Lifestyle and neurocognition in older adults with cognitive impairments

Abstract

ObjectiveTo determine the independent and additive effects of aerobic exercise (AE) and the Dietary Approaches to Stop Hypertension (DASH) diet on executive functioning in adults with cognitive impairments with no dementia (CIND) and risk factors for cardiovascular disease (CVD). MethodsA 2-by-2 factorial (exercise/no exercise and DASH diet/no DASH diet) randomized clinical trial was conducted in 160 sedentary men and women (age >55 years) with CIND and CVD risk factors. Participants were randomly assigned to 6 months of AE, DASH diet nutritional counseling, a combination of both AE and DASH, or health education (HE). The primary endpoint was a prespecified composite measure of executive function; secondary outcomes included measures of language/verbal fluency, memory, and ratings on the modified Clinical Dementia Rating Scale. ResultsParticipants who engaged in AE (d = 0.32, p = 0.046) but not those who consumed the DASH diet (d = 0.30, p = 0.059) demonstrated significant improvements in the executive function domain. The largest improvements were observed for participants randomized to the combined AE and DASH diet group (d = 0.40, p = 0.012) compared to those receiving HE. Greater aerobic fitness (b = 2.3, p = 0.049), reduced CVD risk (b = 2.6, p = 0.042), and reduced sodium intake (b = 0.18, p = 0.024) were associated with improvements in executive function. There were no significant improvements in the memory or language/verbal fluency domains. ConclusionsThese preliminary findings show that AE promotes improved executive functioning in adults at risk for cognitive decline.ClinicalTrials.gov identifier NCT01573546. Classification of evidenceThis study provides Class I evidence that for adults with CIND, AE but not the DASH diet significantly improves executive functioning. Glossary AE = aerobic exercise; CDR = Clinical Dementia Rating; CIND = cognitive impairment without dementia; COWA = Controlled Oral Word Association Test; CVD = cardiovascular disease; DASH = Dietary Approaches to Stop Hypertension; DDD = daily defined dose; ENLIGHTEN = Exercise and Nutritional Interventions for Neurocognitive Health Enhancement; FINGER = Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability; FSRP = Framingham Stroke Risk Profile; MoCA = Montreal Cognitive Assessment; TMT = Trail Making Test. trial Lifestyle and neurocognition in older adults with cognitive impairments: A randomized This information is current as of

Longer Term Effects of Diet and Exercise on Neurocognition: 1‐Year Follow‐up of the ENLIGHTEN Trial

“…Primary results of the ENLIGHTEN trial showed that participants randomized to Exercise demonstrated better performance in the executive function domain compared with the non‐exercisers (d = .32; P = .046), whereas the difference between participants in the DASH diet and non‐DASH diet was not significant (d = .30; P = .059) . The largest between‐intervention group differences were observed for participants randomized to the combined AE and DASH diet group compared with HE controls (d = .40; P = .012).…”

“…The Exercise and Nutritional Interventions for Neurocognitive Health Enhancement (ENLIGHTEN) randomized clinical trial examined the independent and combined effects of aerobic exercise (AE) and the DASH diet on neurocognitive functioning in older adults with CIND. Results of the 6‐month intervention showed that exercise was associated with better executive function compared with non‐exercisers, and that combining exercise with the DASH diet produced better executive functioning compared with education controls . The present report describes the results of a 1‐year follow‐up of the ENLIGHTEN trial.…”

“…We followed a prespecified modeling approach in which a compound symmetry covariance structure was used, although results were unchanged when an unstructured covariance structure was used. We used a similar approach for analyses of changes in 6MWD, dietary adherence, CVD risk, and self‐report measures of QoL and physical activity, consistent with the approach used in our primary publication . Our primary end point was global executive function; secondary cognitive end points included assessments of memory and language/verbal fluency.…”

“…Inclusion criteria included adults age 55 years and older with subjective memory or other cognitive complaints as reflected by a score of .5 or higher on the Mail-In Cognitive Function Screening Instrument 8 and objective evidence of cognitive impairment with scores between 19 and 25 on the Montreal Cognitive Assessment (MoCA) or a score of 12 or lower on Letter fluency or 15 or lower on Animal fluency. 7 Participants also had to be sedentary and either have documented CVD or at least one additional CVD risk factor. The baseline demographic and clinical characteristics of the sample are provided in Table 1.…”

“…Results of the 6-month intervention showed that exercise was associated with better executive function compared with non-exercisers, and that combining exercise with the DASH diet produced better executive functioning compared with education controls. 7 The present report describes the results of a 1-year follow-up of the ENLIGHTEN trial.…”