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Nimmons D, Aker N, Burnand A, Jordan KP, Cooper C, Davies N, Manthorpe J, Chew-Graham CA, Kingstone T, Petersen I, Walters K. Clinical effectiveness of pharmacological and non-pharmacological treatments for the management of anxiety in community dwelling people living with dementia: A systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 157:105507. [PMID: 38097097 DOI: 10.1016/j.neubiorev.2023.105507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
People living with dementia commonly experience anxiety, which is often challenging to manage. We investigated the effectiveness of treatments for the management of anxiety in this population. We conducted a systematic review and meta-analysis of randomised controlled trials, and searched EMBASE, CINAHL, MEDLINE and PsycInfo. We estimated standardised mean differences at follow-up between treatments relative to control groups and pooled these across studies using random-effects models where feasible. Thirty-one studies were identified. Meta-analysis demonstrated non-pharmacological interventions were effective in reducing anxiety in people living with dementia, compared to care as usual or active controls. Specifically, music therapy (SMD-1.92(CI:-2.58,-1.25)), muscular approaches (SMD-0.65(CI:-1.02,-0.28)) and stimulating cognitive and physical activities (SMD-0.31(CI:-0.53,-0.09)). Pharmacological interventions with evidence of potential effectiveness included Ginkgo biloba, probiotics, olanzapine, loxapine and citalopram compared to placebo, olanzapine compared to bromazepam and buspirone and risperidone compared to haloperidol. Meta-analyses were not performed for pharmacological interventions due to studies' heterogeneity. This has practice implications when promoting the use of more non-pharmacological interventions to help reduce anxiety among people living with dementia.
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Affiliation(s)
- Danielle Nimmons
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK.
| | - Narin Aker
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | - Alice Burnand
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | | | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Nathan Davies
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | | | - Tom Kingstone
- School of Medicine, Keele University, Staffordshire, UK
| | - Irene Petersen
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, Centre for Ageing and Population Studies, UCL, London, UK
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Jehu DA, Dong Y, Zhu H, Huang Y, Soares A, Patel C, Aden Z, Hergott C, Ange B, Waller JL, Young L, Hall W, Robinson-Johnson D, Allen C, Sams R, Hamrick M. The effects of strEngth aNd BaLance exercise on Executive function in people living with Dementia (ENABLED): Study protocol for a pilot randomized controlled trial. Contemp Clin Trials 2023; 130:107220. [PMID: 37156373 PMCID: PMC10330466 DOI: 10.1016/j.cct.2023.107220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/05/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Exercise may improve executive function among people living with all-cause dementia (PWD), but more evidence is needed. The aim of this pilot randomized controlled trial (RCT) is to examine whether exercise plus usual care improves the primary outcome of executive function, and secondary physiological (inflammation, metabolic aging, epigenetics) and behavioral (cognition, psychological health, physical function, and falls) outcomes compared to usual care alone among PWD. METHODS AND STUDY DESIGN The strEngth aNd BaLance exercise on Executive function in people living with Dementia (ENABLED) protocol is a pilot parallel, 6-month assessor-blinded RCT (1:1) in residential care facilities, including n = 21 receiving exercise plus usual care and n = 21 usual care alone [NCT05488951]. We will collect primary (Color-Word Stroop Test) and secondary physiological (inflammation, metabolic aging, epigenetics) and behavioral (cognition, psychological health, physical function, and falls) outcomes at baseline and 6 months. We will obtain falls monthly from medical charts. We will collect physical activity, sedentary behavior, and sleep via wrist-worn accelerometers over 7 days at baseline and 6 months. The physical therapist-led adapted Otago Exercise Program will involve 1-h of strength, balance and walking 3×/week for 6 months in groups of 5-7. We will use generalized linear mixed models to examine differences over time in primary and secondary outcomes between groups and examine potential interactions with sex and race. DISCUSSION This pilot RCT will examine the direct effects and potential underlying physiological mechanisms of exercise on executive function and other behavioral outcomes in PWD, which may have implications for clinical care management.
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Affiliation(s)
- Deborah A Jehu
- Interdisciplinary Health Sciences Department, College of Allied Health Sciences, Augusta University, Augusta, GA, USA.
| | - Yanbin Dong
- Georgia Prevention Institute, Augusta University, Augusta, GA, USA.
| | - Haidong Zhu
- Georgia Prevention Institute, Augusta University, Augusta, GA, USA.
| | - Ying Huang
- Georgia Prevention Institute, Augusta University, Augusta, GA, USA.
| | - Andre Soares
- Interdisciplinary Health Sciences Department, College of Allied Health Sciences, Augusta University, Augusta, GA, USA.
| | - Charmi Patel
- Interdisciplinary Health Sciences Department, College of Allied Health Sciences, Augusta University, Augusta, GA, USA.
| | - Zak Aden
- Interdisciplinary Health Sciences Department, College of Allied Health Sciences, Augusta University, Augusta, GA, USA.
| | - Colleen Hergott
- Physical Therapy Department, College of Allied Health Sciences, Augusta University, USA.
| | - Brittany Ange
- Department of Population Health Sciences, Division of Biostatistics and Data Science, Augusta University, USA.
| | - Jennifer L Waller
- Department of Population Health Sciences, Division of Biostatistics and Data Science, Augusta University, USA.
| | - Lufei Young
- School of Nursing, University of North Carolina, Charlotte, NC, USA.
| | - William Hall
- Claiborne Assisted Living Facility, GA College of Nursing, Augusta University, Augusta, GA, USA.
| | | | - Crystal Allen
- Georgia War Veterans Nursing Home, Augusta, GA, USA.
| | - Richard Sams
- Georgia War Veterans Nursing Home, Augusta, GA, USA.
| | - Mark Hamrick
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA, USA.
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Woods B, Rai HK, Elliott E, Aguirre E, Orrell M, Spector A. Cognitive stimulation to improve cognitive functioning in people with dementia. Hippokratia 2023. [DOI: 10.1002/14651858.cd005562.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Bob Woods
- Dementia Services Development Centre Wales; Bangor University; Bangor UK
| | - Harleen Kaur Rai
- Department of Psychiatry and Applied Psychology; Institute of Mental Health, University of Nottingham; Nottingham UK
| | - Emma Elliott
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; Glasgow UK
| | | | - Martin Orrell
- Institute of Mental Health; University of Nottingham; Nottingham UK
| | - Aimee Spector
- Research Department of Clinical, Educational and Health Psychology; University College London; London UK
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Cardona MI, Afi A, Lakicevic N, Thyrian JR. Physical Activity Interventions and Their Effects on Cognitive Function in People with Dementia: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168753. [PMID: 34444501 PMCID: PMC8394441 DOI: 10.3390/ijerph18168753] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Physical activity (PA) has emerged as an alternative nonpharmacological approach to effectively address the effects of dementia. The primary aim was to identify and summarize PA interventions and their effects on cognitive function among persons with dementia (PwD). METHODS A systematic review was conducted with a meta-analysis using different electronic databases, such as PubMed, Embase, APA PsycNET, and the Web of Science. The identified and selected studies were randomized controlled trials (RCTs) that were written in English, published between 2000 and 2020, and implemented among PwD who received a PA intervention and whose cognitive function was measured at baseline and during a follow-up. RESULTS Twenty-two PA intervention studies met the eligibility criteria and showed a medium-size effect on the cognitive function of PwD, 0.4803 (95% CI = 0.1901-0.7704), with a high percentage of heterogeneity (I2 = 86%, p ≤ 0.0001). Moreover, this review complements other reviews by including eight studies that have not previously been considered. Overall, studies have methodological limitations. However, six studies implemented in the past five years have shown more robust methodological designs, including larger sample sizes and more comprehensive measurement tools. CONCLUSION It is not yet possible to draw a conclusion on the ideal PA intervention for this population due to the high proportion of heterogeneity within the included studies. More emphasis is needed on the intensity of PA monitoring and adherence to such programs.
