Extended practice and aerobic exercise interventions benefit untrained cognitive outcomes in older adults: a meta-analysis

Combined Dual-Task Gait Training and Aerobic Exercise to Improve Cognition, Mobility, and Vascular Health in Community-Dwelling Older Adults at Risk for Future Cognitive Decline1

This 6-month experimental case series study investigated the effects of a dual-task gait training and aerobic exercise intervention on cognition, mobility, and cardiovascular health in community-dwelling older adults without dementia. Participants exercised 40 min/day, 3 days/week for 26 weeks on a Biodex GaitTrainer2 treadmill. Participants were assessed at baseline (V0), interim (V1: 12-weeks), intervention endpoint (V2: 26-weeks), and study endpoint (V3: 52-weeks). The study outcomes included: cognition [executive function (EF), processing speed, verbal fluency, and memory]; mobility: usual & dual-task gait (speed, step length, and stride time variability); and vascular health: ambulatory blood pressure, carotid arterial compliance, and intima-media thickness (cIMT). Fifty-six participants [age: 70(6) years; 61% female] were included in this study. Significant improvements following the exercise program (V2) were observed in cognition: EF (p = 0.002), processing speed (p < 0.001), verbal fluency [digit symbol coding (p < 0.001), phonemic verbal fluency (p < 0.001)], and memory [immediate recall (p < 0.001) and delayed recall (p < 0.001)]; mobility: usual & dual-task gait speed (p = 0.002 and p < 0.001, respectively) and step length (p = 0.001 and p = 0.003, respectively); and vascular health: cIMT (p = 0.002). No changes were seen in the remaining outcomes. In conclusion, 26 weeks of dual-task gait training and aerobic exercise improved performance on a number of cognitive outcomes, while increasing usual & dual-task gait speed and step length in a sample of older adults without dementia.

Association between altered physical activity and neurocognitive function among people with schizophrenia: A minimum 6-months' follow-up study

BACKGROUND

The long-term benefits of physical activity on neurocognitive function among patients with schizophrenia, specifically among inpatients, remain unclear. This preliminary study, with a minimum of 6-months' follow-up, examined alterations in physical activity and neurocognitive function in both inpatients and outpatients with schizophrenia.

METHODS

Symptoms and neurocognitive function were assessed at 2 intervals using the Positive and Negative Symptom Scale and Cognitrax, respectively. After each testing period, participants wore an accelerometer for 1week to measure their levels and duration of physical activity. After the 6-months' follow-up (average duration, 235.9±36.2days), participants were divided into 2 groups based on either increased or decreased activity, as compared with baseline: increased-activity and decreased-activity groups.

RESULTS

Of the 29 initially enrolled participants, 25 (mean age, 56.8±11.8years) completed the follow-up. Reaction times in the increased-activity group in daily activity (n=10) improved as compared with the decreased-activity group (n=15). Moreover, cognitive flexibility and executive function improved in the increased-activity group in steps (n=7) compared with the decreased-activity group (n=18). Finally, there was no association between the duration of moderate or vigorous exercise and neurocognitive function.

CONCLUSIONS

Together, our results suggest that increased daily activity and walking, but not high intensity activity, are associated with improved neurocognitive function in patients with schizophrenia.

Exercise Modality Is Differentially Associated with Neurocognition in Older Adults

This study explored the effects of exercise modality and type of fitness index on cognitive function in the older adults as assessed via behavioral and neuroelectrical approaches. Sixty older adults were assigned to an aerobic exercise, a coordination exercise, or a control group based on their previous exercise experience. The participants completed congruent and incongruent trials of a modified Stroop Test, during which, event-related potentials were recorded. The participants also completed multiple physical tests that assessed health- and skill-related fitness. Our findings suggest that, in general, both aerobic and coordination exercise, as well as higher scores on health- and skill-related fitness indices, are positively associated with better performance of various cognitive functions in the elderly population. The mechanisms underlying these relationships may be differentially related to specific neuroelectrical processes involved in neurocognitive control.

Aerobic Fitness and Neurocognitive Function Scores in Young Faroese Adults and Potential Modification by Prenatal Methylmercury Exposure

BACKGROUND

Exposure to methylmercury was shown to decrease neural stem cell populations, whereas aerobic fitness has beneficial effects on the adult brain that relies on improved neurogenesis in the hippocampus.

OBJECTIVES

We examined the association between aerobic fitness and neurocognitive outcomes at young adult age, along with the potential moderating effect of prenatal exposure to methylmercury.

METHODS

At age 22 years, 262 members of a Faroese birth cohort, established in 1986-1987, underwent a graded exercise test of aerobic fitness to measure maximal oxygen uptake (VO_2Max). Their prenatal methylmercury exposure had been assessed from the mercury concentration in cord blood. We estimated cross-sectional associations between VO_2Max and multiple measures of neurocognitive function. In addition, we compared groups with low and high prenatal methylmercury exposure.

RESULTS

A 1 standard deviation (SD) increase in VO_2Max was associated with better scores on short-term memory and cognitive processing speed by 0.21 SD (95% CI: -0.04, 0.46) and 0.28 SD (95% CI: 0.02, 0.54), respectively. In the group with lower prenatal methylmercury exposure, a 1 SD increase in VO_2Max was associated with increased scores on cognitive processing speed by 0.45 SD (95% CI: 0.08, 0.81) and with a slightly lesser benefit in short-term memory. No such association was observed in the group with high prenatal methylmercury exposure.

CONCLUSIONS

Higher aerobic capacity was associated with better performance in short-term memory and processing speed. However, prenatal methylmercury exposure seemed to attenuate these positive associations.

The association between physical activity and cognition in men with and without HIV infection

OBJECTIVES

HIV-associated neurocognitive disorders are highly prevalent, and physical activity (PA) is a modifiable behaviour that may affect neurocognitive function. Our objective was to determine the association between PA and neurocognitive function and the effect of HIV on this association.

METHODS

PA was assessed in the Multicenter AIDS Cohort Study with the International Physical Activity Questionnaire. A neuropsychological test battery assessed global impairment and domain-specific impairment (executive function, speed of processing, working memory, learning, memory, and motor function) every 2 years. Semiannually, the Symbol Digit Modalities Test and Trail Making Test Parts A and B were performed. Adjusted logistic regression models were used to assess the PA-neurocognitive function association. Using longitudinal data, we also assessed the PA category-decline of neurocognitive function association with multivariate simple regression.

