A Prospective Examination of the Relationship between Physical Activity and Dementia Risk in Later Life

Abstract

Purpose.

To examine the relationship between vigorous physical activity and dementia risk.

Design.

Prospective study design utilizing physical activity data from the Health and Retirement Study and cognitive outcome data from the Aging, Demographics, and Memory Study.

Setting.

Community-based.

Subjects.

Adults age 71 and over (N = 808) with 3 to 7 years of physical activity information prior to dementia/no dementia diagnosis.

Measures.

Physical activity was measured by participation in vigorous activities such as aerobics, sports, running, bicycling, and heavy housework three or more times per week (yes/no). Dementia diagnosis was based on an expert panel (e.g., neuropsychologists, neurologists, geropsychiatrists) who performed and reviewed a battery of neuropsychological tests.

Analysis.

Binary logistic regression models were used to account for demographic characteristics, genetic risk factors (one or two apolipoprotein E ε4 alleles), health behaviors (e.g., smoking, drinking alcohol), health indicators (body mass index), and health conditions (e.g., diabetes, heart disease) in a sequential model-building process.

Results.

The relationship between vigorous physical activity and dementia risk remained robust across models. In the final model, older adults who were physically active were 21% (p ≤ .05) less likely than their counterparts to be diagnosed with dementia.

Conclusion.

Vigorous physical activity may reduce the risk for dementia independently of the factors examined here. This study's findings are important given that few preventative strategies for dementia have been explored beyond hormonal therapy and anti-inflammatory drugs.

Keywords

Cognition Health Behavior Exercise Genetic Association Studies Longitudinal Data Alzheimer's Disease Prevention Research Manuscript format: research Research purpose: modeling/relationship testing Study design: nonexperimental Outcome measure: cognitive Setting: state/national Health focus: fitness/physical activity Strategy: education,skill building/behavior change,incentives,policy Target population age: seniors Target population circumstances: education/income level

Get full access to this article

View all access options for this article.

References

Ewbank

. Deaths attributable to Alzheimer's disease in the United States. Am J Public Health. 1999;89:90–92.

Ferri

Prince

Brayne

. Global prevalence of dementia: a Delphi consensus study. Lancet. 2005;366:2112–2117.

Plassman

Langa

Fisher

. Prevalence of dementia in the United States: the Aging, Demographics, and Memory Study. Neuroepidemiology. 2007;29: 125–132.

Federal Interagency Forum on Aging-Related Statistics, Older Americans 2008: Key Indicators of Well-Being. Washington, DC: US Government Printing Office;2008.

Di Carlo

Baldereschi

Amaducci

. Cognitive impairment without dementia in older people: prevalence, vascular risk factors, impact on disability. The Italian Longitudinal Study on Aging. J Am Geriatr Soc. 2000;48:775–782.

Larson

Shadlen

Wang

. Survival after initial diagnosis of Alzheimer disease. Ann Intern Med. 2004;140:501–509.

Evans

Beckett

Field

. Apolipoprotein E epsilon4 and incidence of Alzheimer disease in a community population of older persons. JAMA. 1997;277:822–824.

Kuller

Shemanski

Manolio

. Relationship between ApoE, MRI findings, and cognitive function in the Cardiovascular Health Study. Stroke. 1998;29:388–398.

Notkola

Sulkava

Pekkanen

. Serum total cholesterol, apolipoprotein E epsilon 4 allele, and Alzheimer's disease. Neuroepidemiology. 1998;17:14–20.

10.

Martins

Oulhaj

de Jager

Williams

. APOE alleles predict the rate of cognitive decline in Alzheimer disease. Neurology. 2005;65:1888–1893.

11.

Fratiglioni

Grut

Forsell

. Prevalence of Alzheimer's disease and other dementias in an elderly urban population: relationship with age, sex, and education. Neurology. 1991;41:1886–1892.

12.

Wilson

Mendes De Leon

Barnes

. Participation in cognitively stimulating activities and risk of incident Alzheimer disease. JAMA. 2002;287:742–748.

13.

Kivipelto

Ngandu

Fratiglioni

. Obesity and vascular risk factors at midlife and the risk of dementia and Alzheimer's disease. Arch Neurol. 2005;62:1556–1560.

