Compared to exercise, the effects of exercise combined with cognitive training in people with mild cognitive impairment: a network meta-analysis.

OBJECTIVES: The study aimed to evaluate the relative effectiveness of exercise combined with cognitive training (E&CT) in improving cognitive function compared to exercise alone. METHOD: PubMed, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, and OpenGrey were systematically searched. Additional screenings were performed by reviewing citations of relevant articles. Studies were included if they met inclusion criteria. Both pairwise and network meta-analyses were performed using a random effects model in Stata 15.0. RESULTS: Totally, 46 trials from 54 literature (n = 2846) were eligible for inclusion in the meta-analysis. The network meta-analysis indicated that exercise alone was more efficacious than E&CT in improving global cognition and multicomponent exercise exhibited the highest likelihood (SUCRA value= 89.0%) of being the most effective type. Regarding memory function, E&CT presented greater potential than exercise alone, with the interactive modality ranking first (SUCRA value = 88.4%). Multicomponent exercise was identified as the top intervention for enhancing executive function. The overall quality of the included studies was rated as moderate, and the certainty of evidence ranged from low to high. CONCLUSION: Multicomponent exercise emerged as the optimal intervention for improving global cognition and executive function. Nevertheless, for memory function, the interactive modality of E&CT demonstrated the highest probability of being the most effective choice.

Plasma BDNF/Irisin Ratio Associates with Cognitive Function in Older People.

Background: Reliable blood biomarkers are crucial for early detection and treatment evaluation of cognitive impairment, including Alzheimer's disease and other dementias. Objective: To examine whether plasma biomarkers and their combination are different between older people with mild cognitive impairment (MCI) and cognitively normal individuals, and to explore their relations with cognitive performance. Methods: This cross-sectional study included 250 older adults, including 124 participants with MCI, and 126 cognitively normal participants. Plasma brain-derived neurotrophic factor (BDNF), irisin and clusterin were measured, and BDNF/irisin ratio was calculated. Global cognition was evaluated by the Montreal Cognitive Assessment. Results: Plasma irisin levels, but not BDNF, were significantly different between MCI group and cognitively normal group. Higher irisin concentration was associated with an increased probability for MCI both before and after controlling covariates. By contrast, plasma BDNF concentration, but not irisin, was linearly correlated with cognitive performance after adjusting for covariates. Higher BDNF/irisin ratios were not only correlated with better cognitive performance, but also associated with lower risks of MCI, no matter whether we adjusted for covariates. Plasma BDNF and irisin concentrations increased with aging, whereas BDNF/irisin ratios remained stable. No significant results of clusterin were observed. Conclusions: Plasma BDNF/irisin ratio may be a reliable indicator which not only reflects the odds of the presence of MCI but also directly associates with cognitive performance.

Isolation, characterization, identification and quantification of 6-F oxyphenisatin dipropionate, a novel illegal additive, from a fruit-flavored jelly.

