Physical Fitness in Older People Recently Diagnosed with Cognitive Impairment Compared to Older People Recently Discharged from Hospital

Aerobic exercise and dual-task training combination is the best combination for improving cognitive status, mobility and physical performance in older adults with mild cognitive impairment

AIM

The aim of the present study was to investigate the effects of different exercise combinations on cognitive status, muscle strength of lower extremities, mobility, physical performance, mood and quality of life in older adults with mild cognitive impairment (MCI).

METHODS

A total of 48 older adults with MCI were randomly assigned to four groups: (1) aerobic plus lower extremity strengthening exercises (AG), (2) dual-task training plus lower extremity strengthening exercises (DG), (3) aerobic exercise, dual-task training and lower extremity strengthening exercises (ADG), (4) solely lower extremity strengthening exercises (CG). Patients' cognitive status, lower extremity muscle strength, balance, mobility, activities-specific balance confidence, functional exercise capacity, physical performance, mood and quality of life were evaluated.

RESULTS

In all three intervention groups, there was a significant improvement in cognitive status, balance, mobility, activities-specific balance confidence, physical performance, mood and quality of life (p < 0.05). The most remarkable change was observed in the ADG on cognitive status, mobility and physical performance parameters (p < 0.05). In addition, the most significant improvement in balance parameters was recorded both in the DG and ADG (p < 0.05). Besides, the highest increase in functional exercise capacity was detected both in the AG and ADG (p < 0.05). On the other hand, both exercise combinations were superior to the control group in terms of improving mood and quality of life (p < 0.05).

CONCLUSION

The trial results proved that aerobic exercise and dual-task training is the best combination for improving cognitive status, mobility and physical performance in older adults with MCI.

Mediating role of cognitive status on performance in the two-minute step test and its normative data among Malaysian community-dwelling older persons

INTRODUCTION

The two-minute step test (2MST) has been used to estimate cardiorespiratory fitness and optimum scores are needed for performing activities of daily living with ease among older persons. However, there is limited information on the mediating role of cognitive impairment on 2MST performance and the 2MST normative data. Hence, we aim to identify the mediating role of cognitive status on performance in the 2MST among community-dwelling older adults and to establish the normative values of the 2MST.

METHODS

Participants aged 60 years and above were recruited through multistage random sampling from four states in Malaysia. The participants performed the 2MST using standard protocols. Mean comparison was done using an independent sample t-test or one-way analysis of variance. The 2MST normative values were then outlined descriptively.

RESULTS

Older age groups (60-69 years: 65.4 ± 21.9 times; 70-79 years: 61.7 ± 22.9 times; ≥80 years: 51.6 ± 24.5 times) had significantly lower levels of 2MST performance (p < 0.001). Women (56.6 ± 20.9 times) and participants with mild cognitive impairment (MCI) (58.7 ± 21.7 times) also had significantly lower levels of 2MST performance (p < 0.001) compared with men (69.1 ± 20.7 times) and participants with normal cognition (63.7 ± 21.6 times). Cognitive status had a significant mediation effect for age and sex on 2MST performance (p < 0.001). Therefore, the 2MST normative values were stratified according to cognitive status, sex, and age groups.

CONCLUSION

Validation of these findings in a larger number of older populations with MCI may provide directions for cardiorespiratory fitness training to be emphasised among older persons with MCI. Geriatr Gerontol Int 2022; ••: ••-••.

Comorbidity, cognitive dysfunction, physical functioning, and quality of life in older breast cancer survivors

Purpose

Older breast cancer survivors (BCS) may be at greater risk for cognitive dysfunction and other comorbidities; both of which may be associated with physical and emotional well-being. This study will seek to understand these relationships by examining the association between objective and subjective cognitive dysfunction and physical functioning and quality of life (QoL) and moderated by comorbidities in older BCS.

Methods

A secondary data analysis was conducted on data from 335 BCS (stages I–IIIA) who were ≥ 60 years of age, received chemotherapy, and were 3–8 years post-diagnosis. BCS completed a one-time questionnaire and neuropsychological tests of learning, delayed recall, attention, working memory, and verbal fluency. Descriptive statistics and separate linear regression analyses testing the relationship of each cognitive assessment on physical functioning and QoL controlling for comorbidities were conducted.

Results

BCS were on average 69.79 (SD = 3.34) years old and 5.95 (SD = 1.48) years post-diagnosis. Most were stage II (67.7%) at diagnosis, White (93.4%), had at least some college education (51.6%), and reported on average 3 (SD = 1.81) comorbidities. All 6 physical functioning models were significant (p < .001), with more comorbidities and worse subjective attention identified as significantly related to decreased physical functioning. One model found worse subjective attention was related to poorer QoL (p < .001). Objective cognitive function measures were not significantly related to physical functioning or QoL.

Conclusions

A greater number of comorbidities and poorer subjective attention were related to poorer outcomes and should be integrated into research seeking to determine predictors of physical functioning and QoL in breast cancer survivors.

