Aerobic Training and Circulating Neurotrophins in Alzheimer's Disease Patients: A Controlled Trial.

OBJECTIVE: to verify the effects of aerobic exercise training in circulating BDNF, VEGF165 and IGF-1 plasma levels and cognitive function in Alzheimer's Disease (AD) patients. METHODS: 34 AD patients participated in the study, divided in two groups: Control Group (CG; n = 16) and Training Group (TG; n = 18 - Moderate aerobic training on the treadmill, three times a week, for 12 weeks). BDNF, VEGF165, and IGF-1 plasma levels were considered as a primary outcome. Secondary outcomes included cognitive functions and aerobic fitness. RESULTS: After 12 weeks, maintenance of executive functioning in the TG was found, yet no significant changes on circulating neurotrophins levels were identified. For aerobic fitness, there was an increment in TG group. CONCLUSION: Twelve weeks of aerobic training were neither effective in improving cognitive functioning significantly, nor influential on circulating neurotrophins levels in AD patients.

Relationship Between Aerobic Capacity, Mobility, and Spatial Navigation in Healthy Individuals and Older Adults With Mild Cognitive Impairment: A Cross-Sectional Study.

This study aimed to investigate the relationship between physical ability and spatial navigation in older adults with mild cognitive impairment and healthy controls, using the floor maze test. Study participants (n = 58) were subjected to the following tests: floor maze test, sit-to-stand, 8-foot up-and-go, and aerobic steps. Factorial analyses showed that performance of the physical tests combined explained approximately 87% of the sample variability. Mobility (R2 = .22, p ≤ .001) and aerobic capacity (R2 = .27, p ≤ .001) were both associated with delayed maze time in the floor maze test. Low levels of aerobic capacity were also associated with an increased odds to perform poorly in the delayed maze time after controlling for age, sex, and mild cognitive impairment diagnosis (odds ratio = 3.1; 95% confidence interval [1.0, 9.5]; p = .04). Aerobic capacity and mobility are associated with spatial navigation in patients with mild cognitive impairment and healthy older adults.

Motor-cognitive dual-task performance of older women evaluated using Wii Balance Board.

BACKGROUND: Single- and dual-tasks are influenced by age-related impaired postural balance. Aim of this study was to analyze the Center of Pressure (CoP) oscillation during static balance in the presence or absence of cognitive task on older women. METHODS: Thirty-one healthy older women were assessed in a stand quiet position with open/closed eyes (single-task, OE and CE) and with cognitive task (dual-task, DT) through Wii Balance Board. Sway area, total displacement and CoP oscillation (CO) based on the number of times that CoP traveled through anteroposterior and mediolateral directions. Friedman test was used to compare OE, CE and DT. Dual-task interference percentage was used to quantify the cognitive load on balance whereas Spearman correlation coefficient was used to assess the association of cognitive domains and CO. RESULTS: The CO was significantly higher in DT than in single-tasks and participants were unable to maintain their limits of stability in mediolateral direction. The cost of DT interference was 30.5%, which is partially explained by the deviation of attention from postural control to spatial and temporal orientation. CONCLUSION: Our findings show that cognitive load during DT impairs balance in mediolateral direction, thus indicating the use of WBB to assess cognitive interference on postural control.

Test-retest reliability of the simon task: a short version proposal.

Background: The standard version of the Simon task (an instrument for assessing attentional demands, inhibitory control and the perception-action cycle) comprises a total of 168 trials. Different versions of this task are used in the literature, but it is not clear whether the Simon effect can be found using brief versions of the test.Purpose: This study aims to investigate the presence of the Simon effect and its test-retest reliability in a brief version of 28 trials of the Simon task.Material and Methods: Ninety-two (92) subjects between the ages of 18-30 participated in this study. Participants performed two sessions (test and retest) in which the brief battery of the Simon task was used. Latency (reaction time - RT) and the accuracy (number of errors) were measured for the two typical conditions of the test (corresponding and non-corresponding).Results: A significant interaction (two-way ANOVA) between condition and moment (test vs. retest) was found for RT. Main effects were observed for both conditions (corresponding vs. non- corresponding) and moment (test vs. retest). A good measurement of reliability (α Cronbach = 0.883) was also observed.Conclusions: The 28-trial battery of the Simon Task seems to be efficient for eliciting the Simon Effect and it can therefore be considered reliable.