Objective: This study is aimed to screen, identify and detect illegal additives from healthcare products which claim or imply to have weight-loss effects. Method: Ultra-high performance liquid chromatography-quadruple-time-of-flight mass spectroscopy (UPLC-Q-TOF/MS) was employed to perform non-targeted screening of illegal additives from a total of 26 batches of healthcare products with weight-loss effects. A novel oxyphenisatin dipropionate analog was discovered in a fruit-flavored jelly that was not clearly labeled as containing added drugs. After being separated and purified by silica gel column chromatography, the analog was unambiguously characterized by one-dimensional (1D) and two-dimensional (2D) nuclear magnetic resonance (NMR) spectroscopies. The molecular structure of the analog was finally identified by comparing the spectra of the analog with those of suspected candidates prepared by de novo synthesis strategy. Thereafter, a sensitive and precise reversed phase ultra performance liquid chromatography coupled with photodiode array (UPLC-PDA) detection method was developed and verified for the determination of the analog in 15 batches of real samples. Results: In the MS/MS spectra, the signal intensity of mass/charge ratios (m/z, 242 and 214) of the novel analog fragments was highly similar to that of mass/charge ratios (m/z, 224 and 196) of oxyphenisatin dipropionate fragments. Additionally, the 1D NMR spectrum of the analog was completely consistent with that of one of the suspected candidates prepared by the de novo synthesis strategy. Based on the above analysis, the structure of the analog was determined as 3,3-bis[4'-(propionyloxy)phenyl]-6-fluoro-2-oxoindoline, which was briefly named 6-F oxyphenisatin dipropionate. A developed quantitative method showed good linearity (R2 > 0.999) in a concentration range of 1.0-100 µg/mL. The limits of detection (LOD) and quantification (LOQ) for the analog was 3 mg/kg and 10 mg/kg, respectively. The average recoveries of the analog from spiked three different matrix samples in low (1 time of LOQ), medium (2 times of LOQ), and high (10 times of LOQ) concentrations were varied from 93.9 % to 107.8 % with a precision of 0.03-1.56 %. Results of quantitative analysis in 15 batches of healthcare products revealed that the content of 6-F oxyphenisatin dipropionate in a fruit-flavored jelly and a solid beverage was 118 mg/kg and 330 mg/kg, respectively. Conclusion: In terms of its structure, 6-F oxyphenisatin dipropionate replaces hydrogen atom by the fluorine atom at position 6 on the indolinone fragment in oxyphenisatin dipropionate. To our best knowledge, 6-F oxyphenisatin dipropionate has never been detected as an illegal additive in foods. Such illegal addition of the analog to foods is more concealing, thus the supervision and testing departments should attach great importance to its application in food markets.

Can motor decline be a modifiable marker of clinical progression in subjective cognitive decline? A national prospective cohort study.

OBJECTIVES: Subjective cognitive decline represents a critical stage for preventing mild cognitive impairment and dementia, but the links between clinical progression in the subjective cognitive decline stage and various motor functions remain inconclusive. This cohort study aimed to elucidate the independent and joint associations between the clinical progression of subjective cognitive decline and motor functions. METHODS: We enrolled 4880 community-dwelling elderly participants from a national cohort and used Cox proportional hazard regression model and restricted cubic spline models to explore the longitudinal associations between motor functions (gait, strength, balance, and endurance) and the clinical progression of subjective cognitive decline. RESULTS: During 5-years follow-up, 1239 participants experienced clinical progression. After adjusting for demographics, vascular burden, body components, and polypharmacy, gait speed [hazard ratios (HRs)= 0.96, 95% confidence interval (CI) 0.94-0.99], chair stand test (HRs=1.02, 95%CI 1.01-1.03), and endurance limitation in jogging 1 kilometer (HRs=1.18, 95%CI 1.04-1.34) were significantly associated with clinical progression. Among all participants, individuals characterized by poor upper- and lower-body strength, as well as those with slow pace and reduced endurance, faced the highest risk of cognitive impairment. CONCLUSIONS: This study emphasizes the potential of gait speed, muscle strength, and endurance as non-cognitive indicators of clinical progression in subjective cognitive decline. Understanding their combined effectiveness may reveal primary physiological mechanisms contributing to the dual decline of motor and cognition.

Mechanistic insights of electrocatalytic CO2 reduction by Mn complexes: synergistic effects of the ligands.

The electrocatalytic mechanisms of CO2 reduction catalyzed by pyridine-oxazoline (pyrox)-based Mn catalysts were investigated by DFT calculations. In-depth comparative analyses of pyrox-based and bipyridine-based Mn complexes were carried out. C-OH cleavage is the rate-determining step for both the protonation-first path and the reduction-first path. The free energy of CO2 activation (ΔG1) and the electrons donated by CO ligands in this step are effective descriptors in regulating the C-OH cleavage barrier. The reduction of carboxylate complex 6 (E6) is the potential-determining step for the reduction-first path. Meanwhile, for the protonation-first path, the initial generation (E2) or the regeneration (E8) of active catalyst might be potential-determining. Hirshfeld charge and orbital contribution analysis indicate that E6 is definitely based on the heterocyclic ligand and E2 is related to both the heterocyclic ligand and three CO ligands. Therefore, replacement of the CO ligand by a stronger electron donating ligand can effectively boost the catalytic activity of CO2 reduction without increasing the overpotential in the reduction-first path. This hypothesis is supported by the mechanism calculations of the Mn complex in which the axial CO ligand is replaced by a pyridine or PMe3.

