Effects of Aerobic Dance on Cognition in Older Adults with Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

Cognitive benefits of music in aerobic exercise: Evidence from a Bayesian network meta-analysis in adults with mild cognitive impairment

Aerobic exercise improves cognitive functions in older adults with mild cognitive impairment (MCI), while dance, combining music and synchronized movement, offers additional cognitive benefits. Despite music's potential role in enhancing cognitive outcomes, most research on aerobic exercise has not considered the impact of accompanying music. This review compared the effectiveness of aerobic exercise with music, aerobic exercise without music, and dance on cognitive function in adults with MCI. A total of 38 papers from 25 randomized controlled trials (N = 2048) were synthesized. The multilevel meta-analyses showed that compared to the control group, global cognition was improved by aerobic exercise with music (g = 1.2 [0.47, 1.94]), aerobic exercise without music (g = 0.48 [0.18, 0.79]), and dance (g = 0.55 [0.13, 0.96]). Dance also enhanced short-term memory (g = 0.41 [0.24, 0.59]), learning efficiency (g = 0.39 [0.14, 0.65]), and retrieval fluency (g = 0.7 [0.19, 1.22]). Bayesian network meta-analyses indicated that aerobic exercise with music had the highest probability of being the most effective for improving global cognition, executive function, and processing speed. Dance was likely to be the most beneficial for enhancing short-term memory, learning efficiency, and retrieval fluency. This study supports that incorporating music in exercise amplifies the cognitive benefits beyond exercise alone for individuals with MCI. The "Music Exercise Synergy Model" is proposed to explain the cognitive benefits of combining music with exercise. Dance strategically uses music for coordination, offering psychological, social, cognitive, and neurobiological benefits and contributing to the observed enhancements in memory functions.

Interpersonal synchrony in dance/movement therapy: Neural underpinnings for individuals with dementia

Rising global levels of dementia including Alzheimer's disease call for the treatment of both cognitive and psychosocial deficits of this population. While there is no cure for dementia, the progression can be slowed, and symptoms eased. The positive effects of exercise and dance have been documented as has interpersonal synchrony. Dance/movement therapy uses kinesthetic empathy, attunement, and mirroring to communicate, synchronize, and connect with clients, salient for a population that often struggles with loneliness and isolation. Here I offer a perspective on how dance/movement therapy promotes the social functions and neural underpinning of interpersonal synchrony, possibly providing neuroprotection for this population.

Free Dance Proves to be Effective in Depressive Symptoms, Anxiety and Stress in Women Undergoing Breast Cancer Surgery: A Randomized Clinical Trial

Objective: To analyze the effects of 12 weeks of free dancing compared to the control group and the reference group without breast cancer, on depressive symptoms, anxiety and stress in women after breast cancer surgery and to verify the association between the variables. Methods: Randomized clinical trial, comprising women after breast cancer surgery (57.7 ± 9.0 years) and women without breast cancer (51.5 ± 10.8 years), divided into 3 groups; (a) received the free dance intervention (n = 11); (b) control group with breast cancer (n = 11) maintained their routine activities, and (c) control group without breast cancer (n = 12) who were matched by age and could not perform physical exercise during the study period. The dance intervention lasted 12 weeks, with 60-minute sessions, held twice a week. The evaluated outcomes were: depressive symptoms (Beck Depression Inventory), anxiety (Beck Anxiety Inventory), and stress (Perceived Stress Scale). Results: There was statistically significant improvement in the intragroup for free dance in depressive symptoms (P = .025), anxiety (P = .009) and stress (P = .050). No significant intragroup differences were found in the control group I and control group II, as well as intergroup differences. In the association of variables, the healthy reference group worsened in the simple analysis, for anxiety (P ≤ .001) and stress (P = .040), and worsened in the adjusted analysis, also for anxiety (P ≤ .001) and stress (P = .025). Conclusion: Free dancing had positive effects on depressive symptoms, anxiety and stress in women after breast cancer surgery. After verifying the association of the variables, it was noticed a worsening of the variables in the CGII. Clinical registry: Brazilian Registry of Clinical Trials (ReBEC) (no. 0RBR-772ktp).

[Clinical guidelines «Cognitive disorders in the elderly and senile persons»]

Clinical guidelines «Cognitive disorders in the elderly and senile persons».

Compared to exercise, the effects of exercise combined with cognitive training in people with mild cognitive impairment: a network meta-analysis

OBJECTIVES

The study aimed to evaluate the relative effectiveness of exercise combined with cognitive training (E&CT) in improving cognitive function compared to exercise alone.

METHOD

PubMed, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, and OpenGrey were systematically searched. Additional screenings were performed by reviewing citations of relevant articles. Studies were included if they met inclusion criteria. Both pairwise and network meta-analyses were performed using a random effects model in Stata 15.0.

RESULTS

Totally, 46 trials from 54 literature (n = 2846) were eligible for inclusion in the meta-analysis. The network meta-analysis indicated that exercise alone was more efficacious than E&CT in improving global cognition and multicomponent exercise exhibited the highest likelihood (SUCRA value= 89.0%) of being the most effective type. Regarding memory function, E&CT presented greater potential than exercise alone, with the interactive modality ranking first (SUCRA value = 88.4%). Multicomponent exercise was identified as the top intervention for enhancing executive function. The overall quality of the included studies was rated as moderate, and the certainty of evidence ranged from low to high.

CONCLUSION

Multicomponent exercise emerged as the optimal intervention for improving global cognition and executive function. Nevertheless, for memory function, the interactive modality of E&CT demonstrated the highest probability of being the most effective choice.

Physical exercise for brain plasticity promotion an overview of the underlying oscillatory mechanism

The global recognition of the importance of physical exercise (PE) for human health has resulted in increased research on its effects on cortical activity. Neural oscillations, which are prominent features of brain activity, serve as crucial indicators for studying the effects of PE on brain function. Existing studies support the idea that PE modifies various types of neural oscillations. While EEG-related literature in exercise science exists, a comprehensive review of the effects of exercise specifically in healthy populations has not yet been conducted. Given the demonstrated influence of exercise on neural plasticity, particularly cortical oscillatory activity, it is imperative to consolidate research on this phenomenon. Therefore, this review aims to summarize numerous PE studies on neuromodulatory mechanisms in the brain over the past decade, covering (1) effects of resistance and aerobic training on brain health via neural oscillations; (2) how mind-body exercise affects human neural activity and cognitive functioning; (3) age-Related effects of PE on brain health and neurodegenerative disease rehabilitation via neural oscillation mechanisms; and (4) conclusion and future direction. In conclusion, the effect of PE on cortical activity is a multifaceted process, and this review seeks to comprehensively examine and summarize existing studies' understanding of how PE regulates neural activity in the brain, providing a more scientific theoretical foundation for the development of personalized PE programs and further research.

A methodological and reporting quality assessment of systematic reviews/meta-analyses on exercise interventions for cognitive function in older adults with mild cognitive impairment

Objective

To assess the methodological quality of meta-analytic literature on exercise interventions for cognitive function in patients with mild cognitive impairment (MCI) and the certainty of evidence for its outcome indicators, and to provide clinicians and researchers with more reliable data for making decisions.

Methods

Meta-analytic literature related to the effect of exercise intervention on cognitive function in patients with mild cognitive impairment was searched through PubMed, Cochrane Library, Embase, Scopus, Physiotherapy Evidence Database and Web of Science, all with a search period frame of each database until June 1, 2024. The AMSTAR2 scale was used to evaluate the methodological quality of the included studies.