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Affiliation(s)
- Maria Isabel Cardona
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Rostock/Greifswald, Ellernholzstr. 1–2, 17489 Greifswald, Germany; (A.A.); (J.R.T.)
- Correspondence: ; Tel.: +49-383-486-7593; Fax: +49-383-4861-9551
| | - Adel Afi
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Rostock/Greifswald, Ellernholzstr. 1–2, 17489 Greifswald, Germany; (A.A.); (J.R.T.)
| | - Nemanja Lakicevic
- Sport and Exercise Sciences Research Unit, University of Palermo, 90133 Palermo, Italy;
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Rostock/Greifswald, Ellernholzstr. 1–2, 17489 Greifswald, Germany; (A.A.); (J.R.T.)
- Institute for Community Medicine, University Medicine Greifswald, Ellernholzstraße 1–2, 17489 Greifswald, Germany
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Ballard C, Orrell M, Moniz-Cook E, Woods R, Whitaker R, Corbett A, Aarsland D, Murray J, Lawrence V, Testad I, Knapp M, Romeo R, Zala D, Stafford J, Hoare Z, Garrod L, Sun Y, McLaughlin E, Woodward-Carlton B, Williams G, Fossey J. Improving mental health and reducing antipsychotic use in people with dementia in care homes: the WHELD research programme including two RCTs. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
The effective management of agitation and other neuropsychiatric and behavioural symptoms in people with dementia is a major challenge, particularly in care home settings, where dementia severity is higher and there is limited training and support for care staff. There is evidence for the value of staff training and the use of psychosocial approaches; however, no intervention currently exists that combines these elements into an intervention that is fit for purpose and effective in these settings based on evidence from a randomised controlled trial.
Objective
The objective was to develop and evaluate a complex intervention to improve well-being, reduce antipsychotic use and improve quality of life in people with dementia in care homes through person-centred care, management of agitation and non-drug approaches.
Design
This was a 5-year programme that consisted of six work packages. Work package 1 consisted of two systematic reviews of personalised psychosocial interventions for behavioural and psychological symptoms for people with dementia in care homes. Work package 2 consisted of a metasynthesis of studies examining implementation of psychosocial interventions, in addition to developing a draft Well-being and Health for people with Dementia (WHELD) programme. Work package 3 consisted of a factorial study of elements of the draft WHELD programme in 16 care homes. Work package 4 involved optimisation of the WHELD programme based on work package 3 data. Work package 5 involved a multicentre randomised controlled trial in 69 care homes, which evaluated the impact of the optimised WHELD programme on quality of life, agitation and overall neuropsychiatric symptoms in people with dementia. Work package 6 focused on dissemination of the programme.
Setting
This programme was carried out in care homes in the UK.
Participants
Participants of this programme were people with dementia living in care homes, and the health and care professionals providing treatment and care in these settings.
Results
Work package 1: reviews identified randomised controlled trials and qualitative evidence supporting the use of psychosocial approaches to manage behavioural symptoms, but highlighted a concerning lack of evidence-based training manuals in current use. Work package 2: the meta-analysis identified key issues in promoting the use of interventions in care homes. The WHELD programme was developed through adaptation of published approaches. Work package 3: the factorial trial showed that antipsychotic review alone significantly reduced antipsychotic use by 50% (odds ratio 0.17, 95% confidence interval 0.05 to 0.60). Antipsychotic review plus social interaction significantly reduced mortality (odds ratio 0.36, 95% confidence interval 0.23 to 0.57), but this group showed significantly worse outcomes in behavioural and psychological symptoms of dementia than the group receiving neither antipsychotic review nor social interaction (mean difference 7.37 symptoms, 95% confidence interval 1.53 to 13.22 symptoms). This detrimental impact was reduced when combined with social interaction (mean difference –0.44 points, 95% confidence interval –4.39 to 3.52 points), but with no significant benefits for agitation. The exercise intervention significantly improved neuropsychiatric symptoms (mean difference –3.58 symptoms, 95% confidence interval –7.08 to –0.09 symptoms) but not depression (mean difference –1.21 points, 95% confidence interval –4.35 to 1.93 points). Qualitative work with care staff provided additional insights into the acceptability and feasibility of the intervention. Work package 4: optimisation of the WHELD programme led to a final version that combined person-centred care training with social interaction and pleasant activities. The intervention was adapted for delivery through a ‘champion’ model. Work package 5: a large-scale, multicentre randomised controlled trial in 69 care homes showed significant benefit to quality of life, agitation and overall neuropsychiatric symptoms, at reduced overall cost compared with treatment as usual. The intervention conferred a statistically significant improvement in quality of life (Dementia Quality of Life Scale – Proxy z-score of 2.82, mean difference 2.54, standard error of measurement 0.88, 95% confidence interval 0.81 to 4.28, Cohen’s d effect size of 0.24; p = 0.0042). There were also statistically significant benefits in agitation (Cohen-Mansfield Agitation Inventory z-score of 2.68, mean difference –4.27, standard error of measurement 1.59, 95% confidence interval –7.39 to –1.15, Cohen’s d effect size of 0.23; p = 0.0076) and overall neuropsychiatric symptoms (Neuropsychiatric Inventory – Nursing Home version z-score of 3.52, mean difference –4.55, standard error of measurement 1.28, 95% confidence interval –7.07 to –2.02, Cohen’s d of 0.30; p < 0.001). The WHELD programme contributed to significantly lower health and social care costs than treatment as usual (cost difference –£4740, 95% confidence interval –£6129 to –£3156). Focus groups were conducted with 47 staff up to 12 months after the end of work package 5, which demonstrated sustained benefits. Work package 6: the outputs of the programme were translated into general practitioner workshops and a British Medical Journal e-learning module, an updated national best practice guideline and a portfolio of lay and care home outreach activities.
Limitations
Residents with dementia were not involved in the qualitative work.
Conclusions
The WHELD programme is effective in improving quality of life and reducing both agitation and overall neuropsychiatric symptoms in people with dementia in care homes. It provides a structured training and support intervention for care staff, with lower overall costs for resident care than treatment as usual.
Future work
It will be important to consider the long-term sustainability of the WHELD programme and cost-effective means of long-term implementation.
