Combined physical and cognitive training for older adults with and without cognitive impairment: A systematic review and network meta-analysis of randomized controlled trials

The efficacy of training to improve road safety in elderly pedestrians: A systematic review

Elderly pedestrians are involved in disproportionately more vehicle-pedestrian crashes than younger age groups. Training programs have been found to be effective in training children in pedestrian behaviours that improve their safety, however there is no consensus on whether older adults benefit from training. This systematic review aimed to identify whether training is effective for older adult pedestrians through analysis of training type, modalities, and the lasting effects of training. A systematic search of Medline, PsycINFO, and Scopus was conducted in March 2022 and updated in September 2023. Eight studies met the criteria all of which were high quality. Four distinct training types were found: physical (e.g., training physical strength or balance), behavioural (e.g., training specific pedestrian safety behaviours), cognitive (e.g., training reaction time and executive functioning), and educational (training knowledge about pedestrian safety behaviours). Physical training types were found to be most effective, followed by behavioural, cognitive, and educational respectively. Twelve pedestrian behaviours were measured across the eight studies. Reaction time was the most effectively trained outcome, followed by missed crossing opportunities. Errors of stimuli, median accepted time gap, initiation time and crossing were not effectively trained. The effects of training were maintained at follow-up for missed crossing opportunities only. There was preliminary evidence of potential efficacy of training for specific pedestrian safety behaviours, however, the long-term efficacy of training was not promising. Theory-driven research is needed to better understand why some behaviours are more trainable than others. More research is also needed to determine the real-world generalisability if training is to be recommended for older adult pedestrians.

The Effects of Simultaneous Aerobic Exercise and Video Game Training on Executive Functions and Brain Connectivity in Older Adults

OBJECTIVE

The study was designed to examine the effects of simultaneous combination of aerobic exercise and video game training on executive functions (EFs) and brain functional connectivity in older adults.

DESIGN

A four-armed, quasi-experimental study.

SETTING AND PARTICIPANTS

Community-dwelling adults aged 55 years and older.

METHODS

A total of 97 older adults were divided into one of four groups: aerobic exercise (AE), video game (VG), combined intervention (CI), and passive control (PC). Participants in intervention groups received 32 sessions of training over a 4-month period at a frequency of twice a week. EFs was evaluated using a composite score derived from a battery of neuropsychological tests. The Montreal Cognitive Assessment (MoCA) was employed to evaluate overall cognitive function, while the 6-Minute Walking Test (6MWT) was utilized to gauge physical function. Additionally, the functional connectivity (FC) of the frontal-parietal networks (FPN) was examined as a neural indicator of cognitive processing and connectivity changes.

RESULTS

In terms of EFs, both VG and CI groups demonstrated improvement following the intervention. This improvement was particularly pronounced in the CI group, with a large effect size (Hedge's g = 0.83), while the VG group showed a medium effect size (Hedge's g = 0.56). A significant increase in MoCA scores was also observed in both the VG and CI groups, whereas a significant increase in 6MWT scores was observed in the AE and CI groups. Although there were no group-level changes observed in FC of the FPN, we found that changes in FC was behaviorally relevant as increased FC was associated with greater improvement in EFs.

CONCLUSION

The study offers preliminary evidence that both video game training and combined intervention could enhance EFs in older adults. Simultaneous combined intervention may hold greater potential for facilitating EFs gains. The initial evidence for correlated changes in brain connectivity and EFs provides new insights into understanding the neural basis underlying the training gains.

Computerized cognitive training improves cognitive function in primary breast cancer survivors

Cancer-related cognitive impairment has a significant impact on the quality of life and perceived cognitive ability of breast cancer patients and frequently affects attention, working memory, and executive function. Several interventional approaches to treat these deficits have been studied, including web-based cognitive training, but methods and timing in relation to cancer treatment are heterogeneous. Only few interventions start early after primary breast cancer treatment, a time when many patients report the greatest impairments in quality of life and cognition. In this randomized controlled pilot study, 31 breast cancer survivors with subjective cognitive deficits and a mean post-treatment duration of 6.6 months (SD = 9.3) were assigned to either 14 weeks of a web-based cognitive training program (training group, n = 16) or a control group (n = 15). All patients underwent detailed neuropsychological assessment, evaluation of patient-reported outcomes (PROMs), and neurological examination before (baseline, T1) and after (follow-up, T2) the intervention. Longitudinal (T1 vs. T2) and cross-sectional (T2) cognitive performance was assessed for both groups. Overall cognitive impairment significantly improved in the training group following training (56% vs 25%; p = 0.03, Phi = 0.51), but not in the control group (73% vs. 73%; p = 1) in the longitudinal analysis (T1 vs. T2). Specifically, the training group showed statistically significant improvement of executive functions (p = 0.004, Phi = 0.32). No effects of training on subjective cognitive deficits or PROMs were observed. Comparing cross-sectional cognitive performance at follow-up (T2), the training group showed a significantly lower rate of cognitive impairment overall (p = 0.007, Phi = 0.48) and a better cognitive performance for executive function (p = 0.04, Phi = 0.32) compared to the control group. In this prospective pilot study, web-based cognitive training was efficacious in improving overall cognitive performance and executive function. Importantly, this study investigated a web-based cognitive training for the immediate post-treatment phase, when up to 75% of breast cancer patients experience cognitive decline. These results indicate that cognitive training may improve neuropsychological outcomes for patients with breast cancer.

Effects of nurse-led interventions on the physical and mental health among pre-frail or frail older adults: A systematic review

BACKGROUND

Globally, there is an increase in the number of older people living with frailty, thus effective strategies to prevent and manage frailty are of paramount importance. The effects of nurse-led interventions on the physical and mental health of (pre) frail people have not yet been systematically reviewed.

METHODS

We searched the PubMed, Web of Science, EMBASE, CINAHL, and the Cochrane Library from inception to 8 May 2024. Eligible studies included randomized controlled trials and quasi-experimental trials reporting the effects of nurse-led interventions on physical and mental health outcomes among (pre) frail people. Two researchers independently extracted trial data and assessed the risk of bias by using the risk of bias tool recommended by the Cochrane Back Review Group and the Methodological Index for Non-Randomized Studies.

RESULTS

14 randomized controlled trials and 6 quasi-experimental studies, encompassing 3943 participants, were included in the review. Nurse-led interventions included function-based care (cognitive behavioral therapy, exercise, and multi-domain intervention), personalized integrated care, and advance care planning. The reported outcomes were multiple with most results showing inconsistencies. Overall, function-based care showed more positive effects on physical outcomes (31/37, 84 %) and mental health (11/12, 92 %). However, the effectiveness of existing personalized integrated care and advance care planning might be limited.

CONCLUSIONS

Nurse-led interventions may effectively improve both physical and mental health among (pre) frail older adults, although effectiveness varies by intervention type. Nurses have the potential to play a leading role, both individually and within multidisciplinary teams, in alleviating the rising global burden of frailty. We need more well-designed randomized controlled trials to confirm the effectiveness of nurse-led interventions and identify the most effective type of interventions.

Identifying exercise and cognitive intervention parameters to optimize executive function in older adults with mild cognitive impairment and dementia: a systematic review and meta-analyses of randomized controlled trials

Physical exercise is recognized for its beneficial effects on brain health and executive function, particularly through the careful manipulation of key exercise parameters, including type, intensity, and duration. The aim of this systematic review and meta-analysis was to delineate the optimal types, intensities, and durations of exercise that improve cognitive functions in older adults with mild cognitive impairment (MCI) or dementia. A comprehensive search was conducted in Scopus, Web of Science, and PubMed from their inception until December 2023. The methodological quality and publication bias of the included studies were assessed using the PEDro scale and Egger's regression test, respectively. Separate meta-analyses were performed to assess the overall impact of exercise on cognitive assessments and to explore the effects of different exercise types (i.e., aerobic, resistance, dual-task, mind-body, and multi-component exercises) and intensities (i.e., low, moderate, and high) on executive function. Results were presented as standardized mean differences (SMD) and 95% confidence intervals (95% CI). A meta-regression analysis was conducted to examine the correlation between exercise duration and mean effects. In total, 15,087 articles were retrieved from three databases, of which 35 studies were included in our final analyses. The results indicated high overall methodological quality (PEDro score = 8) but a potential for publication bias (t = 2.08, p = 0.045). Meta-analyses revealed that all types of exercise (SMD = 0.691, CI [0.498 to 0.885], p < 0.001) and intensities (SMD = 0.694, CI [0.485 to 0.903], p < 0.001) show significant effects favoring exercise. Notably, dual-task exercises (SMD = 1.136, CI [0.236 to 2.035], p < 0.001) and moderate-intensity exercises (SMD = 0.876, CI [0.533 to 1.219], p < 0.001) exhibited the greatest effect. No significant correlation was observed between exercise duration and SMD (R² = 0.038, p = 0.313). Overall, our meta-analyses support the role of physical exercise in enhancing executive function in older adults with MCI or dementia. It is essential to carefully tailor exercise parameters, particularly type and intensity, to meet the specific needs of older adults with MCI or dementia. Such customization is crucial for optimizing executive function outcomes and improving overall brain health.

The effect of pre-operative exercise training on post-operative cognitive function: a systematic review

BACKGROUND

With population aging and advances in surgical and anesthetic procedures, the incidence of surgery in patients over the age of 65 years is increasing. One post-operative complication often encountered by older surgical patients is post-operative cognitive dysfunction (POCD). Preoperative exercise training can improve the overall physiological resilience of older surgical patients, yet its impact on post-operative cognition is less well-established.

METHODS

Six databases (Medline (OVID); EMBASE (OVID); EMCARE (OVID); CINAHL (EBSCOHost), the Cochrane Library, and PubMed) were searched for studies reporting the effect of pre-operative physical training on post-operative cognition. The quality of evidence was assessed using the Mixed Methods Assessment Tool.

RESULTS

A total of 3983 studies were initially identified, three of which met the inclusion criteria for this review. Two studies were pilot randomized trials, and one was a prospective randomized trial. Two of the studies were high-quality. Each study used a different type of physical exercise and cognition assessment tool. Across the studies, post-operative cognition (p = 0.005) and attention (p = 0.04) were found to be better in the intervention groups compared to control, with one study reporting no difference between the groups.

CONCLUSION

Preoperative physical training may improve post-operative cognitive function, although more research with a consistent endpoint is required. Future studies should focus on patients at high risk of POCD, such as older adults, and explore the impact of different exercise regimes, including frequency, intensity, time, and type.

