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Monday, December 5, 2011

Alzheimer Disease Cognitive-Communication Interventions

A number of reports suggest that among healthy elderly persons, nearly one third complaint of memory problems.  As our society ages, age-related diseases assume increasing prominence as personal and public health concerns. Disorders of cognition are particularly important in both regards, and Alzheimer’s disease (AD) is by far the most common cause of dementia associated with aging. In 2000, the prevalence of AD in the United States was estimated to be 4.5 million individuals, and this number has been projected to increase to 14 million by 2050.  Although AD is not an inevitable consequence of aging, these numbers speak to the dramatic scope of its impact. Whereas the presence of a subjective memory complaint is a central condition for mild cognitive impairment (MCI), little work has been done to investigate its nature and severity.  Studies have been consistent as to report that individuals with MCI report more memory complaints than controls.

Memory rehabilitation in dementia is gaining importance. Among the increasing number of people affected by AD, the number detected in early stages of the disease is growing quickly. The reasons are obvious: improved clinical assessment in the initial disease stage, increased sensitization of the elderly towards cognitive deficits, and the prescription of drugs retarding cognitive decline. Although skepticism towards cognitive training in dementia is still common among clinicians, given the limited success of early training programs in the 1980s, recent promising studies gave reason for optimism. Memory therapy in the early-to-moderate stages of AD can be successful, if it is tailored to patients' individual daily problems and based on their residual cognitive capacities. In this special issues we are presenting information on  the effectiveness of cognitive training to prevent, amelliorate, and  reduce the progression of age-related cognitive decline in the e lderly

Exercise has been shown to be an effective treatment for cognitive impairment in the elderly. When I conducted a meta-analysis evaluating the effects of exercise on physical and mental function in older adults with cognitive impairments, the results were impressive. The findings showed that older adults with dementia or cognitive impairment who engage in walking, strength or flexibility activities, benefit in terms of physical fitness, cognitive function (d=0.57) and behavior. Improvements were most significant for older subjects that exercised ≥45 minutes per session. A study by Molloy showed that long-term care residents (age >60) improved on 6 of 8 cognitive tests after participation in an exercise program. Palleshi reported a significant pre-post improvement in four cognitive measures, including the MMSE, in 15 older men with mild to moderate AD after 3 months of arm cycle ergometer exercise (3x/wk). Rolland noted that a 5-12 week program of walking/biking activity resulted in significant improvements on MMSE, while reducing behavioral problems in 23 AD patients >70 years old. Longitudinal studies demonstrate that physically active people have a lower risk of developing CI when compared to sedentary people

 

Over time, the brain can sustain damage from reduced blood flow, oxidative stress, inflammation, toxic substances, and disuse. In the same way that the heart responds to the physiological demands of physical activity, so, it appears, does the brain. Environmental alterations that encourage exercise in male APP/PS1 transgenic familial AD mice, reduces the cerebral amyloid load compared with mice in control environments and this shows a dose response.   We hope that the present issue will lead to a conceptual change in the memory rehabilitation of patients with dementia. Considering the evidence that cognitive and behavioral rehabilitation techniques may be promising in slowing and ameliorating the symptoms of dementia additional studies evaluating cognitive and exercise therapy in dementia could be of great value to the field of AD.

 

Mark and I are looking foward to your feedback and comments on this TGR issue with special focus on cognitive and exercise training for dementia.

 

Sincerely,

 

Patricia C. Heyn, PhD

 

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9.      Rolland Y, Rival L, Pillard F, Lafont C, Riviere D, Albarede JL, Vellas, B. (2000). Feasibility of regular physical exercise for patients with moderate to severe Alzheimer's disease.  Journal of Nutrition, Health & Aging: 4 (2), 109-113.

10.    Sutoo D, Akiyama K. (2003) Regulation of brain function by exercise. Neurobiol Dis;13(1):1-14. Review.

 

11.    The Alzheimer's Association. (2011). Maintain Your Brain®: The Science Behind the Recommendations. Diet and Exercise. (Thttp://www.alz.org/maintainyourbrain/science/diet.asp).