Physical Activity Prevents Progression for Cognitive Impairment and Vascular Dementia

Verdelho, Ana; Madureira, Sofia; Ferro, José M.; Baezner, Hansjoerg; Blahak, Christian; Poggesi, Anna; Hennerici, Michael G.; Pantoni, Leonardo; Fazekas, Franz; Scheltens, Philip; Waldemar, Gunhild; Wallin, Anders; Erkinjuntti, Timo; Inzitari, Domenico

doi:10.1161/strokeaha.112.661793

Cited by 105 publications

(74 citation statements)

References 34 publications

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“…67 Physical activity reduces the risk of cognitive impairment, mainly vascular dementia, in older people living independently. 148 There is also evidence that exercise has positive effects on depression 149 and cognition 150 in adults without stroke, and there are preliminary findings that exercise may confer similar effects after stroke. 18,21 Although few studies have investigated the impact of fitness training on cognition and mood after stroke, a recent report 21,151 using combined aerobic and resistance training noted improvements in overall cognition and in the subdomains of attention/concentration and visuospatial/executive function.…”

Section: Cardiovascular Cognitive and Functional Outcome Measuresmentioning

confidence: 99%

Physical Activity and Exercise Recommendations for Stroke Survivors

Billinger¹,

Arena

Bernhardt³

et al. 2014

Stroke

1,128

623

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2532Purpose-This scientific statement provides an overview of the evidence on physical activity and exercise recommendations for stroke survivors. Evidence suggests that stroke survivors experience physical deconditioning and lead sedentary lifestyles. Therefore, this updated scientific statement serves as an overall guide for practitioners to gain a better understanding of the benefits of physical activity and recommendations for prescribing exercise for stroke survivors across all stages of recovery. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and indicate gaps in current knowledge. Results-Physical inactivity after stroke is highly prevalent. The assessed body of evidence clearly supports the use of exercise training (both aerobic and strength training) for stroke survivors. Exercise training improves functional capacity, the ability to perform activities of daily living, and quality of life, and it reduces the risk for subsequent cardiovascular events. Physical activity goals and exercise prescription for stroke survivors need to be customized for the individual to maximize long-term adherence. Conclusions-The recommendation from this writing group is that physical activity and exercise prescription should be incorporated into the management of stroke survivors. The promotion of physical activity in stroke survivors should emphasize low-to moderate-intensity aerobic activity, muscle-strengthening activity, reduction of sedentary behavior, and risk management for secondary prevention of stroke. (Stroke. 2014;45:2532-2553.)

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Section: Cardiovascular Cognitive and Functional Outcome Measuresmentioning

confidence: 99%

Physical Activity and Exercise Recommendations for Stroke Survivors

Billinger¹,

Arena

Bernhardt³

et al. 2014

Stroke

1,128

623

View full text Add to dashboard Cite

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“…It has been demonstrated that patients benefit from recommendations of physical exercise. 39 They may also benefit from cognitive rehabilitation training 40 and pharmacological therapy with acetylcholinesterase inhibitors. 41 …”

Section: Strokementioning

confidence: 99%

Validating a Pragmatic Approach to Cognitive Screening in Stroke Prevention Clinics Using the Montreal Cognitive Assessment