RESULTS

Of 601 men, 44% were HIV-infected. Low, moderate, and high PA was reported in 27%, 25%, and 48% of the HIV-infected men vs. 19%, 32% and 49% of the HIV-uninfected men, respectively. High PA was associated with lower odds of impairment of learning, memory, and motor function [odds ratio (OR) ranging from 0.52 to 0.57; P < 0.05 for all]. The high PA-global impairment association OR was 0.63 [95% confidence interval (CI) 0.39, 1.02]. Among HIV-infected men only, across multiple domains, the high PA-impairment association was even more pronounced (OR from 0.27 to 0.49). Baseline high/moderate PA was not associated with decline of any domain score over time. HIV infection was marginally associated with a higher speed of decline in motor function.

CONCLUSIONS

A protective effect of high PA on impairment in neurocognitive domains was observed cross-sectionally. Longitudinal PA measurements are needed to elucidate the PA-neurocognitive function relationship over time.

Correlations between physical activity and neurocognitive domain functions in patients with schizophrenia: a cross-sectional study

BACKGROUND

Neurocognitive dysfunction is a critical target symptom of schizophrenia treatment. A positive correlation between physical activity level and neurocognitive function has been reported in healthy individuals, but it is unclear whether such a correlation exists in patients with schizophrenia and whether the relationship is different according to inpatients or outpatients. This study aimed to examine the differences in the correlations between physical activity and multiple neurocognitive domains in inpatients and outpatients with schizophrenia and obtain suggestions for further study to facilitate this field.

METHODS

Twenty-nine patients with schizophrenia were examined (16 inpatients and 13 outpatients, 56.0 ± 11.4 years of age). Current symptoms were assessed using the Positive and Negative Symptom Scale and neurocognitive functions using Cognitrax, which yields a composite neurocognitive index (NCI) and 11 domain scores. After testing, participants wore an HJA-750C accelerometer for one week to measure physical activity levels and durations. Partial correlation analyses were performed between exercise and cognitive parameters.

RESULTS

In the outpatient group, higher physical activity was associated with faster Motor and Psychomotor Speeds in outpatients. However, higher physical activity was associated with lower overall NCI, Attention score, and Memory scores in inpatients.

CONCLUSION

Although higher physical activity was associated with better neurocognitive functions of outpatients, in inpatients with non-remitted schizophrenia, higher physical activity was associated with worsening of several cognitive domains. In a future study examining the relationship between physical activity and neurocognitive function for facilitating this research field, separation between inpatients and outpatients are needed because the relationship is different between inpatients and outpatients.

The exercise-glucocorticoid paradox: How exercise is beneficial to cognition, mood, and the brain while increasing glucocorticoid levels

Exercise is known to have beneficial effects on cognition, mood, and the brain. However, exercise also activates the hypothalamic-pituitary-adrenal axis and increases levels of the glucocorticoid cortisol (CORT). CORT, also known as the "stress hormone," is considered a mediator between chronic stress and depression and to link various cognitive deficits. Here, we review the evidence that shows that while both chronic stress and exercise elevate basal CORT levels leading to increased secretion of CORT, the former is detrimental to cognition/memory, mood/stress coping, and brain plasticity, while the latter is beneficial. We propose three preliminary answers to the exercise-CORT paradox. Importantly, the elevated CORT, through glucocorticoid receptors, functions to elevate dopamine in the medial prefrontal cortex under chronic exercise but not chronic stress, and the medial prefrontal dopamine is essential for active coping. Future inquiries may provide further insights to promote our understanding of this paradox.

BDNF Responses in Healthy Older Persons to 35 Minutes of Physical Exercise, Cognitive Training, and Mindfulness: Associations with Working Memory Function

Brain-derived neurotrophic factor (BDNF) has a central role in brain plasticity by mediating changes in cortical thickness and synaptic density in response to physical activity and environmental enrichment. Previous studies suggest that physical exercise can augment BDNF levels, both in serum and the brain, but no other study has examined how different types of activities compare with physical exercise in their ability to affect BDNF levels. By using a balanced cross over experimental design, we exposed nineteen healthy older adults to 35-minute sessions of physical exercise, cognitive training, and mindfulness practice, and compared the resulting changes in mature BDNF levels between the three activities. We show that a single bout of physical exercise has significantly larger impact on serum BDNF levels than either cognitive training or mindfulness practice in the same persons. This is the first study on immediate BDNF effects of physical activity in older healthy humans and also the first study to demonstrate an association between serum BDNF responsivity to acute physical exercise and working memory function. We conclude that the BDNF increase we found after physical exercise more probably has a peripheral than a central origin, but that the association between post-intervention BDNF levels and cognitive function could have implications for BDNF responsivity in serum as a potential marker of cognitive health.

The more the better? A meta-analysis on effects of combined cognitive and physical intervention on cognition in healthy older adults

Both cognitive intervention and physical exercise benefit cognitive function in older adults. It has been suggested that combined cognitive and physical intervention may induce larger effects than cognitive or physical intervention alone, but existing literature has shown mixed results. This meta-analysis aimed at assessing the efficacy of combined intervention on cognition by comparing combined intervention to control group, cognitive intervention and physical exercise. Eligible studies were controlled trials examining the effects of combined intervention on cognition in older adults without known cognitive impairment. Twenty interventional studies comprising 2667 participants were included. Results showed that the overall effect size for combined intervention versus control group was 0.29 (random effects model, p=0.001). Compared to physical exercise, combined intervention produced greater effects on overall effect size (0.22, p<0.01), while no significant difference was found between combined intervention and cognitive intervention. Effects of combined intervention were moderated by age of participants, intervention frequency and setting. The findings suggest that combined intervention demonstrates advantages over control group and physical exercise, while evidence is still lacking for superiority when compared combined intervention to cognitive intervention. More well-designed studies with long follow-ups are needed to clarify the potential unique efficacy of combined intervention for older adults.

The mental-attention Tai Chi effect with older adults

BACKGROUND

Tai Chi practice has some fitness, wellness, and general cognitive effects in older adults. However, benefits of Tai Chi on specific mental-attentional executive processes have not been investigated previously. We studied older Canadian adults of Chinese and non-Chinese origin and from low socioeconomic areas.

METHODS

Sixty-four adults (51-87 years old) took part in a 16-week Tai Chi program. There were two groups: Chinese-background (n = 35) and Non-Chinese-background (n = 29). They received four mental-attention executive tasks before and after the 16-week period. These tasks measured visuospatial reasoning, mental-attentional activation (working memory), attentional inhibition, and balance between these attention factors (field-dependence-independence).