Physical exercise for brain plasticity promotion an overview of the underlying oscillatory mechanism

The global recognition of the importance of physical exercise (PE) for human health has resulted in increased research on its effects on cortical activity. Neural oscillations, which are prominent features of brain activity, serve as crucial indicators for studying the effects of PE on brain function. Existing studies support the idea that PE modifies various types of neural oscillations. While EEG-related literature in exercise science exists, a comprehensive review of the effects of exercise specifically in healthy populations has not yet been conducted. Given the demonstrated influence of exercise on neural plasticity, particularly cortical oscillatory activity, it is imperative to consolidate research on this phenomenon. Therefore, this review aims to summarize numerous PE studies on neuromodulatory mechanisms in the brain over the past decade, covering (1) effects of resistance and aerobic training on brain health via neural oscillations; (2) how mind-body exercise affects human neural activity and cognitive functioning; (3) age-Related effects of PE on brain health and neurodegenerative disease rehabilitation via neural oscillation mechanisms; and (4) conclusion and future direction. In conclusion, the effect of PE on cortical activity is a multifaceted process, and this review seeks to comprehensively examine and summarize existing studies' understanding of how PE regulates neural activity in the brain, providing a more scientific theoretical foundation for the development of personalized PE programs and further research.

Components of effective exergame-based training to improve cognitive functioning in middle-aged to older adults - A systematic review and meta-analysis

BACKGROUND

Exergame-based training is currently considered a more promising training approach than conventional physical and/or cognitive training.

OBJECTIVES

This study aimed to provide quantitative evidence on dose-response relationships of specific exercise and training variables (training components) of exergame-based training on cognitive functioning in middle-aged to older adults (MOA).

METHODS

We conducted a systematic review with meta-analysis including randomized controlled trials comparing the effects of exergame-based training to inactive control interventions on cognitive performance in MOA.

RESULTS

The systematic literature search identified 22,928 records of which 31 studies were included. The effectiveness of exergame-based training was significantly moderated by the following training components: body position for global cognitive functioning, the type of motor-cognitive training, training location, and training administration for complex attention, and exercise intensity for executive functions.

CONCLUSION

The effectiveness of exergame-based training was moderated by several training components that have in common that they enhance the ecological validity of the training (e.g., stepping movements in a standing position). Therefore, it seems paramount that future research focuses on developing innovative novel exergame-based training concepts that incorporate these (and other) training components to enhance their ecological validity and transferability to clinical practice. We provide specific evidence-based recommendations for the application of our research findings in research and practical settings and identified and discussed several areas of interest for future research.

PROSPERO REGISTRATION NUMBER

CRD42023418593; prospectively registered, date of registration: 1 May 2023.

Stepping towards health: a scoping review of square-stepping exercise protocols and outcomes in older adults

BACKGROUND

Square-Stepping Exercise (SSE) is a type of physical-cognitive exercise. Such exercise has been used as an exercise approach in different studies with older adults. This scoping review provides an overview of the protocols and outcomes of studies employing the SSE in older adults.

METHODS

We searched in the PubMed, CINAHL, Scopus, CABI Global Health, and Web of Science databases for articles published between 2006 (first research article published on SSE) to December 2023 that met a robust inclusion criterion. The search yielded 424 articles, and after inclusion criteria being applied, 37 articles were included in the final analysis.

RESULTS

A total of 37 studies were included in the final analysis. Thirty-three out of the 37 studies focused on apparently healthy older adults, while four were conducted with older adults with neurological disease (i.e., multiple sclerosis, Parkinson's disease, and stroke). Most studies (n = 25) adopted an experiment (i.e., randomized controlled trial) or quasi-experimental approach, while 12 were classified as non-randomized (i.e., cross-sectional, mixed methods). The studies were conducted in different parts of the globe and adopted three major formats of intervention delivery, namely in-person, online, and home-based. Frequency, SSE session duration and intervention length significantly varied among studies, and reported outcomes were in the domains of physical and cognitive function.

CONCLUSION

This review comprehensively described the characteristics of 37 studies employing SSE in apparently healthy older adults and older adults with neurological diseases. The findings demonstrated that SSE has been used by researchers across the globe, adopting a variety of forms of delivery, and to particularly improve physical and cognitive function of different segments of the older adult population. The review further identified important gaps in research, including the restricted outcomes, and the lack of studies combining SSE with more traditional exercise modalities to address potential combinatory effects.

Acute Effect of Simultaneous Exercise and Cognitive Tasks on Cognitive Functions in Elderly Individuals with Mild Cognitive Impairment

The increasing prevalence of age-related cognitive decline, alongside the aging global population, underscores the urgent need for innovative and effective preventative strategies. While the advantages of combining physical and cognitive exercises have been recognized as a promising approach to address these socioeconomic challenges, the acute effects of such interventions on cognitive functions remain understudied. This study aimed to investigate whether simultaneous physical and cognitive exercise has a greater beneficial impact on the cognitive functions of older adults with mild cognitive impairment (MCI) than physical exercise alone or reading activities. A total of 44 MCI patients (75% females aged between 65 and 75 years) were randomly assigned to one of three groups: aerobic exercise alone (EG group, n = 15), aerobic combined with cognitive exercises (CEG group, n = 15), or a reading task for controls (CG group, n = 14). Attention, memory, and problem solving were assessed before and after the acute intervention using the Tower of Hanoi, Digit Span, and Stroop tasks, respectively. Statistical analysis revealed that both of the experimental interventions appeared to enhance cognitive function scores (p < 0.05), except for the number of moves in the Tower of Hanoi task, where no improvement was noted. In contrast, no significant differences in any cognitive performance measures were observed following the reading session. Notably, the CEG group exhibited a more pronounced positive impact, especially on working memory. This advantage was specifically evident in the digit span tasks, where significantly greater percentage gains were found in the CEG than in the CG (p = 0.02), while no significant difference existed between the EG and CG. Simultaneous combined exercise has proven to be a more effective method than aerobic physical exercise alone for improving cognitive function. The results of this study are recommended for inclusion in clinical practice guidelines to maintain the mental health of older adults, as simultaneous exercise seems to offer a time-efficient strategy to enhance cognitive performance in adults with MCI.

Compared to exercise, the effects of exercise combined with cognitive training in people with mild cognitive impairment: a network meta-analysis

OBJECTIVES

The study aimed to evaluate the relative effectiveness of exercise combined with cognitive training (E&CT) in improving cognitive function compared to exercise alone.

METHOD

PubMed, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, and OpenGrey were systematically searched. Additional screenings were performed by reviewing citations of relevant articles. Studies were included if they met inclusion criteria. Both pairwise and network meta-analyses were performed using a random effects model in Stata 15.0.

RESULTS

Totally, 46 trials from 54 literature (n = 2846) were eligible for inclusion in the meta-analysis. The network meta-analysis indicated that exercise alone was more efficacious than E&CT in improving global cognition and multicomponent exercise exhibited the highest likelihood (SUCRA value= 89.0%) of being the most effective type. Regarding memory function, E&CT presented greater potential than exercise alone, with the interactive modality ranking first (SUCRA value = 88.4%). Multicomponent exercise was identified as the top intervention for enhancing executive function. The overall quality of the included studies was rated as moderate, and the certainty of evidence ranged from low to high.

CONCLUSION

Multicomponent exercise emerged as the optimal intervention for improving global cognition and executive function. Nevertheless, for memory function, the interactive modality of E&CT demonstrated the highest probability of being the most effective choice.

Efficacy of Nonpharmacological Interventions in Cognitive Impairment: Systematic Review And Network Meta-Analysis

INTRODUCTION

There is currently no known cure for cognitive impairment, which highlights the need to explore other ways of managing this condition. This topic has recently become an area of active research. However, the availability of nonpharmacological options poses a challenge when trying to determine the best treatment for improving cognitive function.

METHODS

We conducted a systematic review and a Bayesian network meta-analysis to compare the effects of nonpharmacological interventions on global cognition in patients with mild cognitive impairment and dementia. The nonpharmacological interventions were classified as aerobic exercise, strength exercise, multicomponent physical exercise, other physical exercises, tai chi, mind-body exercises, traditional cognitive rehabilitation, computer-based cognitive rehabilitation, occupational therapy, music therapy, physical-cognitive rehabilitation, and reminiscence therapy.

RESULTS

Physical-cognitive rehabilitation emerged as the most effective nonpharmacological intervention for enhancing global cognition in patients with unspecified cognitive impairment and dementia, whereas occupational therapy focused on dual-task interventions was found to be the most effective nonpharmacological intervention for mild cognitive impairment.

CONCLUSION

These results underscore the importance of adopting a dual approach to managing cognitive impairment, integrating both cognitive and physical rehabilitation within the same intervention.

Associations of parity and cognitive decline, depression, and chronic comorbidity in West China: Results from WCHAT study

OBJECTIVE

To investigate the associations between parity (the number of offspring a female has borne) and cognitive function, depression, and chronic comorbidity in Western China.

METHODS

A total of 846 women aged 50-55 years were included in the current analysis. Cognitive status was measured using a 10-item short portable mental status questionnaire (SPMSQ). Depressive symptoms were assessed using the 15-item geriatric depression scale (GDS-15). Other characteristics were self-reported. The associations between parity and cognitive decline, depression, and chronic comorbidity were analyzed using univariable and multivariable models. Multivariable models were adjusted for age, ethnic group, occupation, marital status, educational level, lifestyle factors, and sleeping time.

RESULTS

Among the enrolled women, 26.71% were either childless or had one child, 47.40% had two children, 18.32% had three children, and 7.57% had ≥4 children. Compared to women with low parity, women with two or more children exhibited a higher risk of cognitive decline. Moreover, having four or more children was significantly associated with depression and chronic comorbidity. After adjusting covariates, women with three or more children exhibited a higher risk of cognitive decline than those with low parity. However, high parity was not significantly associated with depression or chronic comorbidity after adjustment for covariates.

CONCLUSION

Our study showed that ≥3 children was associated with cognitive decline in women. Longitudinal studies are needed to evaluate this conclusion and to investigate the mechanisms involved. More importantly, families and societies should pay more attention to women's long-term health outcomes related to fertility.

PEMOCS: Evaluating the effects of a concept-guided, PErsonalised, MOtor-Cognitive exergame training on cognitive functions and gait in chronic Stroke-study protocol for a randomised controlled trial

BACKGROUND

Many stroke survivors remain with residual cognitive and motor impairments despite receiving timely acute and sub-acute rehabilitation. This indicates that rehabilitation following stroke should be continuous to meet the needs of individual stroke patients. Both cognitive and motor functions are essential for mastering daily life and, therefore, should be aimed at with rehabilitation. Exergames, motor-cognitive exercises performed using video games, are an auspicious method to train both motor and cognitive functions and at the same time may foster the long-term motivation for training. This study aims to assess the effect of concept-guided, personalised, motor-cognitive exergame training on cognitive and motor functions in chronic stroke survivors.

