tsolaki
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Physical ActivityTRANSCRIPT
www.alzheimer-hellas.gr
Physical activities and Cognitive function
Magda Tsolaki, MD, PhDNeuropsychiatrist
Professor of Aristotle University of Thessaloniki
Chair of Greek Alzheimer Federation
Age is #1 Dementia Risk Factor
04/08/23
Numbers in Greece
1.Prevalence , 9% in subjects more than 70 in Pylea, Thessaloniki2. In Great Alexander municipality
3,6% >65 Tsolaki M. et al, AJAD, 1999 Tsolaki M. et al, ADI2010
Family Ε4 (11% vs 32%) Olive oil
MINDMINDYOUR BODYYOUR BODY
and YOUR BRAINand YOUR BRAIN
Alzheimer Disease Progression Deterioration
Time in years
Mooddisturbances
Cognitiveimpairments
Impaired activities of daily living ADL
Behaviouraldisturbances
Motordisorders
From S GAUTHIER 1996
Clinical Phase
?
LITERATURE
• Participation in both aerobic and resistance training exercises alone, and in combination, leads to sustained improvements in cognitive performance, particularly for executive control tasks
(MEDICINE & SCIENCE IN SPORTS & EXERCISE, 2009; 1510-1530)
Guidelines for Physical Activities
Physical Exercise:Mechanisms of action
1.CNS neuronal apoptosis is a consequence of exercise in the adult rat and suggests that this process is a potential mediator of rapid exercise-induced plasticity. Exercise in mouse models causes neurogenesis in the dentate gyrus.
Alzheimers Res Ther. 2011 Feb
Physical Exercise:Mechanisms of action
2.Exercise engages arousal mechanisms in the reticular-activating system, which involves a big number of neurotransmitter systems.
3. Exercise, also, disengages the higher-order functions of the prefrontal cortex.
4. Improvement of blood circulation and brain oxygen supply J. Am Geriatr. Soc., 38, 123-128, 1990.
Πιθανή επίδραση των παρεμβάσεων στην καθυστέρηση της εμφάνισης της νόσου Alzheimer
1997 2007 2017 2027 2037 2047
Year
ΗΠΑΕπιπολασμός
της ΝΑ(εκατ)
ΝΑ = Alzheimer’s Disease.Brookmeyer R et al. Am J Public Health. 1998;88:1337-1342.
Καθυστέρηση(χρόνια)
00.51.0
2.05.0
8
6
4
2
0
Possible effect of interventions which delay the onset of dementia
Prevalence in USA
Delay (years)
ANIMAL MODELS (Combination of
physical and cognitive exercise )
NBBMBNMBNMBSSS
Other MECHANISMS The current experiment assessed levels
of apoptosis, angiogenesis, and neurogenesis during the first week of an exercise regimen in the adult rat. The results indicate that exercise rapidly induces these processes in the hippocampus and cerebellum
Behav Neurosci. 2011 Feb
TRIALS IN HUMANS(ONLY PHYSICAL EXERCISE)
ACSM (American College of Sports Medicine), 2009
• At least 3 times a week for two weeks• ~ 1 hour
• Warm-up period 5-10 min. Warm-up period 5-10 min. • Main Part 40-50 min.Main Part 40-50 min.
1.1. Stretching 8-10 min.Stretching 8-10 min.2.2. Strength (upper body) 10-15 minStrength (upper body) 10-15 min3.3. Flexibility - Aerobic 8-10 min.Flexibility - Aerobic 8-10 min.4. Balance – Strength (lower body) 15 min.
• Cool down period 5 min
FFA, FFA, Scientific issuesScientific issues Organized interventions
of Increased difficulty
Assessment
Subjective criteria:Heart rate and blood pressure
Subjective criteria: Borg Scale
Borg Scale
Physical exercise and cognitive function
Multiple results of physical exercise on cognitive function3 reviews -meta-analysis and 7 studies
Principles
Scientific model of improvement of cognitive functions – clear methodology and targetSeverity of exercise according the abilities of participants. – step by step changes of exercisesEvery patient can do different activities Balance between duration of exercise and frequency
Physical exercise and Cognitive function
Principles of body exerciseMedical follow upOrganization of the program according abilitiesUse of experienceEncourage of independence
Characteristics of exercise:Simple, preparation– main part- relaxationSocialization
Physical exercise and Cognitive function
SuggestionsDuration (31 – 45 mins)Bigger improvement (more than 6 months). Moderate aerobic exercise
Authors Year Participants Intervention Results
Molloy et al 1988 N=15,
MMSE: 24
1st group: mild aerobic exercise 45΄/ once a week for two
weeks
2nd group: no intervention
Improvement in verbal fluency
Mulrow et al 1994 N=194,
MMSE: 21
1st group ασκήσεις ενδυνάμωσης, ισορροπίας,
κινητικότητας.2η ομάδα: φιλικές
επισκέψεις.45΄/ 3 φορές την
εβδομάδα/ 16 εβδομάδες
Moderate motor improvement
Baum et al 2003 N=20
MMSE: 21
1η ομάδα: εύρος κινητικότητας
καθισμένου2η ομάδα:
ψυχαγωγικές δραστηριότητες60΄/ 3 φορές την
εβδομάδα/ 6 μήνες
Improvement in physical status and MMSE
Stevens et al 2006
N=75MMSE:9 - 23
1η ομάδα: σωματική άσκηση
2η ομάδα: κοινωνικές επισκέψεις
30΄/ 3 φορές την εβδομάδα/ 12
εβδομάδες2η ομάδα: καμία
παρέμβαση
Delay of cognitive and physical deterioration
Physical Exercise Proximal F/U
Hillman et al. Nature Reviews Neuroscience (2008)
RCT of PEx in MCI with Longitudinal FU
Lautenschlager et al. 2008
RCT of PEx in MCI with Longitudinal FU
RCT of PEx in MCI with Longitudinal FU
RCT of PEx in MCI with Longitudinal FU
PEx Reorganises Hippocampal Synaptic Connectivity
Joyce Siette In preparation
What about combining cBT and PEx?
