Screening for Cognitive Impairment in Older Adults

JAMA, Journal Year: 2020, Volume and Issue: 323(8), P. 764 - 764

Published: Feb. 25, 2020

Importance

Early identification of cognitive impairment may improve patient and caregiver health outcomes.

Objective

To systematically review the test accuracy screening instruments benefits harms interventions to treat in older adults (≥65 years) inform US Preventive Services Task Force.

Data Sources

MEDLINE, PubMed, PsycINFO, Cochrane Central Register Controlled Trials through January 2019, with literature surveillance November 22, 2019.

Study Selection

Fair- good-quality English-language studies instruments, pharmacologic nonpharmacologic treatments aimed at persons mild (MCI), moderate dementia, or their caregivers. Extraction Synthesis Independent critical appraisal data abstraction; random-effects meta-analyses qualitative synthesis.

Main Outcomes Measures

Sensitivity, specificity; patient, caregiver, clinician decision-making; function, quality life, neuropsychiatric symptoms; burden well-being.

Results

The included 287 more than 280 000 adults. One randomized clinical trial (RCT) (n = 4005) examined direct effect for on outcomes, including potential harms, finding no significant differences health-related life 12 months (effect size, 0.009 [95% CI, –0.063 0.080]). Fifty-nine 38 531) addressed 49 detect impairment. Mini-Mental State Examination was most-studied instrument, a pooled sensitivity 0.89 (95% 0.85 0.92) specificity 0.93) dementia using cutoff 23 less 24 (15 studies, n 796). Two hundred twenty-four RCTs 3 observational 240 patients caregivers treatment MCI dementia. None trials were linked program; all cases, participants known Medications approved Alzheimer disease (donepezil, galantamine, rivastigmine, memantine) improved scores ADAS-Cog 11 by 1 2.5 points over years. Psychoeducation resulted small benefit (standardized mean difference, –0.24 –0.36 –0.13) months. Intervention uncertain importance.

Conclusions Relevance

Screening can adequately There is empirical evidence, however, that improves outcomes causes harm. It remains unclear whether provide clinically important earlier detected

Language: Английский

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Combined physical and cognitive training for older adults with and without cognitive impairment: A systematic review and network meta-analysis of randomized controlled trials

Ageing Research Reviews, Journal Year: 2020, Volume and Issue: 66, P. 101232 - 101232

Published: Nov. 26, 2020

Language: Английский

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Comparative efficacy of various exercise interventions on cognitive function in patients with mild cognitive impairment or dementia: A systematic review and network meta-analysis

Journal of sport and health science/Journal of Sport and Health Science, Journal Year: 2021, Volume and Issue: 11(2), P. 212 - 223

Published: May 16, 2021

Exercise is a promising nonpharmacological therapy for cognitive dysfunction, but it unclear which type of exercise most effective. The objective this study was to compare and rank the effectiveness various interventions on function in patients with mild impairment (MCI) or dementia examine effects symptoms relevant impairment.We searched PubMed, Web Science, Embase, Cochrane Central Register Controlled Trials, SPORTDiscus, PsycInfo through September 2019 included randomized controlled trials that examined MCI dementia. Primary outcomes global cognition, executive memory cognition. Secondary activities daily living, neuropsychiatric symptoms, quality life. Pairwise analyses network meta-analyses were performed using random model.A total 73 articles from 71 5606 participants included. All types effective increasing maintaining resistance had highest probability being intervention slowing decrease cognition (standard mean difference (SMD) = 1.05, 95% confidence interval (95%CI): 0.56-1.54), (SMD 0.85, 95%CI: 0.21-1.49), 0.32, 0.01-0.63) dysfunction. Subgroup revealed different effects, multicomponent likely be optimal preventing decline 0.99, 0.44-1.54) 0.72, 0.06-1.38). However, only showed significant 0.35, 0.01-0.69). also secondary outcomes.Resistance has especially Multicomponent tends protecting MCI.

