Effects of combined cognitive and exercise interventions on cognition in older adults with and without cognitive impairment: a systematic review

A usability study of a multicomponent video game-based training for older adults

Background

Aging is often accompanied by a decline in sensory, motor and cognitive functions. These age- and lifestyle-related impairments may lead to reduced daily life functioning including gait disturbances, falling and injuries. Most daily life activities, e.g. walking, are tasks which require the concurrent interplay of physical and cognitive functions. Promising options for combined physical-cognitive training are video game-based physical exercises, so-called exergames. This study aimed to [i] determine the usability of a newly developed multicomponent exergame and [ii] explore its effects on physical functions, cognition and cortical activity.

Methods

Twenty-one healthy and independently living older adults were included (10 female, 71.4 ± 5.8 years, range: 65–91) and performed 21 training sessions (each 40 min) over seven weeks. The multicomponent exergame included strength and balance training with Tai Chi-inspired and dance exercises. Participants rated the usability of the exergame (System Usability Scale) and reported on their emotional experience (Game Experience Questionnaire). Attendance and attrition rates were calculated to determine training compliance. Before and after the intervention, physical and cognitive functions as well as resting state electroencephalography (EEG) were assessed.

Results

Results showed a high training attendance rate (87.1%, 18/21 training sessions on average) and a low attrition rate (9.5%, 2 drop-outs). System usability was rated high with a mean score of 75/100. Affective game experience was rated favorable. Gait speed under dual-task condition, lower extremity muscle strength and reaction times in a cognitive task (divided attention) showed significant improvements (p < .05). No significant pre-post differences were found for resting state EEG.

Conclusions

The newly developed exergame seems usable for healthy older adults. Nevertheless, some aspects of the exergame prototype can and should be improved. The training showed to positively influence physical and cognitive functions in a small convenience sample. Future trials are warranted which evaluate the feasibility and usability of the exergame training in a more “real-life” in-home setting and assess the behavioral and neuroplastic changes in a larger population after a longer training period with comparison to a control group.

A randomised controlled trial of an exercise intervention promoting activity, independence and stability in older adults with mild cognitive impairment and early dementia (PrAISED) - A Protocol

BACKGROUND

People with dementia progressively lose cognitive and functional abilities. Interventions promoting exercise and activity may slow decline. We developed a novel intervention to promote activity and independence and prevent falls in people with mild cognitive impairment (MCI) or early dementia. We successfully undertook a feasibility randomised controlled trial (RCT) to refine the intervention and research delivery. We are now delivering a multi-centred RCT to evaluate its clinical and cost-effectiveness.

METHODS

We will recruit 368 people with MCI or early dementia (Montreal Cognitive Assessment score 13-25) and a family member or carer from memory assessment clinics, other community health or social care venues or an online register (the National Institute for Health Research Join Dementia Research). Participants will be randomised to an individually tailored activity and exercise programme delivered using motivational theory to promote adherence and continued engagement, with up to 50 supervised sessions over one year, or a brief falls prevention assessment (control). The intervention will be delivered in participants' homes by trained physiotherapists, occupational therapists and therapy assistants. We will measure disabilities in activities of daily living, physical activity, balance, cognition, mood, quality of life, falls, carer strain and healthcare and social care use. We will use a mixed methods approach to conduct a process evaluation to assess staff training and delivery of the intervention, and to identify individual- and context-level mechanisms affecting intervention engagement and activity maintenance. We will undertake a health economic evaluation to determine if the intervention is cost-effective.

DISCUSSION

We describe the protocol for a multi-centre RCT that will evaluate the clinical and cost-effectiveness of a therapy programme designed to promote activity and independence amongst people living with dementia.

TRIAL REGISTRATION

ISRCTN, ISRCTN15320670. Registered on 4 September 2018.

Effects of functional tasks exercise on cognitive functions of older adults with mild cognitive impairment: a randomized controlled pilot trial

Background

Dementia has been presenting an imminent public health challenge worldwide. Studies have shown a combination of cognitive and physical trainings may have synergistic value for improving cognitive functions. Daily functional tasks are innately cognitive demanding and involve components found in common exercise. Individuals with mild cognitive impairment may demonstrate difficulties with complex activities of daily living. Functional tasks could possibly be used as a means of combined cognitive and exercise training for improving cognitive functions. This pilot aims to validate the effects of functional tasks exercise on cognitive functions and functional status in older adults with mild cognitive impairment.

Methods

A four-arm, rater-blinded randomized controlled trial. Participants (N = 59) were randomized to either a functional task exercise group, a cognitive training group, an exercise training group, or a waitlist control group for 8 weeks. All outcome measures were undertaken at baseline and post-intervention using Neurobehavioral Cognitive Status Examination, Trail Making Test A and B, Chinese Version Verbal Learning Test, Lawton Instrumental Activities of Daily Living Scale, and Zarit Burden Interview.

Results

Results of the Kruskal-Wallis one-way ANOVA showed higher improvement in the functional task exercise group with significant between-group differences in memory (p = 0.009) compared to the exercise group and cognitive training group, functional status (p = 0.005) compared to the cognitive training group and waitlist control group, and caregiver burden (p = 0.037) compared to the exercise group and cognitive training group.

Conclusion

This pilot study showed that functional tasks exercise using simulated functional tasks as a means of combined cognitive and exercise program is feasible and beneficial in improving the memory and functional status of older adults with mild cognitive impairment as well as reducing the care-related burdens of their caregivers. The present findings warrant further well-designed longitudinal studies to examine the sustainability of effects and draw more definitive conclusions.

Trial registration

Australian New Zealand Clinical Trials Registry, ACTRN 12616001635459. Registered on 25 November 2016.

A Pilot Study of an In-Home Multicomponent Exergame Training for Older Adults: Feasibility, Usability and Pre-Post Evaluation

Aging is associated with sensory, motor and cognitive impairments that may lead to reduced daily life functioning including gait disturbances, falls, injuries and mobility restrictions. A strong need exists for implementing effective evidence-based interventions for healthy aging. Therefore, the aim of this study was to (i) evaluate the feasibility and usability of an in-home multicomponent exergame training and (ii) explore its effects on physical functions, cognition and cortical activity. Twenty-one healthy and independently living older adults were included (11 female, 74.4 ± 7.0 years, range: 65-92 years) and performed 24 trainings sessions (each 40 min) over eight weeks. The first part was conducted in a living lab (home-like laboratory environment), the second part at participants' home. The multicomponent exergame included Tai Chi-inspired exercises, dance movements and step-based cognitive games to train strength, balance and cognition. Attendance and attrition rates were calculated and safety during training was evaluated to determine feasibility. Participants rated the usability of the exergame (System Usability Scale) and reported on their game experience (Game Experience Questionnaire). Physical and cognitive functions and cortical activity (resting state electroencephalopathy) were assessed pre and post intervention. Results showed a high training attendance rate for the living lab and the home-based setting (91.7 and 91.0%, respectively) with a rather high attrition rate (28.6%, six drop-outs). Half of the drop-out reasons were related to personal or health issues. System usability was rated acceptable with a mean score of 70.6/100. Affective game experience was rated favorable. Significant improvements were found for minimal toe clearance, short-term attentional span, and information processing speed (p < 0.05). No significant pre-post differences were found for cortical activity. To summarize, the exergame is generally feasible and usable for healthy older adults applied in an in-home setting and provides an overall positive emotional game experience. Nevertheless, flawless technical functionality should be a mandatory consideration. Additionally, the training might have potential positive influence on specific functions in older adults. However, the efficacy has to be evaluated in a future randomized controlled trial assessing the behavioral and neuroplastic changes in a larger population after a longer training period.

Effectiveness of Combined Cognitive and Physical Interventions to Enhance Functioning in Older Adults With Mild Cognitive Impairment: A Systematic Review of Randomized Controlled Trials

Background and Objectives

Cognitive training delivered in conjunction with physical activity, may help to optimize aging and delay or prevent dementia in individuals with mild cognitive impairment (MCI). However, their efficacy is less well studied compared to pharmaceutical treatments. This systematic review synthesizes the emerging evidence on combined cognitive-physical interventions for enhancing functioning in older adults with MCI, with implications for practice and research.

Research Design and Methods

We searched the PubMed, PsycINFO, Ageline, Medline, Web of Science and ProQuest databases, and hand-searched articles published between July 2013 and November 2018. Only randomized controlled trials which incorporated cognitive and physical components targeted to individuals with MCI over the age of 50 were eligible. Our search yielded 10 eligible, independent articles.

Results

Intervention participants with MCI self-reported, or demonstrated, improved functioning across a range of cognitive (global cognitive function, executive function, processing speed, memory, attention, mood, emotion, motivation, brain cortex, orientation), and physical (gait, balance, mobility) outcomes. Interventions which combined cognitive-physical training were comparable to those which isolated these same elements, in terms of their effects on executive function, processing speed, attention, mood, and cardiorespiratory fitness.

Discussion and Implications

There is preliminary evidence to support the positive effects of multicomponent interventions to improve cognitive-motor abilities in older adults at risk of developing dementia. The strength of this research evidence is, however, limited. Longitudinal studies are needed to determine whether these effects are maintained over time. The optimal intervention intensity and length also need to be established.