RESULTS

Chinese participants showed significant gain on Figural Intersections Task (mental-attentional capacity), Antisaccade (attentional inhibition), and Matrix Reasoning (fluid intelligence measure). Both groups evidenced gain on the Water Level Task (attentional balance).

CONCLUSIONS

These gains suggest that Tai Chi can improve mental-attentional vigilance and executive control, when practitioners are sufficiently motivated to pursue this practice, and apply themselves (as our Chinese participants seem to have done). We found that Tai Chi enhanced mental attentional executives in the Chinese sample. The largely negative results with Non-Chinese participants might be explained by less strong motivation and by the relatively short Tai Chi practice period, which contrasts with the prior familiarity with Tai Chi of the Chinese participants.

Exercise-induced neuroprotective effects on neurodegenerative diseases: the key role of trophic factors

Age-related neurodegenerative disorders, like Alzheimer's or Parkinson's disease, are becoming a major issue to public health care. Currently, there is no effective pharmacological treatment to address cognitive impairment in these patients. Here, we aim to explore the role of exercise-induced trophic factor enhancement in the prevention or delay of cognitive decline in patients with neurodegenerative diseases. There is a significant amount of evidence from animal and human studies that links neurodegenerative related cognitive deficits with changes on brain and peripheral trophic factor levels. Several trials with elderly individuals and patients with neurodegenerative diseases report exercise induced cognitive improvements and changes on trophic factor levels including BDNF, IGF-I, among others. Further studies with healthy aging and clinical populations are needed to understand how diverse exercise interventions produce different variations in trophic factor signaling. Genetic profiles and potential confounders regarding trophic factors should also be addressed in future trials.

Conclusions about interventions, programs, and approaches for improving executive functions that appear justified and those that, despite much hype, do not

The 'Executive Functions' (EFs) of inhibitory control, working memory, and cognitive flexibility enable us to think before we act, resist temptations or impulsive reactions, stay focused, reason, problem-solve, flexibly adjust to changed demands or priorities, and see things from new and different perspectives. These skills are critical for success in all life's aspects and are sometimes more predictive than even IQ or socioeconomic status. Understandably, there is great interest in improving EFs. It's now clear they can be improved at any age through training and practice, much as physical exercise hones physical fitness. However, despite claims to the contrary, wide transfer does not seem to occur and 'mindless' aerobic exercise does little to improve EFs. Important questions remain: How much can EFs be improved (are benefits only superficial) and how long can benefits be sustained? What are the best methods for improving EFs? What about an approach accounts for its success? Do the answers to these differ by individual characteristics such as age or gender? Since stress, sadness, loneliness, or poor health impair EFs, and the reverse enhances EFs, we predict that besides directly train EFs, the most successful approaches for improving EFs will also address emotional, social, and physical needs.

Working Memory Training and Speech in Noise Comprehension in Older Adults

Understanding speech in the presence of background sound can be challenging for older adults. Speech comprehension in noise appears to depend on working memory and executive-control processes (e.g., Heald and Nusbaum, 2014), and their augmentation through training may have rehabilitative potential for age-related hearing loss. We examined the efficacy of adaptive working-memory training (Cogmed; Klingberg et al., 2002) in 24 older adults, assessing generalization to other working-memory tasks (near-transfer) and to other cognitive domains (far-transfer) using a cognitive test battery, including the Reading Span test, sensitive to working memory (e.g., Daneman and Carpenter, 1980). We also assessed far transfer to speech-in-noise performance, including a closed-set sentence task (Kidd et al., 2008). To examine the effect of cognitive training on benefit obtained from semantic context, we also assessed transfer to open-set sentences; half were semantically coherent (high-context) and half were semantically anomalous (low-context). Subjects completed 25 sessions (0.5–1 h each; 5 sessions/week) of both adaptive working memory training and placebo training over 10 weeks in a crossover design. Subjects' scores on the adaptive working-memory training tasks improved as a result of training. However, training did not transfer to other working memory tasks, nor to tasks recruiting other cognitive domains. We did not observe any training-related improvement in speech-in-noise performance. Measures of working memory correlated with the intelligibility of low-context, but not high-context, sentences, suggesting that sentence context may reduce the load on working memory. The Reading Span test significantly correlated only with a test of visual episodic memory, suggesting that the Reading Span test is not a pure-test of working memory, as is commonly assumed.

Hypertension and aging

Hypertension is a highly prevalent condition with numerous health risks, and the incidence of hypertension is greatest among older adults. Traditional discussions of hypertension have largely focused on the risks for cardiovascular disease and associated events. However, there are a number of collateral effects, including risks for dementia, physical disability, and falls/fractures which are increasingly garnering attention in the hypertension literature. Several key mechanisms--including inflammation, oxidative stress, and endothelial dysfunction--are common to biologic aging and hypertension development and appear to have key mechanistic roles in the development of the cardiovascular and collateral risks of late-life hypertension. The objective of the present review is to highlight the multi-dimensional risks of hypertension among older adults and discuss potential strategies for treatment and future areas of research for improving overall care for older adults with hypertension.

Neural correlates of working memory training in HIV patients: study protocol for a randomized controlled trial

Background

Potent combined antiretroviral therapy decreased the incidence and severity of HIV-associated neurocognitive disorders (HAND); however, no specific effective pharmacotherapy exists for HAND. Patients with HIV commonly have deficits in working memory and attention, which may negatively impact many other cognitive domains, leading to HAND. Since HAND may lead to loss of independence in activities of daily living and negative emotional well-being, and incur a high economic burden, effective treatments for HAND are urgently needed. This study aims to determine whether adaptive working memory training might improve cognitive functions and neural network efficiency and possibly decrease neuroinflammation. This study also aims to assess whether subjects with the LMX1A-rs4657412 TT(AA) genotype show greater training effects from working memory training than TC(AG) or CC(GG)-carriers.

Methods/Design

60 HIV-infected and 60 seronegative control participants will be randomized to a double-blind active-controlled study, using adaptive versus non-adaptive Cogmed Working Memory Training® (CWMT), 20–25 sessions over 5–8 weeks. Each subject will be assessed with near- and far-transfer cognitive tasks, self-reported mood and executive function questionnaires, and blood-oxygenation level-dependent functional MRI during working memory (n-back) and visual attention (ball tracking) tasks, at baseline, 1-month, and 6-months after CWMT. Furthermore, genotyping for LMX1A-rs4657412 will be performed to identify whether subjects with the TT(AA)-genotype show greater gain or neural efficiency after CWMT than those with other genotypes. Lastly, cerebrospinal fluid will be obtained before and after CWMT to explore changes in levels of inflammatory proteins (cytokines and chemokines) and monoamines.

