Effects of Motor Intervention in Elderly Patients With Dementia: An Analysis of Randomized Controlled Trials

The Effects of Exercise on Synaptic Plasticity in Individuals With Mild Cognitive Impairment: Protocol for a Pilot Intervention Study

BACKGROUND

Mild cognitive impairment (MCI) is a syndrome preceding more severe impairment characterized by dementia. MCI affects an estimated 15% to 20% of people older than 65 years. Nonpharmacological interventions including exercise are recommended as part of overall MCI management based on the positive effects of exercise on cognitive performance. Interval training involves brief intermittent bouts of exercise interspersed with short recovery periods. This type of exercise promotes cognitive improvement and can be performed in individuals with MCI. Synaptic plasticity can be assessed in vivo by the neurophysiological response to repetitive transcranial magnetic stimulation (rTMS). A method to assess synaptic plasticity uses an intermittent theta burst stimulation (iTBS), which is a patterned form of rTMS. Individuals with MCI have decreased responses to iTBS, reflecting reduced synaptic plasticity. It is unknown whether interval training causes changes in synaptic plasticity in individuals living with MCI.

OBJECTIVE

This research will determine whether interval training performed using a cycle ergometer enhances synaptic plasticity in individuals with MCI. The three aims are to (1) quantify synaptic plasticity after interval training performed at a self-determined intensity in individuals with MCI; (2) determine whether changes in synaptic plasticity correlate with changes in serum brain-derived neurotrophic factor, osteocalcin, and cognition; and (3) assess participant compliance to the exercise schedule.

METHODS

24 individuals diagnosed with MCI will be recruited for assignment to 1 of the 2 equally sized groups: exercise and no exercise. The exercise group will perform exercise 3 times per week for 4 weeks. Synaptic plasticity will be measured before and following the 4-week intervention. At these time points, synaptic plasticity will be measured as the response to single-pulse TMS, reflected as the percent change in the average amplitude of 20 motor-evoked potentials before and after an iTBS rTMS protocol, which is used to induce synaptic plasticity. In addition, individuals will complete a battery of cognitive assessments and provide a blood sample from the antecubital vein to determine serum brain-derived neurotrophic factor and osteocalcin.

RESULTS

The study began in September 2023.

CONCLUSIONS

The proposed research is the first to assess whether synaptic plasticity is enhanced after exercise training in individuals with MCI. If exercise does indeed modify synaptic plasticity, this will create a new avenue by which we can study and manipulate neural plasticity in these individuals.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05663918; https://clinicaltrials.gov/study/NCT05663918.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/50030.

Effects of acrobatic training on spatial memory and astrocytic scar in CA1 subfield of hippocampus after chronic cerebral hypoperfusion in male and female rats

Chronic cerebral hypoperfusion leads to neuronal loss in the hippocampus and spatial memory impairments. Physical exercise is known to prevent cognitive deficits in animal models; and there is evidence of sex differences in behavioral neuroprotective approaches. The aim of present study was to investigate the effects of acrobatic training in male and female rats submitted to chronic cerebral hypoperfusion. Males and females rats underwent 2VO (two-vessel occlusion) surgery and were randomly allocated into 4 groups of males and 4 groups of females, as follows: 2VO acrobatic, 2VO sedentary, Sham acrobatic and Sham sedentary. The acrobatic training started 45 days after surgery and lasted 4 weeks; animals were then submitted to object recognition and water maze testing. Brain samples were collected for histological and morphological assessment and flow cytometry. 2VO causes cognitive impairments and acrobatic training prevented spatial memory deficits assessed in the water maze, mainly for females. Morphological analysis showed that 2VO animals had less NeuN labeling and acrobatic training prevented it. Increased number of GFAP positive cells was observerd in females; moreover, males had more branched astrocytes and acrobatic training prevented the branching after 2VO. Flow cytometry showed higher mitochondrial potential in trained animals and more reactive oxygen species production in males. Acrobatic training promoted neuronal survival and improved mitochondrial function in both sexes, and influenced the glial scar in a sex-dependent manner, associated to greater cognitive benefit to females after chronic cerebral hypoperfusion.