Results

Seventeen meta-analyses were included. The AMSTAR2 scale evaluation results showed that there was one medium-quality studies (5.55%), seven low-quality studies (38.88%), and 10 very low-quality studies (55.55%). Methodological deficiencies included failure to prepare a plan and provide a registration number, literature screening, data extraction, reasons for exclusion not described in detail, poor implementation process for systematic evaluation, and failure to describe the source of funding for the included studies or relevant conflicts of interest.

Conclusion

The overall methodological quality of the meta-analytic literature is low, and the certainty of evidence is low. We encourage the conduction of high-quality randomized trials to generate stronger evidence. Subsequent systematic reviews can then synthesize this evidence to inform future research and clinical guidelines.

Moving Towards a Medicine of Dance: A Scoping Review of Characteristics of Dance Interventions Targeting Older Adults and a Theoretical Framework

BACKGROUND

Dance combines cultural and aesthetic elements with behaviors important for brain health, including physical activity, social engagement, and cognitive challenge. Therefore, dance could positively impact public health given the rapidly aging population, increasing incidence of Alzheimer's disease and related dementias, and lack of uptake of exercise in many older adults. Despite a high volume of literature, existing literature does not support evidence-based guidelines for dance to support healthy aging.

OBJECTIVE

To conduct a scoping review of the dance intervention literature in older adults and provide information to facilitate a more consistent approach among scientists in designing dance interventions for older adults that stimulate physical and neurocognitive health adaptations.

METHODS

Study characteristics (sample size, population, study design, outcomes, intervention details) were ascertained from 112 separate studies of dance reported in 127 papers that reported outcomes important for brain health (cardiorespiratory fitness, balance and mobility, cognition, mood, and quality of life).

RESULTS

High heterogeneity across studies was evident. Class frequency ranged from < 1 to 5 classes per week, class length from 30-120 minutes, and intervention duration from 2 weeks to 18 months. Studies often did not randomize participants, had small (< 30) sample sizes, and used varied comparator conditions. Over 50 tests of cognition, 40 dance forms, and 30 tests of mobility were identified.

CONCLUSIONS

Based on these results, important future directions are establishing common data elements, developing intervention mapping and mechanistic modeling, and testing dosing parameters to strengthen and focus trial design of future studies and generate evidence-based guidelines for dance.

Associations Between Music and Dance Relationships, Rhythmic Proficiency, and Spatiotemporal Movement Modulation Ability in Adults with and without Mild Cognitive Impairment

BACKGROUND

Personalized dance-based movement therapies may improve cognitive and motor function in individuals with mild cognitive impairment (MCI), a precursor to Alzheimer's disease. While age- and MCI-related deficits reduce individuals' abilities to perform dance-like rhythmic movement sequences (RMS)-spatial and temporal modifications to movement-it remains unclear how individuals' relationships to dance and music affect their ability to perform RMS.

OBJECTIVE

Characterize associations between RMS performance and music or dance relationships, as well as the ability to perceive rhythm and meter (rhythmic proficiency) in adults with and without MCI.

METHODS

We used wearable inertial sensors to evaluate the ability of 12 young adults (YA; age = 23.9±4.2 years; 9F), 26 older adults without MCI (OA; age = 68.1±8.5 years; 16F), and 18 adults with MCI (MCI; age = 70.8±6.2 years; 10F) to accurately perform spatial, temporal, and spatiotemporal RMS. To quantify self-reported music and dance relationships and rhythmic proficiency, we developed Music (MRQ) and Dance Relationship Questionnaires (DRQ), and a rhythm assessment (RA), respectively. We correlated MRQ, DRQ, and RA scores against RMS performance for each group separately.

RESULTS

The OA and YA groups exhibited better MRQ and RA scores than the MCI group (p < 0.006). Better MRQ and RA scores were associated with better temporal RMS performance for only the YA and OA groups (r2 = 0.18-0.41; p < 0.045). DRQ scores were not associated with RMS performance in any group.

CONCLUSIONS

Cognitive deficits in adults with MCI likely limit the extent to which music relationships or rhythmic proficiency improve the ability to perform temporal aspects of movements performed during dance-based therapies.

Associations between music and dance relationships, rhythmic proficiency, and spatiotemporal movement modulation ability in adults with and without mild cognitive impairment

Background

Personalized dance-based movement therapies may improve cognitive and motor function in individuals with mild cognitive impairment (MCI), a precursor to Alzheimer's disease. While age- and MCI-related deficits reduce individuals' abilities to perform dance-like rhythmic movement sequences (RMS)-spatial and temporal modifications to movement-it remains unclear how individuals' relationships to dance and music affect their ability to perform RMS.

Objective

Characterize associations between RMS performance and music or dance relationships, as well as the ability to perceive rhythm and meter (rhythmic proficiency) in adults with and without MCI.

Methods

We used wearable inertial sensors to evaluate the ability of 12 young adults (YA; age=23.9±4.2 yrs; 9F), 26 older adults without MCI (OA; age=68.1±8.5 yrs; 16F), and 18 adults with MCI (MCI; age=70.8±6.2 yrs; 10F) to accurately perform spatial, temporal, and spatiotemporal RMS. To quantify self-reported music and dance relationships and rhythmic proficiency, we developed Music (MRQ) and Dance Relationship Questionnaires (DRQ), and a rhythm assessment (RA), respectively. We correlated MRQ, DRQ, and RA scores against RMS performance for each group separately.

Results

The OA and YA groups exhibited better MRQ and RA scores than the MCI group (p<0.006). Better MRQ and RA scores were associated with better temporal RMS performance for only the YA and OA groups (r2=0.18-0.41; p<0.045). DRQ scores were not associated with RMS performance in any group.

Conclusions

Cognitive deficits in adults with MCI likely limit the extent to which music relationships or rhythmic proficiency improve the ability to perform temporal aspects of movements performed during dance-based therapies.

Life-long music and dance relationships inform impressions of music- and dance-based movement therapies in individuals with and without mild cognitive impairment

Background

No effective therapies exist to prevent degeneration from Mild Cognitive Impairment (MCI) to Alzheimer's disease. Therapies integrating music and/or dance are promising as effective, non-pharmacological options to mitigate cognitive decline.

Objective

To deepen our understanding of individuals' relationships (i.e., histories, experiences and attitudes) with music and dance that are not often incorporated into music- and dance-based therapeutic design, yet may affect therapeutic outcomes.

Methods

Eleven older adults with MCI and five of their care partners/ spouses participated (4M/12F; Black: n=4, White: n=10, Hispanic/ Latino: n=2; Age: 71.4±9.6). We conducted focus groups and administered questionnaires that captured aspects of participants' music and dance relationships. We extracted emergent themes from four major topics, including: (1) experience and history, (2) enjoyment and preferences, (3) confidence and barriers, and (4) impressions of music and dance as therapeutic tools.

Results

Thematic analysis revealed participants' positive impressions of music and dance as potential therapeutic tools, citing perceived neuropsychological, emotional, and physical benefits. Participants viewed music and dance as integral to their lives, histories, and identities within a culture, family, and/ or community. Participants also identified lifelong engagement barriers that, in conjunction with negative feedback, instilled persistent low self-efficacy regarding dancing and active music engagement. Questionnaires verified individuals' moderately-strong music and dance relationships, strongest in passive forms of music engagement (e.g., listening).

Conclusions

Our findings support that individuals' music and dance relationships and the associated perceptions toward music and dance therapy may be valuable considerations in enhancing therapy efficacy, participant engagement and satisfaction for individuals with MCI.

