Multimodal intervention in older adults improves resting-state functional connectivity between the medial prefrontal cortex and medial temporal lobe

tDCS-enhanced cognitive training improves attention and alters connectivity in control and somatomotor networks: A triple blind study

BACKGROUND

Executive dysfunction such as inattention or forgetfulness can lead to disruptions in a person's daily functioning and quality of life.

OBJECTIVE/HYPOTHESIS

This triple-blinded randomized clinical trial assessed the efficacy of bifrontal (over the forehead) transcranial direct current stimulation (tDCS) concurrent with cognitive training to improve cognitive performance in a healthy sample.

METHODS

Fifty-eight participants were randomly assigned to one of three stimulation conditions (2 mA left anode-right cathode, 2 mA right anode-left cathode, or sham), which was administered with cognitive training tasks 3x/week over 12 weeks with assessments at baseline, midpoint (6 weeks), and post-training (12 weeks). We assessed cognitive performance, functional connectivity, and the influence of individual differences in training advancement.

RESULTS

Forty participants completed training. We found that at midpoint and post, all groups improved significantly on overall cognitive performance. The left anode group's attention & vigilance score improved significantly at post, but the other two groups did not. Greater attention training advancement predicted attention improvement by post, most notably in the left anode group. Finally, within-network connectivity decreased in the control network and increased in the somatomotor network across all groups.

CONCLUSIONS

These results suggest that, given cognitive training, the left anode montage is more effective at improving attention than the right anode montage and sham. Future research may focus on the application of the left anode montage during cognitive training to assess its effectiveness in improving cognition in neuropsychiatric disorders.

Randomized controlled trials of non-pharmacological interventions for healthy seniors: Effects on cognitive decline, brain plasticity and activities of daily living-A 23-year scoping review

Little is known about the simultaneous effects of non-pharmacological interventions (NPI) on healthy older adults' behavior and brain plasticity, as measured by psychometric instruments and magnetic resonance imaging (MRI). The purpose of this scoping review was to compile an extensive list of randomized controlled trials published from January 1, 2000, to August 31, 2023, of NPI for mitigating and countervailing age-related physical and cognitive decline and associated cerebral degeneration in healthy elderly populations with a mean age of 55 and over. After inventorying the NPI that met our criteria, we divided them into six classes: single-domain cognitive, multi-domain cognitive, physical aerobic, physical non-aerobic, combined cognitive and physical aerobic, and combined cognitive and physical non-aerobic. The ultimate purpose of these NPI was to enhance individual autonomy and well-being by bolstering functional capacity that might transfer to activities of daily living. The insights from this study can be a starting point for new research and inform social, public health, and economic policies. The PRISMA extension for scoping reviews (PRISMA-ScR) checklist served as the framework for this scoping review, which includes 70 studies. Results indicate that medium- and long-term interventions combining non-aerobic physical exercise and multi-domain cognitive interventions best stimulate neuroplasticity and protect against age-related decline and that outcomes may transfer to activities of daily living.

Tai Chi Chuan evidence related to impulsivity and impulse related disorders: A scoping review

BACKGROUND

The purpose of this study was to review the evidence for the potential of Tai Chi Chuan (TCC) as a model of meditative movement in benefiting people with impulsivity related disorders and provide guidance for future research.

METHODS

A scoping review of the literature was conducted in five databases. Eligibility criteria were original articles reporting TCC based interventions or included TCC techniques and provided any assessment on impulsivity or related measures, impulse control disorders, or other psychiatric disorders related to impulsivity (e.g., addictive disorders, ADHD, and other conduct disorders). Twenty-eight out of 304 studies initially retrieved were reviewed. The reports concentrated mostly on neurodegenerative conditions, cognitive decline, and substance use disorders (SUD).

RESULTS

TCC had several positive effects in cognitive domains resulting in improvements in memory, executive functions, inhibitory control, attention, and verbal fluency. These improvements in memory, executive function, including inhibitory control and attention, and verbal fluency were associated with changes in the brain plasticity, resting activity, and other neurobiological markers.

CONCLUSION

Albeit no study was found on the use of TCC in impulse control disorders or impulse related conditions, other than SUD, the findings suggest that considering the behavioral impact of TCC, especially the improvement of executive functions, it could be a valuable therapeutic tool for approaching impulse control related disorders.

The effects of football juggling learning on executive function and brain functional connectivity

This study aimed to explore the relationship between motor skill learning and executive function (EF), with an emphasis on the potential effects of football juggling learning. A randomized controlled trial involving 111 participants aged 17-19 years was conducted. Participants were randomly assigned to either the football juggling learning (FJL) group or a control group. The FJL group underwent 70 sessions of football juggling learning, while the control group engaged in their normal daily activities without any exercise intervention during the same time frame. Both groups were assessed for EF performance and underwent functional magnetic resonance imaging (fMRI) scans before and after the experiment. The executive function test included three tasks, namely, inhibition, working memory, and shifting. The results showed significant improvement in inhibition and shifting in both groups, and the FJL group showed greater improvement in these aspects of EF compared to the control group. Additionally, in comparison to the control group, the FJL group exhibited increased functional connectivity within the frontal, temporal, and cerebellar regions from the pre-test to the post-test. Notably, enhanced functional connectivity between the right superior temporal gyrus (posterior division) and left cerebellum 6 was identified in the FJL group and was associated with improved EF performance induced by football juggling learning. These findings shed light on the potential causal relationship between motor skill learning, EF, and brain plasticity. Importantly, our study provides preliminary evidence supporting the use of motor skill learning, such as football juggling, as a potential avenue for cognitive enhancement.

Intrinsic functional brain connectivity changes following aerobic exercise, computerized cognitive training, and their combination in physically inactive healthy late-middle-aged adults: the Projecte Moviment

Lifestyle interventions have positive neuroprotective effects in aging. However, there are still open questions about how changes in resting-state functional connectivity (rsFC) contribute to cognitive improvements. The Projecte Moviment is a 12-week randomized controlled trial of a multimodal data acquisition protocol that investigated the effects of aerobic exercise (AE), computerized cognitive training (CCT), and their combination (COMB). An initial list of 109 participants was recruited from which a total of 82 participants (62% female; age = 58.38 ± 5.47) finished the intervention with a level of adherence > 80%. Only in the COMB group, we revealed an extended network of 33 connections that involved an increased and decreased rsFC within and between the aDMN/pDMN and a reduced rsFC between the bilateral supplementary motor areas and the right thalamus. No global and especially local rsFC changes due to any intervention mediated the cognitive benefits detected in the AE and COMB groups. Projecte Moviment provides evidence of the clinical relevance of lifestyle interventions and the potential benefits when combining them.

Move Your Body, Boost Your Brain: The Positive Impact of Physical Activity on Cognition across All Age Groups

While the physical improvements from exercise have been well documented over the years, the impact of physical activity on mental health has recently become an object of interest. Physical exercise improves cognition, particularly attention, memory, and executive functions. However, the mechanisms underlying these effects have yet to be fully understood. Consequently, we conducted a narrative literature review concerning the association between acute and chronic physical activity and cognition to provide an overview of exercise-induced benefits during the lifetime of a person. Most previous papers mainly reported exercise-related greater expression of neurotransmitter and neurotrophic factors. Recently, structural and functional magnetic resonance imaging techniques allowed for the detection of increased grey matter volumes for specific brain regions and substantial modifications in the default mode, frontoparietal, and dorsal attention networks following exercise. Here, we highlighted that physical activity induced significant changes in functional brain activation and cognitive performance in every age group and could counteract psychological disorders and neural decline. No particular age group gained better benefits from exercise, and a specific exercise type could generate better cognitive improvements for a selected target subject. Further research should develop appropriate intervention programs concerning age and comorbidity to achieve the most significant cognitive outcomes.

Combining exercise with cognitive training and vitamin D3 to improve functional brain connectivity (FBC) in older adults with mild cognitive impairment (MCI). Results from the SYNERGIC trial

Changes in functional brain connectivity (FBC) may indicate how lifestyle modifications can prevent the progression to dementia; FBC identifies areas that are spatially separate but temporally synchronized in their activation and is altered in those with mild cognitive impairment (MCI), a prodromal state between healthy cognitive aging and dementia. Participants with MCI were randomly assigned to one of five study arms. Three times per week for 20-weeks, participants performed 30-min of (control) cognitive training, followed by 60-min of (control) physical exercise. Additionally, a vitamin D₃ (10,000 IU/pill) or a placebo capsule was ingested three times per week for 20-weeks. Using the CONN toolbox, we measured FBC change (Post-Pre) across four statistical models that collapsed for and/or included some or all study arms. We conducted Pearson correlations between FBC change and changes in physical and cognitive functioning. Our sample included 120 participants (mean age: 73.89 ± 6.50). Compared to the pure control, physical exercise (model one; p-False Discovery Rate (FDR) < 0.01 & < 0.05) with cognitive training (model two; p-FDR =  < 0.001), and all three interventions combined (model four; p-FDR =  < 0.01) demonstrated an increase in FBC between regions of the Default-Mode Network (i.e., hippocampus and angular gyrus). After controlling for false discovery rate, there were no significant correlations between change in connectivity and change in cognitive or physical function. Physical exercise alone appears to be as efficacious as combined interventional strategies in altering FBC, but implications for behavioral outcomes remain unclear.

