A systematic literature review and meta-analysis of real-world interventions for cognitive ageing in healthy older adults

Experiences of older adults participating in dance exergames: A systematic review and meta-synthesis

BACKGROUND

Interventions to encourage adequate physical activity amongst older adults have had limited long-term success. Dancing and exergames, two beneficial and enjoyable physical activities for older adults, may make regular exercise more interesting and effective. Dance exergames are physical exercises that integrate sensory, cognitive, psychological, and physical functions by requiring users to interact with game scenarios through deliberate body motions and receive real-time feedback. They provide an inherently enjoyable gaming and workout experience, which may boost exercise adherence. However, little is known about older adults' experiences with dance exergames.

OBJECTIVE

To synthesise the qualitative experiences of older adults participating in dance exergames.

DESIGN

Systematic review and meta-synthesis.

METHODS

Dance exergame studies (peer-reviewed and grey literature) involving older adults in any setting published in English from inception to 17 August 2023 were included. Qualitative or mixed-method studies must use immersive or non-immersive virtual-reality platforms. PubMed, Scopus, CINAHL, The Cochrane Library, ProQuest Dissertations & Theses Global, Google Scholar, and reference lists of relevant studies and reviews were searched for eligible studies. The search strategy for Scopus was: (TITLE-ABS-KEY (danc*) AND TITLE-ABS-KEY (exergames OR exergame OR video AND games OR virtual AND reality) AND TITLE-ABS-KEY (older AND adults OR elderly OR seniors OR geriatrics)). Thematic synthesis by Thomas and Harden was used for meta-synthesis.

RESULTS

Eleven studies (n = 200 older adults) were included. Three themes and 14 subthemes were synthesised: 1) Dance exergames as dual-task training for physical, cognitive, and psychological well-being, 2) Concerns on usability issues, and 3) Possible enhancements of dance exergames. Older adults recognised that dance exergames could improve their physical, cognitive, and psychological well-being. Existing dance exergame systems had several usability issues. For example, some older adults were unfamiliar with using new technology and had trouble in navigating the game systems. The older adults also provided various suggestions for adaptation to their age group, such as ensuring a variety of dances, difficulty levels suited for older adults' cultural backgrounds, and physical and cognitive capabilities.

CONCLUSIONS

Dance exergames may be an attractive way to encourage older adults to exercise, but appropriate modifications are needed. When designing/selecting dance exergames for older persons, researchers, healthcare professionals, and senior care centres should consider using exergames that have simple designs, varied dances that are locally adapted, and appeal to a large proportion of older adults.

REGISTRATION

PROSPERO CRD42023395709.

Exploring the barriers and facilitators to volunteering as an intervention for those with long-term neurological conditions: How make therapeutic volunteering possible?

BACKGROUND

Volunteering may have therapeutic benefits, but little is known about its requirements and potential for people with neurological conditions (pwNC).

DESIGN

Two separate focus groups were conducted in Darmstadt, Germany: one group consisting of six pwNC and another group consisting of four health care professionals and three volunteering service providers. The focus groups were audio-recorded, transcribed and data were managed using NVivo12. The thematic analysis was applied.

RESULTS

Four main themes were identified: (1) Impact of volunteering, (2) Individualisation, (3) Developmental space and (4) Funded supported volunteering.

CONCLUSION

According to the findings, volunteering can be used as a strategy to enhance physical, mental and social well-being in disease management for people with long-term neurological conditions.

PATIENTS OR PUBLIC CONTRIBUTION

Facilitators for accessibility of therapeutic volunteering; involvement of pwNC.

Altered cortical thickness-based structural covariance networks in type 2 diabetes mellitus

Cognitive impairment is a common complication of type 2 diabetes mellitus (T2DM), and early cognitive dysfunction may be associated with abnormal changes in the cerebral cortex. This retrospective study aimed to investigate the cortical thickness-based structural topological network changes in T2DM patients without mild cognitive impairment (MCI). Fifty-six T2DM patients and 59 healthy controls underwent neuropsychological assessments and sagittal 3-dimensional T1-weighted structural magnetic resonance imaging. Then, we combined cortical thickness-based assessments with graph theoretical analysis to explore the abnormalities in structural covariance networks in T2DM patients. Correlation analyses were performed to investigate the relationship between the altered topological parameters and cognitive/clinical variables. T2DM patients exhibited significantly lower clustering coefficient (C) and local efficiency (Elocal) values and showed nodal property disorders in the occipital cortical, inferior temporal, and inferior frontal regions, the precuneus, and the precentral and insular gyri. Moreover, the structural topological network changes in multiple nodes were correlated with the findings of neuropsychological tests in T2DM patients. Thus, while T2DM patients without MCI showed a relatively normal global network, the local topological organization of the structural network was disordered. Moreover, the impaired ventral visual pathway may be involved in the neural mechanism of visual cognitive impairment in T2DM patients. This study enriched the characteristics of gray matter structure changes in early cognitive dysfunction in T2DM patients.

