Effect of artificial gravity on neurocognitive performance during head-down tilt bedrest.

This study evaluated the acute and chronic effects of intermittent and continuous Artificial Gravity (AG) on cognitive performance during 60 days of Head-down tilt bedrest (HDTBR), a well-established ground-based spaceflight analogue method. Participants were randomly assigned to three groups: intermittent AG, continuous AG, and HDTBR control group without AG exposure. Task performance and electrophysiological measures of attention and working memory were investigated during Simple and Complex tasks in the Visual and the Auditory modality. Compared to baseline, faster reaction time and better accuracy was present during HDTBR regarding the Complex tasks, however, the practice effect was diminished in the three HDTBR groups compared to an ambulatory control group. Brain potentials showed a modality-specific decrease, as P3a was decreased only in the Auditory, while P3b decreased in the Visual modality. No evidence for acute or chronic AG-related cognitive impairments during HDTBR was found.

Impaired Standing Balance in Older Adults with Cognitive Impairment after a Severe Fall.

INTRODUCTION: Fall-related sequelae as well as balance and gait impairments are more pronounced in older adults who are cognitively impaired (OACI) compared to older adults who are cognitively healthy (OACH). Evidence is scarce about differences in standing balance and gait in OACH and OACI after a fall, even though these are major risks for recurrent falls. Thus, the aim of this study was to investigate early impairments in gait and balance, by adding inertial measurement units (IMUs) to a functional performance test in OACH and OACI after a severe fall with a presentation to the emergency department (ED) and immediate discharge. METHODS: The study sample was stratified into participants with and without probable cognitive impairment using the result of the Montreal Cognitive Assessment total score (maximum of 30 points). The cutoff for probable cognitive impairment was set at ≤ 24. Standing balance and gait parameters were measured using three IMUs in n = 69 OACH (72.0 ± 8.2 years) and n = 76 OACI (78.7 ± 8.1 years). Data were collected at participants' homes as part of a comprehensive geriatric assessment in the "SeFallED" study within 4 weeks after presentation to the ED after a severe fall (German Clinical Trials Register ID: 00025949). ANCOVA was used for statistical analysis, adjusted for age. RESULTS: The data indicated significantly more sway for OACI compared to OACH during balance tasks, whereas no differences in gait behavior were found. In detail, differences in standing balance were revealed for mean velocity (m/s) during parallel stance with eyes open (ηp2 = 0.190, p < 0.001) and eyes closed on a balance cushion (ηp2 = 0.059, p = 0.029), as well as during tandem stance (ηp2 = 0.034, p = 0.044) between OACI and OACH. Further differences between the two groups were detected for path length (m/s2) during parallel stance with eyes open (ηp2 = 0.144, p < 0.001) and eyes closed (ηp2 = 0.044, p < 0.027) and for range (m/s2) during tandem (ηp2 = 0.036, p = 0.036) and parallel stance with eyes closed (ηp2 = 0.045, p = 0.032). CONCLUSION: Even though both groups have experienced a severe fall with presentation to the ED in the preceding 4 weeks, balance control among OACI indicated a higher fall risk than among OACH. Therefore, effective secondary fall prevention efforts have to be established, particularly for OACI.

Recruiting patients for falls prevention in the emergency department - worth the challenge.

BACKGROUND: Severe falls escalate the risk of future falls and functional decline as indicated by recent global guidelines. To establish effective falls prevention, individuals at highest risk must be thoroughly studied and, therefore, successfully recruited. OBJECTIVE: Recruiting from an emergency department (ED) may mitigate common selection biases, such as overrepresentation of individuals with a higher social status and healthier lifestyle. However, this approach presents unique challenges due to ED-specific conditions. Hence, we present the successes and challenges of an ED-based recruitment for an observational study. METHODS: The SeFallED study targets older adults aged ≥60 years, who present to either of two hospitals in Oldenburg after a fall without subsequent admission. A study nurse addressed individuals in the EDs. Subsequently, potential participants were contacted by phone to arrange a home visit for obtaining written consent. Data of participants were compared with total admissions during the recruitment period to determine recruitment rate and compare patients' characteristics. RESULTS: Over 1.500 individuals met the inclusion criteria. Of these, 288 participants were successfully recruited. Most patients presented to the ED outside of the study team's working hours, and some opted not to participate (main reason: too unwell (40%)). Compared to working hours, a participant was recruited every 14 h. Comparing characteristics, a trend towards better health and younger age was observed. CONCLUSION: ED-based recruitment offers the opportunity to include more diverse individuals in falls prevention. To achieve adequate sample sizes, flexibility in working days and hours of the research team are obligatory. TRIAL REGISTRATION: DRKS00025949.