Frailty and functional brain connectivity (FBC) in older adults with mild cognitive impairment (MCI): baseline results from the SYNERGIC Trial

Functional brain connectivity (FBC), or areas that are anatomically separate but temporally synchronized in their activation, represent a sensitive biomarker for monitoring dementia progression. It is unclear whether frailty is associated with FBC in those at higher risk of progression to dementia (e.g., mild cognitive impairment -MCI-) and if sex plays a role. We used baseline data from the SYNERGIC trial, including participants with MCI that received brain MRI. In this cross-sectional analyses (n = 100), we measured frailty using a deficit accumulation frailty index. Using the CONN toolbox, we assessed FBC of networks and regions of interest across the entire connectome. We used Pearson's correlation to investigate the relationship between FBC and frailty index in the full sample and by sex. We also divided the full sample and each sex into tertiles based upon their frailty index score and then assessed between-tertile differences in FBC. The full sample (cluster: size = 291 p-FDR < 0.05) and males (cluster: size = 993 and 451 p-FDR < 0.01) demonstrated that increasing (stronger) connectivity between the right hippocampus and clusters in the temporal gyrus was positively correlated with increasing (worse) frailty. Males also demonstrated between-tertile differences in right hippocampus connectivity to clusters in the lateral occipital cortex (cluster: size = 289 p-FDR < 0.05). Regardless of frailty status, females demonstrated stronger within-network connectivity of the Default-Mode (p = 0.024). Our results suggest that increasing (worse) frailty was associated with increasing (stronger) connectivity between regions not typically linked, which may reflect a compensation tactic by the plastic brain. Furthermore, the relationship between the two variables appears to differ by sex. Our results may help elucidate why specific individuals progress to a dementia syndrome. NCT02808676. https://www.clinicaltrials.gov/ct2/show/NCT02808676.

From Ancient Patterns of Hand-to-Hand Combat to a Unique Therapy of the Future

The purpose of this publication is to provide generalized knowledge of the area of changes that took place over past centuries in relation to health, social and cultural conditions. In Greek mythology, it was necessary to nurture both body and spirit to be a perfect human being. This link between the concepts of physical beauty and goodness can be also found in later works dedicated to ancient Greek history. Particularly in Greek myths, and in Greek education in general, it was believed that both physical and spiritual excellence were necessary to raise men to achieve their true form. Some of the main forms of implementing this idea were hand-to-hand combat exercises (wrestling, boxing and pankration). Ideas characteristic of the world of ancient Greece, in a general sense, can be observed in the culture of the Far East. The main difference is the fact that these principles did not survive in Western culture as a result of transformation into a consumer society focused on the rejection of moral principles. The brutalisation of the forms of the Roman Games meant that the ideals of the ancient world were forgotten for more than 1500 years. The modern Olympic Games were resurrected in the 19th century. Inspired by the ancient Greek cult of health of body and spirit, they gave rise to a movement known as Olympism. In the Olympic Charter written by Coubertin, Olympism was called "a philosophy of life exalting and combining in a balanced whole the qualities of body, will and mind". The combat sports disciplines have had their place there since the beginning of the modern Olympic Games. The evolution of hand-to-hand combat disciplines, including numerous scientific studies indicating a very broad impact in the area of health, led to this type of physical activity being reached for as an essential element in supporting the health-promoting behaviour of society. Nowadays, physical activity in the area of exercise with elements of hand-to-hand combat, combat sports, or martial arts is an indissoluble link in the prevention and treatment of 21st century diseases. For Parkinson's disease patients, drug treatment is an essential resource for continuing to function in society, but it will not be completely effective without supporting the treatment with appropriate and attractive physical activity (e.g., "Rock Steady Boxing"). Of similar importance is the prevention of dangerous falls, which are common in this population as well as among the elderly or those affected by other diseases of civilisation. Implementing the principles and techniques of safe falling in the teaching of the young population significantly increases the likelihood of applying appropriate responses to these individuals in adulthood and old age. Actions that should be taken now for prevention can be implemented through social programmes, such as "Active today for a healthy future".

Association between social comparison orientation and hippocampal properties in older adults: A multimodal MRI study

Social comparison orientation (SCO) refers to the tendency to compare oneself with others and has two distinct dimensions: one about opinions and the other about abilities. Although dissociable neural mechanisms underlying the two dimensions of social comparison can be assumed, little is known about how each dimension of SCO is associated with cognitive and brain health among older adults. To investigate this, we analyzed the SCO scale questionnaire data, neuropsychological assessment data, and multimodal MRI data collected from 90 community-dwelling older adults. We found that global cognitive performance was positively correlated with the score of the opinion subscale but not with the score of the ability subscale and the total score. Similarly, hippocampal volume was positively correlated with opinion score alone. Additionally, the resting-state functional connectivity between the hippocampal seed and the default mode network showed a positive correlation only with the opinion score. Moreover, fractional anisotropy in the hippocampal cingulum was positively correlated with opinion score only. These findings suggest that global cognition and hippocampal properties in older age are associated with the SCO of opinion, which could reflect a regular habit of performing the types of cognitively demanding activities involved in evaluation of self and other opinions.

The effect of a multimodal intervention program on cognitive and daily function of older persons residing in rural communities: A pilot study

This pilot study aimed to explore the effects of a 12-week multimodal intervention program, comprising cognitive training and cognitive-stimulation, on cognitive performance and daily function of older adults in rural communities. Fifty-one participants were equally assigned to the multimodal intervention, cognitive-stimulation, and no-intervention control groups. Cognition and daily function were assessed using the Korean version of neuropsychological test battery and instrumental activities of daily living at baseline and at the 12-week follow-up assessment, respectively. Compared with the two other groups, the multimodal intervention group showed significant improvement in global cognitive function, attention, and executive function. A significant group-by-time interaction in instrumental activities of daily living was observed among the groups, with a greater improvement observed in the multimodal intervention group and little changes or decreases over time in the other groups. This study suggested the beneficial effects of a multimodal intervention on cognitive and behavioral improvement in older adults.

Mitigating effects and mechanisms of Tai Chi on mild cognitive impairment in the elderly

Mild cognitive impairment (MCI) is a major public health concern that endangers health and decreases the quality of life of the elderly around the world. A recent clinical guideline has recommended regular exercise (twice per week) for patients with MCI as part of an overall approach to management. Tai Chi, a form of light-to-moderate-intensity mind-body exercise, is particularly suitable for seniors. This review aims to summarize epidemiological studies related to the effects of Tai Chi on symptom remission in older adults with MCI and reveal the potential mechanisms. Evidence suggested that Tai Chi can improve cognitive functions and alleviate the accompanying symptoms of MCI in the elderly potentially by activating the expression of signals in different brain regions, altering their connectivity, increasing the brain volume, and modulating brain-derived neurotropic and inflammation factors. Studies comparing various types of Tai Chi may contribute to the identification of paradigms that have appropriate intensities and difficulty and exert good effects on older people with MCI. In addition, studies are warranted to determine the frequency and duration of training that can optimize the beneficial effects of Tai Chi on MCI.

Cognitive Training Effect and Imaging Evidence

Cognitive intervention is a specific form of non-pharmacological intervention used to combat cognitive dysfunction. In this chapter, behavioral and neuroimaging studies about cognitive interventions are introduced. Regarding intervention studies, the form of intervention and the effects of the interventions have been systematically sorted out. In addition, we compared the effects of different intervention approaches, which help people with different cognitive states to choose appropriate intervention programs. With the development of imaging technology, many studies have discussed the neural mechanism of cognitive intervention training and the effects of cognitive intervention from the perspective of neuroplasticity. Behavioral studies and neural mechanism studies are used to improve the understanding of cognitive interventions for the treatment of cognitive impairment.

The Effects of Cognitive Training in Healthy Community Residing Thai Elderly: A Randomized Controlled Trial

Purpose

Cognitive training intervention (CTI) is defined as any mechanism of action of a non-pharmacological procedure provided to improve cognitive function. CTI in healthy elderly has the potential to improve cognitive function; however, the effects of interactive computerized-CTI in old ages have been inconclusive. The present study aimed to determine the effects of low-technology CTI in community-based populations.

Patients and Methods

The study was a 2-arm parallel single-blinded randomized controlled intervention trial. The main outcome measured global cognitive function utilizing the Thai Mental State Examination (TMSE); the minor outcomes were cognitive subdomains and psychosocial outcomes (ie, quality of life and depression). The primary endpoint assessed the treatment effect at the 12th week (T1), while the secondary endpoint evaluated the carry-over effect at the 24th week (T2).

