Cognitive Decline: A Window of Opportunity for Reducing the Risk of Dementia?

The number of people living with dementia is expected to almost double in the next 10 years and more than triple in the next 30 years. Lifestyle risk factors such as obesity, physical inactivity and social isolation are estimated to cause more than 35% of dementia cases worldwide. One of the highest risk groups for developing dementia are those experiencing cognitive decline, such as subjective cognitive decline and mild cognitive impairment. Hence, there is a pressing need to develop interventions to reduce risk, especially for these high risk groups. In the short- to medium-term, a significant proportion of people with cognitive decline can experience a spontaneous improvement in cognition. There is also preliminary evidence that interventions can be beneficial for this group, though this strategy has not been robustly tested. It has been hypothesised that during the cognitive decline period preceding dementia, the brain retains sufficient neuroplasticity that it is possible to modify the trajectory of decline. The thesis explores the outcomes from a multidomain dementia risk reduction intervention for people experiencing cognitive decline, the Body, Brain, Life, for Cognitive Decline (BBL-CD) intervention. The intervention is a proof-of-concept trial that adapts a previously successful primary risk reduction trial to a secondary risk reduction intervention. The thesis is comprised of four publications: First, a protocol paper sets out the rationale, methods and analyses that were conducted. This publication details the evidence for choosing the domains of Mediterranean diet, physical activity, and cognitive engagement. It explains the educational modules the control and intervention groups complete, and the additional activities only undertaken by the intervention group. Second, the primary outcome measures of this thesis were lifestyle risk for Alzheimer's disease and cognition. This paper demonstrated that the intervention group were able to significantly improve overall lifestyle risk and cognition relative to the control group, which showed little change in either outcome measure. Third, the feasibility of the intervention in this participant group was tested using three elements of the Bowen Feasibility Framework: Acceptability, implementation, and efficacy to change lifestyle behaviours. The intervention was found to be highly acceptable, was mostly implemented successfully, and mostly demonstrated efficacy to change lifestyle behaviours. While the intervention was found to be feasible, some major learnings and improvements were identified for future interventions. Finally, a fourth paper examined the potential health-related quality of life outcomes of the intervention. The intervention did not show a significant group x timepoint interaction, required to demonstrate efficacy. However, the presence of several significant between- and within-group differences and the magnitude of these differences (>3 points on SF-36) are reported as potential outcomes of interest in larger, more adequately powered studies in this participant group in the future. Together, these publications combine to form a thesis that lends support to the notion that secondary dementia risk reduction interventions are both feasible and show efficacy. The results support the conduct of larger, longer study to characterise any improvements in lifestyle and cognition more accurately and determine whether these improvements are sustainable long term. This thesis provides proof-of-concept that the cognitive decline period represents a window of opportunity to reduce lifestyle dementia risk and warrants further long-term investigation

Evaluation of the Music Engagement Program for people with Alzheimer's disease and dementia: Study protocol for a pilot trial

Background Alzheimer's disease and dementia are prevalent conditions globally. People with Alzheimer's disease and dementia commonly experience mental health problems, negative emotional states, and behavioural disturbance. Music therapy has previously been used in this population to improve symptoms of mental health problems; however, there is a paucity of evidence-based programs that also explore positive outcomes such as overall quality of life, social outcomes, as well as the acceptability and sustainability of these programs. Aims This project aims to evaluate the effectiveness of the specialised Music Engagement Program (MEP) in improving quality of life, wellbeing, and depression symptoms, in aged-care residents with Alzheimer's disease and dementia. The project also aims to explore how the MEP could be applied and maintained on a broader level throughout the aged-care community. Methods The intervention will take place over 8 weeks in an aged-care facility for people living with dementia in Canberra, Australia. Weekly 45-60-min group singing sessions will be led by a music facilitator. Results The results of the study will be submitted for publication in relevant academic journals and mental health conferences, disseminated to participants on request, to the residential care facility, and via the lead researcher's website. Conclusions This study can provide an indication of the feasibility of the MEP in enhancing the mental health and wellbeing of individuals with Alzheimer's disease and dementia. Further investigation will be required to establish the MEP's ability to be maintained on an ongoing basis with minimal costs and administrative support.This project is supported by a 2017 Excellence in Population Health Research Award, Research School of Population Health, ANU (AG, MP), and by funding provided by ACT Health for ACACIA: The ACT Consumer and Carer Mental Health Research Unit. The project is also supported by in-kind resources from the Centre for Mental Health Research, ANU. The lead author (AG) can disseminate the results of this trial without the express permission of the funding bodies. MB is supported by Medical Research Future Fund (MRFF) Fellowship 1150698

