Physical activity level in people with age

related white matter changes correlates to

better motor performance, lower comorbidity
and higher cognitive level.

Objective:
 The aim of this study is to evaluate the activity level on people with
age-related white matter changes as identified on magnetic resonance
imaging (MRI) in relation to motor performance, cognition and
perceived health.

SIGNIFICANCE OF THE STUDY

 Physical activity plays a pivotal role in the development of disability. It
is important implications since inactive older people with low
physiologic reserves are more vulnerable to disease events and
subsequent disability.

Problem:
 The negative effect of vascular risk factors on progression of both
cardio and cerebrovascular disorder.

METHODS IN SOLVING THE PROBLEM

 Gather information on comorbidity, physical activity level, physical
function, cognition, level of white matter changes and perceived
 health was collected. Physical activity level was classified with a yes or
no question and with the Frenchay Activities Index (FAI).
 Examine the net contribution of various degrees of age related brain
white matter changes (ARWMC) on the development of disability in
older people.

Result:
 Only 36% of the subjects in this study were physically active according
to the yes/no question. 27.5% of the subjects were active according to
the FAI score which evaluates the everyday activities. Being active
discriminated subjects with better physical function. Subjects active
according to the FAI score had a higher cognitive level (p ≤ 0.01), lower
comorbidity (p = 0.02) and performed better on all motor function
tasks as assessed by walking speed (p ≤ 0.01) and the Short Physical
Performance battery (SPPB) (p ≤ 0.01).

Recommendation:
 Moderate physical activity for at least 30 min, no less than 3
times/week to maintain cardiovascular fitness. This level of exercise
can decrease vascular risk factors and the incidence of coronary heart
disease.
 In addition, low intensity physical activity renders other health
benefits such as maintaining physical function, a higher quality of life,
and wellbeing. Many of our daily activities include activities that are
dependent on lower extremity function, which has been found to be
able to predict short-term mortality and nursing home admission in
older adults
Conclusion:
 Being physically active seems to be a long term protective factor. In
our study, the majority of subjects with Age Related White Matter
Changes (ARWMC) with no or mild Instrumental Activity of Daily Living
(IADL) disability did not attain recommended level of activity at first
year follow up. Whether or not increasing physical activity may slow
down cognitive decline and lessen development of disability in
physically inactive subjects with manifest ARWC remains to be studied.
Trial registration: not applicable.

Does the diagnosis of Alzheimer’s

Disease imply immediate
revocation of a driving license?

Objectives
 To present and discuss the current knowledge about the driving
behavior and fitness of patients with Alzheimer Disease (AD) and Mild
Cognitive Impairment (MCI). And by integrating the various sources of
evidence develop a rationale that supports the implementation of a
personalized approach when taking decisions about the driving fitness
of patients belonging in the specific clinical groups

Significance of the study:

 To present the current knowledge about the driving behavior of
individual with two common cognitive disorder, namely Alzheimer
Disease and Mild Cognitive Impairment.

Problem:
 CONTINUE TO DRIVE OR NOT?

Methods of resolving the problem

 Implementation of a personalized approach that is based on
the unique profile of each driver with AD.
 AD patients should be required to undergo a detailed driving
evaluation that covers various components, namely a practice road
rule test, assessment of physical, visual, sensory and cognitive abilities,
as well as on-road assessment.
 More consistent and regular monitoring of driving ability on patients
with MCI is suggested to be formally implemented.

Conclusion
 In conclusion, decisions related to the critical question “Continue to
drive or not?” and concerns about the group drivers with cerebral
diseases should be based on an interdisciplinary approach that
integrates the specialties of neurology, neuropsychology and
transportation engineering.
 A comprehensive intervention following the
clinical pathway of eating and swallowing
disorder in the elderly with dementia.

Objectives:
The aim of tese study is to improve the functional status of eating in
elderly patients with severe eating problems and dementia.

Significance of study
The present of study allowed that the CGA with a multidisciplinary team
could determine the etiologies of ESDED in detail, which could help
independence from AHN and improve AHN and improve AHNFS without
reducing OS. This result indicates that focusing on the etiology of ESDED
is important for improving clinical outcomes.

PROBLEM:
Eating problem in patients with advanced dementia are recognized as
one of the greatest risk factors for their survival.
Eating problems including disturbed eating behavior; dysphagia; nausea;
and anorexia, are associated with various pathologic conditions such as
dementia, stroke, sarcopenia, mental illness, and systemic diseases that
disturb many physical functions.

Methods in resolving the Problem:

a. Comprehensive geriatric assessment (CGA) has been shown to be
effective for improving functonal status and prognosis in elderly patients.
b. In particular, CGA may clarify the etiologies of eating problems and
provide individualized intervention with the potential to improve
dementia patients' decreased oral intake.

RESULTS
 During the intervention period (between 1st april 2013 and 31st
March 2015), 102 cases of ESDED were enrolled in the study and 90
patients had completed recieving CGA. Conversely, 124 ESDED patient
controls were selected from the same hospital enrolled during the
historical period ( between 1st April 1011 and 31st March 2012).
 For the intervention group, an average of 4.3 interventional strategies
was recommended per participant after CGA.
 Serological tests, diagnostic imaging and other diagnostic
examinations were much more frequently performed in the
intervention group.

CONCLUSION:
 Use of CGA with multidisciplinary interventions could improve the
functional status of eating and allow elderly patients with severe
problems and dementia to survive independently without need of
ANH.

RECOMENDATION
For elderly patients with severe eating problems and dementi to help
them become idependent from AHN