Trial registration
Current Controlled Trials ISRCTN40313497 and ISRCTN62237498.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Clive Ballard
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Esme Moniz-Cook
- Faculty of Health and Social Care, Centre of Psychological Care and Ageing, University of Hull, Hull, UK
| | - Robert Woods
- Dementia Service Development Centre, Wales Dementias & Neurodegenerative Diseases Network, Bangor University, Bangor, UK
| | | | - Anne Corbett
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Dag Aarsland
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
- Centre for Age-related Medicine, Stavanger University Hospital, University of Stavanger, Stavanger, Norway
| | - Joanna Murray
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Vanessa Lawrence
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ingelin Testad
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Martin Knapp
- London School of Economics and Political Science, London, UK
| | - Renee Romeo
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Darshan Zala
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health & Social Care, Institute of Medical & Social Care Research, Bangor University, Bangor, UK
| | - Lucy Garrod
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Yongzhong Sun
- Dementia Service Development Centre, Wales Dementias & Neurodegenerative Diseases Network, Bangor University, Bangor, UK
| | | | | | - Gareth Williams
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
| | - Jane Fossey
- Oxford Health NHS Foundation Trust, Oxford, UK
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Eisapour M, Cao S, Boger J. Participatory design and evaluation of virtual reality games to promote engagement in physical activity for people living with dementia. J Rehabil Assist Technol Eng 2020; 7:2055668320913770. [PMID: 32499921 PMCID: PMC7243402 DOI: 10.1177/2055668320913770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 02/17/2020] [Indexed: 11/26/2022] Open
Abstract
Background Exercise is a key component of physical health and quality of life for people living with dementia; however, challenges related to dementia symptoms and aging can make it difficult for people living with dementia to engage in exercise. While immersive virtual reality is showing increasing promise for exercise and rehabilitation applications, there is a lack of research regarding its use with people living with dementia. Methods Through participatory design with exercise therapists, kinesiologists, and people living with dementia, we designed two virtual reality environments (a farm and a gym) that were implemented on head-mounted displays to support five different upper-body exercises. Virtual reality and comparable human-guided exercises were tested with six people living with dementia. Both qualitative and quantitative measures were used, including reaching distance, distance traversed, and speed as well as feelings of enjoyment, engagement, interest, easiness, comfort, and level of effort. Results Participants’ subjective responses, motion, and fitness parameters all demonstrated comparable results between virtual reality and human-guided exercises. Therapists’ feedback also supported virtual reality exercise as an appropriate and engaging method for people living with dementia. Conclusions Collaborating with experts and people living with dementia throughout the design process resulted in an intuitive and engaging design. The results suggest that head-mounted virtual reality has promising potential to support physical activity for people living with dementia.
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Affiliation(s)
- Mazhar Eisapour
- Department of Systems Design Engineering, University of Waterloo, Ontario, Canada
| | - Shi Cao
- Department of Systems Design Engineering, University of Waterloo, Ontario, Canada
| | - Jennifer Boger
- Department of Systems Design Engineering, University of Waterloo, Ontario, Canada.,Research Institute for Aging, Ontario, Canada
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Miyazaki A, Mori H. Frequent Karaoke Training Improves Frontal Executive Cognitive Skills, Tongue Pressure, and Respiratory Function in Elderly People: Pilot Study from a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1459. [PMID: 32102472 PMCID: PMC7068312 DOI: 10.3390/ijerph17041459] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 12/14/2022]
Abstract
We tested whether karaoke training improves cognitive skills and reduces the risk of physical function impairments. We conducted a single-blinded randomized controlled trial in 26 elderly participants at residential care facilities, who were generally healthy or required the lowest level of care. Participants were near the threshold for mild cognitive impairment with the Montreal Cognitive Assessment (MoCA) and close to the sarcopenia cut-off with the skeletal muscle mass index. Pulmonary function as measured with spirometry and tongue strength were used as markers for physical functions affected by sarcopenia. Karaoke training occurred once a week for two hours, with an hour of homework assigned weekly. Karaoke training significantly improved the Frontal Assessment Battery at bedside (FAB) compared with an active control group receiving scratch art training (F = 8.04, permutation p-value = 0.013). Subscore improved with inhibitory control (F = 7.63, permutation p-value = 0.015) and sensitivity to interference (F = 11.98, permutation p-value = 0.001). We observed improved tongue pressure (F = 4.49, permutation p-value = 0.040) and pulmonary function by a greater increase in FIV1 (F = 5.22, permutation p-value = 0.047). Engaging elderly people, especially those in care homes, with karaoke training exercises that are moderately physically challenging may be a key to slowing cognitive decline and preventing dysphagia by sarcopenia.
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Affiliation(s)
- Atsuko Miyazaki
- Technology and Innovation Hub, Cluster for Science, RIKEN, Saitama 351-0198, Japan;
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Physical exercise attenuates cognitive decline and reduces behavioural problems in people with mild cognitive impairment and dementia: a systematic review. J Physiother 2020; 66:9-18. [PMID: 31843427 DOI: 10.1016/j.jphys.2019.11.014] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/30/2019] [Accepted: 11/25/2019] [Indexed: 01/17/2023] Open
Abstract
QUESTIONS What is the effect of physical exercise on cognitive decline and behavioural problems in people with mild cognitive impairment (MCI) or dementia? What is the effect of physical exercise on particular domains of cognitive function? How do training protocols and patients' characteristics influence the outcomes? DESIGN Systematic review and meta-analysis of randomised trials. PARTICIPANTS People with MCI or dementia as their primary diagnosis. INTERVENTION Physical exercise. OUTCOME MEASURES Cognitive function including global cognition, memory, executive function, reasoning, attention, language, and behavioural problems. RESULTS Forty-six trials involving 5099 participants were included in this review. Meta-analysis of the data estimated that aerobic exercise reduced the decline in global cognition, with a standardised mean difference (SMD) of 0.44, 95% CI 0.27 to 0.61, I2 = 69%. For individual cognitive functions, meta-analysis estimated that exercise lessened working memory decline (SMD 0.28, 95% CI 0.04 to 0.52, I2 = 40%). The estimated mean effect on reducing the decline in language function was favourable (SMD 0.17), but this estimate had substantial uncertainty (95% CI -0.03 to 0.36, I2 = 67%). The effects of exercise on other cognitive functions were unclear. Exercise also reduced behavioural problems (SMD 0.36, 95% CI 0.07 to 0.64, I2 = 81%). CONCLUSION Physical exercise can reduce global cognitive decline and lessen behavioural problems in people with MCI or dementia. Its benefits on cognitive function can be primarily attributed to its effects on working memory. Aerobic exercise at moderate intensity or above and a total training duration of > 24 hours can lead to a more pronounced effect on global cognition.
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Effectiveness of Exercise Programs on Patients with Dementia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2308475. [PMID: 31886182 PMCID: PMC6893254 DOI: 10.1155/2019/2308475] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/13/2019] [Accepted: 10/16/2019] [Indexed: 11/17/2022]
Abstract
Exercise programs have been introduced to improve cognitive function, whereas studies showed inconsistent results regarding the effectiveness of exercise programs on patients with dementia. This study aimed to summarize randomized controlled trials (RCTs) to assess the effect of exercise programs on cognition, activities of daily living (ADL), and depression in elderly with dementia. We systematically screened PubMed, Embase, and the Cochrane library for relevant studies throughout November 21, 2018. The pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were employed to calculate cognition, ADL, and depression by using random-effects model. A total of 20 RCTs with 2,051 dementia patients were included in final quantitative meta-analysis. There were no significant differences between exercise programs and control regarding cognition (SMD: 0.44; 95% CI: -0.21-1.09; P=0.183), ADL (SMD: 0.50; 95% CI: -0.03-1.02; P=0.066), and depression (SMD: -0.43; 95% CI: -0.90-0.05; P=0.077). Sensitivity analysis results indicated that exercise programs might play an important role in cognition and ADL, whereas the depression level was unaltered by the exclusion of any particular study. Subgroup analyses indicated that exercise programs were associated with increased cognitive levels if the mean age of patients was <80.0 years when compared with usual care and studies with low quality. Moreover, the ADL level was significantly increased in patients receiving exercise programs versus usual care. These results suggested that exercise programs might play an important role in cognition and ADL in patients with dementia. These results required further verification by large-scale RCTs, especially for depression outcomes.
