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.

Effects of low doses of polyunsaturated Fatty acids on the attention deficit/hyperactivity disorder of children: a systematic review.

UNLABELLED: Since attention deficit/hyperactivity disorder (ADHD) presents high prevalence among children, science has been researching alternative forms of treatment that do not involve medication. OBJECTIVE: To evaluate the effects of polyunsaturated fatty acids (PUFAs) on attention deficit/hyperactivity disorder. METHODS: We reviewed the articles published between 1980 and 2012 indexed in the databases PubMed, APA psychNET, Scopus and Web of Knowledge. RESULTS: Initially 231 articles were selected, out of which 12 met the inclusion criteria. The articles selected reported a modest cognitive and behavioral improvement of the patients after treatment with low doses of PUFAs. Those results might be associated with the evaluation methodology, the doses of PUFAs administered or the duration of treatment.

Functional dependence and caregiver burden in Alzheimer's disease: a controlled trial on the benefits of motor intervention.

BACKGROUND: Cognitive decline has a negative impact on functional activities in Alzheimer's disease. Investigating the effects of motor intervention with the intent to reduce the decline in functionality is an expected target for patients and caregivers. The aim of this study was to verify if a 6-month motor intervention programme promoted functionality in Alzheimer's patients and attenuated caregivers' burden. METHODS: The sample comprised 32 community patients with Alzheimer's disease and their 32 respective caregivers. Patients were divided into two groups: 16 participated in the motor intervention programme and 16 controls. Subjects performed 60 minutes of exercises, three times per week during the 6-month period, to improve flexibility, strength, agility and balance. Caregivers followed the procedures with their patients during this period. Functionality was evaluated by the Berg Functional Balance Scale and the Functional Independence Measure. Caregivers completed the Neuropsychiatric Inventory Caregiver Distress Scale and the Zarit Carer Burden Scale. Two-way ANOVA was used to verify the interaction between time (pre- and post-intervention) and the motor intervention program. RESULTS: While patients in the motor programme preserved their functionality, as assessed by the Functional Independence Measure, the controls suffered a relative decline (motor intervention group: from 109.6 to 108.4 vs controls: from 99.5 to 71.6; P= 0.01). Patients from motor intervention also had better scores than the controls on functional balance assessed by Berg scale (F: 22.2; P= 0.001). As assessed by the Neuropsychiatric Inventory and Zarit scale, burden was reduced among caregivers whose patients participated in the motor intervention programme compared with caregivers whose patients did not participate in this programme (Neuropsychiatric Inventory, caregiver's part: F: 9.37; P= 0.01; Zarit: F: 11.28; P= 0.01). CONCLUSION: Patients from the motor intervention group showed reduced functional decline compared to the controls, and there was an associated decrease in caregivers' burden.

[Systematized physical activity and cognitive performance in elderly with Alzheimer's dementia: a systematic review]. / Atividade física sistematizada e desempenho cognitivo em idosos com demência de Alzheimer: uma revisão sistemática.

OBJECTIVE: Despite the growing evidence of the benefits of physical exercise for cognition, there is a controversy about the systematic practice of physical activity in patients with Alzheimer's disease. Therefore, the objective of this study was to procedure a systematic review of studies that analyzed the effect of systematized physical activity on cognitive performance in elderly individuals with Alzheimer's disease. METHOD: We conducted a search in PsycINFO, Biological Abstracts, Medline, Web of Science, Physical Education and SPORTDiscus Index from 1990 to 2008, using the following keywords: 'physical activity', 'physical therapy', 'exercise', 'fitness', 'aerobic', 'strength', 'intervention', 'cognition', 'cognitive performance', 'Alzheimer's disease', 'Alzheimer's dementia', 'Alzheimer's', and cross-references of selected articles. RESULTS: There were found eight studies that met inclusion criteria adopted for the present work. These studies showed that systematized physical activity contributed to at least improve temporarily some cognitive functions of patients with Alzheimer's disease, particularly, attention, executive functions and language. CONCLUSION: Unable to establish a protocol of recommendations about the type and intensity of systematized physical activity required to produce benefits in cognitive functioning. However, the practice of regular systematized physical activity appears to contribute to the preservation or improvement of cognitive functions in patients with Alzheimer's disease.