Comparison of cognitive functions among frail and prefrail older adults: a clinical perspective.

ABSTRACTObjective:To compare cognitive function among frail and prefrail older adults. DESIGN: Cross-sectional clinical study. PARTICIPANTS: Fifty-one non-institutionalized older individuals participated in this study. MEASUREMENTS: Cognitive functions were evaluated through Mini-Mental State Examination (Global Cognition), Digit Span Forward (short-term memory), Digit Span Backward (working memory), Verbal Fluency Test (semantic memory/executive function). Data were compared using parametric and non-parametric bivariate tests. Binary logistic regression was used to test a frailty prediction model. Statistical significance was defined as p ≤ 0.01 to compare groups. In the regression model, the p value was set to be ≤0.05. RESULTS: Statistically significant differences were observed in global cognition, and short-term memory between frail and prefrail individuals (p ≤ 0.01). Global cognition explained 14-19% of frailty's model. CONCLUSION: According to our findings, the evaluation of cognitive functions among older persons with frailty and prefrailty provides important complementary information to better manage frailty and its progression.

Acute effects of exergames on cognitive function of institutionalized older persons: a single-blinded, randomized and controlled pilot study.

BACKGROUND: Improvements on balance, gait and cognition are some of the benefits of exergames. Few studies have investigated the cognitive effects of exergames in institutionalized older persons. AIMS: To assess the acute effect of a single session of exergames on cognition of institutionalized older persons. METHODS: Nineteen institutionalized older persons were randomly allocated to Wii (WG, n = 10, 86 ± 7 year, two males) or control groups (CG, n = 9, 86 ± 5 year, one male). The WG performed six exercises with virtual reality, whereas CG performed six exercises without virtual reality. Verbal fluency test (VFT), digit span forward and digit span backward were used to evaluate semantic memory/executive function, short-term memory and work memory, respectively, before and after exergames and Δ post- to pre-session (absolute) and Δ % (relative) were calculated. Parametric (t independent test) and nonparametric (Mann-Whitney test) statistics and effect size were applied to tests for efficacy. RESULTS: VFT was statistically significant within WG (-3.07, df = 9, p = 0.013). We found no statistically significant differences between the two groups (p > 0.05). Effect size between groups of Δ % (median = 21 %) showed moderate effect for WG (0.63). DISCUSSION: Our data show moderate improvement of semantic memory/executive function due to exergames session. It is possible that cognitive brain areas are activated during exergames, increasing clinical response. CONCLUSION: A single session of exergames showed no significant improvement in short-term memory, working memory and semantic memory/executive function. The effect size for verbal fluency was promising, and future studies on this issue should be developed. PROTOCOL NUMBER OF BRAZILIAN REGISTRY OF CLINICAL TRIALS: RBR-6rytw2.

Heart rate variability indexes as a marker of chronic adaptation in athletes: a systematic review.

BACKGROUND: Regular exercise promotes functional and structural changes in the central and peripheral mechanisms of the cardiovascular system. Heart rate variability (HRV) measurement provides a sensitive indicator of the autonomic balance. However, because of the diversity of methods and variables used, the results are difficult to compare in the sports sciences. Since the protocol (supine, sitting, or standing position) and measure (time or frequency domain) are not well defined, the aim of this study is to investigate the HRV measures that better indicates the chronic adaptations of physical exercise in athletes. METHOD: PubMed (MEDLINE), Web of Science, SciELO (Scientific Electronic Library), and Scopus databases were consulted. Original complete articles in English with short-term signals evaluating young and adult athletes, between 17 and 40 years old, with a control group, published up to 2013 were included. RESULTS: Selected 19 of 1369 studies, for a total sample pool of 333 male and female athletes who practice different sports. The main protocols observed were the supine or standing positions in free or controlled breathing conditions. The main statistical results found in this study were the higher mean RR, standard deviation of RR intervals, and high frequency in athletes group. In addition, the analyses of Cohen's effect size showed that factors as modality of sport, protocol used and unit of measure selected could influence this expected results. CONCLUSION: Our findings indicate that time domain measures are more consistent than frequency domain to describe the chronic cardiovascular autonomic adaptations in athletes.

