Aging, Aphasia
Conditions
Keywords
aerobic exercise, learning, language, cognition
Brief summary
The aging Veteran population will substantially increase over the next 10 years, as the 24.9% of Veterans who are currently between 55-64 years of age join the 38.5% who are already over age 65. The risk of stroke more than doubles each decade after age 55, which places Veterans at an ever-increasing risk of suffering stroke-related language impairment (i.e., aphasia). Difficulty retrieving words, which negatively impacts psychosocial well-being and quality of life, is the most common complaint in healthy aging and aphasia. Word retrieval interventions to maintain or restore communicative function are needed. Studies have shown that physical exercise can improve word learning in young adults. This study will investigate the effects of exercise on word learning in aging and aphasia. The results will help the us understand how exercise may be used to optimize word retrieval interventions for our aging Veterans.
Detailed description
Difficulty retrieving the right word to communicate a message is the most common complaint in healthy older adults and individuals with stroke-induced language impairment (i.e., aphasia). Novel word learning paradigms have been used to investigate a variety of behavioral and neuromodulatory approaches to improve word retrieval deficits. Previous novel word learning studies have shown that physical exercise can improve long term recall in healthy young adults and that increased levels of dopamine may be responsible for this effect; however, no studies have investigated the effects of exercise on novel word learning in older adults and individuals with aphasia, and very little is known about the mechanisms that support exercise-enhanced word learning in these populations. The aims of this study are to: 1\) to identify the novel word learning paradigm that facilitates immediate and long-term word recall 2a) to investigate how acute, moderate-intensity exercise alters levels of serum brain-derived neurotrophic factor (BDNF) and plasma dopamine 2b) to describe and quantify the association between novel word learning and any observed changes in serum BDNF and plasma dopamine. This research will provide a platform for future investigations of immediate exercise effects on word learning, which are essential for achieving our long-term goal of developing exercise-based word retrieval interventions for healthy older Veterans and Veterans with aphasia. A within subjects crossover design will be used to address Aims 1, 2a and 2b. Subjects will complete aerobic exercise or stretching (training) before engaging in Study Only or Retrieval Practice (learning). Subjects will be counterbalanced within and across conditions. Sixteen healthy older adults (65-89 years) and 16 individuals with aphasia (35-89 years), will be recruited. The study will comprise 18 sessions over 12 weeks. In Week 1, subjects will undergo baseline blood draws, a physical assessment, cognitive and language assessments, and a practice word learning task. In Weeks 2-12, subjects will complete the four conditions. Each condition will last two weeks, with a one-week break between conditions. In each condition, training and learning sessions will take place on Monday, Wednesday and Friday. Training: Subjects will engage in 30 minutes of moderate-intensity cycling or gentle upper and lower limb stretching (control) prior to engaging in a novel word learning task. Learning: Familiar objects (e.g., cup) will be paired with nonwords (e.g., flark). In the Study Only paradigm, object/nonword pairs will be presented three times across three days (Monday, Wednesday, Friday). In the Retrieval Practice paradigm, object/nonword pairs will be presented during the first session (Monday). In subsequent sessions (Wednesday, Friday), subjects will be asked to recall the nonword name of presented objects. Corrective feedback will be provided on each trial. Testing: Recognition and recall testing without corrective feedback will be administered immediately after learning (short-term memory), before training in the second and third learning session (overnight consolidation) and one week after learning (long-term memory). Blood Draws: Three blood samples will be taken at baseline (rest, 30 minutes, 60 minutes). In each of the four conditions, blood samples will be taking during the first and third learning session (at rest, after training, after learning, and 15 minutes after learning). Whole blood will be collected in plain tubes and in anticoagulant-treated tubes for subsequent serum BDNF and plasma dopamine analysis by ELISA. Samples will be analyzed in triplicate to increase reliability.
