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Leroy V, Chen Y, Bouteloup V, Skrobala E, Puisieux F, Fougère B. What Tools Can We Use to Screen for Fall Risk in Older Patients with Mild Cognitive Impairment? Findings from the MEMENTO Cohort. J Am Med Dir Assoc 2023; 24:1028-1034.e18. [PMID: 36682387 DOI: 10.1016/j.jamda.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Identifying risk factors for falls can improve outcomes in older patients without cognitive decline. Yet this has not been demonstrated in older people with mild cognitive impairment (MCI). We therefore sought to better identify risk factors for falls in this particular group. DESIGN The analysis was conducted on the MEMENTO cohort, which is a large, French, prospective cohort. SETTING AND PARTICIPANTS We included older people (>65 years old) with MCI (defined from neuropsychological scores) and a Short Physical Performance Battery (SPPB) score at baseline. METHODS Fallers were defined as participants having fallen at least once during the study's 2-year follow-up period. We compared clinical, neuropsychological, and biological data at baseline in fallers vs nonfallers. Additional analyses were performed on the following subgroups: women, men, people aged ≥75 years. RESULTS Of the 1416 people included in our study, 194 (13.5%) fell at least once. A bivariate analysis showed that fallers were older, predominantly women, less independent in activities of daily living, and more apathetic. Fallers performed less well in executive function, balance, and gait tests. In a multivariable analysis, only age, gender, the number of limitations in instrumental activities of daily living, and living alone were significantly associated with falls. In a multivariable analysis of the subgroup of oldest patients and of the subgroup of men, executive function was significantly worse in fallers than in nonfallers. CONCLUSION AND IMPLICATIONS Our results demonstrate that easily attainable risk factors can be used to identify individuals with MCI with a higher risk of falls and for whom prevention could be beneficial. Future studies are needed to further evaluate the role of mild executive dysfunction in certain subgroups, such as men and oldest patients.
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Affiliation(s)
- Victoire Leroy
- Division of Geriatric Medicine, Tours University Hospital, Tours, France; Education, Ethics, Health (EA 7505), University of Medicine of Tours, Tours, France; Memory Clinic, Tours University Hospital, Tours, France.
| | - Yaohua Chen
- Department of Gerontology, Lille University Hospital, Lille, France; INSERM UMR-S 1172, Vascular and Degenerative Cognitive Disorders, University Lille, Lille, France; Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Vincent Bouteloup
- INSERM U1219, PHARes team, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), University Bordeaux, Bordeaux, France; CIC 1401 EC, Pôle Santé Publique, Bordeaux University Hospital, Bordeaux, France
| | - Emilie Skrobala
- INSERM URM_S1172, CHU Lille Memory Clinic, Distalz Licend, Lille University, Lille, France
| | - François Puisieux
- Department of Gerontology, Lille University Hospital, Lille, France; EA2694, University Lille, Lille, France
| | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, Tours, France; Education, Ethics, Health (EA 7505), University of Medicine of Tours, Tours, France
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The role of comprehensive geriatric assessment in predicting fall risk. Ir J Med Sci 2023; 192:303-310. [PMID: 35296974 DOI: 10.1007/s11845-022-02978-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The prevention of falls among older adults is one of the most important public health issues in today's aging society. There are many factors significantly affecting the risk of falls. AIMS This study aimed to investigate the factors on fall risk in older adults. METHODS A total of 335 elderly outpatients aged 65 and over were included in this cross-sectional study. Comprehensive geriatric assessment was performed on the participants. Tinetti Balance and Gait Assessment Tool (TBGA) and Mini-Mental State Examination (MMSE) were used to assess fall risk and cognitive functions, respectively. RESULTS The mean age of 335 participants was 72.1 ± 6.0 years and 55.2% was female. Of the participants, 40.6% had a moderate-high fall risk according to TBGA and 31.6% had a history of falls within the last year. Although there was no significant difference in MMSE results between the medium-high fall risk group and the low fall risk group, higher MMSE attention and calculation domain score was found to be an independent variable for decreased fall risk and sarcopenia for increased fall risk (p = 0.039, OR = 0.70 and p = 0.037, OR = 3.43, respectively). CONCLUSION The role of sarcopenia in fall risk is well established. In this study, we also showed that attention and calculation play important roles in fall risk. Elderly individuals with low scores in attention and calculation domains need a more detailed assessment in terms of fall risk, even if cognitive functions are considered normal according to the MMSE.
