Combining cognitive stimulation therapy and fall prevention exercise (CogEx) in older adults with mild to moderate dementia: a feasibility randomised controlled trial

Abstract

Background: People living with dementia (PLwD) have a high fall risk as cognitive impairment compromises control of gait and balance. Fall prevention exercises that are effective in healthy older adults may not work for PLwD. Cognitive stimulation therapy (CST) has been shown to improve global cognition in PLwD. A programme which combines cognitive (CST) with physical exercises may reduce falls in PLwD. The aim of this study was to assess the feasibility of undertaking a full scale randomised controlled trial to test the effectiveness of CogEx in decreasing falls in PLwD. Specific objectives included recruitment strategy, data collection, outcome measures, intervention fidelity and facilitator/participant experience. Methods: A mixed methods feasibility randomised controlled trial recruited people from residential aged care. Inclusion criteria were ≥ 65 years old, Montreal Cognitive Assessment (MoCA) score of 10 to 26 and able to participate in a group. Participants were randomised to CST or CST combined with strength and balance exercises (CogEx). Both CST and CogEx groups were for an hour twice a week for 7 weeks. Descriptive statistics were used to report pre-and post-intervention outcome measures (MoCA, Geriatric Depression Scale-15, Quality of Life-Alzheimer's Disease, Alzheimer's Disease Assessment Scale-Cognitive 11, Brief Balance Evaluation Systems Test and Short Form Physical Performance Battery) and attendance. Qualitative analysis of participant focus groups and facilitator interviews used a conventional approach. Sessions were video recorded and exercise completion documented. Results: Thirty-six residents were screened with 23 participants randomised to intervention (CogEx, n = 10) or control (CST, n = 13). The assessments took 45 min to 1.5 h, and there was repetition between two cognitive measures. Ten facilitators completed training with the manualised programme. Exercises were combined into the hour-long CST session; however, limited balance training occurred with participants exercising predominantly in sitting. The facilitators felt the participants engaged more and were safer in sitting.

Exercise to Improve Postural Stability in Older Adults with Alzheimer’s Disease: A Systematic Review of Randomized Control Trials

“…The methodological quality of the included studies is summarized in Table 1 All included studies were randomized control trials [ 7 , 12 , 18 , 20 , 21 , 22 , 23 , 24 ]. The cumulative PEDro scores varied from low (score of 3) to medium quality (score of 7).…”

“…The cumulative PEDro scores varied from low (score of 3) to medium quality (score of 7). Randomization was carried out in 6 studies [ 7 , 12 , 20 , 21 , 22 , 24 ], concealed allocation of randomization occurred in 3 studies [ 12 , 20 , 21 ], assessor blinding in 5 studies [ 12 , 20 , 22 , 23 , 24 ], intention-to-treat analysis in 5 studies [ 12 , 18 , 20 , 21 , 24 ], therapist blinding in 2 studies [ 12 , 24 ] and ≤15% dropouts in 3 studies [ 21 , 23 , 24 ]. There were no studies in which participants were blinded because of the difficulties associated with the interventions.…”

“…It has been reported that older people with cognitive impairment (CI) are twice as likely to fall and be injured compared to those without CI [ 7 , 8 ]. Factors such as frailty, gait impairments and CI contribute to falls, fractures, injuries, and even mortality [ 5 , 7 ].…”

“…It has been reported that older people with cognitive impairment (CI) are twice as likely to fall and be injured compared to those without CI [ 7 , 8 ]. Factors such as frailty, gait impairments and CI contribute to falls, fractures, injuries, and even mortality [ 5 , 7 ]. Gait and cognitive impairments are linked, indicating that gait is no longer just a motor task but rather an activity that involves executive function, attention, and the environment [ 7 , 9 , 10 ].…”

“…Factors such as frailty, gait impairments and CI contribute to falls, fractures, injuries, and even mortality [ 5 , 7 ]. Gait and cognitive impairments are linked, indicating that gait is no longer just a motor task but rather an activity that involves executive function, attention, and the environment [ 7 , 9 , 10 ]. Approximately 50% of older adults with AD have difficulty walking three years following diagnosis, with 33% of these adults classified as non-ambulatory [ 11 ].…”