Efficacy and Safety of Risperidone in Patients With Delirium: The RIDDLE Pilot Study.

BACKGROUND: The cornerstone treatment of delirium is to assess and treat its underlying causes and prevent further complications. Drug therapy may be necessary to control agitation and behavioral symptoms associated with delirium. The aim of this pilot study was to evaluate the feasibility of a randomized placebo controlled trial to evaluate the efficacy and safety of risperidone in the treatment of delirium. METHODS: This was a randomized double-blinded placebo-controlled trial. Patients were enrolled in the study if they were hospitalized and 65 years or older and had a diagnosis of delirium. Delirium Rating Scale revised 98 was used to determine delirium and motor agitation. RESULTS: A total of 14 participants with 57% being men and having a mean age of 86 years were included. There were no statistically significant differences between the risperidone and placebo group for the Delirium Rating Scale revised 98 score. There were no severe adverse reactions reported in the study, and no patients discontinued the study for adverse reactions. CONCLUSIONS: Risperidone at low doses (1 mg daily or less) was well tolerated for the treatment of delirium. Future large-scale trials are needed to evaluate the safety and efficacy of risperidone in the treatment of delirium. This pilot study taught us that the phase 2 RIsperDone DELirium trial will need a multicenter design with more research personnel to increase the number of participants enrolled.

Multiple routes to help you roam: A comparison of training interventions to improve cognitive-motor dual-tasking in healthy older adults.

Cognitive-motor dual-tasking is a complex activity that predicts falls risk and cognitive impairment in older adults. Cognitive and physical training can both lead to improvements in dual-tasking; however, less is known about what mechanisms underlie these changes. To investigate this, 33 healthy older adults were randomized to one of three training arms: Executive function (EF; n = 10), Aerobic Exercise (AE; n = 10), Gross Motor Abilities (GMA; n = 13) over 12 weeks (1 h, 3×/week). Single and dual-task performance (gait speed, m/s; cognitive accuracy, %) was evaluated before and after training, using the 2-back as concurrent cognitive load. Training arms were designed to improve cognitive and motor functioning, through different mechanisms (i.e., executive functioning - EF, cardiorespiratory fitness - CRF, and energy cost of walking - ECW). Compared to baseline, we observed few changes in dual-task gait speed following training (small effect). However, dual-task cognitive accuracy improved significantly, becoming facilitated by walking (large effect). There were no differences in the magnitude of improvements across training arms. We also found that older adults with lower cognitive ability (i.e., MoCA score < 26; n = 14) improved more on the dual-task cognitive accuracy following training, compared to older adults with higher cognitive ability (i.e., MoCA ≥26; n = 18). Taken together, the results suggest that regardless of the type of intervention, training appears to strengthen cognitive efficiency during dual-tasking, particularly for older adults with lower baseline cognitive status. These gains appear to occur via different mechanisms depending on the form of intervention. Implications of this research are paramount, as we demonstrate multiple routes for improving cognitive-motor dual-tasking in older adults, which may help reduce risk of cognitive impairment.

A Comparison of the Effect of Physical Activity and Cognitive Training on Dual-Task Performance in Older Adults.

OBJECTIVES: Studies suggest that cognitive training and physical activity can improve age-related deficits in dual-task performances. However, both of these interventions have never been compared in the same study. This article investigates the improvement in dual-task performance in 2 types of exercise training groups and a cognitive training group and explores if there are specific dual-task components that are more sensitive or more likely to improve following each type of training. METHODS: Seventy-eight healthy inactive participants older than the age of 60 (M = 69.98, SD = 5.56) were randomized to one of three 12-week training programs: aerobic training (AET) = 26, gross motor abilities (GMA) = 27, and cognition (COG) = 25. Before and after the training program, the participants underwent physical fitness tests, and cognitive evaluations involving a computerized cognitive dual task. The AET consisted of high- and low-intensity aerobic training, the GMA of full-body exercises focusing on agility, balance, coordination, and stretching, and the COG of tablet-based exercises focusing on executive functions. RESULTS: Repeated-measures analysis of variance on reaction time data revealed a group × time interaction (F(2,75) = 11.91, p < .01) with COG having the greatest improvement, followed by a significant improvement in the GMA group. Secondary analysis revealed the COG to also improve the intraindividual variability in reaction time (F(1,24) = 8.62, p < .01), while the GMA improved the dual-task cost (F(1,26) = 12.74, p < .01). DISCUSSION: The results show that physical and cognitive training can help enhance dual-task performance by improving different aspects of the task, suggesting that different mechanisms are in play.

