Abstract
Makizako H, Shimada H, Doi T, Yoshida D, Ito K, Kato T, Shimokata H, Washimi Y, Endo
H, Suzuki T. The association between decline in physical functioning and atrophy of
medial temporal areas in community-dwelling older adults with amnestic and nonamnestic
mild cognitive impairment.
Objective
To examine whether declining performance in aspects of physical functioning, including
lower extremity muscle strength, 1-legged balance, walking speed, and exercise capacity,
is associated with atrophy of medial temporal areas in community-dwelling older adults
with mild cognitive impairment (MCI).
Design
Cross-sectional study.
Setting
General community in Japan.
Participants
Community-dwelling older adults 65 years and older with a Clinical Dementia Rating
of 0.5 or memory complaints were enrolled in this study. This study examined 34 participants
with amnestic MCI (aMCI) and 58 nonamnestic MCI (non-aMCI) participants.
Interventions
Not applicable.
Main Outcome Measures
The following physical performance tests were conducted: muscle strength of knee extension,
1-legged standing time, 5-m walking test, and 6-minute walk test (6MWT). The z scores of the voxel-based specific regional analysis system for Alzheimer's disease
were determined to assess the degree of atrophy in the bilateral medial temporal areas
including the entorhinal cortex (MTA-ERC).
Results
In the aMCI group, 6MWT performance was associated with MTA-ERC atrophy (β=–.462, P=.014) after controlling for age. In the stepwise multiple regression analyses, 6MWT
and body mass index were found to be significant determinants of MTA-ERC atrophy in
all participants (R2=.275), as well as the aMCI and non-aMCI groups when analyzed separately (R2=.418 and R2=.216, respectively).
Conclusions
A decline in exercise capacity was found to be more closely associated with atrophy
of the MTA-ERC compared with other aspects of physical functioning in older adults
with MCI, especially the amnestic type. These findings suggest that it is important
for future studies to investigate the effects of increased aerobic activity and improved
fitness on brain volume in older adults at risk of developing dementia.
Key Words
List of Abbreviations:
AD (Alzheimer's disease), aMCI (amnestic mild cognitive impairment), apoE4 (apolipoprotein Eϵ4), BMI (body mass index), GDS (Geriatric Depression Scale), MCI (mild cognitive impairment), MMSE (Mini-Mental State Examination), MRI (magnetic resonance imaging), MTA-ERC (medial temporal areas, including the entorhinal cortex), OLS (1-legged standing), 6MWT (6-minute walk test), VSRAD (voxel-based specific regional analysis system for Alzheimer's disease), WMS-R (Wechsler Memory Scale–Revised), WS (walking speed)To read this article in full you will need to make a payment
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References
- Current concepts in mild cognitive impairment.Arch Neurol. 2001; 58: 1985-1992
- Mild cognitive impairment—beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment.J Intern Med. 2004; 256: 240-246
- A longitudinal study of cardiorespiratory fitness and cognitive function in healthy older adults.J Am Geriatr Soc. 2003; 51: 459-465
- Association of muscle strength with the risk of Alzheimer disease and the rate of cognitive decline in community-dwelling older persons.Arch Neurol. 2009; 66: 1339-1344
- Physical frailty is associated with incident mild cognitive impairment in community-based older persons.J Am Geriatr Soc. 2010; 58: 248-255
- Gait speed under varied challenges and cognitive decline in older persons: a prospective study.Age Ageing. 2009; 38: 509-514
- Association of gait and balance disorders with age-related white matter changes: the LADIS study.Neurology. 2008; 70: 935-942
- A prospective study of cerebral white matter abnormalities in older people with gait dysfunction.Neurology. 2001; 57: 990-994
- Postural instability is associated with brain atrophy and cognitive impairment in the elderly: the J-SHIPP study.Dement Geriatr Cogn Disord. 2010; 29: 379-387
- Cardiorespiratory fitness and brain atrophy in early Alzheimer disease.Neurology. 2008; 71: 210-216
- Mild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials.Arch Neurol. 2004; 61: 59-66
- Predictors of conversion to dementia of probable Alzheimer type in patients with mild cognitive impairment.Curr Alzheimer Res. 2006; 3: 161-170
- MCI is a clinically useful concept.Int Psychogeriatr. 2006; 18 (discussion 9-14): 394-402
- The role of neuroimaging in mild cognitive impairment.Neuropathology. 2007; 27: 570-577
- Voxel-based morphometry to discriminate early Alzheimer's disease from controls.Neurosci Lett. 2005; 382: 269-274
- Role of neuroimaging in Alzheimer's disease, with emphasis on brain perfusion SPECT.J Nucl Med. 2007; 48: 1289-1300
- Aerobic exercise training increases brain volume in aging humans.J Gerontol A Biol Sci Med Sci. 2006; 61: 1166-1170
- Resistance training and executive functions: a 12-month randomized controlled trial.Arch Intern Med. 2010; 170: 170-178
