Using Multimodal Imaging to Examine the Neural Mechanisms of an Integrative Exercise Program for Individuals with Dementia

Alzheimer’s disease (AD) and Alzheimer’s disease related dementia (ADRD) is global health problem of epidemic proportion with no present cure. Moreover, currently available AD/ADRD medications do not alter disease progression, provide only limited benefits with considerable side effects. For this reason, non- pharmacological interventions for AD/ADRD remain highly desirable. Preventing Loss of Independence through Exercise (PLIÉ) is a non-pharmacological, multi-domain, integrative group exercise program developed by researchers at UCSF and the San Francisco VA for individuals with AD/ADRD. PLIÉ integrates elements from traditional Western approaches with various mind-body techniques to: (1) train procedural memory, which remains intact in individuals with AD/ADRD, for basic functional movements that are important for maintaining independence (e.g., sit-to-stand), (2) increase mindful body awareness, and (3) facilitate social connections. In a pilot study that utilized standard pharmaceutical research outcome measures, 18 weeks of PLIÉ improved cognitive and physical function and quality of life in individuals with mild to moderate AD/ADRD and reduced caregiver burden. Importantly, the effect sizes were substantially larger than what has been observed with current dementia medications and affected a broader range of outcomes than current behavioral interventions. However, the neural mechanisms underlying PLIÉ’s beneficial effect in individuals with AD/ADRE remain unclear. Therefore, this study investigates PLIÉ’s neural mechanisms by acquiring neuroimaging data from a subset of the participants enrolled in a VA-funded randomized controlled trial (RCT) of PLIÉ for individuals with AD/ADRD.