Target Screen of Anti-Hyperuricemia Compounds from Cortex Fraxini In Vivo Based on ABCG2 and Bioaffinity Ultrafiltration Mass Spectrometry.

The ATP-binding cassette (ABC) transporter ABCG2 is a significant urate transporter with a high capacity, and it plays a crucial role in the development of hyperuricemia and gout. Therefore, it has the potential to be targeted for therapeutic interventions. Cortex Fraxini, a traditional Chinese medicine (TCM), has been found to possess anti-hyperuricemia properties. However, the specific constituents of Cortex Fraxini responsible for this effect are still unknown, particularly the compound that is responsible for reducing uric acid levels in vivo. In this study, we propose a target screening protocol utilizing bio-affinity ultrafiltration mass spectrometry (BA-UF-MS) to expediently ascertain ABCG2 ligands from the plasma of rats administered with Cortex Fraxini. Our screening protocol successfully identified fraxin as a potential ligand that interacts with ABCG2 when it functions as the target protein. Subsequent investigations substantiated fraxin as an activated ligand of ABCG2. These findings imply that fraxin exhibits promise as a drug candidate for the treatment of hyperuricemia. Furthermore, the utilization of BA-UF-MS demonstrates its efficacy as a valuable methodology for identifying hit compounds that exhibit binding affinity towards ABCG2 within TCMs.

Effectiveness of photobiomodulation for people with age-related cognitive impairment: a systematic review and meta-analysis.

The increasing incident of age-related cognitive impairment worldwide and the lack of pharmaceutical treatments emphasizes the value of non-pharmaceutical therapy. Emerging evidence suggested photobiomodulation (PBM) is a popular intervention to brain disorder; however, it remains unclear the efficacy of PBM for patients with age-related cognitive impairment. The purpose of this systematic review is to compare the different parameters used in PBM, analyze the beneficial effects of PBM as a potential therapy for age-related cognitive impairment. Five electronic database, PubMed, Web of Science, Cochrane Library, CINAHL, and PsycINFO, were systematically searched from inception to November 2021. Relevant randomized controlled trials (RCTs) were screened and assessed for risk of bias. Eleven RCTs evaluating PBM interventions were included. The systematic review and meta-analysis has been registered in PROSPERO(CRD42022374562). Results showed that PBM had a significant moderated effect on global cognition function (SMD=0.51, 95% CI [0.162, 0.864], p=0.004). We found that multiple wavelength PBM (SMD=0.648, 95% CI [0.220, 1.075], p=0.003) had significant effects while single wavelength PBM was non-significant (SMD=0.385, 95% CI [-0.168, 0.987], p=0.172). Laser effect (SMD=0.682, 95% CI [0.37, 0,994], p<0.001) was larger than LED effect (SMD=0.582, 95% CI [0.269, 0.895], p<0.001). PBM in clinical setting (SMD=0.468, 95% CI [0.050, 0.887], p=0.028) had significant effect, but there was no significant effect of home-used PBM (SMD=0.616, 95% CI [-0.121, 1.354], p=0.101). The pool effect of multi-modality PBM (SMD=0.720, 95% CI [0.027, 1.414], p=0.040) was significantly higher in the studies of transcranial irradiation (SMD=0.616, 95% CI [-0.121, 1.354], p=0.010). Cumulative irradiation time was a moderator between the PBM and cognitive function improvement. Photobiomodulation have the potential to improve cognitive function in aging adults. Cumulative irradiation duration, light source, device type, penetration modality, and intervention site can affect the effectiveness of PBM intervention.

The application of saccades to assess cognitive impairment among older adults: a systematic review and meta-analysis.

