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      Continuing education for the prevention of mild cognitive impairment and Alzheimer’s-type dementia: a systematic review and overview of systematic reviews

      systematic-review

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          Abstract

          Objective

          To summarise evidence on the preventive effects of continuing education on mild cognitive impairment and Alzheimer’s-type dementia in adults 45 years or older.

          Design

          Systematic review and overview of systematic reviews.

          Data sources

          We systematically searched MEDLINE, PsycINFO, EMBASE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Scopus for published studies and grey literature databases for unpublished studies from January 1990 to April 2018.

          Methods

          To assess evidence directly addressing our objectives, we conducted a systematic review. Because we were aware of a dearth of direct evidence, we also performed an overview of systematic reviews on leisure activities that mimic formal continuing education. We a priori established the inclusion and exclusion criteria. Two authors independently assessed inclusion and exclusion at the abstract and full-text level, rated the risk of bias, and determined the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation. We resolved all discrepancies by consensus. We synthesised the available evidence narratively.

          Results

          Our searches identified 4933 citations. For the systematic review, only two publications on the same prospective cohort study (Tasmanian Healthy Brain Project) met the inclusion criteria; for the overview of reviews, we included five systematic reviews. Based on 459 participants, preliminary data of the ongoing cohort study indicated that cognitive reserve statistically significantly increased in persons attending university classes compared with the control group (92.5% vs 55.7%, p<0.01). Likewise, language processing capacities statistically significantly improved (p<0.01). Episodic memory, working memory and executive function did not differ significantly between groups. Systematic reviews consistently reported a positive association between participation in cognitively stimulating leisure activities and reduced incidence of dementia and improved cognitive test performance.

          Conclusion

          Available results demonstrate that cognitive reserve increases through continuing education and show a positive association of cognitive leisure activities with both improved cognitive function and lower dementia incidence.

          PROSPERO registration number

          CRD42017063944.

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          Most cited references22

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

          David Moher, Alessandro Liberati, Jennifer Tetzlaff … (2009)
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            Neuroplasticity - exercise-induced response of peripheral brain-derived neurotrophic factor: a systematic review of experimental studies in human subjects.

            Kristel Knaepen, Maaike Goekint, Elsa Marie Heyman … (2010)
            Exercise is known to induce a cascade of molecular and cellular processes that support brain plasticity. Brain-derived neurotrophic factor (BDNF) is an essential neurotrophin that is also intimately connected with central and peripheral molecular processes of energy metabolism and homeostasis, and could play a crucial role in these induced mechanisms. This review provides an overview of the current knowledge on the effects of acute exercise and/or training on BDNF in healthy subjects and in persons with a chronic disease or disability. A systematic and critical literature search was conducted. Articles were considered for inclusion in the review if they were human studies, assessed peripheral (serum and/or plasma) BDNF and evaluated an acute exercise or training intervention. Nine RCTs, one randomized trial, five non-randomized controlled trials, five non-randomized non-controlled trials and four retrospective observational studies were analysed. Sixty-nine percent of the studies in healthy subjects and 86% of the studies in persons with a chronic disease or disability, showed a 'mostly transient' increase in serum or plasma BDNF concentration following an acute aerobic exercise. The two studies regarding a single acute strength exercise session could not show a significant influence on basal BDNF concentration. In studies regarding the effects of strength or aerobic training on BDNF, a difference should be made between effects on basal BDNF concentration and training-induced effects on the BDNF response following an acute exercise. Only three out of ten studies on aerobic or strength training (i.e. 30%) found a training-induced increase in basal BDNF concentration. Two out of six studies (i.e. 33%) reported a significantly higher BDNF response to acute exercise following an aerobic or strength training programme (i.e. compared with the BDNF response to an acute exercise at baseline). A few studies of low quality (i.e. retrospective observational studies) show that untrained or moderately trained healthy subjects have higher basal BDNF concentrations than highly trained subjects. Yet, strong evidence still has to come from good methodological studies. Available results suggest that acute aerobic, but not strength exercise increases basal peripheral BDNF concentrations, although the effect is transient. From a few studies we learn that circulating BDNF originates both from central and peripheral sources. We can only speculate which central regions and peripheral sources in particular circulating BDNF originates from, where it is transported to and to what purpose it is used and/or stored at its final destination. No study could show a long-lasting BDNF response to acute exercise or training (i.e. permanently increased basal peripheral BDNF concentration) in healthy subjects or persons with a chronic disease or disability. It seems that exercise and/or training temporarily elevate basal BDNF and possibly upregulate cellular processing of BDNF (i.e. synthesis, release, absorption and degradation). From that point of view, exercise and/or training would result in a higher BDNF synthesis following an acute exercise bout (i.e. compared with untrained subjects). Subsequently, more BDNF could be released into the blood circulation which may, in turn, be absorbed more efficiently by central and/or peripheral tissues where it could induce a cascade of neurotrophic and neuroprotective effects.
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              Participation in cognitively stimulating activities and risk of incident Alzheimer disease.