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Brown Wilson C, Arendt L, Nguyen M, Scott TL, Neville CC, Pachana NA. Nonpharmacological Interventions for Anxiety and Dementia in Nursing Homes: A Systematic Review. THE GERONTOLOGIST 2019; 59:e731-e742. [PMID: 31054222 PMCID: PMC6858831 DOI: 10.1093/geront/gnz020] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 11/13/2022] Open
Abstract
Anxiety is a major mental disorder in later life that impacts on activities of daily living and quality of life for adults living with dementia in nursing homes. The aim of this article was to systematically review nonpharmacological interventions for older adults living in nursing homes who experience comorbid anxiety and dementia. METHOD A systematic literature search was conducted across key databases (Cinahl, ASSIA, Cochrane reviews and trials, psycARTICLES, psycINFO, and PubMed) to identify studies measuring anxiety as an outcome for an intervention for older adults living with dementia in nursing homes, up to December 31, 2017. RESULTS The search yielded a total of 1,925 articles with 45 articles accessed for full article review. A total of 13 articles were included in this review following quality appraisal based on Cochrane methodology with six different anxiety measures used. The studies included were moderate to high-quality randomized control trials although heterogeneity precluded a combined meta-analysis. CLINICAL IMPLICATIONS The most common interventions used to address anxiety in this population were music therapy and activity-based interventions although there was limited evidence for the efficacy of either intervention. Little is known about effective nonpharmacological treatment for anxiety for people living with dementia in nursing homes. Further research using consistent measurement tools and time points is required to identify effective interventions to improve the quality of life for people living with both dementia and anxiety in nursing homes.
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Affiliation(s)
| | - Lars Arendt
- School of Nursing, Midwifery and Social Work, The University of Queensland, St. Lucia, Australia
| | - Mynhi Nguyen
- School of Psychology, The University of Queensland, St. Lucia, Australia
| | - Theresa L Scott
- School of Psychology, The University of Queensland, St. Lucia, Australia
| | - Christine C Neville
- School of Nursing, Midwifery and Social Work, The University of Queensland, St. Lucia, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, St. Lucia, Australia
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Iizuka A, Suzuki H, Ogawa S, Kobayashi-Cuya KE, Kobayashi M, Takebayashi T, Fujiwara Y. Can cognitive leisure activity prevent cognitive decline in older adults? A systematic review of intervention studies. Geriatr Gerontol Int 2019; 19:469-482. [PMID: 31020777 DOI: 10.1111/ggi.13671] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 03/04/2019] [Accepted: 03/25/2019] [Indexed: 02/05/2023]
Abstract
The aims of this systematic review were to investigate what kind of cognitive leisure activities have been used in intervention studies targeting older adults, and whether these activities improve cognitive function or inhibit cognitive decline. Based on the PRISMA declaration, we searched keywords using three electronic databases: PubMed, PsycINFO and PsycARTICLES. Intervention studies involving cognitive leisure activities with cognitive assessments set as outcomes were included. We regarded cognitive leisure activities as activities for enjoyment or well-being that cause intellectual stimulation (e.g. reading, playing board games). To investigate the influence of each activity on cognitive domains, multicomponent programs (e.g. combined music and art) were excluded. In total, 20 studies were included in the evaluation. Consequently, intervention studies related to arts, writing, board games, reading, handicrafts, a crossword puzzle and learning computer skills were identified. Of the 20 studies, 13 showed improvement in some cognitive domain. In 12 of these 13 studies, the intervention effects were not observed in a specific cognitive domain; rather, the intervention effects were observed across multiple cognitive domains and on working memory. The results of the present review suggest that cognitive function in older adults can be improved through cognitive leisure activity interventions. Activities related to learning new skills, that cause strong intellectual stimulation and that include communication elements were considered particularly effective tools. However, as the number of studies is small, more high-quality research needs to be accumulated. Geriatr Gerontol Int 2019; 19: 469-482.
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Affiliation(s)
- Ai Iizuka
- Research Team for Social Participation and Health Promotion, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Hiroyuki Suzuki
- Research Team for Social Participation and Health Promotion, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Susumu Ogawa
- Research Team for Social Participation and Health Promotion, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kimi Estela Kobayashi-Cuya
- Research Team for Social Participation and Health Promotion, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Momoko Kobayashi
- Research Team for Social Participation and Health Promotion, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Health Promotion, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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The Effect of Ceramic Painting on the Life Satisfaction and Cognitive Status of Older Adults Residing in a Nursing Home. TOPICS IN GERIATRIC REHABILITATION 2019. [DOI: 10.1097/tgr.0000000000000208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Smagula SF, Gujral S, Capps CS, Krafty RT. A Systematic Review of Evidence for a Role of Rest-Activity Rhythms in Dementia. Front Psychiatry 2019; 10:778. [PMID: 31736798 PMCID: PMC6832024 DOI: 10.3389/fpsyt.2019.00778] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Rest-activity rhythm (RAR) disruption may be a risk factor for dementia that can be objectively measured with wearable accelerometers. It is possible that risk monitoring and preventive interventions could be developed targeting RARs. To evaluate whether current evidence supports these applications, we systematically reviewed published studies linking RARs with dementia, its course, and mechanisms. Methods: Entering pre-defined search terms in PsycINFO, MEDLINE, and PubMed databases returned 192 unique titles. We identified 32 articles that met our primary inclusion criteria, namely, that they examined objective RAR measures in the context of dementia, cognition, or brain biomarkers. Results: Cross-sectional studies consistently found that people with dementia had less stable (5/6 studies), more fragmented (4/6 studies), lower amplitude rhythms (5/5 studies), that had a worse fit to 24-h models (3/3 studies). Findings from studies relating RARs to cognitive test performance (rather than diagnostic status) were more nuanced. RAR fragmentation was associated with neurodegeneration biomarkers in 2/2 studies; and 1/1 study found 24-h model fit related to hippocampal hyperactivation. Although 2/2 studies found RARs related to markers of cerebrovascular disease, the specific RARs and cerebrovascular disease measures were not consistent. Longitudinal studies (3/3 articles) reported that lower amplitude and worse 24-h rhythm fit predicted future cognitive impairment and executive function. However, interventions aimed at modifying RARs had mixed effects (e.g., 0/4 studies demonstrated effects of morning light on 24-h model fit; evening light was associated with improved 24-h fit in 2/2 studies reporting); these effects may be more evident in subgroups. Conclusions: Consistent evidence shows that dementia is associated with disrupted RARs. Importantly, recent studies have shown that RAR disruption is associated with dementia biomarkers and, prospectively, with the risk of cognitive impairment. Interventions mostly tried using bright light to modify RARs in people who already have dementia; these studies produced modest effects on RARs and did not show modification of dementia's course. Altogether, these findings suggest studies are needed to understand how RARs relate to changes in brain health earlier in the disease process. Better understanding of the biopsychosocial mechanisms linking RARs with future dementia risk can help further target intervention development.