It's never too late to improvise: The impact of theatre improvisation on elderly population

Despite the availability of improvisational theater training in different settings, studies that assess its effectiveness as a means for enhancing cognitive training for older adults are scarce. This study examines the influence of short theater improvisation exercises on the cognitive flexibility of cognitively-healthy older adults, and their influence on the four core components of improvisation (i.e., spontaneity, flow, creativity, playfulness). The study also examines the correlation between an improvement in these four key agents and an improvement in cognitive flexibility among older adults. This quantitative empirical study was conducted in retirement homes and daycare centers in Israel. A total of 45 participants took part in this study, all in good physical health and with age-appropriate cognitive abilities. The participants were divided into five research groups; each group met twice a week for a one-hour improvisation session over a six-week period. The data was collected through five questionnaires that were completed at four points of time (before, during, and after the workshop). The findings did not indicate a significant effect of the improvisation exercises on the participants' cognitive flexibility, yet they did show improvement in three components of improvisation: spontaneity, flow, playfulness. As such, the findings of this study indicate that despite a normal decline in basic cognitive functioning among older adults, the beneficial effect of improvisation on cognitive flexibility might still occur through spontaneity, playfulness, and flow. In conclusion, short theater improvisation exercises could contribute to various indicators of healthy aging in various settings.

Intrinsic Capacities, Functional Ability, Physiological Systems, and Caregiver Support: A Targeted Synthesis of Effective Interventions and International Recommendations for Older Adults

The ageing population calls for interventions that can assist older people to age healthily. This study aimed to provide a targeted synthesis of high-level research and current evidence-based recommendations on effective interventions for maintaining or preventing the decline in intrinsic capacity, functional ability, and physiological systems, or for caregiver support. Nestled within the healthy ageing framework by the World Health Organization, available evidence was selected in a targeted manner, with the purpose of providing a synthesis that would allow the application of this knowledge in real life. As such, the outcome variables were examined through an Evidence and Gap Map of interventions for functional ability and through guidelines from leading institutions. Systematic reviews, meta-analyses, and guidelines on community-dwelling older adults with or without minor health limitations were considered. Thirty-eight documents were included and over fifty interventions identified. Physical activity interventions were consistently effective across several domains. Recommendations point to screening, whilst highlighting the importance of behavioural factors in the endeavour to age healthily. There is a wide range of activities which are likely to foster healthy ageing. To encourage their uptake, it is important for communities to offer suitable promotion and support, and to make these accessible to the public.

Cognitive Training Effect and Imaging Evidence

Cognitive intervention is a specific form of non-pharmacological intervention used to combat cognitive dysfunction. In this chapter, behavioral and neuroimaging studies about cognitive interventions are introduced. Regarding intervention studies, the form of intervention and the effects of the interventions have been systematically sorted out. In addition, we compared the effects of different intervention approaches, which help people with different cognitive states to choose appropriate intervention programs. With the development of imaging technology, many studies have discussed the neural mechanism of cognitive intervention training and the effects of cognitive intervention from the perspective of neuroplasticity. Behavioral studies and neural mechanism studies are used to improve the understanding of cognitive interventions for the treatment of cognitive impairment.

Possible Association between Physical and Cognitive Function and Stumbling and Falling in Elderly Workers

The aim of this paper is to examine the association between physical and cognitive function and stumbling and falling in elderly workers by conducting work-related questionnaire surveys and physical and cognitive function measurements. A total of 611 men and 121 women aged 40-69 years who participated in physical function measurements between June 2017 and June 2021 were included in the study. The general physical function measurements of upper and lower limb muscle strength, dynamic and static balance, and agility and cognitive function included grip strength, Repeated Rise Test, Trail Making test (TMT), and Three-Meter Time Up Go Test (TUG). We also asked the men and women about their experience of falling and stumbling. Logistic regression analysis showed significant odds ratios (OR) for the associations between stumbling in men and age (OR: 1.98), mental burden (OR: 2.44), frequency of field work (OR: 1.74), seated stepping test count (OR: 0.95), and TMTB time (OR: 0.99). Significant ORs were found between falling in men and age (OR: 2.55), mental burden (OR: 2.40), exercise habits (OR: 2.55), and smoking (OR: 2.00). Significant ORs were found between stumbling in women and d_TUG (OR: 1.59) and mental burden (OR: 6.42). The study suggests that there may be an association between cognitive and physical decline and stumbling and falling in elderly workers.

