An attempt on constructing a systematic review

1. Physical activity on improving
cognitive function in Alzheimer’s
disease: A Systematic Review
(Attempt)
Chiew Keong John, Ng Jun Quan
16/05/19

2. Background information
 1. What is Alzheimer’s Disease (AD)?
◦ A neurodegenerative brain disorder that
progressively deteriorates cognitive function
◦ Leading cause of dementia among older
adults – one new case every 3 seconds
globally
 2. What are the implications of having
AD?
◦ Effect of AD can range and progress from
memory loss and mood swings, to immobility
and death
 3. What is the significance of AD
research?
◦ Upward trend of AD due to increasing life

3. Background information
 4. What are the AD statistics in
Singapore?
◦ 2015 study led by IMH reveals that one in 10
people aged 60 and above may have
dementia
◦ Estimated S$2.8 billion cost in 2015, S$6
billion in 2030
 5. How is AD currently treated?
◦ Symptomatic management via
pharmacologic therapy but unable to
completely halt deterioration
 6. Are there any other forms of
treatment?
◦ Non-pharmacologic therapy such as physical

4. Background information
 7. What does this review add to current
research?
◦ Previous reviews have focused on physical activity as
a form of non-pharmacological therapy, but did not
specifically focus on aerobic exercise as an exercise
modality.
 Aerobic exercise:
◦ Moderate intensity physical activity that can be
sustained for more than just a few minutes, e.g.
walking, jogging, swimming, etc.
◦ Anaerobic exercise that is performed at an intensity
sustained for only a few moments , e.g. sprinting,
weightlifting
 How effective is aerobic exercise in
improving cognitive function in existing AD
patients?

5. Protocol
Inclusion Criteria
 Type of Participants:
 This review will consider all studies that involve human subjects of
ages 50 and older who are clinically diagnosis with Alzheimer’s
Disease and have the physical capability to engage in moderate
levels of physical activity.
 Types of Interventions:
 Interventions of interest included those that performed specifically
aerobic training for a period of 3 weeks or more.
 Types of Outcome Measures:
 The primary outcome measure of interest is cognitive function
encompassing any improvements in reasoning, memory, attention
and language.
 Types of Studies:
 The review considered all studies evaluating the effectiveness or
efficacy of interventions relating to improvement of cognitive function
through aerobic exercises. In the absence of this type of studies,
those that evaluate a combination of aerobic exercises with flexibility
and balance will also be considered.

6. Protocol
Search Strategy
 The search strategy will be designed to access published
materials and comprises of three stages:
 A limited search of Web Of Science and PubMed to identify
relevant keywords contained in the title, abstract and subject
descriptors.
 Terms identified in this way, and the synonyms used by
respective databases, will be used in an extensive search of
the literature.
 Reference lists and bibliographies of the articles collected
from those identified in stage two above will be searched.
 The initial search terms will be ‘exercise’, ‘cognitive’ and
‘Alzheimer’.
 Full copies of articles identified by the search, and considered
to meet the inclusion criteria, based on their title, abstract and
subject descriptors, will be obtained for data synthesis.
Articles identified through reference list and bibliographic
searches will also be considered for data collection based on
their title.

7. Records identified through
database searching
(n = 1134)
Additional records identified
through other sources
(n = 10)
Records screened
(n = 1144)
Records excluded
(including duplicates
removed)
(n = 1131)
Full-text articles assessed
for eligibility
(n = 13)
Full-text articles excluded,
with reasons
(n = 0)
Studies included in
qualitative synthesis
(n = 13)
Studies included in
quantitative synthesis
(meta-analysis)
(n = 13)
PRISMA
Flow of information

8. Results of the review
 Patients experience improvements in cognitive
functions after at least 3 weeks of moderate-high
intensity aerobic exercise
 Walking programmes stagnate cognitive decline
 Slowing down of Alzheimer’s symptoms could be
attributed to increase blood circulation in the brain
& increased neurotransmitter activity from
exercising

9. Moving forward
 Further research into biomolecular mechanisms of dementia,
methods of diagnosis and intervention to improve outcomes.
 Further research into intensity of aerobic exercise needed
◦ Moderate to higher intensity aerobic exercise suggest more promising results
in improving cognitive function, as compared to walking program
 Smart homes – equipped with sensors, video cameras and other
ambient assisted living technologies
◦ Gathering data on night-time wandering, falls, physical activity
◦ Monitor progression of dementia and helps clinician evaluate changing needs
of patient
◦ Types of sensors in development include: leak and spill detectors, glass break
detectors, door and window sensors, voice activation sensors, gait monitors,
fall detectors, caregiver alarms
 Orthotics – to aid with cognitive, functional or physiological deficits
◦ Memory aids devices in the from of glasses, clothing badges
◦ Navigation devices based on standard routes, and corrects navigational errors
and visuospatial deficits