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Klinkovskij A, Shepelev M, Isaakyan Y, Aniskin D, Ulasov I. Advances of Genome Editing with CRISPR/Cas9 in Neurodegeneration: The Right Path towards Therapy. Biomedicines 2023; 11:3333. [PMID: 38137554 PMCID: PMC10741756 DOI: 10.3390/biomedicines11123333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
The rate of neurodegenerative disorders (NDDs) is rising rapidly as the world's population ages. Conditions such as Alzheimer's disease (AD), Parkinson's disease (PD), and dementia are becoming more prevalent and are now the fourth leading cause of death, following heart disease, cancer, and stroke. Although modern diagnostic techniques for detecting NDDs are varied, scientists are continuously seeking new and improved methods to enable early and precise detection. In addition to that, the present treatment options are limited to symptomatic therapy, which is effective in reducing the progression of neurodegeneration but lacks the ability to target the root cause-progressive loss of neuronal functioning. As a result, medical researchers continue to explore new treatments for these conditions. Here, we present a comprehensive summary of the key features of NDDs and an overview of the underlying mechanisms of neuroimmune dysfunction. Additionally, we dive into the cutting-edge treatment options that gene therapy provides in the quest to treat these disorders.
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Affiliation(s)
- Aleksandr Klinkovskij
- Group of Experimental Biotherapy and Diagnostics, Institute for Regenerative Medicine, World-Class Research Centre “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia; (A.K.); (D.A.)
| | - Mikhail Shepelev
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Institute of Gene Biology, Russian Academy of Sciences, 34/5 Vavilova Str., Moscow 119334, Russia
| | - Yuri Isaakyan
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), 8 Trubetskaya Str., Moscow 119991, Russia;
| | - Denis Aniskin
- Group of Experimental Biotherapy and Diagnostics, Institute for Regenerative Medicine, World-Class Research Centre “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia; (A.K.); (D.A.)
| | - Ilya Ulasov
- Group of Experimental Biotherapy and Diagnostics, Institute for Regenerative Medicine, World-Class Research Centre “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia; (A.K.); (D.A.)
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Vuori O, Kallio EL, Wikström A, Jokinen H, Hietanen M. Web-based psychoeducational interventions for managing cognitive impairment-a systematic review. Front Neurol 2023; 14:1249995. [PMID: 37780726 PMCID: PMC10535106 DOI: 10.3389/fneur.2023.1249995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Objective Web-based rehabilitation, a branch of telerehabilitation, is carried out over the internet, unrestricted by time or place. Even though web-based interventions have been reported as feasible and effective in cases of mood disorders, for example, such evidence on the effectiveness of web-based cognitive rehabilitation remains unclear. This systematic review summarizes current knowledge on web-based psychoeducational programs aiming to manage cognitive deficits in patients with diseases that affect cognition. Methods Using the Ovid database and the Web of Science, we systematically searched the Cochrane Database of Systematic Reviews, Medline, and PsycINFO to identify eligible studies. The review protocol (CRD42021257315) was pre-registered with the PROSPERO International Prospective Register of Systematic Reviews. The search was performed 10/13/2022. Two reviewers independently screened titles, abstracts, and full-texts, and extracted data for the selected studies. Two independent reviewers assessed the methodological quality. Results The search retrieved 6,487 articles. Four studies with different patient groups (stroke, traumatic brain injury, brain tumor, and cancer) met the inclusion criteria of this systematic review. The studies examined systematic cognition-focused psychoeducational rehabilitation programs in which the patient worked independently. Three studies found positive effects on subjective cognitive functions, executive functions, and self-reported memory. No effects were found on objective cognitive functions. However, the studies had methodological weaknesses (non-randomized designs, small sample sizes, vaguely described interventions). Overall, adherence and patient satisfaction were good/excellent. Conclusion Web-based cognitive intervention programs are a new approach to rehabilitation and patient education. The evidence, although scarce, shows that web-based interventions are feasible and support subjective cognitive functioning. However, the literature to date is extremely limited and the quality of the studies is weak. More research with high-quality study designs is needed. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=257315, identifier: CRD42021257315.
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Affiliation(s)
- Outi Vuori
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Division of Neuropsychology, HUS Neurocenter, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Eeva-Liisa Kallio
- Division of Neuropsychology, HUS Neurocenter, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Annamaria Wikström
- Division of Neuropsychology, HUS Neurocenter, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Jokinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Division of Neuropsychology, HUS Neurocenter, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Marja Hietanen
- Division of Neuropsychology, HUS Neurocenter, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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Nanousi V, Kalogeraki K, Smyrnaiou A, Tola M, Bokari F, Georgopoulos VC. The Development of a Pilot App Targeting Short-Term and Prospective Memory in People Diagnosed with Dementia. Behav Sci (Basel) 2023; 13:752. [PMID: 37754030 PMCID: PMC10525938 DOI: 10.3390/bs13090752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND According to the World Health Organization, people suffering from dementia exhibit a serious decline in various cognitive domains and especially in memory. AIMS This study aims to create a pilot computer app to enhance short-term memory and prospective memory in individuals with dementia using errorless learning based on their individualized needs. METHODS Fifteen dementia patients and matched controls, matched for age, sex, and education, were selected. Their daily routines were analyzed, and cognitive abilities were assessed using the MoCA test. Considering the participants' illness severity and daily needs, the pilot app was designed to aid in remembering daily tasks (taking medication and meals), object locations, and familiar faces and names. RESULTS An improvement in patients' short-term and prospective memory throughout the training sessions, but not in overall cognitive functioning was observed. A statistically significant difference between patients and healthy controls was indicated in their ability to retain information relevant to them in their short-term memory, or to remember to act in the future following schedules organized at present (p < 0.001). CONCLUSION This app appears beneficial for training dementia patients and healthy individuals in addressing memory challenges. RECOMMENDATION While the pilot app showed promise, further research with larger samples is recommended.
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Affiliation(s)
- Vicky Nanousi
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece
| | - Konstantina Kalogeraki
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece
| | - Aikaterini Smyrnaiou
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece
| | - Manila Tola
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece
| | - Foteini Bokari
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece
| | - Voula Chris Georgopoulos
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece
- Primary Health Care Laboratory, School of Health Rehabilitation Sciences, University of Patras, 26504 Patras, Greece
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Rute-Pérez S, Rodríguez-Domínguez C, Vélez-Coto M, Pérez-García M, Caracuel A. Effectiveness of Computerized Cognitive Training by VIRTRAEL on Memory and Executive Function in Older People: A Pilot Study. Brain Sci 2023; 13:brainsci13040684. [PMID: 37190649 DOI: 10.3390/brainsci13040684] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/15/2023] [Accepted: 04/16/2023] [Indexed: 05/17/2023] Open
Abstract
The prevalence of people over 60 years of age with cognitive impairment has increased in recent decades. As a consequence, numerous computerized cognitive trainings (CCT) have been developed. This pilot study aimed to determine the effectiveness of the CCT with VIRTRAEL in improving older adults' cognition. Fifty-five participants (x¯ = 72.7 years; SD = 6.5) underwent CCT, and twenty participants (x¯ = 76.1 years; SD = 7.6) received face-to-face cognitive stimulation with a paper-and-pencil methodology. Both trainings were conducted in nine sessions (45-60 min each). Participants completed a pre-post training neuropsychological assessment. ANCOVAs and the standardized clinical change were performed. VIRTRAEL's group showed a significant and greater improvement in verbal learning (p < 0.006) and delayed recall (p ≤ 0.001), working memory (p < 0.005), abstract (p < 0.002) and semantic reasoning (p < 0.015), and planning (p < 0.021). Additionally, more large clinical changes (d > 0.8) were found in the VIRTRAEL condition (in verbal learning and delayed free and cued recall) than in the standard group. Here we show that the CCT with VIRTRAEL is effective in improving cognitive function in older adults and is superior to the standard format. These preliminary findings indicate that CCT is a useful tool potentially applicable in the fight against cognitive symptomatology associated with aging and neurodegenerative diseases. VIRTRAEL represents a breakthrough in this field as it is inexpensive and easily accessible to any older person, regardless of whether they live far from health care resources.
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Affiliation(s)
- Sandra Rute-Pérez
- CIMCYC-Mind, Brain and Behavior Research Center, University of Granada, 18011 Granada, Spain
- Department of Developmental and Educational Psychology, Faculty of Education Sciences, University of Granada, 18011 Granada, Spain
| | - Carlos Rodríguez-Domínguez
- Department of Computer Languages and Systems, Faculty of Education, Economy and Technology of Ceuta, University of Granada, 51001 Granada, Spain
| | - María Vélez-Coto
- Department of Psychology, Catholic University of Murcia, Guadalupe, 30107 Murcia, Spain
| | - Miguel Pérez-García
- CIMCYC-Mind, Brain and Behavior Research Center, University of Granada, 18011 Granada, Spain
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, 18011 Granada, Spain
| | - Alfonso Caracuel
- CIMCYC-Mind, Brain and Behavior Research Center, University of Granada, 18011 Granada, Spain
- Department of Developmental and Educational Psychology, Faculty of Education Sciences, University of Granada, 18011 Granada, Spain
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Huynh K, Nategh L, Jamadar S, Stout J, Georgiou-Karistianis N, Lampit A. Cognition-oriented treatments and physical exercise on cognitive function in Huntington's disease: a systematic review. J Neurol 2023; 270:1857-1879. [PMID: 36513779 DOI: 10.1007/s00415-022-11516-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/02/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
Cognitive impairment is prevalent in Huntington's disease (HD), with no treatments currently available. While cognition-oriented treatments and physical exercise have shown efficacy in improving cognition in other populations, they have not been systematically reviewed in HD. This systematic review aims to examine the effects of cognitive and exercise interventions on cognition in HD, along with effects on psychosocial function, functional independence, and neuroimaging outcomes. Seventeen studies (three cognitive, seven exercise, seven combining cognitive and physical exercise) were included. While there was generally low certainty of evidence, interventions that included cognitive training appeared to have larger effect sizes on cognition, while physical exercise (alone or combined with cognitive rehabilitation or stimulation) showed negligible effect sizes. On the other hand, combined interventions had larger effects on psychosocial function. Finally, effects on functional independence appeared negligible following exercise and combined interventions, and effects on neuroimaging outcomes were inconclusive. Larger studies should seek to confirm the benefits of cognitive and physical interventions, and further explore changes in functional independence and neural outcomes.
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Affiliation(s)
- Katharine Huynh
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, 18 Innovation Walk, Clayton, Victoria, 3800, Australia
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Grattan St, Parkville, Victoria, 3010, Australia
| | - Leila Nategh
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Grattan St, Parkville, Victoria, 3010, Australia
| | - Sharna Jamadar
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, 18 Innovation Walk, Clayton, Victoria, 3800, Australia
- Monash Biomedical Imaging, Monash University, 770 Blackburn Rd, Clayton, Victoria, 3800, Australia
| | - Julie Stout
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, 18 Innovation Walk, Clayton, Victoria, 3800, Australia
| | - Nellie Georgiou-Karistianis
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, 18 Innovation Walk, Clayton, Victoria, 3800, Australia.
| | - Amit Lampit
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Grattan St, Parkville, Victoria, 3010, Australia
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Effects of Mindfulness-Based Interventions (MBIs) in Patients with Early-Stage Alzheimer’s Disease: A Pilot Study. Brain Sci 2023; 13:brainsci13030484. [PMID: 36979294 PMCID: PMC10046197 DOI: 10.3390/brainsci13030484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
Bachground In this study, we hypothesize that mindfulness-based interventions (MBIs) may improve well-being and the related outcomes in Alzheimer’s dementia patients (AD-P) at an early stage. MBIs consist of the practice of consciously observing the psychic contents in the present moment (thoughts, sensations, feelings, and other events). This attention allows one to become aware of the psychic contents and integrate them, thus favoring the quality of life and an increase in the mood of practitioners. Methods The randomized controlled study enrolled 22 AD-P at an early stage (age ≥ 60 years) treated with MBIs and 22 patients without treatment (six months of MBI training). Tests (T0–T1 six months): Mini-Mental State Examination (MMPI); Spiritual Well-Being (SWB); Beck Depression Inventory (BDI); SF36. Test-Caregiver: Everyday Cognition scales (ECOG). Results AD-P with mindfulness: Improvement of ECOG (p = 0.026), quality of life (p < 0.001), spiritual well-being (p < 0.001); decrease in depression BDI (p < 0.001). The MMSE remains unchanged. The control group of untreated patients showed a significant worsening in all these dimensions. Conclusions MBI training is effective in increasing quality of life and preventing worsening in patients with early-stage Alzheimer’s dementia.