Bridging the Gap between Research and the Community: Implementing Physical and Cognitive Interventions to Improve Spontaneous Walking Speed in Older Adults.

The application of interventions to enhance mobility in ecological settings remain understudied. This study was developed to evaluate the feasibility of training methods in a community centre and to evaluate their impact on mobility outcomes. Fifty-four participants were randomized to one of three 12-week training programs (three times/week): aerobic (AE), gross motor abilities (GMA) or cognitive (COG). Feasibility was evaluated by calculating adherence, feedback from participants and long-term participation. The impact of these interventions on mobility was assessed by comparing pre- and post-program on Timed-up-and-go (TUG) and spontaneous walking speed (SWS) performances. Results showed relatively high rates of adherence (85.1%) and long-term participation (66.7%), along with favorable feedbacks. SWS significantly improved in COG (0.10 ± 0.11 m.s-1; p = 0.004) and AE (0.06 ± 0.11 m.s-1; p = 0.017) groups, and TUG performance was maintained in all groups. Results of this feasibility study demonstrated successful implementation of physical and cognitive training programs, encouraging the development of real-world applications.

Assessment of the Relationship Between Executive Function and Cardiorespiratory Fitness in Healthy Older Adults.

Associations between cardiorespiratory fitness and brain health in healthy older adults have been reported using a variety of cardiorespiratory fitness estimates (CRFe). Using commonly used methods to determine CRF, we assessed the relationship between CRFe and executive function performance. Healthy older adults (n = 60, mean age 68 years, 77% women), underwent three CRF tests: a Maximal Graded Exercise Test performed on a cycle ergometer, the Rockport Fitness Walking Test, and a Non-Exercise Prediction Equation. Executive function was assessed by a computerized cognitive assessment using an N-Back task (updating cost) and a Stroop task (interference cost, global and local switch cost). Multiple hierarchical regression analyses were conducted to assess the relationship between different CRFe and executive function performance. Regardless of age and education, cardiorespiratory fitness estimated from the Maximal Graded Exercise Test and the Rockport Fitness Walking Test was significantly associated with the global switch cost. All CRFe were associated with the interference cost. No association was observed between CRFe and local switching costs or the updating costs. In the present study, not all subcomponents of executive function were related to CRFe. Interestingly, the executive functions that were associated with CRFe are those that are known to be the most affected by aging.

Delirium and Inflammation in Older Adults Hospitalized for COVID-19: A Cohort Study.

PURPOSE: The occurrence and predictors of delirium in older adults hospitalized for coronavirus disease 2019 (COVID-19) have not been well described. Highlighting the association with inflammatory markers may be useful for identifying delirium. This study aimed to determine the prevalence and incidence of delirium and explore its association with the C-reactive protein (CRP). PATIENTS AND METHODS: This cohort study of adults aged 65 and older with a COVID-19 diagnosis took place at an academic healthcare institution between April and May 2020. COVID-19 was diagnosed by positive nasopharyngeal swab. Serum levels of CRP were collected as a marker of systemic inflammation. The primary outcome was the prevalence and incidence of delirium. Delirium was diagnosed primarily during a patient's stay in hospital based on the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). To ensure that no delirium diagnosis was missed during hospital stay, clinical records were reviewed by clinicians with geriatric medicine training for retrospective diagnoses. RESULTS: A total of 127 patients aged 65 and older were hospitalized with a diagnosis of COVID-19. The median age was 82 years (IQR: 74-88), with 54 (43%) females. Overall, delirium was present in 62 (49%) patients: manifestations of delirium were present on the first day of hospitalization in 53 of these cases (86%), while 9 cases (14%) developed delirium during hospitalization. After controlling for age and sex, the mean CRP value over the first 3 days since arrival was associated with a higher risk of delirium (OR 1.35; 95% CI: 1.01-1.85) for every 50 mg/L increase. CONCLUSION: In this cohort of older adults hospitalized for COVID-19, delirium was highly prevalent. An early increase in CRP levels should raise suspicion about the occurrence of delirium and could improve its diagnosis.

Predictors of delirium in older patients at the emergency department: a prospective multicentre derivation study.

