Physical activity engagement strategies in people with mild cognitive impairment or dementia

Veronika van der Wardt et al. | Physical activity engagement strategies in people with mild cognitive impairment or dementia – a focus group study | Aging & Mental Health | Published online: 07 Apr 2019

Abstract
Objective: This focus group study aimed to explore how to motivate people with mild cognitive impairment (MCI) or dementia and their carers to engage in exercise and physical activity.

Methods: Four focus groups were conducted with six people with MCI or dementia, three carers and four clinicians (nurse, occupational therapist, physiotherapists). A thematic analysis of the data was undertaken.

Results: Five main themes were identified: ‘memory problems’, ‘self-motivation’, ‘external motivation’, ‘design of activities’ and ‘barriers’. Participants viewed exercise positively but emphasised that it needed to fit into their daily routine. Goal-setting was seen as helpful by some participants but others saw this as a source of potential failure. Enjoyment was seen as key to engagement.

Conclusion: Exercise and physical activity interventions need an individualised approach to engage people with MCI or dementia, with a positive emphasis on enjoyment. Goal-setting should be used with caution in this group of people.

Full document available at Aging & Mental Health

 

The effects of vitamin and mineral supplementation on cognitive function and the incidence of dementia in people with mild cognitive impairment.

This review investigated whether people with mild cognitive impairment can reduce their risk of developing dementia, or can prevent their memory or other thinking skills from deteriorating further, by taking vitamin or mineral supplements | Cochrane Database of Systematic Reviews

Vitamins and minerals have many functions in the nervous system which are important for brain health. It has been suggested that various different vitamin and mineral supplements might be useful in maintaining cognitive function and delaying the onset of dementia. In this review, the authors sought to examine the evidence for this in people who already had mild cognitive impairment (MCI).

The authors found eight randomised controlled trials (RCTs), which investigated four different types of vitamin or mineral pills by comparing them to a placebo (a dummy pill). The vitamins tested were B vitamins (vitamin B6, vitamin B12 and folic acid), vitamin E, and vitamin E and C given together. The only mineral tested was chromium.

However, the authors found the amount and quality of research evidence about vitamin and mineral supplements for treating MCI in people without nutritional deficiency is limited. They concluded that at the moment, it is not possible to identify any supplements which can reduce the risk of people with MCI developing dementia or which can effectively treat their symptoms.

Full reference: McCleery J, et al. |  Vitamin and mineral supplementation for preventing dementia or delaying cognitive decline in people with mild cognitive impairment |  Cochrane Database of Systematic Reviews | 2018, Issue 11.

Memory training for adults with probable mild cognitive impairment

Graham J. McDougall, Ian M. McDonough & Michael LaRocca | Memory training for adults with probable mild cognitive impairment: a pilot study |  Aging & Mental Health | Published online: 10 Oct 2018

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Abstract
Background & Objectives:
This pilot study aimed to evaluate the efficacy of memory training and health training intervention over a 24-month period in people with probable mild cognitive impairment (MCI).

Research Design & Methods:
Based on the accepted criteria, and the neuropsychiatric measures used in the trial, MCI was defined as a subjective change in cognition, impairment in episodic memory, preservation of independence of functional abilities, and no dementia. Without a neurological assessment, laboratory tests, and psychometric evaluation combined, some of our participants may have had dementia that we were unable to detect through neuropsychological testing.

Of the 263 total participants, 39 met criteria for a diagnosis of MCI. There were 19 adults in the memory and 20 in health training conditions. Both groups received twenty hours of classroom content that included eight hours of booster sessions at three months post intervention. Hierarchical linear models (HLM) and standardized regression-based (SBR) analyses were used to test the efficacy of the intervention on immediate recall, delayed recall, subjective memory complaints, and memory self-efficacy. Age, education, depression, racial group, ethnic group, MMSE score, and baseline performance were included as covariates.

Results:
Over 24 months, the MCI group in the memory training condition showed better objective and subjective memory outcomes compared with the MCI group in the health training condition.

Conclusions:
Senior WISE Memory training delivered to individuals with MCI was able to forestall the participants’ declining cognitive ability and sustain the benefit over two years in both subjective and objective memory function.

Full detail at Aging & Mental Health 

‘Exergaming’ may help those at risk of Alzheimer’s or related dementias

Older adults with mild cognitive impairment (MCI) showed significant improvement with certain complex thinking and memory skills after exergaming (video games that also require physical exercise) | Frontiers in Aging Neuroscience | via ScienceDaily

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The results of a new study could encourage health care providers to pursue or prescribe exergames (video games that also require physical exercise) in hopes of slowing the debilitating effects of those with MCI, sometimes a stage between normal brain aging and dementia.

Previously published research had found that seniors who exercise using the features of interactive video games experienced greater cognitive health benefits than those who rely on traditional exercise alone.

