Exercise to combat neurocognitive decline in older adults

Background: Older adults with type 2 diabetes (T2D) experience cognitive decline and neural atrophy, and therefore are at high risk for developing dementia. Consequently, older adults at-risk for developing T2D (i.e., overweight or pre-diabetic individuals) are at higher risk for cognitive decline, and intervening at this point may prevent or delay the onset of such decline. One promising lifestyle intervention that may improve neurocognitive function is exercise. For example, 6 months of aerobic training improves cognitive function in overweight or pre-diabetic older adults, but research has not examined whether resistance training (RT) can produce comparable results in this population. Hypothesis: To address whether similar findings would occur in older adults at-risk for T2D, a 6-month progressive RT intervention is needed. We predict that 6 months of thrice-weekly RT will improve cognitive and brain function in older adults at-risk for T2D. Methods: We are conducting a pilot RCT resistance exercise intervention. Participants (n=20) are: 1) community-dwelling men and women aged 60-80 years, 2) sedentary, and 3) have BMI\u3e25 or blood glucose levels of 6.1-7.0 mmol/L. Participants are randomized into one of two groups: 1) RT or 2) balance and tone (BAT; control). Preliminary Results: Our preliminary results suggest that RT improves memory and executive function (assessed via neuropsychological tests) and brain health (increased total brain volume) in older adults at-risk for T2D, compared to BAT. Discussion: Thus far, our findings offer a feasible, cost-efficient lifestyle intervention strategy to improve cognitive and brain health in a population of older adults at-risk for early decline

The effects of resistance training on cognition and brain health in older adults at risk for diabetes: A pilot feasibility study

Type 2 diabetes is associated with neurocognitive deficits and increased risk for dementia, with high prevalence of diabetes occurring in old age. There are many known risk factors for diabetes, including physical inactivity, obesity, and prediabetes. Studies show that individuals who are at risk for diabetes (i.e., have one or more risk factors) already experience some brain deficits seen in diabetes. One way to combat these deficits is aerobic exercise; however, the effects of resistance exercise in this population are relatively unknown. The objectives of this thesis were to report on the current evidence of brain deficits in prediabetes, and to assess the feasibility and preliminary efficacy of resistance training to improve cognition and brain health (structure and function) in older adults at risk for diabetes. A systematic review of cross-sectional and longitudinal studies assessing brain dysfunction in prediabetes was conducted, as well as a 26-week pilot feasibility randomized controlled trial of resistance exercise among older adults at risk for diabetes (i.e., those living with prediabetes and/or obesity). The systematic review found that adults with prediabetes may experience deficits in structural connectivity, but whether deficits in brain volume and cerebrovascular health are present is somewhat inconclusive and may be due to inconsistencies across study methodologies. Results from the pilot feasibility trial found that resistance exercise, compared to balance and stretching exercise, may improve selective cognitive functions, mainly task-switching, selective attention, and response inhibition. Resistance exercise also led to less age-related decline in total brain volume, less hippocampal atrophy, and increased functional activation patterns that mimic that of younger adults and healthy older adults. When assessing feasibility, study adherence, retention, and self-reported enjoyment were high, but recruitment was shown to be challenging. As such, important recruitment recommendations for improving future trials are included in this thesis. In conclusion, resistance exercise may lead to some improvements in cognition and brain health in older adults at risk for diabetes, however a full-scale, powered RCT is needed to further explore these possible effects

Colonial Drivers and Cultural Protectors of Brain Health Among Indigenous Peoples Internationally

Despite relatively higher rates of dementia among Indigenous populations internationally, research into drivers of disparities in brain health and cognitive function has tended to focus on modifiable risk factors over cultural understandings and contextual determinants. By seeking to characterize social and cultural factors that shape brain health and cognition in Indigenous populations, this mini scoping review expands prevailing schools of thought to include Indigenous knowledge systems. This reveals important gaps in culturally aligned care. It also reclaims horizons for research important to Indigenous Peoples that have garnered diminished attention in biomedical approaches. Twenty-three sources were included for data extraction. This synthesis of 23 sources includes health communication about dementia, health provider knowledge about Indigenous health, culturally relevant screening and assessment tools, and culturally grounded care models. Much of the focus is currently still on modifiable risk factors that reside at individual factors, whereas attention to wider social factors that impact populations is needed, as stressors through isolation, discrimination, and unequal care are widely reported. Going forward, identifying structural barriers to living well and recognizing the importance of connection to culture will benefit both Indigenous and non-Indigenous understandings of brain health

