To me the interesting bit is the underlying study showed exercise increased the dementia's progression and was actually harmful. What mechansism's behind that result?
Having gone through three parents+in laws including one we actively caretook in home with this terrible disease I'm not surprised. The progression seemed unstoppable and sickened us while not aiding the parents. The allusion to the victim in a train barrelling through a dark increasingly confusing countryside is so apt.
> To me the interesting bit is the underlying study showed exercise increased the dementia's progression and was actually harmful. What mechansism's behind that result?
I'm no expert, but the association I had was a podcast I listened once with someone interested in life extension (I think it was on a Tim Ferriss podcast). They spoke about "mTOR activation" (IIRC), the basic idea was that having muscles is good (because they increase the need for glucose, helping the pancreas and the liver in regulating it), but building muscles is potentially harmful, because it causes a release of growth hormone, and essentially speeds up metabolism (and hence aging).
Don't quote me on this, and I'm sure there's better sources of this information out there than me. Does this ring a bell to anyone?
Exercise causes the body to produce more anti-oxidants to counteract the greater oxidative stress that comes from faster metabolism, thus preventing aging over time.
The increment is too close to the noise level, so to reach any conclusion it's probably better to wait until there is better study with a clear result. IANAMD.
> ADAS-cog results run on a scale from 0 to 70, with higher scores suggesting greater impairment. The usual-care group had an average score of 23.8, compared with 25.2 for the exercise group (adjusted estimate -1.4, 95% confidence interval [CI] -2.6 to -0.2).
They have to repeat the study with more patients to be able to reduce the error estimation in the average. (Or run study for a longer time so the increment or decrement effect accumulates and it's easier to measure.) But if the first study had no interesting result it may be more difficult to get the foundlings for another similar study.
This is one of those teachable moments;
The administration of this experiment may have affected the results. After the first 4 months there was no change, and after 12 it was slightly worse for those who were made to exercise. Maybe the disruptive nature of the experiment ended up affecting the subjects' mood. Maybe those who were just asked questions found the light interaction pleasurable, staving off deterioration just slightly.
The results are weak at best and completely biased at worse.
This is an interesting one (referring to the title itself and its broad message, rather than actual details which many will never read) -- because: part of me is happy to see actual research reported, regardless of how positive/negative it is to us as humans, possibly helping to balance out a lot of the (perceived) over-reporting of "x may be the cure to y". Of course, the other part of me is sad, because it likely triggers a lot of people to make false decisions (exercise is a chore to many, including me), and it's super easy to mute that motivation-to-exercise with a quick "I read it's not as healthy as they said it was anyway, so...". Considering the context people will be reading a highly-editorialsed version of this in the form of trashy glam magazines, side-columns and Facebook shares in month's time, that is.
Except if you're in a family with a sick parent and you wonder whether you should encourage more exercise or not. Much more important than bar room banter.
I agree with that easy statement. But you have to make decisions, even when there is no science at all.
What is your estimate of the right control group size should be, for such a study?
I am learning from that study that, on 494 patients, they found no clear cut link between exercise and dementia evolution. Are you saying there is a clear cut one?
Maybe there is a link, but if it was very significant, hopefully the study would have detected a correlation.
My bottom-line for my life: don't focus on pushing physical exercise if your loved one has dementia, there is no clear cut link detected today. It is interesting as for some, their "intuition" may make them believe there is one.
Please correct which part of my reasoning is wrong here. I am talking about real life, not a conversation at a bar.
Just wanted to report back that I had a chat with my mother a few minutes ago, mentioning the article, and she'd already seen it on TV, and said she'd always felt the excercise craze is overrated (not joking). That's her conclusion, her entire summary of this news item. She'd never come across the original article.
I find this phenomenon similar to many other diseases. A certain diet or lifestyle works wonders in preventing it. But if you have it, there is little you can do to treat it outside of medical treatment. Eg diabetes, kidney failure, cancer.
This is not only an important point in itself, but could be an interesting way to look at medicine: to model it as a process where something overflows. (I don't know what I mean more precisely than that.)
> It's important to note this does not change what we know about exercise's ability to protect against dementia. People who exercise more are less likely to get dementia, possibly because it maintains blood flow to the brain.
Exercise can delay the onset of dementia. I wasn't aware it has been claimed to slow its progress.
Sadly, there aren't any randomized controlled trials showing that exercise can delay the onset of dementia.
There are observational studies that associated exercises with delayed onset of dementia, but they cannot show the direction of causality - it could be that people who are healthier and not at risk for dementia tend to exercise more as a result.
There are RCTs showing improvement in cognitive function in healthy older adults, which one might hope means that the onset of dementia is delayed - but that has not actually been shown.
IIRC most "slow the onset" things are basically building up enough "reserve" that the symptoms aren't immeditely obvious.
If you're well educated, alert (maybe from exercise?) and so on then the early signs of dementia may just be less obvious. If you forget a few names but can do the cryptic crossword or run a mile then relatives will not push you to get tested.
