Effects of Sport Stacking on Neuropsychological, Neurobiological, and Brain Function Performances in Patients With Mild Alzheimer's Disease and Mild Cognitive Impairment: A Randomized Controlled Trial

White matter integrity of default mode network after a 3-month aerobic dance program in patients with amnestic mild cognitive impairment: a secondary analysis of a randomized clinical trial

Background

Exercise is an effective non-pharmacological strategy to enhance cognitive function in individuals with mild cognitive impairment (MCI). Our previous studies confirmed that aerobic dance can increase the amplitude of low-frequency fluctuations (LFF) in bilateral fronto-temporal, entorhinal, anterior cingulate, and para-hippocampal cortices. However, its effects on structural connections remain unclear. The present study comprised a secondary analysis of a randomized clinical trial and aimed to examine the impact of a 3-month aerobic dance program on white matter integrity of default mode network (DMN) in older adults with amnestic MCI, as assessed by magnetic resonance imaging (MRI).

Methods

A total of 112 patients with memory decline were recruited, 38 of whom completed cognitive assessments and magnetic resonance scans and were randomized to the exercise group (n=19) or the control group (n=19). The exercise group received 3 months of aerobic dance and health education, whereas the control group only received health education. All participants underwent cognitive assessments and MRI scans at baseline and after the 3-month intervention. A series of neuropsychological assessments, including Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Wechsler Memory Scale-Revised Logical Memory (WMS-RLM), Trail Making Test Part A&B (TMT-A&B), Symbol Digit Modalities Test (SDMT), and Forward and Backward Digit Span Task (DST) Chinese version, were used to assess the participants' global cognitive function, memory function, and executive function. Structural connections of the hippocampus-hub temporal network were analyzed using the network-based statistic.

Results

Finally, 16 participants in each group were included in the statistics and analysis. There was no statistical difference in cognitive functions at 3 months in the control group compared with those at baseline. However, the cognitive functions of the exercise group improved significantly after 3 months of aerobic dance, including MMSE (P=0.006), MoCA (P=0.009), WMS-RLM (P=0.005), TMT-A (P=0.007), and DST (P=0.025). Moreover, the exercise group had significantly improved WMS-RLM (P=0.003) compared to the control group after 3 months of intervention. In addition, they showed significant increases in structural connections within the DMN, including the structural connection between hippocampus and para-hippocampus, hippocampus and fusiform gyrus, hippocampus and middle temporal gyrus, and precuneus and middle temporal gyrus. The structural connection between DMN and supplementary motor area was also significantly increased in the exercise group, correlating positively with MMSE (R=0.31, P=0.04) and negatively with TMT-A (R=-0.40, P=0.011), respectively.

Conclusions

A 3-month aerobic dance program may enhance the structural connections in the hippocampus-hub temporal network and improve episodic memory and global cognition in older adults with amnestic MCI.

Resting-State Brain Network Characteristics Related to Mild Cognitive Impairment: A Preliminary fNIRS Proof-of-Concept Study

BACKGROUND

This study investigates the reliability of functional near-infrared spectroscopy (fNIRS) in detecting resting-state brain network characteristics in patients with mild cognitive impairment (MCI), focusing on static resting-state functional connectivity (sRSFC) and dynamic resting-state functional connectivity (dRSFC) patterns in MCI patients and healthy controls (HCs) without cognitive impairment.

METHODS

A total of 89 MCI patients and 83 HCs were characterized using neuropsychological scales. Subject sRSFC strength and dRSFC variability coefficients were evaluated via fNIRS. The study evaluated the feasibility of using fNIRS to measure these connectivity metrics and compared resting-state brain network characteristics between the two groups. Correlations with Montreal Cognitive Assessment (MoCA) scores were also explored.

RESULTS

sRSFC strength in homologous brain networks was significantly lower than in heterologous networks (p < 0.05). A significant negative correlation was also observed between sRSFC strength and dRSFC variability at both the group and individual levels (p < 0.001). While sRSFC strength did not differentiate between MCI patients and HCs, the dRSFC variability between the dorsal attention network (DAN) and default mode network (DMN), and between the ventral attention network (VAN) and visual network (VIS), emerged as sensitive biomarkers after false discovery rate correction (p < 0.05). No significant correlation was found between MoCA scores and connectivity measures.

