Cardiac function and cognition in older community-dwelling cardiac patients.

BACKGROUND: Cognitive deficits have been reported in older cardiac patients. An underlying mechanism for these findings may be reduced cardiac function. The relationship between cardiac function as represented by different echocardiographic measures and different cognitive function domains in older cardiac patients remains unknown. METHODS: An older (≥70 years) heterogeneous group of 117 community-dwelling cardiac patients under medical supervision by a cardiologist underwent thorough echocardiographic assessment including left ventricular ejection fraction, cardiac index, left atrial volume index, left ventricular mass index, left ventricular diastolic function, and valvular calcification. During a home visit, a neuropsychological assessment was performed within 7.1 ± 3.8 months after echocardiographic assessment; the neuropsychological assessment included three subtests of a word-learning test (encoding, recall, recognition) to examine one memory function domain and three executive function tests, including digit span backwards, Trail Making Test B minus A, and the Stroop colour-word test. RESULTS: Regression analyses showed no significant linear or quadratic associations between any of the echocardiographic functions and the cognitive function measures. CONCLUSIONS: None of the echocardiographic measures as representative of cardiac function was correlated with memory or executive function in this group of community-dwelling older cardiac patients. These findings contrast with those of previous studies.

The rest-activity rhythm and physical activity in early-onset dementia.

BACKGROUND: A substantial part of elderly persons with dementia show rest-activity rhythm disturbances. The rest-activity rhythm is important to study in people with early-onset dementia (EOD) for rest-activity rhythm disturbances are predictive of institutionalization, and caregivers of young patients suffer from high distress. OBJECTIVE: The aim of this study was to study (1) whether EOD patients have more rest-activity rhythm disturbances compared with cognitively intact adults; and (2) which factors contribute to a disturbed rhythm. METHODS: We included 61 patients with EOD [mean age 61.9 (4.9) y, 41 (67%) men] and 68 cognitively intact adults [mean age 61.6 (4.5) y, 28 (41%) men]. Rest-activity rhythm was assessed by actigraphy. RESULTS: EOD patients tended to have higher intradaily variability [0.46 (0.16) and 0.39 (0.10), P=0.03]. EOD patients also lay for a longer time in bed [time in bed: 08:49 (0:51) h and 08:07 (0:47) h, P<0.001] and needed more time to fall asleep [sleep onset latency: 23 (22) min and 15 (15) min, P=0.02]. Disturbances in the rest-activity rhythm were predicted by a low level of physical activity, use of antidepressants and central nervous system neurological medications, and being male. CONCLUSIONS: EOD patients showed more variability in the rest-activity rhythm compared with cognitively intact adults. The main predictor for rest-activity rhythm disturbances was a low level of physical activity.

Executive functions of sedentary elderly may benefit from walking: a systematic review and meta-analysis.

OBJECTIVE: The goal of the present meta-analysis was to address studies that examined the relationship between walking as one of the most prevalent types of leisure-time activity and executive function being a higher-order cognitive function essential for independent functioning. METHODS: The following data sources were used: English-language publications in PubMed, EMBASE, PsycINFO, Cinahl, and Cochrane; the last search took place in January 2012. From these data sources, only randomized controlled trials including older people with (N = 3) and without (N = 5) cognitive impairment were selected. RESULTS: Walking has been shown to improve set-shifting and inhibition in sedentary older persons without cognitive impairment (d = 0.36; 95% confidence interval: 0.16-0.55; z = 3.56; p <0.0001). In older persons with cognitive impairment, walking did not show improvements in executive functioning (d = 0.14; 95% confidence interval: -0.36-0.64; z = 0.35; p = 0.56). CONCLUSION: This finding is clinically relevant because participation in a walking program may prevent or postpone a (further) decline in executive function in those who are sedentary.

Pain is associated with recurrent falls in community-dwelling older adults: evidence from a systematic review and meta-analysis.