14.

Peters

Poulter

Warner

. Smoking, dementia and cognitive decline in the elderly, a systematic review. BMC Geriatrics. 2008;8:36.

15.

Larson

Wang

Bowen

. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann Intern Med. 2006; 144:73–81.

16.

Laurin

Verreault

Lindsay

. Physical activity and risk of cognitive impairment and dementia in elderly persons. Arch Neurol. 2001;58:498–504.

17.

Okumiya

Matsubayashi

Wada

. Effects of exercise on neurobehavioral function in community-dwelling older people more than 75 years of age. J Am Geriatr Soc. 1996;44:569–572.

18.

Abbott

White

Ross

. Walking and dementia in physically capable elderly men. JAMA. 2004; 292:1447–1453.

19.

Colcombe

Erickson

Scalf

. Aerobic exercise training increases brain volume in aging humans. J Gerontol A Biol Sci Med Sci. 2006;61:1166–1170.

20.

US Department of Health and Human Services, Can Alzheimer's disease be prevented? In Aging NIoHNIo, ed. The Alzheimer's Project. NIH Publication No. 09-5503. Silver Spring, Md: National Institutes of Health, National Institute on Aging;2009:7–9.

21.

Broe

Creasey

Jorm

. Health habits and risk of cognitive impairment and dementia in old age: a prospective study on the effects of exercise, smoking and alcohol consumption. Aust N Z J Public Health. 1998;22:621–623.

22.

Verghese

Lipton

Katz

. Leisure activities and the risk of dementia in the elderly. N Engl J Med. 2003;348:2508–2516.

23.

Hill

Storandt

Malley

. The impact of long-term exercise training on psychological function in older adults. J Gerontol. 1993;48:P12–P17.

24.

Pate

Pratt

Blair

. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273:402–407.

25.

Sumic

Michael

Carlson

. Physical activity and the risk of dementia in oldest old. J Aging Health. 2007;19:242–259.

26.

Etminan

Gill

Samii

. Effect of non-steroidal anti-inflammatory drugs on risk of Alzheimer's disease: systematic review and meta-analysis of observational studies. BMJ. 2003;327:128.

27.

Hogervorst

Yaffe

Richards

Huppert

. Hormone replacement therapy to maintain cognitive function in women with dementia. Cochrane Database Syst Rev. 2009. Issue 1, Art. No. CD003799. DOI: 10.1002/14651858.CD003799.pub2.

28.

Heeringa

Connor

. Technical Description of the Health and Retirement Study Sample Design. Ann Arbor, MI: Institute for Social Research,University of Michigan. HRS/AHEAD documentation report DR-0021995.

29.

Langa

Plassman

Wallace

. The Aging, Demographics, and Memory Study: study design and methods. Neuroepidemiology. 2005;25:181–191.

30.

Plassman

Khachaturian

Townsend

. Comparison of clinical and neuropathologic diagnoses of Alzheimer's disease in 3 epidemiologic samples. Alzheimers Dement. 2006;2:2–11.

31.

Gerst

Michaels-Obregon

Wong

. The impact of physical activity on disability incidence among older adults in Mexico and the United States. J Aging Res. 2011. doi:10.4061/2011/420714.

32.

Martinez

. Body-weight regulation: causes of obesity. Proc Nutr Soc. 2000; 59:337–345.

33.

World Health Organization Consultation on Obesity Obesity: Preventing and Managing the Global Epidemic. Geneva, Switzerland: World Health Organization;2000.

34.

Barry

Eathorne

. Exercise and aging. Issues for the practitioner. Med Clin North Am. 1994;78:357–376.

35.

Brandt

Folstein

. Differential cognitive impairment in Alzheimer's disease and Huntington's disease. Ann Neurol. 1988;23:555–561.

36.

Folstein

McHugh

. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12:189–198.

37.

McArdle

Smith

Willis

. Cognition and Economic Outcomes in the Health and Retirement Survey. Cambridge, Mass: National Bureau of Economic Research;2009.

38.