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Affiliation(s)
- Stephen F Smagula
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Swathi Gujral
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,Veterans Administration, Veterans Integrated Service Network 4, Mental Illness Research, Education and Clinical Center of Excellence, Pittsburgh, PA, United States
| | - Chandler S Capps
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, PA, United States
| | - Robert T Krafty
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, PA, United States
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Vseteckova J, Deepak-Gopinath M, Borgstrom E, Holland C, Draper J, Pappas Y, McKeown E, Dadova K, Gray S. Barriers and facilitators to adherence to group exercise in institutionalized older people living with dementia: a systematic review. Eur Rev Aging Phys Act 2018; 15:11. [PMID: 30455778 PMCID: PMC6225693 DOI: 10.1186/s11556-018-0200-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 09/27/2018] [Indexed: 11/10/2022] Open
Abstract
Objectives Research suggests targeted exercise is important for people living with dementia, especially those living in residential care. The aim of this review was to collect and synthesize evidence on the known barriers and facilitators to adherence to group exercise of institutionalized older people living with dementia. Methods We searched all available electronic databases. Additionally, we searched trial registries (clinicaltrial.gov, and WHO ICTRP) for ongoing studies. We searched for and included papers from January 1990 until September 2017 in any language. We included randomized, non-randomized trials. Studies were not eligible if participants were either healthy older people or people suffering from dementia but not living in an institution. Studies were also excluded if they were not focused on barriers and facilitators to adherence to group exercise. Results Using narrative analysis, we identified the following themes for barriers: bio-medical reasons and mental wellbeing and physical ability, relationships dynamics, and socioeconomic reasons. The facilitators were grouped under the following thematic frames: bio-medical benefits and benefits related to physical ability, feelings and emotions and confidence improvements, therapist and group relationships dynamics and activity related reasons. Conclusions We conclude that institutionalized older people living with dementia, even those who are physically frail, incontinent and/or have mild dementia can demonstrate certain level of exercise adherence, and therefore can respond positively to exercise programs. Tailored, individually-adjusted and supported physical activity, led by a knowledgeable, engaging and well communicating therapist/facilitator improves the adherence to group exercise interventions of institutionalized older people living with dementia.
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Affiliation(s)
- Jitka Vseteckova
- 1School of Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - Manik Deepak-Gopinath
- 1School of Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - Erica Borgstrom
- 1School of Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - Caroline Holland
- 1School of Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - Jan Draper
- 1School of Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - Yannis Pappas
- 2Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Eamonn McKeown
- 3Health Services Research & Management Division in the School of Health Sciences at City, University of London, London, UK
| | - Klara Dadova
- 4Department of Adapted Physical Activity and Sports Medicine, Faculty of Physical education and Sport, Charles University, Prague, Czech Republic
| | - Steve Gray
- 1School of Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
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Effects of Physical Exercise on Depressive Symptoms in Patients With Cognitive Impairment: A Systematic Review and Meta-Analysis. J Nerv Ment Dis 2018; 206:809-823. [PMID: 30273278 DOI: 10.1097/nmd.0000000000000887] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We aimed to evaluate the efficacy of physical exercise in ameliorating depressive symptoms in patients with cognitive impairment. The databases of PubMed, EMBASE, Web of Science, the Cochrane Library, PsycINFO, China National Knowledge Infrastructure, WanFang, and WeiPu (VIP) were searched to identify randomized controlled trials (RCTs) that involved physical exercise for patients with cognitive impairment. A random effects model and a fixed effects model were used to calculate the pooled effect size. Twenty-one studies were identified. The meta-analysis showed that physical exercise significantly ameliorated depressive symptoms (standardized mean difference [SMD] = -0.23; 95% confidence interval [CI], -0.39 to -0.07; p = 0.004). In addition, beneficial improvements in neuropsychiatric symptoms (mean difference, -4.62; 95% CI, -9.07 to -0.16, p = 0.04), quality of life (SMD = 0.23; 95% CI, 0.01-0.46; p = 0.04), and activities of daily living (SMD = 0.27; 95% CI, 0.12-0.43; p = 0.0005) were observed in our study. No significant improvements were found in anxiety or apathy. Nevertheless, further high-quality, multicenter RCTs are needed to identify the clinical value of our results.
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Abstract
Accumulating research in rodents and humans indicates that exercise benefits brain function and may prevent or delay onset of neurodegenerative conditions. In particular, exercise modifies the structure and function of the hippocampus, a brain area important for learning and memory. This review addresses the central and peripheral mechanisms underlying the beneficial effects of exercise on the hippocampus. We focus on running-induced changes in adult hippocampal neurogenesis, neural circuitry, neurotrophins, synaptic plasticity, neurotransmitters, and vasculature. The role of peripheral factors in hippocampal plasticity is also highlighted. We discuss recent evidence that systemic factors released from peripheral organs such as muscle (myokines), liver (hepatokines), and adipose tissue (adipokines) during exercise contribute to hippocampal neurotrophin and neurogenesis levels, and memory function. A comprehensive understanding of the body-brain axis is needed to elucidate how exercise improves hippocampal plasticity and cognition.
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Affiliation(s)
- C'iana Cooper
- Neuroplasticity and Behavior Unit, Laboratory of Neurosciences, National Institute on Aging, National Institutes of Health, Biomedical Research Center, Baltimore, Maryland 21224
| | - Hyo Youl Moon
- Neuroplasticity and Behavior Unit, Laboratory of Neurosciences, National Institute on Aging, National Institutes of Health, Biomedical Research Center, Baltimore, Maryland 21224
- Institute of Sport Science, Seoul National University, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Henriette van Praag
- Neuroplasticity and Behavior Unit, Laboratory of Neurosciences, National Institute on Aging, National Institutes of Health, Biomedical Research Center, Baltimore, Maryland 21224
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Effects of Physical Activity Programs on the Improvement of Dementia Symptom: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2920146. [PMID: 27819000 PMCID: PMC5081454 DOI: 10.1155/2016/2920146] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/22/2016] [Accepted: 08/24/2016] [Indexed: 11/17/2022]
Abstract
Objective. To confirm that physical activity program improves the symptoms of dementia and the most effective physical activity was selected to help establish exercise programs. Methods. Three databases, PubMed, Science Direct, and Willey online, were used to collect articles. The databases were published between January 2005 and December 2015. Keywords such as “dementia,” and “physical activity” were used in searching for papers. As a result, nine studies were selected in the second screening of the meta-analyses. Results. The improvement in the dementia symptom of physical capacity was 1.05 (high effect size, 95% CI: 0.03 to 0.73), ability of activity of daily living was 0.73 (slightly high effect size, 95% CI: 0.23 to 1.23), cognitive function was 0.46 (medium effect size, 95% CI: 0.26 to 0.66), and psychological state was 0.39 (lower than the medium effect size, 95% CI: 0.01 to 0.77). Conclusion. The physical activity for patients with dementia had an effect on the improvement of physical capacity and combined exercise was the most effective physical activity.
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Brett L, Traynor V, Stapley P. Effects of Physical Exercise on Health and Well-Being of Individuals Living With a Dementia in Nursing Homes: A Systematic Review. J Am Med Dir Assoc 2016; 17:104-16. [DOI: 10.1016/j.jamda.2015.08.016] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 08/17/2015] [Accepted: 08/17/2015] [Indexed: 11/16/2022]
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Groot C, Hooghiemstra A, Raijmakers P, van Berckel B, Scheltens P, Scherder E, van der Flier W, Ossenkoppele R. The effect of physical activity on cognitive function in patients with dementia: A meta-analysis of randomized control trials. Ageing Res Rev 2016; 25:13-23. [PMID: 26607411 DOI: 10.1016/j.arr.2015.11.005] [Citation(s) in RCA: 376] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/10/2015] [Accepted: 11/16/2015] [Indexed: 12/21/2022]
Abstract
Non-pharmacological therapies, such as physical activity interventions, are an appealing alternative or add-on to current pharmacological treatment of cognitive symptoms in patients with dementia. In this meta-analysis, we investigated the effect of physical activity interventions on cognitive function in dementia patients, by synthesizing data from 802 patients included in 18 randomized control trials that applied a physical activity intervention with cognitive function as an outcome measure. Post-intervention standardized mean difference (SMD) scores were computed for each study, and combined into pooled effect sizes using random effects meta-analysis. The primary analysis yielded a positive overall effect of physical activity interventions on cognitive function (SMD[95% confidence interval]=0.42[0.23;0.62], p<.01). Secondary analyses revealed that physical activity interventions were equally beneficial in patients with Alzheimer's disease (AD, SMD=0.38[0.09;0.66], p<.01) and in patients with AD or a non-AD dementia diagnosis (SMD=0.47[0.14;0.80], p<.01). Combined (i.e. aerobic and non-aerobic) exercise interventions (SMD=0.59[0.32;0.86], p<.01) and aerobic-only exercise interventions (SMD=0.41[0.05;0.76], p<.05) had a positive effect on cognition, while this association was absent for non-aerobic exercise interventions (SMD=-0.10[-0.38;0.19], p=.51). Finally, we found that interventions offered at both high frequency (SMD=0.33[0.03;0.63], p<.05) and at low frequency (SMD=0.64[0.39;0.89], p<.01) had a positive effect on cognitive function. This meta-analysis suggests that physical activity interventions positively influence cognitive function in patients with dementia. This beneficial effect was independent of the clinical diagnosis and the frequency of the intervention, and was driven by interventions that included aerobic exercise.