BACKGROUND: Saccade is a novel and feasible method for cognition assessment and has potential to screen older people with cognitive impairment. OBJECTIVES: To systematically summarize the evidence and determine whether different saccade parameters can effectively identify patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD). METHODS: English and Chinese databases were searched until 19 April 2022. Studies analyzing saccade parameters in older adults with normal cognition, MCI, or AD were included. Two researchers independently performed the screening, data extraction, and quality appraisal. Meta-analyses were conducted and standard mean differences and 95% confidence intervals were estimated with a random effects model. RESULTS: Thirty-five studies were included, and 26 studies were pooled for the meta-analysis. The results demonstrated that patients with cognitive impairment exhibited longer latency and lower accuracy rates in the prosaccade and antisaccade tasks, along with lower corrected error rates in the antisaccade tasks. However, the pooled results for antisaccades were more stable, providing the ability to distinguish patients with cognitive impairment among older adults. The results of the subgroup analyses revealed that only the accuracy rates of the antisaccades differed significantly between people with MCI and AD. Regarding the differences between older adults with normal cognition and those with MCI, the effect sizes of latency and the accuracy rates of saccades as well as the corrected error rates of antisaccades were significant. CONCLUSIONS: Saccades, especially antisaccades, are a potential screening and assessment tool for distinguishing older adults with MCI or AD from those with normal cognition.

Target immobilization on glass microfiber membranes as a label-free strategy for hit identification.

The discovery of novel chemical entities targeting G protein-coupled receptors (GPCRs) is usually guided by their receptor affinity. However, traditional affinity assay methods and hit identification procedures are usually laborious and expensive. In this work, the type-2 vasopressin receptor (V2R) was chosen as a prototypical GPCR. Membrane fragments from cells highly expressing SNAP-V2R were immobilized on the surface of a glass microfiber (GMF) coated with O6-benzylguanine (BG). This was achieved by transferring the benzyl group of BG to the active site of the SNAP-tag through a nucleophilic substitution reaction. As a result, a biofilm called SNAP-V2R@GMF-BG was produced that showed good specificity and stability. The adsorption ratio for each V2R ligand treated with SNAP-V2R@GMF-BG was determined by HPLC and exhibited a good linear correlation with the Ki value determined by displacement assays. Furthermore, a Ki prediction assay was performed by comparing the data with that generated by a homogeneous time-resolved fluorescence (HTRF) assay. SNAP-V2R@GMF-BG was also used to screen hit compounds from natural products. After SNAP-V2R@GMF-BG was incubated with the total extract, the ligand that binds to V2R could be separated and subjected to LC‒MS analysis for identification. Baicalein was screened from Clerodendranthus spicatus and verified as a potential V2R antagonist. This V2R-immobilized GMF platform can help determine the affinity of V2R-binding hit compounds and screen the compounds efficiently and accurately.

Regulation of M1/M2 Polarization in LPS-Stimulated Macrophages by 1,25(OH)2D3.

Objective: This study aims to investigate the impact of 1,25(OH)2D3 on the polarization of LPS-stimulated macrophages and the underlying regulatory mechanisms. Methods: Primary macrophages were isolated and identified using immunofluorescence assays to detect macrophage biomarker expression levels. RT-PCR was employed to measure the expression of Arginase 1 (Arg-1), Interleukin-10 (IL-10), Inducible isoform of nitric oxide synthase (iNOS), and Tumor necrosis factor-α (TNF-α) in macrophages treated with various strategies. Western blotting assessed the protein expression levels of AKT1, p-AKT1, NF-κB p65, p-NF-κB p65, STAT3, and p-STAT3 in LPS-stimulated macrophages exposed to different concentrations of 1,25(OH)2D3. Results: As the LPS concentration increased from 0 to 0.5 mg/L, Arg-1, IL-10, iNOS, and TNF-α expression levels significantly increased. However, at LPS concentrations ranging from 1 mg/L to 10 mg/L, the expression of Arg-1, IL-10, iNOS, and TNF-α displayed a trend from increase to decline. The highest M2 polarization (Arg-1 and IL-10) was observed in macrophages stimulated with 0.5 mg/L LPS among the lower concentrations, while the highest M1 polarization (iNOS and TNF-α) was observed in macrophages stimulated with 5 mg/L LPS among the higher concentrations. Subsequent experiments utilized 0.5 mg/L and 5 mg/L LPS as incubation concentrations. Under LPS stimulation, iNOS was significantly upregulated, surpassing the expression level of IL-10, a marker of M2 macrophages. The introduction of 1,25(OH)2D3 facilitated M2 polarization, with 50 nM as the incubation concentration of 1,25(OH)2D3. Furthermore, 1,25(OH)2D3 reversed the elevated expression of p-AKT1, p-NF-κB p65, and p-STAT3 in macrophages stimulated with 5 mg/L LPS. Conclusions: 1,25(OH)2D3 effectively regulates the M1/M2 polarization in LPS-stimulated macrophages.

