteins LRP1 and RAGE in chronic sleep-deprived mice

Sleep plays an important role in the learning process and memory consolidation, and sleep deprivation (SD) leads to inadequate memory consolidation and plays an important role in brain development and plasticity. SD increases β-amyloid levels while impairing cognitive function. We explored the effect of enriched environment (EE) on β-amyloid and transporter protein LRP1 and receptor for advanced glycosylation end-products (RAGE) expression in chronic sleep deprived mice. We randomly divided mice into four groups (n = 10), the standard environment group (Ctrl group), the sleep deprivation group (SD group), the enriched environment intervention group (EE group), and the sleep deprivation plus environmental enrichment intervention group (SD + EE group). A modified multi-platform SD model was used to sleep deprive the mice for 19 h per day. Five hours of EE intervention was performed daily in the EE group and the SD + EE group, respectively. The behavioral measurements of mice were performed by Y-maze method and new object recognition; the expression levels of Aβ1-42, LRP1, and RAGE in prefrontal cortex and hippocampus of mice were measured by immunofluorescence; the expression levels of LRP1 and RAGE in prefrontal cortex and hippocampus were detected by Western blot. The results showed that EE could effectively ameliorate the effects of SD on cognitive impairment, reduce SD induced Aβ deposition, and decrease the expression of RAGE, while increase the expression of LRP1.

The role of Phosphodiesterase-1 and its natural product inhibitors in Alzheimer's disease: A review

Phosphodiesterase-1 (PDE1) is a versatile enzyme that has surprisingly received considerable attention as a possible therapeutic target in Alzheimer's disease (AD) because it maintains the homeostasis of 3',5'-cyclic adenosine monophosphate (cAMP) and 3',5'-cyclic guanosine monophosphate (cGMP) in the brain. 3',5'-cyclic adenosine monophosphate and 3',5'-cyclic guanosine monophosphate are the two key second messengers that regulate a broad range of intracellular processes and neurocognitive functions, specifically memory and cognition, associated with Alzheimer's disease. However, the lack of available selective drugs on the market poses challenges to identifying the beneficial effects of natural products. The present review focuses on Phosphodiesterase-1 and its isoforms, splicing variants, location, distribution, and function; the role of Phosphodiesterase-1 inhibitors in Alzheimer's disease; and the use of vinpocetine and natural products as specific Phosphodiesterase-1 inhibitors. Moreover, it aims to provide ongoing updates, identify research gaps, and present future perspectives. This review indicates the potential role of Phosphodiesterase-1 inhibitors in the treatment of neurodegenerative disorders, such as Alzheimer's disease. Certain clinical trials on the alleviation of Alzheimer's disease in patients are still in progress. Among de novo outcomes, the employment of Phosphodiesterase-1 inhibitors to treat Alzheimer's disease is an important advancement given the absence of particular therapies in the pipeline for this highly prevalent disease. To sum up, Phosphodiesterase-1 inhibition has been specifically proposed as a critical therapeutic approach for Alzheimer's disease. This study provides a comprehensive review on the biological and pharmacological aspects of Phosphodiesterase-1, its role on the Alzheimer's diseases and its significance as Alzheimer's disease therapeutic target in drug discovery from natural products. This review will help clinical trials and scientific research exploring new entities for the treatment and prevention of Alzheimer's disease.

Prediabetes and the incidence of dementia in general population: a systematic review and meta-analysis of prospective studies

BACKGROUND

Continuous hyperglycaemia has been related with dementia. However, it remains unclear whether prediabetes poses a higher risk of dementia. A meta-analysis was therefore conducted to comprehensively investigate the possible role of prediabetes as a risk factor of dementia.

METHODS

Prospective cohort studies reporting the association of prediabetes and dementia were identified from PubMed, Web of Science, and Embase databases. A random-effects model was applied to combine the results by incorporating the influence of heterogeneity. Subgroup analyses were also conducted to explore the influences of study features on the relationship. Sensitivity analysis re-estimated the combined effect size after excluding single studies separately to explore the robustness of the results.

