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Positive Effect of Cognitive Training in Older Adults with Different APOE Genotypes and COVID-19 History: A 1-Year Follow-Up Cohort Study. Diagnostics (Basel) 2022; 12:diagnostics12102312. [PMID: 36292001 PMCID: PMC9600912 DOI: 10.3390/diagnostics12102312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Older people suffer from cognitive decline; several risk factors contribute to greater cognitive decline. We used acquired (COVID-19 infection) and non-modifiable (presence of APOE rs429358 and rs7412 polymorphisms) factors to study the progression of subjective cognitive impairment while observing patients for one year. Cognitive training was used as a protective factor. (2) Methods: Two groups of subjects over the age of 65 participated in the study: group with subjective cognitive decline receiving cognitive training and individuals who did not complain of cognitive decline without receiving cognitive training (comparison group). On the first visit, the concentration of antibodies to COVID-19 and APOE genotype was measured. At the first and last point (1 year later) the Mini-Mental State Examination scale and the Hospital Anxiety and Depression Scale were performed. (3) Results: COVID-19 infection did not affect cognitive function. A significant role of cognitive training in improving cognitive functions was revealed. Older adults with APOE-ε4 genotype showed no positive effect of cognitive training. (4) Conclusions: Future research should focus on cognitive dysfunction after COVID-19 in long-term follow-up. Attention to the factors discussed in our article, but not limited to them, are useful for a personalized approach to maintaining the cognitive health of older adults.
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Essery R, Pollet S, Bradbury K, Western MJ, Grey E, Denison-Day J, Smith KA, Hayter V, Kelly J, Somerville J, Stuart B, Becque T, Zhang J, Slodkowska-Barabasz J, Mowbray F, Ferrey A, Yao G, Zhu S, Kendrick T, Griffin S, Mutrie N, Robinson S, Brooker H, Griffiths G, Robinson L, Rossor M, Ballard C, Gallacher J, Rathod S, Gudgin B, Phillips R, Stokes T, Niven J, Little P, Yardley L. Parallel randomized controlled feasibility trials of the "Active Brains" digital intervention to protect cognitive health in adults aged 60-85. Front Public Health 2022; 10:962873. [PMID: 36203694 PMCID: PMC9530972 DOI: 10.3389/fpubh.2022.962873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/30/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Multidomain interventions to address modifiable risk factors for dementia are promising, but require more cost-effective, scalable delivery. This study investigated the feasibility of the "Active Brains" digital behavior change intervention and its trial procedures. Materials and methods Active Brains aims to reduce cognitive decline by promoting physical activity, healthy eating, and online cognitive training. We conducted 12-month parallel-design randomized controlled feasibility trials of "Active Brains" amongst "lower cognitive scoring" (n = 180) and "higher cognitive scoring" (n = 180) adults aged 60-85. Results We collected 67.2 and 76.1% of our 12-month primary outcome (Baddeley verbal reasoning task) data for the "lower cognitive score" and "higher cognitive score" groups, respectively. Usage of "Active Brains" indicated overall feasibility and satisfactory engagement with the physical activity intervention content (which did not require sustained online engagement), but engagement with online cognitive training was limited. Uptake of the additional brief telephone support appeared to be higher in the "lower cognitive score" trial. Preliminary descriptive trends in the primary outcome data might indicate a protective effect of Active Brains against cognitive decline, but further investigation in fully-powered trials is required to answer this definitively. Discussion Whilst initial uptake and engagement with the online intervention was modest, it was in line with typical usage of other digital behavior change interventions, and early indications from the descriptive analysis of the primary outcome and behavioral data suggest that further exploration of the potential protective benefits of Active Brains are warranted. The study also identified minor modifications to procedures, particularly to improve online primary-outcome completion. Further investigation of Active Brains will now seek to determine its efficacy in protecting cognitive performance amongst adults aged 60-85 with varied levels of existing cognitive performance.
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Affiliation(s)
- Rosie Essery
- University of Southampton, Southampton, United Kingdom,*Correspondence: Rosie Essery
| | | | - Katherine Bradbury
- University of Southampton, Southampton, United Kingdom,NIHR ARC Wessex, Southampton, United Kingdom
| | | | | | | | | | | | - Joanne Kelly
- University of Southampton, Southampton, United Kingdom
| | | | - Beth Stuart
- University of Southampton, Southampton, United Kingdom,Queen Mary University of London, London, United Kingdom
| | - Taeko Becque
- University of Southampton, Southampton, United Kingdom
| | - Jin Zhang
- University of Southampton, Southampton, United Kingdom
| | | | | | - Anne Ferrey
- University of Oxford, Oxford, United Kingdom
| | - Guiqing Yao
- University of Leicester, Leicester, United Kingdom
| | - Shihua Zhu
- University of Southampton, Southampton, United Kingdom
| | - Tony Kendrick
- University of Southampton, Southampton, United Kingdom
| | | | | | | | | | - Gareth Griffiths
- NIHR Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | | | | | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Bernard Gudgin
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - Rosemary Phillips
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - Tom Stokes
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - John Niven
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - Paul Little
- University of Southampton, Southampton, United Kingdom
| | - Lucy Yardley
- University of Southampton, Southampton, United Kingdom,University of Bristol, Bristol, United Kingdom
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Kim H, Lee J, Man Chang S, Kim BS. Effects of a cognitive rehabilitation program based on mnemonic skills and memory compensatory strategies for older adults: A pilot study. Medicine (Baltimore) 2022; 101:e29581. [PMID: 35945795 PMCID: PMC9351895 DOI: 10.1097/md.0000000000029581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND With the aging of the population, the number of people with age-related memory complaints has also increased. The purpose of this study was to develop a cognitive rehabilitation program based on mnemonic skills and memory compensatory strategies (CRM) and to investigate the effects of CRM in community-dwelling older adults without dementia. METHODS This study was an open-label, single-arm, pilot study. We developed a CRM program comprising 8 weekly sessions. The study participants consisted of older adults with normal cognitive function and mild cognitive impairment (MCI). They were recruited from eight dementia counseling centers and one senior welfare center. To assess the effects of CRM, we administered the following tests at baseline and after completion of the program: Subjective Memory Complaints Questionnaire, the Short form of Geriatric Depression Scale, the Euro Quality of life-5 Dimension, and the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery. RESULTS Thirty-two participants completed the study. Among older adults with normal cognitive function, CRM showed significant improvement in verbal memory function. Among the older adults with MCI, CRM showed significant improvements in language ability, verbal recognition memory, nonverbal memory, attention, and processing speed. CONCLUSION CRM improved cognitive function in two distinct populations, older adults with normal cognitive function and older adults with MCI. Additionally, our preliminary findings suggest that older adults with MCI show cognitive improvement in both the trained and non-trained cognitive domains.
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Affiliation(s)
- Hyerim Kim
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, South Korea
| | - Jimin Lee
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, South Korea
| | - Sung Man Chang
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, South Korea
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Byung-Soo Kim
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, South Korea
- Department of Psychiatry, Kyungpook National University Chilgok Hospital, Daegu, South Korea
- *Correspondence: Byung-Soo Kim, Department of Psychiatry, Kyungpook National University Chilgok Hospital, 807, Hoguk-ro, Buk-gu, Daegu 41404, South Korea (e-mail: )
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Lombardi A, Diacono D, Amoroso N, Biecek P, Monaco A, Bellantuono L, Pantaleo E, Logroscino G, De Blasi R, Tangaro S, Bellotti R. A robust framework to investigate the reliability and stability of explainable artificial intelligence markers of Mild Cognitive Impairment and Alzheimer's Disease. Brain Inform 2022; 9:17. [PMID: 35882684 PMCID: PMC9325942 DOI: 10.1186/s40708-022-00165-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/03/2022] [Indexed: 11/11/2022] Open
Abstract
In clinical practice, several standardized neuropsychological tests have been designed to assess and monitor the neurocognitive status of patients with neurodegenerative diseases such as Alzheimer's disease. Important research efforts have been devoted so far to the development of multivariate machine learning models that combine the different test indexes to predict the diagnosis and prognosis of cognitive decline with remarkable results. However, less attention has been devoted to the explainability of these models. In this work, we present a robust framework to (i) perform a threefold classification between healthy control subjects, individuals with cognitive impairment, and subjects with dementia using different cognitive indexes and (ii) analyze the variability of the explainability SHAP values associated with the decisions taken by the predictive models. We demonstrate that the SHAP values can accurately characterize how each index affects a patient's cognitive status. Furthermore, we show that a longitudinal analysis of SHAP values can provide effective information on Alzheimer's disease progression.
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Affiliation(s)
- Angela Lombardi
- Dipartimento di Fisica, Università degli Studi di Bari Aldo Moro, Bari, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Bari, Italy
| | - Domenico Diacono
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Bari, Italy
| | - Nicola Amoroso
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Bari, Italy
- Dipartimento di Farmacia - Scienze del Farmaco, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Przemysław Biecek
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
- Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Warsaw, Poland
| | - Alfonso Monaco
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Bari, Italy
| | - Loredana Bellantuono
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Bari, Italy
- Dipartimento di Scienze mediche di base, Neuroscienze e Organi di senso, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Ester Pantaleo
- Dipartimento di Fisica, Università degli Studi di Bari Aldo Moro, Bari, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Bari, Italy
| | - Giancarlo Logroscino
- Dipartimento di Scienze mediche di base, Neuroscienze e Organi di senso, Università degli Studi di Bari Aldo Moro, Bari, Italy
- Pia Fondazione “Card. G. Panico”, Tricase, Italy
| | | | - Sabina Tangaro
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Bari, Italy
- Dipartimento di Scienze del Suolo, della Pianta e degli Alimenti, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Roberto Bellotti
- Dipartimento di Fisica, Università degli Studi di Bari Aldo Moro, Bari, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, Bari, Italy
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Li F, Parsons J, Peri K, Yu A, Cheung G. Effects of cognitive interventions on quality of life among adults with mild cognitive impairment: A systematic review and meta-analysis of randomised controlled trials. Geriatr Nurs 2022; 47:23-34. [PMID: 35816984 DOI: 10.1016/j.gerinurse.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is considerable research exploring the impact of cognitive interventions on cognition in people with mild cognitive impairment (MCI). However, the impact on quality of life (QOL) is not routinely reported. As QOL is a key predictor of health outcomes, it is important to determine the evidence supporting cognitive interventions for improving QOL in people with MCI. OBJECTIVE To evaluate the evidence on the effectiveness of cognitive interventions for improving QOL among people with MCI. DESIGN Systematic review and meta-analysis. METHODS A systematic database search was conducted from inception to December 11, 2021, using four databases. Quality assessment was conducted, and data on the characteristics of the studies and the effects on QOL were extracted. Subgroup analyses and meta-regression were conducted to elucidate the effects of potential moderator variables on QOL measures. RESULTS Of the 1550 records initially identified, 17 studies met the criteria for the final meta-analysis. The findings revealed that cognitive interventions produced moderate gains in overall QOL compared to the control group at the posttest (standardized mean difference (SMD): 0.53, 95% confidence interval (CI): [0.23, 0.84]), but no statistically significant differences were found at the end of follow-up (SMD: 0.40, 95% CI: [-0.15,0.94]). Furthermore, the effects of cognitive interventions were moderated by intervention duration, session duration, and study location. However, intervention types, session frequency, intervention components, control condition, total number of sessions, types of QOL measures, and responders to QOL-AD had no statistically significant effects on QOL outcome. CONCLUSIONS Cognitive interventions have positive effects on QOL among adults with MCI. However, the high heterogeneity of the included studies calls for more well-designed cognitive intervention trials to examine the association between QOL and relevant moderators.
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Affiliation(s)
- Fei Li
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Level 2, Building 505, 85 Park Road, Grafton, Auckland 1142, New Zealand; School of Nursing, Guangxi Medical University, Guangxi, China.
| | - John Parsons
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Level 2, Building 505, 85 Park Road, Grafton, Auckland 1142, New Zealand
| | - Kathy Peri
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Level 2, Building 505, 85 Park Road, Grafton, Auckland 1142, New Zealand
| | - An Yu
- Te Huataki Waiora School of Health, Division of Health, Engineering, Computing & Science, The University of Waikato, Hamilton, New Zealand
| | - Gary Cheung
- Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Gómez-Soria I, Brandín-de la Cruz N, Cuenca Zaldívar JN, Calvo S, Herrero P, Calatayud E. Effectiveness of Personalized Cognitive Stimulation in Older Adults with Mild Possible Cognitive Impairment: A 12-month Follow-up Cognitive Stimulation in Mild Cognitive Impairment. Clin Gerontol 2022; 45:878-890. [PMID: 34128780 DOI: 10.1080/07317115.2021.1937764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective of this study was to analyze the long-term effects of a personalized cognitive stimulation (PCS) program on the global cognition, cognitive aspects, activities of daily living (ADLs), anxiety, and depression in older adults with possible mild cognitive impairment (MCI). METHODS A 12-month follow-up analysis was carried out in a single-blind, randomized clinical trial to research the long-term effects of a 10-week PCS program evaluating the cognitive level, depression, and anxiety of older adults with possible MCI. RESULTS Fifty older adults were assessed 12 months after the CS program, 23 in the intervention group and 27 in the control group. There were significant differences between the groups at 12 months in the global cognition (p = .002), in global orientation (p < .001), and in spatial orientation (p = .004) in favor of the intervention group, measured with the Spanish version of the Mini-Mental Status Examination (MEC-35). CONCLUSIONS A PCS program could be effective in improving global cognition and global and spatial orientation. CLINICAL IMPLICATIONS A PCS program based on cognitive levels in older adults with possible MCI achieves improvements in global cognition and global and spatial orientation. PCS programs can be applied successfully by trained occupational therapists.
