Effect of passive finger exercises on grip strength and the ability to perform activities of daily living for older people with dementia: a 12-week randomized controlled trial

Construction and evaluation of a neurofeedback system using finger tapping and near-infrared spectroscopy

Introduction

Neurofeedback using near-infrared spectroscopy (NIRS) has been used in patients with stroke and other patients, but few studies have included older people or patients with cognitive impairment.

Methods

We constructed a NIRS-based neurofeedback system and used finger tapping to investigate whether neurofeedback can be implemented in older adults while finger tapping and whether brain activity improves in older adults and healthy participants. Our simple neurofeedback system was constructed using a portable wearable optical topography (WOT-HS) device. Brain activity was evaluated in 10 older and 31 healthy young individuals by measuring oxygenated hemoglobin concentration during finger tapping and neurofeedback implementation.

Results

During neurofeedback, the concentration of oxygenated hemoglobin increased in the prefrontal regions in both the young and older participants.

Discussion

The results of this study demonstrate the usefulness of neurofeedback using simple NIRS devices for older adults and its potential to mitigate cognitive decline.

Developing and evaluating a mindfulness-based finger/hand exercise intervention for ethnically diverse older adults with and without disabilities: A feasibility study

Few exercise interventions target ethnic minority older adults, especially those with disability. We evaluated feasibility of newly-developed finger/hand exercises to promote health in ethnically diverse older adults with/without disability. We conducted 10-minute video exercises daily, supervised by research assistants. The feasibility, evaluated via three studies, focused on recruitment, intervention fidelity, safety, outcome assessment, and acceptability. Studies varied in design and delivery methods, being conducted across settings (senior centers, apartments). We enrolled 101 Chinese older adults (mean age = 72) without disability in Study 1, and 15 older Africans/Hispanics with disability (mean age = 70) in Studies 2 and 3. Intervention, either in-person or online, was implementable and acceptable with high fidelity. Attendance was satisfactory (79.6%, 74.2%, 76.7%) and attrition was low (12%, 0%, 0%). Outcome measures data was ascertained. No adverse events were observed. Preliminary findings indicate feasibility, acceptability, and safety of the simple finger/hand exercise for diverse older adults.

Influence of Single-Digit Exclusions on Grip Strength in Healthy Male Adults

Grip strength (GS) of the human hand is vital to deal with objects of various sizes and shapes in daily life. The strength deteriorates if one or more digits of the hand are amputated. The main aim of this study was to determine the influence of single-digit exclusions on the GS. Healthy adults (n = 102, male) with an age range of 20 to 70 years (mean ± SD, 31.92 ± 13.14 years) participated in the study. The movements of unused digits were restrained using splints to avoid digit enslaving effects. T (Thumb), (I) Index, M (Middle), R (Ring), L (Little) digits were chosen for exclusion based on the digit configurations. The digit configurations were IMRL, MRLT, IMRT IRLT and, IMLT with exclusions T, I, L, M, and, R respectively. The results of two-way ANOVA with repeated measures showed no significant interaction (p = 0.923) between hand dominance and digit configurations. But statistical significance (p = 0.000) was observed in digit configurations and hand dominance individually. The results of posthoc analysis using Bonferroni corrected pairwise comparisons showed no statistical significance (p = 0.004) between IRLT and IMLT of both hands since the corrected p-value was 0.003. The outcomes of the F-test showed no statistical significance (p > 0.05) between the digit configurations IMRLT, IMRL; IMRL, MRLT; MRLT, IMRT; IRLT, IMLT individually within dominant (D) and non-dominant (ND) hands. When the F-test was performed using the same digit configurations between both hands, statistical significance was not observed in all the configurations except IMLT (p < 0.05). The results of the Pearson correlation of GS were observed to be very strong between the same digit configurations of D and ND hands.

Is grip strength useful in screening to predict the severity of locomotive syndrome?