Higher remnant cholesterol is associated with an increased risk of amnestic mild cognitive impairment: a community-based cross-sectional study

Background and aims

Amnestic mild cognitive impairment (aMCI) is the most common subtype of MCI, which carries a significantly high risk of transitioning to Alzheimer's disease. Recently, increasing attention has been given to remnant cholesterol (RC), a non-traditional and previously overlooked risk factor. The aim of this study was to explore the association between plasma RC levels and aMCI.

Methods

Data were obtained from Brain Health Cognitive Management Team in Wuhan (https://hbtcm.66nao.com/admin/). A total of 1,007 community-dwelling elders were recruited for this project. Based on ten tools including general demographic data, cognitive screening and some exclusion scales, these participants were divided into the aMCI (n = 401) and normal cognitive groups (n = 606). Physical examinations were conducted on all participants, with clinical indicators such as blood pressure, blood sugar, and blood lipids collected.

Results

The aMCI group had significantly higher RC levels compared to the normal cognitive group (0.64 ± 0.431 vs. 0.52 ± 0.447 mmol/L, p < 0.05). Binary logistics regression revealed that occupation (P<0.001, OR = 0.533, 95%CI: 0.423-0.673) and RC (p = 0.014, OR = 1.477, 95% CI:1.081-2.018) were associated factors for aMCI. Partial correlation analysis, after controlling for occupation, showed a significant negative correlation between RC levels and MoCA scores (r = 0.059, p = 0.046), as well as Naming scores (r = 0.070, p = 0.026). ROC curve analysis demonstrated that RC levels had an independent predictive efficacy in predicting aMCI (AUC = 0.580, 95%CI: 0.544 ~ 0.615, P < 0.001).

Conclusion

Higher RC levels were identified as an independent indicator for aMCI, particularly in the naming cognitive domain among older individuals. Further longitudinal studies are necessary to validate the predictive efficacy of RC.

A single 1,500 m freestyle at maximal speed decreases cognitive function in athletes

Introduction

Physical exercise can improve cognitive function, and the degree of impact on cognitive function is related to exercise modality, intensity, and duration. However, few studies have been conducted on the effects of competitive sports on cognitive function. The 1,500 m freestyle is the longest pool-based swimming event in the Olympic Games. This study explores the effects of 1,500 m freestyle at maximal speed on athletes' cognitive function and analyzes the potential mechanism of cognitive function reduction in freestyle at maximal speed from the perspective of hemoglobin oxygenation difference (Hbdiff).

Methods

A total of 13 male university swimmers were required to take part in a 1,500 m freestyle competition, swimming at maximal speed. The relevant indicators, including cognitive function and freestyle at maximal speed, before and after the competition were tested and analyzed. Cognitive function was assessed using the Schulte grid test (SGT), the trail-making test (TMT), and the digit span test (DST). The neurobiological characteristics of cognitive function, such as the prefrontal cortex (PFC), response time (RT), and accuracy rate (ACC), were tested using functional near-infrared spectroscopy (fNIRS).

Results

A significant decrease in scores for SGT, TMT, and digit span test-backward (DST-B) (p < 0.01). Oxygenated hemoglobin (Oxy-Hb) concentrations in the right frontopolar area (R-FPA) of brain channels 8 (p < 0.01) and 9 (CH8, 9) (p < 0.05), the right dorsolateral prefrontal cortex (R-DLPFC) CH10 (p < 0.05), and the middle dorsolateral prefrontal cortex (M-DLPFC) CH18 (p < 0.01) were significantly altered, and the right area of the brain was activated. The total Oxy-Hb concentrations in the regions of interest (ROIs) of R-FPA, R-DLFPC, and M-DLFPC were changed significantly (p < 0.01).

Discussion

The exhaustive performance of a 1,500 m freestyle event resulted in both physical fatigue and a decline in cognitive function. This decline may be attributed to the activation of specific regions of interest, namely the FPA, DLPFC, and M-DLPFC, within the prefrontal cortex (PFC), as well as alterations in functional connectivity.

Effects of dance therapy on cognitive and mental health in adults aged 55 years and older with mild cognitive impairment: a systematic review and meta-analysis

BACKGROUND

Individuals with mild cognitive impairment are at high risk of developing dementia. Dance therapy has promising applications in delaying cognitive decline. However, the effectiveness of dance therapy for older adults with mild cognitive impairment is unclear. The objective of this review was to evaluate the effectiveness of dance therapy on global cognitive function, specific cognitive subdomains, quality of life, and mental health in older adults with mild cognitive impairment to enrich health management strategies for dementia.

METHODS

Electronic databases and grey literature were searched from inception up to September 23, 2023. The language was limited to English and Chinese. Relevant studies were screened and assessed for risk of bias. A meta-analysis and subgroup analyses stratified by measurement instrument, dance type, intervention duration, and frequency were conducted using the STATA 16.0 software. This review was conducted in accordance with the PRISMA guidelines.

RESULTS

Ten studies involving 984 participants aged 55 years and over who met the eligibility criteria were included. Dance therapy significantly improved global cognitive function, memory, executive function, attention, language, and mental health (i.e., depression and neuropsychiatric symptoms). However, the effects of dance therapy on processing speed, visuospatial ability, and quality of life in older adults with mild cognitive impairment remain inconclusive. Moreover, dance interventions of longer duration (> 3 months) improved global cognition more than shorter interventions.

CONCLUSION

This review reported that dance therapy was effective in improving global cognitive function, memory, executive function, attention, language, and mental health (i.e., depression and neuropsychiatric symptoms). Hence, it may be an effective non-pharmacological complementary treatment for older adults with mild cognitive impairment.

The effect of aerobic dancing on physical fitness and cognitive function in older adults during the COVID-19 pandemic-a natural experiment

During the Coronavirus disease (COVID-19), the physical activity of older adults is at a lower level. The study aimed to examine the effectiveness of aerobic dancing on physical fitness and cognitive function in older adults. We conducted a randomized controlled trial with 34 older adults who were assigned into an aerobic dancing group and a control group. Three dance sessions weekly for 60 ​min were scheduled for the aerobic dancing group for a total of 12 weeks. Physical fitness, blood pressure, lipids, glucose, cognitive function were assessed before and after the intervention. Baseline adjusted Analysis of Covariance (ANCOVA) was used to determine whether outcome variables varied between groups at pre-test and post-test. Effect size (Cohen's d) was calculated to determine the differences between groups from baseline to post-test. After 12 weeks, we found that the aerobic dancing group showed significant improvement in memory (portrait memory: F ​= ​10.45, p ​= ​0.003, d ​= ​1.18). The Limit of Stability (LOS) parameters in the aerobic dancing group displayed a significant increase after the intervention (right angle: F ​= ​5.90, p ​= ​0.022, d ​= ​0.60; right-anterior angle: F ​= ​4.23, p ​= ​0.049, d ​= ​0.12). Some beneficial effects were found on flexibility, grip strength, balance and subjective well-being (sit and reach: F ​= ​0.25, p ​= ​0.62, d ​= ​-0.40; grip strength: F ​= ​3.38, p ​= ​0.08, d ​= ​0.89; one-legged standing with eyes closed: F ​= ​1.26, p ​= ​0.27, d ​= ​0.50) in the aerobic dancing group. Aerobic dancing training was effective in improving memory and balance ability in older adults during the COVID-19 pandemic in China. In the future, aerobic dancing is a promising tool to encourage physical activity in older adults.

The Impact of Dance Movement Interventions on Psychological Health in Older Adults without Dementia: A Systematic Review and Meta-Analysis

BACKGROUND

Lifestyle-based multimodal interventions that integrate physical, sensory, cognitive and social enrichment are suggested to promote healthy mental aging and resilience against aging and Alzheimer's disease (AD).

