Prevention of CIND by physical activity: Different impact on VCI-ND compared with MCI

doi:10.1016/j.jns.2007.04.054

Journal of the Neurological Sciences

Volume 269, Issues 1–2, 15 June 2008, Pages 80-84

https://doi.org/10.1016/j.jns.2007.04.054 Get rights and content

Abstract

Background

Cognitive impairment that does not meet the criteria for dementia (“Cognitive Impairment, No Dementia” — CIND) is a heterogeneous category with an increased risk of dementia. While greater physical activity is generally associated with a lower odds of both dementia and CIND, whether this effect applies across subgroups is not known.

Objectives

To investigate the association between physical activity and the risk of vascular CIND (VCI-ND) or mild cognitive impairment (MCI).

Methods

In the Canadian Study of Health and Aging community-dwelling cohort, of 4683 people who were not impaired at baseline, 3945 remained without cognitive impairment at 5 years, 454 were diagnosed with CIND, and 284 with dementia. Incident CIND and VCI-ND (n = 163) and MCI (n = 100) subtypes were investigated in relation to baseline physical activity, stratified by sex.

Results

In women, moderate–high exercise was associated with a lower odds of CIND (OR = 0.62, 95% CI = 0.46–0.84) and VCI-ND (0.34, 0.18–0.63) relative to low exercise. There was no association for men or for MCI.

Conclusion

Exercise appears to reduce the risk of VCI-ND in women. Whether the lack of an effect of exercise on the odds of MCI reflects that ‘prevented AD’ is indistinguishable from MCI is an intriguing possibility that merits further study.

Introduction

It is intriguing to consider that exercise might prevent dementia. Exercise not only decreases vascular risk [1] but also may also act specifically on disease pathophysiology, for example by decreasing brain amyloid load in the brain [2] or modulating brain neurotrophic factors [3]. If exercise modifies the risk factors and pathological mechanisms associated with dementia, then it seems plausible that exercise should moderate the risk of dementia. For Alzheimer's disease, this appears largely to hold [4], [5], [6], [7], [8]. However, and somewhat counter-intuitively, the risk of vascular dementia does not seem to be moderated by physical activity [6], [7]. How to account for this is not clear, but it seems reasonable that physical activity might alter the course of either Alzheimer's disease or vascular dementia by delaying impairment or by making impairment less severe. We considered that prevention of dementia might not be all-or-none (i.e. it could fall on a continuum rather than a dichotomy) and that ‘prevented dementia’ might not equate with ‘normal cognitive function.’ Here, our objective was to investigate the association between physical activity and patterns of cognitive impairment more minor than dementia, including vascular cognitive impairment-no dementia (VCI-ND) and mild cognitive impairment (MCI).

Section snippets

Methods

This study utilized data from the Canadian Study of Health and Aging (CSHA), a national, multi-center, prospective cohort study of dementia in persons 65 years and older. A representative population sample (N = 9008) of community-dwelling people was drawn in 1991 from provincial records. Detailed methods have been described elsewhere [9]. An initial interview screened for self-rated health, chronic conditions, functional ability and cognition, the last using the Modified Mini-Mental State (3MS)

Results

Individuals with no cognitive impairment (NCI) were younger and had more education than did those who developed CIND or dementia (Table 1). The sex distribution was similar in each category, except MCI which had fewer females (49% females). Decedents were older, more often male, less educated and were more likely to have high vascular risk, take NSAIDS, and be physically inactive compared to those with NCI. However, they were similar in age and education to the CIND and dementia group but more

Discussion

In this secondary analysis of the Canadian Study of Health and Aging, physical activity was robustly associated with a reduced risk of CIND in women, and specifically of VCI-ND. Despite a significant effect previously reported for Alzheimer's disease in this cohort [6], we did not find a significant association between physical activity and MCI.

Our data must be interpreted with caution. Although the CSHA is a large, representative sample, 19% died during the 5-year follow-up period. People who

Acknowledgements

Funding for these analyses comes from the Canadian Institutes of Health Research (MOP62823) and from the Fountain Innovation Fund of the QEII Research Foundation, Halifax. Susan Kirkland receives support through a Clinical Scholar Award from the Faculty of Medicine at Dalhousie University. Kenneth Rockwood is also supported by the Dalhousie Medical Research Foundation as Kathryn Allen Weldon Professor of Alzheimer Research.

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Prevention of CIND by physical activity: Different impact on VCI-ND compared with MCI

Abstract

Background

Objectives

Methods

Results

Conclusion

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgements

Neurobiol Aging

Lancet

Lancet Neurol

Lancet

Neurobiol Aging

The acute versus the chronic response to exercise

Med Sci Sports Exerc

Voluntary exercise decreases amyloid load in a transgenic model of Alzheimer's disease

J Neurosci

Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older

Ann Intern Med

Physical activity and risk of cognitive impairment and dementia in elderly persons

Arch Neurol

Physical activity, APOE genotype, and dementia risk: findings from the Cardiovascular Health Cognition Study

Am J Epidemiol

Study sampling in the Canadian Study of Health and Aging

Int Psychogeriatr

The Modified Mini-Mental State (3MS) examination

J Clin Psychiatry