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Abstract
BACKGROUND A substantial part of elderly persons with dementia show rest-activity rhythm disturbances. The rest-activity rhythm is important to study in people with early-onset dementia (EOD) for rest-activity rhythm disturbances are predictive of institutionalization, and caregivers of young patients suffer from high distress. OBJECTIVE The aim of this study was to study (1) whether EOD patients have more rest-activity rhythm disturbances compared with cognitively intact adults; and (2) which factors contribute to a disturbed rhythm. METHODS We included 61 patients with EOD [mean age 61.9 (4.9) y, 41 (67%) men] and 68 cognitively intact adults [mean age 61.6 (4.5) y, 28 (41%) men]. Rest-activity rhythm was assessed by actigraphy. RESULTS EOD patients tended to have higher intradaily variability [0.46 (0.16) and 0.39 (0.10), P=0.03]. EOD patients also lay for a longer time in bed [time in bed: 08:49 (0:51) h and 08:07 (0:47) h, P<0.001] and needed more time to fall asleep [sleep onset latency: 23 (22) min and 15 (15) min, P=0.02]. Disturbances in the rest-activity rhythm were predicted by a low level of physical activity, use of antidepressants and central nervous system neurological medications, and being male. CONCLUSIONS EOD patients showed more variability in the rest-activity rhythm compared with cognitively intact adults. The main predictor for rest-activity rhythm disturbances was a low level of physical activity.
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Abstract
BACKGROUND This is an update of our previous 2013 review. Several recent trials and systematic reviews of the impact of exercise on people with dementia are reporting promising findings. OBJECTIVES Primary objectiveDo exercise programs for older people with dementia improve their cognition, activities of daily living (ADLs), neuropsychiatric symptoms, depression, and mortality? Secondary objectivesDo exercise programs for older people with dementia have an indirect impact on family caregivers' burden, quality of life, and mortality?Do exercise programs for older people with dementia reduce the use of healthcare services (e.g. visits to the emergency department) by participants and their family caregivers? SEARCH METHODS We identified trials for inclusion in the review by searching ALOIS (www.medicine.ox.ac.uk/alois), the Cochrane Dementia and Cognitive Improvement Group's Specialised Register, on 4 September 2011, on 13 August 2012, and again on 3 October 2013. SELECTION CRITERIA In this review, we included randomized controlled trials in which older people, diagnosed with dementia, were allocated either to exercise programs or to control groups (usual care or social contact/activities) with the aim of improving cognition, ADLs, neuropsychiatric symptoms, depression, and mortality. Secondary outcomes related to the family caregiver(s) and included caregiver burden, quality of life, mortality, and use of healthcare services. DATA COLLECTION AND ANALYSIS Independently, at least two authors assessed the retrieved articles for inclusion, assessed methodological quality, and extracted data. We analysed data for summary effects. We calculated mean differences or standardized mean difference (SMD) for continuous data, and synthesized data for each outcome using a fixed-effect model, unless there was substantial heterogeneity between studies, when we used a random-effects model. We planned to explore heterogeneity in relation to severity and type of dementia, and type, frequency, and duration of exercise program. We also evaluated adverse events. MAIN RESULTS Seventeen trials with 1067 participants met the inclusion criteria. However, the required data from three included trials and some of the data from a fourth trial were not published and not made available. The included trials were highly heterogeneous in terms of subtype and severity of participants' dementia, and type, duration, and frequency of exercise. Only two trials included participants living at home.Our meta-analysis revealed that there was no clear evidence of benefit from exercise on cognitive functioning. The estimated standardized mean difference between exercise and control groups was 0.43 (95% CI -0.05 to 0.92, P value 0.08; 9 studies, 409 participants). There was very substantial heterogeneity in this analysis (I² value 80%), most of which we were unable to explain, and we rated the quality of this evidence as very low. We found a benefit of exercise programs on the ability of people with dementia to perform ADLs in six trials with 289 participants. The estimated standardized mean difference between exercise and control groups was 0.68 (95% CI 0.08 to 1.27, P value 0.02). However, again we observed considerable unexplained heterogeneity (I² value 77%) in this meta-analysis, and we rated the quality of this evidence as very low. This means that there is a need for caution in interpreting these findings.In further analyses, in one trial we found that the burden experienced by informal caregivers providing care in the home may be reduced when they supervise the participation of the family member with dementia in an exercise program. The mean difference between exercise and control groups was -15.30 (95% CI -24.73 to -5.87; 1 trial, 40 participants; P value 0.001). There was no apparent risk of bias in this study. In addition, there was no clear evidence of benefit from exercise on neuropsychiatric symptoms (MD -0.60, 95% CI -4.22 to 3.02; 1 trial, 110 participants; P value .0.75), or depression (SMD 0.14, 95% CI -0.07 to 0.36; 5 trials, 341 participants; P value 0.16). We could not examine the remaining outcomes, quality of life, mortality, and healthcare costs, as either the appropriate data were not reported, or we did not retrieve trials that examined these outcomes. AUTHORS' CONCLUSIONS There is promising evidence that exercise programs may improve the ability to perform ADLs in people with dementia, although some caution is advised in interpreting these findings. The review revealed no evidence of benefit from exercise on cognition, neuropsychiatric symptoms, or depression. There was little or no evidence regarding the remaining outcomes of interest (i.e., mortality, caregiver burden, caregiver quality of life, caregiver mortality, and use of healthcare services).
