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Chaudhari DS, Jain S, Yata VK, Mishra SP, Kumar A, Fraser A, Kociolek J, Dangiolo M, Smith A, Golden A, Masternak MM, Holland P, Agronin M, White-Williams C, Arikawa AY, Labyak CA, Yadav H. Unique trans-kingdom microbiome structural and functional signatures predict cognitive decline in older adults. GeroScience 2023; 45:2819-2834. [PMID: 37213047 PMCID: PMC10643725 DOI: 10.1007/s11357-023-00799-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/11/2023] [Indexed: 05/23/2023] Open
Abstract
The prevalence of age-related cognitive disorders/dementia is increasing, and effective prevention and treatment interventions are lacking due to an incomplete understanding of aging neuropathophysiology. Emerging evidence suggests that abnormalities in gut microbiome are linked with age-related cognitive decline and getting acceptance as one of the pillars of the Geroscience hypothesis. However, the potential clinical importance of gut microbiome abnormalities in predicting the risk of cognitive decline in older adults is unclear. Till now the majority of clinical studies were done using 16S rRNA sequencing which only accounts for analyzing bacterial abundance, while lacking an understanding of other crucial microbial kingdoms, such as viruses, fungi, archaea, and the functional profiling of the microbiome community. Utilizing data and samples of older adults with mild cognitive impairment (MCI; n = 23) and cognitively healthy controls (n = 25). Our whole-genome metagenomic sequencing revealed that the gut of older adults with MCI harbors a less diverse microbiome with a specific increase in total viruses and a decrease in bacterial abundance compared with controls. The virome, bacteriome, and microbial metabolic signatures were significantly distinct in subjects with MCI versus controls. Selected bacteriome signatures show high predictive potential of cognitive dysfunction than virome signatures while combining virome and metabolic signatures with bacteriome boosts the prediction power. Altogether, the results from our pilot study indicate that trans-kingdom microbiome signatures are significantly distinct in MCI gut compared with controls and may have utility for predicting the risk of developing cognitive decline and dementia- debilitating public health problems in older adults.
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Affiliation(s)
- Diptaraj S Chaudhari
- USF Center for Microbiome Research, Institute for Microbiomes, University of South Florida Morsani College of Medicine, Tampa, FL, 33612, USA
- Center of Excellence for Aging and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Microbiome in aging Gut and Brain (MiaGB) Consortium Team, FL, Tampa, USA
| | - Shalini Jain
- USF Center for Microbiome Research, Institute for Microbiomes, University of South Florida Morsani College of Medicine, Tampa, FL, 33612, USA
- Center of Excellence for Aging and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Microbiome in aging Gut and Brain (MiaGB) Consortium Team, FL, Tampa, USA
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Byrd Alzheimer Center, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Vinod K Yata
- USF Center for Microbiome Research, Institute for Microbiomes, University of South Florida Morsani College of Medicine, Tampa, FL, 33612, USA
- Center of Excellence for Aging and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Microbiome in aging Gut and Brain (MiaGB) Consortium Team, FL, Tampa, USA
| | - Sidharth P Mishra
- USF Center for Microbiome Research, Institute for Microbiomes, University of South Florida Morsani College of Medicine, Tampa, FL, 33612, USA
- Center of Excellence for Aging and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Ambuj Kumar
- Microbiome in aging Gut and Brain (MiaGB) Consortium Team, FL, Tampa, USA
- Research Methodology and Biostatistics Core, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Amoy Fraser
- Microbiome in aging Gut and Brain (MiaGB) Consortium Team, FL, Tampa, USA
- Burnett School of Biomedical Sciences, University of Central Florida College of Medicine, Orlando, FL, USA
- University of Central Florida College of Medicine, FL, Orlando, United States
| | - Judyta Kociolek
- Microbiome in aging Gut and Brain (MiaGB) Consortium Team, FL, Tampa, USA
- Department of Neuroscience, Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Mariana Dangiolo
- Microbiome in aging Gut and Brain (MiaGB) Consortium Team, FL, Tampa, USA
- University of Central Florida College of Medicine, FL, Orlando, United States
| | - Amanda Smith
- Microbiome in aging Gut and Brain (MiaGB) Consortium Team, FL, Tampa, USA
- Byrd Alzheimer Center, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Adam Golden
