[The effect of physical activity on dementia]

Resistance training in women with myotonic dystrophy type 1: a multisystemic therapeutic avenue

Myotonic dystrophy type 1 (DM1) is a hereditary disease characterized by muscular impairments. Fundamental and clinical positive effects of strength training have been reported in men with DM1, but its impact on women remains unknown. We evaluated the effects of a 12-week supervised strength training on physical and neuropsychiatric health. Women with DM1 performed a twice-weekly supervised resistance training program (3 series of 6-8 repetitions of squat, leg press, plantar flexion, knee extension, and hip abduction). Lower limb muscle strength, physical function, apathy, anxiety and depression, fatigue and excessive somnolence, pain, and patient-reported outcomes were assessed before and after the intervention, as well as three and six months after completion of the training program. Muscle biopsies of the vastus lateralis were also taken before and after the training program to assess muscle fiber growth. Eleven participants completed the program (attendance: 98.5 %). Maximal hip and knee extension strength (p < 0.006), all One-Repetition Maximum strength measures (p < 0.001), apathy (p = 0.0005), depression (p = 0.02), pain interference (p = 0.01) and perception of the lower limb function (p = 0.003) were significantly improved by training. Some of these gains were maintained up to six months after the training program. Strength training is a good therapeutic strategy for women with DM1.

Gut-Brain Axis: Focus on Sex Differences in Neuroinflammation

In recent years, there has been a growing interest in the concept of the "gut-brain axis". In addition to well-studied diseases associated with an imbalance in gut microbiota, such as cancer, chronic inflammation, and cardiovascular diseases, research is now exploring the potential role of gut microbial dysbiosis in the onset and development of brain-related diseases. When the function of the intestinal barrier is altered by dysbiosis, the aberrant immune system response interacts with the nervous system, leading to a state of "neuroinflammation". The gut microbiota-brain axis is mediated by inflammatory and immunological mechanisms, neurotransmitters, and neuroendocrine pathways. This narrative review aims to illustrate the molecular basis of neuroinflammation and elaborate on the concept of the gut-brain axis by virtue of analyzing the various metabolites produced by the gut microbiome and how they might impact the nervous system. Additionally, the current review will highlight how sex influences these molecular mechanisms. In fact, sex hormones impact the brain-gut microbiota axis at different levels, such as the central nervous system, the enteric nervous one, and enteroendocrine cells. A deeper understanding of the gut-brain axis in human health and disease is crucial to guide diagnoses, treatments, and preventive interventions.

Effectiveness of nonpharmacological multi-component intervention on depressive symptoms in patients with mild cognitive impairment and dementia: A systematic review and meta-analysis

Patients with mild cognitive impairment (MCI) and dementia are more prone to depression than people without MCI or dementia. Some studies have found nonpharmacological multi-component intervention to be more effective than single-component intervention in improving the condition of patients with MCI and dementia; however, their effect on depressive symptoms is still inconsistent. Therefore, it is necessary to explore the effectiveness of nonpharmacological multi-component intervention in improving depressive symptoms in patients with MCI and dementia. This review retrieved papers from PubMed, Embase, Cochrane Library, CINAHL, PsycINFO and CNKI. The retrieval time limit was set from 1 January 1990 to 25 November 2022. The PRISMA 2020 guideline was used to report the included studies. The result showed that nonpharmacological multi-component intervention could improve depressive symptoms in patients with MCI and dementia. Among them, nonpharmacological multi-component intervention with a duration of <6 months, physical and cognitive activities, or other activities had significant effects. However, each study differed in terms of specific measures, duration and frequency of intervention methods. Accordingly, more randomized controlled trials with larger samples are required to discover the best scheme for nonpharmacological multi-component intervention.

Prospective associations between changes in physical activity and sedentary time and subsequent lean muscle mass in older English adults: the EPIC-Norfolk cohort study

BACKGROUND

The longitudinal associations between physical behaviours and lean muscle mass indices need to be better understood to aid healthy ageing intervention development.

METHODS

We assessed physical behaviours (total physical activity, moderate-to-vigorous physical activity (MVPA), light physical activity, total sedentary time and prolonged sedentary bout time) for 7 days using hip-worn accelerometers. We also assessed domain-specific physical behaviours (walking, cycling, gardening and housework time) with self-report questionnaires at baseline (2006-2011) and follow-up (2012-2016) in the European Prospective Investigation into Cancer (EPIC)-Norfolk study. We assessed body composition using dual-energy X-ray absorptiometry (DEXA) at follow-up in 1535 participants (≥ 60 years at baseline). From this, we derived appendicular lean muscle mass (ALM) indices (% relative ALM = (ALM/total body weight)*100), body mass index (BMI)-scaled ALM (ALM/BMI, kg/kg/m2) and height-scaled ALM (ALM/height2, kg/m2)). We evaluated the prospective associations of both baseline and change in physical behaviours with follow-up muscle mass indices using multivariable linear regression.

