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Increasing precision in exercise prescription to promote cognitive and brain health. The neural interplay between cognitive function and mobility. The relationship between sleep and cognitive function. Preventing falls in high-risk older adults.
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Graduate Student Supervision
Doctoral Student Supervision (Jan 2008 - May 2019)
As the world’s population ages, mobility and cognitive impairments are major health-care priorities. Given the particular relevance of the brain in the manifestation of both conditions, the aims of my dissertation are two-fold: 1) to advance our knowledge of the intrinsic relationship between mobility and cognitive impairments; and 2) to characterize the underlying functional neural mechanisms by which exercise promotes cognitive and mobility outcomes in older adults with mild cognitive impairment. Using magnetic resonance imaging, I focused on characterizing brain structures and brain function – as measured by functional neural activity as well as regional and network connectivity – associated with falls and slow gait. Additionally, I investigated how aerobic exercise may exert influence on mobility and cognitive function via pathways indicated by magnetic resonance imaging derived neural correlates. My research showed that while falls are associated with lower total and regional gray and white matter volume, slow gait, in conjunction with mild cognitive impairment, is reflected by disrupted neural network connectivity. Moreover, my work aligns with emerging concept of neural efficiency by generating evidence that suggests aerobic exercise training may promote mobility and cognitive function by maintaining or improving neural efficiency. Overall, these results contribute to a better understanding of the neural underpinnings of mobility and cognitive impairments, as well as provide new insight into the neural mechanisms by which exercise promotes mobility and cognitive function.
Introduction: The world’s population is aging at an unprecedented rate. By 2050, the number of adults older than 60 years will double from 10% to 20%. This trend has immense implications, due to the prevalence of impaired physical and cognitive functions among older adults. Therefore, it is important to understand the underlying mechanisms for these impairments and identify effective prevention strategies. White matter hyperintensities (WMHs) are common findings on MRI scans of older adults, and are associated with both physical and cognitive decline. Key risk factors for WMHs are related to metabolic and cardiovascular health. Thus, due to the established and significant benefit of targeted exercise training on metabolic and cardiovascular health in older adults, we hypothesized that one mechanism by which exercise, and specifically resistance training (RT), promotes physical and cognitive functions is by reducing WMH progression among older adults. Methods: We explored the associations between WMHs and physical and cognitive functions in Chapters 2 to 4. In Chapter 5, we presented a randomized controlled trial of 52-week RT. Participants were randomized to either once-weekly RT, twice-weekly RT, or twice-weekly balance and tone. We investigated the effect of RT on WMH progression. Results: Results from Chapters 2 and 3 suggest that reduced WMH progression may translate to maintained, or improved, physical and cognitive functions. Chapter 4 demonstrated that physical function is important for cognitive health. Chapter 5 provided proof-of-concept evidence that RT has beneficial effects on WMH progression, which may translate to improved physical and cognitive function. Specifically, we found that reduced WMH progression was significantly iii associated with improved gait speed. Moreover, our results suggest this effect may be dose-dependent, as the significant reduction in WMH progression was only observed among those in the twice-weekly RT group, and not in the once-weekly RT group. Conclusion: We provided converging evidence from four separate studies leading to the conclusion that RT has beneficial effects on WMH progression. Since WMHs are demonstrated to have significant associations with physical and cognitive dysfunctions, we believe that exercise-induced reductions of WMHs progression might translate to improvements in physical and cognitive functions in older adults.
No abstract available.