Results

Eighty-six eligible participants were recruited from a senior society on the edge of Bangkok. At baseline (T0), the mean age and TMSE score among CTI (n = 44) and wait-list (n = 42) groups were similar (age; 66.66 ± 5.52 and 67.52 ± 6.46; TMSE; 28.84 ± 1.38 and 28.83 ± 1.12, respectively). For the CTI group, the mean number of cognitive training sessions was 14.82 ± 7.62. By using intention-to-treat analysis at the primary endpoint, the mean difference score of TMSE in the CTI group was significantly higher than the wait-list group (∆TMSE_{between group} at T1-T0 = 0.57; 95% CI = 0.07 to 1.08), while the effect size was 0.48. At the secondary endpoint, there was no significant difference observed between the CTI and wait-list groups (∆TMSE_{between group} at T2-T0 = 0.33; 95% CI = -0.23 to 0.88), while the effect size was 0.25. The cognitive subdomains and psychosocial outcomes were discovered with no significant difference.

Conclusion

CTI showed significant treatment effect for improvement in global cognitive function in healthy Thai elderly but did not demonstrate carry-over effect. This study provided preliminary evidence of the feasibility of implementing low-technology CTI in middle-income countries.

Tai Chi increases functional connectivity and decreases chronic fatigue syndrome: A pilot intervention study with machine learning and fMRI analysis

BACKGROUND

The latest guidance on chronic fatigue syndrome (CFS) recommends exercise therapy. Tai Chi, an exercise method in traditional Chinese medicine, is reportedly helpful for CFS. However, the mechanism remains unclear. The present longitudinal study aimed to detect the influence of Tai Chi on functional brain connectivity in CFS.

METHODS

The study recruited 20 CFS patients and 20 healthy controls to receive eight sessions of Tai Chi exercise over a period of one month. Before the Tai Chi exercise, an abnormal functional brain connectivity for recognizing CFS was generated by a linear support vector model. The prediction ability of the structure was validated with a random forest classification under a permutation test. Then, the functional connections (FCs) of the structure were analyzed in the large-scale brain network after Tai Chi exercise while taking the changes in the Fatigue Scale-14, Pittsburgh Sleep Quality Index (PSQI), and the 36-item short-form health survey (SF-36) as clinical effectiveness evaluation. The registration number is ChiCTR2000032577 in the Chinese Clinical Trial Registry.

RESULTS

1) The score of the Fatigue Scale-14 decreased significantly in the CFS patients, and the scores of the PSQI and SF-36 changed significantly both in CFS patients and healthy controls. 2) Sixty FCs were considered significant to discriminate CFS (P = 0.000, best accuracy 90%), with 80.5% ± 9% average accuracy. 3) The FCs that were majorly related to the left frontoparietal network (FPN) and default mode network (DMN) significantly increased (P = 0.0032 and P = 0.001) in CFS patients after Tai Chi exercise. 4) The change of FCs in the left FPN and DMN were positively correlated (r = 0.40, P = 0.012).

CONCLUSION

These results demonstrated that the 60 FCs we found using machine learning could be neural biomarkers to discriminate between CFS patients and healthy controls. Tai Chi exercise may improve CFS patients' fatigue syndrome, sleep quality, and body health statement by strengthening the functional connectivity of the left FPN and DMN under these FCs. The findings promote our understanding of Tai Chi exercise's value in treating CFS.

A Multimodal Intervention to Improve Cognition in Community-dwelling Older Adults

OBJECTIVE

To examine the effects of a multimodal intervention composed of cognitive training, physical exercise, and group counseling on cognitive function in community-dwelling older adults.

DESIGN

A four-armed, quasi-experimental intervention study.

SETTING AND PARTICIPANTS

Community-dwelling adults aged 60 years and older (n = 153).

INTERVENTION

Participants were allocated into multimodal intervention, cognitive training plus Taichi exercise, cognitive training, or control group. The multimodal intervention included 18 sessions of cognitive training, 18 sessions of Taichi, and 6 sessions of group reminiscence over six weeks.

MEASUREMENTS

Cognitive function, depressive symptoms, and psychological well-being were assessed at the baseline, postintervention, and three-month follow-up. The primary outcome was the change in overall cognition measured by the Montreal Cognitive Assessment (MoCA) and a composite cognitive score derived from a battery of neuropsychological tests.

RESULTS

For MoCA, there was no significant difference between any of the three intervention groups and controls. For composite cognition, all three intervention groups showed improvements at the three-month follow-up, with a large effect size in the cognitive training plus Taichi group (change difference 0.37, 95% CI 0.18-0.56, Hedge's g = 0.92), and medium effect sizes in the multimodal intervention group (change difference 0.23, 95% CI 0.0 -0.42, g = 0.58) and cognitive training group (change difference 0.22, 95% CI 0.03-0.42, g = 0.55).

CONCLUSIONS

Multimodal intervention, cognitive training plus Taichi, and cognitive training could foster cognitive function in community-dwelling older adults. The combination of cognitive training and Taichi showed greater efficacy than the other two interventions.

Integrated cognitive and physical fitness training enhances attention abilities in older adults

Preserving attention abilities is of great concern to older adults who are motivated to maintain their quality of life. Both cognitive and physical fitness interventions have been utilized in intervention studies to assess maintenance and enhancement of attention abilities in seniors, and a coupling of these approaches is a compelling strategy to buttress both cognitive and physical health in a time- and resource-effective manner. With this perspective, we created a closed-loop, motion-capture video game (Body-Brain Trainer: BBT) that adapts a player’s cognitive and physical demands in an integrated approach, thus creating a personalized and cohesive experience across both domains. Older adults who engaged in two months of BBT improved on both physical fitness (measures of blood pressure and balance) and attention (behavioral and neural metrics of attention on a continuous performance task) outcome measures beyond that of an expectancy matched, active, placebo control group, with maintenance of improved attention performance evidenced 1 year later. Following training, the BBT group’s improvement on the attention outcome measure exceeded performance levels attained by an untrained group of 20-year olds, and showed age-equilibration of a neural signature of attention shown to decline with age: midline frontal theta power. These findings highlight the potential benefits of an integrated, cognitive-physical, closed-loop training platform as a powerful tool for both cognitive and physical enhancement in older adults.

Brain Functional Connectivity in the Resting State and the Exercise State in Elite Tai Chi Chuan Athletes: An fNIRS Study

This study aimed to reveal the characteristics of multi-circuit brain synergy between elite tai chi chuan athletes in resting and exercise states and to provide neuroimaging evidence of improvements in brain function by motor skill training. Functional near-infrared spectroscopy (fNIRS) was used to compare the brain activity of professional tai chi chuan athletes (expert group) and beginners (novice group) in resting and exercise states, and to assess functional connectivity (FC) between the prefrontal lobe and the sensorimotor zone. In the resting state, the FC between the left prefrontal lobe and the right sensorimotor area in the expert group was significantly lower than that in the novice group (P &lt; 0.05). In the exercise state, the patterns of FC between the left prefrontal lobe and right sensorimotor area, the right prefrontal lobe and left sensorimotor area, and the left and right sensorimotor areas in the expert group were significantly lower than that in the novice group (P &lt; 0.05). From the resting state to the locomotor state, the expert group experienced a greater absolute value of functional connection increment between the left prefrontal cortex and right sensorimotor area, and between the left sensorimotor area and right sensorimotor area (P &lt; 0.05). This was positively correlated with the self-evaluation results of motor performance behavior. Under sports conditions, professional athletes’ multi-circuit brain FC strength is significantly reduced, and their elite motor skill performance supports the neural efficiency hypothesis. This may be related to the high adaptation of the brain to specific tasks and the improvement of the integration of somatic perception processing and motor function.

Effects of tai chi and Qigong on cognition in neurological disorders: A systematic review and meta-analysis

OBJECTIVES

To explore whether tai chi and Qigong can improve cognitive function in patients with neurological disorders.

METHODS

The PubMed, Embase, Cochrane Central Register of Controlled Trials, SinoMed Database, Chinese National Knowledge Infrastructure (CNKI), Wanfang, and China Science and Technology Journal Database (VIP) databases were searched from inception to December 24, 2021. The methodological quality of the included studies was evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions criteria.

RESULTS

This study included 2,754 participants from 40 randomized controlled trials (RCT)s with low to high methodological quality. Analysis of active and non-active comparisons showed significant effects for tai chi/Qigong (P<0.05) on global cognitive function, executive function, memory, visuospatial ability, and cognitive processing speed.

CONCLUSIONS

Tai chi and Qigong were effective interventions to improve cognition in patients with Parkinson's disease, stroke, mild cognitive impairment, dementia, and traumatic brain injury; however, no RCTs were performed for other neurological disorders.

