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Jennie L. Wells MSc, MD, FRCPC, FACP
Associate Professor of Medicine
Chair, Division of Geriatric Medicine
Schulich School of Medicine and Dentistry
Western University
31 May 2017
Therapeutic Recreation Ontario Conference
Before Pills . . . Or Why
Leisure is Important!
Disclosures I am currently the site PI or sub-I for pharma
sponsored clinical trials for dementia medications.
(Roche, Eisai, Lilly, Merck, Biogen, Transtech,
Boeringer)
In the past 3 years I have been the sub-I site
investigator for clinical trials sponsored by TauRx,
Lundbeck, Genentech, Bristol-Myers-Squib, Forum.
In the past 3 years I have not had any industry
sponsored honoraria.
I am a past employee of Pfizer Inc and own
employee stock.
Before Pills . . . Why leisure is important . . .
Learning objective:
You will be able to discuss the evidence and appreciate the important
role for Leisure Recreation Therapists to enhance the delivery of non-
pharmacological interventions of exercise, brain activity, meditation,
and diet to delay or evade the onset of dementia, death, and disability.
Outline:
1. Introduction: why is this important?
2. Case – “food for thought”
3. Nutrition
4. Brain exercise, ”thinking,” meditation, music
5. Physical exercise
6. Case discussion & Summary
Introduction—why is this important?
Over the past 25 years we’ve learned lots.
The causes of AD are complex and
multiple.
The baby boomers are aging.
We still don’t have a cure . . .
AD is a neurodegenerative disease that,
on average progresses to death in 6-12
years.
Before Pills . . .
If we can delay the onset of dementia by 5 years, we can reduce the prevalence by 57% and cut the cost by ~50%
(Sperling RA 2012)
Before Pills . . . But, “up to half of AD cases worldwide are . .
attributed to modifiable factors. . . . 1 million AD
cases could be prevented globally if a 25%
reduction in physical inactivity could be achieved in
the world population.”
Lautenschlager 2013
The time to act is now!
Case : Mrs. Toula
Sectamauve Mrs. TS is a 75 yo homemaker with fibromyalgia,
macular degeneration, OA, Depression/anxiety, walks with a cane, lives alone, says she is lonely. She is referred by her doctor to the Kiwanis for “activation.”
No home help; independent IADLS/ADLS. 1 fall with ER visit this year.
“I exercise walking in the Grocery store.”
Strategies? Barriers? Motivators?
Risk Factors for AD
Age
Family History
Gender
Stroke
Down’s syndrome
Head Trauma
Low level of
education
Hypertension
Blass and Poirier, 1996; CSHA 1991(Canadian Study on Heath and Aging)
New: Poor nutrition
Low level of exercise
Risk Factors for AD—what can
we change?
Age
Family History
Gender
Stroke
Nutrition
Level of exercise
Down’s syndrome
Head Trauma
Low level of
education
Hypertension
Blass and Poirier, 1996; CSHA 1991
^ new
What we eat:
Estuch et al. NEJM 2013: Primary Prevention of Cardiovascular Disease with Mediterranean Diet (MD)
“Even the best available drugs, like statins, reduce
heart disease by about 25 percent, which is in the
same ballpark as the Mediterranean diet,” --Dr. Walter
Willett, professor of epidemiology & nutrition at Harvard School of
Public Health.
. . that means that for every 1,000 people who
followed the Mediterranean diet, three people each
year avoid a heart attack or stroke because of the diet.
What we eat: Estruch et al 2013;
Mediterranean Diet (MD) and Cardiovascular Prevention
7447 persons age 55-80 were followed for 4.8 years.
Randomized to MD with extra-virgin olive oil (MDO) (n=2543); MD with nuts (MDN)(n=2454); or (C) control (n=2450)-- low fat.
All received dietician education.
The MD groups received 1 l of olive oil or 75g of mixed nuts (walnuts, hazelnuts, almonds) at no cost. Control (C) received a small non food gift.
Myocardial infarction, stroke or death were primary end points.