METHODS

This study is a single-blinded, randomised controlled trial. Assessments are performed at baseline, after a 12-week intervention, and at a 24-weeks follow-up. Chronic stroke patients (≥ 18 years old, ≥ 6 months post-stroke) able to stand for 3 min, independently walk 10 m, follow a two-stage command, and without other neurological diseases apart from cognitive deficits or dementia are included. Participants in the intervention group perform the exergame training twice per week for 30 (beginning) up to 40 (end) minutes additionally to their usual care programme. Participants in the control group receive usual care without additional intervention(s). Global cognitive functioning (total Montreal Cognitive Assessment (MoCA) score) is the primary outcome. Secondary outcomes include health-related quality of life, specific cognitive functions, single- and dual-task mobility, and spatiotemporal gait parameters. The target sample size for this trial is 38 participants. Linear mixed models with the post-outcome scores as dependent variables and group and time as fixed effects will be performed for analysis.

DISCUSSION

Superior improvements in global cognitive functioning and in the abovementioned secondary outcomes in the intervention group compared to the control group are hypothesised. The results of this study may guide future design of long-term rehabilitation interventions after stroke.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT05524727). Registered on September 1, 2022.

A glimpse into the future: revealing the key factors for survival in cognitively impaired patients

Background

Drawing on prospective data from the National Health and Nutrition Examination Survey (NHANES), our goal was to construct and validate a 5-year survival prediction model for individuals with cognitive impairment (CI).

Methods

This study entailed a prospective cohort design utilizing information from the 2011-2014 NHANES dataset, encompassing individuals aged 40 years or older, with updated mortality status as of December 31, 2019. Predictive models within the derivation and validation cohorts were assessed using logistic proportional risk regression, column-line plots, and least absolute shrinkage and selection operator (LASSO) binomial regression models.

Results

The study enrolled a total of 1,439 participants (677 men, mean age 69.75 ± 6.71 years), with the derivation and validation cohorts consisting of 1,007 (538 men) and 432 (239 men) individuals, respectively. The 5-year mortality rate stood at 16.12% (n = 232). We devised a 5-item column-line graphical model incorporating age, race, stroke, cardiovascular disease (CVD), and blood urea nitrogen (BUN). The model exhibited an area under the curve (AUC) of 0.772 with satisfactory calibration. Internal validation demonstrated that the column-line graph model displayed strong discrimination, yielding an AUC of 0.733, and exhibited good calibration.

Conclusion

To sum up, our study successfully developed and internally validated a 5-item nomogram integrating age, race, stroke, cardiovascular disease, and blood urea nitrogen. This nomogram exhibited robust predictive performance for 5-year mortality in individuals with CI, offering a valuable tool for prognostic evaluation and personalized care planning.

"Brain-IT": Exergame training with biofeedback breathing in neurocognitive disorders

INTRODUCTION

The combination of exergame-based motor-cognitive training with resonance breathing guided by heart-rate variability biofeedback (HRV-BF) targets various relevant mechanisms of action to alleviate the pathological state in mild neurocognitive disorders (mNCD).

METHODS

This randomized controlled trial (RCT) investigated the effectiveness of adding this novel intervention approach to usual care in mNCD. The individualized intervention was delivered via the "Brain-IT" training concept, which was iteratively co-designed, tested, and refined with patient and public involvement.

RESULTS

We observed statistically significant effects with large effect sizes for global cognitive performance, immediate verbal recall, and delayed verbal recall in favor of the intervention group. Fifty-five percent of participants showed a clinically relevant improvement in response to training.

DISCUSSION

Confirmatory RCTs are warranted to investigate whether the observed improvements in cognitive performance translate to affecting the rates of progression to or onset of dementia and test the implementation of the training in clinical practice.

HIGHLIGHTS

We proposed a novel intervention approach for mild neurocognitive disorders. It combines exergame-based training with biofeedback-guided resonance breathing. Our results confirm the effectiveness of this approach. Fifty-five percent of participants showed a clinically relevant improvement in response to training.

Exergaming and cognitive functions in people with mild cognitive impairment and dementia: a meta-analysis

Exergaming is a combination of exercise and gaming. Evidence shows an association between exercise and cognition in older people. However, previous studies showed inconsistent results on the cognitive benefits of exergaming in people with cognitive impairment. Therefore, this study aims to examine the effect of exergaming intervention on cognitive functions in people with MCI or dementia. A systematic literature search was conducted via OVID databases. Randomized controlled trials (RCTs) examined the effect of an exergaming intervention on cognitive functions in people with MCI or dementia were included. Subgroup analyses were conducted according to the type of intervention and training duration. Twenty RCTs with 1152 participants were identified, including 14 trials for MCI and 6 trials for dementia. In people with MCI, 13 studies used virtual-reality (VR)-based exergaming. Those who received VR-based exergaming showed significantly better global cognitive function [SMD (95%CI) = 0.67 (0.23-1.11)], learning and memory [immediate recall test: 0.79 (0.31-1.27); delayed recall test: 0.75 (0.20-1.31)], working memory [5.83 (2.27-9.39)], verbal fluency [0.58 (0.12-1.03)], and faster in executive function than the controls. For people with dementia, all studies used video-based exergaming intervention. Participants with exergaming intervention showed significantly better global cognitive function than the controls [0.38 (0.10-0.67)]. Subgroup analyses showed that longer training duration generated larger effects. The findings suggest that exergaming impacts cognitive functions in people with MCI and dementia. Cognitive benefits are demonstrated for those with a longer training duration. With technological advancement, VR-based exergaming attracts the attention of people with MCI and performs well in improving cognitive functions.

PEMOCS: theory derivation of a concept for PErsonalized MOtor-Cognitive exergame training in chronic Stroke-a methodological paper with an application example

Background

Coping with residual cognitive and gait impairments is a prominent unmet need in community-dwelling chronic stroke survivors. Motor-cognitive exergames may be promising to address this unmet need. However, many studies have so far implemented motor-cognitive exergame interventions in an unstructured manner and suitable application protocols remain yet unclear. We, therefore, aimed to summarize existing literature on this topic, and developed a training concept for motor-cognitive exergame interventions in chronic stroke.

Methods

The development of the training concept for personalized motor-cognitive exergame training for stroke (PEMOCS) followed Theory Derivation procedures. This comprised (1.1) a thorough (narrative) literature search on long-term stroke rehabilitation; (1.2) a wider literature search beyond the topic of interest to identify analogies, and to induce creativity; (2) the identification of parent theories; (3) the adoption of suitable content or structure of the main parent theory; and (4) the induction of modifications to adapt it to the new field of interest. We also considered several aspects of the "Framework for Developing and Evaluating Complex Interventions" by the Medical Research Council. Specifically, a feasibility study was conducted, and refining actions based on the findings were performed.

Results

A training concept for improving cognitive functions and gait in community-dwelling chronic stroke survivors should consider the principles for neuroplasticity, (motor) skill learning, and training. We suggest using a step-based exergame training for at least 12 weeks, 2-3 times a week for approximately 45 min. Gentile's Taxonomy for Motor Learning was identified as suitable fundament for the personalized progression and variability rules, and extended by a third cognitive dimension. Concepts and models from related fields inspired further additions and modifications to the concept.

Conclusion

We propose the PEMOCS concept for improving cognitive functioning and gait in community-dwelling chronic stroke survivors, which serves as a guide for structuring and implementing motor-cognitive exergame interventions. Future research should focus on developing objective performance parameters that enable personalized progression independent of the chosen exergame type.

Network meta-analysis of non-pharmacological interventions for cognitive impairment after an ischemic stroke

Objective

This study aims to evaluate the effectiveness of non-pharmacological interventions in improving cognitive function in patients with ischemic stroke through network meta-analysis.

Methods

We searched databases including the Cochrane Library, PubMed, EmBase, and Web of Science for randomized controlled trials (RCTs) on non-pharmacological treatments to improve cognitive impairment following ischemic stroke. The publication date was up to 15 March 2023. Due to the insufficiency of included studies, supplementary searches for high-quality Chinese literature were performed in databases such as CNKI, WanFang Data, and VIP Chinese Science Journals Database. Two reviewers independently went through the literature, extracted data, and assessed the risk of bias in the included studies using the risk of bias assessment tool recommended by the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. By utilizing R 4.2.3 RStudio software and the GeMTC package, a Bayesian network meta-analysis was conducted to assess the improvement in Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores under a variety of non-pharmacological interventions.

Results

A total of 22 RCTs involving 2,111 patients and 14 different non-pharmacological treatments were included. These interventions were transcranial direct current stimulation (tDCS), reminiscence therapy (RT), remote ischemic conditioning (RIC), physical fitness training (PFT), intensive patient care program (IPCP), moderate-intensity continuous training + high-intensity interval training (MICT + HIIT), medium intensity continuous training (MICT), grip training (GT), acupuncture, cognitive behavioral therapy (CBT), cognitive rehabilitation training (CRT), high pressure oxygen (HPO), moxibustion, and repetitive transcranial magnetic stimulation (rTMS). The results of the network meta-analysis indicated that rTMS had the highest likelihood of being the most effective intervention for improving MMSE and MoCA scores.

Conclusion

The evidence from this study suggests that rTMS holds promise for improving MMSE and MoCA scores in patients with cognitive impairment following ischemic stroke. However, further high-quality research is needed to confirm and validate this finding.

Effects of computerized cognitive training on functional brain networks in patients with vascular cognitive impairment and no dementia

AIMS

Previous neuroimaging studies of vascular cognitive impairment, no dementia (VCIND), have reported functional alterations, but far less is known about the effects of cognitive training on functional connectivity (FC) of intrinsic connectivity networks (ICNs) and how they relate to intervention-related cognitive improvement. This study provides comprehensive research on the changes in intra- and inter-brain functional networks in patients with VCIND who received computerized cognitive training, with a focus on the underlying mechanisms and potential therapeutic strategies.

METHODS

We prospectively collected 60 patients with VCIND who were randomly divided into the training group (N = 30) receiving computerized cognitive training and the control group (N = 30) receiving fixed cognitive training. Functional MRI scans and cognitive assessments were performed at baseline, at the 7-week training, and at the 6-month follow-up. Utilizing templates for ICNs, the study employed a linear mixed model to compare intra- and inter-network FC changes between the two groups. Pearson correlation was applied to calculate the relationship between FC and cognitive function.