OBJECTIVE: The objective of this study was to identify the predictors of incident delirium in this high-risk population. METHODS: This study was a planned sub-analysis of the INDEED multicentre cohort study. We recruited patients aged ≥ 65, independent/semi-independent, with an emergency department (ED) length of stay ≥ 8 h and admitted to any hospital ward. Patients were followed up during their ED stay up to 24 h after ward admission. Sociodemographic characteristics, comorbidities, functional status (OARS), illness severity, level of frailty, cognitive status (TICS-m) and ED/patient environment evaluation were collected during initial interview. Patients were screened for delirium twice a day using the Confusion Assessment Method. Multivariate logistic regression was performed to identify the predictors of delirium. RESULTS: Incident delirium was detected in 68 patients of the 612 patients included (11%). Initially, seven candidate predictors were included in a regression model, of which four were retained using a stepwise selection procedure. Presence of cognitive impairment at baseline (OR 3.6, p < 0.001), absence of mobilization during the whole ED length of stay (OR 3.3, p = 0.002), longer ED length of stay (OR 1.02, p = 0.006) were associated with a higher risk of incident delirium while higher functional status was associated with a lower risk (OR 0.8, p < 0.001). CONCLUSION: More work is needed to determine which tool(s) are most appropriate for the ED use to increase delirium screening compliance among health professionals working in this department. It is really the first step to be able to suggest interventions to decrease delirium incidence.

RéSUMé: OBJECTIF: L'objectif de cette étude était d'identifier les prédicteurs du délirium incident dans cette population à hautrisque. MéTHODES: Cette étude était une sous-analyse planifiée de l'étude de cohorte multicentrique INDEED. Nous avons recruté des patients âgés de ≥ 65 ans, indépendants/semi-indépendants, ayant une durée de séjour au département d'urgence (DU) ≥ 8 h et admis dans n'importe quel service. Les patients ont été suivis pendant leur séjour aux urgences jusqu'à 24 h après leur admission. Les caractéristiques sociodémographiques, les comorbidités, l'état fonctionnel (OARS), la gravité de la maladie, le niveau de fragilité, l'état cognitif (TICS-m) et l'évaluation de l'environnement des urgences/patients ont été recueillis lors de l'entretien initial. Les patients ont été soumis à un dépistage du délirium deux fois par jour à l'aide de la méthode d'évaluation de la confusion. Une régression logistique multivariée a été effectuée pour identifier les prédicteurs de délirium. RéSULTATS: Le délirium incident a été détecté chez 68 des 612 patients inclus (11%). Au départ, sept prédicteurs candidats ont été inclus dans un modèle de régression, dont quatre ont été retenus par une procédure de sélection par étapes. La présence d'un déficit cognitif initial (RC 3,6, p < 0,001), l'absence de mobilisation pendant toute la durée du séjour à l'urgence (RC 3,3, p = 0,002), une durée de séjour plus longue à l'urgence (RC 1,02, p = 0,006) étaient associées à un risque plus élevé de délirium incident, tandis qu'un état fonctionnel plus élevé était associé à un risque plus faible (RC 0,8, p < 0,001). CONCLUSIONS: Des travaux supplémentaires sont nécessaires pour déterminer quel(s) outil(s) sont les plus appropriés au DU afin d'accroître le dépistage du délirium par les professionnels de santé travaillant dans ce service. C'est vraiment la première étape pour pouvoir proposer des interventions visant à diminuer l'incidence du délirium.

Statin use moderates the beneficial effects of aerobic exercise on older adults' performances on the Stroop test: A subanalysis.

Aerobic training can lead to improved cognition in older adults and this effect can be explained by enhanced cardiorespiratory fitness. However, statins could limit the physical benefits of aerobic training by altering the mechanisms through which exercise improves cognition. Whether statins could have an effect on the cognitive benefits associated with aerobic training remains to be elucidated. The objective of this study was to determine whether the cognitive benefits of aerobic training were comparable in statin users and non-users. A total of 144 sedentary participants (>60 y.o.; 106 non-users, 38 statin users) were included. Participants were either part of an aerobic training group (n = 75) or a control group (n = 69). Cognition was assessed using the Stroop test. Analyses were performed on z-score changes from pre to post-intervention of Stroop reaction time (RT) and number of errors, using Two-factor ANCOVAs, while controlling for potential confounding factors (age, education, BMI, Charlson Comorbidity Index, sex, protocol and handgrip strength). The moderating effect of statins on the cognitive changes associated with aerobic training was determined through moderation analyses. An interaction effect on the Stroop switching condition was detected between intervention and statin intake (F [1, 140] = 5.659, P < 0.01). The intervention effect on switching RT was moderated by statin intake, where intervention improved switching RT only in non-users (Effect = 0.1678; P < 0.01). Statins could limit the cognitive benefits of aerobic training on switching capacities in some patients. Future randomized studies including a larger number of participants and looking at different types of statins should be conducted to confirm these results.