Physical exercise, IGF-1 and cognition A systematic review of experimental studies in the elderly.

One of hypothetical mechanisms related to cognition is exercise-induced IGF-1. OBJECTIVE: The aim of this study was to analyze the effects of exercise on IGF-1 levels and cognition in the elderly. METHODS: The article searches were conducted on Pubmed, Web of Science, PsycINFO and Scielo databases and reviewed according to PRISMA guidelines. The inclusion criteria were: [1] original articles published up to 2017; [2] samples including elderly; [3] protocols including physical exercise; [4] longitudinal studies having exercise as main outcome; [5] assessment of IGF-1; [6] cognition assessment. RESULTS: Seven studies were included in this review. Three of the studies showed an exercise-induced increase in IGF-1; three found stable IGF-1 levels and one found a reduction in IGF-1; with and without improvement in cognition. CONCLUSION: Disparities in the type of physical exercise, protocols and samples under different conditions hinder the establishment of a consensus on IGF-1, cognition and physical exercise.

Um dos mecanismos hipotéticos relacionados a cognição é o IGF-1 induzido pelo exercício. OBJETIVO: O objetivo deste estudo foi analisar os efeitos do exercício físico nos níveis de IGF-1 e na cognição de idosos. MÉTODOS: A busca de artigos foi conduzida nas bases de dados Pubmed, Web of Science, PsycINFO e Scielo, revisada de acordo com as recomendações do PRISMA. O critério de inclusão adotado foi: [1] artigos originais publicados até 2017; [2] amostras incluindo idosos; [3] protocolos que incluíssem exercício físico; [4] ensaios randomizados, não randomizados, controlados e não controlados; [5] avaliação dos níveis de IGF-1; [6] avaliação cognitive. RESULTADOS: Sete estudos foram incluídos nesta revisão. Três deles mostraram aumento de IGF-1 por meio do exercício; três verificaram manutenção nos níveis de IGF-1 e um, verificou redução de IGF-1; com e sem melhora cognitive. CONCLUSÃO: Diferenças nos tipos de exercício, protocolos, amostras em diferentes condições dificultam o estabelecimento de um consenso em relação ao IGF-1, cognição e exercício físico.

Effects of Physical Exercise on the P300 of Elderly With Alzheimer's Disease.

BACKGROUND: Evidence regarding the benefits of physical activity on the mental processing information of patients with Alzheimer's disease assessed objectively is scarce and can be observed through event-related potentials, such as the P300. The aim of the study was to identify the effects of physical exercises on mental processing information in the elderly with Alzheimer's disease through neurophysiological measures (P300 amplitude and latency) and reaction time. METHODS: A total of 31 patients with Alzheimer's disease participated in this study: 14 in functional exercise (FE) group and 17 in social gathering (SG) group who carried out three 1-hour sessions per week of FE and SG activities, respectively, for a 12-week period. All groups performed an auditory oddball task. A healthy elderly control group also participated. RESULTS: Significant (P < .05) improvements were observed as a reduction of reaction time after intervention in the FE group (pre = 421.5 ms and post = 360.9 ms). Also, an increase of P300 amplitude at central midline (pre = 5.9 µV and post = 6.9 µV) and parietal midline (pre = 4.7 µV and post = 5.7 µV) was observed in the FE. Finally, a decrease in the P300 latency at frontal midline (pre = 377 ms and post = 367 ms) was observed in the SG after the intervention. CONCLUSION: Physical exercise decreases reaction time and suggests a recovery in cortical activity, whereas SG activities could probably facilitate information processing.