Physical activity trajectories and their determinants in patients with chronic obstructive pulmonary disease: A cohort study.

AIMS AND OBJECTIVES: The aim was to identify latent trajectories in physical activity (PA) and their determinants in adults with chronic obstructive pulmonary disease (COPD) based on the socio-ecological model. BACKGROUND: PA has been linked to poor long-term outcomes in patients with COPD. However, few studies have explored their PA trajectories and their predictors. DESIGN: Cohort study. METHODS: We used data from a national cohort and included 215 participants. PA was quantified using a short PA questionnaire, and group-based trajectory modelling was used to explore the PA trajectories. Multinomial logistic regression was conducted to identify the predictors of PA trajectories. Generalised linear mixed models were used to elucidate the associations between predictors and PA during follow-up. A STROBE checklist was used to guide the reporting of this study. RESULTS: Three PA trajectory patterns were identified among 215 COPD participants with an average age of 60.51 ± 8.87: stable inactive group (66.7%), sharp decline group (25.7%) and stable active group (7.5%). The logistic regression showed that age, sex, income, peak expiratory flow, upper limb capacity, depressive symptoms, the frequency of contact with children were PA predictors. Upper limb capacity weakness and depressive symptoms were found to be associated with a sharp decline in PA during follow-up. CONCLUSIONS: This study revealed three PA trajectories among patients with COPD. In addition to strengthening the physical functions and mental health of patients, support from the family, community and society also play a crucial role in promoting PA of patients with COPD. RELEVANCE TO CLINICAL PRACTICE: It is essential to identify distinct PA trajectories in patients with COPD to develop future interventions that promote PA. NO PATIENT OR PUBLIC CONTRIBUTION: A national cohort study was used and no patients or the public were involved in the design and implementation of this study.

Sleep Characteristics in Older Adults with Different Levels of Risk for Dementia: A Cross-sectional Study.

BACKGROUND: Sleep problems are very prevalent in older adults, especially in those at risk for dementia. But the relationships between sleep parameters and subjective or objective cognitive decline are still inconclusive. AIM: The study aimed to investigate the self-reported and objectively measured sleep characteristics in older adults with mild cognitive impairment (MCI) and subjective cognitive decline (SCD). METHODS: This study adopted a cross-sectional design. We included older adults with SCD or MCI. Sleep quality was measured separately by the Pittsburgh sleep quality index (PSQI) and ActiGraph. Participants with SCD were divided into low, moderate, and high levels of SCD groups. Independent samples T-tests, one-way ANOVA, or nonparametric tests were used to compare the sleep parameters across groups. Covariance analyses were also performed to control the covariates. RESULTS: Around half of the participants (45.9%) reported poor sleep quality (PSQI＜7), and 71.3% of participants slept less than 7 hours per night, as measured by ActiGraph. Participants with MCI showed shorter time in bed (TIB) (p＜0.05), a tendency of shorter total sleep time (TST) at night (p = 0.074) and for each 24-hour cycle (p = 0.069), compared to those with SCD. The high SCD group reported the highest PSQI total score and longest sleep latency than all the other three groups (p＜0.05). Both the MCI and high SCD groups had shorter TIB and TST for each 24-hour cycle than the low or moderate SCD groups. Besides, participants with multiple-domain SCD reported poorer sleep quality than those with single-domain SCD (p＜0.05). CONCLUSION: Sleep dysregulation is prevalent in older adults with a risk for dementia. Our findings revealed that objectively measured sleep duration might be an early sign of MCI. Individuals with high levels of SCD demonstrated poorerself-perceived sleep quality and deserved more attention. Improving sleep quality might be a potential target to prevent cognitive decline for people with a risk for dementia.