OBJECTIVES

This meta-analysis examined the efficacy of dance movement interventions (DMI) as an integrated mind-body activity on outcomes of psychological health in older adults.

METHODS

Pre-registration was carried out with PROSPERO (CRD42021265112). PubMed, Web of Science and PsycINFO were searched for randomized controlled trials (RCT) evaluating the effects of DMI (>4 weeks' duration) compared to comparators on measures of psychological health (primary outcome) and cognitive function (additional outcome) among older adults without dementia (aged ≥55). Data of 14 primary RCT (n = 983, n-DMI = 494, n-control = 489) were synthesized using a random effects meta-analysis with robust variance estimation.

RESULTS

DMI had a small positive effect on overall psychological health (g = 0.30; 95% confidence interval [CI]: 0.06, 0.53; p = 0.02, I²= 65.04) compared to control conditions. Small effects of DMI on positive and negative psychological domains as well as quality of life were not statistically significant. DMI had a medium positive effect on general cognitive function (g = 0.50; 95% CI: 0.12, 0.89, p = 0.02, I²= 79.61) over comparators. None of the primary intervention studies evaluated measures of neuroplasticity.

CONCLUSIONS

We found that DMI was effective in promoting mental health amongst older adults without dementia, suggesting that the multimodal enrichment tool is a potential strategy for health promotion and prevention of AD. High-quality intervention studies are needed to expand evidence on DMI-induced changes in specific psychological domains and identify underlying neurophysiological correlates.

Physical activity and lifestyle modifications in the treatment of neurodegenerative diseases

Neurodegenerative diseases have reached alarming numbers in the past decade. Unfortunately, clinical trials testing potential therapeutics have proven futile. In the absence of disease-modifying therapies, physical activity has emerged as the single most accessible lifestyle modification with the potential to fight off cognitive decline and neurodegeneration. In this review, we discuss findings from epidemiological, clinical, and molecular studies investigating the potential of lifestyle modifications in promoting brain health. We propose an evidence-based multidomain approach that includes physical activity, diet, cognitive training, and sleep hygiene to treat and prevent neurodegenerative diseases.

Effects of physical activity interventions on executive function in older adults with dementia: A meta-analysis of randomized controlled trials

BACKGROUND

To date quantitative meta-analysis with large samples to investigate the effects and potential moderators of physical activity (PA) on executive function (EF) in older adults with dementia is insufficient. Therefore, we conducted this meta-analysis.

DESIGN

Meta-analysis of randomized controlled trials (RCTs).

PARTICIPANTS

Old people with Alzheimer's disease (AD) or related dementia of varying types and severity as the primary diagnosis.

METHODS

PubMed, Web of Science, the Cochrane Library and Embase databases were searched for relevant studies published from 01 January, 2010 to 01 March, 2022. The results of executive function were reported in all RCTs. Random-effects meta-analysis was used to calculate the size of effects. Subgroup analyses of three moderators (including the specific sub-domains of EF, exercise prescription variables, and sample characteristics) were performed.

RESULTS

Eighteen RCTs were included with a combined sample size of 1366. Overall, PA interventions improved overall EF (standardized mean difference [SMD]=0.23, 95% confidence interval [CI] 0.05 to 0.41, p<0.05). The EF sub-domain "planning" was significant moderator (SMD=0.31, 95%CI 0.11 to 1.51, p<0.01), but inhibitory control, working memory and cognitive flexibility were not significant. Regarding exercise prescription variables, type of resistance training; moderate intensity; total duration ≤24 weeks and short (once or twice a week) frequency improved overall EF performance. Session length may be a moderator. Regarding sample characteristics, old-old, AD and both dementia and AD had significant benefits.

CONCLUSIONS AND IMPLICATIONS

EF in older adults with AD or related dementia benefited from physical activity, and the benefit was affected by the type, intensity, total duration, frequency of exercise. Physical activity can be an alternative intervention in aging patients with dementia, to improve EF performance or prevent or EF decline.

IMOVE: Protocol for a randomized, controlled 2x2 factorial trial of improvisational movement and social engagement interventions in older adults with early Alzheimer's disease

Background

In addition to cognitive impairment, people with Alzheimer's disease (PWAD) experience neuropsychiatric symptoms (e.g., apathy, depression), altered gait, and poor balance that further diminish their quality of life (QoL). Here, we describe a unique, randomized, controlled trial to test the hypothesis that both movement and social engagement aspects of a group dance intervention alter the connectivity of key brain networks involved in motor and social-emotional functioning and lead to improved QoL in PWAD.

Methods

IMOVE (NCT03333837) was a single-center, randomized, controlled 2x2 factorial trial that assigned PWAD/caregiver dyads to one of 4 study conditions (Movement Group, Movement Alone, Social Group, or Usual Care control). The Movement Group participated in twice-weekly group improvisational dance (IMPROVment® Method) classes for 12 weeks. The Movement Alone intervention captured the same dance movement and auditory stimuli as the group class without social interaction, and the Social Group used improvisational party games to recapitulate the fun and playfulness of the Movement Group without the movement. The primary outcome was change in QoL among PWAD. Key secondary outcomes were functional brain network measures assessed using graph-theory analysis of resting-state functional magnetic resonance imaging scans, as well as neuropsychiatric symptoms, gait, and balance.

Results

A total of 111 dyads were randomized; 89 completed the study, despite interruption and modification of the protocol due to COVID-19 restrictions (see companion paper by Fanning et al.). The data are being analyzed and will be submitted for publication in 2023.

Motor and cognitive deficits limit the ability to flexibly modulate spatiotemporal gait features in older adults with mild cognitive impairment

Introduction: Dance-based therapies are an emerging form of movement therapy aiming to improve motor and cognitive function in older adults with mild cognitive impairments (MCIs). Despite the promising effects of dance-based therapies on function, it remains unclear how age-related declines in motor and cognitive function affect movement capacity and influence which movements and rhythms maximize dance therapy efficacy. Here, we evaluated the effects of age and MCI on the ability to accurately modulate spatial (i.e., joint kinematics), temporal (i.e., step timing), and spatiotemporal features of gait to achieve spatial and temporal targets during walking. Methods: We developed novel rhythmic movement sequences-nine spatial, nine temporal, and four spatiotemporal-that deviated from typical spatial and temporal features of walking. Healthy young adults (HYA), healthy older adults (HOA), and adults with MCI were trained on each gait modification before performing the modification overground, with kinematic data recorded using wearable sensors. Results: HOA performed spatial (p = 0.010) and spatiotemporal (p = 0.048) gait modifications less accurately than HYA. Individuals with MCI performed spatiotemporal gait modifications less accurately than HOA (p = 0.017). Spatial modifications to the swing phase of gait (p = 0.006, Cohen's d = -1.3), and four- and six-step Duple rhythms during temporal modifications (p ≤ 0.030, Cohen's d ≤ 0.9) elicited the largest differences in gait performance in HYA vs. HOA and HOA vs. MCI, respectively. Discussion: These findings suggest that age-related declines in strength and balance reduce the ability to accurately modulate spatial gait features, while declines in working memory in individuals with MCI may reduce the ability to perform longer temporal gait modification sequences. Differences in rhythmic movement sequence performance highlight motor and cognitive factors potentially underlying deficits in gait modulation capacity, which may guide therapy personalization and provide more sensitive indices to track intervention efficacy.