The Usability of Physical Activity and Cognitive Training Applications in People With Mild Cognitive Impairment

The aim of the current study is to identify key issues with utility, effectiveness, and appeal of specific electronic applications (apps) for people with mild cognitive impairment (MCI) to guide the design and development of a mobile app, which integrates physical activity and cognitive activities. Sixteen participants age ≥65 were recruited from three assisted living facilities in Alabama. Participants were observed playing a physical activity app and cognitive training app via a tablet on two separate occasions. Most participants agreed that Sworkit^®, Elevate^®, and 7-Minute Workout^® were easy to use and fun, less frustrating, and they would recommend them to a friend. Most participants had questions regarding clarification about how to play the games. All (100%) participants smiled and appeared happy when playing the physical activity games, whereas only 35% smiled during the cognitive training games. The current study was instrumental in revealing that people with MCI can use technology and provide feedback regarding use of that technology. Individuals with impaired cognition should be recruited for participation in research for the knowledge they can provide researchers. [Research in Gerontological Nursing, 13(2), 64-72.].

Exploring Cognitively Loaded Physical Activity Compared With Control to Improve Global Cognitive Function in Older Community-Dwelling Adults With Mild Cognitive Impairment: Systematic Review With Meta-Analysis

Objective. A systematic review with a meta-analysis explored effects of cognitively loaded physical activity interventions on global cognition in community-dwelling older adults (≥65 years of age) experiencing mild cognitive impairment (MCI), compared to any control. Methods. A literature search was conducted in 4 databases (MEDLINE [OvidSP], PubMed, CINAHL, and the Cochrane Central Register of Controlled Trials [Wiley]) from inception until January 30, 2018. The meta-analysis was conducted with Review Manager 5.3. Results. Six randomized controlled trials (RCTs) with 547 participants were identified. The interventions ranged from 4 to 52 weeks. Baseline and initial follow-up assessments were used. The primary pooled analysis of all RCTs demonstrated a nonsignificant trivial effect (standardized mean difference [SMD] 0.07, 95% confidence interval [CI] −0.44 to 0.58) favoring the intervention. In pooled subanalysis of 4 RCTs (n = 405) using the same global cognition measure (Mini-Mental State Examination) and duration of intervention >12 weeks, the intervention group achieved a small but significant improvement for global cognition (SMD 0.45, 95% CI 0.14 to 0.75). Conclusion. When all the RCTs were pooled, the effect of cognitively loaded physical activity intervention on global cognitive function in older adults with MCI remained unclear. The subgroup analysis provides translation evidence for future RCT study designs.

Effects of Exercise Modes on Neural Processing of Working Memory in Late Middle-Aged Adults: An fMRI Study

Recent studies have highlighted the importance of regular exercise on cognitive function in aging populations, with aerobic exercise and cardiovascular fitness having received the largest amount of research attention. However, the relationship between exercise mode and cognitive function underlying behavioral modification and neural activation remains unknown. The present study, therefore, sought to examine the associations between different exercise modes and the working memory (WM) aspect of executive function as well as its task-evoked brain activation in the late middle-aged population. Seventy late middle-aged adults were classified into open-skill, closed-skill, or irregular exercise groups based on their participation in exercise activities prior to the study and then performed a spatial working memory (SWM) task while undergoing functional magnetic resonance imaging (fMRI) scanning. The results revealed that exercise groups, regardless of exercise modes, showed better SWM and physical fitness performance. Additionally, the open-skill group exhibited greater brain activation in the prefrontal lobe, anterior cingulate cortex/supplementary motor area (ACC/SMA), and hippocampus than those in the closed-skill group, suggesting a mode-sensitive compensatory mechanism in late middle-aged adults. These findings indicate that exercise promotes cognitive health, improves WM, and enhances neurocognitive scaffolding in late middle-aged adults and further suggest that various exercise modes can effectively modulate frontal and hippocampal function in the face of age-related neurocognitive declines, implications that may inform the development of exercise programs for the elderly.

Effects and Mechanisms of Cognitive, Aerobic Exercise, and Combined Training on Cognition, Health, and Brain Outcomes in Physically Inactive Older Adults: The Projecte Moviment Protocol

Introduction

Age-related health, brain, and cognitive impairment is a great challenge in current society. Cognitive training, aerobic exercise and their combination have been shown to benefit health, brain, cognition and psychological status in healthy older adults. Inconsistent results across studies may be related to several variables. We need to better identify cognitive changes, individual variables that may predict the effect of these interventions, and changes in structural and functional brain outcomes as well as physiological molecular correlates that may be mediating these effects. Projecte Moviment is a multi-domain randomized trial examining the effect of these interventions applied 5 days per week for 3 months compared to a passive control group. The aim of this paper is to describe the sample, procedures and planned analyses.

Methods

One hundred and forty healthy physically inactive older adults will be randomly assigned to computerized cognitive training (CCT), aerobic exercise (AE), combined training (COMB), or a control group. The intervention consists of a 3 month home-based program 5 days per week in sessions of 45 min. Data from cognitive, physical, and psychological tests, cardiovascular risk factors, structural and functional brain scans, and blood samples will be obtained before and after the intervention.

Results

Effects of the interventions on cognitive outcomes will be described in intention-to-treat and per protocol analyses. We will also analyze potential genetic, demographic, brain, and physiological molecular correlates that may predict the effects of intervention, as well as the association between cognitive effects and changes in these variables using the per protocol sample.

Discussion

Projecte Moviment is a multi-domain intervention trial based on prior evidence that aims to understand the effects of CCT, AE, and COMB on cognitive and psychological outcomes compared to a passive control group, and to determine related biological correlates and predictors of the intervention effects.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03123900.

Investigating the effect of physical games on the memory and attention of the elderly in adult day-care centers in Babol and Amol

Background: Physical activity is a behavioral strategy that increases general (public) health, including the mental performance of individuals. The goal of this study was to investigate the effect of group physical games on cognitive performance (memory, attention) of old people in adult day-care centers.

Methods: In this quasi-experimental study, 50 elderly people (aged >60 years) were selected from two adult day-care centers using available sampling and divided into two groups: control and intervention. As approval was received from the Babol Hamrah Salamat adult day-care center to modify the design of the center’s yard, this center was selected to conduct an intervention program. The intervention group received a physical activity program twice a week for 6 weeks. Questionnaires that were used for collecting data included demographic questions, a standard questionnaire for daily activities of living, and a short-term test, the Abbreviated Mental Test Score. Cognitive function was assessed with the Wechsler Memory Scale (WMS) (Form A), before and after the intervention. Statistical analysis of normal variables was performed using independent and paired t-tests and in non-standard cases with Mann–Whitney and Wilcoxon non-parametric tests at a significance level of P<0.05, using SPSS software (version 22).

Results: Statistical analysis showed that the scores of the subjects in the intervention group, compared to the control group, had significantly improved. The calculated mean differences in the intervention groupwere, for memory function d=8.4±3.3 (P=0.001), and for attention and concentration d=4.18±2.38 (P<0.001) (WMS). This level of change in the intervention group was significant.

Conclusion: The results of this study showed that a physical exercise program can improve the memory and attention/concentration of the elderly. Therefore, it seems that such activities are a useful method for maintaining cognitive function.

Psychosocial interventions for people with dementia: a synthesis of systematic reviews

OBJECTIVES

Over the last 10 years there has been a multitude of studies of psychosocial interventions for people with dementia. However, clinical services face a dilemma about which intervention should be introduced into clinical practice because of the inconsistency in some of the findings between different studies and the differences in the study qualities and trustworthiness of evidence. There was a need to provide a comprehensive summary of the best evidence to illustrate what works.

METHODS

A review of the systematic reviews of psychosocial interventions in dementia published between January 2010 and February 2016 was conducted.

RESULTS

Twenty-two reviews (8 physical, 7 cognitive, 1 physical/cognitive and 6 other psychosocial interventions) with a total of 197 unique studies met the inclusion criteria. Both medium to longer-term multi-component exercise of moderate to high intensity, and, group cognitive stimulation consistently show benefits. There is not sufficient evidence to determine whether psychological or social interventions might improve either mood or behaviour due to the heterogeneity of the studies and interventions included in the reviews.

CONCLUSION

There is good evidence that multi-component exercise with sufficient intensity improves global physical and cognitive functions and activities of daily living skills. There is also good evidence that group-based cognitive stimulation improves cognitive functions, social interaction and quality of life. This synthesis also highlights the potential importance of group activities to improve social integration for people with dementia. Future research should investigate longer-term specific outcomes, consider the severity and types of dementia, and investigate mechanisms of change.

Is There a Preferred Mode of Exercise for Cognition Enhancement in Older Age?-A Narrative Review

The aim of this review is to examine the moderating effect of the mode of exercise on the exercise-cognition relationship. Is one mode of exercise more efficient in enhancing cognition than the other? For example, is aerobic exercise preferable over balance training? Based on official guidelines for old age, exercise modes include aerobic activity, strength (resistance) training, flexibility, balance, and coordination. In relation to cognition, these exercise modes are further divided into two categories: physical training—aerobic and strength, and motor training—balance, coordination, and flexibility. The physical training activities are repetitive and automatic in nature, and require high metabolic energy and relatively low neuromuscular effort. The motor activities involve high neuromuscular demands and relatively low metabolic demands. In addition, there are specific movement skills that require more neuromuscular effort (e.g., Tai Chi), and sometimes also greater metabolic demands (e.g., tennis). Selected studies examining the effect of various modes of exercise on cognition contend that both training categories affect neuroplasticity, and consequently cognitive functioning. However, there are two main differences between them: (1) Physical training affects cognition via improvement in cardiovascular fitness, whereas motor training affects cognition directly; (2) Physical training affects neuroplasticity and cognition in a global manner, while motor training is task-specific in increasing brain neuroplasticity and in affecting cognition. Examining the underpinnings of these pathways reveals that there is a difference in the underlying forces behind the two training categories. In the physical training category, it is the intensity of training that enhances neuroplasticity and consequently improves cognition, while in the motor activities it is the task complexity that increases neuroplasticity, which improves cognition. Dual-task training, which includes cognitive demands in addition to physical or motor activity, has proven more effective in improving cognitive functioning than a single task. The implications are that if all training components traditionally recommended by official bodies—physical as well as motor training—are efficient in enhancing cognition, then we merely have to emphasize the inclusion of all exercise modes in our routine exercise regimen for physical as well as cognitive health in advanced age.