Self-reported practices, competence and difficulties towards palliative care among nurses: A cross-sectional study.

OBJECTIVE: Nurses' palliative care practice ability is the key to evaluating the quality of palliative care. This study aimed to identify the current situation of palliative care practices, competence and difficulties among nurses and determine whether difficulties play a mediating role between practices and competence. METHODS: A cross-sectional study was conducted. The online survey comprised demographics, the Palliative Care Self-Reported Practices Scale, the Palliative Care Nursing Self-competence Scale and the Palliative Care Difficulties Scale. Data were analysed by using descriptive statistics, univariate analysis, linear regression and mediation analysis. RESULTS: A total of 284 questionnaires were included for statistical analysis. The mean scores for practices, competence and difficulties were 67.81 (SD = 13.60), 124.28 (41.21) and 44.32 (12.68), respectively. There was a correlation between practices, competence and difficulties (p < 0.01). Competence and difficulties were independent predictors of practices (R2 adj  = 0.384, p < 0.001). Furthermore, difficulties mediated the relationship between practices and competence (b = 0.052, 95% confidence interval: 0.008-0.155). CONCLUSIONS: Continuous efforts should be made to enhance nurses' practices, competence and problem-solving abilities in palliative care. This study suggested further targeted education programmes, especially in special symptom management, interagency and multidisciplinary communication.

Adaptation and validation of the Chinese version of palliative care difficulties scale.

Objective: The Palliative Care Difficulties Scale (PCDS) is the most popular tool in developed countries for the assessment of difficulties perceived by clinical professionals in palliative care practice. This study aimed to culturally adapt the PCDS into a Chinese version and validate the psychometric properties of the adapted Chinese version of the PCDS. Methods: The study was carried out in two major phases: (1) translation and cultural adaption of the PCDS into a Chinese version according to the corresponding guidelines, and (2) evaluation of the psychometric properties of the adapted Chinese version of the PCDS by consulting experts and performing a cross-sectional survey among 284 nurses and physicians. Floor and ceiling effects were estimated by the percentage of participants obtaining the lowest or highest possible scores. Internal consistency reliability was assessed using the Cronbach's α coefficient. Test-retest reliability was evaluated by the intra-class correlation coefficient (ICC). Content validity was evaluated by the content validity index (CVI). Construct validity was calculated by applying the confirmatory factor analysis (CFA). Results: The PCDS was translated and culturally adapted into a Chinese version. Neither floor nor ceiling effects were observed. The scale-level Cronbach's α coefficient was 0.94 with each dimension ranging from 0.84 to 0.92. The scale-level ICC was 0.66 with each dimension ranging from 0.41 to 0.65. Both the item-level and scale-level CVIs were equal to 1. The CFA verified the five-factor structure of the original PCDS with factor loadings for each item ranging from 0.62 to 0.96. Conclusions: The Chinese version of the PCDS showed satisfactory psychometric properties. It is a valid and reliable tool for the assessment of difficulties perceived by clinical staff in palliative care practice.

The feasibility and efficacy of the home-based exercise programs in patients with cognitive impairment: A pilot study.

