Effectiveness of Combined Cognitive and Physical Interventions to Enhance Functioning in Older Adults With Mild Cognitive Impairment: A Systematic Review of Randomized Controlled Trials

Yang, Chenchen; Moore, Ami R.; Mpofu, Elias; Dorstyn, Diana; Li, Qiwei; Yin, Chen

doi:10.1093/geront/gnz149

Cited by 73 publications

(53 citation statements)

References 44 publications

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“…We also clarified the relationship between retention patterns and outcomes from MCI through a 4-year follow-up. The MCI to NC reversion rate ranges from 10% to 50%, depending on the follow-up period and MCI subtype [6,7]. In a previous study with a study population similar to ours and follow-up, the reversion rate was 35% [30], which is similar to the 30.9% rate in our study.…”

Section: Discussionsupporting

confidence: 87%

“…Individuals with MCI, or those who experience impairment across one or more cognitive domains (e.g., memory, language, thinking, and judgment), beyond that expected for age, are at an increased risk of progressing to AD and other types of dementias [3][4][5]. This is concerning, given that up to 20% of people over the age of 65 experience MCI [6,7]. Various factors have been related to the onset of dementia.…”

Section: Introductionmentioning

confidence: 99%

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Modifiable Risk Factor Possession Patterns of Dementia in Elderly with MCI: A 4-Year Repeated Measures Study

Katayama

Lee

Bae

et al. 2020

JCM

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This study clarified the patterns of possessing modifiable risk factors of dementia that can be corrected by the elderly who were primarily determined to have mild cognitive impairment (MCI), and then determined the relationship between retention patterns and outcomes from MCI through a 4-year follow-up study. The participants were 789 community-dwelling elders who were ≥65 years old with MCI at baseline. After 4 years, participants were classified into reverters and nonreverters, according to their cognitive function. Repeated measures analysis was performed after imputing missing values due to dropout. Nine modifiable risk factors at baseline were classified by latent class analysis. Subsequently, we performed binomial logistic regression analysis. The reversion rate of 789 participants was 30.9%. The possession patterns of modifiable risk factors among the elderly with MCI were classified into five patterns: low risk, psychosocial, health behavior, educational, and smoking factors. According to logistic regression analysis, the low risk factors class was more likely to recover from MCI to normal cognitive than the other classes (p < 0.05). These results may provide useful information for designing interventions to prevent cognitive decline and dementia in individuals with MCI.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Modifiable Risk Factor Possession Patterns of Dementia in Elderly with MCI: A 4-Year Repeated Measures Study

Katayama

Lee

Bae

et al. 2020

JCM

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“…Recent systematic reviews have supported the efficacy of cognitive training (Gavelin et al, 2020; Hill et al, 2017; Lampit et al, 2014; Leung et al, 2015) and physical exercise (Falck et al, 2019; Northey et al, 2018) on cognitive performance in older adults with and without cognitive impairment. These interventions have also been recommended in clinical practice guidelines (e.g., for mild cognitive impairment; Petersen et al, 2018) and, increasingly, the possibility of combining physical exercise with cognitively challenging activities has been highlighted as a way to maintain both cognitive and physical health (Yang et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