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Computer-Based Cognitive Training vs. Paper-and-Pencil Training for Language and Cognitive Deficits in Greek Patients with Mild Alzheimer's Disease: A Preliminary Study. Healthcare (Basel) 2023; 11:healthcare11030443. [PMID: 36767018 PMCID: PMC9914594 DOI: 10.3390/healthcare11030443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
The purpose of the present study was to explore whether Computer-Based Cognitive Training (C-BCT) versus Paper-Pencil Cognitive Training (P-PCT) is more beneficial in improving cognitive and language deficits in Greek patients living with Alzheimer's disease (pwAD). Twenty pwAD were assigned to two groups: (a) the C-BCT group, receiving a computer-based cognitive training program using the RehaCom software, and (b) the P-PCT group, which received cognitive training using paper and pencil. The cognitive training programs lasted 15 weeks and were administered twice a week for approximately one hour per session. The analyses of each group's baseline versus endpoint performance demonstrated that the P-PCT group improved on delayed memory, verbal fluency, attention, processing speed, executive function, general cognitive ability, and activities of daily living. In contrast, the C-BCT group improved on memory (delayed and working), naming, and processing speed. Comparisons between the two groups (C-BCT vs. P-PCT) revealed that both methods had significant effects on patients' cognition, with the P-PCT method transferring the primary cognitive benefits to real-life activities. Our findings indicate that both methods are beneficial in attenuating cognitive and language deficits in pwAD. The need for large-scale neurobehavioral interventions to further clarify this issue, however, remains a priority.
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Shusharina N, Yukhnenko D, Botman S, Sapunov V, Savinov V, Kamyshov G, Sayapin D, Voznyuk I. Modern Methods of Diagnostics and Treatment of Neurodegenerative Diseases and Depression. Diagnostics (Basel) 2023; 13:diagnostics13030573. [PMID: 36766678 PMCID: PMC9914271 DOI: 10.3390/diagnostics13030573] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 02/09/2023] Open
Abstract
This paper discusses the promising areas of research into machine learning applications for the prevention and correction of neurodegenerative and depressive disorders. These two groups of disorders are among the leading causes of decline in the quality of life in the world when estimated using disability-adjusted years. Despite decades of research, the development of new approaches for the assessment (especially pre-clinical) and correction of neurodegenerative diseases and depressive disorders remains among the priority areas of research in neurophysiology, psychology, genetics, and interdisciplinary medicine. Contemporary machine learning technologies and medical data infrastructure create new research opportunities. However, reaching a consensus on the application of new machine learning methods and their integration with the existing standards of care and assessment is still a challenge to overcome before the innovations could be widely introduced to clinics. The research on the development of clinical predictions and classification algorithms contributes towards creating a unified approach to the use of growing clinical data. This unified approach should integrate the requirements of medical professionals, researchers, and governmental regulators. In the current paper, the current state of research into neurodegenerative and depressive disorders is presented.
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Affiliation(s)
- Natalia Shusharina
- Baltic Center for Neurotechnologies and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236041 Kaliningrad, Russia
- Correspondence:
| | - Denis Yukhnenko
- Department of Social Security and Humanitarian Technologies, N. I. Lobachevsky State University of Nizhny Novgorod, 603022 Nizhny Novgorod, Russia
| | - Stepan Botman
- Baltic Center for Neurotechnologies and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236041 Kaliningrad, Russia
| | - Viktor Sapunov
- Baltic Center for Neurotechnologies and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236041 Kaliningrad, Russia
| | - Vladimir Savinov
- Baltic Center for Neurotechnologies and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236041 Kaliningrad, Russia
| | - Gleb Kamyshov
- Baltic Center for Neurotechnologies and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236041 Kaliningrad, Russia
| | - Dmitry Sayapin
- Baltic Center for Neurotechnologies and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236041 Kaliningrad, Russia
| | - Igor Voznyuk
- Baltic Center for Neurotechnologies and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236041 Kaliningrad, Russia
- Department of Neurology, Pavlov First Saint Petersburg State Medical University, 197022 Saint Petersburg, Russia
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Lee J, Kim J, Park A, Hong RK, Ko M, Heo M, Kim H, Chung JY. Efficacy of a Mobile-Based Multidomain Intervention to Improve Cognitive Function and Health-Related Outcomes Among Older Korean Adults with Subjective Cognitive Decline. J Alzheimers Dis 2023; 93:1551-1562. [PMID: 37212108 PMCID: PMC10357136 DOI: 10.3233/jad-221299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Subjective cognitive decline (SCD) is a self-reported experience of declining cognitive function showing normal performance in cognitive assessments, which is a known risk factor for dementia. Recent studies highlight the importance of nonpharmacological multidomain interventions that can target multiple risk factors of dementia in older adults. OBJECTIVE This study investigated the efficacy of the Silvia program, a mobile-based multidomain intervention, to improve cognitive function and health-related outcomes of older adults with SCD. We compare its effects to a conventional paper-based multidomain program on various health indicators related to risk factors of dementia. METHODS This prospective randomized controlled trial involved 77 older adults with SCD recruited from the Dementia Prevention and Management Center in Gwangju, South Korea during May to October 2022. Participants were randomly assigned to either the mobile- or paper-based group. Interventions were administered for 12 weeks, where pre- and post-assessments were conducted. RESULTS The K-RBANS total score did not show significant differences between groups. The mobile group showed better improvement in K-PRMQ scores and PSS scores than the paper group. Differences within groups showed that mobile-based interventions significantly improved K-PRMQ, STAI-X-1, PSS, and EQ-5D-5 L scores, while paper-based interventions significantly improved PSS, and EQ-5D-5 L scores. Patient adherence rate was 76.6%. CONCLUSION Overall, the Silvia program was effective for improving self-reported memory failures, stress, anxiety, and health-related quality of life in older adults with SCD. However, longer periods of administration for more than 12 weeks may be needed to achieve significant improvements in cognitive function by objective measures.
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Affiliation(s)
| | | | | | | | | | - Mina Heo
- Gwangju Alzheimer’s Disease and Related Dementia Cohort Research Center, Chosun University, Gwangju, South Korea
| | - Hoowon Kim
- Department of Neurology, School of Medicine, Chosun University, Chosun University Hospital, Gwangju, South Korea
| | - Ji Yeon Chung
- Department of Neurology, School of Medicine, Chosun University, Chosun University Hospital, Gwangju, South Korea
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Falkenreck JM, Kunkler MC, Ophey A, Weigert H, Friese A, Jahr P, Nelles G, Kalbe E, Polidori MC. Effects of the Multicomponent Cognitive Training Program BrainProtect in Cognitively Healthy Adults: A Randomized Controlled Trial. J Alzheimers Dis 2023; 94:1013-1034. [PMID: 37393493 DOI: 10.3233/jad-220619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Abstract
BACKGROUND Cognitive integrity is a fundamental driver of health. The exact structure of strategies against cognitive impairment is still under debate. OBJECTIVE To compare the short-term effects of a multicomponent cognitive training (BrainProtect) with those of general health counseling (GHC) on cognitive abilities and health-related quality of life (HRQoL) in healthy adults in Germany. METHODS In this parallel randomized controlled trial (RCT), 132 eligible cognitively healthy adults (age ≥50 years, Beck Depression Inventory ≤9/63; Montreal Cognitive Assessment ≥26/30) were randomized to either GHC (N = 72) or to intervention with BrainProtect (intervention group, IG; N = 60). IG participants received 8 weekly sessions of 90 min of the group-based BrainProtect program focusing on executive functions, concentration, learning, perception, and imagination, plus nutritional and physical exercise units. Before and after intervention, all participants underwent neuropsychological testing and HRQoL evaluation, blinded for pretest. RESULTS No significant training effect was observed for the primary endpoint of global cognition as assessed by CERAD-Plus-z Total Score (p = 0.113; ηp2 = 0.023). Improvements in several cognitive subtests were shown in the IG (N = 53) compared to the GHC (N = 62) without adverse events. Differences reached significance for verbal fluency (p = 0.021), visual memory (p = 0.013), visuo-constructive functions (p = 0.034), and HRQoL (p = 0.009). Significance was lost after adjustment, though several changes were clinically relevant. CONCLUSION BrainProtect did not significantly impact global cognition in this RCT. Nevertheless, the results of some outcomes indicate clinically meaningful changes, so that a strengthening of the cognitive performance by BrainProtect cannot be excluded. Further studies with larger sample size are needed to confirm these findings.
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Affiliation(s)
- Julia Maria Falkenreck
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michelle Celine Kunkler
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Anja Ophey
- Department of Medical Psychology ∣ Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Hannah Weigert
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | | | | | - Elke Kalbe
- Department of Medical Psychology ∣ Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - M Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Bofanova NS, Tychkov AY, Khanfar YA, Zolotarev RV. [Virtual reality technology as a promising direction in neurorehabilitation]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:131-136. [PMID: 36719129 DOI: 10.17116/jnevro2023123011131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Nervous system damage affects more than a billion people worldwide and is one of the leading causes of cognitive impairment. An urgent issue in modern medicine is the neurorehabilitation of this particular group of patients. The purpose of this article is to search for new approaches to achieve more effective recovery of cognitive functions, precisely by using virtual reality technology as a promising direction in neurorehabilitation. It has been shown that neurobiological effects of virtual reality have a positive effect on the plasticity of neurons, improve cognitive functions and positively affect the psychoemotional state. A case of the positive impact of being in the virtual environment «Outer Space» in a female patient with cognitive impairment and chronic pain is presented.
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Singh A, Chakraborty S, He Z, Tian S, Zhang S, Lustria MLA, Charness N, Roque NA, Harrell ER, Boot WR. Deep learning-based predictions of older adults' adherence to cognitive training to support training efficacy. Front Psychol 2022; 13:980778. [PMID: 36467206 PMCID: PMC9713845 DOI: 10.3389/fpsyg.2022.980778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022] Open
Abstract
As the population ages, the number of older adults experiencing mild cognitive impairment (MCI), Alzheimer's disease, and other forms of dementia will increase dramatically over the next few decades. Unfortunately, cognitive changes associated with these conditions threaten independence and quality of life. To address this, researchers have developed promising cognitive training interventions to help prevent or reverse cognitive decline and cognitive impairment. However, the promise of these interventions will not be realized unless older adults regularly engage with them over the long term, and like many health behaviors, adherence to cognitive training interventions can often be poor. To maximize training benefits, it would be useful to be able to predict when adherence lapses for each individual, so that support systems can be personalized to bolster adherence and intervention engagement at optimal time points. The current research uses data from a technology-based cognitive intervention study to recognize patterns in participants' adherence levels and predict their future adherence to the training program. We leveraged the feature learning capabilities of deep neural networks to predict patterns of adherence for a given participant, based on their past behavior. A separate, personalized model was trained for each participant to capture individualistic features of adherence. We posed the adherence prediction as a binary classification problem and exploited multivariate time series analysis using an adaptive window size for model training. Further, data augmentation techniques were used to overcome the challenge of limited training data and enhance the size of the dataset. To the best of our knowledge, this is the first research effort to use advanced machine learning techniques to predict older adults' daily adherence to cognitive training programs. Experimental evaluations corroborated the promise and potential of deep learning models for adherence prediction, which furnished highest mean F-scores of 75.5, 75.5, and 74.6% for the Convolution Neural Network (CNN), Long Short-Term Memory (LSTM) network, and CNN-LSTM models respectively.