Effects of exergame training combined with omega-3 fatty acids on the elderly brain: a randomized double-blind placebo-controlled trial

Background

Older adults often suffer from age- and behavior-related brain changes affecting neuronal functioning and, therefore, cognitive and motor functions. The improvement of these functions might decrease falls and improve mobility. Previous studies indicate that video game-based physical exercise, so-called exergames, or omega-3 fatty acids (FAs) improve motor and cognitive functioning through brain adaptations. The aim of this study was to assess the effects of exergame training combined with fish oil supplementation on neuronal system levels in the brain and behavioral measurements in older adults. We hypothesized that the combination would differently affect these factors compared to the sole administration of exergame.

Methods

Fifty-eight participants were randomly assigned to one of two groups (N = 29 each group) in a parallel, double-blind, randomized controlled trial lasting 26 weeks. The experimental group received daily fish oil, whereas the control group received daily olive oil. After 16 weeks, both groups started with an exergame training. Measurements were performed pre, during, and post intervention. Primary outcomes were recruitment curves using transcranial magnetic stimulation and response-locked potentials using electroencephalography. Secondary outcomes included executive functions and gait parameters. Blood samples were taken to control for FAs.

Results

Forty-three individuals (mean age 69.4 ± 4.6 years) completed the study (N_experimental = 22, N_control = 21). The results showed no significant time × group interaction effects for any parameters. Blood samples demonstrated significant time × group interaction effects. Post-hoc tests showed a significant increase of omega-3 FAs (p < .001) and a significant decrease of omega-6 FAs (p < .001) for the experimental group.

Conclusion

The combination of exergame training and fish oil did not lead to additional beneficial effects. To trigger possible effects, future studies should carefully consider study design aspects; e.g. study duration, individual nutritional supplementation dose, omega-3 FAs supplementation composition, and placebo. Furthermore, studies should consider neuroimaging methods as these might be more sensitive to assess early brain adaptations. Thus, future studies should be aware of several aspects running a combinatory study that includes omega-3 FAs according to their expected effects.

Trial registration

Swiss National Clinical Trials SNCTP000001623 and ISRCTN12084831 registered 30 November 2015.

Synergistic Benefits of Combined Aerobic and Cognitive Training on Fluid Intelligence and the Role of IGF-1 in Chronic Stroke

BACKGROUND

Paired exercise and cognitive training have the potential to enhance cognition by "priming" the brain and upregulating neurotrophins.

METHODS

Two-site randomized controlled trial. Fifty-two patients >6 months poststroke with concerns about cognitive impairment trained 50 to 70 minutes, 3× week for 10 weeks with 12-week follow-up. Participants were randomized to 1 of 2 physical interventions: Aerobic (>60% VO_2peak using <10% body weight-supported treadmill) or Activity (range of movement and functional tasks). Exercise was paired with 1 of 2 cognitive interventions (computerized dual working memory training [COG] or control computer games [Games]). The primary outcome for the 4 groups (Aerobic + COG, Aerobic + Games, Activity + COG, and Activity + Games) was fluid intelligence measured using Raven's Progressive Matrices Test administered at baseline, posttraining, and 3-month follow-up. Serum neurotrophins collected at one site (N = 30) included brain-derived neurotrophic factor (BDNF) at rest (BDNF_resting) and after a graded exercise test (BDNF_response) and insulin-like growth factor-1 at the same timepoints (IGF-1_rest, IGF-1_response).

RESULTS

At follow-up, fluid intelligence scores significantly improved compared to baseline in the Aerobic + COG and Activity + COG groups; however, only the Aerobic + COG group was significantly different (+47.8%) from control (Activity + Games -8.5%). Greater IGF-1_response at baseline predicted 40% of the variance in cognitive improvement. There was no effect of the interventions on BDNF_resting or BDNF_response; nor was BDNF predictive of the outcome.

CONCLUSIONS

Aerobic exercise combined with cognitive training improved fluid intelligence by almost 50% in patients >6 months poststroke. Participants with more robust improvements in cognition were able to upregulate higher levels of serum IGF-1 suggesting that this neurotrophin may be involved in behaviorally induced plasticity.

Simultaneous Aerobic Exercise and Memory Training Program in Older Adults with Subjective Memory Impairments

Background:

Several modifiable lifestyle factors have been shown to have potential beneficial effects in slowing cognitive decline. Two such factors that may affect cognitive performance and slow the progression of memory loss into dementia in older adults are cognitive training and physical activity. There are currently no effective treatments for dementia; therefore, preventative strategies to delay or prevent the onset of dementia are of critical importance.

Objective:

The aim of this study was to determine the relative effectiveness of simultaneous performance of memory training and aerobic exercise to a sequential performance intervention on memory functioning in older adults.

Methods:

55 older adults (aged 60– 75) with subjective memory impairments (non-demented and non-MCI) completed the intervention that consisted of 90-minute small group classes held twice weekly. Participants were randomized to either 4-weeks of supervised strategy-based memory training done simultaneously while stationary cycling (SIM) or sequentially after the stationary cycling (SEQ). Standardized neurocognitive measures of memory, executive functioning, speed of processing, attention, and cognitive flexibility were assessed at baseline and post-intervention.

Results:

The SIM group, but not the SEQ group, had a significant improvement on composite memory following the intervention (t(51) = 2.7, p = 0.01, effect size (ES) = 0.42) and transfer to non-trained reasoning abilities (t(51) = 6.0, ES = 0.49) and complex attention (t(51) = 3.1, p = 0.003, ES = 0.70). Conversely, the SEQ group, but not the SIM, showed significant improvement in executive functioning (t(51) = 5.0, p = 0.0001, ES = 0.96).

Conclusion:

These findings indicate that a 4-week simultaneous memory training and aerobic exercise program is sufficient to improve memory, attention, and reasoning abilities in older adults.

Effects of Hand Exercise on Eating Action in Patients With Alzheimer's Disease

We aim to investigate whether a popular hand exercise could be used to improve the action of eating in patients with Alzheimer's disease (AD). A 6-month intervention was conducted in 60 patients with AD who live in a nursing home. They were divided into hand exercise and control groups. Patients of the control group maintained their daily routine. The improvement of Edinburgh Feeding Evaluation in Dementia scale in hand exercise group was significantly greater than in the control group ( P = .003). Significant differences in time of autonomous eating and time of simulated eating between patients in the hand exercise and control groups ( P < .05) were noted. The improvements in accuracy of eating action and coordination of eating action from baseline were significant in hand exercise group compared to the control group ( P = .020 and .014, respectively). Hand exercise is a safe and effective intervention to improve the feeding and eating of people with AD.

A scoping review of behaviour change theories in adults without dementia to adapt and develop the 'PHYT in dementia', a model promoting physical activity in people with dementia

INTRODUCTION

Research has established that exercise and physical activity can improve executive functioning, independence and quality of life in people with dementia. A dedicated theory explaining behaviour change in relation to physical activity in people with dementia does not exist. We aimed to develop a theoretical model which can be used to inform effective interventions to promote physical activity in people with dementia.

METHODS

There were five phases: 1. A search of the literature to identify theories which have been used to explain behaviour change in relation to physical activity in adult populations without a diagnosis of dementia; 2. Description of the theories (and sub-theories) and their main constructs; 3. Synthesis of the constructs; 4. Adaptation of the constructs to dementia; 5. Development and explanation of a model for physical activity in people with dementia (the 'PHYT in dementia').

RESULTS

We identified nine theories used to explain behaviour change in relation to physical activity in adult populations without a diagnosis of dementia. Through our synthesis, we identified nine umbrella constructs. We integrated three more dementia-relevant constructs and developed the 'PHYT in dementia'. The model was explained by providing a practical example of its application.

DISCUSSION

Based on a scoping review of behaviour change theories in adults without dementia and following adaptation of the constructs from these theories to dementia, we derived a new theoretical model, the 'PHYT in dementia', which includes both individual-level and environment-level constructs. The model needs to be tested empirically, which our research team will do in the process evaluation of the Promoting Activity, Independence and Stability in Early Dementia and Mild Cognitive Impairment (PrAISED 2) study. Results from field-testing will inform refinement of the model.

The Active Ingredient of Cognitive Restoration: A Multicenter Randomized Controlled Trial of Sequential Combination of Aerobic Exercise and Computer-Based Cognitive Training in Stroke Survivors With Cognitive Decline

OBJECTIVE

To investigate the efficacy of a sequential combination of aerobic exercise and cognitive training on cognitive function and other health-related outcomes in stroke survivors with cognitive decline.

DESIGN

Intervention study and randomized controlled trial.

SETTING

Hospital-based rehabilitation units.

PARTICIPANTS

Survivors of stroke with cognitive decline (N=30) were randomized to sequential combination training (SEQ) (n=15) or an active control (n=15) group.

INTERVENTIONS

The SEQ group received 30 minutes of aerobic exercise, followed by 30 minutes of computerized cognitive training. The control group received 30 minutes of nonaerobic physical exercise, followed by 30 minutes of unstructured mental activities.

MAIN OUTCOME MEASURES

The primary outcome measure was cognitive function. Secondary outcome measures included physical function, social participation, and quality of life.

RESULTS

Compared with the control group, the SEQ group had significantly improved Montreal Cognitive Assessment scores (P=.03) and Wechsler Memory Scale span scores (P=.012) after training. The endurance and mobility level measured by the 6-minute walk test (P=.25) was also enhanced in the SEQ group relative to the control group. However, the transfer of sequential training to social participation (Community Integration Questionnaire) and quality of life (EuroQoL questionnaire) was limited (P>.05 for both).