Cognitive, functional and physical activity impairment in elderly with Alzheimer's disease.

Alzheimer's Disease (AD) is a progressive degenerative disorder that negatively affects quality of life of patients and family members. OBJECTIVE: The aim of this study is to compare the cognition, level of physical activity and functioning of elderly individuals with mild AD and those without dementia. METHODS: The study comprised 24 elderly with mild AD (mean age = 76.9 ± 5.3 years) and 30 elderly without dementia (mean age = 74.1 ± 5.6 years). The following instruments were applied to evaluate cognitive functions: MMSE; Frontal Assessment Battery; Clock Drawing Test; Corsi Blocks, and Verbal Paired Associates. Event-related potential P300 was used to evaluate cognitive processing. The Modified Baecke Questionnaire For Older Adults was applied to evaluate the level of physical activity together with use of a pedometer for 7 consecutive days. For the evaluation of the functioning, the Direct Assessment of Functional Status-Revised scale and functional tests were used. RESULTS: There was a significant difference between the groups in level of physical activity and functioning, except on the test evaluating flexibility. CONCLUSION: Elderly with AD had cognitive, functional and physical activity deficits which can manifest even in the early stages of the disease.

A doença de Alzheimer é um processo neurodegenerativo e progressivo que afeta, negativamente, a qualidade de vida do paciente e de seus familiares. OBJETIVO: Comparar a cognição, nível de atividade física capacidade funcional de idosos no estágio leve da doença de Alzheimer e de idosos sem demência. MÉTODOS: Participaram deste estudo 24 idosos no estágio leve da doença de Alzheimer (média de idade = 76,9 ± 5.3 anos) e 30 idosos sem demência (média de idade = 74,1 ± 5,6 anos). Foram utilizados os seguintes instrumentos de avaliação cognitiva: MEEM, Bateria de Avaliação Frontal, Teste do Desenho do Relógio, Blocos de Corsi e Pares Verbais Associados. Além disso, foi realizado o exame eletroencefalográfico P300 para avaliar o tempo de processamento de informação. Para quantificar o nível de atividade física foi utilizado o Questionário Baecke Modificado para Idosos e o pedômetro, que foi utilizado por 7 dias consecutivos. A funcionalidade foi avaliada através da escala Direct Assessment of Functional Status-Revised, juntamente com testes funcionais que avaliaram os componentes da capacidade funcional. RESULTADOS: Foram encontradas diferenças significativas entre os grupos para o nível de atividade física e funcionalidade motora, com exceção da avaliação da flexibilidade. CONCLUSÃO: Idosos com doença de Alzheimer apresentam prejuízos cognitivos, funcionais e de nível de atividade física, os quais encontram-se alterados nos estágios iniciais da doença.

Possible Cognitive Benefits of Acute Physical Exercise in Children With ADHD.

OBJECTIVE: Studies have suggested that even a single session of physical exercise enhances executive functions. ADHD is among the most common developmental disorders in childhood, but little is known about alternative treatments for this disorder. Therefore, we performed a systematic review of the literature to analyze articles that evaluated the executive functions of children with ADHD after an acute exercise session. METHOD: We reviewed articles indexed in the PubMed, American Psychiatric Association (APA) psychNET, Scopus, and Web of Knowledge databases between 1980 and 2013. RESULTS: Of 231 articles selected, only three met the inclusion criteria. CONCLUSION: Based on these 3 articles, we concluded that 30 min of physical exercise reportedly improved the executive functions of children with ADHD. Due to the small number of articles selected, further studies are needed to confirm these benefits.

Respiratory training as strategy to prevent cognitive decline in aging: a randomized controlled trial.