Comparison of machine learning approaches for near-fall-detection with motion sensors.

Introduction: Falls are one of the most common causes of emergency hospital visits in older people. Early recognition of an increased fall risk, which can be indicated by the occurrence of near-falls, is important to initiate interventions. Methods: In a study with 87 subjects we simulated near-fall events on a perturbation treadmill and recorded them with inertial measurement units (IMU) at seven different positions. We investigated different machine learning models for the near-fall detection including support vector machines, AdaBoost, convolutional neural networks, and bidirectional long short-term memory networks. Additionally, we analyzed the influence of the sensor position on the classification results. Results: The best results showed a DeepConvLSTM with an F1 score of 0.954 (precision 0.969, recall 0.942) at the sensor position "left wrist." Discussion: Since these results were obtained in the laboratory, the next step is to evaluate the suitability of the classifiers in the field.

Sentinel fall presenting to the emergency department (SeFallED) - protocol of a complex study including long-term observation of functional trajectories after a fall, exploration of specific fall risk factors, and patients' views on falls prevention.

BACKGROUND: Falls are a leading cause for emergency department (ED) visits in older adults. As a fall is associated with a high risk of functional decline and further falls and many falls do not receive medical attention, the ED is ideal to initiate secondary prevention, an opportunity generally not taken. Data on trajectories to identify patients, who would profit the most form early intervention and to examine the impact of a fall event, are lacking. To tailor interventions to the individual's needs and preferences, and to address the whole scope of fall risks, we developed this longitudinal study using an extensive assessment battery including dynamic balance and aerobic fitness, but also sensor-based data. Additionally, participative research will contribute valuable qualitative data, and machine learning will be used to identify trips, slips, and falls in sensor data during daily life. METHODS: This is a mixed-methods study consisting of four parts: (1) an observational prospective study, (2) a randomized controlled trial (RCT) to explore whether a diagnostic to measure reactive dynamic balance influences fall risk, (3) machine learning approaches and (4) a qualitative study to explore patients' and their caregivers' views. We will target a sample size of 450 adults of 60 years and older, who presented to the ED of the Klinikum Oldenburg after a fall and are not hospitalized. The participants will be followed up over 24 months (within four weeks after the ED, after 6, 12 and 24 months). We will assess functional abilities, fall risk factors, participation, quality of life, falls incidence, and physical activity using validated instruments, including sensor-data. Additionally, two thirds of the patients will undergo intensive testing in the gait laboratory and 72 participants will partake in focus group interviews. DISCUSSION: The results of the SeFallED study will be used to identify risk factors with high predictive value for functional outcome after a sentinel fall. This will help to (1) establish a protocol adapted to the situation in the ED to identify patients at risk and (2) to initiate an appropriate care pathway, which will be developed based on the results of this study. TRIAL REGISTRATION: DRKS (Deutsches Register für klinische Studien, DRKS00025949 ). Prospectively registered on 4th November, 2021.

Cerebrovascular function and its association with systemic artery function and stiffness in older adults with and without mild cognitive impairment.