Events: MDO-96, p=0.009; MDN-83, p=0.02; C-109.
For just stroke: MDO 49, p=0.03; MDN 32, p=0.003; C 58.
What we eat:Scarmeas JAMA 2009:
Physical Activity, Diet, & Risk of AD
Prospective cohort of 1880 community elders NYC
with no dementia, average age 77, followed for 14 yrs.
Interviewed every 1.5 years, followed for activity &
diet.
Those with the highest adherence to Mediterranean
diet & exercise had the highest probability of
remaining AD-free.
Alzheimer Disease Incidence by High or Low physical Activity
Scores & by Mediterranean-Type Diet Adherence Score
Scarmeas JAMA 2009
MIND Diet study (Morris et al 2015)
Prospective observational study, 4.5 years, 923 subjects age 58-98. Food questionnaires analyzed based on adherence to the MIND diet and DASH diet.
Covariates: age, education, leisure activities, depression,stroke, hypertension, heart disease, BMI, diabetes, medication use.
144 incident cases of AD were diagnosed.
The 1/3 with highest adherence to the MIND diet had lowest rate of AD (HR 0.47, CI .26-.76); moderate adherence DASH-HR 0.67, CI .44-.98.
DASH only—only highest adherence group, HR .61, CI .38-.97.
Mediterranean only—HR .46, CI .26-.79.
Survivor function for incident Alzheimer Disease for the Mediterranean- DASH Intervention for Neurodegenerative
Delay (MIND) diet (tertile adherence)
MIND study (Morris 2015)
What we eat: Meta-analysis(Psaltopoulou et al Annals of Neurology 2013)
Interpretation: “Adherence to a Mediterranean Diet
may contribute to the prevention of a series of brain
diseases.”
22 eligible studies: 11-stroke; 9 depression; 8 cognitive
impairment; 1 Parkinson’s Disease.
The Mediterranean Diet consistently was associated
with a reduced risk for:
Stroke (RR .71 CI ,43-.83)
Depression (.68, CI .54-.86)
Cognitive impairment (.60, CI .43-.83)
What we think:
• Willis et al. JAMA 2006: Long-term effects of cognitive training on everyday functional outcomes in community.
• Randomized single blind study of 2832 people, mean age 73.6,
community dwelling in 6 cities in USA, MMSE > 22, 67% retention.
• Excluded if had diagnosis of AD, medical conditions causing disability,
imminent death; or if had hearing loss/blindness.
• Ten training sessions given for each training group: memory, reasoning,
speed of processing were given and 4 booster sessions were given at 11
& 35 months. The control group had no contact.
• At 5 years all trained groups better cognition than the control group.
• At 5 years, the reasoning trained group had less functional decline.
What we think:• Herholz et al review article 2013: observational,
longitudinal studies with positive cognitive effect
of:
• Life long learning
• Practicing languages throughout life
• Music practice
• Specialized training
• New research to include imaging coupled with
activity.
• Brain plasticity is modulated in animal models by
reward neurotransmitters. The role of reward
networks in human training needs to be explored.
What we think:Khalsa, D. Meditation & AD Prevention: the forgotten factor. P1-104, AAIC 2012.
A review of the literature: cognitive studies, imaging
studies, and other outcomes.
• Meditation slows aging by enhancing telomere length.
• Reduces inflammatory markers.
• Enhances memory.
• Reduces depression, stress, and hypertension.
• Enhances brain volume (Pagnoni 2007).
• Pilot study, 2012—reduces negative emotions in
persons with AD.
What we think: Potential benefits of
mindfulness-based interventions (MBI) in MCI & AD: an
interdisciplinary perspective (Larouche et al 2015)
Stress, depression, & metabolic syndrome accelerate
MCI & AD.
MBI reduces blood pressure, cortisol, inflammation,
regulates serotonin, & white matter hyperintensities.
Future research must achieve deeper understanding of
mechanism & bridge the gap with in fields of neuro-
science as well as basic and clinical knowledge.
