Alzheimer’s disease: physical activity, management of vascular risk both matter

  • Rabin JS & al.
  • JAMA Neurol
  • 16 Jul 2019

  • International Clinical Digest
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Takeaway

  • Greater physical activity and lower vascular risk had independent, additive effects in slowing β-amyloid (Aβ)-related cognitive decline and neurodegeneration.

Why this matters

  • Lack of interventions to prevent and treat dementia, coupled with aging of the population.
  • Relative simplicity and safety of lifestyle interventions.

Key results

  • Significant interaction seen between physical activity, Aβ burden on both cognitive decline (P<.001 and gray matter volume loss>
  • Greater physical activity associated with slower:
    • Aβ-related cognitive decline (β, 0.03; P<.001>
    • Gray matter volume loss (β, 482.07; P=.002).
  • Associations persisted after adjustment for vascular risk.
  • Lower vascular risk independently associated with slower:
    • Aβ-related cognitive decline (β, –0.04; P<.001>
    • Gray matter volume loss (β, –483.41; P=.01).

Study design

  • Prospective longitudinal cohort study of 182 clinically normal older adults (mean age, 73.4 years) from the Harvard Aging Brain Study.
  • Main outcomes: cognition (measured annually with Preclinical Alzheimer Cognitive Composite), neurodegeneration (assessed with longitudinal structural MRI over median 4.5 years, with a focus on total gray matter volume, regional cortical thickness).
  • Funding: National Institute on Aging; others.

Limitations

  • Individuals with high levels of cerebrovascular disease excluded.
  • Population generally well-educated.
  • Physical activity assessed only at baseline, for a limited period.

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