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Affiliation(s)
- Dorothy Forbes
- University of AlbertaFaculty of Nursinglevel 3, Edmonton Clinic Health AcademyEdmontonABCanadaT6G 1C9
| | - Scott C Forbes
- Okanagan CollegeBiology, Human KineticsPenticton Campus583 Duncan Avenue WestPentictonBCCanadaV2A 8E1
| | - Catherine M Blake
- University of Western OntarioSchool of Nursing, Health Sciences Addition H0221151 Richmond StreetLondonONCanadaN6A 3K7
| | - Emily J Thiessen
- University of AlbertaFaculty of Nursinglevel 3, Edmonton Clinic Health AcademyEdmontonABCanadaT6G 1C9
| | - Sean Forbes
- University of FloridaDepartment of Physical Therapy100 S. Newell Drive, McKnight Brain Institute, rm L3‐183GainesvilleFLUSA32610
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Cabrera E, Sutcliffe C, Verbeek H, Saks K, Soto-Martin M, Meyer G, Leino-Kilpi H, Karlsson S, Zabalegui A. Non-pharmacological interventions as a best practice strategy in people with dementia living in nursing homes. A systematic review. Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2014.06.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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The value of personalized psychosocial interventions to address behavioral and psychological symptoms in people with dementia living in care home settings: a systematic review. Int Psychogeriatr 2014; 26:1083-98. [PMID: 24565226 DOI: 10.1017/s1041610214000131] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Several important systematic reviews and meta-analyses focusing on psychosocial interventions have been undertaken in the last decade. However, they have not focused specifically on the treatment of individual behavioral and psychological symptoms of dementia (BPSD) with personalized interventions. This updated systematic review will focus on studies reporting the effect of personalized psychosocial interventions on key BPSD in care homes. METHODS Systematic review of the evidence for psychosocial interventions for BPSD, focusing on papers published between 2000 and 2012. All care home and nursing home studies including individual and cluster randomized controlled trials (RCTs) and pre-/post-test studies with control conditions were included. RESULTS 641 studies were identified, of which 40 fulfilled inclusion and exclusion criteria. There was good evidence to support the value of personalized pleasant activities with and without social interaction for the treatment of agitation, and reminiscence therapy to improve mood. The evidence for other therapies was more limited. CONCLUSIONS There is a growing body of evidence indicating specific effects of different personalized psychosocial interventions on individual BPSD and mood outcomes.
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Abstract
BACKGROUND This is an update of our previous 2008 review. Several recent trials and systematic reviews of the impact of exercise on people with dementia are reporting promising findings. OBJECTIVES Primary: Do exercise programs for older people with dementia improve cognition, activities of daily living (ADLs), challenging behaviour, depression, and mortality in older people with dementia?Secondary: Do exercise programs for older people with dementia have an indirect impact on family caregivers' burden, quality of life, and mortality?Do exercise programs for older people with dementia reduce the use of healthcare services (e.g. visits to the emergency department) by participants and their family caregivers? SEARCH METHODS We identified trials for inclusion in the review by searching ALOIS (www.medicine.ox.ac.uk/alois), the Cochrane Dementia and Cognitive Improvement Group's Specialised Register, on 4 September 2011, and again on 13 August 2012. The search terms used were: 'physical activity' OR exercise OR cycling OR swim* OR gym* OR walk* OR danc* OR yoga OR 'tai chi'. SELECTION CRITERIA In this review, we included randomized controlled trials in which older people, diagnosed with dementia, were allocated either to exercise programs or to control groups (usual care or social contact/activities) with the aim of improving cognition, ADLs, behaviour, depression, and mortality. Secondary outcomes related to the family caregiver(s) and included caregiver burden, quality of life, mortality, and use of healthcare services. DATA COLLECTION AND ANALYSIS Independently, at least two authors assessed the retrieved articles for inclusion, assessed methodological quality, and extracted data. Data were analysed for summary effects using RevMan 5.1 software. We calculated mean differences or standardized mean difference (SMD) for continuous data, and synthesized data for each outcome using a fixed-effect model, unless there was substantial heterogeneity between studies, when we used a random-effects model. We planned to explore heterogeneity in relation to severity and type of dementia, and type, frequency, and duration of exercise program. We also evaluated adverse events. MAIN RESULTS Sixteen trials with 937 participants met the inclusion criteria. However, the required data from three trials and some of the data from a fourth trial were not published and not made available. The included trials were highly heterogeneous in terms of subtype and severity of participants' dementia, and type, duration and frequency of exercise. Only two trials included participants living at home. Our meta-analysis suggested that exercise programs might have a significant impact on improving cognitive functioning (eight trials, 329 participants; SMD 0.55, 95% confidence interval (CI) 0.02 to 1.09). However, there was substantial heterogeneity between trials (I(2) value 80%), most of which we were unable to explain. We repeated the analysis omitting one trial, an outlier, that included only participants with moderate or severe dementia. This reduced the heterogeneity somewhat (I(2) value 68%), and produced a result that was no longer significant (seven trials, 308 participants; SMD 0.31, 95% CI -0.11 to 0.74). We found a significant effect of exercise programs on the ability of people with dementia to perform ADLs (six studies, 289 participants; SMD 0.68, 95% CI 0.08 to 1.27). However, again we observed considerable unexplained statistical heterogeneity (I(2) value 77%) in this meta-analysis. This means that there is a need for caution in interpreting these findings. In further analyses, we found that the burden experienced by informal caregivers providing care in the home may be reduced when they supervise the participation of the family member with dementia in an exercise program (one study, 40 participants; MD -15.30, 95% CI -24.73 to -5.87), but we found no significant effect of exercise on challenging behaviours (one study, 110 participants; MD -0.60, 95% CI -4.22 to 3.02), or depression (six studies, 341 participants; MD -0.14, 95% CI -0.36 to 0.07) . We could not examine the remaining outcomes, quality of life, mortality, and healthcare costs, as either the appropriate data were not reported, or we did not retrieve trials that examined these outcomes. AUTHORS' CONCLUSIONS There is promising evidence that exercise programs can have a significant impact in improving ability to perform ADLs and possibly in improving cognition in people with dementia, although some caution is advised in interpreting these findings. The programs revealed no significant effect on challenging behaviours or depression. There was little or no evidence regarding the remaining outcomes of interest.
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Affiliation(s)
- Dorothy Forbes
- Faculty of Nursing, University of Alberta, 3rd Floor, Clinical Sciences Building, Edmonton, Alberta, Canada, T6G 2G3
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Bowes A, Dawson A, Jepson R, McCabe L. Physical activity for people with dementia: a scoping study. BMC Geriatr 2013; 13:129. [PMID: 24274624 PMCID: PMC4222572 DOI: 10.1186/1471-2318-13-129] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 11/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This scoping study aimed to identify how physical activity may benefit people with dementia; how and/or if current service provide these benefits; and what support they need to do so. METHODS Methods included an evidence review using literature; mapping current service provision through a survey; and in-depth interviews with a sample of service providers. RESULTS The 26 studies included in the review indicated the potential effectiveness of physical activity for people with dementia, including improvements in cognition and mood, behaviour and physical condition. Mechanisms of action and the link with outcomes were poorly defined and implemented.The mapping survey and related interviews showed that service providers were delivering a range of services broadly consistent with the scientific evidence. They tended to take a holistic view of possible benefits, and focused on enjoyment and well-being, more than specific cognitive, physical and behavioural outcomes highlighted in literature. Service providers needed more evidence based information and resources to develop services and realise their potential. CONCLUSION Despite potential benefits demonstrated in literature and practice, there is a need for further research to optimise interventions and to consider some neglected issues including delivery at home and in communities; impacts for carers; physical activities through ADLs; and individual needs. Studies are needed which take a more holistic approach to the effects of physical activity, and outcomes should be broader and include mental health and wellbeing.
