Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging

Role of light walking pace on cognition: Findings from the Maine-Syracuse Longitudinal Study

Moderate- to vigorous intensities of physical activity are recommended for health promotion, including brain health. Regular physical activity is considered a modifiable factor to delay -perhaps prevent- onset of dementias such as Alzheimer's disease. Little is known about the benefits of light physical activity. We analyzed data from a 998 community-dwelling, cognitively unimpaired participants from the Maine-Syracuse Longitudinal Study (MSLS) and investigated the role of light physical activity, defined by walking pace, across two time points. Results revealed light levels of walking pace were associated with higher performance at the first timepoint and less decline by time 2 in the domains of verbal abstract reasoning and visual scanning and tracking, which includes both processing speed and executive function skills. When examining change over time (N = 583), increasing walking pace was associated with less decline at time two for the domains of visual scanning and tracking, working memory, visual spatial ability, and working memory, but not verbal abstract reasoning. These findings highlight the relevance of light physical activity and the need to investigate its contribution to cognitive function. From a public health perspective, this may encourage more adults to adopt a light level of exercise and still reap health benefits.

Comparative efficacy of exercise interventions for cognitive health in older adults: A network meta-analysis

BACKGROUND

Previous studies have consistently demonstrated that exercise mitigates cognitive decline in older adults. However, the most effective types of exercise, along with optimal frequency and duration of interventions, remain inadequately defined. To address these gaps, we conducted a network meta-analysis synthesizing direct and indirect evidence from existing literature to identify the most effective exercise interventions for enhancing cognitive function in older adults.

METHODS

We conducted a systematic search across databases including PubMed and Web of Science to identify randomized controlled trials (RCTs) evaluating the impact of various exercise interventions on cognitive function in older adults. We assessed the quality of included studies and performed a traditional meta-analysis with Review Manager 5.3. Subsequently, a network meta-analysis was conducted using Stata 17.0 to evaluate the effects of different exercise modalities on cognitive outcomes, specifically memory, inhibitory control, and task-switching abilities.

RESULTS

A total of 37 studies encompassing 2585 older adults met the inclusion criteria. The network meta-analysis revealed that resistance training exerted the strongest effect on overall cognitive improvement. Aerobic exercise, multimodal exercise, and physical-mental training followed in effectiveness. Specifically, resistance training significantly enhanced inhibitory control compared to high-intensity interval training (HIIT), aerobic exercise, and other modalities. Physical-mental training emerged as the most effective intervention for improving task-switching ability and demonstrated superior efficacy in enhancing working memory compared to aerobic exercise. Conversely, aerobic exercise showed the strongest effect on memory function, outperforming resistance training, multimodal exercise, and physical-mental training.

CONCLUSION

Resistance training is the most effective exercise modality for enhancing overall cognitive function and inhibitory control in older adults. Physical-mental training offers the greatest benefits for improving working memory and task-switching ability, while aerobic exercise is most beneficial for enhancing memory function. Based on these findings, the recommended exercise protocols are: Resistance Training: 12 weeks, 2-3 times per week, 45 min per session. Aerobic Exercise: 21 weeks, twice per week, 60 min per session. These tailored exercise interventions can inform public health strategies and clinical practices aimed at optimizing cognitive health in the aging population.

REGISTRATION

The protocol for this review was registered in PROSPERO (CRD42024597545).

Prevalence of hearing loss in patients with dementia and its association with dementia severity

Introduction

Dementia and hearing loss pose a substantial global health challenge, and understanding their association is crucial. This study aims to determine the prevalence of hearing loss in dementia patients and investigate the risk factors for dementia severity including hearing loss.

Methods

This study was a cross-sectional study. Patients with dementia diagnosed by a psychiatrist or neurologist were invited to participate in this study. Audiometry and tympanometry were performed for hearing investigation. The severity of dementia was determined by the Thai Mental State Examination questionnaire, and the SD-SLP-01 aphasia screening questionnaire and associate factors were collected.

Results

A total of 88 participants were included in the study. Two participants withdrew because they were unable to complete hearing tests. The prevalence of hearing loss in this study was 94.2%. The prevalence of aphasia was 25.6%. The most common type of hearing loss is sensorineural hearing loss. Twenty-five percent of participants had moderate to severe hearing loss. A statistically significant difference was observed in the mean Thai Mental State Examination scores across different degrees of hearing loss (p = 0.040). The factors that contributed to the severity of dementia included aphasia (OR: 14.40, 95% CI: 4.53-45.73, p < 0.001) and severe hearing loss (OR: 55.00, 95% CI: 0.83-3,650.97, p = 0.014).

Conclusions

Our findings revealed an extremely high prevalence of hearing loss in the dementia population. Furthermore, a statistically significant association was observed between severe hearing loss and dementia.

Sex Differences in Response to Low- Versus High-Volume Aerobic Exercise for Sport-Related Concussion: A Pilot Randomized Controlled Trial

OBJECTIVE

To assess sex differences in behavior and motivation of adolescent athletes with sport-related concussion (SRC) versus controls during a 2-week individualized aerobic exercise intervention.

SETTING

Academic center research laboratory.

PARTICIPANTS

Participants were enrolled within 10 days of SRC (n = 32; 15.6 ± 1.4 years, 33% female, 6.18 ± 2.21 days from injury). Twenty-eight control participants (16.0 ± 1.6 years, 33% female) were recruited.

DESIGN

Randomized control trial with a 1:1 block randomization scheme stratified by participant sex.

MAIN MEASURES

Clinical recovery time as determined by the study physician, heart rate threshold (HRt) on the Buffalo Concussion Treadmill Test, adherence rates (calculated as exercise volume completed/exercise volume prescribed), and behavioral assessments including the perceived competence scale (PCS) and the treatment self-regulation questionnaire (TSRQ).

RESULTS

Females achieved higher initial HRts (P = .007), ie, the maximum HR during exercise testing. Males and females with a concussion showed minimal differences in motivation and perceived competence. Although it did not reach statistical significance (P = .058), females in the low-volume group appeared to recover faster than the high-volume group. This trend was not seen in males. Seven (88%) of exercise-intolerant females had to stop an exercise bout early on 1 or more days due to more-than-mild symptom exacerbation versus 3 (17%) of exercise-intolerant males (P = .002).

CONCLUSION

Females with a concussion prescribed a high volume of aerobic exercise treatment appeared to take longer to recover than females with a concussion who were prescribed a lower volume, which was not seen in males. Increased training heart rate prescriptions due to higher initial HRts and symptom exacerbation during at-home exercise may have affected female exercise behavior. Although aerobic exercise benefits SRC recovery, this study highlights the need for future research to optimize exercise treatment prescriptions for females after SRC.

Long-term physical exercise facilitates putative glymphatic and meningeal lymphatic vessel flow in humans

Regular voluntary exercise has been shown to increase waste transport through the glymphatic system in mice. Here, we investigate the impact of physical exercise on both upstream and downstream brain waste clearance in healthy volunteers via noninvasive MR imaging. Putative glymphatic influx, evaluated using intravenous contrast-enhanced dynamic T1 mapping, increases significantly at the putamen after 12 weeks of long-term exercise using a cycle ergometer. The putative meningeal lymphatic vessel size and flow, measured by intravenous contrast-enhanced black-blood imaging and IR-ALADDIN technique, increase significantly after long-term exercise. Plasma proteomics reveals significant changes in inflammation-related and immune-related proteins (down-regulated: S100A8, S100A9, PSMA3, and DEFA1A3; up-regulated: J chain) after long-term exercise, which correlate with putative glymphatic influx or mLV flow. Our results suggest that increased glymphatic and mLV flow may be the potential mechanism underlying the neuroprotective effects of exercise on cognition, highlighting the importance of long-term, regular exercise.

Physical activity in Alzheimer's disease prevention: Sex differences and the roles of BDNF and irisin

Alzheimer's disease (AD) disproportionately affects women, with postmenopausal hormonal changes contributing to elevated risk. Physical exercise is a promising, non-pharmacological strategy to mitigate cognitive decline and AD progression. Brain-derived neurotrophic factor (BDNF) and irisin are key molecular mediators of exercise-induced brain health and protection against AD pathology by promoting synaptic plasticity, neurogenesis, and reducing amyloidosis, tau pathology, and neuroinflammation in sex-specific mechanisms. This review explores sex and gender influences on exercise outcomes and their interaction with FNDC5/irisin and BDNF signaling pathways in the context of AD prevention. We highlight emerging evidence on the interplay between exercise, sex, and neuroprotective pathways, emphasizing the need for sex-sensitive research designs to advance precision approaches for AD prevention.

The Science of Tai Chi and Qigong and Whole Person Health Part I: Rationale and State of the Science

The emerging paradigm of whole person health shares many core principles with traditional complementary and integrative health frameworks, including Tai Chi and qigong (TCQ). In the Fall of 2023, the Harvard Medical School Osher Center for Integrative Health hosted the inaugural international conference on The Science of Tai Chi for Whole Person Health: Advancing the Integration of Mind-Body Practices into Contemporary Health Care held at Harvard Medical School. A two-part white paper was written to summarize key conference topics, findings, and issues. Part I presented here summarizes the rationale for the conference and synthesizes the state of evidence for TCQ as rehabilitative and preventive tools for a range of clinical conditions, including falls and balance, cognition, mental health, sleep, cardiorespiratory health, musculoskeletal health, cancer, as well as translational evidence related to the neurophysiology, brain and immune function, and biomarkers of inflammation. The state of science of TCQ, viewed through the lens of traditional East Asian health constructs, is also discussed. Part II of this white paper outlines evidence gaps and opportunities and discusses strategies to address challenges in TCQ research, dissemination, and implementation.

