The Effects of Aerobic Exercise in Patients with Early-Onset Dementia: A Scoping Review

BACKGROUND: Early-onset dementia (EOD) defines all dementia related conditions with an onset before the age of 65 years. EOD places a large and distressing psychological, emotional and financial burden on the individuals themselves and their caregivers. For various reasons, diagnostic and treatment strategies for EOD are very challenging. There is a general agreement that not only the human body but also the mind benefits from physical activity and/or exercise. Especially aerobic exercise has shown to have favorable effects on cognitive functions in healthy older adults, as well as in patients with MCI and dementia. However, there are major differences in age, physical fitness level and clinical presentation between EOD and late-onset dementia. Therefore, one cannot just assume that the same type and intensity of exercise will lead to similar effects in the former population. By conducting this scoping review, the authors aimed to identify the evidence on the effectiveness of aerobic exercise on physical and mental health outcomes in individuals with EOD, display gaps in this context, and formulate related directions for future research. SUMMARY: There are a number of reasons to assume that aerobic exercise might be extremely valuable within individuals with EOD. However, this scoping review led to the surprising and striking finding that not a single study so far has investigated the effects of physical exercise on cognition, physical performance and feelings of well-being and quality of life in EOD. Although nowadays the disease is increasingly recognized, coping and (non-pharmacological) treatment strategies for EOD are virtually non-existent. KEY MESSAGES: Exercise intervention studies in EOD are lacking. With this scoping review the authors hope to inspire researchers in the field for related directions for future research. The potential beneficial effects of aerobic exercise in individuals with EOD should be explored and assessed extensively. Secondarily, decent guidelines for non-pharmacological treatment and coping strategies should be developed, with the aim of supporting people with EOD and their caregivers

Association between insulin resistance, lean mass and muscle torque/force in proximal versus distal body parts in healthy young men

Objectives:The purpose of this study was to investigate whether there is already an association of insulin resistance (IR) with muscle mass and –force/torque in an adult population and whether this relationship is the same in distal and proximal body parts. Methods: 358 Healthy young men were divided into a more insulin sensitive (MIS) (n=89) and a less insulin sensitive (LIS) group (n=89), respectively using lower and upper quartiles of HOMA-IR index (Homeostasis Model Assessment of IR). Muscle force/torque and lean mass, were compared between the two groups. Results: LIS subjects had higher absolute thigh lean mass, but not higher thigh muscle torque, resulting in a lower torque per kg muscle. In upper arm, lean mass was higher in LIS subjects, but also absolute muscle torque resulted higher. For handgrip force, the LIS and MIS group had similar results, despite a trend towards higher forearm lean mass in LIS subjects. Lean mass % of total lean mass is lower in LIS subjects in more distal body parts. Conclusions:Already in a young healthy population, IR seems to be associated with lower force/torque per muscle mass and lower lean mass % of total lean mass predominantly in more distal body parts

Understanding the relationship between type 2 diabetes mellitus and falls in older adults: a prospective cohort study

Background: Older adults with type 2 Diabetes Mellitus are at increased risk of falling. The current study aims to identify risk factors that mediate the relationship between diabetes and falls. Methods: 199 older adults (104 with diabetes and 95 healthy controls) underwent a medical screening. Gait (GAITRite (R)), balance (AccuGait (R) force plate), grip strength (Jamar (R)), and cognitive status (Mini-Mental State Examination and Clock Drawing Test) were assessed. Falls were prospectively recorded during a 12-month follow-up period using monthly calendars. Results: Compared to controls, diabetes participants scored worse on all physical and cognitive measures. Sixty-four participants (42 diabetes vs. 22 controls) reported at least one injurious fall or two non-injurious falls ("fallers"). Univariate logistic regression identified diabetes as a risk factor for future falls (Odds Ratio 2.25, 95%CI 1.21-4.15, p = 0.010). Stepwise multiple regressions defined diabetes and poor balance as independent risk factors for falling. Taking more medications, slower walking speed, shorter stride length and poor cognitive performance were mediators that reduced the Odds Ratio of the relationship between diabetes and faller status relationship the most followed by reduced grip strength and increased stride length variability. Conclusions: Diabetes is a major risk factor for falling, even after controlling for poor balance. Taking more medications, poorer walking performance and reduced cognitive functioning were mediators of the relationship between diabetes and falls. Tailored preventive programs including systematic medication reviews, specific balance exercises and cognitive training might be beneficial in reducing fall risk in older adults suffering from diabetes