Increasing participation in habitual intellectual activities on modulating functional connectivity of default mode network among older adults at risk of dementia: study protocol of a randomized controlled trial

BACKGROUND

Active participation in intellectual leisure activities such as calligraphy helps prevent cognitive decline and dementia, but the underlying mechanisms are not fully understood. With disrupted functional connectivity (FC) of default mode network (DMN) associated with cognitive decline, we speculate that intellectual activities might optimize cognitive function through modulating FC of DMN. This two-arm single-blind randomized controlled trial aims to identify the effects of increasing practice of calligraphy on cognitive function and FC of DMN in people with subjective cognitive decline (SCD).

METHODS

One hundred twelve community-living Chinese aged 55 to 75 years old with SCD but without mild cognitive impairment or dementia and with prior practice of calligraphy as defined by 1 h of calligraphy per week will be recruited through elderly social centres in Hong Kong and randomized into either control or intervention group. The control group will continue with their usual practice of calligraphy, whereas the intervention group will double their practice of calligraphy. Measurement of cognitive outcomes and neuroimaging on resting-state FC will be performed at baseline and in 6 months. Repeated measures analysis of variance will be used to assess cognitive and FC changes, with time being the within-group factor, control/intervention as the between-group measure, and important covariates (age, sex, educational and occupational attainment, health, and other lifestyle factors) controlled for.

DISCUSSION

This study will shed light on the underlying neurocognitive mechanisms of how intellectual activities promotes cognitive maintenance. Our anticipated findings will provide evidence that reversing or slowing FC disruption by actively participating in intellectual activities is still possible for the at-risk individuals.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR1900024433 . Registered on 11 July 2019.

Effectiveness of Taijiquan in treating insomnia: A systematic review and meta-analysis of randomized controlled studies

BACKGROUND

Sleep efficiency of <80% based on actigraphy was defined as insomnia as self-reported difficulty falling asleep or waking up at night three to four times per week. It is known that adequate sleep is very important for human wellbeing, affecting people's work and life, insomnia will seriously damage our daily life. There is no recognized non-drug treatment. Studies have found that Taijiquan has a positive effect on insomnia patients. This systematic review and meta-analysis will evaluate the effect of Taijiquan on insomnia.

METHODS

To find all randomized controlled trials exploring the effects of Taijiquan on insomnia patients in Chinese and English, eight databases (Pubmed, Embase, Cochrane library, Web of Science, CNKI, CBM, VIP, and Wanfang Data) were searched. The retrieval time is from database construction to October 2021. Searches were conducted in both English and Chinese language. A meta-analysis by mean difference (MD) and 95% confidence interval (CI) was performed with RevMan 5.3. The risk of bias for each study was accounted for according to the Cochrane Handbook. Our primary outcome was Pittsburg Sleep Quality Index. We explored sources of heterogeneity by comparing effect sizes across different types of etiology, country, control group, and intervention type. The protocol was pre-registered with PROSPERO, CRD42021284511.

RESULTS

Twenty-one RCTs published between 2004 and 2021 with 2,022 participants were included in this study. Twenty-one randomized controlled studies showed that Tai Chi significantly improved PSQI scores in patients with cancer, muscle fibrosis, and sub-health insomnia [MD = -1.16, 95% CI (-1.62, -0.71), P < 0.01]; There is insufficient evidence of improvement in patients with cerebrovascular disease [MD = -0.54, 95% CI (-1.58, 0.51), P = 0.31]; 8-form, 10-form or 24-form Yang's Taijiquan had the same effect in improving PSQI [MD = -1.33, 95% CI (-1.85, -0.81), P < 0.01]. When there is no treatment, exercise, exercise and health education as the control, taijiquan has a significant effect on insomnia treatment, and there is no difference in efficacy compared with cognitive behavioral therapy and health education (usual care) alone.

CONCLUSIONS

The results of the study showed that Taijiquan significantly improved sleep quality in healthy adults and patients with chronic diseases, which suggests that Taijiquan may be considered as an alternative behavioral therapy in the treatment of insomnia. In the future, more high-quality, well-controlled randomized trials are needed to better inform clinical decisions.

Benefits of combined interventions for cognitive enhancement in older adults

OBJECTIVE: To investigate the effects of different combined interventions (Stimullus, MEMO, physical activity, and psychoeducation) on the cognitive performance of older adults. METHODS: This is a quasi-experimental study with pre- and post-intervention. Thirty-four older adults underwent different combined interventions for a period of 48 weeks and were evaluated at three different points (pre-intervention; post-cognitive intervention; post-physical activity or psychoeducation intervention). Cognitive domains (verbal episodic memory, executive function, general cognitive performance) and depressive symptoms were evaluated. RESULTS: Postintervention gains in global, attentional, and mnemonic cognition were observed, as well as a reduction in depressive symptoms. The MEMO intervention + physical activity or psychoeducation resulted in greater cognitive gains, while Stimullus + psychoeducation showed benefits only in evocation and the free learning index, while Stimullus + physical activity resulted in improvement in the investigated variables. CONCLUSION: The results of these combined interventions appear promising for healthy older adults and the impact of these interventions should be discussed with individual older patients and evaluated more broadly in the context of public health.

Changes in Brain Volume Resulting from Cognitive Intervention by Means of the Feuerstein Instrumental Enrichment Program in Older Adults with Mild Cognitive Impairment (MCI): A Pilot Study

There is increasing interest in identifying biological and imaging markers for the early detection of neurocognitive decline. In addition, non-pharmacological strategies, including physical exercise and cognitive interventions, may be beneficial for those developing cognitive impairment. The Feuerstein Instrumental Enrichment (FIE) Program is a cognitive intervention based on structural cognitive modifiability and the mediated learning experience (MLE) and aims to promote problem-solving strategies and metacognitive abilities. The FIE program uses a variety of instruments to enhance the cognitive capacity of the individual as a result of mediation. A specific version of the FIE program was developed for the cognitive enhancement of older adults, focusing on strengthening orientation skills, categorization skills, deductive reasoning, and memory. We performed a prospective interventional pilot observational study on older subjects with MCI who participated in 30 mediated FIE sessions (two sessions weekly for 15 weeks). Of the 23 subjects who completed the study, there was a significant improvement in memory on the NeuroTrax cognitive assessment battery. Complete sets of anatomical MRI data for voxel-based morphometry, taken at the beginning and the end of the study, were obtained from 16 participants (mean age 83.5 years). Voxel-based morphometry showed an interesting and unexpected increase in grey matter (GM) in the anterolateral occipital border and the middle cingulate cortex. These initial findings of our pilot study support the design of randomized trials to evaluate the effect of cognitive training using the FIE program on brain volumes and cognitive function.

Mechanistic Effects of Aerobic Exercise in Alzheimer's Disease: Imaging Findings From the Pilot FIT-AD Trial

Despite strong evidence from animal models of Alzheimer's disease (AD) supporting aerobic exercise as a disease-modifying treatment for AD, human mechanistic studies are limited with mixed findings. The objective of this pilot randomized controlled trial was to examine the effects of 6-month aerobic exercise on hippocampal volume, temporal meta-regions of interest (ROI) cortical thickness, white matter hyperintensity (WMH) volume, and network failure quotient (NFQ), measured with MRI, in community-dwelling older adults with AD dementia. Additionally, the relationships between 6- and 12-month changes in MRI biomarkers and the AD Assessment Scale-Cognition (ADAS-Cog) were examined. Sixty participants were randomized, but one was excluded because baseline MRI failed quality control: 38 randomized to cycling and 21 to stretching. The intervention was moderate-intensity cycling for 20-50 mins, three times a week for 6 months. Control was low-intensity stretching. The study outcomes include hippocampal volume, temporal meta-ROI cortical thickness, WMH volume, and NFQ. Outcomes were measured at baseline, 6 months, and 12 months. The sample averaged 77.3 ± 6.3 years old with 15.6 ± 2.9 years of education and 53% men. Both groups experienced significant declines over 6 months in hippocampal volume (2.64% in cycling vs. 2.89% in stretching) and temporal meta-ROI cortical thickness (0.94 vs. 1.54%), and over 12 months in hippocampal volume (4.47 vs. 3.84%) and temporal meta-ROI cortical thickness (2.27 vs. 1.79%). These declines did not differ between groups. WMH volume increased significantly with the cycling group increasing less (10.9%) than stretching (24.5%) over 6 months (f = 4.47, p = 0.04) and over 12 months (12.1 vs. 27.6%, f = 5.88, p = 0.02). NFQ did not change significantly over time. Pairwise correlational analyses showed a significant negative correlation between 6-month changes in hippocampal volume and ADAS-Cog (r = -0.34, p < 0.05). To conclude, aerobic exercise may reduce the decline in hippocampal volume and temporal meta-ROI cortical thickness during the intervention period, but the effect sizes are likely to be very small and dose-dependent and reverse once the intervention stops. Aerobic exercise is effective on slowing down WMH progression but has no effect on NFQ. Hippocampal atrophy was associated with cognitive decline during the intervention period. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01954550.