BACKGROUND: Inadequate oxygenation may cause lesions and brain atrophy during aging. Studies show a positive association between pulmonary function and the cognitive performance of individuals from middle age on. OBJECTIVE: To investigate the effect of aerobic physical exercises and respiratory training on the blood oxygenation, pulmonary functions, and cognition of the elderly. DESIGN: This was a randomized and controlled trial with three parallel groups. A total of 195 community-dwelling elderly were assessed for eligibility; only n=102 were included and allocated into the three groups, but after 6 months, n=68 were analyzed in the final sample. Participants were randomized into a social interaction group (the control group), an aerobic exercise group (the "walking" group), or a respiratory training group (the "breathing" group). The main outcome measures were the Wechsler Adult Intelligence Scale, Wechsler Memory Scale, Wisconsin Card Sorting Test, respiratory muscular strength, cirtometry (thoracic-abdominal circumference); oxygen saturation in arterial blood (SpO2), and hemogram. RESULTS: No differences were observed for any of the blood parameters. Aerobic exercise and respiratory training were effective in improving the pulmonary parameters. Better cognitive performance was observed for the breathing group as regards abstraction and mental flexibility. The walking group remained stable in the cognitive performance of most of the tests, except attention. The control group presented worst performance in mental manipulation of information, abstraction, mental flexibility, and attention. CONCLUSION: Our results showed that both the walking and breathing groups presented improvement of pulmonary function. However, only the breathing group showed improved cognitive function (abstraction, mental flexibility). The improvement in cognitive functions cannot be explained by blood parameters, such as SpO2, erythrocytes, hemoglobin, and hematocrit.

The influence of physical exercise and leisure activity on neuropsychological functioning in older adults.

It has been suggested that leisure activity and physical exercise can be a protective factor for neuropsychological functions and are associated with a reduced risk of dementia. Thus, the purpose of this study was to investigate the influence of physical exercise and leisure on the neuropsychological functions of healthy older adults. The sample was composed of 51 sedentary female volunteers who were 60-70 years old and were distributed into three groups: A-control, B-leisure, and C-training. Volunteers were submitted to a physical and neuropsychological assessment at baseline and after 6 months. Groups A and B were monitored longitudinally three times a week. Group C improved their neuropsychological functioning and oxygen consumption compared to groups A and B (p = <0.05). The neuropsychological functions of groups A and B were significantly worse after 6 months of monitoring (p = <0.05). The data suggest that physical exercise improves neuropsychological functioning, although leisure activities may also improve this functioning. Thus, an aerobic physical fitness program can partially serve as a non-medication alternative for maintaining and improving these functions in older adults; however, leisure activities should also be considered.

Aerobic physical exercise improved the cognitive function of elderly males but did not modify their blood homocysteine levels.

BACKGROUND: Physical exercise influences homocysteine (Hcy) concentrations, cognitive function and the metabolic profile. The purpose of this study was to investigate the influence of regular physical exercise on Hcy levels, the metabolic profile and cognitive function in healthy elderly males before and after an endurance exercise program. METHODS: Forty-five healthy and sedentary volunteers were randomized into 2 groups: (1) a control group asked not to change their normal everyday activities and not to start any regular physical exercise program and (2) an experimental group trained at a heart rate intensity corresponding to ventilatory threshold 1 (VT-1) for 60 min/day 3 times weekly on alternate days for 6 months using a cycle ergometer. All volunteers underwent cognitive evaluations, blood sample analyses and ergospirometric assessments. RESULTS: A significant improvement in cognitive function was observed in the experimental group compared with the control group (p < 0.05). No significant changes in Hcy levels were observed in the experimental group (p > 0.05), but there was a significant increase in peak oxygen consumption and workload at VT-1 as well as a significant improvement in cholesterol, triglycerides, HDL, glucose, alkaline phosphatase, urea, T3, T4 and prostate-specific antigen compared with the control group (p < 0.05). CONCLUSION: The data suggest that a physical exercise program does not reduce Hcy levels in healthy elderly males, although it improves the cardiovascular and metabolic profile as well as cognitive function.

Acute aerobic exercise increases brain-derived neurotrophic factor levels in elderly with Alzheimer's disease.