Swartz

Cayley

Lanctôt

et al. 2016

Stroke

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Cognitive screening in patients with stroke is endorsed by Best Practice Recommendations, 7 and rapid cognitive assessments are widely used in clinic settings to understand patient function and tailor appropriate therapy. The Montreal CognitiveBackground and Purpose-The Montreal Cognitive Assessment (MoCA) is used commonly to identify cognitive impairment (CI), but there are multiple published cut points for normal and abnormal. We seek to validate a pragmatic approach to screening for moderate-severe CI, by classifying patients into high-, intermediate-, and low-risk categories. Methods-A total of 390 participants attending an academic Stroke Prevention Clinic completed the MoCA and more detailed neuropsychological testing. Between April 23, 2012 and April 30, 2014, all consecutive new referrals to the regional Stroke Prevention Clinic who were English-speaking, not severely aphasic, and could see and write well enough to complete neuropsychological testing were assessed for inclusion, and consenting patients were enrolled. CI was defined as ≥2 SDs below normal for age and education on at least 2 cognitive subtests. A single cut point for CI was compared with 2 cut points (high sensitivity and high specificity) generated using receiver operator characteristic and area under the curve analyses. The intermediate-risk group contained those scoring between the 2 cut points. Results-Thirty-four percent of participants had a symptomatic or silent stroke, 34% were seen for possible or probable transient ischemic attack, and 32% were diagnosed with other vascular or nonvascular conditions. Using a single cut point, sensitivity and specificity were optimal with MoCA ≤22, (sensitivity=60.4%, specificity=89.9%, area under the curve=0.801, positive predictive value=48.5%, negative predictive value=93.5%, positive likelihood ratio=6, and negative likelihood ratio=0.4). Using 2 cut points, sensitivity was optimal with MoCA ≥28 (sensitivity=96.2%, negative predictive value =97.6%, and negative likelihood ratio=1.27), and specificity was optimal with MoCA ≤22 (specificity=89.9%, positive predictive value=48.5%, and positive likelihood ratio=6). 9 There is considerable variability in the diagnostic characteristics of the MoCA within the population with stroke (Table I in the online-only Data Supplement); most commonly, a cut point of ≥26 is considered normal, whereas ≤25 is considered impaired. Conclusions-Stratifying8 This dichotomization stems from the statistical approach to receiver-operating curves, but contradicts clinical thought processes in which screening questions are used throughout a clinical encounter to decide serious concern, no concern, or possible concern and guide further questioning or appropriate actions. The MoCA has been shown to be more sensitive to vascular CI than other quick screens (eg, the Folstein Mini-Mental State Examination), but less specific. [10][11][12] However, this reflects the use of a single cut point. In both clinical practice and research, the MoCA is often used as a surrogate for CI...

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“…At the end of the 3-year Leukoaraiosis and Disability study, 90 of the 639 participants had developed dementia. 21 Physical activity (at least 30 minutes of activity on at least 3 days per week) significantly reduced the risk of cognitive impairment, especially vascular dementia. In a large, racially diverse cohort of 876 older adults (the Northern Manhattan Study), there was more likely to be decline at 5 years in semantic memory and executive function if there were low levels of leisure time physical activity.…”

Section: Healthy Eating and Regular Exercise To Prevent Dementiamentioning

confidence: 99%

Memory loss

et al. 2016

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Purpose of review: Memory loss can be due to a wide variety of causes. We provide new information about the biology of common genetic and acquired causes of memory loss in older adults. Recent findings:New data are available about the genetics of Alzheimer disease (AD), dementia with Lewy bodies (DLB), and frontotemporal dementia. Amyloid PET, FDG-PET, and MRI have improved our understanding of how mild cognitive impairment evolves to AD. Several studies have shown links between concussion and chronic traumatic encephalopathy. Healthy eating and regular exercise have been demonstrated to slow cognitive decline in older adults. Randomized trials continue to show benefits for cholinesterase inhibitors and memantine in patients with AD and DLB. Summary: New causes of memory loss are still being identified. More sophisticated diagnostic tools have improved our ability to make earlier diagnoses in older adults with memory loss. Neurol Clin Pract 2016;6:523-529 R ecent large neuropathologic studies have shown that Alzheimer disease (AD) is still the most common of the chronic neurodegenerative memory disorders, but it is often associated with several comorbid histologic findings, such as cortical Lewy bodies, hippocampal sclerosis, and microinfarcts. Amyloid hypothesis and the genetics of AD While it is well-accepted that memory loss and other cognitive impairments in AD are the result of dysfunction in neuronal networks and synapses, the exact molecular and pathologic steps generating the clinical symptoms of AD remain an issue of some debate. Some have argued that b-amyloid (Ab) is a necessary but insufficient factor to explain the etiology of AD, arguing that Ab aggregations in the brain and decreased Ab levels in spinal fluid are detectable 15-20 years before the clinical symptoms of AD.2 Contradicting this view are recent findings from the Alzheimer's Disease Neuroimaging Initiative (ADNI), which demonstrated that decreases in CSF Ab levels are often not apparent until after there is a noticeable decline in cognitive function, a decline in metabolic activity on FDG-PET, and

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Physical Activity Prevents Progression for Cognitive Impairment and Vascular Dementia

Cited by 105 publications

References 34 publications

Physical Activity and Exercise Recommendations for Stroke Survivors

Physical Activity and Exercise Recommendations for Stroke Survivors

Validating a Pragmatic Approach to Cognitive Screening in Stroke Prevention Clinics Using the Montreal Cognitive Assessment

Memory loss

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