What we think:
Sung H-C et al. J Clin Nurs 2010. A preferred music listening intervention to reduce anxiety older adults with dementia in nursing homes.
n=29 received a 2X/wk 30 min music session while
controls (n=23) had usual care with no music.
preferred music group had significantly lower anxiety
compared to those who received standard care. (p=0.001)
What we think . . . Ridder et al Aging & Mental Health 2013: RCT of
music therapy vs usual care of persons with agitation and dementia.
42 persons had 6 weeks of 2x/wk music sessions vs
standard care.
Agitation decreased in the music group p=0.027,
effect size (0.5)
The music group received less psychotropic
medication.
What we think (and do):Dr. Nina Kraus personal communication 2013:
Music engages sensory, cognitive and reward brain
circuitry. There is over-lap in brain areas for speech and
music.
OPERA: Overlap, Precision, Emotions, Repetition,
Attention.
Even if engaged in music for the first time in older life,
improvement is seen.
Adults aged 60-85 with no musical training improved on
processing speed & memory after 3 months of 30 min
piano lessons & 3 hours per week of practice.
What we think (and do):Satoh et al 2014:
Dual training with physical exercise & music:
119 subjects, age 65-84 were enrolled in once per
week physical exercise with trainer with music
accompaniment for 1 year or the same exercise
without music.
MRIs & cognitive tests done pre and post
The group with physical exercise with music had more
positive effects on cognitive function than exercise
alone.
What we do: Minutes of walking per day at age 50 is associated
with less dementia risk and better brain volumes.Borenstein A et al.
What we do, the habits we maintain moment to moment, day to day, week to week, month to month, year to year changes us.
What we do:
Erickson K et al. The influence of aerobic exercise intervention on Brain Volume in late adulthood. F1-0301, July 2012, AAIC.
120 older adults without dementia were randomized
to moderate walking or stretching/toning for 1 year.
In walkers but not stretchers:
MRI scans show increased hippocampal size.
Blood showed higher levels of Brain Derived
Neurotrophic Factor (BDNF).
What we do:
155 community dwelling Vancouver women 65-75 yrs. MMSE >24, capable of exercise, no resistance exercise in 6 mo, not depressed
Randomized to RT, Resistance Training 1X or 2x/wk, or 2x/wkBalance & Toning, BT--12 mos. 70-71% compliance rate for RT; 62% for BT.
Muscle power was stronger in RT group. (-16% power in BT)
MSK pain reported in 30% RT & 9.5 % BT. NO Pain reports after 4 wks.
RT was more efficacious than BT in improving attention and executive function. Improvement in both the 1x and 2x per week RT was 11-13% better. (BT – 0.5%)
Liu-Ambrose, Nagamatsu etal. Arch Int Med 2010. O1-08-06 AAIC 2012.
Resistance training & executive function: a 12-mo randomized controlled trial(†Refining exercise prescription to promote executive function in older adults)
What we do: (Liu-Ambrose etal CGS 2015)
There’s even more learning from this study!
RT compared with BAT had significantly reduced white
matter Hyperintensity (WMH) on MRI.
Reduced WMH progression is associated with maintenance
of gait speed (p=.04) & improved Stroop performance
(p=.06)
Aside commentary:
Nadkarmi etal JAGS 2013: Type of training of those >65 with
gait impairment matters. Task-oriented (n=23) with training
on timing & coordination resulted in gait speed change
independent of WMH; whereas walking, endurance, balance &
strength (WEBS) had smaller gait speed gains.
What we do:
Nagamatsu L et al. Resistance Training promotes cognitive functions and functional plasticity in senior women with probable mild cognitive impairment (MCI): a 6 mos RCT. F1-03-02, AAIC July 2012.
The EXCEL trial: Exercise for Cognition and Everyday Living.
N=86, 70-80 year old women with MCI were randomized to 6 mos of 2X weekly resistance training--RT (n=28), aerobic training--AT(n=30), or toning (n= 28).
RT improved on important tests of cognition (p=0.04 and <0.03).