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Affiliation(s)
- Alison Bowes
- School of Applied Social Science, University of Stirling, Stirling, Scotland FK9 4LA, UK
| | - Alison Dawson
- School of Applied Social Science, University of Stirling, Stirling, Scotland FK9 4LA, UK
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, 20 West Richmond Street, Edinburgh, Scotland EH8 9DX, UK
| | - Louise McCabe
- School of Applied Social Science, University of Stirling, Stirling, Scotland FK9 4LA, UK
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Camargos EF, Louzada FM, Nóbrega OT. Wrist actigraphy for measuring sleep in intervention studies with Alzheimer's disease patients: application, usefulness, and challenges. Sleep Med Rev 2013; 17:475-88. [PMID: 23669093 DOI: 10.1016/j.smrv.2013.01.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 01/26/2013] [Accepted: 01/28/2013] [Indexed: 10/26/2022]
Abstract
Sleep disorders are common in patients with Alzheimer's disease (AD). An important aspect of intervention studies in patients with sleep disorders is the choice of assessment strategy. This paper presents a literature review concerning assessment strategies for measuring sleep in intervention studies with AD patients, with a focus on actigraphy. Thirty-seven articles were selected for this review, having analysis of sleep/nocturnal rhythm disturbances by actigraphy as the primary or secondary outcome. The advantages and limitations of actigraphy were discussed vis-à-vis polysomnography and subjective interventions. The following methodological aspects were addressed: impact of experimental design and patient setting, inclusion and exclusion criteria, placement of the actigraphy device, adherence to the regimen, duration of recordings and the choice of sleep parameters. Our analyses suggest that the methods used in intervention studies encompassing sleep disorders and dementia could be improved by increasing accuracy of diagnosis, categorization of sleep disturbances, adherence to actigraphy, and by clearly defining the variables and endpoints in each study. Also, controlling variables that could interfere with sleep and describing the data processing and analysis might improve interpretation of results.
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Affiliation(s)
- Einstein F Camargos
- Department of Medical Clinical, Geriatric Medical Centre, HUB, Brasilia University Hospital, SGAN 605 Av. L2 Norte, Asa Norte, Brasilia, DF, CEP 70840-901, Brazil.
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Bossers WJR, van der Woude LHV, Boersma F, Scherder EJA, van Heuvelen MJG. Recommended measures for the assessment of cognitive and physical performance in older patients with dementia: a systematic review. Dement Geriatr Cogn Dis Extra 2012; 2:589-609. [PMID: 23341825 PMCID: PMC3551396 DOI: 10.1159/000345038] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aim/Goal To recommend a set of neuropsychological and physical exercise tests for researchers to assess cognition and physical fitness in clinical trials with older patients with dementia; to create consensus, decrease heterogeneity, and improve research quality. Methods A literature search (2005–2011) yielded 89 randomized controlled trials. To provide information on test recommendations the frequency of test use, effect size of the test outcome, study quality, and psychometric properties of tests were analyzed. Results Fifty-nine neuropsychological tests (cognitive domains: global cognition, executive functioning, memory, and attention) and 10 exercise tests (physical domains: endurance capacity, muscle strength, balance, and mobility) were found. Conclusion The Severe Impairment Battery, Mini Mental State Examination, and Alzheimer Disease Assessment Scale – cognitive subscale were recommended to measure global cognition. The Verbal Fluency Test Category/Letters, Clock Drawing Test, and Trail Making Test-B were recommended to measure executive functioning. No specific memory test could be recommended. The Digit Span Forward, Digit Span Backward, and Trail Making Test-A were recommended to measure attention. As physical exercise tests, the Timed Up and Go and Six Meter Walk for mobility, the Six Minute Walk Distance for endurance capacity, and the Tinetti Balance Scale were recommended.
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Affiliation(s)
- Willem J R Bossers
- Center for Human Movement Sciences, Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Woods B, Aguirre E, Spector AE, Orrell M. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev 2012:CD005562. [PMID: 22336813 DOI: 10.1002/14651858.cd005562.pub2] [Citation(s) in RCA: 328] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cognitive stimulation is an intervention for people with dementia which offers a range of enjoyable activities providing general stimulation for thinking, concentration and memory usually in a social setting, such as a small group. Its roots can be traced back to Reality Orientation (RO), which was developed in the late 1950s as a response to confusion and disorientation in older patients in hospital units in the USA. RO emphasised the engagement of nursing assistants in a hopeful, therapeutic process but became associated with a rigid, confrontational approach to people with dementia, leading to its use becoming less and less common.Cognitive stimulation is often discussed in normal ageing as well as in dementia. This reflects a general view that lack of cognitive activity hastens cognitive decline. With people with dementia, cognitive stimulation attempts to make use of the positive aspects of RO whilst ensuring that the stimulation is implemented in a sensitive, respectful and person-centred manner.There is often little consistency in the application and availability of psychological therapies in dementia services, so a systematic review of the available evidence regarding cognitive stimulation is important in order to identify its effectiveness and to place practice recommendations on a sound evidence base. OBJECTIVES To evaluate the effectiveness and impact of cognitive stimulation interventions aimed at improving cognition for people with dementia, including any negative effects. SEARCH METHODS The trials were identified from a search of the Cochrane Dementia and Cognitive Improvement Group Specialized Register, called ALOIS (updated 6 December 2011). The search terms used were: cognitive stimulation, reality orientation, memory therapy, memory groups, memory support, memory stimulation, global stimulation, cognitive psychostimulation. Supplementary searches were performed in a number of major healthcare databases and trial registers to ensure that the search was up to date and comprehensive. SELECTION CRITERIA All randomised controlled trials (RCTs) of cognitive stimulation for dementia which incorporated a measure of cognitive change were included. DATA COLLECTION AND ANALYSIS Data were extracted independently by two review authors using a previously tested data extraction form. Study authors were contacted for data not provided in the papers. Two review authors conducted independent assessments of the risk of bias in included studies. MAIN RESULTS Fifteen RCTs were included in the review. Six of these had been included in the previous review of RO. The studies included participants from a variety of settings, interventions that were of varying duration and intensity, and were from several different countries. The quality of the studies was generally low by current standards but most had taken steps to ensure assessors were blind to treatment allocation. Data were entered in the meta-analyses for 718 participants (407 receiving cognitive stimulation, 311 in control groups). The primary analysis was on changes that were evident immediately at the end of the treatment period. A few studies provided data allowing evaluation of whether any effects were subsequently maintained. A clear, consistent benefit on cognitive function was associated with cognitive stimulation (standardised mean difference (SMD) 0.41, 95% CI 0.25 to 0.57). This remained evident at follow-up one to three months after the end of treatment. In secondary analyses with smaller total sample sizes, benefits were also noted on self-reported quality of life and well-being (standardised mean difference: 0.38 [95% CI: 0.11, 0.65]); and on staff ratings of communication and social interaction (SMD 0.44, 95% CI 0.17 to 0.71). No differences in relation to mood (self-report or staff-rated), activities of daily living, general behavioural function or problem behaviour were noted. In the few studies reporting family caregiver outcomes, no differences were noted. Importantly, there was no indication of increased strain on family caregivers in the one study where they were trained to deliver the intervention. AUTHORS' CONCLUSIONS There was consistent evidence from multiple trials that cognitive stimulation programmes benefit cognition in people with mild to moderate dementia over and above any medication effects. However, the trials were of variable quality with small sample sizes and only limited details of the randomisation method were apparent in a number of the trials. Other outcomes need more exploration but improvements in self-reported quality of life and well-being were promising. Further research should look into the potential benefits of longer term cognitive stimulation programmes and their clinical significance.
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Affiliation(s)
- Bob Woods
- Dementia ServicesDevelopment CentreWales, Bangor University, Bangor, UK.
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Applicability and Effects of Physical Exercise on Physical and Cognitive Functions and Activities of Daily Living Among People With Dementia. Am J Phys Med Rehabil 2011; 90:495-518. [DOI: 10.1097/phm.0b013e318214de26] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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YOON JIYEONG, OKURA TOMOHIRO, TSUNODA KENJI, TSUJI TAISHI, KOHDA YOSHIE, MITSUISHI YASUHIRO, HASEGAWA CHISA, KIM HOON. RELATIONSHIP BETWEEN COGNITIVE FUNCTION AND PHYSICAL PERFORMANCE IN OLDER ADULTS. ACTA ACUST UNITED AC 2010. [DOI: 10.7600/jspfsm.59.313] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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