RESULTS

We found significantly decreased intra-network FC within the default mode network (DMN) following computerized cognitive training at Month 6 (p = 0.034), suggesting a potential loss of functional specialization. Computerized training led to increased functional coupling between the DMN and sensorimotor network (SMN) (p = 0.01) and between the language network (LN) and executive control network (ECN) at Month 6 (p < 0.001), indicating compensatory network adaptations in patients with VCIND. Notably, the intra-LN exhibited enhanced functional specialization after computerized cognitive training (p = 0.049), with significant FC increases among LN regions, which correlated with improvements in neuropsychological measures (p < 0.05), emphasizing the targeted impact of computerized cognitive training on language abilities.

CONCLUSIONS

This study provides insights into neuroplasticity and adaptive changes resulting from cognitive training in patients with VCIND, with implications for potential therapeutic strategies.

Effects of Multimodal Exercise With Augmented Reality on Cognition in Community-Dwelling Older Adults

OBJECTIVES

This study aims to investigate the effects of an exercise intervention using multimodal exercise with augmented reality and multimodal exercise-only on cognitive function in older adults living in a community dwelling.

DESIGN

Quasi-experimental research study.

SETTING AND PARTICIPANTS

In this control study, 78 participants were divided into 2 experimental groups (with sessions 3 times a week for 12 weeks) and a control group (CG).

METHODS

EG1 participated in a multimodal exercise-only intervention program, EG2 participated in a multimodal exercise program with augmented reality exergames, and CG continued its usual activities. Participants were assessed at baseline and postintervention after 12 weeks.

RESULTS

Comparison between baseline and postintervention at 12 weeks showed significant improvements in executive functions, verbal fluency, choice reaction time, and dual task in EG1, whereas there were improvements in general cognition, executive functions, verbal fluency, discrimination reaction time, and depression in EG2 (P ≤ .05). The clinical effect sizes of the interventions were large for overall cognition, executive functions, and reaction time on single- and dual-task reaction time in EG1 and for overall cognition, executive functions, and verbal fluency in EG2.

CONCLUSION AND IMPLICATIONS

The intervention programs showed significant improvements in several cognitive domains. The multimodal exercise-only showed improvements in more variables than the multimodal exercise with augmented reality, but the augmented reality group showed greater changes between baseline and postintervention.

Orienteering combines vigorous-intensity exercise with navigation to improve human cognition and increase brain-derived neurotrophic factor

Exercise enhances aspects of human cognition, but its intensity may matter. Recent animal research suggests that vigorous exercise, which releases greater amounts of lactate, activates more brain-derived neurotrophic factor (BDNF) in the hippocampus and, thus, may be optimal for supporting cognitive function. The cognitive benefits of exercise may be further augmented when combined with cognitive training. The sport of orienteering simultaneously combines exercise with spatial navigation and, therefore, may result in greater cognitive benefits than exercising only, especially at vigorous intensities. The present study aimed to examine the effects of an acute bout of orienteering at different intensities on cognition and BDNF compared to exercising only. We hypothesized that vigorous-intensity orienteering would increase lactate and BDNF and improve cognition more than moderate-intensity orienteering or vigorous exercise alone. Sixty-three recreationally active, healthy young adults (Mage = 21.10±2.75 years) with no orienteering experience completed a 1.3 km intervention course by navigating and exercising at a vigorous (80-85% of heart rate reserve) or moderate (40-50% of heart rate reserve) intensity or exercising vigorously without navigation. Exercise intensity was monitored using peak lactate, heart rate and rating of perceived exertion. Serum BDNF was extracted immediately before and after the intervention. Memory was assessed using the Mnemonic Similarity Task (high-interference memory) and the Groton Maze Learning Test (spatial memory). Both exercising and orienteering at a vigorous intensity elicited greater peak lactate and increases in BDNF than moderate-intensity orienteering, and individuals with higher peak lactate also had greater increases in BDNF. High-interference memory improved after both vigorous-intensity interventions but did not improve after the moderate-intensity intervention. Spatial memory only increased after vigorous-intensity orienteering, suggesting that orienteering at a vigorous intensity may particularly benefit spatial cognition. Overall, the results demonstrate the benefits of vigorous exercise on human cognition and BDNF.

Improved intraindividual variability in cognitive performance following cognitive and exercise training in older adults

OBJECTIVE

Increased intraindividual variability (IIV) of cognitive performance is a marker of cognitive decline in older adults. Whether computerized cognitive training (CCT) and aerobic exercise counteracts cognitive decline by reducing IIV is unknown. We investigated the effects of CCT with or without aerobic exercise on IIV in older adults.

METHODS

This was a secondary analysis of an 8-week randomized controlled trial. Older adults (aged 65-85 years) were randomized to CCT alone (n = 41), CCT with aerobic exercise (n = 41), or an active control group (n = 42). The CCT group trained using the Fit Brains® platform 3×/week for 1 hr (plus 3×/week of home-based training). The CCT with aerobic exercise group received 15 min of walking plus 45 min of Fit Brains® 3×/week (plus 3×/week of home-based training). The control group received sham exercise and cognitive training (3×/week for 1 hr). We computed reaction time IIV from the Dimensional Change Card Sort Test, Flanker Inhibitory Control and Attention Test (Flanker), and Pattern Comparison Processing Speed Test (PACPS).

RESULTS

Compared with the control group, IIV reduced in a processing speed task (PACPS) following CCT alone (mean difference [95% confidence interval]: -0.144 [-0.255 to -0.034], p < 0.01) and CCT with aerobic exercise (-0.113 [-0.225 to -0.001], p < 0.05). Attention (Flanker congruent) IIV was reduced only after CCT with aerobic exercise (-0.130 [-0.242 to -0.017], p < 0.05).

CONCLUSIONS

A CCT program promoted cognitive health via reductions in IIV of cognitive performance and combining it with aerobic exercise may result in broader benefits.

Dementia Prevention and Treatment: A Narrative Review

Importance

Dementia affects 10% of those 65 years or older and 35% of those 90 years or older, often with profound cognitive, behavioral, and functional consequences. As the baby boomers and subsequent generations age, effective preventive and treatment strategies will assume increasing importance.

Observations

Preventive measures are aimed at modifiable risk factors, many of which have been identified. To date, no randomized clinical trial data conclusively confirm that interventions of any kind can prevent dementia. Nevertheless, addressing risk factors may have other health benefits and should be considered. Alzheimer disease can be treated with cholinesterase inhibitors, memantine, and antiamyloid immunomodulators, with the last modestly slowing cognitive and functional decline in people with mild cognitive impairment or mild dementia due to Alzheimer disease. Cholinesterase inhibitors and memantine may benefit persons with other types of dementia, including dementia with Lewy bodies, Parkinson disease dementia, vascular dementia, and dementia due to traumatic brain injury. Behavioral and psychological symptoms of dementia are best treated with nonpharmacologic management, including identifying and mitigating the underlying causes and individually tailored behavioral approaches. Psychotropic medications have minimal evidence of efficacy for treating these symptoms and are associated with increased mortality and clinically meaningful risks of falls and cognitive decline. Several emerging prevention and treatment strategies hold promise to improve dementia care in the future.

Conclusions and Relevance

Although current prevention and treatment approaches to dementia have been less than optimally successful, substantial investments in dementia research will undoubtedly provide new answers to reducing the burden of dementia worldwide.

A Two-Phased Pilot Study Evaluating the Feasibility and Acceptability of the Cognitively Enriched Walking Program "Take a Walk with Your Brain" for Older Adults

Given the aging population, finding solutions to retain optimal cognitive capacity is a research priority. The potential of physical activity to reduce the risk of cognitive decline and to enhance cognitive functioning is established. Combining physical with cognitive activity has been put forward as a potentially even more effective way to promote healthy cognitive aging. Most studies on combined interventions have however been conducted in laboratory settings. This paper reports on a two-phased pilot study evaluating the acceptability and feasibility of a newly developed real-life cognitively enriched walking program for adults aged 65+ years. In Phase I, the feasibility and enjoyability of the cognitive tasks was evaluated by conducting walk-along interviews with older adults (n = 163). In Phase II, the cognitively enriched walking program was piloted in two groups of older adults (n = 19), and the feasibility and acceptability of the program and cognitive tasks was evaluated by means of questionnaires and focus groups. The cognitive tasks (i.e., median scores of ≥3 on a total of 4 (Phase I) and ≥6 on a total of 10 (Phase II) for most of the tasks) and the cognitively enriched walking program (i.e., median scores of ≥7 on a total of 10) were considered feasible and acceptable. Based on the input of the participants, key considerations for a feasible and acceptable program were defined: participants should be sufficiently challenged cognitively and physically, social interaction is an important motivator, cognitive tasks should make use of stimuli reflecting daily life and be conducted in group, the rationale for the tasks should be explained to participants, the frequency of the group sessions should be maximum 2 times a week, and the program should be supervised by a trained coach. These results warrant future research to establish the effectiveness of this program.

Efficacy of dual-task augmented reality rehabilitation in non-hospitalized adults with self-reported long COVID fatigue and cognitive impairment: a pilot study

BACKGROUND

Cognitive impairment and chronic fatigue represent common characteristics of the long COVID syndrome. Different non-pharmacological treatments have been proposed, and physiotherapy has been proposed to improve the symptoms. This study aimed to evaluate the effects of a dual-task augmented reality rehabilitation protocol in people with long COVID fatigue and cognitive impairment.

METHODS AND MATERIALS

Ten non-hospitalized adults with reported fatigue and "brain fog" symptoms after COVID (7/10 females, 50 years, range 41-58) who participated in 20 sessions of a 1-h "dual-task" training, were compared to 10 long COVID individuals with similar demographics and symptoms (9/10 females, 56 years, range 43-65), who did not participate to any rehabilitation protocol. Cognitive performance was assessed with the Trail Making Test (TMT-A and -B) and Frontal Assessment Battery (FAB), and cardiovascular and muscular fatigue were assessed with the fatigue severity scale (FSS), six-minute walking test and handgrip endurance. Finally, transcranial magnetic stimulation (TMS) investigated cortical excitability.

RESULTS

The mixed-factors analysis of variance found a significant interaction effect only in cognitive performance evaluation, suggesting TMT-B execution time decreased (- 15.9 s, 95% CI 7.6-24.1, P = 0.001) and FAB score improved (1.88, 95% CI 2.93-0.82, P = 0.002) only in the physiotherapy group. For the remaining outcomes, no interaction effect was found, and most parameters similarly improved in the two groups.