Dynamic Functional Connectivity Signifies the Joint Impact of Dance Intervention and Cognitive Reserve

Research on dance interventions (DIs) in the elderly has shown promising benefits to physical and cognitive outcomes. The effect of DIs on resting-state functional connectivity (rs-FC) varies, which is possibly due to individual variability. In this study, we assessed the moderation effects of residual cognitive reserve (CR) on DI-induced changes in dynamic rs-FC and their association on cognitive outcomes. Dynamic rs-FC (rs-dFC) and cognitive functions were evaluated in non-demented elderly subjects before and after a 6-month DI (n = 36) and a control group, referred to as the life-as-usual (LAU) group (n = 32). Using linear mixed models and moderation, we examined the interaction effect of DIs and CR on changes in the dwell time and coverage of rs-dFC. Cognitive reserve was calculated as the residual difference between the observed memory performance and the performance predicted by brain state. Partial correlations accounting for CR evaluated the unique association between changes in rs-dFC and cognition in the DI group. In subjects with lower residual CR, we observed DI-induced increases in dwell time [t(58) = -2.14, p = 0.036] and coverage [t(58) = -2.22, p = 0.030] of a rs-dFC state, which was implicated in bottom-up information processing. Increased dwell time was also correlated with a DI-induced improvement in Symbol Search (r = 0.42, p = 0.02). In subjects with higher residual CR, we observed a DI-induced increase in coverage [t(58) = 2.11, p = 0.039] of another rs-dFC state, which was implicated in top-down information processing. The study showed that DIs have a differential and behaviorally relevant effect on dynamic rs-dFC, but these benefits depend on the current CR level.

Prefrontal Plasticity after a 3-Month Exercise Intervention in Older Adults Relates to Enhanced Cognitive Performance

This study examined exercise intervention effects on older adults' brain structures and function. Brain data were analyzed from 47 healthy adults between 61 and 82 years of age who, in a previous study, showed cognitive improvement following a 3-month intervention. The participants were assigned to a motor exercise intervention group (n = 24), performing exercise training programs for a 12-week period, or a waiting control group (n = 23), abstaining from any exercise program. Structural analysis of the frontal cortex and hippocampus revealed increased gray matter volume and/or thickness in several prefrontal areas in the intervention group and reduced hippocampal gray matter volume in the control group. Importantly, the volume increase in the middle frontal sulcus in the intervention group was associated with a general cognitive improvement after the intervention. Functional analysis showed that the prefrontal functional connectivity during a working memory task differently changed in response to the intervention or waiting in the two groups. The functional connectivity decreased in the intervention group, whereas the corresponding connectivity increased in the control group, which was associated with maintaining cognitive performance. The current longitudinal findings indicate that short-term exercise intervention can induce prefrontal plasticity associated with cognitive performance in older adults.

Tai Chi Chuan Alters Brain Functional Network Plasticity and Promotes Cognitive Flexibility

Objective: This study used resting-state functional magnetic resonance imaging to investigate the effects of 8 weeks of Tai Chi Chuan and general aerobic exercise on the topological parameters of brain functional networks, explored the advantages of Tai Chi Chuan for improving functional network plasticity and cognitive flexibility, and examined how changes in topological attributes of brain functional networks relate to cognitive flexibility. Methods: Thirty-six healthy adults were grouped into Tai Chi Chuan (Bafa Wubu of Tai Chi), general aerobic exercise (brisk walking), and control groups. All of the subjects underwent fMRI and behavioral assessment before and after the exercise intervention. Results: Tai Chi Chuan exercise significantly enhanced the clustering coefficient and local efficiency compared with general aerobic exercise. Regarding the nodal properties, Tai Chi Chuan significantly enhanced the nodal clustering coefficient of the bilateral olfactory cortex and left thalamus, significantly reduced the nodal clustering coefficient of the left inferior temporal gyrus, significantly improved the nodal efficiency of the right precuneus and bilateral posterior cingulate gyrus, and significantly improved the nodal local efficiency of the left thalamus and right olfactory cortex. Furthermore, the behavioral performance results demonstrated that cognitive flexibility was enhanced by Tai Chi Chuan. The change in the nodal clustering coefficient in the left thalamus induced by Tai Chi Chuan was a significant predictor of cognitive flexibility. Conclusion: These findings demonstrated that Tai Chi Chuan could promote brain functional specialization. Brain functional specialization enhanced by Tai Chi Chuan exercise was a predictor of greater cognitive flexibility.

Effects of Mini-Basketball Training Program on Social Communication Impairment and Executive Control Network in Preschool Children with Autism Spectrum Disorder

This study evaluated the effect of a 12-week mini-basketball training program (MBTP) on social communication (SC) and the executive control network (ECN) in preschool children with autism spectrum disorders (ASD). We finally assigned 30 preschool children with ASD to an experiment group (n = 15, 12 males, 3 females) or a control group (n = 15, 13 males, 2 females). The experiment group participated in a 12-week MBTP (40-min sessions per day, 5 days a week), while the control group only received the institutional routine behavioral rehabilitation intervention. The SC of preschool children with ASD was measured using the Social Responsiveness Scale, Second Edition (SRS-2), whereas functional connectivity (FC) of the ECN was assessed using resting-state functional magnetic resonance imaging (rs-fMRI) at pre-and post-test. Our results showed that SC exhibited significant improvement in the intervention group, especially in SRS-2 total score, social cognition, and social communication. We found significantly enhanced functional connectivity between the right cerebellum and left inferior frontal gyrus in the experimental group, while functional connectivity between the left middle temporal gyrus and right cerebellum were decreased in the control group. Furthermore, there were no significant correlations between the change in SC scores and FC of the ECN. Altogether, this study provides valuable insights that a 12-week MBTP improves SC and functional connectivity of the ECN in preschool children with ASD. We further inferred that neural mechanisms might be associated with changing the ECN of preschool ASD children caused by the 12-week MBTP.

Effects of Open-Skill Exercises on Cognition on Community Dwelling Older Adults: Protocol of a Randomized Controlled Trial

(1) Cognitive function may benefit from physical exercise in older adults. However, controversy remains over which mode of exercise is more beneficial. (2) The aim of the proposed study is to investigate the effect of open-skill exercise training on cognitive function in community dwelling older adults compared with closed-skill exercise, cognitive training, and active control. (3) One hundred and sixty participants, aged between 60 and 80 years old, will be recruited from community senior centers in Yangzhou, China and randomly assigned to one of four groups: open-skill exercise group, closed-skill exercise group, mobile game playing group, and active control group. All participants will join a 24-week program involving 50 min sessions three times a week. The primary outcome measure is visuospatial working memory. Secondary measures include subjective memory complaint, attention network, nonverbal reasoning ability, and physical activities. All participants will be measured before, mid-way, and immediately after intervention, and three months later. (4) If successful, this study is expected to provide evidence-based recommendations for older adults to select the most efficient and effective mode of exercise to improve cognitive function. Importantly, the three intervention groups provide an opportunity to separate the cognitive activity component from the physical activity component. Comparison of these components is expected to help elucidate possible mechanisms contributing to the additional cognitive benefit of open-skill exercises.

Functional brain changes associated with cognitive training in healthy older adults: A preliminary ALE meta-analysis

Accumulating evidence suggests that cognitive training (CT) programs may provide healthy older adults (OAs) with cognitive benefits that are accompanied by alterations in neural activity. The current review offers the first quantitative synthesis of the available literature on the neural effects of CT in healthy aging. It was hypothesized that OAs would evidence increased and decreased neural activations across various challenging CTs, and that these effects would be observed as significantly altered clusters within regions of the frontoparietal network (FPN). Online databases and reference lists were searched to identify peer-reviewed publications that reported assessment of neural changes associated with CT programs in healthy OAs. Among the 2097 candidate studies identified, 14 studies with a total of 238 participants met inclusionary criteria. GingerALE software was used to quantify neural effects in a whole-brain analysis. The activation likelihood estimation technique revealed significant increases in activation following CT in the left hemisphere middle frontal gyrus, precentral gyrus, and posterior parietal cortex, extending to the superior occipital gyrus. Two clusters of diminished neural activity following CT were identified within the right hemisphere middle frontal gyrus and supramarginal gyrus, extending to the superior temporal gyrus. These results provide preliminary evidence of common neural effects of different CT interventions within regions of the FPN. Findings may inform future investigations of neuroplasticity across the lifespan, including clinical applications of CT, such as assessing treatment outcomes.

Effects of an integrated intervention program for alcoholism (IIPA) on learning, memory and quality of life (QOL) in persons with alcohol dependence at the Centre for Addiction Medicine, Bengaluru, India

Purpose

This study aims to examine the effectiveness of an integrated intervention program for alcoholism (IIPA) for improving verbal encoding and memory, visuospatial construction, visual memory and quality of life (QoL) in persons with alcohol dependence.