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Bruderer-Hofstetter M, Gorus E, Cornelis E, Meichtry A, De Vriendt P. Influencing factors on instrumental activities of daily living functioning in people with mild cognitive disorder - a secondary investigation of cross-sectional data. BMC Geriatr 2022; 22:791. [PMID: 36217106 PMCID: PMC9552428 DOI: 10.1186/s12877-022-03476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Finding a strategy to reduce the impact of cognitive decline on everyday functioning in persons suffering from cognitive impairment is a public health priority. Instrumental activities of daily living (IADL) are key to everyday functioning. Hence, it is essential to understand the influencing factors on IADL to develop specific interventions to improve everyday functioning in persons with mild cognitive disorder. Therefore, this study aimed to 1) explore different influencing factors on IADL functioning considering all domains of the International Classification of Functioning, disability, and health and 2) rank these factors. METHODS We performed a secondary analysis of a cohort including participants with amnestic mild cognitive impairment (a-MCI) or mild Alzheimer's Dementia (mild AD). The IADL functioning model was used as a starting point to estimate the effects of cognitive and physical function factors and personal and environmental factors on IADL functioning using multiple linear regression analysis, including subgroup analysis in persons with a-MCI. We used standardized coefficient estimates to relate the size of the predictor effects in the final model. RESULTS We included 105 participants (64 a-MCI, 41 mild AD); the mean age was 81.9 years (SD 4.9), with 70% females. Based on a multi-step approach and model fit, the final model included IADL functioning as the response variable and memory, attention, executive function, vision and hearing, mobility, balance, education, and social support as predictors. The final model explained 75% of the variability. The significant predictors in the model were mobility, balance, attention, and education, and were the predictors with the most considerable effects based on standardized coefficient estimates. The subgroup analysis, including only a-MCI participants, revealed a similar pattern. CONCLUSION Our results confirm that IADL functioning in people with mild cognitive disorder is influenced by cognitive and physical function and personal factors. The study provides further insight into understanding IADL functioning impairments in persons with mild impaired cognition and may be used to develop specific non-pharmacological interventions.
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Affiliation(s)
- Marina Bruderer-Hofstetter
- School of Health Professions, Institute of Physiotherapy, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, CH-8400, Winterthur, Switzerland.
| | - Ellen Gorus
- Department Gerontology and Frailty in Ageing (FRIA) Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Geriatrics Department, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Elise Cornelis
- Department of Occupational Therapy and Research & Development in Health & Care, Artevelde University of Applied Sciences, Ghent, Belgium
| | - André Meichtry
- School of Health Professions, Institute of Physiotherapy, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, CH-8400, Winterthur, Switzerland
| | - Patricia De Vriendt
- Department Gerontology and Frailty in Ageing (FRIA) Research Group, Mental Health and Wellbeing (MENT) Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Occupational Therapy Programme, Ghent University, Ghent, Belgium
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Hopkins J, Hill K, Jacques A, Burton E. Prevalence, risk factors and effectiveness of falls prevention interventions for adults living with Mild Cognitive Impairment in the community: A systematic review and meta-analysis. Clin Rehabil 2022; 37:215-243. [PMID: 36189497 DOI: 10.1177/02692155221129832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify falls prevalence, falls risk factors and evaluate the effectiveness of falls prevention interventions for community-dwelling people with Mild Cognitive Impairment. DATA SOURCES Peer-reviewed articles (inception to 4 August 2022) from PubMed, CINAHL, PsycInfo, EMBASE, Scopus, SportDiscus and the Cochrane library. REVIEW METHODS All types of methodological approaches were considered. Inclusion criteria were community-dwelling; diagnosis of Mild Cognitive Impairment; aged 50+ years. Interventions needed to include falls prevention programs aiming to reduce falls and/or risk of falls. Outcomes of interest included number and/or rate of falls, falls prevalence and falls risk factors. For controlled trials, any control group was included. Quality assessment was completed using Cochrane's Risk of Bias Tool for randomized controlled trials and the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields for all other studies. Where statistical data pooling was not possible, narrative synthesis was used to present data in tables and figures. RESULTS Forty-seven studies were included. Prevalence of falls was 43% when data were gathered prospectively for 12 months. Confirmed falls risk factors included slow gait, dual-tasking, postural control and non-amnesic Mild Cognitive Impairment. Few studies evaluated interventions to reduce falls. Six meta-analyses were conducted, no significant reduction in falls was found. CONCLUSIONS Until further high-quality, adequately powered studies are available to guide practice, best practice guidelines recommend balance training as a core component of falls prevention programs for older people generally, as well as people with Mild Cognitive Impairment.