- Microbiome in aging Gut and Brain (MiaGB) Consortium Team, FL, Tampa, USA
- University of Central Florida College of Medicine, FL, Orlando, United States
| | - Michal M Masternak
- Microbiome in aging Gut and Brain (MiaGB) Consortium Team, FL, Tampa, USA
- Burnett School of Biomedical Sciences, University of Central Florida College of Medicine, Orlando, FL, USA
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Peter Holland
- Microbiome in aging Gut and Brain (MiaGB) Consortium Team, FL, Tampa, USA
- Department of Neuroscience, Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Marc Agronin
- Microbiome in aging Gut and Brain (MiaGB) Consortium Team, FL, Tampa, USA
- Behavioral Health, MIND Institute, Miami Jewish Health, Miami, FL, USA
| | - Cynthia White-Williams
- Microbiome in aging Gut and Brain (MiaGB) Consortium Team, FL, Tampa, USA
- Department of Nutrition and Dietetics, University of North Florida, Jacksonville, FL, USA
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, USA
| | - Andrea Y Arikawa
- Microbiome in aging Gut and Brain (MiaGB) Consortium Team, FL, Tampa, USA
- Department of Nutrition and Dietetics, University of North Florida, Jacksonville, FL, USA
| | - Corinne A Labyak
- Microbiome in aging Gut and Brain (MiaGB) Consortium Team, FL, Tampa, USA
- Department of Nutrition and Dietetics, University of North Florida, Jacksonville, FL, USA
| | - Hariom Yadav
- USF Center for Microbiome Research, Institute for Microbiomes, University of South Florida Morsani College of Medicine, Tampa, FL, 33612, USA.
- Center of Excellence for Aging and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
- Microbiome in aging Gut and Brain (MiaGB) Consortium Team, FL, Tampa, USA.
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
- Byrd Alzheimer Center, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
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Manser P, Poikonen H, de Bruin ED. Feasibility, usability, and acceptance of "Brain-IT"-A newly developed exergame-based training concept for the secondary prevention of mild neurocognitive disorder: a pilot randomized controlled trial. Front Aging Neurosci 2023; 15:1163388. [PMID: 37810620 PMCID: PMC10557950 DOI: 10.3389/fnagi.2023.1163388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023] Open
Abstract
Background Exergames provide a promising new approach to implement simultaneous motor-cognitive training, which may support preventing the decline in cognitive functioning in older adults who have a mild neurocognitive disorder (mNCD). Objectives To evaluate feasibility, system usability, and acceptance of "Brain-IT", a newly developed training concept combining exergame-based motor-cognitive training and heart rate variability (HRV) guided resonance breathing for the secondary prevention of mNCD. Methods A pilot randomized controlled trial (RCT) with an allocation ratio of 2:1 (i.e., intervention:control) was conducted. The control group proceeded with usual care. The intervention group performed a 12-week training according to the "Brain-IT" training concept implemented with the "Senso Flex" (Dividat AG) exergaming system in addition to usual care. Feasibility and usability outcomes were analyzed using descriptive statistics. User acceptance was analyzed qualitatively and using Friedman analysis of variance (ANOVA), as well as Wilcoxon signed-rank tests. Results Eighteen participants (77.3 ± 9.8 years; 44.4% females) were included. On average, we recruited 2.2 participants per month, and 35.3% of the individuals contacted were included. The intervention group had an attrition rate of 20% and mean adherence and compliance rates of 85.0 and 84.1%, respectively. The mean system usability score, measured with the system usability scale, was 71.7. High levels of exergame enjoyment, an increase in exergame enjoyment, and internalization of training motivation with large effect sizes (p = 0.03, r = 0.75 and p = 0.03, r = 0.74, respectively), as well as acceptable perceived usefulness, were observed. Preliminary data on the effects of the "Brain-IT" training are promising. Conclusion The feasibility and usability of the "Brain-IT" training are acceptable. However, frequent occurrences of technical problems and difficulties in using the exergame training system were identified as barriers to performing the "Brain-IT" training. To optimize feasibility, either improvements or alternative solutions are required in the hardware and software of the exergame used to implement the "Brain-IT" training. The "Brain-IT" training itself was well-accepted by older adults who have mNCD. Therefore, the effectiveness of the "Brain-IT" training concept should be investigated in future studies. Trial registration clinicaltrials.gov/ct2/show/NCT04996654.
