In several reviews, exercise was reported to be effective in reducing the risk for cognitive decline and dementia [1,2]. However, not all reviews concluded this. One recent review [3] stated that there was still insufficient evidence, as most studies were too small and had insufficient methodological information (intensity, duration) to enable appropriate evaluation. Here we discuss potential confounds or mediators that may explain these discrepancies.We found that most observational studies showed at least some positive associations of exercise, but not always on the same cognitive tests [1]. Variance in studies was induced by inconsistent use of cognitive assessments (e.g. fluid intelligence compound scores vs Symbol Digit Modalities Test (SDMT) scores by itself); different assessments of fitness (objective vs. self reported hours of exercise engaged in); and different cut-offs for high/low exercise across studies. These limitations were echoed by others and recent reviews also illuminated potential confounds associated with both exercise and cognitive improvement, such as lifting of depression, as well as social and cognitive stimulation [4], and an increase in self efficacy (Stock, in press), which have usually not been taken along in analyses or adequately controlled for. Observational studies are limited in their ability to establish causality and many people could have stopped exercise because of other confounding morbidity, which may also affect cognitive function (e.g. vascular disease, see below). Randomised controlled trials (RCT) are better at establishing causality, but can also be affected by choice of measurements and population, suffer from baseline differences, regression to the mean and design of the control conditions (e.g. without social or cognitive stimulating aspects), as well as the above mentioned limitations of potential non-assessed confounds or mediators, such as mood.In our earlier review of 26 RCT studies in community dwelling elderly without known dementia or cognitive impairment, which had been carried out up to 2009 [1], only 6 studies showed overall cognitive improvement, 13 some improvement and 7 none at all. The most consistent cognitive tests to be affected by exercise interventions in this group were simple tests, such as those of concentration and those using simple reaction times. Several earlier reviews suggested that more complex cognitive tests were most affected by exercise. However, our review finding was substantiated by those of the Cochrane meta analyses [5], which is a gold standard medical review system. About half of RCT studies we had included in our review [1], which had used a simple test of concentration and working memory (Digit Span) found that it displayed significant positive results of exercise, but the other half of studies using this test (n=5) had not found any improvement. Of the complex information processing tests previously thought to be most sensitive to exercise, 21 tests (including the Stroop 4x, Symbol Digit Modalities test (SDMT) 4x, CRT 3x,...

IntroductionProfessional footballers commonly experience sports-related injury and repetitive microtrauma to the foot and ankle, placing them at risk of subsequent chronic pain and osteoarthritis (OA) of the foot and ankle. Similarly, repeated heading of the ball, head/neck injuries and concussion have been implicated in later development of neurodegenerative diseases such as dementia. A recent retrospective study found that death from neurodegenerative diseases was higher among former professional soccer players compared with age matched controls. However, well-designed lifetime studies are still needed to provide evidence regarding the prevalence of these conditions and their associated risk factors in retired professional football players compared with the general male population.ObjectivesTo determine whether former professional male footballers have a higher prevalence than the general male population of: (1) foot/ankle pain and radiographic OA; and (2) cognitive and motor impairments associated with dementia and Parkinson’s disease. Secondary objectives are to identify specific football-related risk factors such as head impact/concussion for neurodegenerative conditions and foot/ankle injuries for chronic foot/ankle pain and OA.Methods and analysisThis is a cross-sectional, comparative study involving a questionnaire survey with subsamples of responders being assessed for cognitive function by telephone assessment, and foot/ankle OA by radiographic examination. A sample of 900 adult, male, ex professional footballers will be recruited and compared with a control group of 1100 age-matched general population men between 40 and 100 years old. Prevalence will be estimated per group. Poisson regression will be performed to determine prevalence ratio between the populations and logistic regression will be used to examine risk factors associated with each condition in footballers.Ethics and disseminationThis study was approved by the East Midlands-Leicester Central Research Ethics Committee on 23 January 2020 (REC ref: 19/EM/0354). The study results will be disseminated at national and international meetings and submitted for peer-review publication.

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Background: The aim of the study was to develop a multidimensional quality of life instrument suitable for use among individuals across cultures who have an informal care role for older persons. Methods: Participants were informal carers of older adults in the United Kingdom ( n = 308), United States ( n = 164), and China ( n = 131). We carried out exploratory and confirmatory factor analyses of 61 items derived from the eight-factor Adult Carers Quality of Life Questionnaire with newly added items to define both traditional and nontraditional informal care roles. Results: Findings suggest a 24-item quality of life scale with a six-factor structure to caring for older adults that assesses (a) exhaustion, (b) adoption of a traditional carer role, (c) personal growth, (d) management and performance, (e) level of support, and (f) financial matters. Conclusion: We present a new scale to assess the multidimensional aspects of quality of life among those caring for older adults.

Background: There is a growing body of evidence demonstrating hearing loss in middle-aged and older adults is independently associated with an increased risk of developing cognitive-decline and dementia. Verbal memory is one of the most common functions to decline early in Alzheimer's disease, the most common form of dementia Whilst the exact mechanisms underlying this association remain unclear, poorer test performance may reflect an overarching sensory deficit, as, for instance, most verbal memory tests are predominantly delivered auditorily. Therefore, this study aimed to investigate whether different modes of presentation (i.e., visual, or auditory) influence verbal memory screening test performance in those who failed a hearing screener. Method:The study was conducted via online video-conferencing due to the COVID-19 pandemic. Participants (N= 63) completed a validated hearing screener, which was a digit-in-noise test delivered via the hearWHO smartphone application. Three cognitive tests were also administered: (1) the Modified Telephone Interview for Cognitive Status (TICS-M), presented auditorily; (2) the Hopkins Verbal Learning Test (HVLT), presented visually; and (3) a verbal fluency task as a control. All tests have been used as dementia screening tests.Result: Separate ANCOVAs revealed that, when controlling for age, gender, and education level, adults who failed the hearing screener performed more poorly on the TICS-M compared to individuals who passed (p<.001). No differences between hearing groups were found for the other cognitive tests administered (p≥ .132). Conclusion:This study provides support for the notion that the presentation mode of cognitive tests may account for some of the deficits observed in older adults with hearing loss. As such, researchers and clinicians should be mindful of the sensory deficits experienced by individuals when interpreting cognitive test performance, to avoid the overestimation of cognitive deficits and dementia in adults with hearing loss.