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Affiliation(s)
- Jane Hopkins
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia
| | - Keith Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Angela Jacques
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia.,Institute for Health Research, 3431University of Notre Dame Australia, Fremantle, WA, Australia
| | - Elissa Burton
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia.,enAble Institute, 1649Curtin University, Perth, WA, Australia
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McGibbon C, Jarrett P, Handrigan G, Bouchard D, Tranchant CC, Sexton AM, Yetman L, Robinson B, Crapoulet S, Chamard-Witkowski L, Liu-Ambrose T, Middleton LE, Almeida QJ, Bherer L, Lim A, Speechley M, Kamkar N, Montero Odasso M. Protocol for SYNchronising Exercises, Remedies in GaIt and Cognition at Home (SYNERGIC@Home): feasibility of a home-based double-blind randomised controlled trial to improve gait and cognition in individuals at risk for dementia. BMJ Open 2022; 12:e059988. [PMID: 35361653 PMCID: PMC8971768 DOI: 10.1136/bmjopen-2021-059988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Physical exercise and cognitive training have the potential to enhance cognitive function and mobility in older adults at risk of Alzheimer's disease and related dementia (ADRD), but little is known about the feasibility of delivering multidomain interventions in home settings of older adults at risk of ADRD. This study aims to assess the feasibility of home-based delivery of exercise and cognitive interventions, and to evaluate the relationship between participants' intervention preferences and their subsequent adherence. Secondary objectives include the effect of the interventions on ADRD risk factors, including frailty, mobility, sleep, diet and psychological health. METHODS AND ANALYSIS The SYNchronising Exercises, Remedies in GaIt and Cognition at Home (SYNERGIC@Home) feasibility trial is a randomised control trial that follows a 2×2 factorial design, with a 16-week home-based intervention programme (3 sessions per week) of physical exercises and cognitive training. Participants will be randomised in blocks of four to one of the following four arms: (1) combined exercise (aerobic and resistance)+cognitive training (NEUROPEAK); (2) combined exercise+control cognitive training (web searching); (3) control exercise (balance and toning)+cognitive training; and (4) control exercise+control cognitive training. SYNERGIC@Home will be implemented through video conferencing. Baseline and post-intervention assessments at 4-month and 10-month follow-up will include measures of cognition, frailty, mobility, sleep, diet and psychological health. Primary feasibility outcome is adherence to the interventions. Primary analytic outcome is the relationship between pre-allocation preference for a given intervention and subsequent adherence to the allocated intervention. A series of secondary analytic outcomes examining the potential effect of the individual and combined interventions on cognitive, mobility and general well-being will be measured at baseline and follow-up. ETHICS AND DISSEMINATION Ethics approval was granted by the relevant research ethics boards. Findings of the study will be presented to stakeholders and published in peer-reviewed journals and at provincial, national and international conferences. TRIAL REGISTRATION NUMBER NCT04997681, Pre-results.