Studies indicate the involvement of brain-derived neurotrophic factor (BDNF) in the pathogenesis of Alzheimer's disease (AD). Decreased BDNF levels may constitute a lack of trophic support and contribute to cognitive impairment in AD. The benefits of acute and chronic physical exercise on BDNF levels are well-documented in humans, however, exercise effects on BDNF levels have not been analyzed in older adults with AD. The aim of this study was to investigate the effects of acute aerobic exercise on BDNF levels in older adults with AD and to verify associations among BDNF levels, aerobic fitness, and level of physical activity. Using a controlled design, twenty-one patients with AD (76.3 ± 6.2 years) and eighteen healthy older adults (74.6 ± 4.7 years) completed an acute aerobic exercise. The outcomes included measures of BDNF plasma levels, aerobic fitness (treadmill grade, time to exhaustion, VO2, and maximal lactate) and level of physical activity (Baecke Questionnaire Modified for the Elderly). The independent t-test shows differences between groups with respect to the BDNF plasma levels at baseline (p = 0.04; t = 4.53; df = 37). In two-way ANOVA, a significant effect of time was found (p = 0.001; F = 13.63; df = 37), the aerobic exercise significantly increased BDNF plasma levels in AD patients and healthy controls. A significant correlation (p = 0.04; r = 0.33) was found between BDNF levels and the level of physical activity. The results of our study suggest that aerobic exercise increases BDNF plasma levels in patients with AD and healthy controls. In addition to that, BDNF levels had association with level of physical activity.

Physical exercise and vascular endothelial growth factor (VEGF) in elderly: A systematic review.

UNLABELLED: The aim of this study was to conduct a systematic review of studies that verified the effects of physical exercise on vascular endothelial growth factor (VEGF) in elderly. METHODOLOGY: The bibliographic search was conducted in five database, from 1990 to 2013, with the following keywords and boolean operators: physical exercise OR physical exercise OR physical therapy OR exercise OR training AND VEGF OR vascular endothelial growth factor AND aged OR older OR elderly. The inclusion criteria were: (1) sample including elderly with average age of 60; (2) studies that verified the effects of acute exercise; (3) studies that verified the effects of chronic physical exercise; (4) studies with humans; (5) randomized controlled trials, randomized non-controlled trials, non-randomized controlled trials, non-randomized and non-controlled trials; (6) assessment of VEGF peripheral concentrations. RESULTS: Ten studies were selected, and that four of them verified an increase of VEGF concentrations after practicing physical exercise and six studies did not verify any change on VEGF concentrations. CONCLUSION: Different populations found in this study and the different exercise protocols applied in the studies of this review make it difficult to establish parameters of what would be the best type of exercise to promote an increase on the concentrations of VEGF in the elderly. Therefore, we suggest that further studies can be performed, so that we can establish some recommendations for this population.

Efeito do exercício físico nas funções cognitivas e motoras de idosos com doença de Alzheimer: uma revisão / Effect of physical exercise on the cognitive and motor functions of the older people with Alzheimer's disease: a review

OBJETIVO: Analisar o efeito do exercício físico nos aspectos cognitivos e motores de idosos com doença de Alzheimer. MÉ- TODOS: Foi realizada busca nas seguintes bases de dados: Pub- Med, MEDLINE, LILACS, Periódico CAPES e Web of Science ™, no período de 2011 a 2016. Foram utilizadas as seguintes palavras-chave: "physical exercise", "exercise", "training", "motor intervention", "aged", "older", "elderly", "Alzheimer's dementia", "Alzheimer's disease", "Alzheimer", "Cognition", "cognitive performance", "motor" e "motor performance". RESULTADOS: Além da busca em base de dados, foi realizada busca manual nas listas de referências dos artigos selecionados. Foram encontrados três estudos que preencheram todos os critérios de inclusão adotados neste trabalho. Todos demonstraram melhoras tanto no desempenho cognitivo quanto motor de idosos com doença de Alzheimer submetidos a exercícios físicos. CONCLUSÃO: Observou-se melhora e/ou manutenção das funções cognitivas e motoras em todos os estudos. Apesar disso, não houve consenso sobre o tipo de exercício, sua intensidade e a duração adequada para idosos com doença de Alzheimer. (AU)

