Physical Exercise as a Preventive or Disease-Modifying Treatment of Dementia and Brain Aging
Physical Exercise as a Preventive or Disease-Modifying Treatment of Dementia and Brain Aging
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DOI：
10.4065/mcp.2011.0252
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发表时间：
2011-09-01
影响因子：
8.9
通讯作者：
Petersen, Ronald C.
中科院分区：
文献类型：
--
作者：
Ahlskog, J. Eric;Geda, Yonas E.;Petersen, Ronald C.
一个快速增长的文献强烈表明，运动，特别是有氧运动，可以减轻认知障碍，降低痴呆症的风险。我们使用PubMed（关键词运动和认知）和手稿书目来检查运动的认知神经保护作用的已发表证据。前瞻性研究的荟萃分析记录了与中年运动相关的痴呆症风险显著降低;同样，在几项研究中，中年运动显著降低了轻度认知障碍的后期风险。在痴呆或轻度认知障碍患者中，随机对照试验（RCT）记录了6至12个月运动后与久坐对照组相比更好的认知评分。健康成人有氧运动RCT的荟萃分析也与认知评分的显著改善相关。在一项针对老年人的大型随机对照试验中，一年的有氧运动与海马体积显著增大和空间记忆改善相关;其他针对老年人的随机对照试验记录了有氧运动对年龄相关性灰质体积损失的衰减。横断面研究同样报告了身体健康的老年人与不健康的老年人相比，海马体或灰质体积显着更大。用功能性磁共振成像研究的大脑认知网络显示，在6到12个月的锻炼后，连接性得到了改善。动物研究表明，运动通过各种生物机制促进神经可塑性，提高学习效果。运动对脑神经营养因子的诱导作用已在多项动物研究中得到证实，并在人类中得到了这一过程的间接证据。除了脑神经保护作用外，体育锻炼还可以通过减轻脑血管风险来减轻认知能力下降，包括小血管疾病对痴呆的影响。运动作为一种重要的治疗策略不应被忽视。
A rapidly growing literature strongly suggests that exercise, specifically aerobic exercise, may attenuate cognitive impairment and reduce dementia risk. We used PubMed (keywords exercise and cognition) and manuscript bibliographies to examine the published evidence of a cognitive neuroprotective effect of exercise. Meta-analyses of prospective studies documented a significantly reduced risk of dementia associated with midlife exercise; similarly, midlife exercise significantly reduced later risks of mild cognitive impairment in several studies. Among patients with dementia or mild cognitive impairment, randomized controlled trials (RCTs) documented better cognitive scores after 6 to 12 months of exercise compared with sedentary controls. Meta-analyses of RCTs of aerobic exercise in healthy adults were also associated with significantly improved cognitive scores. One year of aerobic exercise in a large RCT of seniors was associated with significantly larger hippocampal volumes and better spatial memory; other RCTs in seniors documented attenuation of age-related gray matter volume loss with aerobic exercise. Cross-sectional studies similarly reported significantly larger hippocampal or gray matter volumes among physically fit seniors compared with unfit seniors. Brain cognitive networks studied with functional magnetic resonance Imaging display improved connectivity after 6 to 12 months of exercise. Animal studies indicate that exercise facilitates neuroplasticity via a variety of biomechanisms, with improved learning outcomes. Induction of brain neurotrophic factors by exercise has been confirmed in multiple animal studies, with indirect evidence for this process in humans. Besides a brain neuroprotective effect, physical exercise may also attenuate cognitive decline via mitigation of cerebrovascular risk, including the contribution of small vessel disease to dementia. Exercise should not be overlooked as an important therapeutic strategy.