- Email: [email protected]
Monitored physical activity is associated with better cognitive performance in the elderly: A study from the Australian Imaging, Biomarkers and Lifestyle (AIBL) study
Oral O4-07: Prevention II
S162 O4-06-08
EDUCATION LEVEL AND CSF BIOMARKERS IN ALZHEIMER’S DISEASE: THE COGNITIVE RESERVE THEORY
Julien Dumurgier1, Claire Paquet1, Sarah Benisty1, Claire Kiffel1, Claude Lidy2, Franc¸ois Mouton-Liger3, Hughues Chabriat4, Jean-Louis Laplanche5, Jacques Hugon1, 1CMRR Paris Nord, Lariboisie`re - Fernand Widal Hospital, Paris, France; 2Department of Geriatrics, Lariboisie`re - Fernand Widal Hospital, Paris, France; 3 Department of Histology and Biology of Aging, Lariboisie`re - Fernand Widal Hospital, Paris, France; 4Department of Neurology, Lariboisie`re - Fernand Widal Hospital, Paris, France; 5Department of Biochemistry, Lariboisie`re - Fernand Widal Hospital, Paris, France. Contact e-mail: [email protected] Background: In Alzheimer’s disease (AD), the cognitive reserve theory predicts that at any level of assessed clinical severity, the underlying brain pathology is more advanced in patients with more cognitive reserve. Cerebrospinal fluid (CSF) biomarkers could reflect the brain pathology and could be used as surrogates for AD lesions. We investigated the relationship between education level and CSF concentrations of beta-amyloı¨d 142, total tau and phosphorylated tau (ptau-181) in newly diagnosed subjects with AD. Methods: 61 AD patients from our Memory Center underwent lumbar puncture. Level of education was assessed as a 7-levels variable. Generalized linear models were used to study the relations between CSF biomarkers and the level of education. Results: After adjustment for age, sex, and Mini Mental Status Examination (MMSE) score, CSF concentration of beta-amyloı¨d 1-42 was inversely associated with education level (coefficient of linear regression [S.D.] ¼ -39.0 [15.3], p-value ¼ 0.01). In stratified analyses, this relation was only present in the upper third of MMSE. There was no relation between CSF tau or ptau-181 and education. Conclusions: Higher levels of education are associated with more pronounced CSF beta-amyloı¨d 1-42 abnormalities in newly diagnosed AD patients. These differences, present in early forms of the disease, are attenuated in late stages of the disease. These results are consistent with the cognitive reserve theory.
WEDNESDAY, JULY 14, 2010 ORAL O4-07 PREVENTION II O4-07-01
ACTIVITY ENERGY EXPENDITURE AND COGNITIVE IMPAIRMENT IN OLDER ADULTS
Laura E. Middleton1, Todd M. Manini2, Eleanor M. Simonsick3, Tamara B. Harris3, Deborah E. Barnes4,5, Frances Tylavsky6, Jennifer S. Brach7, James E. Everhart8, Kristine Yaffe4,5, 1Heart and Stroke Foundation Center for Stroke Recovery, Sunnybrook Hospital, Toronto, ON, Canada; 2University of Florida, Gainesville, FL, USA; 3National Institute on Aging, Bethesda, MD, USA; 4University of California San Francisco, San Francisco, CA, USA; 5Veterans’ Affairs Medical Center, San Francisco, CA, USA; 6University of Tennessee, Memphis, TN, USA; 7University of Pittsburgh, Pittsburgh, PA, USA; 8National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA. Contact e-mail: middleton_l@ hotmail.com Background: In most studies, physically active people have reduced risk of cognitive impairment in late-life. One limitation of these studies is reliance on self-reported physical activity. The objective of this study was to investigate the relationship between objectively assessed daily activity energy expenditure (AEE) and incidence of cognitive impairment in late-life. Methods: We measured AEE, calculated as 90% of total energy expenditure (assessed using doubly labeled water) minus resting metabolic rate (assessed by indirect calorimetry), in 197 men and women aged 70-79 years who were free of mobility and cognitive impairment in years 2 to 3 of the Health, Aging and Body Composition study. Cognitive function was assessed using the Modified Mini-Mental Examination (3MS) in years 3
(baseline) and at 2 and 5 years follow-up. Cognitive impairment was as defined as a decline of >1.0 standard deviations (9 points) on the 3MS over 5-years. Results: Participants had a mean age of 74.8 years and were 49.8% male. People with higher AEE had lower odds of cognitive impairment (highest sex-specific tertile: 2.9%, middle tertile: 8.8%, lowest tertile: 19.7%) (Figure 1). In logistic regressions adjusted for age, baseline 3MS, and variables associated with AEE (study site, sleep duration), people in the highest tertile of AEE had lower odds of cognitive impairment than those in the lowest tertile (OR (95% CI): High vs. Low: 0.14 (0.030.68)). Although there was no significant difference between people in the middle tertile and lowest tertile (0.37 (0.11-1.19)), there was a trend across tertiles for lower incidence of cognitive impairment with higher AEE (p ¼ 0.03). Conclusions: Our findings indicate that objectively determined greater physical activity is associated with a lower incidence of cognitive impairment. Future studies are needed to confirm these results and rule out unmeasured confounders.