Cognitive gains and cortical thickness changes after 12 weeks of resistance training in older adults with low and high risk of mild cognitive impairment: Findings from a randomized controlled trial

BACKGROUND

In this randomized controlled trial, we assessed the neuroprotective effect of a 12-week resistance training (RT) program on executive control and cortical thickness of the prefrontal, temporal, parietal, and central cortex, regions prone to structural decline in individuals with mild cognitive impairment (MCI).

METHODS

Seventy older adults (aged 60-85 y old, 38 females and 32 males) were randomly allocated to a 12-week lower limb RT program or a waiting list control group. The Montreal Cognitive Assessment (MoCA) was used to stratify participants screened for high (< 26) or low (≥ 26) MCI risk. Cognitive measurements consisted of the two-choice reaction time, Go/No-go, mathematical processing, and memory search tests. Cortical thickness was estimated from 3D T1-weighted MR images.

RESULTS

Complete randomized controlled trial data was obtained from 50 individuals (24 with high MCI risk). Significant Group x Time interactions were found for response on the Go/No-go task and cortical thickness of the right parahippocampal gyrus [F ≥ 5.3, p ≤ 0.03; η2p ≥ 0.12]. An inspection of these observations revealed an increase in cortical thickness (+1.18 %) and a decrease in response time (-4.35 %) in individuals with high MCI risk allocated to the exercise group (both uncorrected p = 0.08). Decreased response time on the Go/No-go task was associated with increased cortical thickness in the right entorhinal gyrus (uncorrected p = 0.01).

CONCLUSIONS

Our study demonstrated that 12 weeks of RT intervention may effectively improve cognitive performance and slow neuronal loss in the hippocampal complex of older adults at high MCI risk. Findings support evidence for the neuroprotective effects of resistance training and its potential role in cognitive health.

Longitudinal Engagement in Modifiable Lifestyle Behaviors and Racial-Ethnic Differences in Dementia Risk

ObjectivesThe objective was to examine racial-ethnic differences in longitudinal engagement for lifestyle behaviors and moderating role of race-ethnicity between lifestyle behaviors and dementia risk.MethodsWe analyzed 2011-2021 National Health and Aging Trends Study data, a nationally representative U.S. sample of 6155 White, Black, Hispanic, and Asian older adults aged 65+. Cox models regressed dementia on the interaction between lifestyle behaviors (physical activity, smoking, and social contacts) and race-ethnicity.ResultsOnly smoking was associated with about a 45% higher dementia risk (aHR = 1.45, 95% CI = 1.11-1.89). On average, Black and Hispanic respondents exhibited less frequent physical activity and social contacts, along with more frequent smoking. There was one significant interaction; more social contacts were associated with lower dementia risk among Asian respondents (aHR = 0.16, 95% CI = 0.05-0.55).DiscussionRacial-ethnic differences in lifestyle behaviors should be considered when addressing dementia disparities. Future research needs to explore the relationship between social contacts and lower dementia risk among Asian older adults.

Mindfulness-Based Interventions Targeting Modifiable Lifestyle Behaviors Associated With Brain Health: A Systematic Review and Meta-Analysis

A systematic review and meta-analysis investigated randomized clinical trials (RCTs) of mindfulness-based interventions (MBIs) targeting lifestyle behaviors commonly associated with brain health in adults. Data sources included Ovid Medline, Ovid PsycINFO, CINAHL [EBSCO], Embase, Cochrane Library [Ovid], Web of Science, and https://ClinicalTrials.gov. Studies were screened using Covidence 2.0. A total of 79 published RCTs of MBIs for adults (18+, patient and non-patient populations) targeting one or more lifestyle behavior (physical activity, sleep, diet, alcohol use, tobacco cessation, and social and mental activities) met eligibility criteria. MBIs were associated with reduced sleep disturbance (40/54 RCTs; 3537 participants; SMD = -.53; 95% CI = -.74 to -.32; I 2 = 78%), increased physical activity (9/17 RCTs analyzed; 685 participants; SMD = .72; 95% CI = .04 to 1.40; I 2 = 89%), improved tobacco cessation (8/12 RCTs; 1234 participants; OR = 2.11; 95% CI = 1.12 to 3.97; I 2 = 55%), and lowered alcohol use (4/6 RCTs; 261 participants; SMD = -.39; 95% CI = -.45 to -.32; I 2 = 0%). This review found moderate to high-quality evidence for MBIs targeting sleep, physical activity, alcohol use, and tobacco cessation. Heterogeneity for these outcomes and insufficient data to analyze diet, mental activities, and cognitive functioning limit our ability to draw definitive conclusions about the effects of MBIs on brain health.

Moderate-to-Vigorous Physical Activity at any Dose Reduces All-Cause Dementia Risk Regardless of Frailty Status

OBJECTIVES

Reaching the moderate-to-vigorous physical activity (MVPA) recommendations of 150 min/wk is difficult for older adults, particularly among those living with frailty and its associated risk of dementia. We examined the dose-response relationship between MVPA and dementia risk among at-risk persons living with and without frailty enrolled in the UK Biobank study.

DESIGN

Survival analysis within a prospective cohort study.

SETTINGS AND PARTICIPANTS

Participants at risk for all-cause dementia who wore an Axivity AX3 triaxial wrist-worn accelerometer between February 2013 and December 2015.

METHODS

MVPA was estimated from wrist-worn accelerometry in a subpopulation of the UK Biobank study. A modified version of the physical frailty phenotype was used to define frailty. Associations between MVPA dose (including interactions with frailty) and first-time incident dementia were analyzed using Cox regression models. MVPA was treated continuously and categorically across 5 levels to estimate the dose-response curve. Models were adjusted for demographics, frailty status, and comorbidities.

RESULTS

This study included 89,667 adults (median age, 63 years; 56% women), with 735 participants developing dementia over an average of 4.4 years. Average weekly MVPA was 126 minutes. Each 30 minutes higher MVPA was associated with a 4% reduction in the risk of all-cause dementia (hazard ratio, 0.96; 95% CI, 0.93-0.99). The hazard ratios for engaging in 0-34.9, 35-69.9, 70-139.9, and ≥140 MVPA minutes per week were 0.59, 0.40, 0.37, and 0.31, respectively (P < .05 for all) compared with 0 MVPA minutes per week. All associations were similar across frailty status (interaction P for all models > .21).

CONCLUSIONS AND IMPLICATIONS

Our results suggest engaging in any additional amount of MVPA reduces dementia risk, with the highest benefit appearing among individuals with no MVPA. These associations are not substantially modified by frailty status.

Physical activity partially mediates the association between health literacy and mild cognitive impairment in older adults: cross-sectional evidence from Switzerland

Individuals' health literacy (HL) is positively associated with healthy behaviors and global cognitive functioning. Current evidence also suggests that physical activity may prevent or delay cognitive decline and dementia. This study examines the potential mediating role of physical activity in the association between HL and cognition in a population-based sample of adults aged 58+ in Switzerland. We used data from 1645 respondents to Wave 8 (2019/2020) of the Survey on Health, Ageing, and Retirement in Europe in Switzerland. HL was assessed using the HLS-EU-Q16 questionnaire. Mild cognitive impairment (MCI) was defined as a 1.5 SD below the mean of age- and education-specific global cognition score. The frequency of moderate and vigorous physical activity was self-reported. The associations were assessed using probit regression models, controlling for social, health, and regional characteristics. Structural equation modeling was used to test the mediation hypothesis. Higher HL was associated with a higher likelihood of being engaged in moderate (P < .001) and vigorous (P < .01) physical activity and with a lower likelihood of having MCI (P < .05). In addition, both moderate (P < .05) and vigorous (P < .01) physical activity were associated with a lower probability of having MCI. Mediation analysis indicated that the association between HL and MCI was partially mediated by both moderate (12.9%) and vigorous (6.7%) physical activity. Given that physical activity may partially mediate the association between HL and MCI, improving HL in older adults could potentially foster engagement in physical activity, which could, in turn, act as a protective factor against MCI.

Lifestyle interventions for dementia risk reduction: A review on the role of physical activity and diet in Western and Asian Countries

Dementia, is a critical global public health challenge with no effective pharmacological treatments. Recent research highlights the significant role of lifestyle interventions, particularly physical activity and dietary habits, in mitigating cognitive decline among the elderly and preventing the progression to dementia in individuals with Mild Cognitive Impairment (MCI). This comprehensive review explores the impact of physical exercise and dietary approaches on cognitive health, comparing strategies adopted in Western and Asian countries. Physical activity, including aerobic, resistance, balance training, and dual-task exercises, has been shown to enhance neurogenesis, improve cerebral blood flow, and delay cognitive decline. In Western countries, structured regimens such as the Mediterranean (MedDiet) and MIND diets are prominent, while Asian countries often integrate traditional mind-body practices like Tai Chi and culturally relevant diets rich in antioxidants and polyphenols. Although both regions recognize the importance of lifestyle changes in reducing dementia risk, their approaches differ significantly, shaped by cultural norms and dietary preferences. This review underscores the need for culturally tailored public health strategies to promote cognitive health globally, highlighting the importance of individualized approaches in MCI and dementia prevention.