The Effects of Combined Cognitive-Physical Interventions on Cognitive Functioning in Healthy Older Adults: A Systematic Review and Multilevel Meta-Analysis

Research has shown that both physical exercise and cognitive training help to maintain cognition in older adults. The question is whether combined training might produce additive effects when the group comparisons are equated in terms of exercise intensity and modality. We conducted a systematic electronic search in MEDLINE, PsycInfo, and Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify relevant studies published up to February 2021. Seven hundred and eighty-three effect sizes were obtained from 50 published intervention studies, involving 6,164 healthy older adults, and submitted to a three-level meta-analysis. Results showed that combined training produced a small advantage in comparison to single cognitive training on executive functions, whereas both types of training achieved similar effects on attention, memory, language, processing speed, and global cognition. Combined training achieved higher training gains in balance than single physical training, indicating a transfer from cognitive training to balance. Performing cognitive and physical exercise simultaneously, and interactive training (e.g., exergames, square stepping) produced the largest gains in executive functions, speed, and global cognition, as well as the largest improvements in physical functions. Aerobic training was associated with higher effects in attention and fitness, whereas non-aerobic training produced larger effects in global cognition and balance. For all cognitive and physical outcomes, training resulted more advantageous when performed in a social context, even though individual training obtained similar results in balance as group training.

Systematic Review Registration:www.crd.york.ac.uk/prospero/, identifier: CRD42020175632.

Making the Best Out of IT: Design and Development of Exergames for Older Adults With Mild Neurocognitive Disorder - A Methodological Paper

Background: Utilizing information technology (IT) systems, for example in form of computerized cognitive screening or exergame-based (also called active videogames) training, has gained growing interest for supporting healthy aging and to detect, prevent and treat neurocognitive disorders (NCD). To ameliorate the effectiveness of exergaming, the neurobiological mechanisms as well as the most effective components for exergame-based training remain to be established. At the same time, it is important to account for the end-users' capabilities, preferences, and therapeutic needs during the design and development process to foster the usability and acceptance of the resulting program in clinical practice. This will positively influence adherence to the resulting exergame-based training program, which, in turn, favors more distinct training-related neurobiological effects. Objectives and Methods: This methodological paper describes the design and development process of novel exergame-based training concepts guided by a recently proposed methodological framework: The 'Multidisciplinary Iterative Design of Exergames (MIDE): A Framework for Supporting the Design, Development, and Evaluation of Exergames for Health' (Li et al., 2020). Case Study: A step-by-step application of the MIDE-framework as a specific guidance in an ongoing project aiming to design, develop, and evaluate an exergame-based training concept with the aim to halt and/or reduce cognitive decline and improve quality of life in older adults with mild neurocognitive disorder (mNCD) is illustrated. Discussion and Conclusion: The development of novel exergame-based training concepts is greatly facilitated when it is based on a theoretical framework (e.g., the MIDE-framework). Applying this framework resulted in a structured, iterative, and evidence-based approach that led to the identification of multiple key requirements for the exergame design as well as the training components that otherwise may have been overlooked or neglected. This is expected to foster the usability and acceptance of the resulting exergame intervention in "real life" settings. Therefore, it is strongly recommended to implement a theoretical framework (e.g., the MIDE-framework) for future research projects in line with well-known checklists to improve completeness of reporting and replicability when serious games for motor-cognitive rehabilitation purposes are to be developed.

Using Theories of Behavior Change to Develop Interventions for Healthy Aging

Healthy aging requires people to adopt and maintain beneficial behaviors in all stages of the life span. Supporting behavior change, including via the motivation to make and maintain those changes, is therefore important for the promotion of healthy aging. The aim of this overview is to introduce theoretical frameworks from the psychology of motivation that lend themselves to the development of effective interventions promoting behavior change conducive to healthy aging. We discuss theoretical frameworks referring to the determinants, properties, and functionality of goals aimed at behavior change, and consider the implications of the various theories for designing interventions to support healthy aging. We first consider theories that focus on beliefs and attitudes as determinants of goals, then we address theories that focus on the structure and content as important properties of goals, and, finally, we examine theories drawing on conscious and nonconscious processes underlying the functionality of these goals. We will present if-then planning and mental contrasting, as well as nudging and boosting, that is, novel strategies of behavior change that support the creation of scalable interventions for healthy aging across the life span. Against this background, new perspectives emerge for modern, state-of-the-art, and individually tailored interventions with the aim of enhancing older people's healthy living.