O4-07-02
MONITORED PHYSICAL ACTIVITY IS ASSOCIATED WITH BETTER COGNITIVE PERFORMANCE IN THE ELDERLY: A STUDY FROM THE AUSTRALIAN IMAGING, BIOMARKERS AND LIFESTYLE (AIBL) STUDY
Belinda M. Brown1,2, Jeremiah J. Peiffer3, Kevin Taddei2, Jonathon K. Foster2, Vanessa K. Ward1,2, Rebecca M. Lachovitzki2, Mark A. Rodrigues2, Tania Taddei2, James Lui2, Veer Gupta2, Simon M. Laws2, Mira R. Rimajova1, Kathryn A. Ellis4, Cassandra Szoeke5, Colin L. Masters4, David Ames4, Christopher Rowe6, Ralph N. Martins2, 1 University of Western Australia, Perth, Australia; 2Edith Cowan University, Perth, Australia; 3Murdoch University, Perth, Australia; 4University of Melbourne, Melbourne, Australia; 5CSIRO, Melbourne, Australia; 6Austin Health, Melbourne, Australia. Contact e-mail: [email protected] Background: Numerous studies have outlined the potential positive impact of physical activity on delaying the onset of Alzheimer’s disease (AD). However these studies have a number of potential weaknesses, including the use of physical activity questionnaires or surveys, which can introduce biases and inaccuracies. We aim to address these weaknesses by using accelerometer activity monitors, which can reliably quantify movement. In this study we are investigating the association between physical activity, measured with accelerometers, and cognitive performance in a large cohort of healthy men and women. Methods: As a component of the CSIRO Australian Imaging, Biomarkers and Lifestyle (AIBL) Flagship study, 164 healthy controls were randomly selected from the AIBL cohort (1112 individuals) to wear an accelerometer unit for 7 consecutive days. The
Oral O4-07: Prevention II
S163
accelerometer unit measured habitual physical activity of each participant, with software subsequently calculating total counts and total kilocalories expended each day. In addition, each participant underwent a comprehensive battery of cognitive tests, which included the; Mini Mental State Examination (MMSE), California Verbal Learning Test (CVLT) and Rey Complex Figure Test (RCFT). Spearman ranked order correlations were calculated between habitual physical activity levels and cognitive test scores using age, gender and estimated IQ as co-variates. Results: Significant positive correlations were observed between physical activity average total counts/day (recorded by the accelerometer), and various cognitive measures, including; CVLT Learning Score T1-5 (r ¼ .137; p ¼ .047), CVLT Retention (r ¼ .138; p ¼ .046), CVLT Delayed Recall (r ¼ .141 p ¼ .043) and RCFT 3 minute delay (r ¼ .168; p ¼ .020). No significant correlation was observed between physical activity and the Mini Mental State Examination score. Conclusions: The use of accelerometers addressed the potential inaccuracies associated with the use of physical activity questionnaires. Collection of reliable data showed positive associations between physical activity and specific elements of cognition (focused on episodic learning and memory). Our results indicate that people participating in higher levels of physical activity are more likely to experience enhanced cognitive performance, a factor that has been linked to protecting the aging brain against AD.