BACKGROUND: Pain and recurrent falls are highly problematic in community-dwelling older adults, yet the association remains elusive. OBJECTIVE: The objective of this study was to investigate the association between pain and recurrent falls in community-dwelling older adults. DESIGN: Two independent reviewers conducted searches of major electronic databases, completed methodological assessment, and extracted the data of all included articles. Articles that were included are those that (1) involved community-dwelling older adults; (2) recorded recurrent falls; and (3) assessed pain. Articles that were excluded are those that included participants with dementia, any neurological conditions, or those with orthopedic trauma/surgery in the past 6 months. RESULTS: Out of a potential of 71 articles, 11 met the inclusion criteria and 7 (N = 9,581) were eligible for the meta-analysis. The annual prevalence of recurrent falls in those reporting pain (12.9%) was higher than the pain-free control group (7.2%, P < 0.001). A global meta-analysis established that pain was associated with recurrent falls (odds ratio [OR]: 2.04, confidence interval [CI]: 1.75-2.39; N = 3,950 with pain and N = 5,631 controls), and this was decreased in a subgroup meta-analysis utilizing prospective studies only (OR: 1.79, CI: 1.44-2.21, P < 0.001, I2 = 0%; N = 3, N = 2,646). A subgroup analysis comparing recurrent fallers vs. non-fallers only (OR: 2.18, CI: 1.82-2.60, N = 6,320, I2 = 0%) established the odds were particularly higher than single fallers vs. non-fallers (OR:1.44, CI: 1.26-1.64, N = 6,903, (I2) = 0%). CONCLUSION: Older adults with pain are at particularly increased risk of recurrent falls. Clinicians working with recurrent fallers should routinely assess pain while pain specialists should inquire about older adults' falls history.

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.

Music education and its effect on intellectual abilities in children: a systematic review.

Far transfer between music education and other cognitive skills, such as academic achievement, has been widely examined. However, the results of studies within similar cognitive domains are found to be inconclusive or contradictory. These differences can be traced back to the analytical methods used, differences in the forms of music education studied and differences in neural activation during the processing of these tasks. In order to gain a better picture of the relationships involved, a literature survey was performed in leading databases, such as PubMed/MedLine, psychINFO, ScienceDirect, Embase, ERIC, ASSIA and Jstor from January 2001 to January 2013. All studies included, concerned the far transfer from music education to other cognitive skills in children aged 4-13 years as compared with controls. These studies were independently selected and their quality was assessed by two authors. This systematic review shows the need to address methodological and analytical questions in greater detail. There is a general need to unify methods used in music education research. Furthermore, the hypothesis that intellectual skills, such as mathematics, reading, writing and intelligence can be divided into sub-functions, needs to be examined as one approach to the problems considered here. When this has been done, detailed analysis of cognitive transfer from music education to other disciplines should become possible.

Are older adults with chronic musculoskeletal pain less active than older adults without pain? A systematic review and meta-analysis.

OBJECTIVE: To compare the overall levels of physical activity of older adults with chronic musculoskeletal pain and asymptomatic controls. REVIEW METHODS: A systematic review of the literature was conducted using a Cochrane methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Major electronic databases were searched from inception until December 2012, including the Cochrane Library, CINAHL, EBSCO, EMBASE, Medline, PubMed, PsycINFO, and the international prospective register of systematic reviews. In addition, citation chasing was undertaken, and key authors were contacted. Eligibility criteria were established around participants used and outcome measures focusing on daily physical activity. A meta-analysis was conducted on appropriate studies. RESULTS: Eight studies met the eligibility criteria, four of these reported a statistically lower level of physical activity in the older adult sampl e with chronic pain compared with the asymptomatic group. It was possible to perform a non-heterogeneous meta-analysis on five studies. This established that 1,159 older adults with chronic pain had a significantly lower level of physical activity (-0.20, confidence interval 95% = -0.34 to -0.06, p = 0.004) compared with 576 without chronic pain. CONCLUSION: Older adults with chronic pain appear to be less active than asymptomatic controls. Although this difference was small, it is likely to be clinically meaningful. It is imperative that clinicians encourage older people with chronic pain to remain active as physical activity is a central non-pharmacological strategy in the management of chronic pain and is integral for healthy aging. Future research should prioritize the use of objective measurement of physical activity.

Limited health literacy and decline in executive function in older adults.

Limited health literacy is associated with worse executive function, but the association between limited health literacy and decline in executive function has not been established because of a lack of longitudinal studies. The authors aimed to examine this association by studying a prospective cohort in the setting of a randomized controlled trial to promote walking in older adults. Participants were community-dwelling older adults (65 years of age or older) who scored 2 or more on the Mini-Cog, without depression (score of less than 15 on the 9-item Patient Health Questionnaire), and who completed baseline and 12-month evaluations (n = 226). Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Executive function measured at baseline and 12 months using the Trail Making Test (TMT), Controlled Oral Word Association Test, and Category Fluency. The associations between health literacy and 12-month decline in each test of executive function were modeled using multivariate linear regression. Health literacy was found to be limited in 37% of participants. Limited health literacy was associated with reduced performance on all 3 executive function tests. In fully adjusted models, limited health literacy was associated with greater 12-month decline in performance on the TMT than higher health literacy (p = .01). In conclusion, older adults with limited health literacy are at risk for more rapid decline in scores on the TMT, a measure of executive function.