PURPOSE: Our aim was to compare cerebrovascular and systemic vascular function between older adults with and without mild cognitive impairment (MCI), and to determine which measures of vascular function best predict the presence of MCI. METHODS: In 41 adults with MCI and 33 adults without MCI (control) we compared middle cerebral artery velocity (MCAv) and cerebrovascular pulsatility index (PI) at rest, cerebrovascular reactivity to CO2, and responsiveness to changes in blood pressure (%∆MCAv/%∆MAP). Systemic vascular function was assessed by flow-mediated dilation (FMD) and stiffness by pulse wave velocity (PWV). RESULTS: Cerebrovascular PI was higher in MCI compared with control (mean ± SD: 1.17 ± 0.27 vs. 1.04 ± 0.21), and MCI exhibited a lower %∆MCAv/%∆MAP (1.26 ± 0.44 vs. 1.50 ± 0.55%). Absolute (p = 0.76) and relative cerebrovascular reactivity to CO2 (p = 0.34) was similar between MCI and control. When age was included as a covariate the significant difference in cerebral PI between groups was lost. PWV was higher (13.2 ± 2.2 vs. 11.3 ± 2.5 m s-1) and FMD% (4.41 ± 1.70 vs. 5.43 ± 2.15%) was lower in MCI compared with control. FMD% was positively associated with PI across the cohort. Logistic regression analysis indicated that FMD and PWV significantly discriminated between MCI and controls, independent of age, whereas the inclusion of cerebrovascular measures did not improve the predictive accuracy of the model. CONCLUSION: These findings raise the possibility that early changes in systemic vascular stiffness and endothelial function may contribute to altered cerebrovascular haemodynamics and impaired cognitive function, and present potential targets for prevention and treatment strategies in people with MCI.

Influence of a 12-Month Structured Exercise Program on the Micronutrient-Cognitive Fitness-Physical Association Profiles in Mild Cognitive Impairment.

Background: Preventive lifestyle strategies have shown promise to slow down or prevent age-related cognitive decline. However, evidence on the reciprocal longitudinal relationships between nutrition biomarkers and cognitive and physical performance is lacking. Studying nutritional, cognitive, and physical profiles over time may help to overcome this knowledge gap. Objective: To investigate the relationship of plasma levels of the robust nutritional- and antioxidant defense-related biomarkers carotenoids and tocopherols with both indicators of cognitive and physical performance in persons with mild cognitive impairment (MCI) participating in a structured exercise program. Methods: Data from 40 participants with MCI of the NeuroExercise study were analyzed. Participants had undergone a blood withdrawal for the analysis of plasma concentrations of six carotenoids, two tocopherols and retinol prior to and after one-year of structured exercise. All participants had undergone a broad spectrum of cognitive and physical performance tests. Results: Significant associations between lipophilic micronutrients and cognitive/physical measures were observed that were previously found to play a role in cognitive and physical frailty. In particular, lutein, zeaxanthin, and lycopene are confirmed as robust, reliable, and stable indicators of nutritional defense. Importantly, these micronutrients were associated with cognitive measures prior to the physical training program and to a more prominent extent with indicators of motoric function after the physical exercise program. Conclusion: Specific profiles of lipophilic micronutrients are associated to cognitive performance measures and, especially after a structured exercise program, to indicators of physical performance.

Disease-inclusive exercise classes improve physical fitness and reduce depressive symptoms in individuals with and without Parkinson's disease-A feasibility study.

BACKGROUND AND PURPOSE: Exercise is an adjunctive treatment in the management of Parkinson's disease (PD), but barriers such as health status, fear of overexertion, and lack of transportation to the location prevent regular exercise participation. Disease-inclusive exercise classes may offer an opportunity to make exercise more accessible for older adults with and without diseases. However, the efficacy of such heterogenous exercise classes is still widely unknown. Therefore, it was the aim of this study to analyze the feasibility of disease-inclusive exercise classes in older adults with and without PD. METHODS: Twenty-one older adults (healthy older adults (HOA): n = 13; PD: n = 8) completed an 8-week multimodal exercise intervention in supervised group sessions. Exercise classes lasted 60 min with the goal of two participations a week. We assessed physical fitness (timed up and go test [TUG], 6-minute walking test [6MWT], single leg stance), depressive symptoms and cognitive functions, and we determined growth factors (BDNF & IGF-1) before and after the intervention to determine the effects and by that, the feasibility of a disease-inclusive exercise program. Repeated measures ANOVA were used to establish changes. RESULTS: TUG and 6MWT improved significantly after the training in both HOA (p = .008; p < .001) and individuals with PD (p = .024; p < .001). Furthermore, individuals with PD increased single leg stance left (p = .003). HOA (p = .003) and individuals with PD (p = .001) decreased their depressive symptoms between pre- and post-test significantly. Whereas growth factors tended to improve, no differences in cognitive functions were revealed. CONCLUSION: Disease-inclusive multicomponent exercise improved physical functions and reduced depressive symptoms independent of health status. This should encourage exercise providers, researchers, and clinicians to further investigate disease-inclusive exercise, because they may have an important social impact and represent a more inclusive society.

