고령자들의 치매 예방 “PASCAL” 교육과 신체자극 운동프로그램이 인지기능 및 치매 위험인자에 미치는 영향

Physical Education, Exercise, Fitness and Sports: Early PM&R Leaders Build a Strong Foundation

To the Editor: Only little is known regarding successful approaches to primary or secondary prevention of most dementia. There is a need for detecting and modifying specific risk factors assessable in the community. From a combined global and local viewpoint, a community-based comprehensive geriatric assessment (CGA) of older adults in a rural Japanese town was performed to investigate its association with cognitive status. Recent investigations have shown that physical performance is an important predictor of change in cognitive function1-3 and that blood pressure (BP) is associated with cognitive performance.4-6 How changes in cognitive function may relate to changes in physical assessments, brachial and central systolic BP and other cardiovascular and clinical endpoints was investigated after 3 and 5 years of follow-up. Annual community-based CGA of elderly adults living in Tosa (Kochi prefecture) has been performed since 2004. Of health check participants aged 75 to 99 in 2005 (reference; second year of project), 133 (94 women, 39 men, mean 2005 age 80.1) were followed up in 2008 and 108 (77 women, 31 men, mean 2005 age 79.9) again in 2010. Left brachial BP and right radial arterial pulse waves were noninvasively measured using oscillometry and tonometry (HEM-9000AI, Omron Healthcare Co., Ltd., Kyoto, Japan).7 SBP2 (radial augmentation index (AI) × (brachial SBP–brachial DBP) + brachial DBP) and AI were determined using pulse wave analysis.8 Because central SBP by direct measurement is reportedly closely associated with radial SBP2,8 radial SBP2 was used as the derived central aortic pressure. Subjects grouped in terms of declining, unchanged, or improving cognitive function were compared using one-way analysis of variance or chi-square tests, complemented by Student t-tests. P < .05 was considered statistically significant. In 2005, mean Mini–Mental State Examination (MMSE) score was 27.5 (range 24–30), mean Hasegawa Dementia Rating Scale—Revised (HDS-R) score was 26.8 (range 19–30), mean modified Kohs’ block design test score was 21.7 (range 2–46), and mean Clock Drawing Test (CDT) score was 8.5 (range 1–10) (Table 1). Improvement (or decline) in cognitive function was defined as an increase (or decrease) of three points on the MMSE. In 2008 (3-year follow-up), men were more likely to have declined than women (P = .04), CDT was larger (P = .01), Timed Up and Go was faster (P = .02), and serum creatinine was higher in the improved than in the unchanged group (P = .04). In 2010 (5-year follow-up), central systolic BP was higher in the declined than in the unchanged group (P = .02), and hemoglobin was higher in the improved than in the unchanged group (P = .002) (Table 1). Anemia in older adults is reportedly associated with greater risk of dementia in the next 11 years,9 perhaps related to chronic brain hypoxia. In the current study, central systolic BP was a predictor of cognitive decline at 5-year follow-up, and physical activity assessed according to the Timed Up and Go test was a short-term predictor of cognitive function. Slow gait was also a strong and early risk factor for cognitive decline in a study of 767 participants aged 70 and older studied over 36.5 months (dementia hazard ratio = 3.27, 95% confidence interval (CI) = 1.55–6.90).2 Other investigations also suggest that high BP in midlife increases the risk of dementia and Alzheimer's disease in older age. High systolic BP was a risk factor for dementia in younger elderly adults (<75) but not in older adults in a less-than-10-year prospective community-based cohort study.4 In a transverse investigation, central BP, but not brachial BP, was a sensitive indicator of cognitive function.6 This is in keeping with the current investigation confirming in older adults that central systolic BP, but not brachial systolic BP, was a statistically significant predictor of cognitive decline at five but not 3 years. Central hemodynamic variables are independently associated with organ damage and incident cardiovascular disease, suggesting that central BP may be different from BP measured on the arm.6, 10 It may thus be more relevant to the study of cognitive function, given that blood is delivered to the brain through the large central arteries. In conclusion, central BP is a long-term predictor of cognitive decline in older adults, whereas preserved physical activity, represented by the Timed Up and Go test is a short-term predictor of cognitive improvement. We would like to extend our thanks to all participants of this study. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Kikuchi: data analysis and writing of the manuscript. Sasaki, Oinuma, Yamanaka G., Okajima, Yamanaka T., Okumiya: data collection. Cornelissen, Matsubayashi, Otsuka: study concept. Sponsor's Role: None.

