Title:Physical Exercise for the Treatment of Neuropsychiatric Disturbances in Alzheimer’s Dementia: Possible Mechanisms, Current Evidence and Future Directions
Volume: 13
Issue: 10
Author(s): Silke Matura, André F. Carvalho, Gilberto S. Alves and Johannes Pantel
Affiliation:
Keywords:
Alzheimer's dementia, BPSD, physical exercise, neuropsychiatric symptoms, neurobiological mechanisms,
psychological mechanisms.
Abstract: Behavioral and psychological symptoms of dementia (BPSD), also
known as neuropsychiatric or non-cognitive symptoms are common and often distressing
features of Alzheimer's Dementia. BPSD significantly increase patient suffering,
early institutionalization and caregiver's burden. The clinical management
of BPSD is dominated by a pharmacological approach, although these medications
often come with serious adverse side-effects. There are only few nonpharmacological
treatment strategies for BPSD. A substantial amount of intervention
studies that have investigated non-pharmacological treatment options for
BPSD have focused on physical exercise. Although these studies are very heterogeneous
in terms of type and severity of dementia, as well as type and duration of
the exercise intervention, the overall picture shows a positive effect of physical exercise in alleviating
BPSD. There is evidence that numerous mechanisms contribute to the positive effect of physical exercise
on BPSD. No attempt has been undertaken so far to give an overview of the existing knowledge
regarding these mechanisms. Therefore, the current review aims to integrate the existing evidence
on psychological and neurobiological mechanisms that contribute to the beneficial effects of
physical exercise in ameliorating BPSD in Alzheimer's dementia. A discussion of psychological
mechanisms such as improved sleep and stress reduction will be followed by a discussion of neurobiological
mechanisms including the exercise induced change in neurotransmitter concentrations, increased
synthesis of neurotrophins and immune activation. The review closes with recommendations
for future research to overcome the shortcomings of existing studies and broaden the current knowledge
on the positive effects of physical exercise on BPSD.
