Accelerated Age-related Cognitive Decline: Impact of Exercise on Executive Function and Neuroplasticity

Accelerated Age-related Cognitive Decline: Impact of Exercise on Executive Function and Neuroplasticity

The purpose of this study is to see if 6 months of home-based walking will improve memory, and brain structure and function, compared to health education in older adults that have chronic kidney disease and mild cognitive impairment.

Following informed consent, participants will undergo tests for heart health, physical function, memory testing, and brain structure and function using imaging (taking pictures of the brain with an MRI). Following these tests participants are randomized to a home-based walking program or health education for 6 months. Participants are given a fitness tracker and gets ongoing telephone coaching during the 6 months. After 6 months the tests are repeated.

Inclusion Criteria:

• • Diagnosed stage 3-4 chronic kidney disease (CKD, estimated glomerular filtration rate (eGFR) <60 to 20 ml/min);

  • >55 yrs of age
  • Mild cognitive impairment (18-26 on the MOCA)
  • ability to undergo an MR
  • no history of major head trauma (No head trauma/concussion with loss of consciousness)
  • Speaks, reads, writes English

Exclusion Criteria:

• • Diagnosed Dementia or a Clinical Dementia Rating Scale score of <2, or a MOCA of <18

  • Participating in a supervised exercise program with intent to increase fitness levels 3 days/week,
  • Requires assistive ambulation
  • Limited exercise capacity due to claudication; unstable angina, severe arthritis, extreme dyspnea on exertion, unstable coronary artery disease
  • Class III-IV heart failure
  • History of uncontrolled sustained arrhythmias, severe/symptomatic aortic or mitral stenosis, hypertrophic obstructive cardiomyopathy, severe pulmonary hypertension, active myocarditis/pericarditis, thrombophlebitis, and recent systemic/pulmonary embolus
  • Resting systolic BP >200 mmHg or resting diastolic BP >110 mmHg
  • Any unforeseen illness or disability that would preclude cognitive testing or exercise training
  • One or more contraindication for MRI; cardiac pacemaker, aneurysm clip, cochlear implants, shrapnel, history of metal fragments in eyes, neurostimulators, diagnosed claustrophobia (MRI only)
  • Any self-reported major psychiatric disorders requiring medical therapy (e.g. schizophrenia, bipolar disorder).
  • Self-reported new diagnosis of clinical depression within 3 months of enrollment or unstable clinical depression requiring medication adjustment within 3 months of enrollment