OBJECTIVE: To examine the feasibility and efficacy of home-based aerobic and resistance exercise interventions for geriatric individuals with cognitive impairment. METHODS: Fourteen participants with cognitive impairment were allocated to either the aerobic group (n = 8) or the resistance group (n = 6), after which they implemented a two-month home-based training program. Feasibility and efficacy outcomes were evaluated. A semi-structured interview was performed after the intervention. RESULTS: All fourteen participants completed the two-month training program. The adherence rate was 0.94 for the aerobic group and 0.96 for the resistance group. No adverse events occurred. The results revealed a trend of group×time interaction effect on delayed recall. Significant group×time interaction effects were revealed on simple physical performance and body composition. Semi-structured interviews identified four motivators for participating in this program, four facilitators for and three barriers to keeping exercising, and some perceived benefits. CONCLUSION: Home-based aerobic and resistance exercise programs are feasible for geriatric individuals with cognitive impairment. The efficacy needs to be further examined.

The relative effectiveness of different combination modes for exercise and cognitive training on cognitive function in people with mild cognitive impairment or Alzheimer's disease: a network meta-analysis.

OBJECTIVES: To compare and rank the relative effectiveness of different modes for exercise combined cognitive training (ECT) in people with Alzheimer's disease (AD) or Mild Cognitive Impairment (MCI). METHODS: We searched PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, PsycInfo, and OpenGrey systematically from inception to May 2020. Studies were included that met the inclusion criteria: randomized controlled trials, involving people with MCI or dementia, performing ECT without other interventions, and assessing global cognitive function, memory function, and executive function. Pairwise and network meta-analyses were performed using a random effects model. RESULTS: We included 20 articles from 16 studies with 1180 participants. For global cognition, separate modality had the highest probability of being the optimal approach (the surface under the cumulative ranking curve (SUCRA) value = 77.5%). For memory function, the interactive mode had the greatest probability of being the best choice (SUCRA = 84.7%). Concerning executive function, the dual-task modality and separate modality had similar SUCRA values. Subgroup analysis revealed no differences for the relative effectiveness of ECT among people with MCI or among all participants. CONCLUSIONS: Separate and interactive combination modality had the highest probability of being the most effective mode for overall cognition and memory performance. However, the evidence is insufficient to reveal the best combination mode for executive function.Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2026879 .

Physical Activity and its Influencing Factors in Community-Dwelling Older Adults With Dementia: A Path Analysis.

Dementia is prevalent in worldwide, and increases the care burden and potential costs. Physical activity (PA) has been increasingly shown to be beneficial for them. This was a cross-sectional observational study aiming to investigate the status of PA among community-dwelling older adults with dementia in Beijing or Hangzhou, China, and verify the relationships between neuropsychiatric symptoms, activities of daily living (ADL), caregivers' fear of patients' falling and their PA using a path analysis approach. The level of PA among 216 included people with dementia was low. PA was related to the neuropsychiatric symptoms, with ADL and caregivers' fear of patients' falling have mediation roles. The findings indicated that person-centered strategies related to the management of these symptoms might be helpful to improve ADL, relieve caregivers' concerns about them falling and consequently foster positive participation in PA.

Effect of exercise on bone mineral density among patients with osteoporosis and osteopenia: A systematic review and network meta-analysis.

AIMS AND OBJECTIVES: To systematically review and compare the efficacy of different exercise interventions on bone mineral density (BMD, g/cm2 ) in patients with osteoporosis and osteopenia. BACKGROUND: It is vitally important to prevent and treat bone loss in patients with osteoporosis and osteopenia. Exercise can effectively increase bone density and slow down bone loss in middle-aged and older people. However, it is still unclear which type of exercise intervention is the most effective on bone mineral density. DESIGN: Systematic review and network meta-analysis (NMA) according to PRISMA. METHODS: Randomised controlled trials of different exercise treatments for osteopenia and primary osteoporosis were included. A Frequentist network meta-analysis was conducted to appraise the efficacy of different types of exercise. The outcome was bone mineral density of different parts of the body. RESULTS: Ninety-seven studies were included. The network meta-analysis showed that combined exercise, resistance exercise, aerobic exercise and mind-body exercise had a significant effect in improving the bone density of lumbar spine. The surface under the cumulative ranking area (SUCRA) values for mind-body exercise was 0.99 and ranked first. For BMD of the femoral neck, all kinds of exercise interventions increased the bone density significantly compared with no exercise and the optimal type was mind-body exercise (SUCRA = 0.99). In terms of the total hip bone mineral density, aerobic exercise and resistance exercise could improve hip bone density, with the resistance exercise (SUCRA = 0.95) ranking as first. CONCLUSIONS: This NMA demonstrated the mind-body exercise might be the optimal exercise type to increase the BMD of the lumbar spine and femoral neck and resistance exercise is the most promising type for total hip BMD.