Master's Student Supervision (2010 - 2018)
Background: Sub-cortical ischemic vascular cognitive impairment (SIVCI) is the most prevalent form of Vascular Cognitive Impairment (VCI). Previous studies have shown that Carotid-Femoral Pulse Wave Velocity (CF-PWV), cognitive function, mobility performance and blood pressure are related to White Matter Lesions (WMLs) volume, but whether these associations exist in those with mild SIVCI is unclear. Thus, in this study of older adults with mild SIVCI, I examined four questions:1) What is the association between total, deep and periventricular WMLs volume on Magnetic Resonance Imaging (MRI) with CF-PWV?2) What are the associations between total, deep and periventricular WMLs volume and measures of global cognitive function and executive function?3) What is the association between total, deep and periventricular WMLs volume with mobility performance? 4) What is the association between total, deep and periventricular WMLs volume with systolic and diastolic blood pressure?Methods: The data of 34 participants diagnosed with mild SIVCI were used for this cross-sectional analysis. Measures of interest included global cognitive function tests, such as Alzheimer’s disease Assessment Scale Cognitive Subscale (ADAS-cog) and Montreal Cognitive Assessment (MoCA). Executive functions were assessed with paper Stroop test, Trails Making Tests (A&B) and animal fluency. Mobility performance was assessed with the Time Up and Go test (TUG) and usual gait speed. CF-PWV was measured using the Complior System (ALAM Medical, France). WMLs volume was quantified for the total, deep and periventricular WMLs with a semi-automated technique.Results: We did not find an association between total or periventricular WMLs volume with CF-PWV, executive function, global cognitive function, mobility performance or blood pressure. Deep WMLs volume was associated with Trails B-A and animal category fluency but not associated with measures of global cognitive function. Deep WMLs volume was significantly associated with diastolic blood pressure. Conclusion: In this exploratory analysis, deep WMLs volume is associated with executive function and diastolic blood pressure. While systolic hypertension has been strongly linked to large vessel stroke events which are commonly complicated by post stroke cognitive impairment and dementia, our findings provide possible mechanistic insight to previous studies that found association between diastolic blood pressure and cognitive decline.
Introduction:Deficits in balance, mobility and executive functions are common among chronic stroke survivors and contribute to increased falls risk. Targeted exercise training reduces falls risk among older adults with chronic stroke and is a promising strategy to promote cognitive function. Specifically, the Otago exercise program (OEP) reduces falls risk and improves executive functions in older adults with a history of falls. Mindful based meditation (MBM) may be a complementary approach to the OEP for promoting balance and mobility and cognitive outcomes among older adults with chronic stroke. Purpose:The purpose of this proof-of-concept study was three-folds: 1) To examine whether MBM combined with OEP (OEP+MBM) is more efficacious than OEP alone (OEP-only) on improving balance, mobility and cognitive outcomes among older adults with chronic stroke. 2) To explore whether OEP-only or OEP+MBM has benefits for mindful attention, as measured by the Five Factor Mindfulness Questionnaire. 3) To assess components of feasibility to optimize larger repeat trials. Methods:Subjects: Twenty-three community dwelling adults aged > 55 years, who experienced a single ischemic or hemorrhagic stroke at least 12 months prior to studyStudy Design: 12-week proof-of-concept, assessor single-blinded randomized controlled trial Results:There is preliminary evidence for meditation practice as a safe intervention for older adults with chronic stroke. Although no statistically significant effects were found, two cognitive variables with marginally significant improvements for the OEP+MBM group provide support for MBM to improve attention and processing speed. Examination of the between-group differences on the outcome variables standardized to standard deviation values provide tentative support for the OEP+MBM intervention and rationale for further research. Self-reported levels of mindfulness did not increase for either group. The feasibility of conducting future repeat studies was verified with 27 subjects recruited to attend information sessions within six weeks, 24/27 (.89) consenting to study participation and strong adherence (>.80) to interventions for all participants.Conclusions: This proof-of-concept study provides an early indication that future studies are warranted to examine whether the addition of MBM to therapeutic exercise has the potential to positively impacts balance, mobility, and cognitive outcomes in older adults with chronic stroke.
No abstract available.
Background: Falls among seniors are a major health issue. About 30% of community-dwelling adults aged 65 years and older experience one or more falls per year. Although not all falls lead to injury, 20% require medical attention and 5% result in fracture. Fall-related injuries are the leading cause of mortality due to unintentional injuries among those 65 and older. Key falls risk factors are categorized into physical factors (e.g. gait speed, balance, muscle strength, etc.) and neurocognitive factors (e.g. cognitive performance, brain volume, etc.). To date, few studies have examined the brain function on falls risk. My thesis explores this question through functional connectivity MRI analysis. Method: A cross-sectional functional magnetic resonance imaging study consisted of 44 (23 non-fallers and 21 fallers) community dwelling older adults. Participants performed the finger tapping motor task and I examined for differences in functional connectivity of four age-related neural networks: default mode network (DMN), fronto-executive network (FE), fronto-parietal network (FP), and motor network (Mot). Results: Significant between-group differences were identified in between-network functional connectivity. Fallers showed decreased connectivity between the FP network and Mot network (p