Effects of balance physical therapy with or without cognitive training in adults with cognitive and balance impairments : a systematic review.

BackgroundDelirium affects nearly 70% of older adults hospitalized in the intensive care unit (ICU), and many of those will be left with persistent cognitive impairment or dementia. There are no effective and scalable recovery models to remediate ICU-acquired cognitive impairment and its attendant elevated risk for dementia or Alzheimer disease (AD). The Improving Recovery and Outcomes Every Day after the ICU (IMPROVE) trial is an ongoing clinical trial which evaluates the efficacy of a combined physical exercise and cognitive training on cognitive function among ICU survivors 50 years and older who experienced delirium during an ICU stay. This article describes the study protocol for IMPROVE.MethodsIMPROVE is a four-arm, randomized controlled trial. Subjects will be randomized to one of four arms: cognitive training and physical exercise; cognitive control and physical exercise; cognitive training and physical exercise control; and cognitive control and physical exercise control. Facilitators administer the physical exercise and exercise control interventions in individual and small group formats by using Internet-enabled videoconference. Cognitive training and control interventions are also facilitator led using Posit Science, Inc. online modules delivered in individual and small group format directly into the participants’ homes. Subjects complete cognitive assessment, mood questionnaires, physical performance batteries, and quality of life scales at baseline, 3, and 6 months. Blood samples will also be taken at baseline and 3 months to measure pro-inflammatory cytokines and acute-phase reactants; neurotrophic factors; and markers of glial dysfunction and astrocyte activation.DiscussionThis study is the first clinical trial to examine the efficacy of combined physical and cognitive exercise on cognitive function in older ICU survivors with delirium. The results will provide information about potential synergistic effects of a combined intervention on a range of outcomes and mechanisms of action.Trial registrationClinicalTrials.gov, NCT03095417. Registered on 23 March 2017. Last updated on 15 May 2017.

Influence of Studies Published by the Journal of the American Geriatrics Society: Top 20 Articles from 2000-2015.

The aim of the study was to explore the effect of acupuncture combined with rehabilitation on cognitive and motor functions in poststroke patients. All patients were divided into Group A and Group B based on different interventions (Group A: acupuncture + conventional rehabilitation, Group B: conventional rehabilitation alone). Acupuncture was conducted once a day, five times a week for 8 weeks, and rehabilitation (including physical therapy and occupational therapy) was conducted for 2 hr per session, once a day, five times a week for 8 weeks. Mini-mental State Examination (MMSE) and Fugl-Meyer Assessment (FMA) were used to assess the motor and cognitive functions at baseline and the end of 8 weeks. After the intervention, FMA and MMSE scores were improved significantly in the two groups (p <.05), compared with the scores prior to intervention. After 8 weeks of intervention, a statistically significant difference in the FMA and MMSE scores was observed between the Group A and the Group B. The results suggested that the combined intervention is more effective than the conventional rehabilitation alone in improving cognitive and motor functions in poststroke patients.

BackgroundOlder adults with cognitive impairments will benefit from multicomponent interventions include cognitive training, exercise, and lifestyle modifications. Many digital therapeutic products predominantly focus on computerized cognitive training, lacking effective approaches to other crucial interventions. This study aimed to investigate the long term effects of multidimensional comprehensive cognitive intervention training program – Brain and Body Rehab Training (BBRT), which integrates multidomain cognitive training with physical‐cognitive training and multidimensional lifestyle interventions on cognitive performance in participants with cognitive impairment after a 8‐month follow‐up.MethodAll participants (n = 351) were allocated into the cognitive unimpaired (CU) group and cognitive impaired (CI) group. Participants were evaluated by cognitive and performance test batteries before, 4 months and 8 months after the interventions. In both groups, an individualized training program is assigned consisting of completing four to five daily tasks, including cognitive training, physical‐cognitive training, lifestyle interventions, chronic disease/diet/sleep/emotion management, and traditional Chinese medicine non‐pharmacological interventions among others. The intervention duration ranges 15‐25 minutes per day, and task difficulty is dynamically adjusted based on individual task performance and periodic cognitive assessments. Participants were asked to take the intervention 3‐4 times per week for 8 months. The statistic analysis were using mixed‐effect regression model.ResultsAfter the 4 months intervention, a significant improvement on the cognitive performance was observed in the CI group compared to the CU group (p&lt;0.001), and the improvement persistent after 8 month follow‐up (p&lt;0.001). The change of cognitive performance were associated with frequency of training repetition and whole time of the intervention.ConclusionsThe BBRT program significantly improved the cognitive function in cognitively impaired participants after 4 months training and had a persistent effect after 8 months. The convenient home‐based multidimensional interventions provides an long term effects for the cognitive impaired participants.

