Effects of a Multidomain Lifestyle Modification on Cognitive Function in Older Adults: An Eighteen-Month Community-Based Cluster Randomized Controlled Trial

Lee, Kang Soo; Lee, Yunhwan; Back, Joung Hwan; Son, Sang Joon; Choi, Seong Hye; Chung, Young-Ki; Lim, Ki Young; Noh, Jai Sung; Koh, Sung Hye; Oh, Byoung Hoon; Hong, Chang Hyung

doi:10.1159/000360820

Cited by 38 publications

(60 citation statements)

References 37 publications

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“…Taken together with the fact that WMH progression can be slowed down and possibly even prevented through anti-hypertensive mediations and lifestyle changes [43], this is an important finding, raising the possibility for intervention before irreversible neurological damage occurs. This is also in line with the studies showing that reduction of vascular disease risk and WMHs decreases the risk of cognitive deterioration [18][19][20][21][22][23][24].…”

Section: Resultssupporting

confidence: 90%

“…Another contributing link belongs to risk factors that are associated with WMHs and cognitive decline including hypertension, high systolic and diastolic blood pressure, hypercholesterolaemia, diabetes, obesity, high glucose levels, and smoking [2,9]. These risk factors are particularly important since they are † Abbreviations: Aβ : Amyloid beta; AD: Alzheimer's disease; ADAS13: Alzheimer's Disease Assessment Scale-13; CSF: Cerebrospinal fluid; DBM: Deformation-based morphometry; FLAIR: Fluid attenuated inversion recovery; GM: Grey matter; MCI; Mild cognitive impairment; MRI: Magnetic resonance imaging; NA: normal aging; T2w: T2-weighted; WM: White matter; WMH: White matter hyperintensities amenable to prevention and treatment [9] and their reduction might impede WMH progression and cognitive deterioration [18][19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

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The Temporal Relationships between White Matter Hyperintensities, Neurodegeneration, Amyloid β, and Cognition

Dadar

Camicioli

Duchesne

et al. 2020

Preprint

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INTRODUCTION:Cognitive decline in Alzheimer's disease is associated with amyloid-β accumulation, neurodegeneration and cerebral small vessel disease, but the temporal relationships between these factors is not well established. METHODS:Data included white matter hyperintensity (WMH) load, grey matter (GM) atrophy and Alzheimer's Disease Assessment Scale-Cognitive-Plus (ADAS13) scores for 720 participants and cerebrospinal fluid amyloid (Aβ1-42) for 461 participants from the Alzheimer's Disease Neuroimaging Initiative. Linear regressions were used to assess the relationships between baseline WMH, GM, and Aβ1-42 to changes in WMH, GM, Aβ1-42, and cognition at one-year follow-up. RESULTS: Baseline WMHs and Aβ1-42 predicted WMH increase and GM atrophy. Baseline WMHs, GM, and Aβ1-42 predicted worsening cognition. Only baseline Aβ1-42 predicted change in Aβ1-42. DISCUSSION: Baseline WMHs lead to greater future GM atrophy and cognitive decline, suggesting that WM damage precedes neurodegeneration and cognitive decline. Baseline Aβ1-42 predicted WMH increase, suggesting a potential role of amyloid in WM damage. Keywords: White matter hyperintensities, small-vessel disease, neurodegenerative disease, Alzheimer's disease, mild cognitive impairment Research in Context 1. Systematic Review: Both amyloid β and neurodegeneration are primary pathologies in Alzheimer's disease. White matter hyperintensities (indicative of presence of cerebrovascular disease) might also be part of the pathological changes in Alzheimer's. However, the temporal relationship between white matter hyperintensities, amyloid β, neurodegeneration, and cognitive decline is still unclear. Interpretation:Our results establish a potential temporal order between white matter hyperintensities, amyloid β, neurodegeneration, and cognitive decline, showing that white matter hyperintensities precede neurodegeneration and cognitive decline. The results provide some evidence that amyloid β deposition, in turn, precedes accumulation of white matter hyperintensities. Future Directions:The current findings reinforce the need for future longitudinal investigations of the mechanisms through which white matter hyperintensities impact the aging population in general and Alzheimer's disease patients, in particular.