Discussion

Improving working memory in HIV patients, using CWMT, might slow the progression or delay the onset of HAND. Observation of decreased brain activation or normalized neural networks, using fMRI, after CWMT would lead to a better understanding of how neural networks are modulated by CWMT. Moreover, validating the greater training gain in subjects with the LMX1A-TT(AA) genotype could lead to a personalized approach for future working memory training studies. Demonstrating and understanding the neural correlates of the efficacy of CWMT in HIV patients could lead to a safe adjunctive therapy for HAND, and possibly other brain disorders.

Trial registration

ClinicalTrial.gov, NCT02602418.

Physical activity and neurocognitive functioning in aging - a condensed updated review

This condensed review gives an overview about two methodological approaches to study the impact of physical activity on cognition in elderly, namely cross-sectional studies and randomized controlled intervention studies with pre- and post-measures. Moreover, this review includes studies investigating different types of physical activity and their relation to cognitive functions in older age. Behavioral data are considered but the main focus lies on neuroscientific methods like event-related potentials (ERPs) and functional magnetic resonance imaging (fMRI).

Older Adult Video Game Preferences in Practice: Investigating the Effects of Competing or Cooperating

Video game interventions with the aim to improve cognition have shown promise for both younger (e.g., Powers et al., 2013) and older adults (e.g., Toril, Reales, and Ballesteros, 2014). Most studies suggest that fast-paced action games produce the largest benefits, but a recent video game intervention with older adults found that an action game intervention can result in poor adherence (Boot et al., 2013). To increase intervention adherence, we investigated older adult video game preferences that might bolster adherence by having participants play a competitive game (Mario Kart DS) or a cooperative game (Lego Star Wars: The Complete Saga) alone or with a partner. Although hypotheses regarding cooperative and multi-player gameplay were not supported, converging evidence suggests multi-player game play may lead to greater enjoyment, which was related to intervention adherence in a previous study (Boot et al., 2013). Insights for gaming intervention studies in older populations are also provided.

The Silent Epidemic - Frailty and Aging with HIV

As the number of older adults with HIV increases, this population is experiencing an increased risk for frailty. While there is no single definition or diagnostic criteria for frailty, it is generally recognized as an accumulation of deficits in functional capacity and ability to perform activities of daily living. Frailty may be present in up to half of older adults living with HIV, and is associated with significant morbidity and mortality risk in this group. Frailty in HIV can either be transient, and linked to the status of HIV infection, or resemble a more typical gradual decline in functional capacity. Frailty risk in HIV may be exacerbated by mitochondrial dysfunction, chronic inflammation, and oxidative stress. Several tools have been developed and adapted to assess different domains of frailty, yet medical treatment of this condition can be complex and should consider management of polypharmacy as well as nutrition and exercise interventions. However, few concrete strategies have been developed to prevent or treat frailty in the context of HIV infection. This review summarizes what is currently known about the prevalence, diagnosis, and management of frailty among older adults living with HIV.

Do cognitive interventions alter the rate of age-related cognitive change?

There has recently been a great deal of interest in cognitive interventions, particularly when applied in older adults with the goal of slowing or reversing age-related cognitive decline. Although seldom directly investigated, one of the fundamental questions concerning interventions is whether the intervention alters the rate of cognitive change, or affects the level of certain cognitive measures with no effect on the trajectory of change. This question was investigated with a very simple intervention consisting of the performance of three versions (treatment) or one version (control) of the relevant cognitive tests at an initial occasion. Participants were retested at intervals ranging from less than 1 to 12 years, which allowed rates of change to be examined in the control and treatment groups. Although the intervention can be considered modest, participants in the treatment group had about .25 standard deviations less negative cognitive change over an interval of approximately three years than those in the control group, which is comparable to effect sizes reported with more intensive interventions. However, there were no interactions of the intervention with length of the interval between occasions, and thus there was no evidence that the intervention affected the course of age-related cognitive decline.

Does multicomponent physical exercise with simultaneous cognitive training boost cognitive performance in older adults? A 6-month randomized controlled trial with a 1-year follow-up

Background

Cognitive impairment is a health problem that concerns almost every second elderly person. Physical and cognitive training have differential positive effects on cognition, but have been rarely applied in combination. This study evaluates synergistic effects of multicomponent physical exercise complemented with novel simultaneous cognitive training on cognition in older adults. We hypothesized that simultaneous cognitive–physical components would add training specific cognitive benefits compared to exclusively physical training.

Methods

Seniors, older than 70 years, without cognitive impairment, were randomly assigned to either: 1) virtual reality video game dancing (DANCE), 2) treadmill walking with simultaneous verbal memory training (MEMORY), or 3) treadmill walking (PHYS). Each program was complemented with strength and balance exercises. Two 1-hour training sessions per week over 6 months were applied. Cognitive performance was assessed at baseline, after 3 and 6 months, and at 1-year follow-up. Multiple regression analyses with planned comparisons were calculated.

Results

Eighty-nine participants were randomized to the three groups initially, 71 completed the training, while 47 were available at 1-year follow-up. Advantages of the simultaneous cognitive–physical programs were found in two dimensions of executive function. “Shifting attention” showed a time×intervention interaction in favor of DANCE/MEMORY versus PHYS (F[2, 68] =1.95, trend P=0.075, r=0.17); and “working memory” showed a time×intervention interaction in favor of DANCE versus MEMORY (F[1, 136] =2.71, trend P=0.051, R²=0.006). Performance improvements in executive functions, long-term visual memory (episodic memory), and processing speed were maintained at follow-up in all groups.

Conclusion

Particular executive functions benefit from simultaneous cognitive–physical training compared to exclusively physical multicomponent training. Cognitive–physical training programs may counteract widespread cognitive impairments in the elderly.

Deconstructing chronic low back pain in the older adult--Step by step evidence and expert-based recommendations for evaluation and treatment part III: Fibromyalgia syndrome

OBJECTIVE

To present the third in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of 12 important contributors to pain and disability in older adults with CLBP. This article focuses on fibromyalgia syndrome (FMS).