BACKGROUND

This study was conducted to investigate the relationship between grip strength and the 25-question Geriatric Locomotive Function Scale (GLFS-25) score and the diagnosis of locomotive syndrome (LS), and the usefulness of grip strength in screening for LS.

METHODS

This cross-sectional study was conducted on 2251 community-dwelling residents (male, n = 1035; female, n = 1216). Subjects with GLFS-25 scores of 0-6 points, 7-15 points, 16-23 points, and 24-100 points were diagnosed with non-LS, LS-1, LS-2, and LS-3, respectively. Multivariate linear regression and multivariate logistic regression analyses were performed to assess the relationship between grip strength and the GLFS-25 score and LS after adjustment for age, sex, and body mass index. A conventional receiver operating characteristic (ROC) curve analysis was used to calculate the optimal cutoff value of grip strength for predicting the severity of LS. The discriminative ability of the model was assessed using the area under the ROC curve (AUC).

RESULTS

The multivariate linear regression analysis showed that grip strength was significantly associated with the GLFS-25 score. The multivariate logistic regression analysis revealed that grip strength was significantly associated with the diagnosis of LS. The optimal cutoff values of grip strength for identifying LS-1 or more, LS-2 or more, and LS-3 or more were 36.0 kg (sensitivity 65.7%, specificity 57.1%, AUC 0.66), 35.0 kg (sensitivity 70.0%, specificity 57.5%, AUC 0.70), and 34.0 kg (sensitivity 67.2%, specificity 62.5%, AUC 0.70), respectively, in males, and 24.0 kg (sensitivity 69.1%, specificity 45.4%, AUC 0.61), 23.0 kg (sensitivity 69.5%, specificity 52.3%, AUC 0.67), and 22.0 kg (sensitivity 69.1%, specificity 61.0%, AUC 0.69) in females.

CONCLUSIONS

The use of grip strength in screening to predict the severity of LS may not be clinically useful. However, the results will increase our understanding of the relationship between grip strength and the GLFS-25 scores and LS.

The Comparative Effectiveness of Traditional Chinese Medicine Exercise Therapies in Elderly People With Mild Cognitive Impairment: A Systematic Review and Network Meta-Analysis

Background

Mild cognitive impairment (MCI) in the elderly is a health problem worldwide. Studies have confirmed that traditional Chinese medicine (TCM) exercise therapies can improve MCI. However, which therapy is the best and their impacts on brain function remain controversial and uncertain. This study aims to compare and rank TCM exercise therapies for MCI in the elderly, and analyze their effects on brain function, in order to find an optimal intervention and provide a basis for clinical treatments decision-making.

Methods

The Web of Science, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Clinical Trials, China National Knowledge Infrastructure (CNKI), Wangfang database, China Science and Technology Journal Database, and Chinese Biomedical Medicine (CBM) were searched through October 28, 2021. Two researchers reviewed all the studies and extracted the data. The ADDIS software version 1.16.8 and the Bayesian hierarchical model were used for pair-wise meta-analysis and network meta-analysis, and the STATA software version 14.0 was used to draw the network evidence plots and funnel plots.

Results

A total of 23 studies on 2282 participants were included in this study. In the pair-wise meta-analysis, TCM exercise therapies (Baduanjin exercise, Tai Chi, Liuzijue exercise and finger exercise) were superior to non-TCM exercise therapies (stretching and toning exercise, usual care, health education and routine daily activities) in terms of MMSE, MoCA and ADL outcomes. In the network meta-analysis, the MMSE outcome ranked Baduanjin exercise (78%) as the best intervention and Tai Chi (36%) as the second. The MoCA outcome ranked Baduanjin exercise (62%) as the best intervention. For the ADL outcome, Baduanjin exercise (60%) ranked the best, and followed by finger exercise (43%).

Conclusion

TCM exercise therapies may improve the cognitive function in elderly patients with MCI. Among the four therapies included, the Baduanjin exercise may be the preferred therapy for MCI in the elderly, and its mechanism may be related to the regulation of cognitive-related brain function and structure.