Protocol for a pragmatic randomised controlled trial of Body Brain Life-General Practice and a Lifestyle Modification Programme to decrease dementia risk exposure in a primary care setting

Introduction It has been estimated that a 10%-25% reduction in seven key risk factors could potentially prevent 1.1-3.0 million Alzheimer's disease cases globally. In addition, as dementia is preceded by more subtle cognitive deficits which have substantial social and economic impact, effective preventative interventions would likely have more extensive benefits. The current study evaluates in primary care a multidomain risk-reduction intervention targeting adults with high risk of developing dementia. Methods and analysis A randomised controlled trial (RCT) is being conducted to evaluate three intervention programmes using a pragmatic approach suitable to the clinic: (1) a 12-week online and face-To-face dementia risk-reduction intervention (Body Brain Life-General Practice (BBL-GP)); (2) a 6-week face-To-face group lifestyle modification programme (LMP); and (3) a 12-week email-only programme providing general health information. We aim to recruit 240 participants, aged 18 and over, to undergo a comprehensive cognitive and physical assessment at baseline and follow-ups (postintervention, 18, 36 and 62 weeks). The primary outcome is dementia risk measured with the modified version of the Australian National University-Alzheimer's Disease Risk Index Short Form. Secondary outcomes are cognitive function measured with Trails A and B, and the Digit Symbol Modalities Test; physical activity with moderate-vigorous physical activity and the International Physical Activity Questionnaire; depression with the Centre for Epidemiological Studies Depression; cost evaluation with the 12-item Short Form Health Survey, Framingham Coronary Heart Disease Risk Score and Australian Type 2 Diabetes Risk Assessment Tool; diet quality with the Australian Recommended Food Score; and sleep quality with the Pittsburgh Sleep Quality Index. Ethics and dissemination This RCT is a novel pragmatic intervention applied in a primary care setting to reduce the dementia risk exposure in adults at high risk. If successful, BBL-GP and LMP will provide a versatile, evidence-based package that can be easily and quickly rolled out to other primary care settings and which can be scaled up at relatively low cost compared with other strategies involving intensive interventions. Trial registration number ACTRN12616000868482This work was supported by National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Cognitive Health and the development of original BBL modules was funded by the NHMRC Dementia Collaborative Research Centres. KJA is funded by NHMRC Fellowship APP1102694

Protocol for a pragmatic randomised controlled trial of Body Brain Life-General Practice and a Lifestyle Modification Programme to decrease dementia risk exposure in a primary care setting

INTRODUCTION: It has been estimated that a 10%-25% reduction in seven key risk factors could potentially prevent 1.1-3.0 million Alzheimer\u27s disease cases globally. In addition, as dementia is preceded by more subtle cognitive deficits which have substantial social and economic impact, effective preventative interventions would likely have more extensive benefits. The current study evaluates in primary care a multidomain risk-reduction intervention targeting adults with high risk of developing dementia. METHODS AND ANALYSIS: A randomised controlled trial (RCT) is being conducted to evaluate three intervention programmes using a pragmatic approach suitable to the clinic: (1) a 12-week online and face-to-face dementia risk-reduction intervention (Body Brain Life-General Practice (BBL-GP)); (2) a 6-week face-to-face group lifestyle modification programme (LMP); and (3) a 12-week email-only programme providing general health information. We aim to recruit 240 participants, aged 18 and over, to undergo a comprehensive cognitive and physical assessment at baseline and follow-ups (postintervention, 18, 36 and 62 weeks). The primary outcome is dementia risk measured with the modified version of the Australian National University-Alzheimer\u27s Disease Risk Index Short Form. Secondary outcomes are cognitive function measured with Trails A and B, and the Digit Symbol Modalities Test; physical activity with moderate-vigorous physical activity and the International Physical Activity Questionnaire; depression with the Centre for Epidemiological Studies Depression; cost evaluation with the 12-item Short Form Health Survey, Framingham Coronary Heart Disease Risk Score and Australian Type 2 Diabetes Risk Assessment Tool; diet quality with the Australian Recommended Food Score; and sleep quality with the Pittsburgh Sleep Quality Index. ETHICS AND DISSEMINATION: This RCT is a novel pragmatic intervention applied in a primary care setting to reduce the dementia risk exposure in adults at high risk. If successful, BBL-GP and LMP will provide a versatile, evidence-based package that can be easily and quickly rolled out to other primary care settings and which can be scaled up at relatively low cost compared with other strategies involving intensive interventions.&nbsp