CONCLUSION

The preliminary results from this study suggest that dual-task rehabilitation could be a feasible protocol to support cognitive symptoms recovery after COVID-19 and could be helpful in those individuals suffering from persisting and invalidating symptoms.

Cognitive and physical declines and falls in older people with and without mild cognitive impairment: a 7-year longitudinal study

OBJECTIVES

We examined longitudinal changes in cognitive and physical function and associations between change in function and falls in people with and without mild cognitive impairment (MCI).

DESIGN

Prospective cohort study with assessments every 2 years (for up to 6 years).

SETTING

Community, Sydney, Australia.

PARTICIPANTS

Four hundred and eighty one people were classified into three groups: those with MCI at baseline and MCI or dementia at follow-up assessments (n = 92); those who fluctuated between cognitively normal and MCI throughout follow-up (cognitively fluctuating) (n = 157), and those who were cognitively normal at baseline and all reassessments (n = 232).

MEASUREMENTS

Cognitive and physical function measured over 2-6 years follow-up. Falls in the year following participants' final assessment.

RESULTS

In summary, 27.4%, 38.5%, and 34.1% of participants completed 2, 4, and 6 years follow-up of cognitive and physical performance, respectively. The MCI and cognitive fluctuating groups demonstrated cognitive decline, whereas the cognitively normal group did not. The MCI group had worse physical function than the cognitively normal group at baseline but decline over time in physical performance was similar across all groups. Decline in global cognitive function and sensorimotor performance were associated with multiple falls in the cognitively normal group and decline in mobility (timed-up-and-go test) was associated with multiple falls across the whole sample.

CONCLUSIONS

Cognitive declines were not associated with falls in people with MCI and fluctuating cognition. Declines in physical function were similar between groups and decline in mobility was associated with falls in the whole sample. As exercise has multiple health benefits including maintaining physical function, it should be recommended for all older people. Programs aimed at mitigating cognitive decline should be encouraged in people with MCI.

The effects of a new immersive multidomain training on cognitive, dual-task and physical functions in older adults

The aim of this study was to assess the potential of multidomain training using Immersive and Interactive Wall Exergames (I2WE) to improve the cognitive and physical functions of older adults. This new generation of exergames offers specific advantageous characteristics (e.g., immersion, virtual cognitive solicitation, high physical stimulation, complex motor skills, multiple social interactions) that could make I2WE an enjoyable multidomain training medium for older adults. A pilot study was set up with 34 participants (M = 69.91 years old). It used the pre-tests - training (3 months, 2 one-hour sessions per week for the 2 groups) - post-tests method to compare: a) the cognitive and the Dual-Task (DT) effects (primary outcomes), b) the physical effects and perceived pleasure (secondary outcomes) between an experimental group following an I2WE program (n = 19) to an active control group performing a Walking and Muscle-Strengthening (WMS) program (n = 15). While visuospatial short-term memory was improved for both groups, only I2WE training enhanced visuospatial working memory, inhibition, and DT. All physical functions, except upper body strength, were enhanced for the 2 groups. The perceived pleasure was higher for the I2WE group than the WMS group. The results of this first study have important clinical implications, showing that I2WE can optimize strategies to improve older adults' physical and cognitive health. Virtual and immersive cognitive stimulation combined with varied physical activity (i.e., aerobic, muscle-strengthening, complex motor skills) appear to be major assets of these new exergames. Moreover, the high level of perceived pleasure to I2WE makes it a promising tool for engaging older adults in sustained multidomain practice.

Systematic Review of Longitudinal Evidence and Methodologies for Research on Neighborhood Characteristics and Brain Health

Objective: Synthesize longitudinal research evaluating neighborhood environments and cognition to identify methodological approaches, findings, and gaps. Methods: Included studies evaluated associations between neighborhood and cognition longitudinally among adults >45 years (or mean age of 65 years) living in developed nations. We extracted data on sample characteristics, exposures, outcomes, methods, overall findings, and assessment of disparities. Results: Forty studies met our inclusion criteria. Most (65%) measured exposure only once and a majority focused on green space and/or blue space (water), neighborhood socioeconomic status, and recreation/physical activity facilities. Similarly, over half studied incident impairment, cognitive function or decline (70%), with one examining MRI (2.5%) or Alzheimer's disease (7.5%). While most studies used repeated measures analysis to evaluate changes in the brain health outcome (51%), many studies did not account for any type of correlation within neighborhoods (35%). Less than half evaluated effect modification by race/ethnicity, socioeconomic status, and/or sex/gender. Evidence was mixed and dependent on exposure or outcome assessed. Conclusion: Although longitudinal research evaluating neighborhood and cognitive decline has expanded, gaps remain in types of exposures, outcomes, analytic approaches, and sample diversity.

Association between dynapenia and cognitive decline in community-dwelling older Japanese adults: The IRIDE Cohort Study

AIM

Muscle mass and strength correlate with cognitive function; however, it remains unclear whether dynapenia (i.e., muscle weakness with preserved muscle mass) is relevant. This study aimed to explore whether dynapenia is associated with global cognitive function in community-dwelling older Japanese adults.

METHODS

This cross-sectional study used data from the Integrated Research Initiative for Living Well with Dementia Cohort Study, which pooled data from five community-based geriatric cohorts. Dynapenia was defined as muscle weakness without muscle mass loss according to the Asian Working Group for Sarcopenia criteria. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). An ordered logistic regression analysis was conducted with dynapenia as the exposure and with cognitive decline stages, defined as an MMSE score of 27-30 for normal cognition, 24-26 for possible cognitive decline, and <24 for cognitive decline, as the outcome, stratified by sex and adjusted for age, muscle mass, education, alcohol consumption, smoking habits, living alone, and non-communicable diseases.

RESULTS

We analyzed data for 3338 participants (2162 female) with preserved muscle mass. Of these, 449 (13.5%) had dynapenia, and 79 (2.4%) exhibited cognitive decline. Multivariate odds ratios (95% confidence interval) for cognitive decline among those with dynapenia, compared with those without dynapenia, were 1.51 (1.02-2.24) for males and 2.08 (1.51-2.86) for females.

CONCLUSIONS

Muscle weakness is associated with cognitive decline, even in individuals with preserved muscle mass. Further studies are needed to better understand the association between muscle weakness and cognitive decline over time in order to develop dementia prevention strategies for those with dynapenia. Geriatr Gerontol Int 2024; 24: 123-129.

Development of a Cognitive Training Support Programme for prevention of dementia and cognitive decline in at-risk older adults

Background

Evidence for the beneficial effects of cognitive training on cognitive function and daily living activities is inconclusive. Variable study quality and design does not allow for robust comparisons/meta-analyses of different cognitive training programmes. Fairly low adherence to extended cognitive training interventions in clinical trials has been reported.

Aims

The aim of further developing a Cognitive Training Support Programme (CTSP) is to supplement the Computerised Cognitive Training (CCT) intervention component of the multimodal Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), which is adapted to different cultural, regional and economic settings within the Word-Wide FINGERS (WW-FINGERS) Network. The main objectives are to improve adherence to cognitive training through a behaviour change framework and provide information about cognitive stimulation, social engagement and lifestyle risk factors for dementia.

Methods

Six CTSP sessions were re-designed covering topics including (1) CCT instructions and tasks, (2) Cognitive domains: episodic memory, executive function and processing speed, (3) Successful ageing and compensatory strategies, (4) Cognitive stimulation and engagement, (5) Wellbeing factors affecting cognition (e.g., sleep and mood), (6) Sensory factors. Session content will be related to everyday life, with participant reflection and behaviour change techniques incorporated, e.g., strategies, goal-setting, active planning to enhance motivation, and adherence to the CCT and in relevant lifestyle changes.

Conclusions

Through interactive presentations promoting brain health, the programme provides for personal reflection that may enhance capability, opportunity and motivation for behaviour change. This will support adherence to the CCT within multidomain intervention trials. Efficacy of the programme will be evaluated through participant feedback and adherence metrics.

Early prediction of mastery of a computerized functional skills training program in participants with mild cognitive impairment

BACKGROUND

Cognition in MCI has responded poorly to pharmacological interventions, leading to use of computerized training. Combining computerized cognitive training (CCT) and functional skills training software (FUNSAT) produced improvements in 6 functional skills in MCI, with effect sizes >0.75. However, 4% of HC and 35% of MCI participants failed to master all 6 tasks. We address early identification of characteristics that identify participants who do not graduate, to improve later interventions.

METHODS

NC participants (n = 72) received FUNSAT and MCI (n = 92) participants received FUNSAT alone or combined FUNSAT and CCT on a fully remote basis. Participants trained twice a week for up to 12 weeks. Participants "graduated" each task when they made one or fewer errors on all 3-6 subtasks per task. Tasks were no longer trained after graduation.

RESULTS

Between-group comparisons of graduation status on baseline completion time and errors found that failure to graduate was associated with more baseline errors on all tasks but no longer completion times. A discriminant analysis found that errors on the first task (Ticket purchase) uniquely separated the groups, F = 41.40, p < .001, correctly classifying 94% of graduators. An ROC analysis found an AUC of .83. MOCA scores did not increase classification accuracy.

CONCLUSIONS

More baseline errors, but not completion times, predicted failure to master all FUNSAT tasks. Accuracy of identification of eventual mastery was exceptional. Detection of risk to fail to master training tasks is possible in the first 15 minutes of the baseline assessment. This information can guide future enhancements of computerized training.

A 10-week intergenerational program bringing together community-living older adults and preschool children (INTERACTION): a pilot feasibility non-randomised clinical trial

BACKGROUND

Social isolation and low levels of physical activity are strong drivers for frailty, which is linked to poor health outcomes and transition to long-term care. Frailty is multifactorial, and thus an integrated approach is needed to maintain older adults' health and well-being. Intergenerational programs represent a novel multifactorial approach to target frailty, social isolation and physical decline but these have not yet been rigorously tested in Australia. Here, we present the results of our pilot study which aimed to test the feasibility of a 10-week intergenerational program between older adults and preschool children.

METHODS

A non-randomised wait-listed controlled trial was conducted. Participants were allocated to either the intervention or wait-list control group. The intervention group received 10 weekly 2-h intergenerational sessions led by trained child educators; the control group continued with their usual routine and received their intergenerational program after the 10-week control period. All participants were assessed at baseline and 10 weeks. The primary outcome was the feasibility and acceptability of the program including measures of recruitment eligibility, adherence and effective data collection across the multiple domains important for frailty, including functional mobility and balance, grip strength, cognitive function, mood, social engagement, quality of life and concerns about falling.