CONCLUSIONS

Aerobic exercise combined with computerized cognitive training has better effects on the cognitive functional status of survivors of stroke than an active control. The cognitive functional status of stroke survivors was better after participation in aerobic exercise combined with computerized training than after active control therapy, demonstrating the clinical significance of this combination therapy.

The quest for synergy between physical exercise and cognitive stimulation via exergaming in people with dementia: a randomized controlled trial

Background

Exercise is often proposed as a non-pharmacological intervention to delay cognitive decline in people with dementia, but evidence remains inconclusive. Previous studies suggest that combining physical exercise with cognitive stimulation may be more successful in this respect. Exergaming is a promising intervention in which physical exercise is combined with cognitively challenging tasks in a single session. The aim of this study was to investigate the effect of exergame training and aerobic training on cognitive functioning in older adults with dementia.

Methods

A three-armed randomized controlled trial (RCT) compared exergame training, aerobic training and an active control intervention consisting of relaxation and flexibility exercises. Individuals with dementia were randomized and individually trained three times a week during 12 weeks. Cognitive functioning was measured at baseline, after the 12-week intervention period and at 24-week follow-up by neuropsychological assessment. The domains of executive function, episodic memory, working memory and psychomotor speed were evaluated. Test scores were converted into standardized z-scores that were averaged per domain. Between-group differences were analysed with analysis of covariance.

Results

Data from 115 people with dementia (mean (SD) age = 79.2 (6.9) years; mean (SD) MMSE score = 22.9 (3.4)) were analysed. There was a significant improvement in psychomotor speed in the aerobic and exergame groups compared to the active control group (mean difference domain score (95% CI) aerobic versus control 0.370 (0.103–0.637), p = 0.007; exergame versus control 0.326 (0.081–0.571), p = 0.009). The effect size was moderate (partial η² = 0.102). No significant differences between the intervention and control groups were found for executive functioning, episodic memory and working memory.

Conclusions

To our knowledge, this is the first RCT evaluating the effects of exergame training and aerobic training on cognitive functioning in people with dementia. We found that both exergame training and aerobic training improve psychomotor speed, compared to an active control group. This finding may be clinically relevant as psychomotor speed is an important predictor for functional decline. No effects were found on executive function, episodic memory and working memory.

Trial registration

Netherlands Trial Register, NTR5581. Registered on 7 October 2015.

Electronic supplementary material

The online version of this article (10.1186/s13195-018-0454-z) contains supplementary material, which is available to authorized users.

Maintain Your Brain: Protocol of a 3-Year Randomized Controlled Trial of a Personalized Multi-Modal Digital Health Intervention to Prevent Cognitive Decline Among Community Dwelling 55 to 77 Year Olds

BACKGROUND

Maintain Your Brain (MYB) is a randomized controlled trial of an online multi-modal lifestyle intervention targeting modifiable dementia risk factors with its primary aim being to reduce cognitive decline in an older age cohort.

METHODS

MYB aims to recruit 8,500 non-demented community dwelling 55 to 77 year olds from the Sax Institute's 45 and Up Study in New South Wales, Australia. Participants will be screened for risk factors related to four modules that comprise the MYB intervention: physical activity, nutrition, mental health, and cognitive training. Targeting risk factors will enable interventions to be personalized so that participants receive the most appropriate modules. MYB will run for three years and up to four modules will be delivered sequentially each quarter during year one. Upon completing a module, participants will continue to receive less frequent booster activities for their eligible modules (except for the mental health module) until the end of the trial.

DISCUSSION

MYB will be the largest internet-based trial to attempt to prevent cognitive decline and potentially dementia. If successful, MYB will provide a model for not just effective intervention among older adults, but an intervention that is scalable for broad use.

Effects of a Cognitive Training With and Without Additional Physical Activity in Healthy Older Adults: A Follow-Up 1 Year After a Randomized Controlled Trial

Background: Combining cognitive training (CT) with physical activity (CPT) has been suggested to be most effective in maintaining cognition in healthy older adults, but data are scarce and inconsistent regarding long-term effects (follow-up; FU) and predictors of success.

Objective: To investigate the 1-year FU effects of CPT versus CT and CPT plus counseling (CPT+C), and to identify predictors for CPT success at FU.

Setting and Participants: We included 55 healthy older participants in the data analyses; 18 participants (CPT group) were used for the predictor analysis.

Interventions: In a randomized controlled trial, participants conducted a CT, CPT, or CPT+C for 7 weeks.

Outcome Measures: Overall cognition, verbal, figural, and working memory, verbal fluency, attention, planning, and visuo-construction.

Results: While within-group comparisons showed cognitive improvements for all types of training, only one significant interaction Group × Time favoring CPT in comparison to CPT+C was found for overall cognition and verbal long-term memory. The most consistent predictor for CPT success (in verbal short-term memory, verbal fluency, attention) was an initial low baseline performance. Lower education predicted working memory gains. Higher levels of insulin-like growth factor 1 (IGF-1) and lower levels of brain-derived neurotrophic factor at baseline (BDNF) predicted alternating letter verbal fluency gains.

Discussion: Within-group comparisons indicate that all used training types are helpful to maintain cognition. The fact that cognitive and sociodemographic data as well as nerve growth factors predict long-term benefits of CPT contributes to the understanding of the mechanisms underlying training success and may ultimately help to adapt training to individual profiles.

Clinical Trial Registration: WHO ICTRP (http://apps.who.int/trialsearch/), identifier DRKS00005194.

The effects of physical exercise on executive function in community-dwelling older adults living with Alzheimer's-type dementia: A systematic review

Executive function deficit is an indicator of Alzheimer's-type dementia and manifests as disruptions of attentional control, memory, cognitive flexibility, planning, and reasoning, among other cognitive problems. Physical exercise is suggested to have a protective effect on global cognition with aging. However, whether it influences executive function in people living with Alzheimer's-type dementia specifically is unknown. The current systematic review examined the efficacy of physical exercise on executive function performance in community-dwelling older adults living with Alzheimer's-type dementia. An electronic search of databases retrieved randomized and non-randomized controlled trials of community-dwelling older adults diagnosed with Alzheimer's-type dementia who completed a physical exercise intervention and who were assessed using an executive function outcome measure. Methodological quality of six studies meeting the inclusion criteria published between 2009 and 2016 was scored independently by two raters using the Physiotherapy Evidence Database and a Cochrane informed domain-based assessment of risk of bias. Trends toward improvement in executive function scores were seen across all six studies, and significant improvement was seen in four of the eligible studies. Future studies should explore the benefits of the American College of Sports Medicine recommended 150 min of physical exercise per week with select measures of executive function.

Making More of IT: Enabling Intensive Motor Cognitive Rehabilitation Exercises in Geriatrics Using Information Technology Solutions

Although the health benefits of physical activity and exercise for older people are well established, a largely sedentary lifestyle still prevails in ageing western societies. Finding new ways to make exercise more accessible and acceptable for older adults must be developed to fully unleash its potential in preventing and weakening age-related physical and cognitive decline. Existing barriers to implement effective exercise-based treatment plans include motivational reservations on both the clinician's and patient's side, but also physical limitations caused by disease or deconditioning. Particularly in the more senior population, debilitating conditions do not allow adherence to currently recommended exercise regimes. A major rethinking of age- and user-adapted exercise is overdue. The high intensities required for physical and mental adaptations must be modifiable and personalized according to the functional status of each patient. Emerging information and communication technologies (ICT) have brought forward a plethora of attractive solutions for smart and adapted exercise, but there remains a vast gap between technological advancement and clinical relevance. Where in the beginning ICT for active ageing mainly focussed on aspects of usability and user experience, the current status of IT as applied in ageing populations noticeably shifted toward new services, applications, and devices that can be offered with the aim to prevent, compensate, care, and/or enhance daily life functioning of senior citizens. In this perspective paper, we aim to summarize the current state of the art in ICT-based interventions aimed at improved motor-cognitive control and make suggestions about how these could be combined with high-intensive interval exercise regimes to make rehabilitation for the impaired older adults more effective, and more fun.

“Shall We Dance?” Older Adults’ Perspectives on the Feasibility of a Dance Intervention for Cognitive Function

We explored perceptions of social dance as a possible intervention to improve cognitive function in older adults with subjective memory complaints. A total of 30 participants (19 females; mean age = 72.6 years; SD = 8.2) took part in the study. This included 21 participants who had self-reported subjective memory complaints and nine spouses who noticed spousal memory loss. Semistructured interviews were conducted, and a thematic analysis was used to analyze the data. Three main themes were constructed: (a) dance seen as a means of promoting social interaction; (b) chronic illness as a barrier and facilitator to participation; and (c) social dance representing nostalgic connections to the past. Overall, the participants were positive about the potential attractiveness of social dance to improve cognitive and social functioning and other aspects of health. In future research, it is important to examine the feasibility of a social dance intervention among older adults with subjective memory complaints.

Technology-based cognitive training and rehabilitation interventions for individuals with mild cognitive impairment: a systematic review

Background

Individuals with mild cognitive impairment (MCI) are at heightened risk of developing dementia. Rapid advances in computing technology have enabled researchers to conduct cognitive training and rehabilitation interventions with the assistance of technology. This systematic review aims to evaluate the effects of technology-based cognitive training or rehabilitation interventions to improve cognitive function among individuals with MCI.

Methods

We conducted a systematic review using the following criteria: individuals with MCI, empirical studies, and evaluated a technology-based cognitive training or rehabilitation intervention. Twenty-six articles met the criteria.