Hypertension is an established risk factor for stroke, ischemic heart disease,1,2 and renal dysfunction.3 The management and prevention of hypertension are important to the prevention of these diseases. Recent evidence has suggested that hypertension also plays a central role in the underlying pathophysiological condition or at prodromal stages before the development of these diseases. Accumulating evidence also indicates that hypertension seems to be linked with common noncardiovascular diseases including dementia, cancer, oral health diseases (OHDs), and osteoporosis. In this brief review, we organize the reported results about the associations between hypertension and these diseases, discussing mainly epidemiological surveys, with the goal of clarifying the relationships between these diseases and hypertension. ### Atrial Fibrillation Atrial fibrillation (AF) is one of the most common types of chronic arrhythmia and is a risk factor for ischemic stroke.4 The Framingham Heart Study revealed that hypertension increases the risk of AF by factors of 1.5 for men and 1.4 for women.5 The Women’s Health Study and a cohort study of Norwegian men showed that high-normal blood pressure (BP) was associated with incident AF.6,7 All of these cohort studies were conducted in Westerners, and these associations were also confirmed in a recent Japanese cohort study.8 In that investigation, compared with normal BP and normal weight, systolic prehypertension with overweight was shown to be associated with an increased risk of incident AF ( P for interaction=0.04). Arterial stiffness, left ventricular hypertrophy, and increased left atrial size are important mediators of the relationship between BP and incident AF.9 Higher systolic BP (SBP) and overweight may mutually exacerbate left ventricular hypertrophy and hypertension, and consequently, they may synergistically increase the risk of AF. ### Chronic Kidney Disease and High BP Chronic kidney disease (CKD) is characterized by a progressive decline in an individual’s glomerular filtration rate over several decades, …

Background: Physical exercise is an effective measure for preventing the onset of cognitive decline and has a direct influence on the aging process. The purpose of this study was to assess the effect of a 6-month physical exercise program on cognition and telomere length in adults over 65 years of age. Method: Seventy-four healthy women were separated into two groups: 41 were included in the intervention group (IG) (72.70 ± 4.127 years and 8.18 ± 1.551 years of education) and 33 in the control group (CG) (71.21 ± 4.127 years and 8.42 ± 2.562). The participants included within the IG carried out three sessions of physical exercise per week for six months. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), the Stroop test and the Trail Making Test (TMT). Saliva samples were taken and analyzed and relative telomere length was calculated. Those conducting the analysis were blind to the group to which the participants had been assigned. Results: An improvement was observed in global cognitive function, in both attentional and executive functions, in the group of adults doing physical exercise as compared to the control group. Six months after the physical exercise program had finished, relative telomere length was found to have increased in the participants in the intervention group. Conclusion: Physical exercise programs can lead to an improvement in both cognitive functions and telomere length.

Indonesia's rapidly aging demographic presents significant challenges, particularly in dementia among older people in resource-limited settings, such as nursing homes. However, there are limited reports on the deterioration of cognitive function and risk factors of dementia among older people in nursing homes. Early identification of dementia is essential for timely intervention and management. This study aimed to investigate and follow up on the cognitive function and risk factors of dementia among older people living in nursing homes. An observational cohort study was conducted over 6 months (April to October 2024) involving 162 participants from government (n = 83) and private nursing homes (n = 79). Implementation of early dementia screening was carried out using the Montreal Cognitive Assessment in the Indonesian version (MoCA INA) instrument to indicate cognitive function impairment. In addition, the Self-reporting of Physical Activity Questionnaire Indonesia (SPAQ-I) was used to identify physical activity. Descriptive statistics, McNemar, Chi-square, Fisher's Exact, Independent t-test, and multivariate regression were then used to analyze data. Older individuals did not differ in terms of gender, age, education, or length of stay. However, residents of the private nursing home had significantly higher physical activity levels (t = -2.04, p = 0.040), and a greater proportion engaged in adequate activity (65.8% vs. 50.6%, χ2 = 4.23, p = 0.040). Over a six-month period, cognitive function significantly declined among residents in the government nursing home (normal: p = 0.021; mild: p = 0.012; moderate: p = 0.003), whereas no significant change was observed among residents in the private nursing home. At the endpoint, mean cognitive function scores were slightly higher in the private nursing home (20.23 ± 3.45) than in the government nursing home (19.70 ± 4.39), with a very small effect size (Cohen's d = 0.13). Multiple regression analysis revealed that older age (β = -0.396, p <0.001) and lower levels of physical activity (β = 0.163, p = 0.030) were significantly associated with lower cognitive scores. Dementia screening can enhance care planning for age-related cognitive impairment by enabling early identification and management. Early detection allows nurses to implement more effective care strategies. Additionally, higher physical activity levels were associated with better cognitive function, highlighting a modifiable factor that may help maintain cognitive health among older adults in nursing homes.

