Influence Of Physical Activity On Cognitive Impairment In Elderly Patients With Dementia - An Essay.

Abstract

Does physical activity reduce cognitive impairment in the elderly with dementia?

The research proposal aims at conducting clinical study for evaluating the influence of physical activity on the cognitive impairment of elderly patients affected with dementia. Indeed, dementia prevalently occurs in aged population and treatment requires heavy investment for reducing the clinical manifestations. Limited research conducted until date for identifying the patterns of life style changes and physical exercise for reducing the cognitive manifestations among patients affected with dementia. However, the evidence based research literature reveals the effectiveness of physical activity in reducing the risk of cognitive impairment across elderly population. The proposed clinical study intends to record the physical activity of elderly demented patients affected with cognitive decline and over the course of time the brain activity of elderly patients effectively captured through EEG and MRI interventions followed by the clinical interview to determine the influence of the proposed physical activity on the mental enhancement of the target population. The proposed qualitative research study requires execution for tenure of three months in the clinical setting under the supervision of clinical investigator. Indeed, 200 randomly selected patients suffering from dementia and cognitive impairment require undergoing systematic exercise sessions assisted by physiotherapists and the outcomes of the sessions require effective recording by the healthcare professionals facilitating the clinical study. The findings of the clinical study require strategic meta-analysis with the application of SPSS software for potentially identifying the impact of the physical activities in reducing the cognitive decline among the demented patients. The research findings will validate the contention advocating the positive influence of physical activity on the reduction in cognitive decline of the affected patients.       

The evidence based clinical literature advocates the contention indicating the positive influence of physical activity in reducing the risk of cardiovascular and cerebral manifestations (Wahlund, Erkinjuntti & Gauthier, 2009, p. 159). Therefore, the potential influence of physical activity on the neurophysiological status of individuals in terms of enhancing patterns of cognition and intellect require prospective analysis for devising clinical strategies in reducing cognitive impairment. Clow and Edmunds (2014, p. 188) describe physical activity as non-pharmacological intervention utilized for mitigating manifestations of Alzheimer’s disease and Dementia. Martin and Preedy (2015) describe the concomitant existence of cognitive decline with the patterns of dementia among affected patients. Therefore, the direct influence of physical activity on the cognitive impairment of demented elderly patients requires conducting prospective qualitative research study in controlled environment across clinical setting.  

The clinical study in the controlled environment requires prospective execution in a UK based hospital by a team of neurophysiologists for comparing and contrasting the neurodegenerative patterns, cerebral atrophy, white matter changes and small vessel disease before and after inducing physical exercise among the study subjects. The effective tracking of these clinical findings followed by the clinical interview with study subjects will determine the extent of behavioural and cognitive modification following the consistent physical activity sessions conducted throughout the tenure of research study. The organization of the study across hospital environment will ensure effective tracking of the study findings by clinicians and radiologists in the controlled environment. The random selection of study subjects will ascertain minimizing study bias and reducing inaccuracies in the clinical outcomes. The study findings will undoubtedly assist the research community in improvising non-therapeutic interventions and physical exercise sessions for improving the patterns of cognition among elderly patients affected with dementia episodes.   

Background

The evidence based clinical literature describes the patterns of cognitive decline among individuals of higher age groups affected with normal aging or episodes of vascular dementia (Panza,  Solfrizzi  & Capurso, 2004, p. 15). Tuokko and Hultsch (2006, p. 64) describe the contention revealing the development of mild cognitive impairment among elderly individuals under the absence of dementia episodes. The research findings reveal the pathophysiology of cognitive impairment under the influence of advancing age with or without the presence of dementia patterns or other developmental abnormalities of brain. The cognitive impairment also relates with the development of Alzheimer’s disease, brain trauma and cerebrovascular accident as evidenced by the clinical literature. The manifestations of cognitive impairment attribute to the patterns of visual disturbances, memory loss, judgemental problems and behavioural alterations. Indeed, definitive therapeutic interventions warranted for treating cognitive manifestations in accordance with the mental abnormalities. However, the determination of direct influence of lifestyle changes and physical activity on cognitive manifestations still requires conducting prospective clinical studies in controlled environment in terms of evaluating mental outcomes and modifications in the brain physiology of the target population. Biddle, Mutrie and Gorely (2015, p. 135) describe weaker links between the impact of physical activity on the cognitive impairment of the younger population. Some research studies reveal the probable enhancement in academic achievement following the physical exercise among population pertaining to younger age groups; however the evidences are yet inconclusive and warrant conducting further studies for re-evaluating the contention. The causal association between physical activity and predisposition of older population toward developing cognitive decline supported by research studies; however, the improvement of cognition under the influence of physical activity among demented elderly people yet requires conducting prospective studies for devising non therapeutic treatment strategies in controlling dementia manifestations. Indeed, the significant aspects of the influence of types of physical activities on physical fitness and the mode of action of physical activity on the reaction time and cognitive adaptability require effective validation while determining the influence of physical activity on the mental enhancement of demented patients. Furthermore, the impact of the social and physical environment of the individuals on the patterns of physical activity and its subsequent influence on cognitive function need evaluation in the controlled environment for evaluating the different aspects of cognitive enhancement of patients’ population. The differential analysis between the positive influences of physical activity on various disease conditions, cognitive dysfunction and predisposition toward developing cognitive decline require effective validation to explore the non – therapeutic aspects of cognitive impairment among patients affected with various mental conditions.   