The effect of a psychomotor intervention on electroencephalography and neuropsychological performances in older adults with and without mild cognitive impairment.

AIM: The aim of this pilot study was to examine the acute effect of a psychomotor intervention (PMI) on auditory-verbal memory, emotional state, and electrocortical activity recorded by electroencephalography on subjectively healthy older adults (sHE) and older adults diagnosed with mild cognitive impairment (MCIs). METHODS: Eleven MCIs and 11 sHE underwent a single 45-min PMI. Resting state electroencephalography, the Rey Auditory-Verbal Learning Test, MoodMeter®, and the Positive and Negative Affect Schedule were compared between groups and pre- and post-PMI. RESULTS: Electroencephalography current source density and activity within the theta frequency band were higher in MCIs than in sHE at baseline, and brain frequency had a tendency to decrease in MCIs after training. Both groups showed improvement on the auditory-verbal memory test. Only among MCIs were there increases in perceived physical state and psychological strain and an improvement in negative affect. CONCLUSIONS: Our findings suggest that acute psychomotor activity may be more effective for MCIs than for sHE. It supports the notion that PMI does have functional influences on the central nervous level and therefore might prevent and treat cognitive, psychological, and psychiatric symptoms of people with mild cognitive impairment.

Inefficient resource allocation is associated with reduced alpha activity in parietal regions in individuals with Parkinson's disease.

The brain's ability to act as an input filter and to suppress actions is crucial to navigate everyday life and impairments in these abilities affect quality of life substantially. Although Parkinson's disease (PD) is primarily known as a movement disorder, recent research has redefined it as a multisystem disorder affecting cognition, in particular inhibitory control and attentional resource allocation. Analysing the neural mechanisms underlying this cognitive deficit provides a better understanding of brain changes observed in patients affected by PD. Therefore, this study aimed to identify resource allocation to relevant and irrelevant stimuli in patients affected by PD. Besides neuropsychological tests, we employed electroencephalographic recordings during an auditory oddball paradigm in 13 patients suffering from idiopathic PD and 11 healthy controls (HC). Participants were instructed to ignore the standard stimulus and to respond as fast as possible to the rarely presented target tone. Event-related potentials (ERP) and time-frequency representations (TFR) were analyzed. Patients affected by PD showed faster response latencies to the task-irrelevant standard tones, but slower response latencies to target tones compared to HC. This observation was prominent at frontal sites during later P3-like processing stages. Reaction time, however, was prolonged in patients with PD, suggesting inefficient resource allocation. Additionally, TFR revealed reduced parietal alpha activity, which is associated with distractor suppression and functional inhibition in patients with PD compared to healthy controls. Thus, our results point towards inefficient resource allocation in patients with PD possibly driven by less functional inhibition through parietal alpha activity.

Auditory event-related potentials in individuals with subjective and mild cognitive impairment.

OBJECTIVE: The analysis of event-related potentials (ERPs) is a useful tool to differentiate between healthy older adults, and individuals with mild cognitive impairment (MCI). Less is known about the ERPs' sensitivity of differentiating between individuals with subjective cognitive impairment (SCI) and MCI, as early evidence indicates similar brain alterations between these two groups. In order, to establish tests that are sensitive to subclinical impairment, this study compared auditory evoked ERPs between individuals with SCI and MCI. METHODS: Besides assessing cognitive performance in four neuropsychological tests (Trail Making Test A + B, verbal fluency letter and category task), latency and amplitude of ERP components evoked by an auditory oddball paradigm were compared between two groups of either individuals with SCI (n = 13) or MCI (n = 13). RESULTS: While individuals with MCI performed significantly worse in all neuropsychological tests (TMT A: p = 0.001, Cohen's d = 1.5; TMT B: p = 0.030, Cohen's d = 0.94; verbal fluency letter: p = 0.0011, Cohen's d = 1.08; verbal fluency category: p = 0.038; Cohen's d = 0.86), no significant differences (p > 0.05) were found in ERP components with small to moderate effect sizes (Cohen's d ranged between 0.11 - 0.59). CONCLUSION: ERPs evoked by an auditory oddball paradigm lack sensitivity to differentiate between individuals with SCI and MCI, although significant differences in cognitive performance were detected by neuropsychological tests. Similar pathophysiological brain alterations may limit utility of ERPs as indicated by previous research and results of this study. Cognitively more challenging tasks than the auditory oddball paradigm may be considered by future investigations.