Systematic Review Registration

https://inplasy.com, identifier: INPLASY202070006.

Exploring Factors Associated With Successful Nonpharmacological Interventions for People With Dementia

Background and purpose

Methods

Results

Conclusions

Association between Skeletal Muscle Mass Index and Convalescent Rehabilitation Ward Achievement Index in Older Patients

Objective:

The aim of the current study was to investigate the association between the skeletal muscle mass index (SMI) and the convalescent rehabilitation ward achievement index (CRWAI) in older patients with functional impairment.

Methods:

We conducted a retrospective cohort study at a single rehabilitation center in Japan to include patients admitted to the convalescent rehabilitation ward because of neurological disease, motor disorder, or disuse syndrome. Patients with missing SMI data, those who died or were transferred to other hospitals due to comorbidities, those aged less than 65 years, and those hospitalized for <7 days were excluded from the study. We divided patients into two groups based on their SMI – the high SMI group (SMI ≥7.0 kg/m² in men and SMI ≥5.7 kg/m² in women) and the low SMI group (SMI <7.0 kg/m² in men and SMI <5.7 kg/m² in women); we then evaluated the association between SMI and the CRWAI score.

Results:

Of the 319 recruited patients, 84 (26%) were in the high SMI group. The medians and interquartile ranges of the CRWAI scores in the high SMI and low SMI groups were 38.6 (23.1–61) and 31.8 (10.1–57.5), respectively (P=0.029). A high SMI was independently and negatively associated with the CRWAI score (β=− 0.16, P=0.014).

Conclusions:

Our study showed that a high SMI was an independent factor negatively influencing the CRWAI score in older patients in a convalescent rehabilitation ward.

Development and Usability Testing of a Finger Grip Enhancer for the Elderly

As people age, their finger function deteriorates due to muscle, nerve, and brain degeneration. While exercises might delay this deterioration, an invention that enhances elderly people’s pinching abilities is essential. This study aims to design and develop a finger grip enhancer that facilitates the day-to-day pinching activities of elderly people. This research is an extension of a previous study that conceptualised a finger grip enhancer. The device facilitates finger flexion on the thumb and index finger, and weighs 520 g, allowing for improved portability and sufficient force exertion (13.9 N) for day-to-day pinching. To test for usability, eleven subjects aged 65 years and above performed a pinch-lift-hold test on various household objects. The pinch force before and after utilising the device was measured. Using Minitab 18, the statistical significance of using this device was analysed with a paired-samples t-test. With this device, the elderly people’s pinching abilities significantly improved in both pinch force and pinch force steadiness (p < 0.05). The proposed device has the potential to enhance elderly people’s quality of life by supporting a firm pinch in the handling of everyday objects. This research has applicational value in developing exoskeleton devices for patients who require rehabilitation.

Feasibility of improving strength and functioning and decreasing the risk of falls in older adults with Alzheimer's dementia: a randomized controlled home-based exercise trial

PURPOSE

To determine the effects of a Home-based multimodal exercise program for older people with Alzheimer's disease (AD-HOMEX) on muscle strength, mobility, the risk of falls and functioning.

MATERIALS AND METHODS

A trial with a blinded assessor was conducted involving 40 older people with mild to moderate AD randomized to an intervention group (IG) or control group (CG). The IG participated in a 16-week protocol with three 60-minute sessions per week. The sessions were performed at the participant's home by a physiotherapist and involved progressive individualized physical exercises. Muscle strength (5X Sit-to-Stand Test [5XSTS], 30-Second Chair Stand test, isokinetic and hand-grip dynamometer), functioning (DAFS-R and ADL-Q), mobility and the risk of falls (TUG) were assessed at baseline and after training. Intention-to-treat analysis was adopted.

