At age 75, he shifted from full-time to part-time work. He had gout, atrial fibrillation, hyperlipidemia, and a history of Lyme disease that had been treated successfully with doxycycline. His Montreal Cognitive Assessment (MoCA) scores were in the normal range at age 77 (26/30) and age 79 (27/30). Over 8 years, his clinical diagnosis remained amnestic mild cognitive impairment and his MMSE scores changed from 27 to 26. Amyloid PET scans at ages 73 and 75 were positive for Alzheimer's disease. Fluorodeoxyglucose-PET (FDG-PET) showed bilateral temporoparietal hypometabolism consistent with an Alzheimer's disease etiology.Īt age 76, testing showed marked anterograde memory impairment with initial encoding followed by rapid forgetting. MRI showed atrophy and a likely venous malformation in the superior lateral aspect of the right intraconal orbit. Patient 2, an engineering management consultant, presented with memory complaints at age 72. Both he and his wife said he was an intense, competitive tennis player. His exercise regimen involved general physical activity and playing tennis, which increased after retirement to 4 to 6 times per week, averaging 2 hours each session. He retired at age 75 and played bridge regularly. He had treated atrial fibrillation, thyroid disease, hypertension, and hyperlipidemia. His MMSE score fell from 28/30 to 25/30 during his last 10 years of follow-up. MRIs over time showed atrophy in several brain regions and progressive left temporal atrophy, mild cerebrovascular disease, and a small, stable meningioma. Neuropsychological testing at 1- to 3-year intervals consistently uncovered cognitive deficits with extremely slow cognitive decline.Ĭerebrospinal fluid (CSF) biomarkers at age 69 supported an Alzheimer's etiology. Testing showed impairment in visual memory and executive function. Patient 1 was a lawyer and a judge who presented at age 64 with memory complaints. "Vigorous, regular exercise was the most likely explanation for their lack of deterioration, because they had multiple medical problems and did not focus on diet or cognitively-stimulating activities beyond what they did earlier in life." "The two patients in this report had Alzheimer's brain pathology based on established biomarkers and clinical features but showed little cognitive decline for 16 years and 8 years, respectively," he said. "We know that mild to moderate exercise is associated with a lower risk of developing dementia, including Alzheimer's disease, but the effects of vigorous, regular exercise have been poorly studied," Devanand told MedPage Today. Of all the possible contributors, intense physical activity was the likely disease-modifying factor, Davangere Devanand, MD, of Columbia University Irving Medical Center in New York City, and co-authors wrote in Alzheimer's & Dementia.īoth patients regularly exercised vigorously for hours a day and increased their participation after they either retired or reduced their work hours. Why the "strikingly benign, atypical clinical course"? Mini-Mental State Examination (MMSE) declines averaged 0.3 points per year for patient 1 and 0.125 points per year for patient 2, compared with the average 2-point MMSE annual decline in patients with mild to moderate Alzheimer's disease.
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