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

Gavelin

Dong

Minkov

et al. 2020

Preprint

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Background Large systematic reviews have pointed to the efficacy of cognitive training and physical exercise on cognitive performance in older adults, making them the most common interventions in multidomain dementia prevention trials. However, it remains unclear to which extent combinations of these interventions yield additive effects beyond their individual components and what combination strategies are most beneficial. Our aim therefore was to synthesize the evidence from randomized controlled trials of combined cognitive and physical training on cognitive, physical, psychosocial and functional outcomes in older adults with or without cognitive impairment, and to compare and rank the efficacy of the three main types of combined intervention delivery formats (simultaneous, sequential or exergaming) relative to either intervention alone or control conditions. Methods and Findings We systematically searched MEDLINE, Embase and PsycINFO from inception to 23 July 2019. Change from baseline to post-intervention were extracted for each outcome and results were analyzed using random-effects models. The overall efficacy of combined interventions was assessed using multivariate pairwise meta-analysis and the comparative efficacy across different intervention delivery formats and control conditions was investigated using network meta-analysis. A total of 47 trials encompassing 4052 participants were eligible, including cognitively healthy older adults (k=30), mild cognitive impairment (k=13), dementia (k=2) and Parkinson disease (k=2). Due to the small number of identified studies in dementia and Parkinson disease, these were excluded from the pooled analyses and instead summarized narratively. Relative to any control condition, combined interventions were associated with small and heterogeneous effects on overall cognitive (k=41, Hedges g = 0.22, 95% CI 0.14 to 0.30, prediction interval -0.34 to 0.78) and physical function (k=32, g = 0.25, 95% CI 0.13 to 0.37, prediction interval -0.46 to 0.96). Cognitive and physical effects were similar for cognitively healthy older adults and those with mild cognitive impairment. No robust evidence for benefit on psychosocial function (k=9) or functional abilities (k=2) was found. The efficacy of simultaneous and sequential training for cognition exceeded all control conditions apart from cognitive training alone, with small to moderate effect estimates and moderate certainty of the evidence. The efficacy of simultaneous and sequential training on physical outcomes was comparable but not significantly greater than physical exercise alone. Exergaming was ranked low for both outcomes and superior only to passive control. The certainty of the evidence was low for physical outcomes, and we were not able to compare interventions in Parkinson disease and dementia. Conclusion Combined cognitive and physical training, delivered either simultaneously or sequentially, is efficacious for cognitive and physical outcomes in cognitively healthy and mildly impaired older adults, but not superior to cognitive or physical exercise alone in each domain. There is little systematic evidence to support potential additive effects of combined interventions or the use of exergaming in older adults. Given simultaneous training is as efficacious but less burdensome than sequential design, the former may be better suited for practical implementation to promote cognitive alongside physical health in late life. More research is needed to establish the effects of combined interventions on everyday function and well-being.

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“…These therapeutic effects of Baduanjin were similar to those of other physical exercises 36 and combined cognitive and physical interventions. 37…”

Section: Discussionmentioning

confidence: 99%

“…These therapeutic effects of Baduanjin were similar to those of other physical exercises 36 and combined cognitive and physical interventions. 37 Meta-analysis of the cerebrospinal fluid indexes reported by three studies suggested that Baduanjin may improve cognitive function by reducing Tau protein levels and increasing Aβ 1-42 levels in the cerebrospinal fluid. Some studies have shown that biomarkers such as Tau protein and Aβ 1-42 are closely related to cognitive function; for example, a high Tau/Aβ 1-42 ratio is associated with worse performance on cognition and memory tests, and plays an important role in the early detection and identification of early Alzheimer disease.…”

Section: Discussionmentioning

confidence: 99%

Systematic review and meta-analysis of randomized controlled trials assessing the impact of Baduanjin exercise on cognition and memory in patients with mild cognitive impairment

Liu

Nie

et al. 2020

Clin Rehabil

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Objective: To determine the effectiveness of Baduanjin exercise in improving cognition and memory in patients with mild cognitive impairment. Data sources: Relevant English- and Chinese-language studies published until 15th September 2020 were retrieved from the PubMed, Web of Science, Cochrane Library, Embase, EBSCOhost, OVID, National Knowledge Infrastructure, WANFANG DATA, VIP Information, and SinoMed databases. Review methods: Randomized controlled trials assessing Baduanjin exercise in patients with mild cognitive impairment were included. Two researchers independently identified eligible studies and extracted data. Risk-of-bias assessment was performed using the Cochrane Risk of Bias Tool. Results: This study included 16 randomized controlled trials (1054 participants) from China that used Chinese versions of standardized tests. Most studies had no significant bias, and only one study had a high risk of bias in the random allocation category. Compared with conventional therapy alone, Baduanjin plus conventional therapy significantly improved the Montreal Cognitive Assessment and Mini-Mental State Examination scores after 6 months of treatment ( P < 0.00001 for both), significantly decreased the tau/Aβ1–42 ratio in the cerebrospinal fluid ( P < 0.00001), and significantly improved some dimensional scores on the Wechsler Memory Scale and the auditory verbal learning test scores at 6 months ( P < 0.05 for all). Conclusion: Compared with conventional therapy, Baduanjin plus conventional therapy significantly improved cognitive and memory function in patients with mild cognitive impairment.

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Effectiveness of Combined Cognitive and Physical Interventions to Enhance Functioning in Older Adults With Mild Cognitive Impairment: A Systematic Review of Randomized Controlled Trials

Cited by 73 publications

References 44 publications

Modifiable Risk Factor Possession Patterns of Dementia in Elderly with MCI: A 4-Year Repeated Measures Study

Modifiable Risk Factor Possession Patterns of Dementia in Elderly with MCI: A 4-Year Repeated Measures Study

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

Systematic review and meta-analysis of randomized controlled trials assessing the impact of Baduanjin exercise on cognition and memory in patients with mild cognitive impairment

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