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Time course of changes in motor-cognitive exergame performances during task-specific training in patients with dementia: identification and predictors of early training response.
J Neuroeng Rehabil. 2018 11 08; 15(1):100.JN

Abstract

BACKGROUND

Some studies have already suggested that exergame interventions can be effective to improve physical, cognitive, motor-cognitive, and psychological outcomes in patients with dementia (PwD). However, little is known about the training volume required to induce such positive effects and the inter-individual differences in training response among PwD. The aim of the study was to analyze the time course of changes in motor-cognitive exergame performances during a task-specific training program and to identify predictors of early training response in PwD.

METHODS

Secondary analyses of data from the intervention group (IG) of a randomized, placebo-controlled trial to improve motor-cognitive performances in PwD. Fifty-six geriatric patients with mild-to-moderate dementia randomized to the IG underwent a 10-week, task-specific training program (2×/week) on an exergame-based balance training system (Physiomat®), combining postural control tasks with cognitive tasks of an established neuropsychological test (Trail Making Test). Main outcome was the time required to complete different Physiomat®-Tasks (PTs) assessed at baseline (T1), training session 7 (TS7) and 14 (TS14), and post-intervention after 20 training sessions (T2). Reliable change indices were used to identify early responders from T1 to TS7. A multivariate logistic regression analysis was performed to determine independent predictors of early training response.

RESULTS

Completion time significantly improved already from T1 to TS7 in all PTs (p ≤ .001-.006), with moderate to very large effect sizes (r = .38-.52; Cohen's d = .85-1.45). For most PTs, significant progressive improvements from TS7 to TS14 and TS14 to T2 were not observed. Thirty-one (59.6%) participants were classified as early responders and 21 (40.4%) as non-early responders. Lower baseline exergame performance and lower visuospatial and divided attention abilities were independently associated with early training response.

CONCLUSIONS

Substantial task-specific improvements in complex motor-cognitive exergame performances can be obtained within a surprisingly short intervention period in PwD. Our results confirm that not only an excellent training response can be achieved in this patient population, but also that more vulnerable patients with greater deficits in domain-specific cognitive functions associated with fall risk may even reap the most and fastest benefit from motor-cognitive exergame interventions.

TRIAL REGISTRATION

ISRCTN registry, ISRCTN37232817 (retrospectively registered on 04/02/2012).

Authors+Show Affiliations

Department of Geriatric Research, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany. christian.werner@bethanien-heidelberg.de. Center for Geriatric Medicine, Heidelberg University, Heidelberg, Germany. christian.werner@bethanien-heidelberg.de.Department of Radiological Diagnostics, Theresien Hospital Mannheim, Mannheim, Germany.Institute of Gerontology, Heidelberg University, Heidelberg, Germany.Network of Aging Research (NAR), Heidelberg University, Heidelberg, Germany.Department of Geriatric Research, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany. Center for Geriatric Medicine, Heidelberg University, Heidelberg, Germany.Department of Geriatric Research, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany.

Pub Type(s)

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

Language

eng

PubMed ID

30409202

Citation

Werner, Christian, et al. "Time Course of Changes in Motor-cognitive Exergame Performances During Task-specific Training in Patients With Dementia: Identification and Predictors of Early Training Response." Journal of Neuroengineering and Rehabilitation, vol. 15, no. 1, 2018, p. 100.
Werner C, Rosner R, Wiloth S, et al. Time course of changes in motor-cognitive exergame performances during task-specific training in patients with dementia: identification and predictors of early training response. J Neuroeng Rehabil. 2018;15(1):100.
Werner, C., Rosner, R., Wiloth, S., Lemke, N. C., Bauer, J. M., & Hauer, K. (2018). Time course of changes in motor-cognitive exergame performances during task-specific training in patients with dementia: identification and predictors of early training response. Journal of Neuroengineering and Rehabilitation, 15(1), 100. https://doi.org/10.1186/s12984-018-0433-4
Werner C, et al. Time Course of Changes in Motor-cognitive Exergame Performances During Task-specific Training in Patients With Dementia: Identification and Predictors of Early Training Response. J Neuroeng Rehabil. 2018 11 8;15(1):100. PubMed PMID: 30409202.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Time course of changes in motor-cognitive exergame performances during task-specific training in patients with dementia: identification and predictors of early training response. AU - Werner,Christian, AU - Rosner,Rebekka, AU - Wiloth,Stefanie, AU - Lemke,Nele Christin, AU - Bauer,Jürgen M, AU - Hauer,Klaus, Y1 - 2018/11/08/ PY - 2018/06/26/received PY - 2018/10/10/accepted PY - 2018/11/10/entrez PY - 2018/11/10/pubmed PY - 2019/11/12/medline KW - Balance KW - Cognition KW - Dementia KW - Dual-task KW - Exergaming KW - Interactive KW - Postural control KW - Response SP - 100 EP - 100 JF - Journal of neuroengineering and rehabilitation JO - J Neuroeng Rehabil VL - 15 IS - 1 N2 - BACKGROUND: Some studies have already suggested that exergame interventions can be effective to improve physical, cognitive, motor-cognitive, and psychological outcomes in patients with dementia (PwD). However, little is known about the training volume required to induce such positive effects and the inter-individual differences in training response among PwD. The aim of the study was to analyze the time course of changes in motor-cognitive exergame performances during a task-specific training program and to identify predictors of early training response in PwD. METHODS: Secondary analyses of data from the intervention group (IG) of a randomized, placebo-controlled trial to improve motor-cognitive performances in PwD. Fifty-six geriatric patients with mild-to-moderate dementia randomized to the IG underwent a 10-week, task-specific training program (2×/week) on an exergame-based balance training system (Physiomat®), combining postural control tasks with cognitive tasks of an established neuropsychological test (Trail Making Test). Main outcome was the time required to complete different Physiomat®-Tasks (PTs) assessed at baseline (T1), training session 7 (TS7) and 14 (TS14), and post-intervention after 20 training sessions (T2). Reliable change indices were used to identify early responders from T1 to TS7. A multivariate logistic regression analysis was performed to determine independent predictors of early training response. RESULTS: Completion time significantly improved already from T1 to TS7 in all PTs (p ≤ .001-.006), with moderate to very large effect sizes (r = .38-.52; Cohen's d = .85-1.45). For most PTs, significant progressive improvements from TS7 to TS14 and TS14 to T2 were not observed. Thirty-one (59.6%) participants were classified as early responders and 21 (40.4%) as non-early responders. Lower baseline exergame performance and lower visuospatial and divided attention abilities were independently associated with early training response. CONCLUSIONS: Substantial task-specific improvements in complex motor-cognitive exergame performances can be obtained within a surprisingly short intervention period in PwD. Our results confirm that not only an excellent training response can be achieved in this patient population, but also that more vulnerable patients with greater deficits in domain-specific cognitive functions associated with fall risk may even reap the most and fastest benefit from motor-cognitive exergame interventions. TRIAL REGISTRATION: ISRCTN registry, ISRCTN37232817 (retrospectively registered on 04/02/2012). SN - 1743-0003 UR - https://www.unboundmedicine.com/medline/citation/30409202/Time_course_of_changes_in_motor_cognitive_exergame_performances_during_task_specific_training_in_patients_with_dementia:_identification_and_predictors_of_early_training_response_ L2 - https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-018-0433-4 DB - PRIME DP - Unbound Medicine ER -