Cognitive Training Exercises Research Articles

Journal Digest: IRT; Motivational Therapy; Mental Health Apps; and More

Journal Digest: IRT; Motivational Therapy; Mental Health Apps; and More

Treatment engagement in first-episode schizophrenia: Associations between intrinsic motivation and attendance during cognitive training and an aerobic exercise program

Systematic cognitive training and aerobic exercise programs have emerged as promising interventions to improve cognitive deficits in first-episode schizophrenia, with successful outcomes closely linked with greater treatment engagement (e.g., higher attendance and homework completion rates). Unfortunately, treatment disengagement from these services remains a persistent issue. Intrinsic motivation, or the willingness to exert effort because a task is inherently interesting or meaningful, has emerged as a promising malleable personal factor to enhance treatment engagement. This study investigated whether early task-specific intrinsic motivation and its domains (e.g., interest, perceived competence, and value) predicted treatment engagement within the context of intensive cognitive training and aerobic exercise interventions over a 6-month period. Thirty-nine participants with first-episode schizophrenia were administered baseline measures of task-specific intrinsic motivation inventories, one for cognitive training and one for exercise, and completed a 6-month randomized clinical trial comparing a neuroplasticity-based cognitive training plus aerobic exercise program against the same cognitive training alone. Results indicated that higher baseline scores of intrinsic motivation for cognitive training, specifically early perceptions of task interest and value, were predictive of greater cognitive training and exercise group attendance. Scores for exercise-specific intrinsic motivation were generally unrelated to indices of exercise participation, with the exception that the gain over time in perceived choice for exercise was linked with greater exercise homework completion and a similar directional tendency for greater in-clinic exercise attendance. This study provides support for monitoring and enhancing motivation early during service delivery to maximize engagement and the likelihood of successful treatment outcomes.

Effect of SUPERBRAIN program in Amyloid PET positive mild dementia patient: Cognitive outcome, EEG and stool microbiome

AbstractBackgroundThe effect of SUPERBRAIN (multi‐domain lifestyle intervention program), on the mild stage of AD positive mild stage of dementia for an 8‐week treatment in the cognitive function, EEG and stool microbiom outcome.MethodA total of 58 amnestic MCI or early stage of mild dementia patient (CDR 0.5‐1) with amyloid PET positive, were recruited. Patients were randomized to either three group of 1) Superbrain with Memory pack group, 2) Memory pack only group, 3) control group. Memory Pack is nutritional support that is supplied by Daesang Yuup that is specially designed for brain reinforcing formula such as choline, serine, glycine, etc. Cognitive training programs and exercise programs were conducted two persons in a group session twice in a week for the 8 week in the hospital. The primary outcome was the change in the total scale of index score of the Repeatable Battery for the Assessment of Neuropsychological Status (RBARNS) after 2 months of training. Analysis of covariance was used to compare the index score of the RBANS between the three groups.ResultThe age was 75.70 (5.26) in treatment group, 75.75 (5.80) for Memory pack only group, 75.00 (6.50) for control group (P value. 0.967). The baseline MMSE scores were 22. 38 (3.50) in treatment group, 20.75 (1.75) for Memory pack only group, 21.63(2.50) for control group (P value. 0.492). RBARNS score showed improvements in the total RBARNS scale index score (72(15.78) in Baseline to Fup 78.88(16.51) in the treatment group (P value 0.05) compared to Memory pack only (75.38(9.02) in Baseline to Fup 79.00(8.68) (P value 0.045) and control group (75.38(11.90) in Baseline to Fup 75.75(18.79) (0.970). The MMSE were significantly improved in both treatment group (22.38, 24.13; p = 0.013) and Memory pack only group(20.75,22.57, P = 0.045) as well but worsened in control group (21.63, 20.00 P = 0.142) compared to baseline. The CDR sum of box statistically worsened in the control group compared to treatment group and memory pack group.ConclusionCognitive improvement was evident even in this short term 8 weeks of multi‐domain intervention program of for AD dementia which needs further study for the long‐term outcome.

An integrated intervention of computerized cognitive training and physical exercise in virtual reality for people with Alzheimer's disease: The jDome study protocol.