Physiological influences on neurovascular coupling: A systematic review of multimodal imaging approaches and recommendations for future study designs

In this review, we have amalgamated the literature, taking a multimodal neuroimaging approach to quantify the relationship between neuronal firing and haemodynamics during a task paradigm (i.e., neurovascular coupling response), while considering confounding physiological influences. Original research articles that used concurrent neuronal and haemodynamic quantification in humans (n ≥ 10) during a task paradigm were included from PubMed, Scopus, Web of Science, EMBASE and PsychINFO. Articles published before 31 July 2023 were considered for eligibility. Rapid screening was completed by the first author. Two authors completed the title/abstract and full-text screening. Article quality was assessed using a modified version of the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A total of 364 articles were included following title/abstract and full-text screening. The most common combination was EEG/functional MRI (68.7%), with cognitive (48.1%) and visual (27.5%) tasks being the most common. The majority of studies displayed an absence/minimal control of blood pressure, arterial gas concentrations and/or heart rate (92.9%), and only 1.3% monitored these factors. A minority of studies restricted or collected data pertaining to caffeine (7.4%), exercise (0.8%), food (0.5%), nicotine (2.7%), the menstrual cycle (0.3%) or cardiorespiratory fitness levels (0.5%). The cerebrovasculature is sensitive to numerous factors; thus, to understand the neurovascular coupling response fully, better control for confounding physiological influences of blood pressure and respiratory metrics is imperative during study-design formulation. Moreover, further work should continue to examine sex-based differences, the influence of sex steroid hormone concentrations and cardiorespiratory fitness.

Aged mice show a reduction in 5-HT neurons and decreased cellular activation in the dentate gyrus when exposed to acute running

Serotonin (5-HT) is an important neurotransmitter for cognition and neurogenesis in the dentate gyrus (DG), which occurs via movement stimulation such as physical activity. Brain 5-HT function changes secondary to aging require further investigation. We evaluated whether aged animals would present changes in the number of 5-HT neurons in regions such as the dorsal (DRN) and median (MRN) raphe nuclei and possible changes in the rate of cellular activation in the DG in response to acute running, as a reduction in 5-HT neurons could contribute to a decline in neuronal activation in the DG in response to physical activity in aged mice. This study was conducted on adult (3 months old) and aged (19 months old) male and female mice. Immunohistochemistry, microscopic analysis, and treadmill-running tests were also performed. The data revealed that in aged mice, a reduction in the number of 5-HT neurons in the DRN and MRN of male and female mice was observed. The reduction in the DRN was greater in females. Furthermore, aged animals demonstrate a lower rate of c-Fos labeling in the DG when stimulated by physical exercise. These data indicate that aging may be associated with a reduction in the number of 5-HT neurons in the DRN and MRN, which may lead to a decline in 5-HT availability in the target regions, including the DG. The reduced c-Fos expression in the DG after running in aged mice indicates a decreased response to physical activity, which is potentially linked to serotonergic deficits.

Alzheimer's disease: a comprehensive review of epidemiology, risk factors, symptoms diagnosis, management, caregiving, advanced treatments and associated challenges

Background

Alzheimer's disease (AD) is a chronic, progressive neurodegenerative disorder characterized by cognitive decline, memory loss, and impaired reasoning. It is the leading cause of dementia in older adults, marked by the pathological accumulation of amyloid-beta plaques and neurofibrillary tangles. These pathological changes lead to widespread neuronal damage, significantly impacting daily functioning and quality of life.

Objective

This comprehensive review aims to explore various aspects of Alzheimer's disease, including its epidemiology, risk factors, clinical presentation, diagnostic advancements, management strategies, caregiving challenges, and emerging therapeutic interventions.

Methods

A systematic literature review was conducted across multiple electronic databases, including PubMed, MEDLINE, Cochrane Library, and Scopus, from their inception to May 2024. The search strategy incorporated a combination of keywords and Medical Subject Headings (MeSH) terms such as "Alzheimer's disease," "epidemiology," "risk factors," "symptoms," "diagnosis," "management," "caregiving," "treatment," and "novel therapies." Boolean operators (AND, OR) were used to refine the search, ensuring a comprehensive analysis of the existing literature on Alzheimer's disease.

Results

AD is significantly influenced by genetic predispositions, such as the apolipoprotein E (APOE) ε4 allele, along with modifiable environmental factors like diet, physical activity, and cognitive engagement. Diagnostic approaches have evolved with advances in neuroimaging techniques (MRI, PET), and biomarker analysis, allowing for earlier detection and intervention. The National Institute on Aging and the Alzheimer's Association have updated diagnostic criteria to include biomarker data, enhancing early diagnosis.

Conclusion

The management of AD includes pharmacological treatments, such as cholinesterase inhibitors and NMDA receptor antagonists, which provide symptomatic relief but do not slow disease progression. Emerging therapies, including amyloid-beta and tau-targeting treatments, gene therapy, and immunotherapy, offer potential for disease modification. The critical role of caregivers is underscored, as they face considerable emotional, physical, and financial burdens. Support programs, communication strategies, and educational interventions are essential for improving caregiving outcomes. While significant advancements have been made in understanding and managing AD, ongoing research is necessary to identify new therapeutic targets and enhance diagnostic and treatment strategies. A holistic approach, integrating clinical, genetic, and environmental factors, is essential for addressing the multifaceted challenges of Alzheimer's disease and improving outcomes for both patients and caregivers.

Physical activity modifies cognitive impairment-associated mortality risks among chronic kidney disease

BACKGROUND

Older chronic kidney disease (CKD) patients frequently face unrecognized cognitive impairment and excess mortality. Physical activity (PA) reduces cognitive decline but whether PA modifies cognitive impairment-associated mortality remains unknown.

METHODS

From 2005 to 2011, 30,561 older Taiwanese CKD patients were enrolled. Patients were divided into intact cognition (≥8 scores), mild (6-7 scores), and severe (≤5 scores) cognitive impairment groups by the Short Portable Mental Status Questionnaire (SPMSQ), and were also categorized into high-PA (≥60 min/week of moderate-intensity PA), low-PA (20-60 min/week) or inactive (<20 min/week) groups. Cox regression was conducted to evaluate the individual and joint associations of cognitive impairment and PA on all-cause and cardiovascular mortality.

RESULTS

After a median follow-up of 4.52 years, the all-cause mortality were higher in CKD patients with severe (multivariable-adjusted hazard ratio [aHR] 2.31; 95% confidence interval [CI] 2.05-2.60) and mild (aHR 1.74; CI 1.51-1.99) cognitive impairment than cognitively intact ones. Remarkably, decreased PA amount interacted and amplified the cognitive impairment-associated mortality risks. Notably, the high-PA status linked to lower overall mortality risks both in mild (aHR 0.65; CI 0.45-0.93) and severe (aHR 0.73; CI 0.54-0.99) cognitively-impaired patients as compared to inactivity. Survival tree analysis indicated the least mortality in those with high PA and >8 SPMSQ scores. Similar associations were found in the cardiovascular mortality.

LIMITATIONS

Residual confounding and single ethnicity.

CONCLUSIONS

Cognitive impairment defined by SPMSQ was progressively associated with higher mortality among elderly CKD. Higher PA linked to lower cognitive impairment-associated death risks, and could be promoted for longevity benefits.

Physical activity initiated from midlife on risk of dementia and cognitive impairment: The Health and Retirement Study

BACKGROUND

Physical activity is associated with lower risk of dementia and cognitive impairment, but existing randomized controlled trials have shown conflicting results. As cognitive decline occurs decades before the onset of dementia, physical activity interventions initiated in late life may have missed the potential window for prevention. An ideal trial of physical activity initiated from midlife and lasts till incident dementia and cognitive impairment in late life is not feasible. We aimed to estimate the effectiveness of a hypothetical physical activity intervention initiated from midlife on reducing dementia and cognitive impairment by emulating target trials using observational data.

METHODS

The Health and Retirement Study was used to emulate target trials among noninstitutionalized participants aged 45 to 65 years with normal cognition who were physically inactive in the previous 2 years. Cognitive status was determined based on Langa-Weir classification of cognitive function (including immediate and delayed word recall tests, serial sevens subtraction, counting backward). Individuals were categorized as initiating physical activity or not, based on the self-reported physical activity. Intention-to-treat and per-protocol analysis were conducted with pooled logistic regression models with inverse-probability of treatment and censoring weights to estimate risk ratios (RRs), and 95% confidence intervals (95% CIs) were calculated with 200 sets of bootstrapping.

RESULTS

Among 1505 participants (average age 57.6 ± 4.8 years, 67% women, 76.5% White), 72 cases of dementia and 409 cases of cognitive impairment occurred. After 12 years of follow-up, physical activity reduced dementia (RR = 0.70, 95% CI: 0.43, 0.99) for intention-to-treat analysis, and reduced dementia (RR = 0.51, 95% CI: 0.19, 0.99) and cognitive impairment (RR = 0.77, 95% CI: 0.61, 0.92) for per-protocol analysis. No significant reduction was found among older adults.

CONCLUSIONS

Physical activity initiated during midlife may reduce dementia and cognitive impairment in late life, which highlights the importance of preventing cognitive outcomes at an earlier stage of life.