              Robert Wilson (2002)
              Frequent participation in cognitively stimulating activities has been hypothesized to reduce risk of Alzheimer disease (AD), but prospective data regarding an association are lacking. To test the hypothesis that frequent participation in cognitive activities is associated with a reduced risk of AD. Longitudinal cohort study with baseline evaluations performed between January 1994 and July 2001 and mean follow-up of 4.5 years. A total of 801 older Catholic nuns, priests, and brothers without dementia at enrollment, recruited from 40 groups across the United States. At baseline, they rated frequency of participation in common cognitive activities (eg, reading a newspaper), from which a previously validated composite measure of cognitive activity frequency was derived. Clinical diagnosis of AD by a board-certified neurologist using National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association criteria and change in global and specific measures of cognitive function, compared by cognitive activity score at baseline. Baseline scores on the composite measure of cognitive activity ranged from 1.57 to 4.71 (mean, 3.57; SD, 0.55), with higher scores indicating more frequent activity. During an average of 4.5 years of follow-up, 111 persons developed AD. In a proportional hazards model that controlled for age, sex, and education, a 1-point increase in cognitive activity score was associated with a 33% reduction in risk of AD (hazard ratio, 0.67; 95% confidence interval, 0.49-0.92). Results were comparable when persons with memory impairment at baseline were excluded and when terms for the apolipoprotein E epsilon4 allele and other medical conditions were added. In random-effects models that controlled for age, sex, education, and baseline level of cognitive function, a 1-point increase in cognitive activity was associated with reduced decline in global cognition (by 47%), working memory (by 60%), and perceptual speed (by 30%). These results suggest that frequent participation in cognitively stimulating activities is associated with reduced risk of AD.
              Article 0 comments Cited 264 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2019
                Publication date (Electronic): 2 July 2019
                Volume: 9
                Issue: 7
                Electronic Location Identifier: e027719
                Affiliations
                [1 ] departmentDepartment for Evidence-based Medicine and Clinical Epidemiology , Donau-Universitat Krems , Krems, Austria
                [2 ] departmentDepartment for Continuing Education Research and Educational Management , Donau-Universitat Krems , Krems, Austria
                [3 ] departmentDepartment for Clinical Neurosciences and Preventive Medicine , Donau-Universitat Krems , Krems, Austria
                [4 ] departmentCenter for Geriatric Medicine and Geriatric Nursing , Donau-Universitat Krems , Krems, Austria
                [5 ] departmentEvidence-based Practice Center , RTI International , Research Triangle Park, North Carolina, USA
                Author notes
                [Correspondence to ] Dr. Nina Matyas; nina.matyas@ 123456ext.donau-uni.ac.at
                Author information
                http://orcid.org/0000-0003-3107-8524
                Article
                Publisher ID: bmjopen-2018-027719
                DOI: 10.1136/bmjopen-2018-027719
                PMC ID: 6609120
                PubMed ID: 31270114
                SO-VID: 6d262275-b3b9-452d-a3e8-c92312f67141
                Copyright © © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 08 November 2018
                Date revision received : 24 May 2019
                Date accepted : 06 June 2019
                Categories
                Subject: Mental Health
                Subject: Research
                Subject: 1506
                Subject: 1712
                Custom metadata
                special-feature unlocked

                ScienceOpen disciplines: Medicine
                Keywords: systematic review,dementia,mild cognitive impairment,preventive medicine,continuing education
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: systematic review, dementia, mild cognitive impairment, preventive medicine, continuing education

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