Design/methodology/approach

The sample comprised treatment-seeking alcohol-dependent persons (n = 50), allotted into two groups: (1) the treatment as usual (TAU) group (n = 25) and (2) the treatment group (n = 25)]. The groups were matched on age (±1 year) and education (±1 year). The TAU group received standard pharmacological treatment, psychotherapeutic sessions on relapse prevention and yoga for 18 days, while the treatment group received IIPA sessions in addition to the usual treatment. Auditory verbal learning test, complex figure test and QoL scale were administered at pre- and post-treatment along with screening measures.

Findings

The two groups were comparable on demographic variables, clinical characteristics and outcome measures at baseline. Pre- to post-treatment changes (gain scores) comparison between the treatment and TAU groups revealed a significant difference in verbal encoding, verbal and visual memory, verbal recognition, visuospatial construction and QoL.

Research limitations/implications

This study suggests that IIPA is effective for improving learning and memory in both modality (verbal and visual) and QoL in persons with alcoholism. The IIPA may help in better treatment recovery.

Practical implications

The IIPA may help in treatment for alcoholism and may enhance treatment efficacy.

Originality/value

IIPA is effective for improving learning and memory in both modalities and QoL in persons with alcohol dependence. The IIPA may help in better treatment recovery.

The Impact of the BAILAMOS™ Dance Program on Brain Functional Connectivity and Cognition in Older Latino Adults: A Pilot Study

Dance is a culturally salient form of physical activity (PA) for older Latinos. Resting-state functional connectivity (FC) is a putative biomarker for age-related cognitive decline. We aimed to investigate the impact of the BAILAMOS™ dance program on FC in three brain functional networks (Default Mode [DMN], Frontoparietal [FPN], and Salience [SAL] networks), and cognition. Ten cognitively healthy older Latinos participated in the four-month BAILAMOS™ dance program. We assessed PA levels (self-reported and device-assessed) and estimated cardiorespiratory fitness, cognition, and resting-state FC via functional magnetic resonance imaging at baseline and post-intervention. We performed paired t-tests and Pearson correlations. Given the pilot nature of the study, significance levels were set at p < 0.05 and effect sizes are reported. We observed a significant increase in self-reported moderate leisure-time PA from pre- to post-intervention (t(9) = 3.16, p = 0.011, d = 0.66). FC within-FPN regions of interest (ROIs) significantly increased pre- to post-intervention (t(9) = 2.35, p = 0.043, d = 0.70). DMN ROIs showed an increase, with a moderate effect size, in the integration with other networks' ROIs (t(9) = 1.96, p = 0.081, d = 0.64) post-intervention. Increases in moderate leisure-time PA at post-intervention were associated with increases in the FC within-FPN (R = 0.79, p = 0.006). Our results suggest that dance might be a promising approach for improving age-related disruption of FC within- and between-networks commonly associated with cognitive decline.

Integrity of the Prefronto-striato-thalamo-prefrontal Loop Predicts Tai Chi Chuan Training Effects on Cognitive Task-switching in Middle-aged and Older Adults

Tai Chi Chuan (TCC) exercise has been shown to improve cognitive task-switching performance in older adults, but the extent of this positive effect varies among individuals. Past research also shows that brain white matter integrity could predict behavioral gains of cognitive and motor learning. Therefore, in this randomized controlled trial (NCT02270320), we examined whether baseline integrity of three target white matter tract groups was predictive of task-switching improvement after 12-week TCC training in middle-aged and older adults. Thirty-eight eligible participants were randomly assigned to a TCC group (n = 19) and a control group (n = 19). Cognitive task-switching and physical performances were collected before and after training. Brain diffusion spectrum MR images were acquired before training and the general fractional anisotropy (GFA) of each target white matter tract group was calculated to indicate baseline white matter integrity of that group. Correlation and regression analyses between these GFAs and post-training task-switching improvement were analyzed using adjusted p-values. After 12 weeks, significant task-switching and physical performance improvements were found only in the TCC group. Moreover, higher baseline GFA of the prefronto-striato-thalamo-prefrontal loop fibers (r = −0.63, p = 0.009), but not of the prefronto-parietal/occipital (r = −0.55, p = 0.026) and callosal (r = −0.35, p = 0.189) fiber groups, was associated with greater reductions of task-switching errors after the TCC training. Multiple regression analysis revealed that baseline GFA of the prefronto-striato-thalamo-prefrontal loop fibers was the only independent white matter integrity predictor of task-switching error reductions after TCC training (β = −0.620, adjusted R² change = 0.265, p = 0.009). These findings not only highlight the important role of baseline integrity of the prefronto-striatal circuits in influencing the extent of positive cognitive task-switching effects from short-term TCC training, but also implicate that preserving good white matter integrity in the aging process may be crucial in order to gain the best cognitive effects of exercise interventions.

Effects of Mind-Body Exercise on Brain Structure and Function: A Systematic Review on MRI Studies

Mind–body exercise has been proposed to confer both physical and mental health benefits. However, there is no clear consensus on the neural mechanisms underlying the improvements in health. Herein, we conducted a systematic review to reveal which brain region or network is regulated by mind–body exercise. PubMed, Web of Science, PsycINFO, SPORTDiscus, and China National Knowledge Infrastructure databases were systematically searched to identify cross-sectional and intervention studies using magnetic resonance imaging (MRI) to explore the effect of mind–body exercise on brain structure and function, from their inception to June 2020. The risk of bias for cross-sectional studies was assessed using the Joanna Briggs Institute (JBI) checklist, whereas that of interventional studies was analyzed using the Physiotherapy Evidence Database (PEDro) scale. A total of 15 studies met the inclusion criteria. Our analysis revealed that mind–body exercise modulated brain structure, brain neural activity, and functional connectivity, mainly in the prefrontal cortex, hippocampus/medial temporal lobe, lateral temporal lobe, insula, and the cingulate cortex, as well as the cognitive control and default mode networks, which might underlie the beneficial effects of such exercises on health. However, due to the heterogeneity of included studies, more randomized controlled trials with rigorous designs, similar measured outcomes, and whole-brain analyses are warranted.

Effectiveness of an Innovative Cognitive Treatment and Telerehabilitation on Subjects With Mild Cognitive Impairment: A Multicenter, Randomized, Active-Controlled Study

Background

In recent years, the potential usefulness of cognitive training procedures in normal aging and mild cognitive impairment (MCI) have received increased attention.

Objective

The main aim of this study was to evaluate the efficacy of the face-to-face cognitive virtual reality rehabilitation system (VRRS) and to compare it to that of face-to-face cognitive treatment as usual for individuals with MCI. Moreover, we assessed the possibility of prolonging the effects of treatment with a telerehabilitation system.

Methods

A total of 49 subjects with MCI were assigned to 1 of 3 study groups in a randomized controlled trial design: (a) those who received face-to-face cognitive VRRS (12 sessions of individualized cognitive rehabilitation over 4 weeks) followed by telerehabilitation (36 sessions of home-based cognitive VRRS training, three sessions for week); (b) those who received face-to-face cognitive VRRS followed by at-home unstructured cognitive stimulation (36 sessions of home-based unstructured cognitive stimulation, three sessions for week); and (c) those who received face-to-face cognitive treatment as usual (12 sessions of face-to-face cognitive treatment as usual).

Results

An improvement in memory, language and visuo-constructional abilities was observed after the end of face-to-face VRRS treatment compared to face-to-face treatment as usual. The application of home-based cognitive VRRS telerehabilitation seems to induce more maintenance of the obtained gains than home-based unstructured stimulation.

Discussion

The present study provides preliminary evidence in support of individualized VRRS treatment and telerehabilitation delivery for cognitive rehabilitation and should pave the way for future studies aiming at identifying optimal cognitive treatment protocols in subjects with MCI.

Clinical Trial Registration

www.ClinicalTrials.gov, identifier NCT03486704.

MRI Predictors of Cognitive Training Outcomes

The prospect of improving or maintaining cognitive functioning has provoked a steadily increasing number of cognitive training interventions over the last years, especially for clinical and elderly populations. However, there are discrepancies between the findings of the studies. One of the reasons behind these heterogeneous findings is that there are vast inter-individual differences in how people benefit from the training and in the extent that training-related gains are transferred to other untrained tasks and domains. In this paper, we address the value of incorporating neural measures to cognitive training studies in order to fully understand the mechanisms leading to inter-individual differences in training gains and their generalizability to other tasks. Our perspective is that it is necessary to collect multimodal neural measures in the pre- and post-training phase, which can enable us to understand the factors contributing to successful training outcomes. More importantly, this understanding can enable us to predict who will benefit from different types of interventions, thereby allowing the development of individually tailored intervention programs.