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Affiliation(s)
- Isabel Gómez-Soria
- Departamento de Fisiatría y Enfermería, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain
| | | | | | - Sandra Calvo
- iPhysio Research Group, Universidad San Jorge, Zaragoza, Spain
| | - Pablo Herrero
- Departamento de Fisiatría y Enfermería, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain
| | - Estela Calatayud
- Departamento de Fisiatría y Enfermería, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain
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Kognitive Interventionen bei der Alzheimer-Krankheit. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2022; 90:344-351. [PMID: 35858612 DOI: 10.1055/a-1869-4377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Cognitive interventions (CI) are an important part in the treatment of Alzheimer's disease (AD). These non-pharamcological treatment options are manifold and can be matched to a patient's particular symptoms and needs. This article gives an overview of CIs and their theoretical background, as well as empirical evidence concerning their efficacy at different stages of the disease. Specific determinants of their effectiveness and possible clinical applications are discussed, while also recent developments, such as computer-based CIs, are considered.
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Dimachki S, Tarpin-Bernard F, Croisile B, Chainay H. Study design and protocol of a low to high intensity computer-based cognitive training at home in supplement to standard care in patients with AD. BMJ Open 2022; 12:e050993. [PMID: 35725247 PMCID: PMC9214369 DOI: 10.1136/bmjopen-2021-050993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Recent studies on cognitive training in patients with Alzheimer's disease (AD) showed positive long-term effects on cognition and daily living, suggesting remote computer-based programmes to increase training sessions while reducing patient's travelling. The aim of this study is to examine short-term and long-term benefits of computer-based cognitive training at home in patients with mild to moderate AD, as a complement to the training in speech and language therapists' (SLT) offices. The secondary purpose is to study training frequency required to obtain noticeable effects. METHODS AND ANALYSES This is a national multicentre study, conducted in SLT offices. The patients follow training in one of three conditions: once a week in SLT office only (regular condition) and once a week in SLT office plus one or three times per week at home. The trainings' content in SLT office and at home is identical. For all three groups near and far transfer will be compared with evaluate training frequency's effect. Our primary outcome is executive and working memory scores in experimental tasks, and the secondary is neuropsychological tests and questionnaires' scores. Linear models' analyses are considered for all measures with a random intercept for patients and another for per practice. The fixed effects will be: three modality groups and time, repeated measures, (T0-pretraining, T1-post-training, T2-long-term follow-up) and the interaction pairs. ETHICS AND DISSEMINATION The study got ethics approval of the national ethical committee CPP Sud Méditerranée III (No 2019-A00458-49) and of the National Commission for Information Technology and Liberties (No 919217). Informed consent is obtained from each participant. Results will be disseminated in oral communications or posters in international conferences and published in scientific journals. TRIAL REGISTRATION NUMBER NCT04010175.
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Affiliation(s)
- Samar Dimachki
- Laboratoire d'Etude des Mécanismes Cognitifs, Université Lyon 2, Lyon, France
| | | | - Bernard Croisile
- Neurology Hospital - Neuropsychology Department, Hospices Civils de Lyon, Lyon, France
| | - Hanna Chainay
- EMC Laboratory - (Etudes des Mécanismes Cognitifs), Universite Lumiere Lyon 2, Lyon, France
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Lu Y, Liu C, Fawkes S, Wang Z, Yu D. Perceived extrinsic barriers hinder community detection and management of mild cognitive impairment: a cross-sectional study of general practitioners in Shanghai, China. BMC Geriatr 2022; 22:497. [PMID: 35681136 PMCID: PMC9185915 DOI: 10.1186/s12877-022-03175-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background General practitioners (GPs) play a critical role in community detection and management of mild cognitive impairment (MCI). Although adequate knowledge is essential, healthcare practice is shaped by intrinsic and extrinsic factors. This study aimed to test the mediating effect of perceived extrinsic barriers on the associations between knowledge, attitudes, and intended practice of GPs in community detection and management of MCI. Methods A cross-sectional study was conducted through an online survey of 1253 GPs sampled from 56 community health centres (CHCs) in Shanghai in 2021. Perceived extrinsic barriers were rated on a five-point Likert scale for patient engagement, working environment, and system context, respectively. A summed score was generated subsequently for each domain ranging from 0 to 100, with a higher score indicating higher barriers. The mediating effect of perceived extrinsic barriers (second-order) and the moderation effect of training on the association between MCI knowledge and practice scores, as well as the moderation effect of past experience on the association between MCI knowledge and extrinsic barriers, were tested through structural equation modelling (SEM) with a partial least square (PLS) approach. Results The study participants reported an average barrier score of 65.23 (SD = 13.98), 58.34 (SD = 16.95), and 60.37 (SD = 16.99) for patient engagement, working environment, and system context, respectively. Although knowledge had both direct and indirect (through attitudes) effects on intended practice, perceived extrinsic barriers negatively mediated (β = − 0.012, p = 0.025) the association between knowledge and practice. Training moderated the effect of knowledge on practice (β = − 0.066, p = 0.014). Conclusions Perceived extrinsic barriers have a detrimental effect on the translation of knowledge into practice for community detection and management of MCI. The effect of training on practice declines when knowledge scores become higher. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03175-4.
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Affiliation(s)
- Yuan Lu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China.,School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia.,Tongji University School of Medicine, Shanghai, 200092, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Sally Fawkes
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Zhaoxin Wang
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Dehua Yu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China. .,Tongji University School of Medicine, Shanghai, 200092, China. .,Shanghai General Practice and Community Health Development Research Center, Shanghai, 200090, China.
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Improvements in Cognitive Performance With Computerized Training in Older People With and Without Cognitive Impairment: Synergistic Effects of Skills-Focused and Cognitive-Focused Strategies. Am J Geriatr Psychiatry 2022; 30:717-726. [PMID: 34924275 PMCID: PMC9261111 DOI: 10.1016/j.jagp.2021.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Both cognitively impaired (CI) and nonimpaired (NC) older people have challenges in performing everyday tasks. Previous skills training efforts in NC individuals have led to improvements in both functional skills and cognitive functioning. We evaluated the cognitive benefits of combining computerized cognitive training (CCT) with a computer-based functional skills assessment and training (CFSAT) program in a sample of CI and NC older adults. DESIGN Randomized parallel clinical trial with two treatment conditions: up to 24 sessions of CFSAT training alone or CFSAT plus speed focused CCT. PARTICIPANTS NC (n = 62) and CI (n = 55) older adults, ranging in age from 60-86 years (M = 73.12), primarily female (90%), and ethnically diverse (21% Hispanic, 52% African American). Participants were divided based on Montreal Cognitive Assessment scores and cognitive complaints. SETTING Three different community centers in Miami, FL. MEASUREMENTS The Brief Assessment of Cognition, app version, was used to measure cognitive performance across six different cognitive domains before and after training. RESULTS All six cognitive domains improved from baseline. Multivariate analyses found the effects of the combined CFSAT and CCT to be superior. The interaction of training condition and cognitive status was not statistically significant, indicating no global impact of cognitive status on improvements in cognition across training conditions. CONCLUSIONS CFSAT training was associated with cognitive benefits, particularly in CI participants. The combined intervention led to greater improvements. Consistent with results of previous studies, there is considerable evidence of cognitive plasticity in older adults, including those with CI.
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Knowledge, attitudes, and practice of general practitioners toward community detection and management of mild cognitive impairment: a cross-sectional study in Shanghai, China. BMC PRIMARY CARE 2022; 23:114. [PMID: 35545764 PMCID: PMC9092880 DOI: 10.1186/s12875-022-01716-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 04/21/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND General practitioners (GPs) are in a unique position for community detection and management of mild cognitive impairment (MCI). However, adequate knowledge, attitudes, and practice (KAP) are prerequisites for fulfilling such a role. This study aims to assess the MCI-related KAP of GPs in Shanghai, China. METHODS An online survey was conducted on 1253 GPs who were recruited from 56 community health centres (CHCs) in Shanghai between April and May 2021. Knowledge (8 items), attitudes (13 items), and practice (11 items) were assessed using a scale endorsed by a panel of multidisciplinary experts. An average summed score was calculated and transformed into a score ranging from 0 to 100 for knowledge, attitudes, and practice, respectively. Adjusted odds ratios (AORs) were calculated for potential predictors of higher levels of KAP scores (with mean value as a cutoff point) through logistic modelling. The mediating role of attitudes on the association between knowledge and practice was tested using the PROCESS model 4 macro with 5000 bootstrap samples through linear regression modelling. RESULTS A total of 1253 GPs completed the questionnaire, with an average score of 54.51 ± 18.18, 57.31 ± 7.43, and 50.05 ± 19.80 for knowledge, attitudes, and practice, respectively. More than 12% of respondents scored zero in knowledge, 28.4% tended not to consider MCI as a disease, and 19.1% completely rejected MCI screening. Higher levels of knowledge were associated with more favourable attitudes toward community management of MCI (AOR = 1.974, p < 0.001). Higher compliance with practice guidelines was associated with both higher levels of knowledge (AOR = 1.426, p < 0.01) and more favourable attitudes (AOR = 2.095, p < 0.001). The association between knowledge and practice was partially mediated by attitudes (p < 0.001). Training was associated with higher levels of knowledge (AOR = 1.553, p < 0.01), while past experience in MCI management was associated with more favourable attitudes (AOR = 1.582, p < 0.05) and higher compliance with practice guidelines (AOR = 3.034, p < 0.001). MCI screening qualification was associated with higher compliance with practice guidelines (AOR = 2.162, p < 0.05), but less favourable attitudes (AOR = 0.452, p < 0.05). CONCLUSION The MCI knowledge of GPs in Shanghai is low, and is associated with less favourable attitudes toward MCI management and low compliance with practice guidelines. Attitudes mediate the association between knowledge and practice. Training is a significant predictor of knowledge. Further studies are needed to better understand how the attitudes of GPs in Shanghai are shaped by the environments in which they live and work.
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Audiffren M, André N, Baumeister RF. Training Willpower: Reducing Costs and Valuing Effort. Front Neurosci 2022; 16:699817. [PMID: 35573284 PMCID: PMC9095966 DOI: 10.3389/fnins.2022.699817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
The integrative model of effortful control presented in a previous article aimed to specify the neurophysiological bases of mental effort. This model assumes that effort reflects three different inter-related aspects of the same adaptive function. First, a mechanism anchored in the salience network that makes decisions about the effort that should be engaged in the current task in view of costs and benefits associated with the achievement of the task goal. Second, a top-down control signal generated by the mechanism of effort that modulates neuronal activity in brain regions involved in the current task to filter pertinent information. Third, a feeling that emerges in awareness during effortful tasks and reflects the costs associated with goal-directed behavior. The aim of the present article is to complete this model by proposing that the capacity to exert effortful control can be improved through training programs. Two main questions relative to this possible strengthening of willpower are addressed in this paper. The first question concerns the existence of empirical evidence that supports gains in effortful control capacity through training. We conducted a review of 63 meta-analyses that shows training programs are effective in improving performance in effortful tasks tapping executive functions and/or self-control with a small to large effect size. Moreover, physical and mindfulness exercises could be two promising training methods that would deserve to be included in training programs aiming to strengthen willpower. The second question concerns the neural mechanisms that could explain these gains in effortful control capacity. Two plausible brain mechanisms are proposed: (1) a decrease in effort costs combined with a greater efficiency of brain regions involved in the task and (2) an increase in the value of effort through operant conditioning in the context of high effort and high reward. The first mechanism supports the hypothesis of a strengthening of the capacity to exert effortful control whereas the second mechanism supports the hypothesis of an increase in the motivation to exert this control. In the last part of the article, we made several recommendations to improve the effectiveness of interventional studies aiming to train this adaptive function."Keep the faculty of effort alive in you by a little gratuitous exercise every day."James (1918, p. 127).
