Vascular Function Is Improved After an Environmental Enrichment Program
Authors: Bruno Rosa Maria , Stea Francesco , Sicari Rosa , Ghiadoni Lorenzo , Taddei Stefano , Ungar Andrea , Bonuccelli Ubaldo , Tognoni Gloria , Cintoli Simona , Del Turco Serena , Sbrana Silverio , Gargani Luna , D’Angelo Gennaro , Pratali Lorenza , Berardi Nicoletta , Maffei Lamberto , Picano Eugenio , Andreassi M.G. , Angelucci A. , Baldacci F. , Baroncelli L. , Begenisic T. , Bellinvia P.F. , Biagi L. , Bonaccorsi J. , Bonanni E. , Borghini A. , Braschi C. , Broccardi M. , Caleo M. , Carlesi C. , Carnicelli L. , Cartoni G. , Cecchetti L. , Cenni M.C. , Ceravolo R. , Chico L. , Cioni G. , Costa M. , D’Ascanio P. , De Nes M. , Di Coscio E. , Di Galante M. , di Lascio N. , Faita F. , Falorni I , Faraguna U. , Fenu A. , Fortunato L. , Franco R. , Gargiulo R. , Giorgi F.S. , Iannarella R. , Iofrida C. , Kusmic C. , Limongi F. , Maestri M. , Maffei M. , Maggi S. , Mainardi M. , Mammana L. , Marabotti A. , Mariotti V. , Melissari E. , Mercuri A. , Molinaro S. , Narducci R. , Navarra T. , Noale M. , Pagni C. , Palumbo S. , Pasquariello R. , Pellegrini S. , Pietrini P. , Pizzorusso T. , Poli A. , Retico A. , Ricciardi E. , Rota G. , Sale A. , Scabia G. , Scali M. , Scelfo D. , Siciliano G. , Tonacci A. , Tosetti M. , Turchi S. , Volpi L. 
Published: April 2018

Environmental enrichment may slow cognitive decay possibly acting through an improvement in vascular function. Aim of the study was to assess the effects of a 7-month cognitive, social, and physical training program on cognitive and vascular function in patients with mild cognitive impairment. In a single-center, randomized, parallel-group study, 113 patients (age, 65–89 years) were randomized to multidomain training (n=55) or usual care (n=58). All participants underwent neuropsychological tests and vascular evaluation, including brachial artery flow-mediated dilation, carotid–femoral pulse wave velocity, carotid distensibility, and assessment of circulating hematopoietic CD34+ and endothelial progenitor cells. At study entry, an age-matched control group (n=45) was also studied. Compared with controls, patients had at study entry a reduced flow-mediated dilation (2.97±2.14% versus 3.73±2.06%;
P
=0.03) and hyperemic stimulus (shear rate area under the curve, 19.1±15.7 versus 25.7±15.1×10
−3
;
P
=0.009); only the latter remained significant after adjustment for confounders (
P
=0.03). Training improved Alzheimer disease assessment scale cognitive (training, 14.0±4.8 to 13.1±5.5; nontraining, 12.1±3.9 to 13.2±4.8;
P
for interaction visit×training=0.02), flow-mediated dilation (2.82±2.19% to 3.40±1.81%, 3.05±2.08% to 2.24±1.59%;
P
=0.006;
P
=0.023 after adjustment for diameter and shear rate area under the curve), and circulating hematopoietic CD34
+
cells and prevented the decline in carotid distensibility (18.4±5.3 to 20.0±6.6, 23.9±11.0 to 19.5±7.1 Pa
−1
;
P
=0.005). The only clinical predictor of improvement of cognitive function after training was established hypertension. There was no correlation between changes in measures of cognitive and vascular function. In conclusion, a multidomain training program slows cognitive decline, especially in hypertensive individuals. This effect is accompanied by improved systemic endothelial function, mobilization of progenitor CD34
+
cells, and preserved carotid distensibility.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01725178.