RESULTS

Over 5.5 years (SD 14.8) follow-up, higher baseline accelerometer-measured physical activity and lower sedentary time were associated with higher subsequent relative ALM and BMI-scaled ALM, but not height-scaled ALM (e.g. 0.02% higher subsequent relative ALM per minute/day of baseline MVPA for men). Greater increases in physical activity and greater declines in sedentary time variables were associated with higher subsequent relative ALM and BMI-scaled ALM, but not height-scaled ALM (e.g. 0.001 kg/kg/m2 subsequent BMI-scaled ALM and 0.04% subsequent relative ALM per min/day/year increases in LPA over follow-up; 0.001 kg/kg/m2 subsequent BMI-scaled ALM and -0.03% subsequent relative ALM per min/day/year less of total sedentary time over follow-up). Greater increases in women's cycling and gardening over follow-up were associated with greater subsequent relative ALM (cycling 0.9% per hour/week/year; gardening 0.2% per hour/week/year) and BMI-scaled ALM (cycling 0.03 kg/kg/m2 per hour/week/year; gardening 0.004 kg/kg/m2 per hour/week/year).

CONCLUSION

Physical behaviours across all intensities, and in women more specifically cycling and gardening, may help prevent age-related declines in muscle mass.

Association between self-perception of aging and cognitive function in Chinese older adults: The mediation effect of health behaviors

OBJECTIVE

To investigate the association between self-perception of aging (SPA) and cognitive function in Chinese older adults, and to explore the mediating role of health behaviors.

METHODS

This study included 5,445 Chinese older adults from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Correlation, linear regression and mediation effect analysis were employed to evaluate the association.

RESULTS

SPA is significantly related to the health behaviors (r = 0.160, P < 0.01) and cognition (r = 0.086, P < 0.01), and health behaviors exhibited a positive correlation with cognition (r = 0.179, P < 0.01). SPA and health behaviors significantly impacted cognition (β = 0.032, P = 010; β = 0.103, P < 0.001). Health behaviors partially mediated the effect of SPA on cognitive function, accounting for 27.12 % of the total effect.

CONCLUSION

Health behaviors mediate the association between SPA and cognitive function. Healthcare providers should prioritize addressing SPA of older adults and encourage them to engage in health behaviors for cognitive health.

Tango-therapy vs physical exercise in older people with dementia; a randomized controlled trial

BACKGROUND

Dementia is a growing health concern that affects millions of people worldwide. Gait and mobility disorders are often present and represent a major risk factor for falls. The purpose of this study was to investigate the effectiveness of tango-therapy in gait speed, functional mobility, balance, falls, ability to perform activities of daily living and quality of life.

METHODS

A randomised controlled trial with 31 participants living in a specialised dementia unit, aged 65 to 93 years old, who were randomly assigned to tango group (IG) or physical exercise group (CG). The primary outcome was gait speed and Timed Up and Go test. The secondary outcomes include the Short Physical Performance Battery, the ability to perform activities of daily living (Katz Index) and quality of life (Quality of life in Alzheimer Disease). Measurements were performed at baseline, and after one and three months of training.

RESULTS

After 3 months, IG improved gait speed (p = 0.016), implying a statistically significant difference between groups in favour of IG (p = 0.003). CG significantly worsened the time to complete the TUG (p = 0.039). Both groups declined in their ability to perform activities of daily living, being statistically significant only in the CG (p < 0.001).

CONCLUSION

Tango interventions showed efficacy in improving gait speed and in mitigating the decline in functional mobility and ADL skill capacities. Allowing older people with dementia access to non-pharmacological interventions may be a successful strategy to prevent functional decline.

TRIAL REGISTRATION

Registered at ClinicalTrials.gov (ID: NCT05744011).