Cognitive training in neurodegenerative diseases: a way to boost neuroprotective molecules?

Combined physical (PHY) and cognitive (COG) training in sequential (SEQ) and simultaneous (SIMUL) sessions may delay the progression of cognitive impairment. To date, no study has directly compared in older adults with cognitive impairment the effects of COG training, PHY training, SEQ motor-cognitive training and SIMUL motor-cognitve training on specific indices of cognitive performance and activities of daily living (ADL). The purpose of this study was to determine whether SEQ and SIMUL motor-cognitive training can improve treatment outcomes compared with PHY or COG training alone. We also aimed to compare the effects of SEQ versus SIMUL motor-cognitive training on cognitive functions and instrumental ADL (IADL) in older adults with cognitive impairment. A cluster randomized controlled trial was conducted. Eighty older adults with cognitive impairment were randomly assigned to COG, PHY, SEQ or SIMUL training groups. The intervention consisted of 90-min training sessions, totaling 36 sessions. Outcome measures were the Montreal Cognitive Assessment, three subtests of the Wechsler Memory Scale (WMS) and the Lawton IADL scale. Significant interaction effects between group and time were found in WMS-spatial span (p = 0.04) and WMS-word lists (p = 0.041). For WMS-spatial span, the SIMUL group showed outperformed the COG (p = 0.039), PHY (p = 0.010) and SEQ groups (p = 0.017). For WMS-word lists, the SEQ group improve more than COG (p = 0.013), PHY (p = 0.030) and SIMUL (p = 0.019) groups. No significant differences were found in IADL performance among four groups (p = 0.645). Our study showed SEQ and SIMUL motor-cognitive training led to more pronounced improvements in visuospatial working memory or verbal memory compared with isolated COG or PHY training for community-based older adults with cognitive impairment. For enhancing effects on IADL, we suggest the use of sensitive measurement tools and context-enriched cognitive training involving real-life task demands.

REVIEW QUESTION / OBJECTIVE The objective of this review is to identify the effectiveness of combined cognitive and physical interventions on the risk of falls in cognitively impaired older adults. INCLUSION CRITERIA Types of participants Older persons who are 65 years or older will be included. Studies where the majority of participants have been indicated through mean ages and standard deviations will also be eligible for inclusion. Participants who have been diagnosed or identified as having a cognitive impairment will be included in this review. The participants will be characterized as having a cognitive impairment through: 1. Diagnosis of a dementia or cognitive impairment or other condition which directly results in reduced cognition. 2. Reduced Mini Mental State Examination or other such global assessment of cognition, e.g. through the Montreal Cognitive Assessment. Participants will not be limited by dementia diagnosis (i.e. Alzheimer's disease, vascular, mild cognitive impairment), but their cognitive impairment must be acquired and progressive in nature. Studies with a population of older adults with an increased risk of falls will be considered but will only be included if more than 75% of the total sample has reduced cognition identified in the criteria above. Types of intervention(s)/phenomena of interest This review will consider publications that describe multifactorial or multiple interventions where a physical and cognitive element has been noted by the authors or reviewers. It is the aim of this review to capture studies which have a combined physical and cognitive element in the intervention; however studies which TRUNCATED AT 250 WORDS

BackgroundOlder adults with cognitive impairments will benefit from multicomponent interventions include cognitive training, exercise, and lifestyle modifications. However, many existing digital therapeutic products predominantly focus on computerized cognitive training, lacking effective approaches to other crucial interventions. We proposed a multidimensional comprehensive cognitive intervention training program – Brain and Body Rehab Training (BBRT), which integrates multidomain cognitive training with physical‐cognitive training and multidimensional lifestyle interventions and developed the digital therapeutic product – BBRT‐online based on WeChat mini‐program. The present study was to assess the effectiveness of BBRT in older adults with subjective memory impairments.MethodUsing the WeChat mini‐program platform, we developed the BBRT‐online digital therapeutics product. Prior to the intervention, users undergo Game‐based Cognitive Assessment – Three‐Minute Version (G3). Subsequently, an individualized training program is assigned consisting of completing four to five daily tasks, including cognitive training, physical‐cognitive training, lifestyle interventions, chronic disease/diet/sleep/emotion management, and traditional Chinese medicine non‐pharmacological interventions among others (Figure 1). The intervention duration ranges 15‐25 minutes per day, and task difficulty is dynamically adjusted based on individual task performance and periodic cognitive assessments. Additionally, remote online administration services and internet communities are strongly recommended to offer emotional support and enhance intervention effectiveness. Sixty older adults reporting subjective memory complaints were recruited, with 30 assigned to receive BBRT‐online training and the remainder serving as the control group. Cognitive function was evaluated using the G3 at baseline and three months later. T‐tests were conducted to assess the impact of BBRT‐online on cognitive function.ResultAt baseline, there was no significant difference in G3 scores between the BBRT group (53.5±10.87) and the control group (55.1±11.77, p = 0.583). Following three months of intervention, the BBRT group demonstrated a significantly higher G3 score (61.5±6.85) compared to baseline (p&lt;0.001, Figure 2). Conversely, no such difference was observed in the control group (55.5 ± 9.34, p = 0.911).ConclusionThe BBRT digital therapeutics enabled cognitive assessment and individualized cognitive interventions and significantly improved cognitive function in older adults. Further studies are required to evaluate its effectiveness.