Colder Climates and Dementia: An Ecological Analysis of Climate-Patterned Temperature's Influence on Neurological Health

Countries with lower climate-patterned temperatures (Tcp), typically colder, have not been consistently correlated with higher dementia risk in population studies. This study explores Tcp's influence on global and regional dementia rates. Country-specific Tcp data was analyzed alongside dementia incidence using bivariate analysis, partial correlation, and multiple linear regression. Factors like life expectancy (Life e(0)), economic affluence, genetic predisposition (Biological State Index), and urbanization were considered. Both Pearson's r and nonparametric tests revealed a significant inverse correlation between Tcp and dementia incidence, holding true even after adjusting for life expectancy, affluence, genetic predisposition, and urbanization. Multiple linear regression identified Tcp as a key predictor of dementia incidence, ranking second after life expectancy. Affluence, genetic predisposition, and urbanization did not significantly predict dementia rates. Tcp's predictive power was consistent across different country groups, with minor correlation variations between developing versus developed countries and LMICs versus high-income nations. Countries with colder climate (lower Tcp) may experience higher dementia rates, a correlation robust across major risk factors. Including Tcp in dementia studies is crucial for understanding its public health implications.

A Dual Group-Based 11-Year Trajectory Analysis of Cognitive Impairment and Transport Restriction for Community-Dwelling Older Adults

OBJECTIVES

To examine the trajectories of cognitive impairment and transport restriction over time and the interrelation between these trajectories among older adults.

METHODS

Group-based trajectory modeling was used on the longitudinal National Health and Aging Trends Study (NHATS) over 11 years from 2011 to 2021, among 5753 participants, stratified by age in 2011 to three groups of 65-74 years, 75-84 years, and 85 years and above.

RESULTS

For transport restrictions, these trajectory groups were: (1) a majority with no restrictions, (2) low and increasing or stable, and (3) moderate or high and decreasing. The overall pattern was largely consistent across the three age groups, with the older group showing a higher predicted likelihood of transport restrictions compared to the younger group. For each of the three age groups, there were two cognitive impairment trajectories including (1) low and (2) increasing cognitive impairment. The proportions of increasing cognitive impairment were 12.3% among the 65-74 years old, 27.3% among the 75-84 years old, and 40.4% among the 85 years and above old. Compared with those with no transport restriction, the other two trajectories with either low or moderate transport restrictions were more likely to belong to increasing cognitive impairment. The odds ratio was 3.06 (95% CI 2.0-4.68) for low & increasing transport restrictions versus 1.57 (95% CI 0.96-2.56) for moderate & decreasing transport restrictions among 65-74 years old. The odds ratio was 2.38 (95% CI 1.68-3.38) for low & increasing transport restrictions versus 1.88 (95% CI 1.39-2.55) for moderate & decreasing transport restrictions among 75-84 years old.

CONCLUSIONS

Cognitive impairment was more likely to co-occur with those with low and increasing transport restrictions than with those with moderate and decreasing transport restrictions. Addressing transport restriction among older adults holds the potential to ameliorate cognitive outcomes.

Cardiovascular health, measured using Life's Essential 8, is associated with reduced dementia risk among older men and women

BACKGROUND

Dementia poses considerable challenges to healthy aging. Prevention and management of dementia are essential given the lack of effective treatments for this condition.

METHODS

A secondary data analysis was conducted using data from 928 InCHIANTI study participants (55% female) aged 65 years and older without dementia at baseline. Cardiovascular health (CVH) was assessed by the "Life's Essential 8" (LE8) metric that included health behaviors (diet, physical activity, smoking status, sleep duration) and health factors (body mass index, blood lipid, blood glucose, blood pressure). This new LE8 metric scores from 0 to 100, with categorization including "low LE8" (0-49), indicating low CVH, "moderate LE8 (50-79)", indicating moderate CVH, and "high LE8 (80-100)", indicating high CVH. Dementia was ascertained by a combination of neuropsychological testing and clinical assessment at each follow-up visit. Cox proportional hazards models were used to examine associations between CVH at baseline and risk of incident dementia after a median follow-up of 14 years.

RESULTS

Better CVH (moderate/high LE8 vs. low LE8) was inversely associated with the risk of incident dementia (hazard ratio [HR]: 0.61, 95% confidence interval [CI]: 0.46-0.83, p = 0.001). Compared with health factors, higher scores of the health behaviors (per 1 standard deviation [SD]), specifically weekly moderate-to-vigorous physical activity time (per 1 SD), were significantly associated with a lower risk of incident dementia (health behaviors: HR:0.84, CI:0.73-0.96, p = 0.01; physical activity: HR: 0.62, CI: 0.53-0.72, p < 0.001).

CONCLUSION

While longitudinal studies with repeated measures of CVH are needed to confirm these findings, improving CVH, measured by the LE8 metric, may be a promising dementia prevention strategy.

Physical Activity Component of the Greek Interventional Geriatric Study to Prevent Cognitive Impairment and Disability (GINGER): Protocol Development and Feasibility Study

BACKGROUND/OBJECTIVES

Individuals with subjective cognitive decline (SCD) have an increased risk of developing dementia, while non-pharmacological multicomponent lifestyle interventions are recommended for prevention/management. The Greek Interventional Geriatric Initiative to Prevent Cognitive Impairment and Disability (GINGER) is such a multicomponent approach, encompassing simultaneous interventions (cognitive training, depression and sleep management, etc.). Exercise/Physical activity (PA) is suggested as one such intervention. This study (i) presents the exercise protocol developed for GINGER and (ii) explores its feasibility (acceptability, applicability, adherence, users' satisfaction and reliability).

METHODS

Exercise/PA protocol development, targeting SCD individuals aged > 55 years, utilized relevant guidelines/literature followed by focus group involving exercise specialists. Data were synthesized through consensus to design optimal exercise interventions prescribed on participant's physical capacity (heart rate, exertion, etc.), comprising 6-month combined aerobic, strengthening, balance and dual-task exercises, delivered 3 times/weekly in two group-based supervised sessions (in-person and online) and one home-based session. Physical outcomes include balance, aerobic capacity [2-Minute Walk Test (2 MWT), IPAQ-7], strength [Hand Grip Strength (HGS), Sit-to-Stand], fear of falling. Eligibility for entering intervention is low IPAQ-7, 2 MWT or HGS scoring. Feasibility was explored with adherence (exercise diaries and Exercise Adherence Rating Scale) and satisfaction (Patient Satisfaction Questionnaire) Results: Intervention was easily delivered with good reliability across testers' assessments on 13 SCD participants (ICCs = 0.62-0.99), and improved physical outcomes, whereas users' adherence and satisfaction scored highly.

CONCLUSIONS

The exercise protocol for SCD was feasible, acceptable, applicable, reliable, demonstrating adherence and satisfaction, while improving physical parameters. It is thus integrated in the GINGER study, where multiple simultaneous interventions will take place to prevent/enhance cognitive function.

Alzheimer's Disease: Exploring the Landscape of Cognitive Decline

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline, memory loss, and impaired daily functioning. The pathology of AD is marked by the accumulation of amyloid beta plaques and tau protein tangles in the brain, along with neuroinflammation and synaptic dysfunction. Genetic factors, such as mutations in APP, PSEN1, and PSEN2 genes, as well as the APOE ε4 allele, contribute to increased risk of acquiring AD. Currently available treatments provide symptomatic relief but do not halt disease progression. Research efforts are focused on developing disease-modifying therapies that target the underlying pathological mechanisms of AD. Advances in identification and validation of reliable biomarkers for AD hold great promise for enhancing early diagnosis, monitoring disease progression, and assessing treatment response in clinical practice in effort to alleviate the burden of this devastating disease. In this paper, we analyze data from the CAS Content Collection to summarize the research progress in Alzheimer's disease. We examine the publication landscape in effort to provide insights into current knowledge advances and developments. We also review the most discussed and emerging concepts and assess the strategies to combat the disease. We explore the genetic risk factors, pharmacological targets, and comorbid diseases. Finally, we inspect clinical applications of products against AD with their development pipelines and efforts for drug repurposing. The objective of this review is to provide a broad overview of the evolving landscape of current knowledge regarding AD, to outline challenges, and to evaluate growth opportunities to further efforts in combating the disease.

Sedentary behavior and associated factors on admissions to internal medicine wards

The relationship between sedentary lifestyle and chronic diseases is well known. This study examined the prevalence and factors associated with reduced physical activity (PA) among internal medicine inpatients on admission. In this single-center, cross-sectional study, inpatients aged 50 years or older were prospectively enrolled at a tertiary care facility in Ankara, Türkiye. PA was assessed using the International Physical Activity Questionnaire (IPAQ). Care and performance indicators, quality of life (EQ-5D 3L), nutritional status, timed up-and-go test, muscle strength, and cognitive status were assessed. Participants were classified into 3 groups of PA levels as low, moderate, and high. Study end points were the prevalence of low PA level and associated factors. Of the 240 participants (mean age: 62.7 ± 8.0 years; women: 50%), 47.1% (n = 113), 40.8% (n = 98) and 12.1% (n = 29) had low, moderate, and high PA, respectively. Type 2 diabetes mellitus (45.1%), hypertension (66.4%), coronary artery disease (41.6%), dementia (8.8%), and multimorbidity (53.1%) were more common in the low PA group. Outdoor walking < 3 days per week (OR: 4.44, 95% CI 1.55 to 12.74, p = 0.006, functional dependence in and outside home (OR: 4.25, 95% CI 1.13 to 15.92, p = 0.032) and EQ-5D VAS score (OR: 0.97, 95% CI 0.95 to 0.99, p = 0.011) were independently associated with low PA level on multivariable logistic regression analysis. This study found low or medium levels of PA in almost nine out of ten admissions to an internal medicine clinic. On the other hand, low PA level was not associated with most classical comorbidities but with altered performance and care indicators.