Current Diagnostic and Treatment Methods of Alzheimer's Disease: A Narrative Review

To diagnose and predict the possibility of Alzheimer's or a different kind of dementia, medical professionals employ tests that look at a patient's mental competence; however, such methods are impracticable. A reliable diagnosis at the start of treatment is essential for therapy. Except in situations with apparent genetic variations, most Alzheimer's patients lack a known etiology. Therefore, every Alzheimer's patient receives the same treatment plan, regardless of the etiology, which may or may not be successful in slowing or preventing the disease's progression. Tau pathology is further complicated by the amyloid buildup that arises from the cellular phase of Alzheimer's disease (AD). Alzheimer's is a degenerative, diverse, complicated, and incurable neurological disorder primarily affecting elderly individuals. The currently accepted drugs available for treating AD, which involve cholinesterase inhibitors and N-methyl-D-aspartate (NMDA)-receptor antagonists only provide temporary relief from symptoms. The neurological disorder primarily affecting elderly individuals is degenerative, diverse, complicated, and incurable. Accurate diagnosis is the most essential prerequisite before beginning therapy. Most Alzheimer's patients' causes are still unclear, except for instances where hereditary variations have been noted. The gut microbiota composition significantly influences AD and any age-associated neurological illness. Therapies are very useful in improving the cognitive functions of AD. New microbiota-based therapy alternatives may now be available due to the more recent connection between the altered gut microbiome and neurodegeneration through the gut microbiota-brain axis.

Mendelian randomization study on the causal effect of chickenpox on dementia

Some viruses, such as varicella zoster virus, are associated with severe dementia. The present study aims to identify the causal link between chickenpox and dementia. To date, the largest publicly available genome-wide association study (GWAS) for chickenpox (710 cases and 211 856 controls from European individuals) and for dementia (5933 cases and 212 859 controls from European individuals) were used to performed this two-sample Mendelian randomization (MR) study. We found no significant pleiotropy or heterogeneity in all seven selected chickenpox genetic instrumental variants in dementia GWAS. Of seven chickenpox genetic variants, two are located in the intergenic region and five are located in intron. We found that as chickenpox genetically increased, dementia risk increased based on an inverse-variance weighted analysis (β = 0.070, 95% confidence interval [CI] for β: 0.014-0.126; odds ratio [OR] = 1.073, 95% CI for OR: 1.015-1.134; p = 0.014) and weighted median (β = 0.071, 95% CI for β: 0.002-0.141; OR = 1.074, 95% CI for OR: 1.002-1.152; p = 0.045). Reverse MR analysis showed no causal effect of dementia on chickenpox. Our analysis suggests a causal effect of genetically increased chickenpox on dementia risk. Thus, chickenpox may be a potential risk factor for dementia.

Physical Exercise as a Nonpharmacological Intervention for the Treatment of Neuropsychiatric Symptoms in Persons With Dementia: A Meta-analysis of Randomized Controlled Trials

BACKGROUND

Neuropsychiatric symptoms (NPS) are prevalent in dementia and affect both patients and caregivers in multiple ways. Because of the complications of drug treatments, nonpharmacological interventions, such as exercise, are of particular value. This study aimed to investigate the effect of exercise on the NPS of dementia and draw recommendations for the disease management.

METHODS

Meta-analyses were conducted on the findings of randomized controlled trials identified during an initial systematic review of the literature, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The included studies examined the effect of exercise interventions on patients with dementia or mild cognitive impairment using valid assessment tools. The quality of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation analysis.

RESULTS

The meta-analyses revealed that exercise significantly limits NPS [mean difference: -5.28, (95% CI, -9.46, -1.11), P = 0.01] and symptoms of depression [standardized mean difference: -0.16, (95% CI, -0.29, -0.02), P = 0.02], and has a beneficial effect on agitation symptoms. The Grading of Recommendations, Assessment, Development, and Evaluation analysis results showed that exercise has a moderate and high confidence positive effect on NPS and depression, respectively.

CONCLUSIONS

Exercise could be an alternative approach for nonpharmacological treatment of NPS in dementia. Therefore, exercise could be utilized as a treatment of choice or to support existing treatment regimens.

Concepts of dementia prevention in the health promotion among older adults: A narrative review

The number of older adults with dementia is predicted to markedly increase in the coming decades. A person suffers from dementia every 3 seconds globally, and one out of every 7 people suffers from dementia in Taiwan. The purpose of this narrative review is to integrate existing concepts of dementia prevention into health promotion and improve older adults' quality of life. This narrative review was performed using the PubMed database by searching for basic research and systematic reviews on dementia prevention and health promotion among older adults. We established a framework for dementia prevention and health promotion with regard to the physical, mental, spiritual, and social health aspects. We identified the following strategies related to older adults towards dementia prevention and health promotion in follows: Physical health promotion: cognitive activities, physical activities, body mass index, balanced diet, rainbow diet, Mediterranean diet, dietary approaches to stop hypertension diet, mind diet, no smoking and drinking, avoiding the "three highs" (i.e., hyperglycemia, hyperlipidemia, and hypertension), and head trauma; Mental health promotion: Positive thinking, Brief Symptom Rating Scale (BSRS-5), depression scale, and ascertained dementia 8 questionnaire (AD8) screening; Spiritual health promotion: religious beliefs, spiritual music, meditative activities, mindfulness, yoga, Qi-gong, Tai-chi, and Baduanjin; and Social health promotion: A supportive family system, socialization, social support, social networks, social interaction, and social participation. The conclusion of this narrative review was to integrate the concepts of dementia prevention and health promotion among older adults.