BackgroundOlder adults with cognitive impairments will benefit from multicomponent interventions include cognitive training, exercise, and lifestyle modifications. However, many existing digital therapeutic products predominantly focus on computerized cognitive training, lacking effective approaches to other crucial interventions. We proposed a multidimensional comprehensive cognitive intervention training program – Brain and Body Rehab Training (BBRT), which integrates multidomain cognitive training with physical‐cognitive training and multidimensional lifestyle interventions and developed the digital therapeutic product – BBRT‐online based on WeChat mini‐program. The present study was to assess the effectiveness of BBRT in older adults with subjective memory impairments.MethodUsing the WeChat mini‐program platform, we developed the BBRT‐online digital therapeutics product. Prior to the intervention, users undergo Game‐based Cognitive Assessment – Three‐Minute Version (G3). Subsequently, an individualized training program is assigned consisting of completing four to five daily tasks, including cognitive training, physical‐cognitive training, lifestyle interventions, chronic disease/diet/sleep/emotion management, and traditional Chinese medicine non‐pharmacological interventions among others (Figure 1). The intervention duration ranges 15‐25 minutes per day, and task difficulty is dynamically adjusted based on individual task performance and periodic cognitive assessments. Additionally, remote online administration services and internet communities are strongly recommended to offer emotional support and enhance intervention effectiveness. Sixty older adults reporting subjective memory complaints were recruited, with 30 assigned to receive BBRT‐online training and the remainder serving as the control group. Cognitive function was evaluated using the G3 at baseline and three months later. T‐tests were conducted to assess the impact of BBRT‐online on cognitive function.ResultAt baseline, there was no significant difference in G3 scores between the BBRT group (53.5±10.87) and the control group (55.1±11.77, p = 0.583). Following three months of intervention, the BBRT group demonstrated a significantly higher G3 score (61.5±6.85) compared to baseline (p&lt;0.001, Figure 2). Conversely, no such difference was observed in the control group (55.5 ± 9.34, p = 0.911).ConclusionThe BBRT digital therapeutics enabled cognitive assessment and individualized cognitive interventions and significantly improved cognitive function in older adults. Further studies are required to evaluate its effectiveness.

Single-domain and multidomain lifestyle interventions for the prevention of cognitive decline in older adults who are cognitively unimpaired: a systematic review and network meta-analysis.

Understanding the effectiveness of nonpharmacological interventions to improve cognitive function in older adults with MCI and identifying the best intervention may help inform ideas for future RCT studies and clinical decision-making. The main focus of this study was to assess the comparative effectiveness of nonpharmacological interventions on cognitive function in older adults with MCI and to rank the interventions. RCT studies until September 2022 were searched from six databases, including PubMed, the Cochrane Library, Embase, Web of Science, PsycINFO and CINAHL. The risk of bias in eligible trials was evaluated using the Cochrane Risk of Bias tool. Both pairwise and network meta-analyses were used, and pooled effect sizes were reported using SMD and the corresponding 95% confidence intervals. A total of 28 RCT studies were included in this study, pooling 18 categories of nonpharmacological interventions. MBE (mind-body exercise) (SMD (standard mean difference): 0.24, 95% CI: 0.08-0.41, P = 0.004), DTE (dual-task exercise) (SMD: 0.61, 95% CI: 0.09-1.13, P = 0.02), PE (physical exercise) (SMD: 0.58, 95% CI: 0.04-1.12, P = 0.03) may be effective in improving cognitive function in older adults with MCI. Acupressure + CT (cognitive training) was the top-ranked intervention among all interventions. No greater benefits of MA (mindful awareness) on cognitive function were found. Overall, nonpharmacological interventions significantly improved cognitive function in older adults with MCI. Acupressure + CT(cognitive training) was the most effective intervention for managing cognitive impairment. Future studies with high quality and large sample size RCT studies are needed to confirm our results.