METHODS

A modified Delphi approach was used to create the evaluation and treatment algorithm, the table discussing the rationale behind each of the algorithm components, and the stepped-care drug recommendations. The team involved in the creation of these materials consisted of a principal investigator, a 5-member content expert panel, and a 9-member primary care panel. The evaluation and treatment recommendations were based on availability of medications and other resources within the Veterans Health Administration (VHA) facilities. However, non-VHA panelists were also involved in the development of these materials, which can be applied to both VA and civilian settings. The illustrative clinical case was taken from the clinical practice of the principal investigator.

RESULTS

Following expert consultations and a review of the literature, we developed an evaluation and treatment algorithm with supporting materials to aid in the care of older adults with CLBP who have concomitant FMS. A case is presented that demonstrates the complexity of pain evaluation and management in older patients with CLBP and concomitant FMS.

CONCLUSIONS

Recognition of FMS as a common contributor to CLBP in older adults and initiating treatment targeting both FMS and CLBP may lead to improved outcomes in pain and disability.

Gains in cognition through combined cognitive and physical training: the role of training dosage and severity of neurocognitive disorder

Physical as well as cognitive training interventions improve specific cognitive functions but effects barely generalize on global cognition. Combined physical and cognitive training may overcome this shortcoming as physical training may facilitate the neuroplastic potential which, in turn, may be guided by cognitive training. This study aimed at investigating the benefits of combined training on global cognition while assessing the effect of training dosage and exploring the role of several potential effect modifiers. In this multi-center study, 322 older adults with or without neurocognitive disorders (NCDs) were allocated to a computerized, game-based, combined physical and cognitive training group (n = 237) or a passive control group (n = 85). Training group participants were allocated to different training dosages ranging from 24 to 110 potential sessions. In a pre-post-test design, global cognition was assessed by averaging standardized performance in working memory, episodic memory and executive function tests. The intervention group increased in global cognition compared to the control group, p = 0.002, Cohen’s d = 0.31. Exploratory analysis revealed a trend for less benefits in participants with more severe NCD, p = 0.08 (cognitively healthy: d = 0.54; mild cognitive impairment: d = 0.19; dementia: d = 0.04). In participants without dementia, we found a dose-response effect of the potential number and of the completed number of training sessions on global cognition, p = 0.008 and p = 0.04, respectively. The results indicate that combined physical and cognitive training improves global cognition in a dose-responsive manner but these benefits may be less pronounced in older adults with more severe NCD. The long-lasting impact of combined training on the incidence and trajectory of NCDs in relation to its severity should be assessed in future long-term trials.

Memory training plus yoga for older adults

Previous tests of the SeniorWISE intervention with community-residing older adults that were designed to improve affect and cognitive performance were successful and positively affected these outcomes. In this study, we tested whether adding yoga to the intervention would affect the outcomes. Using a quasiexperimental pre-post design, we delivered 12 hours of SeniorWISE memory training that included a 30-minute yoga component before each training session. The intervention was based on the four components of self-efficacy theory: enactive mastery experience, vicarious experience, verbal persuasion, and physiologic arousal. We recruited 133 older adults between the ages of 53 and 96 years from four retirement communities in Central Texas. Individuals were screened and tested and then attended training sessions two times a week over 4 weeks. A septuagenarian licensed psychologist taught the memory training, and a certified yoga instructor taught yoga. Eighty-three participants completed at least 9 hours (75%) of the training and completed the posttest. Those individuals who completed made significant gains in memory performance, instrumental activities of daily living, and memory self-efficacy and had fewer depressive symptoms. Thirteen individuals advanced from poor to normal memory performance, and seven improved from impaired to poor memory performance; thus, 20 individuals improved enough to advance to a higher functioning memory group. The findings from this study of a memory training intervention plus yoga training show that the benefits of multifactorial interventions had additive benefits. The combined treatments offer a unique model for brain health programs and the promotion of nonpharmacological treatment with the goals of maintaining healthy brain function and boosting brain plasticity.

Effects of physical exercise on central nervous system functions: a review of brain region specific adaptations

Pathologies of central nervous system (CNS) functions are involved in prevalent conditions such as Alzheimer's disease, depression, and Parkinson's disease. Notable pathologies include dysfunctions of circadian rhythm, central metabolism, cardiovascular function, central stress responses, and movement mediated by the basal ganglia. Although evidence suggests exercise may benefit these conditions, the neurobiological mechanisms of exercise in specific brain regions involved in these important CNS functions have yet to be clarified. Here we review murine evidence about the effects of exercise on discrete brain regions involved in important CNS functions. Exercise effects on circadian rhythm, central metabolism, cardiovascular function, stress responses in the brain stem and hypothalamic pituitary axis, and movement are examined. The databases Pubmed, Web of Science, and Embase were searched for articles investigating regional brain adaptations to exercise. Brain regions examined included the brain stem, hypothalamus, and basal ganglia. We found evidence of multiple regional adaptations to both forced and voluntary exercise. Exercise can induce molecular adaptations in neuronal function in many instances. Taken together, these findings suggest that the regional physiological adaptations that occur with exercise could constitute a promising field for elucidating molecular and cellular mechanisms of recovery in psychiatric and neurological health conditions.

Executive function and self-regulated exergaming adherence among older adults

The rise in dementia and the evidence of cognitive benefits of exercise for the older adult population together make salient the research into variables affecting cognitive benefit and exercise behavior. One promising avenue for increasing exercise participation has been the introduction of exergaming, a type of exercise that works in combination with virtual reality to enhance both the exercise experience and health outcomes. Past research has revealed that executive function (EF) was related to greater use of self-regulatory strategies, which in turn was related to greater adherence to exercise following an intervention (McAuley et al., 2011). Best et al. (2014) found improvement in EF related to adherence to exercise post- intervention. Anderson-Hanley et al. (2012) found that for older adults aerobic exergaming yielded greater cognitive benefit than traditional exercise alone; however, questions remain as to the possible impact of greater cognitive benefit and other factors on participants’ involvement in exercise following the end of an intervention. The current study presents follow-up data exploring the relationship between EF, self-regulation, and exercise behavior in the post-intervention (naturalistic) period. Herein, it was predicted that higher EF at the start of the naturalistic window, would predict subsequent exercise with an exergame. Contrary to expectations, results suggest that those with poorer EF are likely to exergame more frequently. The results of this study contradict previous literature, but suggest an interesting relationship between EF, self-regulation, and exercise behaviors when exergaming is employed, particularly with older adults with some cognitive decline. We hypothesize that other factors may be at work, perhaps expectation of cognitive benefit might act as a unique motivator.

