scholarly journals Live Video Adaptations to a Mind-Body Activity Program for Chronic Pain and Cognitive Decline: Protocol for the Virtual Active Brains Study

10.2196/25351 ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. e25351
Author(s):  
Ryan A Mace ◽  
James D Doorley ◽  
Paula J Popok ◽  
Ana-Maria Vranceanu
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
Cognitive Decline ◽  
Cognitive Functions ◽  
Self Report ◽  
Treatment Manual ◽  
Pain Clinic ◽  
Live Video ◽  
Activity Program ◽  
Body Activity

Background Chronic pain (CP) and cognitive decline (CD) are costly, challenging to treat, prevalent among older adults, and worsen each other over time. We are iteratively developing Active Brains-Fitbit (AB-F), a live video program for older adults with CP and CD that teaches mind-body skills and gradual increases in step count. AB-F has demonstrated feasibility; acceptability; and signs of improvement in emotional, physical, and cognitive functions when delivered in person to older adults. Objective We are conducting a feasibility randomized controlled trial (RCT) of AB-F versus a time- and dose-matched educational control (health enhancement program [HEP]) in older adults with CP and CD. Here, we describe virtual adaptions to our study protocol, manualized treatments, evaluation plan, and study design in response to feedback from former participants and COVID-19. We will evaluate the feasibility benchmarks and the potential of AB-F to improve physical, emotional, and cognitive functions. Methods This is a single-blind pilot RCT. Participants are randomized to AB-F or HEP. Patients are recruited through pain clinic referrals, institutional registries, and flyers. Interested participants are screened for eligibility via telephone and provide electronic informed consent. After randomization, participants are mailed all study documents, including their treatment manual, an ActiGraph accelerometer, and a Fitbit (separate envelope for AB-F only). Both conditions are manualized and delivered over 8 weekly sessions via Zoom. Participants complete self-report and performance-based (6-min walk test and Montreal Cognitive Assessment) outcome measures via Zoom at baseline and post intervention. Primary outcomes are a priori set feasibility (recruitment, quantitative measures, and adherence), acceptability, credibility, expectancy, and satisfaction benchmarks. Secondary outcomes are physical, cognitive, and emotional functions as well as intervention targets (social function, pain intensity, pain-specific coping, and mindfulness). Results The trial is ongoing. We have recruited 21 participants (10 AB-F and 11 HEP) across 2 rounds. Only 2 participants have withdrawn (1 before baseline and 1 before the first session). All 19 remaining participants have completed the baseline assessment. In the first round, attendance is high (11 out of 12 participants completed all 4 sessions so far), and AB-F participants are adherent to their Fitbit and step goals (5 out of 6 participants). Conclusions Preliminary findings are promising for the feasibility of our completely virtual AB-F intervention. However, these findings need to be confirmed at the trial conclusion. This study will answer important questions about the feasibility of delivering a completely virtual mind-body activity program to older adults with comorbid CP and CD, which, to our knowledge, is unprecedented. Details on integrating multiple digital platforms for virtual assessments and intervention delivery will inform treatment development for older adults and those with comorbid CP and CD, which is crucial during the COVID-19 pandemic. Trial Registration ClinicalTrials.gov NCT04044183; https://clinicaltrials.gov/ct2/show/NCT04044183 International Registered Report Identifier (IRRID) DERR1-10.2196/25351

scholarly journals Live Video Adaptations to a Mind-Body Activity Program for Chronic Pain and Cognitive Decline: Protocol for the Virtual Active Brains Study (Preprint)

2020 ◽  
Author(s):  
Ryan A Mace ◽  
James D Doorley ◽  
Paula J Popok ◽  
Ana-Maria Vranceanu
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
Cognitive Decline ◽  
Cognitive Functions ◽  
Self Report ◽  
Treatment Manual ◽  
Pain Clinic ◽  
Live Video ◽  
Activity Program ◽  
Body Activity