Rationale for a Multi-Factorial Approach for the Reversal of Cognitive Decline in Alzheimer's Disease and MCI: A Review

Alzheimer's disease (AD) is a multifactorial, progressive, neurodegenerative disease typically characterized by memory loss, personality changes, and a decline in overall cognitive function. Usually manifesting in individuals over the age of 60, this is the most prevalent type of dementia and remains the fifth leading cause of death among Americans aged 65 and older. While the development of effective treatment and prevention for AD is a major healthcare goal, unfortunately, therapeutic approaches to date have yet to find a treatment plan that produces long-term cognitive improvement. Drugs that may be able to slow down the progression rate of AD are being introduced to the market; however, there has been no previous solution for preventing or reversing the disease-associated cognitive decline. Recent studies have identified several factors that contribute to the progression and severity of the disease: diet, lifestyle, stress, sleep, nutrient deficiencies, mental health, socialization, and toxins. Thus, increasing evidence supports dietary and other lifestyle changes as potentially effective ways to prevent, slow, or reverse AD progression. Studies also have demonstrated that a personalized, multi-therapeutic approach is needed to improve metabolic abnormalities and AD-associated cognitive decline. These studies suggest the effects of abnormalities, such as insulin resistance, chronic inflammation, hypovitaminosis D, hormonal deficiencies, and hyperhomocysteinemia, in the AD process. Therefore a personalized, multi-therapeutic program based on an individual's genetics and biochemistry may be preferable over a single-drug/mono-therapeutic approach. This article reviews these multi-therapeutic strategies that identify and attenuate all the risk factors specific to each affected individual. This article systematically reviews studies that have incorporated multiple strategies that target numerous factors simultaneously to reverse or treat cognitive decline. We included high-quality clinical trials and observational studies that focused on the cognitive effects of programs comprising lifestyle, physical, and mental activity, as well as nutritional aspects. Articles from PubMed Central, Scopus, and Google Scholar databases were collected, and abstracts were reviewed for relevance to the subject matter. Epidemiological, pathological, toxicological, genetic, and biochemical studies have all concluded that AD represents a complex network insufficiency. The research studies explored in this manuscript confirm the need for a multifactorial approach to target the various risk factors of AD. A single-drug approach may delay the progression of memory loss but, to date, has not prevented or reversed it. Diet, physical activity, sleep, stress, and environment all contribute to the progression of the disease, and, therefore, a multi-factorial optimization of network support and function offers a rational therapeutic strategy. Thus, a multi-therapeutic program that simultaneously targets multiple factors underlying the AD network may be more effective than a mono-therapeutic approach.

Randomized Controlled Trial of Social Ballroom Dancing and Treadmill Walking: Preliminary Findings on Executive Function and Neuroplasticity From Dementia-at-Risk Older Adults

This randomized controlled trial (NCT03475316) examined the relative efficacy of 6 months of social ballroom dancing and treadmill walking on a composite executive function score, generated from digit symbol substitution test, flanker interference, and walking while talking tasks. Brain activation during functional magnetic resonance imaging (fMRI) versions of these executive function tasks were secondary outcomes. Twenty-five dementia-at-risk older adults (memory impairment screen score of ≥3 to ≤6 and/or an Alzheimer's disease-8 Dementia Screening Interview of ≥1) were randomized in June 2019 to March 2020-16 completed the intervention before study termination due to the COVID-19 (eight in each group). Composite executive function scores improved post-intervention in both groups, but there was no evidence for between-group differences. Social dancing, however, generated greater improvements on digit symbol substitution test than treadmill walking. No intervention-related differences were observed in brain activation-although less hippocampal atrophy (tertiary) was observed following social dancing than treadmill walking. These preliminary findings are promising but need to be confirmed in future large-scale and sufficiently powered randomized controlled trials.

Effects of exercise interventions on executive function in old adults with mild cognitive impairment: A systematic review and meta-analysis of randomized controlled trials

AIMS

To assess the effect of exercise interventions on subdomains of executive function (EF) in older adults with mild cognitive impairment (MCI).

METHODS

Nine electronic databases were comprehensively searched from their inception to February 2021. Randomized controlled trials examining the effect of exercise training on EF in MCI were included.

RESULTS

Twenty-four eligible articles involving 2278 participants were identified. The results showed that exercise interventions had positive benefits on working memory, switching and inhibition in MCI. Subgroup analysis based on exercise prescriptions revealed that both aerobatic exercise and mind-body exercise had similar positive effect size on working memory. However, only mind-body exercise had significant effect on switching. Exercise training with moderate frequency (3-4 times/week) had larger effect size than low frequency (1-2 times/week) and only moderate frequency had positive benefits on switching. Both short (4-12 weeks), medium (13-24 weeks) and long (more than 24 weeks) exercise duration significantly ameliorate working memory and switching, however with short duration having slight larger effect sizes than medium and long.

CONCLUSION

Exercise significantly improves three subdomains of EF in MCI, especially mind-body exercise. Exercise training sticking to at least 4 weeks with 3-4 times a week tends to have larger effect size.

Functional Profile of Older Adults Hospitalized in Rehabilitation Units of the National Network of Integrated Continuous Care of Portugal: A Longitudinal Study

BACKGROUND

The success of healthy aging depends on the ability of countries to study and act on frailty in the elderly, control chronic diseases, improve functional capacity and prevent cognitive decline and social interaction.

AIM

(1) to evaluate the functional profile of older adults hospitalized in a Unit of the National Network of Integrated Continuous Care of Portugal; and (2) to assess the relationship between functional profile and age, gender, level of education and emotional state.

METHODS

Longitudinal study with a population of 59,013 older adults (65 years or older) hospitalized in Medium-Term Care and Rehabilitation Units in Portugal.

RESULTS

Older age (≥85 years), no school attendance, low body mass index and presence of sad or depressed mood were predictive factors for a deficit in functional capacity. We identified significant improvements in rehabilitation, but after 210 days of hospitalization, older people incurred a loss of functionality. Total compensation needs were typified by severe deficits in self-care and functional capacity: 47.1%. A moderate deficit was present in 43.1%, and a slight self-care and functional deficit occurred in 9.8% of the individuals.

CONCLUSIONS

Knowing the determinants of functional capacity and self-care needs will make it possible to define priority intervention groups and implement quality and financing models based on gains in functionality.

The influence of exercise interventions on cognitive functions in patients with amnestic mild cognitive impairment: A systematic review and meta-analysis

Introduction

Patients with amnestic mild cognitive impairment (aMCI) are more likely to develop dementia compared to patients with non-aMCI (naMCI). Among the mixed samples of aMCI and naMCI, exercise interventions are effective for patients with MCI to improve cognitive functions. However, the influence of exercise interventions on patients with aMCI is still unclear.

Objective

The objective of this systematic review and meta-analysis is to evaluate the influence of exercise interventions on cognitive functions in patients with aMCI.

Methods

Four literature databases (PubMed, Web of Science, EBSCO, and Cochrane Library) and three Chinese databases (China National Knowledge Infrastructure, Wanfang, and China Science and Technology Journal Database) were searched from their inception to August 31, 2022. Based on the preliminary search of seven databases and their cited references, a total of 2,290 records were identified. Finally, 10 studies with a total of 28 data points involving 575 participants with aMCI were included in this meta-analysis. If the measurements of outcomes were different among studies, the effect size was synthesized using the standardized mean difference (SMD) with a 95% confidence interval (CI). If the measurements were the same, the weight mean difference (WMD) with a 95% CI was used to integrate the effect size.