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Affiliation(s)
- Ankita Singh
- Department of Computer Science, Florida State University, Tallahassee, FL, United States
| | - Shayok Chakraborty
- Department of Computer Science, Florida State University, Tallahassee, FL, United States,*Correspondence: Shayok Chakraborty
| | - Zhe He
- School of Information, Florida State University, Tallahassee, FL, United States,College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Shubo Tian
- Department of Statistics, Florida State University, Tallahassee, FL, United States
| | - Shenghao Zhang
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Mia Liza A. Lustria
- School of Information, Florida State University, Tallahassee, FL, United States
| | - Neil Charness
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Nelson A. Roque
- Department of Psychology, University of Central Florida, Orlando, FL, United States
| | - Erin R. Harrell
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, United States
| | - Walter R. Boot
- Department of Psychology, Florida State University, Tallahassee, FL, United States
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He Z, Tian S, Singh A, Chakraborty S, Zhang S, Lustria MLA, Charness N, Roque NA, Harrell ER, Boot WR. A Machine-Learning Based Approach for Predicting Older Adults' Adherence to Technology-Based Cognitive Training. Inf Process Manag 2022; 59:103034. [PMID: 35909793 PMCID: PMC9337718 DOI: 10.1016/j.ipm.2022.103034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Adequate adherence is a necessary condition for success with any intervention, including for computerized cognitive training designed to mitigate age-related cognitive decline. Tailored prompting systems offer promise for promoting adherence and facilitating intervention success. However, developing adherence support systems capable of just-in-time adaptive reminders requires understanding the factors that predict adherence, particularly an imminent adherence lapse. In this study we built machine learning models to predict participants' adherence at different levels (overall and weekly) using data collected from a previous cognitive training intervention. We then built machine learning models to predict adherence using a variety of baseline measures (demographic, attitudinal, and cognitive ability variables), as well as deep learning models to predict the next week's adherence using variables derived from training interactions in the previous week. Logistic regression models with selected baseline variables were able to predict overall adherence with moderate accuracy (AUROC: 0.71), while some recurrent neural network models were able to predict weekly adherence with high accuracy (AUROC: 0.84-0.86) based on daily interactions. Analysis of the post hoc explanation of machine learning models revealed that general self-efficacy, objective memory measures, and technology self-efficacy were most predictive of participants' overall adherence, while time of training, sessions played, and game outcomes were predictive of the next week's adherence. Machine-learning based approaches revealed that both individual difference characteristics and previous intervention interactions provide useful information for predicting adherence, and these insights can provide initial clues as to who to target with adherence support strategies and when to provide support. This information will inform the development of a technology-based, just-in-time adherence support systems.
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Affiliation(s)
- Zhe He
- School of Information, Florida State University, Tallahassee, Florida USA
- College of Medicine, Florida State University, Tallahassee, Florida USA
| | - Shubo Tian
- Department of Statistics, Florida State University, Tallahassee, Florida USA
| | - Ankita Singh
- Department of Computer Science, Florida State University, Tallahassee, Florida USA
| | - Shayok Chakraborty
- Department of Computer Science, Florida State University, Tallahassee, Florida USA
| | - Shenghao Zhang
- Department of Psychology, Florida State University, Tallahassee, Florida USA
| | - Mia Liza A. Lustria
- School of Information, Florida State University, Tallahassee, Florida USA
- College of Medicine, Florida State University, Tallahassee, Florida USA
| | - Neil Charness
- Department of Psychology, Florida State University, Tallahassee, Florida USA
| | - Nelson A. Roque
- Department of Psychology, University of Central Florida, Orlando, Florida USA
| | - Erin R. Harrell
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama USA
| | - Walter R. Boot
- Department of Psychology, Florida State University, Tallahassee, Florida USA
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Miao Y, Cui L, Li J, Chen Y, Xie X, Guo Q. Cognitive Improvement After Multi-Domain Lifestyle Interventions in an APOE ɛ4 Homozygous Carrier with Mild Cognitive Impairment: A Case Report and Literature Review. J Alzheimers Dis 2022; 89:1131-1142. [DOI: 10.3233/jad-220374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alzheimer’s disease (AD) is a degenerative disease of the central nervous system with insidious onset and chronic progression. The pathogenesis of AD is complex, which is currently considered to be the result of the interaction between genetic and environmental factors. The APOE ɛ4 is the strongest genetic risk factor for sporadic AD and a risk factor for progression from mild cognitive impairment (MCI) to AD. So far, no effective drugs have been found for the progression of MCI. However, the effects of nonpharmacological interventions such as nutrition, cognitive, and physical exercises on early AD have received increasing attention. We followed up cognitive assessment scales, Aβ-PET and MRI examination of a patient with MCI for 4 years, who carried APOE ɛ4 homozygous with a clear family history. After 4 years of multi-domain lifestyle interventions including nutrition, socialization, and physical exercises, the patient’s cognitive function, especially memory function, improved significantly. Intracerebral amyloid deposition was decreased, and hippocampal atrophy improved. Based on this case, this study reviewed and discussed the interaction of APOE ɛ4 with the environment in AD research in recent years, as well as the impact and mechanisms of non-pharmaceutical multi-domain lifestyle interventions on MCI or early AD. Both the literature review and this case showed that multi-domain lifestyle interventions may reduce the risk of disease progression by reducing Aβ deposition in the brain and other different pathologic mechanisms, which offers promise in brain amyloid-positivity or APOE ɛ4 carriers.
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Affiliation(s)
- Ya Miao
- Department of Geriatrics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Liang Cui
- Department of Geriatrics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Junpeng Li
- PET Center, Fudan University Affiliated Huashan Hospital, Shanghai, China
| | - Yixin Chen
- Department of Geriatrics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Xiangqing Xie
- Department of Geriatrics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Qihao Guo
- Department of Geriatrics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
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Galvin-McLaughlin D, Klee D, Memmott T, Peters B, Wiedrick J, Fried-Oken M, Oken B. Methodology and preliminary data on feasibility of a neurofeedback protocol to improve visual attention to letters in mild Alzheimer's disease. Contemp Clin Trials Commun 2022; 28:100950. [PMID: 35754975 PMCID: PMC9228283 DOI: 10.1016/j.conctc.2022.100950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/11/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022] Open
Abstract
Background Brain-computer interface (BCI) systems are controlled by users through neurophysiological input for a variety of applications, including communication, environmental control, and motor rehabilitation. Although individuals with severe speech and physical impairment are the primary users of this technology, BCIs have emerged as a potential tool for broader populations, including delivering cognitive training/interventions with neurofeedback (NFB). Methods This paper describes the development and preliminary testing of a protocol for use of a BCI system with NFB as an intervention for people with mild Alzheimer's disease (AD). The intervention focused on training visual attention and language skills, as AD is often associated with functional impairments in both. This funded pilot study called for enrolling five participants with mild AD in a six-week BCI EEG-based NFB intervention that followed a four-to-seven-week baseline phase. While two participants completed the study, the remaining three participants could not complete the intervention phase because of COVID-19 restrictions. Results Preliminary pilot results suggested: (1) participants with mild AD were able to participate in a study with multiple assessments per week and complete all outcome measures, (2) most outcome measures were reliable during the baseline phase, and (3) all participants with mild AD learned to operate a BCI spelling system with training. Conclusions Although preliminary results demonstrate practical feasibility to deliver NFB intervention using a BCI to adults with AD, completion of the protocol in its entirety with more participants is needed to further assess whether implementing NFB-based cognitive intervention is justified by functional treatment outcomes. Trial registration This study was registered with ClinicalTrials.gov (NCT03790774).
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Affiliation(s)
- Deirdre Galvin-McLaughlin
- Institute on Development & Disability, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Daniel Klee
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Tab Memmott
- Institute on Development & Disability, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Betts Peters
- Institute on Development & Disability, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Jack Wiedrick
- Biostatistics & Design Program, Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Melanie Fried-Oken
- Institute on Development & Disability, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
- Department of Otolaryngology, Oregon Health & Science University, Portland, OR, USA
| | - Barry Oken
- Institute on Development & Disability, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA
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16
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Kognitive Interventionen bei der Alzheimer-Krankheit. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2022; 90:344-351. [PMID: 35858612 DOI: 10.1055/a-1869-4377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Cognitive interventions (CI) are an important part in the treatment of Alzheimer's disease (AD). These non-pharamcological treatment options are manifold and can be matched to a patient's particular symptoms and needs. This article gives an overview of CIs and their theoretical background, as well as empirical evidence concerning their efficacy at different stages of the disease. Specific determinants of their effectiveness and possible clinical applications are discussed, while also recent developments, such as computer-based CIs, are considered.
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17
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Suárez-Méndez I, Bruña R, López-Sanz D, Montejo P, Montenegro-Peña M, Delgado-Losada ML, Marcos Dolado A, López-Higes R, Maestú F. Cognitive Training Modulates Brain Hypersynchrony in a Population at Risk for Alzheimer's Disease. J Alzheimers Dis 2022; 86:1185-1199. [PMID: 35180120 DOI: 10.3233/jad-215406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent studies demonstrated that brain hypersynchrony is an early sign of dysfunction in Alzheimer's disease (AD) that can represent a proxy for clinical progression. Conversely, non-pharmacological interventions, such as cognitive training (COGTR), are associated with cognitive gains that may be underpinned by a neuroprotective effect on brain synchrony. OBJECTIVE To study the potential of COGTR to modulate brain synchrony and to eventually revert the hypersynchrony phenomenon that characterizes preclinical AD. METHODS The effect of COGTR was examined in a sample of healthy controls (HC, n = 41, 22 trained) and individuals with subjective cognitive decline (SCD, n = 49, 24 trained). Magnetoencephalographic (MEG) activity and neuropsychological scores were acquired before and after a ten-week COGTR intervention aimed at improving cognitive function and daily living performance. Functional connectivity (FC) was analyzed using the phase-locking value. A mixed-effects ANOVA model with factors time (pre-intervention/post-intervention), training (trained/non-trained), and diagnosis (HC/SCD) was used to investigate significant changes in FC. RESULTS We found an average increase in alpha-band FC over time, but the effect was different in each group (trained and non-trained). In the trained group (HC and SCD), we report a reduction in the increase in FC within temporo-parietal and temporo-occipital connections. In the trained SCD group, this reduction was stronger and showed a tentative correlation with improved performance in different cognitive tests. CONCLUSION COGTR interventions could mitigate aberrant increases in FC in preclinical AD, promoting brain synchrony normalization in groups at a higher risk of developing dementia.
