Abstract
We aimed to determine whether neuropsychological deficits and brain atrophy could predict the efficacy of non-pharmacological interventions. Forty-six participants with mild-to-moderate dementia were monitored for 6 months; 25 underwent an intervention involving physical exercise with music, and 21 performed cognitive stimulation tasks. Participants were categorized into improvement (IMP) and no-IMP subgroups. In the exercise-with-music group, the no-IMP subgroup performed worse than the IMP subgroup on the Rivermead Behavioural Memory Test at baseline. In the cognitive-stimulation group, the no-IMP subgroup performed worse than the IMP subgroup on Raven’s Colored Progressive Matrices and the cognitive functional independence measure at baseline. In the no-IMP subgroup, voxel-based morphometric analysis at baseline revealed more extensive gray matter loss in the anterior cingulate gyrus and left middle frontal gyrus in the exercise-with-music and cognitive-stimulation groups, respectively. Participants with mild-to-moderate dementia with cognitive decline and extensive cortical atrophy are less likely to show improved cognitive function after non-pharmaceutical therapy.
Highlights
The World Alzheimer Report has estimated that there were 46.8 million people with dementia worldwide in 2015, and that this number will reach 131.5 million by 2050 (Prince et al, 2015)
Accumulating evidence suggests that non-pharmacological treatment may maintain or decrease the rate of cognitive decline in adults with mild cognitive impairment and early stage dementia (Rodakowski et al, 2015)
Additional studies have suggested that physical exercise combined with cognitive training exerts a greater positive impact on cognitive function than physical exercise alone (Fabre et al, 2002; Oswald et al, 2006; Shatil, 2013; Satoh et al, 2014, 2017; Tabei et al, 2017)
Summary
The World Alzheimer Report has estimated that there were 46.8 million people with dementia worldwide in 2015, and that this number will reach 131.5 million by 2050 (Prince et al, 2015). The lack of pharmacological options (e.g., vaccines or disease-modifying agents) has shifted the focus of researchers toward non-pharmacological treatments for dementia, such as cognitive training, aerobic physical exercise, and music therapy (Gates and Sachdev, 2014; Groot et al, 2016; Zhang et al, 2017). Accumulating evidence suggests that non-pharmacological treatment may maintain or decrease the rate of cognitive decline in adults with mild cognitive impairment and early stage dementia (Rodakowski et al, 2015). Physical ExM induces greater positive effects on visuospatial function and leads to more extensive neuroanatomical changes (Tabei et al, 2017) than exercise alone. In participants with mild-to-moderate dementia, ExM exerts greater positive effects on cognitive function and activities of daily living than CS using portable game consoles or drills (e.g., easy calculations, mazes, and mistake-searching in pictures) (Satoh et al, 2017)
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