Impaired Cognitive Function is Associated with Motor Function and Activities of Daily Living in Mild to Moderate Alzheimer's Dementia

BACKGROUND

The deterioration of cognitive and motor functions and activities of daily living is common in Alzheimer's dementia.

OBJECTIVES

The purpose of this study was to investigate the correlation and the strength of the relationship between cognitive function and motor function and activities of daily living after a diagnosis of Alzheimer's disease dementia.

METHODS

Sixty-three patients with mild to moderate Alzheimer's disease dementia in a community setting of South Korea were examined for cognitive and motor functions, and functional levels. The test or measures used for cognitive function were the Mini-Mental State Examination (MMSE), Global Deterioration Scale (GDS), and Clinical Dementia Rating (CDR). The 10-meter walking test (10MWT), Berg Balance Scale (BBS), and Timed Up and Go Test (TUG) were used to examine motor function, while the Modified Barthel Index (MBI) and Katz Index (KI) were used to examining activities of daily living.

RESULTS

The MMSE had a positive correlation with that from the BBS (r=.338, p<.05), MBI (r=.363, p<.05), and KI (r=.276, p<.05). The GDS was negatively correlated with BBS (r=.319, p<.05). Multivariate regression analysis showed that MMSE was a major explanatory variable for BBS (R2 =.115, β=.338, p<.05) MBI (R2 =.131, β=.363, p<.05), and KI (R2 =.076, β=.276, p<.05).

CONCLUSION

The results of the present study show that cognitive function by MMSE is correlated with balance by BBS and activities of daily living by MBI and KI, and MMSE, which are tests or measures for cognitive function, can be explanatory variable to explain variations in the BBS, MBI, and KI in the persons with mild to moderate Alzheimer's dementia. It may mean that a decrease in cognitive function was found to affect motor function and activities of daily living. Based on this study, appropriate intervention approaches including physical exercise, should be considered for caring for persons with mild to moderate Alzheimer's dementia in a community setting.

Motivation as a mechanism underpinning exercise-based falls prevention programmes for older adults with cognitive impairment: a realist review

OBJECTIVES

This review aimed to identify mechanisms underlying participation in falls prevention interventions, in older adults with cognitive impairment. In particular we studied the role of motivation.

DESIGN

A realist review of the literature.

DATA SOURCES

EMBASE, MEDLINE, CINAHL, the Cochrane Library, PsycINFO and PEDRO.

ELIGIBILITY CRITERIA

Publications reporting exercise-based interventions for people with cognitive impairment, including dementia, living in the community.

DATA EXTRACTION AND SYNTHESIS

A 'rough programme theory' (a preliminary model of how an intervention works) was developed, tested against findings from the published literature and refined. Data were collected according to elements of the programme theory and not isolated to outcomes. Motivation emerged as a key element, and was prioritised for further study.

RESULTS

An individual will access mechanisms to support participation when they think that exercise will be beneficial to them. Supportive mechanisms include having a 'gate-keeper', such as a carer or therapist, who shares responsibility for the perception of exercise as beneficial. Lack of access to support decreases adherence and participation in exercise. Motivational mechanisms were particularly relevant for older adults with mild-to-moderate dementia, where the exercise intervention was multicomponent, in a preferred setting, at the correct intensity and level of progression, correctly supported and considered, and flexibly delivered.

CONCLUSION

Motivation is a key element enabling participation in exercise-based interventions for people with cognitive impairment. Many of the mechanisms identified in this review have parallels in motivational theory. Clinically relevant recommendations were derived and will be used to further develop and test a motivationally considered exercise-based falls intervention for people with mild dementia.

PROSPERO REGISTRATION NUMBER

CRD42015030169.

Podiatry intervention versus usual care to prevent falls in care homes: pilot randomised controlled trial (the PIRFECT study)

Background

Common foot problems are independent risk factors for falls in older people. There is evidence that podiatry can prevent falls in community-dwelling populations. The feasibility of implementing a podiatry intervention and trial in the care home population is unknown. To inform a potential future definitive trial, we performed a pilot randomised controlled trial to assess: (i) the feasibility of a trial of a podiatry intervention to reduce care home falls, and (ii) the potential direction and magnitude of the effect of the intervention in terms of number of falls in care home residents.