Interventions
Subjects will engage in 30 minutes of moderate-intensity cycling prior to word learning using Retrieval Practice (active retrieval during learning)
Subject will engage in 30 minutes of gentle upper- and lower- limb stretching prior to word learning using Retrieval Practice (active retrieval during learning)
Subjects will engage in 30 minutes of gentle stretching prior to word learning using Study Only (no active retrieval during learning)
Subjects will engage in 30 minutes of gentle stretching prior to word learning using Study Only (no active retrieval during learning)
Sponsors
Study design
Intervention model description
2x2 crossover design comparing two learning paradigms (Study Only vs. Retrieval Practice) and two training conditions (Moderate Intensity Exercise vs. Gentle Stretching)
Eligibility
Inclusion criteria
* monolingual English speakers * low physical activity on the International Physical Activity Questionnaire * physician's written approval for participation in moderate-intensity exercise
Exclusion criteria
* VO2 max \>26 (men) and 22 (women) * inability to cycle for 3 minutes at 50 revolutions/minute with no resistance * any comorbid condition with exercise contraindications * use of hormone replacement therapy * dopaminergic * anti-depressant * anti-psychotic * or illicit drugs * consumption of \>14 alcoholic drinks/week or \> 1pack of cigarettes/day * uncorrected hearing or vision impairments that interfere with study procedures * inability to read or repeat nonwords (e.g., flark) * inability to learn one novel word during a practice learning task * below cut-off on the Montreal Cognitive Assessment or the Comprehensive Aphasia Test Cognitive Screen * and/or \>10 on the Beck Depression Inventory
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Study-Specific Word Recall Task | Assessment occurs over a two-week period for each of the 4 intervention/arms: Week 1: Monday, Wednesday, Friday, Week 2: Friday | Study-specific word recall task comprising trained items. Participant is shown each trained item and types the name. Acquisition: immediately after exercise or stretching on Monday, Wednesday and Friday. Consolidation: immediately before exercise or stretching on Wednesday and Friday, one week after training (Friday) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Serum BDNF Concentration Levels (pg/mL) | Assessment occurs on Monday, Wednesday and Friday of Week 1 for each of the 4 intervention/arms | Blood samples collected to measure serum BDNF concentration levels (pg/mL), as follows: 1. Before moderate intensity exercise or gentle stretching 2. Immediately after moderate intensity exercise or gentle stretching 3. Immediately after word learning 4. 15 minutes after word learning |
| Plasma Dopamine | Assessment occurs on Monday, Wednesday and Friday of Week 1 for each of the 4 intervention/arms | The investigators will collect blood samples to detect changes in plasma dopamine in the training conditions on Monday and Friday sessions, as follows:. 1. Before exercise or stretching 2. Immediately after exercise or stretching 3. Immediately after word learning 4. 15 minutes after word learning |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Healthy Older Adults Participants complete all four study interventions
Retrieval Practice + Moderate Intensity Exercise: Subjects will engage in 30 minutes of moderate-intensity cycling prior to word learning using Retrieval Practice (active retrieval during learning)
Retrieval Practice + Gentle Stretching: Subject will engage in 30 minutes of gentle upper- and lower- limb stretching prior to word learning using Retrieval Practice (active retrieval during learning)
Study Only + Moderate Intensity Exercise: Subjects will engage in 30 minutes of gentle stretching prior to word learning using Study Only (no active retrieval during learning)
Study Only + Gentle Stretching: Subjects will engage in 30 minutes of gentle stretching prior to word learning using Study Only (no active retrieval during learning) | 16 |
| Individuals With Aphasia Participants complete all four study interventions
Retrieval Practice + Moderate Intensity Exercise: Subjects will engage in 30 minutes of moderate-intensity cycling prior to word learning using Retrieval Practice (active retrieval during learning)
Retrieval Practice + Gentle Stretching: Subject will engage in 30 minutes of gentle upper- and lower- limb stretching prior to word learning using Retrieval Practice (active retrieval during learning)
Study Only + Moderate Intensity Exercise: Subjects will engage in 30 minutes of gentle stretching prior to word learning using Study Only (no active retrieval during learning)
Study Only + Gentle Stretching: Subjects will engage in 30 minutes of gentle stretching prior to word learning using Study Only (no active retrieval during learning) | 3 |
| Total | 19 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Screen fail | 1 | 0 |