Lazarov et al. (cited in Yaffe, 2013, p. 188) describe the significance of physical activity in enhancing the patterns of neurogenesis across the elderly brain. The preclinical studies also contend the partial reduction in age associated neurogenesis with the enhancement of physical activity among the target population. However, these research studies exhibit inconsistencies in terms of variations in cognitive improvement measured between target populations of various age groups in controlled situations. The influence of physical activity on the clinical outcomes of dementia in terms of sustained alteration in anti – oxidative defense pathways of brain need in-depth analysis while determining the its actual influence on cognitive decline among elderly demented patients. Indeed, exploration of biochemical mechanisms related to the patterns of physical activity on the cognitive function, mental health and predisposition toward developing dementia would open up new gateways to strategize the non-therapeutic treatment interventions for mitigating the adverse cognitive outcomes in elderly patients affected with cognitive reduction under the influence of pre – existing dementia. This would further require analysing the cumulative effect of other clinical comorbidities including metabolic syndromes, cerebral inflammation, oxidative decline and vascular disorders on impairment of memory and cognition among the elderly demented patients. The analysis of the cerebral mechanisms indicating enhancement of cerebral vascularity and hippocampal volume with the initiation of physical activity will identify new paradigms in terms of devising patterns of physical activity for treating various mental conditions including cognitive decline and dementia. McNamara (2011, p. 78) evaluates the findings from clinical studies indicating the reduced predisposition among elderly individuals in terms of developing dementia under the influence of physical activity. Another contention revealing the influence of physical activity during middle age on the cognitive decline in later stages of life explored through various clinical studies revealed evidences advocating the potential influence of physical exercise in early stages of life in reducing the predisposition toward cognitive impairment in later stages. However, the age specific variations in cognitive improvement under the influence of physical activity require further exploration in terms of prospective clinical studies. Indeed, the concrete clinical evidences indicating the direct improvement in cognitive adaptability and predisposition, or delay in cognitive impairment are still missing in evidence based clinical literature and require conducting prospective studies for exploring the clinical outcomes. The evidence based clinical literature reveals the multifactorial – complex mechanisms attributing to the influence of physical activity on the cognitive enhancement of elderly population. Indeed, the reduction of vascular disruption with the exercise induced neurotrophic enhancement of brain activity facilitated by neurophysiological repair processes improves cognition among demented patients as evidenced by the research studies. The moderate evidences in relation to the influence of physical activity on the cognitive enhancement of elderly demented population warrant the need of conducting qualitative research studies on the larger scale for preventing the state of cognitive decline and predisposition toward developing dementia in the older ages. The evidence based clinical literature demonstrates the influence of cardiovascular comorbidities on the cognitive status of the demented population (Mancia, Grassi & Redon, 2014, p. 185). However, direct causal relationship between the influence of physical exercise and reduction in cardiovascular predisposition provides some insight in terms of conducting clinical trials for exploring direct linkage between the potential effects of physical activity and cognitive enhancement of elderly demented population. Acevedo and Ekkekakis (2006, p. 47) reveal the positive impact of physical activity training on the executive control processes of the aged population. Indeed, the executive control procedures include the activities pertaining to scheduling, task coordination, working memory, interference control and planning. The evidence based literature further describes the consistent decline of these processes among human population with the progression of the aging process. The effective delineation of the substantial decline of these executive cognitive functions due to age vs. dementia highly required for devising mitigating strategies in reducing cognitive reduction resulting under the influence of dementia episodes across the elderly population. Further clinical studies reveal the protective influence of physical activity on the cognition and verbal memory of the middle aged individuals; however, the degree of brain fitness enhancement from physical activity among elderly individuals require further exploration in terms of clinical studies for recording the improvement in brain potential through EEG following the physical activity.