The cerebral changes induced by exercise interventions in people with mild cognitive impairment and Alzheimer's disease: A systematic review.

OBJECTIVES: This study aimed to summarize the effects of exercise on the brain structure and function measured by imaging and electroencephalography methods in people with mild cognitive impairment and Alzheimer's disease. METHODS: We systematically searched different electronic databases, including PubMed, Web of Science, Embase, Cochrane Central Register of controlled trials, SPORTDiscus, PsycINFO up to September 2021. Randomized controlled trials with exercise interventions in people with mild cognitive impairment and Alzheimer's disease were included. The outcomes included all the structural and functional brain changes measured by neuroimaging and electroencephalography approaches. All the outcomes were summarized and tabulated. The protocol has been registered on the PROSPERO (CDR42020192579). RESULTS: Nineteen articles from 12 trials were included. Most studies focused on people with mild cognitive impairment and revealed positive effects on the volumes of hippocampus and cingulate cortex, the resting state functional connectivity between the hippocampus and other brain regions, the brain activity in several regions, the cerebral blood flow, electroencephalogram, and P300 latency and amplitude. Different types of exercise could produce distinct effects and intensity was a factor affecting the effects of aerobic and resistance exercise interventions. Meanwhile, limited studies paid attention to people with Alzheimer's disease and showed insignificant results. CONCLUSIONS: Exercise has positive effects on the brain structures and functions in people with mild cognitive impairment, while for people with Alzheimer's disease, limited studies revealed insignificant effects.

Comparative efficacy of various exercise interventions on cognitive function in patients with mild cognitive impairment or dementia: A systematic review and network meta-analysis.

BACKGROUND: Exercise is a promising nonpharmacological therapy for cognitive dysfunction, but it is unclear which type of exercise is most effective. The objective of this study was to compare and rank the effectiveness of various exercise interventions on cognitive function in patients with mild cognitive impairment (MCI) or dementia and to examine the effects of exercise on the symptoms relevant to cognitive impairment. METHODS: We searched PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, and PsycInfo through September 2019 and included randomized controlled trials that examined the effectiveness of exercise interventions in patients with MCI or dementia. Primary outcomes included global cognition, executive cognition, and memory cognition. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, and quality of life. Pairwise analyses and network meta-analyses were performed using a random effects model. RESULTS: A total of 73 articles from 71 trials with 5606 participants were included. All types of exercise were effective in increasing or maintaining global cognition, and resistance exercise had the highest probability of being the most effective intervention in slowing the decrease in global cognition (standard mean difference (SMD) = 1.05, 95% confidence interval (95%CI): 0.56-1.54), executive function (SMD = 0.85, 95%CI: 0.21-1.49), and memory function (SMD = 0.32, 95%CI: 0.01-0.63) in patients with cognitive dysfunction. Subgroup analyses for patients with MCI revealed different effects, and multicomponent exercise was most likely to be the optimal exercise therapy for preventing the decline of global cognition (SMD = 0.99, 95%CI: 0.44-1.54) and executive function (SMD = 0.72, 95%CI: 0.06-1.38). However, only resistance exercise showed significant effects on memory function for patients with MCI (SMD = 0.35, 95%CI: 0.01-0.69). Exercise interventions also showed various effects on the secondary outcomes. CONCLUSION: Resistance exercise has the highest probability of being the optimal exercise type for slowing cognitive decline in patients with cognitive dysfunction, especially in patients with dementia. Multicomponent exercise tends to be most effective in protecting global cognition and executive function in patients with MCI.