For the latest study, researchers wanted to target older adults diagnosed with or at risk for MCI.  Researchers initially enrolled more than 100 seniors for the study. Over six months, 14 (evenly split between men and women) persisted with regular exergaming. The average age was 78.

The first group of seven was assigned to pedal along a scenic virtual reality bike path several times a week. The second group was given a more challenging task for the brain: pedal while playing a video game that included chasing dragons and collecting coins.

The results were compared against data collected from a separate group of eight seniors who played video games on a laptop but did not pedal, and also a group from the previous research who only rode a traditional stationary bike with no gaming component.

At the end of the randomized clinical trial, participants in both the group that pedaled along a virtual bike path and those that chased dragons and collected coins experienced significantly better executive function, which controls, in part, multi-tasking and decision making.

Benefits for both groups were also seen for verbal memory and physical function, suggesting it may be worth the effort for seniors to incorporate exergaming into a daily exercise regime.

The authors acknowledged that further research with a larger sample size is needed to confirm the team’s findings.  In the meantime, the research suggests benefits of exercising while also stimulating the brain with some mental challenge, such as navigating a scenic bike path or interactively playing a video game.

Full story at ScienceDaily

Full reference: Anderson-Hanley, C . et al. The Aerobic and Cognitive Exercise Study (ACES) for Community-Dwelling Older Adults With or At-Risk for Mild Cognitive Impairment (MCI): Neuropsychological, Neurobiological and Neuroimaging Outcomes of a Randomized Clinical TrialFrontiers in Aging Neuroscience, 2018; 10

 

The diagnostic accuracy of automated tests for cognitive impairment

Review finds some promising results for identifying MCI and early dementia, but notes shortcomings within available evidence | International Journal of  Geriatric Psychiatry

Abstract
Objective
The aim of this review is to determine whether automated computerised tests accurately identify patients with progressive cognitive impairment and, if so, to investigate their role in monitoring disease progression and/or response to treatment.

Methods
Six electronic databases (Medline, Embase, Cochrane, Institute for Scientific Information, PsycINFO, and ProQuest) were searched from January 2005 to August 2015 to identify papers for inclusion. Studies assessing the diagnostic accuracy of automated computerised tests for mild cognitive impairment (MCI) and early dementia against a reference standard were included. Where possible, sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios were calculated. The Quality Assessment of Diagnostic Accuracy Studies tool was used to assess risk of bias.

Results
Sixteen studies assessing 11 diagnostic tools for MCI and early dementia were included. No studies were eligible for inclusion in the review of tools for monitoring progressive disease and response to treatment. The overall quality of the studies was good. However, the wide range of tests assessed and the non‐standardised reporting of diagnostic accuracy outcomes meant that statistical analysis was not possible.

Conclusion
Some tests have shown promising results for identifying MCI and early dementia. However, concerns over small sample sizes, lack of replicability of studies, and lack of evidence available make it difficult to make recommendations on the clinical use of the computerised tests for diagnosing, monitoring progression, and treatment response for MCI and early dementia. Research is required to establish stable cut‐off points for automated computerised tests used to diagnose patients with MCI or early dementia.

Aslam, R. W. et al. | A systematic review of the diagnostic accuracy of automated tests for cognitive impairment | International Journal of  Geriatric Psychiatry | Volume 33, Issue 4 | April 2018 | Pages 561-575

Everyday technology use and activity involvement in mild cognitive impairment

Research findings point to a need for early support focusing on the use of everyday technology for persons with MCI

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Objectives: The aims were to describe longitudinal patterns in terms of perceived ability to use everyday technology (ET) and involvement in everyday activities over five years in older adults with mild cognitive impairment (MCI), and to examine the predictive value of these patterns regarding diagnostic outcomes.

Method: Thirty older adults diagnosed with MCI at inclusion, reported their perceived ability in using ET and involvement in everyday activities on seven occasions over five years. Individual longitudinal case plots and a pattern-oriented analysis were used to compare the participants’ distribution in earlier identified stable/ascending, fluctuating and descending patterns of functioning (year 0–2). Fisher’s exact test was used for testing the relation between pattern and diagnostic outcomes.

Results: An initial descending pattern of functioning tended to continue; none of these participants later developed a more stable pattern. More congruent trajectories of change appeared over time. Pattern affinity years 0–2 and diagnostic outcome were significantly related (p = .05), with a dementia diagnosis being more likely for those initially displaying an early descending pattern

Conclusion: These findings point to a need for early support focusing on the use of ET for persons with MCI who early after diagnosis descend in functioning.

Full reference: Annicka Hedman, Anders Kottorp & Louise Nygård | Patterns of everyday technology use and activity involvement in mild cognitive impairment: a five-year follow-up study | Aging & Mental Health, 22:5, 603-610