Language: Английский

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Promoting Successful Cognitive Aging: A Ten-Year Update

Journal of Alzheimer s Disease, Journal Year: 2021, Volume and Issue: 81(3), P. 871 - 920

Published: April 27, 2021

A decade has passed since we published a comprehensive review in this journal addressing the topic of promoting successful cognitive aging, making good time to take stock field. Because there have been limited large-scale, randomized controlled trials, especially following individuals from middle age late life, some experts questioned whether recommendations can be legitimately offered about reducing risk decline and dementia. Despite uncertainties, clinicians often need at least make provisional patients based on highest quality data available. Converging lines evidence epidemiological/cohort studies, animal/basic science human proof-of-concept intervention studies provide guidance, highlighting strategies for enhancing reserve preventing loss capacity. Many suggestions made 2010 supported by additional research. Importantly, is growing consensus among major health organizations mitigate promote healthy aging. Regular physical activity treatment cardiovascular factors all these organizations. Most also embraced cognitively stimulating activities, heart-healthy diet, smoking cessation, countering metabolic syndrome. Other behaviors like regular social engagement, limiting alcohol use, stress management, getting adequate sleep, avoiding anticholinergic medications, sensory deficits, protecting brain against toxic damage endorsed, although less consistently. In update, each offer practical advice behavior-change techniques help adopt brain-healthy behaviors.

Language: Английский

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Evaluating the Clinical Effectiveness of an Exergame-Based Training Program Using “WarioWare: Move It!” to Enhance Physical and Cognitive Function in Older Adults with Mild Cognitive Impairment and Dementia in Rural Long-Term Care Facilities: A Randomized Controlled Trial (Preprint)

Journal of Medical Internet Research, Journal Year: 2025, Volume and Issue: 27, P. e69109 - e69109

Published: Jan. 7, 2025

Cognitive impairment is an important public health challenge among older adults, particularly in long-term care facilities (LTCFs), where prevalence higher due to staffing shortages, limited resources, and difficulty maintaining structured exercise programs. Furthermore, adults often lose interest repetitive interventions. The exergame "WarioWare: Move It!" (Nintendo) offers a novel solution by combining aerobic exercise, motor coordination, balance training, cognitive engagement into immersive experience. This study aimed assess the clinical efficacy of exergame-based training program delivered via improving physical flexibility, joint range motion, hand dexterity, function living LTCFs. was conducted across multiple rural LTCFs Shanxi Province, China. Participants were randomly assigned intervention or control group. protocol encompassed two 60-minute sessions per week over 12 weeks, using motion-sensing exercises such as waving, jumping, arm swinging, rotational movements, object-mimicking postures with Joy-Con controllers. Primary outcome measures derived through tests, including sit reach test, shoulder flexibility trunk rotation elbow figure-of-8 walk standing dexterity tests. Statistical analysis performed mixed ANOVA, time within-participant factor group between-participant factor, effects on various measures. A total 232 participants recruited, 32 (13.8%) patients mild dementia, 18 (7.8%) moderate 182 (78.4%) impairment, all whom completed study. ANOVA revealed significant × interactions assessments, remaining distance between hands toes during forward bend (F2,156=8.484; P<.001; η²=0.098), clasped behind back (F2,156=3.666; P=.04; η²=0.045), angle formed left right (F2,156=17.353; η²=0.182). Significant also emerged for flexion (F2,156=17.655; η²=0.185), abduction (F2,156=6.281; P=.004; η²=0.075), (F2,156=3.298; P=.049; η²=0.041). In addition, complete test (F2,156=11.846; η²=0.132) number blocks moved within 1 minute (F2,156=4.016; P=.02; η²=0.049) showed interactions. Finally, scale-based exhibited statistically (all P values <.001). significantly improved dementia residing innovative feasible approach promoting resource-limited settings, demonstrating its potential widespread application diverse low-resource environments. ClinicalTrials.gov NCT06717971; https://clinicaltrials.gov/study/NCT06717971.

Language: Английский

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Effects of low- and high-intensity physical exercise on physical and cognitive function in older persons with dementia: a randomized controlled trial

Alzheimer s Research & Therapy, Journal Year: 2020, Volume and Issue: 12(1)

Published: March 19, 2020

Abstract Background Potential moderators such as exercise intensity or apolipoprotein-E4 (ApoE4) carriership may determine the magnitude of effects on physical and cognitive functions in patients with dementia (PwD). We determined a 24-week aerobic strength training program low- high-intensity phase function. Methods In an assessor-blinded randomized trial, 91 PwD (all-cause dementia, recruited from daycare residential care facilities, age 82.3 ± 7.0 years, 59 women, Mini-Mental State Examination 20.2 4.4) were allocated to control group. group, participated walking lower limb 12 weeks offered three times/week. Attention-matched participants performed flexibility exercises recreational activities. assessed adherence, compliance, for each session. (endurance, gait speed, mobility, balance, leg strength) (verbal memory, visual executive function, inhibitory control, psychomotor speed) performance-based tests at baseline after 6, 12, 18, 24, 36 (follow-up). ApoE4 was post-intervention. Results Sixty-nine analyzed. Their mean attendance ~ 60% during study period. There no significant vs. intervention endurance, favor group (Cohen’s d = 0.13–0.18). Gait speed significantly improved 0.05 m/s 0.41) but declined follow-up. any measures − 0.04). did not moderate Conclusions Exercise superior activities our sample PwD. However, effect provided protection mobility loss detraining beneficial moderated speed. global cognition only (trend level). Trial registration Netherlands Register, NTR5035 . Registered 2 March 2015.

