Combined Aerobic Exercise and Cognitive Training in Seniors at Increased Risk 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 and blood exosomal synaptic protein levels in seniors at increased risk for Alzheimer's Disease.

Detailed Description
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Alzheimer's disease (AD) is the most common cause of dementia in people older than 65 years worldwide. The neuropathological changes of AD occur decades before the onset of cognitive impairment, suggesting that early identification and timely intervention may postpone the clinical progress. In addition to its characteristic amyloid β and tau pathology, AD is also marked by synaptic dysfunction. Abnormal synaptic protein levels, such as growth associated protein 43 (GAP43), neurogranin, synaptotagmins, and synaptosome associated protein 25 (SNAP25) have been observed in the brain tissue and cerebrospinal fluid (CSF). Blood neuro-exosomal synaptic proteins have emerged as promising predictors for AD and cognitive decline. Particularly, the investigators previously reported a combination of blood neuro-exosomal protein (GAP43, neurogranin, SNAP25, and synaptotagmin 1) can predict AD 5 to 7 years before the clinical onset. Both physical exercise and cognitive training have been demonstrated to improve cognitive function in AD and to exert a protective effect against developing dementia in the normal aging population. Furthermore, cognitive stimulation is an established modulator of synaptic plasticity and physical exercise might regulate synapse functional and structural change. However, whether cognitive training and physical exercise can alter exosomal synaptic protein levels and the relationship of biomarker changes to cognitive function in those seniors at increased risk for AD remain unclear. In this study, the investigators aim to assess the effects of a long-term combined aerobic exercise and cognitive training program on cognitive function and the predictive biomarkers (blood neuro-exosomal synaptic proteins: GAP43, neurogranin, SNAP25, and synaptotagmin 1) in seniors at increased risk of AD with abnormally decreased levels of the biomarkers. determine the relationship of biomarker changes with cognitive function in these people. confirm the predictive value of the blood neuro-exosomal synaptic proteins for AD in a longitudinal setting.

Official Title
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Combined Aerobic Exercise and Cognitive Training for Alzheimer's Disease Prevention in At-Risk Seniors Estimated by An Exosomal Synaptic Protein Model: Cognition and Exosomal Synaptic Proteins 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 low levels of blood neuro-exosomal synaptic proteins (GAP43<1983pg/ml, synaptotagmin 1<431pg/ml, neurogranin<1433pg/ml, SNAP25<448pg/ml) Exclusion criteria: Had major neurologic diagnosis (e.g., Alzheimer's disease, 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 disorders 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 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 | 
| 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 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in concentrations of blood neuro-exosomal GAP43 over time | Concentrations of blood neuro-exosomal GAP43 will be evaluated at the enrollment and year 1, year 3, year 5, year 7, and measured in pg/ml. | baseline time, year 1, year 3, year 5, year 7 | 
| Changes in concentrations of blood neuro-exosomal neurogranin over time | Concentrations of blood neuro-exosomal neurogranin will be evaluated at the enrollment and year 1, year 3, year 5, year 7, and measured in pg/ml. | baseline time, year 1, year 3, year 5, year 7 | 
| Changes in concentrations of blood neuro-exosomal SNAP25 over time | Concentrations of blood neuro-exosomal SNAP25 1 will be evaluated at the enrollment and year 1, year 3, year 5, year 7, and measured in pg/ml. | baseline time, year 1, year 3, year 5, year 7 | 
| Changes in concentrations of blood neuro-exosomal synaptotagmin1 over time | Concentrations of blood neuro-exosomal synaptotagmin1 will be evaluated at the enrollment and year 1, year 3, year 5, year 7, and measured in pg/ml. | baseline time, year 1, year 3, year 5, year 7 | 
| The area under curve of the blood neuro-exosomal synaptic proteins (GAP43, neurogranin, SNAP25, and synaptotagmin1) for the accurate diagnosis of AD | The area under curve is used to show the ability of the blood neuro-exosomal synaptic proteins (GAP43, neurogranin, SNAP25, and synaptotagmin1) to diagnose AD. The value of area under curve is higher, then the ability of the blood neuro-exosomal synaptic proteins to diagnose AD is stronger. | up to 7 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Alzheimer's disease, aerobic exercise, exosome, synaptic protein, biomarker, prevention, cognitive training