The relationship between micronutrients and cognitive ability in an elderly population with mild cognitive impairment and Alzheimer's disease: a cross-sectional study

BACKGROUND

Mild cognitive impairment (MCI) and Alzheimer's disease (AD) are significant neurodegenerative disorders with increasing prevalence worldwide. Lifestyle and dietary factors, including micronutrients, have been suggested as modifiable risk factors for disease development. This study aims to investigate the association between micronutrients and cognitive ability in these diseases.

METHODS

A cross-sectional study involving 105 participants with MCI and AD was conducted. Dietary assessments were performed using a validated food frequency questionnaire (FFQ), and micronutrient intake was calculated based on nutrient content. Disease severity was evaluated using the Functional Assessment Staging Tool (FAST). Statistical analyses, including correlation coefficients and multiple regression models, were employed to examine the association between micronutrients and disease progression.

RESULTS

The results revealed significant correlations between disease severity and several micronutrients, including omega-3 fatty acids (B = -0.2, P = 0.01), carotenoids (B = -0.19, P = 0.02), dietary antioxidant compounds, including vitamins A, C, D, E (B = -0.19, P = 0.02), selenium (B = -0.17, P = 0.03), alpha-carotene (B = -0.16, P = 0.04), beta-carotene (B = -0.17, P = 0.03), and lycopene (B = -0.16, P = 0.04). Multivariate regression analysis showed that higher intake of omega-3 fatty acids was associated with slower disease progression. Furthermore, the levels of these micronutrients declined in advanced stages of the disease.

CONCLUSION

Omega-3 fatty acids and carotenoids may affect the cognitive ability and disease progression. Further longitudinal studies are warranted to establish causality and explore the therapeutic implications of these findings for the prevention and management of MCI and AD.

A feasibility and usability study of a virtual reality tool (VESPA 2.0) for cognitive rehabilitation in patients with mild cognitive impairment: an ecological approach

Introduction

Mild cognitive impairment (MCI) or "mild neurocognitive disorder" represents an intermediate status between normality and dementia. It is characterized by cognitive decline that does not significantly interfere with normal daily living activities. Virtual reality (VR) is the new frontier of rehabilitation.

Methods

We enrolled 50 MCI patients who underwent a neuropsychological evaluation and participated in 40 sessions of cognitive treatment using the Virtual Environment for a Superior Neuro-Psychiatry, Second Generation (VESPA 2.0) System. This preliminary study highlights the role of VR tools for cognitive rehabilitation (CR) for the recovery of cognitive functions and consequent better management of MCI condition. Our study demonstrated that the VESPA 2.0 System is a valuable tool in a context that closely resembles real-life situations rather than controlled, artificial environments as traditional cognitive training methods.

Results

The results showed that the patient group had significant improvements between T0 and T1 (assessment), in particular, in the global cognitive profile, visuospatial skills, and executive functions after treatment with the VESPA 2.0 System.

Discussion

Our findings contribute with new evidence of understanding the impact of using simulations of the Activities of Daily Living (ADL) scale in the CR.

The Hidden Dangers of Sedentary Living: Insights into Molecular, Cellular, and Systemic Mechanisms

With the aging of the global population, neurodegenerative diseases are emerging as a major public health issue. The adoption of a less sedentary lifestyle has been shown to have a beneficial effect on cognitive decline, but the molecular mechanisms responsible are less clear. Here we provide a detailed analysis of the complex molecular, cellular, and systemic mechanisms underlying age-related cognitive decline and how lifestyle choices influence these processes. A review of the evidence from animal models, human studies, and postmortem analyses emphasizes the importance of integrating physical exercise with cognitive, multisensory, and motor stimulation as part of a multifaceted approach to mitigating cognitive decline. We highlight the potential of these non-pharmacological interventions to address key aging hallmarks, such as genomic instability, telomere attrition, and neuroinflammation, and underscore the need for comprehensive and personalized strategies to promote cognitive resilience and healthy aging.

Best practice in dementia health care: Key clinical practice pointers from a national conference and innovative opportunities for pharmacy practice

OBJECTIVE

Sub-optimal care of people living with dementia has serious consequences for older populations. The 2021 Australian Royal Commission noted that a large proportion of older adults in aged care live with dementia, yet there are limitations in the knowledge and understanding of staff who care for them. In the pursuit of educating pharmacists, physicians, allied health care professionals, researchers, academics, people living with dementia and their carers, and the public, who are facing the challenges of dementia management, the 'Best Practice in Dementia Health Care' conference was held on November 10, 2022 at Western Health (Sunshine Hospital, Melbourne, Australia).

METHODS

Sixteen experts presented on the current practice and challenges associated with delivering best practice dementia health care to older Australians, often highlighting how medication-related challenges impacted on their area of practice.

RESULTS

Presenters highlighted the importance of individualised medication management plans, considerations of culture and Indigenous communities, the role of technology, and the impact of exercise and the physical environment on care of people living with dementia. Key clinical practice messages from each expert presenter fit into four main topics: 'navigating complexities of medication management'; 'enhancing wellbeing'; 'supportive settings and environments'; and 'programs and services improving care'.

CONCLUSIONS

Pharmacists are crucial members of allied health care teams. They have the necessary medication and comorbidity expertise to review medication regimens, liaise with all health care providers, and provide holistic, pharmacological and non-pharmacological patient education. Towards providing best practice dementia health care, pharmacists can contribute in several ways, such as providing health practitioner education to increase understanding about medications and how they can impact on allied health practice, to ensure that medications are prescribed appropriately and safely. Further, pharmacists can make available resources to ensure people living with dementia receive culturally safe and appropriate care, while advocating for greater understanding of the history and experiences of people living with dementia to ensure care aligns with their day-to-day routines. Finally, pharmacists can provide peer-support to other health care professionals and care staff to ensure optimal management of behavioural and psychological symptoms of dementia. The information and insights shared at the conference can serve as a valuable resource for pharmacists and other health care professionals and researchers working to improve the lives of those living with dementia.

Feasibility of superimposed supine cycling and lower body negative pressure as an effective means of prolonging exercise tolerance in individuals experiencing persisting post-concussive symptoms: Preliminary results

To examine the feasibility, utility and safety of superimposed lower body negative pressure (LBNP) and tilt during supine cycling in individuals suffering from persisting post-concussive symptoms (PPCS). Eleven individuals aged 17-31 (6 females/5 males) participated in two randomized separate visits, 1 week apart. A ramp-incremental test was performed during both visits until volitional failure. Visits included no pressure (control) or LBNP at -40 Torr (experimental) with head-up tilt at 15 degrees (females) or 30 degrees (males). Transcranial Doppler ultrasound was utilized to quantify middle cerebral artery velocity (MCAv), while symptom reports were filled out before and 0, 10, and 60 min post-exertion. Ratings of exertion and overall condition followed similar trends for participants across both tests. The relative increase in MCAv was blunted during the experimental condition (8%) compared to control (24%), while a greater heart rate (17 beats/min) was achieved during the LBNP condition (P = 0.047). Symptom severity at the 0 and 10 min post-exertion time points displayed negligible-to-small effect sizes between conditions (Wilcoxon's r < 0.11). Symptom reporting was lower at the 60 min post-exertion time point with these displaying a moderate effect size (Wilcoxon's r = 0.31). The combination of LBNP and tilt during supine cycling did not change the participants' subjective interpretation of the exertional test but attenuated the hyperpnia-induced vasodilatory MCAv response, while also enabling participants to achieve a higher heart rate during exercise and reduced symptoms 1 h later. As this protocol is safe and feasible, further research is warranted in this area for developing PPCS treatment options. HIGHLIGHTS: What is the central question of this study? What are the feasibility, safety and utility of combining head-up tilt with lower body negative pressure during supine cycling for blunting the increase in cerebral blood velocity seen during moderate-intensity exercise in individuals experiencing persisting post-concussion symptoms? What is the main finding and its importance? Although no differences were found in symptoms between conditions within the first 10 min following exertion, symptom severity scores showed a clinically meaningful reduction 60 min following the experimental condition compared to the non-experimental control condition.

Effects of resistance exercise and whey protein supplementation on cognitive function in older men: secondary analysis of a randomised, double-blind, placebo-controlled trial

PURPOSE

Ageing is associated with cognitive decline. This study investigated the individual and combined effects of resistance exercise (RE) and whey protein supplementation (PRO) on cognitive function in older men.

METHODS

In a pooled-groups analysis, 36 older men (age: 67 ± 4 years) were randomised to either RE (2 x/week; n = 18) or no exercise (NE; n = 18), and either PRO (2 × 25 g/d whey protein isolate; n = 18) or control (CON, 2 × 23.75 g maltodextrin/d; n = 18). A sub-analysis was also conducted between RE + CON (n = 9) and RE + PRO (n = 9). At baseline and 12 weeks, participants completed a battery of neuropsychological tests (CANTAB; Cambridge Cognition, UK) and neurobiological, inflammatory, salivary cortisol and insulin sensitivity biomarkers were quantified.

RESULTS

PRO improved executive function z-score (+0.31 ± 0.08) greater than CON (+0.06 ± 0.08, P = 0.03) and there was a trend towards improved global cognitive function (P = 0.053). RE and RE + PRO did not improve any cognitive function domains (p ≥ 0.07). RE decreased tumor necrosis factor-alpha (P = 0.02) and interleukin-6 (P = 0.048) concentrations compared to NE, but changes in biomarkers did not correlate with changes in cognitive domains. Muscle strength (r = 0.34, P = 0.045) and physical function (ρ = 0.35-0.51, P < 0.05) outcomes positively correlated with cognitive function domains at baseline, but only Δskeletal muscle index correlated with Δepisodic memory (r = 0.34, P = 0.046) following the intervention.

