The Feasibility of a Combined Lifestyle Physical Activity and Cognitive Training Intervention to Prevent Cognitive Impairment in Older Women With Cardiovascular Disease

Dual-task training and cognitive performance in individuals with coronary artery disease and/or heart failure: a systematic review

Introduction

Dual-task training (DTT) emerged as a promising intervention strategy to improve cognition in individuals with cardiovascular diseases (CVDs). The aim of this study is to describe the literature on the relationship between motor-cognitive DTT and cognitive performance (CP) in individuals with coronary artery disease (CAD) and/or heart failure (HF).

Method

This systematic review includes intervention and observational studies that assessed motor-cognitive DTT on CP in individuals with CAD and/or HF. Searches were performed in the MEDLINE/Pubmed, Scielo, Lilacs, PEDro, and EMBASE databases. Methodological quality was assessed using the PEDro and ROBII scales for intervention studies and the Newcastle-Ottawa Scale for observational studies. The certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Results

A total of 2,098 articles were retrieved, and 21 articles were selected for full reading. Among these, 16 were excluded according to pre-specified exclusion criteria, resulting in five studies conducted between 2018 and 2022, conducted in three countries (United States, Portugal, and Russia). The studies included 228 individuals, comprising one study with HF participants, one including women with CAD, two including individuals that underwent myocardial revascularization, and one with patients with CAD enrolled in a phase 2 of cardiac rehabilitation program. Each study used different combinations of motor and cognitive tasks, conducted sequentially (n = 2 studies) or simultaneously (n = 3 studies), with one study using virtual training. The overall certainty of evidence for CP was low according to GRADE approach. Reduction in postoperative cognitive dysfunction after myocardial revascularization was observed in two studies. Moreover, the results indicate that DTT may have a positive impact on memory, selective attention, and conflict resolution capacity.

Conclusion

The studies reviewed indicate motor-cognitive DTT as a potential approach to improve CP in individuals with CAD and/or HF.

Systematic Review Registration

www.crd.york.ac.uk/prospero/display_record.php?ID=CRD4202341516, identifier (CRD 4202341516).

Overcoming Pandemic-Related Challenges in Recruitment and Screening: Strategies and Representation of Older Women With Cardiovascular Disease for a Multidomain Lifestyle Trial to Prevent Cognitive Decline

BACKGROUND

Recruiting participants with cardiovascular disease into research during the COVID-19 pandemic was challenging, particularly those at risk of health disparities.

OBJECTIVE

During the pandemic, 12 cohorts of older women with cardiovascular disease were recruited from cardiology clinics into a lifestyle intervention trial to prevent cognitive decline. Objectives were to ( a ) describe the results of modified recruitment/screening strategies to overcome pandemic-related challenges and ( b ) evaluate differences in age, race, and ethnicity between patients recruited/randomized, recruited/not randomized (entered recruitment but not randomized because of being ineligible or not interested), and not recruited (clinic patients who met preliminary criteria but did not enter recruitment).

METHODS

This was a cross-sectional descriptive analysis. In-person study strategies proposed before the COVID-19 pandemic were modified before study onset (September 2020). Women 65 years or older with cardiovascular disease were recruited from cardiology clinics by clinicians, posted flyers, and letters mailed to patients randomly selected from electronic health record data extractions. Patients were classified as recruited/randomized, recruited/not randomized, and not recruited.

RESULTS

Of 5719 patients potentially eligible, 1689 patients entered recruitment via referral (49.1%), posted flyers (0.5%), or mailed letters (50.3%), and 253 patients were successfully recruited/randomized. Recruited/randomized participants were, on average, 72.4 years old (range, 65-90 years old), non-Hispanic White (54.2%), non-Hispanic Black (38.3%), Hispanic/Latinx (1.6%), and other/not reported (5.1%). The recruited/randomized group was significantly younger with fewer patients of Hispanic/Latinx ethnicity compared with those not recruited.

CONCLUSIONS

During the pandemic, all recruitment/screening goals were met using modified strategies. Differences in sociodemographic representation indicate a need for tailored strategies.

DNP-PhD Collaboration in NINR-Funded Physical Activity Trials: A Series of Case Studies

Collaboration between Doctor of Nursing Practice (DNP) scholars and Doctor of Philosophy (PhD) scholars is crucial to efficiently advance and disseminate nursing science. Also, DNP-PhD collaboration can help achieve priorities outlined in the recent National Institute of Nursing Research (NINR) Strategic Plan. The purpose of this series of case studies is to describe exemplars of ongoing DNP-PhD collaborations across three NINR-funded trials (1 completed, 2 ongoing) testing physical activity interventions for women at risk for cardiovascular disease. In our three physical activity intervention trials for women, we categorized examples of DNP-PhD collaboration by the four phases of the team-based research model (development, conceptualization, implementation, and translation). Across all three trials, DNP and PhD scholars contributed successfully to all phases of research in an iterative manner. Future work should focus on expanding DNP-PhD collaboration in behavioral trials, which can inform adapted, contemporary models of iterative DNP-PhD collaboration.