Self-selected or imposed exercise? A different approach for affective comparisons.

The aim of this study was to compare the psychological and physiological responses of self-selected and imposed sessions of equivalent intensities and durations and allowing to participants a free control of pace during the self-selected session. Seventeen participants completed three sessions on a cycle ergometer. Participant's VO2Peak and lactate threshold were measured during an incremental exercise test. During the second and third sessions, participants could view a virtual cyclist on a monitor. During the self-selected session, participants were allowed free control of the intensity and duration. To ensure that the imposed session replicated the self-selected session in intensity, participants were instructed to follow an additional virtual cyclist, which was displayed on a monitor using the CompuTrainer 3D software. Power output and physiological and psychological variables were recorded during the sessions. A two-way ANOVA showed no effect of condition for power output (P = 0.940), heart rate (HR) (P = 0.965), VO2 (P = 0.898), blood lactate (P = 0.667), Feeling Scale (P = 0.877), Felt Arousal Scale (P = 0.924) and CR100 (P = 0.939). A paired t-test showed no significant difference in Physical Activity Enjoyment Scale scores between sessions (P = 0.054). In contrast to previous studies, the self-selected session did not provide better affective responses than the imposed session with same intensity and duration.

Prevalence of dynapenia and overlap with disability, depression, and executive dysfunction.

OBJECTIVE: This study aims to investigate handgrip strength and dynapenia prevalence among older adults stratified by Brazilian macroregions. Additionally, we aim to evaluate the overlap between dynapenia and Instrumental Activities of Daily Living (IADL) disability, depression, and executive dysfunction on a national basis and by each Brazilian macroregion. METHODS: This cross-sectional analysis was based on data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). A multistage cluster sample design was used, with a representative population-based study of non-institutionalized community-dwelling Brazilians aged ≥ 50 years from 70 municipalities across all five macroregions of the country. The outcome variable was dynapenia. Covariables were IADL disability, depression, and executive dysfunction. The Brazilian macroregions were used for stratification. In addition, the following additional variables were included: age group, gender, education level, macroregions (North, Northeast, Southeast, South, and Midwest), self-reported health, multimorbidity, and falls. RESULTS: A total of 8,849 (94%) of the sample provided complete information for the handgrip strength assessment and were included in this analysis. Dynapenia prevalence was higher in North and Northeast regions (28.5% and 35.1%, respectively). We identified statistically significant differences between different macroregions for dynapenia, IADL disability, and verbal fluency, with worse values in the North and Northeast regions. In the North and Northeast macroregions, nearly half of the subjects that presented executive dysfunction and IADL disability also had dynapenia. There was a more significant overlap in the prevalence of all four conditions in the North and Northeast regions (4.8% and 5.5%, respectively), whereas the overlap was smaller in the South (2.3%). There was also a smaller overlap in the prevalence of dynapenia and depression in the South (5.8%) compared with other macroregions. CONCLUSIONS: Macroregions in Brazil exhibit marked differences in the prevalence of dynapenia and in its overlap with IADL disability, depression, and executive dysfunction.

Association among race/color, gender, and intrinsic capacity: results from the ELSI-Brazil study.

