Combined Aerobic Exercise and Cognitive Training in Seniors With Genetic Susceptibility for Alzheimer's Disease

Study Overview
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Brief Summary
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The study aims to investigate the effect of a long-term combined aerobic exercise and cognitive training program on cognitive function, daily function, psychosocial status, and neural plasticity in seniors with genetic susceptibility for Alzheimer's Disease.

Detailed Description
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Alzheimer's disease (AD) is the most common type of dementia and the leading cause of disability in people older than 65 years worldwide. However, there is no effective disease-modifying therapy currently. Therefore, improvement of cognitive function in people at risk and, potentially, prevention of cognitive decline has been gaining attraction. Our previous research reported a model of a combination single nucleotide polymorphism (SNP) (rs3777215, rs234434, rs71352238, and rs4420638) can predict AD onset with high performance, which is useful to identify people at risk for AD and thus allows for timely treatment and prevention. Both aerobic exercise and cognitive training have been demonstrated beneficial effects on cognition in subjects with AD and healthy populations. Moreover, the synergistic effects of the combination have been proven recently. However, the effect of combined aerobic exercise and cognitive training on seniors with genetic susceptibility for AD remains to be elucidated. Herein, this study aims to assess the effects of long-term combined aerobic exercise and cognitive training on cognitive function, daily function, psychosocial status, and neural plasticity in seniors with single nucleotide polymorphism of rs3777215, rs234434, rs71352238, and rs4420638. confirm the predictive value of the SNP model for AD in a longitudinal setting.

Official Title
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Combined Aerobic Exercise and Cognitive Training for Alzheimer's Disease Prevention in Seniors With Genetic Susceptibility Estimated by Polygenic Risk Models: Cognition and Neural Plasticity Effects

Conditions
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Alzheimer Disease

Intervention / Treatment
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* Behavioral: Combined aerobic exercise and cognitive training program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Mandarin-speaking subjects. Not clinically demented. Meeting the cutoff values of MMSE and CDR. With positive variation of rs3777215, rs234434, rs71352238, and rs4420638. Exclusion Criteria: Had major neurologic diagnosis (e.g., Parkinson's disease, stroke, encephalitis, and epilepsy) or other condition that might impair cognition or confound assessments. Had a history of psychotic episodes or had major depression (Hamilton Depression Rating Scale score > 24 points). Had severe systemic diseases, such as tumors, cardiovascular or orthopedic disorder that can affect the ability to perform the proposed intervention tasks.