Equity, diversity, and inclusion at the Ivey School of Business: A principles guide

Equity, diversity, and inclusion (EDI) is an essential part of education delivery. As such, the goal of this collaborative work is to develop a first of its kind EDI principles guide to inform teaching and learning at the Ivey School of Business. In collaboration with Indigenous partners at Western University, I conducted an in-depth literature review on Indigenous culture and perspectives and created Indigeneityfocused content for the EDI guide. Covered topics included definitions of indigeneity, relevant terminology, common Indigenous practices, and resources to promote cultural safety within the academic environment. My team’s ultimate goal is to have this guide available to students, faculty, and staff at the Ivey School of Business in the upcoming school year.https://ir.lib.uwo.ca/headandheartprogram_2021/1007/thumbnail.jp

Diabetes in Indigenous Populations – a Medical School Teaching Case

https://ir.lib.uwo.ca/headandheartprogram_2020/1004/thumbnail.jp

Changes in cognition and brain function following 26 weeks of progressive resistance training in older adults at risk for diabetes: A pilot randomized controlled trial

Introduction Type 2 diabetes is associated with deficits in cognition and brain health. Individuals with 1 or more risk factors for diabetes (i.e., obesity, prediabetes) already experience some neurocognitive impairment and are at risk for further decline. One way to combat these deficits is through exercise; however, whether resistance exercise can improve these functions in this at-risk group is unknown. Methods This study was a pilot randomized controlled trial. Participants were aged 60-80 and had prediabetes (fasting capillary glucose 6.1-6.9 mmol/L) and/or were overweight or obese (body mass index of 25 or above). Participants completed resistance training or balance and stretching exercise (control) thrice-weekly for 6 months. Neuropsychological tests were used to assess cognitive ability, while functional magnetic resonance imaging was used to examine brain activation patterns. Results Resistance training led to improvements in task-switching, attention, and conflict resolution, as well as improved patterns of brain activation that may mimic healthy older adults. Conclusions Resistance exercise may serve as an effective behavioural strategy to improve neurocognition in older adults at risk for type 2 diabetes. A large-scale powered trial is needed to further explore these findings

Relevance and Premises of Values-Based Practice for Decision Making in Brain Health

Brain health is a complex concept, shaped by a plethora of determinants related to physical health, healthy environments, safety and security, learning and social connection, as well as access to quality healthcare services. Decision-making in this complex field is characterized by diverse values, potentially conflicting interests, and asymmetrically influential stakeholders. Values-based practice (VBP) is a toolkit for balancing values in a democratic and inclusive way, so that every stakeholder feels a sense of ownership over the decision made. In VBP, the emphasis is on good process rather than on pre-determined ‘correct’ outcomes. Based on two case vignettes, we highlight the relevance of the ten principles of VBP for balancing different values to the satisfaction of those directly concerned, in a given decision-making process. In addition, we argue that the successful implementation of VBP in the complex area of brain health, as well as in other fields, is premised on higher order values (meta-values), beyond mutual respect and the legal, regulatory, and bioethical framework. These include mutual regard, reciprocity, autonomy, and an egalitarian attitude towards VBP procedures and involved stakeholders

Table_1_Colonial drivers and cultural protectors of brain health among Indigenous peoples internationally.DOCX

Despite relatively higher rates of dementia among Indigenous populations internationally, research into drivers of disparities in brain health and cognitive function has tended to focus on modifiable risk factors over cultural understandings and contextual determinants. By seeking to characterize social and cultural factors that shape brain health and cognition in Indigenous populations, this mini scoping review expands prevailing schools of thought to include Indigenous knowledge systems. This reveals important gaps in culturally aligned care. It also reclaims horizons for research important to Indigenous Peoples that have garnered diminished attention in biomedical approaches. Twenty-three sources were included for data extraction. This synthesis of 23 sources includes health communication about dementia, health provider knowledge about Indigenous health, culturally relevant screening and assessment tools, and culturally grounded care models. Much of the focus is currently still on modifiable risk factors that reside at individual factors, whereas attention to wider social factors that impact populations is needed, as stressors through isolation, discrimination, and unequal care are widely reported. Going forward, identifying structural barriers to living well and recognizing the importance of connection to culture will benefit both Indigenous and non-Indigenous understandings of brain health.</p