AT improved on balance, mobility, and cardiovascular capacity (p=0.04).
The changes in exerciser cognition were evident in functional changes in MRI scans.
What we do:
Barnes et al. JAMA 2013. The Mental Activity and eXercise (MAX) trial: a RCT to enhance cognitive function in older adults.
126 inactive community living older adults, ave age 73.4, with memory complaints.
All subjects had physical exercise & brain exercise. What varied was the type. Stretching & tone vs aerobic, 1 hour 3x/wk. Mental activity was intensive computer vs educational DVDs, 1 hour 3x/wk. 12 week program.
All groups improved p<0.001.
There was no difference between groups, p= 0.26.
Impression: what matters most is to be active!
What we do:
Vreugdenhil et al. Scand J Caring Sci 2012. A community-based exercise programme to improve functional ability in PWD: a RCT.
40 persons with AD (ave age 74.1, MMSE 22) & their carer were
randomized to exercise vs usual care for 4 months.
Carer-lead daily home based walking & exercise program.
The MMSE improved by 2.6 points, p<0.001. !!!
Improvement on functional tasks, p=0.007.
Faster walking and transferring speed, p=0.004.
Literature review: Littbrand et al. Applicability & Effects of
Physical Exercise on Physical& Cognitive Function & ADL Among
People with Dementia. AJPMR 2011;90(6): 495-518.
What we do:Effects of the Finnish AD Exercise Trial: (FINALEX): a Randomized Control Trial Pitkala et al JAMA 2013.
210 home dwelling AD patients with caregiver.
Outcomes: Functional Independence Measure (FIM), physical performance measure, and social and health costs.
3 groups followed for 1 year: GE, group exercise 2X/week—4-hour sessions--1 hour training. HE, home exercise 2X/week—1-hour training. CG, Control group—usual care.
Deterioration was fastest in the control group (~2X as fast) p=0.015.
Both GE and HE had fewer falls than CG.
Costs trended less in the HE group vs CG.
Costs were less in the GE vs CG, p=0.03.
Lifestyle Interventions & Independence
for Elders (LIFE study) Sink et al JAMA
2015
RCT, single blind, 24 mo,1635 community living seniors, age 70-89, USA.
Inclusion/exclusion criteria: No dementia (3MSE cutoff adjusted for education
& ethnicity), co-morbidity, walk 400m w/o Ax < 15 min, at risk for mobility
dependency.
Participants: Mean BMI= 30, ~28% DM, 20% gluc. Intol., ~7% stroke, HTN
75%, CVD ~29%, ~66% college ed; walking speed = 0.83 m/s. At baseline,
ave. walking & strength training= 75, PA; 87, HE, min/wk.
Intervention: 2 group sessions/wk & home 3-4 X/week; goal 30 min walk, 10
min of leg resistance training & 10 min of balance training.
71% compliance at PA sessions; self report increase in activity 130 min/wk,
PA; 31 min/wk, HE .
Conclusion: Among sedentary older adults a 24 mo moderate intensity PA program compared with health education did not result in improvements in global or domain-specific cognitive function.
BUT!!
Those > 80 (n=307) & those with
poorer baseline physical
performance (n=328) had
improvement in executive function
compared to HE group. (p=0.01)
Lifestyle Interventions &
Independence for Elders (LIFE study)Sink et al JAMA 2015
What we do:
Is it ever too late to start walking? NO!!
Winchester J et al. Arch of Gerontol and Ger 2013.
Walking stabilizes cognitive functioning in Alzheimer
Disease.
Sedentary persons with AD declined over 1 year.
Those who had >2 hours per week of physical activity
improved.
Those with ~1 hours/week of activity plateaued.
Cognitive scores of walkers and sedentary over time
Winchester J et al Archives of Gerontology and Geriatrics 2013
Kemoun et al. 2010
Van De Winckel et al. 2004
Venturelli et al. 2011
Vreugdenhil et al. 2012
Study or Subgroup
Figure 1--A forest plot of the meta-analysis of RCT studies that have measured global cognitive outcome. Exercise interventions were found to have a positive effect on global cognitive outcome.Farina, N. et al. International Psychogeriatrics 2014, 26:1 9-18
Meta-analysis of Exercise interventions to enhance cognition. Farina et al 2014.
