Discussion
decline in functional mobility, Parkinson’s disease, dementia
BLIND, CORTEX, NEUROLOGICAL DISORDERS
The objective of this randomised controlled study carried out on institutionalised older people with dementia, was to evaluate the effect of tango-therapy intervention in gait speed, functional mobility, balance, falls, ADL and QoL. First, it is crucial to emphasise the population's attributes. Despite acceptable physical mobility (all were able to walk 10 m unassisted), cognitive capacities were severely compromised, making communication extremely challenging. However, intervention attendance and well-being show that both interventions were well accepted and enjoyed. The results revealed that the IG improved the gait speed. Conversely, the CG exhibited a significant decline in functional mobility as measured by the TUG test, as well as in ADL skills.Several studies show that gait speed is an indicator of various underlying pathophysiological processes [In addition, the CG significantly worsened their functional mobility, measured through the TUG test. Like the gait speed test, the TUG is a valuable indicator of the state of physical health. Previous research has identified links between the TUG, risk of falling [Despite there being no statistically significant differences, the number of falls increased in the CG while it decreased in the IG. In addition, the number of fallers decreased in both groups, but more markedly in the IG. This is consistent with data from a metanalysis which concluded that those who engaged in dance-based activities had a statistically significant reduced risk of falling (37%) and number of falls (31%) compared with their peers who engaged in walking, seated exercise, general aerobics and other types of exercise [Regarding the abilities to perform ADLs, both groups experienced a deterioration, but this decline was statistically significant only for the CG. Other studies have shown a stabilisation of self-care skills through dance interventions [The mechanism by which the tango interventions improve or maintain these parameters is not clear, since factors affecting gait speed and functional mobility in older people with dementia are not entirely known. However, thanks to recent advances in the understanding of neuromotor function, we hypothesize that these results derive from three main reasons: the presence of music, the performance of dance and the particular characteristics of tango.Postural control, general movement and gait are complex processes that associate the interaction of various parts of the central nervous system [Furthermore, the motor cortex, somatosensory cortex, basal ganglia, and cerebellum are all involved in various aspects of dance learning and performance [Tango dance has been shown to have potential benefits for gait rehabilitation in individuals with neurological disorders. Some studies have suggested that the specific characteristics of tango, such as its rhythmic structure, partner interaction, and focus on weight shifting and balance control, can help improve gait [Tango therapy has been largely used in Parkinson’s disease [Contrary to dance, physical exercise for older people is usually composed of monotonous and analytical movements, devoid of interest and motivation. In fact, previous studies have highlighted that physical exercises that included multi-sensory stimulation and multi-task activities have better results than physical programs with only static, resistance, and flexibility training [Regarding the effect on QoL, both interventions led to an improvement. However, these changes were not statistically significant. There was a notable improvement in both groups between the pre-test and the 1-month post-test, followed by a slight decline between the 1-month post-test and the 3-month post-test. This pattern might be explained by a 20-day interruption after the first post-test due to a Covid-19 outbreak, which affected the frequency and number of activities. The principal aim of non-pharmacological interventions is to enhance or maintain QoL. As in our previous study [A major strength of this study was allowing for the participation of institutionalised older adults with dementia, an extremely vulnerable population, despite numerous ethical, legal and logistical obstacles. The methodological consistency of this study is another of its strengths, since it was possible to carry out a randomisation of the participants and compare the intervention with another non-pharmacological intervention, of proven efficacy in several conditions. Our study's findings underscore the potential benefits of incorporating dance interventions, such as tango, into care plans for older individuals with dementia. These interventions demonstrate improvements in gait speed and help prevent functional decline, highlighting their relevance in clinical practice. However, we also noted some limitations: the study sample size was small, the absence of data about pharmacotherapy, there was no follow-up to determine the long-term effects of the intervention, it was not possible to automatically measure spatiotemporal parameters of gait nor to blind the assessment. Future studies should try to increase the sample size, follow-up on participants for at least one year and minimise the risk of bias by using blinding techniques whenever possible. Additionally, there should be an assessment of specific cognitive functions, such as visuo-spatial abilities or constructional praxis and technical outcome measurements.