NeuroExercise: The Effect of a 12-Month Exercise Intervention on Cognition in Mild Cognitive Impairment-A Multicenter Randomized Controlled Trial.

Exercise intervention studies in mild cognitive impairment (MCI), a prodromal stage of Alzheimer's disease (AD), have demonstrated inconsistent yet promising results. Addressing the limitations of previous studies, this trial investigated the effects of a 12-month structured exercise program on the progression of MCI. The NeuroExercise study is a multicenter randomized controlled trial across three European countries (Ireland, Netherlands, Germany). Hundred and eighty-three individuals with amnestic MCI were included and were randomized to a 12-month exercise intervention (3 units of 45 min) of either aerobic exercise (AE; n = 60), stretching and toning exercise (ST; n = 65) or to a non-exercise control group (CG; n = 58). The primary outcome, cognitive performance, was determined by an extensive neuropsychological test battery. For the primary complete case (CC) analyses, between-group differences were analyzed with analysis of covariance under two conditions: (1) the exercise group (EG = combined AE and ST groups) compared to the CG and (2) AE compared to ST. Primary analysis of the full cohort (n = 166, 71.5 years; 51.8% females) revealed no between-group differences in composite cognitive score [mean difference (95% CI)], 0.12 [(-0.03, 0.27), p = 0.13] or in any cognitive domain or quality of life. VO2 peak was significantly higher in the EG compared to the CG after 12 months [-1.76 (-3.39, -0.10), p = 0.04]. Comparing the two intervention groups revealed a higher VO2peak level in the aerobic exercise compared to the stretching and toning group, but no differences for the other outcomes. A 12-month exercise intervention did not change cognitive performance in individuals with amnestic MCI in comparison to a non-exercise CG. An intervention effect on physical fitness was found, which may be an important moderator for long term disease progression and warrants long-term follow-up investigations. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02913053, identifier: NCT02913053.

Rating of perceived exertion - a valid method for monitoring light to vigorous exercise intensity in individuals with subjective and mild cognitive impairment?

In rehabilitation settings, exercise intensity is often monitored with Borg's rating of perceived exertion (RPE). However, previous studies showed that severe cognitive impairment may limit the usability of the RPE. The aim of this study was to assess the relationship between RPE and heart rate (HR), and to establish whether a target RPE can be used to achieve exercise intensity based on an individual's HR-RPE in people with early cognitive impairment. 97 participants (74.7 ± 6 years) with early cognitive impairment completed an incremental exercise test. Of these, 54 were tested during a single, RPE guided exercise session. RPE and HR were monitored throughout. Correlations between HR and RPE were assessed using Spearman's correlation. Mean differences between measured HR and target HR were calculated and compared using a two-way ANOVA with factors cognition and exercise mode. Bland-Altman plots were constructed to analyse the agreement between target and measured HR. HR and RPE correlated moderately with each other (p < 0.001; r = 0.555) and no differences between target and measured HR were observed. Bland-Altman plots revealed a mean difference of 1.2 bpm and a 95% level of agreement was between 24.4 and -22.1 bpm. No differences in rating accuracy were observed between different cognitive impairment levels nor between different exercise modes. Bland-Altman plots revealed some variance between the participants with almost half of them missing target HR by 10bpm or more. Therefore, the RPE should only be applied with caution and, if possible, with other measurements (e.g. heart rate monitors) to ensure that target intensity is reached.

Validation of a widely used heart rate monitor to track steps in older adults.