Adherence to secondary prevention measures after acute coronary syndrome in patients associated exclusively with the public and private healthcare systems in Brazil

Adherence to secondary prevention measures after acute coronary syndrome (ACS) is essential to prevent disease recurrence. In Brazil, the Brazilian Unified Health System (SUS, in Portuguese), and the private healthcare system (PHCS) coexist. We aimed to evaluate the adherence to secondary prevention in patients with ACS who were assisted by either SUS or PHCS. In this longitudinal prospective study, patients with ACS were admitted to the four cardiological reference hospitals of Sergipe, three of which assisted PHCS users, and one, SUS users. We analyzed the two patient care models with multiple logistic regression models for adherence to physical activity, pharmacotherapy, and smoking cessation. We enrolled 581 volunteers in this study: 44.1 % from SUS and 55.9 % from PHCS. PHCS users showed greater adherence to pharmacotherapy at both 30 and 180 (p = 0.001) days after ACS with better results in all classes of medications (p < 0.05) than SUS users did. They also showed better adherence to physical activity (p = 0.047). There was no distinction between the groups regarding smoking cessation. The secondary prevention measures after ACS were more effective in PHCS users than in SUS users due to better adherence, especially to pharmacotherapy and regular physical activity.

Quality Care Alleviates Behavioral Cognitive Impairment and Reduces Complications in Elderly Patients with Cardiovascular and Cerebrovascular Diseases

Objective

Cardiovascular and cerebrovascular disease (CCVD) remains the most common factor of death around the world. Nursing care plays a key role in the recovery of patients with CCVD. This study was to explore the application of quality care in aged patients with CCVD.

Methods

Totally, 74 aged CCVD patients admitted from June 2018 to June 2019 in Dongying People's Hospital were randomly assigned in 2 groups with the same treatment. The control group was treated with routine care intervention, and the observation group was treated with quality care intervention for 12 weeks. Meanwhile, the frequency of agitation behaviors and cognitive ability were assessed, and complication was counted.

Results

The observation group showed decreased Cohen-Mansfield Agitation Inventory (CAMI) scores from 47.31 ± 8.27 to 38.73 ± 6.94, raised Mini-Mental State Examination (MMSE) scores from 15.01 ± 3.9 to 19.34 ± 3.15 and Montreal Cognitive Assessment (MoCA) scores from 16.92 ± 5.48 to 20.37 ± 4.16, and reduced complications after quality care intervention.

Conclusion

Quality care intervention exerted a better application effect on aged CCVD patients, along with reduction of agitation, improvement of mental condition and behavioral cognitive function, and reduced complications.

Compensatory and Lifestyle-Based Brain Health Program for Subjective Cognitive Decline: Self-Implementation versus Coaching

Although recent studies have explored the potential of multidomain brain health programs, there is a dearth of literature on operationalizing this research to create a clinical treatment program specifically for subjective cognitive decline (SCD). Patients seen by geriatricians in primary care and by behavioral neurology services at our institution presenting with SCD were recruited via a patient-appropriate flyer. After all participants had a 1-h brain health consultation with a neuropsychologist and were provided with program materials, they were randomized to attend a 10-week intervention designed to support program implementation (N = 10) or the control group of implementing the program on their own (N = 11). The program included (1) a calendar-based executive and memory support system for compensatory training and (2) training in healthy lifestyle. There were no significant differences between groups for any outcomes. Participants across both groups showed significant improvements with moderate effect sizes in compensatory strategy use, anxiety symptoms, and daily functioning, which were sustained through 6-month follow-up. They also increased physical activity by the end of the intervention period but did not sustain this through 6-month follow-up. Our pilot study demonstrates preliminary feasibility of a cognitive compensatory and lifestyle-based brain health program. Additional research is recommended to further develop two potentially scalable implementation strategies—coaching and self-implementation after brief consultation.

A study protocol for MindMoves: A lifestyle physical activity and cognitive training intervention to prevent cognitive impairment in older women with cardiovascular disease

INTRODUCTION

Cognitive impairment (CI) and cardiovascular disease (CVD) disproportionately affect women compared to men, and CVD increases risk of CI. Physical activity and cognitive training can improve cognition in older adults and may have additive or synergistic effects. However, no combined intervention has targeted women with CVD or utilized a sustainable lifestyle approach. The purpose of the trial is to evaluate efficacy of MindMoves, a 24-week multimodal physical activity and cognitive training intervention, on cognition and serum biomarkers in older women with CVD. Three serum biomarkers (brain-derived neurotrophic factor [BDNF], vascular endothelial growth factor [VEGF], and insulin-like growth factor 1 [IGF-1]) were selected as a priori hypothesized indicators of the effects of physical activity and/or cognitive training on cognition.

METHODS

The study design is a randomized controlled trial with a 2 × 2 factorial design, to determine independent and combined efficacies of Mind (tablet-based cognitive training) and Move (lifestyle physical activity with goal-setting and group meetings) on change in cognition (primary outcome) and serum biomarkers (secondary outcomes). We will recruit 254 women aged ≥65 years with CVD and without CI from cardiology clinics. Women will be randomized to one of four conditions: (1) Mind, (2) Move, (3) MindMoves, or (4) usual care. Data will be obtained from participants at baseline, 24, 48, and 72 weeks.

DISCUSSION

This study will test efficacy of a lifestyle-focused intervention to prevent or delay cognitive impairment in older women with CVD and may identify relevant serum biomarkers that could be used as early indicators of intervention response.