CONCLUSIONS

fNIRS can be used to study resting-state brain networks, with dRSFC variability being more sensitive than sRSFC strength for discriminating between MCI patients and HCs. The DAN-DMN and VAN-VIS regions were found to be particularly useful for the identification of dRSFC differences between the two groups.

CLINICAL TRIAL REGISTRATION

ChiCTR2200057281, registered on 6 March, 2022; https://www.chictr.org.cn/showproj.html?proj=133808.

Systematic review and meta-analysis of repetitive transcranial magnetic stimulation (rTMS) for activities of daily living in Alzheimer's disease

OBJECTIVE

This systematic review of randomised controlled trials (RCTs) was conducted to assess the effect of repetitive transcranial magnetic stimulation (rTMS) on activities of daily living (ADLs) in Alzheimer's disease (AD) patients.

DATA SOURCES

Ten databases were retrieved for pertinent Chinese and English literatures published up until January 2024.

REVIEW METHODS

All RCTs of rTMS for ADLs in AD were included in this meta-analysis. Two researchers independently selected the literatures, retrieved the data of included literatures, accessed risk-of-bias of literatures with the Cochrane Collaboration's quality criteria and then cross-checked. Meta-analysis was carried out with Cochrane's Review Manager (RevMan, version 5.4). The PRISMA guidelines were followed in this systematic review.

RESULTS

The 37 literatures involving 2461 patients with AD were included in this study. Compared with the control groups received the interventions such as routine pharmacotherapy, cognitive training, ect., with/without sham-rTMS, the experiment groups received the interventions of the control groups and rTMS. The findings were as follows: ADL scale [mean difference (MD) = -3.92, 95%CI (-4.93, -2.91), P < 0.00001]; Barthel Index (BI) [MD = 9.75, 95% CI (6.66, 12.85), P < 0.00001]; Modified Barthel Index (MBI) [MD = 5.43, 95% CI (3.13, 7.73), P < 0.00001]. The differences were statistically significant for all indicators. In 29 studies, rTMS stimulation sites were located in the dorsolateral prefrontal cortex (DLPFC).

CONCLUSION

The rTMS could improve the ADLs in AD patients, and the DLPFC was a frequently used stimulation site of the rTMS for AD treatment.

A systematic review of lifestyle-based interventions for managing Alzheimer's disease: Insights from randomized controlled trials

BACKGROUND

Alzheimer's disease (AD) presents a significant challenge in healthcare, prompting exploration into non-pharmacological interventions to complement traditional treatments.

OBJECTIVE

This systematic review explores the efficacy of lifestyle-based interventions in managing AD.

METHODS

A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus between 2018 and 2023, selecting randomized controlled trials examining factors such as exercise, diet, stress, and cognitive training in AD patients.

RESULTS

The review revealed physical exercise as the predominant non-pharmacological intervention, accompanied by dietary modifications, cognitive training, and therapies such as mindfulness and music. While exercise demonstrated improvements in quality of life, its cognitive benefits were limited. Modified diets, such as Atkins and ketogenic, displayed inconsistent effects on cognitive function but influenced other health-related parameters. Additionally, probiotic therapy and novel cognitive training technologies were explored.

CONCLUSIONS

Despite some interventions showing promise in enhancing cognitive function and slowing disease progression, uncertainties remain regarding the dose-response relationship, underlying mechanisms, and potential synergistic effects. Moreover, consideration of genetic and sex-based disparities is warranted. This synthesis underscores the need for further research to elucidate the nuances of non-pharmacological interventions in managing AD effectively.

PROSPERO REGISTRATION NUMBER

CRD42023432823.

Exercise effects on neuropsychiatric symptoms and quality of life in mild cognitive impairment: a systematic review and meta-analysis

Background

Exercise is considered as a cost-efficient option for individuals with mild cognitive impairment (MCI). Although the potential benefits of exercise for improving cognitive function are recognized, its impact on neuropsychiatric symptoms (NPS) and the quality of life (QoL) in individuals with MCI remains unclear.

Objective

This study aims to investigate the effects of exercise interventions on NPS, including depression, anxiety, sleep disorders, and the quality of life in individuals with MCI.

