Maybe You Can't Exercise Your Way Out of Dementia?
POSTED ON 8/28/2018 IN Research BY Chris Centeno
Dementia is one of the biggest chronic health problems facing industrialized society. However, we all have a sense that maybe if we're active enough, eat right, and stay away from too much alcohol, we can dodge the dementia bullet. Today and later this week, I'll cover two recent studies. One that shows that this may be a pipe dream and the other that shows that strategy may work.
Dementia and Its Many Forms
There are many different classifications of dementia (e.g., Alzheimer's dementia, vascular dementia, dementia with Lewy bodies, frontotemporal lobar degeneration, etc.), but in all of its forms, dementia defines neurodegenerative diseases in which brain cells, or neurons, become damaged or die. Dementia-type disease processes are degenerative, irreversible, and both develop and progress at a slow rate. Dementia can be genetic. Digging deeper into the genetic association, research recently found that dementia with Lewy bodies, for example, has its own individual genetic makeup, separate from other dementia diseases, such as Alzheimer's or Parkinson's. While we'd known this about the other dementias, finding that Lewy Body has its own progressive genetic disease was disturbing. Environmental factors, such as toxins, drugs, and so on, may also increase the risk for or intensify dementia, especially if one is already genetically susceptible.
Environmental Risks Associated with Dementia
One recent study linked general anesthesia used for surgery to an increased risk of dementia. This was especially relevant in patients who at some point in their lives had experienced delirium (i.e., a state of severe confusion, restlessness, incoherent thought, etc.) following a surgery. Another study supported this, finding up to a 60% increased risk for dementia attributed to general anesthesia during a prior surgery. Living with chronic pain has also been linked to dementia risk. A study comparing those with chronic pain to those without found 9% more cognitive decline in those with pain that was predicted to greatly accelerate over time. This is one of many reasons addressing pain rather than resigning yourself to live with it may be so critical. In recent years, the condition of the gut microbiome has become front and center in our quest for good health. Studies have also discovered close connections between the brain and gut, and an unhealthy diet that includes things such as artificial sweeteners makes the gut a very unhealthy environment. One study found direct links between the condition of the gut and the condition of the brain, suggesting an unhealthy gut increases the risk of dementias, such as Parkinson's and Alzheimer's. These are just a drop in the bucket of the many environmental risks we come into contact with as we go through life. Lowering your environmental risks is a good start to proactively addressing brain health, especially if you do have that genetic risk, but what if dementia is already an issue? Some studies have suggested exercise can be helpful, while many others have suggested the opposite. Our feature study today seeks to answer or at least add clarity to the question, "Does exercise improve dementia?"
Does Exercise Improve Dementia?
With multiple small studies (many of them animal based) providing a variety of conflicting information either concluding exercise improves dementia or it doesn't, the purpose of the new study was to perform a high-level randomized controlled trial to analyze the effect of physical activity on dementia in a human population. The study consisted of nearly 500 participants with dementia randomly separated into two groups. One group participated in an exercise program that included both strength training and aerobic exercise (at a moderate to high intensity) for four months, while the second group did not participate in an exercise program. Participants were followed for 12 months. The results? As would be expected, the group that exercised did have improvements in physical fitness levels. However both groups experienced the predictable worsening of their dementia over time. In fact, the exercise group experienced more of a decline in their cognitive function than the nonexercise group, though researchers weren't sure it was enough of a difference to be clinically relevant. In addition, there were no differences between the two groups in the number of falls, quality of life, or activities of daily living. The upshot? If you have dementia already, exercise doesn't seem to help. On Thursday, however, I'll review a recent dementia study that points in the opposite direction. After all, that's why science is so interesting. Study A finds X while study B finds Y. Stay tuned...
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