A 9-Week Aerobic and Strength Training Program Improves Cognitive and Motor Function in Patients with Dementia: A Randomized, Controlled Trial. Multimodal Cognitive Enhancement Therapy for Patients with Mild Cognitive Impairment and Mild Dementia: A Multi- Center, Randomized, Controlled, Double-Blind, Crossover Trial. Physical Exercise with Multicomponent Cognitive Intervention for Older Adults with Alzheimer's Disease: A 6-Month Randomized Controlled Trial Non-pharmacological, multicomponent group therapy in patients with degenerative dementia: a 12-month randomzied, controlled trial Beneficial effects of multisensory and cognitive stimulation on age-related cognitive decline in long-term-care institutions Feasibility of a Combined Aerobic and Strength Training Program and Its Effects on Cognitive and Physical Function in Institutionalized Dementia Patients. A Pilot Study Participation in cognitively stimulating activities and risk of incident Alzheimer disease. Effectiveness of a multicomponent exercise program in the attenuation of frailty in long-term nursing home residents: study protocol for a randomized clinical controlled trial Cognitive training for patients with dementia living in a sicilian nursing home: a novel web-based approach A randomized, double-blind, placebo-controlled study of the efficacy and safety of donepezil in patients with Alzheimer's disease in the nursing home setting. Effects of multimodal nondrug therapy on dementia symptoms and need for care in nursing home residents with degenerative dementia: a randomized-controlled study with 6-month follow-up. Exercise or Social Intervention for Nursing Home Residents with Dementia: A Pilot Randomized, Controlled Trial. Methodological index for non‐randomized studies (MINORS): development and validation of a new instrument An integrated dementia intervention for Korean older adults. Effects of Physical Activity in Nursing Home Residents with Dementia: A Randomized Controlled Trial
OBJECTIVE To compare training and follow-up effects of combined aerobic and strength training versus aerobic-only training on cognitive and motor function in institutionalized patients with dementia and to explore whether improved motor function mediates improved cognitive function . METHODS Using a 9-week , parallel , three-group , single-blind , r and omized , controlled trial with a follow-up assessment at week 18 , we assessed 109 patients with dementia ( age 85.5 ± 5.1 years ) in a psycho-geriatric nursing home . Each 9-week intervention consisted of 36 , 30-minute sessions . A combined group ( N = 37 ) received and completed two strength and two walking sessions per week , an aerobic group ( N = 36 ) completed four walking sessions , and a social group ( N = 36 ) completed four social visits per  week . Cognitive and motor functions were assessed at baseline , after the 9-week intervention , and after a consecutive 9 weeks of usual care . RESULTS Baseline corrected post-test scores in the combined versus the social group were higher for global cognition , visual memory , verbal memory , executive function , walking endurance , leg muscle strength , and balance . Aerobic versus social group scores were higher for executive function . Follow-up effects reversed toward baseline values . Motor improvement did not significantly mediate cognitive improvement . CONCLUSION Compared with a nonexercise control group , a combination of aerobic and strength training is more effective than aerobic-only training in slowing cognitive and motor decline in patients with dementia . No mediating effects between improvements in cognitive function via improved motor function were found . Future research into the underlying mechanistic associations is needed We developed and evaluated the effect of Multimodal Cognitive Enhancement Therapy ( MCET ) consisting of cognitive training , cognitive stimulations , reality orientation , physical therapy , reminiscence therapy , and music therapy in combination in older people with mild cognitive impairment ( MCI ) or mild dementia . This study was a multi-center , double-blind , r and omized , placebo-controlled , two-period cross-over study ( two 8-week treatment phases separated by a 4-week wash-out period ) . Sixty-four participants with MCI or dementia whose Clinical Dementia Rating was 0.5 or 1 were r and omized to the MCET group or the mock-therapy ( placebo ) group .  Outcomes were measured at baseline , week 9 , and week 21 . Fifty-five patients completed the study .  