RESULTS

There was a significant group-evaluation time interaction for the 5XSTS (p = 0.011). The IG demonstrated an improved performance on the 5XSTS (p = 0.020) and a reduced risk of falls (p = 0.000), whereas the CG exhibited a worse functional limitation (p = 0.008) after 16 weeks. The CG had an increased risk of falls (p = 0.006) and worse performance on the ADL-Q (p = 0.047) at the follow-up evaluation. An improvement in the IG and worsening in the CG were found regarding transition patterns between severity levels of functional limitation based on the ADL-Q.

CONCLUSIONS

Home-based physical exercise for older people with mild to moderate AD is an effective strategy that decreases the risk of falls and improves strength and functioning.

Cultural engagement and incidence of cognitive impairment: A six-year longitudinal follow-up of the Japan Gerontological Evaluation Study (JAGES)

Background

Active engagement in intellectually enriching activities reportedly lowers the risk of cognitive decline; however, few studies have examined this association, including engagement in traditional cultural activities. This study aimed to elucidate the types of cultural engagement associated with lower risk of cognitive impairment.

Methods

We examined the association between cultural engagement and cognitive impairment using Cox proportional hazards models in a cohort of 44,985 participants (20,772 males and 24,213 females) aged 65 years or older of the Japan Gerontological Evaluation Study from 2010 to 2016. Intellectual activities (eg, reading books, magazines, and/or newspapers), creative activities (eg, crafts and painting), and traditional cultural activities (eg, poetry composition [haiku], calligraphy, and tea ceremony/flower arrangement) were included among cultural engagement activities.

Results

Over a follow-up period of 6 years, incident cognitive disability was observed in 4,198 respondents (9.3%). After adjusting for potential confounders, such as depression and social support, intellectual activities were protectively associated with the risk of cognitive impairment (hazard ratio [HR] for those who read and stated that reading was their hobby, 0.75; 95% confidence interval [CI] 0.66–0.85 and HR for those who read but did not consider reading a hobby, 0.72; 95% CI, 0.65–0.80). Engagement in creative activities was also significantly correlated with lower risk of cognitive impairment (crafts: HR 0.71; 95% CI, 0.62–0.81 and painting: HR 0.80; 95% CI, 0.66–0.96). The association between traditional cultural activities and the risk of cognitive impairment was not statistically significant.

Conclusions

Engagement in intellectual and creative activities may be associated with reduced risk of dementia.

The impact of exercise on patients with dementia: A 2-year follow-up

The current absence of a disease-modifying treatment for Alzheimer disease highlights the necessity for the benefits of nonpharmacological approaches. We aimed to investigate the effect of exercise in older patients with Alzheimer dementia.This is an observational, prospective cohort study in medical center. Eighty older patients with Alzheimer dementia, including 54 with mild dementia and 26 with moderate dementia, were followed up over 2 years. Patients were divided into exercise and no-exercise groups according to their weekly exercise habit. Mini-Mental State Examination (MMSE), clinical dementia rating (CDR), and senior fitness test were checked initially. We defined death and unexpected hospitalization as the outcomes.Age, sex, education years, and MMSE showed no significant differences between the groups (P > .05) in all patients. All the patients of the exercise group had significantly better left upper body strength, higher aerobic endurance, and left and right balance maintenance time than those of the no-exercise group (P < .05). There were no changes in hospitalization and mortality between the exercise and non-exercise groups during the 2-year follow-ups in all participants. However, in the mild and moderate dementia subgroups, age, sex, education years, and MMSE showed no significant differences between the groups (P > .05). The exercise group had significantly better lower body strength, left upper body strength, aerobic endurance, right upper body flexibility, lower body flexibility, balance maintenance, and agility than the no-exercise group in patients with mild dementia (P < .05). Moreover, the exercise group had significantly lesser unexpected hospitalization than the no-exercise group in the patients with mild dementia (P = .037).Despite the similarity in the status of dementia, exercise habit was found to be associated with a better senior fitness test score status. Hence, exercise can decrease unexpected hospitalization in patients with mild dementia but not those with total dementia.