SHEDD: Sussex Health Exercise and Diet in Dementia

Nicolas Farina, BSc., MSc. and Prof Jenny Rusted, School of Psychology, University of Sussex Design Dr Naji Tabet, Sussex Partnership NHS foundation Trust A longitudinal study, in which participants are tested annually for up to 3 years. Background Measures Dementia is a neurodegenerative disorder that causes the progressive decline of cognition. This decline results in functional impairments which eventually lead to a A battery of measures will be given to patients and their carers at home, lasting loss in independence. It is currently estimated that 800,000 patients suffer with the approximately 2-3 hours. These measures include: disorder, making it the most prevalent neurodegenerative disorder in the UK. Along with preventing the onset of dementia, there is a great need to assist those who Cognitive Measures: already have a diagnosis of the disorder. Current medication has a limited efficacy • Addenbrookes Cognitive Examination Revised – a validated dementia screening tool, on symptoms. A better understanding of the role of non-pharmacological factors is sensitive to early cognitive dysfunction. particularly important as the number of dementia cases are expected to increase by • Trials A and B – require participants to use complex visual scanning with a 38% by 2022. motor component. • Stroop Switch Task – a measure of selective and task switching. Various lifestyle factors have been found to have a positive effect on cognitive • Card sort task – is a task which involves prospective , self-initiated performance in people with dementia, including; diet, exercise, social interaction monitoring along with maintenance of dual goals. and cognitive stimulation. The problem in current research is that these factors are • Prospective and Retrospective Memory Questionnaire - a questionnaire developed explored independently, without considering the interactions that may exist between for carers to report prospective and retrospective memory slips in patients them. One possible example of such an interaction is between diet and exercise. Poor everyday activities. cerebrovascular health, present in Alzheimer’s disease (AD) and • Digit Symbol Substitution – a measure of attention and psychomotor speed. (VaD), results in reduced cerebral perfusion preventing beneficial nutrients from • Map Search Task – a measure of selective attention with only a minimal reaching target neurons. Exercise can improve vascular health and therefore potentially memory component. enhance the beneficial effects of a healthy diet. • Controlled Oral Word Association Task – assess speed and search of , along with a component of self-monitoring. • National Adult Reading Test – a pronunciation task of 50 irregular words to provide “Healthy” Dementia Cognitive an estimate of premorbid IQ. Diet Pathology decline Lifestyle Questionnaires: Cerebral Profusion • Food Frequency Questionnaire – a measure of habitual diet by asking the frequency Key with specific food items or food groups over the past year. Attenuates • Physical Activity Scale for the Elderly – a measure of habitual physical activity. Increases • Lubben Social Network Scale – a measure of the participants’ social network size. Exercise • Florida Cognitive Activities Scale – assesses cognitive activities in the elderly over the past year.

Figure 1: A theoretical model of the interaction between exercise and diet in the Functional Measures: cognitive decline of dementia • Clinical Dementia Rating – is a method to quantify the severity of symptoms in dementia. Aim • Bristol Activities of Daily Living – developed specifically for dementia patients to assess functional ability in daily activities. The aim of this study is to determine the effects of different lifestyle factors and their interactions on the cognitive progression of dementia. Neuropsychiatric Measures: • Neuropsychiatric Inventory – evaluates 12 neuropsychiatric disturbances commonly found in dementia. Methods • Cornell Scale of Depression in Dementia – assesses signs and symptoms of major depression in patients with dementia. Two hundred participants will be recruited within Sussex Partnership NHS Foundation Trust. Physiological Measures: Height, weight, blood pressure, hand grip strength, lung function, head circumference, calf circumference, upper arm circumference, leg length The inclusion criteria and waist circumference.

A clinical diagnosis of AD, VaD or Mixed type Dementia; aged between 65 and Venous Blood Measures: APOE status, inflammatory markers, nutritional levels, and 90; presence of a personal consultee (family member/close friend); a standard of oxidative stress levels. English equivocal to that of a native speaker. Exclusion criteria: Severe psychiatric or behavioural disorders; diagnosis of severe dementia (MMSE<12). Medical History: Current medication, history of smoking, alcohol intake, psychiatric Patients that fit the above criteria are approached by a member of clinical staff about diagnosis, other clinical diagnosis, accommodation status, date of diagnosis, onset of the research and are given the option to contact the research team. memory impairment and infections over the past 5 years. Analysis

Correlations will be used to determine the relationships between lifestyle factors, biomarkers and cognitive outcome measures. The mean average scores of the cognitive tasks will also be compared between participant subgroups, e.g. high physical activity vs low physical activity groups. Structural equation modelling will be used in hope to develop the optimum lifestyle profile in combating the cognitive decline in dementia.

Current Progress

To date 52 participants have been recruited. Participants have a mean age of 82.32 (SD=5.57), and there is an approximate 1:1 gender ratio. The majority of participants have a diagnosis of AD (76%) followed by mixed type (18%) and VaD (6%). Participants have a mean MMSE of 23.26 (SD=4.07) highlighting that on average participants have a mild diagnosis of dementia. Only a single participant has withdrawn from the study following recruitment.

Acknowledgements This PhD is jointly funded by the Economic and Social Research Council and the Sussex Partnership NHS Foundation Trust. Contact details Nicolas Farina: [email protected] Tel: 01273 872776

www.sussexpartnership.nhs.uk/r-and-d Dedicated to Research