Physical fitness linked to lower cognitive impairment in dementia

Dr Eddy Davelaar from the Department of Psychological Sciences discusses the importance of physical fitness in offsetting cognitive impairment in adults with dementia.

 

Dementia and cognitive impairment cost the UK economy approximately £26 billion per year. The number of people with dementia in England and Wales has been projected to increase by 57% from 2016 to 2040, primarily because of extended life expectancy. Finding ways to slow its severity and progression could have life-changing effects for the 800,000 people estimated to be living with dementia in the UK.

With the increased incidence in dementia, people are interested to know whether it could be prevented through changes in their lifestyle, such as eating habits, exercise, and decreased environmental stress. Research does suggest that a healthy lifestyle lowers the risk of dementia. We were interested in physical fitness as one of the lifestyle factors. In our recent article published in Frontiers in Public Health, we asked the question of whether self-reported physical fitness is associated with cognitive, or thinking ability in people with dementia.

To assess this, we used a cross-sectional design with two groups. The first group was made up of 30 older individuals (aged 65+ years) with dementia, who were attending the Alzheimer’s café social events. Those people in the dementia group have lower cognitive performance than the 40 age-matched participants from our control group, who do not have dementia.

We tested everyone on a wide range of cognitive tests, such as verbal fluency, prospective memory, and clock drawing. We also administered a 15-item questionnaire on physical fitness, which asked about strength (eg. ability to lift things), balance, and aerobic conditioning (eg. taking a brisk walk or taking the stairs instead of lifts). Many studies have shown strong correlations between self-report and objective measures of physical fitness. In addition, this questionnaire is available to everyone for self-assessment.

Our findings showed that in the group of dementia patients, those with greater physical fitness also had a greater general cognitive ability. Even those patients with the best cognitive performance still performed worse than the healthy individuals, who did not show this link between physical and cognitive fitness. Thus, physical fitness seems to buffer dementia-related cognitive deterioration.

We ran a number of checks on the results and found that the association did not change when we controlled for the age of the participants, the number of years since dementia diagnosis, the type of dementia, or even whether the person used to be physically active when they were younger. The latter finding suggests that the current state of being physically fit and capable is key to observing this cognitive benefit.

There are at least two explanations for these findings. First, the cardiovascular hypothesis states that physical activity stimulates blood circulation in frontal-striatal circuits (neural pathways that connect frontal lobe regions with the basal ganglia that mediate motor, cognitive, and behavioural functions within the brain), that are critical in executive functioning, such as planning and reasoning.

A second hypothesis suggests that physical fitness measures, such as strength and balance, require efficient brain representations of motor plans. The processes by which these motor representations become more efficient also leads to enhanced cognitive representations. Both hypotheses underscore the expression, ‘what is good for the heart is good for the brain’.

We are currently in the process of addressing the question of whether physical fitness (using both self-report and objective measures) is associated with cognitive decline or cognitive impairment in the absence of dementia. This would assess whether greater physical fitness is associated with greater mental fitness in general, or with cognitive fitness specific in the context of dementia.

Future research could also extend this work using longitudinal study designs in order to address the question of whether a change in physical fitness is associated with a change in the risk of dementia, which has important implications for health policy and age-appropriate physical intervention programmes for both healthy individuals and dementia patients.

Read the original, peer-reviewed article: Increased Physical Fitness Is Associated with Higher Executive Functioning in People with Dementia (2017).

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Gender and Class in English Asylums, 1890-1914

This post was contributed by Dr Louise Hide, Honorary Research Fellow in Birkbeck’s Department of History, Classics and Archaeology.

In July 1905, a young draper’s assistant from south-east London was admitted to Bexley Asylum. Gertrude L. was 25 and this was her third admission into a lunatic asylum.

Initially, she was described as ‘strange and irrational in manner’. But by January 1906, she was corresponding with her friends on the outside. One letter that was copied and left in her case file provides an intriguing insight into asylum life from the patient’s point of view:

in this so called asylum … you are … treated like the worst form of cattle … We work all the hours God sends without proper nourishment or a proper bed … our hours of work are from 8 in the morn to 20 or 30 minutes past 7 in the evening … and you never see the colour of a copper coin.

From the 1960s to the late ‘80s, Marxist and feminist scholars set out to disabuse Whiggish historians of the notion that the understanding and treatment of mental illness had followed an uninterrupted upward trajectory called ‘progress’ from the late 18th century. As a result of this work, we know a great deal about why and how people were admitted to asylums, but far less about what actually happened to them once the ward door had been shut and the key turned.

What was life like inside these vast ‘monster’ institutions? And how were relationships between doctors, nurses and attendants, and patients constructed by shifting ideas around masculinity and femininity?

Book coverMy book, Gender and Class in English Asylums, 1890-1914, sets out to answer these questions through a detailed analysis primarily of asylum case notes, committee minutes and annual reports. I have focused on two institutions, Claybury and Bexley. Each was built for 2,000 patients by the newly formed London County Council and opened in 1893 and 1898 respectively.

The turn of the century was an important moment in asylum history. Late Victorian psychiatry was experiencing a ‘clinical turn’ away from the old prison-like asylums towards the new mental hospitals, from the ‘lunatic’ to the mental patient, the attendant to the nurse. That, at least, was the idea even though the reality took some time to catch up.

Location is important, too. London had far higher lunacy rates than any other part of the country. Why?

Migration into the city was one reason. Lack of space and desperate poverty was another; families were simply unable to look after members who could not contribute to the household budget. But there was another reason, too: the abhorrent notion of degeneracy, which claimed that physical, mental and moral ‘defects’ (criminality, prostitution etc.) were passed on from one generation to another, creating an increasingly ‘unfit’ population. And this hereditary ‘taint’ was believed to be particularly prevalent in large, overcrowded urban areas, such as London.

Indeed, degeneracy theory fed directly into eugenics, making the early 20th century one of the darkest periods of psychiatric history.

My book looks at the impact of some of the overarching ideologies that were circulating at the time – degeneracy, feminism, socialism, science and the medicalisation of madness – on people in the asylum.

General hospitals had a powerful influence on the faltering discipline of psychiatry. Gradually, a new generation of well-qualified and scientifically-minded physicians, including a handful of women, started to take up asylum posts. Nurses began to receive formal training and gain recognised qualifications. And, perhaps most controversially, female nurses were moved into male wards shaking up these men-only bastions.

As a result, the highly gendered male doctor/female nurse binary was reinforced, marginalising many male attendants and reducing some to little more than nursing auxiliaries.

To return to Gertrude L., the patient experience is an important part of the book. During a period when virtually every aspect of asylum life was intended to act as ‘treatment’, I endeavour to reveal the effects on patients of the admission process, drugs, seclusion and restraint, the ward environment, work and amusements.

Why, for example, were the ‘rougher’ women put to work in the laundry? How were ward interiors designed in order to distract patients from their dark and troubling thoughts? In what way was food rationed according to a patient’s sex? And what were the consequences of forcing pauper patients to wear communal clothes?

There was, of course, no single patient experience. However, my book does, I hope, provide greater insights into how wider social and medical discourses influenced the lives of men and women living and working inside London’s late Victorian asylums at the most quotidian levels.

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