IntroductionAlzheimer's disease is a neurodegenerative syndrome characterized by cognitive deficits, loss of daily functions, and mental and behavioral disorders, which cause stress and negatively affect the quality of life. Studies in the field suggest that combining cognitive training with physical activity can reduce the risk of developing the disease and, once neurodegeneration has begun, it slows its progress. In particular, virtual reality and augmented reality administer cognitive stimulation while providing a link to autobiographical memory through reminiscence, enabling the improvement of the person's quality of life. The present protocol aims to evaluate the effectiveness of cognitive and physical treatments, integrated with the addition of virtual reality and reminiscence elements, using the Brainer software, in which people will find cognitive training, and the jDome® BikeAround™ system, which will allow participants to pedal along a personalized path projected on a schematic, using an exercise bike connected to the system.Methods and analysisFor this study, 78 patients with mild Alzheimer's dementia were recruited and divided into the Experimental Group (EG) and Control Group (CG). Sixteen treatment sessions of 60 min each were conducted for both groups (2 training sessions per week, for 8 weeks), including 1 patient at a time. The EG received cognitive treatment with Brainer and physical training with jDome, while the CG received cognitive treatment with Brainer and physical training with a classic bicycle. The evaluation mainly focused on the assessment of the person's cognitive status. Other analyses were conducted on the quality of life, mood, behavioral disorders, and physical function, which were considered secondary outcomes.DiscussionsThe ultimate goal of the present study is to test the effectiveness of a treatment for people with mild Alzheimer's focused on the integration of cognitive training and aerobic physical activity, using an exercise bike, with the addition of virtual reality and reminiscence elements.Ethics and disseminationThe study was approved by the Ethics Committee of the IRCCS INRCA. It was recorded in ClinicalTrials.gov on 2 June 2022 with the number NCT05402423. The study findings will be used for publication in peer-reviewed scientific journals and presentations in scientific meetings.

Effect of a multicomponent exercise program and cognitive stimulation (VIVIFRAIL-COGN) on falls in frail community older persons with high risk of falls: study protocol for a randomized multicenter control trial

BackgroundFalls represent important drivers of intrinsic capacity losses, functional limitations and reduced quality of life in the growing older adult’s population, especially among those presenting with frailty. Despite exercise- and cognitive training-based interventions have shown effectiveness for reducing fall rates, evidence around their putative cumulative effects on falls and fall-related complications (such as fractures, reduced quality of life and functional limitations) in frail individuals remains scarce. The main aim of this study is to explore the effectiveness program combining an individualized exercise program and an executive function-based cognitive training (VIVIFRAIL-COGN) compared to usual care in the prevention of falls and fall-related outcomes over a 1-year follow-up.MethodsThis study is designed as a four-center randomized clinical trial with a 12-week intervention period and an additional 1-year follow-up. Three hundred twenty frail or pre-frail (≥ 1 criteria of the Frailty Phenotype) older adults (≥ 75 years) with high risk of falling (defined by fall history and gait performance) will be recruited in the Falls Units of the participating centers. They will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will participate in a home-based intervention combining the individualized Vivifrail multicomponent (aerobic, resistance, gait and balance and flexibility) exercise program and a personalized executive function-based cognitive training (VIVIFRAIL-COGN). The CG group will receive usual care delivered in the Falls Units, including the Otago Exercise Program. Primary outcome will be the incidence of falls (event rate/year) and will be ascertained by self-report during three visits (at baseline, and 6 and 12 weeks) and telephone-based contacts at 6, 9 and 12 months after randomization. Secondarily, effects on measures of physical and cognitive function, quality of life, nutritional, muscle quality and psychological status will be evaluated.DiscussionThis trial will provide new evidence about the effectiveness of an individualized multidomain intervention by studying the effect of additive effects of cognitive training and physical exercise to prevent falls in older frail persons with high risk of falling. Compared to usual care, the combined intervention is expected to show additive effects in the reduction of the incidence of falls and associated adverse outcomes.Trial registrationNCT04911179 02/06/2021.

