Florindo Stella

Benefits of physical exercise on executive functions in older people with Parkinson's disease

The benefits of physical exercise on cognitive functioning have been reported in the literature, but the potential benefits to slow the eventual decline in executive functioning (EF) caused by neurodegeneration from Parkinsons Disease (PD) have rarely been studied. Thus the objective of this study was to analyze the effects of a multimodal physical exercise program on EF in older people with Parkinsons disease. The EF of the older people was evaluated by neuropsychological testing, and for confounding variables such as attention, depressive symptoms and anxiety, before and after intervention. The 20 participants were assigned into Control (CG) and Trained (TG) Groups. The TG participated in generalized physical training for 6 months. The ANOVA showed a significant interaction (p<.05) that indicated a beneficial contribution of training on EF. No significant interactions were found in the results for confounding variables between groups and pre- and post-intervention, which supports the beneficial findings of physical exercise training on EF.

The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia

BACKGROUND Neuropsychiatric symptoms (NPS) affect almost all patients with dementia and are a major focus of study and treatment. Accurate assessment of NPS through valid, sensitive and reliable measures is crucial. Although current NPS measures have many strengths, they also have some limitations (e.g. acquisition of data is limited to informants or caregivers as respondents, limited depth of items specific to moderate dementia). Therefore, we developed a revised version of the NPI, known as the NPI-C. The NPI-C includes expanded domains and items, and a clinician-rating methodology. This study evaluated the reliability and convergent validity of the NPI-C at ten international sites (seven languages). METHODS Face validity for 78 new items was obtained through a Delphi panel. A total of 128 dyads (caregivers/patients) from three severity categories of dementia (mild = 58, moderate = 49, severe = 21) were interviewed separately by two trained raters using two rating methods: the original NPI interview and a clinician-rated method. Rater 1 also administered four additional, established measures: the Apathy Evaluation Scale, the Brief Psychiatric Rating Scale, the Cohen-Mansfield Agitation Index, and the Cornell Scale for Depression in Dementia. Intraclass correlations were used to determine inter-rater reliability. Pearson correlations between the four relevant NPI-C domains and their corresponding outside measures were used for convergent validity. RESULTS Inter-rater reliability was strong for most items. Convergent validity was moderate (apathy and agitation) to strong (hallucinations and delusions; agitation and aberrant vocalization; and depression) for clinician ratings in NPI-C domains. CONCLUSION Overall, the NPI-C shows promise as a versatile tool which can accurately measure NPS and which uses a uniform scale system to facilitate data comparisons across studies.

Exercise programs improve mobility and balance in people with Parkinson's disease

Compromised balance and loss of mobility are among the major consequences of Parkinsons disease (PD). The literature documents numerous effective interventions for improving balance and mobility. The purpose of this study was to verify the effectiveness of two exercise programs on balance and mobility in people with idiopathic PD. Thirty-four participants, with idiopathic PD that ranged from Stage I to Stage III on the Hoehn & Yahr (H&Y) scale, were assigned to two groups. Group 1 (n = 21; 67+/-9 years old) was engaged in an intensive exercise program (aerobic capacity, flexibility, strength, motor coordination and balance) for 6 months: 72 sessions, 3 times a week, 60 minutes per session; while Group 2 (n = 13; 69+/-8 years old) participated in an adaptive program (flexibility, strength, motor coordination and balance) for 6 months: 24 sessions, once a week, 60 minutes per session. Balance and basic functional mobility were assessed in pre- and post-tests by means of the Berg Balance Scale and the Timed Up and Go Test. Before and after the interventions, groups were similar in clinical conditions (H&Y, UPDRS, and Mini-Mental). A MANOVA 2 (programs) by 2 (moments) revealed that both groups were affected by the exercise intervention. Univariate analyses showed that participants improved their mobility and balance from pre- to post-test. There were no differences between groups in either mobility or balance results. Both the intensive and adaptive exercise programs improved balance and mobility in patients with PD.

Efeitos de um programa de atividade física nas funções cognitivas, equilíbrio e risco de quedas em idosos com demência de Alzheimer