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Affiliation(s)
- Isabel Suárez-Méndez
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Center for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Madrid, Spain.,Departamento de Estructura de la Materia, Física Térmica y Electrónica, Universidad Complutense de Madrid (UCM), Facultad de Ciencias Físicas, Madrid, Spain.,Department of Experimental Psychology, Faculty of Psychology, Complutense University of Madrid (UCM), Madrid, Spain
| | - Ricardo Bruña
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Center for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Madrid, Spain.,Department of Experimental Psychology, Faculty of Psychology, Complutense University of Madrid (UCM), Madrid, Spain.,Networking Research Center on Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - David López-Sanz
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Center for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Madrid, Spain.,Department of Psychobiology, Faculty of Psychology, Complutense University of Madrid (UCM), Madrid, Spain
| | - Pedro Montejo
- Center for the Prevention of Cognitive Impairment (Madrid Salud), Madrid City Council, Spain
| | - Mercedes Montenegro-Peña
- Department of Experimental Psychology, Faculty of Psychology, Complutense University of Madrid (UCM), Madrid, Spain.,Center for the Prevention of Cognitive Impairment (Madrid Salud), Madrid City Council, Spain
| | - María Luisa Delgado-Losada
- Department of Experimental Psychology, Faculty of Psychology, Complutense University of Madrid (UCM), Madrid, Spain
| | | | - Ramón López-Higes
- Department of Experimental Psychology, Faculty of Psychology, Complutense University of Madrid (UCM), Madrid, Spain
| | - Fernando Maestú
- Laboratory of Cognitive and Computational Neuroscience (UCM-UPM), Center for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Madrid, Spain.,Department of Experimental Psychology, Faculty of Psychology, Complutense University of Madrid (UCM), Madrid, Spain.,Networking Research Center on Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), Madrid, Spain
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18
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Neuronavigated Magnetic Stimulation combined with cognitive training for Alzheimer's patients: an EEG graph study. GeroScience 2021; 44:159-172. [PMID: 34970718 DOI: 10.1007/s11357-021-00508-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022] Open
Abstract
Alzheimer's disease (AD) is the most common neurodegenerative disorder in elderly subjects. Recent studies verified the effects of cognitive training combined with repetitive transcranial magnetic stimulation (rTMS-COG) in AD patients. Here, we analyzed neuropsychological and neurophysiological data, derived from electroencephalography (EEG), to evaluate the effects of a 6-week protocol of rTMS-COG in 72 AD. We designed a randomized, double-blind, sham-controlled trial to evaluate efficacy of rTMS on 6 brain regions obtained by an individual MRI combined with COG related to brain areas to stimulate (i.e., syntax and grammar tasks, comprehension of lexical meaning and categorization tasks, action naming, object naming, spatial memory, spatial attention). Patients underwent neuropsychological and EEG examination before (T0), after treatment (T1), and after 40 weeks (T2), to evaluate the effects of rehabilitation therapy. "Small World" (SW) graph approach was introduced allowing us to model the architecture of brain connectivity in order to correlate it with cognitive improvements. We found that following 6 weeks of intensive daily treatment the immediate results showed an improvement in cognitive scales among AD patients. SW present no differences before and after the treatment, whereas a crucial SW modulation emerges at 40-week follow-up, emphasizing the importance of rTMS-COG rehabilitation treatment for AD. Additional results demonstrated that the delta and alpha1 SW seem to be diagnostic biomarkers of AD, whereas alpha2 SW might represent a prognostic biomarker of cognitive recovery. Derived EEG parameters can be awarded the role of diagnostic and predictive biomarkers of AD progression, and rTMS-COG can be regarded as a potentially useful treatment for AD.
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19
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Satler C, Faria ET, Rabelo GN, Garcia A, Tavares MCH. Inhibitory control training in healthy and highly educated older adults. Dement Neuropsychol 2021; 15:387-395. [PMID: 34630928 PMCID: PMC8485651 DOI: 10.1590/1980-57642021dn15-030012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/21/2021] [Indexed: 04/04/2024] Open
Abstract
Executive function training is considered a promising tool for delaying the natural effects of aging on cognition. However, there are still few studies that propose a unimodal intervention with a focus on inhibitory control, and none of them has studied the effect of this type of intervention on older adults (OA). OBJECTIVE The aim of this study is to investigate the benefits of inhibitory control training in healthy OA by comparing the two assessment time points, namely, before and after training. METHODS Twenty-seven participants were included after interview and checking the inclusion criteria. The training was based on the stop-signal paradigm and carried out in 21 sessions. RESULTS Participants performed better after training by reducing the false alarm error rate (i.e., for stop-signal trials), reducing omission error rate, showing an increase in hit rate, Go response time (i.e., for go-signal trials), stop-signal response time, and showing a decrease in the level of anxiety. The executive function training had no significant impact on the scores obtained in the complementary neuropsychological tests. CONCLUSIONS These results are consistent with previous studies that support the viability and effectiveness of cognitive intervention for executive functions in OA and suggest a positive effect of the intervention, which may be related to the learning experience of a new and challenging task.
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Affiliation(s)
- Corina Satler
- Faculdade de Ceilândia, Universidade de Brasília - Brasília, DF, Brazil
| | - Edison Tostes Faria
- Laboratory of Neuroscience and Behaviour, Department of Physiological Science, Institute of Biology, Universidade de Brasília - Brasília, DF, Brazil
| | - Gabriel Neiva Rabelo
- Laboratory of Neuroscience and Behaviour, Department of Physiological Science, Institute of Biology, Universidade de Brasília - Brasília, DF, Brazil
| | - Ana Garcia
- Laboratory of Neuroscience and Behaviour, Department of Physiological Science, Institute of Biology, Universidade de Brasília - Brasília, DF, Brazil
| | - Maria Clotilde Henriques Tavares
- Laboratory of Neuroscience and Behaviour, Department of Physiological Science, Institute of Biology, Universidade de Brasília - Brasília, DF, Brazil
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20
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Contreras-Somoza LM, Irazoki E, Toribio-Guzmán JM, de la Torre-Díez I, Diaz-Baquero AA, Parra-Vidales E, Perea-Bartolomé MV, Franco-Martín MÁ. Usability and User Experience of Cognitive Intervention Technologies for Elderly People With MCI or Dementia: A Systematic Review. Front Psychol 2021; 12:636116. [PMID: 33967901 PMCID: PMC8100576 DOI: 10.3389/fpsyg.2021.636116] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/31/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction Incorporating technology in cognitive interventions represents an innovation, making them more accessible, flexible, and cost-effective. This will not be feasible without adequate user-technology fit. Bearing in mind the importance of developing cognitive interventions whose technology is appropriate for elderly people with cognitive impairment, the objective of this systematic review was to find evidence about usability and user experience (UX) measurements and features of stimulation, training, and cognitive rehabilitation technologies for older adults with mild cognitive impairment (MCI) or dementia. Method The Medline, PubMed, Scopus, ScienceDirect, and PsycINFO databases were searched for literature published in the last 10 years (2009–2019), and three researchers independently reviewed potentially eligible studies, following specific inclusion criteria. A systematic review of the studies was conducted, presenting a qualitative synthesis of usability and UX measures with their outcomes, study characteristics and features of the cognitive intervention technologies. Results Ten studies were selected: five were cognitive stimulation and five were cognitive training. Most of them (60%) were computer-based programs with a serious game format. Efficiency and effectiveness were the most frequent measurements used for collecting objective usability data, showing that elderly people with cognitive impairment require more time (45%) and help (40%) but can complete tasks (60%). Regarding UX or subjective usability data, questionnaires and scales were the most used methods, reporting positive experience despite certain difficulties with the interface in five studies. Conclusion Measuring usability and UX in cognitive intervention technologies for older adults with MCI or dementia provides an integrated view that can contribute to their development according to the needs and characteristics of the target population. More research is required to include this population group in usability and UX studies, as well as standardized tools and consensus on the relationship of these terms to guarantee the future effectiveness of cognitive intervention technologies. Review registration This review was registered in the PROSPERO (CRD42020158147) International Register of Systematic Review Protocols.
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Affiliation(s)
- Leslie María Contreras-Somoza
- Faculty of Psychology, University of Salamanca, Salamanca, Spain.,Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain
| | - Eider Irazoki
- Faculty of Psychology, University of Salamanca, Salamanca, Spain.,Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain
| | - José Miguel Toribio-Guzmán
- Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain
| | | | - Angie Alejandra Diaz-Baquero
- Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain.,Biomedical Research Institute of Salamanca, University of Salamanca, Salamanca, Spain
| | - Esther Parra-Vidales
- Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain
| | | | - Manuel Ángel Franco-Martín
- Faculty of Psychology, University of Salamanca, Salamanca, Spain.,Biomedical Research Institute of Salamanca, University of Salamanca, Salamanca, Spain.,Río Hortega Hospital's Psychiatry and Mental Health Service, Valladolid, Spain.,Zamora Public Welfare Complex, Zamora, Spain
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21
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Mattes A, Roheger M. Nothing wrong about change: the adequate choice of the dependent variable and design in prediction of cognitive training success. BMC Med Res Methodol 2020; 20:296. [PMID: 33287734 PMCID: PMC7720538 DOI: 10.1186/s12874-020-01176-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/24/2020] [Indexed: 11/18/2022] Open
Abstract
Background Even though investigating predictors of intervention success (e.g Cognitive Training, CT) is gaining more and more interest in the light of an individualized medicine, results on specific predictors of intervention success in the overall field are mixed and inconsistent due to different and sometimes inappropriate statistical methods used. Therefore, the present paper gives a guidance on the appropriate use of multiple regression analyses to identify predictors of CT and similar non-pharmacological interventions. Methods We simulated data based on a predefined true model and ran a series of different analyses to evaluate their performance in retrieving the true model coefficients. The true model consisted of a 2 (between: experimental vs. control group) × 2 (within: pre- vs. post-treatment) design with two continuous predictors, one of which predicted the success in the intervention group and the other did not. In analyzing the data, we considered four commonly used dependent variables (post-test score, absolute change score, relative change score, residual score), five regression models, eight sample sizes, and four levels of reliability. Results Our results indicated that a regression model including the investigated predictor, Group (experimental vs. control), pre-test score, and the interaction between the investigated predictor and the Group as predictors, and the absolute change score as the dependent variable seemed most convenient for the given experimental design. Although the pre-test score should be included as a predictor in the regression model for reasons of statistical power, its coefficient should not be interpreted because even if there is no true relationship, a negative and statistically significant regression coefficient commonly emerges. Conclusion Employing simulation methods, theoretical reasoning, and mathematical derivations, we were able to derive recommendations regarding the analysis of data in one of the most prevalent experimental designs in research on CT and external predictors of CT success. These insights can contribute to the application of considered data analyses in future studies and facilitate cumulative knowledge gain. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-020-01176-8.
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Affiliation(s)
- André Mattes
- Department of Individual Differences and Psychological Assessment, University of Cologne, Pohligstraße 1, 50969, Cologne, Germany
| | - Mandy Roheger
- Department of Neurology, University Medicine Greifswald, Walther-Rathenau Str. 49, 17489, Greifswald, Germany.
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22
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Riva G, Mancuso V, Cavedoni S, Stramba-Badiale C. Virtual reality in neurorehabilitation: a review of its effects on multiple cognitive domains. Expert Rev Med Devices 2020; 17:1035-1061. [PMID: 32962433 DOI: 10.1080/17434440.2020.1825939] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Neurological diseases frequently cause adult-onset disability and have increased the demand for rehabilitative interventions. Neurorehabilitation has been progressively relying on computer-assisted programs and, more recently, on virtual reality (VR). Current reviews explore VR-based neurorehabilitation for assessing and treating the most common neurological pathologies. However, none of them explored specifically the impact of VR on multiple cognitive domains. AREAS COVERED The present work is a review of 6 years of literature (2015-2020) on VR in neurorehabilitation with the purpose of analyzing its effects on memory, attention, executive functions, language, and visuospatial ability. EXPERT OPINION Our review suggests that VR-based neurorehabilitation showed encouraging results for executive functions and visuospatial abilities particularly for both acute and neurodegenerative conditions. Conversely, memory, and attention outcomes are conflicting, and language did not show significant improvements following VR-based rehabilitation. Within five years, it is plausible that VR-based intervention would be provided in standalone and mobile-based platforms that won't need a PC to work, with reduced latency and improved user interaction.
