Validation of Cognitive Rehabilitation as a Balance Rehabilitation Strategy in Patients with Parkinson's Disease: Study Protocol for a Randomized Controlled Trial

Resistance exercise to reduce risk of falls in people with Alzheimer's disease: a randomised clinical trial

OBJECTIVES

To evaluate the impact of resistance exercise on the risk of falls, fear of falling, muscle strength, neuropsychiatric symptoms and ability to perform activities of daily living in people with Alzheimer's disease (AD).

DESIGN

Single-blinded randomised controlled trial.

SETTING

Five aged care centres specialising in AD, located in Andalucía, Spain.

PARTICIPANTS

Sixty people diagnosed with AD were assigned at random to either the intervention group (n = 30) or the control group (n = 30).

INTERVENTIONS

The intervention group completed three weekly resistance exercise sessions for 12 weeks, in addition to cognitive training, until completion of the study. The control group undertook cognitive training alone.

MAIN OUTCOME MEASURE

Main outcome measure: risk of falls (Short Physical Performance Battery).

SECONDARY OUTCOMES

muscle strength (hand dynamometry), neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire), fear of falling (Activities-Specific Balance Confidence Scale) and ability to perform activities of daily living (Lawton Instrumental Activities of Daily Living Scale).

RESULTS

The analysis demonstrated differences in favour of the intervention group, in both the short and medium term, for risk of falls [post-treatment: mean difference (MD) 1.5, 95% CI of the difference 0.9 to 2.0; 3-month follow up: MD 1.1, 95% CI of the difference 0.6 to 1.6]; fear of falling (post-treatment: MD 1.5, 95% CI of the difference 4.0 to 7.7; 3-month follow up: MD 6.3, 95% CI of the difference 4.3 to 8.2); activities of daily living (post-treatment: MD 0.2, 95% CI of the difference -0.01 to 0.4; 3-month follow up: MD 0.3, 95% CI of the difference 0.01 to 0.5); neuropsychiatric symptoms (post-treatment: MD -2.2, 95% CI of the difference -3.3 to -1.0; 3-month follow up: MD -2.4, 95% CI of the difference -3.7 to -1.2); and dynamometry (post-treatment: MD 3.1, 95% CI of the difference 2.5 to 3.7; 3-month follow up: MD 2.6, 95% CI of the difference 1.9 to 3.3).

CONCLUSION

Resistance exercise effectively reduces the risk of falls, fear of falling and neuropsychiatric symptoms, and improves muscle strength in people with AD in both the short and medium term. CONTRIBUTION OF THE PAPER.

Quality-of-Life- and Cognitive-Oriented Rehabilitation Program through NeuronUP in Older People with Alzheimer's Disease: A Randomized Clinical Trial

(1) Background: Alzheimer's disease (AD) is a progressive neurodegenerative disorder marked by cognitive decline and functional impairment. The NeuronUP platform is a computer program whose main function is cognitive stimulation through three types of activities that change so that the user does not manage to learn it. This program provides opportunities to work on various domains, including activities of daily living (ADLs), social skills, and cognitive functions. The main objective of this randomized clinical trial was to assess the impact of integrating the NeuronUP platform with conventional occupational therapy to enhance or maintain cognitive, perceptual, and quality of life (QoL) abilities in people with AD compared to a control group. (2) Methods: A randomized, single-blind clinical trial was conducted. The sample was randomized using a software program, OxMar, which allowed the separation of the sample into a control group (CG) that received their conventional occupational therapy sessions and an experimental group (EG) that received therapy with NeuronUP, in addition to their conventional occupational therapy sessions. An eighteen-week intervention was conducted. (3) Results: The study included 20 participants, and significant differences were observed in most variables analyzed, indicating improvements after the intervention, particularly in measures of QoL and cognitive status. (4) Conclusions: Our findings demonstrate that an eighteen-week experimental protocol, incorporating the NeuronUP platform alongside conventional occupational therapy, led to improvements in cognitive status and QoL in older adults with AD. Thus, integrating the NeuronUP platform as a complementary tool to occupational therapy can be a valuable resource for enhancing the QoL of individuals with AD. However, due to the small sample size, further studies are needed to corroborate these findings.

