Exercise is prescribed to reduce the risk of a number of chronic health conditions, including obesity, diabetes and cardiovascular disease. Medical researchers at a number of institutions, including Washington University School of Medicine, are studying whether exercise and cholesterol-lowering medication are good for brain health as well. They are recruiting older adults for a two-year Risk Reduction for Alzheimer’s Disease study.
Alzheimer’s is the most common form of dementia, brought on by changes in the brain, usually beginning in late middle age. It is characterized by changes in memory, thinking and behavior, which interfere with daily tasks and lead to the memory lapses, confusion, emotional instability progressively lead to loss of mental ability. Age, family history and genetics are risk factors. Lifestyle choices and effectively managing other health conditions may also be factors.
The Alzheimer’s Association says some of the strongest evidence links heart health to brain health, as the risk of developing Alzheimer’s or vascular dementia appears to be increased by many conditions that damage the heart and blood vessels. Additionally, studies of donated brain tissue suggest that plaques and tangles are more likely to cause Alzheimer’s symptoms if strokes or damage to the brain’s blood vessels are also present.
“There is now mounting evidence to suggest that there is a link between cardiovascular disease and Alzheimer’s disease,” said Ellen F. Binder, M.D., professor of Medicine and Occupational Therapy at the Washington University School of Medicine.
For its new Risk Reduction study, Washington University is recruiting individuals between the ages of 60 and 85 who may be at higher risk of developing Alzheimer’s disease due to high blood pressure and a family history of dementia in a parent or sibling, or people with concerns that their own memory has changed.
“Our study is designed specifically to look at whether more intensive blood pressure management will reduce cognitive decline,” Dr. Binder said. “I think this is a very important study for African Americans because of the increased risk of Alzheimer’s disease and the increased prevalence of high blood pressure as a risk factor in African Americans.”
In this two-year study, participants must be willing to undergo an aerobic exercise program and/or medication to manage blood pressure and blood cholesterol levels. Participants must also have a primary care physician at the time of screening.
The Risk Reduction study tests to see if aerobic exercise alone or combined with blood pressure- and cholesterol-reducing medication will reduce the risk of cognitive changes over two years, compared to the current standard approach for medical management of blood pressure and cholesterol.
“We do a screening exam, blood work, an EKG on everyone at no charge,” Dr. Binder said. “They have a brain MRI and they have cognitive testing at the beginning of the study, then at one year, and then at two years.”
A different study, the SPRINT trial, showed that getting participants below 120 in systolic blood pressure resulted in significant cardiovascular benefit among high-risk patients with hypertension compared with routine blood pressure management to <140 mm Hg. The rrAD study wants to see if intensive interventions to reduce cardiovascular disease risk will reduce Alzheimer’s risk as well.
“What we would expect is that there will be less cognitive decline in the groups that receive the interventions,” Dr. Binder said. “And we expect that the combination of intensive blood pressure management, statin and exercise may give the greatest protection.”
She said this is a study where there is some benefit for everybody, even if those in the usual care group. “You are getting a home exercise program, you’re getting more attention,” Dr. Binder said. “It’s often motivating for people to be in a study, just for their own health.”
She said WUSM has been recruiting and enrolling patients since November 2016 and plans to continue enrollment until at least May 2019.
Other institutions participating trial include the University of Texas Southwestern Medical Center, Texas Health Presbyterian Hospital Dallas, University of Kansas Alzheimer’s Disease Center, Michigan State University, and the Pennington Biomedical Research Center at Louisiana State University.
For more information on the Risk Reduction trial, contact Monica Sewell, study coordinator, at sewellm@wustl.edu or at 314-286-2716; or Adriana Martin, recruitment coordinator at 314-273-1355.
Find out more about the study at http://www.rradtrial.org.
