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Muñoz-Llerena A, Ladrón-de-Guevara L, Medina-Rebollo D, Alcaraz-Rodríguez V. Impact of Physical Activity on Autonomy and Quality of Life in Individuals with Down Syndrome: A Systematic Review. Healthcare (Basel) 2024; 12:181. [PMID: 38255069 PMCID: PMC10815496 DOI: 10.3390/healthcare12020181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Down syndrome (DS) is the most common genetic alteration in humans, resulting from the trisomy of chromosome 21. Individuals with DS are characterized by physical traits and limitations related to intellectual functioning and the development of motor skills. People with DS tend to have lower levels of physical activity (PA) than the general population, despite its benefits for health and quality of life, which could be caused by barriers such as the lack of adapted programs or knowledge on how to adapt them. Therefore, this systematic review aimed to examine the impact of physical activity or sports programs on autonomy and quality of life in individuals with DS. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to search four databases (Scopus, Web of Science, PubMed, and SportDiscus), adhering to the population, intervention, comparison, and outcome strategy. A total of 13 studies were selected that followed different training programs (combined training, adapted football, technology-based, pulmonary training, gymnastics and dance, water-based, and whole body vibration). Most of the interventions provided benefits for autonomy or quality of life (physical, psychological, cognitive, emotional, and social) in people with DS. In conclusion, the benefits of physical activity and sports programs adapted to people with DS are positive.
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Affiliation(s)
- Antonio Muñoz-Llerena
- Department of Physical Education and Sports, University of Seville, 41013 Seville, Spain;
- Research Group “Social Inclusion, Physical Education and Sport, and European Policies in Research - INEFYD” (HUM-1061), University of Seville, 41013 Seville, Spain; (L.L.-d.-G.); (D.M.-R.)
| | - Laura Ladrón-de-Guevara
- Research Group “Social Inclusion, Physical Education and Sport, and European Policies in Research - INEFYD” (HUM-1061), University of Seville, 41013 Seville, Spain; (L.L.-d.-G.); (D.M.-R.)
- Department of Physical Education and Sport, Centro de Estudios Universitarios Cardenal Spínola CEU, 41930 Seville, Spain
| | - Daniel Medina-Rebollo
- Research Group “Social Inclusion, Physical Education and Sport, and European Policies in Research - INEFYD” (HUM-1061), University of Seville, 41013 Seville, Spain; (L.L.-d.-G.); (D.M.-R.)
- Department of Physical Education and Sport, Centro de Estudios Universitarios Cardenal Spínola CEU, 41930 Seville, Spain
| | - Virginia Alcaraz-Rodríguez
- Research Group “Social Inclusion, Physical Education and Sport, and European Policies in Research - INEFYD” (HUM-1061), University of Seville, 41013 Seville, Spain; (L.L.-d.-G.); (D.M.-R.)
- Department of Sports and Computer Sciences, Universidad Pablo de Olavide, 41013 Seville, Spain
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Frank L, Helsel B, Dodd D, Bodde AE, Danon JC, Sherman JR, Forsha DE, Szabo-Reed A, Washburn RA, Donnelly JE, Ptomey LT. The association between cardiovascular health and cognition in adults with Down syndrome. J Neurodev Disord 2023; 15:43. [PMID: 38057709 PMCID: PMC10699046 DOI: 10.1186/s11689-023-09510-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION Evidence in the general population suggests that predictors of cardiovascular health such as moderate to vigorous physical activity (MVPA), cardiorespiratory fitness, and systolic blood pressure are associated with cognitive function. Studies supporting these associations in adults with Down syndrome (DS) are limited. The purpose of this study was to examine the associations between systolic blood pressure, cardiorespiratory fitness, and MVPA on cognition in adults with DS. METHODS This is a cross-sectional analysis using baseline data from a trial in adults with DS. Participants attended a laboratory visit where resting blood pressure, cardiorespiratory fitness (VO2 Peak), and cognitive function (CANTAB® DS Battery) were obtained. The cognitive battery included tests measuring multitasking, episodic memory, and reaction time. Physical activity (accelerometer) was collected over the week following the laboratory visit. Pearson correlations and linear regressions were used to measure the impact of systolic blood pressure, cardiorespiratory fitness, and MVPA on cognitive outcomes. RESULTS Complete data was available for 72 adults with DS (26.8 ± 9.3 years of age, 57% female). At baseline, VO2 Peak (21.1 ± 4.2 ml/kg/min) and MVPA were low (14.4 ± 14.4 min/day), and systolic blood pressure was 118.3 ± 13.3 mmHg. VO2 Peak was correlated with simple movement time (rho = - 0.28, p = 0.03) but was not significant using a linear regression controlling for age and sex. Systolic blood pressure was significantly associated with episodic memory (first attempt memory score: β = - 0.11, p = 0.002; total errors: β = 0.58, p = 0.001) and reaction time (five-choice movement time: β = 4.11, p = 0.03; simple movement time: β = 6.14, p = 0.005) using age- and sex-adjusted linear regressions. No associations were observed between MVPA and multitasking, episodic memory, or reaction time. CONCLUSION Predictors of cardiovascular health, including cardiorespiratory fitness and systolic blood pressure, were associated with some aspects of cognition in adults with DS. While future research should examine the role of improved cardiovascular health on delaying decreases in cognitive function and dementia in adults with DS, we recommend that health care providers convey the importance of exercise and cardiovascular health to their patients with DS. TRIAL REGISTRATION NCT04048759, registered on August 7, 2019.