OBJECTIVE: To analyze the effect of physical exercise on the cognitive and motor aspects of older people with Alzheimer's disease. METHODS: The following databases were searched: Pubmed, Medline, Lilacs, CAPES Journal, and Web of Science from 2011 to 2016. The following keywords were used: "Physical exercise", "exercise", "training "" Motor intervention "," Aged "," older "," elderly","Alzheimer's dementia","Alzheimer's disease","Alzheimer", "Cognition", "cognitive performance", "Motor". RESULTS: In addition to database search, a manual search was performed in the reference lists of the selected articles. Three studies were found that fulfilled all the inclusion criteria adopted in this study. All of them demonstrated improvements in both the cognitive and motor performance of older people with Alzheimer's disease undergoing physical exercises. CONCLUSION: Improvement and/or maintenance of cognitive and motor functions was observed in all studies. Despite this, there was no consensus on the type of exercise, its intensity and adequate duration for elderly people with Alzheimer's disease. (AU)

Physical exercise modulates peripheral levels of brain-derived neurotrophic factor (BDNF): a systematic review of experimental studies in the elderly.

UNLABELLED: The objective of this study was to conduct a systematic review of studies that analyzed the effect of physical exercise on the peripheral levels of BDNF in elderly individuals. METHOD: We conducted a search in PsycINFO, Biological Abstracts, Pubmed, Web of Science, and Science Direct from 1990 to 2011, using the following keywords: "physical exercise", "physical activity", "physical therapy", "training", "BDNF", "neuroplasticity", "neurotrophins", "neuroplasticity proteins", "aged", "older", "elderly". The articles were considered for inclusion in the review if they were studies with elderly, assessed peripheral (serum and/or plasma) BDNF and evaluated an acute exercise or chronic exercise (training). RESULTS: Five randomized controlled trial and one randomized non-controlled trial studies were analyzed. Five out of six studies reported a significantly higher BDNF response to aerobic acute exercise and to aerobic or strength training program in healthy elderly and elderly with different pathologies. CONCLUSION: It was not possible to establish a recommendation protocol for the type and intensity of physical exercise required to produce an increase in levels BDNF. However, physical exercise, particularly, moderate-intensity exercises seem to be more effective to promote increase the peripheral levels of BDNF in the elderly.

Multimodal exercise intervention improves frontal cognitive functions and gait in Alzheimer's disease: a controlled trial.

AIM: The objective of the present study was to investigate the effect of a multimodal exercise intervention on frontal cognitive functions and kinematic gait parameters in patients with Alzheimer's disease. METHODS: A sample of elderly patients with Alzheimer's disease (n=27) were assigned to a training group (n=14; aged 78.0±7.3 years) and a control group (n=13; aged 77.1±7.4 years). Multimodal exercise intervention includes motor activities and cognitive tasks simultaneously. The participants attended a 1-h session three times a week for 16 weeks, and the control participants maintained their regular daily activities during the same period. The frontal cognitive functions were evaluated using the Frontal Assessment Battery, the Clock Drawing Test and the Symbol Search Subtest. The kinematic parameters of gait-cadence, stride length and stride speed were analyzed under two conditions: (i) free gait (single task); and (ii) gait with frontal cognitive task (walking and counting down from 20--dual task). RESULTS AND DISCUSSION: The patients in the intervention group significantly increased the scores in frontal cognitive variables, Frontal Assessment Battery (P<0.001) and Symbol Search Subtest (P<0.001) after the 16-week period. The control group decreased the scores in the Clock Drawing Test (P=0.001) and increased the number of counting errors during the dual task (P=0.008) after the same period. CONCLUSION: The multimodal exercise intervention improved the frontal cognitive functions in patients with Alzheimer's disease.