This chapter describes modifiable risk and protective factors for dementia and will focus on so-called lifestyle changes which largely relate to the behavioural environment. Results from longitudinal observational studies have identified several possible modifiable physiological risk factors associated with both cardiovascular disease and dementia. These include increased blood pressure, central obesity and high levels of total cholesterol. The direction of these associations, however, may change over the lifespan. For instance, people in the lead up to and with dementia have shown changed profiles of these risk factors (including loss of muscle mass and weight, lowered blood pressure and a decrease in total cholesterol). It is therefore perhaps not surprising that treatment of these risk factors at a late stage has shown variable results. For optimal effects in the prevention of dementia, a lifespan approach, starting with neonatal and childhood prevention of such risk factors, as well as promoting those factors known to protect individuals from dementia is warranted. Observational studies have suggested that smoking cessation in midlife can still significantly reduce the risk of later-life dementia. Similarly, exercise provides a low cost-effective method to improve cardiovascular disease risk parameters, but can also have direct beneficial effects on brain function. Many observational studies indicate protective effects from engaging in exercise and there may also be dose-dependent effects of engaging in physical activities in reducing dementia risk. However, meta-analyses have shown mixed effects and suggest that combined interventions (including cognitive activities) may be better for tertiary prevention. Diet, supplements and medical approaches (e.g. statins to reduce cholesterol levels) seem less effective for this kind of prevention. Whilst risk models have been used to investigate cumulative effects of dementia risk factors, there is also a need for models including multiple protective factors, such as associations of exercise and diet together and potential offsetting of risk (e.g. poor diets) with protective factors (e.g. exercise) to better focus policies across governments to enable societies to promote a life course, which is more protective of brain health. In sum, combining physical and psychosocial activities (exercise, cognitive stimulation) may be the best approach for prevention aimed at early and late interventions. Pathways focusing on addressing cardiovascular risk factors and nutritional deficiencies clearly need to be addressed in midlife at the latest – but preferably from the earliest stages of life, including healthy parents – to have substantial impact. A lifespan approach seems the best option for societies to reduce their population’s risk of future dementia. Currently, large trials are underway in midlife to investigate these multimodal treatments for the primary and secondary prevention of dementia. However, a societal lifespan approach starting before birth for optimal prevention of cardiovascular disease and dementia in later life is likely to pay enormous dividends for future healthy brain ageing.

Fish oil supplementation and physical exercise program: Distinct effects on different memory tasks

The objective of this study was to investigate the effects of a nutritional education and physical exercise program on obese children (47 boys and 36 girls). The nutritional education and physical exercise program was provided for 6 weeks and dietary habits, nutrient intake and hematological profiles were measured before and after the program. The BMI (body mass index, ㎏/㎡) in male children was significantly reduced to 24.58±2.81 from 25.89±3.27 (p＜0.01) and it was significantly reduced to 24.29±3.51 from 25.21±3.59 in female children after the completion of nutritional education and exercise program. Body fat in male children was remarkably reduced to 32.69±7.74% after education from 37.38±9.21% (p＜0.001). After the program total cholesterol concentration in male children was reduced to 176.48±29.10 ㎎/dL from 196.03±29.10 ㎎/dL, whereas there was no significant difference in females before and after the nutritional education and exercise program. The grasping power of male children (p＜0.05) and backmuscle strength of male (p＜0.05) and female children (p＜0.001) were significantly increased after the exercise program. The nutrient intakes that were different before and after the nutrition education were calories (p＜0.05) and carbohydrate (p＜0.05) in male children, and a significant increase in intake of vitamin A (p＜0.05) was found in female children. There was a significant difference in meal time regularity before and after program. The findings of this study showed that there was a significant decrease in both body fat and weight, in addition to normalization of hematological profiles after the completion of nutrition education and physical exercise programs.

