Public Release:  A 'heart healthy' diet and ongoing, moderate physical activity may protect against cognitive decline

Alzheimer's Association

Vienna, July 14, 2009 - Eating a "heart healthy" diet and maintaining or increasing participation in moderate physical activity may help preserve our memory and thinking abilities as we age, according to new research reported today at the Alzheimer's Association 2009 International Conference on Alzheimer's Disease (ICAD 2009) in Vienna.

"We can't do anything about aging or family history, but research continues to show us that there are lifestyle decisions we all can make to keep our brains healthier, and that also may lower our risk of memory decline as we age," said William Thies, PhD, Chief Medical & Scientific Officer at the Alzheimer's Association.

Dietary Approaches to Stop Hypertension (DASH) Eating Pattern May Reduce Age-Related Cognitive Decline

The Dietary Approaches to Stop Hypertension (DASH) diet is often recommended by physicians to people with high blood pressure or pre-hypertension. The DASH diet eating plan has been proven to lower blood pressure in studies sponsored by the National Institutes of Health. High blood pressure is considered a risk factor for Alzheimer's and dementia.

Heidi Wengreen, RD, PhD, Assistant Professor of Nutrition at Utah State University, and colleagues examined associations between how closely people adhered to the DASH diet and risk of cognitive decline and dementia among older participants in the Cache County Study on Memory, Health and Aging.

In 1995, 3,831 study participants 65 years of age or older completed a survey that included a food frequency questionnaire and cognitive assessment. Cognitive function was checked again during four assessments over 11 years using the Modified Mini-Mental State examination (3MS), which is graded on a 100 point scale. A DASH diet adherence score was created based on consumption levels of nine food-group/nutrient components -- fruit, vegetables, nut/legumes, whole grains, low-fat dairy, sodium, sweets, non-fish meat, and fish. Participants were ranked by DASH score into five groups, or quintiles.

The researchers found that higher DASH scores were associated with higher scores for cognitive functioning at the beginning of the study and over time. Those in the highest quintile scored 1.42 points higher at baseline and 1.81 points higher after 11 years on the 3MS than did those in the lowest quintile of the DASH score (p-values < 0.001).

They also found that four of the nine food-group/nutrient components used to create the DASH score were independently associated with 3MS scores -- vegetables, whole grains, low-fat dairy, nut/legumes. The scientists created a diet adherence score based on just these four components which they then tested for association with changes in cognitive abilities on the 3MS. Those in the highest quintile scored 1.72 points higher at baseline and 3.73 points higher after 11 years than did those in the lowest quintile of the four-component score (p-values < 0.001).

"Our results suggest that including whole grains, vegetables, low-fat dairy foods, and nuts in one's diet may offer benefits for cognition in late life," Wengreen said. "However, we need more research before we can confidently say how much of these foods to include in your diet to experience some benefit."

Maintaining or Increasing Activity Levels May Slow Cognitive Decline in Elderly

Studies have found that older adults who are physically active may experience slower rates of cognitive decline. Less is known about the impact of changes in physical activity levels on rate of cognitive decline.

Deborah E. Barnes, PhD, MPH, Assistant Professor of Psychiatry at the University of California, San Francisco, and a geriatrics researcher at the San Francisco VA Medical Center, and colleagues studied changes in levels of both physical activity and cognitive function over seven years in 3,075 white and black elders aged 70-79 years in the Health, Aging and Body Composition Study. Physical activity was assessed based on self-reported number of minutes walked per week at the beginning of the study and after two, four, and seven years of follow-up. Participants were classified at each time point as sedentary (0 minutes per week), low (less than 150 minutes per week) or high (150 minutes per week or more). Changes over time were classified as consistently sedentary, maintaining (low or high), decreasing, or increasing/fluctuating. Cognitive function was assessed using the 3MS.

The researchers found that 21% of study participants were consistently sedentary, 12% maintained their activity levels, 26% had declining levels, and 41% had increasing or fluctuating levels. After adjustment for age, sex, race, education, study site, diabetes, hypertension, smoking, alcohol consumption and baseline 3MS score, they found that the mean rate of decline in 3MS scores was 0.62 points/year in those who were consistently sedentary, 0.54 points/year (p=0.30) in those with declining activity levels, 0.44 points/year (p=0.01) in those with increasing/fluctuating activity levels, and 0.40 points/year (p=0.04) in those who maintained their activity levels.

"We found that older adults who were sedentary throughout the study had the lowest levels of cognitive function at the beginning and experienced the fastest rate of cognitive decline," Barnes said. "Cognitive decline also was faster in those whose physical activity levels consistently declined during the study period."

