Scand J Caring Sci; 2012; 26; 12–19 
 A community‐based exercise programme to improve functional ability in people with Alzheimer’s disease: a randomized controlled trial Rationale:  Dementia is a common neurodegenerative condition in older age associated with functional decline across multiple domains. This decline impacts not only on the person with dementia, but also on their informal carers and health and aged care systems. With the number of people with dementia rapidly increasing and few effective treatments, there is now a critical need for interventions to improve functional ability in those with the condition. Aims and objective:  This study assesses the effectiveness of a community‐based home exercise programme in improving cognitive and physical function and independence in activities of daily living (ADL) in people with Alzheimer’s disease, the most common form of dementia. Methods:  In a 4‐month randomized controlled trial, 40 community‐dwelling patients diagnosed with Alzheimer’s disease and their informal carers were randomly allocated to either the treatment (exercise plus usual treatment) or control (usual treatment) group. The exercise programme consisted of daily exercises and walking under the supervision of their carer. Patients were assessed at baseline and 4‐months follow‐up by a blinded assessor on primary outcome measures of cognitive and physical function and ADL using standardized assessment scales. Results:  Sixteen men and 24 women diagnosed with Alzheimer’s disease participated in the study. They had a mean age of 74.1 years (range 51–89) and a mean Mini Mental State Examination score of 22.0 (range 10–28), indicating mild to moderate dementia. At 4‐months follow‐up, patients who exercised, compared with controls, had improved cognition (increased Mini Mental State Examination scores by 2.6 points, p < 0.001), better mobility (2.9 seconds faster on Timed Up and Go, p = 0.004) and increased Instrumental Activities of Daily Living scores by 1.6 (p = 0.007). Conclusion:  This study suggests that participation in a community‐based exercise programme can improve cognitive and physical function and independence in ADL in people with Alzheimer’s disease.

Background:The metabolic syndrome is a risk factor for cardiovascular diseases, which have been linked to Alzheimer disease. However, a link between Alzheimer disease and the metabolic syndrome has not yet been established.Objective: To investigate the relationship between the metabolic syndrome and Alzheimer disease.Design, Setting, and Participants: Case-control study of 50 consecutive patients diagnosed with probable Alzheimer disease from the Memory Disorders Clinics, Launceston, Australia, and Bristol, England, and 75 cognitively normal controls. Main Outcome Measures:The odds ratio of the metabolic syndrome as defined by the National Cholesterol Education Program Adult Treatment Panel III.Results: Compared with controls, patients with Alzheimer disease had a significantly larger mean waist circumference, higher mean plasma concentrations of triglycerides and glucose, and a lower mean plasma concentration of high-density lipoprotein cholesterol, but they had lower mean systolic blood pressure. The metabolic syndrome was associated with Alzheimer disease (odds ratio, 3.2; 95% confidence interval, 1.2-8.4; P=.02), and this association was strengthened when the hypertension component was excluded (odds ratio, 7.0; 95% confidence interval, 2.7-18.3; PϽ.001). All of the analyses were adjusted for age, sex, and location.Conclusions: This study suggests that Alzheimer disease is associated with the metabolic syndrome. This could have implications for the prevention and treatment of Alzheimer disease.

Background/Aims: Obesity has a strong association with vascular and metabolic diseases, which have been linked with Alzheimer disease (AD). While recent studies have reported an association between mid-life obesity and dementia, the role of later-life obesity is less clear. This study investigated the relation between AD, obesity and abdominal obesity at later-life in a case-control study. Methods: Participants were 50 consecutive patients with probable AD from memory disorders clinics in Launceston, Australia, and Bristol, England, and 75 cognitively normal controls. Height and weight [from which body mass index (BMI) was calculated] and hip and waist circumferences (from which waist-hip ratio was calculated) were measured. Participants were classified according to their BMI as: underweight (BMI <20.0 kg/m²); normal weight (BMI 20.0–24.9 kg/m²); overweight (BMI 25–29.9 kg/m²), or obese (BMI ≧30 kg/m²). They were classified as abdominally obese if their waist-hip ratio was >0.9 (men) or >0.8 (women). Results: AD was associated with obesity [OR 9.5, 95% CI 2.4–37.3, p = 0.001], underweight (OR 5.4, CI 0.9–33.7, p = 0.07) and abdominal obesity (OR 2.5, CI 1.1–5.7, p = 0.027) using logistic regression analyses adjusted for age, sex and location. The inclusion of metabolic risk factors in the model increased the ORs for obesity (OR 12.6, CI 2.8–56.5, p = 0.001) and underweight (OR 7.9, CI 1.0–66.3, p = 0.056). Conclusion: AD may be associated with obesity, underweight and abdominal obesity at later life. Larger prospective studies are required to investigate this further.

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