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Exercise program may help patients with mild to moderate dementia: what if this program is the overlooked 'drug' for dementia?


SAN DIEGO -- Men and women with mild to moderate dementia who participated in a small pilot study involving a novel exercise program focused on movements required to maintain functions of daily living experienced improvements in cognitive function, physical performance, and caregiver burden, compared with those who did not participate.

"Currently available medications do not stop or slow progression of Alzheimer's disease," Deborah E. Barnes, Ph.D., said at the annual meeting of the American Academy of Neurology. "They are associated with small improvements in cognitive function, but they have minimal impact on physical function, quality of life, and caregiver burden."

Speaking in hypothetical terms, Dr. Barnes continued, "What if we had an overlooked drug that was clinically proven in randomized, controlled trials to increase cognitive function and hippocampal volume in older adults, slow cognitive decline in individuals with mild cognitive impairment, enhance neurogenesis, and reduce beta-amyloid in animal models?

"That would be pretty amazing. What if this drug also had other health benefits throughout the body and had minimal side effects?"

This candidate "drug," she proposed, is a program known as Preventing Loss of Independence Through Exercise (PLIE), which was developed by Dr. Barnes and her associates at the Osher Center for Integrative Medicine at the University of California, San Francisco.

The program combines elements of Eastern and Western exercise traditions and focuses on performing basic functional movements, increasing body awareness, and encouraging social engagement, she said.

In a pilot trial, the researchers studied 11 adults with mild to moderate dementia who attended an adult day care program in San Francisco. They were assigned to either the PLIE intervention group, which met 2-3 days per week for 18 weeks, or to a usual care group. Blinded assessors administered a battery of tests pre- and postintervention to study participants and their caregivers. Measures used for participants included the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) to measure cognitive function, the Quality of Life in Alzheimer's Disease (QoL-AD) tool to measure quality of life, and the Short Physical Performance Battery (SPPB) to measure physical function.

Measures used for caregivers included the Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory (ADCS-ADL) to measure participant function, the QoL-AD to measure participant quality of life, the Neuropsychiatric Inventory Questionnaire to measure the frequency and severity of dementia-related symptoms (NPI-FS), as well as the NPI Caregiver Distress Scale (NPI-D).

The researchers also administered the Caregiver Burden Inventory (CBI).

Of the 11 study participants, 6 were assigned to the intervention group and 5 to usual care. The average age of participants was 84 years, and most (82%) were female. The mean age of caregivers was 56 years. The majority (82%) were daughters who had been caring for their parent for 3-4 years.

After 18 weeks, the intervention group had a decline of 4.6 points on the ADAS-cog (with lower scores being better) while the usual care group had an increase of 2.4 points on the measure, for an effect size of 0.76. "This is a substantially higher treatment effect than what's usually seen with dementia medications, which is usually around the order of 0.20," noted Dr. Barnes of the department of psychiatry at UCSF. In addition, scores on the QoL-AD improved 6 points in the intervention group and 2.6 points in the usual care group, for an effect size of 0.83. Scores on the SPPB improved 1 point in the intervention group and 0.2 points in the usual care group, for an effect size of 0.34.

"Although these effect sizes were not statistically significant because of the small sample size, they were well within the clinically meaningful range," she said.

There were no real differences for caregiver test measurements on participant function as measured by the ADCS-ADL scale, but caregiver-reported participant quality of life as measured by the QoL-AD improved 2.2 points in the intervention group, compared with 0 points in the usual care group, for an effect size of 0.33. For frequency and severity of the dementia-related symptoms on the NPI-FS, the intervention group declined 3.4 points, compared with 3 points for the usual care group, for an effect size of 0.02.

Caregiver distress as measured by the NPI-D improved in the intervention group with a decline of 2.3 points, compared with an increase of 0.5 points in the usual care group, for an effect size of 0.28. There was an effect size of 0.49 for the PLIE intervention on the CBI, based on a decline of 5.5 points in the exercise group and an increase of 1.7 points in the usual care group.

Dr. Barnes speculated that the PLIE program is effective in part "because there are repetitions of the same sequence of events in each class. 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 program incorporates simple functional movements that increase in complexity as participants become "more facile with the movements, really focusing on being able to stand and sit down safely--basic physical functions that decline in dementia. We also have a slow pace, which gives them enough time to absorb the information and consolidate it."

The study was funded by a gift to the Osher Center for Integrative Medicine at the University of California, San Francisco. Dr. Barnes said she had no relevant financial disclosures.


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Author:Brunk, Doug
Publication:Family Practice News
Geographic Code:1U9CA
Date:Apr 15, 2013
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