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Affiliation(s)
- Patrick Manser
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Hanna Poikonen
- Learning Sciences and Higher Education, Department of Humanities, Social and Political Sciences, ETH Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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3
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Sheffler JL, Kiosses DN, He Z, Arjmandi BH, Akhavan NS, Klejc K, Naar S. Improving Adherence to a Mediterranean Ketogenic Nutrition Program for High-Risk Older Adults: A Pilot Randomized Trial. Nutrients 2023; 15:nu15102329. [PMID: 37242211 PMCID: PMC10223314 DOI: 10.3390/nu15102329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Mediterranean ketogenic nutrition (MKN) may directly target multiple neurobiological mechanisms associated with dementia risk in older adults. Despite its promise, this type of nutrition can be challenging to learn and adhere to in a healthy manner. Our team used the National Institutes of Health Obesity Related Behavioral Intervention Trials (NIH ORBIT) model to develop and pilot a program to help older adults with memory concerns use MKN. (2) Methods: Using a two-arm, randomized design, we evaluated an MKN Adherence (MKNA) program compared to an MKN education (MKNE) program (N = 58). The primary difference between study arms involved the use of motivational interviewing (MI) strategies and behavior change techniques (BCT) only in the MKNA arm. Participants were included if they evidenced subjective memory concerns or objective memory impairment on the Montreal Cognitive Assessment (Score 19 ≤ 26). Primary outcomes examined included feasibility, acceptability, adherence, and clinical outcomes associated with the program. (3) Results: Overall, there was relatively high program completion in both groups, with 79% of participants completing the 6-week program. The recruitment protocol required adjustment but was successful in reaching the target sample size. Retention (82%) and session attendance (91%) were higher in the MKNA arm compared to the MKNE (retention = 72%; attendance = 77%). Overall, most participants in both groups rated the program as "excellent" using the client satisfaction questionnaire. Participants in the MKNA arm evidenced higher objective and self-reported adherence to MKN during the 6-week program. Further, there was some evidence of clinical benefits of the program, although these effects diminished as adherence decreased in the 3 months follow-up. (4) Discussion: This pilot trial demonstrated that the MKN program incorporating MI and BCT strategies may better engage and retain participants than a nutrition education program alone, although participants in both groups reported high satisfaction.
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Affiliation(s)
- Julia L Sheffler
- Center for Translational Behavioral Science, College of Medicine, Florida State University, Tallahassee, FL 32306, USA
| | - Dimitris N Kiosses
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY 10605, USA
| | - Zhe He
- School of Information, Florida State University, Tallahassee, FL 32306, USA
| | - Bahram H Arjmandi
- College of Health and Human Sciences, Florida State University, Tallahassee, FL 32306, USA
| | - Neda S Akhavan
- College of Health and Human Sciences, Florida State University, Tallahassee, FL 32306, USA
| | - Kamelia Klejc
- Center for Translational Behavioral Science, College of Medicine, Florida State University, Tallahassee, FL 32306, USA
| | - Sylvie Naar
- Center for Translational Behavioral Science, College of Medicine, Florida State University, Tallahassee, FL 32306, USA
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4
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Reorganization of Brain Networks as a Substrate of Resilience: An Analysis of Cytochrome c Oxidase Activity in Rats. Neuroscience 2023; 516:75-90. [PMID: 36805003 DOI: 10.1016/j.neuroscience.2023.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 02/18/2023]
Abstract
The unpredictable chronic mild stress (UCMS) model has been used to induce depressive-like symptoms in animal models, showing adequate predictive validity. Our work aims to evaluate the effects of environmental enrichment (EE) on resilience in this experimental model of depression. We also aim to assess changes in brain connectivity using cytochrome c oxidase histochemistry in cerebral regions related to cognitive-affective processes associated with depressive disorder: dorsal hippocampus, prefrontal cortex, amygdala, accumbens, and habenula nuclei. Five groups of rats were used: UCMS, EE, EE + UCMS (enrichment + stress), BG (basal level of brain activity), and CONT (behavioral tests only). We assessed the hedonic responses elicited by sucrose solution using a consumption test; the anxiety level was evaluated using the elevated zero maze test, and the unconditioned fear responses were assessed by the cat odor test. The behavioral results showed that the UCMS protocol induces elevated anhedonia and anxiety. But these responses are attenuated previous exposure to EE. Regarding brain activity, the UCMS group showed greater activity in the habenula compared to the EE + UCMS group. EE induced a functional reorganization of brain activity. The EE + UCMS and UCMS groups showed different patterns of connections between brain regions. Our results showed that EE favors greater resilience and could reduce vulnerability to disorders such as depression and anxiety, modifying metabolic brain activity.