Data synthesis

The results showed that exercise interventions had no significant effects on improving several specific domains of cognitive functions including working memory (WMD = -0.05; 95% CI = -0.74 to 0.63; p = 0.88; I ² = 78%) and attention (SMD = 0.20; 95% CI = -0.31 to 0.72; p = 0.44; I ² = 60%). Additionally, exercise interventions had a significant effect on global cognitive function (SMD = 0.70; 95% CI = 0.50-0.90; p < 0.00001; I ² = 29%) and some specific cognitive domains including immediate recall (SMD = 0.55; 95% CI = 0.28-0.81; p < 0.0001; I ² = 0%), delayed recall (SMD = 0.66; 95% CI = 0.45-0.87; p < 0.00001; I ² = 37%), and executive function (SMD = 0.38; 95% CI = 0.16-0.60; p= 0.0006; I ² = 4%). Furthermore, subgroup analysis based on the intervention forms indicated that multi-component interventions (SMD = 0.44; 95% CI = 0.11-0.77; p = 0.009; I ² = 0%) appeared to be less effective than the single-component intervention (SMD = 0.85; 95% CI = 0.60-1.10; p < 0.00001; I ² = 10%) in terms of boosting global cognitive function.

Conclusion

This meta-analysis suggests that the exercise can help patients with aMCI improve global cognitive function. And exercise interventions have positive influence on enhancing several specific cognitive domains such as immediate recall, delayed recall, and executive function.Systematic review registration: http://www.crd.york.ac.uk/PROSPERO, identifier: CRD42022354235.

Dance movement therapy for neurodegenerative diseases: A systematic review

Background

The proportion of the world's elderly population continues to rise, and the treatment and improvement of neurodegenerative diseases have become issue of public health importance as people live longer and many countries have aging populations. This systematic review aims to discuss the effects of dance movement therapy (DMT) on motor function, cognitive deficit, mood, and quality of life in people with neurodegenerative diseases, such as Parkinson's disease (PD), mild cognitive impairment (MCI), Alzheimer's disease (AD).

Methods

Two reviewers independently conducted systematic search on the Cochrane library, PubMed database, Web of Science Core Collection database, and Physiotherapy Evidence database until February 1, 2022. Only systematic analyses and randomized controlled trials were included and further analyzed.

Results

Thirty-three studies on PD, 16 studies on MCI, 4 studies on AD were obtained. This systematic review found that DMT substantially improved the global cognitive function, memory, and executive function on the population with MCI. Compared with the non-dance group, DMT remarkably improved general disease condition, balance, and gait for individuals with PD. The evidence of the efficacy of DMT on AD is insufficient, and further research is needed.

Conclusion

DMT can effectively improve the motor function and cognitive deficits in neurodegenerative diseases. Positive effects of DMT on the mood and quality of life in ND patients are controversial and require further evidence. Future research on the effects of DMT on AD requires scientific design, large sample size, long-term comprehensive intervention, and clear reporting standards.

Systematic review registration

www.osf.io/wktez, identifier: 10.17605/OSF.IO/UYBKT.

Is Subjective Age Associated with Physical Fitness in Community-Dwelling Older Adults?

Although subjective age has been associated with a range of health-related outcomes, there has been little systematic study on the relationship between the subjective age and physical fitness in a given population. The purpose of this study was to determine the prospective association between subjective age and physical fitness in community-dwelling older adults. A sample of 276 older people who lived in the community was studied. Subjective age was measured by a face-to-face interview. Grip strength, balancing on one leg with eyes open, the 30 s chair stand test, 4 m habitual walk, and 6 min walk test were measured to reflect physical fitness. Results indicated that the felt younger older adults had a higher level of physical fitness compared to their felt older and felt the same counterparts. Multiple linear regression analysis indicated that all the measured physical fitness items were significantly associated with subjective age in older men. All of the measured physical fitness items except for the 4 m habitual walk were remarkably related to subjective age in older women. The findings suggest that subjective age is closely associated with physical fitness in community-dwelling older adults. Much attention should be paid to the promotion of physical fitness to improve the subjective age of older adults.

Effect of 3-Month Aerobic Dance on Hippocampal Volume and Cognition in Elderly People With Amnestic Mild Cognitive Impairment: A Randomized Controlled Trial

As an intermediate state between normal aging and dementia, mild cognitive impairment (MCI), especially amnestic MCI (aMCI), is a key stage in the prevention and intervention of Alzheimer’s disease (AD). Whether dancing could increase the hippocampal volume of seniors with aMCI remains debatable. The aim of this study was to investigate the influence of aerobic dance on hippocampal volume and cognition after 3 months of aerobic dance in older adults with aMCI. In this randomized controlled trial, 68 elderly people with aMCI were randomized to either the aerobic dance group or the control group using a 1:1 allocation ratio. Ultimately, 62 of 68 participants completed this study, and the MRI data of 54 participants were included. A specially designed aerobic dance routine was performed by the dance group three times per week for 3 months, and all participants received monthly healthcare education after inclusion. MRI with a 3.0T MRI scanner and cognitive assessments were performed before and after intervention. High-resolution three-dimensional (3D) T1-weighted anatomical images were acquired for the analysis of hippocampal volume. A total of 35 participants (mean age: 71.51 ± 6.62 years) were randomized into the aerobic dance group and 33 participants (mean age: 69.82 ± 7.74 years) into the control group. A multiple linear regression model was used to detect the association between intervention and the difference of hippocampal volumes as well as the change of cognitive scores at baseline and after 3 months. The intervention group showed greater right hippocampal volume (β [95% CI]: 0.379 [0.117, 0.488], p = 0.002) and total hippocampal volume (β [95% CI]: 0.344 [0.082, 0.446], p = 0.005) compared to the control group. No significant association of age or gender was found with unilateral or global hippocampal volume. There was a correlation between episodic memory and intervention, as the intervention group showed a higher Wechsler Memory Scale-Revised Logical Memory (WMS-RLM) score (β [95% CI]: 0.326 [1.005, 6.773], p = 0.009). Furthermore, an increase in age may cause a decrease in the Mini-Mental State Examination (MMSE) score (β [95% CI]: −0.366 [−0.151, −0.034], p = 0.002). In conclusion, 3 months of aerobic dance could increase the right and total hippocampal volumes and improve episodic memory in elderly persons with aMCI.

Clinical Trial Registration: This study was registered on the Chinese Clinical Trial Registry [www.chictr.org.cn], identifier [ChiCTR-INR-15007420].

Improvisational Movement to Improve Quality of Life in Older Adults With Early-Stage Dementia: A Pilot Study

Alzheimer's disease has profound effects on quality of life, affecting not only cognition, but mobility and opportunities for social engagement. Dance is a form of movement that may be uniquely suited to help maintain quality of life for older adults, including those with dementia, because it inherently incorporates movement, social engagement, and cognitive stimulation. Here, we describe the methods and results of the pilot study for the IMOVE trial (NCT03333837, www.clinicaltrials.gov), a clinical trial designed to use improvisational dance classes to test the effects of movement and social engagement in people with mild cognitive impairment (MCI) or early-stage dementia. The pilot study was an 8-week investigation into the feasibility and potential effects of an improvisational dance intervention on people with MCI or early-stage dementia (PWD/MCI) and their caregivers (CG). The pilot aimed to assess changes in quality of life, balance, mood, and functional brain networks in PWD/MCI and their CG. Participants were recruited as dyads (pairs) that included one PWD/MCI and one CG. Ten total dyads were enrolled in the pilot study with five dyads assigned to the usual care control group and five dyads participating in the dance intervention. The intervention arm met twice weekly for 60 min for 8 weeks. Attendance and quality of life assessed with the Quality of Life in Alzheimer's disease (QoL-AD) questionnaire were the primary outcomes. Secondary outcomes included balance, mood and brain network connectivity assessed through graph theory analysis of functional magnetic resonance imaging (fMRI). Class attendance was 96% and qualitative feedback reflected participants felt socially connected to the group. Increases in quality of life and balance were observed, but not mood. Brain imaging analysis showed increases in multiple brain network characteristics, including global efficiency and modularity. Further investigation into the positive effects of this dance intervention on both imaging and non-imaging metrics will be carried out on the full clinical trial data. Results from the trial are expected in the summer of 2022.

