Упражнения при деменции / Альцгеймере — Erickson 2011 аэробика УВЕЛИЧИВАЕТ объём гиппокампа + FINGER 2015 мультидоменная УМЕНЬШАЕТ когнитивный спад

Livingston 2024 Lancet Commission + FINGER 2015/Ngandu + Erickson 2011 + Northey 2018 + Sofi 2011 + Erickson 2022 framework. Dementia is the umbrella term for acquired progressive cognitive decline severe enough to interfere with daily life. Alzheimer's disease accounts for ~60-70% of cases; vascular dementia ~15%; Lewy body dementia ~5%; frontotemporal dementia ~5%; mixed pathology is common in late life. Risk factors: APOE-ε4 (strongest genetic), age, female sex, family history, cardiovascular disease, diabetes, obesity, smoking, alcohol excess, poor sleep, depression, social isolation, hearing loss, traumatic brain injury, low education, physical inactivity. The Livingston 2024 Lancet Commission identified 14 MODIFIABLE risk factors that together account for approximately 45% of dementia cases — meaning nearly half of dementia is potentially preventable through public-health and individual-level interventions. NEW pharmacology: lecanemab (Leqembi, FDA 2023) and donanemab (Kisunla, FDA 2024) — anti-amyloid monoclonal antibodies that modestly slow decline in early Alzheimer's; both require MRI monitoring for ARIA (amyloid-related imaging abnormalities — edema + hemorrhage) + ApoE genotyping (homozygotes higher risk); access is limited and benefit modest but historic. Exercise per Erickson 2011 RCT: 12 months of aerobic exercise INCREASED hippocampal volume by ~2% (vs ~1% annual atrophy in controls) + improved spatial memory. FINGER 2015 multidomain trial (diet + exercise + cognitive training + cardiovascular risk monitoring): significantly REDUCED cognitive decline in at-risk older adults. Northey 2018 meta-analysis confirmed aerobic + resistance benefit. Erickson 2022 review: combined aerobic + resistance + balance + cognitive engagement is the optimal protocol. STAGE-AWARE: early-stage → traditional exercise programs with progressive resistance + moderate aerobic + balance + dual-task; moderate-stage → simplified instructions + supervised + emphasis on familiar movements + chair-based options; severe-stage → range of motion + walking with assistance + music + chair-based + emphasis on quality of life. AVOID exhaustion (sundowning trigger).

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain low-intensity activation (sarcopenia common in elderly), wall-push-up for upper-body push at low load (familiar, low fall risk), scapular-retraction for upper-back posture + counter forward-head from chronic device use, cat-cow for spinal mobility, supine-knee-to-chest for low-back release + hip flexor stretch, diaphragmatic-breathing for respiratory + parasympathetic activation + calming (anxiety + agitation reduction), seated-march for cardio without joint impact + safer balance option, sit-to-stand for functional + bone-loading + the SPECIFIC falls-prevention move (quadriceps strength = falls prevention = injury prevention), chin-tuck for cervical posture + dysphagia preparation. The AI coach also knows the nutrition side — MIND DIET (Morris 2015): green leafy 7.5+ servings/week + berries 1+/week + nuts 5×/week + olive oil + whole grains + fish 1+/week + poultry 2+/week + beans 4+/week + ≤4 red meat + ≤1 butter + ≤5 pastries + ≤1 cheese + ≤1 wine/day = 35-53% AD risk reduction; Mediterranean 53% reduction (Scarmeas 2006); omega-3 DHA 1-2 g; B12 + folate + B6 (homocysteine reduction Smith 2010 VITACOG); vit D check + supplement; antioxidants via food; protein 1.0-1.2 g/kg + leucine; hydration emphasis (elderly thirst blunted); social meals matter (Livingston 2024 protective); swallowing safety later (SLP + soft textures); weight management (sarcopenic weight loss faster, adequate caloric/protein focus); AVOID ultra-processed + high-GI + alcohol excess + restrictive fads + coconut oil mega-doses. CRITICAL: Alzheimer's Association + Alzheimer Europe + Dementia Alliance International + Lewy Body Dementia Association + AFTD + UsAgainstAlzheimer's + neurology (dementia-experienced) + geriatrics + caregivers + dietitian + SLP + advance care planning + family support. This is NEVER a replacement for dementia-experienced multidisciplinary care.