Occupational performance issues in older adults with subjective cognitive decline

Rationale and protocol of the LEAD 2.0 study: a randomized controlled trial assessing the feasibility of a virtually delivered 6-month exercise and nutrition intervention in older adults with subjective cognitive decline (SCD)

BACKGROUND

With growing prevalence of dementia worldwide, dementia risk reduction is a key interest of the World Health Organization's Global Dementia Action Plan. Subjective cognitive decline (SCD) is a prominent predictor of future dementia diagnosis. Therefore, people with SCD are an important group for dementia prevention intervention. Exercise and healthy diet are associated with a 30-60% decrease in dementia risk in longitudinal studies. Technological advances yield the potential of trials that deliver lifestyle interventions virtually, reaching people in a wide geographical spread. However, the feasibility of large-scale virtual trials still needs to be established.

OBJECTIVE

This trial aims to examine the feasibility of a factorial randomized controlled trial exploring a 6-month virtual, exercise and healthy diet intervention. Secondary objectives will examine whether feasibility outcomes vary by gender or technology access.

METHODS

We will recruit 140 older adults (65 + years) with SCD, who will receive a combination of Aerobic and Resistance Exercise (EX) or Stretching and Toning (STRETCH) and either Diet Counseling (DIET) or Brain Health Education (ED). Participants will be randomized to four weekly hours of one of four intervention arms: (1) EX and DIET; (2) EX and ED; (3) STRETCH and DIET; or (4) STRETCH and ED. EX will include moderate intensity aerobic and resistance training. DIET will instruct participants in brain healthy food choices. Assessments will be performed virtually at baseline, 6 months (post-intervention), and 12 months. Feasibility will be measured by recruitment rate, adherence, and retention.

DISCUSSION

Established feasibility will set the stage for a definitive trial. Feasibility results will also inform future virtual programs/services. In the long-term, if the interventions are feasible and beneficial, this intervention model could scale up and spread quickly to reach at-risk individuals for the purpose of dementia risk reduction.

TRIAL REGISTRATION

The Lifestyle, Exercise, and Diet (LEAD 2.0) study is registered with the US National Institutes of Health clinical trials registry (ClinicalTrials.gov identifier NCT06078748). This report complies with the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement.

[Effects of a personalised, adapted computerised cognitive stimulation programme versus stimulating leisure activities in younger and older adults with mild or subjective cognitive impairment. Protocol for a randomised controlled trial]

BACKGROUND

Mild cognitive impairment represents a transitional stage between healthy aging and dementia, with subjective cognitive impairment being a key predictor of progression to dementia. This randomized controlled trial aims to compare the effectiveness of a personalized computerized cognitive stimulation program with that of stimulating leisure activities in younger and older adults with mild or subjective cognitive impairment.

METHODS

Participants aged = 50 with mild cognitive impairment, subjective cognitive impairment, or scores between 24 and 31 on the Spanish Mini-Mental State Examination were recruited. Exclusion criteria comprised living in residential care, use of acetylcholinesterase inhibitors, sensory impairments, agitation, or having received cognitive stimulation in the past 12 months. Fifty-nine community-dwelling individuals in Zaragoza, Spain, were randomly assigned to two interventions group or a control group. The first intervention group will receive personalized computerized cognitive stimulation for 30 minutes per day, five days per week, while the second intervention group will participate in two to five stimulating leisure activities. The intervention will last eight weeks. The control group will receive the usual care for the same duration. The primary outcome is the assessment of global cognition; secondary outcomes include memory, verbal fluency, activities of daily living, and mood.

Association between social capital and quality of life in older adults with subjective cognitive decline: A cross-sectional study

BACKGROUND

Subjective cognitive decline (SCD) is increasingly recognized as a clinical and medical risk factor for mild cognitive impairment (MCI) and dementia. Currently, there is little evidence regarding the quality of life (QoL) in older adults with SCD and the impact of social capital on their QoL.

AIMS

To examine the perceptions of social capital and QoL among older adults with SCD.

METHODS

A total of 325 participants (92.9 % response rate) with a self-reported diagnosis of SCD completed the Chinese version of the 36-item Short-Form Health Survey, the Chinese Shortened Social Capital Scale and the Generalized Anxiety Disorder Scale. A t-test was used to compare the QoL score of our sample with the Chinese norm. Pearson correlation analysis and multivariate linear regression analysis were used to assess the association of social capital with QoL.

RESULTS

Social capital were strongly correlated with the total QoL, as well as its physical component summary and mental component summary. The QoL score of older adults with SCD was significantly lower than the Chinese norm (P < 0.001). Multivariate analysis showed that social capital, physical activity, nutrition and anxiety symptoms were factors associated with QoL among older SCD population (P < 0.05).

