“And a one and a two. . .”: Exercise as a way to improve Alzheimer’s (World Alzheimer Awareness Day)

Posted on September 21, 2015 by

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Alzheimer’s disease is the leading cause of dementia and the fifth leading cause of death for those 65 and older write Casey, Antimisiaris, and O’Brien in their 2010 article in Pharmacy and Therapeutics, “Drugs for Alzheimer’s Disease: Are They Effective?”

I imagine everyone nows by no that the journey involves progressive cognitive loss and impairment until the sufferer can no longer can for him or herself.  There’s not a big reason for hope. Of the five drugs approved by the FDA to manage Alzheimer’s disease (or AD),  the authors point out that the drugs are “supportive or palliative rather than curative or disease-modifying therapies, and they do not appear to alter the final outcome of the disease.”

This remains true, three years after publication.  But their following statement may no longer be correct. Write the authors, “As of this writing, no alternatives to these medications are available.”

As of this writing, it is just possible–or just starting to be possible–to examine the very beginnings of an alternative.

Principal investigator Deborah E. Barnes, PhD, MPH, and her fellow researchers did exercise with a small group of older people exhibiting cognitive impairment.

Now, Barnes shared with Medscape that this wasn’t just touching your toes and doing jumping jacks and situps (much as we all love those activities). Actually, she claimed, standard exercise programs have improved physical function in those with dementia (something’s better than nothing)–but people don’t know about how exercise affects the mind and cognition. (Frankly, I don’t feel any smarter when I run in place; in fact, I feel rather like a fool, but that’s for another time. And this is another program entirely–no lifting barbels weighing more than my 12-year-old niece.)

Barnes et. al. created a totally novel program,  titled Preventing Loss of Independence through Exercise, which–quite elegantly, I thought–had the acronym PLIÉ.  Barnes told Medscape that the program, “combines the best elements of eastern and western exercise traditions including yoga, tai chi, Feldenkrais, physical therapy, occupational therapy, mindfulness, and dance movement therapy.”

The tiny study was 18-weeks long: 6 patients with mild to moderate dementia who were in an adult day care program received PLIE sessions 3 days a week. They were compared with 5 patients who received the usual care.

Barnes emphasized  that a crucial component of PLIÉ was its work on supporting procedural memory via repetition of the same sequence of simple movements, whose complexity increases over time.

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Internal Medicine News quoted Dr. Barnes as saying that, “We know that memory for events is impaired in people with dementia, but procedural memory is actually maintained pretty well. What we found in the class was that people would come in after they’d been doing it a few weeks. They would not remember having been in the class before, but we would start going through the movements, and they knew exactly what do to. They knew which movement came next in the sequence, so they were building procedural memory for these movements.”

The researchers claim that the results show improvement in:

  • cognitive and physical function,
  • quality of life, and
  • reduction in caregiver burden.

Interestingly, Barnes published a piece in April’s JAMA on a remarkably similar topic, but with no cross-reference that I could see (in the spirit of full disclosure: I only read the abstract).

 

I recall (from 4 paragraphs ago) that her last pilot was quite small, so this time I was pretty impressed to hear the researchers were willing to work with 126 adults who were both inactive and had cognitive issues. It didn’t sound like a fun work-out class.

Now, I share with you the Interventions, because I think it’s the honest, upright thing to do as a blogger–even though by the time they got to the “MA-I/whatever-in-the-world-they’re-talking-about,” I was totally lost.   I hope you enjoy:

“All participants engaged in home-based mental activity (1 h/d, 3 d/wk) plus class-based physical activity (1 h/d, 3 d/wk) for 12 weeks and were randomized to either mental activity intervention (MA-I; intensive computer) or mental activity control (MA-C; educational DVDs) plus exercise intervention (EX-I; aerobic) or exercise control (EX-C; stretching and toning); a 2 × 2 factorial design was used so that there were 4 groups: MA-I/EX-I, MA-I/EX-C, MA-C/EX-1, and MA-C/EX-C.”

You got that?

Once again it was all good news. To cut to the chase [and, to be honest, I usually do skip down to the Discussion/Conclusion–stats are not my thing], they found: “In inactive older adults with cognitive complaints, 12 weeks of physical plus mental activity was associated with significant improvements in global cognitive function. . .”

If this works across the board–hooray!  Not only does the patient get to dance, but her mind dances, too.  The striking results reveal new neural pathways that may open a door that’s been locked for too long,