BACKGROUND Chronic pain (CP) and cognitive decline (CD) are costly, challenging to treat, prevalent among older adults, and worsen each other over time. We are iteratively developing Active Brains-Fitbit (AB-F), a live video program for older adults with CP and CD that teaches mind-body skills and gradual increases in step count. AB-F has demonstrated feasibility; acceptability; and signs of improvement in emotional, physical, and cognitive functions when delivered in person to older adults. OBJECTIVE We are conducting a feasibility randomized controlled trial (RCT) of AB-F versus a time- and dose-matched educational control (health enhancement program [HEP]) in older adults with CP and CD. Here, we describe virtual adaptions to our study protocol, manualized treatments, evaluation plan, and study design in response to feedback from former participants and COVID-19. We will evaluate the feasibility benchmarks and the potential of AB-F to improve physical, emotional, and cognitive functions. METHODS This is a single-blind pilot RCT. Participants are randomized to AB-F or HEP. Patients are recruited through pain clinic referrals, institutional registries, and flyers. Interested participants are screened for eligibility via telephone and provide electronic informed consent. After randomization, participants are mailed all study documents, including their treatment manual, an ActiGraph accelerometer, and a Fitbit (separate envelope for AB-F only). Both conditions are manualized and delivered over 8 weekly sessions via Zoom. Participants complete self-report and performance-based (6-min walk test and Montreal Cognitive Assessment) outcome measures via Zoom at baseline and post intervention. Primary outcomes are a priori set feasibility (recruitment, quantitative measures, and adherence), acceptability, credibility, expectancy, and satisfaction benchmarks. Secondary outcomes are physical, cognitive, and emotional functions as well as intervention targets (social function, pain intensity, pain-specific coping, and mindfulness). RESULTS The trial is ongoing. We have recruited 21 participants (10 AB-F and 11 HEP) across 2 rounds. Only 2 participants have withdrawn (1 before baseline and 1 before the first session). All 19 remaining participants have completed the baseline assessment. In the first round, attendance is high (11 out of 12 participants completed all 4 sessions so far), and AB-F participants are adherent to their Fitbit and step goals (5 out of 6 participants). CONCLUSIONS Preliminary findings are promising for the feasibility of our completely virtual AB-F intervention. However, these findings need to be confirmed at the trial conclusion. This study will answer important questions about the feasibility of delivering a completely virtual mind-body activity program to older adults with comorbid CP and CD, which, to our knowledge, is unprecedented. Details on integrating multiple digital platforms for virtual assessments and intervention delivery will inform treatment development for older adults and those with comorbid CP and CD, which is crucial during the COVID-19 pandemic. CLINICALTRIAL ClinicalTrials.gov NCT04044183; https://clinicaltrials.gov/ct2/show/NCT04044183 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/25351

Feasibility randomized controlled trial of a mind-body activity program for older adults with chronic pain and cognitive decline: The virtual “Active Brains” study

2021 ◽  
Author(s):  
James D Doorley ◽  
Ryan A Mace ◽  
Paula J Popok ◽  
Victoria A Grunberg ◽  
Anya Ragnhildstveit ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
Randomized Controlled Trial ◽  
Cognitive Decline ◽  
Controlled Trial ◽  
A Priori ◽  
Exit Interviews ◽  
Randomized Controlled ◽  
Activity Program ◽  
Body Activity

Abstract Background and Objectives Chronic pain (CP) and cognitive decline (CD) are highly co-morbid and debilitating among older adults. We iteratively developed Active Brains–Fitbit (AB-F), a group mind-body activity program aided by a Fitbit that is feasible and associated with improvements in physical, cognitive, and emotional functioning when delivered in person to older adults with CP and CD. We adapted our intervention and methodology for remote delivery to bypass barriers to participation. Here we report on a feasibility randomized controlled trial of the virtual AB-F versus a Health Enhancement Program (HEP) educational control followed by qualitative exit interviews. Research Design and Methods Older adults (age ≥ 60) with CP and CD (2 cohorts) completed eight weeks of AB-F (n = 8) or HEP (n = 11). Study procedures were fully remote via live video. Quantitative analyses explored feasibility and acceptability markers and within group improvements in outcomes. Qualitative analyses were primarily deductive using the Framework Method. Results AB-F met a-priori set feasibility benchmarks, similar to our in-person pilot. Participation in AB-F was associated with preliminary signals of improvement in multimodal physical function, emotional function (anxiety), cognitive function, pain intensity, and coping (e.g., pain self-efficacy, catastrophizing). Participation in HEP was associated with smaller or negligible improvements. Exit interviews confirmed feasibility and satisfaction with our completely remote interventions and methodology. Discussion and Implications Results provide evidence for the feasibility of our completely remote study, and for initial markers of improvement after AB-F. The results will inform a fully powered remote efficacy trial.