The intensity of chair-assisted exercises in cognitively healthy older adults.

INTRODUCTION: The American College of Sports Medicine prescribes regular performance of at least moderate-intensity physical activity for healthy aging. This study examined whether 1 session of 30 min of chair-assisted exercises for the elderly meets this intensity criterion. METHOD: This cross-sectional study included 47 cognitively healthy volunteers (mean age 84 years). During the performance of 30 min of chair-assisted exercises the authors determined oxygen uptake (VO2), carbon dioxide production, heart rate (HR), and rating of perceived exertion (RPE). These measures were expressed as a percentage of the estimated maximal VO2 (VO2max) and the estimated maximal HR (HRmax) and estimated as metabolic equivalent units (METs). RESULTS: Participants performed chair-assisted exercises at 61.0% ± 14.7% of VO2max, 67.6% ± 11.3% HRmax, 3.9 ± 0.9 METs, and 13.1 ± 2.1 RPE. CONCLUSIONS: The intensity of these chair-assisted exercises is at least moderate for older adults, which is necessary for healthy aging.

Study protocol: EXERcise and cognition in sedentary adults with early-ONset dementia (EXERCISE-ON).

BACKGROUND: Although the development of early-onset dementia is a radical and invalidating experience for both patient and family there are hardly any non-pharmacological studies that focus on this group of patients. One type of a non-pharmacological intervention that appears to have a beneficial effect on cognition in older persons without dementia and older persons at risk for dementia is exercise. In view of their younger age early-onset dementia patients may be well able to participate in an exercise program. The main aim of the EXERCISE-ON study is to assess whether exercise slows down the progressive course of the symptoms of dementia. METHODS/DESIGN: One hundred and fifty patients with early-onset dementia are recruited. After completion of the baseline measurements, participants living within a 50 kilometre radius to one of the rehabilitation centres are randomly assigned to either an aerobic exercise program in a rehabilitation centre or a flexibility and relaxation program in a rehabilitation centre. Both programs are applied three times a week during 3 months. Participants living outside the 50 kilometre radius are included in a feasibility study where participants join in a daily physical activity program set at home making use of pedometers. Measurements take place at baseline (entry of the study), after three months (end of the exercise program) and after six months (follow-up). Primary outcomes are cognitive functioning; psychomotor speed and executive functioning; (instrumental) activities of daily living, and quality of life. Secondary outcomes include physical, neuropsychological, and rest-activity rhythm measures. DISCUSSION: The EXERCISE-ON study is the first study to offer exercise programs to patients with early-onset dementia. We expect this study to supply evidence regarding the effects of exercise on the symptoms of early-onset dementia, influencing quality of life. TRIAL REGISTRATION: The present study is registered within The Netherlands National Trial Register (ref: NTR2124).

Physical inactivity in aging and dementia: a review of its relationship to pain.

AIMS: The goal of this brief review is to address studies examining the relationship between physical inactivity and pain in aging and dementia. BACKGROUND: A decrease in the level of physical activity is characteristic of older persons, both with and without dementia. Passive behaviour is often considered to be part of the apathy frequently observed in patients with dementia, although it could also be a sign of pain. Design. Literature review. Method. Searches were performed in PubMed and Embase. A total of 15 studies concerning the relationship between physical inactivity and pain in older persons with and without dementia were identified (older persons without dementia: 12; with dementia: 3). RESULTS: In older persons without dementia, a positive relationship between physical inactivity and pain has been demonstrated. In older persons with dementia, pain may cause physical inactivity and physical inactivity may cause pain. Conclusions. In older persons, a positive relationship between physical inactivity and pain was demonstrated. More specifically, pain may cause physical inactivity. In older persons with dementia pain may cause physical inactivity and vice versa. RELEVANCE TO CLINICAL PRACTICE: Nurses' awareness of physical inactivity as an indication of pain in older persons with and without dementia may reduce the risk of underdiagnosis and subsequent undertreatment of pain.

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 Alzheimer's disease (AD). DESIGN: Descriptive study. SETTING: University Alzheimer's 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.

Observation of hand movements by older persons with dementia: effects on cognition: a pilot study.