Language: Английский

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Effectiveness of Exergaming in Improving Cognitive and Physical Function in People With Mild Cognitive Impairment or Dementia: Systematic Review

JMIR Serious Games, Journal Year: 2020, Volume and Issue: 8(2), P. e16841 - e16841

Published: April 12, 2020

Individuals with mild cognitive impairment and dementia have impaired physical functions, leading to a reduced quality of life compared those without such impairment. Exergaming, which is defined as combination exercise gaming, an innovative, fun, relatively safe way in virtual reality or gaming environment. Therefore, exergaming may help people living overcome obstacles that they experience regarding regular activities.The aim this systematic review was studies on interventions administered elderly individuals dementia, summarize the results related functions balance, gait, executive function, episodic memory.We searched Cochrane Central Register Controlled Trials (CENTRAL), Medline, Embase, PsycINFO, Amed, Nursing Database for articles published from inception respective databases January 2019. We included all clinical trials review. The risk bias independently evaluated by two reviewers using Collaboration Risk Bias Non-randomized Studies Interventions tools.Ten involving 702 participants were There consistent evidence 7 low showing statistically significant effects functioning dementia. With respect 3 5 full-scale found positive results, intensity most games classified moderate.Overall, innovative tool improving function although there high heterogeneity among terms duration, frequency, platform used. moderate high. More high-quality more accurate outcome indicators are needed further exploration validation benefits population.

Language: Английский

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The efficacy of exergaming in people with major neurocognitive disorder residing in long-term care facilities: a pilot randomized controlled trial

Alzheimer s Research & Therapy, Journal Year: 2021, Volume and Issue: 13(1)

Published: March 30, 2021

It is currently unknown whether exergaming efficacious in people with major neurocognitive disorder (MNCD) residing long-term care facilities. This pilot randomized controlled trial (RCT) explored the efficacy of a stepping exergame program on gait speed, balance, mobility, reaction time, cognitive and neuropsychiatric outcomes, quality life, daily life functioning MNCD facilities.Participants were randomly assigned to 8 weeks, three times weekly, 15 min versus watching preferred music videos. The device consisted pressure-sensitive step training platform which participants performed movements play games. automatically adapted level participants' capabilities. Short Physical Performance Battery (SPPB), time test (SRTT), Montréal Cognitive Assessment (MoCA), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression Dementia (CSDD), Quality Life (DQoL), Katz Activities Daily Living (Katz ADL) assessed at baseline post-intervention. A Quade's non-parametric ANCOVA controlling values post hoc Bonferroni correction (p < 0.00625) was used analyze pre- post-differences between groups. Partial eta-squared (η2p) effect sizes calculated.Forty-five 55 inpatients mild moderate (Mini-Mental State Examination score = 17.2 ± 4.5; aged 70-91; 35 women) completed study. group (n 23) demonstrated improvements speed 0.001, η2p 0.41), total SPPB 0.64), SRTT (p<0.001, 0.51), MoCA 0.38), reductions CSDD 0.43) compared control 22). There no differences NPI 0.165, 0.05), DQoL 0.012, 0.16), ADL 0.008, 0.16) post-intervention scores experimental group, albeit DQol measures showed large group. mean attendance rate 82.9% 73.7% study-related adverse events reported by participants, nor observed research team.The findings this RCT suggest that an individually improves lower extremity functioning, symptoms depression facilities.ClinicalTrials.gov, NCT04436302.

Language: Английский

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Exergaming as a Physical Exercise Strategy Reduces Frailty in People With Dementia: A Randomized Controlled Trial

Journal of the American Medical Directors Association, Journal Year: 2019, Volume and Issue: 20(12), P. 1502 - 1508.e1

Published: Aug. 10, 2019

Language: Английский

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Comparison of exergames versus conventional exercises on the cognitive skills of older adults: a systematic review with meta-analysis

Archives of Gerontology and Geriatrics, Journal Year: 2021, Volume and Issue: 97, P. 104485 - 104485

Published: July 15, 2021

Language: Английский

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