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Smart Moves to Prevent Dementia

Smart Moves to Prevent Dementia

  • Three new studies show that aerobic exercise can improve cognitive function in older persons with mild vascular cognitive impairment; psychotropic medications used to treat PTSD may increase the risk of dementia; and adding 3 biomarkers to cardiovascular risk scores may help predict cognitive impairment in elderly persons.[1-3] Scroll through the slides for the latest findings and take-home messages.

  • 1. A 6-Month Aerobic Exercise Program Can Improve Cognition in Older Adults With Mild Vascular Cognitive Impairment (VCI): Thirty-eight older adults with mild VCI were randomly assigned to either aerobic training consisting of three 1-hour walking classes each week for 6 weeks or usual care. Functional MRI brain scans and other tests measured neural activity and cognitive ability at the beginning and end of the study. Those in the aerobic training group showed significant improvements in reaction times on cognitive tests and changes in brain activity that resembled healthy brains. No changes were recorded in the control group.[1] Source.

  • Clinical Implications for Study 1: Aerobic exercise may minimize the impact of VCI on both cognitive performance and brain function. “Overall, we showed that three times a week of brisk walking can significantly improve cognitive function and increase the efficiency of the brains of older adults with mild VCI. Get moving for a healthy body and a healthy brain. Protecting your physical health and brain health may be as simple as taking regular walks,” says lead author, Teresa Liu-Ambrose, PhD, PT, of the University of British Columbia in Vancouver.

  • 2. The Use of Psychotropic Medications for PTSD May Significantly Increase the Risk of Dementia Among Older Adults: A nationwide sample included 417,172 US veterans aged 56 years or older who did not have dementia or mild cognitive impairment at baseline. Among these veterans, 22,674 (5.4%) had PTSD at baseline, and 25,639 (6.15%) received a diagnosis of dementia during the follow-up period. Patients with PTSD who used SSRIs, novel antidepressants, or atypical antipsychotics were significantly more likely to receive a diagnosis of dementia than those either with or without PTSD who did not use psychotropic medications. SNRIs and benzodiazepines were associated with significant independent effects on the risk of dementia, which suggests that these drugs might be associated with increased risk, regardless of a PTSD diagnosis.[2] Source

  • Clinical Implications for Study 2: SSRIs and SNRIs could possibly affect cognitive function and the risk of dementia in patients with PTSD because of their effects on serotonin and noradrenaline, respectively. The results suggest that the anticholinergic properties of psychotropic drugs may affect cognition. Clinicians may want to consider alternative treatments for PTSD, especially if their patients have other risk factors for dementia.

  • 3. The Addition of Blood Biomarkers to Several Dementia Risk Prediction Models Helps Predict Cognitive Decline in Very Old Adults: A meta-analysis from pooled results of 3 large longitudinal, population-based cohort studies of 85-year-old persons free of stroke or dementia showed greater risk of incident global cognitive impairment when oxi-inflammatory load was added in. Oxi-inflammatory load was defined as the cumulative risk score of 3 blood biomarkers—C-reactive protein, homocysteine, and interleukin-6—which previously have been associated with cognitive decline but not in very old adults.[3] Source

  • Clinical Implications for Study 3: Biomarkers of cardiovascular risk may be useful for identifying individuals at risk for future cognitive impairment. Both oxidative stress and inflammation have been implicated in the pathophysiology of dementia. Intervention strategies to reduce oxi-inflammatory load could potentially target improvements in both cardiovascular health and cognitive function.

References: 

1. Hsu CL, Best JR, Davis JC, et al. Aerobic exercise promotes executive functions and impacts functional neural activity among older adults with vascular cognitive impairment. Br J Sports Med. 2017 Apr 21. pii: bjsports-2016-096846. doi: 10.1136/bjsports-2016-096846.

2. Mawanda F, Wallace RB, McCoy K, Abrams TE. PTSD, psychotropic medication use, and the risk of dementia among US veterans: a retrospective cohort study. J Am Geriatr Soc. 2017;65:1043-1050. doi:10.1111/jgs.14756.

3. Harrison SL, de Craen AJM, Kerse N, et al. Predicting risk of cognitive decline in very old adults using three models: the Framingham Stroke Risk Profile; the Cardiovascular Risk Factors, Aging, and Dementia Model; and oxi-inflammatory biomarkers. J Am Geriatr Soc. 2017;65:381-389.

Comments

Essentially, it says we don't know how to treat dementia.

Michael @

Exercising your brain with all that it means to be human (ie like emotion and expression of feelings and opinions) is important . Language , communication , and thinking skills need to be exercised. Unfortunately, caregivers are exhausted trying to assist a person to do that, after the rigidity of thinking patterns have been there for years. Prevention is better than trying to close the gate after the horse has left.

Brenda E @

Rx to prevent dementia: Get up off the couch. ESPN is bad for your brain.

Steven @

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