CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(05): 447-456
DOI: 10.1590/0004-282X-ANP-2020-0284
View and Review

Physical exercise is effective for neuropsychiatric symptoms in Alzheimer's disease: a systematic review

Exercício físico é efetivo para sintomas neuropsiquiátricos na doença de Alzheimer: uma revisão sistemática
1   Universidade Federal do Triângulo Mineiro, Programa de Pós-Graduação em Educação Física, Uberaba MG, Brazil.
,
2   Universidade Federal de Uberlândia, Programa de Pós-Graduação em Ciências da Saúde, Uberlândia MG, Brazil.
,
3   Universidade do Estado de Santa Catarina, Programa de Pós-Graduação em Ciências do Movimento Humano, Florianópolis SC, Brazil.
,
4   Instituto Master Professor Antônio Carlos, Faculdade de Medicina, Araguari, MG, Brazil.
,
1   Universidade Federal do Triângulo Mineiro, Programa de Pós-Graduação em Educação Física, Uberaba MG, Brazil.
,
1   Universidade Federal do Triângulo Mineiro, Programa de Pós-Graduação em Educação Física, Uberaba MG, Brazil.
› Institutsangaben

ABSTRACT

Background: Neuropsychiatric symptoms are disorders frequently seen in Alzheimer's disease. These symptoms contribute to reduction of brain reserve capacity and, in addition, they present unfavorable implications, such as: poor prognosis for the disease, increased functional decline, increased burden on the caregiver and institutionalization. This scenario makes neuropsychiatric symptoms one of the biggest problems in Alzheimer's disease, and gives rise to a need for treatments focused on improving these symptoms. Sow progress in drug trials has led to interest in exploring non-pharmacological measures for improving the neuropsychiatric symptoms of Alzheimer's disease, such as physical exercise. Objective: To ascertain the effect of exercise on the neuropsychiatric symptoms of Alzheimer's disease and its implications. Methods: This was a systematic review of effective longitudinal research, conducted by searching for articles in the PubMed, Web of Science, CINAHL and Scopus electronic databases, from 2009 to 2019. Studies in which the sample consisted of elderly people aged 65 years old or over with a diagnosis of Alzheimer's disease were included. Initially 334 articles were identified. After exclusions, 21 articles remained to be read in full. From these, five articles fitted the eligibility criteria, and a further two articles were added through manual searches in the references of the articles found. Results: Out of the seven articles analyzed in this review, five studies revealed that physical exercise had a positive effect on the neuropsychiatric symptoms of Alzheimer's disease. Conclusion: This systematic review indicated that physical exercise is a favorable non-pharmacological means for attenuating the neuropsychiatric symptoms of elderly people with Alzheimer's disease, with special attention to aerobic exercises.

RESUMO

Introdução: Sintomas neuropsiquiátricos são desordens frequentemente observadas na Doença de Alzheimer, os quais contribuem para a diminuição da capacidade de reserva cerebral e ocasiona implicações ruins, como mau prognóstico da doença, aumento do declínio funcional, aumento da sobrecarga do cuidador e institucionalização. Esse cenário faz com que os sintomas neuropsiquiátricos se tornem um dos maiores problemas da Doença de Alzheimer, incitando, assim, o interesse em explorar medidas não-farmacológicas nos sintomas neuropsiquiátricos na Doença de Alzheimer, como o exercício físico. Objetivo: Verificar o efeito do exercício físico em sintomas neuropsiquiátricos da Doença de Alzheimer e suas implicações. Métodos: Trata-se de uma revisão sistemática com pesquisas longitudinais efetivadas por meio da busca de artigos nas bases de dados eletrônicas: PubMed, Web of Science, CINAHL e Scopus, de 2009 a 2019. Foram incluídos estudos cuja amostra foi constituída por idosos com diagnóstico de Doença de Alzheimer com idade igual ou acima de 65 anos. Inicialmente, foram identificados 334 artigos; após as exclusões, restaram 21 artigos para leitura na íntegra. Destes, cinco artigos se enquadraram nos critérios de elegibilidade, assim como dois artigos adicionados por meio de busca manual nas referências dos artigos encontrados. Resultados: Dos sete artigos analisados na presente revisão, cinco estudos revelaram um efeito positivo do exercício físico em sintomas neuropsiquiátricos na Doença de Alzheimer. Conclusão: Esta revisão sistemática indica que o exercício físico é um meio não-farmacológico favorável à atenuação dos sintomas neuropsiquiátricos de idosos com Doença de Alzheimer, com especial atenção na modalidade aeróbia.

