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Bakgrund: Demens är en vanligt förekommande sjukdom som orsakas av degenerativa förändringar i hjärnan som ger upphov till varierande symtom som försämrat språk, minne och social förmåga. Diverse kognitiva test kan användas som utvärderingsinstrument för att beräkna svårighetsgraden av en demensdiagnos. Det finns studier som visar olika resultat på hur fysisk aktivitet, och specifikt aerob träning, påverkar kognitionen. Vad gäller rekommendationer om fysisk aktivitet så krävs mer forskning för att veta hur fysisk aktivitet påverkar kognitionen hos personer med demens. Syfte: Syftet med denna litteraturöversikt är att undersöka effekten av aerob träning på kognitionen hos personer med demens.  Metod: Sökning efter RCT-studier skedde via Pubmed. Artiklarna granskades separat av båda författarna för att sedan jämföra bedömning av inklusion eller exklusion. Studiernas kvalitet bedömdes med TESTEX, och tillförlitligheten av det sammanvägda resultatet bedömdes med GRADEstud. Även denna bedömning utfördes av författarna separat, för att sedan jämföras och beslut nåddes i konsensus.  Resultat: Åtta artiklar inkluderades. Fyra studier presenterade statistiskt signifikant resultat på något av de använda testen, men endast 8 av 44 totalt utförda kognitiva test var statistiskt signifikanta. Studiernas kvalitet bedömdes god eller mycket god, men det sammanvägda resultatet bedömdes ha mycket låg tillförlitlighet på grund av studiernas bristande samstämmighet och precision. Slutsats: Det finns i dagsläget mycket låg evidens för att aerob träning påverkar kognitiva funktioner positivt. Mer forskning krävs för att utvärdera effekten av aerob träning på kognition. Studier med längre interventionsperioder och större populationer rekommenderas. / Background: Dementia is a common disease caused by degenerative changes in the brain, which presents symptoms such as impaired language, memory and social skills. Various cognitive tests can be used as evaluation instruments to calculate the severity of a dementia diagnosis. There are studies that show different results on how physical activity, specifically aerobic exercise, affects cognition. Regarding recommendations for physical activity, more research is needed to know how physical activity affects cognition in people with dementia. Aim: The aim of this literature review is to examine the effect of aerobic exercise on cognition for people with dementia.  Method: A search for RCT-studies was conducted on PubMed. The articles were reviewed separately by both authors, followed by comparison of assessment for inclusion or exclusion. The quality of the studies was analyzed with TESTEX, and the reliability of the combined result was assessed with GRADEstud. This assessment was also performed by the authors separately, followed by comparisons, and decisions reached in consensus. Results: Eight studies were included. Four studies presented statistically significant results in any of the used tests, however only 8 of 44 total executed cognitive tests were statistically significant. The quality of the studies was assessed to be good or excellent, however the reliability of the combined results was assessed to be very low due to the lack of consistency and precision of the studies.  Conclusion: There is very low evidence that aerobic exercise has a positive effect on cognitive functions. More research is needed to evaluate the effect of aerobic exercise on cognition. Studies with longer intervention and larger populations are recommended.

