Would older adults with mild cognitive impairment adhere to and benefit from a structured lifestyle activity intervention to enhance cognition?: a cluster randomized controlled trial.

Linda Chiu-Wa Lam,Ada Wai-Tung Fung,Edward Man-Fuk Leung,Tony Leung,Wai Chi Chan,Alan Winston

doi:10.1371/journal.pone.0118173

Abstract

BackgroundEpidemiologic evidence suggests that cognitive and physical activities are associated with better cognition in late life. The present study was conducted to examine the possible benefits of four structured lifestyle activity interventions and compare their effectiveness in optimizing cognition for older adults with mild cognitive impairment (MCI).Method and FindingsThis was a 12-month cluster randomized controlled trial. 555 community-dwelling Chinese older adults with MCI (295 with multiple-domain deficits (mdMCI), 260 with single-domain deficit (sdMCI)) were recruited. Participants were randomized into physical exercise (P), cognitive activity (C), integrated cognitive and physical exercise (CP), and social activity (S, active control) groups. Interventions comprised of one-hour structured activities three times per week. Primary outcome was Clinical Dementia Rating sum of boxes (CDR-SOB) scores. Secondary outcomes included Chinese versions of Alzheimer’s Disease Assessment Scale - Cognitive subscale (ADAS-Cog), delayed recall, Mini-Mental State Examination, Category Verbal Fluency Test (CVFT) and Disability Assessment for Dementia – Instrumental Activities of Daily Living (DAD-IADL). Percentage adherence to programs and factors affecting adherence were also examined. At 12th month, 423 (76.2%) completed final assessment. There was no change in CDR-SOB and DAD-IADL scores across time and intervention groups. Multilevel normal model and linear link function showed improvement in ADAS-Cog, delayed recall and CVFT with time (p<0.05). Post-hoc subgroup analyses showed that the CP group, compared with other intervention groups, had more significant improvements of ADAS-Cog, delayed recall and CVFT performance with sdMCI participants (p<0.05). Overall adherence rate was 73.3%. Improvements in ADAS-Cog and delayed recall scores were associated with adherence after controlling for age, education, and intervention groups (univariate analyses).ConclusionsStructured lifestyle activity interventions were not associated with changes in everyday functioning, albeit with some improvements in cognitive scores across time. Higher adherence was associated with greater improvement in cognitive scores. Factors to enhance adherence should be specially considered in the design of psychosocial interventions for older adults with cognitive decline.Trial RegistrationClinicalTrials.gov ChiCTR-TRC-11001359

Highlights

It is estimated that 35.6 million people lived with dementia worldwide in 2010, and the number will double every 20 years.[1]
Structured lifestyle activity interventions were not associated with changes in everyday functioning, albeit with some improvements in cognitive scores across time
Higher adherence was associated with greater improvement in cognitive scores

Summary

Introduction

It is estimated that 35.6 million people lived with dementia worldwide in 2010, and the number will double every 20 years.[1]. Cognitive activity participation is associated with better cognition, which is postulated to be related to neuroplasticity changes and neuronal stimulation in relation to activities that demands high cognitive load.[4,5,6,7,8,9,10] Interestingly, the protective effect of these activities appears to be independent of known pathological burden of Alzheimer’s disease, which opens up an option for adjuvant interventions that act through pathways other than the amyloid or tau pathologies.[11] While the findings are encouraging, it is not easy to administer lifestyle interventions to promote cognitive health in older adults.[12] Firstly, alterations in lifestyles are hard to achieve, and even more difficult to sustain This becomes especially challenging to people who have already experienced cognitive decline. The present study was conducted to examine the possible benefits of four structured lifestyle activity interventions and compare their effectiveness in optimizing cognition for older adults with mild cognitive impairment (MCI)

Methods

Results

Conclusion