Synergistic Effects of Cognitive Training and Physical Exercise on Dual-Task Performance in Older Adults.

BACKGROUND: Studies report benefits of physical exercise and cognitive training to enhance cognition in older adults. However, most studies did not compare these interventions to appropriate active controls. Moreover, physical exercise and cognitive training seem to involve different mechanisms of brain plasticity, suggesting a potential synergistic effect on cognition. OBJECTIVE: This study investigated the synergistic effect of cognitive training and aerobic/resistance physical exercise on dual-task performance in older adults. Intervention effects were compared to active controls for both the cognitive and the exercise domain. METHOD: Eighty-seven older adults completed one of 4 different combinations of interventions, in which computer lessons was active control for cognitive training and stretching/toning exercise control for aerobic/resistance training: (a) cognitive dual-task training and aerobic/resistance training (COG+/AER+), (b) computer lessons and aerobic/resistance training (COG-/AER+), (c) cognitive dual-task training and stretching/toning exercises (COG+/AER-), and (d) computer lessons and stretching/toning exercises (COG-/AER-). The primary outcome was performance in an untrained transfer dual task. Stepwise backward removal regression analyses were used to predict pre- versus post-test changes in groups that have completed the dual-task training, aerobic/resistance or both interventions. RESULTS: Participation in AER+ did not predict improvement in any dual-task outcomes. Participation in COG+ predicted reduction in dual-task cost and participation in COG+/AER+ predicted reduction in task-set cost. DISCUSSION: Results suggest that the combination of cognitive and physical training protocols exerted a synergistic effect on task-set cost which reflects the cost of maintaining multiple response alternatives, whereas cognitive training specifically improved dual-task cost, which reflects the ability of synchronizing concurrent tasks.

Sex-moderated association between body composition and cognition in older adults.

BACKGROUND: Some studies have reported an association between body composition and cognition in older adults, but underlying mechanisms and physiological factors remain poorly understood. Moreover, sex-related differences in metabolic health and age-related cognitive decline have gained major interest lately. The present study investigated the potential moderating effect of sex on the relationship between body composition and cognition in older adults. METHODS: Global cognition, assessed by the Montreal Cognitive Assessment (MoCA), and body composition, measured using dual-energy x-ray absorptiometry (DXA), were analyzed in 155 women and 65 men aged 60 years old or more. Moderation analyses were computed to determine if sex moderates the effect of the different body composition parameters on the MoCA while controlling for the body mass index and the level of education of the participants. RESULTS: Sex moderated the association between total lean mass, trunk lean mass, arms lean mass, and the MoCA score. These body composition parameters were positively associated with cognition only in men. Fat mass was not associated with cognition in any sex. CONCLUSION: Overall, higher lean mass and in particular trunk and arms lean mass was associated with higher cognitive abilities in older men. Longitudinal studies or intervention studies are needed to further identify physiological mechanisms that sustain the relationship between lean mass and cognition.

Effects of an 8-week training cessation period on cognition and functional capacity in older adults.