BACKGROUND: Activity tracking devices gain popularity in research, which is due to their multiple features (e.g. heart rate monitor, step count) and easy handling. Nevertheless, many devices used for research are lacking validation of specific features. This study aimed to assess the validity of the Polar M400© activity tracker to count steps in older adults and, therefore, compared it to a previously validated pedometer (Omron Walking Style©) and observed step count. METHODS: Thirty-two older adults (mean age: 74.8±5.9 years) walked at a self-selected, normal gait speed on a tartan track for 200 meters while wearing the activity tracker and the pedometer. Additionally, steps were counted manually. Data was analysed using Kruskal-Wallis test and Lin's concordance coefficient. Furthermore, Bland Altman plots were employed to evaluate accuracy of the activity tracker. RESULTS: Kruskal-Wallis test revealed significant differences between the step count of the activity tracker and the pedometer (P=0.011) but no further differences were observed. Lin's concordance showed a moderate correlation between activity tracker and pedometer (rc=0.561) and between pedometer and observed step count (rc=0.690). A high correlation was detected between activity tracker and observed step count (rc=0.802). Bland Altman plots revealed good accuracy of the activity tracker. CONCLUSIONS: The Polar M400© activity tracker accurately assesses steps during walking in older adults. Nevertheless, a slight overestimation compared to the pedometer was observed, which should be considered when using the activity tracker for tracking steps over a longer period of time.

Neurocognitive performance is enhanced during short periods of microgravity-Part 2.

Previous studies showed a decrease in reaction time during the weightlessness phase of a parabolic flight. This effect was found to be stronger with increasing task complexity and was independent of previous experience of weightlessness as well as anti-nausea medication. Analysis of event related potentials showed a decreased amplitude of the N100-P200 complex in weightlessness but was not able to distinguish a possible effect of task complexity. The present study aimed to extend this previous work, by comparing behavioral (reaction time) and neurological (event related potentials analysis) performance to a simple (oddball) and a complex (mental arithmetic + oddball) task during weightlessness. 28 participants participated in two experiments. 11 participants performed a simple oddball experiment in the 1G and 0G phases of a parabolic flight. 17 participants were presented a complex arithmetic task in combination with an oddball task during the 1G and 0G phases of a parabolic flight. Reaction time as well as event related potentials (ERP) were assessed. Results revealed a reduced reaction time (p < .05) for the complex task during 0G. No gravity effects on reaction time were found for the simple task. In both experiments a reduction of typical ERP amplitudes was noticeable in weightlessness. It is assumed that the weightlessness induced fluid shift to the brain is positively affecting neuro-behavioral performance.

Associations of Lipophilic Micronutrients with Physical and Cognitive Fitness in Persons with Mild Cognitive Impairment.

Age-associated cognitive impairment in general and dementia in particular are a global concern. Preventive lifestyle strategies are highly used but there is a lack of information on the reciprocal relationships between nutrition biomarkers and measures of both cognitive and physical performance. To fill this gap of knowledge, the relationship between plasma levels of the robust nutrition- and antioxidant defense-related biomarkers carotenoid and tocopherols and both indicators of cognitive and physical performance was investigated in a group of persons with mild cognitive impairment participating in the NeuroExercise Study at the German Sport University in Cologne, Germany. In 56 participants with full dataset, significant correlations independently of fruit and vegetable intake were found between plasma levels of ß-cryptoxanthin and Timed Up&Go test (p < 0.05), γ-tocopherol and number of daily steps (p < 0.01), as well as between four out of six measured carotenoids-lutein; zeaxanthin; ß-cryptoxanthin and ß-carotene-and the computerized CogState International Shopping List subtest (p < 0.01). In light of the increasing attention towards the nutritional cognitive neuroscience of carotenoids, computerized measures of cognitive performance might be further implemented in future studies investigating the effects of lifestyle interventions against cognitive and physical impairment.

The Effect of Different Exercise Modes on Domain-Specific Cognitive Function in Patients Suffering from Parkinson's Disease: A Systematic Review of Randomized Controlled Trials.

BACKGROUND: Supervised exercise training alleviates motor symptoms in people with Parkinson's disease (PD). However, the efficacy of exercise to improve nonmotor symptoms such as cognitive function is less well known. OBJECTIVE: To systematically review evidence on the efficacy of different exercise modes (coordination exercise, resistance exercise, aerobic exercise) on domain-specific cognitive function in patients with PD. METHODS: Parallel-group randomized controlled trials published before March 2018 were included. Primary outcome measures included global cognitive function and its subdomains, and the Unified Parkinson's Disease Rating Scale was included as a secondary outcome. Methodological quality was assessed using the Physiotherapy Evidence Database scale. RESULTS: The literature search yielded 2,000 articles, of which 11 met inclusion criteria. 508 patients (mean age 68±4 years) were included with a disease severity from 1 to 4 on the Hoehn & Yahr stage scale. Overall study quality was modest (mean 6±2, range 3-8/10). In 5 trials a significant between-group effect size (ES) was identified for tests of specific cognitive domains, including a positive effect of aerobic exercise on memory (ES = 2.42) and executive function (ES = 1.54), and of combined resistance and coordination exercise on global cognitive function (ES = 1.54). Two trials found a significant ES for coordination exercise (ES = 0.84-1.88), which led to improved executive function compared with that of non-exercising control subjects. CONCLUSION: All modes of exercise are associated with improved cognitive function in individuals with PD. Aerobic exercise tended to best improve memory; however, a clear effect of exercise mode was not identified.