What we
do:
Carcel et al. Ballroom dancing improves memory in older adults. P1-101,
AAIC 2012.
Tai Chi studies: Chu, AAIC 2014 ; Wu Y, J of Sport & Health Science
2013.(The effects of Tai Chi exercise on cognitive function in older adults: A
meta-analysis)
Planned FIT-AD trial (Yu 2014) will use cycling as intervention.
Neville & Henwood 2014. Swimming improves behaviour & well-being in
persons with dementia.
BOTTOM LINE: MOVE! DO SOMETHING!
What we do:Park J et al. JAGS 2017; 65:592-97
Chair yoga: an RCT of Sit and Fit versus Health
Education Program (HEP)
131 adults over age 65 with lower limb arthritis
8 week intervention, 2x/wk, for 45 min
The yoga group:
Had less pain, less interference of pain in activities,
less fatigue, and improved gait speed
What we do: Play mahjong! Cheng, Int J Psychiatry 2006
62 persons with Alzheimer’s (MMSE < 24)
Played 2-4X per week.
Improved MMSE, digit span, and verbal memory
Play Chess! Don’t watch TV! Wang 2006 “Leisure Activity & Risk of cognitive Impairment: The Chongqing Aging Study” Mind sport reduced the risk of cognitive impairment
TV watching was associated with increased risk!
Verghese 2006—higher participation in leisure activity is associate with lower risk of mild cognitive impairment in those >75 yr old.
What we do: Art
Storytelling, Reminiscence
Crafts
Theatre, drama
1. McGreevy J, Nurs Older People 2016
2. George DR, Dementia 2014
3. Pollanen SH, Occup Ther Health Care 2014
What we doBarengo NC et al. Leisure-time PA (LTPA)
Reduces Total & Cardiovascular Mortality & Cardiovascular Disease Incidence in Older Adults. JAGS 2017; 65: 504-10.
Finnish men & women, age 65-74, N=2456 followed 1997-2007.
Baseline LTPA reduces risk of CV & total mortality independently of known CV risks.
LTPA is dose dependent.
What we do:
What we do:
Head D et al. 2012. Exercise Engagement as a Moderator of the Effects of the APOE Genotype on Amyloid Deposition.
Amyloid binding in the brain is one marker associated with AD as is level of Cerebrospinal Fluid Markers.
CSF samples taken, Amyloid-PET scans done, self-reported 10-year exercise history, subjects were “genotyped.” Results controlled for age, sex, education, medical diseases. 201 total subjects. 168 had PET scans; 165 had CSF sampling.
201 cognitively normal, age 45-88, 108 ApoE carriers.
ApoE carriers who are exercisers had a marked protection from Amyloid deposition, p<0.001.
0
0.05
0.1
0.15
0.2
0.25
Nonexercisers
ApoE4 -
(n = 86)
Exercisers
ApoE4 -
(n=25)
Nonexercisers
ApoE4 +
(n = 39)
Exercisers
ApoE4 +
(n = 13)
Am
ylo
id
Bin
din
g
Head D et al. 2012. Exercise Engagement as a Moderator of the Effects of the APOE Genotype on Amyloid Deposition.
Association between Amyloid status & exercise engagement
What we do:
Wang H-X. An Active Lifestyle Postpones Dementia onset by More than One Year in very Old Adults. O1-08-
01 AAIC 2012.
The age of onset for dementia is later for persons with
higher levels of mental, physical, or social activity
(p=0.001).
~1400 people, mean age of 80, followed for 9 yrs.
Of the 388 who developed dementia, those who were
inactive were 17 months younger than their active
counterpart.
Case : Mrs. Toula
Sectamauve Mrs. TS is a 75 yo homemaker with fibromyalgia,
macular degeneration, OA, Depression/anxiety, walks with a cane, lives alone, says she is lonely. She is referred by her doctor to the Kiwanis for “activation.”