The effects of exercise programs on cognition, activities of daily living, and neuropsychiatric symptoms in community-dwelling people with dementia—a systematic review

Background

The prevalence of dementia is expected to increase dramatically. Due to a lack of pharmacological treatment options for people with dementia, non-pharmacological treatments such as exercise programs have been recommended to improve cognition, activities of daily living, and neuropsychiatric symptoms. However, inconsistent results have been reported across different trials, mainly because of the high heterogeneity of exercise modalities. Thus, this systematic review aims to answer the questions whether exercise programs improve cognition, activities of daily living as well as neuropsychiatric symptoms in community-dwelling people with dementia.

Methods

Eight databases were searched for articles published between 2016 and 2021 (ALOIS, CENTRAL, CINAHL, Embase, MEDLINE, PsycINFO, PubMed, Web of Science). Randomized controlled trials evaluating the effects of any type of physical activity on cognition, activities of daily living, or neuropsychiatric symptoms in community-dwelling people with a formal diagnosis of dementia were included in this systematic review. Two authors independently assessed eligibility and quality of the studies. The methodology was in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

Results

Eight publications covering seven trials were included in this review with the majority investigating either a combination of strength and aerobic exercise or aerobic exercise alone. This review revealed that there is no clear evidence for the beneficial effects of exercise on cognition. None of the included trials found an impact on activities of daily living. Although different randomized controlled trials reported inconsistent results, one trial indicated that especially aerobic exercise may improve neuropsychiatric symptoms.

Conclusion

Our systematic review did not confirm the impact of exercise on cognition and activities of daily living in community-dwelling people with dementia. The results suggested that aerobic exercise might be effective to reduce neuropsychiatric symptoms. Well-designed trials including only community-dwelling people with a formal diagnosis of dementia, large samples, long-term follow-ups, and detailed description of adherence to the intervention are needed to improve the scientific evidence on the best type of exercise modality.

Trial registration

PROSPERO, CRD42021246598.

Relationships of Physical Activity, Depression, and Sleep with Cognitive Function in Community-Dwelling Older Adults

This cross-sectional, observational study aimed to integrate the analyses of relationships of physical activity, depression, and sleep with cognitive function in community-dwelling older adults using a single model. To this end, physical activity, sleep, depression, and cognitive function in 864 community-dwelling older adults from the Suwon Geriatric Mental Health Center were assessed using the International Physical Activity Questionnaire, Montgomery-Asberg Depression Rating Scale, Pittsburgh Sleep Quality Index, and Mini-Mental State Examination for Dementia Screening, respectively. Their sociodemographic characteristics were also recorded. After adjusting for confounders, multiple linear regression analysis was performed to investigate the effects of physical activity, sleep, and depression on cognitive function. Models 4, 5, 7, and 14 of PROCESS were applied to verify the mediating and moderating effects of all variables. Physical activity had a direct effect on cognitive function (effect = 0.97, p < 0.01) and indirect effect (effect = 0.36; confidence interval: 0.18, 0.57) through depression. Moreover, mediated moderation effects of sleep were confirmed in the pathways where physical activity affects cognitive function through depression (F-coeff = 13.37, p < 0.001). Furthermore, these relationships differed with age. Thus, the associations among physical activity, depression, and sleep are important in interventions for the cognitive function of community-dwelling older adults. Such interventions should focus on different factors depending on age.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Bidirectional associations of accelerometer-assessed physical activity and sedentary time with physical function among older English adults: the EPIC-Norfolk cohort study