Improved cognitive performance following aerobic exercise training in people with traumatic brain injury

OBJECTIVE

To examine cognitive function in individuals with traumatic brain injury (TBI) prior to and after participation in an aerobic exercise training program.

DESIGN

Pre-post intervention study.

SETTING

Medical research center.

PARTICIPANTS

Volunteer sample of individuals (N=7) (age, 33.3±7.9y) with chronic nonpenetrating TBI (injury severity: 3=mild, 4=moderate; time since most current injury: 4.0±5.5y) who were ambulatory.

INTERVENTION

Twelve weeks of supervised vigorous aerobic exercise training performed 3 times a week for 30 minutes on a treadmill.

MAIN OUTCOME MEASURES

Cognitive function was assessed using the Trail Making Test Part A (TMT-A), Trail Making Test Part B (TMT-B), and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Sleep quality and depression were measured with the Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory, version 2 (BDI-II). Indices of cardiorespiratory fitness were used to examine the relation between improvements in cognitive function and cardiorespiratory fitness.

RESULTS

After training, improvements in cognitive function were observed with greater scores on the TMT-A (10.3±6.8; P=.007), TMT-B (9.6±7.0; P=.011), and RBANS total scale (13.3±9.3; P=.009). No changes were observed in measures of the PSQI and BDI-II. The magnitude of cognitive improvements was also strongly related to the gains in cardiorespiratory fitness.

CONCLUSIONS

These findings suggest that vigorous aerobic exercise training may improve specific aspects of cognitive function in individuals with TBI and cardiorespiratory fitness gains may be a determinant of these improvements.

Training versus engagement as paths to cognitive enrichment with aging

While a training model of cognitive intervention targets the improvement of particular skills through instruction and practice, an engagement model is based on the idea that being embedded in an intellectually and socially complex environment can impact cognition, perhaps even broadly, without explicit instruction. We contrasted these 2 models of cognitive enrichment by randomly assigning healthy older adults to a home-based inductive reasoning training program, a team-based competitive program in creative problem solving, or a wait-list control. As predicted, those in the training condition showed selective improvement in inductive reasoning. Those in the engagement condition, on the other hand, showed selective improvement in divergent thinking, a key ability exercised in creative problem solving. On average, then, both groups appeared to show ability-specific effects. However, moderators of change differed somewhat for those in the engagement and training interventions. Generally, those who started either intervention with a more positive cognitive profile showed more cognitive growth, suggesting that cognitive resources enabled individuals to take advantage of environmental enrichment. Only in the engagement condition did initial levels of openness and social network size moderate intervention effects on cognition, suggesting that comfort with novelty and an ability to manage social resources may be additional factors contributing to the capacity to take advantage of the environmental complexity associated with engagement. Collectively, these findings suggest that training and engagement models may offer alternative routes to cognitive resilience in late life.

Making working memory work: a meta-analysis of executive-control and working memory training in older adults

This meta-analysis examined the effects of process-based executive-function and working memory training (49 articles, 61 independent samples) in older adults (> 60 years). The interventions resulted in significant effects on performance on the trained task and near-transfer tasks; significant results were obtained for the net pretest-to-posttest gain relative to active and passive control groups and for the net effect at posttest relative to active and passive control groups. Far-transfer effects were smaller than near-transfer effects but were significant for the net pretest-to-posttest gain relative to passive control groups and for the net gain at posttest relative to both active and passive control groups. We detected marginally significant differences in training-induced improvements between working memory and executive-function training, but no differences between the training-induced improvements observed in older adults and younger adults, between the benefits associated with adaptive and nonadaptive training, or between the effects in active and passive control conditions. Gains did not vary with total training time.

Is the effect of aerobic exercise on cognition a placebo effect?

A number of studies and meta-analyses conclude that aerobic fitness (walking) interventions improve cognition. Such interventions typically compare improvements from these interventions to an active control group in which participants engage in non-aerobic activities (typically stretching and toning) for an equivalent amount of time. However, in the absence of a double-blind design, the presence of an active control group does not necessarily control for placebo effects; participants might expect different amounts of improvement for the treatment and control interventions [1]. We conducted a large survey to explore whether people expect greater cognitive benefits from an aerobic exercise intervention compared to a control intervention. If participants expect greater improvement following aerobic exercise, then the benefits of such interventions might be due in part to a placebo effect. In general, expectations did not differ between aerobic and non-aerobic interventions. If anything, some of the results suggest the opposite (e.g., respondents expected the control, non-aerobic intervention to yield bigger memory gains). These results provide the first evidence that cognitive improvements following aerobic fitness training are not due to differential expectations.

Evaluating the relationship between change in performance on training tasks and on untrained outcomes

Training interventions for older adults are designed to remediate performance on trained tasks and to generalize, or transfer, to untrained tasks. Evidence for transfer is typically based on the trained group showing greater improvement than controls on untrained tasks, or on a correlation between gains in training and in transfer tasks. However, this ignores potential correlational relationships between trained and untrained tasks that exist before training. By accounting for crossed (trained and untrained) and lagged (pre-training and post-training) and cross-lagged relationships between trained and untrained scores in structural equation models, the training-transfer gain relationship can be independently estimated. Transfer is confirmed if only the trained but not control participants' gain correlation is significant. Modeling data from the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) study (Smith et al., 2009), transfer from speeded auditory discrimination and syllable span to list and text memory and to working memory was demonstrated in 487 adults aged 65-93. Evaluation of age, sex, and education on pretest scores and on change did not alter this. The overlap of the training with transfer measures was also investigated to evaluate the hypothesis that performance gains in a non-verbal speeded auditory discrimination task may be associated with gains on fewer tasks than gains in a verbal working memory task. Gains in speeded processing were associated with gains on one list memory measure. Syllable span gains were associated with improvement in difficult list recall, story recall, and working memory factor scores. Findings confirmed that more overlap with task demands was associated with gains to more of the tasks assessed, suggesting that transfer effects are related to task overlap in multimodal training.