CONCLUSION

In older men, PRO improved cognitive function, most notably executive functioning. RE did not improve any cognitive function domains but did decrease biomarkers of systemic inflammation. No synergistic effects were observed.

Can exercise benefits be harnessed with drugs? A new way to combat neurodegenerative diseases by boosting neurogenesis

Adult hippocampal neurogenesis (AHN) is affected by multiple factors, such as enriched environment, exercise, ageing, and neurodegenerative disorders. Neurodegenerative disorders can impair AHN, leading to progressive neuronal loss and cognitive decline. Compelling evidence suggests that individuals engaged in regular exercise exhibit higher production of proteins that are essential for AHN and memory. Interestingly, specific molecules that mediate the effects of exercise have shown effectiveness in promoting AHN and cognition in different transgenic animal models. Despite these advancements, the precise mechanisms by which exercise mimetics induce AHN remain partially understood. Recently, some novel exercise molecules have been tested and the underlying mechanisms have been proposed, involving intercommunications between multiple organs such as muscle-brain crosstalk, liver-brain crosstalk, and gut-brain crosstalk. In this review, we will discuss the current evidence regarding the effects and potential mechanisms of exercise mimetics on AHN and cognition in various neurological disorders. Opportunities, challenges, and future directions in this research field are also discussed.

Markers of Biological Brain Aging Mediate Effects of Vascular Risk Factors on Cognitive and Motor Functions: A Multivariate Imaging Analysis of 40,579 Individuals

The increasing global life expectancy brings forth challenges associated with age-related cognitive and motor declines. To better understand underlying mechanisms, we investigated the connection between markers of biological brain aging based on magnetic resonance imaging (MRI), cognitive and motor performance, as well as modifiable vascular risk factors, using a large-scale neuroimaging analysis in 40,579 individuals of the population-based UK Biobank and Hamburg City Health Study. Employing partial least squares correlation analysis (PLS), we investigated multivariate associative effects between three imaging markers of biological brain aging - relative brain age, white matter hyperintensities of presumed vascular origin, and peak-width of skeletonized mean diffusivity - and multi-domain cognitive test performances and motor test results. The PLS identified a latent dimension linking higher markers of biological brain aging to poorer cognitive and motor performances, accounting for 94.7% of shared variance. Furthermore, a mediation analysis revealed that biological brain aging mediated the relationship of vascular risk factors - including hypertension, glucose, obesity, and smoking - to cognitive and motor function. These results were replicable in both cohorts. By integrating multi-domain data with a comprehensive methodological approach, our study contributes evidence of a direct association between vascular health, biological brain aging, and functional cognitive as well as motor performance, emphasizing the need for early and targeted preventive strategies to maintain cognitive and motor independence in aging populations.

Prediction of Mild Cognitive Impairment Status: Pilot Study of Machine Learning Models Based on Longitudinal Data From Fitness Trackers

BACKGROUND

Early signs of Alzheimer disease (AD) are difficult to detect, causing diagnoses to be significantly delayed to time points when brain damage has already occurred and current experimental treatments have little effect on slowing disease progression. Tracking cognitive decline at early stages is critical for patients to make lifestyle changes and consider new and experimental therapies. Frequently studied biomarkers are invasive and costly and are limited for predicting conversion from normal to mild cognitive impairment (MCI).

OBJECTIVE

This study aimed to use data collected from fitness trackers to predict MCI status.

METHODS

In this pilot study, fitness trackers were worn by 20 participants: 12 patients with MCI and 8 age-matched controls. We collected physical activity, heart rate, and sleep data from each participant for up to 1 month and further developed a machine learning model to predict MCI status.

RESULTS

Our machine learning model was able to perfectly separate between MCI and controls (area under the curve=1.0). The top predictive features from the model included peak, cardio, and fat burn heart rate zones; resting heart rate; average deep sleep time; and total light activity time.

CONCLUSIONS

Our results suggest that a longitudinal digital biomarker differentiates between controls and patients with MCI in a very cost-effective and noninvasive way and hence may be very useful for identifying patients with very early AD who can benefit from clinical trials and new, disease-modifying therapies.

mHealth Apps for Dementia, Alzheimer Disease, and Other Neurocognitive Disorders: Systematic Search and Environmental Scan

BACKGROUND

Lifestyle behaviors including exercise, sleep, diet, stress, mental stimulation, and social interaction significantly impact the likelihood of developing dementia. Mobile health (mHealth) apps have been valuable tools in addressing these lifestyle behaviors for general health and well-being, and there is growing recognition of their potential use for brain health and dementia prevention. Effective apps must be evidence-based and safeguard user data, addressing gaps in the current state of dementia-related mHealth apps.

OBJECTIVE

This study aims to describe the scope of available apps for dementia prevention and risk factors, highlighting gaps and suggesting a path forward for future development.

METHODS

A systematic search of mobile app stores, peer-reviewed literature, dementia and Alzheimer association websites, and browser searches was conducted from October 19, 2022, to November 2, 2022. A total of 1044 mHealth apps were retrieved. After screening, 152 apps met the inclusion criteria and were coded by paired, independent reviewers using an extraction framework. The framework was adapted from the Silberg scale, other scoping reviews of mHealth apps for similar populations, and background research on modifiable dementia risk factors. Coded elements included evidence-based and expert credibility, app features, lifestyle elements of focus, and privacy and security.

RESULTS

Of the 152 apps that met the final selection criteria, 88 (57.9%) addressed modifiable lifestyle behaviors associated with reducing dementia risk. However, many of these apps (59/152, 38.8%) only addressed one lifestyle behavior, with mental stimulation being the most frequently addressed. More than half (84/152, 55.2%) scored 2 points out of 9 on the Silberg scale, with a mean score of 2.4 (SD 1.0) points. Most of the 152 apps did not disclose essential information: 120 (78.9%) did not disclose expert consultation, 125 (82.2%) did not disclose evidence-based information, 146 (96.1%) did not disclose author credentials, and 134 (88.2%) did not disclose their information sources. In addition, 105 (69.2%) apps did not disclose adherence to data privacy and security practices.

CONCLUSIONS

There is an opportunity for mHealth apps to support individuals in engaging in behaviors linked to reducing dementia risk. While there is a market for these products, there is a lack of dementia-related apps focused on multiple lifestyle behaviors. Gaps in the rigor of app development regarding evidence base, credibility, and adherence to data privacy and security standards must be addressed. Following established and validated guidelines will be necessary for dementia-related apps to be effective and advance successfully.

The Effects of Physical Activity on Experimental Models of Vascular Dementia: A Systematic Review and Meta-Analysis

Background

Physical activity is associated with improved brain health and cognition in humans. However, the validity, range, and quality of evidence for the beneficial outcomes linked to exercise in experimental models of vascular dementia (VaD) have not been evaluated. We performed a systematic review and meta-analysis of studies that assessed the effect of exercise intervention on models of VaD to provide an unbiased and comprehensive determination of the cognitive function and brain morphology benefits of exercise.

Summary

A systematic search in three databases as well as study design characteristics and experimental data extraction were completed in December 2021. We investigated the effects of exercise on cognitive function and brain-morphology outcomes in VaD models. Twenty-five studies were included for systematic review, while 21 studies were included in the meta-analysis. These studies included seven models of VaD in rats (60%, 15 studies), mice (36%, 9 studies), and pigs (4%, 1 study). None of the included studies used aged animals, and the majority of studies (80%) used only male animals.

Key Message Exercise improves cognition but increased neuro-inflammation in VaD models

Exercise improved cognitive function as well as some markers of brain morphology in models of VaD. However, exercise increased anxiety and neuro-inflammatory signals in VaD models. Further, we observed increased reporting anomalies such as a lack of blinding to group treatment or data analysis and randomization of animals to groups. Our report could help in the appropriate design of experimental studies seeking to investigate the effects of exercise as a non-pharmacological intervention on VaD models with a high translational impact.

Acrobatic training prevents learning impairments and astrocyte remodeling in the hippocampus of rats undergoing chronic cerebral hypoperfusion: sex-specific benefits

Background

Chronic cerebral hypoperfusion (CCH) leads to memory and learning impairments associated with degeneration and gliosis in the hippocampus. Treatment with physical exercise carries different therapeutic benefits for each sex. We investigated the effects of acrobatic training on astrocyte remodeling in the CA1 and CA3 subfields of the hippocampus and spatial memory impairment in male and female rats at different stages of the two-vessel occlusion (2VO) model.

Methods

Wistar rats were randomly allocated into four groups of males and females: 2VO acrobatic, 2VO sedentary, sham acrobatic, and sham sedentary. The acrobatic training was performed for 4 weeks prior to the 2VO procedure. Brain samples were collected for morphological and biochemical analysis at 3 and 7 days after 2VO. The dorsal hippocampi were removed and prepared for Western blot quantification of Akt, p-Akt, COX IV, cleaved caspase-3, PARP, and GFAP. GFAP immunofluorescence was performed on slices of the hippocampus to count astrocytes and apply the Sholl's circle technique. The Morris water maze was run after 45 days of 2VO.

Results

Acutely, the trained female rats showed increased PARP expression, and the 2VO-trained rats of both sexes presented increased GFAP levels in Western blot. Training, mainly in males, induced an increase in the number of astrocytes in the CA1 subfield. The 2VO rats presented branched astrocytes, while acrobatic training prevented branching. However, the 2VO-induced spatial memory impairment was partially prevented by the acrobatic training.