RESULTS

Nineteen adults were included, with nine in the intervention and ten in the control group. A total of 42% of older adults screened were eligible, 75% of participants were present at each intervention session and the overall attrition rate was 21% (n = 4). The reasons for participant absence were primarily health-related. Missing data was minimal for the majority of assessments but more apparent for the cognitive testing where completion rates ranged from 53 to 79% for baseline tests and 73 to 100% for those who received follow-up testing.

CONCLUSIONS

The high program compliance and low attrition show that a 10-week intergenerational program embedded in the local community, designed for community-living older adults and preschool children, is feasible and acceptable to older adults. Our next trial will test the efficacy of intergenerational programs in this setting.

Motor learning in golf-a systematic review

Golf is a sport that consists of complex movement skills that need to be executed with utmost precision. Consequently, motor skill learning plays a crucial role in golf, and large numbers of studies address various methods of motor learning. In the present review, we give a systematic overview of randomized controlled trials (RCTs) on motor learning of golf-specific motor skills. Three electronic databases were searched for RCTs looking at the effect of at least one learning method on performance in a golf-specific motor task. We grouped the studies depending on the learning strategies "cognitive training", "practice scheduling", "augmented feedback", "implicit and explicit learning" and "focus of attention". Fifty-two RCTs met the eligibility criteria and were included in the systematic review. Superior methods within their respective strategies were an external focus of attention and increasing contextual interference, as well as errorless learning. For "cognitive training" and "augmented feedback", no single method can be considered the most favorable. The overall biggest limitations were the lack of statistical power for more than half of the RCTs, and the fact that most studies of the present review investigated simple putting tasks in novices only. Although we have shown superiority of specific learning methods, transferability of the recommendations that can be derived from simple golf tasks in novices to sport-specific tasks in advanced players still has to be demonstrated and require study designs with the intention to provide practical recommendations for coaches and athletes in the sport of golf.

Cognitive-exercise dual-task attenuates chronic cerebral ischemia-induced cognitive impairment by activating cAMP/PKA pathway through inhibiting EphrinA3/EphA4

BACKGROUND

The prevalence of vascular cognitive impairment induced by chronic cerebral ischemia (CCI) is increasing year by year. Cognitive-exercise dual-task intervention has shown beneficial effects on improving cognitive performance in ischemic patients. It is well known that the tyrosine kinase ligand-receptor (Ephrin-Eph) system plays an important role in synaptic transmission and that the cAMP/PKA pathway is associated with cognitive function. However, it is unclear whether they are responsible for the dual-task improving cognitive impairment in CCI.

METHODS

Bilateral common carotid artery occlusion (BCCAO) in SD rats was used to establish the CCI model. The effects of dual-task and single-task on cognitive function and the expressions of EphrinA3, EphA4, cAMP, and PKA in rats were detected by the novel object recognition (NOR) test, immunofluorescence staining, quantitative real-time polymerase chain reaction (qPCR), and Western blotting (WB), respectively. Overexpression or knockdown of EphrinA3 in astrocytes or rats were constructed by lentivirus infection to verify the effects of EphrinA3/EphA4 on the cAMP/PKA pathway.

RESULTS

After dual-task intervention, the discrimination index of rats increased significantly compared with the rats in the CCI group. The expressions of EphrinA3 and EphA4 were decreased, while the expressions of cAMP and PKA were increased. Furthermore, knockdown of EphrinA3 alleviated the trend of CCI-induced cognitive decline in rats and OGD-stimulated cellular damage. It also increased cAMP/PKA expression in hippocampal neurons.

CONCLUSION

Cognitive-exercise dual-task can significantly improve the cognitive impairment induced by CCI, and this effect may be better than that of the cognitive or exercise single-task intervention. The improvement may be related to the inhibition of EphrinA3/EphA4, followed by activation of the cAMP/PKA pathway.

Mid-Term and Long-Lasting Psycho-Cognitive Benefits of Bidomain Training Intervention in Elderly Individuals with Mild Cognitive Impairment

Background: This study investigated whether combining simultaneous physical and cognitive training yields superior cognitive outcomes compared with aerobic training alone in individuals with mild cognitive impairment (MCI) and whether these benefits persist after four weeks of detraining. Methods: Forty-four people with MCI (11 males and 33 females) aged 65 to 75 years were randomly assigned to an 8-week, twice-weekly program of either aerobic training (AT group, n = 15), aerobic training combined with cognitive games (ACT group, n = 15), or simply reading for controls (CG group, n = 14). Selective attention (Stroop), problem-solving (Hanoi Tower), and working memory (Digit Span) tasks were used to assess cognitive performances at baseline, in the 4th (W4) and 8th weeks (W8) of training, and after 4 weeks of rest (W12). Results: Both training interventions induced beneficial effects on all tested cognitive performance at W4 (except for the number of moves in the Hanoi tower task) and W8 (all p <0.001), with the ACT group exhibiting a more pronounced positive impact than the AT group (p < 0.05). This advantage was specifically observed at W8 in tasks such as the Stroop and Tower of Hanoi (% gain ≈40% vs. ≈30% for ACT and AT, respectively) and the digit span test (% gain ≈13% vs. ≈10% for ACT and AT, respectively). These cognitive improvements in both groups, with the greater ones in ACT, persisted even after four weeks of detraining, as evidenced by the absence of a significant difference between W8 and W12 (p > 0.05). Concerning neuropsychological assessments, comparable beneficial effects were recorded following both training regimens (all p < 0.05 from pre- to post-intervention). The control group did not show any significant improvement in most of the cognitive tasks. Conclusions: The greater mid-term and long-lasting effects of combined simultaneous physical-cognitive training underscores its potential as a cost-effective intervention for the prevention and management of cognitive decline. While these results are valuable in guiding optimal physical and mental activity recommendations for adults with MCI, further neurophysiological-based studies are essential to offer robust support and deepen our understanding of the mechanisms underlying these promising findings.

Cognition in vestibular disorders: state of the field, challenges, and priorities for the future

Vestibular disorders are prevalent and debilitating conditions of the inner ear and brain which affect balance, coordination, and the integration of multisensory inputs. A growing body of research has linked vestibular disorders to cognitive problems, most notably attention, visuospatial perception, spatial memory, and executive function. However, the mechanistic bases of these cognitive sequelae remain poorly defined, and there is a gap between our theoretical understanding of vestibular cognitive dysfunction, and how best to identify and manage this within clinical practice. This article takes stock of these shortcomings and provides recommendations and priorities for healthcare professionals who assess and treat vestibular disorders, and for researchers developing cognitive models and rehabilitation interventions. We highlight the importance of multidisciplinary collaboration for developing and evaluating clinically relevant theoretical models of vestibular cognition, to advance research and treatment.

Effects of home-based interventions using exergames on physical and cognitive functions in community-dwelling older adults: a PRISMA-P-compliant protocol for a systematic review

Introduction

Physical activity and exercise are crucial to counteract physical and cognitive decline in old age. Home-based exergame training can be a solution to overcome physical inactivity. This systematic review aims to provide a comprehensive overview of home-based exergame interventions and evaluate their effectiveness in improving cognitive and physical functions through physical activity enhancement in older adults.

Methods and analysis

We are conducting a systematic literature search including studies examining (1) community-dwelling older adults aged 60 years and older without any specific disease, (2) exergame-based exercise programs that take place at least partially in a home setting, and (3) intervention-related physical and/or cognitive outcomes. We will include randomized controlled trials and any other type of pre-post study published in English. There are no restrictions in terms of control group type and publication date. A search string was created and used in PubMed, Web of Science, Embase, Scopus and CINAHL. In addition, a hand search is carried out. This involves checking the references of the included studies and searching Google Scholar for further studies. The included studies will be summarized and, if homogeneity is sufficient, a random-effects meta-analysis will be performed. We will assess the risk of bias using RoB 2.0 and ROBINS-I.

Conclusion

The findings of this systematic review will help to define the most suitable exergame programs to counteract cognitive and physical decline in older adults. Additionally, they will inform the development of effective home-based exergame systems and point to future pathways of digital rehabilitation in older adults.

Registration

Prospero (ID: CRD42023374234).

Mapping the landscape of research on insulin resistance: a visualization analysis of randomized clinical trials

BACKGROUND

Insulin resistance, a condition in which cells do not respond adequately to insulin, plays a crucial role in diabetes and related metabolic disorders. Randomized clinical trials (RCTs) explore interventions to manage insulin resistance, contributing to evidence-based medical progress. The current study aimed to analyze the global research landscape and trends in RCTs targeting insulin resistance.

METHODS

This study used bibliometric analysis and data visualization to examine RCT publications on insulin resistance from 2003 to 2022. The Scopus database was used due to its comprehensive coverage. The search strategy involved combining terms related to insulin resistance with RCT-related terms. The search query was validated, and core bibliometric indicators were used to analyze publication growth, origin, productivity, quality, and citations.

RESULTS

Between 2003 and 2022, 1077 RCT-focused publications on insulin resistance were identified from a pool of 24,932 related articles. The growth followed two phases, with a significant increase after 2008. The USA (n = 308; 28.60%), Iran (n = 165; 15.32%), China (n = 110; 10.21%), and the UK (n = 92; 8.54%) were the main contributors. The active institutions included Tehran University of Medical Sciences (n = 38; 3.53%) and Harvard Medical School (n = 31; 2.88%). Prominent funding agencies include the National Institutes of Health (n = 88; 8.17%) and the National Institute of Diabetes and Digestive and Kidney Diseases (n = 86; 7.99%). The top journals included the American Journal of Clinical Nutrition (n = 44; 4.09%) and Diabetes Care (n = 35; 3.25%). Co-occurrence analysis revealed three clusters addressing "utilizing lipid panels as indicators of insulin resistance," "analyzing the impact of diet composition and physical activity on insulin sensitivity among obese individuals," and "exploring insulin resistance in cases of polycystic ovary syndrome."

CONCLUSIONS

This comprehensive bibliometric analysis highlights the global research landscape and trends in RCTs targeting insulin resistance. Research on lipid panels, diet impact, and insulin resistance in patients with polycystic ovary syndrome will continue to be a hotspot. The findings offer valuable information on research priorities, international collaborations, and impactful publications. This study provides a foundation for future directorial investigations in this critical area of metabolic health.

Predictors of progression from subjective cognitive decline to objective cognitive impairment: A systematic review and meta-analysis of longitudinal studies

BACKGROUND

Subjective cognitive decline is one of the first symptoms of dementia. With increasing awareness of brain health and a rising prevalence of dementia, a growing number of individuals seek medical assistance for purely subjective cognitive decline. However, only individuals with specific characteristics tend to experience clinical progression.