Authors’ contributions:

The study was developed by DCBM, FGMC and FDGS. Searches, selection of articles and review of eligibility were carried out by DCBM and DRF. Data extraction and analysis were conducted by DCBM, DRF. Critical evaluation of the results was performed by DCBM, DRF, KF and SSH. The article was written by DCBM. Critical review of the article was done by SSH, FGMC and FDGS.




Publikationsverlauf

Eingereicht: 17. Juni 2020

Angenommen: 03. August 2020

Artikel online veröffentlicht:
07. Juni 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 
  • References

  • 1 Kales HC. Common Sense: Addressed to geriatric psychiatrists on the subject of behavioral and psychological symptoms of dementia. Am J Geriatr Psychiatry. 2015 Nov;23(12):1209-13. https://doi.org/10.1016/j.jagp.2015.10.001
  • 2 McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack Jr CR, Kawas CH, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011 May;7(3):263-9. https://doi.org/10.1016/j.jalz.2011.03.005
  • 3 Craig D, Mirakhur A, Hart DJ, McIlroy SP, Passmore AP. A cross-sectional study of neuropsychiatric symptoms in 435 patients with Alzheimer's disease. Am J Geriatr Psychiatry. 2005 Jun;13(6):460-8. https://doi.org/10.1176/appi.ajgp.13.6.460
  • 4 Veronese N, Solmi M, Basso C, Smith L, Soysal P. Role of physical activity in ameliorating neuropsychiatric symptoms in Alzheimer disease: A narrative review. Int J Geriatr Psychiatry. 2019 Sep;34(9):1316-25. https://doi.org/10.1002/gps.4962
  • 5 Cerejeira J, Lagarto L, Mukaetova-Ladinska EB. Behavioral and psychological symptoms of dementia. Front Neurol. 2012 May;3:73. https://doi.org/10.3389/fneur.2012.00073
  • 6 Schneider LS, Tariot PN, Dagerman KS, Davis SM, Hsiao JK, Saleem Ismail M, et al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. N Engl J Med. 2006 Oct;355(15):1525-38. https://doi.org/10.1056/NEJMoa061240
  • 7 Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA. 2005 Oct;294(15):1934-43. https://doi.org/10.1001/jama.294.15.1934
  • 8 Ströhle A, Schmidt DK, Schultz F, Fricke N, Staden T, Hellweg R, et al. Drug and exercise treatment of Alzheimer disease and mild cognitive impairment: a systematic review and meta-analysis of effects on cognition in randomized controlled trials. Am J Geriatr Psychiatry. 2015 Dec;23(12):1234-49. https://doi.org/10.1016/j.jagp.2015.07.007
  • 9 Hoffmann K, Sobol NA, Frederiksen KS, Beyer N, Vogel A, Vestergaard K, et al. Moderate-to-high intensity physical exercise in patients with Alzheimer's disease: a randomized controlled trial. J Alzheimers Dis. 2016;50(2):443-53. https://doi.org/10.3233/JAD-150817
  • 10 Steinberg M, Leoutsakos J-MS, Podewils LJ, Lyketsos CG. Evaluation of a home-based exercise program in the treatment of Alzheimer's disease: The Maximizing Independence in Dementia (MIND) study. Int J Geriatr Psychiatry. 2009 Jul;24(7):680-5. https://doi.org/10.1002/gps.2175
  • 11 Stella F, Canonici AP, Gobbi S, Galduroz RFS, Cação JC, Gobbi LTB. Attenuation of neuropsychiatric symptoms and caregiver burden in Alzheimer's disease by motor intervention: a controlled trial. Clinics (Sao Paulo). 2011;66(8):1353-60. https://doi.org/10.1590/s1807-59322011000800008
  • 12 McCurry SM, Pike KC, Vitiello MV, Logsdon RG, Larson EB, Teri L. Increasing walking and bright light exposure to improve sleep in community-dwelling persons with Alzheimer's disease: results of a randomized, controlled trial. J Am Geriatr Soc. 2011 Aug;59(8):1393-402. https://doi.org/10.1111/j.1532-5415.2011.03519.x