The development and malleability of executive control abilities

Executive control (EC) generally refers to the regulation of mental activity. It plays a crucial role in complex cognition, and EC skills predict high-level abilities including language processing, memory, and problem solving, as well as practically relevant outcomes such as scholastic achievement. EC develops relatively late in ontogeny, and many sub-groups of developmental populations demonstrate an exaggeratedly poor ability to control cognition even alongside the normal protracted growth of EC skills. Given the value of EC to human performance, researchers have sought means to improve it through targeted training; indeed, accumulating evidence suggests that regulatory processes are malleable through experience and practice. Nonetheless, there is a need to understand both whether specific populations might particularly benefit from training, and what cortical mechanisms engage during performance of the tasks used in the training protocols. This contribution has two parts: in Part I, we review EC development and intervention work in select populations. Although promising, the mixed results in this early field make it difficult to draw strong conclusions. To guide future studies, in Part II, we discuss training studies that have included a neuroimaging component – a relatively new enterprise that also has not yet yielded a consistent pattern of results post-training, preventing broad conclusions. We therefore suggest that recent developments in neuroimaging (e.g., multivariate and connectivity approaches) may be useful to advance our understanding of the neural mechanisms underlying the malleability of EC and brain plasticity. In conjunction with behavioral data, these methods may further inform our understanding of the brain–behavior relationship and the extent to which EC is dynamic and malleable, guiding the development of future, targeted interventions to promote executive functioning in both healthy and atypical populations.

A complex multimodal activity intervention to reduce the risk of dementia in mild cognitive impairment--ThinkingFit: pilot and feasibility study for a randomized controlled trial

BACKGROUND

Dementia affects 35 million people worldwide and is currently incurable. Many cases may be preventable because regular participation in physical, mental and social leisure activities during middle age is associated with up to 47% dementia risk reduction. However, the majority of middle-aged adults are not active enough. MCI is therefore a clear target for activity interventions aimed at reducing dementia risk. An active lifestyle during middle age reduces dementia risk but it remains to be determined if increased activity reduces dementia risk when MCI is already evident. Before this can be investigated conclusively, complex multimodal activity programmes are required that (1) combine multiple health promoting activities, (2) engage people with MCI, and (3) result in sufficient adherence rates.

METHODS

We designed the ThinkingFit programme to engage people with MCI in a complex intervention comprised of three activity components: physical activity, group-based cognitive stimulation (GCST) and individual cognitive stimulation (ICST). Engagement and adherence was promoted by applying specific psychological techniques to enhance behavioural flexibility in an early pre-phase and during the course of the intervention. To pilot the intervention, participants served as their own controls during a 6- to 12-week run-in period, which was followed by 12 weeks of activity intervention.

RESULTS

Out of 212 MCI patients screened, 163 were eligible, 70 consented and 67 completed the intervention (mean age 74 years). Activity adherence rates were high: physical activity = 71%; GCST = 83%; ICST = 67%. Significant treatment effects (p < .05) were evident on physical health outcomes (decreased BMI and systolic blood pressure, [pre/post values of 26.3/25.9 kg/m2 and 145/136 mmHg respectively]), fitness (decreased resting and recovery heart rate [68/65 bpm and 75/69 bpm]), and cognition (improved working memory [5.3/6.3 items]).

CONCLUSIONS

We found satisfactory recruitment, retention and engagement rates, coupled with significant treatment effects in elderly MCI patients. It appears feasible to conduct randomized controlled trials of the dementia prevention potential of complex multimodal activity programmes like ThinkingFit.

TRIAL REGISTRATION

ClinicalTrials.gov registration nr: NCT01603862; date: 17/5/2012.

Physical activity program for patients with dementia and their relative caregivers: randomized clinical trial in Primary Health Care (AFISDEMyF study)

BACKGROUND

The aging of the population has led to the increase of chronic diseases, especially dementia and cardiovascular diseases, and it has become necessary for their relatives to dedicate more time in caregiving.The objective in the first phase of this study is to evaluate the effectiveness of a Primary Health Care procedure to increase the physical activity of people with dementia and their relative caregivers. Also the effect on the cognitive state and cardiovascular risk will be assessed.

METHODS/DESIGN

DESIGN

Clinical, multicentric and randomized trial. A simple random sampling to select 134 patients diagnosed with dementia will be carried out. After contacting their relatives, his/her participation in the trial will be requested. A basal assessment will be made and the participants will be asigned to control or intervention group (1:1).

VARIABLES

The main measure will be the assessment of physical activity (podometer and 7-PAR) in patients and caregivers. In patients with dementia: ADAS-cog, functional degree and cardiovascular risk. In caregivers: cardiovascular risk, general health and quality of life.

INTERVENTION

For 3 months, participants will receive instructions to do physical activity with an adapted program. This program will be designed and applied by Primary Health Care professionals in patients with dementia and their caregivers. The control group will receive regular care.

ANALYSIS

An intention-to-treat analysis will be carried out by comparing the observed differences between basal, 6 and 12 months measures. Change in the mean of daily steps assessed with the podometer and 7-PAR will be the main result.

DISCUSSION

If the main hypothesis is confirmed, it could be useful to improve the cognitive state of patients with dementia, as well as the cardiovascular risk of all of them. The results can be good to improve technical features of the devices that register the physical activity in the patients with dementia, and it could facilitate its commercialization.

TRIAL REGISTRATION

Clinical Trials.gov Identifier: NCT02044887.

Effect of music-based multitask training on cognition and mood in older adults

BACKGROUND

in a secondary analysis of a randomised controlled trial, we investigated whether 6 months of music-based multitask training had beneficial effects on cognitive functioning and mood in older adults.

METHODS

134 community-dwellers aged ≥65 years at increased risk for falling were randomly assigned to either an intervention group (n = 66) who attended once weekly 1-h supervised group classes of multitask exercises, executed to the rhythm of piano music, or a control group with delayed intervention (n = 68) who maintained usual lifestyle habits, for 6 months. A short neuropsychological test battery was administered by an intervention-blinded neuropsychologist at baseline and Month 6, including the mini-mental state examination (MMSE), the clock-drawing test, the frontal assessment battery (FAB) and the hospital anxiety (HADS-A) and depression scale.

RESULTS

intention-to-treat analysis showed an improvement in the sensitivity to interference subtest of the FAB (adjusted between-group mean difference (AMD), 0.12; 95% CI, 0.00 to 0.25; P = 0.047) and a reduction in anxiety level (HADS-A; AMD, -0.88; 95% CI, -1.73 to -0.05; P = 0.039) in intervention participants, as compared with the controls. Within-group analysis revealed an increase in MMSE score (P = 0.004) and a reduction in the number of participants with impaired global cognitive performance (i.e., MMSE score ≤23; P = 0.003) with intervention.

CONCLUSION

six months of once weekly music-based multitask training was associated with improved cognitive function and decreased anxiety in community-dwelling older adults, compared with non-exercising controls. Studies designed to further delineate whether training-induced changes in cognitive function could contribute to dual-task gait improvements and falls reduction, remain to be conducted.

