Effect of exercise on cognition, physical functioning, fall rate, and neuropsychiatric symptoms in people with dementia

Alzheimer’s disease (AD) is a progressive degenerative disorder that leads to cognitive and functional decline, various neuropsychiatric symptoms (NPS), and often early placement in institutional care. The current options of prevention or pharmacological treatment of AD are very limited, and thus, interest in non-pharmacological approaches is growing. One of the most keenly studied subjects is physical exercise as a therapeutic strategy for persons with AD. Numerous studies have shown that physical exercise has a positive effect on cognition in healthy adults. However, findings in subjects with cognitive impairments are scarce and conflicting. This study explores the effects of exercise on persons with cognitive impairment or dementia. Study 1, a systematic review, explores the evidence from randomized controlled trials (RCTs) of cognitive benefits of exercise in people with mild cognitive impairment (MCI) or dementia. 22 trials meeting the inclusion criteria were included in the review. The studies among older subjects with MCI reported some positive effects of physical exercise on cognition. However, studies performed among older subjects with dementia showed more inconsistent results. FINALEX (Finnish Alzheimer Disease Exercise Trial) is an RCT (n=210) examining the effects of a 12-month exercise programme in community-dwelling AD patients randomized into three study arms: home-based exercise (n=70), group-based exercise (n=70), and control group (n=70) without active intervention. Home-based exercise was associated with a modest gain in executive function compared with controls at 12 months. Among participants with mild dementia, the deterioration in physical functioning was slower in the intervention group than in the controls. A reduction in fall rate in participants with advanced dementia was observed in the exercise group compared with controls. No difference between the exercise and control groups was found in NPS at 6 months or in depressive symptoms at 12 months. Furthermore, the exercise intervention did not reduce the rate of institutionalization among AD patients. The exercise intervention was safe; no falls or major injuries occurred during the sessions. The current literature provides evidence that exercise interventions may have beneficial effects in persons with cognitive impairments. The results of this large RCT conducted among community-dwelling persons with AD strengthen this association.Alzheimerin tauti on etenevä muistisairaus, joka aiheuttaa älyllisen ja fyysisen toimintakyvyn heikentymistä sekä käyttäytymisen muutoksia. Alzheimerin taudin edetessä itsenäinen selviytyminen arkielämässä heikentyy ja hoivan sekä pitkäaikaisen laitoshoidon tarve kasvaa. Alzheimerin tautiin ei ole tällä hetkellä ehkäisevää tai parantavaa lääkkeellistä hoitoa ja tästä syystä kiinnostus lääkkeettömiä hoitoja kohtaan onkin kasvanut. Liikunnan mahdollisuuksia Alzheimerin taudin ehkäisyssä ja hoidossa tutkitaan innokkaasti. Tutkimukset ovat osoittaneet, että liikunnalla on myönteisiä vaikutuksia terveiden ikääntyneiden älyllisiin toimintoihin. On mahdollista, että liikunnan avulla voidaan ylläpitää älyllisiä toimintoja ja toimintakykyä sekä vähentää neuropsykiatrisia oireita myös Alzheimerin tautia sairastavilla henkilöillä. Väitöskirjatutkimuksen tarkoituksena oli selvittää liikunnan vaikutuksia muistisairailla henkilöillä. Yhtenä osatyönä toteutettuun systemaattiseen katsaukseen hyväksyttiin 22 satunnaistettua, kontrolloitua tutkimusta, jotka raportoivat liikunnan vaikutuksista muistitoimintoihin lievästä muistin heikentymisestä tai muistisairaudesta kärsivillä henkilöillä. Tutkimuksissa, joiden kohderyhmänä olivat lievää muistitoimintojen heikentymistä sairastavat iäkkäät henkilöt, todettiin positiivinen yhteys liikuntaharjoittelun ja muistitoimintojen välillä. Muistisairailla tutkimustulokset jäivät katsauksen perusteella ristiriitaisiksi. FINALEX (Finnish Alzheimer Disease Exercise Trial) on satunnaistettu, kontrolloitu tutkimus, jossa selvitettiin 12 kuukauden ohjatun liikuntaharjoittelun vaikutuksia kotona asuvilla Alzheimerin tautia sairastavilla henkilöillä. Tutkittavia oli yhteensä 220, heidät jaettiin kolmeen saman suuruiseen ryhmään: kotiharjoittelijat, ryhmäharjoittelijat sekä verrokkiryhmä. Kotiharjoittelijat kuntoilivat omassa kodissaan fysioterapeutin ohjaamina, kun taas 10 hengen ryhmät harjoittelivat päivätoimintakeskuksissa kahden fysioterapeutin johdolla. Yksilöllisellä, tutkittavan kotona toteutetulla liikuntaharjoittelulla todettiin positiivisia vaikutuksia toiminnanohjaukseen vuoden harjoittelujakson jälkeen. Lievää Alzheimerin tautia sairastavilla päivittäisen toimintakyvyn heikentyminen oli merkitsevästi hitaampaa liikuntaryhmässä kuin verrokkiryhmässä. Edennyttä Alzheimerin tautia sairastavien ryhmässä liikuntaharjoittelu vähensi merkittävästi kaatumisia verrokkeihin nähden 12 kuukauden seurannassa. Liikunta – ja verrokkiryhmien välillä ei ollut merkitsevää eroa neuropsykiatrisissa oireissa. Tutkittavat sitoutuivat harjoitteluun erinomaisesti ja poisjättäytyneiden määrä oli pieni. Tutkimuksen perusteella voidaan todeta, että muistisairaat henkilöt hyötyvät säännöllisestä, yksilöllisesti toteutetusta liikunnan harjoittelusta. Liikunta on turvallinen ja helposti toteutettava osa hyvää muistisairauden hoitoa. Se tuo muiden positiivisten vaikutustensa lisäksi mukanaan myös iloa ja elämänlaatua