  • 13 Nascimento CMC, Teixeira CVL, Gobbi LTB, Gobbi S, Stella F. A controlled clinical trial on the effects of exercise on neuropsychiatric disorders and instrumental activities in women with Alzheimer's disease. Rev Bras Fisioter. 2012 Jun;16(3):197-204. https://doi.org/10.1590/s1413-35552012005000017.
  • 14 Yu F. Improving recruitment, retention, and adherence to 6-month cycling in Alzheimer's disease. Geriatr Nurs. 2013 May-Jun;34(3):181-6. https://doi.org/10.1016/j.gerinurse.2012.12.014
  • 15 Venturelli M, Sollima A, Cè E, Limonta E, Bisconti AV, Brasioli A, et al. Effectiveness of exercise- and cognitive-based treatments on salivary cortisol levels and sundowning syndrome symptoms in patients with Alzheimer's disease. J Alzheimers Dis. 2016 Jul;53(4):1631-40. https://doi.org/10.3233/JAD-160392
  • 16 Ohmana H, Savikko NRN, Strandberg TE, Kautiainen H, Raivio MM, Laakkonen ML, et al. Effects of frequent and long-term exercise on neuropsychiatric symptoms in patients with Alzheimer's disease - Secondary analyses of a randomized, controlled trial (FINALEX). Eur Geriatr Med. 2017;8(2):153-7. https://doi.org/10.1016/j.eurger.2017.01.004
  • 17 Lyketsos CG, Carrillo MC, Ryan JM, Khachaturian AS, Trzepacz P, Amatniek J, et al. Neuropsychiatric symptoms in Alzheimer's disease. Alzheimers Dement. 2011 Sep;7(5):532-9. https://doi.org/10.1016/j.jalz.2011.05.2410
  • 18 Hernández SSS, Sandreschi PF, da Silva FC, Arancibia BAV, Silva R, Gutierres PJB, et al. What are the benefits of exercise for Alzheimer's disease? A systematic review of the past 10 years. J Aging Phys Act. 2015 Oct;23(4):659-68. https://doi.org/10.1123/japa.2014-0180
  • 19 Panza GA, Taylor BA, MacDonald HV, Johnson BT, Zaleski AL, Livingston J, et al. can exercise improve cognitive symptoms of Alzheimer's disease? J Am Geriatr Soc. 2018 Mar;66(3):487-95. https://doi.org/10.1111/jgs.15241
  • 20 Menegardo CS, Friggi FA, Scardini JB, Rossi TS, Vieira TS, Tieppo A, et al. Sundown syndrome in patients with Alzheimer's disease dementia. Dement Neuropsychol. 2019 Oct-Dec;13(4):469-74. https://doi.org/10.1590/1980-57642018dn13-040015
  • 21 Knöchel C, Oertel-Knöchel V, O’Dwyer L, Prvulovic D, Alves G, Kollmann B, et al. Cognitive and behavioural effects of physical exercise in psychiatric patients. Prog Neurobiol. 2012 Jan;96(1):46-68. https://doi.org/10.1016/j.pneurobio.2011.11.007
  • 22 Chapman SB, Aslan S, Spence JS, DeFina LF, Keebler MW, Didehbani N, et al. Shorter term aerobic exercise improves brain, cognition, and cardiovascular fitness in aging. Front Aging Neurosci. 2013 Nov;5:75. https://doi.org/10.3389/fnagi.2013.00075
  • 23 Lista I, Sorrentino G. Biological mechanisms of physical activity in preventing cognitive decline. Cell Mol Neurobiol. 2009 Dec;30:493-503. https://doi.org/10.1007/s10571-009-9488-x
  • 24 Cotman CW, Berchtold NC, Christie L-A. Exercise builds brain health: key roles of growth factor cascades and inflammation. Trends Neurosci. 2007 Sep;30(9):464-72. https://doi.org/10.1016/j.tins.2007.06.011
  • 25 Coelho FG de M, Gobbi S, Andreatto CAA, Corazza DI, Pedroso RV, Santos-Galduróz RF. Physical exercise modulates peripheral levels of brain-derived neurotrophic factor (BDNF): a systematic review of experimental studies in the elderly. Arch Gerontol Geriatr. 2013 Jan-Feb;56(1):10-5. https://doi.org/10.1016/j.archger.2012.06.003
  • 26 Archer T, Josefsson T, Lindwall M. Effects of physical exercise on depressive symptoms and biomarkers in depression. CNS Neurol Disord Drug Targets. 2014;13(10):1640-53. https://doi.org/10.2174/1871527313666141130203245
  • 27 Cassilhas RC, Viana VAR, Grassmann V, Santos RT, Santos RF, Tufik S, et al. The impact of resistance exercise on the cognitive function of the elderly. Med Sci Sports Exerc. 2007 Aug;39(8):1401-7. https://doi.org/10.1249/mss.0b013e318060111f
