Laura Eggermont

Gait in ageing and associated dementias; its relationship with cognition.

The focus of this review is on the close relationship between gait and cognition in ageing and associated dementias. This close relationship is supported by epidemiological studies, clinical studies of older people with and without dementia that focused on the intensity of the physical activity, clinical studies with older persons without dementia examining a relationship between gait and specific cognitive processes, and human and animal experimental studies examining a neural basis for such a relationship. Despite these findings, most studies with patients with dementia focus exclusively on the relationship between cognition and dementia, with relatively few addressing the relationship between gait and dementia. However, subtle disturbances in gait can be observed in ageing and in (preclinical) subtypes of dementia that are not known for prominent motor disturbances, i.e. Mild Cognitive Impairment, Alzheimers Disease, vascular Cognitive Impairment No Dementia, Subcortical Ischaemic Vascular Dementia, Frontotemporal Mild Cognitive Impairment, and Frontotemporal Dementia, supporting a close relationship between gait and cognition. The relationship between gait and cognition is weakened by the few available intervention studies that examine the effects of walking on cognition in patients with (preclinical) dementia. These studies report equivocal results, which will be discussed. Finally, suggestions for future research will be made.

Exercise, cognition and Alzheimer's disease: More is not necessarily better

Regional hypoperfusion, associated with a reduction in cerebral metabolism, is a hallmark of Alzheimers disease (AD) and contributes to cognitive decline. Cerebral perfusion and hence cognition can be enhanced by exercise. The present review describes first how the effects of exercise on cerebral perfusion in AD are mediated by nitric oxide (NO) and tissue-type plasminogen activator, the release of which is regulated by NO. A conclusion of clinical relevance is that exercise may not be beneficial for the cognitive functioning of all people with dementia if cardiovascular risk factors are present. The extent to which cardiovascular risk factors play a role in the selection of older people with dementia in clinical studies will be addressed in the second part of the review in which the effects of exercise on cognition are presented. Only eight relevant studies were found in the literature, emphasizing the paucity of studies in this field. Positive effects of exercise on cognition were reported in seven studies, including two that excluded and two that included patients with cardiovascular risk factors. These findings suggest that cardiovascular risk factors do not necessarily undo the beneficial effects of exercise on cognition in cognitively impaired people. Further research is called for, in view of the limitations of the clinical studies reviewed here.

Pain and the Risk for Falls in Community-Dwelling Older Adults: Systematic Review and Meta-Analysis

OBJECTIVE To conduct a systematic review and meta-analysis to establish the association between pain and falls in community-dwelling older adults. DATA SOURCES Electronic databases from inception until March 1, 2013, including Cochrane Library, CINAHL, EBSCO, EMBASE, PubMed, and PsycINFO. STUDY SELECTION Two reviewers independently conducted the searches and completed methodological assessment of all included studies. Studies were included that (1) focused on adults older than 60 years; (2) recorded falls over 6 or more months; and (3) identified a group with and without pain. Studies were excluded that included (1) participants with dementia or a neurologic condition (eg, stroke); (2) participants whose pain was caused by a previous fall; or (3) individuals with surgery/fractures in the past 6 months. DATA EXTRACTION One author extracted all data, and this was independently validated by another author. DATA SYNTHESIS A total of 1334 articles were screened, and 21 studies met the eligibility criteria. Over 12 months, 50.5% of older adults with pain reported 1 or more falls compared with 25.7% of controls (P<.001). A global meta-analysis with 14 studies (n=17,926) demonstrated that pain was associated with an increased odds of falling (odds ratio [OR]=1.56; 95% confidence interval [CI], 1.36-1.79; I(2)=53%). A subgroup meta-analysis incorporating studies that monitored falls prospectively established that the odds of falling were significantly higher in those with pain (n=4674; OR=1.71; 95% CI, 1.48-1.98; I(2)=0%). Foot pain was strongly associated with falls (n=691; OR=2.38; 95% CI, 1.62-3.48; I(2)=8%) as was chronic pain (n= 5367; OR=1.80; 95% CI, 1.56-2.09; I(2)=0%). CONCLUSIONS Community-dwelling older adults with pain were more likely to have fallen in the past 12 months and to fall again in the future. Foot and chronic pain were particularly strong risk factors for falls, and clinicians should routinely inquire about these when completing falls risk assessments.

Cardiac disease and cognitive impairment: a systematic review

Cognitive impairment in cardiac patients may interfere with disease management. This review describes studies examining specific cognitive impairments in cardiac patients and studies that investigate the link between echocardiographic and cognitive measures. Executive function impairments were frequently reported in different patient groups. Also, lower cardiac output and worse left ventricular diastolic function are linked to executive function deficits. In cardiac patients, special attention should be paid to these executive function impairments in view of their role in disease management and independent living. Interventions that stimulate executive function should be encouraged and integrated in cardiac treatment protocols.