O4-07-03
COGNITIVE STIMULATION AND REHABILITATION MEDIATED BY COMPUTERS AND INTERNET: A CONTROLLED STUDY
Andre´ J. Xavier1, Eleonora d’Orsi2, Luiz R. Ramos3, Daniel Sigulem3, Josenei B. dos Santos2, Anna Quialheiro1, Giovana Olivieri1, Lenemar N. Pedroso1, Ranier Berger1, Monique Baldin1, Emily K. Lida1, Thaı´s Batista1, 1Unisul, Floriano´polis, Brazil; 2Universidade Federal de Santa Catarina, Floriano´polis, Brazil; 3Universidade Federal de Sa˜o Paulo, Sa˜o Paulo, Brazil. Contact e-mail: [email protected] Background: Computers and internet can provide a great variety of progressive mind exercises in order to prevent and rehabilitate cognitive decline. Methods: An intervention controlled study conducted with community elder people to compare changes in MMSE score before and after internet and computers workshops. Participants were invited to the workshops and a similar control group was obtained from the same facilities. Were realized 17 workshops, from 2004 to 2009 in Local Area Network (LAN) houses, one computer per person, they were recruited from university specialized outpatient ambulatories in Sa˜o Paulo and Floriano´polis in Brazil. Eligibility criteria: above 54 years, both genders, at least 1 year of schooling, exclusion criteria: living in a nursing home, blindness, deafness, upper limbs paralysis. Each workshop was composed by 20 sessions of 1,5 hours each, twice a week, groups of 5 to 15 elders one monitor and 1 observer. The functional and cognitive data was obtained, in both groups by trained and supervised personnel. Analysis was bivariate, multivariate, Cox regression model and paired samples T test. Results: Population of 173 (71controls), 74% female, age 70,1 (6 10,05) years , schooling 8,86 (6 4,9) years, sedentarism 54%, depression 32%, diabetes 19%, hypertension 64%, dyslipidemia 36%, tobacco exposition 35%, hypothyroidism 11%, obesity 25%, circulatory disease 18%, initial MMSE 25,30 (6 4,7), Activities of the Daily Living score (ADL) 13,17 (6 3,2). No significant statistical differences between intervention and control groups among the variables above. The MMSE of intervention group improved from 25,29 6 4,61 to 26,85 6 4,18 p ¼ 0,000, no changes in control group. Cox regression for the end point ‘‘Final MMSE better 4 points’’ the intervention group had a protective RR of 3,20 (1,21 - 8,42 CI95%) p ¼ 0,018. For the end point ‘‘Final MMSE worst 3 points’’ the workshop group had protective Relative Risk (RR) of 0,15 (0,03 - 0,71), adjusted for gender, age, education, and sedentarism, depression, hypertension, diabetes, obesity, hypothyroidism, dyslipidemia, tobacco exposition and circulatory disease. Conclusions: This cognitive stimulation and rehabilitation methodology can prevent cognitive loss and improve cognitive status.