To develop healthy ageing interventions, longitudinal associations between objectively assessed physical behaviours and physical function need to be better understood. We assessed associations between accelerometer-assessed total physical activity (PA), moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary time and prolonged sedentary bout time, and clinically assessed physical function (grip strength, usual walking speed (UWS), chair stand speed) at two time-points in 3188 participants (≥ 60 years) of the EPIC-Norfolk study. Bidirectional associations were assessed using multivariable linear regression. Over an average of 6.1 years, baseline physical behaviours (greater total PA, MVPA and LPA, and less sedentary time) were associated with better subsequent walking and chair stand speed. Better baseline physical function was associated with better follow-up physical behaviours. There were no bidirectional associations between changes in physical behaviours and grip strength. Improvements in UWS were associated with improvements in all physical behaviours. Improvements in chair stand speed were associated with improvements in total PA, MVPA, and sedentary bout time. Improvements in physical behaviours were associated with improvements in UWS (3.1 cm/s/yr per 100 cpm/yr  total PA, 3.6 cm/s/yr per hr/day/yr MVPA, 2.5 cm/s/yr per hr/day/yr LPA, - 2.9 cm/s/yr per hour/day/yr sedentary time, and - 1.6 cm/s/yr per hr/day/yr prolonged sedentary bout time). Only improvements in total PA, MVPA and sedentary bout time were associated with improvements in chair stand speed. In conclusion, we found bidirectional associations between changes in some physical behaviours and physical function and between baseline physical behaviours and subsequent physical function, highlighting the importance of considering the full range of physical behaviours to promote healthy ageing.

Correlates of cognitive impairment in the elderly in China: A cross-sectional study

Background

To identify correlates of the incidence of cognitive impairment among older Chinese populations through the use of logistic regression analysis-based decision tree approaches.

Methods

Correlates of cognitive impairment among older Chinese adults were identified through logistic regression analyses, with significant variables subsequently being incorporated into a decision tree analysis, with the CHAID method being employed for pre-pruning.

Results

The risk score derived from the combination of logistic regression and decision tree analyses (0.237) was lower than that derived from a decision tree analysis alone (0.389). The primary factors related cognitive impairment in this patient population included age, gender, residence status, physical health status, and caring for grandchildren.

Conclusion

A combination of logistic regression and decision tree analyses can lower predicted risk scores, enabling the subdivision of populations with different characteristics and providing intuitive and specific insight regarding the effects of individual variables on predictive analyses. Overall, these results suggest that older adults in rural areas of China should be the focus of further cognitive impairment screening and interventions, particularly for older women.

Aerobic Exercise Regulates Apoptosis through the PI3K/Akt/GSK-3β Signaling Pathway to Improve Cognitive Impairment in Alzheimer’s Disease Mice

Neuronal apoptosis is an important factor in the etiology of Alzheimer's disease (AD). Aerobic exercise (AE) enhances learning and memory, improves cognitive impairment, increases telomere binding protein expression, and decreases apoptosis regulators, but it remains unclear whether it can improve cognitive impairment caused by neuronal apoptosis in AD. Therefore, this study investigated whether an 8-week running table exercise intervention could reduce apoptosis and improve cognitive function in the hippocampal neurons of AD model mice. After the exercise intervention, we evaluated the learning memory ability (positioning, navigation, and spatial search) of mice using a Morris water labyrinth, Nissl staining, immunohistochemistry, and protein application to detect hippocampal PI3K/Akt/GSK-3β signaling pathway protein and hippocampal neuronal cell apoptosis protein B cell lymphoma 2 (Bcl-2) and apoptosis-promoting protein bcl-2-related X (Bax) protein expression. The results showed that aerobic exercise improved the location and spatial exploration ability of mice, increased the number of PI3K- and p-Akt-positive cells, increased the expression of PI3K, p-Akt, and bcl-2 proteins, decreased the expression of GSK-3β and Bax proteins, and increased the bcl-2/Bax ratio of mice. The results suggest that aerobic exercise can reduce apoptosis and improve cognitive function in AD mice. The molecular mechanism may involve activation of the PI3K/Akt/GSK-3β signaling pathway.

New Possibilities in the Therapeutic Approach to Alzheimer’s Disease

Despite the fact that Alzheimer’s disease (AD) is the most common cause of dementia, after many years of research regarding this disease, there is no casual treatment. Regardless of the serious public health threat it poses, only five medical treatments for Alzheimer’s disease have been authorized, and they only control symptoms rather than changing the course of the disease. Numerous clinical trials of single-agent therapy did not slow the development of disease or improve symptoms when compared to placebo. Evidence indicates that the pathological alterations linked to AD start many years earlier than a manifestation of the disease. In this pre-clinical period before the neurodegenerative process is established, pharmaceutical therapy might prove invaluable. Although recent findings from the testing of drugs such as aducanumab are encouraging, they should nevertheless be interpreted cautiously. Such medications may be able to delay the onset of dementia, significantly lowering the prevalence of the disease, but are still a long way from having a clinically effective disease-modifying therapy.