The influence of music genre on explosive power, repetitions to failure and mood responses during resistance exercise

Objectives: To investigate the influence of different music genres on the psychological, psychophysical and psychophysiological responses during power-based and strength-based resistance exercises. Design: Repeated-measures counterbalanced design. Method: Sixteen resistance-trained participants completed an explosive power test in the squat and bench exercises at 30% 1RM across no music, electronic dance music, metal and self-selected conditions. Peak and mean values were recorded for power and velocity. A progressive loading protocol assessed the impact of condition on repetitions to failure at 60, 70 and 80% 1RM in the squat and bench exercises. For all tests, recording of heart rate and rating of perceived exertion were completed after every set, blood lactate after protocol completion, and mood states before and after. Results: Using magnitude-based inferences, music either had no effect or a small detrimental effect on power and velocity, depending on the exercise. Repetitions to failure increased by a small to moderate amount for all music conditions compared to no music at low but not high intensities. Self-selected music provided additional small benefits in repetitions than other music conditions. Rating of perceived exertion was similar between self-selected, metal and no music conditions, whereas electronic dance music revealed higher responses. Vigour increased after all music conditions but remained unchanged in no music. Conclusions: Explosive power exercises either remain unchanged or are disadvantaged when completed to music. Various music genres could improve repetition to failure training at low to moderate intensities, although individuals might expect greatest improvements using self-selected music, without concomitant increases in perceived effort

Decision-making and future planning for children with life-limiting conditions: a qualitative systematic review and thematic synthesis

Background In the last decade, the number of children with life-limiting and life-threatening conditions in England has almost doubled, and it is estimated that worldwide, there are 1.2 million children with palliative care needs. Families and professionals caring for children with life-limiting conditions are likely to face a number of difficult treatment decisions and develop plans for future care over the course of the child's life, but little is known about the process by which these decisions and plans are made. Methods The purpose of this review is to synthesize findings from qualitative research that has investigated decision-making and future planning for children with life-limiting conditions. A systematic search of six online databases was conducted and identified 887 papers for review; five papers were selected for inclusion, using predefined criteria. Reference list searching and contacting authors identified a further four papers for inclusion. Results Results sections of the papers were coded and synthesized into themes. Nineteen descriptive themes were identified, and these were further synthesized into four analytical themes. Analytical themes were ‘decision factors’, ‘family factors’, ‘relational factors’ and ‘system factors’. Conclusions Review findings indicate that decision-making and future planning is difficult and needs to be individualized for each family. However, deficits in understanding the dynamic, relational and contextual aspects of decision-making remain and require further research

Constraints on the χ_(c1) versus χ_(c2) polarizations in proton-proton collisions at √s = 8 TeV

The polarizations of promptly produced χ_(c1) and χ_(c2) mesons are studied using data collected by the CMS experiment at the LHC, in proton-proton collisions at √s=8  TeV. The χ_c states are reconstructed via their radiative decays χ_c → J/ψγ, with the photons being measured through conversions to e⁺e⁻, which allows the two states to be well resolved. The polarizations are measured in the helicity frame, through the analysis of the χ_(c2) to χ_(c1) yield ratio as a function of the polar or azimuthal angle of the positive muon emitted in the J/ψ → μ⁺μ⁻ decay, in three bins of J/ψ transverse momentum. While no differences are seen between the two states in terms of azimuthal decay angle distributions, they are observed to have significantly different polar anisotropies. The measurement favors a scenario where at least one of the two states is strongly polarized along the helicity quantization axis, in agreement with nonrelativistic quantum chromodynamics predictions. This is the first measurement of significantly polarized quarkonia produced at high transverse momentum