OBJECTIVE: To analyze the effects of regular, systematic and supervised activity on the cognitive functions, balance and risk of falls of elderly patients with Alzheimers Dementia (AD). METHODS: Sixteen elderly patients (mean age 78.5±6.8 years) were divided into two groups: intervention group (IG; n=9) and routine group (RG; n=7). The IG exercised systematically for six months, and both groups were submitted to the following tests: Mini-Mental State Examination (MMSE), Berg Balance Scale (BBS), Timed Up-and-Go (TUG) and the agility/dynamic balance (AGIBAL) item of the American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD) test battery. RESULTS: There was a statistically significant interaction (two-way ANOVA; F1,14=32.07; p=0.01) between groups and moments for the AGIBAL. The Mann Whitney U test indicated significant differences between groups (p=0.03), only at the post-intervention moment for the TUG measured in steps and for BBS. Therefore, no significant intergroup differences were found for the TUG, BBS and MMSE at the pre-intervention moment or at post-intervention moment for the TUG measured in seconds and MMSE. The intragroup analysis by means of the Wilcoxon test showed a significant decline in the TUG, BBS and MMSE for the RG, but not for the IG. Spearmans coefficient showed a significant correlation between the results of the MMSE and AGIBAL. CONCLUSIONS: Physical activity may be an important non-pharmacological approach that can benefit cognitive functions and balance and reduce the risk of falls. Moreover, agility and balance are associated with cognitive functions in elderly patients with AD.OBJECTIVE To analyze the effects of regular, systematic and supervised activity on the cognitive functions, balance and risk of falls of elderly patients with Alzheimers Dementia (AD). METHODS Sixteen elderly patients (mean age 78.5+/-6.8 years) were divided into two groups: intervention group (IG; n=9) and routine group (RG; n=7). The IG exercised systematically for six months, and both groups were submitted to the following tests: Mini-Mental State Examination (MMSE), Berg Balance Scale (BBS), Timed Up-and-Go (TUG) and the agility/dynamic balance (AGIBAL) item of the American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD) test battery. RESULTS There was a statistically significant interaction (two-way ANOVA; F1,14=32.07; p=0.01) between groups and moments for the AGIBAL. The Mann Whitney U test indicated significant differences between groups (p=0.03), only at the post-intervention moment for the TUG measured in steps and for BBS. Therefore, no significant intergroup differences were found for the TUG, BBS and MMSE at the pre-intervention moment or at post-intervention moment for the TUG measured in seconds and MMSE. The intragroup analysis by means of the Wilcoxon test showed a significant decline in the TUG, BBS and MMSE for the RG, but not for the IG. Spearmans coefficient showed a significant correlation between the results of the MMSE and AGIBAL. CONCLUSIONS Physical activity may be an important non-pharmacological approach that can benefit cognitive functions and balance and reduce the risk of falls. Moreover, agility and balance are associated with cognitive functions in elderly patients with AD.

A controlled clinical trial on the effects of motor intervention on balance and cognition in institutionalized elderly patients with dementia

Purpose: To analyse the effects of two interventions on the cognition and balance of institutionalized elderly people with mixed dementia. Methods: Fifty-four participants were allocated into three groups. Group 1 was assisted by an interdisciplinary programme comprising physiotherapy, occupational therapy and physical education. A physiotherapist alone carried out the intervention in group 2. Group 3 was considered as control. Assessors were blinded to guarantee the absence of bias. Cognitive functions were analysed with the Mini-Mental State Examination and the Brief Cognitive Screening Battery. Balance was assessed with the Berg Balance Scale and the Timed Get-Up-and-Go Test. Multiple analysis of variance (MANOVA) was used to test possible main effects of the interventions. Results: The results showed benefits on the balance of subjects in both groups 1 (F=3.9, P<0.05) and 2 (F=3.1, P<0.05), compared with group 3. MANOVA did not indicate benefits on the cognitive functions between groups 1 and 3 (F=1.1, P>0.05) and groups 2 and 3 (F=1.6, P>0.05). However, univariate analysis indicated some benefits of the interdisciplinary intervention on two specific domains measured by the Brief Cognitive Screening Battery (F=26.5, P<0.05; F=4.4, P<0.05). Conclusion: Six months of multidisciplinary or physiotherapeutic intervention were able to improve a persons balance. Although global cognition did not improve through treatment, when the intervention was carried out on a multidisciplinary basis we observed an attenuation in the decline of global cognition on two specific cognitive domains. Exercises applied in different contexts may have positive outcomes for people with dementia.

Neuropsychiatric symptoms in Alzheimer's disease are related to functional connectivity alterations in the salience network

Neuropsychiatric syndromes are highly prevalent in Alzheimers disease (AD), but their neurobiology is not completely understood. New methods in functional magnetic resonance imaging, such as intrinsic functional connectivity or “resting‐state” analysis, may help to clarify this issue. Using such approaches, alterations in the default‐mode and salience networks (SNs) have been described in Alzheimers, although their relationship with specific symptoms remains unclear. We therefore carried out resting‐state functional connectivity analysis with 20 patients with mild to moderate AD, and correlated their scores on neuropsychiatric inventory syndromes (apathy, hyperactivity, affective syndrome, and psychosis) with maps of connectivity in the default mode network and SN. In addition, we compared network connectivity in these patients with that in 17 healthy elderly control subjects. All analyses were controlled for gray matter density and other potential confounds. Alzheimers patients showed increased functional connectivity within the SN compared with controls (right anterior cingulate cortex and left medial frontal gyrus), along with reduced functional connectivity in the default‐mode network (bilateral precuneus). A correlation between increased connectivity in anterior cingulate cortex and right insula areas of the SN and hyperactivity syndrome (agitation, irritability, aberrant motor behavior, euphoria, and disinhibition) was found. These findings demonstrate an association between specific network changes in AD and particular neuropsychiatric symptom types. This underlines the potential clinical significance of resting state alterations in future diagnosis and therapy. Hum Brain Mapp 35:1237–1246, 2014.