According to the researchers, sedentary elders who began new aerobic exercise programs experienced improvements in cognitive function, especially the ability to process complex information quickly. "Sedentary individuals should be encouraged to engage in physical activity at least occasionally," Barnes said. "People who are currently active should be encouraged to maintain or increase their activity levels."

Moderate Long-Term Physical Activity May Improve Late Life Cognition; Long-Term Strenuous Activity May Increase Risk of Cognitive Impairment

Long-term strenuous physical activity has been shown to decrease lifetime exposure to ovarian hormones in women and has been found to play a protective role against breast cancer. However reduction in ovarian hormone exposure has been associated with increased risk of cognitive impairment. At the same time, long-term physical activity is associated with improved cognition but the intensity required to preserve cognition is not known.

Mary C. Tierney, PhD, CPsych, Professor of Family and Community Medicine at the University of Toronto, and Senior Scientist and Director, Geriatric Research Unit, Brain Sciences Program at Sunnybrook Health Sciences Centre, and colleagues sought to examine the associations between both long-term strenuous and moderate activity levels and cognition in recently postmenopausal women.

Study participants were 90 women aged 50-63 years, one to 10 years post natural menopause, with no history of breast cancer, HRT use, psychiatric disorder, dementia or other neurological condition. Participants gave details on the amount of their strenuous and moderate physical recreational activities from high school to menopause. Eight memory and brain function tests were administered to all participants.

After adjusting for age, education, reproductive years, cigarette smoking, alcohol consumption, parity, and periods of amenorrhea, the researchers found that long-term strenuous activity was consistently associated with poorer performance on all eight of the tests; with statistically significant results on tests of semantic memory, working memory, delayed verbal recall, and sustained attention (p < 0.05). Moderate physical activity was consistently associated with better performance on all eight of the tests, with statistically significant results on cognitive flexibility, working memory, and sustained attention (p < 0.05).

"Our results suggest that long-term strenuous activity may increase the risk of cognitive impairment in recently postmenopausal women," Tierney said. "On the other hand, moderate long-term physical activity may improve later life cognition. These preliminary findings have important implications for women's health and support the need for large-scale studies including both women and men."

Alzheimer's Risk Gene May Reduce Benefits of Physical Activity to Cognitive Ability

While the relationship of physical activity with cognitive performance as we age is a subject of considerable research, much less is known about how this relationship is impacted by the Alzheimer's risk gene Apolipoprotein E (APOE). The APOE gene comes in three types, or alleles, known as e2, e3, and e4. Each person gets one type of APOE from each parent, making the possible combinations: e2/e2, e2/e3, e2/e4, e3/e3, e3/e4, e4/e4. Having two copies of e4 conveys the highest risk for Alzheimer's; having one e4 also raises one's risk. E3 is the most common type. E2, though rare, is thought to be protective.

Thomas Obisesan, MD, MPH, FAAFP, Chief of the Division of Geriatrics at Howard University Hospital and professor of medicine at Howard University College of Medicine, Washington, D.C., and colleagues examined this issue using data from The Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). They identified 1,799 men and women age 60 and older who had data on levels of aerobic-related physical activity (AR-PA), such as walking, jogging, bicycling or swimming; mental status test scores; and APOE genotype.

In their analysis, the researchers found that physical activity was associated with enhanced cognitive function, and that this relationship was differentially influenced by the person's APOE genotype: non-E4 carriers and people with one copy of E4 performed better than people with two copies of E4. After adjusting for age, ethnicity, severe chronic medical illness, lean body mass, and education, aerobic physical activity continued to show a statistically significant association with cognitive function in non-E4 carriers but not in people with E4 (any combination)

"In our nationally representative sample, persons who reported higher levels of aerobic physical activity had better memory than those who reported no such activity. This was especially true in those people who didn't have the APOE-e4 Alzheimer's risk gene," Obisesan said.

"Because physical activity is a low-cost, low-risk, readily available intervention, it may prove to be an important public health strategy to reduce or prevent memory loss and other symptoms of mental decline in the elderly. Future rigorous clinical trials are needed to confirm these findings," Obisesan added.

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About ICAD 2009

The 2009 Alzheimer's Association International Conference on Alzheimer's Disease (ICAD 2009) brings together more than 3,000 researchers from 70 countries to share groundbreaking research and information on the cause, diagnosis, treatment and prevention of Alzheimer's disease and related disorders. As a part of the Association's research program, ICAD 2009 serves as a catalyst for generating new knowledge about dementia and fostering a vital, collegial research community. ICAD 2009 will be held in Vienna, Austria at Messe Wien Exhibition and Congress Center from July 11󈝼.

