Bustamante, Ivee V.

BSN 3E

Moderate Exercise Improves Memory in Older Adults

February 3, 2011 — Aerobic exercise training that gets sedentary older adults up and walking for 40 minutes 3 times a week has
been shown to increase the size of the hippocampus and improve memory after 1 year.

The findings appear in the January 31 issue of the Proceedings of the National Academy of Sciences of the United States of
America.

"There are 2 very important messages to take home from this study," lead investigator Kirk Erickson, PhD, professor of psychology
at the University of Pittsburgh in Pennsylvania, toldMedscape Medical News. "The first is that the brain remains modifiable until late
adulthood, and this gives us a lot of promise for interventions and treatments that could prevent or delay or even reverse atrophy of
the brain. The second major message is that it's never too late to start exercising."

Dr. Erickson and his colleagues recruited 60 adults aged 60 to 80 years who got 30 minutes or less of physical activity per week to
embark on a course of aerobic training that involved a program of brisk walking. A similar number of sedentary adults who served as
controls were randomized to stretching and toning exercises.

"They were fairly inactive individuals, which is unfortunately very common in society, but nonetheless, we brought them in and
started them walking. We first started them walking 10 to 15 minutes at a time because they were not used to exercise, and
eventually we progressed them to about 40 minutes a day for 3 days a week and that lasted for a year," he explained.

The participants were supervised, accompanied by trained personnel who monitored their heart rate and level of exertion. All had
experienced some degree of brain atrophy although this had not yet progressed to a diagnosis of dementia, and were otherwise
healthy, albeit with the usual complement of aches and pains typical for a population of this age, Dr. Erickson said.

In addition, all had to get approval from their personal physicians to participate in the study.

Magnetic resonance images (MRIs) were collected before the intervention, after 6 months, and again after the completion of the
program.

"MRI allowed us to get very high-resolution, detailed images of their brain, and then we were able to use some algorithms to
segment out certain brain regions and calculate the size of the hippocampus," Dr. Erickson said.

In addition, participants were given a memory test that measured their spatial memory at the same 3 time points in the study.

Both groups were similar with regard to their hippocampal volume and memory at baseline.

At the end of 1 year, participants in the aerobic exercise training group increased the volume of the left hippocampus by 2.12% and
the right hippocampus by 1.97%, whereas the control group actually displayed a 1.40% and 1.43% decline in the left and right
hippocampus, respectively.

The study also found that those in the aerobic exercise group showed improved memory function compared with their performance
at the start of the study. This improvement was associated with the increased size of the hippocampus. Increased hippocampal
volume was also associated with greater levels of brain-derived neurotrophic factor, a small molecule involved in learning and
memory.

"Up to now, we have never demonstrated that if we take people who are previously sedentary and give them exercise that we can
actually increase the size of this region of the brain," said Dr. Erickson.

"Clinicians should really try to get their older patients moving. It's easy for us to think that exercise only exerts its effects on our
bodies from the neck down, but clearly that's not the case. Our brains are parts of our bodies, and we see the same types of
benefits on our brains as we do our bodies. I think that is easily overlooked and something we don't often think about."

Cyrus Raji, MD, PhD, a researcher at the University of Pittsburgh who has conducted research on the benefits of exercise for
Alzheimer's disease, commented that the study is important because it shows in a very concrete way how beneficial exercise can be
for seniors.

"This is a randomized clinical trial, which is the highest form of clinical investigation you can have. What was most exciting to me
about the study is that they showed that the specific part of the hippocampus, the anterior part of the hippocampus, benefits the
most from exercise training," Dr. Raji, who was not part of the current study, told Medscape Medical News.

"This is important because Alzheimer's disease is known to start in and target that part of the hippocampus. The finding helps
explain how exercise can reduce the risk for Alzheimer's disease and is another reason why everybody of all age groups, but
especially the elderly, should, based on this study, engage in regular forms of physical activity."