Methods

Informed by Medical Research Council guidance on developing and evaluating complex interventions, we conducted a single blind, pilot randomised controlled trial in six care homes in the East of Scotland. Participants were randomised to either: (i) a three month podiatry intervention comprising core podiatry care, foot and ankle exercises, orthoses and footwear provision or (ii) usual care. Falls-related outcomes (number of falls, time to first fall) and feasibility-related outcomes (recruitment, retention, adherence, data collection rates) were collected. Secondary outcomes included: generic health status, balance, mobility, falls efficacy, and ankle joint strength.

Results

474 care home residents were screened. 43 (9.1%) participants were recruited: 23 to the intervention, 20 to control. Nine (21%) participants were lost to follow-up due to declining health or death. It was feasible to deliver the trial elements in the care home setting. 35% of participants completed the exercise programme. 48% reported using the orthoses ‘all or most of the time’. Completion rates of the outcome measures were between 93% and 100%. No adverse events were reported. At the nine month follow-up period, the intervention group per-person fall rate was 0.77 falls vs. 0.83 falls in the control group.

Conclusions

A podiatry intervention to reduce falls can be delivered to care home residents within a pilot randomised controlled trial of the intervention. Although not powered to determine effectiveness, these preliminary data provide justification for a larger trial, incorporating a full process evaluation, to determine whether this intervention can significantly reduce falls in this high-risk population.

Trial registration

ClinicalTrials.gov identifier: NCT02178527; Date of registration: 17 June 2014.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-017-0541-1) contains supplementary material, which is available to authorized users.

Act-Belong-Commit: Lifestyle Medicine for Keeping Mentally Healthy

Lifestyle medicine has generally focused on behaviors related to improving physical health and preventing physical illnesses, with little attention to behaviors related to mental health. This reflects the far greater concern in health systems around the globe for physical health over mental health. The Act-Belong-Commit campaign is the first major attempt to provide a lifestyle framework for promoting mental health that can be applied at a population level, within specific settings, and in the clinic. This article describes the campaign and offers clinicians a guide to implementing the campaign in their practice.

Service-related needs of older people with dementia: perspectives of service users and their unpaid carers

BACKGROUND

Dementia is a major cause of disability among older people and constitutes one of the greatest challenges currently facing families and health and social care services in the developed world. In response to trends in dementia prevalence and the impact the condition has on peoples' lives, dementia care has been placed high on the public and political agenda in the United Kingdom. However, despite significant public resources being allocated to combat the impact of the disease, recent evidence indicates that numerous challenges in relation to service provision remain. This study aimed to develop a deeper understanding of the lived experience of people with dementia regarding their service-related needs.

METHOD

The study made use of data gathered through individual semi-structured, narrative interviews conducted with persons with experience of dementia and their unpaid carers.

RESULTS

Although participants were generally satisfied with the services they received, a number of unmet needs related to service provision were identified. In terms of diagnostic procedures the findings of this study indicate the need for early diagnosis delivered through a comprehensive assessment package. The participants also highlighted the need for well-coordinated post-diagnostic support, greater continuity of care concerning the personnel involved, and enhanced access to non-pharmacological interventions to support identity and social engagement.

CONCLUSION

This study contributes to a better understanding of service-related needs of people with dementia in relation to diagnostic procedures and post-diagnostic support.

Making sense(s) in dementia: a multisensory and motor-based group activity program

Lack of engagement in meaningful activities is associated with poor quality of life in dementia; thus, the development of these activities has been recommended. This pilot study aimed to develop a multisensory and motor-based group activity program for residents with dementia and assess its impact on residents' behavior. The program was designed using a multisensory and motor-based approach in sixteen 45-minute weekly sessions tailored to residents' characteristics. Four residents with advanced dementia participated in the program. The frequency and duration of the residents' behavior were assessed using video recordings. All residents participated in the proposed activities, although they were more participative and communicative in some sessions than in others. Group activity programs based on multisensory and motor stimulation can be a promising approach for people with advanced dementia; however, further research is needed. This study may serve as reference to the implementation of future programs aiming to increase person-centeredness of the care provided.