OBJECTIVE: To investigate associations among race/color, gender, and intrinsic capacity (IC) (total and by domains) in middle-aged and older adults from a Brazilian cohort. As a secondary objective, we investigate these associations across Brazilian regions. METHODS: This is a cross-sectional study conducted with baseline data from the 2015-2016 Brazilian Longitudinal Study of Aging (ELSI-Brazil). IC was investigated via cognitive (verbal fluency), physical (gait velocity/handgrip), and psychosocial (Center for Epidemiological Studies Depression) domains. Moreover, IC sensory domain was evaluated via self-reported sensory disease diagnoses (vision and/or hearing impairment) and race/color was identified via self-reported criteria. RESULTS: We evaluated a total of 9,070 participants (aged ≥ 50 years). Black and Brown participants were 80% and 41% more likely to show a worse IC cognitive domain than white controls, respectively (OR = 1.80, 95%CI: 1.42-2.28, p < 0.001 and OR = 1.41, 95%CI: 1.21-1.65, p < 0.001). Moreover, Black and Brown women had almost a threefold greater chance of showing a worse IC than white men (OR = 2.91, 95%CI: 1.89-4.47, p < 0.001 and OR = 2.51, 95%CI: 2.09 - 3.02, p < 0.001) and a 62% (OR = 1.62, 95%CI: 1.02-2.57) and 32% (OR = 1.32, 95%CI: 1.10-1.57) greater risk of falling below our IC score cutoff point than white women. We found the greatest differences in the Brazilian South, whereas its North showed the lowest associations among race/color, gender, and IC. CONCLUSION: IC racial and gender disparities reinforce the need for public health policies to guarantee equality during aging. Promoting greater access to good health care requires understanding how racism and sexism can contribute to health inequities and their consequences in different Brazilian regions.

Floor Maze Test is capable of differentiating spatial navigation between frail and pre-frail institutionalized older persons.

Investigation of the association between physical frailty and cognitive performance through spatial navigation is important to enable the identification of individuals with cognitive impairment and physical comorbidity. Objective: To analyze the association between spatial navigation and frailty in frail and pre-frail institutionalized older adults. Methods: Forty older people of both sexes, aged 60 years or over, residing in four Brazilian Long-Term Care Facilities (LTCFs) participated in this study. The following tests were applied: Mini-Mental State Examination (MMSE), 2.44m Timed Up and Go, Floor Maze Test (FMT), and Fried's frailty criteria. For data analysis, the Mann-Whitney and independent t-tests were used to compare the groups (frail x pre-frail), principal component analysis was used to explore the main variables related to the data variance, and binary logistic regression to estimate associations. Results: There was a significant difference in performance in the FMT immediate maze time (IMT) (p=0.02) and in the delayed maze time (DMT) (p=0.009) between the pre-frail and frail older adults. An association between FMT DMT performance and frailty was found, showing that older people with shorter times on the DMT (better performance) had approximately four times the chance of not being frail (odds ratio - OR=4.219, 95% confidence interval - 95%CI 1.084-16.426, p=0.038). Conclusion: Frailty is associated with impaired spatial navigation ability in institutionalized older adults, regardless of gait speed performance.

A investigação da associação entre fragilidade física e desempenho cognitivo por meio da navegação espacial é importante para possibilitar a identificação de indivíduos com déficit cognitivo e comorbidade física. Objetivo: Analisar a associação entre navegação espacial e fragilidade em idosos institucionalizados frágeis e pré-frágeis. Métodos: Participaram deste estudo 40 idosos de ambos os sexos, com idade igual ou superior a 60 anos, residentes em quatro instituições de longa permanência (ILPI) brasileiras. Foram aplicados os seguintes testes: Miniexame do Estado Mental (MEEM), 2,44m Timed Up and Go, Floor Maze Test (FMT) e os critérios de fragilidade de Fried. Para a análise dos dados, foram utilizados os testes t independente e de Mann-Whitney para comparar os grupos (frágeis x pré-frágeis), foi feita análise de componentes principais para explorar as principais variáveis relacionadas à variância dos dados e regressão logística binária para estimar associações. Resultados: Houve diferença significativa no desempenho do FMT no tempo imediato do labirinto (TIL) (p=0,02) e no tempo posterior do labirinto (TPL) (p=0,009) entre os idosos pré-frágeis e frágeis. Encontrou-se associação entre o desempenho no FMT TPL e fragilidade, mostrando que idosos com menor tempo de TPL (melhor desempenho) tiveram aproximadamente quatro vezes mais chance de não serem frágeis (odds ratio ­ OR=4,219, intervalo de confiança de 95% ­ IC95% 1,084­16,426, p=0,038). Conclusão: A fragilidade está associada à habilidade de navegação espacial prejudicada em idosos institucionalizados, independentemente do desempenho da velocidade da marcha.

Acute affective responses to high-intensity interval exercise: Implications on the use of different stimulus-recovery amplitudes.