Detectie van valrisico bij ouderen met type 2 diabetes

Dit is een korte samenvatting van een deel van het doctoraatsproefschrift “Falls in Older People with Type 2 Diabetes Mellitus - Implications for specific and generic risk detection”. Dit proefschrift werd verdedigd op 04/07/2013; promotor: prof. dr. D. Cambier; copromotor: prof. dr. P. Calders. Het onderzoek werd verricht aan Vakgroep Revalidatiewetenschappen en Kinesitherapie (REVAKI), Universiteit Gent. Financiering: Bijzonder Onderzoeksfonds (BOF)

Understanding the relationship between walking aids and falls in older adults : a prospective cohort study

Background: A substantial proportion of older adults living in residential aged care facilities are use wheelchairs or walk with aids. The relationship between using walking aids and falling is somewhat inconsistent and poorly understood. Purpose: To investigate the use of walking aids as a risk factor for future falls among older adults living in residential aged care facilities and to identify spatiotemporal gait parameters that mediate the potential relationship between walking aids and falling. Methods: Forty-three older adults (22 using walking aids and 21 not using walking aids) living in residential aged care facilities were enrolled in this study. Fall history, fear of falling, and the use of psychotropic agents were registered. Spatiotemporal gait (GAITRite (R)), grip strength (Jamar (R)), and cognitive status (Mini-Mental State Examination and Clock Drawing Test) were assessed. Falls were prospectively recorded during a 12-month follow-up period using monthly calendars. Results: Individuals using walking aids were older (P = .012), had a greater fear of falling (P = .017), and demonstrated a more conservative gait pattern compared with those not using walking aids. They walked slower (P < .001) and had a lower cadence (P < .001) and shorter step length (P = .018) and step time (P = .003). Twenty-two participants (15 using walking aids vs 7 not using walking aids) reported at least one fall ("fallers"). Univariate logistic regression identified using walking aids as a risk factor for future falls (odds ratio, 3.98; 95% confidence interval, 1.10-14.37; P = .035). A lower cadence, increased stance percentage, decreased swing percentage, increased age, and greater psychotropic drug intake were mediators that reduced the odds ratio of the relationship between using walking aids and faller status the most. Conclusions: Using walking aids is a risk factor for future falls among the older population living in residential settings. A substantial proportion of the relationship between walking aids and future falls could be explained by an altered spatiotemporal gait pattern, increased age, and psychotropic drug intake. This finding supports the aim of extensive training periods and appropriate instructions on the proper use of walking aids in terms of adequate and safe gait patterns

Does footwear matter when performing spatiotemporal gait analysis among older women?

Background and Purpose: Although shoe type may influence gait performance and is considered to be an extrinsic fall risk factor, little or no attention is paid to it when conducting research in this field. Therefore, this study aimed to assess the effect of various types of footwear under single-and dual-task conditions on spatiotemporal gait characteristics in older women. Methods: Fifty-seven community-dwelling women (68.0 +/- 4.6 years) were enrolled in this study. Spatiotemporal gait analysis using the GAITRite walkway was performed under 4 footwear conditions (barefoot, slippers, high heels, and standard shoes) and 3 task conditions (single-task, motor dual-task, and cognitive dual-task). Two-factor repeated-measures analysis of variance was conducted. Primary outcomes were velocity, cadence, stride time, stride length, and stride length variability. Results: Irrespective of task condition, walking barefoot resulted in a significantly slower gait pattern with decreased cadence and stride length and increased stride time and stride length variability compared with walking with the standard shoe. These significant gait alterations were also observed when adding a cognitive task to normal walking. The effects of footwear were most obvious during the cognitive dual-task condition and for the spatiotemporal parameters velocity and stride length. Conclusions: Footwear matters when analyzing gait in older women. It should be described in greater detail by gait researchers. Footwear should also be considered by clinicians in light of the study findings and its effects on gait. Older women are strongly discouraged to walk barefoot because barefoot walking adversely affects gait patterns. A well-fitting standard shoe with laces, a low and wide heel, firm heel collar and a grooved, moderately hard sole is recommended in research, rehabilitation, and daily use