Impact of physical activity on activity of daily living in moderate to severe dementia: a critical review

The objectives of this study were to describe the different modalities of physical activity programs designed for moderate to severe dementia and to identify their impact on functional independence in activities of daily living (ADL). A critical review of randomized controlled trials related to the impact of physical activity programs in moderately to severely demented persons on ADL performance and meta-analysis of the identified studies were performed. Among the 303 identified articles, five responded to the selection criteria. Four out of the five studies demonstrated limited methodological quality. In one high-quality study, physical activity programs significantly delayed deterioration of ADL performance. The program components and ADL assessment tools vary widely across studies. Although the proposed treatments have not proven their efficiency in improving the ADL status of the patients, they were able to limit the decline in ADL functioning. Future research is warranted in order to identify clinically relevant modalities for physical activity programs for people with moderate to severe dementia.

Atividade física e sintomas neuropsiquiátricos em pacientes com demência de Alzheimer

Na demência de Alzheimer (DA) é comum a presença de sintomas neuropsiquiátricos resultantes de mudanças anatômicas e bioquímicas no cérebro. O objetivo deste estudo foi realizar uma revisão sistemática dos estudos que investigaram a relação entre atividade física e sintomas neuropsiquiátricos na DA. Efetuou-se uma pesquisa nas bases de dados: Academic Search Premier, Biological Abstracts, Medline, PsycINFO, Pubmed, Scielo, Science Direct, Sport Discus e Web of Science, utilizando-se as seguintes palavras - chave e operadores boleanos: (Neuropsychiatric disturbances OR Neuropsychiatric symptoms OR Neuropsychological disturbances OR Aberrant behavior OR Aberrant behaviour OR Behavior disturbances OR Behaviour disturbances OR Behavior management OR Behaviour management OR Disruptive behavior OR Disruptive behaviour) AND (Alzheimer) AND (Exercise OR Motor intervention OR training OR Physical activity OR fitness), além de referências cruzadas dos artigos selecionados. Foram encontrados oito estudos que preencheram os critérios de inclusão. Concluiu-se que bons resultados têm sido evidenciados para os distúrbios de agitação e sono de pacientes com DA. Entretanto então há um consenso de qual o melhor tipo de atividade para estes pacientes.

Effects of a motor and multisensory-based approach on residents with moderate-to-severe dementia

Involving institutionalized people with dementia in their routines may be challenging, particularly in advanced stages of the disease. Motor and multisensory stimulation may help to maintain or improve residents' remaining abilities such as communication and self-care. This study examines the effects of a motor and multisensory-based approach on the behavior of 6 residents with moderate-to-severe dementia. A single-group, pre- and post test design was conducted. Motor and multisensory stimulation strategies were implemented in residents' morning care routines by staff, after the provision of training and assistance. Twelve video recordings of morning care (6 pre- and 6 post interventions) were coded for the type of residents' behavior. Results showed a tendency toward improvements in residents' levels of caregiver-direct gaze, laughing and engagement, and a reduction of closed eyes, during morning care. The introduction of a motor and multisensory-based approach in care routines may improve residents' engagement and attention to the environment.

Can balance exercise programmes improve balance and related physical performance measures in people with dementia? A systematic review

This review presents the physical performance outcomes of randomised trials investigating exercise programmes that included balance exercise for older people with dementia. A systematic literature search through five computerised bibliographic databases until February 2009 was carried out. Of 1,038 potentially relevant published articles, only seven met the inclusion criteria and were extracted. Findings from the review for a total of 632 participants showed that almost all of the included studies addressed exercise or physical activities as the main intervention; however, only two of the studies focused on balance exercise. The effect size values varied from no effect (0.00) to a large effect (3.29) of the interventions for a range of physical performance outcome measures. Findings also suggest that it is feasible to conduct exercise programmes with older people with dementia. However, further studies with more specific exercise designed to improve balance performance in order to prevent falls are required for older people with dementia.