| Overall Study | Unable to access veins for blood draw | 0 | 1 |
| Overall Study | Withdrawal by Subject | 6 | 1 |
Baseline characteristics
| Characteristic | Healthy Older Adults | Total | Individuals With Aphasia |
|---|---|---|---|
| Age, Continuous | 74.1 years STANDARD_DEVIATION 5.1 | 71.5 years STANDARD_DEVIATION 10.4 | 57.7 years STANDARD_DEVIATION 21.1 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 16 Participants | 19 Participants | 3 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 4 Participants | 5 Participants | 1 Participants |
| Race (NIH/OMB) More than one race | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 11 Participants | 13 Participants | 2 Participants |
| Region of Enrollment United States | 16 Participants | 19 Participants | 3 Participants |
| Sex: Female, Male Female | 7 Participants | 9 Participants | 2 Participants |
| Sex: Female, Male Male | 9 Participants | 10 Participants | 1 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 23 | 0 / 5 |
| other Total, other adverse events | 1 / 23 | 1 / 5 |
| serious Total, serious adverse events | 0 / 23 | 0 / 5 |
Outcome results
Study-Specific Word Recall Task
Study-specific word recall task comprising trained items. Participant is shown each trained item and types the name. Acquisition: immediately after exercise or stretching on Monday, Wednesday and Friday. Consolidation: immediately before exercise or stretching on Wednesday and Friday, one week after training (Friday)
Time frame: Assessment occurs over a two-week period for each of the 4 intervention/arms: Week 1: Monday, Wednesday, Friday, Week 2: Friday
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Healthy Older Adults | Study-Specific Word Recall Task | Consolidation- Retrieval Practice + Moderate Intensity Exercise | 4.6 number of words gained | Standard Deviation 4.1 |
| Healthy Older Adults | Study-Specific Word Recall Task | Consolidation- Study Only + Moderate Intensity Exercise | 3.6 number of words gained | Standard Deviation 3.2 |
| Healthy Older Adults | Study-Specific Word Recall Task | Consolidation- Retrieval Practice + Gentle Stretching | 4.6 number of words gained | Standard Deviation 4.5 |
| Healthy Older Adults | Study-Specific Word Recall Task | Acquisition- Study Only + Gentle Stretching | 5.4 number of words gained | Standard Deviation 2.7 |
| Healthy Older Adults | Study-Specific Word Recall Task | Acquisition- Retrieval Practice + Gentle Stretching | 4.8 number of words gained | Standard Deviation 3.8 |
| Healthy Older Adults | Study-Specific Word Recall Task | Consolidation- Study Only + Gentle Stretching | 3.5 number of words gained | Standard Deviation 3.6 |
| Healthy Older Adults | Study-Specific Word Recall Task | Acquisition- Study Only + Moderate Intensity Exercise | 4.8 number of words gained | Standard Deviation 3.6 |
| Healthy Older Adults | Study-Specific Word Recall Task | Acquisition- Retrieval Practice + Moderate Intensity Exercise | 6.4 number of words gained | Standard Deviation 3.6 |
| Individuals With Aphasia | Study-Specific Word Recall Task | Acquisition- Study Only + Moderate Intensity Exercise | 1.7 number of words gained | Standard Deviation 3.8 |
| Individuals With Aphasia | Study-Specific Word Recall Task | Consolidation- Retrieval Practice + Moderate Intensity Exercise | 1.5 number of words gained | Standard Deviation 2.1 |
| Individuals With Aphasia | Study-Specific Word Recall Task | Acquisition- Retrieval Practice + Gentle Stretching | 1.7 number of words gained | Standard Deviation 2.5 |
| Individuals With Aphasia | Study-Specific Word Recall Task | Consolidation- Retrieval Practice + Gentle Stretching | 0.7 number of words gained | Standard Deviation 2.1 |
| Individuals With Aphasia | Study-Specific Word Recall Task | Acquisition- Retrieval Practice + Moderate Intensity Exercise | 1.7 number of words gained | Standard Deviation 2.1 |
| Individuals With Aphasia | Study-Specific Word Recall Task | Consolidation- Study Only + Moderate Intensity Exercise | 1.3 number of words gained | Standard Deviation 2.3 |
| Individuals With Aphasia | Study-Specific Word Recall Task | Acquisition- Study Only + Gentle Stretching | 2.7 number of words gained | Standard Deviation 2.9 |
| Individuals With Aphasia | Study-Specific Word Recall Task | Consolidation- Study Only + Gentle Stretching | 1.3 number of words gained | Standard Deviation 2.3 |
Plasma Dopamine
The investigators will collect blood samples to detect changes in plasma dopamine in the training conditions on Monday and Friday sessions, as follows:. 1. Before exercise or stretching 2. Immediately after exercise or stretching 3. Immediately after word learning 4. 15 minutes after word learning
Time frame: Assessment occurs on Monday, Wednesday and Friday of Week 1 for each of the 4 intervention/arms
Population: We were not able to obtain reliable measurements of dopamine for analysis.