Background: Many adolescents and young adults (AYAs) aged 15-39 years describe struggling with cancer-related cognitive impairment (CRCI) after treatment. CRCI (e.g., memory, concentration, and learning difficulties) often causes distress, diminishes quality of life (QoL), and impedes young adults' participation in academic, recreational, and social experiences. Yet, CRCI is poorly understood in AYAs and options to prevent or treat this burdensome side effect are lacking. Based on growing evidence suggesting that physical activity (PA) may enhance cognitive function in older adults, individuals with diseases of cognition, and breast cancer survivors, research exploring links between PA and CRCI in AYAs is warranted. Thus, the purpose of this observational, mixed methods thesis was to explore how AYA cancer survivors experience and cope with CRCI, taking into consideration potential predisposing factors (i.e., medical, psychological), interventional strategies (i.e., PA), and outcomes (i.e., QoL). Methods: Over a nine-month period, 90 AYAs who had completed primary cancer treatment self-referred; 49 were eligible and enrolled into the study. Of these, 46 participants (M_age=31.4±5.4; 91.3% female; 39.1% blood cancer) completed an online survey and three web-based neuropsychological tests; semi-structured interviews were conducted on a rolling basis with a sub-set (n=16) who reported clinically meaningful CRCI. Quantitative data were analyzed descriptively and qualitative data were analyzed thematically. Results: Overall, participants were active based on their self-reported moderate-to-vigorous intensity PA (MVPA; M=27.3±20.6) and relative to scale ranges, they reported moderate levels of depressive symptoms, stress, fatigue, and quality of life (M=12.1±5.5; M=21.1±7.2; M=25.2±11.5; M=68.8±18.3, respectively). On average, participants reported clinically meaningful CRCI (M=44.7±17.4), and as compared to normative values, their neuropsychological test scores indicated poor executive functioning and processing speed, but not working memory. Bivariate correlations between cognitive function (self-reported and objective) and medical characteristics (i.e., time since diagnosis, cancer stage, chemotherapy exposure) had small-to-moderate effect sizes. Small-to-large correlations were observed between cognitive function and psychological factors (i.e., depressive symptoms, stress, fatigue, QoL). Finally, correlations between cognitive function and MVPA were favourable, though effect sizes were small. Moreover, qualitative data provided insight into how AYAs experience and cope with their cognitive impairment, which was summarized within four themes: (1) descriptions and interpretations of the CRCI phenomenon, (2) effects of CRCI on day-to-day life and QoL, (3) cognitive-behavioural self-management strategies, and (4) recommendations for improving care. Conclusion: Results confirm that cancer can impact AYAs' cognitive function and have detrimental effects for their daily life and overall QoL. AYAs reported using various cognitive-behavioural self-management strategies, including PA; taken together with quantitative data, findings suggest that PA may be a promising strategy to cope with CRCI. However, high-quality experimental research is needed to confirm this association, test the processes by which this may occur, as well as to determine optimal PA dosages/contexts for managing CRCI.

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Parkinson’s disease (PD) is a neurodegenerative disorder associated with motor disturbance and non-motor symptoms (NMS). Although NMS such as sleep and circadian disruption, cognitive impairment, and mood disturbance are prevalent and debilitating, treatments are limited, owing to lack of knowledge about their etiologies and interactions. This project comprised two studies of NMS in mild to moderate idiopathic PD without dementia. The hypothesis of Study 1 was that disruption of rest-activity circadian rhythm contributes to cognitive impairment in PD independently of sleep disruption. Thirty-five participants underwent 7-10 days of actigraphy monitoring, which provided estimates of sleep and circadian functioning, and then neuropsychological testing. Hierarchical regression showed that circadian interdaily stability predicted executive function, visuospatial function, and psychomotor speed, though not memory, independently of sleep. Sleep efficiency independently predicted executive but not other cognitive function. Study 2 examined daily temporal associations between sleep, subjective cognition, and mood (anxiety, positive affect) in PD. Twenty participants used a smartphone app to engage in 14 days of ecological momentary assessment (EMA) of daytime symptoms and subjective sleep quantity and quality. They wore actigraphs for objective sleep assessment. The hypothesis was that sleep quality would predict cognition and mood. Multilevel modeling indicated that subjective sleep quality was bidirectionally associated with mood on a day-to-day basis (i.e., last night’s perceived sleep affected today’s mood, which in turn will affect tonight’s sleep). There was also a trend for subjective sleep quality to predict the next day’s subjective cognitive function. Objective sleep was not associated with any daytime symptoms. Study 1 provided the first evidence that circadian rhythm contributes to cognition in PD independently of sleep. Study 2 indicated that, on a daily timescale, subjective sleep is relevant to mood and possibly cognition in PD, whereas objective sleep is either insufficiently sensitive or not relevant. Together these findings support the use of EMA to investigate small-timescale interactions among NMS, and present circadian rhythms and sleep perception as intervention targets for improving cognition and mood, and ultimately for enhancing quality of life in PD. / 2020-02-15T00:00:00Z

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