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Would older adults with mild cognitive impairment adhere to and benefit from a structured lifestyle activity intervention to enhance cognition?: a cluster randomized controlled trial.

Abstract

BACKGROUND

Epidemiologic evidence suggests that cognitive and physical activities are associated with better cognition in late life. The present study was conducted to examine the possible benefits of four structured lifestyle activity interventions and compare their effectiveness in optimizing cognition for older adults with mild cognitive impairment (MCI).

METHOD AND FINDINGS

This was a 12-month cluster randomized controlled trial. 555 community-dwelling Chinese older adults with MCI (295 with multiple-domain deficits (mdMCI), 260 with single-domain deficit (sdMCI)) were recruited. Participants were randomized into physical exercise (P), cognitive activity (C), integrated cognitive and physical exercise (CP), and social activity (S, active control) groups. Interventions comprised of one-hour structured activities three times per week. Primary outcome was Clinical Dementia Rating sum of boxes (CDR-SOB) scores. Secondary outcomes included Chinese versions of Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog), delayed recall, Mini-Mental State Examination, Category Verbal Fluency Test (CVFT) and Disability Assessment for Dementia - Instrumental Activities of Daily Living (DAD-IADL). Percentage adherence to programs and factors affecting adherence were also examined. At 12th month, 423 (76.2%) completed final assessment. There was no change in CDR-SOB and DAD-IADL scores across time and intervention groups. Multilevel normal model and linear link function showed improvement in ADAS-Cog, delayed recall and CVFT with time (p<0.05). Post-hoc subgroup analyses showed that the CP group, compared with other intervention groups, had more significant improvements of ADAS-Cog, delayed recall and CVFT performance with sdMCI participants (p<0.05). Overall adherence rate was 73.3%. Improvements in ADAS-Cog and delayed recall scores were associated with adherence after controlling for age, education, and intervention groups (univariate analyses).

CONCLUSIONS

Structured lifestyle activity interventions were not associated with changes in everyday functioning, albeit with some improvements in cognitive scores across time. Higher adherence was associated with greater improvement in cognitive scores. Factors to enhance adherence should be specially considered in the design of psychosocial interventions for older adults with cognitive decline.

TRIAL REGISTRATION

ClinicalTrials.gov ChiCTR-TRC-11001359.

Links

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  • Authors+Show Affiliations

    ,

    Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong.

    ,

    Department of Psychiatry, The University of Hong Kong, Hong Kong.

    ,

    Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong.

    ,

    Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong.

    Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong.

    Source

    PloS one 10:3 2015 pg e0118173

    MeSH

    Activities of Daily Living
    Affect
    Age Factors
    Aged
    Aged, 80 and over
    Cognition
    Cognitive Dysfunction
    Female
    Geriatric Assessment
    Humans
    Life Style
    Male
    Middle Aged
    Outcome Assessment (Health Care)
    Time Factors

    Pub Type(s)

    Clinical Trial
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    25826620

    Citation

    Lam, Linda Chiu-Wa, et al. "Would Older Adults With Mild Cognitive Impairment Adhere to and Benefit From a Structured Lifestyle Activity Intervention to Enhance Cognition?: a Cluster Randomized Controlled Trial." PloS One, vol. 10, no. 3, 2015, pp. e0118173.
    Lam LC, Chan WC, Leung T, et al. Would older adults with mild cognitive impairment adhere to and benefit from a structured lifestyle activity intervention to enhance cognition?: a cluster randomized controlled trial. PLoS ONE. 2015;10(3):e0118173.
    Lam, L. C., Chan, W. C., Leung, T., Fung, A. W., & Leung, E. M. (2015). Would older adults with mild cognitive impairment adhere to and benefit from a structured lifestyle activity intervention to enhance cognition?: a cluster randomized controlled trial. PloS One, 10(3), pp. e0118173. doi:10.1371/journal.pone.0118173.
    Lam LC, et al. Would Older Adults With Mild Cognitive Impairment Adhere to and Benefit From a Structured Lifestyle Activity Intervention to Enhance Cognition?: a Cluster Randomized Controlled Trial. PLoS ONE. 2015;10(3):e0118173. PubMed PMID: 25826620.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Would older adults with mild cognitive impairment adhere to and benefit from a structured lifestyle activity intervention to enhance cognition?: a cluster randomized controlled trial. AU - Lam,Linda Chiu-Wa, AU - Chan,Wai Chi, AU - Leung,Tony, AU - Fung,Ada Wai-Tung, AU - Leung,Edward Man-Fuk, Y1 - 2015/03/31/ PY - 2014/06/24/received PY - 2015/01/05/accepted PY - 2015/4/1/entrez PY - 2015/4/1/pubmed PY - 2016/3/16/medline SP - e0118173 EP - e0118173 JF - PloS one JO - PLoS ONE VL - 10 IS - 3 N2 - BACKGROUND: Epidemiologic evidence suggests that cognitive and physical activities are associated with better cognition in late life. The present study was conducted to examine the possible benefits of four structured lifestyle activity interventions and compare their effectiveness in optimizing cognition for older adults with mild cognitive impairment (MCI). METHOD AND FINDINGS: This was a 12-month cluster randomized controlled trial. 555 community-dwelling Chinese older adults with MCI (295 with multiple-domain deficits (mdMCI), 260 with single-domain deficit (sdMCI)) were recruited. Participants were randomized into physical exercise (P), cognitive activity (C), integrated cognitive and physical exercise (CP), and social activity (S, active control) groups. Interventions comprised of one-hour structured activities three times per week. Primary outcome was Clinical Dementia Rating sum of boxes (CDR-SOB) scores. Secondary outcomes included Chinese versions of Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog), delayed recall, Mini-Mental State Examination, Category Verbal Fluency Test (CVFT) and Disability Assessment for Dementia - Instrumental Activities of Daily Living (DAD-IADL). Percentage adherence to programs and factors affecting adherence were also examined. At 12th month, 423 (76.2%) completed final assessment. There was no change in CDR-SOB and DAD-IADL scores across time and intervention groups. Multilevel normal model and linear link function showed improvement in ADAS-Cog, delayed recall and CVFT with time (p<0.05). Post-hoc subgroup analyses showed that the CP group, compared with other intervention groups, had more significant improvements of ADAS-Cog, delayed recall and CVFT performance with sdMCI participants (p<0.05). Overall adherence rate was 73.3%. Improvements in ADAS-Cog and delayed recall scores were associated with adherence after controlling for age, education, and intervention groups (univariate analyses). CONCLUSIONS: Structured lifestyle activity interventions were not associated with changes in everyday functioning, albeit with some improvements in cognitive scores across time. Higher adherence was associated with greater improvement in cognitive scores. Factors to enhance adherence should be specially considered in the design of psychosocial interventions for older adults with cognitive decline. TRIAL REGISTRATION: ClinicalTrials.gov ChiCTR-TRC-11001359. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/25826620/Would_older_adults_with_mild_cognitive_impairment_adhere_to_and_benefit_from_a_structured_lifestyle_activity_intervention_to_enhance_cognition:_a_cluster_randomized_controlled_trial_ L2 - http://dx.plos.org/10.1371/journal.pone.0118173 DB - PRIME DP - Unbound Medicine ER -