It is more that the higher you start the more your cognition can decline before you have symptoms that are bad enough to be diagnosed. If you started out with a youthful g of 150 and you declined to 100 then no doctor would even notice, but if you started at 75 then a decline to 65 will be catastrophic.
This makes me wonder if there are easier ways to get more blood flow to the brain and enjoy the protective benefit, such as sleeping with your legs up every night, or showering with very warm water every morning and evening.
There is considerable nervous system involvement in safe exercise. I wonder if playing a twitchy video game would have similar cognitive effects. If hand-eye coordination can improve in teens, I don't see why it can't improve in dementia patients and improved coordination might mask some symptoms.
The assumption is exercise results in higher blood flow which does "something". I know its easier to concentrate when you have practice concentrating, and for many boring people, exercise might be their only daily experience with concentrating, aside from the rare occasional dementia testing. Possibly forcing concentration on a regular basis (via exercise, or whatever alternative) results in better cognitive test results.
I suppose a lot depends on defining exercise as staring at a TV while walking on a treadmill vs playing racquetball.
In all honesty, I'm surprised to find that exercise is not beneficial to something. In seemingly every case, living+exercise > living. I'm sure these researchers were thinking the same when they designed the study.
"Is he in bad shape? Eh, chuck in some exercise, that's gotta help."
>The researchers said their exercise programme "does not slow cognitive decline in people with mild to moderate dementia".
> They were recruited through memory clinics – specialist services that help people who have problems with their memory – and GP surgeries. Carers were asked to take the decision on behalf of people whose dementia meant they were unable to.
I think we have to be very careful about what these researchers characterize as "mild to moderate dementia". I would contend that people who are forced to seek professional help - let alone those who are unable to make decisions for themselves, are beyond the point of "mild to moderate dementia". A good argument could be made that the vast majority of people with "mild" dementia are not under professional care and do not require a caretaker to make decisions for them. They are forgetful, absentminded, and/or showing other "mild" symptoms of dementia.
Caregiver informed consent (and participant assent) for research is common when working with populations with significant cognitive impairment. Human research review committees essentially always require that to protect participants.
You're certainly right that lots of people with early stage dementia are community living and not diagnosed.
>populations with significant cognitive impairment.
"Significant cognitive impairment" should not be characterized as, "mild dementia". If it is too difficult to recruit people with mild dementia for a study, then they should report their results as being relevent to only those with "moderate" dementia.
The diagnostic criteria for mild dementia are significant cognitive impairment that interferes with activities of everyday living. There are plenty of people still living at home with a caregiver/spouse, and people living at home on their own that meet these criteria.
> It's important to note this does not change what we know about exercise's ability to protect against dementia. People who exercise more are less likely to get dementia, possibly because it maintains blood flow to the brain.
> However, once the brain has been damaged by dementia, exercise may not help prevent further damage.
After reading the study, it seems like they just made some people aged over 70, with progressed dementia, get light exercise twice a week for 4 months. That's it.
Unsurprisingly, there wasn't much of a difference.
Personally I'm pissed at the way this study is presented. It makes a lot of people falsely assume that exercise is useless, while it's definitely not.
Unless you have one foot in the grave and more than mild dementia, exercise is probably still good for you. In fact the study concludes nothing for longer periods or different modes of exercise, even for people this old and with dementia already onset.
Sending an old man to the gym for "mild-to-moderate intensity" aerobic exercise is a bad idea in the first place.
"People who exercise more are less likely to get dementia, possibly because it maintains blood flow to the brain. "
Or, perhaps, people who are able to exercise and have the drive and foresight to exercise regularly for years don't have early stages of dementia. Unless a study has been done that randomized persons at age 40-50 to 'exercise' and "no exercise" groups, and followed them for 30-40 years, this is a hard question to answer. Following groups of people who self-sort themselves into exercisers and non-exercisers does not answer this question, as the exerciser group may include less early-dementia persons (ie those 20-30 years from a clinical diagnosis, but who may be experiencing early behavioral changes that are not diagnostic).
You’re right but you should have included decent sources in your initial comment.
Sadly the vegan crowd overlaps too much with the pseudoscientific new age/alt med/antivaxxers crowd, so skeptical types are quick to dismiss any suggestion that such a diet is healthier.
And people generally don’t like to hear that eating meat is bad for them anyway.
If anyone is interested in why you instinctively react so negatively to the idea that your diet is unhealthy and unnecessarily wasteful/harmful, there’s a great Ted Talk on it: https://youtube.com/watch?v=o0VrZPBskpg
Ah yes, livekindly.co and the freelance journalist. The CNN article that's the meat (hah) and potatoes of that link suggests that it's not a vegan but a Mediterranean style diet with some dairy and also chicken, turkey, and fish included.
Having gone through three parents+in laws including one we actively caretook in home with this terrible disease I'm not surprised. The progression seemed unstoppable and sickened us while not aiding the parents. The allusion to the victim in a train barrelling through a dark increasingly confusing countryside is so apt.