Vibration perception threshold in relation to postural control and fall risk assessment in elderly

Purpose: This study investigates (i) the potential discriminative role of a clinical measure of peripheral neuropathy (PN) in assessing postural performance and fall risk and (ii) whether the integration of a simple screening vibration perception threshold (VPT) for PN in any physical (fall risk) assessment among elderly should be recommended, even if they do not suffer from DM. Method: One hundred and ninety-five elderly were entered in a four-group model: DM with PN (D+; n = 75), DM without PN (D-; n = 28), non-diabetic elderly with idiopathic PN (C+; n = 31) and non-diabetic elderly without PN (C-; n = 61). Posturographic sway parameters were captured during different static balance conditions (AMTI AccuGait, Watertown, MA). VPT, fall data, Mini-Mental State Examination and Clock Drawing Test were registered. Two-factor repeated-measures ANOVA was used to compare between groups and across balance conditions. Results: The groups with PN demonstrated a strikingly comparable, though bigger sway, and a higher prospective fall incidence than their peers without PN. Conclusions: The indication of PN, irrespective of its cause, interferes with postural control and fall incidence. The integration of a simple screening for PN (like bio-thesiometry) in any fall risk assessment among elderly is highly recommended

Prospective evaluation of the long-term effects of clinical voiding reeducation or voiding school for lower urinary tract conditions in children

Introduction : Although the short-term effects of urotherapy as a treatment strategy for lower urinary tract (LUT) conditions have been well documented, the long-term effects remain largely unknown. A better insight into the long-term effects of urotherapy could improve the clinical guidelines for children with incontinence. Objective : This study aimed to investigate the long-term effects (i.e., from 6 months to 2 years) from a clinical voiding reeducation program among children with LUT conditions. Study design : This study was a prospective continuation of the follow-up study of Hoebeke et al. (2011). Thirty-eight children (mean age 9 years) with LUT conditions completed an extensive clinical voiding reeducation program (VS). Data on medication, voiding, drinking, pelvic floor tone, uroflowmetry, and incontinence were recorded 2 years after the VS. These data were compared with the outcomes at 6 months follow-up and at intake before voiding school. Results : Six months after voiding school, 22 children continued having daytime incontinence (ID) and/or enuresis (EN). Six of them became dry at 2 years. Conversely, 16 children were dry at 6 months, of which eight relapsed at 2 years. Whereas all parameters significantly improved 6 months after VS, further improvements from 6 months to 2 years could only be noticed for the proportion of children suffering from overactive bladder (92% at intake, 55% at 6-month follow-up and 18% at 2-year follow-up) (Figure). Fluid intake and pelvic floor tone improved after 6 months, but showed a significant relapse after 2 years (P = 0.013, P = 0.031, respectively). Discussion : Hoebeke et al. (2011) concluded that results continued to improve after VS. No further improvements could be noticed 2 years after VS, although individual shifts were present. The results of the present study underline the value of long-term follow-up to detect those needing ongoing treatment to prevent relapse. Fluid intake and pelvic floor tone deteriorated from 6 months to 2 years. It could be hypothesized that inadequate fluid intake, possibly leading to decreased voided volumes, may be seen as an indicator for upcoming incontinence relapse. It could be stated that adequate fluid intake and pelvic floor tone may play a role in remaining continent for the long term. Study limitations should be considered. The study population was heterogeneous and rather small. Together with other missing values, this could have influenced the results. Conclusion : Close individual, long-term follow-up after clinical voiding reeducation in children is recommended in order to timely detect and prevent potential relapse