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Affiliation(s)
- Michel Audiffren
- Research Centre on Cognition and Learning, Centre National de la Recherche Scientifique, University of Poitiers, Poitiers, France
| | - Nathalie André
- Research Centre on Cognition and Learning, Centre National de la Recherche Scientifique, University of Poitiers, Poitiers, France
| | - Roy F. Baumeister
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
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Kajimoto Y, Kameda M, Kambara A, Kuroda K, Tsuji S, Nikaido Y, Saura R, Wanibuchi M. Impact of Early Intervention for Idiopathic Normal Pressure Hydrocephalus on Long-Term Prognosis in Prodromal Phase. Front Neurol 2022; 13:866352. [PMID: 35481276 PMCID: PMC9035988 DOI: 10.3389/fneur.2022.866352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives Because the progression of idiopathic normal pressure hydrocephalus (iNPH) is partially irreversible, we hypothesized that early intervention would markedly improve its prognosis. To test this hypothesis, we retrospectively investigated the long-term prognosis of patients with early intervention in the prodromal phase of iNPH. Methods We defined the prodromal phase of iNPH as a 3m Timed Up and Go (TUG) of 13.5 s or less and a Mini-Mental State Examination (MMSE) of 24 or more. Of the 83 iNPH patients who underwent shunt surgery at Osaka Medical and Pharmaceutical University Hospital over 3 years from January 2015, 12 prodromal phase cases (73.3 ± 6.2 years, 10 males and 2 females) were included in the study. The iNPH grading scale (INPHGS), MMSE, Frontal Assessment Battery (FAB), intermittent gait disturbance (IGD), social participation status, and development of comorbidities were evaluated over 4 years. Results Preoperative MMSE was 27.2 ± 1.5, FAB was 14.1 ± 1.8, TUG was 10.7 ± 1.4 s, and total iNPHGS was 2.8 ± 1.4. At 1, 2, 3, and 4 years postoperatively, total INPHGS improved to 0.8, 0.9, 1.5, and 1.7, respectively, and remained significantly better than preoperatively except at 4 years postoperatively. The MMSE improved slightly to 27.5 after 1 year and then declined by 0.35 per year. After 4 years, the mean MMSE was 26.1, and only one patient had an MMSE below 23. FAB improved to 15.2 after 1 year and then declined slowly at 0.85/year. Ten patients (83%) maintained a high capacity for social participation postoperatively. The preoperative tendency to fall and IGD in 9 (75%) and 8 (67%) patients, respectively, completely disappeared postoperatively, resulting in improved mobility. Shunt malfunction associated with four weight fluctuations and one catheter rupture caused temporary worsening of symptoms, which were recovered by valve re-setting and catheter revision, respectively. Conclusion Early intervention in the prodromal phase of iNPH patients maintained good cognitive and mobility function and social participation ability in the long term. The maintenance of long-term cognitive function suggests its preventive effect on dementia. To realize early intervention for iNPH, it is desirable to establish an early diagnosis system for iNPH.
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Affiliation(s)
- Yoshinaga Kajimoto
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
- *Correspondence: Yoshinaga Kajimoto
| | - Masahiro Kameda
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Akihiro Kambara
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kenji Kuroda
- Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Shohei Tsuji
- Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yasutaka Nikaido
- Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Ryuichi Saura
- Department of Physical and Rehabilitation Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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64
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Gong CH, Sato S. Can mild cognitive impairment with depression be improved merely by exercises of recall memories accompanying everyday conversation? A longitudinal study 2016-2019. QUALITY IN AGEING AND OLDER ADULTS 2022. [DOI: 10.1108/qaoa-09-2021-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to find out a simple cognitive intervention method to use MCI and suffering people with depression. As the elderly society increases around the world, the number of elderly people with diseases and dementia is increasing rapidly. Mild cognitive impairment (MCI), a pre-stage to dementia, is a critical treatment time to slow disease progression. However, there is currently no appropriate medication. Furthermore, MCI patients with depression are more difficult to treat.
Design/methodology/approach
To overcome these problems, the authors confirmed improvements and delayed effects in MCI patients in this study for three years through cognitive intervention, demonstrating its effectiveness. Cognitive interventions were conducted for memory retrieval and steadily stimulated the brain by performing tasks to solve problems during daily conversations.
Findings
As a result, the intervention group retained mini-mental state examination and Montreal cognitive assessment scores on the domains of cognitive function and also instrumental activities of daily living in the domain of motion compared to the non-intervention group. Moreover, significant improvements in geriatric depression scales-15 and quality-of-life scales enabled the patients to maintain stable living compared to before the intervention. In addition, the intervention group showed a change in patterns that allowed them to voluntarily devote time to going out at the end of the study.
Research limitations/implications
This study was originally planned to compare the rates of transmission from MCI to dementia by tracking over five years (2016–2021). However, due to the impact of COVID-19, which began to spread around the world in 2020, further face-to-face visits and cognitive intervention became impossible. Thus, only half of the data in the existing plans were collected. Although it is difficult to present accurate results for the rate of transmission from MCI to dementia, the tendency was confirmed, indicating sufficient implications as an intervention.
Originality/value
This study was originally planned to compare the rates of transmission from MCI to dementia by tracking three years (2016–2019). The authors had studied for long-term effect.
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Hol HR, Flak MM, Chang L, Løhaugen GCC, Bjuland KJ, Rimol LM, Engvig A, Skranes J, Ernst T, Madsen BO, Hernes SS. Cortical Thickness Changes After Computerized Working Memory Training in Patients With Mild Cognitive Impairment. Front Aging Neurosci 2022; 14:796110. [PMID: 35444526 PMCID: PMC9014119 DOI: 10.3389/fnagi.2022.796110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Adaptive computerized working memory (WM) training has shown favorable effects on cerebral cortical thickness as compared to non-adaptive training in healthy individuals. However, knowledge of WM training-related morphological changes in mild cognitive impairment (MCI) is limited. Objective The primary objective of this double-blind randomized study was to investigate differences in longitudinal cortical thickness trajectories after adaptive and non-adaptive WM training in patients with MCI. We also investigated the genotype effects on cortical thickness trajectories after WM training combining these two training groups using longitudinal structural magnetic resonance imaging (MRI) analysis in Freesurfer. Method Magnetic resonance imaging acquisition at 1.5 T were performed at baseline, and after four- and 16-weeks post training. A total of 81 individuals with MCI accepted invitations to undergo 25 training sessions over 5 weeks. Longitudinal Linear Mixed effect models investigated the effect of adaptive vs. non-adaptive WM training. The LME model was fitted for each location (vertex). On all statistical analyzes, a threshold was applied to yield an expected false discovery rate (FDR) of 5%. A secondary LME model investigated the effects of LMX1A and APOE-ε4 on cortical thickness trajectories after WM training. Results A total of 62 participants/patients completed the 25 training sessions. Structural MRI showed no group difference between the two training regimes in our MCI patients, contrary to previous reports in cognitively healthy adults. No significant structural cortical changes were found after training, regardless of training type, across all participants. However, LMX1A-AA carriers displayed increased cortical thickness trajectories or lack of decrease in two regions post-training compared to those with LMX1A-GG/GA. No training or training type effects were found in relation to the APOE-ε4 gene variants. Conclusion The MCI patients in our study, did not have improved cortical thickness after WM training with either adaptive or non-adaptive training. These results were derived from a heterogeneous population of MCI participants. The lack of changes in the cortical thickness trajectory after WM training may also suggest the lack of atrophy during this follow-up period. Our promising results of increased cortical thickness trajectory, suggesting greater neuroplasticity, in those with LMX1A-AA genotype need to be validated in future trials.
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Affiliation(s)
- Haakon R. Hol
- Department of Radiology, Sørlandet Hospital, Arendal, Norway
- Department of Radiology, Oslo University Hospital, Oslo, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- *Correspondence: Haakon R. Hol,
| | | | - Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Knut Jørgen Bjuland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars M. Rimol
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andreas Engvig
- Department of Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Jon Skranes
- Department of Pediatrics, Sørlandet Hospital, Arendal, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Thomas Ernst
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Bengt-Ove Madsen
- Department of Geriatric and Internal Medicine, Sørlandet Hospital, Arendal, Norway
| | - Susanne S. Hernes
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Geriatric and Internal Medicine, Sørlandet Hospital, Arendal, Norway
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Functional connectivity as a neural correlate of cognitive rehabilitation programs’ efficacy: A systematic review. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02989-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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67
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Ríos Rincón AM, Daum C, Miguel Cruz A, Liu L, Stroulia E. Feasibility and Acceptability of a Serious Mobile-Game Intervention for Older Adults. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2022.2030849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Adriana Maria Ríos Rincón
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Christine Daum
- Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
- Department of Occupational Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Antonio Miguel Cruz
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
- Glenrose Rehabilitation Research Innovation & Technology (GRRIT) hub, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Lili Liu
- Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Eleni Stroulia
- Department of Computing Science, Faculty of Science, Edmonton, Alberta, Canada
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Levy SA, Smith G, De Wit L, DeFeis B, Ying G, Amofa P, Locke D, Shandera-Ochsner A, McAlister C, Phatak V, Chandler M. Behavioral Interventions in Mild Cognitive Impairment (MCI): Lessons from a Multicomponent Program. Neurotherapeutics 2022; 19:117-131. [PMID: 35415779 PMCID: PMC9130435 DOI: 10.1007/s13311-022-01225-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 01/03/2023] Open
Abstract
Comparative effectiveness of behavioral interventions to mitigate the impacts of degeneration-based cognitive decline is not well understood. To better address this gap, we summarize the studies from the Healthy Action to Benefit Independence & Thinking (HABIT®) program, developed for persons with mild cognitive impairment (pwMCI) and their partners. HABIT® includes memory compensation training, computerized cognitive training (CCT), yoga, patient and partner support groups, and wellness education. Studies cited include (i) a survey of clinical program completers to establish outcome priorities; (ii) a five-arm, multi-site cluster randomized, comparative effectiveness trial; (iii) and a three-arm ancillary study. PwMCI quality of life (QoL) was considered a high-priority outcome. Across datasets, findings suggest that quality of life was most affected in groups where wellness education was included and CCT withheld. Wellness education also had greater impact on mood than CCT. Yoga had a greater impact on memory-dependent functional status than support groups. Yoga was associated with better functional status and improved caregiver burden relative to wellness education. CCT had the greatest impact on cognition compared to yoga. Taken together, comparisons of groups of program components suggest that knowledge-based interventions like wellness education benefit patient well-being (e.g., QoL and mood). Skill-based interventions like yoga and memory compensation training aid the maintenance of functional status. Notably, better adherence produced better outcomes. Future personalized intervention approaches for pwMCI may include different combinations of behavioral strategies selected to optimize outcomes prioritized by patient values and preferences.
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Affiliation(s)
- Shellie-Anne Levy
- Department of Clinical and Health Psychology, University of Florida, Gainesville, PO Box 100165, Florida, FL, 32653, USA.
| | - Glenn Smith
- Department of Clinical and Health Psychology, University of Florida, Gainesville, PO Box 100165, Florida, FL, 32653, USA
| | - Liselotte De Wit
- Department of Clinical and Health Psychology, University of Florida, Gainesville, PO Box 100165, Florida, FL, 32653, USA
| | - Brittany DeFeis
- Department of Clinical and Health Psychology, University of Florida, Gainesville, PO Box 100165, Florida, FL, 32653, USA
| | - Gelan Ying
- Department of Clinical and Health Psychology, University of Florida, Gainesville, PO Box 100165, Florida, FL, 32653, USA
| | - Priscilla Amofa
- Department of Clinical and Health Psychology, University of Florida, Gainesville, PO Box 100165, Florida, FL, 32653, USA
| | - Dona Locke
- Division of Neuropsychology, Mayo Clinic, Scottsdale, AZ, USA
| | - Anne Shandera-Ochsner
- Department of Psychiatry and Psychology, Mayo Clinic Health System, La Crosse, WI, USA
| | - Courtney McAlister
- Department of Psychiatry and Psychology, Mayo Clinic Health System, La Crosse, WI, USA
| | - Vaishali Phatak
- Department of Neurological Sciences, University of Nebraska Medical Center Omaha, Nebraska, USA
| | - Melanie Chandler
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
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Manser P, de Bruin ED. Making the Best Out of IT: Design and Development of Exergames for Older Adults With Mild Neurocognitive Disorder - A Methodological Paper. Front Aging Neurosci 2021; 13:734012. [PMID: 34955806 PMCID: PMC8698204 DOI: 10.3389/fnagi.2021.734012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/03/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Utilizing information technology (IT) systems, for example in form of computerized cognitive screening or exergame-based (also called active videogames) training, has gained growing interest for supporting healthy aging and to detect, prevent and treat neurocognitive disorders (NCD). To ameliorate the effectiveness of exergaming, the neurobiological mechanisms as well as the most effective components for exergame-based training remain to be established. At the same time, it is important to account for the end-users' capabilities, preferences, and therapeutic needs during the design and development process to foster the usability and acceptance of the resulting program in clinical practice. This will positively influence adherence to the resulting exergame-based training program, which, in turn, favors more distinct training-related neurobiological effects. Objectives and Methods: This methodological paper describes the design and development process of novel exergame-based training concepts guided by a recently proposed methodological framework: The 'Multidisciplinary Iterative Design of Exergames (MIDE): A Framework for Supporting the Design, Development, and Evaluation of Exergames for Health' (Li et al., 2020). Case Study: A step-by-step application of the MIDE-framework as a specific guidance in an ongoing project aiming to design, develop, and evaluate an exergame-based training concept with the aim to halt and/or reduce cognitive decline and improve quality of life in older adults with mild neurocognitive disorder (mNCD) is illustrated. Discussion and Conclusion: The development of novel exergame-based training concepts is greatly facilitated when it is based on a theoretical framework (e.g., the MIDE-framework). Applying this framework resulted in a structured, iterative, and evidence-based approach that led to the identification of multiple key requirements for the exergame design as well as the training components that otherwise may have been overlooked or neglected. This is expected to foster the usability and acceptance of the resulting exergame intervention in "real life" settings. Therefore, it is strongly recommended to implement a theoretical framework (e.g., the MIDE-framework) for future research projects in line with well-known checklists to improve completeness of reporting and replicability when serious games for motor-cognitive rehabilitation purposes are to be developed.