  • 28 Sobol NA, Dall CH, Høgh P, Hoffmann K, Frederiksen KS, Vogel A, et al. Change in fitness and the relation to change in cognition and neuropsychiatric symptoms after aerobic exercise in patients with mild Alzheimer's disease. J Alzheimers Dis. 2018;65(1):137-45. https://doi.org/10.3233/JAD-180253
  • 29 Erickson KI, Voss MW, Prakash RS, Basak C, Szabo A, Chaddock L, et al. Exercise training increases size of hippocampus and improves memory. Proc Natl Acad Sci U S A. 2011 Feb;108(7):3017-22. https://doi.org/10.1073/pnas.1015950108
  • 30 Geda YE, Schneider LS, Gitlin LN, Miller DS, Smith GS, Bell J, et al. Neuropsychiatric symptoms in Alzheimer's disease: Past progress and anticipation of the future. Alzheimers Dement. 2013 Sep;9(5):602-8. https://doi.org/10.1016/j.jalz.2012.12.001
  • 31 Price AE, Corwin SJ, Friedman DB, Laditka SB, Colabianchi N, Montgomery KM. Physical activity and cognitive-health content in top-circulating magazines, 2006-2008. J Aging Phys Act. 2011 Apr;19(2):147-68. https://doi.org/10.1123/japa.19.2.147
  • 32 Campbell S, Marriott M, Nahmias C, MacQueen GM. Lower hippocampal volume in patients suffering from depression: a meta-analysis. Am J Psychiatry. 2004 Apr;161(4):598-607. https://doi.org/10.1176/appi.ajp.161.4.598
  • 33 McIlroy S, Craig D. Neurobiology and genetics of behavioural syndromes of Alzheimer's disease. Curr Alzheimer Res. 2004 May;1(2):135-42. https://doi.org/10.2174/1567205043332180z
  • 34 Lourenco MV, Frozza RL, de Freitas GB, Zhang H, Kincheski GC, Ribeiro FC, et al. Exercise-linked FNDC5/irisin rescues synaptic plasticity and memory defects in Alzheimer's models. Nat Med. 2019 Jan;25(1):165-75. https://doi.org/10.1038/s41591-018-0275-4
  • 35 Newhouse A, Chemali Z. Neuroendocrine disturbances in neurodegenerative disorders: a scoping review. Psychosomatics. 2020 Mar-Apr;61(2):105-15. https://doi.org/10.1016/j.psym.2019.11.002
  • 36 Beserra AHN, Kameda P, Deslandes AC, Schuch FB, Laks J, Moraes HS de. Can physical exercise modulate cortisol level in subjects with depression? A systematic review and meta-analysis. Trends Psychiatry Psychother. 2018 Oct-Dec;40(4):360-8. https://doi.org/10.1590/2237-6089-2017-0155
  • 37 Stella F, Canonici AP, Gobbi S, Santos-Galduroz RF, Cacao JC, Bucken-Gobbi LT. Attenuation of neuropsychiatric symptoms and caregiver burden in Alzheimer's disease by motor intervention: a controlled trial. Clinics. 2011;66(8):1353-60. http://dx.doi.org/10.1590/S1807-59322011000800008
  • 38 Christofoletti G, Oliani MM, Bucken-Gobbi LT, Gobbi S, Beinotti F, Stella F. Physical activity attenuates neuropsychiatric disturbances and caregiver burden in patients with dementia. Clinics (Sao Paulo). 2011;66(4):613-8. http://dx.doi.org/10.1590/S1807-59322011000400015
  • 39 Alqahtani MS, Alshbriqe AA, Awwadh AA, Alyami TA, Alshomrani MS, Alhazzani A. Prevalence and risk factors for depression among caregivers of alzheimer's disease patients in Saudi Arabia. Neurol Res Int. 2018 Sep 16;2018:2501835. https://doi.org/10.1155/2018/2501835
  • 40 Medrano M, Rosario RL, Payano AN, Capellán NR. Burden, anxiety and depression in caregivers of Alzheimer patients in the Dominican Republic. Dement Neuropsychol. 2014 Oct-Dec;8(4):384-8. https://doi.org/10.1590/S1980-57642014DN84000013
  • 41 Garre-Olmo J, López-Pousa S, Vilalta-Franch J, de Gracia Blanco M, Vilarrasa AB. Grouping and trajectories of the neuropsychiatric symptoms in patients with Alzheimer's disease, part I: symptom clusters. J Alzheimers Dis. 2010;22(4):1157-67. https://doi.org/10.3233/JAD-2010-101212