It is well known that physical exercise has beneficial effects on cognitive function in older adults. Recently, several physical exercise programs with virtual reality (VR) have been proposed to support physical exercise benefits. However, it is still unclear whether VR physical exercise (VR-PE) has positive effects on cognitive function in older adults. The purpose of this study was to conduct a systematic review (SR) of the effects of VR-PE on cognitive function in older adults with and without cognitive decline. We used academic databases to search for research papers. The criteria were intervention study using any VR-PE, participants were older adults with and without mild cognitive decline (not dementia), and cognitive functions were assessed. We found that 6 of 11 eligible studies reported the significant benefits of the VR-PE on a wide range of cognitive functions in aging populations. The SR revealed that VR-PE has beneficial effects on the inhibition of executive functions in older adults with and without mild cognitive decline. Moreover, VR-PE selectively leads to improvements in shifting and general cognitive performance in healthy older adults. The SR suggests that VR-PE could be a successful approach to improve cognitive function in older adults with and without cognitive decline.

Cognitive Impairment in Dialysis Patients: Focus on the Blood Vessels?

Objectives: Older immigrants from non-industrialised countries are a growing group, they have comparatively many health problems and are often hard to reach through health promotion and other preventive services. The...

A dvances in our understanding of vascular cognitive impairment (VCI) have springboarded from further elucidation of the role of vascular risk factors, surgical procedures, medications, and neuroimaging studies that are related to this condition. The main focus of this VCI review will highlight the relation of diabetes mellitus and hippocampal dysfunction in VCI; coronary artery bypass surgery and cognitive decline; the role of cerebral amyloid angiopathy (CAA) in vascular dysfunction; and a discussion of other cardiovascular risk factors, treatment, and neuroimaging findings related to disease progression; and histopathologic and genetic correlates.

Randomized Controlled Trial of Exercise and Nutrition Supplementation on Physical and Cognitive Function in Older Chinese Adults Aged 50 Years and Older

Objective: To evaluate the impact of a multicomponent physical exercise program on clinical variables associated with the glymphatic clearance system, sleep-awake patterns, and cognitive function in individuals with mild cognitive impairment or mild Alzheimer’s disease. Methods: This is a single-center parallel randomized controlled trial involving pre- and post-intervention assessments. The intervention consists of a 12 (±3)-week multicomponent aerobic and resistance physical exercise program of moderate intensity divided into 2 groups: an experimental group (undergoing multicomponent training) and a control group (no intervention). Eligible participants are those diagnosed with probable mild cognitive impairment or mild Alzheimer’s disease. Expected results: Anticipated outcomes suggest that the multicomponent training protocol, incorporating both aerobic and resistance physical exercises at a moderate intensity, will yield improvements in glymphatic clearance dynamics, sleep-awake parameters, and performance on cognitive, functional, and behavioral tasks among eligible patients. Relevance: The need to move beyond cognitive clinical testing justifies our trial, which proposes an assessment employing neuroimaging techniques and the analysis of biomarkers present in cerebrospinal fluid in conjunction with clinical tests for physical and cognitive assessment.

Multiple factors combined are currently recognized as contributors to cognitive decline. The main independent risk factor for cognitive impairment and dementia is advanced age followed by other determinants such as genetic, socioeconomic, and environmental factors, including nutrition and physical activity. In the next decades, a rise in dementia cases is expected due largely to the aging of the world population. There are no hitherto effective pharmaceutical therapies to treat age-associated cognitive impairment and dementia, which underscores the crucial role of prevention. A relationship among diet, physical activity, and other lifestyle factors with cognitive function has been intensively studied with mounting evidence supporting the role of these determinants in the development of cognitive decline and dementia, which is a chief cause of disability globally. Several dietary patterns, foods, and nutrients have been investigated in this regard, with some encouraging and other disappointing results. This review presents the current evidence for the effects of dietary patterns, dietary components, some supplements, physical activity, sleep patterns, and social engagement on the prevention or delay of the onset of age-related cognitive decline and dementia.