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Affiliation(s)
- Patrick Manser
- Movement Control and Learning - Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Eling D de Bruin
- Movement Control and Learning - Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,OST - Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
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70
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Pastells-Peiró R, Fernández-Lago H, Rubinat Arnaldo E, Bellon F, Martínez-Soldevila J, Gea-Sánchez M. Information and communication technologies for the improvement of cognitive function in healthy older adults: a systematic review protocol. BMJ Open 2021; 11:e046544. [PMID: 34916307 PMCID: PMC8679132 DOI: 10.1136/bmjopen-2020-046544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Mild cognitive impairment is one of the consequences of ageing, causing functional disability, a poor quality of life and an increased socioeconomic expenditure. Evidence shows that patients go through a long preclinical stage in which cognitive deficits appear subtly until they reach the threshold of dementia. Non-pharmacological interventions have been gaining ground as prevention of modifiable factors of cognitive decline such as obesity, diabetes, physical inactivity or social isolation. Along these lines, Information and Communication Technologies (ICTs) can be a tool for cognitive stimulation, cognitive training and cognitive rehabilitation. The main objective of the systematic review will be to review and analyse the use of ICTs for the improvement of cognitive functions in healthy older adult population aged 50 and over, for the prevention of cognitive impairment METHODS: A systematic review will be conducted including randomised clinical trials in adults without diseases or accidents associated with cognitive impairment, and whom have used ICTs for the improvement of cognitive functions between 2010 and 2020 in English or Spanish. The articles that report data on cognitive function by domain, for example, memory or executive functions, or by test will be included. The databases Medline (PubMed), CinahlPlus, Scopus, ISI WoS, CENTRAL and IEEE Xplore will be searched. Studies that meet the inclusion criteria will be analysed according to the Cochrane RoB2 tool for risk of bias assessment. ETHICS AND DISSEMINATION Ethical approval is not necessary as this is a systematic review. The results will be published in scientific journals, as well as in specialised congresses on the subject of study.
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Affiliation(s)
- Roland Pastells-Peiró
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
- Society, Health, Education and Culture Research Group (GESEC), University of Lleida, Lleida, Spain
| | - Helena Fernández-Lago
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
- Society, Health, Education and Culture Research Group (GESEC), University of Lleida, Lleida, Spain
| | - Esther Rubinat Arnaldo
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
- Society, Health, Education and Culture Research Group (GESEC), University of Lleida, Lleida, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Filip Bellon
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
| | - Jordi Martínez-Soldevila
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
- Society, Health, Education and Culture Research Group (GESEC), University of Lleida, Lleida, Spain
| | - Montserrat Gea-Sánchez
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Grup de Recerca de Cures en Salut, Lleida Institute for Biomedical Research Dr. Pifarré Foundation (IRBLleida), Lleida, Spain
- Society, Health, Education and Culture Research Group (GESEC), University of Lleida, Lleida, Spain
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71
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Lu Y, Liu C, Fawkes S, Ma J, Liu Y, Yu D. Inequality in Social Support Associated With Mild Cognitive Impairment: A Cross-Sectional Study of Older (≥60 Years) Residents in Shanghai, China. Front Public Health 2021; 9:706322. [PMID: 34888276 PMCID: PMC8649958 DOI: 10.3389/fpubh.2021.706322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Social support plays a critical role in the detection and management of mild cognitive impairment (MCI). However, socioeconomic inequalities exist in both social support and health care services. Our study aimed to compare the level of social support received by MCI patients in comparison with those without MCI and to determine its link with income. Methods: Secondary data analyses were performed. Social support was measured using the Duke Social Support Index (DSSI) and satisfaction ratings. Multivariate logistic regression models were constructed to determine the associations of personal income and MCI with social support after adjustment for variations in the sociodemographic and health characteristics of the respondents. The multiplicative and additive interaction effects of income and MCI were further examined through introducing the MCI*Income variable to the regression models and using the relative excess risk due to interaction (RERI) analysis, respectively. Results: The logistic regression models showed that the respondents with MCI had significantly lower social support as measured by the DSSI scores (AOR = 33.03, p < 0.001) and satisfaction ratings (AOR = 7.48, p < 0.001) compared with those without MCI. Similarly, social support decreased with lower personal income (p < 0.001). There existed a significant multiplicative interaction effect between personal income and MCI on social support (AOR = 0.30-0.32, p < 0.01). The gap in social support between those with and without MCI was higher in the higher income group compared with the lower income group (p < 0.001). No significant additive interaction effects on social support were found between MCI and income. Conclusions: There are significant disparities in social support between people living with and without MCI. Such a gap is more profound in people with higher income. The inequality in social support associated with MCI may present a significant challenge to the successful implementation of community MCI detection and management.
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Affiliation(s)
- Yuan Lu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.,School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Sally Fawkes
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Jia Ma
- Community Health Service Centre of Dinghai in YangPu District, Shanghai, China
| | - Yalin Liu
- Community Health Service Centre of JiaDing Town in JiaDing District, Shanghai, China
| | - Dehua Yu
- Department of General Practice, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China
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Sun J, Zeng H, Pan L, Wang X, Liu M. Acupressure and Cognitive Training Can Improve Cognitive Functions of Older Adults With Mild Cognitive Impairment: A Randomized Controlled Trial. Front Psychol 2021; 12:726083. [PMID: 34867607 PMCID: PMC8635488 DOI: 10.3389/fpsyg.2021.726083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Given the limited effectiveness of pharmacological treatments in mitigating cognitive decline in individuals with mild cognitive impairment (MCI), there is a pressing need for developing effective non-pharmacological intervention programs to counteract MCI-related cognitive decline. Acupressure and cognitive training are safe and cost-effective; however, evidence of the effect of acupressure or the combined effect of acupressure and cognitive training on cognitive functions of older adults with MCI is limited. Objective: To evaluate both the individual and combined effects of acupressure and cognitive training on cognitive functions of older adults with MCI. Methods: One hundred and eighty older adults with MCI were recruited and randomly assigned to combined acupressure and cognitive training group (n = 45), acupressure group (n = 45), cognitive training group (n = 45), or control group (n = 45). Participants in the experimental groups received self-administered and group-based training sessions, while those in the control group received routine community education. The intervention lasted for 6 months. The cognitive functions of all the participants were assessed at multiple stages, including pre-intervention, at the end of the third and sixth months. Results: One hundred and fifty-one participants completed the study, and all participants analyzed in intervention groups completed at least 85% of all practice sessions recommended. Repeated measures analysis of variance of the scores of Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at different time points among the four groups revealed that the group effect, time effect, and interaction effect were all significant (p < 0.01). Pairwise comparisons with Bonferroni correction showed that the scores of MMSE and MoCA in acupressure group, cognitive training group, and combined group were significantly raised compared with control group (p < 0.01). Compared with acupressure or cognitive training groups, the scores of MMSE and MoCA in combined group were significantly higher (p < 0.05). The scores of MMSE and MoCA in acupressure group had no significant differences with those in cognitive training group (p > 0.05). Conclusion: Acupressure and cognitive training both could improve the cognitive functions of older adults with MCI, and when used together, the effects were enhanced. Clinical Trial Registration: This study was registered in the Chinese Clinical Trial Registry (No.ChiCTR2100049955).
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Affiliation(s)
- Jingxian Sun
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Hui Zeng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Lu Pan
- Second Xiangya Hospital, Central South University, Changsha, China
| | | | - Mengjiao Liu
- Second Xiangya Hospital, Central South University, Changsha, China
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73
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Guan H, Wang C, Tao D. MRI-based Alzheimer's disease prediction via distilling the knowledge in multi-modal data. Neuroimage 2021; 244:118586. [PMID: 34563678 DOI: 10.1016/j.neuroimage.2021.118586] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/09/2021] [Accepted: 09/16/2021] [Indexed: 12/14/2022] Open
Abstract
Mild cognitive impairment (MCI) conversion prediction, i.e., identifying MCI patients of high risks converting to Alzheimer's disease (AD), is essential for preventing or slowing the progression of AD. Although previous studies have shown that the fusion of multi-modal data can effectively improve the prediction accuracy, their applications are largely restricted by the limited availability or high cost of multi-modal data. Building an effective prediction model using only magnetic resonance imaging (MRI) remains a challenging research topic. In this work, we propose a multi-modal multi-instance distillation scheme, which aims to distill the knowledge learned from multi-modal data to an MRI-based network for MCI conversion prediction. In contrast to existing distillation algorithms, the proposed multi-instance probabilities demonstrate a superior capability of representing the complicated atrophy distributions, and can guide the MRI-based network to better explore the input MRI. To our best knowledge, this is the first study that attempts to improve an MRI-based prediction model by leveraging extra supervision distilled from multi-modal information. Experiments demonstrate the advantage of our framework, suggesting its potentials in the data-limited clinical settings.
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Affiliation(s)
- Hao Guan
- School of Computer Science, The University of Sydney, Australia
| | - Chaoyue Wang
- School of Computer Science, The University of Sydney, Australia.
| | - Dacheng Tao
- School of Computer Science, The University of Sydney, Australia; JD Explore Academy, China.
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74
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Whitfield T, McConnell B, Renouf P, Mansour H, Zabihi S, Aguirre E, Walker Z, Cooper C, Marchant NL. The effect of remotely delivered lifestyle interventions on cognition in older adults without dementia: A systematic review and meta-analysis. Ageing Res Rev 2021; 72:101505. [PMID: 34757173 PMCID: PMC9761296 DOI: 10.1016/j.arr.2021.101505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/21/2021] [Accepted: 10/26/2021] [Indexed: 01/04/2023]
Abstract
Up to 40% of dementias may be preventable via risk factor modification. This inference has motivated the development of lifestyle interventions for reducing cognitive decline. Typically delivered to older adults face-to-face, the COVID-19 pandemic has necessitated their adaptation for remote delivery. We systematically reviewed randomized controlled trials of remotely delivered lifestyle interventions (≥4 weeks duration and delivered >50% remotely), for adults aged ≥ 60 without dementia, examining effects on objective cognitive measures. Comparators were active (face-to-face or remote) or passive. Ten studies (n = 2967) comprising multidomain (k = 4), physical activity (k = 3) or psychosocial (k = 3) remote interventions were included. Data were synthesized using robust variance estimation meta-analysis. The pooled estimate comparing the effect of remote interventions versus comparators on cognition was not significant (g=-0.02; 95%CI [-0.14, 0.09]; p = .66); subgroup analyses by type of intervention or comparator also yielded non-significant effects. Most studies had low risk of bias. Current evidence to support remote lifestyle interventions is limited. Included studies were conducted pre-pandemic, and evaluated individual, rather than group interventions. Future studies may exploit the greater digital connectivity of older people since the pandemic. Group formats, more frequently efficacious than individual interventions in face-to-face dementia prevention trials, may be a rational approach for future remote trials.
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Affiliation(s)
- Tim Whitfield
- Division of Psychiatry, University College London, London, UK
| | | | - Philippa Renouf
- Division of Psychiatry, University College London, London, UK
| | - Hassan Mansour
- Division of Psychiatry, University College London, London, UK,Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sedigheh Zabihi
- Division of Psychiatry, University College London, London, UK
| | - Elisa Aguirre
- Department of Clinical, Educational and Health Psychology, University College London, London, UK,North East London Mental Health Foundation Trust, London, UK
| | - Zuzana Walker
- Division of Psychiatry, University College London, London, UK,Essex Partnership University NHS Foundation Trust, Essex, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK,Camden and Islington NHS Foundation Trust, London, UK
| | - Natalie L. Marchant
- Division of Psychiatry, University College London, London, UK,Correspondence to: Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
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75
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Langton-Frost N, Brodsky MB. Speech-language pathology approaches to neurorehabilitation in acute care during COVID-19: Capitalizing on neuroplasticity. PM R 2021; 14:217-226. [PMID: 34595841 PMCID: PMC8661644 DOI: 10.1002/pmrj.12717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 09/03/2021] [Accepted: 09/24/2021] [Indexed: 11/11/2022]
Abstract
Neurologic manifestations associated with a coronavirus disease 2019 (COVID‐19) diagnosis are common and often occur in severe and critically ill patients. In these patients, the neurologic symptoms are confounded by critical care conditions, such as acute respiratory distress syndrome (ARDS). Patients with dual diagnoses of COVID‐19 and neurologic changes such as myopathy, polyneuropathy, and stroke are likely at a higher risk of experiencing deficits with swallowing, communication, and/or cognition. Speech‐language pathologists are an integral part of both the critical care and neurologic disorders multi‐disciplinary teams, offering valuable contributions in the evaluation, treatment, and management of these areas. Patients in intensive care units (ICUs) who require mechanical ventilation often experience difficulty with communication and benefit from early speech‐language pathology intervention to identify the most efficient communication methods with the medical team and caregivers. Moreover, patients with neurologic manifestations may present with cognitive‐linguistic impairments such as aphasia, thereby increasing the need for communication‐based interventions. Difficulties with voice and swallowing after extubation are common, often requiring frequent treatment sessions, possibly persisting beyond ICU discharge. After leaving the ICU, patients with COVID‐19 often experience physical, cognitive, and mental health impairments collectively called post‐intensive care syndrome. This is often a lengthy road as they progress toward full recovery, requiring continued speech‐language pathology treatment after hospital discharge, capitalizing on the principles of neuroplasticity.