About the Alzheimer's Association

The Alzheimer's Association is the leading voluntary health organization in Alzheimer care, support and research. Our mission is to eliminate Alzheimer's disease through the advancement of research, to provide and enhance care and support for all affected, and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer's. For more information, visit www.alz.org.

Heidi Wengreen, et al -- DASH diet adherence scores and cognitive decline and dementia among aging men and women: Cache County study of Memory Health and Aging (Funders: National Institute on Aging, Utah State University Agriculture Experiment Station)

Deborah Barnes, et al - The impact of changes in physical activity levels on rate of cognitive decline in a biracial cohort of non-demented elders (Funder: National Institutes of Health)

Mary Tierney, et al - Intensity of long-term physical activity and later life cognition in postmenopausal women (Funders: Women's Health Student Experience, Women's College Hospital, University of Toronto; Geriatric Research Unit, Sunnybrook Health Sciences Centre)

Thomas Obisesan, et al - Aerobic-related physical activity interacting with apolipoprotein E genotypes, is associated with better cognitive function in a nationally representative sample: The Third National Health and Nutrition Examination Survey (NHANES III) (Funder: National Institutes of Health)

All materials to be presented at the 2009 Alzheimer's Association International Conference on Alzheimer's Disease (ICAD 2009) are embargoed for publication and broadcast until the date and time of presentation at the International Conference on Alzheimer's Disease, unless the Alzheimer's Association provides written notice of change of embargo date/time in advance.

All materials to be presented at the 2009 Alzheimer's Association International Conference on Alzheimer's Disease (ICAD 2009) are embargoed for publication and broadcast until the date and time of presentation at the International Conference on Alzheimer's Disease, unless the Alzheimer's Association provides written notice of change of embargo date/time in advance.

Control #: 09-A-1909-ALZ O3-02 - Epidemiology 2, Presentation #O3-02-04; Speaking Time: 7/14/2009, 3:45 - 4:00 PM

DASH diet adherence scores and cognitive decline and dementia among aging men and women: Cache County study of Memory Health and Aging.

Heidi J. Wengreen, Chailyn Nelson, Ronald Munger, Christopher Corcoran
Cache County Study Investigators, Utah State University, Logan, UT, USA.

Contact e-mail: heidi.wengreen@usu.edu

Disclosure Block: H.J. Wengreen, None; C. Nelson, None; R. Munger, None; C. Corcoran, None.

Background: The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is recommended in the current dietary guidelines for Americans.

Methods: We prospectively examined associations between DASH diet adherence scores and risk of cognitive decline and dementia among aging men and women of the Cache County Study on Memory, Health and Aging. In 1995, 3831 residents 65 years of age or older completed a baseline survey that included a food frequency questionnaire and cognitive assessment. Cognitive function was assessed using the Modified Mini-Mental State examination (3MS) during four assessments spanning 11 years. A DASH diet adherence score (DASH score) based on nine food-group/nutrient components (fruit, vegetables, nut/legumes, whole grains, low-fat dairy, sodium, sweets, non-fish meat, and fish) was calculated. Multivariable mixed effects models were used to examine change in average 3MS score over time across increasing quintiles of the DASH score.

Results: Higher DASH scores were associated with higher 3MS scores at baseline and over time. Those in the highest quintile scored 1.42 (0.32) points higher at baseline and 1.81 (0.28) points higher after 11 years than did those in the lowest quintile of the DASH score (p-values < 0.001). Four of the nine food-group/nutrient components used to create the DASH score were independently associated with 3MS scores (vegetables, whole grains, low-fat dairy, nut/legumes; p-values = 0.037, 0.013, 0.005, < 0.001). A 4-component diet adherence score was computed and associations were examined across increasing quintile of the 4-component score. Those in the highest quintile scored 1.72 (0.38) points higher at baseline and 3.73 (0.26) points higher after 11 years than did those in the lowest quintile of the 4-component score (p-values < 0.001). Those in the highest quintile of the 4-component score had lower risk for dementia than did those in the lowest quintile, but this finding was only significant for those without an APOE e4 allele (hazard ratio, 0.39; 95% confidence interval, 0.19, 0.82).

Conclusions: Adhering to the DASH eating pattern, and especially focusing on consuming recommended amounts vegetables, nut/legumes, whole grains, and low-fat dairy products may help to attenuate age-related cognitive decline and decrease risk for dementia among the elderly.