RESULTS

Nine studies involving 29 986 adults from the general population, 6265 (20.9%) of whom had prediabetes, were included. It was shown that prediabetes was not independently associated with a higher incidence of dementia compared with normoglycaemia (adjusted risk ratio (RR): 1.01, 95% confidence interval (CI): 0.85-1.21, P = 0.89, I²  = 39%). Subgroup analyses according to the definitions of prediabetes, follow-up duration, method for diagnosis of dementia, and quality score produced similar findings (P for all subgroup differences >0.05). In addition, prediabetes was not independently associated with the incidence of Alzheimer's disease (RR: 1.24, 95% CI: 0.98-1.56, P = 0.07, I²  = 0%) or vascular dementia (RR: 1.16, 95% CI: 0.70-1.92, P = 0.56, I²  = 0%). Different definitions of prediabetes have the potential to influence the results, as reflected in the subgroup analysis for Alzheimer's disease (RR: 1.30, 95% CI: 1.06-1.60, P = 0.01, I²  = 0%).

CONCLUSIONS

Prediabetes may not be an independent risk factor of all-cause dementia or vascular dementia in the general adult population. However, changing the definition of prediabetes may have an impact on the outcome for Alzheimer's disease.

The Effects of a Magic Intervention Program on Cognitive Function and Neurocognitive Performance in Elderly Individuals With Mild Cognitive Impairment

Objectives

Cognitive training is one of the management options for elderly individuals who suffer from mild cognitive impairment (MCI) and an effective way to improve executive function. This study aimed to evaluate the effectiveness of a magic intervention program as a method of cognitive training in improving cognitive function and neurocognitive performance in this group.

Methods

Twenty-four participants aged 60-80 years with MCI were recruited and randomly assigned to a magic intervention group or a control group. The magic intervention group received a 6-week magic intervention program. The primary endpoints were the scores for the cognitive assessment tests [e.g., Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA)] for general cognitive function. The secondary endpoints were the behavioral [e.g., accuracy and reaction times] and the electroencephalographic [e.g., event-related potential (ERP) P3 amplitudes] performance during the Flanker task to assess attention and inhibitory control. All variables were measured before and after the magic intervention.

Results

The results showed that the 6-week magic intervention significantly improved the MoCA scores in the cognitive assessment tests although no significant pre-post intervention difference was observed in the MMSE scores. In terms of neurocognitive performance, the magic intervention had significantly positive effects on the accuracy, reaction times, and P3 amplitudes when performing the Flanker task.

Conclusion

The results of the present study showed that the 6-week magic intervention had beneficial effects on the cognitive and electrophysiological performance in the elderly subjects with MCI. For such a group, lifestyle intervention programs that encourage participation such as the magic practice and performance may be a viable suggestion to prevent the progression of MCI to Alzheimer's disease.

Long-term exercise pre-training attenuates Alzheimer's disease-related pathology in a transgenic rat model of Alzheimer's disease

Alzheimer's disease (AD) is the most common form of dementia. Despite enormous efforts around the world, there remains no effective cure for AD. This study was performed to investigate the effects of long-term exercise pretreatment on the typical pathology of AD in a novel transgenic AD rat model. Male 2-month-old animals were divided into the following groups: wild-type (WT) rats, AD rats, and AD rats with treadmill exercise pretreatment (AD-Exe). After exercise pretreatment, the Barnes maze task, passive avoidance task, and cued fear conditioning test were performed to test learning and memory function. The elevated plus maze, open field test, sucrose preference test, and forced swim test were conducted to measure anxious-depressive-like behavior. Immunofluorescence staining, Golgi staining, transmission electron microscopy, Western blot analysis, F-Jade C staining, TUNEL staining, and related assay kits were conducted to measure Aβ plaques, tau hyperphosphorylation, neuronal damage, neuronal degeneration, dendritic spine density, synapses, synaptic vesicles, mitochondrial morphology, mitochondrial dynamic, oxidative stress, and neuroinflammation. Behavioral tests revealed that long-term exercise pretreatment significantly alleviated learning and memory dysfunction and anxious-depressive-like behaviors in AD animals. In addition, exercise pretreatment attenuated amyloid-β deposition and tau hyperphosphorylation and preserved spine density, synapses, and presynaptic vesicles. Exercise also inhibited neuronal damage, neuronal apoptosis, and neuronal degeneration. Additional studies revealed the imbalance of mitochondrial dynamics was significantly inhibited by exercise pretreatment accompanied by a remarkable suppression of oxidative stress and neuroinflammation. Our findings suggest that long-term exercise pretreatment alleviated behavioral deficits and typical pathologies of the AD rat model, supporting long-term exercise pretreatment as a potential approach to delay the progression of AD.