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Affiliation(s)
- Lauren Frank
- School of Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1073, Kansas City, KS, 66160, USA
| | - Brian Helsel
- Department of Neurology, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Danica Dodd
- School of Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1073, Kansas City, KS, 66160, USA
| | - Amy E Bodde
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1073, Kansas City, KS, 66160, USA
| | - Jessica C Danon
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1073, Kansas City, KS, 66160, USA
| | - Joseph R Sherman
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1073, Kansas City, KS, 66160, USA
| | - Daniel E Forsha
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Amanda Szabo-Reed
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1073, Kansas City, KS, 66160, USA
| | - Richard A Washburn
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1073, Kansas City, KS, 66160, USA
| | - Joseph E Donnelly
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1073, Kansas City, KS, 66160, USA
| | - Lauren T Ptomey
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1073, Kansas City, KS, 66160, USA.
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Lang L, Wang Y. Markov model combined with MR diffusion tensor imaging for predicting the onset of Alzheimer's disease. Open Life Sci 2023; 18:20220714. [PMID: 37954101 PMCID: PMC10638840 DOI: 10.1515/biol-2022-0714] [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: 06/20/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 11/14/2023] Open
Abstract
Alzheimer's disease (AD) affects cognition, behavior, and memory of brain. It causes 60-80% of dementia cases. Cross-sectional imaging investigations of AD show that magnetic resonance (MR) with diffusion tensor image (DTI)-detected lesion locations in AD patients are heterogeneous and distributed across the imaging area. This study suggested that Markov model (MM) combined with MR-DTI (MM + MR-DTI) was offered as a method for predicting the onset of AD. In 120 subjects (normal controls [NCs], amnestic mild cognitive impairment [aMCI] patients, and AD patients) from a discovery dataset and 122 subjects (NCs, aMCI, and AD) from a replicated dataset, we used them to evaluate the white matter (WM) integrity and abnormalities. We did this by using automated fiber quantification, which allowed us to identify 20 central WM tracts. Point-wise alterations in WM tracts were shown using discovery and replication datasets. The statistical analysis revealed a substantial correlation between microstructural WM alterations and output in the patient groups and cognitive performance, suggesting that this may be a potential biomarker for AD. The MR-based classifier demonstrated the following performance levels for the basis classifiers, with DTI achieving the lowest performance. The following outcomes were seen in MM + MR-DTI using multimodal techniques when combining two modalities. Finally, a combination of every imaging method produced results with an accuracy of 98%, a specificity of 97%, and a sensitivity of 99%. In summary, DTI performs better when paired with structural MR, despite its relatively weak performance when used alone. These findings support the idea that WM modifications play a significant role in AD.