Mini-Mental State Examination ( effect size = 0.47 , p = 0.013 ) and Alzheimer 's Disease Assessment Scale-Cognitive Subscale ( effect size = 0.35 , p = 0.045 ) scores were significantly improved in the MCET compared with mock-therapy group . Revised Memory and Behavior Problems Checklist frequency ( effect size = 0.38 , p = 0.046 ) and self-rated Quality of Life - Alzheimer 's Disease ( effect size = 0.39 , p = 0.047 ) scores were significantly improved in the MCET compared with mock-therapy . MCET improved cognition , behavior , and quality of life in people with MCI or mild dementia more effectively than conventional cognitive enhancing activities did Aims : This study aim ed to investigate the effect of 6-month physical exercise with a multicomponent cognitive program ( MCP ) on the cognitive function of older adults with moderate to severe Alzheimer 's disease ( AD ) . Methods : We included 33 participants with AD in a 6-month r and omized controlled trial . The intervention group participated in physical exercise and received a MCP . The control group received only the MCP . Before and after the intervention , cognitive outcomes were assessed using the Alzheimer 's Disease Assessment Scale-Cognitive Subscale ( ADAS-cog ) , Mini-Mental State Examination , and the Clock Drawing Test . Physical performance was evaluated by exercise time , the number of pedal rotation , total load , grip strength , and the Berg Balance Scale ( BBS ) . Results : In all cognitive measures , there were no significant improvements between the two groups after 6 months in the baseline value-adjusted primary analysis . However , the ADAS-cog score was significantly lower between the two groups in secondary analysis adjusted for baseline value , age , sex , and education years . All physical outcomes were significantly higher in the intervention group except for total load compared with baseline measurements . Conclusion : This study indicates that it is possible to improve cognitive function in older adults with moderate to severe AD through 6-month physical exercise with a multicomponent cognitive intervention Background Currently available pharmacological and non-pharmacological treatments have shown only modest effects in slowing the progression of dementia . Our objective was to assess the impact of a long-term non-pharmacological group intervention on cognitive function in dementia patients and on their ability to carry out activities of daily living compared to a control group receiving the usual care . Methods A r and omized , controlled , single-blind longitudinal trial was conducted with 98 patients ( follow-up : n = 61 ) with primary degenerative dementia in five nursing homes in Bavaria , Germany . The highly st and ardized intervention consisted of motor stimulation , practice in activities of daily living , and cognitive stimulation ( acronym MAKS ) . It was conducted in groups of ten patients led by two therapists for 2 hours , 6 days a week for 12 months . Control patients received treatment as usual .  Cognitive function was assessed using the cognitive subscale of the Alzheimer 's Disease Assessment Scale ( ADAS-Cog ) , and the ability to carry out activities of daily living using the Erlangen Test of Activities of Daily Living ( E-ADL test ) at baseline and after 12 months . Results Of the 553 individuals screened , 119 ( 21.5 % ) were eligible and 98 ( 17.7 % ) were ultimately included in the study . At 12 months , the results of the per protocol analysis ( n = 61 ) showed that cognitive function and the ability to carry out activities of daily living had remained stable in the intervention group but had decreased in the control patients ( ADAS-Cog : adjusted mean difference : -7.7 , 95 % CI -14.0 to -1.4 , P = 0.018 , Cohen 's d = 0.45 ; E-ADL test : adjusted mean difference : 3.6 , 95 % CI 0.7 to 6.4 , P = 0.015 , Cohen 's d = 0.50 ) . The effect sizes for the intervention were greater in the subgroup of patients ( n = 50 ) with mild to moderate disease ( ADAS-Cog : Cohen 's d = 0.67 ; E-ADL test : Cohen 's d = 0.69 ) . Conclusions A highly st and ardized , non-pharmacological , multicomponent group intervention conducted in a nursing-home setting was able to postpone a decline in cognitive function in dementia patients and in their ability to carry out activities of daily living for at least 12 months . Trial Registration http://www.is rct n.com Identifier : IS RCT The aim of the present report was to evaluate the effectiveness and impact of multisensory and cognitive stimulation on improving cognition in elderly persons living in long-term-care institutions ( institutionalized [ I ] ) or in communities with their families ( noninstitutionalized [ NI ] ) . We compared neuropsychological performance using language and Mini-Mental State Examination ( MMSE ) test scores before and after 24 and 48 stimulation sessions . The two groups were matched by age and years of schooling . Small groups of ten or fewer volunteers underwent the stimulation program , twice a week , over 6 months ( 48 sessions in total ) . Sessions were based on language and memory exercises , as well as visual , olfactory , auditory , and ludic stimulation , including music , singing , and dance . Both