The effect of high-intensity interval exercise (HIIE) on affective responses is unclear due to the several variables of HIIE, which may be minimized by using derived variables (e.g. amplitude). The amplitude reflects the difference between stimulus and recovery intensities, being more representative of the physiological changes than central tendency variables such as average intensity. This study aimed to compare the affective responses in HIIE sessions in different amplitudes with a vigorous-intensity continuous exercise (VICE) session. Eleven participants completed five sessions. The peak oxygen consumption (VO2Peak) and peak power (Wpeak) were measured. Participants performed one VICE and three HIIE sessions (10x[1min-90%WPeak/1min-50%WPeak]; 10x[1min-100%WPeak/1min-40%WPeak]; and 10x[1min-110%WPeak/1min-40%WPeak]). The exercise sessions were performed at the same average intensity (70%WPeak) and duration (20 min). The Feeling Scale (FS) was applied in each minute throughout the exercise sessions. Regarding the FS responses, a two-way repeated-measures ANOVA showed no significant interaction for FS (P=0.093) or main effect for condition (P=0.206) and time (P=0.078), indicating that irrespective of the amplitude of the HIIE, FS results were similar between conditions. The effect size (ES) analysis showed a small effect in favour of HIIE-90/50 (ES=0.30) and HIIE-100/40 (ES=0.26) and a null effect on HIIE-110/30 (ES=0.08) when compared to VICE. Chi-squared analysis showed no significant differences between conditions in the number of participants that reduced, maintained, or increased the FS from pre-exercise to last stimulus and recovery indicating a high variability of the affective responses. HIIE sessions provide similar affective responses when performed at the same average intensity, even with different amplitudes.Highlights HIIE amplitude reflects the difference between stimulus and recovery intensities and seems not to modulate the affective responses to HIIE sessions configured with different amplitudes.HIIE sessions performed at the same average intensity and different amplitudes result in similar affective responses.High inter-individual variability of affective responses occurs in HIIE sessions configured based on the amplitude.

Alzheimer's disease genes and proteins associated with resistance and aerobic training: An in silico analysis.

BACKGROUND: Exercise appears to be a viable intervention for maintaining cognitive function and regaining functional autonomy, and perhaps even contributing to a slower progression of Alzheimer's Disease (AD). OBJECTIVE: To explore different neuroplasticity pathways modulated by aerobic and strength training, determine whether signaling pathways overlapped for each specific training method (aerobic and strength training), and evaluate whether there is a functional relationship between APOE and APP gene expression with aerobic training modulated by BDNF; and strength training modulated by IGF-1. METHODS: An in silico analysis was performed to analyze the connection between exercise types and neuroplasticity as a protective factor in AD. The platform provides a protein-protein interaction network translated into known and predicted interactions. A score > 0.70 was determined as high confidence and the network was considered significant when the Protein-Protein Interaction Enrichment was <0.01. RESULTS: Multiple functional associations considered significant between the analyzed proteins. The results of our gene network model support that exercise, both aerobic and strength, can modulate genes that affect hippocampal neuroplasticity and neurogenesis, which may delay cognitive decline and Alzheimer's related symptoms. CONCLUSION: The investigation about the functional association of aerobic training via BDNF in the modulation of APP, APOE, and MAPT genes in the hippocampus seems to be established, while strength training seems to induce the production of IGF-1 and IGF-1R, modulating AKT1.

Spatial navigation in older adults with mild cognitive impairment and dementia: A systematic review and meta-analysis.

In this systematic review and meta-analysis, we compared the spatial navigation performance of older adults with mild cognitive impairment (MCI), Alzheimer's Disease (AD), and other dementias, using healthy older adults as controls. In addition, we evaluated the possible influence of the environment type (virtual and real), protocol (object- or environment-based), and the navigation mode (active and passive navigation) on spatial navigation task performance. In total, 1372 articles were identified and 24 studies were included in the meta-analysis. We found a large effect size on the spatial navigation performance of patients with cognitive decline (standardized mean difference (SMD) = 0.87, confidence interval (CI95%) = 0.62-1.09, p < 0.001), especially amnestic MCI (SMD = 1.10, CI95% = 0.71-1.49, p < 0.001) and patients with AD (SMD = 1.60, CI95% = 1.25-1.95, p < 0.001). However, the tasks did not identify mixed and vascular dementia (SMD = 0.92, CI95% = -0.33-2.18, p = 0.15 and SMD = 0.65, CI95% = -0.67-1.97, p = 0.33, respectively). Spatial navigation ability assessed using the Floor Maze Test showed the largest effect size in differentiating healthy older adults and patients with cognitive decline (SMD = 1.98,CI95% = 1.00-2.97, p < 0.001). In addition, tasks that require walking showed the greatest differences between the two groups. These results suggest that spatial navigation impairment is important, but disease-specific behavioral biomarker of the dementia pathology process that can be identified even in the early stages.