Cognitive, functional and physical activity impairment in elderly with Alzheimer's disease / Comprometimento cognitivo, funcional e de nível de atividade física de idosos com doença de alzheimer: prejuízos na doença de alzheimer

ABSTRACT Alzheimer's Disease (AD) is a progressive degenerative disorder that negatively affects quality of life of patients and family members. Objective: The aim of this study is to compare the cognition, level of physical activity and functioning of elderly individuals with mild AD and those without dementia. Methods: The study comprised 24 elderly with mild AD (mean age = 76.9 ± 5.3 years) and 30 elderly without dementia (mean age = 74.1 ± 5.6 years). The following instruments were applied to evaluate cognitive functions: MMSE; Frontal Assessment Battery; Clock Drawing Test; Corsi Blocks, and Verbal Paired Associates. Event-related potential P300 was used to evaluate cognitive processing. The Modified Baecke Questionnaire For Older Adults was applied to evaluate the level of physical activity together with use of a pedometer for 7 consecutive days. For the evaluation of the functioning, the Direct Assessment of Functional Status-Revised scale and functional tests were used. Results: There was a significant difference between the groups in level of physical activity and functioning, except on the test evaluating flexibility. Conclusion: Elderly with AD had cognitive, functional and physical activity deficits which can manifest even in the early stages of the disease.

RESUMO A doença de Alzheimer é um processo neurodegenerativo e progressivo que afeta, negativamente, a qualidade de vida do paciente e de seus familiares. Objetivo: Comparar a cognição, nível de atividade física capacidade funcional de idosos no estágio leve da doença de Alzheimer e de idosos sem demência. Métodos: Participaram deste estudo 24 idosos no estágio leve da doença de Alzheimer (média de idade = 76,9 ± 5.3 anos) e 30 idosos sem demência (média de idade = 74,1 ± 5,6 anos). Foram utilizados os seguintes instrumentos de avaliação cognitiva: MEEM, Bateria de Avaliação Frontal, Teste do Desenho do Relógio, Blocos de Corsi e Pares Verbais Associados. Além disso, foi realizado o exame eletroencefalográfico P300 para avaliar o tempo de processamento de informação. Para quantificar o nível de atividade física foi utilizado o Questionário Baecke Modificado para Idosos e o pedômetro, que foi utilizado por 7 dias consecutivos. A funcionalidade foi avaliada através da escala Direct Assessment of Functional Status-Revised, juntamente com testes funcionais que avaliaram os componentes da capacidade funcional. Resultados: Foram encontradas diferenças significativas entre os grupos para o nível de atividade física e funcionalidade motora, com exceção da avaliação da flexibilidade. Conclusão: Idosos com doença de Alzheimer apresentam prejuízos cognitivos, funcionais e de nível de atividade física, os quais encontram-se alterados nos estágios iniciais da doença.

Physical exercise, IGF-1 and cognition: a systematic review of experimental studies in the elderly / Exercício físico, IGF11 e cognição: uma revisão sistemática de estudos experimentais em idosos

ABSTRACT One of hypothetical mechanisms related to cognition is exercise-induced IGF-1. Objective: The aim of this study was to analyze the effects of exercise on IGF-1 levels and cognition in the elderly. Methods: The article searches were conducted on Pubmed, Web of Science, PsycINFO and Scielo databases and reviewed according to PRISMA guidelines. The inclusion criteria were: [1] original articles published up to 2017; [2] samples including elderly; [3] protocols including physical exercise; [4] longitudinal studies having exercise as main outcome; [5] assessment of IGF-1; [6] cognition assessment. Results: Seven studies were included in this review. Three of the studies showed an exercise-induced increase in IGF-1; three found stable IGF-1 levels and one found a reduction in IGF-1; with and without improvement in cognition. Conclusion: Disparities in the type of physical exercise, protocols and samples under different conditions hinder the establishment of a consensus on IGF-1, cognition and physical exercise.