Edentulism and Trajectories of Cognitive Functioning Among Older Adults: The Role of Dental Care Service Utilization

2019 ◽  
Vol 32 (7-8) ◽  
pp. 744-752 ◽  
Author(s):  
Sae Hwang Han ◽  
Bei Wu ◽  
Jeffrey A. Burr
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Cognitive Functioning ◽  
Service Utilization ◽  
Dental Care ◽  
Care Service ◽  
Health Care Expenditures ◽  
Self Report ◽  
Dental Services

Objective: This study examined the associations between edentulism, dental care service utilization, and cognitive functioning trajectories among older adults. Method: Longitudinal data from the Health and Retirement Study (2006-2014) were employed to examine individuals aged 51 and older who were identified as having normal cognition at baseline ( N = 12,405). Cognitive functioning was measured with a modified version of the Telephone Interview for Cognition Status. Edentulism was self-reported as total tooth loss at baseline. Dental care service utilization was measured by self-report of having visited a dentist at least once during the previous 2 years. Results: The results indicated that edentulism and dental care service utilization were independently associated with cognitive decline during the observation period. Findings also showed that dental care service utilization moderated the association between edentulism and cognitive decline. Discussion: The findings suggested that providing access to dental services may promote cognitive health and potentially reduce health care expenditures.

Are Adverse Childhood Experiences Associated with Worse Cognitive Function in Older Adults?

2021 ◽  
pp. 1-10
Author(s):  
Amy B. Halpin ◽  
Rebecca K. MacAulay ◽  
Angelica R. Boeve ◽  
Lisa M. D’Errico ◽  
Sahvannah Michaud
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Adverse Childhood Experiences ◽  
Community Dwelling ◽  
Self Report ◽  
Executive Attention ◽  
Childhood Experiences ◽  
Intellectual Function ◽  
Adverse Childhood ◽  
Increased Risk

Abstract Objectives: Adverse childhood experiences (ACE) are associated with an increased risk for dementia, but this relationship and modifying factors are poorly understood. This study is the first to our knowledge to comprehensively examine the effect of ACE on specific cognitive functions and measures associated with greater risk and resiliency to cognitive decline in independent community-dwelling older adults. Methods: Verbal/nonverbal intelligence, verbal memory, visual memory, and executive attention were assessed. Self-report measures examined depression, self-efficacy, and subjective cognitive concerns (SCC). The ACE questionnaire measured childhood experiences of abuse, neglect, and household dysfunction. Results: Over 56% of older adults reported an adverse childhood event. ACE scores were negatively associated with income and years of education and positively associated with depressive symptoms and SCC. ACE scores were a significant predictor of intellectual function and executive attention; however, these relationships were no longer significant after adjusting for education. Follow-up analyses using the PROCESS macro revealed that relationships among higher ACE scores with intellectual function and executive attention were mediated by education. Conclusions: Greater childhood adversity may increase vulnerability for cognitive impairment by impacting early education, socioeconomic status, and mental health. These findings have clinical implications for enhancing levels of cognitive reserve and addressing modifiable risk factors to prevent or attenuate cognitive decline in older adults.

Abstract 04: Incident Heart Failure and Longitudinal Cognitive Trajectories in the Cardiovascular Health Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Christa Schank ◽  
Natalie J Blades ◽  
Sarwat I Chaudhry ◽  
John A Dodson ◽  
W T Longstreth ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Adults ◽  
Cognitive Decline ◽  
Cardiovascular Health ◽  
Self Report ◽  
Cognitive Test ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Incident Heart Failure ◽  
Rate Of Decline

OBJECTIVE: To determine whether older adults who develop incident heart failure (HF) experience faster cognitive decline than those without HF. METHODS: We analyzed longitudinal cognitive test data from the Cardiovascular Health Study, a community-based study of adults aged 65 years and older. Participants in this analysis did not have HF or history of stroke at baseline and were censored when they experienced incident clinical stroke. Incident HF was identified by self-report of physician-diagnosed HF and confirmed by adjudicated review of inpatient and outpatient medical records and medication use. Outcomes were mean score and rate of decline in mean score on the 100-point Modified Mini-Mental State Examination (3MSE), administered annually up to nine times from 1990 to 1998. A linear mixed effects model was used to model the relationship of cognitive decline with HF and age, adjusted for demographics, health behaviors, and comorbid conditions including hypertension and diabetes. RESULTS: Analyses included 5,211 participants with mean age 74 years at baseline, of whom 545 (10.5%) developed incident HF over a median follow-up of 7.8 years. Mean 3MSE score was lower at the time of HF diagnosis compared with no HF, and declined faster after incident HF compared with no HF. For example, at age 80, covariate-adjusted predicted mean 3MSE score was 88.6 points (95% CI: 88.3, 89.0) in participants without HF, but 87.6 points (95% CI: 87.3, 87.9) in those with newly diagnosed HF. Predicted five-year decline in mean 3MSE score from age 80 to age 85 was 5.9 points (95% CI: 5.7, 6.0) in participants without HF, but 10.0 points (95% CI: 8.6, 11.3) in those diagnosed with incident HF at age 80. Faster decline in 3MSE score after HF diagnosis was seen at all ages studied. The figure shows predicted mean 3MSE score trajectories without HF (solid line) and after HF diagnosed at ages 70, 75, 80, and 85 (dashed lines), with 95% CI shaded. CONCLUSIONS: Older adults diagnosed with incident HF experience faster average cognitive decline than those without HF.