groups were assessed at the beginning ( before stimulation ) , in the middle ( after 24 sessions ) , and at the end ( after 48 sessions ) of the stimulation program . Although the NI group showed higher performance in all tasks in all time windows compared with I subjects , both groups improved their performance after stimulation . In addition , the improvement was significantly higher in the I group than the NI group . Language tests seem to be more efficient than the MMSE to detect early changes in cognitive status . The results suggest the impoverished environment of long-term-care institutions may contribute to lower cognitive scores before stimulation and the higher improvement rate of this group after stimulation . In conclusion , language tests should be routinely adopted in the neuropsychological assessment of elderly subjects , and long-term-care institutions need to include regular sensorimotor , social , and cognitive stimulation as a public health policy for elderly persons Objectives We examined the feasibility of a combined aerobic and strength training program in institutionalized dementia patients and studied the effects on cognitive and physical function . Methods Thirty-three patients with dementia , recruited from one nursing home , participated in this non-r and omized pilot study ( 25 women ; age = 85.2±4.9 years ; Mini Mental State Examination = 16.8±4.0 ) . In phase 1 of the study , seventeen patients in the Exercise group ( EG ) received a combined aerobic and strength training program for six weeks , five times per week , 30 minutes per session , in an individually supervised format and successfully concluded the pre and posttests . In phase 2 of the study , sixteen patients in the Social group ( SG ) received social visits at the same frequency , duration , and format and successfully concluded the pre and posttests . Results Indices of feasibility showed that the recruitment and adherence rate , respectively were 46.2 % and 86.3 % . All EG patients completed the exercise program according to protocol without adverse events . After the six-week program , no significant differences on cognitive function tests were found between the EG and SG . There was a moderate effect size in favor for the EG for the Visual Memory Span Forward ; a visual attention test . There were significant differences between groups in favor for the EG with moderate to large effects for the physical tests Walking Speed ( p = .003 ) , Six-Minute Walk Test ( p = .031 ) , and isometric quadriceps strength ( p = .012 ) . Conclusions The present pilot study showed that it is feasible to conduct a combined aerobic and strength training program in institutionalized patients with dementia . The selective cognitive visual attention improvements and more robust changes in motor function in favor of EG vs. SG could serve as a basis for large r and omized clinical trials . Trial Registration trialregister.nl CONTEXT Frequent participation in cognitively stimulating activities has been hypothesized to reduce risk of Alzheimer disease ( AD ) , but prospect i ve data regarding an association are lacking . OBJECTIVE To test the hypothesis that frequent participation in cognitive activities is associated with a reduced risk of AD . DESIGN Longitudinal cohort study with baseline evaluations performed between January 1994 and July 2001 and mean follow-up of 4.5 years . PARTICIPANTS AND SETTING A total of 801 older Catholic nuns , priests , and brothers without dementia at enrollment , recruited from 40 groups across the United States . At baseline , they rated frequency of participation in common cognitive activities  ( eg , reading a newspaper ) , from which a previously vali date d composite measure of cognitive activity frequency was derived . MAIN OUTCOME MEASURES Clinical diagnosis of AD by a board-certified neurologist using National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer 's Disease and Related Disorders Association criteria and change in global and specific measures of cognitive function , compared by cognitive activity score at baseline . RESULTS Baseline scores on the composite measure of cognitive activity ranged from 1.57 to 4.71 ( mean , 3.57 ; SD , 0.55 ) , with higher scores indicating more frequent activity . During an average of 4.5 years of follow-up , 111 persons developed AD . In a proportional hazards model that controlled for age , sex , and education , a 1-point increase in cognitive activity score was associated with a 33 % reduction in risk of AD ( hazard ratio , 0.67 ; 95 % confidence interval , 0.49 - 0.92 ) . Results were comparable when persons with memory impairment at baseline were excluded and when terms for the apolipoprotein E epsilon4 allele and other medical conditions were added . In r and om-effects models that controlled for age , sex , education , and baseline level of cognitive