ICT-Based Individualized Training of Institutionalized Individuals With Dementia. Evaluation of Usability and Trends Toward the Effectiveness of the InCoPE-App

Physical activity interventions can alleviate the course of disease for individuals with dementia (IWD) who have been extraordinarily affected by the COVID-19 pandemic. Information and Communication Technology (ICT) provides new opportunities not only to mitigate negative effects of the pandemic but also to sustainably improve everyday life of IWD in nursing homes. The aim of the present study was to evaluate the ICT-based InCoPE-App, which was used to assess physical and cognitive performance and deliver individualized exercise for IWD, with regard to 1) user experience of nursing assistants, and 2) trends toward the effectiveness of the intervention on physical and cognitive performance of IWD. An 18-week individualized multidomain intervention (2 × 60 min/session) was delivered to an intervention group (IG; n = 10, mean age 88.4 ± 5.6, 70% female) by nursing assistants (n = 10, mean age 56.1 ± 10.4, 90% female) using the InCoPE-App. A control group (CG; n = 3, mean age 87.3 ± 3.5, 100% female) received conventional treatment. User experience was assessed among nursing assistants by different questionnaires, i.e., PSSUQ and ISONORM 9241/110-S for usability, and AttrakDiff2 for pragmatic (PQ), hedonic quality-identity and stimulation (HQI and HQS), and attractiveness (ATT). Trends toward the effectiveness of the intervention were assessed using MMSE (global cognitive function), FICSIT-4 (balance), 6MWT and TUG (mobility), and m30CST (function of lower limbs). Usability of the InCoPE-App was rated as high by nursing assistants (mean ± SD; overall PSSUQ 2.11 ± 0.75; overall ISONORM 9241/110-S 1.90 ± 0.88; ATT 1.86 ± 1.01; PQ 1.79 ± 1.03; HQI 1.8 ± 0.79; and HQS 1.37 ± 0.69). Dropout was high in the total sample (36.7%). Trends toward the effectiveness were observed within IG in nine IWD who showed positive or neutral trends in at least two physical performance outcomes. Seven participants had positive or neutral trends in the FICSIT-4, seven participants in m30CST, and four and seven participants in 6MWT and TUG, respectively. In conclusion, the InCoPE-App has good nursing assistant-rated usability, whereas training effects and intervention adherence were rather low most likely due to COVID-19 restrictions. Single-subject research revealed more positive than negative trends in IG of IWD. Further research is needed to evaluate feasibility, suitability, and effectiveness of the InCoPE-App.

Analysis of Trunk Neuromuscular Activation During Equine-Assisted Therapy in Older Adults

The three-dimensional movement of the horse in physical therapy is a valuable kinesio-therapeutic phenomenon that simultaneously affects several body systems, including particularly the neuromuscular system. However, the effects of equine-assisted services (EAS) on neuromuscular activation patterns in older adults have not been thoroughly investigated. In this study, we evaluated the impact of a 10-weeks EAS program on trunk muscles in older adults who used a saddle and placed their feet in stirrups for the first 15 minutes and out of stirrups for the remaining 15 minutes of 30-minute EAS sessions. We gathered electromyographic (EMG) data of the trunk muscles five times each on the first, fifth, and 10th sessions: pre-EAS and post-EAS on a stationary horse and at 1-minute, 15-minutes, and 30-minutes on a horse in motion. Participants were 20 adults, aged 60-79 years. We analyzed normalized EMG data with 5 (session time) by 3 (session number) analyses of variance (ANOVAs) with repeated measures and with Bonferroni's testing (p ≤ .05). There was a significant difference over the number of interventions for the right thoracic paravertebral muscle (p = .025) and session time effect for the left trapezius (p = .042), right thoracic paravertebral (p < .001), right and left multifidus (p < .001), and right and left rectus abdominis muscles (p < .001). Thus, trunk muscles in older adults showed complex neuromuscular activation synchronized with the horse's movement, which was influenced by session time and number of interventions. The practical implication of these findings is that EAS can reduce fall risk among elderly adults of both sexes.

The Methodological Quality of Studies Investigating the Acute Effects of Exercise During Hypoxia Over the Past 40 years: A Systematic Review