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Mavragani A, Michels L, Schmidt A, Barinka F, de Bruin ED. Effectiveness of an Individualized Exergame-Based Motor-Cognitive Training Concept Targeted to Improve Cognitive Functioning in Older Adults With Mild Neurocognitive Disorder: Study Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e41173. [PMID: 36745483 PMCID: PMC9941909 DOI: 10.2196/41173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Simultaneous motor-cognitive training is considered promising for preventing the decline in cognitive functioning in older adults with mild neurocognitive disorder (mNCD) and can be highly motivating when applied in the form of exergaming. The literature points to opportunities for improvement in the application of exergames in individuals with mNCD by developing novel exergames and exergame-based training concepts that are specifically tailored to patients with mNCD and ensuring the implementation of effective training components. OBJECTIVE This study systematically explores the effectiveness of a newly developed exergame-based motor-cognitive training concept (called "Brain-IT") targeted to improve cognitive functioning in older adults with mNCD. METHODS A 2-arm, parallel-group, single-blinded randomized controlled trial with a 1:1 allocation ratio (ie, intervention: control), including 34 to 40 older adults with mNCD will be conducted between May 2022 and December 2023. The control group will proceed with the usual care provided by the (memory) clinics where the patients are recruited. The intervention group will perform a 12-week training intervention according to the "Brain-IT" training concept, in addition to usual care. Global cognitive functioning will be assessed as the primary outcome. As secondary outcomes, domain-specific cognitive functioning, brain structure and function, spatiotemporal parameters of gait, instrumental activities of daily living, psychosocial factors, and resting cardiac vagal modulation will be assessed. Pre- and postintervention measurements will take place within 2 weeks before starting and after completing the intervention. A 2-way analysis of covariance or the Quade nonparametric analysis of covariance will be computed for all primary and secondary outcomes, with the premeasurement value as a covariate for the predicting group factor and the postmeasurement value as the outcome variable. To determine whether the effects are substantive, partial eta-squared (η2p) effect sizes will be calculated for all primary and secondary outcomes. RESULTS Upon the initial submission of this study protocol, 13 patients were contacted by the study team. Four patients were included in the study, 2 were excluded because they were not eligible, and 7 were being informed about the study in detail. Of the 4 included patients, 2 already completed all premeasurements and were in week 2 of the intervention period. Data collection is expected to be completed by December 2023. A manuscript of the results will be submitted for publication in a peer-reviewed open-access journal in 2024. CONCLUSIONS This study contributes to the evidence base in the highly relevant area of preventing disability because of cognitive impairment, which has been declared a public health priority by the World Health Organization. TRIAL REGISTRATION ClinicalTrials.gov NCT05387057; https://clinicaltrials.gov/ct2/show/NCT05387057. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41173.