function , a 1-point increase in cognitive activity was associated with reduced decline in global cognition ( by 47 % ) , working memory ( by 60 % ) , and perceptual speed ( by 30 % ) . CONCLUSION These results suggest that frequent participation in cognitively stimulating activities is associated with reduced risk of AD Background There is increasing evidence suggesting that cognition and physical frailty interact within a cycle of decline associated with aging which has been called cognitive frailty . Exercise programs have demonstrated to be an effective tool to prevent functional and cognitive decline during aging , but little is known about their potential to restore or maintain functionality in individuals that require long-term nursing care . Besides , WHO has recently highlighted the importance of introducing systematic musculoskeletal health programs for older people living in residential care , as they represent a particularly vulnerable group for the development of noncommunicable diseases . Methods This is a multicentre r and omized controlled trial . 114 participants will be r and omly allocated to a  usual care group or to an  intervention group .  Inclusion criteria are as follows : ≥ 70 years , ≥ 50 on the Barthel Index , ≥ 20 on MEC-35 who are capable to st and up and walk independently for 10 m. Subjects in the intervention group will add to the activities scheduled for the control group the participation in a 6 months long multicomponent exercise program design ed to improve strength , balance and walking retraining . Study assessment s will be conducted at baseline and at 3 and 6 months . The primary outcome is change in function assessed by Short Physical Performance Battery and secondary outcomes include other measurements to assess all together the condition of frailty , which includes functionality , sedentary behaviors , cognitive and emotional status and biological markers . The present study has been approved by the Committee on Ethics in Research of the University of the Basque Country ( Humans Committee Code M10/2016/105 ; Biological Sample s Committee Code M30/2016/106 ) . Discussion Results from this research will show if ageing related functional and cognitive deterioration can be effectively prevented by physical exercise in institutionalized elders . It is expected that the results of this research will guide clinical practice in nursing home setting s , so that clinicians and policymakers can provide more evidence -based practice for the management of institutionalized elder people . Trial registration The protocol has been registered under the Australian and New Zeal and Clinical Trials Registry ( ANZCTR ) with the identifier : ACTRN12616001044415 Dementia is an increasing challenge for health care and social system in developed countries . Interventions with a cognitive focus , also using assistive technology , are leading to promising results in improving cognitive and behavior symptoms in individuals with dementia . Aim of our study was to evaluate the combined effects of the st and ard cognitive training in addition to web-based rehabilitation in dementia people living in a nursing home . We have studied twenty dementia people ( 10 females and 10 males ) with a mild to moderate cognitive decline ( MMSE 25 ± 3.4 ) associated to moderate behavioral alterations , and mainly due to vascular causes . These patients were r and omly assigned to one of two groups ( experimental or st and ard treatment — namely the control group ) . All participants in the experimental group completed the specific training , consisting of 24 sessions of web-based cognitive training , for 8 weeks , in addition to st and ard rehabilitation . Each participant was evaluated by a skilled neuropsychologist before and after each treatment . The experimental group had a statistically significant change of the Geriatric Depression Scale ( p = 0.03 ) , Constructive Apraxia ( p < 0.001 ) , Matrices Attentive ( p = 0.01 ) , and Mini Mental State Examination ( p = 0.04 ) . Web-based cognitive rehabilitation can be useful in improving cognitive performance , besides psychological well-being , in demented individuals living in home care OBJECTIVES To evaluate the safety and efficacy of donepezil in the management of patients with Alzheimer 's disease ( AD ) residing in nursing home facilities . DESIGN Twenty-four-week , r and omized , multicenter , parallel-group , double-blind , placebo-controlled trial . SETTING Twenty-seven nursing homes across the United States . PARTICIPANTS Two hundred eight nursing home patients with a diagnosis of probable or possible AD , or AD with cerebrovascular disease ; mean Mini-Mental State Examination ( MMSE ) score 14.4 ; mean age 85.7 . MEASUREMENTS The primary outcome measure was the Neuropsychiatric Inventory-Nursing Home Version ( NPI-NH ) . Secondary efficacy measures were the Clinical Dementia Rating ( Nursing Home Version)-Sum of the Boxes ( CDR-SB ) , MMSE , and the Physical Self-Maintenance Scale ( PSMS ) . Safety was monitored by  physical examinations , vital signs , clinical laboratory tests , electrocardiograms ( ECGs ) , and treatment-emergent adverse events ( AEs ) .  