Exercise under hypoxia and the physiological impact compared to normoxia or hypoxia has gained attention in the last decades. However, methodological quality assessment of articles in this area is lacking in the literature. Therefore, this article aimed to evaluate the methodologic quality of trials studying exercise under hypoxia. An electronic search was conducted until December 2021. The search was conducted in PubMed, CENTRAL, and PEDro using the PICO model. (P) Participants had to be healthy, (I) exercise under normobaric or hypobaric hypoxia had to be (C) compared to exercise in normoxia or hypoxia on (O) any physiological outcome. The 11-item PEDro scale was used to assess the methodological quality (internal validity) of the studies. A linear regression model was used to evaluate the evolution of trials in this area, using the total PEDro score of the rated trials. A total of n = 81 studies met the inclusion criteria and were processed in this study. With a mean score of 5.1 ± 0.9 between the years 1982 and 2021, the mean methodological quality can be described as “fair.” Only one study reached the highest score of 8/10, and n = 2 studies reached the lowest observed value of 3/10. The linear regression showed an increase of the PEDro score of 0.1 points per decade. A positive and small tendency toward increased methodologic quality was observed. The current results demonstrate that a positive and small tendency can be seen for the increase in the methodological quality in the field of exercise science under hypoxia. A “good” methodological quality, reaching a PEDro score of 6 points can be expected in the year 2063, using a linear regression model analysis. To accelerate this process, future research should ensure that methodological quality criteria are already included during the planning phase of a study.

Cognitive and Physical Intervention in Metals’ Dysfunction and Neurodegeneration

Metals—especially iron, copper and manganese—are important elements of brain functions and development. Metal-dysregulation homeostasis is associated with brain-structure damage to the motor, cognitive and emotional systems, and leads to neurodegenerative processes. There is more and more evidence that specialized cognitive and motor exercises can enhance brain function and attenuate neurodegeneration in mechanisms, such as improving neuroplasticity by altering the synaptic structure and function in many brain regions. Psychological and physical methods of rehabilitation are now becoming increasingly important, as pharmacological treatments for movement, cognitive and emotional symptoms are limited. The present study describes physical and cognitive rehabilitation methods of patients associated with metal-induced neurotoxicity such as Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis, Huntington’s disease and Wilson’s disease. In our review, we describe physical (e.g., virtual-reality environments, robotic-assists training) and psychological (cognitive training, cognitive stimulation, neuropsychological rehabilitation and cognitive-behavioral and mindfulness-based therapies) methods, significantly improving the quality of life and independence of patients associated with storage diseases. Storage diseases are a diverse group of hereditary metabolic defects characterized by the abnormal cumulation of storage material in cells. This topic is being addressed due to the fact that rehabilitation plays a vital role in the treatment of neurodegenerative diseases. Unfortunately so far there are no specific guidelines concerning physiotherapy in neurodegenerative disorders, especially in regards to duration of exercise, type of exercise and intensity, as well as frequency of exercise. This is in part due to the variety of symptoms of these diseases and the various levels of disease progression. This further proves the need for more research to be carried out on the role of exercise in neurodegenerative disorder treatment.

Brain CT can predict low lean mass in the elderly with cognitive impairment: a community-dwelling study

Background

The coexistence of sarcopenia and dementia in aging populations is not uncommon, and they may share common risk factors and pathophysiological pathways. This study aimed to evaluate the relationship between brain atrophy and low lean mass in the elderly with impaired cognitive function.

Methods

This cross-sectional study included 168 elderly patients who visited the multi-disciplinary dementia outpatient clinic at Kaohsiung Chang Gung Memorial Hospital for memory issues, between 2017 and 2019. The body composition was assessed by dual energy X-ray absorptiometry (DEXA) and CT based skeletal muscle index including L3 skeletal muscle index (L3SMI) and masseter muscle mass index (MSMI). The brain atrophy assessment was measured by CT based visual rating scale. Possible predictors of low lean mass in the elderly with cognitive impairement were identified by binary logistic regression. ROC curves were generated from binary logistic regression.

Results

Among the 81 participants, 43 (53%) remained at a normal appendicular skeletal muscle index (ASMI), whereas 38 (47%) showed low ASMI. Compared with the normal ASMI group, subjects with low ASMI exhibited significantly lower BMI, L3SMI, and MSMI (all p < 0.05), and showed significant brain atrophy as assessed by visual rating scale (p < 0.001). The accuracy of predictive models for low ASMI in the elderly with cognitive impairment were 0.875, (Area under curve (AUC) = 0.926, 95% confidence interval [CI] 0.844–0.972) in model 1 (combination of BMI, GCA and L3SMI) and 0.885, (Area under curve (AUC) = 0.931, [CI] 0.857–0.979) in model 2 (combination of BMI, GCA and MSMI).

Conclusions

Global cortical atrophy and body mass index combined with either L3 skeletal muscle index or masseter skeletal muscle index can predict low lean mass in the elderly with cognitive impairment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02626-8.