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Affiliation(s)
| | - Lars Michels
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - André Schmidt
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Filip Barinka
- Clinic for Neurology, Hirslanden Hospital Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Motor Control and Learning Group - Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
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6
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Zary N, Adcock-Omlin M, de Bruin ED. Design Considerations for an Exergame-Based Training Intervention for Older Adults With Mild Neurocognitive Disorder: Qualitative Study Including Focus Groups With Experts and Health Care Professionals and Individual Semistructured In-depth Patient Interviews. JMIR Serious Games 2023; 11:e37616. [PMID: 36602851 PMCID: PMC9853342 DOI: 10.2196/37616] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/28/2022] [Accepted: 10/10/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Exergames have attracted growing interest in the prevention and treatment of neurocognitive disorders. The most effective exergame and training components (ie, exercise and training variables such as frequency, intensity, duration, or volume of training and type and content of specific exergame scenarios) however remain to be established for older adults with mild neurocognitive disorders (mNCDs). Regarding the design and development of novel exergame-based training concepts, it seems of crucial importance to explicitly include the intended users' perspective by adopting an interactive and participatory design that includes end users throughout different iterative cycles of development. OBJECTIVE This study aimed to determine the capabilities, treatment preferences, and motivators for the training of older adults with mNCD and the perspectives of individuals on training goals and settings and requirements for exergame and training components. METHODS A qualitative study including expert focus groups and individual semistructured in-depth patient interviews was conducted. Data were transcribed to a written format to perform qualitative content analysis using QCAmap software. RESULTS In total, 10 experts and health care professionals (80% females) and 8 older adults with mNCD (38% females; mean age 82.4, SD 6.2 years) were recruited until data saturation was observed. CONCLUSIONS The psychosocial consequences of patients' self-perceived cognitive deterioration might be more burdensome than the cognitive changes themselves. Older adults with mNCD prefer integrative forms of training (such as exergaming) and are primarily motivated by enjoyment or fun in exercising and the effectiveness of the training. Putting the synthesized perspectives of training goals, settings, and requirements for exergames and training components into context, our considerations point to opportunities for improvement in research and rehabilitation, either by adapting existing exergames to patients with mNCDs or by developing novel exergames and exergame-based training concepts specifically tailored to meet patient requirements and needs.
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Affiliation(s)
| | - Manuela Adcock-Omlin
- Motor Control and Learning Group - Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Motor Control and Learning Group - Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Health, OST - Eastern Swiss University of Applied Sciences, St.Gallen, Switzerland
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7
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Lee D, Lee VMY, Hur SK. Manipulation of the diet-microbiota-brain axis in Alzheimer's disease. Front Neurosci 2022; 16:1042865. [PMID: 36408394 PMCID: PMC9672822 DOI: 10.3389/fnins.2022.1042865] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Several studies investigating the pathogenesis of Alzheimer's disease have identified various interdependent constituents contributing to the exacerbation of the disease, including Aβ plaque formation, tau protein hyperphosphorylation, neurofibrillary tangle accumulation, glial inflammation, and the eventual loss of proper neural plasticity. Recently, using various models and human patients, another key factor has been established as an influential determinant in brain homeostasis: the gut-brain axis. The implications of a rapidly aging population and the absence of a definitive cure for Alzheimer's disease have prompted a search for non-pharmaceutical tools, of which gut-modulatory therapies targeting the gut-brain axis have shown promise. Yet multiple recent studies examining changes in human gut flora in response to various probiotics and environmental factors are limited and difficult to generalize; whether the state of the gut microbiota in Alzheimer's disease is a cause of the disease, a result of the disease, or both through numerous feedback loops in the gut-brain axis, remains unclear. However, preliminary findings of longitudinal studies conducted over the past decades have highlighted dietary interventions, especially Mediterranean diets, as preventative measures for Alzheimer's disease by reversing neuroinflammation, modifying the intestinal and blood-brain barrier (BBB), and addressing gut dysbiosis. Conversely, the consumption of Western diets intensifies the progression of Alzheimer's disease through genetic alterations, impaired barrier function, and chronic inflammation. This review aims to support the growing body of experimental and clinical data highlighting specific probiotic strains and particular dietary components in preventing Alzheimer's disease via the gut-brain axis.