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Affiliation(s)
- Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano , Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart , Milan, Italy
| | - Valentina Mancuso
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano , Milan, Italy
| | - Silvia Cavedoni
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano , Milan, Italy
| | - Chiara Stramba-Badiale
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano , Milan, Italy
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23
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Chan JYC, Chan TK, Kwok TCY, Wong SYS, Lee ATC, Tsoi KKF. Cognitive training interventions and depression in mild cognitive impairment and dementia: a systematic review and meta-analysis of randomized controlled trials. Age Ageing 2020; 49:738-747. [PMID: 32378715 DOI: 10.1093/ageing/afaa063] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression is common in people with cognitive impairment but the effect of cognitive training in the reduction of depression is still uncertain. AIMS The purpose of this paper is to evaluate the effect of cognitive training interventions in the reduction of depression rating scale score in people with cognitive impairment. METHODS Literature searches were conducted via OVID databases. Randomized controlled trials (RCTs) evaluated the effect of cognitive training interventions for the reduction of depression rating scale score in people with mild cognitive impairment (MCI) or dementia were included. Mean difference (MD) with 95% confidence interval (CI) was used to combine the results of Geriatric Depression Scale (GDS). Standardized mean difference (SMD) was used to combine the results of different depression rating scales. Subgroup analyses were conducted according to the types of cognitive training and severity of cognitive impairment, i.e. MCI and dementia. RESULTS A total of 2551 people with MCI or dementia were extracted from 36 RCTs. The baseline mean score of GDS-15 was 4.83. Participants received cognitive training interventions had a significant decrease in depression rating scale score than the control group (MD of GDS-15 = -1.30, 95% CI = -2.14--0.47; and SMD of eight depression scales was -0.54 (95% CI = -0.77--0.31). In subgroup analyses, the effect size of computerized cognitive training and cognitive stimulation therapy were medium-to-large and statistically significant in the reduction of depression rating scale score. CONCLUSIONS Cognitive training interventions show to be a potential treatment to ameliorate depression in people with cognitive impairment.
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Affiliation(s)
- Joyce Y C Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Tak Kit Chan
- Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, Hong Kong
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Samuel Y S Wong
- Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, Hong Kong
| | - Allen T C Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Kelvin K F Tsoi
- Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, Hong Kong
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong
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24
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Brem AK, Di Iorio R, Fried PJ, Oliveira-Maia AJ, Marra C, Profice P, Quaranta D, Schilberg L, Atkinson NJ, Seligson EE, Rossini PM, Pascual-Leone A. Corticomotor Plasticity Predicts Clinical Efficacy of Combined Neuromodulation and Cognitive Training in Alzheimer's Disease. Front Aging Neurosci 2020; 12:200. [PMID: 32733232 PMCID: PMC7360860 DOI: 10.3389/fnagi.2020.00200] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 06/09/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with cognitive training for treatment of cognitive symptoms in patients with Alzheimer's disease (AD). A secondary objective was to analyze associations between brain plasticity and cognitive effects of treatment. METHODS In this randomized, sham-controlled, multicenter clinical trial, 34 patients with AD were assigned to three experimental groups receiving 30 daily sessions of combinatory intervention. Participants in the real/real group (n = 16) received 10 Hz repetitive transcranial magnetic stimulation (rTMS) delivered separately to each of six cortical regions, interleaved with computerized cognitive training. Participants in the sham rTMS group (n = 18) received sham rTMS combined with either real (sham/real group, n = 10) or sham (sham/sham group, n = 8) cognitive training. Effects of treatment on neuropsychological (primary outcome) and neurophysiological function were compared between the 3 treatment groups. These, as well as imaging measures of brain atrophy, were compared at baseline to 14 healthy controls (HC). RESULTS At baseline, patients with AD had worse cognition, cerebral atrophy, and TMS measures of cortico-motor reactivity, excitability, and plasticity than HC. The real/real group showed significant cognitive improvement compared to the sham/sham, but not the real/sham group. TMS-induced plasticity at baseline was predictive of post-intervention changes in cognition, and was modified across treatment, in association with changes of cognition. INTERPRETATION Combined rTMS and cognitive training may improve the cognitive status of AD patients, with TMS-induced cortical plasticity at baseline serving as predictor of therapeutic outcome for this intervention, and potential mechanism of action. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.gov, identifier NCT01504958.
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Affiliation(s)
- Anna-Katharine Brem
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Riccardo Di Iorio
- Department of Geriatrics, Neurosciences and Orthopaedics, Polyclinic A. Gemelli Foundation-IRCCS, Rome, Italy
| | - Peter J. Fried
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Albino J. Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal
- Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- NOVA Medical School – Faculdade de Ciências Médicas de Lisboa, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Camillo Marra
- Department of Geriatrics, Neurosciences and Orthopaedics, Polyclinic A. Gemelli Foundation-IRCCS, Rome, Italy
| | - Paolo Profice
- Department of Geriatrics, Neurosciences and Orthopaedics, Polyclinic A. Gemelli Foundation-IRCCS, Rome, Italy
| | - Davide Quaranta
- Department of Geriatrics, Neurosciences and Orthopaedics, Polyclinic A. Gemelli Foundation-IRCCS, Rome, Italy
| | - Lukas Schilberg
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Natasha J. Atkinson
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Erica E. Seligson
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Paolo Maria Rossini
- Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele, Rome, Italy
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew SeniorLife, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
- Guttmann Brain Health Institut, Institut Guttmann, Universitat Autonoma Barcelona, Barcelona, Spain
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25
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Simon SS, Castellani M, Belleville S, Dwolatzky T, Hampstead BM, Bahar-Fuchs A. The design, evaluation, and reporting on non-pharmacological, cognition-oriented treatments for older adults: Results of a survey of experts. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2020; 6:e12024. [PMID: 32523978 PMCID: PMC7276188 DOI: 10.1002/trc2.12024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/11/2020] [Indexed: 12/16/2022]
Abstract
Introduction Cognitive decline and dementia significantly affect independence and quality of life in older adults; therefore, it is critical to identify effective cognition-oriented treatments (COTs; eg, cognitive training, rehabilitation) that can help maintain or enhance cognitive functioning in older adults, as well as reduce dementia risk or alleviate symptoms associated with pathological processes. Methods The Cognitive Intervention Design Evaluation and Reporting (CIDER), a working group from the Non-Pharmacological Interventions Professional Interest Area (NPI-PIA) of the Alzheimer's Association conducted as survey in 2017 with experts in COTs worldwide. The survey's aims were three-fold: (1) determine the common attitudes, beliefs, and practices of experts involved in the COTs research targeting older people; (2) identify areas of relative agreement and disagreement among experts in the field; and (3) offer a critical review of the literature, including recommendations for future research. Results The survey identified several areas of agreements among experts on critical features of COTs, and on study design and outcome measures. Nevertheless, there were some areas with relative disagreement. Critically, expert opinions were not always supported by scientific evidence, suggesting that methodologic improvements are needed regarding design, implementation, and reporting of COTs. There was a clear consensus that COTs provide benefits and should be offered to cognitively unimpaired older adults, mild cognitive impairment (MCI), and mild dementia, but opinions differed for moderate and severe dementia. In addition, there is no consensus on the potential role of COTs in dementia prevention, indicating that future research should prioritize this aspect. Discussion Evidence of COTs in older adults is encouraging, but additional evidence is needed to enhance dementia prevention. Consensus building and guidelines in the field are critical to improve and accelerate the development of high-quality evidence for COTs in cognitively unimpaired older adults, and those with MCI and dementia.
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Affiliation(s)
- Sharon Sanz Simon
- Cognitive Neuroscience Division Department of Neurology Columbia University New York New York.,Old Age Research Group (PROTER) Department of Psychiatry São Paulo Medical School University of São Paulo São Paulo Brazil
| | - Mary Castellani
- Academic Unit for Psychiatry of Old Age Department of Psychiatry University of Melbourne Melbourne Australia
| | - Sylvie Belleville
- Psychology Department Université de Montréal Montreal Canada.,Research Center Institut Universitaire de Gériatrie de Montréal Montreal Canada
| | - Tzvi Dwolatzky
- Rambam Health Care Campus and Rappaport Faculty of Medicine Technion-Israel Institute of Technology Haifa Israel
| | - Benjamin M Hampstead
- Mental Health Service VA Ann Arbor Healthcare System Ann Arbor Michigan.,Neuropsychology Section Department of Psychiatry University of Michigan Ann Arbor Michigan
| | - Alex Bahar-Fuchs
- Academic Unit for Psychiatry of Old Age Department of Psychiatry University of Melbourne Melbourne Australia
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26
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Kallio EL, Hietanen M, Kautiainen H, Pitkälä KH. Neuropsychological outcome of cognitive training in mild to moderate dementia: A randomized controlled trial. Neuropsychol Rehabil 2020; 31:935-953. [PMID: 32295483 DOI: 10.1080/09602011.2020.1749674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Effectiveness of a 12-week cognitive training (CT) programme for community-dwelling patients with dementia was evaluated on various cognitive functions (attention, memory, executive functions and reasoning) and psychological well-being (PWB). A single-blind randomized controlled trial was conducted in adult day care centres in Helsinki, Finland. Participants (N = 147) were older individuals with mild to moderate dementia living at home and attending day care (mean age 83 years, 72% female, 63% at mild stage of dementia). The intervention group (n = 76) received systematic CT for 45 min twice a week while the control group (n = 71) attended day care as usual. The cognitive and psychological outcomes were measured at baseline, and followed up at 3 and 9 months. No differences between the two groups in changes of any of the cognitive functions, or PWB over time were found. We observed a positive trend at 3 months in the change for PWB favouring the intervention group, but no significant interaction effect was found (p = .079; d = -0.31). Thus, systematic CT appears to have no effect on neuropsychological outcomes of cognitive functioning and PWB in older adults who already have dementia.
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Affiliation(s)
- Eeva-Liisa Kallio
- Department of General Practice and Primary Health Care, University of Helsinki, and Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Neuropsychology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marja Hietanen
- Clinical Neurosciences, Neuropsychology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, and Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | - Kaisu H Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki, and Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
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27
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Sado M, Funaki K, Ninomiya A, Knapp M, Mimura M. Does the Combination of the Cognitive Interventions Improve the Function of Daily Living and Save the Long-Term Care Cost? A Pilot Study of Effectiveness and Cost Saving Analysis of "Learning Therapy" for People with Dementia. J Alzheimers Dis 2020; 74:775-784. [PMID: 32116248 DOI: 10.3233/jad-190886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although the effects of various types of cognitive interventions have been evaluated, effectiveness and cost-saving effect of the combination of the different cognitive interventions is unknown. OBJECTIVE This study aimed to evaluate the feasibility of conducting a definitive trial to assess the effectiveness of combined cognitive intervention. METHODS A matched controlled trial of learning therapy (LT), a combination of cognitive training and stimulation, was conducted. The samples were recruited from the nursing homes. Inclusion criteria were as follows: age 65 years or older, clinical diagnosis of dementia, level of activities of daily living at II or above, Mini-Mental State Examination score between 10 and 26, receiving long-term-care services without history of LT, and provision of written consent. The primary outcomes were safety, validity of eligibility, retention rate, and effect on the functions of daily living represented by Criterion Time for Certification of Needed Long-Term-Care (CT for CNLTC) at 12 months. Cost-benefit analysis was also conducted to assess the cost saving effect of LT. RESULTS No serious adverse events were detected. The exclusion rate at the screening phase was 5% and the retention rate was 77% at 12 months. LT demonstrated statistically significant improvement in CT for CNLTC at 12 months (Δ=18.8, almost equivalent to "one" degree of the care needed level) and saved the long-term-care cost by JPY 200,000 (USD 1,618). CONCLUSIONS LT is effective for improving care recipients' level of care needed and has a cost saving effect. A randomized controlled trial is required to verify these findings. CLINICAL TRIAL REGISTRATION This study was approved by the ethics committee at Keio University School of Medicine (ID: 20150061). This trial was registered at University hospital Medical Information Network Clinical Trial Registry (UMIN-CTR ID: UMIN000018223).