The research objective in the context of evidence based clinical literature relates to identifying the effect of physical activity on cognitive impairment of the elderly demented individuals. The interference of physical activity on dementia and cognitive impairment in terms of improving the mental outcomes and positive influence on white matter changes requires effective evaluation in the clinical setting under controlled conditions.        

The qualitative randomized clinical study will focus on performing multifactorial analysis of the influence of physical activity on the cognitive outcomes of the demented patients in the controlled environment. Indeed, 200 study subjects suffering from dementia and cognitive impairment, and pertaining to age groups between 65 – 75 years require prospective selection randomly from various multispecialty hospitals across United Kingdom. The degree of dementia and cognitive impairment need thorough analysis with the application of MRI and EEG interventions. The brain potentials and white matter changes of the selected subjects require analysis and initial findings need to be captured in clinical database with the commencement of the study. Three months of regular physical exercise sessions for the research subjects require effective organization in clinical setting for a tenure of three months following which the MRI and EEG investigation repeated and contrasted with the initial findings. Furthermore, the clinical interview requires to be conducted at the time of enrolment of participants for evaluating their executive status and dementia rating. Indeed, the formal cognitive assessment through the clinical interview will focus on evaluating the orientation, attention, memory, language, executive function, praxis and visuospatial orientation of the target population (Cooper and Greene, 2005). The comparative analysis of both clinical assessments will indeed assist in determining the changes in memory and cognition of the target population following the exercise/physical activity intervention during the clinical study. The study subjects require random bifurcation into two equal groups A and B; however, group A will actively undertake physical activity session contrary to group B that will remain under observational mode throughout the study. The comparative analysis of the clinical findings between both groups will assist in determining patterns of cognitive alterations following the exercise induction among the target population.         

Participants

The rationale of the clinical study follows the effective evaluation of the influence of physical activity on the cognitive impairment of demented patients. The inclusion criteria of the research study follows the below mention convention:

1. The prospective participants correspond to age groups between 65 – 75 years.
2. The participants undergoing treatment for Dementia under various medical specialties.
3. The sustained level of cognitive decline observed in the research participants and evident through clinical interview and MRI/EEG interventions.
4. The research participants must be capable of effectively performing activities of daily living without any external assistance.   

The exclusion parameters contend the following pre-requisites:

1. Patients suffering from cardiovascular comorbidities.
2. Patients affected with gastrointestinal and cerebral malignancies.
3. Physically disabled patients.

The qualitative nature of clinical study ascertains the accuracy in clinical findings with added flexibility in research configuration. The findings by Willis, Inman and Valenti (2010, p. 223) reveal the utilization of multiple-methods, critical multiplism, theoretical pluralism and interdisciplinary approaches in qualitative research models. The proposed clinical study also intends to employ the blend of clinical approaches including comparative analysis between MRI, EEG and clinical interview findings to track and evaluate the improvement in cognitive decline following the exercise intervention.  

Indeed, obtaining informed consent from each research participant is a prerequisite for initiating the clinical study. Chin and Lee (2008, pp. 28-29) describe the significance of informed consent in clinical studies for retaining the autonomy and dignity of the research subjects. The proposed study requires attaining informed consent from all participants for avoiding any kind of bias during the tenure of the clinical investigation. Indeed, informed consent is the preliminary ethical requirement for retaining patient’s autonomy in the clinical study (Ravina, 2012, p. 187).  

The clinical data requires collection electronically in medical database for its effective retrieval following the research intervention. The database requires funding from the sponsoring authorities for configuring site based electronic health records. The evidence based clinical literature documents electronic health records and government payer administrative data sets as preliminary sources of data for recording the clinical trial information (Institute of Medicine, 2010, p. 91). The acquisition of informed consent will also facilitate the ethical approval of research study in accordance with the international ethical standards.