Cardiorespiratory Fitness and Cognitive Function are Positively Related Among Participants with Mild and Subjective Cognitive Impairment.

BACKGROUND: By 2030, about 74 million people will be diagnosed with dementia, and many more will experience subjective (SCI) or mild cognitive impairment (MCI). As physical inactivity has been identified to be a strong modifiable risk factor for dementia, exercise and physical activity (PA) may be important parameters to predict the progression from MCI to dementia, but might also represent disease trajectory modifying strategies for SCI and MCI. OBJECTIVE: A better understanding of the relationship between activity, fitness, and cognitive function across the spectrum of MCI and SCI would provide an insight into the potential utility of PA and fitness as early markers, and treatment targets to prevent cognitive decline. METHODS: 121 participants were stratified into three groups, late MCI (LMCI), early MCI (EMCI), and SCI based on the Montreal Cognitive Assessment (MoCA). Cognitive function assessments also included the Trail Making Test A+B, and a verbal fluency test. PA levels were evaluated with an interviewer-administered questionnaire (LAPAQ) and an activity monitor. An incremental exercise test was performed to estimate cardiorespiratory fitness and to determine exercise capacity relative to population normative data. RESULTS: ANCOVA revealed that LMCI subjects had the lowest PA levels (LAPAQ, p = 0.018; activity monitor, p = 0.041), and the lowest exercise capacity in relation to normative values (p = 0.041). Moreover, a modest correlation between MoCA and cardiorespiratory fitness (r = 0.25; p < 0.05) was found. CONCLUSION: These findings suggest that during the earliest stages of cognitive impairment PA and exercise capacity might present a marker for the risk of further cognitive decline. This finding warrants further investigation using longitudinal cohort studies.

Real World Recruiting of Older Subjects with Mild Cognitive Impairment for Exercise Trials: Community Readiness is Pivotal.

Prevention trials in subjects with mild cognitive impairment (MCI), especially lifestyle interventions, can be difficult to carry out, particularly the recruitment and retention of subjects. We experienced these challenges in our multi-site one-year exercise trial in MCI, NeuroExercise. Trial recruitment rates differed significantly across sites; the non-medical sport university site, providing free access to a range of group exercise in a sports environment, proved far more successful than memory clinics linked to hospitals. This suggests that non-medical settings and a non-medical research community facilitating physical activities may be important factors in recruitment of subjects with MCI for large prevention trials.

Cognitive Impairment Is Reflected by an Increased Difference between Real and Imagined Timed Up and Go Test Performance.

BACKGROUND: Recent research suggests using an imaginary version of the Timed Up and Go test (TUG) for a first assessment of cognitive impairment. By using the time difference between a real (TUGr) and an imagined (TUGi) TUG task, the objective of this study was to examine the effect of cognitive impairment on motor imagery ability. METHODS: Fifty-two participants (mean age 69.3 ± 4.0 years) with mild cognitive impairment or subjective cognitive impairment were included in this study. The time difference between the TUGr and the TUGi was used as the main outcome. The Trail Making Test part B (TMT B), the ratio between TMT A and TMT B, and the Montreal Cognitive Assessment (MoCA) battery were the main independent variables. RESULTS: The difference between TUGr and TUGi performance time and the TMT B performance time increased with decreasing cognitive function (p < 0.01). There was no relationship between TUGr and TUGi performance time and TMT B/A ratio. There were significant correlations between TUG time differences and the MoCA score (r = -0.489, p < 0.01), the TMT B (r = 0.364, p < 0.01), and the TMT B/A ratio (r = 0.377, p < 0.01). CONCLUSION: The combination of TUGr and TUGi may have added value in assessing cognitive impairment, which is a possible pre-stage of dementia.