Neuropsychiatric Symptoms as Predictors of Falls in Long-Term Care Residents With Cognitive Impairment

Objectives: Falls and neuropsychiatric symptoms (NPS) are common among long-term care residents with cognitive impairment. Despite the high prevalence of falls and NPS, little is known about their association. The aim of our study was to explore how NPS, particularly the severity of NPS and specific NPS subgroups, are associated with falls and how psychotropics modify this association. Design: Longitudinal cohort study. Setting and Participants: In total, 532 long-term care residents aged 65 years or older in Helsinki, Finland. Methods: NPS were measured with Neuropsychiatric Inventory (NPI) at baseline. Participants were grouped into 3 groups: no significant NPS (NPI points 0-3), low NPS burden (NPI 4-12), and high NPS burden (NPI >12). The number of falls, injuries, fractures, and hospitalizations were collected from medical records over 12 months following baseline assessment. Results: Altogether, 606 falls occurred during the follow-up year. The falls led to 121 injuries, 42 hospitalizations, and 20 fractures. Falls and injuries increased significantly with NPS burden (P <.001): 330 falls in the high NPS group (n = 184), 188 falls in the low NPS group (n = 181), and 88 falls in the no significant NPS group (n = 167). The risk of falling showed a curvilinear association with NPI total score. Of NPS subgroups, psychosis and hyperactivity were associated with a higher incidence rate ratio of falls, whereas apathy had a protective association even after adjustment for age, sex, and mobility. Affective symptoms were not associated with falls. Psychotropics did not modify the association between NPS burden and falls. Conclusions and Implications: The results of this study show that NPS, especially NPS severity, may predict falls and fall-related negative consequences. Severity of NPS should be taken into account when assessing fall risk in long-term care residents with cognitive impairment. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.Peer reviewe

Use of Anticholinergic Drugs According to Various Criteria and Their Association With Psychological Well-Being and Mortality in Long-Term Care Facilities

Objectives: To compare 3 internationally established criteria for drugs with anticholinergic properties (DAPs) and their associated factors in long-term care facilities, and to investigate the association between use of DAPs and psychological well-being (PWB) or mortality. Design: Cross-sectional study and 1-year follow-up of all-cause mortality. Setting and Participants: Of all 4449 residents living in long-term care facilities in Helsinki in 2011, 2432 (>= 65 years of age) participated after exclusion of residents with severe dementia. Measurements: Data on demographics, medication use, and active diagnoses were collected by trained staff using structured questionnaires. DAP use was defined by the following 3 international criteria: Chew's list, the Anticholinergic Risk Scale, and the Anticholinergic Drug Scale. The total number of DAPs was counted and referred to as anticholinergic burden. PWB was assessed by a questionnaire and yielded a score ranging from 0 to 1. Mortality data was retrieved from central registers. Results: Of all participants, 85% were DAP users according to at least 1 of the 3 criteria used. Overlap between the 3 criteria was only moderate. DAP users were younger and a larger proportion of them had better cognition. However, they suffered more often from depression and other psychiatric diagnoses than nonusers. DAP users had lower PWB scores than those not using DAPs, and PWB decreased linearly in the overlapping groups from nonusers to those using DAPs according to all 3 criteria. The total number of DAPs used predicted mortality. Conclusions and Implications: DAP use and PWB appear to be negatively associated. When combining several criteria of DAPs, their burden predicted mortality. Clinicians should carefully consider the potential benefits and harms when prescribing DAPs to older persons. (C) 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.Peer reviewe