Tai Chi Chuan vs General Aerobic Exercise in Brain Plasticity: A Multimodal MRI Study

This study contrasted the impact of Tai Chi Chuan and general aerobic exercise on brain plasticity in terms of an increased grey matter volume and functional connectivity during structural magnetic resonance imaging (sMRI) and resting-state functional magnetic resonance imaging (rs-fMRI), explored the advantages of Tai Chi Chuan in improving brain structure and function. Thirty-six college students were grouped into Tai Chi Chuan (Bafa Wubu of Tai Chi), general aerobic exercise (brisk walking) and control groups. Individuals were assessed with a sMRI and rs-fMRI scan before and after an 8-week training period. The VBM toolbox was used to conduct grey matter volume analyses. The CONN toolbox was used to conduct several seed-to-voxel functional connectivity analyses. We can conclude that compared with general aerobic exercise, eight weeks of Tai Chi Chuan exercise has a stronger effect on brain plasticity, which is embodied in the increase of grey matter volume in left middle occipital gyrus, left superior temporal gyrus and right middle temporal gyrus and the enhancement of functional connectivity between the left middle frontal gyrus and left superior parietal lobule. These findings demonstrate the potential and advantages of Tai Chi Chuan exercises in eliciting brain plasticity.

Long-term Tai Chi Training Is Associated With Better Dual-task Postural Control and Cognition in Aging Adults

OBJECTIVE

Many activities within our daily lives require us to stand upright while concurrently performing a cognitive task (ie, dual tasking). The "costs" of dual tasking can present as a detriment to either task, or even both. Evidence supports that tai chi (TC), a mind-body exercise, improves both postural control and cognition. The purpose of this study was to (1) determine whether long-term TC training reduces dual-task costs to standing postural control, and (2) determine whether it characterizes the relationship between these costs and cognition in aging adults with and without long-term TC training.

METHODS

Twenty-six TC experts (age 63 ± 8 y, TC experience 24 ± 11 y) and 60 controls (TC naïve: age 64 ± 8 y) were studied. Center-of-pressure sway speed and elliptical area were recorded during quiet and dual-task standing. In addition, postural sway speed and range were analyzed in the anterior-posterior and medial-lateral direction. Dual-task cost was calculated as the percent change in center-of-pressure outcomes from quiet to dual-task conditions. Cognition was assessed with the digit span (verbal memory), trail making test (working memory and task switching ability), category naming (semantic verbal fluency), and F-A-S test (phonemic verbal fluency).

RESULTS

TC experts had significantly lower dual-task costs to postural control in elliptical area (16.1 vs 110.4%, 95% confidence interval [CI], -94.27 to -0.07) compared with TC-naïves. TC experts also performed better on the digit span (23.5 vs 19.2; 95% CI, 0.68 to 3.59), trail making test A (28.5 vs 32.6 s; 95% CI, -3.83 to -0.21), and category naming (46.2 vs 41.3, 95%, CI 0.80 to 4.09), compared with TC naïves. There was not a clear significant association between better cognitive functioning and lower dual-task costs for either groups. These group differences and associations were independent of age, body mass index, education, and physical activity level.

CONCLUSIONS

These observations suggest cognitive-motor benefits from TC and the need for future controlled trials.

Effects and Mechanisms of Cognitive, Aerobic Exercise, and Combined Training on Cognition, Health, and Brain Outcomes in Physically Inactive Older Adults: The Projecte Moviment Protocol

INTRODUCTION

Age-related health, brain, and cognitive impairment is a great challenge in current society. Cognitive training, aerobic exercise and their combination have been shown to benefit health, brain, cognition and psychological status in healthy older adults. Inconsistent results across studies may be related to several variables. We need to better identify cognitive changes, individual variables that may predict the effect of these interventions, and changes in structural and functional brain outcomes as well as physiological molecular correlates that may be mediating these effects. Projecte Moviment is a multi-domain randomized trial examining the effect of these interventions applied 5 days per week for 3 months compared to a passive control group. The aim of this paper is to describe the sample, procedures and planned analyses.

METHODS

One hundred and forty healthy physically inactive older adults will be randomly assigned to computerized cognitive training (CCT), aerobic exercise (AE), combined training (COMB), or a control group. The intervention consists of a 3 month home-based program 5 days per week in sessions of 45 min. Data from cognitive, physical, and psychological tests, cardiovascular risk factors, structural and functional brain scans, and blood samples will be obtained before and after the intervention.

RESULTS

Effects of the interventions on cognitive outcomes will be described in intention-to-treat and per protocol analyses. We will also analyze potential genetic, demographic, brain, and physiological molecular correlates that may predict the effects of intervention, as well as the association between cognitive effects and changes in these variables using the per protocol sample.

DISCUSSION

Projecte Moviment is a multi-domain intervention trial based on prior evidence that aims to understand the effects of CCT, AE, and COMB on cognitive and psychological outcomes compared to a passive control group, and to determine related biological correlates and predictors of the intervention effects.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03123900.

Effects of sustained cognitive activity on white matter microstructure and cognitive outcomes in healthy middle-aged adults: A systematic review

Adults who remain cognitively active may be protected from age-associated changes in white matter (WM) and cognitive decline. To determine if cognitive activity is a precursor for WM plasticity, the available literature was systematically searched for Region of Interest (ROI) and whole-brain studies assessing the efficacy of cognitive training (CT) on WM microstructure using Diffusion Tensor Imaging (DTI) in healthy adults (> 40 years). Seven studies were identified and included in this review. Results suggest there are beneficial effects to WM microstructure after CT in frontal and medial brain regions, with some studies showing improved performance in cognitive outcomes. Benefits of CT were shown to be protective against age-related WM microstructure decline by either maintaining or improving WM after training. These results have implications for determining the capacity for training-dependent WM plasticity in older adults and whether CT can be utilised to prevent age-associated cognitive decline. Additional studies with standardised training and imaging protocols are needed to confirm these outcomes.

KIBRA polymorphism modulates gray matter volume to influence cognitive ability in the elderly

Genetic variation in the kidney and brain expressed protein (KIBRA) rs17070145 gene has been linked to episodic memory and cognitive aging; yet, the neural mechanism underlying this association remains to be fully understood. Using the magnetic resonance imaging (MRI) technique, this study investigated the effect of KIBRA polymorphism on gray matter volume in 37 healthy, Chinese adults from the older population. Voxel-based morphometry (VBM) analysis revealed that KIBRA gene selectivity influences the prefrontal cortex and the parahippocampal cortex. The gray matter volume (GMV) in these structures is significantly lower in KIBRA C-allele carriers than in TT carriers. Moreover, multi-voxel pattern correlation analysis revealed that decreased prefrontal GMV could in turn affect individual cognitive function in C-allele carriers; whereas, TT individuals utilized more integrated gray matter volume in whole-brain voxels to achieve relatively better cognitive function. Overall, the findings suggest that the KIBRA rs17070145 polymorphism modulates gray matter volume, which in turn further influences cognitive function in the elderly.

Computerized multi-domain cognitive training reduces brain atrophy in patients with amnestic mild cognitive impairment

The present study aimed to explore the effect of computerized multi-domain cognitive training (MDCT) on brain gray matter volume and neuropsychological performance in patients with amnestic mild cognitive impairment (amnestic MCI). Twenty-one patients with amnestic MCI participated in a computerized MDCT program. The program targeted a broad set of cognitive domains via programs focused on reasoning, memory, visuospatial, language, calculation, and attention. Seventeen Participants completed the intervention and all completed a battery of neuropsychological tests to evaluate cognitive function while 12 out of 17 underwent 3 T MRI scanning before and after the intervention to measure gray matter (GM) volume. We examined correlations between the changes in neuropsychological scores and GM volumes across participants after the intervention. After training, we observed significant increases in GM volume in the right angular gyrus (AG) and other parietal subareas near the intraparietal sulcus (p < 0.05, FWE-corrected, 10000 permutations). However, we found no significant changes in neuropsychological test scores (p > 0.05). A correlation analysis revealed positive correlations between the changes in GM volume in the right AG and scores in the immediate recall component of the Hopkins Verbal Learning Test-Revised (HVLT-R) (r = 0.64, p = 0.024) and the Brief Visuospatial Memory Test-Revised (BVMT-R) (r = 0.67, p = 0.016). Our findings indicate that a computerized MDCT program may protect patients with amnestic MCI against brain GM volume loss and has potential in preserving general cognition. Thus, our non-pharmacological intervention may slow the rate of disease progression.

Changes in default mode network connectivity in different glucose metabolism status and diabetes duration

Aims/hypotheses

It is now generally accepted that diabetes increases the risk for cognitive impairment, but the precise mechanisms are poorly understood. In recent years, resting-state functional magnetic resonance imaging (rs-fMRI) is increasingly used to investigate the neural basis of cognitive dysfunction in type 2 diabetes (T2D) patients. Alterations in brain functional connectivity may underlie diabetes-related cognitive dysfunction and brain damage. The aim of this study was to investigate the changes in default mode network (DMN) connectivity in different glucose metabolism status and diabetes duration.