Dr. Erickson and Dr. Raji have disclosed no relevant financial relationships.

Proc Natl Acad Sci U S A. Published online January 31, 2011.

Diet Rich in Flavonoids May Guard Against Parkinson's Disease

February 15, 2011 — Regular consumption of flavonoids, especially anthocyanins found mainly in berries, may help
protect against Parkinson's disease (PD), according to new observational results using data on men and women in
the Health Professional Follow-Up Study and the Nurses' Health Study.

The relationship however, was only significant among men. The findings were released February 13 ahead of
presentation in April at the American Academy of Neurology 63rd Annual Meeting in Honolulu, Hawaii.

"Some animal studies suggest a potential protective effect of flavonoids and berries on PD," Xiang Gao, MD, PhD, of
the Harvard School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts, told Medscape
Medical News.

Until now, however, there have been no prospective human studies on this topic, he noted. "Our study is the first one
to look at whether intakes of flavonoid and flavonoid-rich foods are associated with future risk of developing PD.

"Although it's too early to say that eating berries can reduce PD risk, benefits of berries have been reported in several
previous studies, for example, lowering risk of hypertension," Dr. Gao concluded. "So it is good, at least no harm, if
we can have 2 to 3 cups of berries a week."

Gender Differences

The researchers analyzed more than 2 decades worth of follow-up data on 49,281 men in the Health Professional
Follow-Up Study and 80,336 women in the Nurses' Health Study. They had detailed information on intake of total
flavonoids and their subclasses, including anthocyanins. Their analysis focused on 5 major sources of flavonoid-rich
foods, including tea, berry fruits, apples, red wine, and oranges/orange juice.

During follow-up, a total of 805 subjects developed PD. In men, after adjusting for multiple confounders, those in the
top quintile of flavonoid consumption were about 40% less likely to develop PD relative to those in the bottom quintile
of consumption.

"For men, the updated relative risk of the highest vs lowest total flavonoid intake is 0.6 (95% confidence interval, 0.43
– 0.83)," Dr. Gao told Medscape Medical News.

In women, there was no relationship between overall flavonoid consumption and developing PD. "Honestly," said Dr.
Gao, "we don't have an answer for this observed gender difference at this time. Clearly, more studies are needed to
explore this."

Honestly, we don't have an answer for this observed gender difference at this time. Clearly, more studies are
needed to explore this.

In pooled analyses looking at different subclasses of flavonoids, intakes of anthocyanins and anthocyanin-rich foods,
such as berries and apples, were significantly associated with lower risk for PD in men and women (Pfor trend < .05
for both).

Why anthocyanins? "We don't know the exact mechanisms at this time; however, it is established that anthocyanins
can cross blood brain barrier," Dr. Gao said.

He also noted that animal studies have shown that consumption of anthocyanin-rich foods, such as blueberries or
strawberries, increase dopamine release, alleviating oxidative stress and suppressing neuroinflammation in the brain.

Antioxidants in PD is an area of "keen interest," Connie Marras, MD, PhD, of Toronto Western Hospital Movement
Disorders Centre and University of Toronto, Ontario, Canada, who was not involved in the study, noted in an
interview with Medscape Medical News. "Some people feel that oxidative stress may contribute to the pathology to
Parkinson's disease in one way or another, and we are continuing to pursue trials of antioxidants — coenzyme Q10,
for example."

This new study provides a "very interesting finding that needs to be pursued," she added. "But it's an observational
study, so we really don't know if this 'signal' is really related to a causal association between the flavonoid intake and
Parkinson's disease or are these types of foods indicative of a lifestyle that protects against Parkinson's disease."

Dr Gao agrees that "more studies are needed to examine potential neuroprotective effects of anthocyanins and other
flavonoids."

The study was supported by the National Institutes of Health. The researchers and Marras have disclosed no
relevant financial relationships.

American Academy of Neurology 63rd Annual Meeting: Abstract 3697.