Conclusion

Acrobatic training restricted the astrocytic remodeling caused by 2VO in the CA1 and CA3 subfields of the hippocampus. The improvement in spatial memory was associated with more organized glial scarring in the trained rats and better cell viability observed in females.

Physical activity patterns and cognitive function in elderly women: a cross-sectional study from NHANES 2011-2014

Background

Amid the backdrop of global aging, the increasing prevalence of cognitive decline among the elderly, particularly within the female demographic, represents a considerable public health concern. Physical activity (PA) is recognized as an effective non-pharmacological intervention for mitigating cognitive decline in older adults. However, the relationship between different PA patterns and cognitive function (CF) in elderly women remains unclear.

Methods

This study utilized data from National Health and Nutrition Examination Survey (NHANES) 2011-2014 to investigate the relationships between PA, PA patterns [inactive, Weekend Warrior (WW), and Regular Exercise (RE)], and PA intensity with CF in elderly women. Multivariate regression analysis served as the primary analytical method.

Results

There was a significant positive correlation between PA and CF among elderly women (β-PA: 0.003, 95% CI: 0.000-0.006, P = 0.03143). Additionally, WW and RE activity patterns were associated with markedly better cognitive performance compared to the inactive group (β-WW: 0.451, 95% CI: 0.216-0.685, P = 0.00017; β-RE: 0.153, 95% CI: 0.085-0.221, P = 0.00001). Furthermore, our results indicate a progressive increase in CF with increasing PA intensity (β-MPA- dominated: 0.16, 95% CI: 0.02-0.09, P = 0.0208; β-VPA-dominated: 0.21, 95% CI: 0.09-0.34, P = 0.0011; β-Total VPA: 0.31, 95% CI: -0.01-0.63, P = 0.0566).

Conclusion

Our study confirms a positive association between PA and CF in elderly women, with even intermittent but intensive PA models like WW being correlated with improved CF. These findings underscore the significant role that varying intensities and patterns of PA play in promoting cognitive health among older age groups, highlighting the need for adaptable PA strategies in public health initiatives targeting this population.

Regional brain aging: premature aging of the domain general system predicts aphasia severity

Premature brain aging is associated with poorer cognitive reserve and lower resilience to injury. When there are focal brain lesions, brain regions may age at different rates within the same individual. Therefore, we hypothesize that reduced gray matter volume within specific brain systems commonly associated with language recovery may be important for long-term aphasia severity. Here we show that individuals with stroke aphasia have a premature brain aging in intact regions of the lesioned hemisphere. In left domain-general regions, premature brain aging, gray matter volume, lesion volume and age were all significant predictors of aphasia severity. Increased brain age following a stroke is driven by the lesioned hemisphere. The relationship between brain age in left domain-general regions and aphasia severity suggests that degradation is possible to specific brain regions and isolated aging matters for behavior.

Towards new perspectives: A scoping review and meta-synthesis to redefine brain health for multiple sclerosis

BACKGROUND AND PURPOSE

Research promoting the health of the brain has increased exponentially over the last decade. The importance of 'brain health' for multiple sclerosis (MS), as one example, is a high priority. However, as research into the concept increases, so does varied use of the term.

METHODS

A scoping review, guided by the methodological framework of the Joanna Briggs Institute, was conducted to collate the evidence relating to brain health for MS. A comprehensive literature search incorporated six search strategies to retrieve both scientific and grey literature sources. All evidence sources were qualitatively charted and synthesized (meta-synthesis) according to their definition of brain health used, outcome measures and brain-healthy lifestyle elements.

RESULTS

Seventy evidence sources (34 peer reviewed, 36 grey literature) were eligible for inclusion. Of these, just over half (n = 40, 57%) provided a definition of brain health. The most common definition alluded to the biomedical model of neurological reserve (n = 22, 55%), a self-remodelling theory described to retain optimal brain function. Twenty-nine outcome measures of brain health were identified, the most frequent being magnetic resonance imaging metrics (n = 25, 83%). Physical activity was the most prevalent brain-healthy lifestyle element (n = 44), followed by avoidance of smoking (n = 26) and diet (n = 24).

CONCLUSIONS

Brain health should be considered a primary target for optimal disease and lifestyle management across the MS disease course. A working definition reflecting a shift from a medical lens towards broader biopsychosocial contexts that may influence brain health for people living with MS is proposed.

The effect of physical exercise intervention on the ability of daily living in patients with Alzheimer's dementia: a meta-analysis

Objective

To systematically evaluate the effect of physical exercise intervention on the activities of daily living (ADL) on patients with Alzheimer's dementia (AD) and explore the optimal exercise scheme.

Methods

PubMed, EMBASE, the Cochrane Library, Web of Science, and Science Direct databases were searched from 1987 to December 2023 to collect randomized controlled trials (RCTs). Two investigators independently screened the literature and extracted data according to the inclusion and exclusion criteria. The quality of the included studies was evaluated using Cochrane Review Manager 5.3. And STATA 16.0 was used for performing the meta-analysis.

Results

Fifteen randomized controlled trials were included. The results of the meta-analysis showed that physical exercise had a positive effect on the improvement of ADL in patients with AD [standardized mean difference (SMD) = 0.312, 95% confidence interval (CI 0.039-0.585), P = 0.02], and the difference was statistically significant. The results of subgroup analysis showed that anaerobic exercises such as strength and balance training with a medium cycle of 12-16 weeks and lasting 30-45 min each time were more ideal for the improvement of basic daily living ability of AD patients.

Conclusion

Physical exercise can effectively improve activities of daily living in patients with Alzheimer's dementia and it may be a potential non-drug treatment for AD patients.

Randomized controlled trials of non-pharmacological interventions for healthy seniors: Effects on cognitive decline, brain plasticity and activities of daily living-A 23-year scoping review

Little is known about the simultaneous effects of non-pharmacological interventions (NPI) on healthy older adults' behavior and brain plasticity, as measured by psychometric instruments and magnetic resonance imaging (MRI). The purpose of this scoping review was to compile an extensive list of randomized controlled trials published from January 1, 2000, to August 31, 2023, of NPI for mitigating and countervailing age-related physical and cognitive decline and associated cerebral degeneration in healthy elderly populations with a mean age of 55 and over. After inventorying the NPI that met our criteria, we divided them into six classes: single-domain cognitive, multi-domain cognitive, physical aerobic, physical non-aerobic, combined cognitive and physical aerobic, and combined cognitive and physical non-aerobic. The ultimate purpose of these NPI was to enhance individual autonomy and well-being by bolstering functional capacity that might transfer to activities of daily living. The insights from this study can be a starting point for new research and inform social, public health, and economic policies. The PRISMA extension for scoping reviews (PRISMA-ScR) checklist served as the framework for this scoping review, which includes 70 studies. Results indicate that medium- and long-term interventions combining non-aerobic physical exercise and multi-domain cognitive interventions best stimulate neuroplasticity and protect against age-related decline and that outcomes may transfer to activities of daily living.

The Role of Physical Activity in Adjunctive Nursing Management of Neuro-Degenerative Diseases among Older Adults: A Systematic Review of Interventional Studies

Neurodegenerative diseases such as dementia and Parkinson's disease pose significant challenges to older adults globally. While pharmacological treatments remain primary, increasing evidence supports the role of non-pharmacological strategies like physical activity in managing these conditions. This systematic review critically evaluates the effectiveness of Nursing based physical activity interventions in improving cognitive function, physical functioning, mobility, and overall quality of life among older adults with neurodegenerative diseases. We conducted a comprehensive search across PubMed, EMBASE, Web of Science, CENTRAL, and other relevant databases, focusing on randomized controlled trials and observational studies that examined the impact of structured physical activity. Our findings from nineteen studies involving 1673 participants indicate that interventions ranging from aerobic exercises, resistance training, to mind-body exercises like Tai Chi and yoga have beneficial effects. Specifically, physical activity was consistently found to enhance cognitive performance, increase mobility, and improve balance and daily living activities, contributing to a better quality of life. However, these benefits vary depending on the type, intensity, and duration of the activity performed. Despite promising results, limitations such as small sample sizes, study heterogeneity, and short-term follow-up periods call for more robust, long-term studies to solidify these findings. This review underscores the potential of tailored physical activity programs as adjunctive therapy in the comprehensive management of neurodegenerative diseases among the elderly population.

Interactions between physical exercise, associative memory, and genetic risk for Alzheimer's disease

The ε4 allele of the APOE gene heightens the risk of late onset Alzheimer's disease. ε4 carriers, may exhibit cognitive and neural changes early on. Given the known memory-enhancing effects of physical exercise, particularly through hippocampal plasticity via endocannabinoid signaling, here we aimed to test whether a single session of physical exercise may benefit memory and underlying neurophysiological processes in young ε3 carriers (ε3/ε4 heterozygotes, risk group) compared with a matched control group (homozygotes for ε3). Participants underwent fMRI while learning picture sequences, followed by cycling or rest before a memory test. Blood samples measured endocannabinoid levels. At the behavioral level, the risk group exhibited poorer associative memory performance, regardless of the exercising condition. At the brain level, the risk group showed increased medial temporal lobe activity during memory retrieval irrespective of exercise (suggesting neural compensatory effects even at baseline), whereas, in the control group, such increase was only detectable after physical exercise. Critically, an exercise-related endocannabinoid increase correlated with task-related hippocampal activation in the control group only. In conclusion, healthy young individuals carrying the ε4 allele may present suboptimal associative memory performance (when compared with homozygote ε3 carriers), together with reduced plasticity (and functional over-compensation) within medial temporal structures.