TRIALS IN HUMAN(PROTECTIVE)
Can Physical Exercise Prevent Cognitive
Decline?
PHYSICAL EXERCISE AND DEMENTIA
Physical activity or exercise can prevent or delay the onset of age-related cognitive impairment or dementia (Middleton K.R., 2007)
Positive effects of physical activity on attention, memory, communication, executive functions and global mental functioning, in older people with dementia.
(Eggermont L., Swaab D., et al, 2005; Fang Yu, Kolanowski A. M., 2006)
TRIALS IN HUMAN(THERAPEUTIC)
OUR EXPERIENCE RHEA, a non pharmacological
cognitive training intervention in patients with Mild Cognitive Impairment (MCI): A Pilot Study
Kounti F, 1, 2 Bakoglidou E, 1, 2
Agogiatou C, 1, 2 Emerson Lombardo NB,5 Serper LL,4 Tsolaki M1, 2, 3
PARTICIPANTS 58 MCI patients with MMSE=27.69,
assigned to 2 groups of 29 each (experimental, 20-weekly RHEA sessions, and no-therapy control), matched for age, gender, education, cholinesterase inhibitors, cognitive abilities.
NEUROPSYCHOLOGICAL TESTS• MMSE [Mini Mental State Examination-MMSE (Roth,
Huppert, Tum, & Mouthjoy, 1988)] • TEA [Test of Every Day Attention(Robertson et al.,
1989)] • RBMT [Rivermead Behavioural Memory Test (Wilson et
al.,1989)]
• ROCFT [Rey Osterreith Complex Figure Test (Rey,1941)]
NEUROPSYCHOLOGICAL TESTS
• FUCAS [Functional Cognitive Assessment Scale-FUCAS (Kounti, Efklides, Tsolaki, & Kiosseoglou, 2006)]
• WCST [Wisconsin Card Sorting Test (Berg, 1948)]
• ΧΣΑ [Verbal fluency (Kosmidis, Vlachou, Panagiotaki, & Kiosseoglou, 2004)]
• FRSSD [Functional Rating Scale of Symptoms of Dementia-FRSSD (Hutton, 1990)]
RHEA Intervention Design and Rationale
• The RHEA intervention was 90 minutes duration, once a week, for 20 weeks.
• The tasks are ecological. The stimuli that are used are shapes, colours, sizes, and numbers. The technical materials include wreath, boards with letters, cards with colours, shapes and numbers, corridors with numbers, balls, wands, rings, and cones.
RHEA Intervention Design and Rationale
• Each session includes 5 exercises lasting approximately 15 minutes each.
• The program has tasks with an increasing degree of difficulty varying according to the cognitive and kinetic performance of the participants
1st Exercise (Free movements)
1st Exercise (Free movements)
2nd Exercise: Walking
2nd Exercise (Walking)
3rd Exercise (Balance)
3rd Exercise (Balance)
4th Exercise (mild movement abilities)
4th Exercise (mild movement abilities)
5th Exercise (Free voluntary movements)
5th Exercise (Free voluntary movements)
Results (MCI)The benefit of the experimental group was in
Attention (p=0.002), Language(p=0.015), Visual-spatial (p=0.013), MMSE (p=0.047), ADL(p=0.009). Experimental participants improved cognitive and
functional performances while control participants remained stable.
OUR EXPERIENCE
EFFECTS OF AN EXERCISE INTERVENTION ON COGNITIVE FUNCTION OF ALZHEIMER’S DISEASE
PATIENTS
C.A. Mouzakidis, M.Tsolaki
METHODS
24 AD patients
Exercise Group (n=12). Mean Age = 65.70, SD = 7.73, Education = 9.33, SD = 2.90. Control Group (n=12). Mean Age = 68.50, SD = 3.87, Education = 8.92, SD = 4.72.
AssessmentCognitive Functions (MMSE)
Psychomotor Measures
Equipment• Colored easy controlled balls, sticks, hoops of different
sizes, plastic bottles, soda cans, tennis balls, chairs, dumbbells.