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Affiliation(s)
- Daniel Lee
- Middleton High School, Middleton, WI, United States
| | - Virginia M-Y. Lee
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Seong Kwon Hur
- Center for Neurodegenerative Disease Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
- Department of Neuroscience, Genentech, Inc., South San Francisco, CA, United States
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8
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McBean L, O'Reilly S. Diet quality interventions to prevent neurocognitive decline: a systematic review and meta-analysis. Eur J Clin Nutr 2022; 76:1060-1072. [PMID: 34732834 DOI: 10.1038/s41430-021-01032-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the impact of diet quality interventions on neurocognitive decline in older adults. DESIGN Four databases were searched (Medline, EMBASE, CENTRAL and PsycINFO) for randomised controlled trials involving diet quality interventions and cognitive outcomes in older adults. Study quality was assessed using the Cochrane Risk of Bias tool. Outcomes selected for meta-analysis were memory and executive function, for which standardised mean differences (SMD) were calculated. Subgroup and sensitivity analyses were undertaken to explore causes of heterogeneity. Additional outcomes of global cognitive function, incident dementia, attention, language/verbal fluency, and processing speed were narratively synthesised. RESULTS Twelve studies were included, investigating the Mediterranean, Dietary Approaches to Stop Hypertension and Nordic diets. Risk of bias varied across studies. Dietary intervention had a significant effect on memory (SMD: 0.98; 95% CI: 0.39, 1.57; p = 0.001) and executive function (SMD: 2.02; 95% CI: 1.04, 3.01; p < 0.00001), although neither outcome was significant in sensitivity analyses. Heterogeneity was high (I2 = 99%) prior to sensitivity analyses and low (I2 = 0%) after. Results for narratively synthesised cognitive measures were inconsistent with no clear direction of effect. CONCLUSION The current body of evidence would suggest the effect of dietary intervention on neurocognitive decline in older adults is unclear given the considerable heterogeneity and bias present across studies. These findings should be interpreted with consideration to the limited number of studies that could be included and the large variation in study designs. Further randomised controlled trials with harmonised cognitive outcomes and assessments are needed to clarify direction of effect.
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Affiliation(s)
- Laura McBean
- School of Agriculture and Food Science, UCD, Belfield, Dublin, 4, Ireland
| | - Sharleen O'Reilly
- School of Agriculture and Food Science, UCD, Belfield, Dublin, 4, Ireland. .,UCD Institute of Food and Health, UCD, Belfield, Dublin, 4, Ireland.
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9
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Manser P, de Bruin ED. Making the Best Out of IT: Design and Development of Exergames for Older Adults With Mild Neurocognitive Disorder - A Methodological Paper. Front Aging Neurosci 2021; 13:734012. [PMID: 34955806 PMCID: PMC8698204 DOI: 10.3389/fnagi.2021.734012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/03/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Utilizing information technology (IT) systems, for example in form of computerized cognitive screening or exergame-based (also called active videogames) training, has gained growing interest for supporting healthy aging and to detect, prevent and treat neurocognitive disorders (NCD). To ameliorate the effectiveness of exergaming, the neurobiological mechanisms as well as the most effective components for exergame-based training remain to be established. At the same time, it is important to account for the end-users' capabilities, preferences, and therapeutic needs during the design and development process to foster the usability and acceptance of the resulting program in clinical practice. This will positively influence adherence to the resulting exergame-based training program, which, in turn, favors more distinct training-related neurobiological effects. Objectives and Methods: This methodological paper describes the design and development process of novel exergame-based training concepts guided by a recently proposed methodological framework: The 'Multidisciplinary Iterative Design of Exergames (MIDE): A Framework for Supporting the Design, Development, and Evaluation of Exergames for Health' (Li et al., 2020). Case Study: A step-by-step application of the MIDE-framework as a specific guidance in an ongoing project aiming to design, develop, and evaluate an exergame-based training concept with the aim to halt and/or reduce cognitive decline and improve quality of life in older adults with mild neurocognitive disorder (mNCD) is illustrated. Discussion and Conclusion: The development of novel exergame-based training concepts is greatly facilitated when it is based on a theoretical framework (e.g., the MIDE-framework). Applying this framework resulted in a structured, iterative, and evidence-based approach that led to the identification of multiple key requirements for the exergame design as well as the training components that otherwise may have been overlooked or neglected. This is expected to foster the usability and acceptance of the resulting exergame intervention in "real life" settings. Therefore, it is strongly recommended to implement a theoretical framework (e.g., the MIDE-framework) for future research projects in line with well-known checklists to improve completeness of reporting and replicability when serious games for motor-cognitive rehabilitation purposes are to be developed.
