Diseases

Public call for co-financing of research projects in 2021

Public call for co-financing of research projects in 2021

Scientific background, problem identification and objective of the proposed research Scientific background

The number of older adults is increasing worldwide, as mortality at younger ages is decreasing

In  addition, 50 million people suffer from dementia, and experts predict that this number will increase to  152 million by 2050

Objective.

The number of older adults is increasing worldwide, as mortality at younger ages is decreasing [1]. In  addition, 50 million people suffer from dementia, and experts predict that this number will increase to  152 million by 2050 [2]. Dementia affects not only the sufferers themselves, but also their families and  caregivers, and represents a global economic burden [3]. When considering the risk for developing  dementia, we should take a look at the life course of the individual.

A growing body of literature  supports the twelve potentially modifiable risk factors for dementia modeled by the 2020 Lancet  Commission on dementia prevention, intervention, and care: Obesity, hypertension, low education,  physical inactivity, diabetes, depression, smoking, alcohol consumption, low social contact, air  pollution, hearing impairment, and traumatic brain injury [4]. The above risks contribute to the decline  in cognitive performance and ultimately dementia. It is well documented that cognitive deficits cause  progression towards dementia [5,6].

It has been suggested that impairment in executive functions,  attention, and working memory are the earliest and most prominent cognitive symptoms [7].  Individuals with better developed cognitive abilities are less likely to develop and more likely to  postpone the onset of dementia [8]. People in good physical condition can tolerate a higher  neuropathological load without suffering cognitive impairment [9]. The association between a low  cognitive score and high risk or incidence of injury indicates a direct relationship between higher  cognitive control and executive function [10,11].  

To date, no effective pharmacological drug has been developed to reverse dementia, and the side  effects of symptom alleviating drugs may not outweigh their benefits [12]. Non-pharmacological  approaches seem desirable to prevent cognitive decline and consequently dementia. Physical exercise  and cognitive training have been suggested as possible strategies to protect against dementia [4]. A meta-analysis of longitudinal observational studies showed that physical exercise is associated with a  reduced risk of dementia [4]. In Framingham Study, the authors prospectively followed 3,714  participants (70 ± 7 years) for the development of incident dementia over a period of up to 10 years.  Results showed that lower baseline physical activity was associated with a higher risk of dementia,  suggesting that individuals may benefit from staying physically active into old age [13].

Physical activity  has been found to prevent cerebral atrophy or even increase hippocampal volume [14]. Furthermore,  a recent review found that up to 82% of total brain gray matter volume can be altered by physical  activity [15], providing additional scientific evidence for the use of physical activity as a lifestyle  intervention. However, studies that examined the effect of exercise interventions on cognitive  performance showed conflicting results. A systematic review of exercise intervention studies on

Conclusions.

The foreseen achievements are to identify the benefits of combined physical exercise and cognitive  training. It is hypothesized that the EXP group will improve significantly and clinically meaningful in the  domains of their functional status (cognitive and physical domains) after the intervention compared  to the CON group.

We will use novel instrumentation for sensitive detection of cognitive adaptation  after a period of physical exercise and cognitive training. Based on our findings, we could develop  guidelines and exercise protocols (physical and cognitive) aimed at improving cognitive and physical performance, thus improving the quality of life of HD patients.

Importantly, in case our hypotheses will  be confirmed, we will be able to offer evidence-based improvement of chronic renal-replacement  therapy programs. Since I have full-time employment at the nephrology department of University  Medical Centre, the long-term follow-ups are feasible and successful interventions (physical and  cognitive) will become a regular clinical practice for HD patients. 

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