Serum BDNF Concentration Levels (pg/mL)
Blood samples collected to measure serum BDNF concentration levels (pg/mL), as follows: 1. Before moderate intensity exercise or gentle stretching 2. Immediately after moderate intensity exercise or gentle stretching 3. Immediately after word learning 4. 15 minutes after word learning
Time frame: Assessment occurs on Monday, Wednesday and Friday of Week 1 for each of the 4 intervention/arms
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Healthy Older Adults | Serum BDNF Concentration Levels (pg/mL) | Moderate Intensity Exercise- Before Exercise | 195.50 serum BDNF concentration levels (pg/mL) | Standard Deviation 36 |
| Healthy Older Adults | Serum BDNF Concentration Levels (pg/mL) | Moderate Intensity Exercise- Immediately After Exercise | 218.98 serum BDNF concentration levels (pg/mL) | Standard Deviation 79.39 |
| Healthy Older Adults | Serum BDNF Concentration Levels (pg/mL) | Moderate Intensity Exercise- Immediately After Learning | 209.95 serum BDNF concentration levels (pg/mL) | Standard Deviation 75.7 |
| Healthy Older Adults | Serum BDNF Concentration Levels (pg/mL) | Moderate Intensity Exercise- 15 Minutes After Learning | 204.17 serum BDNF concentration levels (pg/mL) | Standard Deviation 57.36 |
| Healthy Older Adults | Serum BDNF Concentration Levels (pg/mL) | Gentle Stretching- Before Stretching | 199.92 serum BDNF concentration levels (pg/mL) | Standard Deviation 48.72 |
| Healthy Older Adults | Serum BDNF Concentration Levels (pg/mL) | Gentle Stretching- Immediately After Stretching | 217.14 serum BDNF concentration levels (pg/mL) | Standard Deviation 49.33 |
| Healthy Older Adults | Serum BDNF Concentration Levels (pg/mL) | Gentle Stretching- Immediately After Learning | 222.03 serum BDNF concentration levels (pg/mL) | Standard Deviation 58.78 |
| Healthy Older Adults | Serum BDNF Concentration Levels (pg/mL) | Gentle Stretching- 15 Minutes After Learning | 218.00 serum BDNF concentration levels (pg/mL) | Standard Deviation 60 |
| Individuals With Aphasia | Serum BDNF Concentration Levels (pg/mL) | Gentle Stretching- 15 Minutes After Learning | 117.76 serum BDNF concentration levels (pg/mL) | Standard Deviation 40.87 |
| Individuals With Aphasia | Serum BDNF Concentration Levels (pg/mL) | Moderate Intensity Exercise- Before Exercise | 137.83 serum BDNF concentration levels (pg/mL) | Standard Deviation 51.88 |
| Individuals With Aphasia | Serum BDNF Concentration Levels (pg/mL) | Gentle Stretching- Before Stretching | 180.25 serum BDNF concentration levels (pg/mL) | Standard Deviation 42.48 |
| Individuals With Aphasia | Serum BDNF Concentration Levels (pg/mL) | Moderate Intensity Exercise- Immediately After Exercise | 156.01 serum BDNF concentration levels (pg/mL) | Standard Deviation 70.25 |
| Individuals With Aphasia | Serum BDNF Concentration Levels (pg/mL) | Gentle Stretching- Immediately After Learning | 140.85 serum BDNF concentration levels (pg/mL) | Standard Deviation 23.66 |
| Individuals With Aphasia | Serum BDNF Concentration Levels (pg/mL) | Moderate Intensity Exercise- Immediately After Learning | 153.70 serum BDNF concentration levels (pg/mL) | Standard Deviation 28.94 |