Results

Studies were characterized by considerable variation in study design, intervention content, and technologies applied. The major types of technologies applied included computerized software, tablets, gaming consoles, and virtual reality. Use of technology to adjust the difficulties of tasks based on participants’ performance was an important feature. Technology-based cognitive training and rehabilitation interventions had significant effect on global cognitive function in 8 out of 22 studies; 8 out of 18 studies found positive effects on attention, 9 out of 16 studies on executive function, and 16 out of 19 studies on memory. Some cognitive interventions improved non-cognitive symptoms such as anxiety, depression, and ADLs.

Conclusion

Technology-based cognitive training and rehabilitation interventions show promise, but the findings were inconsistent due to the variations in study design. Future studies should consider using more consistent methodologies. Appropriate control groups should be designed to understand the additional benefits of cognitive training and rehabilitation delivered with the assistance of technology.

Electronic supplementary material

The online version of this article (10.1186/s12877-018-0893-1) contains supplementary material, which is available to authorized users.

A mixed methods systematic review of multimodal non-pharmacological interventions to improve cognition for people with dementia

Objective

Multimodal non-pharmacological interventions have been argued to have the potential to complement current pharmacological approaches to improving quality of life for people living with dementia. The aim of this review was to identify, synthesise and appraise the evidence for the effectiveness of multimodal non-pharmacological interventions for improving cognitive function specifically.

Method

After a comprehensive search strategy including grey literature, 26 studies were reviewed. The inclusion criteria concerned adults with a primary diagnosis of dementia. Studies used two or more different modes of intervention, and measured a cognitive outcome. Due to differences in the conceptualisations of the term ‘multimodal’, a typology of modes and methods was developed to facilitate classification of candidate studies.

Results

Twenty-one group studies and five case studies were found. Group studies used two or three modes of intervention and multiple methods to implement them. Interventions utilised were cognitive, physical, psychological and psychosocial, nutrition, fasting, gut health, sleep hygiene, stress reduction, detoxification, hormonal health and oxygen therapy. Five individual case studies were found in two separate papers. Each personalised patient treatment utilised in-depth assessments and prescribed up to nine different modes. In 19 (90%) of the 21 group comparisons, participants were reported to have cognitive improvements, stability with their dementia or a delay in their decline. The extent of these improvements in terms of meaningful clinical change was variable.

Conclusion

Multimodal non-pharmacological interventions have the potential to complement singular therapeutic approaches by addressing multiple modifiable risk factors currently understood to contribute towards cognitive decline.

Motor-cognitive effects of a computerized game-based training method in people with dementia: a randomized controlled trial

OBJECTIVES

To examine the effects of a computerized, game-based training on motor-cognitive performances, the transfer of training effects on untrained tasks, and the sustainability of training gains in people with dementia.

METHOD

Ninety-nine individuals with a mean age of 82.9 (5.8) and dementia participated in a 10-week randomized controlled trial with three-month follow-up. The intervention group (IG) received a motor-cognitive training on (Physiomat®) including concurrent dual-tasks of balance control with cognitive demands (Physiomat®-Trail Making Tasks (PTMTs)). The control group (CG) performed non-specific, low-intensity exercises. Duration and accuracy at different complexity levels of trained and untrained PTMTs and the number of successfully performed tasks (PTMT score) were assessed.

RESULTS

Physiomat® training significantly improved the duration and accuracy at almost all complexity levels of trained (P ≤ 0.001-0.047, η_p² = 0.065-0.589) and untrained PTMTs (P < 0.001-0.005, η_p² = 0.073-0.459). Significant effects were also found for the PTMT score of trained (P < 0.001, η_p² = 0.211) and untrained PTMTs (P < 0.001, η_p² = 0.184). Training gains were partly sustained at follow-up.

CONCLUSION

Physiomat® is feasible and has the potential to sustainably improve motor-cognitive performances in people with dementia.

The Enhanced Interactive Physical and Cognitive Exercise System (iPACESTM v2.0): Pilot Clinical Trial of an In-Home iPad-Based Neuro-Exergame for Mild Cognitive Impairment (MCI)

Given increasing longevity worldwide, older adults and caregivers are seeking ways to curb cognitive decline especially for those with mild cognitive impairment (MCI, now mild neurocognitive disorder, mNCD, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-V). This quasi-experimental, within-subjects pilot clinical trial was designed to replicate and extend the study of cognitive benefits for MCI by improving upon our prior interactive Physical and Cognitive Exercise Study (iPACESTM v1.0) by increasing the usability of the neuro-exergame and exploring possible underlying neurobiological mechanisms. Older adults were enrolled in a three-month, in-home trial of a portable neuro-exergame (iPACES™ v2.0) where participants pedaled and steered along a virtual bike path (Memory Lane™). Neuropsychological function was assessed at baseline after component familiarization intervals (e.g., two weeks of exercise-only, game-only, etc.) and after three months of interactive neuro-exergame intervention. Fourteen participants were enrolled in the study and seven completed the final evaluation. Intent-to-treat analyses were conducted with imputed missing data (total n = 14). Significant improvement in executive function (Stroop) was found (d = 0.68, p = 0.02) only. Changes in salivary biomarkers (cortisol and insulin-like growth factor 1; IGF-1) were significantly associated with improved cognition. Further research is needed, but pilot data suggest that a portable in-home neuro-exergame may be an additional, practical tool to fight back against cognitive decline and dementia.

Falls prevention through physical and cognitive training (falls PACT) in older adults with mild cognitive impairment: a randomized controlled trial protocol

Background

The presence of mild cognitive impairment (MCI) in older adults increases their fall risk. While physical exercise is effective in reducing falls rate and risk of falls, and cognitive training in improving cognitive functioning in healthy older adults, their effectiveness in preventing falls and reducing risks of falls in MCI when administered simultaneously is not yet established. Therefore, this study aims to determine the effectiveness of combined physical and cognitive training in preventing falls and decreasing risks of falls among community-dwelling older persons with MCI.

Methods/design

This is a single-blind, multicentre, randomized controlled trial. At least ninety-three community-dwelling older adults with MCI aged 60 or above will be recruited. They will be randomly allocated into four groups: Physical Training alone (PT), Cognitive Training alone (CT), combined Physical And Cognitive Training (PACT) and Waitlist Group (WG). The PT group will perform exercises (flexibility, endurance, strengthening, and balance training) for 60–90 min three times per week for 12 weeks. The CT group will be involved in a paper-based training focusing on orientation, memory, attention and executive functioning for 60–90 min per session, once a week for 12 weeks. The PACT group will undergo cognitive training incorporated in physical exercise for 60–90 min three times per week for 12 weeks. The WG will receive the intervention, combined physical and cognitive training, at a later date. Assessors blinded to participant allocation will conduct pre-intervention, post-intervention, and 6-month follow-up assessments. The primary outcome measure will be falls rate. The secondary outcome measures will be Physiologic Profile Assessment and Falls Risk for Older Persons in the Community, and assessments that evaluate cognitive, physical and psychological factors related to falls.

Discussion

Considering the possible physical, social, financial and psychological consequences of a fall, we hope to provide insights on the effectiveness of combining physical and cognitive training on falls and fall-related factors for older adults with MCI. It is projected that the combined interventions will lead to significantly lower falls rate and reduced risk of falls compared to using single or no intervention.

Trial registration

ClinicalTrials.gov NCT03167840. Registered on May 30, 2017.

Psychosocial interventions for Alzheimer's disease cognitive symptoms: a Bayesian network meta-analysis

BACKGROUND

Alzheimer disease (AD) is the most common type of dementia with cognitive decline as one of the core symptoms in older adults. Numerous studies have suggested the value of psychosocial interventions to improve cognition in this population, but which one should be preferred are still matters of controversy. Consequently, we aim to compare and rank different psychosocial interventions in the management of mild to moderate AD with cognitive symptoms.

METHODS

We did a network meta-analysis to identify both direct and indirect evidence in relevant studies. We searched MEDLINE, EMBASE, PsycINFO through the OVID database, CENTRAL through the Cochrane Library for clinical randomized controlled trials investigating psychosocial interventions of cognitive symptoms in patients with Alzheimer disease, published up to August 31, 2017. We included trials of home-based exercise(HE), group exercise(GE), walking program(WP), reminiscence therapy(RT), art therapy(AT) or the combination of psychosocial interventions and acetylcholinesterase inhibitor (ChEIs). We extracted the relevant information from these trials with a predefined data extraction sheet and assessed the risk of bias with the Cochrane risk of bias tool. The outcomes investigated were Mini-Mental State Examination (MMSE) and compliance. We did a pair-wise meta-analysis using the fixed-effects model and then did a random-effects network meta-analysis within a Bayesian framework.

RESULTS

We deemed 10 trials eligible, including 682 patients and 11 treatments. The quality of included study was rated as low in most comparison with Cochrane tools. Treatment effects from the network meta-analysis showed WP was better than control (SMD 4.89, 95% CI -0.07 to 10.00) while cognitive training and acetylcholinesterase inhibitor (CT + ChEIs) was significantly better than the other treatments, when compared with simple ChEIs treatment, assessed by MMSE. In terms of compliance, the pair-wise meta-analysis indicated that WP and HE are better than GE and AT, while CT + ChEIs, CST + ChEIs are better than other combined interventions.

CONCLUSION

Our study confirmed the effectiveness of psychosocial interventions for improving cognition or slowing down the progression of cognitive impairment in AD patients and recommended several interventions for clinical practice.