Adherence of older women with strength training and aerobic exercise

Background

Participation of older people in a program of regular exercise is an effective strategy to minimize the physical decline associated with age. The purpose of this study was to assess adherence rates in older women enrolled in two different exercise programs (one aerobic exercise and one strength training) and identify any associated clinical or functional factors.

Methods

This was an exploratory observational study in a sample of 231 elderly women of mean age 70.5 years. We used a structured questionnaire with standardized tests to evaluate the relevant clinical and functional measures. A specific adherence questionnaire was developed by the researchers to determine motivators and barriers to exercise adherence.

Results

The adherence rate was 49.70% in the aerobic exercise group and 56.20% in the strength training group. Multiple logistic regression models for motivation were significant (P=0.003) for the muscle strengthening group (R²=0.310) and also significant (P=0.008) for the aerobic exercise group (R²=0.154). A third regression model for barriers to exercise was significant (P=0.003) only for the muscle strengthening group (R²=0.236). The present study shows no direct relationship between worsening health status and poor adherence.

Conclusion

Factors related to adherence with exercise in the elderly are multifactorial.

Effect of resistance-type exercise training with or without protein supplementation on cognitive functioning in frail and pre-frail elderly: secondary analysis of a randomized, double-blind, placebo-controlled trial

Physical activity has been proposed as one of the most effective strategies to prevent cognitive decline. Protein supplementation may exert an additive effect. The effect of resistance-type exercise training with or without protein supplementation on cognitive functioning in frail and pre-frail elderly people was assessed in a secondary analysis. Two 24-week, double-blind, randomized, placebo-controlled intervention studies were carried out in parallel. Subjects performed a resistance-type exercise program of two sessions per week (n=62) or no exercise program (n=65). In both studies, subjects were randomly allocated to either a protein (2×15 g daily) or a placebo drink. Cognitive functioning was assessed with a neuropsychological test battery focusing on the cognitive domains episodic memory, attention and working memory, information processing speed, and executive functioning. In frail and pre-frail elderly, resistance-type exercise training in combination with protein supplementation improved information processing speed (changes in domain score 0.08±0.51 versus -0.23±0.19 in the non-exercise group, p=0.04). Exercise training without protein supplementation was beneficial for attention and working memory (changes in domain scores 0.35±0.70 versus -0.12±0.69 in the non-exercise group, p=0.02). There were no significant differences among the intervention groups on the other cognitive tests or domain scores.

Relationship of age to impulsivity and decision making: a baseline secondary analysis of a behavioral treatment study in stimulant use disorders

Because stimulant use disorders remain prevalent across the lifespan, cognition is an important area of clinical care and research focus among aging adults with stimulant use disorders. This secondary analysis of a National Institute on Drug Abuse Clinical Trials Network study suggests that decision making, verbal learning/memory, executive function, and set shifting are important cognitive domains to screen clinically and treat in aging adults with stimulant use disorders. Some suggestions are made on how clinical treatment providers can practically use these results. An important direction for future research is the development of cognitively remediating treatments for impaired cognitive domains in aging adults with stimulant use disorders.

Impact of aerobic exercise on neurobehavioral outcomes

Numerous studies have examined the relationship between physical activity and cognitive function, demonstrating that greater physical activity is associated with lower incidence of cognitive impairment in later life. Due to an increasingly large number of older adults at risk for cognitive impairment, the relationship between physical activity and cognition has garnered increasing public health relevance and multiple randomized trials have demonstrated that exercise interventions among sedentary adults improve cognitive performance in multiple domains of function. This article will examine the relationship between physical activity and cognitive function by reviewing several different areas of literature, including the prevalence of cognitive impairment, assessment methods, observational studies examining physical activity and cognition, and intervention studies. The present review is intended to provide a historical tutorial of existing literature linking physical activity, exercise, and cognitive function among both healthy and clinical populations.

Voluntary exercise regionally augments rates of cerebral protein synthesis

Exercise is a natural form of neurophysiologic stimulation that has known benefits for mental health, maintenance of cerebral function, and stress reduction. Exercise is known to induce an upregulation of brain-derived neurotrophic factor and this is thought to be involved in associated increases in neural plasticity. Protein synthesis is also an essential component of adaptive plasticity. We hypothesized that exercise may stimulate changes in brain protein synthesis as part of its effects on plasticity. Here, we applied the quantitative autoradiographic L-[1-(14)C]leucine method to the in vivo determination of regional rates of cerebral protein synthesis (rCPS) in adult rats following a seven day period of voluntary wheel-running and their sedentary counterparts. In four of 21 brain regions examined, the mean values of rCPS in the exercised rats were statistically significantly higher than in sedentary controls; regions affected were paraventricular hypothalamic nucleus, ventral hippocampus as a whole, CA1 pyramidal cell layer in ventral hippocampus, and frontal cortex. Increases in rCPS approached statistical significance in dentate gyrus of the ventral hippocampus. Our results affirm the value of exercise in encouraging hippocampal and possibly cortical neuroplasticity, and also suggest that exercise may modulate stimulation of stress-response pathways. Ultimately, our study indicates that measurement of rCPS with PET might be used as a marker of brain response to exercise in human subjects.

Effects of music therapy on behavioral and psychological symptoms of dementia: a systematic review and meta-analysis

Behavioral and psychological symptoms of dementia (BPSD) are common problems for patients and caregivers. Although music therapy is considered a non-pharmacological intervention for the management of BPSD, its effectiveness remains unclear. This study aimed to investigate the effects of music therapy on BPSD, cognitive function, and activities of daily living in patients with dementia. A literature search was conducted in the following databases: MEDLINE, CINAHL, PsycINFO, and Igaku Chuo Zasshi. We selected 20 studies, including randomized controlled trials, controlled clinical trials, cohort studies, and controlled trials, and conducted a meta-analysis using standardized mean differences (SMD). The results showed that music therapy had moderate effects on anxiety [SMD, -0.64; 95% confidence interval (CI), -1.05 - -0.24; p=0.002] and small effects on behavioral symptoms (SMD, -0.49; 95% CI, -0.82 - -0.17; p=0.003). In studies of duration >3 months, music therapy had large effects on anxiety (SMD, -0.93; 95% CI, -1.72 - -0.13; p=0.02). The present systematic review and meta-analysis suggests that music therapy is effective for the management of BPSD.