The following clinical parameters retrieved through clinical interview require recording in medical database for their prospective analysis following the accomplishment of research study:

The comparative analysis of study findings between both groups of participants prior and after the study will track and identify the changes in mental function, cognition and vascular activity of brain following the systematized exercise sessions executed during the clinical study. The clinical findings among group A will determine the extent of cognitive improvement under study subjects following the physical activity; however, the findings with group B will indicate the cognitive stability or decline over the course of time in the absence of physical activity. The comparison of findings between both age groups will precisely identify the intensity and scope of cognitive alteration following the physical activity. The clinical variables require evaluation with the application of SPSS software for deriving the final conclusion. Verma (2013, p. 10) elaborates the capacity of SPSS software in effectively detecting data errors with the application of its descriptive statistics. The regression analysis, logical checks, standard deviation and minimum vs. maximum score pertaining to clinical findings will assist in statistically evaluating the percentage of cognitive improvement among demented patients under the influence of physical exercise. The analysis of confidence intervals and p – values will determine the authenticity of clinical study in evaluating the study findings.   

The proposed timetable for undertaking the research study categorically bifurcates each phase of study in accordance with the following convention:

The estimates cost incurred in executing the study attributes to $ 50, 000 in accordance with the expenses related to patients enrolment, clinical investigations, physical activity sessions, deployment of health care staff and other miscellaneous considerations.

Conclusion

The proposed research study will indeed track and evaluate the clinical links between the physical activity and its potential influence on the patterns of cognitive deficit among elderly patients affected with dementia episodes. The study protocol will undoubtedly define systematic patterns in context to the intensity of physical activity warranted to generate the clinical goals in terms of enhancing the cognition and mental capacity of the aged people suffering with dementia. The study will also delineate the cognitive decline under the influence of age advancement from the cognitive impairment resulting from sustained patterns of dementia among the target population. This will further facilitate the configuration of non – therapeutic clinical interventions (including diet management and exercise) for mitigating the cognitive manifestations among elderly population for prophylactically treating them to prevent the progression of dementia episodes. The particular focus on the improvement of demented patients’ executive functions by physical activity will indeed define new realm of medical therapeutics for treating the cognitive manifestations with the acquisition of minimal invasive techniques.  The clinical findings from the proposed study will enhance the scope of prospectively conducting qualitative and quantitative studies to validate and explore the definitive relationship between various types of physical activities and enhancement of brain’s vascularity and functional capacity in the community environment. The proposal holds promise in effectively identifying the influence of physical activities on the vascular enhancement, increase in the volume of grey matter, neurophysiological performance, plasticity, size and amyloid deposition in human brain. 

References

Acevedo, E.O. and Ekkekakis, P., 2006. Psychobiology of Physical Activity. USA: Human Kinetics.

Biddle, S.J.H., Mutrie, N. and Gorely, T., 2015. Psychology of Physical Activity: Determinants, Well-Being and Interventions (3^rd ed). New York: Routledge.

Chin, R. and Lee, B.Y., 2008. Principles and Practice of Clinical Trial Medicine. California: Academic Press.

Clow, A. and Edmunds, S., 2014. Physical Activity and Mental Health. USA: Human-Kinetics.

Cooper, S. and Greene, J.D.W., 2005. The clinical assessment of the patient with early dementia. J Neurol Neurosurg Psychiatry. Vol. 76, pp.15-24.

Institute of Medicine., 2010. Clinical Data as the Basic Staple of Health Learning:: Creating and Protecting a Good School. USA: The National Academies Press.

Mancia, G., Grassi, G. & Redon, J., 2014. Manual of Hypertension of the European Society of Hypertension (2^nd ed). USA: CRC

Martin, C.R. and Preedy, V.R., 2015. Diet and Nutrition in Dementia and Cognitive Decline. UK: Academic Press. 

McNamara, P. (2011). Dementia: Treatment and Developments. California: ABC – CLIO.

Panza, F., Solfrizzi, V. and Capurso, A., 2004. Diet and Cognitive Decline. New York: Nova Science.

Ravina, B., 2012. Clinical Trials in Neurology: Design, Conduct, Analysis. New York: Cambridge.

Tuokko, H.A. and Hultsch, D.F., 2006. Mild Cognitive Impairment: International Perspectives. USA: Psychology Press. 

Verma, J.P., 2013. Data Analysis in Management with SPSS Software. Springer: New York. 

Wahlund, L.O., Erkinjuntti, T. and Gauthier, S., 2009. Vascular Cognitive Impairment in Clinical Practice. New York: Cambridge. 

Willis, J., Inman, D. and Valenti, R., Completing a Professional Practice Dissertation: A Guide for Doctoral Students and Faculty. USA: IAP.

Yaffe, K. (2013). Chronic Medical Disease and Cognitive Aging: Toward a Healthy Body and Brain. New York: Oxford.