RESUMO. Um dos mecanismos hipotéticos relacionados a cognição é o IGF-1 induzido pelo exercício. Objetivo: O objetivo deste estudo foi analisar os efeitos do exercício físico nos níveis de IGF-1 e na cognição de idosos. Métodos: A busca de artigos foi conduzida nas bases de dados Pubmed, Web of Science, PsycINFO e Scielo, revisada de acordo com as recomendações do PRISMA. O critério de inclusão adotado foi: [1] artigos originais publicados até 2017; [2] amostras incluindo idosos; [3] protocolos que incluíssem exercício físico; [4] ensaios randomizados, não randomizados, controlados e não controlados; [5] avaliação dos níveis de IGF-1; [6] avaliação cognitive. Resultados: Sete estudos foram incluídos nesta revisão. Três deles mostraram aumento de IGF-1 por meio do exercício; três verificaram manutenção nos níveis de IGF-1 e um, verificou redução de IGF-1; com e sem melhora cognitive. Conclusão: Diferenças nos tipos de exercício, protocolos, amostras em diferentes condições dificultam o estabelecimento de um consenso em relação ao IGF-1, cognição e exercício físico.

Balance, executive functions and falls in elderly with Alzheimer's disease (AD): a longitudinal study.

Elderly individuals with AD are more susceptible to falls, which might be associated with decrements in their executive functions and balance, among other things. We aimed to analyze the effects of a program of dual task physical activity on falls, executive functions and balance of elderly individuals with AD. We studied 21 elderly with probable AD, allocated to two groups: the training group (TG), with 10 elderly who participated in a program of dual task physical activity; and the control group (CG), with 11 elderly who were not engaged in regular practice of physical activity. The Clock Drawing Test (CDT) and the Frontal Assessment Battery (FAB) were used in the assessment of the executive functions, while the Berg Balance Scale (BBS) and the Timed Up-and-Go (TUG)-test evaluated balance. The number of falls was obtained by means of a questionnaire. We observed a better performance of the TG as regards balance and executive functions. Moreover, the lower the number of steps in the TUG scale, the higher the scores in the CDT, and in the FAB. The practice of regular physical activity with dual task seems to have contributed to the maintenance and improvement of the motor and cognitive functions of the elderly with AD.

Gait and risk of falls associated with frontal cognitive functions at different stages of Alzheimer's disease.

The decline in frontal cognitive functions contributes to alterations of gait and increases the risk of falls in patients with dementia, a category which included Alzheimer's disease (AD). The objective of the present study was to compare the gait parameters and the risk of falls among patients at different stages of AD, and to relate these variables with cognitive functions. This is a cross-sectional study with 23 patients with mild and moderate AD. The Clinical Dementia Rating was used to classify the dementia severity. The kinematic parameters of gait (cadence, stride length, and stride speed) were analyzed under two conditions: (a) single task (free gait) and (b) dual task (walking and counting down). The risk of falls was evaluated using the Timed Up-and-Go test. The frontal cognitive functions were evaluated using the Frontal Assessment Battery (FAB), the Clock Drawing Test (CDT) and the Symbol Search Subtest. The patients who were at the moderate stage suffered reduced performance in their stride length and stride speed in the single task and had made more counting errors in the dual task and still had a higher fall risk. Both the mild and the moderate patients exhibited significant decreases in stride length, stride speed and cadence in the dual task. Was detected a significant correlation between CDT, FAB, and stride speed in the dual task condition. We also found a significant correlation between subtest Similarities, FAB and cadence in the dual task condition. The dual task produced changes in the kinematic parameters of gait for the mild and moderate AD patients and the gait alterations are related to frontal cognitive functions, particularly executive functions.