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Affiliation(s)
- Chris McGibbon
- Faculty of Kinesiology, University of New Brunswick Fredericton, Fredericton, New Brunswick, Canada
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Pam Jarrett
- Department of Geriatric Medicine, Horizon Health Network, Saint John, New Brunswick, Canada
- Faculty of Medicine, Deptartment of Internal Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Grant Handrigan
- Faculty of Health Sciences and Community Services, School of Kinesiology and Recreation, Universite de Moncton, Moncton, New Brunswick, Canada
| | - Danielle Bouchard
- Faculty of Kinesiology, University of New Brunswick Fredericton, Fredericton, New Brunswick, Canada
| | - Carole C Tranchant
- Faculty of Health Sciences and Community Services, School of Food Science, Nutrition and Family Studies, Universite de Moncton, Moncton, New Brunswick, Canada
| | - Andrew M Sexton
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Linda Yetman
- Research Services, Horizon Health Network, Saint John, New Brunswick, Canada
| | - Bryn Robinson
- Research Services, Horizon Health Network, Saint John, New Brunswick, Canada
| | | | - Ludivine Chamard-Witkowski
- Department of Neuroscience, Dr Georges-L-Dumont University Hospital Centre, Moncton, New Brunswick, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Quincy J Almeida
- Faculty of Science, Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Louis Bherer
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Andrew Lim
- Neurology Division, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Nellie Kamkar
- Gait and Brain Laboratory, Lawson Health Research Institute, London, Ontario, Canada
| | - Manuel Montero Odasso
- Gait and Brain Laboratory, Lawson Health Research Institute, London, Ontario, Canada
- Department of Medicine (Geriatrics), Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Bisbe M, Fuente-Vidal A, López E, Moreno M, Naya M, de Benetti C, Milà R, Bruna O, Boada M, Alegret M. Comparative Cognitive Effects of Choreographed Exercise and Multimodal Physical Therapy in Older Adults with Amnestic Mild Cognitive Impairment: Randomized Clinical Trial. J Alzheimers Dis 2020; 73:769-783. [PMID: 31868666 PMCID: PMC7029368 DOI: 10.3233/jad-190552] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Recent research on mild cognitive impairment (MCI) has primarily focused on searching for measures to prevent or delay the progression of MCI to dementia. Physical exercise has shown to be effective in the prevention of age-related cognitive decline in elderly adults with MCI. However, the most effective type and dose of exercise for the improvement of cognition are yet to be determined. Objective: To compare the cognitive effects of choreographed exercise (Choreography group) with a multimodal physical therapy program (Physical Therapy group) in elderly adults with amnestic MCI, a population with an increased risk of developing dementia. Methods: We conducted a randomized clinical trial with two parallel groups under allocation concealment and assessor blinding. Participants were allocated into Choreography or Physical Therapy group and performed exercises twice per week in 60-minute sessions during 12 weeks. Results: Thirty-six participants with amnestic MCI, ages 65 to 85, were assessed at baseline and after 12 weeks of intervention, by comprehensive validated neuropsychological and physical assessments. A Repeated measures General Lineal Model showed statistically significant differences in cognitive and physical outcomes. Both groups significantly improved in visual delayed recall. The Choreography group exhibited significantly more benefits on verbal recognition memory than the Physical Therapy group. Conclusion: Greater cognitive benefits were achieved in the choreographic intervention than in the multimodal physical therapy, mainly in those functions more related to the risk of conversion to dementia. Additional studies are needed to confirm whether the observed effects are related to delayed onset of Alzheimer’s disease in elderly adults with amnestic MCI.
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Affiliation(s)
- Marta Bisbe
- Department of Physical Therapy and Nursing of Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain.,Department of Psychology of Blanquerna Faculty of Psychology, Education and Sports Sciences, Ramon Llull University, Barcelona, Spain
| | - Andrea Fuente-Vidal
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), University of Vic, Barcelona, Spain
| | - Elisabet López
- Department of Psychology of Blanquerna Faculty of Psychology, Education and Sports Sciences, Ramon Llull University, Barcelona, Spain
| | - Marta Moreno
- Physical Therapy Ambulatory Service, Barcelona, Spain
| | - Marian Naya
- Physical Therapy Ambulatory Service, Barcelona, Spain