Immersive Virtual Reality Reaction Time Test and Relationship with the Risk of Falling in Parkinson's Disease

Immersive virtual reality (IVR) uses customized and advanced software and hardware to create a digital 3D reality in which all of the user's senses are stimulated with computer-generated sensations and feedback. This technology is a promising tool that has already proven useful in Parkinson's disease (PD). The risk of falls is very high in people with PD, and reaction times and processing speed may be markers of postural instability and functionality, cognitive impairment and disease progression. An exploratory study was conducted to explore the feasibility of reaction time tests performed in IVR as predictors of falls. A total of 26 volunteers (79.2% male; 69.73 ± 6.32 years) diagnosed with PD (1.54 ± 0.90 H&Y stage; 26.92 ± 2.64 MMSE) took part in the study. IVR intervention was feasible, with no adverse effects (no Simulator Sickness Questionnaire symptoms). IVR reaction times were related (Spearman's rho) to functionality (timed up and go test (TUG) (rho = 0.537, p = 0.005); TUG-Cognitive (rho = 0.576, p = 0.020); cognitive impairment mini mental state exam (MMSE) (rho = -0.576, p = 0.002)) and the years of the patients (rho = 0.399, p = 0.043) but not with the first PD symptom or disease stage. IVR test is a complementary assessment tool that may contribute to preventing falls in the proposed sample. Additionally, based on the relationship between TUG and reaction times, a cut-off time is suggested that would be effective at predicting the risk of suffering a fall in PD patients using a simple and quick IVR test.

One-year prediction of cognitive decline following cognitive-stimulation from real-world data

Clinical evidence based on real-world data (RWD) is accumulating exponentially providing larger sample sizes available, which demand novel methods to deal with the enhanced heterogeneity of the data. Here, we used RWD to assess the prediction of cognitive decline in a large heterogeneous sample of participants being enrolled with cognitive stimulation, a phenomenon that is of great interest to clinicians but that is riddled with difficulties and limitations. More precisely, from a multitude of neuropsychological Training Materials (TMs), we asked whether was possible to accurately predict an individual's cognitive decline one year after being tested. In particular, we performed longitudinal modelling of the scores obtained from 215 different tests, grouped into 29 cognitive domains, a total of 124,610 instances from 7902 participants (40% male, 46% female, 14% not indicated), each performing an average of 16 tests. Employing a machine learning approach based on ROC analysis and cross-validation techniques to overcome overfitting, we show that different TMs belonging to several cognitive domains can accurately predict cognitive decline, while other domains perform poorly, suggesting that the ability to predict decline one year later is not specific to any particular domain, but is rather widely distributed across domains. Moreover, when addressing the same problem between individuals with a common diagnosed label, we found that some domains had more accurate classification for conditions such as Parkinson's disease and Down syndrome, whereas they are less accurate for Alzheimer's disease or multiple sclerosis. Future research should combine similar approaches to ours with standard neuropsychological measurements to enhance interpretability and the possibility of generalizing across different cohorts.

Feasibility and Effects of an Immersive Virtual Reality Exergame Program on Physical Functions in Institutionalized Older Adults: A Randomized Clinical Trial

One of the pillars which underpins active aging is found in the performance of physical activity. While adherence to physical activity programs has traditionally been low in older people, immersive virtual reality (IVR) could provide an alternative and complementary training mode. A randomized clinical trial was conducted to explore the feasibility and effects of a 10-week IVR exergame program on physical functions of 24 institutionalized older adults who were allocated to an experimental group (EG n = 13; 85.08 ± 8.48 years) and control group (CG n = 11; 84.82 ± 8.10 years). The IVR intervention was feasible, with no adverse effects being reported (no Simulator Sickness Questionnaire symptoms; low negative experience scores on the Game Experience Questionnaire < 0.34/4), no dropouts, high adherence, and good post-gaming usability (System Usability Scale > 73.96%). The EG showed significant improvements: Tinetti scores for balance (1.84 ± 1.06; p < 0.001), gait (1.00 ± 1.08; p < 0.001), total score (2.84 ± 1.67; p < 0.001), and handgrip (4.96 ± 4.22; p < 0.001) (pre−post assessment). The CG showed significantly worsened compared to the EG: Five times sit-to-stand test, Tinetti scores for balance, gait, and total score, and the Timed Up and Go test total score (post-assessment). The findings show that the IVR intervention is a feasible method to approach a personalized exercise program and an effective way by which to improve physical function in the target population.