Online physical exercise and the neuropsychiatric symptoms in patients with dementia: a cross-sectional study during the COVID-19 pandemic.

Social isolation is necessary during the COVID-19 pandemic but can be harmful to mental health, especially in people with neurocognitive disorders. Although physical exercise can alleviate neuropsychiatric symptoms and improve quality of life (QoL), sedentary behavior increased during the pandemic. Online interventions can contribute to improving physical activity and mental health. Objective: The objective of this study was to compare the neuropsychiatric symptoms and QoL of older adults with neurocognitive disorders who participated in an online physical exercise program with sedentary patients during the COVID-19 pandemic. Methods: In this cross-sectional study, 25 older patients with neurocognitive disorders (control group=11; online exercise group=14) were evaluated based on Neuropsychiatric Inventory (NPI) and the Quality of Life in Alzheimer's Disease (QoL-AD) scale. Results: There were differences between the two groups in the total NPI (U=36.50, p=0.025) and the nighttime behavior disturbances item (U=38.00, p=0.033), both with large effect sizes (ES=-1.03, 95% confidence interval [CI]:-1.83 to -0.16 and ES=-1.06, 95%CI -1.86 to -0.19, respectively). In terms of QoL-AD, a difference was identified only in the memory subitem (U=20.00, p=0.005), with a large ES (1.59, 95%CI 0.59-2.48). Conclusions: Older adults with neurocognitive disorders who participated in an online physical exercise program, during the COVID-19 pandemic, showed fewer neuropsychiatric total symptoms, fewer nighttime disturbances episodes, and better subjective memory, compared to their physically inactive counterparts. Randomized controlled trials should be performed to better understand the effect of physical exercise in neuropsychiatric symptoms in dementia patients during periods of social isolation.

O isolamento social é necessário na pandemia de COVID-19, mas pode impactar a saúde mental, especialmente em idosos com demência, dada a alta prevalência de sintomas neuropsiquiátricos. Apesar da prática de exercícios físicos contribuir para a redução desses sintomas e a melhora da qualidade de vida, houve um aumento de comportamento sedentário durante a pandemia. Objetivo: Comparar os sintomas neuropsiquiátricos e a qualidade de vida de idosos com distúrbios neurocognitivos que participaram de um programa de exercícios físicos online voltado a pacientes sedentários durante a pandemia de COVID-19. Métodos: Neste estudo de corte transversal, 25 idosos diagnosticados com transtorno neurocognitivo (controle=11; exercícios online=14) foram avaliados por meio do inventário neuropsiquiátrico (INP) e da escala de qualidade de vida na doença de Alzheimer (QV-DA). Resultados: Observou-se diferença entre os grupos no INP total (U=36,50, p=0,025), com tamanho de efeito grande (effect size [ES]=-1,03, intervalo de confiança - IC95% -1,83 a -0,16), e no subdomínio sono (U=38,00, p=0,033), com tamanho de efeito grande (ES=-1,06, IC95% -1,86 a -0,19), favoráveis ao grupo fisicamente ativo. Na QV-DA, houve diferença entre os grupos apenas no subitem memória (U=20,00, p=0,005), com tamanho de efeito grande (ES=1,59, IC95% 0,59 a 2,48), não houve diferença na pontuação total (U=45,5, p=0,277). Conclusões: Idosos submetidos a rotina de exercícios físicos com supervisão online na pandemia de COVID-19 apresentam menos sintomas neuropsiquiátricos, melhor qualidade de sono e memória quando comparados aos fisicamente inativos. Estudos randomizados controlados devem ser feitos para a melhor compreensão dos efeitos do exercício físico nos sintomas neuropsiquiátricos de pacientes com demência durante períodos de isolamento social.

Clinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: The World Federation of Societies of Biological Psychiatry (WFSBP) and Canadian Network for Mood and Anxiety Treatments (CANMAT) Taskforce.

OBJECTIVES: The therapeutic use of nutrient-based 'nutraceuticals' and plant-based 'phytoceuticals' for the treatment of mental disorders is common; however, despite recent research progress, there have not been any updated global clinical guidelines since 2015. To address this, the World Federation of Societies of Biological Psychiatry (WFSBP) and the Canadian Network for Mood and Anxiety Disorders (CANMAT) convened an international taskforce involving 31 leading academics and clinicians from 15 countries, between 2019 and 2021. These guidelines are aimed at providing a definitive evidence-informed approach to assist clinicians in making decisions around the use of such agents for major psychiatric disorders. We also provide detail on safety and tolerability, and clinical advice regarding prescription (e.g. indications, dosage), in addition to consideration for use in specialised populations. METHODS: The methodology was based on the WFSBP guidelines development process. Evidence was assessed based on the WFSBP grading of evidence (and was modified to focus on Grade A level evidence - meta-analysis or two or more RCTs - due to the breadth of data available across all nutraceuticals and phytoceuticals across major psychiatric disorders). The taskforce assessed both the 'level of evidence' (LoE) (i.e. meta-analyses or RCTs) and the assessment of the direction of the evidence, to determine whether the intervention was 'Recommended' (+++), 'Provisionally Recommended' (++), 'Weakly Recommended' (+), 'Not Currently Recommended' (+/-), or 'Not Recommended' (-) for a particular condition. Due to the number of clinical trials now available in the field, we firstly examined the data from our two meta-reviews of meta-analyses (nutraceuticals conducted in 2019, and phytoceuticals in 2020). We then performed a search of additional relevant RCTs and reported on both these data as the primary drivers supporting our clinical recommendations. Lower levels of evidence, including isolated RCTs, open label studies, case studies, preclinical research, and interventions with only traditional or anecdotal use, were not assessed. RESULTS: Amongst nutraceuticals with Grade A evidence, positive directionality and varying levels of support (recommended, provisionally recommended, or weakly recommended) was found for adjunctive omega-3 fatty acids (+++), vitamin D (+), adjunctive probiotics (++), adjunctive zinc (++), methylfolate (+), and adjunctive s-adenosyl methionine (SAMe) (+) in the treatment of unipolar depression. Monotherapy omega-3 (+/-), folic acid (-), vitamin C (-), tryptophan (+/-), creatine (+/-), inositol (-), magnesium (-), and n-acetyl cysteine (NAC) (+/-) and SAMe (+/-) were not supported for this use. In bipolar disorder, omega-3 had weak support for bipolar depression (+), while NAC was not currently recommended (+/-). NAC was weakly recommended (+) in the treatment of OCD-related disorders; however, no other nutraceutical had sufficient evidence in any anxiety-related disorder. Vitamin D (+), NAC (++), methylfolate (++) were recommended to varying degrees in the treatment of the negative symptoms in schizophrenia, while omega-3 fatty acids were not, although evidence suggests a role for prevention of transition to psychosis in high-risk youth, with potential pre-existing fatty acid deficiency. Micronutrients (+) and vitamin D (+) were weakly supported in the treatment of ADHD, while omega-3 (+/-) and omega-9 fatty acids (-), acetyl L carnitine (-), and zinc (+/-) were not supported. Phytoceuticals with supporting Grade A evidence and positive directionality included St John's wort (+++), saffron (++), curcumin (++), and lavender (+) in the treatment of unipolar depression, while rhodiola use was not supported for use in mood disorders. Ashwagandha (++), galphimia (+), and lavender (++) were modestly supported in the treatment of anxiety disorders, while kava (-) and chamomile (+/-) were not recommended for generalised anxiety disorder. Ginkgo was weakly supported in the adjunctive treatment of negative symptoms of schizophrenia (+), but not supported in the treatment of ADHD (+/-). With respect to safety and tolerability, all interventions were deemed to have varying acceptable levels of safety and tolerability for low-risk over-the-counter use in most circumstances. Quality and standardisation of phytoceuticals was also raised by the taskforce as a key limiting issue for firmer confidence in these agents. Finally, the taskforce noted that such use of nutraceuticals or phytoceuticals be primarily recommended (where supportive evidence exists) adjunctively within a standard medical/health professional care model, especially in cases of more severe mental illness. Some meta-analyses reviewed contained data from heterogenous studies involving poor methodology. Isolated RCTs and other data such as open label or case series were not included, and it is recognised that an absence of data does not imply lack of efficacy. CONCLUSIONS: Based on the current data and clinician input, a range of nutraceuticals and phytoceuticals were given either a supportive recommendation or a provisional recommendation across a range of various psychiatric disorders. However several had only a weak endorsement for potential use; for a few it was not possible to reach a clear recommendation direction, largely due to mixed study findings; while some other agents showed no obvious therapeutic benefit and were clearly not recommended for use. It is the intention of these guidelines to inform psychiatric/medical, and health professional practice globally.