Effects of Intradialytic Cognitive and Physical Exercise Training on Cognitive and Physical Abilities in Hemodialysis Patients: Study Protocol for a Randomized Controlled Trial

The prevalence of cognitive impairment in hemodialysis (HD) patients is extremely high. Despite the well-documented benefits of interventions on cognitive function, there is a widespread call for effective strategies that will show the long-term consequences in patients undergoing dialysis. The aim of this research protocol was to investigate the effect of cognitive training combined with physical exercise on cognitive function, physical performance, and frailty indicators in the HD population. We will conduct a randomized controlled intervention trial to examine the effects of a combined non-pharmacological intervention in the form of intradialytic physical exercise and intradialytic cognitive training on cognitive function, indicators of frailty, and physical performance measures in HD patients. The group of patients receiving the study intervention will be compared to the control group receiving standard HD care. The duration of the intervention will be 12 weeks. We will use sensitive instruments (cognitive domain tests) to assess cognitive functions. The primary outcome of the study at 12 weeks will be performance on the Alertness subtest of the computerized Test of Attentional Performance. Secondary study outcomes are: Performance in other domains of cognitive function (executive function, psychomotor speed, information processing efficiency, working memory, and attention), physical fitness (10 repetition sit-to-stand test, timed up and go test, handgrip strength test, spontaneous gait speed, and stork balance test), and assessment of frailty (Edmonton Frail Scale). Study outcomes will be assessed at baseline, immediately after the 12-week intervention, and 6 months after the end of the study without specific further intervention (retention effect assessment). This study will be among the first to test the synergistic effects of a uniquely designed physical exercise and cognitive training intervention on functional status in HD patients. We believe our results will contribute to dementia prevention research by demonstrating the long-term efficacy of our combined intervention. Clinical Trial Registration: ClinicalTrials.Gov, NCT05150444.

The Impact of Low Hemoglobin Levels on Cognitive Brain Functions

The prevalence of dementia is around 5% worldwide in people above 65 years, which increases with aging. Alzheimer's disease is the most common cause of dementia in the elderly. On the other hand, anemia is considered one of the most prevalent comorbidities in the elderly with a prevalence of 11% in those above the age of 65. It is crucial that we find the association between anemia and dementia, as this linkage can prove beneficial. Many currently conducted studies support the idea that anemia is a significant risk factor for dementia. However, some studies still consider anemia and dementia as just an aging process, nothing more. In our study, we found that there are a lot of theories, such as low brain hemoglobin associated with low oxygen levels, which leads to neuron damage. One article mentioned that it is dependent on the level of hemoglobin as an effect with mild to moderate anemia, but apparent with severe forms of it. Researchers are expected to further explore and identify the exact relationship between anemia and dementia. We used the PubMed database as the principal source for data search and extracted articles exploring the relationship and role of anemia in decreasing the cognitive brain functions in the elderly. We reviewed 35 different articles, including clinical trials, review papers, randomized controlled trials (RCTs), and original research published between 2010 and 2020 to find commonly accepted pathophysiology that highlights how anemia causes a decrease in cognitive brain functions.