No home help; independent IADLS/ADLS. 1 fall with ER visit this year.
“I exercise walking in the Grocery store.”
Strategies? Barriers? Motivators?
Case : Mrs. Toula
Sectamauve What is her personal history of hobbies, community
engagement?
What is her personality?
What are her personal goals? (common ground)
What are her fears for the future?
Now, what are your strategies?
Summary: There is growing strong evidence that a Mediterranean
Diet prevents dementia and vascular disease.
Exercise is a strong modulator of cognition with a
protective effect.
Meditation is a health promotion practice that has a
multimodal effect on brain health.
Learning and doing new things is associated with
brain health.
What you do at RTs matters!!!
It’s never too late!
References:• Barnes et al. The Mental Activity and eXercise (MAX) trial: a RCT to enhance cognitive
function in older adults. JAMA 2013; 173(9): 797-804..• Beking K and Vieira A. Flavenoid intake & disability-adjusted life years due to AD and
related dementias: a population-based study involving 23 developed countries. Public Health Nutrition 2010; 13(9): 1403-9.
• Borenstein A et al. Minutes of Walking per day at ate 50 is associated with Dementia risk. P1-098. AAIC 2012.
• Buchman A et al. Association Between Late-life Social Activity & Motor Decline in Older Adults. Arch Intern Med 2009; 169(12): 1139-46.
• Cao C. et al. High Blood Caffeine Levels in Older Adults Linked to Avoidance of AD. J Alz Disease 2012; 29: 1-14.
• Carcel C et al. Can ballroon dancing make you smarter: An investigation of its relationship with hippocampal volume and memory performance in older adults. P1-
101, AAIC 2012.• Carey AN et al. The beneficial effects of tree nuts on the aging brain. Nutrition &
Aging 2012; 1(1): 55-67.• Cheng S-T et al. Mental & Physical Activities Delay Cognitive Declinie in Older
Persons with Dementia. Am J Ger Soc Feb 2013.• Erickson K et al. The influence of aerobic exercise intervention on Brain Volume in
late adulthood. F1-0301, AAIC 2012.• Estruch et al.Mediterranean Diet & Cardiovascular Prevention. NEJM 2013;
368(14):1279-1290.• Fallah N et al. Refining exercise prescription to promote executive function in older
adults using multistate transition modeling. O1-08-06 AAIC 2012.
Frautschy S et al. Impact of diet and exercise on development of tau pathology. O2-
05-01 AAIC 2012.
Helcer J et al. Cognitive Behaviour Therapy to Combat Hopelessness and Low Self
Efficacy in AD. P2-325, AAIC 2012
Head D. et al. Exercise Engagement as a Moderator of the Effects of APOE Genotype
on Amyloid Deposition. Arch Neurol 2102;69(5):636-643.
Khalsa, D. Meditation & AD Prevention: the forgotten factor. P1-104. AAIC 2012.
Kraus Nina. Canadian Conference on Dementia, Oct. 2013; Vancouver, BC.
Kraus N. Music Training: an Antidote for Aging? The Hearing Journal 2013;66(3):52.
Kuriyama S. Green Tea consumption & cognitive function: a cross-sectional study
from the Tsurugaya Project 123. Am J Clin Nut 2006;83(2):355-61.
Lamport DJ et al. The effects of flavenoid & other polyphenol consumption on
cognitive performance: a systematic review of human experimental & epidemiological
studies. Nutr & Aging 2012;1(1):5-25.
Lautenschlager N. Can participation in Mental and Physical Activity Protect Cognition
in Old Age? JAMA 2013;173(9):805-6.
References: Lindsay J et al. Risk Factors for AD: A prospective Analysis from the Canadian Study on Health
and Aging. Am J of Epi 2002;156(5):445-453.
Lopez J e tal. Spirituality & self-efficacy in dementia family caregiving: trust in God & in yourself. Internat Psychoger Assoc 2012; 12(24):1943-52.