Results

There were 17 randomized controlled trials (RCTs) involving 1,575 participants were included. The findings indicate a small but significant positive effect of exercise on depression (standardized mean difference [SMD] = -0.47, 95% confidence interval [CI]: -0.73 to -0.21), but the quality of the evidence is low. Mind-body exercises were relatively more effective in alleviating depression. No significant improvements were observed in sleep disorders (SMD = -1.27, 95% CI: -2.80 to 0.26). Exercise improved anxiety in one study but had no effect in the other. It also improved quality of life in seven studies, with two showing no effect.

Conclusion

The findings suggest that exercise, particularly mind-body exercises, can improve depression in individuals with MCI. However, the effect of exercise on anxiety, sleep disorders, and quality of life is still uncertain, necessitating additional research. These findings underscore the significance of integrating customized exercise programs in managing MCI to boost quality of life and mitigate NPS.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/. ID: CRD42023445369.

Effect of tDCS combined with virtual reality for post-stroke cognitive impairment: a randomized controlled trial study protocol

BACKGROUND

Post-stroke cognitive impairment (PSCI) not only increases patient mortality and disability, but also adversely affects motor function and the ability to perform routine daily activities. Current therapeutic approaches for, PSCI lack specificity, primarily relying on and medication and traditional cognitive therapy supplemented by a limited array of tools. Both transcranial direct current stimulation (tDCS) and virtual reality (VR) training have demonstrated efficacy in improving cognitive performance among PSCI patients. Previous findings across various conditions suggest that implementing a therapeutic protocol combining tDCS and VR (tDCS - VR) may yield superior in isolation. Despite this, to our knowledge, no clinical investigation combining tDCS and VR for PSCI rehabilitation has been conducted. Thus, the purpose of this study is to explore the effects of tDCS - VR on PSCI rehabilitation.

METHODS

This 4-week, single-center randomized clinical trial protocol will recruit 200 patients who were randomly assigned to one of four groups: Group A (tDCS + VR), Group B (tDCS + sham VR), Group C (sham tDCS + VR), Group D (sham tDCS + sham VR). All four groups will receive conventional cognitive rehabilitation training. The primary outcome measurement utilizes the Mini-Mental State Examination (MMSE). Secondary outcome measures include the Montreal Cognitive Assessment, Frontal Assessment Battery, Clock Drawing Test, Digital Span Test, Logic Memory Test, and Modified Barthel Index. Additionally, S-YYZ-01 apparatus for diagnosis and treating language disorders assesses subjects' speech function. Pre- and post-four-week intervention assessments are conducted for all outcome measures. Functional near-infrared spectroscopy (fNIRS) is employed to observe changes in oxygenated hemoglobin (HbO), deoxy-hemoglobin (HbR), and total hemoglobin (HbT) in the cerebral cortex.

DISCUSSION

Our hypothesis posits that the tDCS - VR therapy, in opposed to individual tDCS or VR interventions, could enhance cognitive function, speech ability and daily living skills in PSCI patients while concurrently augmenting frontal cortical activity. This randomized study aims to provide a robust theoretical foundation supported by scientific evidence for the practical implementation of the tDCS - VR combination as a secure and efficient PSCI rehabilitation approach.

TRIAL REGISTRATION

Chictr.org.cn Identifier: ChiCTR2300070580. Registered on 17th April 2023.

Comparison of the activation level in the sensorimotor cortex between motor point and proximal nerve bundle electrical stimulation