Cognitive training using a mobile app as a coping tool against COVID-19 distress: A crossover randomized controlled trial

BackgroundThe COVID-19 pandemic has been suggested to constitute a broad base stressor with severe mental health consequences. mHealth applications are accessible self-help tools that can be used to reduce psychological distress during the pandemic. This randomized controlled trial evaluated the effects of mobile-based cognitive training exercises on COVID-19 related distress and maladaptive cognitions. MethodsFollowing initial screening (n = 924), participants scoring 1 standard deviations above the mean of the COVID-19 Distress Scale were randomized into two groups. Participants in the immediate-app group (iApp; n = 25) started using the application at baseline (T0) for 12 days (from T0 to T1). Participants in the delayed-app group (dApp; n = 22) started using the mobile application at T1 (crossover) and used it for the following 12 days (T1 to T2). ResultsIntention to treat analyses indicated that the iApp group exhibited lower COVID-19 distress, lower depression, fewer intolerance of uncertainty and obsessive beliefs than the dApp group at T1. In addition, using the app for 12 consecutive days was associated with large effect-size reductions (Cohen's d ranging from 0.81 to 2.35) in COVID-19 distress and related maladaptive cognitions in the iApp group (from T0 to T1) and the dApp group (from T1 to T2). Moreover, these reductions were maintained at the follow-up. LimitationsThis study was a crossover trial with a relatively limited sample size and mainly female participants. ConclusionOur findings underscore the usefulness of brief, low-intensity, portable interventions in alleviating the negative effects of the pandemic on mental health.

Technologies of Ascription: How Does a Dementia Diagnosis Acquire its Symbolic Power of Exclusion in Later Life?

Amidst the widespread stigma and exclusion attached to dementia in dominant narratives of successful ageing, this article addresses a gap in the scientific literature concerning our understanding of the medicalization of cognitive decline as a natural phenomenon. To this end, it explores how a dementia diagnosis acquires its symbolic power of exclusion in later life through an ethnography of cognitive rehabilitation therapy in two memory clinics in a southern European nation. It argues that this symbolic power of exclusion is locally produced through the meaning making practices of therapists and researchers administering regular cognitive training therapy and exercises to support autonomy. It shows how the different steps involved in rehabilitation play a role in dividing later life by defining and reifying a category of abnormal ageing during the cognitive assessment, and by applying a confrontational approach exposing decline. It shows how this approach generates the position of older adults who can be rehabilitated against those who cannot; the latter representing a “failed” ageing in the narrative of successful ageing. This article proposes the adoption of the concept of “technologies of ascription” to characterize this process of exclusion through reification and confrontation of “abnormal cognitive decline.” The paper argues that such practices are central to the local production of the symbolic power attached to a dementia diagnosis as well as its capacity to fragment later life. Finally, it argues for the utility of this concept in offering new opportunities for anthropology to characterize exclusion in later life through medicalization.

Tai Chi enhances cognitive training effects on delaying cognitive decline in mild cognitive impairment.

Cognitive training and physical exercise have shown positive effects on delaying progression of mild cognitive impairment (MCI) to dementia. We explored the enhancing effect from Tai Chi when it was provided with cognitive training for MCI. In the first 12 months, the cognitive training group (CT) had cognitive training, and the mixed group (MixT) had additional Tai Chi training. In the second 12 months, training was only provided for a subgroup of MixT. In the first 12 months, MixT and CT groups were benefited from training. Compared to the CT group, MixT had additional positive effects with reference to baseline. In addition, Compared to short-time training, prolonged mixed training further delayed decline in global cognition and memory. Functional magnetic resonance imaging showed more increased regional activity in both CT and MixT. Tai Chi enhanced cognitive training effects in MCI.Moreover, Tai Chi and cognitive mixed training showed effects on delaying cognitive decline.

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

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. A four-armed, quasi-experimental intervention study. Community-dwelling adults aged 60 years and older (n=153). 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. 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. 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). 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.

