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

 

Setting personal goals for dementia care

Research finds that goal setting may help people with dementia work with healthcare professionals and caregivers to identify and achieve realistic goals that are most important to them. | Journal of the American Geriatrics Society | News Medical

New research published in the Journal of the American Geriatrics Society has concluded that “goal attainment scaling” (GAS) can be used in clinical care to help people with dementia and their caregivers set and achieve personalised health goals.

old-690842_1920The researchers developed a process for using GAS to set goals and to measure whether participants reached those goals. In a first phase of the study, they tested goal setting with 32 people who had dementia and their caregivers.

In the next phase, the dementia care managers helped an additional 101 people with dementia and their caregivers set care goals. The research team used a scale to measure how well the participants achieved their goals 6 and 12 months after setting them.

Most often, the goals focused on improving quality of life for the person with dementia, followed by caregiver support goals. Some commonly chosen goals for the person with dementia included:

  • Maintaining physical safety
  • Continuing to live at home
  • Receiving medical care related to dementia
  • Avoiding hospitalization
  • Maintaining mental stimulation
  • Remaining physically active

Commonly chosen caregiver goals included:

  • Maintaining the caregiver’s own health
  • Managing stress
  • Minimizing family conflict related to dementia caregiving

Full story: Personalized goal setting to improve dementia care | News Medical

Full reference: Lee A. Jennings et al. | Personalized Goal Attainment in Dementia Care: Measuring What Persons with Dementia and Their Caregivers Want | Journal of the American Geriatrics Society | 2018

 

Physical fitness and dementia risk in the very old: a study of the Lothian Birth Cohort 1921

 Sibbett, R. A., Russ, T.C.,  Allerhand, M., Deary, I.J., &  Starr, J. M. | 2018| Physical fitness and dementia risk in the very old: a study of the Lothian Birth Cohort 1921 |BMC Psychiatry |  18 | 285 | https://doi.org/10.1186/s12888-018-1851-3

A new article in the BMC Psychiatry examines physical fitness and dementia risk in the very old (participants aged 79 at starting point of the study). Unlike previous studies whch have found an association with old age and dementia risk, this study found that lower fitness beyond age 79 was not a risk factor for subsequent dementia.

Abstract 

Background

Previous studies have demonstrated that individual measures of fitness – such as reduced pulmonary function, slow walking speed and weak handgrip – are associated with an increased risk of dementia. Only a minority of participants included in these studies were aged over 80. The aim of this study was therefore to investigate the association between physical fitness and dementia in the oldest old.
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Methods

Subjects (n = 488) were enrolled in the Lothian Birth Cohort 1921 and aged 79 at baseline. Dementia cases arising after enrolment were determined using data from death certificates, electronic patient records and clinical reviews. Fitness measures included grip strength, forced expiratory volume in 1 s (FEV1) and walking speed over 6 m, measured at 79 years. Dementia risk associated with each fitness variable was initially determined by logistic regression analysis, followed by Cox regression analysis, where death was considered as a competing risk. APOE ε4 status, age, sex, height, childhood IQ, smoking, history of cardiovascular or cerebrovascular disease, hypertension and diabetes were included as additional variables. Cumulative incidence graphs were calculated using Aalen-Johansen Estimator.

Results

Although initial results indicated that greater FEV1 was associated with an increased risk of dementia (OR (odds ratio per unit increase) 1.93, p = 0.03, n = 416), taking into account the competing risk of mortality, none of the fitness measures were found to be associated with dementia; FEV1 (HR (hazard ratio per unit increase) 1.30, p = 0.37, n = 416), grip strength (HR 0.98, p = 0.35, n = 416), walking speed (HR 0.99, p = 0.90, n = 416). The presence of an APOE ɛ4 allele was however an important predictor for dementia (HR 2.85, p < 0.001, n = 416). Cumulative incidence graphs supported these findings, with an increased risk of dementia for APOE ɛ4 carriers compared with non-carriers. While increased FEV1 was associated with reduced risk of death, there was no reduction in risk for dementia.

Conclusions

In contrast to previous studies, this study found that lower fitness beyond age 79 was not a risk factor for subsequent dementia. This finding is not explained by those with poorer physical fitness, who would have been more likely to develop dementia, having died before onset of dementia symptoms.