Objective.Neuromuscular electrical stimulation (NMES) is widely used for motor function rehabilitation in stroke survivors. Compared with the conventional motor point (MP) stimulation, the stimulation at the proximal segment of the peripheral nerve (PN) bundles has been demonstrated to have multiple advantages. However, it is not known yet whether the PN stimulation can increase the cortical activation level, which is crucial for motor function rehabilitation.Approach.The current stimuli were delivered transcutaneously at the muscle belly of the finger flexors and the proximal segment of the median and ulnar nerves, respectively for the MP and PN stimulation. The stimulation intensity was determined to elicit the same contraction levels between the two stimulation methods in 18 healthy individuals and a stroke patient. The functional near-infrared spectroscopy and the electromyogram were recorded to compare the activation pattern of the sensorimotor regions and the target muscles.Main Results.For the healthy subjects, the PN stimulation induced significantly increased concentration of the oxygenated hemoglobin in the contralateral sensorimotor areas, and enhanced the functional connectivity between brain regions compared with the MP stimulation. Meanwhile, the compound action potentials had a smaller amplitude and the H-reflex became stronger under the PN stimulation, indicating that more sensory axons were activated in the PN stimulation. For the stroke patient, the PN stimulation can elicit finger forces and induce activation of both the contralateral and ipsilateral motor cortex.Conclusions. Compared with the MP stimulation, the PN stimulation can induce more cortical activation in the contralateral sensorimotor areas possibly via involving more activities in the central pathway.Significance.This study demonstrated the potential of the PN stimulation to facilitate functional recovery via increasing the cortical activation level, which may help to improve the outcome of the NMES-based rehabilitation for motor function recovery after stroke.

Comparative efficacy of various exercise interventions on sleep in patients with cognitive impairment: a systematic review and meta-analysis

Background

Sleep disturbances are an early indicator of cognitive impairment and exacerbate its progression. While pharmacological treatments for sleep disorders exist, their side-effect profile includes an increased risk of falls and the potential to exacerbate cognitive impairment. Non-pharmacological treatments such as physical exercise should be considered. However, uncertainties persist. We aimed to assess the potential benefits of exercise interventions on sleep in patients with cognitive impairment and determine the specific effects of various exercise modalities.

Materials and methods

A systematic search was performed on seven databases for eligible studies published before Nov 2022. Randomized controlled trials of exercise for patients with cognitive impairment (mild cognitive impairment and Alzheimer's disease) were included. All analyses were conducted using RevMan version 5.4. Meta-analysis and The Grading of Recommendations Assessment Development and Evaluations (GRADE) quality ratings were performed on sleep quality and objective sleep data.

Results

A total of 8 randomized controlled trials were included with a sample size of 486 subjects. For patients with cognitive impairment, physical exercise had a beneficial effect on sleep quality [MD = -3.55 (-5.57, -1.32), Z = 3.13, p = 0.002] and total sleep time [MD = 33.77 (23.92, 43.62), Z = 6.72, P < 0.00001]. No improvement was found in sleep efficiency and nocturnal awakening time. Subgroup analysis showed that multi-component exercise produced superior results.

Conclusion

Physical exercise may improve sleep quality and total sleep time for patients with cognitive impairment. Multi-component exercise designed individually is more effective. Large-scale randomized controlled trials with objective sleep outcome measurements are warranted.Clinical trial registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022377221.

Brain network mechanism on cognitive control task in the elderly with brain aging: A functional near infrared spectroscopy study

Objective

To study the brain network mechanism of cognitive control in the elderly with brain aging.

Materials and methods

21 normal young people and 20 elderly people were included in this study. Mini-mental State Examination and functional near-infrared spectroscopy (fNIRS) synchronous judgment test (including forward tests and reverse judgment tests) were performed on all subjects. To observe and compare differences in brain region activation and brain functional connectivity between subjects and forward and reverse trials by recording functional connectivity (FC) in different task paradigms and calculating bilateral prefrontal and primary motor cortical (PMC) areas.

Results

In the forward and reverse judgment tests, the reaction time of the elderly group was significantly longer than the young group (P &lt; 0.05), and there was no significant difference in the correct rate. In the homologous regions of interest (ROI) data, the FC of PMC and prefrontal cortex (PFC) in the elderly group was significantly decreased (P &lt; 0.05). In the heterologous ROI data, except for left primary motor cortex (LPMC)-left prefrontal cortex (LPFC), the other PMC and PFC of the elderly group were significantly lower than the young group (P &lt; 0.05) while processing the forward judgment test. However, the heterologous ROI data of LPMC-right prefrontal cortex (RPFC), LPMC-LPFC and RPFC-LPFC in the elderly group were significantly lower than the young group (P &lt; 0.05) while processing the reverse judgment test.

Conclusion

The results suggest that brain aging affected degeneration of whole brain function, which reduce the speed of information processing and form a brain network functional connection mode different from that of young people.