Cognitive Training and Aerobic Exercise as Intervention Techniques for Mild Cognitive Impairment: A Research Protocol

Introduction: Mild cognitive impairment (MCI) is characterized by cognitive decline, prodromal to dementia. However, no medications currently exist. However, research suggests intervention techniques like exercise and cognitive training to slow MCI-progression. The purpose of this research protocol is to determine whether these intervention techniques work more efficiently in combination or separately. Methods: 80 participants with MCI will be recruited and divided into four groups of 20 participants each; Group-1 will be exposed to cognitive training, Group-2 will be exposed to aerobic exercise, Group-3 will be exposed to both, and Group-4 will be exposed to none. All participants will write a series of cognitive tests that establish a baseline cognition level. After six- months of training, participants will rewrite the tests. An analysis of variance will be done on pre- and post-test scores to identify the strategy that produces the most positive change. Results: Since past literature has found that cognitive training and physical exercise effectively slow cognitive decline, it can be anticipated that a combination of both will be more effective than either intervention alone. It can also be anticipated that all groups involving cognitive training and physical exercise, either alone or in combination, will experience more positive change on their post-test scores than the controls. Discussion: Literature suggests that a combination of two effective interventions may be more effective than either alone; a study examining the impact of two interventions on falls and cognition in individuals with MCI found both interventions together was the most effective treatment. By conducting a longitudinal study involving a Control-group and multiple cognition-screening tests, this protocol enables the investigation of another possible treatment avenue for individuals with MCI. Conclusion: By examining the interaction between two effective treatment methods for MCI, a condition without medications, this study provides individuals with MCI an additional treatment route that may slow cognitive decline. To permit generalization, future studies should be conducted using larger participant pools that are matched for demographic factors.

Pilot feasibility study of cognitive training exercises for Egyptian adults: Proof of concept.

Cognitive training exercises (CTE) are promising and effective interventions to enhance cognitive reserve and slowdown cognitive deterioration in people with subjective memory impairment (SCI) and mild cognitive impairment (MCI). In this pilot study, we aimed to assess the feasibility of CTE among Egyptian adults. Eighteen participants above 40 years old were recruited. They underwent baseline neuropsychological assessment and functional assessment. However, after receiving a 6 weeks' cognitive training, eight participants (seven with MCI and one was cognitively intact) dropped out from the study. Finally, 10 participants (8 participants with MCI, 1 with SCI and 1 was cognitively intact) completed 12 weeks of CTE and undergone the post-assessment afterward. CTE included visual, verbal, memory, executive function, visuospatial, attention, and psychokinetic exercises through onsite and home-based sessions. For the 10 participants who completed 12 weeks of CTE, the Wilcoxon signed-rank test showed a statistically significant change in the scores of mini-mental state examination (Z=-2.546, p=0.011), semantic fluency test (Z=-2.913, p=0.004), subjective memory complaint questionnaire (Z=-2.913, p=0.004), Consortium to Establish a Registry for Alzheimer's Disease Word List (first trial: Z=-2.641, p=0.008; Word list recall: Z=-2.825, p=0.005), construction abilities (immediate: Z=-2.121, p=0.034; delayed recall: Z=-2.414, p=0.016), and Digit span test (forward: Z=-2.724, p=0.006; backward: Z=-2.724, p=0.006). The results of this study suggested that CTE are feasible among Egyptian adults, especially those with MCI, and potentially effective in enhancing global cognition and after 12 weeks of training. Future research should shed light on the efficacy of longitudinal CTE implementation in Arab adults' populations.

Different Modulatory Effects of Cognitive Training and Aerobic Exercise on Resting State Functional Connectivity of Entorhinal Cortex in Community-Dwelling Older Adults.