The full article can be read at BMC Psychiatry

How physical exercise prevents dementia

Physical exercise seems beneficial in the prevention of cognitive impairment and dementia in old age, numerous studies have shown. Now researchers have explored in one of the first studies worldwide how exercise affects brain metabolism | ScienceDaily

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In order to further advance current state of knowledge on the positive influence of physical activity on the brain, gerontologists and sports physicians at Goethe University Frankfurt have examined the effects of regular exercise on brain metabolism and memory of 60 participants aged between 65 and 85 in a randomised controlled trial. Their conclusion: regular physical exercise not only enhances fitness but also has a positive impact on brain metabolism.

 

Physical function and depression in nursing home residents with dementia

Among elderly people in general, better physical function is associated with lower incidence of depressive symptoms. It is also related to better mental health, quality of life and well-being | BMJ Open

https://www.flickr.com/photos/simajr/4182166296/
Image source: sima dimitric – Flickr // CC BY 2.0

Objectives: The primary aim of this study is to describe depression and physical function in nursing home residents with dementia, as well as to examine the associations between depression and balance function, lower limb muscle strength, mobility and activities of daily living. The secondary aim is to examine the differences in physical function between the groups classified as depressed and not depressed.

Results: Nursing home residents with dementia are a heterogeneous group in terms of physical function and depression. By applying the recommended cut-off of 8 on CSDD, 23.5% of the participants were classified as being depressed. The results revealed significant associations between higher scores on CSDD (indicating more symptoms of depression) and lower scores on BBS (95% CI −0.12 to −0.02, p=0.006), 30 s CST (95% CI −0.54 to −0.07, p=0.001) as well as maximum walking speed (95% CI −4.56 to −0.20, p=0.003) (indicating lower level of physical function).

Conclusion: Better muscle strength, balance and higher walking speed were significantly associated with less depressive symptoms. The potential interaction of dementia with poor physical function and depression indicates an area to explore in future epidemiological studies with a prospective design.

Full reference: Kvæl, L.A.H. et al.  (2017) Associations between physical function and depression in nursing home residents with mild and moderate dementia: a cross-sectional study. BMJ Open. 7:e016875.

Interventions to prevent cognitive decline & dementia

Evidence supporting three interventions that might slow cognitive decline and the onset of dementia is encouraging but insufficient to justify a public health campaign focused on their adoption | ScienceDaily

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Image source: NASEM

Cognitive training, blood pressure management for people with hypertension, and increased physical activity all show modest but inconclusive evidence that they can help prevent cognitive decline and dementia, but there is insufficient evidence to support a public health campaign encouraging their adoption, says a new report from the National Academies of Sciences, Engineering, and Medicine.  Additional research is needed to further understand and gain confidence in their effectiveness, said the committee that conducted the study and wrote the report.

Cost-effectiveness of physical activity in Alzheimer’s disease

This study explores the cost-effectiveness of a supervised moderate-to-high intensity aerobic exercise programme in people diagnosed with Alzheimer’s disease (AD) and estimate incremental cost-effectiveness ratios (ICER) using participant-reported and proxy-reported measures of health-related quality of life (HRQoL) | BMJ Open

Interventions: Control group received treatment as usual. The intervention group performed 1 hour of supervised moderate-to-high intensity aerobic exercise three times weekly for 16 weeks.

Primary and secondary outcomes measures: Different physical, functional and health measures were obtained at inclusion (baseline) and 4 and 16 weeks after. HRQoL (EuroQol-5 Dimensions-5 Levels/EQ-Visual Analogue Scale) was reported by the participants and the primary caregivers as proxy respondents. Differences in HRQOL as reported by the participant and caregiver were explored as were different values of caregiver time with respite from care tasks.

Results: The intervention cost was estimated at €608 and €496 per participant, with and without transport cost, respectively. Participants and caregivers in the intervention group reported a small, positive non-significant improvement in EQ-5D-5L and EQ-VAS after 16 weeks. The ICER was estimated at €72 000/quality-adjusted life year using participant-reported outcomes and €87000 using caregiver-reported outcomes.

Conclusions: The findings suggest that the exercise intervention is unlikely to be cost-effective within the commonly applied threshold values. The cost of the intervention might be offset by potential savings from reduction in use of health and social care.

Full reference: Sopina, E. et al. (2017) Cost-effectiveness of a randomised trial of physical activity in Alzheimer’s disease: a secondary analysis exploring patient and proxy-reported health-related quality of life measures in Denmark. BMJ Open. 7:e015217.