Long-term Impact of Behavioral Weight Loss Intervention on Cognitive Function

Espeland, Mark A.; Rapp, Stéphen R.; Bray, George A.; Houston, Denise K.; Johnson, Karen C.; Kitabchi, Abbas E.; Hergenroeder, Andrea L.; Williamson, Jeff D.; Jakicic, John M.; Dorsten, Brent Van; Kritchevsky, Stephen B.; Subgroup, Memory

doi:10.1093/gerona/glu031

Cited by 70 publications

(93 citation statements)

References 38 publications

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“…These results were consistent with our earlier findings that the intensive lifestyle intervention improved physical functioning and mobility(27), but not with the lack of effect we have reported for cognitive function (29). ILI participants had more weight loss and better fitness, which might contribute to higher preference scores in the mobility and ambulation domains (27, 30).…”

Section: Discussionsupporting

confidence: 92%

Impact of intensive lifestyle intervention on preference‐based quality of life in type 2 diabetes: Results from the Look AHEAD trial

Zhang

Hire

Espeland

et al. 2016

Obesity

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Objective To assess the effect of an intensive lifestyle intervention (ILI) compared with standard diabetes support and education (DSE) on preference-based health-related quality of life (HRQOL) in persons with overweight or obesity and type 2 diabetes. Methods Look AHEAD was a multisite, randomized trial of 5145 participants assigned to ILI or DSE. Four instruments were administered during the trial: Feeling Thermometer (FT), Health Utilities Index Mark 2 (HUI2), Health Utilities Index Mark 3 (HUI3), and Short Form 6D (SF-6D). Linear mixed effect models were used to estimate the mean difference in preference scores by treatment group over 9 years. Results The ILI had higher mean FT (0.019, 95% CI, 0.015 to 0.024, p<0.001) and SF-6D (0.011, 95% CI, 0.006 to 0.014, p<0.001) scores than the DSE. No significant group-differences were observed for the HUI2 (0.004, 95% CI, -0.003 to 0.010, p=0.23) and HUI3 (0.004, -0.004 to 0.012, p=0.36). In year one, the ILI had higher mean preference scores for all instruments. Thereafter, the increases remained significant only for FT and SF-6D and the effects also become smaller. Conclusions ILI aimed at reducing bodyweight among persons with overweight or obesity and type 2 diabetes improves preference-based HRQOL in the short term, but its long-term effect is unclear.

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Section: Discussionsupporting

confidence: 92%

Impact of intensive lifestyle intervention on preference‐based quality of life in type 2 diabetes: Results from the Look AHEAD trial

Zhang

Hire

Espeland

et al. 2016

Obesity

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“…16 We found no significant differences between intervention groups on measures of global cognitive function, verbal memory, attention, executive function, or processing speed.…”

Section: Resultsmentioning

confidence: 53%

“…16 In that prior report, tests of interaction to compare the relative intervention effects among overweight and heavier participants at enrollment reached nominal levels of statistical significance for processing speed (p 5 0.03) and a composite formed by averaging scores across the cognitive battery (p 5 0.05). The associations for 3MSE we now describe in the full Look AHEAD cohort are consistent with this interaction.…”

Section: Resultsmentioning

confidence: 92%

“…15 Its lifestyle intervention did not improve overall cognitive function over 8 years of follow-up. 16 However, an ancillary study found that the intervention was associated with better measures of brain structure (i.e., less evidence of cerebrovascular disease and brain atrophy). 17 Here we report findings from a standardized assessment of mild cognitive impairment (MCI) and probable dementia after 10-13 years of follow-up.…”

mentioning

confidence: 99%

“…The cognitive battery (supplemental data at Neurology.org) measured attention, concentration, verbal learning and memory, working memory, other executive function abilities, and processing speed. 16 We used the 100-point Modified Mini-Mental State Examination (3MSE) to assess global cognitive functioning, with higher scores reflecting better performance. 22 Adjudication of cognitive impairment.…”

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confidence: 99%

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Effect of a long-term intensive lifestyle intervention on prevalence of cognitive impairment