The entorhinal cortex (EC) plays an essential role in age-related cognitive decline. However, the effect of functional connectivity (FC) changes between EC and other cerebral cortices on cognitive function remains unclear. The aim of this study was to explore the modulation of two interventions (cognitive training and aerobic exercise) on EC-FC in community-dwelling older adults. In total, 94 healthy older adults aged between 65 and 75 years were assigned to either the cognitive training or aerobic exercise group to receive 24 sessions over 12 weeks, or to a control group. Resting-state functional magnetic resonance imaging was performed at both baseline and 12-month follow-up. Compared to the cognitive training group, the aerobic exercise group showed greater EC-FC in the bilateral middle temporal gyrus, right supramarginal gyrus, left angular gyrus, and right postcentral gyrus. Compared to the control group, the cognitive training group had a decreased EC-FC in the right hippocampus, right middle temporal gyrus, left angular gyrus, and right postcentral gyrus and an increased EC-FC in the bilateral pallidum, while the aerobic exercise group showed increased EC-FC between the right medial prefrontal cortex(mPFC), bilateral pallidum, and right precuneus. Baseline EC-FC in the mPFC was positively correlated with the visuospatial/constructional index score of the Repeatable Battery for the Assessment of Neuropsychological Status. In the cognitive training group, EC-FC value changes in the right hippocampus were negatively correlated with changes in the RBANS delayed memory index score, while in the aerobic exercise group, EC-FC value changes in the left angular gyrus were positively correlated with changes in the RBANS attention index score. These findings support the hypothesis that both cognitive training and aerobic exercise can modulate EC-FC in aging populations but through different neural pathways.

Effects of Combined Interventions with Aerobic Physical Exercise and Cognitive Training on Cognitive Function in Stroke Patients: A Systematic Review.

(1) Background: Stroke is a major cause of permanent disability in multiple functions, including the cognitive domain. Since both cognitive training and aerobic physical exercise may exert positive effects on cognition after stroke, one may expect synergistic benefits when combining both interventions. (2) Methods: We carried out a systematic search of studies testing, in adult stroke patients, whether structured aerobic exercise combined with cognitive training led to higher cognitive benefits than either of these interventions when applied singly, or than interventions not including aerobic exercise or cognitive training. (3) Results: Five fair-quality randomized controlled trials fulfilled the search criteria. Exercise intensity was moderate-vigorous and cognitive training was mainly computer-based. The studies were heterogeneous regarding the cognitive tests used, and for this reason, a meta-analysis was not performed. Only three studies included follow-up assessment. The combined intervention was associated with pre-post improvement in at least one cognitive test in all the studies, and with higher positive effects compared to other conditions (although statistical significance was not always reached) in four studies. (4) Conclusions: Further trials including a long-term follow-up and comprehensive neuropsychological testing should be undertaken to determine whether combined aerobic exercise and cognitive training leads to additive cognitive benefits after stroke.

Neuromodulatory Interventions for Traumatic Brain Injury.

Neuromodulatory Interventions for Traumatic Brain Injury.

Synergistic Effects of Cognitive Training and Physical Exercise on Dual-Task Performance in Older Adults.

Studies report benefits of physical exercise and cognitive training to enhance cognition in older adults. However, most studies did not compare these interventions to appropriate active controls. Moreover, physical exercise and cognitive training seem to involve different mechanisms of brain plasticity, suggesting a potential synergistic effect on cognition. This study investigated the synergistic effect of cognitive training and aerobic/resistance physical exercise on dual-task performance in older adults. Intervention effects were compared to active controls for both the cognitive and the exercise domain. Eighty-seven older adults completed one of 4 different combinations of interventions, in which computer lessons was active control for cognitive training and stretching/toning exercise control for aerobic/resistance training: (a) cognitive dual-task training and aerobic/resistance training (COG+/AER+), (b) computer lessons and aerobic/resistance training (COG-/AER+), (c) cognitive dual-task training and stretching/toning exercises (COG+/AER-), and (d) computer lessons and stretching/toning exercises (COG-/AER-). The primary outcome was performance in an untrained transfer dual task. Stepwise backward removal regression analyses were used to predict pre- versus post-test changes in groups that have completed the dual-task training, aerobic/resistance or both interventions. Participation in AER+ did not predict improvement in any dual-task outcomes. Participation in COG+ predicted reduction in dual-task cost and participation in COG+/AER+ predicted reduction in task-set cost. Results suggest that the combination of cognitive and physical training protocols exerted a synergistic effect on task-set cost which reflects the cost of maintaining multiple response alternatives, whereas cognitive training specifically improved dual-task cost, which reflects the ability of synchronizing concurrent tasks.