Spatial navigation and dual-task performance in patients with Dementia that present partial dependence in instrumental activity of daily living

BACKGROUND

Instrumental activities of daily living (IADLs) ability impairments are clearly related to cognitive and motor decline, as well as to the progression of Dementia. However, more low-cost assessments are necessary to better understand the process of IADL in patients with Dementia.

OBJECTIVE

To compare cognitive, motor and cognitive-motor performance at different stages of dependence on IADL in patients with Dementia.

METHODS

Dementia patients (n = 53, age range: 63-94) and healthy older adults (n = 39, age range: 62-97) were included, and those with Dementia were separated into IADL 1 (n = 18), IADL 2 (n = 17), IADL 3 (n = 18). All groups performed cognitive (Trail making test A, semantic verbal fluency, and Stroop test), motor (sit to stand, aerobic steps, and 8-foot up-and-go), and cognitive-motor tests (dual-task, and spatial navigation). One-way ANOVA, Kruskal-Wallis, and Bonferroni post-hoc tests were used to compare groups. Also, an effect size (ES) has been applied to evaluate differences among the dementia groups while the healthy older adults were used as a reference group.

RESULTS

Only cognitive-motor and cognitive tests showed significant differences among groups (IADL 1 x IADL 2 x IADL 3). Compared with the healthy group, the ES analysis exposed that patients in different stages of IADL showed the worst performance on tests combining motor and cognitive demand, but not for motor and cognitive function separately.

CONCLUSION

Poor dual-task and spatial navigation abilities are present in partial dependence in IADL, and these tasks should be considered as a functionality screening tool in patients with Dementia.

Psychomotor, Functional, and Cognitive Profiles in Older People with and without Dementia:What Connections?

BACKGROUND

In typical aging, it is possible to observe a decline in psychomotor domains, such as balance or global and fine motor skills as well as a cognitive and functional decline. Although, it is not clear which psychomotor domains are mostly affected in elderly with dementia and the association with the cognitive and functional level.

OBJECTIVE

To identify the correlation between psychomotor, cognitive, and functional skills, and seeking whether there are differences among persons with and without dementia.

DESIGN AND METHODS

A total of 120 persons with dementia (ages between 61 and 99 years old; mean age 80.6 ± 7.4) and 377 persons without dementia (ages between 60 and 99 years old; mean age 77.2 ± 8.7) were recruited from nursing homes, day-care centers, and home care. Consenting participants were assessed in psychomotor, cognitive, and functional domains using the Mini Mental State Examination (MMSE) to assess cognitive impairment, the Barthel Index (BI), and Lawton Index (LI) to identify basic and instrumental activities of daily living and a Portuguese Version of Éxamen Geronto-Psychomoteur (P-EGP) to evaluate psychomotor skills.

RESULTS

People with dementia showed a higher percentage of cognitive deficit and higher level of dependency in basic and instrumental activities of daily living. Further, findings also showed significant differences in psychomotor domains and total of P-EGP, with exception of Joint Mobilizations of Upper and Lower Limbs. There were moderate to strong correlations between the totals of the scales, and between the totals and domains.

CONCLUSIONS

The population with dementia has higher percentage of cognitive deficit, higher dependency on the performance of basic and instrumental activities of daily living and poorer psychomotor performance, except in joint mobilizations. It was also possible to find strong correlations between the total of P-EGP and the total of cognitive and functional scales. Implications for future research and practice are discussed.

Mobility as a predictor of all-cause mortality in older men and women: 11.8 year follow-up in the Tromsø study

BACKGROUND

Disability in older adults is associated with loss of independence, institutionalization, and death. The aim of this study was to study the association between the Timed Up and Go (TUG) test and all-cause mortality in a population-based sample of older men and women.

METHODS

Our study population was home dwellers aged 65 and above, who participated in the fifth wave of the Tromsø study. This study included the TUG test and a range of lifestyle and mortality predictors. Participants were linked to the Cause of Death Registry and followed up for mortality for a maximum of 11.8 years. Cox regression was used to investigate the association between TUG and total mortality.

RESULTS

Mean TUG score was 12.6 s, and men performed better than women. The oldest participants had poorer TUG score compared to younger participants, increasing 0.25 s per year. There was a significant association between TUG and all-cause mortality, and the association was equally strong in men and women. Across the TUG-score categories, from quickest fifth to slowest fifth, the mortality increased in a step-wise fashion. Compared to the quickest fifth, the slowest fifth had hazard ratio (HR) of 1.79 (95% confidence interval (CI) 1.33, 2.42) in a model adjusted for age and gender. For each standard deviation TUG-score the increase in HR was 1.23 (95% CI 1.14, 1.33). The association between the TUG score and mortality remained significant after adjusting for self-reported health, body mass index, smoking and education.

CONCLUSIONS

A significant association between the TUG score and mortality was observed in both men and women. Identifying older people with poor TUG may aid in identifying those at risk and thus targeted interventions may be applied.