- Effects of aerobic exercise on mild cognitive impairment: a controlled trial.Arch Neurol. 2010; 67: 71-79
- Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial.JAMA. 2008; 300: 1027-1037
- Mild cognitive impairment.Lancet. 2006; 367: 1262-1270
- Mild cognitive impairment as a diagnostic entity.J Intern Med. 2004; 256: 183-194
- “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- Geriatric Depression Scale.Psychopharmacol Bull. 1988; 24: 709-711
- Japanese Alzheimer's Disease Neuroimaging Initiative: present status and future.Alzheimers Dement. 2010; 6: 297-299
- Wechsler Memory Scale–Revised Manual.The Psychological Corporation, San Antonio1987
- Lower-extremity function in cognitively healthy aging, mild cognitive impairment, and Alzheimer's disease.Arch Phys Med Rehabil. 2010; 91: 584-588
- Association between lower digit symbol substitution test score and slower gait and greater risk of mortality and of developing incident disability in well-functioning older adults.J Am Geriatr Soc. 2008; 56: 1618-1625
- The structure underlying physical performance measures for older adults in the community.Aging (Milano). 1995; 7: 451-458
- Two-, six-, and 12-minute walking tests in respiratory disease.Br Med J (Clin Res Ed). 1982; 284: 1607-1608
- A means of assessing maximal oxygen intake.JAMA. 1968; 203: 201-204
- Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds.Phys Ther. 2002; 82: 128-137
- Atrophy of the parahippocampal gyrus and regional cerebral blood flow in the limbic system in chronic alcoholic patients.Alcohol. 2010; 44: 439-445
- Cardiorespiratory fitness and preserved medial temporal lobe volume in Alzheimer disease.Alzheimer Dis Assoc Disord. 2009; 23: 188-197
- Circulating insulin-like growth factor I mediates the protective effects of physical exercise against brain insults of different etiology and anatomy.J Neurosci. 2001; 21: 5678-5684
- Reduced mortality and brain damage after locomotor activity in gerbil forebrain ischemia.Stroke. 1994; 25: 1862-1869
- Learning causes synaptogenesis, whereas motor activity causes angiogenesis, in cerebellar cortex of adult rats.Proc Natl Acad Sci U S A. 1990; 87: 5568-5572
- Exercise: a behavioral intervention to enhance brain health and plasticity.Trends Neurosci. 2002; 25: 295-301
- Exercise and brain neurotrophins.Nature. 1995; 373: 109
- Voluntary exercise decreases amyloid load in a transgenic model of Alzheimer's disease.J Neurosci. 2005; 25: 4217-4221
- Motor dysfunction in mildly demented AD individuals without extrapyramidal signs.Neurology. 1999; 53: 956-962
- Motor function in subjects with mild cognitive impairment and early Alzheimer's disease.Dement Geriatr Cogn Disord. 2005; 19: 299-304
- Physical exercise, aging, and mild cognitive impairment: a population-based study.Arch Neurol. 2010; 67: 80-86
- Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older.Ann Intern Med. 2006; 144: 73-81
- A prospective study of physical activity and cognitive decline in elderly women: women who walk.Arch Intern Med. 2001; 161: 1703-1708
- After reaching retirement age physical activity sustains cerebral perfusion and cognition.J Am Geriatr Soc. 1990; 38: 123-128
- Aerobic fitness reduces brain tissue loss in aging humans.J Gerontol A Biol Sci Med Sci. 2003; 58: 176-180
- An 18-year follow-up of overweight and risk of Alzheimer disease.Arch Intern Med. 2003; 163: 1524-1528
- Change in body mass index and risk of incident Alzheimer disease.Neurology. 2005; 65: 892-897
- Midlife and late-life obesity and the risk of dementia: Cardiovascular Health Study.Arch Neurol. 2009; 66: 336-342
- Association between late-life body mass index and dementia: the Kame Project.Neurology. 2009; 72: 1741-1746
- Body mass index and cognitive decline in a biracial community population.Neurology. 2008; 70: 360-367
- Accelerated weight loss and incident dementia in an elderly African-American cohort.J Am Geriatr Soc. 2011; 59: 18-25
- Obesity: preventing and managing the global epidemic.World Health Organ Tech Rep Ser. 2000; 894 (1-253): i-xii
- Descriptive epidemiology of body mass index in Japanese adults in a representative sample from the National Nutrition Survey 1990-1994.Int J Obes Relat Metab Disord. 1998; 22: 684-687
- IANA (International Academy on Nutrition and Aging) Expert Group: weight loss and Alzheimer's disease.J Nutr Health Aging. 2007; 11: 38-48
- Measurement of competence: reliability and validity of the TMIG Index of Competence.Arch Gerontol Geriatr. 1991; 13: 103-116
- The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis.Arch Phys Med Rehabil. 2004; 85: 1694-1704
- Endurance and strength training outcomes on cognitively impaired and cognitively intact older adults: a meta-analysis.J Nutr Health Aging. 2008; 12: 401-409
- Apolipoprotein E epsilon4 allele, temporal lobe atrophy, and white matter lesions in late-life dementias.Arch Neurol. 1999; 56: 961-965
Article info
Footnotes
Supported in part by the Ministry of Health, Labour and Welfare, Japan (Project for Optimizing Long-Term Care; [grant no. B-3]).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