Cognitive Impairment in Dialysis Patients: Focus on the Blood Vessels?

Effectiveness of technology-assisted nonpharmacological interventions for cognitive impairment in older adults: A systematic review and network meta-analysis.

From the December Issue of JAMDA

It is estimated that up to 75% of cancer survivors may experience cognitive impairment as a result of cancer treatment and given the increasing size of the cancer survivor population, the number of affected people is set to rise considerably in coming years. There is a need, therefore, to identify effective, non-pharmacological interventions for maintaining cognitive function or ameliorating cognitive impairment among people with a previous cancer diagnosis. To evaluate the cognitive effects, non-cognitive effects, duration and safety of non-pharmacological interventions among cancer patients targeted at maintaining cognitive function or ameliorating cognitive impairment as a result of cancer or receipt of systemic cancer treatment (i.e. chemotherapy or hormonal therapies in isolation or combination with other treatments). We searched the Cochrane Centre Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PUBMED, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PsycINFO databases. We also searched registries of ongoing trials and grey literature including theses, dissertations and conference proceedings. Searches were conducted for articles published from 1980 to 29 September 2015. Randomised controlled trials (RCTs) of non-pharmacological interventions to improve cognitive impairment or to maintain cognitive functioning among survivors of adult-onset cancers who have completed systemic cancer therapy (in isolation or combination with other treatments) were eligible. Studies among individuals continuing to receive hormonal therapy were included. We excluded interventions targeted at cancer survivors with central nervous system (CNS) tumours or metastases, non-melanoma skin cancer or those who had received cranial radiation or, were from nursing or care home settings. Language restrictions were not applied. Author pairs independently screened, selected, extracted data and rated the risk of bias of studies. We were unable to conduct planned meta-analyses due to heterogeneity in the type of interventions and outcomes, with the exception of compensatory strategy training interventions for which we pooled data for mental and physical well-being outcomes. We report a narrative synthesis of intervention effectiveness for other outcomes. Five RCTs describing six interventions (comprising a total of 235 participants) met the eligibility criteria for the review. Two trials of computer-assisted cognitive training interventions (n = 100), two of compensatory strategy training interventions (n = 95), one of meditation (n = 47) and one of physical activity intervention (n = 19) were identified. Each study focused on breast cancer survivors. All five studies were rated as having a high risk of bias. Data for our primary outcome of interest, cognitive function were not amenable to being pooled statistically. Cognitive training demonstrated beneficial effects on objectively assessed cognitive function (including processing speed, executive functions, cognitive flexibility, language, delayed- and immediate- memory), subjectively reported cognitive function and mental well-being. Compensatory strategy training demonstrated improvements on objectively assessed delayed-, immediate- and verbal-memory, self-reported cognitive function and spiritual quality of life (QoL). The meta-analyses of two RCTs (95 participants) did not show a beneficial effect from compensatory strategy training on physical well-being immediately (standardised mean difference (SMD) 0.12, 95% confidence interval (CI) -0.59 to 0.83; I(2)= 67%) or two months post-intervention (SMD - 0.21, 95% CI -0.89 to 0.47; I(2) = 63%) or on mental well-being two months post-intervention (SMD -0.38, 95% CI -1.10 to 0.34; I(2) = 67%). Lower mental well-being immediately post-intervention appeared to be observed in patients who received compensatory strategy training compared to wait-list controls (SMD -0.57, 95% CI -0.98 to -0.16; I(2) = 0%). We assessed the assembled studies using GRADE for physical and mental health outcomes and this evidence was rated to be low quality and, therefore findings should be interpreted with caution. Evidence for physical activity and meditation interventions on cognitive outcomes is unclear. Overall, the, albeit low-quality evidence may be interpreted to suggest that non-pharmacological interventions may have the potential to reduce the risk of, or ameliorate, cognitive impairment following systemic cancer treatment. Larger, multi-site studies including an appropriate, active attentional control group, as well as consideration of functional outcomes (e.g. activities of daily living) are required in order to come to firmer conclusions about the benefits or otherwise of this intervention approach. There is also a need to conduct research into cognitive impairment among cancer patient groups other than women with breast cancer.