BACKGROUND: Multiple types of exercise interventions have been described as effective methods for improving cognition and mobility in older adults. In addition to combined strength and aerobic training, gross motor activities have shown benefits. However, adherence to exercise is a challenge, which may bring about periods of training cessation. Importantly, short-term training cessation may lead to a loss of fitness adaptations. The effects of training cessation on cognition and functional capacity are not well known, especially within the context of dual-tasking in older adults. OBJECTIVES: We examined the effects of an 8-week training cessation period on cognition (executive functioning (EF) in single (ST) and dual-task (DT)) and functional capacity (10 m Walk and 6 Minute Walk Test) of healthy older adults, after one of three training interventions: combined lower body strength and aerobic, combined upper body strength and aerobic, or gross motor activities. MATERIALS AND METHODS: Forty older adults (70.5 ± 5.5 years, 67.5% F) participated in training sessions, 3×/week for 8 weeks prior to training cessation. Pre (T0), post (T1) and follow-up (post-cessation, T2) measures of EF (performance in inhibition and updating/working memory indices of the Random Number Generation task) in ST and DT (treadmill walking at 0.67 m·s-1, 1.11 m·s-1, and 1.56 m·s-1), and functional capacity were assessed. Changes in ST and DT as well as functional capacity tests were analyzed using two-way ANOVAs (time ∗ group) with repeated measures for the time factor (T0, T1 and T2). RESULTS: Improvements in inhibition indices were observed in ST for all time comparisons (T0-T1, T1-T2 and T0-T2). Inhibition in DT improved from T0-T2 and from T1-T2. Working memory declined from T0-T2 and from T1-T2. Functional capacity performance was maintained from T1-T2 (small improvement from T0-T1 and from T0-T2). DISCUSSION: Performances in inhibition were maintained or improved after cessation of training. We found no interaction between training groups, whatever the condition, indicating similar training cessation effects regardless of the intervention. CONCLUSIONS: Multiple types of exercise interventions may lead to positive benefit to inhibition and functional capacity in older adults, and it may also be possible to retain these benefits after a short cessation period.

Serial Ottawa 3DY assessments to detect delirium in older emergency department community dwellers.

BACKGROUND: delirium is associated with increased morbidity and mortality among older emergency department (ED) patients. When using physician gestalt, delirium is missed in the majority of patients. The Ottawa 3DY (O3DY) has been validated to detect cognitive dysfunction among older ED patients. OBJECTIVES: to determine the sensitivity and specificity of serial O3DY assessments to detect delirium in older ED patients. DESIGN: a prospective observational multicenter cohort study. SETTING: four Quebec EDs. PARTICIPANTS: independent or semi-independent older patients (age ≥ 65 years) with an ED stay of at least 8 hours that required hospitalisation. MEASUREMENTS: eligible patients were evaluated using serial O3DY assessments at least 6 hours apart. The primary outcome was delirium after at least 8 hours in the ED. The reference standard for delirium assessment was the confusion assessment method (CAM). The sensitivity and specificity of the serial O3DY to detect delirium were calculated. RESULTS: we enrolled 301 patients (mean age 77 years, 49.5% male, 3.0% with a history of mild dementia). Thirty patients (10.0%) were CAM positive for delirium. Patients had a median of three O3DY assessments. Serial O3DY evaluations to detect delirium among patients with at least one abnormal O3DY had a sensitivity of 86.7% (95% confidence interval-CI 69.3-96.2%) and a specificity of 44.3% (95%; CI 38.3-50.4%). CONCLUSION: serial O3DY testing demonstrates good sensitivity as a screening tool to detect delirium among older adult patients with prolonged ED lengths of stay. Emergency physicians should consider the use of the serial O3DY over clinician gestalt to improve delirium detection.

Dance your stress away: comparing the effect of dance/movement training to aerobic exercise training on the cortisol awakening response in healthy older adults.

This study aimed to examine in healthy older adults the effects of dance/movement training (DMT) on the cortisol awakening response (CAR), a marker of chronic stress. Forty participants (mean age = 67.45, 75% women) were randomized into three groups: DMT (n = 12) - a set of exercises to promote gross motor skills, body awareness, and socialization; aerobic exercise training (AT; n = 14) - high intensity activity on a recumbent bicycle, and wait list (WL; n = 14). Both DMT and AT groups were supervised by licensed instructors and met three times a week for three months. Before and after their respective program, participants of all groups provided saliva samples on 3 d at 0-, 30- and 60-min after awakening, and had their fitness level evaluated. A significant group × time interaction (F(2,34) = 5.79, p = .01, η2partial = 0.25) was found, with the DMT group showing lower salivary cortisol values post-training, while the other two groups showed no change from baseline in their CAR. Cardiorespiratory fitness improved only in the AT group, while DMT showed no group-specific physical functioning improvements. The results are discussed in terms of the importance of physical and psychological effects of training on change in cortisol levels.

Gross Motor Skills Training Leads to Increased Brain-Derived Neurotrophic Factor Levels in Healthy Older Adults: A Pilot Study.