Littbrand H et al. Applicability & Effects of Phyical Exercise on Physical& Cognitive Function & ADL Among People with Dementia. AJPMR 2011;90(6):495-518.
Liu-Ambrose T et al. Resistance training and executive functions: a 12-month randomized controlled trial. Arch Int Med 2010;170(2):170-8.
Moss A et al. Effects of an 8 week Meditation Program on Mood & Anxiety in Pts with Memory Loss. J Alt M & Compl Med 2012;18(1):48-53.
O’Brien J et al. Long-term consumption of nuts in relation to cognitive function and decline in women. P2-158, AAIC 2012.
Pagnoni G & Cekic M. Age effects on grey matter volume & attentional performance in Zen meditation. Neurbio of Aging 2007;28:1623-27.
Nagamatsu L et al. Resistance Training promotes cognitive functions and functional plasticity in senior women with probable mild cognitive impairment (MCI): a 6 mos RCT. F1-03-02, AAIC 2012.
Nelson P et al. Self-reported Head Injury (HI) and risk of Cognitive impairment & AD type pathology in a Longitudinal AD Center Cohort O5-05-04, AAIC 2013.
References for 2013 talk: Pettersen J. Vitamin D & Verbal fluency: Are higher levels better? P3-141, AAIC 2013.
Pitkala et al Effects of the Finnish AD Exercise Trial: (FINALEX): a Randomized Control Trial. JAMA 2013; 173(10):894-901.
Raglio A et al. Efficancy of Music therapy in the Treatment of Behavioural & Pschiatric Symptoms of Dementia. Alz Dis Assoc Disord 2008; 22(2):158-162.
Rendeiro C et al. Dietary Levels of Pure Flavonoids Improve Spatial Memory Performance & Increase Hippocampal Brain-derived Neurotrophic Factor. Plos One 2013;8(5):1-9.
Rovio S et al. Leisure-time physical activity at midlife and the risk of dementia & AD. The Lancet Neurology 2005;4:705-711.
Scarmeas N et al. Physical Activity, Diet, & Risk of AD. JAMA 2009; 302(6):627-37.
Shah T et al. Cross Training of Auditory and visual Brain Training Software program improves cognition and alters plasma BDNF levels in Healthy older adults. O1-08-03 AAIC 2012.
Sung H-C et al. A preferred music listening intervention to reduce anxiety in older adults with dementia in nursing homes. J Clin Nurs 2010;19:1056-64
Svansdottir HB & Snaedal J. Music therapy in moderate & severe dementia of Alzheimer type: a case-control study. Internat Psychogeriatri Assoc 2006;18(4):613-21.
Tippet W & Rizkalla M. Training the Brain: Can Cognitive Training Alter the Global Effects of Alzheimer Disease? Abstract # O2-01-03. Alzheimer Association International Conference AAIC July 2012.
References: Vreugdenhil et al. A community-based exercise programme to improve
functional ability in people with AD: a RCT. Scand J Caring Sci 2012;26(1):12-
19.
Wang H-X. An Active Lifestyle Postpones Dementia onset by More than One
Year in very Old Adults. O1-08-01 AAIC 2012.
Westerlund O et al. Relationship Between Marital & Parental Status and Risk
of Dementia & AD. P3-204, AAIC 2013.
Willis et al. Long-term effects of cognitive training on everyday functional
outcomes in community JAMA 2006; 296(23)):2805-14.
Winchester J et al. Arch of Gerontol & Ger 2013;56:96-103.
Wu Y et al. The effects of Tai Chi exercise on cognitive function in older adults:
A meta-analysis. J Sport & Health Sci 2013; Sept 28: on-line publication.
For 2015 talk:
What we do: Diet and Exercise: AD mouse model.
Frautschy S et al. Impact of diet and exercise on development of tau pathology. O2-05-01 July 2012 AAIC.
Curcumin (anti-inflammatory), Omega-3 FA, α-lipoic acid (anti-oxidant) and voluntary exercise reduced “tau pathology” synergistically.
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