Making the Best Out of IT: Design and Development of Exergames for Older Adults With Mild Neurocognitive Disorder - A Methodological Paper

Background: Utilizing information technology (IT) systems, for example in form of computerized cognitive screening or exergame-based (also called active videogames) training, has gained growing interest for supporting healthy aging and to detect, prevent and treat neurocognitive disorders (NCD). To ameliorate the effectiveness of exergaming, the neurobiological mechanisms as well as the most effective components for exergame-based training remain to be established. At the same time, it is important to account for the end-users' capabilities, preferences, and therapeutic needs during the design and development process to foster the usability and acceptance of the resulting program in clinical practice. This will positively influence adherence to the resulting exergame-based training program, which, in turn, favors more distinct training-related neurobiological effects. Objectives and Methods: This methodological paper describes the design and development process of novel exergame-based training concepts guided by a recently proposed methodological framework: The 'Multidisciplinary Iterative Design of Exergames (MIDE): A Framework for Supporting the Design, Development, and Evaluation of Exergames for Health' (Li et al., 2020). Case Study: A step-by-step application of the MIDE-framework as a specific guidance in an ongoing project aiming to design, develop, and evaluate an exergame-based training concept with the aim to halt and/or reduce cognitive decline and improve quality of life in older adults with mild neurocognitive disorder (mNCD) is illustrated. Discussion and Conclusion: The development of novel exergame-based training concepts is greatly facilitated when it is based on a theoretical framework (e.g., the MIDE-framework). Applying this framework resulted in a structured, iterative, and evidence-based approach that led to the identification of multiple key requirements for the exergame design as well as the training components that otherwise may have been overlooked or neglected. This is expected to foster the usability and acceptance of the resulting exergame intervention in "real life" settings. Therefore, it is strongly recommended to implement a theoretical framework (e.g., the MIDE-framework) for future research projects in line with well-known checklists to improve completeness of reporting and replicability when serious games for motor-cognitive rehabilitation purposes are to be developed.

Effects of Acute Dance and Aerobic Exercise on Drug Craving and Food Reward in Women with Methamphetamine Dependence

INTRODUCTION

Drug dependence causes an overestimation of drug-related stimuli and an underestimation of non-drug-related stimuli, such as food. The purpose of this study was to investigate the effects of acute moderate-intensity dance and aerobic exercise on drug craving, appetite, prefrontal neural activation to food cues, and food reward in women with methamphetamine MA dependence.

METHODS

Thirty-nine women who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition MA dependence criteria participated in the experiment and were randomly assigned to either a dance (n = 20) or exercise (n = 19) group. A moderate-intensity (65%-75% maximum heart rate) 35-min dance or treadmill intervention counterbalanced with a reading control session was conducted. After the intervention or control, subjective drug craving was measured before and after exposure to drug-related cues. Visual analog scales were used to measure subjective feelings of appetite. Participants then completed a visual food cue paradigm while using functional near-infrared spectroscopy to monitor prefrontal blood oxygen changes. Finally, the Leeds Food Preference Questionnaire was used to measure reward responses to different categories of food.

RESULTS

The results showed that the dance and exercise interventions reduced subjective craving for drugs after being exposed to drug cues (P = 0.019). Implicit wanting (P < 0.001) and relative preferences (P = 0.001) for high-calorie savory foods were all increased after interventions relative to control. Compared with the control session, the left dorsolateral prefrontal cortex (P = 0.020) was activated when viewing high-calorie foods after moderate-intensity aerobic exercise.

CONCLUSIONS

The current results support the use of moderate-intensity exercise as a therapeutic intervention to restore the balance between drug and nondrug rewards by decreasing cue-induced MA craving and increasing food reward.

Disentangling Mitochondria in Alzheimer's Disease

Alzheimer's disease (AD) is a major cause of dementia in older adults and is fast becoming a major societal and economic burden due to an increase in life expectancy. Age seems to be the major factor driving AD, and currently, only symptomatic treatments are available. AD has a complex etiology, although mitochondrial dysfunction, oxidative stress, inflammation, and metabolic abnormalities have been widely and deeply investigated as plausible mechanisms for its neuropathology. Aβ plaques and hyperphosphorylated tau aggregates, along with cognitive deficits and behavioral problems, are the hallmarks of the disease. Restoration of mitochondrial bioenergetics, prevention of oxidative stress, and diet and exercise seem to be effective in reducing Aβ and in ameliorating learning and memory problems. Many mitochondria-targeted antioxidants have been tested in AD and are currently in development. However, larger streamlined clinical studies are needed to provide hard evidence of benefits in AD. This review discusses the causative factors, as well as potential therapeutics employed in the treatment of AD.

Effects of Dance Interventions on Cognition, Psycho-Behavioral Symptoms, Motor Functions, and Quality of Life in Older Adult Patients With Mild Cognitive Impairment: A Meta-Analysis and Systematic Review

Background: Dance interventions are considered beneficial for older patients with mild cognitive impairment in many aspects. We conducted a comprehensive systematic review and meta-analysis to assess the effects of dance on different aspects (cognitive function, emotions, physical function, and quality of life) of this population. Methods: A systematic search of PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, Embase, American Psychological Association PsycInfo, ProQuest, Scopus, Cumulative Index to Nursing and Allied Health Literature, the Chinese BioMedical Literature Database, the VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang Data database was performed. Two reviewers independently assessed the study quality. Results: Fourteen studies were retrieved from the databases for analysis. The pooled results showed that dance interventions significantly improved global cognition (standardized mean difference [SMD] = 0.73, 95% confidence interval [CI]: 0.47 to 0.99, P < 0.00001), rote memory (mean difference [MD] = -2.12, 95% CI: -4.02 to -0.21, P = 0.03), immediate recall (SMD = 0.54, 95% CI: 0.30 to 0.78, P < 0.0001), delayed recall (SMD = 0.56, 95% CI: 0.26 to 0.86, P = 0.0002) and attention (SMD = 0.38, 95% CI: 0.13 to 0.64, P = 0.003). No significant improvement was found in executive function, language, depression, anxiety, dementia-related behavioral symptoms, motor function, and quality of life. Conclusion: Dance interventions benefit most aspects of cognitive functions. The evidence for the effects of dance on psycho-behavioral symptoms, motor function and quality of life remains unclear. More trials with rigorous study designs are necessary to provide this evidence.

Pilot testing of Dual-task Zumba Gold (DTZ) for community-dwelling people with mild cognitive impairment: A mixed-methods study

Dual-tasking (e.g., enrichment of physical activities with mental exercises) is an innovative strategy to enhance older adults' cognition. Meanwhile, Zumba is a popular dance program, but research is limited about its utility on older people or those with mild cognitive impairment (MCI). This study assessed the feasibility of a new intervention called dual-task Zumba Gold (DTZ) for people with MCI. A mixed-methods feasibility study involving ten people aged ≥55 years with MCI was conducted from December 2020 to March 2021. Nine participants completed the study (90%) with high intervention acceptability. Program adherence (90.3%) and implementation fidelity (92.2%) were high. Participants also expressed the program's benefits, challenges, and facilitators. Moreover, pilot test results suggested improvements in global cognition (Z=-2.680; p=0.007), quality of life (Z=-2.688; p=0.008), and mobility (Z=-2.333; p=0.020). Hence, DTZ is feasible and acceptable for people with MCI, offering potential multidomain effects. Future randomized controlled studies should confirm these outcomes.

