A Multi-Domain Intervention Protocol for the Potential Reversal of Cognitive Frailty: “WE-RISE” Randomized Controlled Trial

Abstract

Following the rapid increase of the aging population, health promotion and prevention of physical disability and dementia in older persons are essential for healthy aging. For example, there may be a potential to prevent or reverse cognitive frailty, the coexistence of both physical frailty and cognitive impairment in older persons. However, evidence-based interventions targeting the prevention or potential reversibility of cognitive frailty among community dwelling older adults are scarce. In this paper, we described the rationale, development and delivery of a multi-domain intervention comprising multi-component physical exercise prescription, cognitive training, dietary counseling and promotion of psychosocial support, called the WE-RISE trial. The aim of WE-RISE intervention is to potentially reverse cognitive frailty. This is a two-armed, single blinded, randomized controlled trial conducted over a duration of 6 months, at senior citizen activity centers within the Klang Valley, Malaysia. Ambulating, community dwelling older adults aged 60 years and above with cognitive frailty are randomized into two groups; (1) intervention group: which receives an instructor based "WE-RISE" intervention for the first 3 months, and then a home-based "WE-RISE at Home" intervention for the following 3 months; (2) control group: usual care with no modifications to their daily routine. Primary outcome is cognitive frailty status and secondary outcome include physical function, cognitive performance, nutritional status, psychosocial status and quality of life which are obtained during baseline screening and subsequent follow ups at 3rd and 6th month. Description of the intervention is done using the template for intervention description and replication (TIDieR) checklist. This trial protocol has received approval from Research Ethics Committee of Universiti Kebangsaan Malaysia (UKM PPI/111/8/JEP-2018-558) and the Department of Social Welfare Malaysia (MyResearch Reference: JKMM 100/12/5/2: 2018/405). Trial registration number: ACTRN12619001055190.

Physical Activity Patterns, Psychosocial Well-Being and Coping Strategies Among Older Persons with Cognitive Frailty of the “WE-RISE” Trial Throughout the COVID-19 Movement Control Order

“…The WE-RISE intervention includes a guided 3-month home program (WE-RISE at Home) which may have enabled the participants to carry out multi-component exercise training safely and effectively on their own. 24 It can be hypothesized that given their exposure to the intervention and awareness of the importance of maintaining an active lifestyle, these participants may have been more motivated to execute some form of physical activity in the comforts of their own homes during the MCO. Regarding the functional independence of the participants in our study, both groups have considerably adequate levels of functional independence.…”

“… 17 Figure 1 summarizes the trial flow and further detailed information on the WE-RISE trial has been described in the protocol paper. 24 …”

“…2020;8(471):1–11. Operational definition of cognitive frailty as outlined in the paper by Kelaiditi et al 24

Figure 1 Study trial flow diagram.

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“… 17 , 20 In an effort to specifically address the clinical manifestations of cognitive frailty and potential reversibility, a multi-domain intervention (The WE-RISE intervention) was conducted prior to the pandemic in senior citizen activity centers among community-dwelling older persons with this condition. 24 …”

Comprehensive Model for Physical and Cognitive Frailty: Current Organization and Unmet Needs

“…The research is also focusing on disease-modifying therapies targeting various forms of dementia and in particular Alzheimer's type. Ongoing clinical trials (Murukesu et al, 2020) are testing feasible and promising treatments capable to slow down the natural course of the disease.…”