Assessing the Physical Activity Readiness of Inactive Older Adults

1997 ◽  
Vol 14 (1) ◽  
pp. 65-73 ◽  
Author(s):  
Bradley J. Cardinal
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Preliminary Evidence ◽  
Self Report ◽  
Moderate Physical Activity ◽  
Old Adults ◽  
Activity Program ◽  
Age Cohort ◽  
The Relationship ◽  
Activity Indices

The purpose of this study was to examine the relationship between inactive older adults’ physical activity readiness (based on the Physical Activity Readiness Questionnaire [PARQ]) and several biometric, demographic, and physical activity indices. Participants were 181 (91 female, 90 male) inactive 60- to 89-year-old adults (M age = 70.2 ± 6.6 yr.). Self-report measures were completed and body mass index (BMI) and VO2max were estimated. BMI, weight, and VO2max were significantly associated with physical activity readiness. There was no significant association among 10-year age cohort and physical activity readiness. The blood pressure question excluded the largest number of participants (42%). Overall, 45.3% of the participants appeared to be healthy enough to begin a low to moderate physical activity program. Preliminary evidence suggests the PARQ may be a useful method of identifying older adults for whom low to moderate physical activity participation is safe.

scholarly journals Specific Activities and the Trajectories of Cognitive Decline among Middle-aged and Older Adults: A Five-year Longitudinal Cohort Study

2020 ◽  
Author(s):  
Bingyu Li ◽  
Jiefeng Bi ◽  
Chang Wei ◽  
Feng Sha
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Cognitive Decline ◽  
Mental Status ◽  
Cognitive Functions ◽  
Age Groups ◽  
Longitudinal Cohort Study ◽  
Longitudinal Cohort ◽  
Card Games ◽  
Specific Activities

Abstract Background: Emerging evidence indicates that leisure activities are associated with higher risk of cognitive impairment and dementia among the older adults, but how specific activities influence cognitive decline among different age groups, especially the late middle-aged and the early old, remains inadequately studied. This study aims to examine association between specific activities with trajectories of cognitive functions in different age groups in China. Methods: This longitudinal cohort study included 14,161 Chinese individuals aged 45 years or above from the China Health and Retirement Longitudinal Study (CHARLS). Data were collected bi-annually from 2011 to 2015. Cognitive function, including memory and mental status, was measured by Telephone Interview of Cognitive Status (TICS) battery. Mixed effects growth models were applied to analyse the association between specific activities and cognitive functions.Results: Four activities, respectively interacting with friends, playing Mah-jong or other card games, going to a sport and providing help to others, were found to be significantly associated with participants’ cognitive functioning. All four activities are associated with better memory. Infrequently playing Mah-jong or other card games and daily sports are significantly associated with better mental status. In addition, specific effect of each activity varies among population of different age, education level, gender and residence. Conclusions: This study identifies four social activities that are associated with better cognitive functions, and provides a comprehensive, in-depth understanding on the specific protective effect of each activity among different subgroups. These findings have practical implications for feasible and personalized cognitive health interventions.

Virtual Mind-Body Program for Obese Knee Osteoarthritis Patients with Comorbid Depression: Development and Feasibility Pilot (Preprint)

2021 ◽  
Author(s):  
Ryan A. Mace ◽  
Jonathan Greenberg ◽  
Nicole Lemaster ◽  
Brooke Duarte ◽  
Terence Penn ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Pain Catastrophizing ◽  
Phase 1 ◽  
A Priori ◽  
Phase 2 ◽  
Live Video ◽  
Exit Interviews ◽  
Activity Program ◽  
Body Activity ◽  
Joint Disorder