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Affiliation(s)
- Mitsuhiro Sado
- Department of Neuropsychiatry, Keio University School of Medicine, Center for Stress Research, Keio University, Tokyo, Japan
| | - Kei Funaki
- Department of Neuropsychiatry, Keio University School of Medicine, Center for Stress Research, Keio University, Tokyo, Japan
| | - Akira Ninomiya
- Department of Neuropsychiatry, Keio University School of Medicine, Center for Stress Research, Keio University, Tokyo, Japan
| | - Martin Knapp
- Department of Social Policy, London School of Economics and Political Science, London, UK
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Center for Stress Research, Keio University, Tokyo, Japan
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28
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Han E, Park J, Kim H, Jo G, Do HK, Lee BI. Cognitive Intervention with Musical Stimuli Using Digital Devices on Mild Cognitive Impairment: A Pilot Study. Healthcare (Basel) 2020; 8:healthcare8010045. [PMID: 32106559 PMCID: PMC7151070 DOI: 10.3390/healthcare8010045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/04/2020] [Accepted: 02/21/2020] [Indexed: 12/01/2022] Open
Abstract
The effect of music therapy on cognitive function has been widely reported; however, its clinical implications remain controversial. Performing therapeutic musical activities in groups using individualized instruments can help overcome the issues of engagement and compliance. We aimed to evaluate the effect of a cognitive intervention with musical stimuli using digital devices on mild cognitive impairment (MCI). In this prospective study, 24 patients with MCI (intervention group, 12; and control group, 12) were enrolled. We developed an electronic device with musical instruments and the Song-based Cognitive Stimulation Therapy protocol (SongCST). Patients in the intervention group underwent a 10-week cognitive intervention involving musical stimuli generated by our device. Effect of the intervention on cognitive function was evaluated by the Mini-Mental State Examination-Dementia Screening (MMSE-DS), Montreal Cognitive Assessment-Korean (MOCA-K), and Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB). In the intervention group, MMSE-DS and MOCA-K scores improved significantly after the 10-week intervention. The changes in MOCA-K and CDR-SB scores were significantly different between the intervention and control groups. Our study showed that music therapy with digital devices has a positive effect on the executive function and overall disease severity in patients with MCI. Our study can facilitate individualization of music therapy using digital devices in groups.
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Affiliation(s)
- Eunyoung Han
- Department of Music Therapy, Graduate School, Ewha Womans University, Seoul 52, Korea;
- Department of Neurology, Haeundae Paik Hospital, Inje University, Busan 50834, Korea;
| | - Jinse Park
- Department of Neurology, Haeundae Paik Hospital, Inje University, Busan 50834, Korea;
- Correspondence:
| | - Haeyu Kim
- Department of Neurological Surgery, Haeundae Paik Hospital, Inje University, Busan 50834, Korea;
| | - Geunyeol Jo
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University, Busan 50834, Korea; (G.J.); (H.-K.D.)
| | - Hwan-Kwon Do
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University, Busan 50834, Korea; (G.J.); (H.-K.D.)
| | - Byung In Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University, Busan 50834, Korea;
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29
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Roheger M, Folkerts AK, Krohm F, Skoetz N, Kalbe E. Prognostic factors for change in memory test performance after memory training in healthy older adults: a systematic review and outline of statistical challenges. Diagn Progn Res 2020; 4:7. [PMID: 32478173 PMCID: PMC7240921 DOI: 10.1186/s41512-020-0071-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The goal is to investigate prognostic factors for change in memory test performance in healthy older adults and to report and discuss the different statistical procedures used for investigating this topic in the literature. METHODS Prognostic factors were here understood as any measures that were investigated to estimate change in memory test performance. MEDLINE, Web of Science Core Collection, CENTRAL, and PsycInfo were searched up to November 2019. Prognostic factor and prognostic factor finding studies investigating prognostic factors on verbal and non-verbal short- and long-term memory after conducting memory training in healthy older adults were included. Risk of bias was assessed using the QUIPS tool. RESULTS Our search yielded 12,974 results. We included 29 studies that address prognostic factors of change in memory test performance, including sociodemographic, (neuro-)psychological, genetic, and biological parameters. Studies showed high variation and methodological shortcomings with regard to the assessment, statistical evaluation, and reporting of the investigated prognostic factors. Included studies used different types of dependent variables (change scores vs. post-test scores) when defining change in memory test performance leading to contradictory results. Age was the only variable investigated throughout most of the studies, showing that older adults benefit more from training when using the change score as the dependent variable. CONCLUSION Overall, there is a need for adequate reporting in studies of prognostic factors for change in memory test performance. Because of inconsistencies and methodological shortcomings in the literature, conclusions regarding prognostic factors remain uncertain. As a tentative conclusion, one may say that the higher the age of the participant, the more profound the improvement in memory test performance will be after memory training. TRIAL REGISTRATION CRD42019127479.
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Affiliation(s)
- Mandy Roheger
- grid.6190.e0000 0000 8580 3777Department of Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 68, 50937 Cologne, Germany
| | - Ann-Kristin Folkerts
- grid.6190.e0000 0000 8580 3777Department of Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 68, 50937 Cologne, Germany
| | - Fabian Krohm
- grid.6190.e0000 0000 8580 3777Department of Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 68, 50937 Cologne, Germany
| | - Nicole Skoetz
- grid.6190.e0000 0000 8580 3777Evidence-Based Oncology, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Elke Kalbe
- grid.6190.e0000 0000 8580 3777Department of Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 68, 50937 Cologne, Germany
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30
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He W, Wang M, Jiang L, Li M, Han X. Cognitive interventions for mild cognitive impairment and dementia: An overview of systematic reviews. Complement Ther Med 2019; 47:102199. [PMID: 31780033 DOI: 10.1016/j.ctim.2019.102199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/20/2019] [Accepted: 09/22/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Conducting an overview of systematic reviews (SRs)/Meta analyses (MAs) to assess the effectiveness of cognitive interventions on participants with mild cognitive impairment (MCI) or dementia and evaluate the methodological quality of SRs/MAs. METHODS PubMed, EMBASE, Cochrane library, Web of science, China National Knowledge Infrastructure (CNKI) and Chinese Biomedical Databases (CBM) were systematically searched from inception to January 1, 2019 to identify SRs/MAs. Three reviewers independently screened the articles, extracted data and assessed the quality of the included studies according to the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Grading of Recommendations Assessment Development and Evaluation (GRADE) was used to evaluate the quality of evidence. RESULTS A total of 22 reviews were included. New meta-analyses (36 RCTs) showed that cognitive interventions were more effective than routine therapies for the alleviation of MCI and dementia symptoms (SMD: 0.62; 95%CI: 0.47, 0.78; I2 = 53.9%). The results of AMSTAR-2 showed that the methodological quality of most included studies was critically low, and two reviews were low quality. The lowest score was item 10, none of reviews reported on the sources of funding for the included studies. Followed by the "provide a list of excluded studies and justify the exclusions" item with only one (4.5%) reviews conforming to this item. Results of GRADE manifested that moderate quality evidence was provided in 11 reviews (39.3%), 12 (42.9%) were low quality and 5 (17.8%) were very low. CONCLUSION The present SRs/MAs indicated that persons with MCI or dementia could benefit from cognitive interventions. Future trial designs should focus on measuring changes in individual specific cognitive functions. More high-quality evidence is needed to further determine the effectiveness of cognitive interventions.
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Affiliation(s)
- Wenbo He
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Meng Wang
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Lili Jiang
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Meixuan Li
- School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence Based Medicine Center, Lanzhou University, Lanzhou, 730000, China; Evidence Based Social Science Research Center, Lanzhou, 730000, China
| | - Xuemei Han
- School of Public Health, Lanzhou University, Lanzhou, 730000, China.
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31
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Can physical and cognitive training based on episodic memory be combined in a new protocol for daily training? Aging Clin Exp Res 2019; 31:1615-1623. [PMID: 30569279 DOI: 10.1007/s40520-018-1107-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/14/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cognitive training (CT) is defined as guided practice on a set of standard tasks designed to stimulate particular cognitive functions. Recent studies have shown that physical exercise is beneficial for cognitive activity in older adults and patients with degenerative diseases. AIMS The main objective of the present study is to create a new cognitive tool able to provide training for cognitive functions that take advantage of the physical activity involved in the execution of the task. A study concerning the application of a new CT tool for episodic memory is presented and divided in two parts. The first one aims at developing a new sensorized device, called SmartTapestry, for physical and cognitive training. The second part aims at understanding its technical viability and level of sensitivity in stimulating the same cognitive domain covered by the standardized tests, despite the introduction of the physical activity variable. METHODS The SmartTapestry device was tested with a total of 53 subjects, 29 healthy subjects and 24 subjects suffering from mild cognitive impairment. RESULTS AND DISCUSSIONS The results show a good correlation between the two approaches (p < 0.005), suggesting that SmartTapestry can stimulate the same cognitive functions of traditional cognitive tasks, with the addition of physical exercise. CONCLUSIONS The results of this study may be useful in designing ecological and combined cognitive-physical tools, which can be used daily at home, reducing the presence of clinical staff, to train at the same time the brain and the body so as to improve the cognitive treatments efficacy.
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32
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Reis J, Román GC, Giroud M, Palmer VS, Spencer PS. Medical management, prevention and mitigation of environmental risks factors in Neurology. Rev Neurol (Paris) 2019; 175:698-704. [PMID: 31648732 DOI: 10.1016/j.neurol.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 09/29/2019] [Accepted: 10/02/2019] [Indexed: 11/25/2022]
Abstract
The human environment and exposures arising therefrom are major contributors to neurological disorders ranging from stroke to neurodegenerative diseases. Reduction of exposure to environmental risk factors, with the goal of disease prevention or control, is addressed at the individual as well as the societal level and in recognition of differential subject vulnerability. We examine some practical solutions in high-income countries that may allow a better adaptation to environmental risks and reduce their adverse impact on the nervous system. We consider the citizen's role in reducing unhealthy exposures and explore new approaches to treatment.
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Affiliation(s)
- J Reis
- Department of neurology, university of Strasbourg, university hospital of Strasbourg, Strasbourg, France; Association RISE, 3, rue du Loir, 67205 Oberhausbergen, France.
| | - G C Román
- Department of neurology, methodist neurological institute and research institute, Houston methodist hospital, Houston, TX, USA; Weill Cornell medical college, Cornell university, New York, NY, USA
| | - M Giroud
- Dijon stroke registry, EA 7460, university of Bourgogne-Franche Comté, Inserm, santé publique France, university hospital of Dijon, Dijon, France
| | - V S Palmer
- Department of neurology, school of medicine, Oregon health & science university, Portland, OR, USA
| | - P S Spencer
- Department of neurology, school of medicine, Oregon health & science university, Portland, OR, USA
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33
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Effects of interval walking training compared to normal walking training on cognitive function and arterial function in older adults: a randomized controlled trial. Aging Clin Exp Res 2019; 31:1451-1459. [PMID: 30565191 DOI: 10.1007/s40520-018-1093-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/07/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE This study investigated whether interval walking training (IWT) improves cognitive function and arterial function in older adults. METHODS A total of 68 older adults registered in clinical trials (mean age ± standard deviation, 70 ± 4 years) were randomly assigned to two groups: one group performed IWT (n = 34), and the other performed normal walking training (NWT, n = 34). Participants in the IWT group performed five or more sets of low-intensity walking (duration: 3 min per set; peak aerobic capacity for walking: 40%) followed by high-intensity walking (duration: 3 min per set; peak aerobic capacity for walking: > 70%). The NWT group walked at approximately 50% of the peak aerobic capacity for walking. The IWT and NWT were performed for 20 weeks. Trail making test-A and B and carotid-femoral pulse wave velocity (cfPWV) were measured in both groups at baseline and again at the end of the 20-week study period. RESULTS Compared to baseline, time for trail making test-A (IWT group: P = 0.00004, NWT group: P = 0.000006) and B (IWT group: P = 0.03, NWT group: P = 0.003) as well as cfPWV (IWT group: P = 0.000002, NWT group: P = 0.03) decreased significantly after the 20-week study period in both groups. However, cfPWV in the IWT group decreased significantly more than that in the NWT group (P = 0.03). CONCLUSION These results suggested that although both IWT and NWT were similarly effective at improving cognitive function, IWT reduced central arterial stiffness more than NWT.
