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Physical activity and dementia risk in the elderly

Findings from a prospective Italian study

From the Department of Internal Medicine (G.R., P.F., A.L., N.P., E.R.), Cardioangiology, and Hepatology; University Hospital S. Orsola-Malpighi, Bologna; and Health District of Lugo (M.B., E.D.), Local Health Unit Ravenna, Italy.

Address correspondence and reprint requests to Dr. Giovanni Ravaglia, Department of Internal Medicine, Cardioangiology, and Hepatology, University Hospital S. Orsola-Malpighi, Via Massarenti, 9-40138 Bologna, Italy giovanni.ravaglia{at}unibo.it

Objective: To examine the effect of physical activity on risk of developing Alzheimer disease (AD) and vascular dementia (VaD) in the elderly.

Methods: Data are from a prospective population-based cohort of 749 Italian subjects aged 65 and older who, in 1999/2000, were cognitively normal at an extensive assessment for clinically overt and preclinical dementia and, in 2003/2004, underwent follow-up for incident dementia. Baseline physical activity was measured as energy expenditure on activities of different intensity (walking, stair climbing, moderate activities, vigorous activities, and total physical activity).

Results: Over 3.9 ± 0.7 years of follow-up there were 86 incident dementia cases (54 AD, 27 VaD). After adjustment for sociodemographic and genetic confounders, VaD risk was significantly lower for the upper tertiles of walking (hazard ratio [HR] 0.27, 95% CI 0.12 to 0.63), moderate (HR 0.29, 95% CI 0.12 to 0.66), and total physical activity (HR 0.24, 95% 0.11 to 0.56) compared to the corresponding lowest tertile. The association persisted after accounting for vascular risk factors and overall health status. After adjustment for sociodemographic and genetic confounders, AD risk was not associated with measures of physical activity and results did not change after further adjustment for vascular risk factors and overall health and functional status.

Conclusions: In this cohort, physical activity is associated with a lower risk of vascular dementia but not of Alzheimer disease. Further research is needed about the biologic mechanisms operating between physical activity and cognition.

Abbreviations: ACSM = American College of Sports Medicine; AD = Alzheimer disease; ADL = activities of daily living; CDCP = Centers for Disease Control and Prevention; CSBA = Conselice Study of Brain Ageing; GDS = Geriatric Depression Scale; HR = hazard ratio; IADL = instrumental activities of daily living; MCI = mild cognitive impairment; MDB = Mental Deterioration Battery; MMSE = Mini-Mental State Examination; VaD = vascular dementia.

Supplemental data at www.neurology.org

e-Pub ahead of print on December 19, 2007, at www.neurology.org.

Supported by grants from the Italian Ministry of University and Scientific Research (basic-oriented research funds).

Disclosure: The authors report no conflicts of interest.

Received May 28, 2007. Accepted in final form September 17, 2007.