Aerobic exercise promotes executive functions and impacts functional neural activity among older adults with vascular cognitive impairment.

BACKGROUND: Vascular cognitive impairment (VCI) results from cerebrovascular disease, and worldwide, it is the second most common type of cognitive dysfunction. While targeted aerobic training is a promising approach to delay the progression of VCI by reducing cardiometabolic risk factors, few randomised controlled trials to date have specifically assessed the efficacy of aerobic training on cognitive and brain outcomes in this group at risk for functional decline. AIM: To examine the effect of moderate-intensity aerobic training on executive functions and functional neural activity among older adults with mild subcortical ischaemic VCI (SIVCI). METHODS: Older adults with mild SIVCI were randomly assigned to: (1) 6-month, 3×/week aerobic training (n=10) or (2) usual care (control; n=11). Participants completed functional MRI (fMRI) at baseline and trial completion. During the fMRI sessions, behavioural performance on the Eriksen flanker task and task-evoked neural activity were assessed. RESULTS: At trial completion, after adjusting for baseline general cognition, total white matter lesion volume and flanker performance, compared with the control group, the aerobic training group significantly improved flanker task reaction time. Moreover, compared with the controls, the aerobic training group demonstrated reduced activation in the left lateral occipital cortex and right superior temporal gyrus. Reduced activity in these brain regions was significantly associated with improved (ie, faster) flanker task performance at trial completion. SUMMARY: Aerobic training among older adults with mild SIVCI can improve executive functions and neural efficiency of associated brain areas. Future studies with greater sample size should be completed to replicate and extend these findings.

Where to build the bridge between evidence and practice?: results of an international workshop to prioritize knowledge translation activities in traumatic brain injury care.

INTRODUCTION: Treatment of patients with traumatic brain injury (TBI) should be based upon the strongest evidence to achieve optimal patient outcomes. Given the challenges, efforts involved, and delays in uptake of evidence into practice, priorities for knowledge translation (KT) should be chosen carefully. An international workshop was convened to identify KT priorities for acute and rehabilitation care of TBI and develop KT projects addressing these priorities. METHODS: An expert panel of 25 neurotrauma clinicians, researchers, and KT scientists representing 4 countries examined 66 neurotrauma research topics synthesized from 2 neurotrauma evidence resources: Evidence Based Review of Acquired Brain Injury and Global Evidence Mapping projects. The 2-day workshop combined KT theory presentations with small group activities to prioritize topics using a modified Delphi method. RESULTS: Four acute care topics and 3 topics in the field of rehabilitation were identified. These were focused into 3 KT project proposals: optimization of intracranial pressure and nutrition in the first week following TBI; cognitive rehabilitation following TBI; and vocational rehabilitation following TBI. CONCLUSION: Three high-priority KT projects were developed: the first combined 2 important topics in acute TBI management of intracranial pressure management and nutrition, and the other projects focused on cognitive rehabilitation and vocational rehabilitation.

An overview of published research about the acute care and rehabilitation of traumatic brain injured and spinal cord injured patients.

Knowledge of the breadth, nature, and volume of traumatic brain injury (TBI) and spinal cord injury (SCI) research can aid in research planning. This study aimed to provide an overview of existing TBI and SCI research to inform identification of knowledge translation (KT), systematic review (SR), and primary research opportunities. Topics and relevant articles from three large neurotrauma evidence resources were synthesized: the Global Evidence Mapping (GEM) Initiative (129 topics and 1644 articles), the Acquired Brain Injury Evidence-Based Review (ERABI; 152 topics and 732 articles), and the Spinal Cord Injury Rehabilitation Evidence (SCIRE) Project (297 topics and 1650 articles). A de-duplicated dataset of SRs, randomized controlled trials (RCTs), and other studies identified by these projects was created. In all, 145 topics were identified (66 TBI and 79 SCI), yielding 3466 research articles (1256 TBI and 2210 SCI). Topics with KT potential included cognitive therapies for TBI and prevention/management of urinary tract problems post-SCI, which accounted for 17% and 18%, respectively, of the TBI and SCI yield. Topics that may require SR included management of raised intracranial pressure in TBI, and ventilation and intermittent positive pressure interventions following SCI. Topics for which primary research may be needed included pharmacological therapies for neurological recovery post-TBI, and management of sleep-disordered breathing post-SCI. There was a larger volume of non-intervention (epidemiological) studies in SCI than in TBI. This comprehensive overview of TBI and SCI research can aid funding agencies, researchers, clinicians, and other stakeholders in prioritizing and planning TBI and SCI research.