Effective multicomponent interventions in comparison to active control and no interventions on physical capacity, cognitive function and instrumental activities of daily living in elderly people with and without mild impaired cognition - A systematic review and network meta-analysis

Multicomponent interventions (MCT) combine physical exercises and cognitive training and seem to be most effective in improving cognition in elderly people. However, literature is inconclusive if MCTs are superior to active comparison interventions, if delivery modes matter, and if people can transfer achieved effects to instrumental activities of daily living (IADL). This network meta-analysis aimed to a) identify MCTs that were effective on physical capacity and/or cognitive function and able to transfer these effects into IADL in elderly people with normal cognition (NC) and mild cognitive impairment (MCI); b) provide a rating on the best interventions per outcome; c) evaluate MCTs' mode of delivery. Eligible studies were randomized controlled trials comparing MCTs to active comparison or no treatments. Six studies in participants with MCI (n = 1088) and eleven studies in participants with NC (n = 670) were included. Five effective MCTs that were superior to physical exercises or cognitive training alone in improving physical capacity and/or cognitive function were detected, however none of these MCTs improved IADL. In people with NC MCTs performed separately or simultaneously were effective. However, in people with MCI MCTs performed separately were more effective. A framework needs to be developed to better understand the mediating effects of physical capacity and cognitive function on IADL and to design MCTs that effectively improve IADL.

Effects of combined intervention of physical exercise and cognitive training on cognitive function in stroke survivors with vascular cognitive impairment: a randomized controlled trial

OBJECTIVE:

This study evaluated the possible effect of the combined intervention of physical exercise and cognitive training on cognitive function in stroke survivals with vascular cognitive impairment.

DESIGN:

A single-blind (investigator-blinded but not subject-blinded) randomized controlled trial.

SETTING:

Medical Rehabilitation Center of Shanghai General Hospital, China.

SUBJECTS:

A total of 225 patients (mean age 64.59 years, SD = 4.27) who exhibited vascular cognitive impairment were included in this study.

INTERVENTIONS:

Patients were randomly allocated into one of the four groups: (1) physical exercise ( n = 56; 50-minute session), (2) cognitive training ( n = 57; 60-minute session), (3) combined intervention of physical exercise and cognitive training ( n = 55; 50-minute session + 60-minute session), or (4) control groups ( n = 57; 45-minute session). All participants received training for 36 sessions, three days per week, for 12 weeks.

PRIMARY MEASURES:

Measures were recorded at baseline, after the intervention and at a six-month follow-up. Primary measurements included the Trail Making Part B, Stroop, forward digit span, and mental rotation tests.

RESULTS:

A total of 179 participants (79.56% response rate) completed the study. Cognitive performances on all four tasks in the combined training group improved significantly after the intervention ( P < 0.01). Changes in cognitive performance were greater in the combined intervention group than those in the physical exercise group (e.g. forward digit span, 13.61% vs. 2.18%, P = 0.003), the cognitive training group (e.g. mental rotation, 17.36% vs. 0.87%, P  = 0.002), and the control group (e.g. Stroop, -4.11% vs. -0.72%, P  = 0.026).

CONCLUSION:

The combined intervention produced greater benefits on cognitive function compared to either training alone in stroke survivors with vascular cognitive impairment.

Aging brain: the effect of combined cognitive and physical training on cognition as compared to cognitive and physical training alone - a systematic review

This review presents a critical examination of current knowledge of the impact of combined cognitive and physical training on cognition in healthy elderly subjects. The objectives are to evaluate the contribution of cognitive and physical training to the enhancement of cognition, and to determine the interest of combining these two training types in one intervention in terms of the benefits for cognition (direct and transfer), long-term maintenance, and transfer to daily living. To do so, a systematic electronic search was conducted in PubMed and Google Scholar. Exclusion criteria were animal and pathological aging studies. We focused on the shared and different behavioral impacts of these two types of training on cognition, as well as their functional and structural impact on the brain. The review indicates that both cognitive and physical training have an impact on cognition and on the brain. However, each type of training seems to preferentially enhance different cognitive functions and specifically impact both brain structure and function. Even though some results argue in favor of a complementarity between cognitive and physical training and the superiority of combined cognitive and physical training, the current state of knowledge does not permit any definitive conclusion. Thus, the present review indicates the need for additional investigations.

Thinking-While-Moving Exercises May Improve Cognition in Elderly with Mild Cognitive Deficits: A Proof-of-Principle Study

Background

Noninvasive interventions to aid healthy cognitive aging are considered an important healthcare priority. Traditional approaches typically focus on cognitive training or aerobic exercise training. In the current study, we investigate the effect of exercises that directly combine cognitive and motor functions on visuomotor skills and general cognition in elderly with various degrees of cognitive deficits.

Subjects and Methods

A total of 37 elderly, divided into four groups based on their level of cognition, completed a 16-week cognitive-motor training program. The weekly training sessions consisted of playing a videogame requiring goal-directed hand movements on a computer tablet for 30 minutes. Before and after the training program, all participants completed a test battery to establish their level of cognition and visuomotor skills.

Results

We observed an overall change in visuomotor behavior in all groups, as participants completed the tasks faster but less accurately. More importantly, we observed a significant improvement in measures of overall cognition in the subaverage cognition group and the mild-to-moderate cognitive deficits group.

Conclusion

Our findings indicate that (1) cognitive-motor exercises induce improved test scores, which is most prominent in elderly with only mild cognitive deficits, and (2) cognitive-motor exercises induce altered visuomotor behavior and slight improvements in measures of general cognition.

Physical activity to improve cognition in older adults: can physical activity programs enriched with cognitive challenges enhance the effects? A systematic review and meta-analysis

BACKGROUND

Aging-related cognitive decline and cognitive impairment greatly impacts older adults' daily life. The worldwide ageing of the population and associated wave of dementia urgently calls for prevention strategies to reduce the risk of cognitive decline. Physical activity (PA) is known to improve cognitive function at older age through processes of neuroplasticity. Yet, emerging studies suggest that larger cognitive gains may be induced when PA interventions are combined with cognitive activity (CA). This meta-analysis evaluates these potential synergistic effects by comparing cognitive effects following combined PA + CA interventions to PA interventions (PA only), CA interventions (CA only) and control groups.

METHODS

Pubmed, Embase, PsycInfo, CINAHL and Sportdiscus were searched for English peer-reviewed papers until April 2018. Data were extracted on cognition and factors potentially influencing the cognitive effects: mode of PA + CA combination (sequential or simultaneous), session frequency and duration, intervention length and study quality. Differences between older adults with and without mild cognitive impairments were also explored.

RESULTS

Forty-one studies were included. Relative to the control group, combined PA + CA intervention showed significantly larger gains in cognition (g = 0.316; 95% CI 0.188-0.443; p < .001). Studies that compared combined PA + CA with PA only, showed small but significantly greater cognitive improvement in favor of combined interventions (g = 0.160; 95% CI 0.041-0.279; p = .008). No significant difference was found between combined PA + CA and CA only interventions. Furthermore, cognitive effects tended to be more pronounced for studies using simultaneous designs (g = 0.385; 95%CI 0.214-0.555; p < .001) versus sequential designs (g = 0.114; 95%CI -0.102- 0.331, p = .301). Effects were not moderated by session frequency, session duration, intervention length or study quality. Also, no differences in effects were found between older adults with and without mild cognitive impairments.

CONCLUSION

Findings of the current meta-analysis suggest that PA programs for older adults could integrate challenging cognitive exercises to improve cognitive health. Combined PA + CA programs should be promoted as a modality for preventing as well as treating cognitive decline in older adults. Sufficient cognitive challenge seems more important to obtain cognitive effects than high doses of intervention sessions.

Effects of golf training on cognition in older adults: a randomised controlled trial

BACKGROUND

Although research indicates that a physically active lifestyle has the potential to prevent cognitive decline and dementia, the optimal type of physical activity/exercise remains unclear. The present study aimed to determine the cognitive benefits of a golf-training programme in community-dwelling older adults.

METHODS

We conducted a randomised controlled trial between August 2016 and June 2017 at a general golf course. Participants included 106 Japanese adults aged 65 and older. Participants were randomly assigned to either a 24-week (90-120 min sessions/week) golf-training group or a health education control group. Postintervention changes in Mini-mental State Examination (MMSE) and National Centre for Geriatrics and Gerontology-Functional Assessment Tool scores were regarded as primary outcome measures. Secondary outcome measures included changes in physical performance and Geriatric Depression Scale (GDS) scores.

RESULTS

A total of 100 participants (golf training, n=53; control, n=47) completed the assessments after the 24-week intervention period. The adherence to the golf programme was 96.2% (51/53 participants). Analysis using linear mixed models revealed that the golf training group exhibited significantly greater improvements in immediate logical memory (p=0.033), delayed logical memory (p=0.009) and composite logical memory (p=0.013) scores than the control group. However, no significant changes in MMSE, word memory, Trail Making Test or Symbol Digital Substitution Test scores were observed. In addition, no significant changes in grip strength, walking speed or GDS were observed.

CONCLUSIONS

Golf-based exercise interventions may improve logical memory in older adults, but no significant changes in other cognitive tests. Further follow-up investigations are required to determine whether the observed effects are associated with delayed onset of mild cognitive impairment or Alzheimer's disease in older adults.

TRIAL REGISTRATION NUMBER

UMIN-CTR UMIN000024797; Pre-results.