O4-07-04
COGNITIVE TRAINING IN OLDER ADULTS
Jeffery J. Summers1, Anna Wolf1, Sarah Elder2, Mathew Summers1, Kelly Limbrick1, Malcolm Tyler3, 1University of Tasmania, Hobart, Australia; 2Alzheimer’s Australia Tas, Hobart, Australia; 3Department of Health and Human Services, Tasmania, Hobart, Australia. Contact e-mail: [email protected] Background: A question that has stimulated much recent interest in the field of cognitive ageing is whether providing older adults with specific training programs can slow or even reverse the cognitive decline associated with ageing. Previous research, however, has been hampered by methodological limitations and small effect sizes. The aim of the present study is to evaluate the long-term effects of a cognitive training program on measures of cognitive function and task-related neural activity in healthy, community dwelling older adults. Methods: A total of 117 participants (Age M ¼ 66.50, SD ¼ 7.01 yrs) completed the 10-week Active Cognitive Enhancement (ACE) multidimensional training program which has been designed to enhance a range of cognitive abilities. Prior to the start of the program participants underwent extensive testing of general psychological and cognitive functioning using normative-referenced neuropsychological tests, as well as a computerized test battery involving tasks assessing visual attention and learning,
S162 O4-06-08
EDUCATION LEVEL AND CSF BIOMARKERS IN ALZHEIMER’S DISEASE: THE COGNITIVE RESERVE THEORY
Julien Dumurgier1, Claire Paquet1, Sarah Benisty1, Claire Kiffel1, Claude Lidy2, Franc¸ois Mouton-Liger3, Hughues Chabriat4, Jean-Louis Laplanche5, Jacques Hugon1, 1CMRR Paris Nord, Lariboisie`re - Fernand Widal Hospital, Paris, France; 2Department of Geriatrics, Lariboisie`re - Fernand Widal Hospital, Paris, France; 3 Department of Histology and Biology of Aging, Lariboisie`re - Fernand Widal Hospital, Paris, France; 4Department of Neurology, Lariboisie`re - Fernand Widal Hospital, Paris, France; 5Department of Biochemistry, Lariboisie`re - Fernand Widal Hospital, Paris, France. Contact e-mail: [email protected] Background: In Alzheimer’s disease (AD), the cognitive reserve theory predicts that at any level of assessed clinical severity, the underlying brain pathology is more advanced in patients with more cognitive reserve. Cerebrospinal fluid (CSF) biomarkers could reflect the brain pathology and could be used as surrogates for AD lesions. We investigated the relationship between education level and CSF concentrations of beta-amyloı¨d 142, total tau and phosphorylated tau (ptau-181) in newly diagnosed subjects with AD. Methods: 61 AD patients from our Memory Center underwent lumbar puncture. Level of education was assessed as a 7-levels variable. Generalized linear models were used to study the relations between CSF biomarkers and the level of education. Results: After adjustment for age, sex, and Mini Mental Status Examination (MMSE) score, CSF concentration of beta-amyloı¨d 1-42 was inversely associated with education level (coefficient of linear regression [S.D.] ¼ -39.0 [15.3], p-value ¼ 0.01). In stratified analyses, this relation was only present in the upper third of MMSE. There was no relation between CSF tau or ptau-181 and education. Conclusions: Higher levels of education are associated with more pronounced CSF beta-amyloı¨d 1-42 abnormalities in newly diagnosed AD patients. These differences, present in early forms of the disease, are attenuated in late stages of the disease. These results are consistent with the cognitive reserve theory.
WEDNESDAY, JULY 14, 2010 ORAL O4-07 PREVENTION II O4-07-01
ACTIVITY ENERGY EXPENDITURE AND COGNITIVE IMPAIRMENT IN OLDER ADULTS
Laura E. Middleton1, Todd M. Manini2, Eleanor M. Simonsick3, Tamara B. Harris3, Deborah E. Barnes4,5, Frances Tylavsky6, Jennifer S. Brach7, James E. Everhart8, Kristine Yaffe4,5, 1Heart and Stroke Foundation Center for Stroke Recovery, Sunnybrook Hospital, Toronto, ON, Canada; 2University of Florida, Gainesville, FL, USA; 3National Institute on Aging, Bethesda, MD, USA; 4University of California San Francisco, San Francisco, CA, USA; 5Veterans’ Affairs Medical Center, San Francisco, CA, USA; 6University of Tennessee, Memphis, TN, USA; 7University of Pittsburgh, Pittsburgh, PA, USA; 8National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA. Contact e-mail: middleton_l@ hotmail.com Background: In most studies, physically active people have reduced risk of cognitive impairment in late-life. One limitation of these studies is reliance on self-reported physical activity. The objective of this study was to investigate the relationship between objectively assessed daily activity energy expenditure (AEE) and incidence of cognitive impairment in late-life. Methods: We measured AEE, calculated as 90% of total energy expenditure (assessed using doubly labeled water) minus resting metabolic rate (assessed by indirect calorimetry), in 197 men and women aged 70-79 years who were free of mobility and cognitive impairment in years 2 to 3 of the Health, Aging and Body Composition study. Cognitive function was assessed using the Modified Mini-Mental Examination (3MS) in years 3
(baseline) and at 2 and 5 years follow-up. Cognitive impairment was as defined as a decline of >1.0 standard deviations (9 points) on the 3MS over 5-years. Results: Participants had a mean age of 74.8 years and were 49.8% male. People with higher AEE had lower odds of cognitive impairment (highest sex-specific tertile: 2.9%, middle tertile: 8.8%, lowest tertile: 19.7%) (Figure 1). In logistic regressions adjusted for age, baseline 3MS, and variables associated with AEE (study site, sleep duration), people in the highest tertile of AEE had lower odds of cognitive impairment than those in the lowest tertile (OR (95% CI): High vs. Low: 0.14 (0.030.68)). Although there was no significant difference between people in the middle tertile and lowest tertile (0.37 (0.11-1.19)), there was a trend across tertiles for lower incidence of cognitive impairment with higher AEE (p ¼ 0.03). Conclusions: Our findings indicate that objectively determined greater physical activity is associated with a lower incidence of cognitive impairment. Future studies are needed to confirm these results and rule out unmeasured confounders.