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Affiliation(s)
- Nicole Langton-Frost
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Martin B Brodsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, USA
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76
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Shea TB. Improvement of cognitive performance by a nutraceutical formulation: Underlying mechanisms revealed by laboratory studies. Free Radic Biol Med 2021; 174:281-304. [PMID: 34352370 DOI: 10.1016/j.freeradbiomed.2021.07.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/28/2022]
Abstract
Cognitive decline, decrease in neuronal function and neuronal loss that accompany normal aging and dementia are the result of multiple mechanisms, many of which involve oxidative stress. Herein, we review these various mechanisms and identify pharmacological and non-pharmacological approaches, including modification of diet, that may reduce the risk and progression of cognitive decline. The optimal degree of neuronal protection is derived by combinations of, rather than individual, compounds. Compounds that provide antioxidant protection are particularly effective at delaying or improving cognitive performance in the early stages of Mild Cognitive Impairment and Alzheimer's disease. Laboratory studies confirm alleviation of oxidative damage in brain tissue. Lifestyle modifications show a degree of efficacy and may augment pharmacological approaches. Unfortunately, oxidative damage and resultant accumulation of biomarkers of neuronal damage can precede cognitive decline by years to decades. This underscores the importance of optimization of dietary enrichment, antioxidant supplementation and other lifestyle modifications during aging even for individuals who are cognitively intact.
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Affiliation(s)
- Thomas B Shea
- Laboratory for Neuroscience, Department of Biological Sciences, University of Massachusetts Lowell, Lowell, MA, 01854, USA.
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77
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Comparative Effects of Physical Exercise and Other Behavioral Interventions on Functional Status Outcomes in Mild Cognitive Impairment. J Int Neuropsychol Soc 2021; 27:805-812. [PMID: 34308814 PMCID: PMC8458219 DOI: 10.1017/s1355617721000485] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Lifestyle modifications for those with mild cognitive impairment (MCI) may promote functional stability, lesson disease severity, and improve well-being outcomes such as quality of life. The current analysis of our larger comparative effectiveness study evaluated which specific combinations of lifestyle modifications offered as part of the Mayo Clinic Healthy Action to Benefit Independence in Thinking (HABIT) program contributed to the least functional decline in people with MCI (pwMCI) over 18 months. METHODS We undertook to compare evidence-based interventions with one another rather than to a no-treatment control group. The interventions were five behavioral treatments: computerized cognitive training (CCT), yoga, Memory Support System (MSS) training, peer support group (SG), and wellness education (WE), each delivered to both pwMCI and care partners, in a group-based program. To compare interventions, we randomly withheld one of the five HABIT® interventions in each of the group sessions. We conducted 24 group sessions with between 8 and 20 pwMCI-partner dyads in a session. RESULTS Withholding yoga led to the greatest declines in functional ability as measured by the Functional Activities Questionnaire and Clinical Dementia Rating. In addition, memory compensation (calendar) training and cognitive exercise appeared to have associations (moderate effect sizes) with better functional outcomes. Withholding SG or WE appeared to have little effect on functioning at 18 months. CONCLUSIONS Overall, these results add to the growing literature that physical exercise can play a significant and lasting role in modifying outcomes in a host of medical conditions, including neurodegenerative diseases.
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78
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Zhu Y, Zhong Q, Ji J, Ma J, Wu H, Gao Y, Ali N, Wang T. Effects of Aerobic Dance on Cognition in Older Adults with Mild Cognitive Impairment: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2021; 74:679-690. [PMID: 32083578 DOI: 10.3233/jad-190681] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Regular aerobic exercises could improve global cognition in older adults with mild cognitive impairment (MCI), such as aerobic dance a type of commonly practiced aerobic exercises. However, its effects remain debatable in improving the cognitive function in patients with MCI. OBJECTIVE The aim of this systematic review and meta-analysis is to evaluate the effects of aerobic dance on cognitive function among older adults with MCI. METHODS We searched articles in the MEDLINE, PubMed, Embase, and The Cochrane Library databases from inception to 28 February 2019, with the following criteria: 1) randomized controlled trials; 2) older adults with MCI; 3) aerobic dance intervention. RESULTS Five studies of 842 participants were identified. This meta-analysis showed that aerobic dance can significantly improve global cognition (Mini-Mental State Examination: MD = 1.43; 95% CI:[0.59, 2.27]; p = 0.0009; Alzheimer's Disease Assessment Scale-Cognitive Subscale: MD=-2.30; 95% CI:[-3.60, -1.00]; p = 0.0005), and delayed recall ability (SMD = 0.46;95% CI: [0.30, 0.62]; p < 0.00001) in older adults with MCI. In addition, have positive effects on improving executive function (Trial-Making Test A: MD = -2.37;95% CI:[-4.16, -0.58]; p = 0.010; Trial-Making Test B: MD = -16.0; 95% CI: [-30.03, -2.11]; p = 0.020) and immediate recall ability (SMD = 0.24;95% CI: [0.01, 0.46]; p = 0.04). CONCLUSION Aerobic dance significantly improves global cognitive function and memory in older adults with MCI. In addition, it also benefits executive function. However, due to the limitations as the review states, more randomized controlled trials with better study design and larger sample sizes should be conducted in the future research to make it much clearer.
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Affiliation(s)
- Yi Zhu
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qian Zhong
- First Clinical Medical College, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jie Ji
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Han Wu
- Department of Rehabilitation, Nanjing Drum Tower Hospital, The Affiliated Hospital of the Medical School at Nanjing University, Nanjing, Jiangsu, China
| | - Yaxin Gao
- First Clinical Medical College, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Nawab Ali
- First Clinical Medical College, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Tong Wang
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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79
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The Effect of Mindfulness-based Programs on Cognitive Function in Adults: A Systematic Review and Meta-analysis. Neuropsychol Rev 2021; 32:677-702. [PMID: 34350544 PMCID: PMC9381612 DOI: 10.1007/s11065-021-09519-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 07/19/2021] [Indexed: 11/28/2022]
Abstract
Mindfulness-based programs (MBPs) are increasingly utilized to improve mental health. Interest in the putative effects of MBPs on cognitive function is also growing. This is the first meta-analysis of objective cognitive outcomes across multiple domains from randomized MBP studies of adults. Seven databases were systematically searched to January 2020. Fifty-six unique studies (n = 2,931) were included, of which 45 (n = 2,238) were synthesized using robust variance estimation meta-analysis. Meta-regression and subgroup analyses evaluated moderators. Pooling data across cognitive domains, the summary effect size for all studies favored MBPs over comparators and was small in magnitude (g = 0.15; [0.05, 0.24]). Across subgroup analyses of individual cognitive domains/subdomains, MBPs outperformed comparators for executive function (g = 0.15; [0.02, 0.27]) and working memory outcomes (g = 0.23; [0.11, 0.36]) only. Subgroup analyses identified significant effects for studies of non-clinical samples, as well as for adults aged over 60. Across all studies, MBPs outperformed inactive, but not active comparators. Limitations include the primarily unclear within-study risk of bias (only a minority of studies were considered low risk), and that statistical constraints rendered some p-values unreliable. Together, results partially corroborate the hypothesized link between mindfulness practices and cognitive performance. This review was registered with PROSPERO [CRD42018100904].
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80
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Yong L, Liu L, Ding T, Yang G, Su H, Wang J, Yang M, Chang J. Evidence of Effect of Aerobic Exercise on Cognitive Intervention in Older Adults With Mild Cognitive Impairment. Front Psychiatry 2021; 12:713671. [PMID: 34354619 PMCID: PMC8329556 DOI: 10.3389/fpsyt.2021.713671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/28/2021] [Indexed: 11/14/2022] Open
Abstract
This study aimed to evaluate the effectiveness of aerobic exercise as a cognitive intervention for older adults with mild cognitive impairment (MCI). The PubMed, EMBASE (Ovid), Cochrane Library, Web of Science, and Medline databases were searched from their inception until 30 April 2021. Randomized controlled trials (RCTs) examining the effects of aerobic exercise on global cognitive function in older adults with MCI were included. Ten eligible trials with acceptable methodological quality were identified. The meta-analysis results showed that aerobic exercise significantly improved the MMSE (N = 956, MD = 0.60, 95% CI: 0.28-0.92, p = 0.0003, I 2 = 31%, fixed effects model) and MoCA scores (N = 398, MD = 1.67, 95% CI. 1.18-2.15, p < 0.0001, I 2 = 37%, fixed-effects model) and overall cognitive performance in patients with MCI. The results of this study suggest that participation in regular aerobic exercise can improve cognitive function in older adults with MCI. These findings should be used with caution considering the limitations of the study.
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Affiliation(s)
- Liming Yong
- School of Physical Education, Southwest University, Chongqing, China
- Institute of Motor Quotient, Southwest University, Chongqing, China
| | - Lei Liu
- Qingdao Mental Health Center, Qingdao University, Qingdao, China
| | - Ting Ding
- Qingdao Mental Health Center, Qingdao University, Qingdao, China
| | - Gao Yang
- School of Physical Education, Southwest University, Chongqing, China
| | - Haibing Su
- School of Physical Education, Southwest University, Chongqing, China
| | - Jibing Wang
- International College of Football, Tongji University, Shanghai, China
| | - Ming Yang
- School of Physical Education, Southwest University, Chongqing, China
- Institute of Motor Quotient, Southwest University, Chongqing, China
| | - Jindong Chang
- School of Physical Education, Southwest University, Chongqing, China
- Institute of Motor Quotient, Southwest University, Chongqing, China
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81
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Lanca M, Abrams DN, Crittenden P, Jones KM. Cognitive Stabilization Intervention during the Era of COVID-19. Dev Neuropsychol 2021; 46:298-313. [PMID: 34225510 DOI: 10.1080/87565641.2021.1943398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
As COVID-19 halted traditional neuropsychological assessment due to infection risk, neuropsychologists considered alternative practice models. Cognitive stabilization intervention (CSI) via telehealth, was developed to stabilize cognition in advance of neuropsychological assessment. It incorporates elements of evidence-based treatments, including cognitive training, sleep training, and medication adherence training within a motivational interview framework. Two case vignettes are described. One vignette describes an elder man who received CSI to manage sleep difficulties, forgetfulness, and mood symptoms. Another vignette describes a woman who completed CSI following an autoimmune disorder episode to improve sleep, organization, and attention. The benefits and limitations of CSI are discussed.
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Affiliation(s)
- Margaret Lanca
- Department of Psychiatry, Harvard Medical School/Cambridge Health Alliance, Cambridge, USA
| | - Danielle N Abrams
- Department of Psychiatry, Harvard Medical School/Cambridge Health Alliance, Cambridge, USA
| | - Persephone Crittenden
- Department of Psychiatry, Harvard Medical School/Cambridge Health Alliance, Cambridge, USA
| | - Kelly M Jones
- Private Practice, Boston & Woburn, Massachusetts, USA
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82
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Abstract
Classification between individuals with mild cognitive impairment (MCI) and healthy controls (HC) based on electroencephalography (EEG) has been considered a challenging task to be addressed for the purpose of its early detection. In this study, we proposed a novel EEG feature, the kernel eigen-relative-power (KERP) feature, for achieving high classification accuracy of MCI versus HC. First, we introduced the relative powers (RPs) between pairs of electrodes across 21 different subbands of 2-Hz width as the features, which have not yet been used in previous MCI-HC classification studies. Next, the Fisher’s class separability criterion was applied to determine the best electrode pairs (five electrodes) as well as the frequency subbands for extracting the most sensitive RP features. The kernel principal component analysis (kernel PCA) algorithm was further performed to extract a few more discriminating nonlinear principal components from the optimal RPs, and these components form a KERP feature vector. Results carried out on 51 participants (24 MCI and 27 HC) show that the newly introduced subband RP feature showed superior classification performance to commonly used spectral power features, including the band power, single-electrode relative power, and also the RP based on the conventional frequency bands. A high leave-one-participant-out cross-validation (LOPO-CV) classification accuracy 86.27% was achieved by the RP feature, using a simple linear discriminant analysis (LDA) classifier. Moreover, with the same classifier, the proposed KERP further improved the accuracy to 88.24%. Finally, cascading the KERP feature to a nonlinear classifier, the support vector machine (SVM), yields a high MCI-HC classification accuracy of 90.20% (sensitivity = 87.50% and specificity = 92.59%). The proposed method demonstrated a high accuracy and a high usability (only five electrodes are required), and therefore, has great potential to further develop an EEG-based computer-aided diagnosis system that can be applied for the early detection of MCI.