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Section: Resultssupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

The Temporal Relationships between White Matter Hyperintensities, Neurodegeneration, Amyloid β, and Cognition

Dadar

Camicioli

Duchesne

et al. 2020

Preprint

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“…However, many studies have examined potential relationships between physical activity and cognitive function [24-28]. Hamer and Chida [26] identified 16 prospective studies that investigated the proposed inverse association between physical activity and cognitive decline.…”

Section: Discussionmentioning

confidence: 99%

Physical Activity and Cognitive Function among Older Adults with an Elevated Gamma Gap

Frith¹,

Loprinzi²

2018

Med Princ Pract

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Objective: An elevated gamma gap is indicative of high serum concentrations of globulin proteins, some of which elicit acute inflammatory responses. An impaired cognitive function has been linked to central and peripheral inflammation, while exercise is associated with protective, anti-inflammatory benefits. In this study, we evaluated whether the gamma gap is associated with cognitive function among older adults and whether physical activity is favorably associated with cognitive function among those with an elevated gamma gap. Materials and Methods: Data from the 1999–2002 National Health and Nutrition Examination Survey (NHANES) were used to identify 2,352 older adults aged between 60 and 85 years. The gamma gap was evaluated by subtracting albumin from total protein, i.e., gamma gap = total protein (g/dL) – albumin (g/dL). Those at or above 3.1 g/dL (31.0 g/L) were considered to have an elevated gamma gap. The Digit Symbol Substitution Test (DSST) was used to assess cognitive function tasks of pairing and free recall among participants. Participants were asked open-ended questions about participation in leisure-time physical activity over the previous 30 days. Results: Those with an elevated gamma gap (DSST, 44.8) had a lower cognitive function score when compared to those without an elevated gamma gap (DSST, 50.1) (p < 0.001). After adjustments, and among those with an elevated gamma gap, those meeting the moderate-to-vigorous intensity physical activity (MVPA) guidelines (vs. not meeting them) had a DSST score of 6.42 units higher (β = 6.42, 95% CI 3.85–8.99, p < 0.001). Conclusion: In this national sample of older adults, the gamma gap was associated with cognitive function, and among those with an elevated gamma gap, meeting the physical activity guidelines was associated with a higher cognitive function. Relevant clinical implications are discussed, as the gamma gap may be predictive of the risk for early mortality and reduced quality of life. Experimental work is needed to investigate whether physical activity training programs are effective in reducing an elevated gamma gap and preserving optimal cognitive functioning among at-risk individuals.

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“…Full texts of 27 studies 191 were independently assessed by two reviewers and 12 were excluded ( Figure 1). Fifteen RCTs 192 met the inclusion criteria [16,17,[22][23][24][25][26][27][28][29][30][31][32][33][34] as shown in Table 1. 193 194 Most trials (n = 7) were conducted in Europe (Spain, Netherlands, Germany, Italy and Finland), 195 followed by Australia (n = 3), USA (n = 3), Canada (n = 1) and Korea (n = 1).…”

mentioning

confidence: 99%

Interventions involving a major dietary component improve cognitive function in cognitively healthy adults: a systematic review and meta-analysis

et al. 2019

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47Accumulating evidence suggests a role for diet in promoting brain health. The purpose of this 48 systematic review was to (i) quantitatively assess whether interventions with a major dietary 49 component can enhance cognition in cognitively healthy adults, and, (ii) identify responsive 50 domains of cognition to inform the design of future dietary trials. Electronic databases were 51 systematically searched to find eligible randomized controlled trials that assessed the effect of 52 interventions with a major dietary component on cognitive function or incident dementia, in 53 adults without known cognitive impairment. Standardized mean differences (SMD) (95% 54 confidence Interval [CI]) were combined using a random-effects meta-analysis and tests of 55 homogeneity of variance were calculated. Two trials reported dementia outcomes and were 56 qualitatively described. Fifteen trials encompassing 6,480 participants were eligible for meta-57 analysis. Compared to control, intervention improved performance on measures of global 58 cognition (SMD=0.14; 95% CI 0.01 to 0.27, P=0.05; I 2 76%), executive function (SMD=0.11; 5995% CI 0.04 to 0.18, P=0.003; I 2 0%) and processing speed (SMD=0.12; 95% CI 0.05 to 0.19, 60 P=0.001; I 2 0%). There was no effect of intervention on delayed memory (SMD=0.04; 95% CI -61 0.02 to 0.09, P=0.18; I 2 4%). Significant heterogeneity and funnel plot asymmetry were detected 62 for global cognition but removal of studies with high risk of bias did not change the pooled 63 findings. Current evidence is limited but indicates that diverse interventions improve non-64 memory cognitive functions during normal cognitive aging. Measures of executive function and 65 processing speed should be considered as feasible end-points in future dietary intervention trials. 66 67

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Effects of a Multidomain Lifestyle Modification on Cognitive Function in Older Adults: An Eighteen-Month Community-Based Cluster Randomized Controlled Trial

Cited by 38 publications

References 37 publications

The Temporal Relationships between White Matter Hyperintensities, Neurodegeneration, Amyloid β, and Cognition

The Temporal Relationships between White Matter Hyperintensities, Neurodegeneration, Amyloid β, and Cognition

Physical Activity and Cognitive Function among Older Adults with an Elevated Gamma Gap

Interventions involving a major dietary component improve cognitive function in cognitively healthy adults: a systematic review and meta-analysis

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