Reaching reliable change using short, daily, cognitive training exercises delivered on a mobile application: The case of Relationship Obsessive Compulsive Disorder (ROCD) symptoms and cognitions in a subclinical cohort

BackgroundRelationship Obsessive Compulsive Disorder (ROCD) is a presentation of OCD centering on interpersonal relationships. The aim of this Randomized Control Trial (RCT) was to assess the efficacy of short, game like, daily cognitive interventions delivered via mobile application in reducing subclinical ROCD symptoms and associated phenomena. MethodsFifty university students identified as having subclinical levels of ROCD symptoms (using the Structured Clinical Interview for DSM-5 Clinical Version) were randomized into: immediate-use group (iApp group; n = 25) and delayed-use group (dApp group; n = 25). The iApp group started using the evaluated cognitive-behavioral training application at baseline for 15 days (T0 to T1). The dApp group commenced using the application at T1 for 15 days (T1 to T2). All participants completed questionnaires at baseline (T0), 15 days from baseline (T1), and 30 days from baseline (T2). ResultsRepeated measure MANOVAs showed significant Group (iApp vs. dApp) × Time (T0 vs. T1) interactions. These interactions indicated greater decrease in ROCD symptoms, OCD beliefs and social anxiety symptoms, as well as a greater increase in self-esteem in the iApp group compared to dApp group at T1. Moreover, the Reliable Change Index (RCI) indicated reliable change on ROCD symptoms for a significant portion of participants (42–52%). LimitationsSample size and the use of self-report measures limits the generalizability of the results. ConclusionsShort, daily cognitive training interventions delivered via mobile applications may be useful in reducing subclinical ROCD symptoms and associated features. Further testing is needed for clinical populations.

Clinical and methodological considerations for psychological treatment of cognitive impairment in major depressive disorder.

Cognitive impairment is considered a core feature of major depressive disorder (MDD) and research into psychological treatments aiming to address cognitive impairment are gaining momentum. Compared with the well-established research base of cognitive treatment trials in schizophrenia, including meta-analyses, mood disorder research is much more preliminary. To focus on identifying the important factors to consider in developing larger-scale psychological treatment trials targeting cognitive impairment in mood disorders. Trial design recommendations have been published for cognitive treatment trials in bipolar disorder. An in-depth discussion of methodological considerations in the development of cognitive treatment trials for MDD. Methodological considerations include: screening for, and defining, cognitive impairment; mood state when cognitive intervention begins; medication monitoring during cognitive interventions; use of concomitant therapy; level of therapist involvement; duration and dose of treatment; choice of specific cognitive training exercises; home practice; improving adherence; appropriate comparison therapies in clinical trials; and choice of primary outcomes. As well as guidance for clinical trial development, this review may be helpful for clinicians wanting to provide cognitive interventions for individuals with MDD.

A Comprehensive Intervention for Promoting Successful Aging Amongst Older People With Diabetes With Below-Normal Cognitive Function-A Feasibility Study.

Background: Older people with diabetes have an increased risk for disability and cognitive dysfunction, which may impede self-care capacity. These are not evaluated routinely in current health systems. In the Center for Successful Aging with Diabetes, patients over the age of 60 undergo multi-disciplinary evaluation days and are provided with an integrated (cognitive, physical, nutritional, and medical) treatment plan. Among individuals with below-normal cognitive function, self-adherence to these recommendations poses a challenge. Thus, the aim of this study was to test the feasibility of a multidisciplinary intervention amongst older people with diabetes with below-normal cognitive function and sub-optimal glucose control.Methods: Patients with a MoCA score under 26 and A1C >= 7.5% participated in a two-arm intervention: (A) a medical intervention: monthly meetings with a diabetes nurse-educator, supervised by a diabetes specialist and study psychologist during which changes in their pharmacological regimen of glucose, blood pressure, and lipid control were made and (B) a cognitive/physical rehabilitation intervention. This arm consisted of (1) an intensive phase-group meetings which included computerized cognitive training, aerobic, balance, and strength exercise, and group discussions and (2) a monthly consolidation phase. Outcomes included change in A1C, change in strength, balance, and aerobic exercise capacity as well as change in quality of life.Results: After 12 months there was a 0.7% reduction in A1C. After 3 months there was a statistically significant improvement in physical indices, including aerobic capacity (6-min walk), balance (FSST) and indices assessing the risk of fall (10-meter walk, time up and go). There was no additional improvement in physical indices between the 3 and 12 month visits. For some of the physical measures, the improvement observed after 3 months persisted partially to the 12-month visit.Conclusions: This feasibility study provides preliminary data that support the efficacy of the complex interventions described. The findings suggest that this older population would require an ongoing “intensive phase” intervention. Larger prospective randomized trials are needed.