BACKGROUND/AIM: Hand movement observation activates mirror neurons, located in brain areas that are vulnerable to Alzheimer's disease. We examined the effects of hand movement observation on cognition in older persons with dementia. METHODS: Nursing home residents with dementia (n = 44) watched either videos showing hand movements or videos showing a documentary for 30 min, 5 days a week, for 6 weeks. Neuropsychological tests were performed at baseline, week 6 and week 12. RESULTS: Linear mixed model analyses revealed a significant interaction effect on an attention test, but not on cognitive domains. Additional analyses showed that a face recognition task improved significantly. CONCLUSION: Although these findings do not support an overall beneficial effect of hand movement observation on cognition in dementia, specific cognitive functions improved. Future studies are warranted.

Higher-level hand motor function in aging and (preclinical) dementia: its relationship with (instrumental) activities of daily life--a mini-review.

A causal relationship between physical activity such as walking and cognitive functions - particularly executive functions and memory - has been observed in elderly people with and without dementia. Executive functions play an important role in the (instrumental) activities of daily life [(I)ADL]. However, a close relationship has also been found between motor activity of the upper limb, particularly the hand, and (I)ADL. Indeed, in aging, a decline in hand motor function is related to a decrease in (I)ADL, an increase in functional dependency, admission to a nursing home, and even mortality. This review begins by addressing clinical studies on the effect of age on higher-level hand motor activity. It then discusses higher-level hand motor function in age-related neurodegenerative diseases such as mild cognitive impairment, Alzheimer's disease and vascular dementia. It concludes by discussing the contribution of higher-level hand motor function assessment to the diagnosis of the various subtypes of (preclinical) dementia and by addressing the clinical relevance of studying higher-level hand motor function, procedural learning, and (I)ADL in aging and (preclinical) dementia.

Relationship between chronic pain and cognition in cognitively intact older persons and in patients with Alzheimer's disease. The need to control for mood.

BACKGROUND: Brain areas that are involved in cognition and mood also play a role in pain processing. OBJECTIVE: The goal of the present study was to examine the relationship between chronic pain and cognition [executive functions (EF) and memory], while controlling for mood, in cognitively intact older persons and in patients with Alzheimer's disease (AD). METHODS: Two groups of subjects participated: 20 older persons without dementia and 19 patients in an early stage of probable AD who suffered from arthrosis/arthritis. Pain intensity and pain affect were assessed by the Colored Analogue Scale for Pain Intensity and for Pain Affect, the Faces Pain Scale (FPS) and the Number of Words Chosen-Affective (NWC-A). Level of depression and anxiety were evaluated by questionnaires. EF and memory were assessed by neuropsychological tests. RESULTS: The results show that significant correlations between specific cognitive functions, pain intensity and pain affect were lacking in the cognitively intact older persons. Cognition, in particular memory, appeared to be related to depressive symptoms. In contrast, a significant positive correlation was observed between EF, pain intensity and pain affect measured by the FPS in the AD group. CONCLUSIONS: Although older persons with depression were excluded, in studies on pain and cognition one should control for the presence of depressive symptoms in older persons with and without dementia.

Ambulatory but sedentary: impact on cognition and the rest-activity rhythm in nursing home residents with dementia.

Physical activity has been positively associated with cognition and the rest-activity rhythm. In the present study, nursing staff classified ambulatory nursing home residents with moderate dementia either as active (n=42) or as sedentary (n=34). We assessed the rest-activity rhythm by means of actigraphy, and we administered neuropsychological tests to assess cognitive functioning. Compared with the group that was considered sedentary, the group that was considered active had a significantly better rest-activity rhythm, indicating agreement between nursing staff classifications and data gathered by the actigraph. Cognitive function was related neither to active-sedentary classification nor to actigraph measures. Similar ambulatory nursing home residents with dementia may show considerable differences in their level of daily physical activity and in their rest-activity rhythm, but the precise relationship among all variables requires further investigation.

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, Alzheimer's 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.

Physical activity and cognition in Alzheimer's disease: relationship to vascular risk factors, executive functions and gait.

Epidemiological studies show a positive relationship between physical activity and cognition in patients with Alzheimer's disease (AD). A relatively small number of intervention studies have examined the effects of physical activity, such as walking, on cognition in AD patients. The results of these studies, reviewed here, include both positive and negative findings. The finding that physical activity does not improve cognition in all AD patients could be explained by two factors that have received little attention thus far: executive dysfunction and gait disturbances. These two factors are part of a cascade of events, initiated by cerebrovascular disease in AD. This cascade of events is addressed in detail. Finally, (non)pharmacological interventions to improve executive dysfunctions and gait disturbances in patients with AD are discussed.

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

Regional hypoperfusion, associated with a reduction in cerebral metabolism, is a hallmark of Alzheimer's 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.