BACKGROUND Knee osteoarthritis (KOA) is the most common joint disorder in the U.S. and a leading cause of disability. Depression and obesity are highly comorbid with KOA and accelerate knee degeneration and disability through biopsychosocial mechanisms. Mind-body physical activity programs can engage biological, mechanical, and psychological mechanisms to improve outcomes in KOA, but such programs are not currently available. OBJECTIVE Here, we report on a mixed-methods study to adapt a mind-body activity program for the unique needs of patients with KOA, depression, and obesity (GetActive-OA) delivered via live video. METHODS Participants were adults (age ≥ 45) from rural Kentucky with obesity (BMI ≥ 30 kg/m2), idiopathic KOA with mild to moderate radiographic changes, and elevated depressive symptoms (PHQ-9 ≥ 10) recruited from two orthopedic centers. In Phase 1, we developed GetActive-OA and the study protocol using qualitative focus group feedback from the study population (N = 9; 2 focus groups, 90 minutes) and multidisciplinary expertise from clinical psychologists and orthopedic researchers. In Phase 2, we explored the initial feasibility, credibility, and acceptability of GetActive-OA, live video delivery, and study procedures via an open pilot with exit interviews (N = 5, 1 group). This research was guided by the NIH Model Stage 1A. RESULTS Phase 1 qualitative analyses revealed nuanced information about: 1) challenges with coping and increasing activity, 2) high interest in a mind-body activity program, 3) program participation facilitators (flexibility with technology) and barriers (amotivation, forgetfulness), and 4) perceived challenges with data collection procedures (blood and urine samples, homework). Phase 2 quantitative analyses showed that GetActive-OA met most a priori feasibility markers (e.g., feasibility of recruitment, acceptability, expectancy, credibility, adherence, and program satisfaction). Adherence to ActiGraph wear and collection of blood samples was low. Participation in GetActive-OA was associated with signals of improvements in pain, KOA symptoms, depression, anxiety, pain catastrophizing, self-efficacy, and general coping. Qualitative exit interviews confirmed quantitative findings and provided valuable information to optimize the program and protocol. CONCLUSIONS Patients with KOA, depression, and obesity from rural Kentucky are interested in a virtual mind-body activity program this comorbidity GetActive-OA shows promise, but the program and protocol require further NIH stage 1 refinement before formal efficacy testing (NIH model stage II). INTERNATIONAL REGISTERED REPORT RR2-10.1016/j.conctc.2021.100720

Can fluid and general intelligence be differentiated in an older adult population?

2006 ◽  
Vol 29 (2) ◽  
pp. 143-145 ◽  
Author(s):  
Nancy A. Zook ◽  
Deana B. Davalos
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Frontal Lobe ◽  
Older Adult ◽  
Cognitive Functions ◽  
Fluid Intelligence ◽  
Adult Population ◽  
General Intelligence ◽  
Older Adult Population ◽  
Pattern Of Performance

The question of whether fluid intelligence can be differentiated from general intelligence in older adults is addressed. Data indicate that the developmental pattern of performance on fluid tasks differs from the pattern of general intelligence. These results suggest that it is important to identify changes in fluid cognitive functions associated with frontal lobe decline, as they may be early indicators of cognitive decline.

scholarly journals Benefits of VR Physical Exercise on Cognition in Older Adults with and without Mild Cognitive Decline: A Systematic Review of Randomized Controlled Trials

Healthcare ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 883
Author(s):  
Kohei Sakaki ◽  
Rui Nouchi ◽  
Yutaka Matsuzaki ◽  
Toshiki Saito ◽  
Jérôme Dinet ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Cognitive Function ◽  
Physical Exercise ◽  
Cognitive Decline ◽  
Cognitive Functions ◽  
Beneficial Effects ◽  
Positive Effects ◽  
Wide Range ◽  
Aging Populations

It is well known that physical exercise has beneficial effects on cognitive function in older adults. Recently, several physical exercise programs with virtual reality (VR) have been proposed to support physical exercise benefits. However, it is still unclear whether VR physical exercise (VR-PE) has positive effects on cognitive function in older adults. The purpose of this study was to conduct a systematic review (SR) of the effects of VR-PE on cognitive function in older adults with and without cognitive decline. We used academic databases to search for research papers. The criteria were intervention study using any VR-PE, participants were older adults with and without mild cognitive decline (not dementia), and cognitive functions were assessed. We found that 6 of 11 eligible studies reported the significant benefits of the VR-PE on a wide range of cognitive functions in aging populations. The SR revealed that VR-PE has beneficial effects on the inhibition of executive functions in older adults with and without mild cognitive decline. Moreover, VR-PE selectively leads to improvements in shifting and general cognitive performance in healthy older adults. The SR suggests that VR-PE could be a successful approach to improve cognitive function in older adults with and without cognitive decline.

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