Exercise is recognized as a promising approach to counteract aging-associated declines in cognitive functions. However, the exact molecular pathways involved remain unclear. Aerobic training interventions and improvements in peak oxygen uptake (VO2peak) have been associated with increases in the peripheral concentration of brain-derived neurotrophic factor (BDNF) and better cognitive performances. However, other training interventions such as resistance training and gross motor skills programs were also linked with improvements in cognitive functions. Thus far, few studies have compared different types of physical exercise training protocols and their impact on BDNF concentrations, especially in participants over 60 years old. The main objective of this study was to compare the effects of three exercise protocols on plasma BDNF concentrations at rest in healthy older adults. Thirty-four older adults were randomized into three interventions: (1) lower body strength and aerobic training (LBS-A), (2) upper body strength and aerobic training (UBS-A), or (3) gross motor activities (GMA). All interventions were composed of 3 weekly sessions over a period of 8 weeks. Physical, biochemical, and cognitive assessments were performed pre and post-intervention. All interventions resulted in improved cognitive functions but the GMA intervention induced a larger increase in plasma BDNF concentrations than LBS-A. No correlation was observed between changes in BDNF concentrations and cognitive performances. These findings suggest that a program of GMA could lead to enhancements in plasma BDNF concentrations. Moreover, cognition improvement could occur without concomitant detectable changes in BDNF, which highlights the multifactorial nature of the exercise-cognition relationship in older adults.

Relationships between lower body strength and the energy cost of treadmill walking in a cohort of healthy older adults: a cross-sectional analysis.

PURPOSE: Gait speed is associated with survival in older adults and it was suggested that an elevated energy cost of walking (Cw) is an important determinant of gait speed reduction. Thus far, little is known about the factors that contribute to a lower Cw but it was shown that lower body strength training could reduce the Cw. Therefore, the objective of this study was to investigate the relationship between lower body strength and the Cw in a cohort of healthy older adults. METHODS: A total of 48 participants were included in this study (70.7 ± 5.4 years). After a geriatric and a neuropsychological assessment, participants underwent a fitness testing protocol which included a maximal oxygen uptake test, assessment of the Cw at 4 km h-1 on a treadmill, an isokinetic maximal strength test for the ankle, knee and hip joints and a body composition assessment. Relationships between strength variables and the Cw were assessed with partial correlations and linear regression analyses. RESULTS: Hip extensors and hip flexors peak torque was significantly correlated with the Cw (r = -0.36 and -0.32, respectively; p < 0.05). A tendency towards significance was identified for the ankle plantar flexors (r = -0.25, p = 0.09). Hip extensors peak torque was the only significant neuromuscular parameter included in the linear regression analysis (p < 0.05). CONCLUSION: These results show that hip extensors are an important muscle group with regards to the Cw measured on a treadmill in this cohort of healthy older adults.

Effects of combined physical and cognitive training on fitness and neuropsychological outcomes in healthy older adults.

PURPOSE: Physical exercise and cognitive training have been shown to enhance cognition among older adults. However, few studies have looked at the potential synergetic effects of combining physical and cognitive training in a single study. Prior trials on combined training have led to interesting yet equivocal results. The aim of this study was to examine the effects of combined physical and cognitive interventions on physical fitness and neuropsychological performance in healthy older adults. METHODS: Seventy-six participants were randomly assigned to one of four training combinations using a 2×2 factorial design. The physical intervention was a mixed aerobic and resistance training program, and the cognitive intervention was a dual-task (DT) training program. Stretching and toning exercises and computer lessons were used as active control conditions. Physical and cognitive measures were collected pre- and postintervention. RESULTS: All groups showed equivalent improvements in measures of functional mobility. The aerobic-strength condition led to larger effect size in lower body strength, independently of cognitive training. All groups showed improved speed of processing and inhibition abilities, but only participants who took part in the DT training, independently of physical training, showed increased task-switching abilities. The level of functional mobility after intervention was significantly associated with task-switching abilities. CONCLUSION: Combined training did not yield synergetic effects. However, DT training did lead to transfer effects on executive performance in neuropsychological tests. Both aerobic-resistance training and stretching-toning exercises can improve functional mobility in older adults.

Multiple roads lead to Rome: combined high-intensity aerobic and strength training vs. gross motor activities leads to equivalent improvement in executive functions in a cohort of healthy older adults.