O4-07-02
MONITORED PHYSICAL ACTIVITY IS ASSOCIATED WITH BETTER COGNITIVE PERFORMANCE IN THE ELDERLY: A STUDY FROM THE AUSTRALIAN IMAGING, BIOMARKERS AND LIFESTYLE (AIBL) STUDY
Belinda M. Brown1,2, Jeremiah J. Peiffer3, Kevin Taddei2, Jonathon K. Foster2, Vanessa K. Ward1,2, Rebecca M. Lachovitzki2, Mark A. Rodrigues2, Tania Taddei2, James Lui2, Veer Gupta2, Simon M. Laws2, Mira R. Rimajova1, Kathryn A. Ellis4, Cassandra Szoeke5, Colin L. Masters4, David Ames4, Christopher Rowe6, Ralph N. Martins2, 1 University of Western Australia, Perth, Australia; 2Edith Cowan University, Perth, Australia; 3Murdoch University, Perth, Australia; 4University of Melbourne, Melbourne, Australia; 5CSIRO, Melbourne, Australia; 6Austin Health, Melbourne, Australia. Contact e-mail: [email protected] Background: Numerous studies have outlined the potential positive impact of physical activity on delaying the onset of Alzheimer’s disease (AD). However these studies have a number of potential weaknesses, including the use of physical activity questionnaires or surveys, which can introduce biases and inaccuracies. We aim to address these weaknesses by using accelerometer activity monitors, which can reliably quantify movement. In this study we are investigating the association between physical activity, measured with accelerometers, and cognitive performance in a large cohort of healthy men and women. Methods: As a component of the CSIRO Australian Imaging, Biomarkers and Lifestyle (AIBL) Flagship study, 164 healthy controls were randomly selected from the AIBL cohort (1112 individuals) to wear an accelerometer unit for 7 consecutive days. The
Oral O4-07: Prevention II
S163
accelerometer unit measured habitual physical activity of each participant, with software subsequently calculating total counts and total kilocalories expended each day. In addition, each participant underwent a comprehensive battery of cognitive tests, which included the; Mini Mental State Examination (MMSE), California Verbal Learning Test (CVLT) and Rey Complex Figure Test (RCFT). Spearman ranked order correlations were calculated between habitual physical activity levels and cognitive test scores using age, gender and estimated IQ as co-variates. Results: Significant positive correlations were observed between physical activity average total counts/day (recorded by the accelerometer), and various cognitive measures, including; CVLT Learning Score T1-5 (r ¼ .137; p ¼ .047), CVLT Retention (r ¼ .138; p ¼ .046), CVLT Delayed Recall (r ¼ .141 p ¼ .043) and RCFT 3 minute delay (r ¼ .168; p ¼ .020). No significant correlation was observed between physical activity and the Mini Mental State Examination score. Conclusions: The use of accelerometers addressed the potential inaccuracies associated with the use of physical activity questionnaires. Collection of reliable data showed positive associations between physical activity and specific elements of cognition (focused on episodic learning and memory). Our results indicate that people participating in higher levels of physical activity are more likely to experience enhanced cognitive performance, a factor that has been linked to protecting the aging brain against AD.
