Using Multimodal Imaging to Examine the Neural Mechanisms of an Integrative Exercise Program for Individuals with Dementia
Abstract
The burden of Alzheimer?s disease (AD) and AD-related dementias (AD/ADRD) is enormous for affected individuals (an estimated 46.8 million people worldwide in 2015), caregivers, and healthcare costs (estimated to be $159-$215 billion in 2010, with a projected increase to $379-$511 billion in 2040 in the US). Across the Veterans Integrated Service Network (VISN), the estimated prevalence of AD/ADRD ranges from 5.8% to 9.4%. The incidence of dementia is expected to almost double worldwide every 20 years, to 74.7 million in 2030 and 131.5 million in 2050. Because currently available dementia medications have considerable side effects while offering only limited benefits, non-pharmacological interventions for dementia are highly desirable. Preventing Loss of Independence through Exercise (PLI�) is a non-pharmacological, multi-domain, integrative group exercise program developed by researchers at the University of California, San Francisco (UCSF) and the San Francisco Veterans Affairs Medical Center (SF VAMC) for individuals AD/ADRD. The development of PLI� was informed by basic neuroscience findings that individuals with AD/ADRD have a preserved ability to learn perceptual and motor skills through repeated exposure despite having an impaired ability to consciously recall new information. Thus, PLI� focuses on training perceptual and motor skills that build strength and enhance the capacity to perform the movements that are most needed for daily function (e.g., transitioning safely from sitting to standing) and help individuals with AD/ADRD maintain functional independence. Additionally, PLI� incorporates the ?best elements? from different Eastern and Western exercise modalities, particularly greater in-the-moment body awareness and social connection. We have pilot tested the PLI� intervention at an adult day program in San Francisco. Six seniors with mild to moderate AD/ADRD were randomly assigned to participate in the PLI� program for 18 weeks, 2 to 3 days/week (depending on their daily attendance at the adult day program) while five seniors with mild to moderate AD/ADRD were randomly assigned to engage in the standard chair-based exercises at the adult day program (i.e., Usual Care). Compared to seniors in the Usual Care group, seniors who took part in PLI� showed improved cognitive function (as assessed by the cognitive subscale of the Alzheimer?s Disease Assessment Scale), improved physical performance (as assessed by the Short Physical Performance Battery), and improved quality of life (as assessed by the Quality of Life in Alzheimer?s Disease questionnaire) at the end of 18 weeks. Importantly, PLI� also had a beneficial effect on the caregivers, who reported reduced caregiver burden and distress related to their loved one?s AD/ADRD behaviors. Based on the strength of this promising pilot data, the Department of Veterans Affairs? (VA?s) Office of Rehabilitation Research and Development awarded study co-investigator Dr. Deborah Barnes funding to conduct a randomized clinical trial of PLI�. However, the budget of the VA grant did not allow for a neuroimaging component to investigate PLI�?s underlying neural mechanisms. Therefore, the proposed study will take advantage of this time-limited opportunity to obtain neuroimaging data from participants enrolled in the VA-funded trial to examine PLI�?s effect on brain structure and brain function in individuals with AD/ADRD. We will accomplish this by acquiring neuroimaging data from PLI� trial participants who are eligible for magnetic resonance imaging (MRI) before and after they undergo 16 weeks of PLI� (for 1 hour, 2 days/week) or 16 weeks of Usual Care. The proposed study is innovative because it leverages the randomize-controlled design and infrastructure of a funded clinical trial to elucidate the neural mechanisms of a novel, non-pharmacological intervention that, in pilot testing, improved cognitive and physical function and quality of life in individuals
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Aug 07, 2017
- Source ID
- W81XWH1710490
Entities
People
- Linda L Chao
Organizations
- Northern California Institute for Research and Education
- United States Army