Vascular Function Is Improved After an Environmental Enrichment Program: The Train the Brain-Mind the Vessel Study


Environmental enrichment may slow cognitive decay possibly acting through an improvement in vascular function. Aim of the study was to assess the effects of a 7-month cognitive, social, and physical training program on cognitive and vascular function in patients with mild cognitive impairment. In a single-center, randomized, parallel-group study, 113 patients (age, 65-89 years) were randomized to multidomain training (n=55) or usual care (n=58). All participants underwent neuropsychological tests and vascular evaluation, including brachial artery flow-mediated dilation, carotid-femoral pulse wave velocity, carotid distensibility, and assessment of circulating hematopoietic CD34+ and endothelial progenitor cells. At study entry, an age-matched control group (n=45) was also studied. Compared with controls, patients had at study entry a reduced flow-mediated dilation (2.97\ub12.14% versus 3.73\ub12.06%; P=0.03) and hyperemic stimulus (shear rate area under the curve, 19.1\ub115.7 versus 25.7\ub115.1 710-3; P=0.009); only the latter remained significant after adjustment for confounders (P=0.03). Training improved Alzheimer disease assessment scale cognitive (training, 14.0\ub14.8 to 13.1\ub15.5; nontraining, 12.1\ub13.9 to 13.2\ub14.8; P for interaction visit 7training=0.02), flow-mediated dilation (2.82\ub12.19% to 3.40\ub11.81%, 3.05\ub12.08% to 2.24\ub11.59%; P=0.006; P=0.023 after adjustment for diameter and shear rate area under the curve), and circulating hematopoietic CD34+ cells and prevented the decline in carotid distensibility (18.4\ub15.3 to 20.0\ub16.6, 23.9\ub111.0 to 19.5\ub17.1 Pa-1; P=0.005). The only clinical predictor of improvement of cognitive function after training was established hypertension. There was no correlation between changes in measures of cognitive and vascular function. In conclusion, a multidomain training program slows cognitive decline, especially in hypertensive individuals. This effect is accompanied by improved systemic endothelial function, mobilization of progenitor CD34+ cells, and preserved carotid distensibility

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