Therapies for mobility disability in persons with multiple sclerosis

INTRODUCTION

Mobility disability is one of the most widespread and impactful consequences of multiple sclerosis (MS). Disease modifying drugs (DMDs) may delay the progression of disability over time; however, there is minimal evidence supporting the efficacy of DMDs for reversing mobility disability or restoring ambulatory function in persons with MS. Areas covered: This review outlines symptomatic pharmacologic and non-pharmacologic therapeutic approaches that target mobility disability with the goal of restoring and improving walking function. First, the efficacy of dalfampridine, currently the only Food and Drug Administration approved symptomatic pharmacologic agent that improves walking in persons with MS is described. Next, a review of the efficacy of non-pharmacologic therapies for improving walking, including exercise training, physical therapy, and gait training is given. Last, guidance on future research on mobility in MS is provided by emphasizing the importance of combinatory treatment approaches that include multiple intervention modalities, as the best treatment plan likely involves a comprehensive, multidisciplinary approach. Expert commentary: There has been an increased effort to develop symptom-specific treatments in MS that directly target mobility disability; however, more research is needed to determine the efficacy of these rehabilitative strategies alone and together for improving walking in persons with MS.

Relations Between Exercise Habit and Visual Attentional Ability in Older Adult Community Dwellers: Evidences From the Yakumo Study

Objective:

The relation between mild everyday exercise and cognitive ability in healthy older people was examined using cohort study database.

Methods:

Individually calculated linear regression coefficients in digit cancelation task performances for 11 years age from 65 to 75 years were compared between mild exercise habit holders and non-holders.

Results:

Exercise habit holders showed significantly smaller age-related decline than non-holders, irrespective of task difficulty.

Discussion:

The results suggested that even mild exercise habit for long years possesses benefits on sustaining cognitive function in older people as well as the physical activities such as programmed in a sport gym. It also becomes clear that it is difficult for ordinary older adult to continue exercising habits for many years. Therefore, more substantial ways are required for local health officials to advertise the effectiveness of mild exercise habits and to devise the necessary work to become a habit.

Effects of 2-Year Cognitive⁻Motor Dual-Task Training on Cognitive Function and Motor Ability in Healthy Elderly People: A Pilot Study

We aimed to examine the effect of 2-year cognitive⁻motor dual-task (DT) training on cognitive functions and motor ability of healthy elderly people without marked cognitive impairment. From the 25 participants of our 12-week DT trial conducted in 2014, we recruited 8 subjects who voluntarily participated in a new DT training program once a week for 2 years (exercise (EX) group). Their cognitive functions were evaluated by the Modified Mini-Mental State (3MS) examination and the Trail Making Test, and results were compared with those of the 11 subjects who discontinued the training and did not perform any types of exercise for 2 years (non-exercise (NO) group). Subjects in the NO group showed deterioration in the 3MS examination results, especially in the cognitive domain of attention. Meanwhile, participation in DT training maintained the scores in almost all domains of cognitive function, as well as the total 3MS scores. However, both groups had impaired quadriceps muscle strength and motor ability after the 2-year observation period. These results suggest that participating in exercise program comprising DT training for 2 years may be beneficial for maintaining the broad domains of cognitive function in healthy elderly people, although further verification is needed.

The Aerobic and Cognitive Exercise Study (ACES) for Community-Dwelling Older Adults With or At-Risk for Mild Cognitive Impairment (MCI): Neuropsychological, Neurobiological and Neuroimaging Outcomes of a Randomized Clinical Trial

Prior research has found that cognitive benefits of physical exercise and brain health in older adults may be enhanced when mental exercise is interactive simultaneously, as in exergaming. It is unclear whether the cognitive benefit can be maximized by increasing the degree of mental challenge during exercise. This randomized clinical trial (RCT), the Aerobic and Cognitive Exercise Study (ACES) sought to replicate and extend prior findings of added cognitive benefit from exergaming to those with or at risk for mild cognitive impairment (MCI). ACES compares the effects of 6 months of an exer-tour (virtual reality bike rides) with the effects of a more effortful exer-score (pedaling through a videogame to score points). Fourteen community-dwelling older adults meeting screening criteria for MCI (sMCI) were adherent to their assigned exercise for 6 months. The primary outcome was executive function, while secondary outcomes included memory and everyday cognitive function. Exer-tour and exer-score yielded significant moderate effects on executive function (Stroop A/C; d's = 0.51 and 0.47); there was no significant interaction effect. However, after 3 months the exer-tour revealed a significant and moderate effect, while exer-score showed little impact, as did a game-only condition. Both exer-tour and exer-score conditions also resulted in significant improvements in verbal memory. Effects appear to generalize to self-reported everyday cognitive function. Pilot data, including salivary biomarkers and structural MRI, were gathered at baseline and 6 months; exercise dose was associated with increased BDNF as well as increased gray matter volume in the PFC and ACC. Improvement in memory was associated with an increase in the DLPFC. Improved executive function was associated with increased expression of exosomal miRNA-9. Interactive physical and cognitive exercise (both high and low mental challenge) yielded similarly significant cognitive benefit for adherent sMCI exercisers over 6 months. A larger RCT is needed to confirm these findings. Further innovation and clinical trial data are needed to develop accessible, yet engaging and effective interventions to combat cognitive decline for the growing MCI population.

ClinicalTrials.gov ID: NCT02237560

Effects of a 10-week multimodal exercise program on physical and cognitive function of nursing home residents: a psychomotor intervention pilot study

BACKGROUND

Nursing home institutionalization tends to exacerbate loss of functioning.

AIMS

Examine the feasibility and the effect of a psychomotor intervention-a multimodal exercise program promoting simultaneous cognitive and motor stimulation-on the executive (planning ability and selective attention) and physical function of nursing home residents.

METHODS

Seventeen participants engaged in a 10-week multimodal exercise program and 17 maintained usual activities.

RESULTS

Exercise group improved planning ability (25-32%), selective attention (19-67%), and physical function [aerobic endurance, lower body strength, agility, balance, gait, and mobility (19-41%)], corresponding to an effect size ranging from 0.29 (small) to 1.11 (high), p < 0.05.

DISCUSSION

The multimodal exercise program was feasible and well tolerated. The program improved executive and physical functions of the nursing home residents, reverting the usual loss of both cognitive and motor functioning in older adult institutionalized.

CONCLUSIONS

Multimodal exercise programs may help to maintain or improve nursing home residents' functioning.

Hippocampal TET1 and TET2 Expression and DNA Hydroxymethylation Are Affected by Physical Exercise in Aged Mice

The function of 5-hydroxymethylcytosine (5hmC) is poorly understood. 5hmC is an epigenetic modification of DNA, resulting from the oxidation of 5-methylcytosine (5mC) by the Fe2⁺, and 2-oxoglutarate-dependent, 10–11 translocation methylcytosine dioxygenases (TET1, TET2, and TET3). Recent evidence suggests that, in addition to being an intermediate in active demethylation, 5hmC may also have an epigenetic role. 5hmC is enriched in the adult brain, where it has been implicated in regulating neurogenesis. The rate of adult neurogenesis decreases with age, however physical exercise has been shown to counteract this deficit. Here, we investigated the impact of voluntary exercise on the age-related changes of TET1, TET2, expression and 5hmC content in the hippocampus and hypothalamus. For this purpose, we used voluntary exercise in young adult (3 months) and aged (18 months) mice as a rodent model of healthy brain aging. We measured the levels of hippocampal and hypothalamic TET1, TET2 mRNA, and 5hmC and memory [Object Location (OL) test] in mice that either exercised for 1 month or remained sedentary. While aging was associated with decreased TET1 and TET2 expression, voluntary exercise counteracted the decline in expression. Moreover, aged mice that exercised had higher hippocampal 5hmC content in the promoter region of miR-137, an miRNA involved in adult neurogenesis. Exercise improved memory in aged mice, and there was a positive correlation between 5hmC miR-137 levels and performance in the OL test. In the hypothalamus neither exercise nor aging affected TET1 or TET2 expression. These results suggest that exercise partially restores the age-related decrease in hippocampal TET1 and TET2 expression, which may be linked to the improvement in memory. Future studies should further determine the specific genes where changes in 5hmC levels may mediate the exercise-induced improvements in memory and neurogenesis in aged animals.

Mild cognitive impairment in the elderly Relationship between communication and functional capacity

Mild Cognitive Impairment is characterized as an intermediate form between age-related change and dementia. For the elderly, autonomy and independence are related to the ability to remain active in conducting their social activities and, for this to occur, communication is fundamental in this process.

OBJECTIVE

To assess the association between communication and the abilities of elderly people with mild cognitive impairment to perform instrumental activities of daily living.

METHODS

A cross-sectional, quantitative, analytical, correlational study was conducted at the Open University of the Third Age (UnATI), a program of the Federal University of Pernambuco. This study included 92 people, comprising 46 elderly with mild cognitive impairment and a caregiver or family member who met the inclusion criteria. The elderly were asked to complete a sociodemographic questionnaire and Lawton-Brody's Instrumental Activities of Daily Living Scale. The caregivers were asked to complete the Functional Assessment of Communication Skills. The following variables were studied: social communication skills and instrumental activities of daily living. Data were stored in an Excel® 2007 spreadsheet, and the Pearson correlation test was used for the statistical analysis.

RESULTS

There were statistically significant correlations in four domains of social communication: referring to family members by name (p=0.0033); requesting information about people or events (p=0.0355); understanding conversations in a noisy environment (p=0.0448); and understanding what they watch on television or listen to on the radio (p=0.0127).

CONCLUSION

Changes in the communication of elderly people with mild cognitive impairment interfere with their ability to perform instrumental activities autonomously and independently.

Can functional task exercise improve executive function and contribute to functional balance in older adults with mild cognitive impairment? A pilot study

Introduction

Individuals with cognitive impairment are more susceptible to falls associated with decreased executive function and balance. This pilot study investigated whether functional task exercise could improve executive function, which might further affect the functional balance in older adults with mild cognitive impairment.