All materials to be presented at the 2009 Alzheimer's Association International Conference on Alzheimer's Disease (ICAD 2009) are embargoed for publication and broadcast until the date and time of presentation at the International Conference on Alzheimer's Disease, unless the Alzheimer's Association provides written notice of change of embargo date/time in advance.

Control #: 09-A-652-ALZ O2-02 - Epidemiology 1, Presentation #O2-02-04; Speaking Time: 7/13/2009, 3:45 - 4:00 PM

The impact of changes in physical activity levels on rate of cognitive decline in a biracial cohort of non-demented elders

Deborah E. Barnes1, Eleanor M. Simonsick2, Tamara B. Harris2, Jennifer Brach3, Sandra K. Pope4, Kristine Yaffe1, for the Health ABC Study

1University of California, San Francisco, and San Francisco VA Medical Center, San Francisco, CA, USA; 2National Institute on Aging, Baltimore, MD, USA; 3University of Pittsburgh, Pittsburgh, PA, USA; 4University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Contact e-mail: Deborah.Barnes@ucsf.edu

Disclosure Block: D.E. Barnes, E.M. Simonsick, T.B. Harris, J. Brach, S.K. Pope, K. Yaffe - None.

Background: Prior studies have found that older adults who are physically active experience slower rates of cognitive decline. Less is known about the impact of changes in physical activity levels on rate of cognitive decline.

Methods: Subjects were participants in the Health, Aging and Body Composition Study, a prospective study of 3,075 non-demented, white and black elders (age 70-79 years) recruited from two U.S. communities. Physical activity was assessed based on self-reported number of minutes walked per week (min/wk) at baseline and after 2, 4 and 7 years of follow-up and classified at each time point as sedentary (0 min/wk), low (< 150 min/wk) or high (≥150 min/wk, based on the U.S. Surgeon General's recommended guidelines). Changes over time were classified as being consistently sedentary, maintaining (either low or high), decreasing, or increasing/fluctuating. Cognitive function was assessed at the same time points using the Modified Mini-Mental State (3MS) Examination, a global measure of cognition with a maximum score of 100. Repeated measures random effects regression was used to estimate differences between physical activity groups in baseline 3MS scores and rate of decline.

Results: Twenty-one percent of subjects were consistently sedentary while 12% maintained their activity levels, 26% had declining levels and 41% had increasing or fluctuating levels. After adjustment for age, sex, race, education, study site, diabetes, hypertension, smoking, alcohol consumption and baseline 3MS score, the mean rate of decline in 3MS scores was -0.62 points/year in those who were consistently sedentary compared to -0.54 points/year (p=0.30) in those with declining activity levels, -0.44 points/year (p=0.01) in those with increasing/fluctuating activity levels and -0.40 points/year (p=0.04) in those who maintained their activity levels (Figure).

Conclusions: Non-demented elders who maintained or increased their activity levels at some point during follow-up experienced significantly slower rates of cognitive decline than those who were consistently sedentary or whose activity levels declined. These findings suggest that older adults may be able to minimize their rate of cognitive decline by maintaining or increasing their physical activity levels. This research was supported in part by the Intramural Research Program of the NIH, National Institute on Aging and by NIA contract #s: N01-AG-6-2101, N01-AG-2103, N01-AG-6-2106.

All materials to be presented at the 2009 Alzheimer's Association International Conference on Alzheimer's Disease (ICAD 2009) are embargoed for publication and broadcast until the date and time of presentation at the International Conference on Alzheimer's Disease, unless the Alzheimer's Association provides written notice of change of embargo date/time in advance.

Control #: 09-A-649-ALZ P3 - Tuesday Posters, Presentation #: P3-116; Speaking Time: 7/14/2009, 12:30 - 3:00 PM

Intensity of long-term physical activity and later life cognition in postmenopausal women

Mary C. Tierney1, Rahim Moineddin2, Judith Manson1, Angela Morra2, Jennifer Blake1

1Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; 2University of Toronto, Toronto, ON, Canada.

Contact e-mail: mary.tierney@sunnybrook.ca

Disclosure Block: M.C. Tierney, None; R. Moineddin, None; J. Manson, None; A. Morra, None; J. Blake, None.

Background: Long-term strenuous physical activity decreases lifetime exposure to ovarian hormones in women and has been found to play a protective role against breast cancer; however reduction in ovarian hormone exposure has been associated with increased risk of cognitive impairment. Long-term physical activity has been found to be associated with improved cognition but the intensity required to preserve cognition is not known. Our purpose was to examine the associations between both long-term strenuous and moderate activity levels and cognition in recently postmenopausal women.