Effects of multidomain versus single-domain training on executive control and memory in older adults: study protocol for a randomized controlled trial

BackgroundPrevious research suggests that both cognitive training and physical exercise help to maintain brain health and cognitive functions that decline with age. Some studies indicate that combined interventions may produce larger effects than each intervention alone. The aim of this study is to investigate the effects of combined cognitive and physical training compared to cognitive training and physical training alone on executive control and memory functions in healthy older adults.ObjectivesThe main objectives of this four-arm randomized controlled trial (RCT) are: to investigate the synergetic effects of a simultaneous, group-based multidomain training program that combines cognitive video-game training with physical exercise, in comparison to those produced by cognitive training combined with physical control activity, physical training combined with cognitive control activity, or a combination of both control activities; to investigate whether event-related potential latencies of the P2 component are shorter and N2 and P3b components assessed in a memory-based task switching task are enhanced after training; and to find out whether possible enhancements persist after a 3-month period without training.MethodsIn this randomized, single-blind, controlled trial, 144 participants will be randomly assigned to one of the four combinations of cognitive training and physical exercise. The cognitive component will be either video-game training (cognitive intervention, CI) or video games not specifically designed to train cognition (cognitive control, CC). The physical exercise component will either emphasize endurance, strength, and music–movement coordination (exercise intervention, EI) or stretching, toning, and relaxation (exercise control, EC).DiscussionThis RCT will investigate the short and long-term effects of multidomain training, compared to cognitive training and physical training alone, on executive control and memory functions in healthy older adults, in comparison with the performance of an active control group.Trial registrationClinicalTrials.gov, NCT03823183. Registered on 21 January 2019.

Randomized controlled trial on the efficacy of a multilevel non-pharmacologic intervention in older adults with subjective memory decline: design and baseline findings of the E.Mu.N.I. study

Alzheimer's Disease (AD) is a multifactorial disorder driven by genetic and modifiable lifestyle risk factors. Lifestyle primary prevention initiatives may reduce the prevalence and incidence of dementia in older adults. The E.Mu.N.I study is a randomized controlled trial investigating the effect of multilevel non-pharmacologic interventions on cognitive performances (primary outcome) and structural and vascular brain MRI markers (secondary outcome), as well as markers of brain functional connectivity change (exploratory outcome), in older adults with subjective memory decline (SMD). Here, we present the study design and the baseline features of the sample. Cognitively intact older adults with SMD, enrolled between February 2016 and June 2017, were randomly assigned to one of the 3 interventions for 1year: Active Control Intervention (ACI), i.e., educational lessons; Partial Intervention (PI), i.e., homotaurine administration (100mg/die) and lessons on the Mediterranean diet; Multilevel Intervention (MI), i.e., PI plus computerized cognitive training and physical exercise training. One-hundred and twenty-eight eligible participants were enrolled (66% female; age: 68 ± 5years). Eighty-two percent of the sample was composed of volunteers with SMD from the community. Participants were randomly allocated to the interventions as follows: ACI (N = 40), PI (N = 44), MI (N = 44). No significant differences among groups emerged on socio-demographic, clinical-neuropsychological variables and MRI markers at baseline. The outcomes obtained from the E.Mu.N.I. study will clarify the efficacy of multilevel non-pharmacologic interventions on cognitive and neuroimaging markers in SMD individuals. This is a crucial step forward for the development of cost-effective non-pharmacologic primary prevention initiatives for AD.