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Tesi etd-02252016-192748

Thesis type
Tesi di dottorato di ricerca
Effectiveness of cognitive and physical training in slowing progression to dementia: a clinical and experimental study. Focus on relationship with cardiovascular fitness
Settore scientifico disciplinare
Corso di studi
tutor Dott.ssa Sicari, Rosa
Parole chiave
  • endothelial function
  • demenza
  • dementia
  • compromissione cognitiva
  • cognitive impairment
  • arterial stiffness
  • funzione endoteliale
  • allenamento
  • rigidit√† arteriosa
  • training
Data inizio appello
Riassunto analitico
Physical activity is beneficial to vascular health; on the other hand, vascular damage is associated with cognitive impairment. Both physical activity and a cognitively stimulating environment are known to delay the onset of dementia. The Train The Brain study evaluated the effectiveness of a comprehensive program of physical training and mental activity in delaying cognitive decline in elderly people with initial cognitive impairment, at the same time investigating the relationship between physical, vascular, neurological, and cognitive fitness.<br>Elders age 65-89 with were recruited with the help of family physicians and territorial services. All participants underwent a neurological and cardiologic evaluation. Carotid-femoral pulse wave velocity and carotid pressure were measured with the SphygmoCor system (AtCor, Australia). Longitudinal ultrasound scans of the common carotid were performed and 10-second video clips were recorded to be analysed offline through the Cardiovascular Suite software (Quipu srl, Italy), with the computation of diameter, intima-media thickness, wall cross-sectional area, distensibility coefficient, and elastic modulus. The latter software was used also to measure endothelial function through flow mediated dilation (FMD) of the brachial artery. Subjects classified as mild cognitive impairment at the neurological examination were randomized either to standard care, or a 7-month program of physical training and environmental stimulation (lectures, games, music, social activities) three hours a week. The evaluation was then repeated.<br>Data were obtained for 54 patients who underwent training and 36 controls. The intervention was successful in improving cognitive function as measured through the ADAS-Cog score: 11.95 (3.86) to 13.00 (4.73) for no training, 14.32 (4.27) to 12.85 (4.03) for training, time x treatment p&lt;0.001. Pulse wave velocity showed no significant effect (p=0.5). FMD improved with intervention (no training: 3.20 (2.03) to 2.50 (1.77) %; training: from 2.82 (2.19) to 3.42 (1.82); p=0.014). All selected carotid parameters were influenced by the combination of time and treatment,<br>in a diverging trend, at a statistically significant level, with intervention determining less dilated, less thick and less stiff vessels. None of the parameters measured analysing the vessels showed a correlation <br>The proposed 7-months program improved cognitive function in elders with initial cognitive impairment. There was a significant difference in behaviour in time of the two groups as for endothelial function and carotid enlargement, wall thickening and arterial stiffening. The intervention seems to oppose the typical harmful effects of aging on vessels; at the same time, the positive effects on cognition and vascular health do not appear as directly correlated.<br>