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83
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Kim H, Hong JP, Kang JM, Kim WH, Maeng S, Cho SE, Na KS, Oh SH, Park JW, Cho SJ, Bae JN. Cognitive reserve and the effects of virtual reality-based cognitive training on elderly individuals with mild cognitive impairment and normal cognition. Psychogeriatrics 2021; 21:552-559. [PMID: 33934441 DOI: 10.1111/psyg.12705] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/24/2021] [Accepted: 04/14/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cognitive reserve (CR) is a concept proposed to account for discrepancies between the extent of brain pathology and clinical manifestations of that pathology. This study aimed to explore the associations between CR and the effects of cognitive training using fully immersive virtual reality (VR). METHODS A total of 44 older adults (22 cognitively normal, 22 with mild cognitive impairment) underwent eight cognitive training sessions using VR for a period of 4 weeks. CR was assessed using the Cognitive Reserve Index questionnaire (CRIq). To evaluate baseline cognitive function and the effects of VR training, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery was administered to all participants before and after the training. RESULTS Greater improvement in the total CERAD score was seen for cognitively normal participants with higher versus lower scores on the Education subdomain of the CRIq. Among patients with mild cognitive impairment, none of the CRIq subdomain scores (Education, Working Activity, Leisure Time) were related to a change in CERAD total scores. The CRIq total score did not predict the improvement of global cognition in either group. CONCLUSIONS This study revealed different impacts of CR on cognitive training according to the participants' cognitive status. It also suggests that employing three proxies of CR rather than using a composite score would provide a more accurate understanding of one's CR.
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Affiliation(s)
- Hyeyoung Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Myeong Kang
- Department of Psychiatry, Gachon University College of Medicine Gil Medical Center, Incheon, Republic of Korea
| | - Won-Hyoung Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea
| | - Seri Maeng
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea
| | - Seo-Eun Cho
- Department of Psychiatry, Gachon University College of Medicine Gil Medical Center, Incheon, Republic of Korea
| | - Kyoung-Sae Na
- Department of Psychiatry, Gachon University College of Medicine Gil Medical Center, Incheon, Republic of Korea
| | - Seok Hee Oh
- Department of Computer Engineering, Gachon University, Seongnam, Republic of Korea
| | - Jung Woon Park
- Department of IT Convergence Engineering, Gachon University Graduate School, Seongnam, Republic of Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gachon University College of Medicine Gil Medical Center, Incheon, Republic of Korea
| | - Jae Nam Bae
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea
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84
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McMurray J, Levy A, Holyoke P. Psychometric Evaluation and Workflow Integration Study of a Tablet-Based Tool to Detect Mild Cognitive Impairment in Older Adults: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e25520. [PMID: 34018966 PMCID: PMC8178737 DOI: 10.2196/25520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/16/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND With the rapid aging of the global population, experts anticipate a surge in the prevalence of mild cognitive impairment (MCI) and dementia worldwide. It is argued that developing more sensitive, easy to administer, and valid MCI screening tools for use in primary care settings may initiate timely clinical and personal care planning and treatment, enabling early access to programs and services. Including functional competence measures in screening tests makes them more ecologically valid and may help to identify cognitive deficits at an earlier stage. OBJECTIVE We aim to conduct a preliminary evaluative study comparing the sensitivity, specificity, and reliability of the BrainFx Screen (referred to as SCREEN hereafter), a novel digital tool designed to assess functional competence and detect early signs of cognitive impairment, with the Quick Mild Cognitive Impairment, a validated and highly sensitive tool that detects MCI in the older adult population. We will also investigate the perceived usefulness and integration of the SCREEN into primary care practice to identify demonstrable impacts on clinical workflow and health care providers' (HCP) perceptions of its success as a screening tool. Patients' perceptions of completing the SCREEN and its impact on their quality of life will also be explored. METHODS This study has a concurrent, mixed methods, prospective, and quasi-experimental design. Participants will be recruited from 5 primary care family health teams (FHTs; defined by multidisciplinary practice and capitated funding) across southwestern Ontario, Canada. Participants will include HCPs, patients, care partners, and FHT administrative executives. Patients 55 years and older with no history of diagnoses for MCI, dementia, or Alzheimer disease rostered in one of the FHTs participating in the study will be eligible to participate. Their care partners will help triangulate the qualitative data collected from patients. Participating FHTs will identify an occupational therapist from their site to participate in the study; this HCP will both administer the research protocol and participate in semistructured in-depth interviews and questionnaires. Principal component analysis will be conducted on the SCREEN data to understand the test components better. Tests comparing sensitivity, specificity, and test-retest reliability will assess the validity of SCREEN as a screening tool for MCI. RESULTS This paper describes the study protocol and its activities to date. Data collection was halted early because of COVID-19 restrictions on research activity, and data analysis is currently in progress. CONCLUSIONS At the end of the project, we anticipate having an initial comparative evaluation of the SCREEN as a tool for early detection of MCI in primary care older adult patient populations. Resource constraints on this research study limit our ability to conduct a randomized controlled trial; however, the results will assist developers of the SCREEN in determining whether rigorous controlled testing is warranted. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/25520.
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85
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Lajeunesse A, Potvin MJ, Labelle V, Chasles MJ, Kergoat MJ, Villalpando JM, Joubert S, Rouleau I. Effectiveness of a Visual Imagery Training Program to Improve Prospective Memory in Older Adults with and without Mild Cognitive Impairment: A Randomized Controlled Study. Neuropsychol Rehabil 2021; 32:1576-1604. [PMID: 33947319 DOI: 10.1080/09602011.2021.1919529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Prospective memory (PM) problems in aging and, to a greater extent, in mild cognitive impairment (MCI), compromise functional independence. This study examined the effectiveness of a cognitive training program based on visual imagery to improve PM among older adults with and without MCI. Participants were older adults, 24 with MCI and 24 cognitively healthy (HOA). Half of them (12 MCI and 12 HOA) were randomly assigned to the PM training program, the other half to the no-training control group. All participants also completed a pre- and post-test evaluation, including neuropsychological tests, questionnaires, and the Ecological Test of Prospective Memory (TEMP). There was no significant effect of the intervention on the TEMP total, event-based or time-based scores for either the MCI or HOA groups. However, the trained MCI group committed fewer false alarms (i.e., more efficient identification of prospective cues) in the event-based condition of the TEMP at post-test. On the other hand, all trained participants performed better than control participants on retrospective memory tests, which suggests that visual imagery-based training is more effective to improve retrospective memory than PM. Possible explanations for these results are explored.
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Affiliation(s)
- Ariane Lajeunesse
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada.,Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada.,Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Marie-Julie Potvin
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada.,Neurotraumatology Program, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada
| | - Véronique Labelle
- Centre de services ambulatoires en santé mentale et de réadaptation en dépendance de Charlemagne, CISSS de Lanaudière, Charlemagne, Canada
| | - Marie-Joëlle Chasles
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada.,Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| | - Marie-Jeanne Kergoat
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada.,Department of Medicine, Université de Montréal, Montreal, Canada
| | - Juan Manuel Villalpando
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada.,Department of Medicine, Université de Montréal, Montreal, Canada
| | - Sven Joubert
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada.,Department of Psychology, Université de Montréal, Montreal, Canada
| | - Isabelle Rouleau
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada.,Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
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86
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Cintoli S, Radicchi C, Noale M, Maggi S, Meucci G, Tognoni G, Bonuccelli U, Sale A, Berardi N, Maffei L. Effects of combined training on neuropsychiatric symptoms and quality of life in patients with cognitive decline. Aging Clin Exp Res 2021; 33:1249-1257. [PMID: 31385203 DOI: 10.1007/s40520-019-01280-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/17/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Cognitive impairments associated with aging and dementia are major sources of neuropsychiatric symptoms (NPs) and deterioration in quality of life (QoL). Preventive measures to both reduce disease and improve QoL in those affected are increasingly targeting individuals with mild cognitive impairment (MCI) at early disease stage. However, NPs and QoL outcomes are too commonly overlooked in intervention trials. The purpose of this study was to test the effects of physical and cognitive training on NPs and QoL in MCI. METHODS Baseline data from an MCI court (N = 93, mean age 74.9 ± 4.7) enrolled in the Train the Brain (TtB) study were collected. Subjects were randomized in two groups: a group participated to a cognitive and physical training program, while the other sticked to usual standard care. Both groups underwent a follow-up re-evaluation after 7 months from baseline. NPs were assessed using the Neuropsychiatric Inventory (NPI) and QoL was assessed using Quality of Life-Alzheimer's Disease (QOL-AD) scale. RESULTS After 7 months of training, training group exhibited a significant reduction of NPs and a significant increase in QOL-AD with respect to no-training group (p = 0.0155, p = 0.0013, respectively). Our preliminary results suggest that a combined training can reduce NPs and improve QoL. CONCLUSIONS Measuring QoL outcomes is a potentially important factor in ensuring that a person with cognitive deficits can 'live well' with pathology. Future data from non-pharmacological interventions, with a larger sample and a longer follow-up period, could confirm the results and the possible implications for such prevention strategies for early cognitive decline.
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Affiliation(s)
- Simona Cintoli
- Institute of Neuroscience of the CNR, Via G. Moruzzi 1, 56100, Pisa, Italy
- Department NEUROFARBA, University of Florence, Florence, Italy
| | - Claudia Radicchi
- Institute of Neuroscience of the CNR, Via G. Moruzzi 1, 56100, Pisa, Italy
| | - Marianna Noale
- Institute of Neuroscience of the CNR, Via G. Moruzzi 1, 56100, Pisa, Italy
| | - Stefania Maggi
- Institute of Neuroscience of the CNR, Via G. Moruzzi 1, 56100, Pisa, Italy
| | - Giuseppe Meucci
- Department of Clinical Medicine, U.O.C. Neurology, Livorno, Italy
| | - Gloria Tognoni
- Department of Clinical and Experimental Medicine-Neurology Unit, University of Pisa and AOU Pisa, Pisa, Italy
| | - Ubaldo Bonuccelli
- Department of Clinical and Experimental Medicine-Neurology Unit, University of Pisa and AOU Pisa, Pisa, Italy
| | - Alessandro Sale
- Institute of Neuroscience of the CNR, Via G. Moruzzi 1, 56100, Pisa, Italy
| | - Nicoletta Berardi
- Institute of Neuroscience of the CNR, Via G. Moruzzi 1, 56100, Pisa, Italy.
| | - Lamberto Maffei
- Institute of Neuroscience of the CNR, Via G. Moruzzi 1, 56100, Pisa, Italy
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87
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The Effect of Cognitive Intervention on Cognitive Function in Older Adults With Alzheimer's Disease: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2021; 32:247-273. [PMID: 33893905 DOI: 10.1007/s11065-021-09486-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Abstract
Cognitive intervention includes cognitive stimulation, cognitive training, and cognitive rehabilitation. This systematic review was performed to re-assess the efficacy of cognitive intervention for the patients with Alzheimer's disease (AD). Twenty studies (2012 participants) were eventually included. For global cognitive function, the combined mean difference (MD) in eight studies was 1.67 (95% Confidence Interval: 0.45, 2.89, p = 0.007; Q = 33.28, df = 8, p < 0.0001, τ2 = 2.17, I2 = 76%) for the short term. The pooled standardized mean difference (SMD) of six RCTs was 1.61 (95% Confidence Interval: 0.65, 2.56, p = 0.0009; Q = 127.66, df = 6, p < 0.00001, τ2 = 1.56, I2 = 95%) for the medium term. The pooled SMD of seven studies was 0.79 (95% Confidence Interval: 0.33, 1.25, p = 0.0008; Q = 35.10, df = 7, p < 0.0001, τ2 = 0.33, I2 = 80%) for the long term. For depression, the pooled SMD of two trials was -0.48 (95% Confidence Interval: -0.71, -0.24; p < 0.0001, I2 = 4%) for the short term. Cognitive training may show obvious improvements in global cognitive function whether after short, medium, or long-term interventions and in depression after short term intervention. However, the positive effect of the intervention on general cognitive function or depression did not seem to persist after intervention ended. There is still a lack of reliable and consistent conclusions relevant to the effect of cognitive stimulation and cognitive rehabilitation on observed outcomes, cognitive training for memory or other non-cognitive outcomes. PROSPERO registration number: CRD42019121768.
