Peer-supported exercise intervention for persons with mild cognitive impairment: a waitlist randomised controlled trial (the BRAin Vitality Enhancement trial)

BACKGROUND

motivating older people with cognitive impairment to remain physically active is challenging.

OBJECTIVE

this study aimed to examine the effects of a peer-supported exercise intervention on the cognitive function and health-related quality of life (HRQoL) of persons with mild cognitive impairment (MCI).

DESIGN

a two-arm randomised controlled trial.

SETTING AND PARTICIPANTS

community-dwelling persons with MCI were recruited from community centres for older adults in Hong Kong.

METHODS

participants randomised to the intervention group received an 8-week group-based peer-supported multicomponent exercise intervention, while the waitlist control group received usual care. A battery of neuropsychological tests and the Short Form-36 were administered at baseline, immediately post-intervention and 3 months post-intervention.

RESULTS

two hundred and twenty-nine participants were randomised to the intervention (n = 116) or control (n = 113) group. Compared with the control group, participants in the intervention group showed significantly greater improvements in processing speed and attention measured by the Colour Trails Test 1 (β = 7.213, 95% confidence interval [CI] = 2.870-11.557, P = 0.001) and working memory measured by the Digit Span Backward Test (β = 0.540, 95% CI = 0.199-0.881, P = 0.002) immediately post-intervention. The effects were sustained at 3 months post-intervention. Similarly, significantly greater improvements in sequencing and mental flexibility measured by the Colour Trails Test 2 were observed in the intervention group 3 months post-intervention (β = 6.979, 95% CI = 3.375-10.584, P < 0.001). Changes in global cognition, short-term memory and HRQoL were not significant.

CONCLUSION

the peer-supported exercise intervention was effective at sustaining improvements in executive function, attention and working memory in persons with MCI.

Brain Vitality Enhancement (BRAVE) program to promote brain health among persons with mild cognitive impairment: A study protocol

AIM

This study aims to evaluate the effects of a community-based program entitled 'Brain Vitality Enhancement (BRAVE)' on the cognitive function, physical and mental well-being of persons with mild cognitive impairment.

STUDY DESIGN

This is a parallel wait list randomized controlled trial.

METHODS

The BRAVE program consists of two phases. Phase 1 is an empowerment workshop for training 50 peer mentors to be the exercise ambassadors, while Phase 2 is a supervised exercise program for 250 persons with mild cognitive impairment. They will be randomly allocated to intervention or wait list control groups. For the intervention group, the peer mentors and mentees will be matched according to gender and residential areas to form mentor-mentee groups to attend an 8-week supervised exercise training. The mentor-mentee groups will continue to participate mentor-directed exercise sessions in the community thereafter. A mobile application will be developed for self-directed learning. We hypothesize that persons with mild cognitive impairment receiving the BRAVE program will demonstrate better cognitive function and health-related quality of life than the control group who receive usual care. This study is funded by a grant from the Food and Health Bureau of the Government of Hong Kong Special Administrative Region in April 2018.

DISCUSSION

This study will empower a group of golden-aged adults to be the ambassadors to promote brain health in the community and persons with mild cognitive impairment to integrate moderate-intensity exercise into their lifestyle to achieve long-term beneficial effects on their cognition and well-being.

IMPACT

Given the population with mild cognitive impairment is growing rapidly and expected to keep escalating in coming decades and limited treatment options for cognitive decline and its significant burden on the health and social care system, this study is timely to promote active ageing in the society and reduce the burden associated with cognitive decline.

Erroneous automated refraction in a case of asteroid hyalosis

To our knowledge, this is the first report of asteroid hyalosis giving rise to spurious automated refraction readings. A patient with asteroid hyalosis had uneventful phacoemulsification with intraocular lens implantation. Using a Nikon autorefractor, the postoperative refraction was +13.0 diopters (D); retinoscopy revealed that it should be +1.0 D. Asteroid hyalosis changes the optical quality of the vitreous and can cause an incorrect reading from automated equipment such as autorefractors and A-scan ultrasound scanners. In patients with asteroid hyalosis, results from autorefractors should be viewed in conjunction with clinical findings.