Association of Physical Activity With Cognitive Function Among Older Adults in Rural Sichuan, China

The purpose of this study was to explore the relationship between total physical activity and different dimensions of cognitive function (orientation, attention, and memory) among older adults in rural Sichuan, China. This cross-sectional study involved 715 older adults (average age of 72 years). Total PA was measured by the Physical Activity Scale for the Elderly, and cognitive function was assessed by the Telephone Interview for Cognitive Status (TICS) questionnaire. The multivariate linear regression analysis indicated that total PA and household PA were significantly associated with the overall Telephone Interview for Cognitive Status score (β = 0.143, p < .001; β = 0.115, p = .002, respectively), the orientation dimension (β = 0.142, p < .001; β = 0.131, p = .001, respectively), and the memory dimension (β = 0.179, p < .001; β = 0.134, p = .001, respectively). The study showed a positive association between total PA, household PA, and cognitive function in older adults, especially in the orientation dimension and the memory dimension of cognitive function.

Effects of Cognitive/Exercise Dual-Task Program on the Cognitive Function, Health Status, Depression, and Life Satisfaction of the Elderly Living in the Community

The elderly population in Korea is rapidly increasing. It is necessary to develop multi-faceted and complex interventions for prevention and delay of dementia, balance improvement, and physical activity, among the elderly living in the community. This study aimed to examine the effects of the cognitive/exercise dual-task program on cognitive function, health status, depression, and life satisfaction of the elderly living in the community. A quasi-experimental study design using a pretest-posttest control group was employed. The study included a total of 65 elderly participants (intervention: n = 32, control: n = 33) in Seoul, South Korea. The cognitive/exercise dual-task program as an intervention was composed of 20 sessions for a total of 10 weeks, held twice a week for about 50 min each session. Measures were general characteristics of study participants, the Korean version of Mini-Mental State Examination (MMSE-K), Korean elderly health status assessment tool, Korean version of Geriatric Depression Scale, and the elderly life satisfaction scale. Data were collected from October 2020 to March 2021. There were statistically significant differences on cognitive function, health status, depression, and life satisfaction between two groups. The cognitive/exercise dual-task program was an effective intervention for improving cognitive function, health status, and life satisfaction, and for decreasing depression of the elderly living in the community. Health care providers need to pay attention to cognitive/exercise dual-task programs for elderly living in the community.

Depression and its correlation with social support and health-promoting lifestyles among Chinese university students: a cross-sectional study

OBJECTIVES

To investigate the prevalence of depression in college students and determine how social support and healthy lifestyle factors are associated with depression in this population.

DESIGN

A cross-sectional design.

SETTING

A comprehensive university in Changsha, Hunan, South China. The study was conducted from May to June 2019.

PARTICIPANTS

A total of 541 students at the comprehensive university.

PRIMARY AND SECONDARY OUTCOME MEASURES

The Zung Self-Rating Depression Scale, Social Support Rating Scale and Health-Promoting Lifestyle Profile-II (HPLP-II) were used to evaluate depression, social support and lifestyles, respectively, and analyse the mutual relationships among them.

RESULTS

Among the 541 participants, 161 (29.8%) experienced depressive symptoms, and there were significant gender-related and academic discipline-related differences in self-rated depression. The average social support score was 38.06 (38.06±7.52). The average HPLP-II score was 71.09 (71.09±11.47). A monofactor analysis showed that depression was correlated with social support and a healthy lifestyle. As demonstrated by logistic regression analysis, being a woman (OR=2.613, 95% CI: 1.541 to 4.43), inadequate social support (OR=0.912, 95% CI: 0.877 to 0.948), poor nutrition (OR=0.87, 95% CI: 0.775 to 0.977) and lack of self-actualisation (OR=0.644, 95% CI: 0.572 to 0.724) were significantly correlated with depression.

CONCLUSIONS

Owing to the high prevalence of depression among Chinese university students, educational institutions must take measures such as providing compulsory mental health education courses and improving the psychological counselling services available to students.

Possible Neuroprotective Mechanisms of Physical Exercise in Neurodegeneration

Physical exercise (PE) improves physical performance, mental status, general health, and well-being. It does so by affecting many mechanisms at the cellular and molecular level. PE is beneficial for people suffering from neuro-degenerative diseases because it improves the production of neurotrophic factors, neurotransmitters, and hormones. PE promotes neuronal survival and neuroplasticity and also optimizes neuroendocrine and physiological responses to psychosocial and physical stress. PE sensitizes the parasympathetic nervous system (PNS), Autonomic Nervous System (ANS) and central nervous system (CNS) by promoting many processes such as synaptic plasticity, neurogenesis, angiogenesis, and autophagy. Overall, it carries out many protective and preventive activities such as improvements in memory, cognition, sleep and mood; growth of new blood vessels in nervous system; and the reduction of stress, anxiety, neuro-inflammation, and insulin resistance. In the present work, the protective effects of PE were overviewed. Suitable examples from the current research work in this context are also given in the article.