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Affiliation(s)
- Patrick Manser
- Movement Control and Learning - Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Eling D de Bruin
- Movement Control and Learning - Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,OST - Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
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Hakim AM. A Proposed Hypothesis on Dementia: Inflammation, Small Vessel Disease, and Hypoperfusion Is the Sequence That Links All Harmful Lifestyles to Cognitive Impairment. Front Aging Neurosci 2021; 13:679837. [PMID: 33994998 PMCID: PMC8116506 DOI: 10.3389/fnagi.2021.679837] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/31/2021] [Indexed: 12/17/2022] Open
Abstract
There is growing consensus that certain lifestyles can contribute to cognitive impairment and dementia, but the physiological steps that link a harmful lifestyle to its negative impact are not always evident. It is also unclear whether all lifestyles that contribute to dementia do so through the same intermediary steps. This article will focus on three lifestyles known to be risk factors for dementia, namely obesity, sedentary behavior, and insufficient sleep, and offer a unifying hypothesis proposing that lifestyles that negatively impact cognition do so through the same sequence of events: inflammation, small vessel disease, decline in cerebral perfusion, and brain atrophy. The hypothesis will then be tested in a recently identified risk factor for dementia, namely hearing deficit. If further studies confirm this sequence of events leading to dementia, a significant change in our approach to this debilitating and costly condition may be necessary, possible, and beneficial.
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Affiliation(s)
- Antoine M. Hakim
- Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
- Division of Neurology, University of Ottawa, Ottawa, ON, Canada
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11
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Lazar RM, Howard VJ, Kernan WN, Aparicio HJ, Levine DA, Viera AJ, Jordan LC, Nyenhuis DL, Possin KL, Sorond FA, White CL. A Primary Care Agenda for Brain Health: A Scientific Statement From the American Heart Association. Stroke 2021; 52:e295-e308. [PMID: 33719523 DOI: 10.1161/str.0000000000000367] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A healthy brain is critical for living a longer and fuller life. The projected aging of the population, however, raises new challenges in maintaining quality of life. As we age, there is increasing compromise of neuronal activity that affects functions such as cognition, also making the brain vulnerable to disease. Once pathology-induced decline begins, few therapeutic options are available. Prevention is therefore paramount, and primary care can play a critical role. The purpose of this American Heart Association scientific statement is to provide an up-to-date summary for primary care providers in the assessment and modification of risk factors at the individual level that maintain brain health and prevent cognitive impairment. Building on the 2017 American Heart Association/American Stroke Association presidential advisory on defining brain health that included "Life's Simple 7," we describe here modifiable risk factors for cognitive decline, including depression, hypertension, physical inactivity, diabetes, obesity, hyperlipidemia, poor diet, smoking, social isolation, excessive alcohol use, sleep disorders, and hearing loss. These risk factors include behaviors, conditions, and lifestyles that can emerge before adulthood and can be routinely identified and managed by primary care clinicians.
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12
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Cognitive Training as a Potential Activator of Hippocampal Neurogenesis in the Rat Model of Sporadic Alzheimer's Disease. Int J Mol Sci 2020; 21:ijms21196986. [PMID: 32977423 PMCID: PMC7582834 DOI: 10.3390/ijms21196986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 01/20/2023] Open
Abstract
There is a growing body of evidence that interventions like cognitive training or exercises prior to the manifestation of Alzheimer’s disease (AD) symptoms may decelerate cognitive decline. Nonetheless, evidence of prevention or a delay of dementia is still insufficient. Using OXYS rats as a suitable model of sporadic AD and Wistar rats as a control, we examined effects of cognitive training in the Morris water maze on neurogenesis in the dentate gyrus in presymptomatic (young rats) and symptomatic (adult rats) periods of development of AD signs. Four weeks after the cognitive training, we immunohistochemically estimated densities of quiescent and amplifying neuronal progenitors, neuronal-lineage cells (neuroblasts and immature and mature neurons), and astrocytes in young and adult rats, and the amyloid precursor protein and amyloid-β in adult rats. Reference memory was defective in OXYS rats. The cognitive training did not affect neuronal-lineage cells’ density in either rat strain either at the young or adult age, but activated neuronal progenitors in young rats and increased astrocyte density and downregulated amyloid-β in adult OXYS rats. Thus, to activate adult neurogenesis, cognitive training should be started before first neurodegenerative changes, whereas cognitive training accompanying amyloid-β accumulation affects only astrocytic support.