Non-pharmacological interventions on cognitive functions in older people with mild cognitive impairment (MCI)

Mild cognitive impairment (MCI) can be a stage of pre-dementia. There is no consensus about pharmacological treatment for this population, so it is important to structure non-pharmacological interventions for increasing their cognitive reserve. We intended to analyze the effects of non-pharmacological interventions in the cognitive functions in older people with MC, in form of a systemic review. Data sources were the Web of Science, Biological Abstracts, Medline, Pub Med, EBSCHost, Scirus and Google Scholar. All studies were longitudinal trials, with MCI sample, aged>60 years, community-dwelling, and having cognitive functions as dependent variable. Seven studies, from 91 previously selected ones, were identified according to the inclusion criteria. Six studies used cognitive intervention, improving memory and one study used physical activity as intervention, improving executive functions. The results show evidence that physical activity and cognitive exercise may improve memory and executive functions in older people with MCI. But yet, more controlled studies are needed to establish a protocol of recommendations regarding the systemization of exercise, necessary to produce benefits in the cognitive functioning in older people with MCI.

Effects of obstacle height on obstacle crossing in mild Parkinson's disease.

The aim of this study was to compare the locomotor behavior of people with Parkinsons disease (PD) and healthy older adults during obstacle negotiation, both in the approaching and crossing phases. Twelve people with idiopathic PD, with mild to moderate disease, and 12 healthy individuals (CG) walked across an 8m pathway for three obstacle conditions: no obstacle, low obstacle and high obstacle. Each performed five trials for each obstacle condition. Performance was more disturbed for the high obstacle than the low obstacle. During the approach phase, people with PD demonstrated shorter stride length (F(1,22)=8.55, P=0.008) and greater stride duration (F(1,22)=7.371, P=0.013) than controls. Those with PD also increased their stance phase durations (F(1,22)=7.426, P=0.012) for both obstacle conditions, while the CG maintained comparable step durations for all conditions. For the crossing phase, people with PD demonstrated shorter step length (F(1,22)=9.699, P=0.005) over the obstacle. Leading limbs were closer to the obstacle, before and after crossing. Thus PD hypokinesia compromises the approach and crossing phases of obstacle negotiation.

RISCO DE QUEDAS EM IDOSOS COM DOENÇA DE PARKINSON E DEMÊNCIA DE ALZHEIMER: UM ESTUDO TRANSVERSAL

OBJECTIVE: To compare the risk of falls among elderly people with Parkinsons disease (PD) and Alzheimers dementia (AD) and among healthy peers (controls). In addition, the aim was to analyze relationships between risk of falls and cognitive decay and between risk of falls and physical activity. METHOD: Twenty subjects were assessed: seven with PD (69.57 ± 2.40 years), six with AD (77.5 ± 2.32 years) and seven healthy peers (74.71 ± 2.58 years). The following instruments were used: Berg Balance Scale (BBS), Timed Up and Go test (TUG), Mini-Mental State Examination (MMSE) and Modified Baecke Questionnaire for Older Adults (MBQOA). RESULTS: The Kruskal-Wallis (KW) test indicated significant differences between the groups, relating to BBS (KW = 9.67, p<0.01) and TUG (KW = 9.14, p<0.01, for time expended, and KW = 10.04, p<0.01, for number of steps). Bonferroni post-hoc pairs analysis showed that balance was highly compromised in the AD group, such that lower MMSE values were observed. The PD group was characterized by presenting higher levels of physical activity. Spearmans test produced low correlations between MMSE and BBS (rs=0.59); MMSE and TUG (rs=-0.52 and rs=-0.62); MBQOA and BBS (rs=0.54); and MBQOA and TUG (rs=-0.39 and rs=-0.42). CONCLUSION: These low correlations must be analyzed carefully, because these variables are influenced by multiple factors. In the AD group, the cognitive decay can be positively associated with greater risk of falls. In the PD group, physical activity may have assisted in maintaining the risk of falls at similar levels to the control group.

Benefits of Multimodal Exercise Intervention for Postural Control and Frontal Cognitive Functions in Individuals with Alzheimer's Disease: A Controlled Trial

To verify the effects of a systematized multimodal exercise intervention program on frontal cognitive function, postural control, and functional capacity components of individuals with Alzheimers disease (AD).