Espeland¹,

Luchsinger²,

Baker³

et al. 2017

Neurology

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Objective: To assess whether an average of 10 years of lifestyle intervention designed to reduce weight and increase physical activity lowers the prevalence of cognitive impairment among adults at increased risk due to type 2 diabetes and obesity or overweight.Methods: Central adjudication of mild cognitive impairment and probable dementia was based on standardized cognitive test battery scores administered to 3,802 individuals who had been randomly assigned, with equal probability, to either the lifestyle intervention or the diabetes support and education control. When scores fell below a prespecified threshold, functional information was obtained through proxy interview.Results: Compared with control, the intensive lifestyle intervention induced and maintained marked differences in weight loss and self-reported physical activity throughout follow-up. At an average (range) of 11.4 (9.5-13.5) years after enrollment, when participants' mean age was 69.6 (54.9-87.2) years, the prevalence of mild cognitive impairment and probable dementia was 6.4% and 1.8%, respectively, in the intervention group, compared with 6.6% and 1.8%, respectively, in the control group (p 5 0.93). The lack of an intervention effect on the prevalence of cognitive impairment was consistent among individuals grouped by cardiovascular disease history, diabetes duration, sex, and APOE e4 allele status (all p $ 0.50). However, there was evidence (p 5 0.03) that the intervention effect ranged from benefit to harm across participants ordered from lowest to highest baseline BMI.Conclusions: Ten years of behavioral weight loss intervention did not result in an overall difference in the prevalence of cognitive impairment among overweight or obese adults with type 2 diabetes. Clinicaltrials.gov identifier: NCT00017953 (Action for Health in Diabetes).Level of evidence: This study provides Class II evidence that for overweight adults with type 2 diabetes, a lifestyle intervention designed to reduce weight and increase physical activity does not lower the risk of cognitive impairment. Neurology ® 2017;88:2026-2035 GLOSSARY 3MSE 5 Modified Mini-Mental State Examination; BMI 5 body mass index; DSE 5 diabetes support and education; FAQ 5 Functional Assessment Questionnaire; HbA1c 5 glycated hemoglobin; ILI 5 intensive lifestyle intervention; MCI 5 mild cognitive impairment; OR 5 odds ratio.

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Effect of a 24-Month Physical Activity Intervention vs Health Education on Cognitive Outcomes in Sedentary Older Adults

Sink

Espeland

Castro

et al. 2015

JAMA

333

258

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IMPORTANCE Epidemiological evidence suggests that physical activity benefits cognition, but results from randomized trials are limited and mixed.OBJECTIVE To determine whether a 24-month physical activity program results in better cognitive function, lower risk of mild cognitive impairment (MCI) or dementia, or both, compared with a health education program. DESIGN, SETTING, AND PARTICIPANTSA randomized clinical trial, the Lifestyle Interventions and Independence for Elders (LIFE) study, enrolled 1635 community-living participants at 8 US centers from February 2010 until December 2011. Participants were sedentary adults aged 70 to 89 years who were at risk for mobility disability but able to walk 400 m. INTERVENTIONS A structured, moderate-intensity physical activity program (n = 818) that included walking, resistance training, and flexibility exercises or a health education program (n = 817) of educational workshops and upper-extremity stretching. MAIN OUTCOMES AND MEASURES Prespecified secondary outcomes of the LIFE study included cognitive function measured by the Digit Symbol Coding (DSC) task subtest of the Wechsler Adult Intelligence Scale (score range: 0-133; higher scores indicate better function) and the revised Hopkins Verbal Learning Test (HVLT-R; 12-item word list recall task) assessed in 1476 participants (90.3%). Tertiary outcomes included global and executive cognitive function and incident MCI or dementia at 24 months.RESULTS At 24 months, DSC task and HVLT-R scores (adjusted for clinic site, sex, and baseline values) were not different between groups. The mean DSC task scores were 46.26 points for the physical activity group vs 46.28 for the health education group (mean difference, −0.01 points [95% CI, −0.80 to 0.77 points], P = .97). The mean HVLT-R delayed recall scores were 7.22 for the physical activity group vs 7.25 for the health education group (mean difference, −0.03 words [95% CI, −0.29 to 0.24 words], P = .84). No differences for any other cognitive or composite measures were observed. Participants in the physical activity group who were 80 years or older (n = 307) and those with poorer baseline physical performance (n = 328) had better changes in executive function composite scores compared with the health education group (P = .01 for interaction for both comparisons). Incident MCI or dementia occurred in 98 participants (13.2%) in the physical activity group and 91 participants (12.1%) in the health education group (odds ratio, 1.08 [95% CI, 0.80 to 1.46]).CONCLUSIONS AND RELEVANCE Among sedentary older adults, a 24-month moderate-intensity physical activity program compared with a health education program did not result in improvements in global or domain-specific cognitive function.

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Long-term Impact of Behavioral Weight Loss Intervention on Cognitive Function

Abstract: Eight years of intensive lifestyle intervention did not alter cognitive function in obese adults with type 2 diabetes; however, there was evidence for benefit among overweight but not obese individuals. Changes in cognition were not assessed in this cross-sectional study.

Cited by 70 publications

References 38 publications

Impact of intensive lifestyle intervention on preference‐based quality of life in type 2 diabetes: Results from the Look AHEAD trial

Impact of intensive lifestyle intervention on preference‐based quality of life in type 2 diabetes: Results from the Look AHEAD trial

Effect of a long-term intensive lifestyle intervention on prevalence of cognitive impairment

Effect of a 24-Month Physical Activity Intervention vs Health Education on Cognitive Outcomes in Sedentary Older Adults

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