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Ju YJ, Nam CM, Lee SG, Park S, Hahm MI, Park EC. Evaluation of the South Korean national long-term care insurance-funded cognitive function training programme for older people with mild dementia. Age Ageing 2019; 48:636-642. [PMID: 31268493 DOI: 10.1093/ageing/afz067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 04/20/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES despite the extensive literature on the effectiveness of cognitive training, its effectiveness has not been demonstrated within a population-based long-term care system. To provide cognitive training services to older people with mild dementia, Korea introduced a special dementia rating, as a long-term care grades, in the national long-term care insurance in July 2014. These services are only offered to those with the special dementia rating. This study evaluated the national long-term care insurance-funded cognitive function training programme for older people with mild dementia. METHODS data were derived from the Korean National Health Insurance Elderly Cohort database between 2008 and 2015. We compared changes in function between the intervention (n = 352) and control (n = 1952) groups before (2014) and after (2015) introduction of the cognitive function training programme. Difference-in-differences analysis was performed, to compare changes in each score between the intervention and control groups before and after introduction of the cognitive function training programme. RESULTS introduction of the cognitive function training programme was associated with significantly less cognitive function decline in the intervention group than in the control groups (β = -3.39; standard errors [SE] = 1.14; P = 0.003). A subgroup analysis revealed that this effect increased in subjects in the youngest group, low income bracket, who had a primary caregiver, who were supported in multiple activities of daily living by the primary caregiver, or who were not living alone. CONCLUSIONS introduction of the cognitive function training programme was associated with positive effects on cognitive function.
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Affiliation(s)
- Yeong Jun Ju
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chung Mo Nam
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Gyu Lee
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Sohee Park
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Myung-Il Hahm
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Nishiura Y, Nihei M, Nakamura-Thomas H, Inoue T. Effectiveness of using assistive technology for time orientation and memory, in older adults with or without dementia. Disabil Rehabil Assist Technol 2019; 16:472-478. [PMID: 31424302 DOI: 10.1080/17483107.2019.1650299] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIMS The purposes of this study were to reveal the effectiveness of an electric calendar, showing the date and schedule automatically for older people, and to prove the characteristics of appropriate users. MATERIAL AND METHODS The participants were 27 older adults with or without dementia (9 men and 18 women, mean age: 81.5 ± 6.9 years, range: 72-94 years). The study design was a cross-over randomized controlled trial, with 15 participants (55.6%) allocated to the first group to use the electric calendar, and 12 participants (44.4%) to the second intervention group. The outcome measures are daily behaviors and cognitive function assessed by the Mini-Mental State Examination and Neurobehavioral Cognitive Status Examination. RESULTS Participants showed significant increase in total Mini-Mental State Examination score (p = 0.020, a paired t-test) after intervention period, whereas there was no significant difference after no intervention. Daily activities related healthcare were improved. The participants with positive outcomes showed higher motivations, and around 18 points in Mini-Mental State Examination. Most healthy older adults mentioned that electric calendars were useful, but unnecessary. CONCLUSION AND SIGNIFICANCE Using the electric calendar was effective in improving global cognitive function and daily activities. The target users are older people, who (1) might have mild dementia, (2) have difficulties in daily activities, (3) can be supported by caregivers, and (4) have positive motivation to new technologies.IMPLICATIONS FOR REHABILITATIONAn electric calendar is effective on grovel cognitive function, and activities of daily living related to healthcare in older adults, as well as reality orientation therapy.The electric calendar can be useful for older people with mild dementia or mild cognitive impairment, having difficulties activities of daily living, supported by caregivers at regular intervals.
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Affiliation(s)
- Yuko Nishiura
- Department of Assistive Technology, National Rehabilitation Centre for Persons with Disabilities, Saitama, Japan
| | - Misato Nihei
- Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | | | - Takenobu Inoue
- Department of Assistive Technology, National Rehabilitation Centre for Persons with Disabilities, Saitama, Japan
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The Modulatory Effect of Cerebrovascular Burden in Response to Cognitive Stimulation in Healthy Ageing and Mild Cognitive Impairment. Neural Plast 2019; 2019:2305318. [PMID: 31467519 PMCID: PMC6701285 DOI: 10.1155/2019/2305318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/15/2019] [Accepted: 06/13/2019] [Indexed: 12/21/2022] Open
Abstract
Background Cerebrovascular burden is a common pathology in mild cognitive impairment (MCI) and Alzheimer's disease (AD), with an additive impact on cognitive functioning. Despite being proposed as a potential moderator of cholinesterase inhibiting drug therapy, there is a paucity of evidence investigating the impact of cerebrovascular pathology on responsiveness to cognitive interventions. Method The current study uses neuropsychological, neurostructural, and functional connectivity indices to characterise response to a cognitive stimulation paradigm in 25 healthy ageing and 22 MCI participants, to examine the hypothesised detrimental effects of concurrent vascular pathology. Results In both healthy ageing and MCI, increased levels of vascular pathology limited the potential for a neuroplastic response to cognitive stimulation. In healthy ageing, participants with lower levels of vascular burden had greater functional connectivity response in the target posterior default mode network. Those with low levels of vascular pathology in the MCI cohort had increased functional connectivity of the right insula and claustrum within the salience network. Burden did not, however, predict cognitive or neuroanatomical changes. Conclusions The current research evidences the modulatory effect of cerebrovascular pathology in interventions aimed at re-establishing network connectivity to prevent cognitive deterioration and delay the transition to the dementia stage of AD. Examination of co-occurring vascular pathology may improve precision in targeting treatment to MCI candidates who may respond optimally to such cognitive interventions.
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Effect of Paper-Based Cognitive Training in Early Stage of Alzheimer's Dementia. Dement Neurocogn Disord 2019; 18:62-68. [PMID: 31297136 PMCID: PMC6609531 DOI: 10.12779/dnd.2019.18.2.62] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 11/27/2022] Open
Abstract
Background and Purpose Cognitive training refers to a series of standardized tasks with inherent challenges that target specific cognitive domains. Positive outcome of cognitive training in persons with Alzheimer's disease has been reported. In this study, the objective was to design sets of cognitive training program, “Gipum-seo” which is combined cognitive training, consists of different levels of difficulty using predesigned paper-and-pencil exercises. Also, to evaluate the effects of the cognitive training on patients' with early stage of Alzheimer's disease. Methods The subjects for this study were forty participants who were diagnosed with early stage of Alzheimer's dementia. To test the efficacy of paper-based cognitive training programs to cognition, all patients were randomly grouped to either an intervention group (n=20) or a control group (n=20). The intervention group regularly received 24 sessions of paper-based cognitive training over a 12-week period. Neuropsychological examinations were conducted before and after this training period. Results After the 12 weeks, the intervention group showed a significant change in Korean version of the Mini-Mental State Examination (25.90±3.8), compared to the control group (23.7±2.8) (p=0.042). The training group also showed a significant improvement in language, attention and executive function, as compared with controls. Conclusions Paper-based cognitive training might have beneficial effects on the general cognitive functions in the early stage of Alzheimer's dementia.
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Park J, Kim SE, Kim EJ, Lee BI, Jeong JH, Na HR, Choi SH, Kang DY, Park KW. Effect of 12-week home-based cognitive training on cognitive function and brain metabolism in patients with amnestic mild cognitive impairment. Clin Interv Aging 2019; 14:1167-1175. [PMID: 31303750 PMCID: PMC6610290 DOI: 10.2147/cia.s200269] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/22/2019] [Indexed: 12/29/2022] Open
Abstract
Purpose We assessed the effect of home-based cognitive intervention (HCI) on cognitive function along with brain metabolism by 18F-FDG PET in patients with amnestic MCI (aMCI). Patients and methods Fifty-seven patients with aMCI from three hospitals were randomized (30 HCI, 27 control). For 12 weeks, subjects received HCI. Thirty-two subjects (15 HCI, 17 control) underwent brain 18-F-FDG-PET imaging at baseline and at 12 and 24 weeks. Results The HCI group showed significant improvement in the scores of the Controlled Oral Word Association Test (COWAT) 12 and at 24 weeks. Significant brain metabolic changes by 18F-FDG PET were not observed. Conclusion The current study suggests that HCI was effective in improving general cognition along with frontal executive function in patients with aMCI.
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Affiliation(s)
- Jinse Park
- Department of Neurology, Haueundae Paik Hospital, Inje University, Busan, South Korea
| | - Si-Eun Kim
- Department of Neurology, Haueundae Paik Hospital, Inje University, Busan, South Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, South Korea
| | - Byung In Lee
- Department of Neurology, Haueundae Paik Hospital, Inje University, Busan, South Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Hae Ri Na
- Department of Neurology, Bobath Memorial Hospital, Seongnam, South Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, South Korea
| | - Do-Young Kang
- Department of Nuclear Medicine, College of Medicine, Dong-A University, Busan, South Korea
| | - Kyung Won Park
- Department of Neurology, Cognitive Disorders and Dementia Center, Dong-A University College of Medicine and Institute of Convergence Bio-Health, Busan, South Korea
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Tseng CF, Lee SH, Hsieh TC, Lee RP. Smart Restored by Learning Exercise Alleviates the Deterioration of Cognitive Function in Older Adults with Dementia-A Quasi-Experimental Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071270. [PMID: 30970666 PMCID: PMC6480400 DOI: 10.3390/ijerph16071270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/05/2019] [Accepted: 04/07/2019] [Indexed: 11/16/2022]
Abstract
Maintaining cognitive function is essential for older adults with dementia. The purpose of this study was to investigate the effectiveness of Smart Restored by Learning Exercise (SRLE) on cognitive functions, neuropsychiatric symptoms, and frontal lobe functions in elderly people with dementia. A total of 68 older adults with dementia participated in this study. A quasi-experimental design was used, and convenience sampling and assignment approaches were adopted to select the participants for experimental and control groups. The experimental group engaged in SRLE for 6 months. The control group received routine care without SRLE. The participants’ cognitive function, neuropsychiatric symptoms, and frontal lobe function at baseline were evaluated using the Mini-Mental State Examination (MMSE), Neuropsychiatry Inventory (NPI), and Frontal Assessment Battery (FAB), respectively, in month 3 and month 6. The Group by Time interaction was statistically significant for MMSE and FAB scores, which indicated the different group effects between months 3 and 6. The results also showed that the improvement of MMSE, NPI, and FAB scores in the SRLE group were significantly better than the control group (t = −5.99~4.90, p < 0.001) at both months 3 and 6. In conclusion, long-term facilities may provide residents with SRLE every day to prevent a decline in the residents’ levels of cognitive function.
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Affiliation(s)
- Chi-Fen Tseng
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan.