OBJECTIVES

This study aims to summarize the predictors of objective cognitive impairment in individuals with subjective cognitive decline and to identify those at higher risk of clinical progression.

DESIGN

Systematic review and meta-analysis.

METHODS

We systematically searched 11 electronic databases from inception to February 1, 2023, for longitudinal studies investigating factors associated with the clinical progression of subjective cognitive decline. Effect sizes were pooled using fixed-effects and random-effects models. Leveraging the results of the meta-analysis, we developed two risk prediction models for objective cognitive impairment.

RESULTS

Forty-six cohort studies were included in the systematic review, of which 28 met the meta-analysis criteria. Fifteen predictors were identified, including 4 biomarkers (amyloid β deposition, lower Hulstaert Formula scores, apolipoprotein e4, and hippocampus atrophy), four epidemiological factors (older age at baseline, impaired instrumental activity of daily living, depression, and anxiety), and seven neuropsychological factors (participants in clinical settings, older age at onset, stable symptom, concerns, cognitive decline confirmed by informant, severe symptoms, and poor performance on Trail Making Test B). Based on the meta-analysis results, we developed two risk prediction models. The first model (Model1) incorporates epidemiological and neuropsychological factors, distinguishing individuals with low and medium risk. The second model (Model2) includes additional biomarkers to enhance predictive performance and identify individuals at high risk.

CONCLUSIONS

This study provides a comprehensive characterization of individuals undergoing clinical progression from subjective cognitive decline to mild cognitive impairment or dementia. The developed models support the prediction of progression risk in both memory clinic and community settings, aiding in the early identification of individuals at risk of disease conversion and facilitating the translation of evidence into clinical practice.

REGISTRATION

The systematic review and meta-analysis have been registered in PROSPERO (CRD 42023392476).

TWEETABLE ABSTRACT

Factors for predicting progression from subjective cognitive decline to objective cognitive impairment: evidence from longitudinal studies.

Effects of 6-Month Combined Physical Exercise and Cognitive Training on Neuropsychological and Neurophysiological Function in Older Adults with Subjective Cognitive Decline: A Randomized Controlled Trial

Background

Multidomain intervention may delay or ameliorate cognitive decline in older adults at risk of Alzheimer's disease, particularly in the memory and inhibitory functions. However, no study systematically investigates the changes of brain function in cognitively-normal elderly with subjective cognitive decline (SCD) when they receive multidomain intervention.

Objective

We aimed to examine whether a multidomain intervention could improve neuropsychological function and neurophysiological activities related to memory and inhibitory function in SCD subjects.

Methods

Eight clusters with a total of 50 community-dwelling SCD older adults were single-blind, randomized into intervention group, which received physical and cognitive training, or control group, which received treatment as usual. For the neuropsychological function, a composite Z score from six cognitive tests was calculated and compared between two groups. For the neurophysiological activities, event-related potentials (ERPs) of memory function, including mismatch negativity (MMN) and memory-P3, as well as ERPs of inhibitory function, including sensory gating (SG) and inhibition-P3, were measured. Assessments were performed at baseline (T1), end of the intervention (T2), and 6 months after T2 (T3).

Results

For the neuropsychological function, the effect was not observed after the intervention. For the neurophysiological activities, improved MMN responses of ΔT2-T1 were observed in the intervention group versus the control group. The multidomain intervention produced a sustained effect on memory-P3 latencies of ΔT3-T1. However, there were no significant differences in changes of SG and inhibition-P3 between intervention and control groups.

Conclusions

While not impactful on neuropsychological function, multidomain intervention enhances specific neurophysiological activities associated with memory function.

Protocol of the MOVI-ageing randomized controlled trial: a home-based e-Health intervention of cognitively demanding exercise for the improvement of cardiorespiratory fitness and cognitive function in older individuals

Objective

To describe the protocol of the MOVI-ageing randomized controlled trial, a home-based eHealth intervention of cognitive-demanding exercise for older adults, in improving global cognitive function and basic cognitive functions, cardiorespiratory fitness, and muscle fitness.

Methods

This randomized controlled trial will include participants identified in the social centers of Cuenca and Talavera de la Reina who agree to participate and provide informed consent. Adults aged 60-80 years of both genders retired regardless of the reason for retirement, who do not meet frailty criteria according to Fried criteria, and without cognitive impairment will be invited to participate. This study will be developed in two phases: (i) a 12-week randomized efficacy/feasibility trial and (ii) a large-scale implementation randomized trial phase with a 12-week follow-up following similar procedures. In addition, a qualitative study on barriers to and facilitators of the implementation of the physical exercise intervention using eHealth for older people will be conducted. Participants will have access to a platform including videos of cognitively demanding physical exercise. The participants will be remotely and off-line guided through the physical exercise intervention, and the research team will be able to check the degree of compliance with the program and its correct execution. The participants will receive feedback on their compliance with the routines and reinforcement messages.

Implications

The implementations of the findings and their inclusion in guidelines may directly impact in older people's life, and relatives, through the prevention of morbidity and the reduction of years lost to disability. These benefits may be reflected in the reduction of economic expenditure by reducing the demand for social and health care services.

Ethics

The Clinical Research Ethics Committee of the 'Virgen de la Luz' Hospital in Cuenca approved the study protocol (registration number: 2022/PI3222). In addition, this protocol was previously registered in Clinicaltrials.gov (Number: NCT05928078).

A Newly Developed Exergame-Based Telerehabilitation System for Older Adults: Usability and Technology Acceptance Study

BACKGROUND

Telerehabilitation has gained significance as a tool to deliver and supervise therapy and training as effective as traditional rehabilitation methods yet more accessible and affordable. An exergame-based telerehabilitation system has recently been developed within the scope of the international Continuum-of-Care (COCARE) project. The system comprises training devices for use in clinics (Dividat Senso) and at home (Dividat Senso Flex), an assessment system, and a rehabilitation cockpit, and its focus lies on home-based motor-cognitive training, which is remotely managed by health care professionals (HPs).

OBJECTIVE

This study aims to analyze the usability, acceptance, and enjoyment of the COCARE system from the perspective of primary (older adults [OAs]) and secondary (HPs) end users.

METHODS

At 3 trial sites (located in Switzerland, Italy, and Cyprus), participants engaged in a single-session trial of the COCARE system, including testing of exergames and assessments. Mixed methods encompassing qualitative approaches (eg, think aloud) and quantitative measures (eg, Exergame Enjoyment Questionnaire [EEQ], System Usability Scale [SUS], and Unified Theory of Acceptance and Use of Technology [UTAUT] questionnaire) were used to analyze participants' perceptions of the system and identify potential barriers to its implementation in a home setting. In addition, the associations of performance during gameplay and assessments, demographics, and training motivation (Behavioral Regulation in Exercise Questionnaire-3 [BREQ-3]) with usability, acceptance, and enjoyment were explored.

RESULTS

A total of 45 OAs and 15 HPs participated in this study. The COCARE system achieved good acceptance ratings (OAs: 83%, range 36%-100% and HPs: 81%, range 63.8%-93.3% of the maximum score), and OAs indicated high enjoyment (mean 73.3, SD 12.7 out of 100 points in the EEQ) during the exergame session. The system's usability, assessed with the SUS, received scores of 68.1 (SD 18.8; OAs) and 70.7 (SD 12.3; HPs) out of 100 points, with substantial differences observed between the trial sites. Several requirements for improvement were identified. Commonly mentioned barriers to adoption included the movement-recognition sensitivity of the Senso Flex, its limited markings, and difficulties in understanding certain instructions for assessments and games. Performance in games and assessments showed the highest significant correlations with the SUS (Spearman ρ=0.35, P=.02 to ρ=0.52, P<.001). The BREQ-3 had significant correlations with all usability measures, thereby even large significant correlations with enjoyment (Spearman ρ=0.58; P<.001). Age had moderately significant correlations with the SUS (Spearman ρ=-0.35; P=.02) and the UTAUT total score (ρ=-0.35; P=.02) but no significant correlation with the EEQ. Concerning sex and years of education, no significant correlations were found.

CONCLUSIONS

The study's findings will inform the further development of the COCARE system toward a user-friendly and widely accepted version, enhancing cognitive and physical functions in OAs. Future randomized controlled trials should evaluate the system's feasibility and effectiveness.

Exploring the Role of Neuroplasticity in Development, Aging, and Neurodegeneration

Neuroplasticity refers to the ability of the brain to reorganize and modify its neural connections in response to environmental stimuli, experience, learning, injury, and disease processes. It encompasses a range of mechanisms, including changes in synaptic strength and connectivity, the formation of new synapses, alterations in the structure and function of neurons, and the generation of new neurons. Neuroplasticity plays a crucial role in developing and maintaining brain function, including learning and memory, as well as in recovery from brain injury and adaptation to environmental changes. In this review, we explore the vast potential of neuroplasticity in various aspects of brain function across the lifespan and in the context of disease. Changes in the aging brain and the significance of neuroplasticity in maintaining cognitive function later in life will also be reviewed. Finally, we will discuss common mechanisms associated with age-related neurodegenerative processes (including protein aggregation and accumulation, mitochondrial dysfunction, oxidative stress, and neuroinflammation) and how these processes can be mitigated, at least partially, by non-invasive and non-pharmacologic lifestyle interventions aimed at promoting and harnessing neuroplasticity.

Combined exercise and cognitive interventions for adults with mild cognitive impairment and dementia: A systematic review and network meta-analysis

BACKGROUND

Exercise and cognitive interventions are beneficial for adults with preclinical and clinical dementia, but it is unclear whether the combination of these two components could generate synergistic benefits and what intervention designs would optimize this effect.

OBJECTIVES

This review aims to compare the effects of combined exercise and cognitive interventions on cognitive, psychological, functional outcomes, and health-related quality of life with the corresponding single approach and control groups in adults with mild cognitive impairment and dementia. It also aims to identify the optimal intervention design and factors affecting treatment effects.

METHODS

A comprehensive search was conducted in ten databases from inception to 23rd November 2022. The methodological quality of studies was evaluated by the Cochrane risk of bias tool. Pairwise meta-analyses were performed to assess the effects of combined interventions relative to the single type of intervention and control groups, with further subgroup analysis to explore the factors affecting treatment effects. Network meta-analyses were used to identify the optimal intervention components.