The Impact of Pandemic-Related Restrictions on Dementia Risk Factors in Older Adults

Adults aged 65+ are at highest risk for severe COVID-19 outcomes, and prior to the distribution of vaccines in the U.S., were strongly advised to quarantine at home to reduce risk of infection. This study examines how COVID-19 restrictions impacted various dementia risk factors and social determinants of health among older adults. Data came from the Systematic Multi-Domain Alzheimer's Risk Reduction Trial, a randomized controlled trial of a multi-domain intervention in higher-risk older adults (aged 70-89). A questionnaire was administered to participants (n = 156; 90.7% response rate) between May 2020 and March 2021. The data show a significant decline in social activity, physical activity, and mood among respondents. Compared to living with others, living alone was associated with worsened physical activity, diet, and subjective memory/thinking, adjusted for sex and age. These results suggest that the COVID-19 pandemic exacerbated several risk factors for dementia in older adults, particularly in those living alone.

A systematic review and meta-analysis of the effects of physical exercise on white matter integrity and cognitive function in older adults

In the context of a globally aging population, exploring interventions that counteract age-related cognitive decline and cerebral structural alterations is paramount. Among various strategies, physical exercise (PE) emerges as a prevalent activity routinely incorporated in many individuals' lives. This systematic review and meta-analysis aims to elucidate the impact of PE on white matter (WM) integrity and cognitive function in older adults. Data from 581 participants, 312 in the PE intervention group, and 269 in the control group were extracted from nine randomized controlled trials (RCTs) retrieved from databases including PubMed, Embase, Web of Science, and the Cochrane Library. The results indicated a significant improvement in white matter (WM) integrity in individuals engaged in PE, as evidenced by enhanced fractional anisotropy (FA) scores (SMD = 0.4, 95% confidence interval (CI) [0.05, 0.75], P = 0.024). The GRADE assessment revealed a moderate risk. However, no significant associations were found between PE and other metrics such as radial diffusivity (RD), mean diffusivity (MD), white matter volume (WMV), hippocampal volume (HV), and cognitive functions (executive function [EF], memory, processing speed). In conclusion, our study emphasizes the potential neurostructural and cognitive functional benefits of physical exercise for the brain health of older adults.

Neurovascular coupling impairment as a mechanism for cognitive deficits in COVID-19

Components that comprise our brain parenchymal and cerebrovascular structures provide a homeostatic environment for proper neuronal function to ensure normal cognition. Cerebral insults (e.g. ischaemia, microbleeds and infection) alter cellular structures and physiologic processes within the neurovascular unit and contribute to cognitive dysfunction. COVID-19 has posed significant complications during acute and convalescent stages in multiple organ systems, including the brain. Cognitive impairment is a prevalent complication in COVID-19 patients, irrespective of severity of acute SARS-CoV-2 infection. Moreover, overwhelming evidence from in vitro, preclinical and clinical studies has reported SARS-CoV-2-induced pathologies in components of the neurovascular unit that are associated with cognitive impairment. Neurovascular unit disruption alters the neurovascular coupling response, a critical mechanism that regulates cerebromicrovascular blood flow to meet the energetic demands of locally active neurons. Normal cognitive processing is achieved through the neurovascular coupling response and involves the coordinated action of brain parenchymal cells (i.e. neurons and glia) and cerebrovascular cell types (i.e. endothelia, smooth muscle cells and pericytes). However, current work on COVID-19-induced cognitive impairment has yet to investigate disruption of neurovascular coupling as a causal factor. Hence, in this review, we aim to describe SARS-CoV-2's effects on the neurovascular unit and how they can impact neurovascular coupling and contribute to cognitive decline in acute and convalescent stages of the disease. Additionally, we explore potential therapeutic interventions to mitigate COVID-19-induced cognitive impairment. Given the great impact of cognitive impairment associated with COVID-19 on both individuals and public health, the necessity for a coordinated effort from fundamental scientific research to clinical application becomes imperative. This integrated endeavour is crucial for mitigating the cognitive deficits induced by COVID-19 and its subsequent burden in this especially vulnerable population.

A review: effects of neurofeedback on patients with mild cognitive impairment (MCI), and Alzheimer's disease (AD)

Neurofeedback training (NFT) is a non-invasive method and has been shown to be effective for attention deficit/hyperactivity disorder (ADHD) and various psychiatric disorders. The aim of this paper is to evaluate the effectiveness of NFT for patients with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) or Vascular Diseases (VD), so that we searched research articles from four databases, using the keywords neurofeedback, elderly, MCI, AD, VD, and dementia. As a result, 13 articles were identified regarding the effectiveness of NFT in patients with MCI and AD. Although each study differed in study design, training protocol, electroencephalogram (EEG) electrode placement, and reward and inhibition frequency bands, all were shown to enhance memory, attention, and other cognitive abilities. Additional well-designed, randomized studies with sufficient power are needed to further confirm the effectiveness of NFT.

Trajectories of quality of life and cognition in different multimorbidity patterns: Evidence from SHARE

OBJECTIVES

The study aimed to observe the trajectory of quality of life (QoL) and cognition, and to a analyze the bidirectional association between cognition and QoL for diverse multimorbidity patterns.

METHODS

In total, 16,153 older participants age ≥50 years were included from the Survey of Health, Ageing and Retirement in Europe (SHARE). We used latent class analysis (LCA) to identify multimorbidity patterns in the baseline population. We used linear mixed models (LMM) to examine the trajectory of cognition and QoL in different multimorbidity patterns. A cross-lagged model was employed to analyze the bidirectional association between cognition and QoL in diverse multimorbidity patterns.

RESULTS

Latent class analysis identified four multimorbidity patterns: high and low comorbidity burden (HC and LC), cardiometabolic (CA), and osteoarthrosis (OS). The HC group had the poorest cognitive function and QoL (p for trend < 0.001). Delayed and immediate episodic memory in the OS group declined at a highest rate (p for trend < 0.001). Additionally, a bidirectional association between cognition and QoL was observed. The effect of cognitive function on QoL was relatively stronger than the reverse in the CA and LC groups.

CONCLUSIONS

The rate of decline in cognition and QoL over the time differs in diverse multimorbidity patterns, and patients with four or more chronic diseases should be specially considered. Notably, early monitoring of cognitive function and can help break the vicious cycle between cognitive deterioration and poor QoL in patients with OS or CA diseases.

Frontotemporal disorders: the expansive panoply of syndromes and spectrum of etiologies

Background

Frontotemporal lobe disorders (FTD) are amongst the most common brain neurodegenerative disorders. Their relatively covert, frequently subtle presentations and diverse etiologies, pose major challenges in diagnosis and treatments. Recent studies have yielded insights that the etiology in the majority are due to environmental and sporadic causes, rather than genetic in origin.

Aims

To retrospectively examine the cognitive and behavioral impairments in the veteran population to garner the range of differing syndrome presentations and etiological subcategories with a specific focus on frontotemporal lobe disorders.

Methodology

The design is a retrospective, observational registry, case series with the collection of epidemiological, clinical, cognitive, laboratory and radiological data on people with cognitive and behavioral disorders. Inclusion criteria for entry were veterans evaluated exclusively at Orlando VA Healthcare System, neurology section, receiving a diagnosis of FTD by standard criteria, during the observation period dated from July 2016 to March 2021. Frontotemporal disorders (FTD) were delineated into five clinical 5 subtypes. Demographic, cardiovascular risk factors, cognitive, behavioral neurological, neuroimaging data and presumed etiological categories, were collected for those with a diagnosis of frontotemporal disorder.

Results

Of the 200 patients with FTD, further cognitive, behavioral neurological evaluation with standardized, metric testing was possible in 105 patients. Analysis of the etiological groups revealed significantly different younger age of the traumatic brain injury (TBI) and Gulf War Illness (GWI) veterans who also had higher Montreal Cognitive Assessment (MOCA) scores. The TBI group also had significantly more abnormalities of hypometabolism, noted on the PET brain scans. Behavioral neurological testing was notable for the findings that once a frontotemporal disorder had been diagnosed, the four different etiological groups consistently had abnormal FRSBE scores for the 3 principal frontal presentations of (i) abulia/apathy, (ii) disinhibition, and (iii) executive dysfunction as well as abnormal Frontal Behavioral Inventory (FBI) scores with no significant difference amongst the etiological groups. The most common sub-syndromes associated with frontotemporal syndromes were the Geschwind-Gastaut syndrome (GGS), Klüver-Bucy syndrome (KBS), involuntary emotional expression disorder (IEED), cerebellar cognitive affective syndrome (CCA), traumatic encephalopathy syndrome (TES) and prosopagnosia. Comparisons with the three principal frontal lobe syndrome clusters (abulia, disinhibition, executive dysfunction) revealed a significant association with abnormal disinhibition FRSBE T-scores with the GGS. The regression analysis supported the potential contribution of disinhibition behavior that related to this complex, relatively common behavioral syndrome in this series. The less common subsyndromes in particular, were notable, as they constituted the initial overriding, presenting symptoms and syndromes characterized into 16 separate conditions.

Conclusion

By deconstructing FTD into the multiple sub-syndromes and differing etiologies, this study may provide foundational insights, enabling a more targeted precision medicine approach for future studies, both in treating the sub-syndromes as well as the underlying etiological process.