Atividade física sistematizada e desempenho cognitivo em idosos com demência de Alzheimer: uma revisão sistemática

OBJETIVO : Apesar da crescente evidência dos benefícios do exercício físico para a cognição, existem controvérsias a respeito da prática de atividade física sistematizada em pacientes com doença de Alzheimer. Desta forma, o objetivo deste trabalho foi o de realizar uma revisão sistemática dos estudos que analisaram o efeito da atividade física sistematizada no desempenho cognitivo em idosos com doença de Alzheimer. MÉTODO : Efetuou-se uma pesquisa na PsycINFO, Biological Abstracts, Medline, Web of Science, Physical Education Index e SPORTDiscus, no período de 1990 a 2008, utilizando-se as seguintes palavras-chave: "physical activity", "physical therapy", "exercise", "fitness", "aerobic", "strength", "intervention", "cognition", "cognitive performance", "Alzheimer's disease", "Alzheimer's dementia", "Alzheimer", além de referências cruzadas dos artigos selecionados. RESULTADOS: Foram encontrados oito estudos que preencheram os critérios de inclusão adotados para o presente trabalho. Estes estudos mostraram que a atividade física sistematizada contribuiu para melhorar pelo menos temporariamente as funções cognitivas em paciente com doença de Alzheimer, particularmente, atenção, funções executivas e linguagem. CONCLUSÃO: Não foi possível estabelecer um protocolo de recomendações a respeito do tipo e intensidade da atividade física sistematizada necessária para produzir benefícios no funcionamento cognitivo. No entanto, a prática regular de atividade física sistematizada parece contribuir para a preservação ou mesmo melhora das funções cognitivas em pacientes com doença de Alzheimer.

Comportamento e barreiras

Este estudo analisa as barreiras percebidas à prática de atividade física e os estágios de mudança de comportamento de idosos institucionalizados preservados cognitivamente. Trinta participantes responderam ao Mini-Exame do Estado Mental, ao Questionário sobre Estágios de Mudança de Comportamento e ao Questionário sobre Barreiras à Prática de Atividade Física. Os resultados mostraram que poucos idosos institucionalizados apresentam uma alta percepção de descrença nos benefícios da atividade física. Entretanto, muito poucos praticam atividades físicas e a maioria não pretende incluí-las em seu estilo de vida. O estágio de comportamento no qual se encontram pode estar sendo mediado pela percepção de barreiras. Conclui-se, coerentemente com as principais barreiras reportadas, que a promoção de atividade física para o idoso institucionalizado deve, prioritariamente, enfatizar a conscientização sobre os riscos do sedentarismo e os benefícios da prática mesmo na presença de doenças, bem como preparar um ambiente seguro e sem gasto financeiro individual.

The effects of exercise on cognition in older adults with and without cognitive decline: a systematic review

OBJECTIVE

To systematically review the effect of physical exercise on cognition in older adults with and without cognitive decline.

DATA SOURCES

: Randomized controlled trials were identified by literature searches in PubMed, EMBASE, CENTRAL, PsycINFO, and AgeLine.

STUDY SELECTION

Papers were included on the basis of predefined inclusion criteria.

DATA EXTRACTION

Data on study population, exercise intervention, and effectiveness were extracted. Two independent reviewers assessed methodological quality.

DATA SYNTHESIS

Twenty-three studies were included-15 among cognitively healthy subjects and 8 among subjects with cognitive decline. Seven studies were qualified as high-quality studies, 2 in cognitively healthy subjects and 5 in subjects with cognitive decline. In cognitively healthy subjects, significant beneficial intervention effects were observed in 5 studies on information processing, executive function, or memory. Interventions in these studies included aerobic exercise only (n = 2); strength exercise (n = 1); strength and balance exercise (n = 1); or all-round exercise including aerobic, strength, balance and flexibility training (n = 1). In subjects with cognitive decline, 5 studies observed beneficial effects on general cognition, executive functions, and memory. Interventions included aerobic (n = 3) or strength exercise combined with flexibility or balance exercise (n = 2).

CONCLUSIONS

Beneficial effects of various exercise programs on aspects of cognition have been observed in studies among subjects with and without cognitive decline. The majority of the studies, however, did not find any effect. The small number of included studies; lack of high-quality studies; and the large variability in study populations, exercise protocols, and outcome measures complicate interpretation of the results. More high-quality trials are needed to assess the effects of different types of exercise on cognitive function in older adults with and without cognitive decline.