Methods: Participants were 90 women aged 50-63 years, 1 to10 years post natural menopause, with no history of breast cancer, HRT use, psychiatric disorder, dementia or other neurological condition. Participants provided information on the amount of strenuous and moderate physical recreational activities in which they engaged during successive periods from high school to menopause. Summary measures of each type of physical activity were constructed. Neuropsychological tests measuring memory and frontal lobe functioning were also administered.

Results: Linear regression analyses were conducted for each of 8 neuropsychological outcome measures, adjusted for age, education, reproductive years, cigarette smoking, alcohol consumption, parity, and periods of amenorrhea, to control for potential effects on outcome and exposure to ovarian hormones. Strenuous and moderate activity levels were both included in each of the 8 regression models. Long-term strenuous activity was consistently associated with poorer performance on all 8 of the neuropsychological measures: significant negative associations at p < 0.05 were found on tests of semantic memory, working memory, delayed verbal recall, and sustained attention. Moderate activity was consistently associated with better performance on all 8 of the outcome measures: significant positive associations at p < 0.05 were found on tests of cognitive flexibility, working memory, and sustained attention.

Conclusions: Long-term strenuous activity may increase the risk of cognitive impairment in recently postmenopausal women. Thus strenuous physical activity, while protective for breast cancer, may have deleterious effects on later life cognition whereas moderate long-term physical activity may improve later life cognition. The consistency of the direction of the relationships of these preliminary findings has important implications for lifestyle recommendations and supports the need for large-scale longitudinal studies including both women and men.

All materials to be presented at the 2009 Alzheimer's Association International Conference on Alzheimer's Disease (ICAD 2009) are embargoed for publication and broadcast until the date and time of presentation at the International Conference on Alzheimer's Disease, unless the Alzheimer's Association provides written notice of change of embargo date/time in advance.

Control #: 09-A-1904-ALZ P2 - Monday Posters, Presentation #P2-105; Speaking Time: 7/13/2009 12:30 - 3:00 PM

Aerobic-related physical activity interacting with apolipoprotein E genotypes, is associated with better cognitive function in a nationally representative sample: The Third National Health and Nutrition Examination Survey (NHANES III)

Thomas O. Obisesan, Jamie Hamilton, Richard F. Gillum Howard University, Washington, DC, USA.

Contact e-mail: tobisesan@howard.edu

Disclosure Block: T.O. Obisesan, None; J. Hamilton, None; R.F. Gillum, None.

Background: The interactive effects of aerobic-related physical activity (AR-PA) with Apolipoprotein E (APOE) genotypes on cognitive performance, are yet to be examined in a nationally representative US sample. Whether this relationship is influenced by age, is a subject of much debate. We test the hypothesis that AR-PA is associated with enhanced cognitive performance, and that this relationship is differentially influenced by APOE genotypes and age, using a nationally representative US sample (The Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994)).

Methods: We analyzed data from 7159 persons, age ≥60 who participated in NHANES III. From this sample, 1799 older American men and women had data on AR-PA, Short Portable Mini Mental Status Examination (Sp-MMSE) and important co-variates, and were genotyped at the APOE locus. Self-reported socio-demographics and biochemical measurements were also obtained.

Results: In the entire sample, AR-PA associated with enhanced cognitive function, and this relationship was differentially influenced by APOE genotypes, with non-E4 carriers and E4 heterozygote performing better than E4 homozygote. Initial regression analysis adjusted for age, ethnicity, severe chronic medical illness, lean body mass (LBM), and education showed statistically significant association of AR-PA with cognitive function (age-group 60-69: β=0.52±0.18; P=0.007); and (age-group ≥ 70: β=0.56±0.23; P=0.022), respectively, in non-E4 but not in E4 carriers (age-group 60-69: β=0.01±0.2352; P=0.95); and (age-group ≥ 70: β=0.58±0.35; P=0.109), respectively. With additional adjusted for mobility limitation, the association of AR-PA with cognitive performance in non-E4 carriers though became slightly attenuated, remained statistically significant in age-group 60-69 (β=0.43±0.16; P=0.014) and tended towards significance in the older age-group ≥ 70 (β=0.37±0.23; P=0.117). Whereas mobility limitation (proxy measure for sedentary lifestyle) showed a strong but negative association with cognitive function (β= -0.78±0.16; P < 0.001) in non-E4 carriers aged ≥ 70, the difference did not reach significance level in the remaining groups.

Conclusions: In a nationally representative sample, AR-PA associated with better cognitive performance, an effect that predominated in non-E4 APOE genotype group and likely influenced by age. Collectively, our observation adds to growing evidence that increased levels of AR-PA may offer an important intervention strategy to attenuate cognitive decline as the population ages.

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