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Can Physical Cues Signal Dementia?

FRIDAY Aug. 15, 2008 -- Memory loss and confusion often provide the first clues to the onset of dementia. But recent research suggests that physical -- not mental -- impairment may be an earlier harbinger of trouble.

In a study involving more than 2,200 adults aged 65 and older, walking and balance problems were early indicators of future dementia. Poor handgrip was a later sign of developing dementia.

The findings, published in the Archives of Internal Medicine, suggest a link between brain health and physical fitness.

"Maybe this will be another motivator to either keep people active or motivate them to become active if they're not," said study co-author Dr. Eric B. Larson, director of the Group Health Center for Health Studies in Seattle.

Still, one expert said it might be a bit premature to use gait and grip to detect dementia.

"This is a questionable concept, since we do not know the strength of the direction or association between physical health and mental function," said Patricia C. Heyn, clinical assistant professor of physical medicine and rehabilitation at the University of Colorado Health Sciences Center in Aurora, Colo. "Here is when we ask which comes first -- the egg or the chicken?"

Still, Heyn believes new tools sensitive enough to catch physical and cognitive changes at very early stages must be developed and studied. Today, dementia is mostly detected in advanced stages, she noted.

Added Dr. Constantine G. Lyketsos, the Elizabeth Plank Althouse Professor and chairman of psychiatry at Johns Hopkins Bayview Medical Center in Baltimore: "By being able to detect the fact that they're on the path to dementia, I think we'll be able in the future to target better therapies that might prevent the onset (of dementia) or potentially to prepare the ground for the person in the family to face the disease," he said.

Dementia seriously impairs the ability to carry out normal daily activities, according to the U.S. National Institute on Aging. That impairment can run the spectrum, from having trouble finding the right words to performing multi-step tasks, such as preparing a meal or caring for oneself. Alzheimer's disease is the most common type of dementia, affecting an estimated 4.5 million Americans.

Larson and his colleagues at the University of Washington followed study participants for six years. Initially, none of them showed signs of dementia or Alzheimer's disease. The researchers assessed their physical and mental function every two years. By the sixth year, 319 people had developed dementia, including 221 Alzheimer's cases. Those with higher physical performance scores at the start of the study were three times less likely to develop dementia.

Following up on this work, Larson is preparing another study that will examine a larger group of individuals over a 10-year period.

Larson believes the evidence points to a connection between mind and body. In fact, in an earlier study, he and his colleagues found that people who exercised regularly were less likely to develop dementia, including Alzheimer's.

Cognitive function, like physical function, is determined by a combination of mental and physical fitness, he explained. Brain tissue, like muscle, requires blood and oxygen.

"So, if you can improve that element of the way our bodies work, which is what physical fitness does, you're going to be also protecting the brain from cognitive decline," Larson said. "And, conversely, if you can maintain your brain function by exercising it, you may also be improving your ability to stay physically active."

In his own practice, consisting largely of patients in their 70s and 80s, Larson often recommends consulting a personal trainer or physical therapist for help starting a fitness program.

Will exercise actually prevent mental decline? Lyketsos said the jury is still out. "What's known is that people who exercise are less likely to get dementia. But people who exercise might be different in other ways," he said. "They might be people who are healthy anyway."

On the other hand, a physical fitness regimen tailored to an individual's needs couldn't hurt. The message to older people with dementia and younger adults who want to prevent mental decline is simple:

"Exercise, exercise, exercise," Heyn said. "Move as much as you can."

More information

Do you believe your loved one is suffering from mental decline? The Family Caregiver Alliance has information on diagnosing dementia.

Posted: August 2008


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