Effects of nurse-led square dancing on older patients with mild cognitive impairment combined with depressive symptoms: A pilot study

OBJECTIVE

The present study aimed to verify the feasibility and preliminary effects of nurse-led square dancing designed to improve older adults' cognitive function and depressive symptoms who with MCI.

METHODS

A quasi-experimental pilot study design was adopted for the present study. Screening for cognitive function was conducted among older adults (≥ 60 years old) living in two communities in Beijing who complained of memory loss. A total of 107 older patients with MCI and depressive symptoms were diagnosed after obtaining informed consent. Thirty-five patients selected from each community were included in the study as control and intervention groups, respectively. The two groups of patients received health education while the intervention group participated in a square dance intervention program led by nurses three times per week for 60 min per session over a period of three months. The Montreal Cognitive Assessment-Peking version (MoCA-P) and Geriatric Depression Scale (GDS-30) were used to assess the cognitive function and depressive symptoms of patients in the two groups at three time intervals; before intervention, at the end of the three-month intervention period, and over a three-month follow-up period after the end of intervention.

RESULTS

Feasibility of the intervention was established with a high completion rate of 90%. Data collection for 63 out of 70 patients enrolled for the study was completed after six months. MoCA-P and GDS-30 scores of the intervention group were significantly different after the intervention when compared with the control group. A significant improvement in cognition was observed in the intervention group, and depressive symptoms decreased after intervention and follow-up when compared with the control group. During the intervention and follow-up phases, the MoCA-P score of the intervention group increased gradually with time. Furthermore, the MoCA-P and GDS-30 scores of the control group remained unchanged.

CONCLUSION

This study has revealed that square dance intervention exerts a positive impact on cognitive function and depressive symptoms among older patients suffering from MCI and depressive symptoms. The results of this study support the feasibility and preliminary effects of square dancing on relieving cognitive decline and depressive symptoms. Square dancing is a recommended type of intervention that can be applied to the local Chinese population because of its simplicity, convenience, and suitability for the older adults.

The effect of dance interventions on cognition, neuroplasticity, physical function, depression, and quality of life for older adults with mild cognitive impairment: A systematic review and meta-analysis

BACKGROUND

Mild cognitive impairment is an age-related cognitive disorder which is associated with frequent memory lapses, impaired judgement, and progressive functional decline. If untreated early, 39.2% of people with mild cognitive impairment could progress to develop dementia. However, there are currently no approved pharmacological interventions to treat the condition, which lead researchers to explore non-pharmacological options, such as dance therapy.

OBJECTIVES

This systematic review aimed to examine the effectiveness of dance interventions on cognition, neuroplasticity, physical function, depression, and quality of life in older adults with mild cognitive impairment.

METHODS

Seven databases were systematically searched from their respective inception dates to 31 March 2020. Relevant randomized controlled trials (RCTs) were screened and assessed for risk of bias. Eight RCTs evaluating dance interventions were included.

RESULTS

Results showed that dance interventions had a significant moderate effect on global cognition (SMD=0.54, Z = 3.55, p<0.001), significantly improved memory (SMD=0.33, Z = 3.97, p<0.001), visuospatial function (SMD=0.42, Z = 2.41, p = 0.02), and language (SMD=0.39, Z = 2.69, p = 0.007). We found that dance interventions produced a significant moderate effect on physical function (SMD=0.55, Z = 3.43, p<0.001), and a significant effect on quality of life (SMD=0.93, Z = 5.04, p<0.0.001).

CONCLUSION

Dance is a non-pharmacological and inexpensive intervention that can be implemented for older adults on a large scale. It can slow down the cognitive deterioration of older adults with mild cognitive impairment. However, the findings should be interpreted with caution due to the heterogeneity in intervention designs. Rigorous design studies with long-term follow-ups, neuroimaging, biological markers, and comprehensive neuropsychological assessment are required to understand the mechanism of dance interventions and demonstrate its efficacy for older adults with mild cognitive impairment. The protocol was registered on PROSPERO (CRD42020173659).

Comparison of Traditional Chinese Exercises and Nontraditional Chinese Exercise Modalities on Cognitive and Executive Function in Community Middle-Aged and Older Adults: A Cross-Sectional Study

Background

Current evidence indicates that regular exercise can have a positive impact on cognitive function in older adults, but whether different exercise modalities may induce differential protective effects in different cognitive domains is uncertain.

Objective

To compare the effect of traditional Chinese exercise (TCE) modalities and non-traditional Chinese exercise (non-TCE) modalities on cognitive and executive function in community middle-aged and older adults through a cross-sectional study.

Methods

A total of 350 community middle-aged and older adults aged over 55 years participated in this study. Information on demographic characteristics, lifestyle and behavioural habits, and regular exercise was collected by a self-designed questionnaire. Global cognitive ability and executive function were assessed using the Montreal Cognitive Assessment (MoCA) scale, the clock drawing test (CDT), the animal naming test (ANT), and the trail making test (TMT). Eligible subjects were categorized into the no regular exercise (no-RE), non-TCE, or TCE groups according to their self-reported exercise information. Comparisons of global cognitive and executive function among the three groups were conducted using ANOVA or the general linear model with adjustment for potential confounding factors.

Results

The results showed that for the non-TCE or TCE groups, the MoCA and CDT scores were significantly higher, and the TMT-A test time was significantly shorter than those in the no-RE group (all P < 0.05), but no significant difference was observed for the TMT-B and ANT tests. After adjustment for potential confounding factors, the MoCA, the CDT, and TMT-A scores in the TCE group were significant compared to those in the no-RE group. In addition, subgroup analysis showed that in the TCE group, the MoCA scores were significantly higher than those in the non-TCE group. Furthermore, in the TCE group, the CDT scores for those with an exercise duration of <5 years were higher and the TMT-A test time for those with an exercise duration of ≥5 years was shorter than those in the non-TCE group.

Conclusions

Both TCE and non-TCE have potential protective effects on global cognitive and executive function in community middle-aged and older adults. Compared to the non-TCE modality, the TCE modality may have a more positive association with these protective effects. Furthermore, prospective studies are needed to confirm these findings.

The effectiveness of dance interventions on cognition in patients with mild cognitive impairment: A meta-analysis of randomized controlled trials

This meta-analysis of randomized controlled trials (published or unpublished RCTs in English) examined the effectiveness of dance interventions compared to waitlist/active controls on cognitive functions in patients with mild cognitive impairment (MCI). Literature search was conducted on MEDLINE, EMBASE, CINAHL and related databases through 3 August 2019. Risk of bias was assessed with the PEDro scale regarding randomization, allocation concealment, group comparability, blinding, attrition and selective reporting. Five included RCTs (N = 358) used Latin, ballroom and aerobic dances (frequency: 1-3 session/week; intensity: light to moderate; time: 25-60 min/session; type: aerobic). Results show that dance interventions improve global cognition (SMD [95 % CI] = 0.48 [0.21, 0.74]), attention (SMD [95 % CI] = 0.33 [0.12, 0.54]), immediate (SMD [95 % CI] = 0.54 [0.38, 0.71]) and delayed recall (SMD [95 % CI] = 0.33 [0.01, 0.64]), and visuospatial ability (SMD [95 % CI] = 0.16 [0.01, 0.32]). Study limitations include a small number of RCTs and high heterogeneity in some cognitive domains. In summary, dance interventions improve some cognitive domains in MCI. (PROSPERO registration: CRD42019145418).