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88
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Reynolds GO, Willment K, Gale SA. Mindfulness and Cognitive Training Interventions in Mild Cognitive Impairment: Impact on Cognition and Mood. Am J Med 2021; 134:444-455. [PMID: 33385339 DOI: 10.1016/j.amjmed.2020.10.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 12/29/2022]
Abstract
With the lack of disease-modifying pharmacologic treatments for mild cognitive impairment and dementia, there has been an increasing clinical and research focus on nonpharmacological interventions for these disorders. Many treatment approaches, such as mindfulness and cognitive training, aim to mitigate or delay cognitive decline, particularly in early disease stages, while also offering potential benefits for mood and quality of life. In this review, we highlight the potential of mindfulness and cognitive training to improve cognition and mood in mild cognitive impairment. Emerging research suggests that these approaches are feasible and safe in this population, with preliminary evidence of positive effects on aspects of cognition (attention, psychomotor function, memory, executive function), depression, and anxiety, though some findings have been unclear or limited by methodological weaknesses. Even so, mindfulness and cognitive training warrant inclusion as current treatments for adults with mild cognitive impairment, even if there is need for additional research to clarify treatment outcomes and questions related to dose, mechanisms, and transfer and longevity of treatment effects.
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Affiliation(s)
| | - Kim Willment
- Department of Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Seth A Gale
- Department of Neurology, Brigham and Women's Hospital, Boston, Mass
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89
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Pappa K, Flegal KE, Baylan S, Evans JJ. Working memory training: Taking a step back to retool and create a bridge between clinical and neuroimaging research methods. APPLIED NEUROPSYCHOLOGY-ADULT 2021; 29:1669-1680. [PMID: 33794120 DOI: 10.1080/23279095.2021.1904243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Improvements in patient outcomes and mortality after brain injury alongside increasing ageing population have resulted in an increasing need to develop cognitive interventions for individuals experiencing changes in their cognitive function. One topic of increasing research interest is whether cognitive functions such as attention, memory and executive functioning can be improved through the use of working memory training interventions. Both clinical and neuroimaging researchers are working to evidence this, but their efforts rarely come together. We discuss here several issues that may be hindering progress in this area, including the tools researchers utilize to measure cognition, the choice between employing active or passive control groups, the focus on transfer effects at the expense of well-characterized training effects, and the overall lack of neuroimaging studies in individuals with neurological disorders. We argue that the only way to advance the field is to build bridges between the disciplines of clinical neuropsychology and cognitive neuroscience. We suggest a multi-level framework to validate the efficacy of working memory interventions and other forms of cognitive training that combine both clinical and neuroimaging approaches. We conclude that in order to move forward we need to form multidisciplinary teams, employ interdisciplinary methods, brain imaging quality rating tools and build national and international collaborations based on open science principles.
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Affiliation(s)
- Katerina Pappa
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kristin E Flegal
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Satu Baylan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jonathan J Evans
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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90
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Hernes SS, Flak MM, Løhaugen GCC, Skranes J, Hol HR, Madsen BO, Knapskog AB, Engvig A, Pripp A, Ulstein I, Lona T, Zhang X, Chang L. Working Memory Training in Amnestic and Non-amnestic Patients With Mild Cognitive Impairment: Preliminary Findings From Genotype Variants on Training Effects. Front Aging Neurosci 2021; 13:624253. [PMID: 33658917 PMCID: PMC7917210 DOI: 10.3389/fnagi.2021.624253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/12/2021] [Indexed: 11/13/2022] Open
Abstract
Working memory training (WMT) effects may be modulated by mild cognitive impairment (MCI) subtypes, and variations in APOE-epsilon (APOE-ε) and LMX1A genotypes. Sixty-one individuals (41 men/20 women, mean age 66 years) diagnosed with MCI (31 amnestic/30 non-amnestic) and genotyped for APOE-ε and LMX1A completed 4 weeks/20-25 sessions of WMT. Cognitive functions were assessed before, 4 weeks and 16 weeks after WMT. Except for Processing Speed, the non-amnestic MCI group (naMCI) outperformed the amnestic MCI (aMCI) group in all cognitive domains across all time-points. At 4 weeks, working memory function improved in both groups (p < 0.0001), but at 16 weeks the effects only remained in the naMCI group. Better performance was found after training for the naMCI patients with LMX1A-AA genotype and for the APOE-ε4 carriers. Only the naMCI-APOE-ε4 group showed improved Executive Function at 16 weeks. WMT improved working memory and some non-trained cognitive functions in individuals with MCI. The naMCI group had greater training gain than aMCI group, especially in those with LMX1A-AA genotype and among APOE-ε4-carriers. Further research with larger sample sizes for the subgroups and longer follow-up evaluations is warranted.
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Affiliation(s)
- Susanne S Hernes
- Department of Geriatric and Internal Medicine, Sørlandet Hospital, Arendal, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Marianne M Flak
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Pediatrics, Sørlandet Hospital HF, Arendal, Norway
| | - Gro C C Løhaugen
- Department of Pediatrics, Sørlandet Hospital HF, Arendal, Norway
| | - Jon Skranes
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Pediatrics, Sørlandet Hospital HF, Arendal, Norway
| | - Haakon R Hol
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Radiology, Sørlandet Hospital HF, Arendal, Norway
| | - Bengt-Ove Madsen
- Department of Geriatric and Internal Medicine, Sørlandet Hospital, Arendal, Norway
| | - Anne-Brita Knapskog
- Department of Geriatric Medicine, The Memory Clinic, Oslo University Hospital, Oslo, Norway
| | - Andreas Engvig
- Department of Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Are Pripp
- Oslo Centre of Biostatistics and Epidemiology Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Ingun Ulstein
- Department of Geriatric Medicine, The Memory Clinic, Oslo University Hospital, Oslo, Norway
| | - Trine Lona
- Department of Psychiatry, Age Psychiatry, The Hospital of Telemark, Skien, Norway
| | - Xin Zhang
- Department of Diagnostic Radiology and Nuclear Medicine, and Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, and Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Medicine, John A. Burns School of Medicine, The University of Hawai'i at Mānoa, Honolulu, HI, United States
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91
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Gómez CS, Rodríguez EJF. The effectiveness of a training programme in everyday cognition in healthy older adults: a randomised controlled trial. BMC Geriatr 2021; 21:79. [PMID: 33509113 PMCID: PMC7842078 DOI: 10.1186/s12877-020-01998-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Everyday cognition is the application of basic cognitive skills and knowledge of the specific cognitive domain for the resolution of problems that are integrated within the instrumental domains of functioning. The main objective is to evaluate the effectiveness of a Training Programme in Everyday Cognition in order to improve the levels of everyday cognition and global cognitive performance in older adults. METHODS A randomised controlled trial of two groups. The sample was composed of healthy older adults. The intervention of the experimental group consisted of an Everyday Cognition Training Programme, and the intervention of the control group consisted of a Conventional Cognitive Training Programme. The Rapid Assessment of Cognitive Functions test (ERFC) and the Everyday Cognition Battery test (ECB) were used to assess the intervention. RESULTS Total sample (n = 237) composed of 44 men and 223 women, with a mean age of 73.45 years. Statistically significant differences (p < 0.001) were evidenced between the control group and the experimental group in both the ECB and ERFC; in the final evaluation of the study and in the follow-up. CONCLUSION The use of a Daily Cognition Training Programme presents greater benefits in terms of both global cognitive performance and everyday cognition than the use of a Conventional Cognitive Training Programme in elderly adults. TRIAL REGISTRATION ClinicalTrials.gov : NCT04041999 . Retrospectively registered. Date of trial registration: 8th July 2019.
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Affiliation(s)
- Celia Sánchez Gómez
- Department of Evolutionary and Educational Psychologyt, Faculty of Psychology. University of Salamanca, Avenida de la Merced, 109, 37005 Salamanca, Spain
| | - Eduardo José Fernández Rodríguez
- Department of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
- Biomedical Research Institute of Salamanca, Salamanca, Spain
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92
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Rymaszewska J, Lion KM, Stańczykiewicz B, Rymaszewska JE, Trypka E, Pawlik-Sobecka L, Kokot I, Płaczkowska S, Zabłocka A, Szcześniak D. The improvement of cognitive deficits after whole-body cryotherapy - A randomised controlled trial. Exp Gerontol 2021; 146:111237. [PMID: 33454354 DOI: 10.1016/j.exger.2021.111237] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/20/2020] [Accepted: 01/04/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Whole-body cryotherapy (WBC) - a repetitive, short-term exposure to extremely low temperatures - may become an effective early intervention for mild cognitive impairment (MCI). It is a heterogeneous group of symptoms associated with cognitive dysfunction which is estimated to transform into dementia in 50% cases. STUDY DESIGN The prospective randomised double-blind sham-controlled study aimed to determine the efficacy of WBC on cognitive functioning and biological mechanisms. The study was registered with Australian New Zealand Clinical Trials Registry (ACTRN12619001627145). METHODS Participants with MCI (n = 62; (20<MoCA>26) were randomly allocated to cryogenic temperatures (-110 °C till -160 °C) (EG, n = 33) or placebo-controlled group (CG, n = 29). Cognitive functions were measured at baseline (T1), after the 10th WBC session (T2) and after 2 week-break (T3) with DemTect, SLUMS and Test Your Memory (TYM). Secondary outcome measures included quality of life (WHOQoL-BREF), self-reported well-being (VAS) and depressive symptoms (GDS). Whole blood samples (10 ml) were collected at T1 and T2 to evaluate levels of cytokines, neurotrophins, NO and biochemical parameters CRP total cholesterol, prolactin). RESULTS There were significant differences between groups measured at T2 in immediate recall (DemTect) and in orientation (TYM) in favour of WBC group. Improvement in mood was detected in self-reported depressive symptoms level (WHOQoL-26; T2 p = 0.04; VAS mood T2 p = 0.02; T3 p = 0.07). The significant reduction of BDNF level was observed (p < 0.05). CONCLUSIONS WBC may increase the performance of cognitive functions. It seems promising to combine WBC with existing behavioural and cognitive trainings in the future studies investigating early interventions methods in MCI.
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Affiliation(s)
| | - Katarzyna M Lion
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland; Menzies Health Institute Queensland, Griffith University, Australia.
| | | | - Julia E Rymaszewska
- Student Scientific Association at Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Elżbieta Trypka
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Lilla Pawlik-Sobecka
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Izabela Kokot
- Department of Laboratory Diagnostics, Division of Laboratory Diagnostics, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
| | - Sylwia Płaczkowska
- Department of Laboratory Diagnostics, Diagnostics Laboratory for Teaching and Research, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
| | - Agnieszka Zabłocka
- Laboratory of Microbiome Immunobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Dorota Szcześniak
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
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93
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Efficacy of cognitive intervention programs in amnesic mild cognitive impairment: A systematic review. Arch Gerontol Geriatr 2021; 94:104332. [PMID: 33486120 DOI: 10.1016/j.archger.2020.104332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Amnesic mild cognitive impairment (aMCI) is considered a prodromal stage of Alzheimer's disease. Given the absence of an effective pharmacological treatment for aMCI, increasing numbers of studies are attempting to understand how cognitive interventions could benefit aMCI patients. The aim of this systematic review was to evaluate the current evidence regarding the efficacy on cognition of cognitive intervention programs in older adults with aMCI. METHODS We searched for randomized controlled trials and clinical trials published until March 2020 on PubMed, Web of Science, Cochrane Library, SCOPUS, and OTseeker. A total of 454 works were identified and 7 studies that met the inclusion criteria, were included in this review. PRISMA guidelines were followed and PEDro scale was included for the measurement of the quality of the selected studies. RESULTS Cognitive interventions showed positive effects on cognition. Cognitive training programs considerably enhanced the Mini Mental State Examination scores. However, no relevant differences in global cognition were found using other assessment tools as DRS-2 or ADAS-Cog Scale. Cognitive training and cognitive rehabilitation programs seemed to improve several cognitive domains as memory, language or executive function in aMCI patients in both post-training and at follow-up analysis. CONCLUSIONS Our findings support that cognitive interventions can be an effective option for people with aMCI. Cognitive interventions improved global cognitive function post-intervention, but also seemed to enhance some cognitive domains post-intervention and at follow-up. However, more studies are needed to analyze the potential benefits of cognitive intervention on aMCI.