| | | | - Raimon Milà
- Department of Physical Therapy and Nursing of Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Olga Bruna
- Department of Psychology of Blanquerna Faculty of Psychology, Education and Sports Sciences, Ramon Llull University, Barcelona, Spain
| | - Mercè Boada
- Research Center and Memory Clinic. Fundació ACE. Institut Català de Neurociències Aplicades. Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Montserrat Alegret
- Research Center and Memory Clinic. Fundació ACE. Institut Català de Neurociències Aplicades. Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
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Zhang C, Dong X, Ding M, Chen X, Shan X, Ouyang H, Tao Q. Executive Control, Alerting, Updating, and Falls in Cognitively Healthy Older Adults. Gerontology 2020; 66:494-505. [DOI: 10.1159/000509288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/10/2020] [Indexed: 11/19/2022] Open
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Physical Therapist Determination of Discharge Disposition in the Acute Care Setting. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2019. [DOI: 10.1097/jat.0000000000000099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Cognitive Function Is Associated With Mobility in Community Dwelling Older Adults With a History of Cardiovascular Disease. Cardiopulm Phys Ther J 2019. [DOI: 10.1097/cpt.0000000000000095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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10
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Montero-Odasso M, Almeida QJ, Burhan AM, Camicioli R, Doyon J, Fraser S, Li K, Liu-Ambrose T, Middleton L, Muir-Hunter S, McIlroy W, Morais JA, Pieruccini-Faria F, Shoemaker K, Speechley M, Vasudev A, Zou GY, Berryman N, Lussier M, Vanderhaeghe L, Bherer L. SYNERGIC TRIAL (SYNchronizing Exercises, Remedies in Gait and Cognition) a multi-Centre randomized controlled double blind trial to improve gait and cognition in mild cognitive impairment. BMC Geriatr 2018; 18:93. [PMID: 29661156 PMCID: PMC5902955 DOI: 10.1186/s12877-018-0782-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022] Open
Abstract
Background Physical exercise, cognitive training, and vitamin D are low cost interventions that have the potential to enhance cognitive function and mobility in older adults, especially in pre-dementia states such as Mild Cognitive Impairment (MCI). Aerobic and progressive resistance exercises have benefits to cognitive performance, though evidence is somewhat inconsistent. We postulate that combined aerobic exercise (AE) and progressive resistance training (RT) (combined exercise) will have a better effect on cognition than a balance and toning control (BAT) intervention in older adults with MCI. We also expect that adding cognitive training and vitamin D supplementation to the combined exercise, as a multimodal intervention, will have synergistic efficacy. Methods The SYNERGIC trial (SYNchronizing Exercises, Remedies in GaIt and Cognition) is a multi-site, double-blinded, five-arm, controlled trial that assesses the potential synergic effect of combined AE and RT on cognition and mobility, with and without cognitive training and vitamin D supplementation in older adults with MCI. Two-hundred participants with MCI aged 60 to 85 years old will be randomized to one of five arms, four of which include combined exercise plus combinations of dual-task cognitive training (real vs. sham) and vitamin D supplementation (3 × 10,000 IU/wk. vs. placebo) in a quasi-factorial design, and one arm which receives all control interventions. The primary outcome measure is the ADAS-Cog (13 and plus modalities) measured at baseline and at 6 months of follow-up. Secondary outcomes include neuroimaging, neuro-cognitive performance, gait and mobility performance, and serum biomarkers of inflammation (C reactive protein and interleukin 6), neuroplasticity (brain-derived neurotropic factor), endothelial markers (vascular endothelial growth factor 1), and vitamin D serum levels. Discussion The SYNERGIC Trial will establish the efficacy and feasibility of a multimodal intervention to improve cognitive performance and mobility outcomes in MCI. These interventions may contribute to new approaches to stabilize and reverse cognitive-mobility decline in older individuals with MCI. Trial Registration Identifier: NCT02808676. https://www.clinicaltrials.gov/ct2/show/NCT02808676. Electronic supplementary material The online version of this article (10.1186/s12877-018-0782-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Manuel Montero-Odasso
- Department of Medicine, Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada. .,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada. .,Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Canada.