Relationship of Neuropsychiatric Symptoms with Falls in Alzheimer's Disease : Does Exercise Modify the Risk?

Peer reviewe

Monetary value of informal caregiving in dementia from a societal perspective

Peer reviewe

How Do Community-Dwelling Persons with Alzheimer Disease Fall? Falls in the FINALEX Study

Peer reviewe

Effects of frequent and long-term exercise on neuropsychiatric symptoms in patients with Alzheimer's disease - Secondary analyses of a randomized, controlled trial (FINALEX)

Background: Neuropsychiatric symptoms (NPS) are common in Alzheimer's disease (AD) and are associated with admission to institutional care. Current guidelines recommend non-pharmacological interventions as the first-line treatment for NPS. However, high-quality randomized studies focused on NPS are scarce. The objective here was to examine whether a regular and long-term exercise programme either at home or as a group-based exercise at an adult day care centre has beneficial effects on AD patients' NPS or permanent institutionalizations. Design, setting, and participants: A randomized, controlled trial with 210 community-dwelling AD patients. Intervention: Two types of intervention comprising (1) group-based exercise in day care centres (GE) and (2) tailored home-based exercise (HE), both twice a week for 12 months, were compared with (3) a control group (CG) receiving usual community care. Measurements: NPS were measured with the Neuropsychiatric Inventory (NPI) at baseline and 6 months, and depression with the Cornell Scale for Depression in Dementia (CSDD) at baseline and 12 months. Data on institutionalizations were retrieved from central registers. Results: No significant differences between the groups were detected in NPI at 6 months or in CSDD at 12 months when analyses were adjusted for age, sex, baseline Clinical Dementia Rating, and Functional Independence Measure. There was no difference in admissions to permanent institutional care between the groups. Conclusions: Regular, long-term exercise intervention did not decrease NPS in patients with AD. (C) 2017 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.Peer reviewe

Neuropsychiatric symptoms as predictors of falls in long-term care residents with cognitive impairment

Abstract Objectives: Falls and neuropsychiatric symptoms (NPS) are common among long-term care residents with cognitive impairment. Despite the high prevalence of falls and NPS, little is known about their association. The aim of our study was to explore how NPS, particularly the severity of NPS and specific NPS subgroups, are associated with falls and how psychotropics modify this association. Design: Longitudinal cohort study. Setting and Participants: In total, 532 long-term care residents aged 65 years or older in Helsinki, Finland. Methods: NPS were measured with Neuropsychiatric Inventory (NPI) at baseline. Participants were grouped into 3 groups: no significant NPS (NPI points 0‒3), low NPS burden (NPI 4‒12), and high NPS burden (NPI >12). The number of falls, injuries, fractures, and hospitalizations were collected from medical records over 12 months following baseline assessment. Results: Altogether, 606 falls occurred during the follow-up year. The falls led to 121 injuries, 42 hospitalizations, and 20 fractures. Falls and injuries increased significantly with NPS burden (P &lt; .001): 330 falls in the high NPS group (n = 184), 188 falls in the low NPS group (n = 181), and 88 falls in the no significant NPS group (n = 167). The risk of falling showed a curvilinear association with NPI total score. Of NPS subgroups, psychosis and hyperactivity were associated with a higher incidence rate ratio of falls, whereas apathy had a protective association even after adjustment for age, sex, and mobility. Affective symptoms were not associated with falls. Psychotropics did not modify the association between NPS burden and falls. Conclusions and Implications: The results of this study show that NPS, especially NPS severity, may predict falls and fall-related negative consequences. Severity of NPS should be taken into account when assessing fall risk in long-term care residents with cognitive impairment