Effectiveness of Exercise- and Cognitive-Based Treatments on Salivary Cortisol Levels and Sundowning Syndrome Symptoms in Patients with Alzheimer's Disease

Massimo Venturelli, Alessio Sollima, Emiliano Cè, Eloisa Limonta, Angela V. Bisconti, Anna Brasioli, Ettore Muti, Fabio Esposito

Research output: Contribution to journalArticle

Abstract

Sundowning syndrome (SDS) in patients with Alzheimer's disease (AD) is characterized by the intensification of behavioral disorders at sunset. Despite SDS etiology being unclear, a strong relationship between high cortisol levels and SDS has been reported. Aerobic exercise (AE) and cognitive training (CT) can reduce cortisol levels. However, whether SDS would benefit from AE and CT is still unknown. Therefore, the aim of this study was to investigate whether AE and CT treatments are effective in reducing SDS via downregulation of cortisol levels. The possible additive effects of combined AECT were also assessed. Eighty AD patients were randomly assigned to AE (n=20), CT (n=20), AECT (n=20), and standard therapy (no treatment, NT; n=20). Treatments were administered for 3 months, 5 days/week, 1 hour before sunset. Before and after treatments, salivary cortisol levels were sampled at 7, 11, 15, at sunset, and 20 (time of day). Blind assessment of behavioral disorders (neuropsychiatric inventory, NPI) and agitation (agitated behavior scale, ABS) were also performed. After interventions, cortisol levels were reduced in AE and AECT by ∼26. In the same groups, NPI and ABS decreased by ∼50. By contrast, cortisol and behavioral disorders were similar to baseline in CT and NT. Changes in NPI and ABS were significantly correlated with the reduction in cortisol levels. AE or AECT effects on SDS and cortisol levels and the lack of effect of CT alone indicate the effectiveness of an exercise-based treatment on SDS, suggesting a possible hypothalamicpituitaryadrenal axis dysregulation underpinning SDS.

Original languageEnglish
Pages (from-to)1631-1640
Number of pages10
JournalJournal of Alzheimer's Disease
Volume53
Issue number4
DOIs
Publication statusPublished - 2016

Keywords

  • Alzheimer's disease
  • Behavioral disorders
  • Cortisol
  • Exercise

ASJC Scopus subject areas

  • Clinical Psychology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health

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