O4-07-03
COGNITIVE STIMULATION AND REHABILITATION MEDIATED BY COMPUTERS AND INTERNET: A CONTROLLED STUDY
Andre´ J. Xavier1, Eleonora d’Orsi2, Luiz R. Ramos3, Daniel Sigulem3, Josenei B. dos Santos2, Anna Quialheiro1, Giovana Olivieri1, Lenemar N. Pedroso1, Ranier Berger1, Monique Baldin1, Emily K. Lida1, Thaı´s Batista1, 1Unisul, Floriano´polis, Brazil; 2Universidade Federal de Santa Catarina, Floriano´polis, Brazil; 3Universidade Federal de Sa˜o Paulo, Sa˜o Paulo, Brazil. Contact e-mail: [email protected] Background: Computers and internet can provide a great variety of progressive mind exercises in order to prevent and rehabilitate cognitive decline. Methods: An intervention controlled study conducted with community elder people to compare changes in MMSE score before and after internet and computers workshops. Participants were invited to the workshops and a similar control group was obtained from the same facilities. Were realized 17 workshops, from 2004 to 2009 in Local Area Network (LAN) houses, one computer per person, they were recruited from university specialized outpatient ambulatories in Sa˜o Paulo and Floriano´polis in Brazil. Eligibility criteria: above 54 years, both genders, at least 1 year of schooling, exclusion criteria: living in a nursing home, blindness, deafness, upper limbs paralysis. Each workshop was composed by 20 sessions of 1,5 hours each, twice a week, groups of 5 to 15 elders one monitor and 1 observer. The functional and cognitive data was obtained, in both groups by trained and supervised personnel. Analysis was bivariate, multivariate, Cox regression model and paired samples T test. Results: Population of 173 (71controls), 74% female, age 70,1 (6 10,05) years , schooling 8,86 (6 4,9) years, sedentarism 54%, depression 32%, diabetes 19%, hypertension 64%, dyslipidemia 36%, tobacco exposition 35%, hypothyroidism 11%, obesity 25%, circulatory disease 18%, initial MMSE 25,30 (6 4,7), Activities of the Daily Living score (ADL) 13,17 (6 3,2). No significant statistical differences between intervention and control groups among the variables above. The MMSE of intervention group improved from 25,29 6 4,61 to 26,85 6 4,18 p ¼ 0,000, no changes in control group. Cox regression for the end point ‘‘Final MMSE better 4 points’’ the intervention group had a protective RR of 3,20 (1,21 - 8,42 CI95%) p ¼ 0,018. For the end point ‘‘Final MMSE worst 3 points’’ the workshop group had protective Relative Risk (RR) of 0,15 (0,03 - 0,71), adjusted for gender, age, education, and sedentarism, depression, hypertension, diabetes, obesity, hypothyroidism, dyslipidemia, tobacco exposition and circulatory disease. Conclusions: This cognitive stimulation and rehabilitation methodology can prevent cognitive loss and improve cognitive status.
O4-07-04
COGNITIVE TRAINING IN OLDER ADULTS
Jeffery J. Summers1, Anna Wolf1, Sarah Elder2, Mathew Summers1, Kelly Limbrick1, Malcolm Tyler3, 1University of Tasmania, Hobart, Australia; 2Alzheimer’s Australia Tas, Hobart, Australia; 3Department of Health and Human Services, Tasmania, Hobart, Australia. Contact e-mail: [email protected] Background: A question that has stimulated much recent interest in the field of cognitive ageing is whether providing older adults with specific training programs can slow or even reverse the cognitive decline associated with ageing. Previous research, however, has been hampered by methodological limitations and small effect sizes. The aim of the present study is to evaluate the long-term effects of a cognitive training program on measures of cognitive function and task-related neural activity in healthy, community dwelling older adults. Methods: A total of 117 participants (Age M ¼ 66.50, SD ¼ 7.01 yrs) completed the 10-week Active Cognitive Enhancement (ACE) multidimensional training program which has been designed to enhance a range of cognitive abilities. Prior to the start of the program participants underwent extensive testing of general psychological and cognitive functioning using normative-referenced neuropsychological tests, as well as a computerized test battery involving tasks assessing visual attention and learning,