Physical and Cognitive Training to Enhance Intensive Care Unit Survivors' Cognition: A Mapping Review

PURPOSE

The aim of this study was to examine current literature regarding effects of physical or cognitive training and simultaneous (dual-task) physical and cognitive training on cognition in adults surviving an intensive care unit (ICU) stay.

DESIGN

Systematic mapping.

METHODS

A literature search was conducted to examine effects of physical and/or cognitive training on cognitive processes.

RESULTS

Few studies targeted adults surviving ICU. Independently, physical and cognitive interventions improved cognition in healthy older adults with and without cognitive impairment. Simultaneous interventions may improve executive function. Small sample size and heterogeneity of interventions limited the ability to make inferences.

CONCLUSION

Literature supports positive effects of single- and dual-task training on recovering cognition in adults. This training could benefit ICU survivors who need to regain cognitive function and prevent future decline.

RELEVANCE TO PRACTICE

With the growing number of ICU survivors experiencing cognitive deficits, it is essential to develop and test interventions that restore cognitive function in this understudied population.

Opportunities for enhancing brain health across the lifespan

As we age, there are characteristic changes in our thinking, reasoning and memory skills (referred to as cognitive ageing). However, variation between people in the timing and degree of change experienced suggests that a range of factors determine individual cognitive ageing trajectories. This narrative review considers some of the lifestyle factors that might promote (or harm) cognitive health. The focus on lifestyle factors is because these are potentially modifiable by individuals or may be the targets of behavioural or societal interventions. To support that, the review briefly considers people's beliefs and attitudes about cognitive ageing; the nature and timing of cognitive changes across the lifespan; and the genetic contributions to cognitive ability level and change. In introducing potentially modifiable determinants, a framing that draws evidence derived from epidemiological studies of dementia is provided, before an overview of lifestyle and behavioural predictors of cognitive health, including education and occupation, diet and activity.

Learning as an Important Privilege: A Life Span Perspective with Implications for Successful Aging

Research has demonstrated the cognitive and mental health benefits of learning new skills and content across the life span, enhancing knowledge as well as cognitive performance. We argue that the importance of this learning – which is not available equally to all – goes beyond the cognitive and mental health benefits. Learning is important for not only the maintenance, but also enhancement of functional independence in a dynamic environment, such as changes induced by the COVID-19 pandemic and technological advances. Learning difficult skills and content is a privilege because the opportunities for learning are neither guaranteed nor universal, and it requires personal and social engagement, time, motivation, and societal support. This paper highlights the importance of considering learning new skills and content as an <i>important privilege</i> across the life span and argues that this privilege becomes increasingly exclusionary as individuals age, when social and infrastructural support for learning decreases. We highlight research on the potential positive and negative impacts of retirement, when accessibility to learning opportunities may vary, and research on learning barriers due to low expectations and limited resources from poverty. We conclude that addressing barriers to lifelong learning would advance theories on life span cognitive development and raise the bar for successful aging. In doing so, our society might imagine and achieve previously unrealized gains in life span cognitive development, through late adulthood.

Does dance counteract age-related cognitive and brain declines in middle-aged and older adults? A systematic review

BACKGROUND

Dance is a multidomain activity that combines aerobic, coordination and cognitive exercise. This music-associated physical and cognitive exercise is a leisure activity that motivates people, elicits emotions, and avoids boredom, promoting adherence to practice. Continuing physical activity is of paramount importance, since cognitive benefits tend to disappear or even reverse when training ceases.

OBJECTIVE

The question we addressed in this systematic review is what influence dance has on the brain and cognition of healthy middle-aged and older adults.

LITERATURE SURVEY

We systematically reviewed the effects of dance on brain and cognition in older adults using MEDLINE, Psyc-Info, PubMed and Scopus databases.

METHODOLOGY

After screening 1051 studies, thirty-five met the eligibility inclusion criteria. These studies showed that dance improves brain structure and function as well as physical and cognitive functions.

CONCLUSIONS

The protective effect of dance training on cognition in older adults, together with the possibility of adapting intensity and style to suit possible physical limitations makes this activity very suitable for older adults.