Duration36 weeks (3
times/week)90 minutes/time
Description of Exercise Program• Warm up Period (30’). Aerobic & range of motion
exercises• Main Exercise Period (50’). flexibility, strength of upper
and lower limbs, endurance, dexterity, balance, agility, speed, attention and accuracy, co-ordination, orientation, memory, self-control, and co-operation
• Cool down Period (10’). Main purpose to allow the heart rate to return to normal and the body to relax.
RESULTS
The patients of the exercise group managed to maintain their cognitive and functional abilities, while the patients of the control group deteriorated.
Exercise Group (n = 12)
Control Group(n = 12)
BeforeMean (SD)
AfterΜean (SD)
BeforeΜean (SD)
AfterΜean (SD)
MMSE 18,50 (8,85) 18,33 (9,02) 16,25 (5,64) 12,83 (5,57)*
*p< 0.05
Soda Pop Test 12 16.50 (±11.79) 13.20 (±11.20) NS
Finger Dexterity 12 29.75 (±31.00) 25.85 (±23.26) NS
Hand Tapping 12 62.00 (±19.00) 70.00 (±11.67) NS
Reaction Time (cm) 12 38.50 (±15.51) 29.70 (±13.75) p = 0.001
Repetitive Arm and Hand Movements
Right Hand 12 3.21 (±0.97) 2.75 (±0.74) p = 0.001
Left Hand 12 3.44(±0.97) 3.00 (±0.78) p = 0.010
Grip Test (kg)
Right Hand 12 27.58 (±6.37) 30.00 (±7.29) p = 0.007
Left Hand 12 24.33 (±7.40) 26.50 (±8.10) p = 0.007
Sequential Arm and Hand Movements 12 1.75 (±2.05) 0.83 (±2.00) p = 0.050
Reeling String on a Stick 11 17.17 (±11.93) 15.22 (±11.00) p = 0.001
Bounce a Ball 12 2.17 (±2.21) 1.08 (±2.06) NS
Throw a Ball to a target 12 2.08 (±1.24) 0.92 (±1.24) p = 0.004
Bowling 12 2.17 (±2.33) 3.50 (±2.71) NS
Gait Control 11 0.45 (±1.21) 0.09 (±0.30) NS
Static Balance 12 25.17 (±22.61) 33.81 (±23.57) p = 0.008
Step Into and Out of a Hoop 12 0.83 (±1.64) 1.58 (±2.35) NS
Sit and Reach Test 12 49.25 (±13.50) 52.17 (±15.35) p = 0.006
Agility 12 7.00 (±4.26) 8.25 (±5.67) NSNS = non-significant
OUR EXPERIENCE (MCI) Tsolaki M, Kounti F, Agogiatou C, Poptsi E,
Bakoglidou E, Zafeiropoulou M, Soumbourou A, Nikolaidou E, Batsila G, Siambani A, Nakou S, Mouzakidis C, Tsiakiri A, Zafeiropoulos S, Karagiozi K, Messini C, Diamantidou A, Vasiloglou M.
Effectiveness of Nonpharmacological Approaches in Patients with Mild Cognitive Impairment. Neurodegener Dis. 2010 Dec 3
ΝΟΣΟΣ ΝΟΣΟΣ ALZHEIMERALZHEIMER
Μάγδα Τσολάκη,Μάγδα Τσολάκη, MD, PhD MD, PhDΝευρολόγος-Ψυχίατρος, Νευρολόγος-Ψυχίατρος,
Θεολόγος,Θεολόγος,Αναπληρώτρια Καθηγήτρια, Αναπληρώτρια Καθηγήτρια,
Α.Π.Θ.Α.Π.Θ.Πρόεδρος της Ελληνικής Πρόεδρος της Ελληνικής
Ομοσπονδίας Νόσου Ομοσπονδίας Νόσου AlzheimerAlzheimer
CLINICAL TRIALS(Combination of
physical and cognitive exercise )
What is LLM ?
• Long Lasting Memories (LLM) is an integrated ICT platform which:
combines state-of-the-art cognitive exercises with physical activityin the framework of an advanced ambient assisted living environment.
20112011
Component 1: Effects of Physical Exercise in the Elderly
• Regular physical exercise, significantly improves physical functioning of individuals at any age
• Engagement of elderly individuals in regular physical exercise programs has demonstrated improvement in
aerobic capacity, muscular strength, muscular endurance, flexibility, balance,
motor control and performance, skill acquisition, coordination, cognition and psychological well being
(www.who.int/hpr/ageing/heidelberg_eng.pdf)
20112011
LLM Design Idea
20112011
The PilotsPilots in 5 countries
Austria Spain France Greece Cyprus
20112011
2011
Expected Results
pre post
Cogn
itive
Fun
ctio
n
Theory Expected Results
Results from Konstanz:10 weeks physical training2 x 45 min/week
Hertzog et al., 2009
LLM
Control
ΓΙΑΤΙ ΟΧΙ AKOMH ΣΤΟ ΑΙΜΑ;
Thank you very much for your attention