| | - Quincy J Almeida
- Sun Life Financial Movement Disorders Research Centre, Wilfrid Laurier University, Waterloo, Canada
| | - Amer M Burhan
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Richard Camicioli
- Geriatric and Cognitive Neurology, University of Alberta, Edmonton, Canada
| | - Julien Doyon
- Functional Neuroimaging Unit, University of Montreal, Montreal, Canada
| | - Sarah Fraser
- Department of Psychology-University of Ottawa, Ottawa, Canada
| | - Karen Li
- Department of Psychology and PERFORM Centre, Concordia University, Montreal, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Centre for Hip Health and Mobility, and Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Research Institute, University of British Columbia, Vancouver, Canada
| | - Laura Middleton
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Susan Muir-Hunter
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - William McIlroy
- Division of Neurology and Department of Medicine, University of Toronto. Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - José A Morais
- Division of Geriatrics and Centre of Excellence in Aging and Chronic Disease, McGill University, Montreal, Canada
| | - Frederico Pieruccini-Faria
- Department of Medicine, Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada.,Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Canada
| | - Kevin Shoemaker
- Department of Kinesiology, University of Western Ontario, London, Canada
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - Akshya Vasudev
- Department of Psychiatry, Division of Geriatric Psychiatry and Department of Medicine, Division of Clinical Pharmacology, University of Western Ontario, London, Canada
| | - G Y Zou
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada.,Robarts Clinical Trials Inc, London, Canada
| | - Nicolas Berryman
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada.,Department of Sports Studies, Bishop's University, Sherbrooke, Canada
| | - Maxime Lussier
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada.,Faculty of Medicine, University of Montreal, Montréal, Canada
| | | | - Louis Bherer
- Department of Psychology and PERFORM Centre, Concordia University, Montreal, Canada.,Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada.,Faculty of Medicine, University of Montreal, Montréal, Canada.,Montreal Heart Institute, Research Centre, Montreal, Canada
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Lach HW, Harrison BE, Phongphanngam S. Falls and Fall Prevention in Older Adults With Early-Stage Dementia: An Integrative Review. Res Gerontol Nurs 2016; 10:139-148. [PMID: 27665756 DOI: 10.3928/19404921-20160908-01] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/12/2016] [Indexed: 11/20/2022]
Abstract
Older adults with mild cognitive impairment (MCI) and early-stage dementia have an increased risk of falling, with risks to their health and quality of life. The purpose of the current integrative review was to evaluate evidence on fall risk and fall prevention in this population. Studies were included if they examined falls or fall risk factors in older adults with MCI or early-stage dementia, or reported interventions in this population; 40 studies met criteria. Evidence supports the increased risk of falls in individuals even in the early stages of dementia or MCI, and changes in gait, balance, and fear of falling that may be related to this increased fall risk. Interventions included exercise and multifactorial interventions that demonstrated some potential to reduce falls in this population. Few studies had strong designs to provide evidence for recommendations. Further study in this area is warranted. [Res Gerontol Nurs. 2017; 10(03):139-148.].
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Powell-Cope G, Campbell R, Hahm B, Bulat T, Westphal J. Sociotechnical probabilistic risk modeling to predict injurious falls in community living centers. ACTA ACUST UNITED AC 2016; 53:881-892. [PMID: 28273322 DOI: 10.1682/jrrd.2015.08.0165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 01/29/2016] [Indexed: 11/05/2022]
Abstract
The goal of this study was to apply sociotechnical probabilistic risk assessment to prioritize risks and prevention strategies for serious injurious falls of residents in nursing homes. Risk modeling teams consisted of 26 clinical and nonclinical staff from three Department of Veterans Affairs community living centers and one state Veteran's nursing home. Participants met in groups several times to identify and assign probabilities to provider and resident at-risk behaviors and equipment failures. They identified prevention strategies for the failures that accounted for the highest levels of risk. Six scenarios were modeled: (1) transferring from bed to wheelchair, (2) propelling from bedside to bathroom, (3) transferring from wheelchair to toilet, (4) transferring from toilet to wheelchair, (5) propelling from bathroom to bedside, and (6) transferring from wheelchair to bed. The greatest paths of risk were for residents with impaired mobility and high fragility. A 26% reduction in injurious falls could be achieved by (1) reducing the number of unassisted transfers through a modest improvement in response time to alarms, (2) installing automatic brake locks on 90% of wheelchairs, (3) making the wheelchair maintenance process highly reliable, and (4) decreasing improper transfer techniques by 10%.
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Affiliation(s)
- Gail Powell-Cope
- Department of Veterans Affairs Health Services Research and Development Center of Innovation on Disability and Rehabilitation Research
| | | | - Bridget Hahm
- Department of Veterans Affairs Health Services Research and Development Center of Innovation on Disability and Rehabilitation Research
| | - Tatjana Bulat
- Veterans Integrated Service Network 8 Patient Safety Center of Inquiry, James A. Haley Veterans' Hospital, Tampa, FL
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