CONCLUSION

The findings of the current study suggest that older adults with SCD may experience lower QoL. Social capital is associated with the QoL in older adults with SCD. These findings have implications for clinicians who work with older adults with SCD.

Characterizing Cognition in Everyday Life of Older Adults With Subjective Cognitive Decline

Subjective cognitive decline (SCD), the subjective experience of worsening cognition with no objective cognitive impairment, poses a heightened risk for dementia. This study aimed to characterize cognition in the everyday life of people with SCD, is crucial for understanding and preventing further functional and cognitive decline. One hundred and thirty-five older adults (age 70.7±6.7) with SCD were assessed using functional-cognition measures: Multifactorial Memory Questionnaire (MMQ), Behavior Rating Inventory of Executive Function–Adult version (BRIEF-A), and Multiple Errands Test (MET). The resulted showed that older adults with SCD reported lower memory satisfaction (Hedges’s g = 0.41) on the MMQ, and worse metacognition on the BRIEF-A (Hedges’s g = 0.63) compared with published normative data. They completed an average of only 6/12 required tasks on the MET. The findings show functional difficulties related to SCD and inform the development of occupational therapy intervention for this population.

Feasibility and preliminary efficacy of the LEAD trial: a cluster randomized controlled lifestyle intervention to improve hippocampal volume in older adults at-risk for dementia

BACKGROUND

Healthy diet and exercise are associated with reduced risk of dementia in older adults. The impact of diet and exercise interventions on brain health is less consistent, especially with dietary interventions which rely on varying approaches. Our objective was to evaluate the feasibility and preliminary efficacy of a 6-month intervention combining exercise with a novel dietary counseling approach to improve hippocampal volume among older adults at-risk for dementia.

METHODS

Participants with vascular risk factors and subjective cognitive decline or early mild cognitive impairment were cluster randomized in groups of 3-4 to the diet intervention (DIET) or control education (ED) group. All participants engaged in 1 h of supervised exercise per week and additional exercise at home. DIET involved 1 h per week of group-based dietary counseling comprising education, goal setting, and strategy training. ED involved 1 h per week of group-based brain health education classes. Our primary outcome was change in hippocampal volume from baseline to 6 months. Secondary outcomes included changes in cognitive function, blood biomarkers, diet, and fitness. Recruitment challenges and early discontinuation of the trial due to COVID-19 necessitated a revised focus on feasibility and preliminary efficacy.

RESULTS

Of 190 older adults contacted, 14 (7%) were eligible and enrolled, constituting 21% of our recruitment target. All participants completed the intervention and attended 90% of exercise and DIET/ED sessions on average. All 6-month assessments prior to COVID-19 were completed but disruptions to in-person testing resulted in incomplete data collection. No serious adverse events occurred and all participants expressed positive feedback about the study. Preliminary findings did not identify any significant changes in hippocampal volume; however, substantial improvements in diet and HbA1c were observed with DIET compared to ED (d = 1.75 and 1.07, respectively).

CONCLUSIONS

High adherence and retention rates were observed among participants and preliminary findings illustrate improvements in diet quality and HbA1c. These results indicate that a larger trial is feasible if difficulties surrounding recruitment can be mitigated.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03056508 .

The role of disability and depressive symptoms in the relation between objective cognitive performance and subjective cognitive decline

BACKGROUND

Subjective cognitive decline (SCD) and subjective memory decline (SMD) are common among older people. Evidence linking SCD and SMD with cognitive and memory impairment is inconsistent. Moreover, little is known about the associations of SCD and SMD with disability. We aimed to explore the associations of SCD and SMD with objective cognitive and memory performance, disability, and depressive symptoms.

MATERIALS AND METHODS

In a cross-sectional study we conducted face to face interviews in a randomized sample of people aged ≥65 years living in the Canton of Ticino, southern Switzerland, between May 2021 and April 2022. We measured subjective cognitive decline with the MyCog, a subsection of the Subjective Cognitive Decline Questionnaire (SCD-Q); cognitive functioning with the Community Screening Instrument for Dementia; memory with the consortium to establish a registry for alzheimer's disease (CERAD) 10-word list learning task; and disability and depressive symptoms with the world health organization disability assessment schedule 2.0 (WHO-DAS 2.0) and the Euro-Depression (EURO-D) scales, respectively.

RESULTS

Of the 250 participants 93.6% reported at least one cognitive difficulty, and 40.0% SMD. Both SCD and SMD were associated with poorer objective cognitive/memory performance, and independently with greater disability, and more depressive symptoms. But in participants with high disability and depressive symptoms subjective and objective cognition were no longer associated. Disability fully mediated the associations of poorer objective cognitive and memory performance with subjective cognitive and memory decline.

CONCLUSION

Routine clinical assessments of cognitive function should include formal enquires about SCD and SMD, and also account for disability and depressive symptoms.