RESULTS

Twenty-nine randomized controlled trials involving 2910 participants were included. The results of pairwise meta-analyses indicated that combined interventions were superior to exercise in improving response inhibition, working memory, and delayed recall, but were not superior to cognitive interventions in all outcomes. Combined interventions were superior to active/passive controls in improving global cognition, response inhibition, immediate recall, delayed recall, category fluency, processing speed, and visuospatial ability. Influences of the clinical severity of dementia (mild cognitive impairment vs dementia), combination format (sequential vs simultaneous combination), mode of delivery (group-based vs individual-based vs mixed), training duration (short: ≤12 weeks vs medium: 13-24 weeks vs long: >24 weeks), and types of control (active vs passive control) were not detected. The network meta-analysis results indicated that the optimal intervention components varied across different outcomes, with multimodal exercise combining cognitive training demonstrated the greatest effects among all other combined or single component interventions in improving global cognition.

CONCLUSIONS

This review suggests the advantage of combined interventions over exercise with comparable effects when compared with cognitive interventions in the population with mild cognitive impairment and dementia. Full scale multi-arm randomized controlled trials to compare the effects of combined interventions with cognitive interventions are warranted.

Effectiveness of photobiomodulation for people with age-related cognitive impairment: a systematic review and meta-analysis

The increasing incident of age-related cognitive impairment worldwide and the lack of pharmaceutical treatments emphasizes the value of non-pharmaceutical therapy. Emerging evidence suggested photobiomodulation (PBM) is a popular intervention to brain disorder; however, it remains unclear the efficacy of PBM for patients with age-related cognitive impairment. The purpose of this systematic review is to compare the different parameters used in PBM, analyze the beneficial effects of PBM as a potential therapy for age-related cognitive impairment. Five electronic database, PubMed, Web of Science, Cochrane Library, CINAHL, and PsycINFO, were systematically searched from inception to November 2021. Relevant randomized controlled trials (RCTs) were screened and assessed for risk of bias. Eleven RCTs evaluating PBM interventions were included. The systematic review and meta-analysis has been registered in PROSPERO(CRD42022374562). Results showed that PBM had a significant moderated effect on global cognition function (SMD=0.51, 95% CI [0.162, 0.864], p=0.004). We found that multiple wavelength PBM (SMD=0.648, 95% CI [0.220, 1.075], p=0.003) had significant effects while single wavelength PBM was non-significant (SMD=0.385, 95% CI [-0.168, 0.987], p=0.172). Laser effect (SMD=0.682, 95% CI [0.37, 0,994], p<0.001) was larger than LED effect (SMD=0.582, 95% CI [0.269, 0.895], p<0.001). PBM in clinical setting (SMD=0.468, 95% CI [0.050, 0.887], p=0.028) had significant effect, but there was no significant effect of home-used PBM (SMD=0.616, 95% CI [-0.121, 1.354], p=0.101). The pool effect of multi-modality PBM (SMD=0.720, 95% CI [0.027, 1.414], p=0.040) was significantly higher in the studies of transcranial irradiation (SMD=0.616, 95% CI [-0.121, 1.354], p=0.010). Cumulative irradiation time was a moderator between the PBM and cognitive function improvement. Photobiomodulation have the potential to improve cognitive function in aging adults. Cumulative irradiation duration, light source, device type, penetration modality, and intervention site can affect the effectiveness of PBM intervention.

Dual task measures in older adults with and without cognitive impairment: response to simultaneous cognitive-exercise training and minimal clinically important difference estimates

BACKGROUND

Responsiveness and minimal clinically important difference (MCID) are critical indices to understand whether observed improvement represents a meaningful improvement after intervention. Although simultaneous cognitive-exercise training (SCET; e.g., performing memory tasks while cycling) has been suggested to enhance the cognitive function of older adults, responsiveness and MCID have not been established. Hence, we aimed to estimate responsiveness and MCIDs of two dual task performance involving cognition and hand function in older adults with and without cognitive impairment and to compare the differences in responsiveness and MCIDs of the two dual task performance between older adults with and without cognitive impairment.

METHODS

A total of 106 older adults completed the Montreal Cognitive Assessment and two dual tasks before and after SCET. One dual task was a combination of Serial Sevens Test and Box and Block Test (BBT), and the other included frequency discrimination and BBT. We used effect size and standardized response mean to indicate responsiveness and used anchor- and distribution-based approaches to estimating MCID ranges. When conducting data analysis, all participants were classified into two cognitive groups, cognitively healthy (Montreal Cognitive Assessment ≥ 26) and cognitively impaired (Montreal Cognitive Assessment < 26) groups, based on the scores of the Montreal Cognitive Assessment before SCET.

RESULTS

In the cognitively healthy group, Serial Seven Test performance when tasked with BBT and BBT performance when tasked with Serial Seven Test were responsive to SCET (effect size = 0.18-0.29; standardized response mean = 0.25-0.37). MCIDs of Serial Seven Test performance when tasked with BBT ranged 2.09-2.36, and MCIDs of BBT performance when tasked with Serial Seven Test ranged 3.77-5.85. In the cognitively impaired group, only frequency discrimination performance when tasked with BBT was responsive to SCET (effect size = 0.37; standardized response mean = 0.47). MCIDs of frequency discrimination performance when tasked with BBT ranged 1.47-2.18, and MCIDs of BBT performance when tasked with frequency discrimination ranged 1.13-7.62.

CONCLUSIONS

Current findings suggest that a change in Serial Seven Test performance when tasked with BBT between 2.09 and 2.36 corrected number (correct responses - incorrect responses) should be considered a meaningful change for older adults who are cognitively healthy, and a change in frequency discrimination performance when tasked with BBT between 1.47 and 2.18 corrected number (correct responses - incorrect responses) should be considered a meaningful change for older adults who are cognitively impaired. Clinical practitioners may use these established MCIDs of dual tasks involving cognition and hand function to interpret changes following SCET for older adults with and without cognitive impairment.

TRIAL REGISTRATION

NCT04689776, 30/12/2020.

Effects of combined physical and cognitive program performed in socially enriched environment on older people's cognitive abilities and quality of life (StimCoAPS): study protocol for a randomized controlled trial

The number of older people worldwide is constantly increasing. However, ageing is accompanied by a decline in cognitive ability that can affect quality of life. Cognitive, physical and social activities can all slow this decline but social factors and their contribution to the well-being remain under-researched. The aim of this study is to analyse how the practice environment can foster these social relations and thus enhance well-being and to identify the psychological dimensions that are activated by social relations. This study is a 3-year randomised controlled trial designed to assess the effects on participants' cognitive abilities and quality of life of a combined (ie, physical and cognitive) training programme in different social practice environments. A total of 159 older people (≥65 years old) will be recruited and randomly assigned to one of three practice environments: individual practice at home (n=53), group practice in a gymnasium (n=53) and group practice in an enriched environment (n=53). All participants will complete 12-week combined training sessions and will be assessed four times: before the start, in the middle, at the end and 6 months after the end of the programme. They will undergo cognitive function (episodic memory and executive functions), physical capacity (aerobic fitness, muscle strength and dynamic balance) and psychosocial assessments (indicators of psychological well-being, social support, self-esteem, anxiety, depression and achievement goal strategies), as well as semistructured interviews. Statistical analyses will be conducted to assess the effect of the practice environment on the perceived benefits of this programme in terms of cognitive abilities and quality of life, and to determine the role of psychosocial factors in this relationship. This protocol has been approved by an institutional review board (CERSTAPS: IRB00012476-2022-20-01-146). Trials registration number: NCT05721508.

Cognitive rehabilitation and aerobic exercise for cognitive impairment in people with progressive multiple sclerosis (CogEx): a randomised, blinded, sham-controlled trial

BACKGROUND

Cognitive dysfunction in people with relapsing-remitting multiple sclerosis can improve with cognitive rehabilitation or exercise. Similar effects have not been clearly shown in people with progressive multiple sclerosis. We aimed to investigate the individual and synergistic effects of cognitive rehabilitation and exercise in patients with progressive multiple sclerosis.

METHODS

CogEx was a randomised, sham-controlled trial completed in 11 hospital clinics, universities, and rehabilitation centres in Belgium, Canada, Denmark, Italy, UK, and USA. Patients with progressive multiple sclerosis were eligible for inclusion if they were aged 25-65 years and had an Expanded Disability Status Scale (EDSS) score of less than 7. All had impaired processing speed defined as a performance of 1·282 SD or greater below normative data on the Symbol Digit modalities Tests (SDMT). Participants were randomly assigned (1:1:1:1), using an interactive web-response system accessed online from each centre, to cognitive rehabilitation plus exercise, cognitive rehabilitation plus sham exercise, exercise plus sham cognitive rehabilitation, or sham exercise plus sham cognitive rehabilitation. The study statistician created the randomisation sequence that was stratified by centre. Participants, outcome assessors, and investigators were blinded to group allocation. The study statistician was masked to treatment during analysis only. Interventions were conducted two times per week for 12 weeks: cognitive rehabilitation used an individualised, computer-based, incremental approach to improve processing speed; sham cognitive rehabilitation consisted of internet training provided individually; the exercise intervention involved individualised aerobic training using a recumbent arm-leg stepper; and the sham exercise involved stretching and balance tasks without inducing cardiovascular strain. The primary outcome measure was processing speed measured by SDMT at 12 weeks; least squares mean differences were compared between groups using linear mixed model in all participants who had a 12-week assessment. The trial is registered with ClinicalTrials.gov, NCT03679468, and is completed.

FINDINGS

Between Dec 14, 2018, and April 2, 2022, 311 people with progressive multiple sclerosis were enrolled and 284 (91%) completed the 12-week assessment (117/311 [38%] male and 194/311 [62%] female). The least squares mean group differences in SDMT at 12 weeks did not differ between groups (p=0·85). Compared with the sham cognitive rehabilitation and sham exercise group (n=67), differences were -1·30 (95% CI -3·75 to 1·16) for the cognitive rehabilitation plus exercise group (n=70); -2·78 (-5·23 to -0·33) for the sham cognitive rehabilitation plus exercise group (n=71); and -0·71 (-3·11 to 1·70) for the cognitive rehabilitation plus sham exercise group (n=76). 11 adverse events possibly related to the interventions occurred, six in the exercise plus sham cognitive rehabilitation group (pain, dizziness, and falls), two in the cognitive rehabilitation plus sham exercise group (headache and pain), two in the cognitive rehabilitation and exercise group (increased fatigue and pain), and one in the dual sham group (fall).

INTERPRETATION

Combined cognitive rehabilitation plus exercise does not seem to improve processing speed in people with progressive multiple sclerosis. However, our sham interventions were not inactive. Studies comparing interventions with a non-intervention group are needed to investigate whether clinically meaningful improvements in processing speed might be attainable in people with progressive multiple sclerosis.

FUNDING

MS Canada.