RESULTS Eighty-two percent of donepezil- and 74 % of placebo-treated patients completed the trial . Eleven percent of donepezil- and 18 % of placebo-treated patients withdrew because of AEs . Mean NPI-NH 12-item total scores improved relative to baseline for both groups , with no significant differences observed between the groups at any assessment . Mean change from baseline CDR-SB total score improved significantly with donepezil compared with placebo at Week 24 ( P < .05 ) . The change in CDR-SB total score was not influenced by age . Differences in mean change from baseline on the MMSE favored donepezil over placebo at Weeks 8 , 16 , and 20 ( P < .05 ) . No significant differences were observed between the groups on the PSMS . Overall rates of occurrence and severity of AEs were similar between the two groups ( 97 % placebo , 96 % donepezil ) . Gastrointestinal AEs occurred more frequently in donepezil-treated patients . In general , AEs were similar in older and younger donepezil-treated patients , with the majority of patients experiencing only AEs that were transient and mild or moderate in severity . Weight loss was reported as an AE more frequently in older patients , although a loss at last visit of > or=7 % of screening weight occurred at the same rate in older and younger patients ( 9 % of donepezil- and 6 % of placebo-treated patients ) . No significant differences between groups in vital sign changes , bradycardia , or rates of clinical ly significant laboratory or ECG abnormalities were observed . CONCLUSION Patients treated with donepezil maintained or improved in cognition and overall dementia severity in contrast to placebo-treated patients who declined during the 6-month treatment period . The safety and tolerability profile was comparable with that reported in outpatient studies of donepezil . These findings also suggest that advanced age , comorbid illnesses , and high concomitant medication usage should not be barriers to donepezil treatment . Given the apparent improvement in behavior in the placebo group , and the high use of concomitant medications in both groups , the impact of donepezil on behavior in the nursing home setting is unresolved and merits further investigation . In summary , effects on cognition , overall dementia severity , and safety and tolerability findings are consistent with previous findings in out patients and support the use of donepezil in patients with AD who reside in nursing homes OBJECTIVES To determine the efficacy of multimodal , nondrug therapy on symptoms of dementia and need for care in institutionalized individuals with degenerative dementia . DESIGN R and omized , controlled , longitudinal trial . Data were analyzed using multiple linear regression . SETTING Five German nursing homes . PARTICIPANTS One hundred thirty-nine nursing home residents with primary degenerative dementia ( Mini-Mental State Examination score < 24 ) . INTERVENTION The 6-month intervention comprised three components : motor stimulation , activities of daily living , and cognitive stimulation ( MAKS ) . Groups of 10 patients led by two therapists participated in the st and ardized intervention for 2 hours , 6 days a week . The intervention was described in detail in an intervention manual . Adherence to the manual was high . Controls received treatment as usual . MEASUREMENTS Overall geriatric symptoms were recorded using the Nurses ' Observation Scale for Geriatric Patients , functional independence using the Barthel Index , and care time using the Re source Utilization in Dementia-Formal Care . RESULTS Of 646 individuals screened , 146 were eligible , and 130 were included in the intention-to-treat analysis . At 6 months , results of the per- protocol analysis ( n = 119 ) showed improvement in overall dementia symptoms in the MAKS group and no change in the control group ( adjusted mean difference ( AMD ) = -6.8 , 95 % confidence interval ( CI ) = -10.3 to -3.3 ; P < .001 , Cohen d = 0.66 ) . This effect was greatest on the social behavior ( AMD = -1.9 , 95 % CI = -2.9 to -0.8 ; P < .001 ; Cohen d = 0.54 ) and instrumental activity of daily living ( IADL ) ( AMD = -1.4 , 95 % CI = -2.5 to -0.30 ; P = .01 ; Cohen d = 0.43 ) subscales . No effect was seen on functional independence or total care time . CONCLUSION This 6-month nondrug multimodal intervention improved dementia symptoms in nursing home residents , especially in social behavior and IADL capabilities OBJECTIVES To compare the effects of exercise with those of a structured nonphysical intervention on ability