Improvisational Movement to Improve Quality of Life in Older Adults With Early-Stage Dementia: A Pilot Study

Abstract

Alzheimer's disease has profound effects on quality of life, affecting not only cognition, but mobility and opportunities for social engagement. Dance is a form of movement that may be uniquely suited to help maintain quality of life for older adults, including those with dementia, because it inherently incorporates movement, social engagement, and cognitive stimulation. Here, we describe the methods and results of the pilot study for the IMOVE trial (NCT03333837, www.clinicaltrials.gov), a clinical trial designed to use improvisational dance classes to test the effects of movement and social engagement in people with mild cognitive impairment (MCI) or early-stage dementia. The pilot study was an 8-week investigation into the feasibility and potential effects of an improvisational dance intervention on people with MCI or early-stage dementia (PWD/MCI) and their caregivers (CG). The pilot aimed to assess changes in quality of life, balance, mood, and functional brain networks in PWD/MCI and their CG. Participants were recruited as dyads (pairs) that included one PWD/MCI and one CG. Ten total dyads were enrolled in the pilot study with five dyads assigned to the usual care control group and five dyads participating in the dance intervention. The intervention arm met twice weekly for 60 min for 8 weeks. Attendance and quality of life assessed with the Quality of Life in Alzheimer's disease (QoL-AD) questionnaire were the primary outcomes. Secondary outcomes included balance, mood and brain network connectivity assessed through graph theory analysis of functional magnetic resonance imaging (fMRI). Class attendance was 96% and qualitative feedback reflected participants felt socially connected to the group. Increases in quality of life and balance were observed, but not mood. Brain imaging analysis showed increases in multiple brain network characteristics, including global efficiency and modularity. Further investigation into the positive effects of this dance intervention on both imaging and non-imaging metrics will be carried out on the full clinical trial data. Results from the trial are expected in the summer of 2022.

IMOVE: Protocol for a randomized, controlled 2x2 factorial trial of improvisational movement and social engagement interventions in older adults with early Alzheimer's disease

“…Studies capable of capturing the complexity of interpersonal interactions while determining physiological mechanisms and respecting the integrity of the dance form under investigation are challenging to design and execute. The IMOVE study is the product of a unique, highly innovative, and productive partnership [ 49 , 50 ] that combines expertise in dance and neuroscience. To our knowledge, there is no published mechanistic model to explain the effects of dance on QoL or secondary symptoms in PWAD.…”

“…The IMPROVment method and theory were described previously [ 49 , 50 ]. Briefly, this improvisational dance method is grounded in 4 principles that shape the tone of the class and result in a sense of social belonging: non-judgment, non-competitiveness, curiosity, and playfulness.…”

“…Our pilot data showed a difference of 1.4 on the QOL-AD between the UC control and dance group [ 50 ]. Although the pilot did not test separate effects of social engagement and dance movement and was an 8-week rather than a 12-week intervention, the pilot data suggested the amount of change we could expect.…”

“…Ongoing community classes as well as the largest support group for people with Parkinson's disease in Forsyth County, North Carolina, USA arose from this study, demonstrating the establishment of meaningful social connections among participants. Additionally, a pilot study evaluated the feasibility and potential benefits of IMPROVment classes (twice weekly for 8 weeks) versus usual care in people with MCI or early-stage dementia and their CGs [ 50 ]. The intervention arm (n = 5 dyads) demonstrated 96% class attendance, and qualitative feedback suggested that participants felt socially connected to the group.…”

Rationale for a Multi-Factorial Approach for the Reversal of Cognitive Decline in Alzheimer’s Disease and MCI: A Review

“…The most challenging aspect of dance training required the subjects to recall the dance steps and routines in a timely manner [ 181 ]. While all forms of dance reduce stress, improve cardiovascular health, and stimulate social connectivity, some dance forms that involve split-second changes in steps and complicated moves have an advantage over others when it comes to boosting cognitive acuity [ 178 , 179 , 180 , 182 , 183 ]. Dancing involves continuous learning, which improves the kinesthetic, rational, musical, and emotional aspects of the brain, and ultimately promotes neural connectivity [ 184 , 185 ].…”