Factors associated with adherence to sports and exercise among outpatients with major depressive disorder.

INTRODUCTION: Individuals with major depressive disorder (MDD) face more barriers to engagement in sports and exercise interventions. Evaluating clinical and demographic factors associated with adherence to sports and exercise among MDD outpatients could support development of new options and strategies to increase their participation. METHODS: In a cross-sectional study, 268 depressed outpatients were evaluated (83.51% females; mean age = 50.74 [standard deviation {SD} = 10.39]). Sports and exercise participation were assessed using a question about participation frequency during the previous month. Clinical and demographic factors were evaluated. Linear regression was used to identify predictors of participation in sports and exercise. RESULTS: MDD patients with mild symptoms of depression (odds ratio [OR] = 2.42; 95% confidence interval [95%CI] 1.00, 5.88; p = 0.04) and patients with mild to moderate symptoms (OR = 3.96; 95%CI 1.41, 11.15; p = 0.009) were more likely to engage regularly in sports and exercise than patients with more severe depression. Moreover, smoking (OR = 0.23; 95%CI 0.67, 0.80; p = 0.007) and being divorced (OR = 0.22; 95%CI 0.57, 0.86; p = 0.03) were associated with lower rates of engagement in sports and exercise. CONCLUSION: Our findings indicate a significant association between clinical and demographic factors and participation in sports and exercise among MDD outpatients.

Beyond the Mini-Mental State Examination: The Use of Physical and Spatial Navigation Tests to Help to Screen for Mild Cognitive Impairment and Alzheimer's Disease.

BACKGROUND: Spatial navigation and dual-task (DT) performance may represent a low-cost approach to the identification of the cognitive decline in older adults and may support the clinical diagnosis of mild cognitive impairment (MCI) and Alzheimer's disease (AD). OBJECTIVE: To assess the accuracy of different types of motor tasks in differentiating older persons with MCI and AD from healthy peers. METHODS: Older adults aged 60 years or over (n = 105; healthy = 39; MCI = 23; AD = 43) were evaluated by the floor maze test (FMT), the senior fitness test, and DT performance. Receiver operating characteristic curve (ROC) analysis was used to evaluate the accuracy of the tests. We also performed principal component analysis (PCA) and logistic regression analysis to explore the variance and possible associations of the variables within the sample. RESULTS: FMT (AUC = 0.84, sensitivity = 75.7%, specificity = 76.1%, p < 0.001) and DT (AUC = 0.87, sensitivity = 80.4%, specificity = 86.9%, p < 0.001) showed the highest performance for distinguishing MCI from AD individuals. Moreover, FMT presented better sensitivity in distinguishing AD patients from their healthy peers (AUC = 0.93, sensitivity = 94%, specificity = 85.6%, p < 0.001) when compared to the Mini-Mental State Examination. PCA revealed that the motor test performance explains a total of 73.9% of the variance of the sample. Additionally, the results of the motor tests were not influenced by age and education. CONCLUSION: Spatial navigation tests showed better accuracy than usual cognitive screening tests in distinguishing patients with neurocognitive disorders.