| Individuals With Aphasia | Serum BDNF Concentration Levels (pg/mL) | Gentle Stretching- Immediately After Stretching | 201.19 serum BDNF concentration levels (pg/mL) | Standard Deviation 93.51 |
| Individuals With Aphasia | Serum BDNF Concentration Levels (pg/mL) | Moderate Intensity Exercise- 15 Minutes After Learning | 129.34 serum BDNF concentration levels (pg/mL) | Standard Deviation 12.9 |
Word Recognition
Participants complete word recognition task on trained items. Acquisition: immediately after exercise or stretching on Monday, Wednesday, and Friday Consolidation: immediately before exercise or stretching on Monday and Wednesday, and one week after learning (Friday)
Time frame: Assessment occurs over a two-week period for each of the 4 intervention/arms: Week 1: Monday, Wednesday, Friday, Week 2: Friday
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Healthy Older Adults | Word Recognition | Acquisition- Retrieval Practice + Moderate Intensity Exercise | 3.1 number of words gained | Standard Deviation 2.3 |
| Healthy Older Adults | Word Recognition | Consolidation- Retrieval Practice + Moderate Intensity Exercise | 3.0 number of words gained | Standard Deviation 3 |
| Healthy Older Adults | Word Recognition | Acquisition- Retrieval Practice + Gentle Stretching | 3.1 number of words gained | Standard Deviation 2 |
| Healthy Older Adults | Word Recognition | Consolidation- Retrieval Practice + Gentle Stretching | 2.9 number of words gained | Standard Deviation 2.6 |
| Healthy Older Adults | Word Recognition | Acquisition- Study Only + Moderate Intensity Exercise | 2.7 number of words gained | Standard Deviation 2.2 |
| Healthy Older Adults | Word Recognition | Consolidation- Study Only + Moderate Intensity Exercise | 1.8 number of words gained | Standard Deviation 2.4 |
| Healthy Older Adults | Word Recognition | Acquisition- Study Only + Gentle Stretching | 1.9 number of words gained | Standard Deviation 2.2 |
| Healthy Older Adults | Word Recognition | Consolidation- Study Only + Gentle Stretching | 3.2 number of words gained | Standard Deviation 2.8 |
| Individuals With Aphasia | Word Recognition | Consolidation- Study Only + Gentle Stretching | 1.7 number of words gained | Standard Deviation 0.5 |
| Individuals With Aphasia | Word Recognition | Acquisition- Retrieval Practice + Moderate Intensity Exercise | 4.0 number of words gained | Standard Deviation 1.7 |
| Individuals With Aphasia | Word Recognition | Acquisition- Study Only + Moderate Intensity Exercise | 2.3 number of words gained | Standard Deviation 1.5 |
| Individuals With Aphasia | Word Recognition | Consolidation- Retrieval Practice + Moderate Intensity Exercise | 3.5 number of words gained | Standard Deviation 0.07 |
| Individuals With Aphasia | Word Recognition | Acquisition- Study Only + Gentle Stretching | 2.7 number of words gained | Standard Deviation 3.1 |
| Individuals With Aphasia | Word Recognition | Acquisition- Retrieval Practice + Gentle Stretching | 3.0 number of words gained | Standard Deviation 3.5 |
| Individuals With Aphasia | Word Recognition | Consolidation- Study Only + Moderate Intensity Exercise | 0.3 number of words gained | Standard Deviation 2.1 |
| Individuals With Aphasia | Word Recognition | Consolidation- Retrieval Practice + Gentle Stretching | -1.7 number of words gained | Standard Deviation 1.5 |