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94
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Meeuwsen KD, Groeneveld KM, Walker LA, Mennenga AM, Tittle RK, White EK. Z-score neurofeedback, heart rate variability biofeedback, and brain coaching for older adults with memory concerns. Restor Neurol Neurosci 2021; 39:9-37. [PMID: 33386829 PMCID: PMC7990441 DOI: 10.3233/rnn-201053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The three-month, multi-domain Memory Boot Camp program incorporates z-score neurofeedback (NFB), heart rate variability (HRV) biofeedback, and one-on-one coaching to teach memory skills and encourage behavior change in diet, sleep, physical fitness, and stress reduction. OBJECTIVE This prospective trial evaluates the Memory Boot Camp program for adults ages 55 to 85 with symptoms of Mild Cognitive Impairment (MCI) and subjective memory complaints. METHODS Participants were evaluated via the Montreal Cognitive Assessment (MoCA), NeuroTrax Global Cognitive Score, measures of anxiety, depression, sleep, quality of life, quantitative electroencephalography (QEEG), and HRV parameters at four timepoints: baseline, pre-program, post-program, and follow-up. The trial included a three-month waiting period between baseline and pre-program, such that each participant acted as their own control, and follow-up took place six months after completion of the program. RESULTS Participants' MoCA scores and self-reported measures of anxiety, depression, sleep quality, and quality of life improved after treatment, and these changes were maintained at follow-up. Physiological changes in HRV parameters after treatment were not significant, however, breathing rate and QEEG parameters were improved at post-program and maintained at follow-up. Finally, participants' improvement in MoCA score over the treatment period was correlated with their improvement in two brain oscillation parameters targeted by the z-score NFB protocol: relative power of delta and relative power of theta. CONCLUSIONS Trial results suggest that the Memory Boot Camp program is a promising treatment strategy for older adults with symptoms of MCI and subjective memory complaints.
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95
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The Art of Remediating Age-Related Cognitive Decline: Art Therapy Enhances Cognition and Increases Cortical Thickness in Mild Cognitive Impairment. J Int Neuropsychol Soc 2021; 27:79-88. [PMID: 32762792 DOI: 10.1017/s1355617720000697] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Previous research on art therapy (AT) in cognitive aging has been lacking. AT can potentially engender significant cognitive gains, due to its rigorous cognitive involvement, making it useful to tackle age-related cognitive decline. Along with these cognitive gains, associated neuroplastic changes are hypothesized to arise from AT as well. The current intervention examined the effects of an AT intervention on cognitive outcomes and cortical thickness (CT) among participants with mild cognitive impairment. METHOD Participants were assigned to AT (n = 22) and an active control group (n = 27). In both, weekly 45-min sessions were carried out across 3 months. Cognitive assessments and structural magnetic resonance imaging scans were carried out at baseline and 3-month follow-up. Whole brain analyses on CT were carried out. Cognitive outcomes were analyzed using hierarchical linear models. RESULTS Significant gains in immediate memory and working memory span were observed in the AT group, relative to the control group. Significantly increased CT in the AT group, relative to controls, was observed in a right middle frontal gyrus (MFG) cluster. Furthermore, CT changes in this cluster were significantly and positively correlated with changes in immediate memory. CONCLUSION These findings highlighted the role of MFG neuroplasticity in enhancing certain cognitive functions in AT. AT is a neuroplastic intervention capable of engendering significant cognitive gains and associated cortical changes in the context of age-related cognitive decline, even when executed as a low-intensity intervention across 3 months. Given the preliminary nature of these findings, future larger sampled studies are needed.
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Bogolepova A, Vasenina E, Gomzyakova N, Gusev E, Dudchenko N, Emelin A, Zalutskaya N, Isaev R, Kotovskaya Y, Levin O, Litvinenko I, Lobzin V, Martynov M, Mkhitaryan E, Nikolay G, Palchikova E, Tkacheva O, Cherdak M, Chimagomedova A, Yakhno N. Clinical Guidelines for Cognitive Disorders in Elderly and Older Patients. Zh Nevrol Psikhiatr Im S S Korsakova 2021. [DOI: 10.17116/jnevro20211211036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sgard C, Bier JC, Peigneux P. Gesturing helps memory encoding in aMCI. J Neuropsychol 2020; 15:396-409. [PMID: 33332711 DOI: 10.1111/jnp.12238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 11/21/2020] [Indexed: 11/29/2022]
Abstract
Encoding in episodic memory is a step often impaired in patients with amnestic Mild Cognitive Impairment (aMCI). However, procedural memory processes are still relatively preserved. In line with previous research on the enactment effect, we investigated the potential benefit of encoding words combined with imitative gestures on episodic memory. Based on the Grober and Buschke's free/cued recall procedure, we developed the Symbiosis test in which 13 patients with aMCI and 16 healthy elderly participants learned 32 words belonging to 16 different semantic categories either in a verbal encoding (A) or a bimodal (B; verbal and motor imitation) condition, using a blocked ABBA/BAAB procedure. Overall, memory retrieval was better in healthy participants than in patients with aMCI, and better for cued retrieval in the bimodal encoding (gesture cues) than the verbal encoding (category cues) condition, but there was no interaction effect between group and encoding conditions. These results show that performing concomitant gestures can enhance cued episodic memory retrieval in patients with aMCI and in healthy elderly controls. The Symbiosis test broadens the scope of the enactment effect, from action phrases to isolated words learning in patients with aMCI. Future work should investigate how bimodal encoding provides novel perspectives for memory rehabilitation in patients with aMCI.
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Affiliation(s)
- Clara Sgard
- UR2NF - Neuropsychology and Functional Neuroimaging Research Unit, CRCN, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jean-Christophe Bier
- Department of Neurology, Université Libre de Bruxelles (ULB), Erasme Hospital, Brussels, Belgium
| | - Philippe Peigneux
- UR2NF - Neuropsychology and Functional Neuroimaging Research Unit, CRCN, Université Libre de Bruxelles (ULB), Brussels, Belgium
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98
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Enhancement of Executive Functions but Not Memory by Multidomain Group Cognitive Training in Patients with Parkinson's Disease and Mild Cognitive Impairment: A Multicenter Randomized Controlled Trial. PARKINSONS DISEASE 2020; 2020:4068706. [PMID: 33312495 PMCID: PMC7721510 DOI: 10.1155/2020/4068706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 02/05/2023]
Abstract
Background Meta-analyses have demonstrated cognitive training (CT) benefits in Parkinson's disease (PD) patients. However, the patients' cognitive status has only rarely been based on established criteria. Also, prediction analyses of CT success have only sparsely been conducted. Objective To determine CT effects in PD patients with mild cognitive impairment (PD-MCI) on cognitive and noncognitive outcomes compared to an active control group (CG) and to analyze CT success predictors. Methods Sixty-four PD-MCI patients (age: 67.61 ± 7.70; UPDRS-III: 26.58 ± 13.54; MoCA: 24.47 ± 2.78) were randomized to either a CT group or a low-intensity physical activity CG for six weeks (twice weekly, 90 minutes). Outcomes were assessed before and after training. MANOVAs with follow-up ANOVAs and multiple regression analyses were computed. Results Both interventions were highly feasible (participation, motivation, and evaluation); the overall dropout rate was 4.7%. Time × group interaction effects favoring CT were observed for phonemic fluency as a specific executive test (p=0.018, ηp2=0.092) and a statistical trend for overall executive functions (p=0.095, ηp2=0.132). A statistical trend for a time × group interaction effect favoring CG was shown for the digit span backward as a working memory test (p=0.098, ηp2=0.043). Regression analyses revealed cognitive baseline levels, education, levodopa equivalent daily dose, motor scores, and ApoE status as significant predictors for CT success. Conclusions CT is a safe and feasible therapy option in PD-MCI, yielding executive functions improvement. Data indicate that vulnerable individuals may show the largest cognitive gains. Longitudinal studies are required to determine whether CT may also attenuate cognitive decline in the long term. This trial is registered with DRKS00010186.
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Palumbo R, Di Domenico A, Piras F, Bazzano S, Zerilli M, Lorico F, Borella E. Measuring global functioning in older adults with cognitive impairments using the Rasch model. BMC Geriatr 2020; 20:492. [PMID: 33228541 PMCID: PMC7685614 DOI: 10.1186/s12877-020-01886-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/10/2020] [Indexed: 11/30/2022] Open
Abstract
Background Cognitive and functional measures are often measured and interpreted separately during the clinical evaluation of patients with cognitive impairment. This can sometimes lead to a challenging interpretation when measures do not show concordance, especially after a clinical intervention. In this study, the development and evaluation of a new approach, using the Rasch model, that combines cognitive and functional measures in one single and more powerful measure (compared to stand-alone tests) to assess global functioning in older adults with cognitive impairment (including dementia) was presented. Methods Clinical data from 265 older adults’ subjects diagnosed with mild cognitive impairment, or dementia, included: The Mini-mental state examination (MMSE), the Esame Neuropsicologico Breve (ENB) – a neuropsychological battery used in Italy–, the Activities of Daily Living (ADL), and the Instrumental Activities of Daily Living (IADL) questionnaires. Results Patients with severe cognitive impairment showed lower global functioning score compared to patients with moderate impairment. Receiver Operating Characteristic (ROC) curve analyses were performed to determine sensitivity and specificity of the global functioning score resulting from the combined measure. Results showed that the global functioning score discriminates better between patients with severe and moderate cognitive impairment compared to the ENB, ADL, and IADL when considered separately. Conclusions The Rasch model was able to combine cognitive and functional measures into a single score (global functioning score). All together, these results suggest that the diverse cognitive and functional measures can be considered part of one single dimension (global functioning) and that this dimension can be measured as a single construct and score. This study offers an alternative perspective for future development of instruments that would help clinicians in measuring global functioning in older adults’ patients at different stages of cognitive impairments and different baseline level of performance.
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Affiliation(s)
- Rocco Palumbo
- Department of Psychological, Health and Territorial Sciences, University of Chieti, Via dei Vestini 31, 66100, Chieti, Italy. .,Department of Neurology, Boston University, School of Medicine, Boston, MA, USA.
| | - Alberto Di Domenico
- Department of Psychological, Health and Territorial Sciences, University of Chieti, Via dei Vestini 31, 66100, Chieti, Italy
| | - Federica Piras
- IRCCS Santa Lucia Foundation, Neuropsychiatry Laboratory, Clinical and Behavioral Neurology Department, Rome, Italy
| | - Salvatore Bazzano
- Centro Decadimento Cognitivo Asl7 di Bassano del Grappa, Bassano del Grappa, Italy
| | - Mario Zerilli
- Centro Decadimento Cognitivo Asl7 di Bassano del Grappa, Bassano del Grappa, Italy
| | - Fabio Lorico
- Centro Decadimento Cognitivo Asl7 di Bassano del Grappa, Bassano del Grappa, Italy
| | - Erika Borella
- Department of General Psychology, University of Padova, Padova, Italy
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Manenti R, Gobbi E, Baglio F, Macis A, Ferrari C, Pagnoni I, Rossetto F, Di Tella S, Alemanno F, Cimino V, Binetti G, Iannaccone S, Bramanti P, Cappa SF, Cotelli M. Effectiveness of an Innovative Cognitive Treatment and Telerehabilitation on Subjects With Mild Cognitive Impairment: A Multicenter, Randomized, Active-Controlled Study. Front Aging Neurosci 2020; 12:585988. [PMID: 33304267 PMCID: PMC7701275 DOI: 10.3389/fnagi.2020.585988] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
Background In recent years, the potential usefulness of cognitive training procedures in normal aging and mild cognitive impairment (MCI) have received increased attention. Objective The main aim of this study was to evaluate the efficacy of the face-to-face cognitive virtual reality rehabilitation system (VRRS) and to compare it to that of face-to-face cognitive treatment as usual for individuals with MCI. Moreover, we assessed the possibility of prolonging the effects of treatment with a telerehabilitation system. Methods A total of 49 subjects with MCI were assigned to 1 of 3 study groups in a randomized controlled trial design: (a) those who received face-to-face cognitive VRRS (12 sessions of individualized cognitive rehabilitation over 4 weeks) followed by telerehabilitation (36 sessions of home-based cognitive VRRS training, three sessions for week); (b) those who received face-to-face cognitive VRRS followed by at-home unstructured cognitive stimulation (36 sessions of home-based unstructured cognitive stimulation, three sessions for week); and (c) those who received face-to-face cognitive treatment as usual (12 sessions of face-to-face cognitive treatment as usual). Results An improvement in memory, language and visuo-constructional abilities was observed after the end of face-to-face VRRS treatment compared to face-to-face treatment as usual. The application of home-based cognitive VRRS telerehabilitation seems to induce more maintenance of the obtained gains than home-based unstructured stimulation. Discussion The present study provides preliminary evidence in support of individualized VRRS treatment and telerehabilitation delivery for cognitive rehabilitation and should pave the way for future studies aiming at identifying optimal cognitive treatment protocols in subjects with MCI. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT03486704.
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Affiliation(s)
- Rosa Manenti
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Elena Gobbi
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | - Ambra Macis
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Ilaria Pagnoni
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | - Sonia Di Tella
- IRCCS, Fondazione Don Carlo Gnocchi - ONLUS, Milan, Italy
| | - Federica Alemanno
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital and Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Giuliano Binetti
- MAC Memory Clinic and Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Sandro Iannaccone
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital and Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Stefano F Cappa
- NEtS, Scuola Universitaria Superiore IUSS-Pavia, Pavia, Italy.,IRCCS Fondazione Mondino, Pavia, Italy
| | - Maria Cotelli
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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