to perform activities of daily living ( ADLs ) and physical and cognitive function of persons with dementia ( PWDs ) living in nursing homes ( NH ) . DESIGN Cluster-r and omized pilot-controlled trial . SETTING Seven French NHs . PARTICIPANTS PWDs living in NHs . MEASUREMENTS NHs were r and omized to an exercise group ( 4 NHs , n = 47 ) or structured social activity group ( 3 NHs , n = 50 ) for a 24-week intervention performed twice per week for 60 minutes per session . The main endpoint was ADL performance ( Alzheimer 's Disease Cooperative Study Activities of Daily Living Inventory for Severe Alzheimer 's Disease Scale ( ADCS-ADL-sev ) ; range 0 - 54 , higher is better ) ; secondary endpoints were overall cognitive function ( Mini-Mental State Examination ( MMSE ) ) and performance-based tests of physical function ( Short Physical Performance Battery ( SPPB ) , usual gait speed ) . RESULTS Ninety-one participants with at least one postbaseline ADL assessment were included in efficacy analysis . Groups differed at baseline in terms of sex , neuropsychiatric symptoms , and nutritional status . Multilevel analysis adjusted for baseline differences between groups found no significant difference between effects of exercise and social activity  ( group-by-time interaction ) , with adjusted mean differences at 6 months of 1.9 points for ADCS-ADL-sev and 0.55 points for MMSE favoring social activity and 0.6 points for SPPB and 0.05 m/s favoring exercise .  Adverse events did not differ between groups , except that the social activity group had more falls than the exercise group . CONCLUSION A larger , longer trial is required to determine whether exercise has greater health benefits than nonphysical interventions for institutionalized PWDs Background : Because of specific method ological difficulties in conducting r and omized trials , surgical research remains dependent predominantly on observational or non‐r and omized studies . Few vali date d instruments are available to determine the method ological quality of such studies either from the reader 's perspective or for the purpose of meta‐ analysis . The aim of the present study was to develop and vali date such an instrument Called dotage in Korea , dementia is primarily characterized by cognitive impairments . Secondary manifestations include mental-emotional problems , including depression . This study was design ed to examine the effects of an integrated dementia intervention for Korean older adults . The intervention is composed of cognitive stimulation training , exercise , music , art , and horticultural therapy .  Participants included 38 older adults with mild dementia . Twenty were assigned to the experimental group and 18 to the control group . Participants in the experimental group attended 18 program sessions . Significant differences were found postintervention between the two groups in measures of cognitive function , depression levels , and mental-emotional health . The findings indicate that this integrated dementia intervention can be applied to help older adults with mild dementia Background / Aims : There is no consensus regarding the optimal nonpharmacological intervention to slow down dementia-related decline . We examined whether physical stimulation interventions were effective in reducing cognitive , physical , mood , and behavioral decline in nursing home residents with dementia . Methods : Eighty-seven nursing home residents with dementia were r and omly assigned to 3 physical activity interventions : activities of daily living ( ADL ) training , multicomponent exercise training , or combined multicomponent exercise and ADL training . Outcomes were measured at baseline , and after 3 and 6 months . Results : A 6-month ADL training benefitted executive functions , physical endurance , and depression among men . Exercise training benefitted only grip strength of participants with mild-to-moderate cognitive impairment . A combined training benefitted functional mobility compared to ADL training , depressive symptoms and agitation compared to exercise training , and physical endurance compared to no physical stimulation . Conclusions : ADL training appears to be effective for nursing home residents with moderately severe dementia . It remains unclear whether exercise training is an effective type of stimulation
Introduction : Multimodal non-pharmacological interventions ( MNPIs ) have been reported to be effective in improving the cognitive function .
Therefore , it is necessary to study these interventions in older people with dementia ( PWD ) in nursing homes ( NHs ) .
Aims : This study aim ed to investigate the effects , contents , frequency , duration , length , and form of MNPIs on the global and specific cognitive functions  of PWD in NHs through a systematic review , and to consider what kind of intervention design is most effective .