P3–117: Prevention of CIND by physical activity: Different impact on VCI–ND compared with MCI

Cognitive impairment that does not meet the criteria for dementia (“Cognitive Impairment, No Dementia” – CIND) is a heterogeneous category, but people with CIND are at increased risk of dementia. While greater physical activity is associated with a lower incidence of both dementia and CIND in general, whether this effect applies across subgroups is not known. To investigate the association between physical activity and the risk of CIND sub–types (vascular CIND (VCI–ND) and mild cognitive impairment (MCI)). The Canadian Study of Health and Aging is a cohort study of dementia. Of 6709 community–dwelling people not cognitively impaired and with risk factor questionnaires at baseline (1991–1992), 4683 completed a 5–year follow up (1996–1997). Of these 4863, 3945 remained without cognitive impairment, 454 were diagnosed with CIND, and 284 with dementia. Incident CIND and VCI–ND and MCI subtypes were investigated by levels of physical activity at baseline. Compared with no physical activity, high levels of physical activity were associated with reduced risks of CIND (age–, sex–, education–, and vascular risk factor index– adjusted odds ratio, 0.73; 95% confidence interval, 0.53–0.99) and of VCI–ND (0.50; 0.27–0.92). When stratified, there was a linear trend for decreasing incident CIND and VCI–ND with increasing physical activity only in women (p=0.008 and p=0.001 respectively) or in VRFI below 0.15 (p=0.03 and p=0.01 respectively). No association was found for men or VRFI above 0.30 or for MCI. Increased physical activity has been associated with a reduced incidence of Alzheimer's Disease, but less so with Vascular Dementia. In contrast, we showed a reduced incidence of VCI–ND, but not MCI, with high levels of physical activity. People with MCI who exercised may represent a heterogeneous group, compared to those who do not exercise. Some people who ‘only’ developed MCI might have developed dementia had they not participated in high levels of physical activity. Exercise appears to reduce the risk of some types of CIND, especially VCI–ND. Whether the lack of an effect of exercise on MCI incidence reflects that ‘prevented AD’ is indistinguishable from MCI is an intriguing possibility that merits further study.

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