| Objective:To observe the relationship between the deficiency of both body and mind in cognitive frailty and the hippocampal subregion,verifying the intervention effect of Baduanjin on cognitive frailty,and exploring the mechanism of Baduanjin effect based on the hippocampal subregion,and clarify the mechanism of Baduanjin's "body and mind co cultivation" on this basis.Methods:Study 1: Twenty-six elderly volunteers with cognitive frailty and 26 healthy control elderly volunteers were matched according to gender,age,years of education in community were recruited.The two groups of subjects were scanned by structural magnetic resonance imaging,and the volume changes of hippocampal subregion were analyzed.Study 2: A total of 102 elderly people with cognitive frailty in community were recruited and randomly divided into Baduanjin group and control group.The control group was given dietary guidance and health education,and Baduanjin group was given 24 weeks Baduanjin intervention on this basis.Montreal Cognitive Assessment(MoCA),Wechsler Memory Scale(WMS)and Edmonton frail scale(EFS)were used to evaluate the overall cognitive function,memory and physical frailty;dynamic and static balance evaluation analyzer and CAMRY-EH101 electronic force meter were used to evaluate balance function and muscle strength before intervention,12 weeks and 24 weeks after intervention.Independent samples t-test or Mann Whitney U-test were used to analyze the differences of outcome indicators between two groups.Study 3: Based on study 2,part of subjects performed structural MRI scanning before and after the intervention following the principle of voluntary.The correlation between the change of hippocampal subregion volume with cognitive and physical frailty indicators was analyzed.Result:Study 1:1.Analysis showed that the volumes of left presubiculum,parasubiculum,molecular layer,hippocampal amygdala transition area(HATA),right angular gyrus 1(CA1)and presubiculum in cognitive frailty group were significantly lower than those in control group(P < 0.05/12).2.Age,gender,years of education,Beck Depression Index(BDI)and total intracranial volume(TIV)were used as covariates,the correlation between the behavior and the volume of hippocampal subregion in cognitive frailty group was analyzed.It was found that left molecular layer and right CA1 were positively correlated with MoCA score(r=0.435,P=0.049;r=0.447,P=0.042);left HATA was negatively correlated with EFS score(r=-0.525,P=0.042);right CA1 and right presubiculum were positively correlated with MQ score(r=0.500,P=0.021;r=0.446,P=0.043);left parasubiculum was positively correlated with picture test(r=0.496,P=0.022);right CA1 was positively correlated with regeneration score(r=0.475,P=0.030).Study 2:There was no significant difference in baseline indicators between Baduanjin group and control group except age.After 12 weeks of intervention,the scores of MoCA,MQ,recognition,association and recitation in Baduanjin group were significantly higher than those in the control group(P<0.05),and the EFS score in Baduanjin group was significantly lower than that in the control group(P=0.014).After 24 weeks of intervention,the MoCA scores,MQ,recording,recognition,association and back count,balance stability coefficient,right knee extensor strength of Baduanjin group were significantly higher than those of control group(P<0.05);the EFS score,total track length of double foot eye opening and unit area track length of single foot eye opening of Baduanjin group were significantly lower than those of control group(P<0.05).Study 3:1.On the basis of the second part,a total of 50 subjects completed the MRI scan including26 in Baduanjin group and 24 in control group.After 24 weeks of intervention,the MoCA score,MQ,recording,recognition and association,balance stability coefficient and right knee extensor strength of Baduanjin group were significantly higher than those of control group(P<0.05);the EFS score and total track length of foot open eye shaking of Baduanjin group were significantly lower than those of control group(P<0.05).2.After 24 weeks of intervention,analysis showed that,in Baduanjin group,4 hippocampal subregion the volume difference of before and after exercise were significantly greater than that in the control group: left parasubiculum,HATA,right CA1 and presubiculum(P<0.05/12).3.With age,gender,years of education,marital status as covariates,correlation analysis shows that the change of right CA1 volume was positively correlated with the change of MoCA score(r=0.510,P=0.015);the change of left parasubiculum and HATA volume was negatively correlated with the change of EFS(r=-0.534,P=0.011;r=-0.575,P=0.005);the change of right CA1 and right presubiculum volume was positively correlated with the change of MQ(r=0.484,P=0.022;r=0.435,P=0.043);the change of left parasubiculum volume was positively correlated with the change of picture test score(r=0.509,P=0.016).Conclusions:1.The atrophy of hippocampal presubiculum,left molecular layer,parasubiculum,HATA,right CA1 in the elderly with cognitive frailty is closely related to the decline of cognitive and physical function.2.After 24 weeks of Baduanjin intervention,the overall cognitive function,memory and physical frailty of the elderly with cognitive frailty were significantly improved.3.Baduanjin might improve the cognitive and physical function of the elderly with cognitive frailty by changing the structural plasticity of the hippocampal left parasubiculum,HATA and right CA1 and presubiculum. |
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