Ofstedal

Fisher

Herzog

. Documentation of Cognitive Functioning Measures in the Health and Retirement Study. Ann Arbor, Mich: Survey Research Center, University of Michigan;2005. HRS documentation report DR-006.

39.

Pierce

Madden

Siegel

Blumenthal

. Effects of aerobic exercise on cognitive and psychosocial functioning in patients with mild hypertension. Health Psychol. 1993;12:286–291.

40.

Stampfer

Colditz

. Physical activity and risk of stroke in women. JAMA. 2000;283:2961–2967.

41.

Ross

Petrovich

White

. Characterization of risk factors for vascular dementia: the Honolulu-Asia aging study. Neurology. 1999;53:337–343.

42.

Friedland

Fritsch

Smyth

. Patients with Alzheimer's disease have reduced activities in midlife compared with healthy control-group members. Proc Natl Acad Sci U S A. 2001;98:3440–3445.

43.

Penedo

Dahn

. Exercise and well-being: a review of mental and physical health benefits associated with physical activity. Curr Opin Psychiatry. 2005;18:189–193.

44.

Stern

. What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc. 2002;8: 448–460.

45.

Cotman

Engesser-Cesar

. Exercise enhances and protects brain function. Exerc Sport Sci Rev. 2004;30:75–79.

46.

Gomez-Pinilla

Kesslak

. Spatial learning and physical activity contribute to the induction of fibroblast growth factor: neural substrates for increased cognition associated with exercise. Neuroscience. 1998;85:53–61.

47.

van Praag

Christie

Sejnowski

Gage

. Running enhances neurogenesis, learning, and long-term potentiation in mice. Proc Natl Acad Sci U S A. 1999;96:13427–13431.

48.

Colcombe

Erickson

Raz

. Aerobic fitness reduces brain tissue loss in aging humans. J Gerontol A Biol Sci Med Sci. 2003;58:176–180.

49.

Flicker

McCaul

Hankey

. Body mass index and survial in men and women aged 70 to 75. J Am Geriatr Soc. 2010;58:234–241.

50.

Heiat

Vaccarino

Krumholz

. An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons. Arch Intern Med. 2001;161:1194–1203.

51.

Janssen

Mark

. Elevated body mass index and mortality risk in the elderly. Obes Rev. 2007;8:41–59.

52.

Villareal

Banks

Siener

. Physical frailty and body composition in obese elderly men and women. Obes Res. 2004;12:913–920.

53.

Barrera

Bunout

Gattas

. A high body mass index protects against femoral neck osteoporosis in healthy elderly subjects. Nutrition. 2004;20:769–771.

54.

Johnson

Wilkins

Morris

. Accelerated weight loss may precede diagnosis in Alzheimer disease. Arch Neurol. 2006;63:1312–1317.

55.

Bennett

Wilson

Schneider

. Education modifies the relation of AD pathology to level of cognitive function in older persons. Neurology. 2003;60: 1909–1915.

56.

Bretsky

Buckwalter

Seeman

. Evidence for an interaction between apolipoprotein E genotype, gender, and Alzheimer disease. Alzheimer Dis Assoc Disord. 1999;13:216–221.

57.

Fisher

. Social desirability bias and the validity of indirect questioning. J Consum Res. 1993;20:303–315.

58.

Bowles

FitzGerald

Morrow

Jr . Construct validity of self-reported historical physical activity. Am J Epidemiol. 2004;160: 279–286.

59.

Doody

Stevens

Beck

. Practice parameter: management of dementia (an evidence-based review). Neurology. 2001; 56:1154–1166.

60.

Nelson

Rejeski

Blair

. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116:1094–1105.

61.

Centers for Disease Control and Prevention. Prevalence and trends data; physical activity. 2009. Available at: http://apps.nccd.cdc.gov/brfss/index.asp. Accessed January 6, 2011.

62.

Stuck

Walthert

Nikolaus

. Risk factors for functional status decline in community-living elderly people: a systematic literature review. Social Sci Med. 1999;48:445–469.

63.

Comas-Herrera

Wittenberg

Pickard

Knapp

. Cognitive impairment in older people: future demand for long-term care services and the associated costs. Int J Geriatr Psychiatry. 2007;22:1037–1045.