Altered Cerebellar-Cerebral Circuits in Patients With Type 2 Diabetes Mellitus

The role of the cerebellum in type 2 diabetes mellitus (T2DM) has been receiving increased attention. However, the functional connectivity (FC) between the cerebellar subregions and the cerebral cortex has not been investigated in T2DM. Therefore, the purpose of this study was to investigate cerebellar-cerebral FC and the relationship between FC and clinical/cognitive variables in patients with T2DM. A total of 34 patients with T2DM and 30 healthy controls were recruited for this study to receive a neuropsychological assessment and undergo resting-state FC. We selected four subregions of the cerebellum (bilateral lobules IX, right and left Crus I/II, and left lobule VI) as regions of interest (ROIs) to examine the differences in cerebellar-cerebral circuits in patients with T2DM compared to healthy controls. Correlation analysis was performed to examine the relationship between FC and clinical/cognitive variables in the patients. Compared to healthy controls, patients with T2DM showed significantly decreased cerebellar-cerebral FC in the default-mode network (DMN), executive control network (ECN), and visuospatial network (VSN). In the T2DM group, the FC between the left cerebellar lobule VI and the right precuneus was negatively correlated with the Trail Making Test A (TMT-A) score (r = −0.430, P = 0.013), after a Bonferroni correction. In conclusion, patients with T2DM have altered FC between the cerebellar subregions and the cerebral networks involved in cognitive and emotional processing. This suggests that a range of cerebellar-cerebral circuits may be involved in the neuropathology of T2DM cognitive dysfunction.

The Global Brain Health Survey: Development of a Multi-Language Survey of Public Views on Brain Health

Background: Brain health is a multi-faceted concept used to describe brain physiology, cognitive function, mental health and well-being. Diseases of the brain account for one third of the global burden of disease and are becoming more prevalent as populations age. Diet, social interaction as well as physical and cognitive activity are lifestyle factors that can potentially influence facets of brain health. Yet, there is limited knowledge about the population's awareness of brain health and willingness to change lifestyle to maintain a healthy brain. This paper introduces the Global Brain Health Survey protocol, designed to assess people's perceptions of brain health and factors influencing brain health.

Methods: The Global Brain Health Survey is an anonymous online questionnaire available in 14 languages to anyone above the age of 18 years. Questions focus on (1) willingness and motivation to maintain or improve brain health, (2) interest in learning more about individual brain health using standardized tests, and (3) interest in receiving individualized support to take care of own brain health. The survey questions were developed based on results from a qualitative interview study investigating brain health perceptions among participants in brain research studies. The survey includes 28 questions and takes 15–20 min to complete. Participants provide electronically informed consent prior to participation. The current survey wave was launched on June 4, 2019 and will close on August 31, 2020. We will provide descriptive statistics of samples distributions including analyses of differences as a function of age, gender, education, country of residence, and we will examine associations between items. The European Union funded Lifebrain project leads the survey in collaboration with national brain councils in Norway, Germany, and Belgium, Brain Foundations in the Netherlands and Sweden, the National University of Ostroh Academy and the Women's Brain Project.

Discussion: Results from this survey will provide new insights in peoples' views on brain health, in particular, the extent to which the adoption of positive behaviors can be encouraged. The results will contribute to the development of policy recommendations for supporting population brain health, including measures tailored to individual needs, knowledge, motivations and life situations.

Investigating associations between personality and the efficacy of interventions for cognitive ageing: A systematic review

The personal and societal impact of age-related cognitive decline supports the development of effective interventions. While some strategies, such as cognitive training, exercise or socio-intellectual engagement, appear beneficial, few studies have examined the association between personality and intervention efficacy. A systematic review was therefore conducted to summarise and synthesise the literature regarding the influence of personality traits on the effectiveness of non-pharmacological interventions for cognitive ageing. A systematic search of PubMed, PsycINFO and Web of Science was carried out. Of the 2100 papers identified by the search strategy, 10 studies were retained that met the relevant criteria (e.g., intervention studies with one or more cognitive outcomes and a measure of personality). Of these, two studies reported that higher levels of Openness to Experience were associated with greater improvement in memory performance after cognitive training interventions. Another found a positive association between Openness and improvement in divergent thinking following a novel group-based problem solving programme. One social intervention study reported positive moderating effects of Conscientiousness and Agreeableness, and mixed effects of Extraversion. Mixed evidence was also found regarding Need for Cognition, with one study reporting a positive association with memory improvement and another reporting less improvement in divergent thinking. Others found no evidence of personality influencing intervention outcomes. Due to the relatively small and heterogeneous sample of studies identified, any conclusions should currently be considered preliminary. These findings highlight the need for further research exploring the role of personality in intervention efficacy, so that interventions might be better tailored to individuals.