Depressive Symptoms, Chronic Pain, and Falls in Older Community-Dwelling Adults: The MOBILIZE Boston Study

To examine whether overall depressive symptoms and symptom clusters are associated with fall risk and to determine whether chronic pain mediates the relationship between depression and fall risk in aging.

Walking the line: a randomised trial on the effects of a short term walking programme on cognition in dementia

Background: Walking has proven to be beneficial for cognition in healthy sedentary older people. The aim of this study was to examine the effects of a walking intervention on cognition in older people with dementia. Methods: 97 older nursing home residents with moderate dementia (mean age 85.4 years; 79 female participants; mean Mini-Mental State Examination 17.7) were randomly allocated to the experimental or control condition. Participants assigned to the experimental condition walked for 30 min, 5 days a week, for 6 weeks. To control for personal communication, another group received social visits in the same frequency. Neuropsychological tests were assessed at baseline, directly after the 6 week intervention and again 6 weeks later. Apolipoprotein E (ApoE) genotype was determined. Results: Differences in cognition between both groups at the three assessments were calculated using a linear mixed model. Outcome measures included performance on tests that formed three domains: a memory domain, an executive function domain and a total cognition domain. Results indicate that there were no significant time×group interaction effects or any time×group×ApoE4 interaction effects. Conclusion: Possible explanations for the lack of a beneficial effect of the walking programme on cognition could be the level of physical activation of the intervention or the high frequency of comorbid cardiovascular disease in the present population of older people with dementia. Trial registration number: Nederlands Trial Register, TC1230, http://www.trialregister.nl/trialreg/index.asp

Comparing Pain Severity Versus Pain Location in the MOBILIZE Boston Study: Chronic Pain and Lower Extremity Function

BACKGROUND This study compared measures of chronic pain, for example, number of pain sites and overall pain severity, in relation to lower extremity function in the older population. METHODS Six hundred older adults (mean age 77.9 years, 64% female) were queried about presence of chronic pain. Number of pain sites was categorized as none, single site, multisite, or widespread. Pain severity was measured in quartiles of the Brief Pain Inventory pain severity subscale. Lower extremity function was assessed by the Short Physical Performance Battery (SPPB), a composite measure of gait speed, balance, and chair stands. RESULTS Many older persons reported multisite or widespread pain (40%). Increased pain sites and pain severity were associated with poorer SPPB performance after adjusting for age, sex, height, and weight. With further adjustment for education, comorbid conditions, and depressive symptoms, multisite pain (p < .001) and most severe pain (p < .05) were associated with poorer SPPB performance, but assessed together in the same model, only the association with multisite/widespread pain remained significant (p < .01). When specific joint pain sites were evaluated together, only knee pain was associated with lower SPPB score. Pain severity was independently associated with slower gait, pain location was associated with poorer balance, and chair stands performance was associated with both pain measures. CONCLUSIONS Although multisite pain rather than pain severity was more strongly associated with overall lower extremity function, differences emerged with specific SPPB subtests. Longitudinal studies are needed to understand risk for lower extremity function decline related to chronic pain characteristics in older adults.

Physical Activity and Executive Function in Aging: The MOBILIZE Boston Study

OBJECTIVES: To determine the relationship between physical activity and cognition, specifically executive function, and the possible mediating role of factors such as cardiovascular disease (CVD) and CVD risk factors, chronic pain, and depressive symptoms.

Lower-Extremity Function in Cognitively Healthy Aging, Mild Cognitive Impairment, and Alzheimer's Disease

OBJECTIVE To examine differences in lower-extremity function in cognitive healthy older persons, older persons with mild cognitive impairment (MCI), and older persons with Alzheimers disease (AD). DESIGN Descriptive study. SETTING University Alzheimers disease clinical and research program. PARTICIPANTS Older persons (N=66) were studied (mean age, 76.7y); 22 were cognitively normal, 22 were diagnosed with probable MCI, 22 were diagnosed with probable AD. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Lower-extremity function was assessed by the four-meter walk test (4MWT), Timed Up & Go (TUG) test, and sit-to-stand (STS) test. RESULTS Analysis of variance, adjusting for covariates, revealed that performance on the 4MWT was significantly lower in the MCI and AD groups as compared with controls. TUG test performance was worse in the AD group compared with controls. No significant group differences were found for STS performance. CONCLUSIONS These results suggest an association between cognitive impairment and lower-limb function in older persons. Walking speed could be evaluated for its possible utility in screening older persons at risk for cognitive impairment and falls.

The more physical inactivity, the more agitation in dementia.

Epidemiological studies show a close relationship between physical activity and cognition. A causal relationship between physical activity and cognition has been observed in children, adolescents, older people without dementia, and in older people in a very early stage of dementia. Considering these positive effects, we argue that a decline in physical activity has a detrimental effect on cognition and behavior in patients with dementia. Merely living in a nursing home reduces the level of physical activity. The level of physical activity may even be reduced to a minimum when physical restraints are applied. The use of physical restraints coincides with stress, further aggravating the already existing neuropathology, which may increase stress and agitation even more. Exercise may reduce stress and agitation.