Method

This was a single-group pre-test/post-test pilot. A total of 43 participants completed a 10-week structured functional task exercise programme, performing simulated functional tasks. Paired-samples t-test was performed to evaluate intervention effects. Associations between variables were examined using Pearson's correlation coefficient. Multiple regression analysis was performed to explore the contribution of cognitive variables to functional balance.

Results

Significant improvements were shown in general cognitive functions, executive function, functional balance and functional status. All executive function outcomes were significantly associated with functional balance. Everyday problem-solving ability was the only significant cognitive contributor ( β = 0.407, p < 0.05) to functional balance after controlling for the confounding factors.

Conclusion

This pilot showed functional task exercise using simulated functional task as a means of intervention was feasible and was associated with observed improvements in executive function and functional balance in older adults with mild cognitive impairment, whereas everyday problem-solving ability was found to be associated with functional balance. Further well-designed controlled studies are needed to draw more definitive conclusions.

The Effects of Combinations of Cognitive Impairment and Pre-frailty on Adverse Outcomes from a Prospective Community-Based Cohort Study of Older Chinese People

Objectives

To examine how various combinations of cognitive impairment (overall performance and specific domains) and pre-frailty predict risks of adverse outcomes; and to determine whether cognitive frailty may be defined as the combination of cognitive impairment and the presence of pre-frailty.

Design

Community-based cohort study.

Participants

Chinese men and women (n = 3,491) aged 65+ without dementia, Parkinson’s disease and/or frailty at baseline.

Measurements

Frailty was characterized using the Cardiovascular Health Study criteria. Overall cognitive impairment was defined by a Cantonese Mini-Mental Status Examination (CMMSE) total score (<21/24/27, depending on participants’ educational levels); delayed recall impairment by a CMMSE delayed recall score (<3); and language and praxis impairment by a CMMSE language and praxis score (<9). Adverse outcomes included poor quality of life, physical limitation, increased cumulative hospital stay, and mortality.

Results

Compared to those who were robust and cognitively intact at baseline, those who were robust but cognitively impaired were more likely to develop pre-frailty/frailty after 4 years (P < 0.01). Compared to participants who were robust and cognitively intact at baseline, those who were pre-frail and with overall cognitive impairment had lower grip strength (P < 0.05), lower gait speed (P < 0.01), poorer lower limb strength (P < 0.01), and poorer delayed recall at year 4 [OR, 1.6; 95% confidence interval (CI), 1.2–2.3]. They were also associated with increased risks of poor quality of life (OR, 1.5; 95% CI, 1.1–2.2) and incident physical limitation at year 4 (OR, 1.8; 95% CI, 1.3–2.5), increased cumulative hospital stay at year 7 (OR, 1.5; 95% CI, 1.1–2.1), and mortality over an average of 12 years (OR, 1.5; 95% CI, 1.0–2.1) after adjustment for covariates. There was no significant difference in risks of adverse outcomes between participants who were pre-frail, with/without cognitive impairment at baseline. Similar results were obtained with delayed recall and language and praxis impairments.

Conclusion

Robust and cognitively impaired participants had higher risks of becoming pre-frail/frail over 4 years compared with those with normal cognition. Cognitive impairment characterized by the CMMSE overall score or its individual domain score improved the predictive power of pre-frailty for poor quality of life, incident physical limitation, increased cumulative hospital stay, and mortality. Our findings support to the concept that cognitive frailty may be defined as the occurrence of both cognitive impairment and pre-frailty, not necessarily progressing to dementia.

Meditation and Music Improve Memory and Cognitive Function in Adults with Subjective Cognitive Decline: A Pilot Randomized Controlled Trial

BACKGROUND

While effective therapies for preventing or slowing cognitive decline in at-risk populations remain elusive, evidence suggests mind-body interventions may hold promise.

OBJECTIVES

In this study, we assessed the effects of Kirtan Kriya meditation (KK) and music listening (ML) on cognitive outcomes in adults experiencing subjective cognitive decline (SCD), a strong predictor of Alzheimer's disease.

METHODS

Sixty participants with SCD were randomized to a KK or ML program and asked to practice 12 minutes/day for 3 months, then at their discretion for the ensuing 3 months. At baseline, 3 months, and 6 months we measured memory and cognitive functioning [Memory Functioning Questionnaire (MFQ), Trail-making Test (TMT-A/B), and Digit-Symbol Substitution Test (DSST)].

RESULTS

The 6-month study was completed by 53 participants (88%). Participants performed an average of 93% (91% KK, 94% ML) of sessions in the first 3 months, and 71% (68% KK, 74% ML) during the 3-month, practice-optional, follow-up period. Both groups showed marked and significant improvements at 3 months in memory and cognitive performance (MFQ, DSST, TMT-A/B; p's≤0.04). At 6 months, overall gains were maintained or improved (p's≤0.006), with effect sizes ranging from medium (DSST, ML group) to large (DSST, KK group; TMT-A/B, MFQ). Changes were unrelated to treatment expectancies and did not differ by age, gender, baseline cognition scores, or other factors.

CONCLUSIONS

Findings of this preliminary randomized controlled trial suggest practice of meditation or ML can significantly enhance both subjective memory function and objective cognitive performance in adults with SCD, and may offer promise for improving outcomes in this population.

A 24-Week Multi-Modality Exercise Program Improves Executive Control in Older Adults with a Self-Reported Cognitive Complaint: Evidence from the Antisaccade Task

Exercise programs involving aerobic and resistance training (i.e., multiple-modality) have shown promise in improving cognition and executive control in older adults at risk, or experiencing, cognitive decline. It is, however, unclear whether cognitive training within a multiple-modality program elicits an additive benefit to executive/cognitive processes. This is an important question to resolve in order to identify optimal training programs that delay, or ameliorate, executive deficits in persons at risk for further cognitive decline. In the present study, individuals with a self-reported cognitive complaint (SCC) participated in a 24-week multiple-modality (i.e., the M2 group) exercise intervention program. In addition, a separate group of individuals with a SCC completed the same aerobic and resistance training as the M2 group but also completed a cognitive-based stepping task (i.e., multiple-modality, mind-motor intervention: M4 group). Notably, pre- and post-intervention executive control was examined via the antisaccade task (i.e., eye movement mirror-symmetrical to a target). Antisaccades are an ideal tool for the study of individuals with subtle executive deficits because of its hands- and language-free nature and because the task's neural mechanisms are linked to neuropathology in cognitive decline (i.e., prefrontal cortex). Results showed that M2 and M4 group antisaccade reaction times reliably decreased from pre- to post-intervention and the magnitude of the decrease was consistent across groups. Thus, multi-modality exercise training improved executive performance in persons with a SCC independent of mind-motor training. Accordingly, we propose that multiple-modality training provides a sufficient intervention to improve executive control in persons with a SCC.

Effects and mechanism of the HECT study (hybrid exercise-cognitive trainings) in mild ischemic stroke with cognitive decline: fMRI for brain plasticity, biomarker and behavioral analysis

Purpose

Cognitive decline after stroke is highly associated with functional disability. Empirical evidence shows that exercise combined cognitive training may induce neuroplastic changes that modulate cognitive function. However, it is unclear whether hybridized exercise-cognitive training can facilitate cortical activity and physiological outcome measures and further influence on the cognitive function after stroke. This study will investigate the effects of two hybridized exercise-cognitive trainings on brain plasticity, physiological biomarkers and behavioral outcomes in stroke survivors with cognitive decline.

Methods and significance

This study is a single-blind randomized controlled trial. A target sample size of 75 participants is needed to obtain a statistical power of 95% with a significance level of 5%. Stroke survivors with mild cognitive decline will be stratified by Mini-Mental State Examination scores and then randomized 1:1:1 to sequential exercise-cognitive training, dual-task exercise-cognitive training or control groups. All groups will undergo training 60 min/day, 3 days/week, for a total of 12 weeks. The primary outcome is the resting-state functional connectivity and neural activation in the frontal, parietal and occipital lobes in functional magnetic resonance imaging. Secondary outcomes include physiological biomarkers, cognitive functions, physical function, daily functions and quality of life. This study may differentiate the effects of two hybridized trainings on cognitive function and health-related conditions and detect appropriate neurological and physiological indices to predict training effects. This study capitalizes on the groundwork for a non-pharmacological intervention of cognitive decline after stroke.

A Six-Month Cognitive-Motor and Aerobic Exercise Program Improves Executive Function in Persons with an Objective Cognitive Impairment: A Pilot Investigation Using the Antisaccade Task

Persons with an objective cognitive impairment (OCI) are at increased risk for progression to Alzheimer's disease and related dementias. The present pilot project sought to examine whether participation in a long-term exercise program involving cognitive-motor (CM) dual-task gait training and aerobic exercise training improves executive function in persons with an OCI. To accomplish our objective, individuals with an OCI (n = 12) as determined by a Montreal Cognitive Assessment (MoCA) score of less than 26 and older adults (n = 11) deemed to be cognitively healthy (i.e., control group: MoCA score ≥26) completed a six-month moderate-to-high intensity (65-85% maximum heart rate) treadmill-based CM and aerobic exercise training program wherein pre- and post-intervention executive control was examined via the antisaccade task. Notably, antisaccades require a goal-directed eye-movement mirror-symmetrical to a target and represent an ideal tool for the study of executive deficits because of its hands- and language-free nature. As well, the cortical networks mediating antisaccades represent regions associated with neuropathology in cognitive decline and dementia (e.g., dorsolateral prefrontal cortex). Results showed that antisaccade reaction times for the OCI group reliably decreased by 30 ms from pre- to post-intervention, whereas the control group did not produce a reliable pre- to post-intervention change in reaction time (i.e., 6 ms). Thus, we propose that in persons with OCI long-term CM and aerobic training improves the efficiency and effectiveness of the executive mechanisms mediating high-level oculomotor control.