Methods

We used a seed-based fMRI analysis to investigate positive and negative DMN connectivity in four groups (39 subjects with normal glucose metabolism [NGM], 23 subjects with impaired glucose metabolism [IGM; i.e., prediabetes], 59 T2D patients with a diabetes duration of <10 years, and 24 T2D patients with a diabetes duration of ≥10 years).

Results

Negative DMN connectivity increased and then regressed with deteriorating glucose metabolism status and extending diabetes duration. DMN connectivity showed a significant correlation with diabetes duration.

Conclusion/interpretation

This study suggests that DMN connectivity may exhibit distinct patterns in different glucose metabolism status and diabetes duration, providing some potential neuroimaging evidence for early diagnosis and further understanding of the pathophysiological mechanisms of diabetic brain damage.

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Subjects include NGM, IGM, and T2D with different glucose metabolism status.

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DMN connectivity exhibited distinct patterns in different glucose metabolism status.

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Compensatory enhancement was observed in the negative DMN FC.

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DMN FC showed a significant correlation with diabetes duration.

The effect of aerobic dance intervention on brain spontaneous activity in older adults with mild cognitive impairment: A resting-state functional MRI study

The current study aimed to evaluate the effect of a specially designed moderate-intensity aerobic dance (SDMIAD) on brain spontaneous activity in older adults with mild cognitive impairment (MCI) using resting-state functional magnetic resonance imaging (RS-fMRI). A total of 38 subjects with MCI were recruited to the current study and were randomized into two groups: Exercise (EG, n=19) and control (CG, n=19). The EG was treated with a SDMIAD and usual care for 3 months. The CG only received usual care. None of the patients were administered medicine that affected cognition during the intervention. The cognitive assessments and RS-fMRI examination were performed on the two groups at recruitment and after 3 months. The cognitive functions were assessed by various neuropsychological tests. The brain spontaneous activity change was assessed using an index, the amplitude of low-frequency fluctuation (ALFF) of fMRI signal. Cognitive assessments demonstrated that EG had significantly improved results in the Mini-Mental State Examination, the Montreal Cognitive Assessment, Wechsler Memory Scale-Revised Logical Memory (WMS-R LM) and the Symbol Digit Modalities Test (all P<0.05), and the difference in changes in WMS-R LM from baseline to 3 months between the EG and the CG was also statistically significant (P<0.05) after 3 months of SDMIAD. The performance of all the cognitive assessments did not demonstrate significant differences in CG. Compared with baseline, EG exhibited significantly increased ALFF in several areas, including the bilateral fronto-temporal, entorhinal, anterior cingulate and parohippocampal cortex after 3 months of SDMIAD (P<0.05); whereas the CG exhibited significantly increased ALFF only in a few areas, including right temporal and posterior cingulate cortex (P<0.05). The SDMIAD may effectively improve the cognitive function in older adults with MCI. RS-fMRI provided a quantitative method for evaluating the effect of aerobic exercise on cognitive function.

Functional Connectivity Within the Executive Control Network Mediates the Effects of Long-Term Tai Chi Exercise on Elders' Emotion Regulation

Previous research has identified the effects of tai chi exercise on elders' executive control or on their emotion regulation. However, few works have attempted to reveal the relationships between tai chi, executive control, and emotion regulation in the same study. The current resting-state study investigated whether the impact of tai chi on elders' emotion regulation was mediated by the resting-state functional connectivity within the executive control network. A total of 26 elders with long-term tai chi experience and 26 demographically matched healthy elders were recruited. After the resting-state scan, both groups were required to complete a series of questionnaires, including the Five Facets Mindfulness Questionnaire (FFMQ), and a sequential decision task, which offered an index of the subjects' emotion-regulation ability by calculating how their emotional response could be affected by the objective outcomes of their decisions. Compared to the control group, the tai chi group showed higher levels of non-judgment of inner experiences (a component of the FFMQ), stronger emotion-regulation ability, and a weaker resting-state functional connectivity between the dorsolateral prefrontal cortex (DLPFC) and the middle frontal gyrus (MFG). Moreover, the functional connectivity between the DLPFC and the MFG in the tai chi group fully mediated the impact of non-judgment of inner experience on their emotion-regulation ability. These findings highlighted that the modulation of non-judgment of inner experience on long-term tai chi practitioners' emotion regulation was achieved through decreased functional connectivity within the executive control network.

Task-Switching Performance Improvements After Tai Chi Chuan Training Are Associated With Greater Prefrontal Activation in Older Adults

Studies have shown that Tai Chi Chuan (TCC) training has benefits on task-switching ability. However, the neural correlates underlying the effects of TCC training on task-switching ability remain unclear. Using task-related functional magnetic resonance imaging (fMRI) with a numerical Stroop paradigm, we investigated changes of prefrontal brain activation and behavioral performance during task-switching before and after TCC training and examined the relationships between changes in brain activation and task-switching behavioral performance. Cognitively normal older adults were randomly assigned to either the TCC or control (CON) group. Over a 12-week period, the TCC group received three 60-min sessions of Yang-style TCC training weekly, whereas the CON group only received one telephone consultation biweekly and did not alter their life style. All participants underwent assessments of physical functions and neuropsychological functions of task-switching, and fMRI scans, before and after the intervention. Twenty-six (TCC, N = 16; CON, N = 10) participants completed the entire experimental procedure. We found significant group by time interaction effects on behavioral and brain activation measures. Specifically, the TCC group showed improved physical function, decreased errors on task-switching performance, and increased left superior frontal activation for Switch > Non-switch contrast from pre- to post-intervention, that were not seen in the CON group. Intriguingly, TCC participants with greater prefrontal activation increases in the switch condition from pre- to post-intervention presented greater reductions in task-switching errors. These findings suggest that TCC training could potentially provide benefits to some, although not all, older adults to enhance the function of their prefrontal activations during task-switching.

Revealing the Neural Mechanisms Underlying the Beneficial Effects of Tai Chi: A Neuroimaging Perspective

Tai Chi Chuan (TCC), a traditional Chinese martial art, is well-documented to result in beneficial consequences in physical and mental health. TCC is regarded as a mind-body exercise that is comprised of physical exercise and meditation. Favorable effects of TCC on body balance, gait, bone mineral density, metabolic parameters, anxiety, depression, cognitive function, and sleep have been previously reported. However, the underlying mechanisms explaining the effects of TCC remain largely unclear. Recently, advances in neuroimaging technology have offered new investigative opportunities to reveal the effects of TCC on anatomical morphologies and neurological activities in different regions of the brain. These neuroimaging findings have provided new clues for revealing the mechanisms behind the observed effects of TCC. In this review paper, we discussed the possible effects of TCC-induced modulation of brain morphology, functional homogeneity and connectivity, regional activity and macro-scale network activity on health. Moreover, we identified possible links between the alterations in brain and beneficial effects of TCC, such as improved motor functions, pain perception, metabolic profile, cognitive functions, mental health and sleep quality. This paper aimed to stimulate further mechanistic neuroimaging studies in TCC and its effects on brain morphology, functional homogeneity and connectivity, regional activity and macro-scale network activity, which ultimately lead to a better understanding of the mechanisms responsible for the beneficial effects of TCC on human health.

Patterns of Age-Related Cognitive Differences in Adults with Autism Spectrum Disorder

Little is known about age-related cognitive differences in autism spectrum disorder (ASD). However, given the overlap in cognitive impairments in ASD to those seen in typical aging, it is possible that adults with ASD will face even greater cognitive difficulties as they age. The current study used a cross-sectional design to examine age-related cognitive differences in adults with ASD and age and IQ-matched adults with typical development (age range 30-67 years). Results indicated that both age and diagnosis were related to poorer cognitive performance. However, adults with ASD exhibited pronounced age effects on measures related to executive functioning compared to adults with typical development, suggesting that aging in ASD may disproportionately affect specific cognitive processes.

Effects of a 10-week multimodal exercise program on physical and cognitive function of nursing home residents: a psychomotor intervention pilot study

BACKGROUND

Nursing home institutionalization tends to exacerbate loss of functioning.

AIMS

Examine the feasibility and the effect of a psychomotor intervention-a multimodal exercise program promoting simultaneous cognitive and motor stimulation-on the executive (planning ability and selective attention) and physical function of nursing home residents.

METHODS

Seventeen participants engaged in a 10-week multimodal exercise program and 17 maintained usual activities.

RESULTS

Exercise group improved planning ability (25-32%), selective attention (19-67%), and physical function [aerobic endurance, lower body strength, agility, balance, gait, and mobility (19-41%)], corresponding to an effect size ranging from 0.29 (small) to 1.11 (high), p < 0.05.

DISCUSSION

The multimodal exercise program was feasible and well tolerated. The program improved executive and physical functions of the nursing home residents, reverting the usual loss of both cognitive and motor functioning in older adult institutionalized.

CONCLUSIONS

Multimodal exercise programs may help to maintain or improve nursing home residents' functioning.