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13
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Sherchan P, Miles F, Orlich M, Fraser G, Zhang JH, Talbot K, Duerksen-Hughes PJ. Effects of Lifestyle Factors on Cognitive Resilience: Commentary on "What This Sunny, Religious Town in California Teaches Us About Living Longer". Transl Stroke Res 2020; 11:161-164. [PMID: 32062815 DOI: 10.1007/s12975-020-00788-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Prativa Sherchan
- Department of Physiology and Pharmacology, Basic Sciences, Center for Neuroscience Research, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| | - Fayth Miles
- Center for Nutrition, Healthy Lifestyle, and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA, 92350, USA.,Department of Basic Science, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Michael Orlich
- Department of Preventive Medicine and School of Public Health, Center for Nutrition, Healthy Lifestyle, and Disease Prevention, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Gary Fraser
- Center for Nutrition, Healthy Lifestyle, and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA, 92350, USA
| | - John H Zhang
- Department of Physiology and Pharmacology, Basic Sciences, Center for Neuroscience Research, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA.,Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA.,Departments of Anesthesiology and Neurology, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
| | - Konrad Talbot
- Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA.,Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA
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14
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Smith PJ, Mabe SM, Sherwood A, Doraiswamy PM, Welsh-Bohmer KA, Burke JR, Kraus WE, Lin PH, Browndyke JN, Babyak MA, Hinderliter AL, Blumenthal JA. Metabolic and Neurocognitive Changes Following Lifestyle Modification: Examination of Biomarkers from the ENLIGHTEN Randomized Clinical Trial. J Alzheimers Dis 2020; 77:1793-1803. [PMID: 32925039 PMCID: PMC9999371 DOI: 10.3233/jad-200374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous studies have demonstrated that aerobic exercise (AE) and the Dietary Approaches to Stop Hypertension (DASH) diet can improve neurocognition. However, the mechanisms by which lifestyle improves neurocognition have not been widely studied. We examined the associations between changes in metabolic, neurotrophic, and inflammatory biomarkers with executive functioning among participants from the Exercise and Nutritional Interventions for Neurocognitive Health Enhancement (ENLIGHTEN) trial. OBJECTIVE To examine the association between changes in metabolic function and neurocognition among older adults with cognitive impairment, but without dementia (CIND) participating in a comprehensive lifestyle intervention. METHODS ENLIGHTEN participants were randomized using a 2×2 factorial design to receive AE, DASH, both AE+DASH, or a health education control condition (HE) for six months. Metabolic biomarkers included insulin resistance (homeostatic model assessment [HOMA-IR]), leptin, and insulin-like growth factor (IGF-1); neurotrophic biomarkers included brain derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF); and inflammatory biomarkers included interleukin-6 (IL-6) and C-Reactive Protein (CRP). RESULTS Participants included 132 sedentary older adults (mean age = 65 [SD = 7]) with CIND. Results demonstrated that both AE (d = 0.48, p = 0.015) and DASH improved metabolic function (d = 0.37, p = 0.039), without comparable improvements in neurotrophic or inflammatory biomarkers. Greater improvements in metabolic function, including reduced HOMA-IR (B = -2.3 [-4.3, -0.2], p = 0.033) and increased IGF-1 (B = 3.4 [1.2, 5.7], p = 0.004), associated with increases in Executive Function. CONCLUSION Changes in neurocognition after lifestyle modification are associated with improved metabolic function.
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Affiliation(s)
- Patrick J Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Stephanie M Mabe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - P Murali Doraiswamy
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Kathleen A Welsh-Bohmer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - James R Burke
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - William E Kraus
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Pao-Hwa Lin
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Jeffrey N Browndyke
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Michael A Babyak
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Alan L Hinderliter
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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Affiliation(s)
- Ozioma Okonkwo
- Department of Medicine and Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, WI, USA
| | - Henriette van Praag
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, and Brain Institute, Florida Atlantic University, Jupiter, FL, USA
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