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Affiliation(s)
- Lili Lang
- Basic Medical College, Changzhi Medical College, Changzhi, Shanxi, 046000, China
| | - Ying Wang
- Endoscopic Chamber, Muling Town Forest District Hospital, Mudanjiang, Heilongjiang, 157513, China
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Dodd D, Helsel B, Bodde AE, Danon JC, Sherman JR, Donnelly JE, Washburn RA, Ptomey LT. The association of increased body mass index on cardiorespiratory fitness, physical activity, and cognition in adults with down syndrome. Disabil Health J 2023; 16:101497. [PMID: 37407386 PMCID: PMC10680094 DOI: 10.1016/j.dhjo.2023.101497] [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: 02/10/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Obesity is a significant risk factor for Alzheimer's disease; however, this association has not been explored in adults with Down syndrome. OBJECTIVE To examine the association of obesity, assessed by body mass index (BMI), with factors related to Alzheimer's disease risk including cardiorespiratory fitness, physical activity, and cognition in adults with Down syndrome. METHODS Adults with Down syndrome attended a laboratory visit where BMI, cardiorespiratory fitness (VO2 peak), and cognitive function (CANTAB® DS Battery) were obtained. Physical activity (accelerometer) was collected over the week following the laboratory visit. Wilcoxon rank sum tests were used to evaluate differences in cardiorespiratory fitness, sedentary time, moderate-to-vigorous physical activity (MVPA), and cognition between adults with obesity (BMI≥ 30 kg/m2) and those with healthy weight or overweight (BMI <30 kg/m2). Spearman correlations and linear regressions were used to measure the impact of BMI on cardiorespiratory fitness, MVPA, sedentary time, and cognition. RESULTS Data was collected for 79 adults with Down syndrome (26.7 ± 9.0 years of age, 54% female, 54% with obesity). VO2 peak was significantly lower in participants with obesity (18.4 ± 2.5 ml/kg/min) compared to those with healthy weight or overweight (22.9 ± 4.0 ml/kg/min, p < 0.001). BMI was negatively associated with cardiorespiratory fitness (rho = -0.614, p < 0.001). No associations were observed between BMI and physical activity or cognition. CONCLUSIONS Lower BMI was associated with improved cardiorespiratory fitness. However, no associations were observed between BMI and cognition or physical activity. NCT REGISTRATION NCT04048759.
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Affiliation(s)
- Danica Dodd
- School of Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA; Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Brian Helsel
- Department of Neurology, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Amy E Bodde
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Jessica C Danon
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Joseph R Sherman
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Joseph E Donnelly
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Richard A Washburn
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Lauren T Ptomey
- Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
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Lamsal Lamichhane S, Ramesh V, Opara CO, Khan FY, Kabiraj G, Kauser H, Palakeel JJ, Ali M, Chaduvula P, Chhabra S, Mohammed L. Treatment Modalities for Dementia in Down’s Syndrome: A Literature Review. Cureus 2022; 14:e27881. [PMID: 36110433 PMCID: PMC9462651 DOI: 10.7759/cureus.27881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022] Open
Abstract
Down's syndrome (DS) is the most well-known chromosomal abnormality characterized by an extra chromosome 21 and multiple systemic issues. The higher production of amyloid precursor protein (APP), the precursor peptide of beta-amyloid, predisposes persons with DS to early Alzheimer's disease (AD). The prevalence of dementia has increased as a function of the extended life expectancy of persons with DS. Because we know little about the treatment of dementia in persons with DS, this review focuses on the pathophysiology and management strategies to improve the overall quality of life.
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Montgomery RN, Ptomey L, Mahnken JD. A flexible test for early-stage studies with multiple endpoints. J Appl Stat 2022; 50:3048-3061. [PMID: 37969544 PMCID: PMC10631391 DOI: 10.1080/02664763.2022.2097204] [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: 11/24/2021] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
Abstract
This paper builds on the recently proposed prediction test for muliple endpoints. The prediction test combines information across multiple endpoints while accounting for the correlation between them. The test performs well with small samples relative to the number of endpoints of interest and is flexible in the hypotheses across the individual endpoints that can be combined. The prediction test addresses a global hypothesis that is of particular interest in early-stage studies and can be used as justification for continuing on to a larger trial. However, the prediction test has several limitations which we seek to address. First, the prediction test is overly conservative when both the effect sizes across all endpoints and the number of endpoints are small. By using a parametric bootstrap to estimate the null distribution, we show that the test achieves the nominal error rate in this situation and increases the power of the test. Second, we provide a framework to allow for predictions of a difference on one or more endpoints. Finally, we extend the test with a composite null hypothesis that allows for different null hypothesized predictive abilities across the endpoints which can be especially useful if the study contains both familiar and novel endpoints. We use an example from a physical activity trial to illustrate these extensions.
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Affiliation(s)
- R. N. Montgomery
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - L.T. Ptomey
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - J. D. Mahnken
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
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