The effects of physical activity on cognition in older adults have been extensively investigated in the last decade. Different interventions such as aerobic, strength, and gross motor training programs have resulted in improvements in cognitive functions. However, the mechanisms underlying the relationship between physical activity and cognition are still poorly understood. Recently, it was shown that acute bouts of exercise resulted in reduced executive control at higher relative exercise intensities. Considering that aging is characterized by a reduction in potential energy ([Formula: see text] max - energy cost of walking), which leads to higher relative walking intensity for the same absolute speed, it could be argued that any intervention aimed at reducing the relative intensity of the locomotive task would improve executive control while walking. The objective of the present study was to determine the effects of a short-term (8 weeks) high-intensity strength and aerobic training program on executive functions (single and dual task) in a cohort of healthy older adults. Fifty-one participants were included and 47 (age, 70.7 ± 5.6) completed the study which compared the effects of three interventions: lower body strength + aerobic training (LBS-A), upper body strength + aerobic training (UBS-A), and gross motor activities (GMA). Training sessions were held 3 times every week. Both physical fitness (aerobic, neuromuscular, and body composition) and cognitive functions (RNG) during a dual task were assessed before and after the intervention. Even though the LBS-A and UBS-A interventions increased potential energy to a higher level (Effect size: LBS-A-moderate, UBS-A-small, GMA-trivial), all groups showed equivalent improvement in cognitive function, with inhibition being more sensitive to the intervention. These findings suggest that different exercise programs targeting physical fitness and/or gross motor skills may lead to equivalent improvement in cognition in healthy older adults. Such results call for further investigation of the multiple physiological pathways by which physical exercise can impact cognition in older adults.

Fitness level moderates executive control disruption during exercise regardless of age.

The purpose of this study was to assess the effects of exercise intensity, age, and fitness levels on executive and nonexecutive cognitive tasks during exercise. Participants completed a computerized modified-Stroop task (including denomination, inhibition, and switching conditions) while pedaling on a cycle ergometer at 40%, 60%, and 80% of peak power output (PPO). We showed that a bout of moderate-intensity (60% PPO) to high-intensity (80% PPO) exercise was associated with deleterious performance in the executive component of the computerized modified-Stroop task (i.e., switching condition), especially in lower-fit individuals (p < .01). Age did not have an effect on the relationship between acute cardiovascular exercise and cognition. Acute exercise can momentarily impair executive control equivalently in younger and older adults, but individual's fitness level moderates this relation.

Physical functioning is associated with processing speed and executive functions in community-dwelling older adults.

OBJECTIVES: The aim of this study was to examine the association between physical functioning and cardiovascular burden on the cognitive performance of community-dwelling older adults. METHOD: Ninety-three adults aged 60 and older completed a medical evaluation by a geriatrician, performance-based physical tests, and neuropsychological assessments. Cognitive composite scores (memory, speed, and executive) as well as a physical functioning score were created by averaging standardized z-scores of selected tests. A cardiovascular burden index was also computed by totalling the number of cardiovascular risk factors and diseases. RESULTS: Multiple hierarchical regression analyses reveal that higher level of physical functioning was significantly associated with greater processing speed and better executive functions but was not associated with memory performance. These relations were independent of age, sex, and level of education. Cardiovascular burden was not significantly associated with any cognitive domain. DISCUSSION: These results suggest that cognition is related to simple performance-based physical tests and highlight the importance of intervention studies aimed at enhancing cognitive and physical functioning in older adults.

Depressive symptoms are independently associated with recurrent falls in community-dwelling older adults.

ABSTRACT Background: Falls and depression are two major public health problems that affect millions of older people each year. Several factors associated with falls are also related to depressive symptoms such as medical conditions, sleep quality, use of medications, cognitive functioning, and physical capacities. To date, studies that investigated the association between falls and depressive symptoms did not control for all these shared factors. The current study addresses this issue by examining the relationship between falls and depression symptoms after controlling for several confounders. Methods: Eighty-two community-dwelling older adults were enrolled in this study. The Geriatric Depression Scale (GDS-30) was used to evaluate the presence of depressive symptoms, and the following question was used to assess falls: "Did you fall in the last 12 months, and if so, how many times?" Results: Univariate analyses indicated that the number of falls was significantly correlated with gender (women), fractures, asthma, physical inactivity, presence of depressive symptoms, complaints about quality of sleep, use of antidepressant drugs, and low functional capacities. Multivariate analyses revealed that depressive symptoms were significantly and independently linked to recurrent falls after controlling for confounders. Conclusions: Results of the present study highlight the importance of assessing depressive symptoms during a fall risk assessment.