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Combined aerobic exercise and cognitive training program<br> | Behavioral: Combined aerobic exercise and cognitive training program<br>* Participants will take part in a combined aerobic exercise and cognitive training program. The program will include moderate cycling exercise and cognitive game resolving at the same time. The tasks will be instructed and supervised by a fitness expert and a trained clinical neuropsychologist.<br>|
| No Intervention: Standard health counseling at baseline<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in cognitive function over time as assessed by the Montreal Cognitive Assessment (MoCA) | MoCA will be performed to evaluate the cognition of participants at the enrollment and year 1, year 3, year 5, year 7. The score ranges from 0 to 30, with higher values indicating better cognition. | baseline time, year 1, year 3, year 5, year 7 | 
| Change in cognitive function over time as assessed by Mini Mental State Examination (MMSE) | MMSE will be performed to evaluate the cognition of participants at the enrollment and year 1, year 3, year 5, year 7. The score ranges from 0 to 30, with higher values indicating better cognition. | baseline time, year 1, year 3, year 5, year 7 | 
| Change in cognitive function over time as assessed by Clinical Dementia Rating (CDR) | CDR will be performed to evaluate the cognition of participants at the enrollment and year 1, year 3, year 5, year 7. The score ranges from 0 to 18, with higher values indicating worse cognition. | baseline time, year 1, year 3, year 5, year 7 | 
| Change in cognitive function over time as assessed by Verbal Fluency Test | Verbal Fluency Test will be performed to evaluate the semantic memory function of participants at the enrollment and year 1, year 3, year 5, year 7. Participants are asked to produce as many animals as possible within 1 minute. The score is the number of animals, with higher scores indicating better cognition. | baseline time, year 1, year 3, year 5, year 7 | 
| Change in cognitive function over time as assessed by Digit Span Test-Forward and Backward | Digit Span Tests will be performed to evaluate the working memory of participants at the enrollment and year 1, year 3, year 5, year 7. The total scores are twelve for each test, with higher values indicating better cognition. | baseline time, year 1, year 3, year 5, year 7 | 
| Change in cognitive function over time as assessed by Trail-Making Test Parts A and B (TMT-A and TMT-B) | TMT-A and TMT-B will be performed to evaluate the executive function of participants at the enrollment and year 1, year 3, year 5, year 7. Scoring is based on time taken to complete the test (e.g., 35 seconds yielding a score of 35), with lower scores indicating better cognition. | baseline time, year 1, year 3, year 5, year 7 | 
| Change in cognitive function over time as assessed by Boston Naming Test (BNT) | BNT will be performed to evaluate the language function of participants at the enrollment and year 1, year 3, year 5, year 7. The score ranges from 0 to 30, with higher values indicating better cognition. | baseline time, year 1, year 3, year 5, year 7 | 
| Change in cognitive function over time as assessed by California Verbal Learning Test (CVLT) | CVLT will be performed to evaluate the memory function of participants at the enrollment and year 1, year 3, year 5, year 7. Participants are asked to finish immediate recall, delayed recall, and delayed recognition tasks in the test, with higher scores indicating better cognition. | baseline time, year 1, year 3, year 5, year 7 | 
| Change in cognitive function over time as assessed by the Rey-Osterrieth Complex Figure Test (ROCF) | ROCF will be performed to evaluate the visuospatial function and other cognition domains of participants at the enrollment and year 1, year 3, year 5, year 7. Participants are asked to produce a complicated line drawing, with higher scores indicating better cognition. | baseline time, year 1, year 3, year 5, year 7 | 
| The area under curve of the SNP model (rs3777215, rs234434, rs71352238 and rs4420638) for the accurate diagnosis of AD | The area under curve is used to show the ability of the SNP model (rs3777215, rs234434, rs71352238 and rs4420638) to diagnose AD. The value of area under curve is higher, then the ability of the SNP model to diagnose AD is stronger. | up to 7 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in whole brain volume as accessed by brain MRI | Brain MRI will be performed to evaluate the whole brain volume of participants at the enrollment and year 1, year 3, year 5, year 7. Whole brain volume is measured in mL and determined by Freesurfer analysis. There is no defined maximum. Zero is the theoretical minimum. Greater number indicates larger brain volume. | baseline time, year 1, year 3, year 5, year 7 | 
| Change in daily function over time as assessed by Activities of daily living (ADL) | ADL will be performed to evaluate the daily function of participants at the enrollment and year 1, year 3, year 5, year 7. The score ranges from 14 to 64, with lower values indicating better function. | baseline time, year 1, year 3, year 5, year 7 | 
| Change in anxiety over time as assessed by Hamilton Anxiety Rating Scale (HAMA) | HAMA will be performed to evaluate the daily function of participants at the enrollment and year 1, year 3, year 5, year 7. The score ranges from 0 to 64, with higher values indicating more severe anxiety. | baseline time, year 1, year 3, year 5, year 7 | 
| Change in depression over time as assessed by Hamilton Depression Scale (HAMD) | HAMD will be performed to evaluate the daily function of participants at the enrollment and year 1, year 3, year 5, year 7. The score ranges from 0 to 96, with higher values indicating more severe depression. | baseline time, year 1, year 3, year 5, year 7 | 
| Change in neuropsychiatric symptoms over time as assessed by Neuropsychiatric Inventory Questionnaire (NPI-Q) | NPI-Q will be performed to evaluate the daily function of participants at the enrollment and year 1, year 3, year 5, year 7. The score ranges from 0 to 144, with higher values indicating more severe neuropsychiatric symptoms. | baseline time, year 1, year 3, year 5, year 7 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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prevention, Alzheimer's disease, cognitive training, aerobic exercise, genetic susceptibility, neural plasticity