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien 970, Taiwan.
| | - Shao-Huai Lee
- Department of Family Studies and Child Development, Shih Chien University, Taipei 10462, Taiwan.
- Taiwan Smart Restored by Learning Exercise Development Association, Taipei 10696, Taiwan.
| | - Tsung-Cheng Hsieh
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan.
| | - Ru-Ping Lee
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan.
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Özbe D, Graessel E, Donath C, Pendergrass A. Immediate Intervention Effects of Standardized Multicomponent Group Interventions on People with Cognitive Impairment: A Systematic Review. J Alzheimers Dis 2019; 67:653-670. [PMID: 30689588 PMCID: PMC6398841 DOI: 10.3233/jad-180980] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is no curative medical treatment for dementia. Therefore, researchers turned their attention to non-pharmacological treatment approaches. Many reviews analyzed the efficacy of single-component interventions, but there has been no systematic review of multicomponent interventions so far. OBJECTIVE The aim was to systematically review studies using standardized multicomponent group interventions for persons with dementia or persons with mild cognitive impairment (MCI) and to analyze their immediate intervention effects. METHODS The databases PubMed, PsycINFO, PSYNDEX, and CINAHL were systematically searched. We included randomized controlled trials with people with MCI or dementia, which implemented interventions with at least two components that targeted different outcome domains. Additionally, the intervention had to be standardized and in a group setting. RESULTS Nine studies met the inclusion criteria with a total sample size of N = 513 participants. Six studies applied two, two studies applied three, and one study applied four components. Four studies, which combined at least a physical and a cognitive component, had a positive effect on non-cognitive symptoms of dementia. Two of these interventions additionally had a positive effect on cognitive abilities. One study reported a positive effect on activities of daily living and another study showed an effect on quality of life. CONCLUSION In spite of the heterogeneity of the studies, multicomponent interventions suggest a positive effect on non-cognitive symptoms, especially the combination of cognitive and physical components. Single studies had also an effect on additional outcome domains. By trend the effects are dependent on application rate and used assessments.
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Affiliation(s)
- Dominik Özbe
- Center for Health Service Research in Medicine, Department of Psychiatry and Psychotherapy, University Clinic Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Elmar Graessel
- Center for Health Service Research in Medicine, Department of Psychiatry and Psychotherapy, University Clinic Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Carolin Donath
- Center for Health Service Research in Medicine, Department of Psychiatry and Psychotherapy, University Clinic Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Anna Pendergrass
- Center for Health Service Research in Medicine, Department of Psychiatry and Psychotherapy, University Clinic Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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Zucchella C, Sinforiani E, Tamburin S, Federico A, Mantovani E, Bernini S, Casale R, Bartolo M. The Multidisciplinary Approach to Alzheimer's Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment. Front Neurol 2018; 9:1058. [PMID: 30619031 PMCID: PMC6300511 DOI: 10.3389/fneur.2018.01058] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/21/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Alzheimer's disease (AD) and dementia are chronic diseases with progressive deterioration of cognition, function, and behavior leading to severe disability and death. The prevalence of AD and dementia is constantly increasing because of the progressive aging of the population. These conditions represent a considerable challenge to patients, their family and caregivers, and the health system, because of the considerable need for resources allocation. There is no disease modifying intervention for AD and dementia, and the symptomatic pharmacological treatments has limited efficacy and considerable side effects. Non-pharmacological treatment (NPT), which includes a wide range of approaches and techniques, may play a role in the treatment of AD and dementia. Aim: To review, with a narrative approach, current evidence on main NPTs for AD and dementia. Methods: PubMed and the Cochrane database of systematic reviews were searched for studies written in English and published from 2000 to 2018. The bibliography of the main articles was checked to detect other relevant papers. Results: The role of NPT has been largely explored in AD and dementia. The main NPT types, which were reviewed here, include exercise and motor rehabilitation, cognitive rehabilitation, NPT for behavioral and psychological symptoms of dementia, occupational therapy, psychological therapy, complementary and alternative medicine, and new technologies, including information and communication technologies, assistive technology and domotics, virtual reality, gaming, and telemedicine. We also summarized the role of NPT to address caregivers' burden. Conclusions: Although NPT is often applied in the multidisciplinary approach to AD and dementia, supporting evidence for their use is still preliminary. Some studies showed statistically significant effect of NPT on some outcomes, but their clinical significance is uncertain. Well-designed randomized controlled trials with innovative designs are needed to explore the efficacy of NPT in AD and dementia. Further studies are required to offer robust neurobiological grounds for the effect of NPT, and to examine its cost-efficacy profile in patients with dementia.
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Affiliation(s)
| | - Elena Sinforiani
- Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | - Stefano Tamburin
- Neurology Unit, University Hospital of Verona, Verona, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sara Bernini
- Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto Casale
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Bergamo, Italy
| | - Michelangelo Bartolo
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Bergamo, Italy
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García-Betances RI, Cabrera-Umpiérrez MF, Arredondo MT. Computerized neurocognitive interventions in the context of the brain training controversy. Rev Neurosci 2018; 29:55-69. [PMID: 28822228 DOI: 10.1515/revneuro-2017-0031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 06/29/2017] [Indexed: 11/15/2022]
Abstract
This article presents, in the form of an analytic narrative review, a complete picture of the state-of-the-art, challenges, and perspectives in the field of information and communication technology (ICT)-based neurocognitive interventions for older adults. The narrative particularly focuses on applications aimed at mild cognitive impairment and similar age-related cognitive deficits, which are analyzed in the context of the brain training controversy. Clarifying considerations are provided about the nature and present extent of the brain training debate, regarding the possible influence it has on the support received by research and development initiatives dealing with innovative computerized neurocognitive interventions. It is recommended that, because of the preliminary nature of most data currently available in this area, further research initiatives must be supported in the quest for better effectiveness of computer-based interventions intended for age-related cognitive impairment. The conclusion suggests that advanced ICT-based tools, such as virtual and augmented reality technologies, are the most fitting platforms for applying nonpharmacological computerized neurocognitive interventions.
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Affiliation(s)
- Rebeca Isabel García-Betances
- Life Supporting Technologies (LifeSTech), Superior Technical School of Telecommunications Engineers (ETSIT), Universidad Politécnica de Madrid (UPM), Av. Complutense no. 30, Ciudad Universitaria, E-28040 Madrid, Spain
| | - María Fernanda Cabrera-Umpiérrez
- Life Supporting Technologies (LifeSTech), Superior Technical School of Telecommunications Engineers (ETSIT), Universidad Politécnica de Madrid (UPM), Av. Complutense no. 30, Ciudad Universitaria, E-28040 Madrid, Spain
| | - María T Arredondo
- Life Supporting Technologies (LifeSTech), Superior Technical School of Telecommunications Engineers (ETSIT), Universidad Politécnica de Madrid (UPM), Av. Complutense no. 30, Ciudad Universitaria, E-28040 Madrid, Spain
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de Boer C, Echlin HV, Rogojin A, Baltaretu BR, Sergio LE. Thinking-While-Moving Exercises May Improve Cognition in Elderly with Mild Cognitive Deficits: A Proof-of-Principle Study. Dement Geriatr Cogn Dis Extra 2018; 8:248-258. [PMID: 30140274 PMCID: PMC6103359 DOI: 10.1159/000490173] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/16/2018] [Indexed: 11/19/2022] Open
Abstract
Background Noninvasive interventions to aid healthy cognitive aging are considered an important healthcare priority. Traditional approaches typically focus on cognitive training or aerobic exercise training. In the current study, we investigate the effect of exercises that directly combine cognitive and motor functions on visuomotor skills and general cognition in elderly with various degrees of cognitive deficits. Subjects and Methods A total of 37 elderly, divided into four groups based on their level of cognition, completed a 16-week cognitive-motor training program. The weekly training sessions consisted of playing a videogame requiring goal-directed hand movements on a computer tablet for 30 minutes. Before and after the training program, all participants completed a test battery to establish their level of cognition and visuomotor skills. Results We observed an overall change in visuomotor behavior in all groups, as participants completed the tasks faster but less accurately. More importantly, we observed a significant improvement in measures of overall cognition in the subaverage cognition group and the mild-to-moderate cognitive deficits group. Conclusion Our findings indicate that (1) cognitive-motor exercises induce improved test scores, which is most prominent in elderly with only mild cognitive deficits, and (2) cognitive-motor exercises induce altered visuomotor behavior and slight improvements in measures of general cognition.
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Affiliation(s)
- Casper de Boer
- School of Kinesiology and Health Science, Centre for Vision Research, York University, Toronto, Ontario, Canada.,VUmc Alzheimercentrum, Amsterdam, the Netherlands
| | - Holly V Echlin
- School of Kinesiology and Health Science, Centre for Vision Research, York University, Toronto, Ontario, Canada
| | - Alica Rogojin
- School of Kinesiology and Health Science, Centre for Vision Research, York University, Toronto, Ontario, Canada
| | - Bianca R Baltaretu
- School of Kinesiology and Health Science, Centre for Vision Research, York University, Toronto, Ontario, Canada
| | - Lauren E Sergio
- School of Kinesiology and Health Science, Centre for Vision Research, York University, Toronto, Ontario, Canada
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Nguyen JP, Suarez A, Le Saout E, Meignier M, Nizard J, Lefaucheur JP. Combining cognitive training and multi-site rTMS to improve cognitive functions in Alzheimer's disease. Brain Stimul 2018. [DOI: 10.1016/j.brs.2018.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Kallio EL, Öhman H, Hietanen M, Soini H, Strandberg TE, Kautiainen H, Pitkälä KH. Effects of Cognitive Training on Cognition and Quality of Life of Older Persons with Dementia. J Am Geriatr Soc 2018; 66:664-670. [DOI: 10.1111/jgs.15196] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Eeva-Liisa Kallio
- Department of General Practice and Primary Health Care; University of Helsinki; and Unit of Primary Health Care; Helsinki University Hospital; Helsinki Finland
- Clinical Neurosciences; Neuropsychology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Hannareeta Öhman
- Department of General Practice and Primary Health Care; University of Helsinki; and Unit of Primary Health Care; Helsinki University Hospital; Helsinki Finland
- City of Helsinki; Hospital; Rehabilitation; and Care Services; Helsinki Finland
| | - Marja Hietanen
- Clinical Neurosciences; Neuropsychology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Helena Soini
- City of Helsinki; Social Services and Health Care Department; Helsinki Finland
| | - Timo E. Strandberg
- University of Helsinki and Helsinki University Hospital; Helsinki Finland
- Center for Life Course Health Research; University of Oulu; Oulu Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care; University of Helsinki; and Unit of Primary Health Care; Helsinki University Hospital; Helsinki Finland
| | - Kaisu H. Pitkälä
- Department of General Practice and Primary Health Care; University of Helsinki; and Unit of Primary Health Care; Helsinki University Hospital; Helsinki Finland
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Abstract
Dementia is a syndrome seen most commonly in older people and characterized by a decline in cognitive performance which impacts on the person's ability to function. There are approximately 47 million people worldwide with dementia and there are 10 million new cases every year. It is a major cause of disability and dependence and impacts on the physical, psychologic, and social well-being of families and carers. Alzheimer's disease is the most common form of dementia. Gait and balance impairments are common in people with dementia and contribute to the significantly elevated risk of falls. Older people with dementia are at increased risk of injury, institutionalization, hospitalization, morbidity, and death after a fall. There is preliminary evidence, predominantly from relatively small studies, that falls and disability can be prevented in this population. However, more good-quality research is needed, both to provide some certainty around the existing evidence base as well as to explore alternate approaches to prevention, including combined cognitive-motor training and cognitive pharmacotherapy.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia
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Feasibility and baseline findings of a Finnish cognitive training (FINCOG) intervention in a randomised controlled trial among community-dwelling persons with dementia. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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