Cerebral changes improved by physical activity during cognitive decline: A systematic review on MRI studies

Abstract

Current treatment in late-life cognitive impairment and dementia is still limited, and there is no cure for brain tissue degeneration or reversal of cognitive decline. Physical activity represents a promising non-pharmacological interventional approach in many diseases causing cognitive impairment, but its effect on brain integrity is still largely unknown. Especially research of cerebral alterations in disease state that goes beyond observations of clinical improvement is crucial to understand disease processes and possible effective treatments. In this systematic review, we address the question how physical activity and fitness in mild cognitive impairment (MCI) and Alzheimer's disease (AD) influences brain architecture compared to cognitively healthy elderly. We review both interventional studies comprising aerobic, coordinative and resistance exercises and observational studies on fitness and physical activity combined with Magnetic Resonance imaging (MRI). Different MRI approaches were included such as volumetric and structural analyses, Diffusion Tensor Imaging (DTI), functional MRI and Cerebral Blood Flow (CBF). We evaluate MRI results for different exercise modalities and performed a methodological evaluation of interventional studies in cognitive decline compared to normal aging. According to our results, among 12 interventions in AD/MCI, aerobic exercise is most frequently applied (9 studies). Interventions in AD/MCI altogether reveal a higher methodological quality compared to interventions in healthy elderly (8.33 ± 2.19 vs. 6.25 ± 2.36 out of 13 points), with most frequent missing aspects related to descriptions of complications, lack of intention-to-treat and statistical power analyses. Effects of aerobic exercise and fitness seem to mainly impact brain structures sensitive to neurodegeneration, which especially comprise frontal, temporal and parietal regions, such as the hippocampal/parahippocampal region, precuneus, anterior cingulate and prefrontal cortex, which are reported by several studies. General fitness measured via an objective fitness assessment and questionnaires seems to have a more global cerebral effect, probably due to its long-term application, whereas distinct intervention effects of durations between 3 and 6 months seem to concentrate on more local brain regions as the hippocampus, which can also be influenced by region of interest analyses. There is still a lack of evidence on other or combined types of intervention modalities, such as resistance, coordinative as well as multicomponent exercise during cognitive decline, and complex interventions as dancing. Future research should examine their beneficial effect on brain integrity, since several non-MRI studies already point to their advantageous impact. As a further future prospect, combination and application of newly developed imaging methods such as metabolic imaging should be envisaged to understand physical activity and its cerebral influence under its many-sided facets.

Keywords: Dementia; Exercise; Fitness; MRI; Neuroimaging; Physical activity.

Fig. 1

Flow chart of the inclusion process of literature according to the PRISMA criteria. A total of 23 studies is included in this review.

Fig. 2

Overview of included studies in MCI and AD patients with number of included subjects who underwent MRI.

Fig. 3

Overview of brain regions affected by intervention studies (A), fitness (B) and physical activity evaluated via questionnaires (C) for MCI/AD patients (blue) and cognitively healthy elderly (red). The color grading (overlay transparency) is shown for a single study for reported brain regions. Therefore, an accumulation resulting in increased color grading will occur when certain ROIs are reported by several studies. For intervention studies (A), relevance of brain regions is weighted by methodological quality (0 to 100% of criteria fulfilled). For observational studies (B and C) total sample size is taken for weighting (categorization into samples of <50 subjects, 50–100, 100–200, 200–500, >500 subjects). For comparison purposes, only results from volume and cortical thickness analyses were included. On the right, corresponding illustration of brain regions reported for intervention and observational studies in relation to sample size and reported number of brain regions belonging to superordinate brain regions is given. These are illustrated via circle size (1–5 reported sub-regions). Overview of the names of the brain regions included in this graphical illustration in detail are listed in the supplementary (volume and cortical thickness). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)