The Role of Individual Characteristics in Predicting Short- and Long-Term Cognitive and Psychological Benefits of Cognitive Stimulation Therapy for Mild-to-Moderate Dementia

Introduction: This study examined the role of individual characteristics in predicting short- and long-term benefits of the Italian version of Cognitive Stimulation Therapy (CST-IT), an evidence-based intervention for people with mild-to-moderate dementia.Materials and Methods: Data were drawn from a sample (N = 123) of people with dementia (PwD) who took part in a multicenter controlled clinical trial of CST-IT. Assessments at pre-test, immediately after completing the treatment, and 3 months later investigated the following outcomes: general cognitive functioning and language, mood and behavior, everyday functioning, and quality of life. Age, education and baseline (pre-test) cognitive functioning, mood (depression) and behavioral and neuropsychiatric symptoms were considered as predictors of any short- and long-term benefits.Results: Linear mixed-effects models showed that different individual characteristics -particularly education and age- influenced the benefits of CST-IT, depending on the outcome measures considered. Higher education predicted larger gains in general cognitive functioning and, along with less severe depressive symptoms, in language (magnification effects). Older age was associated with positive changes in mood (compensation effects). Albeit very modestly, older age was also associated with larger gains in everyday functioning (compensation effects). Gains in quality of life were predicted by older age and lower education (compensation effects). Baseline cognitive functioning, mood and/or behavioral symptoms broadly influenced performance too, but their role again depended on the outcomes considered.Discussion: These findings underscore the importance of considering and further exploring how psychosocial interventions like CST are affected by individual characteristics in order to maximize their efficacy for PwD.

Trials and Treatments for Vascular Brain Health: Risk Factor Modification and Cognitive Outcomes

There is robust evidence linking vascular health to brain health, cognition, and dementia. In this article, we present evidence from trials of vascular risk factor treatment on cognitive outcomes. We summarize findings from randomized controlled trials of antihypertensives, lipid-lowering medications, diabetes treatments (including antidiabetic drugs versus placebo, and intensive versus standard glycemic control), and multidomain interventions (that target several domains simultaneously such as control of vascular and metabolic factors, nutrition, physical activity, and cognitive stimulation etc). We report that evidence on the efficacy of vascular risk reduction interventions is promising, but not yet conclusive, and several methodological limitations hamper interpretation. Evidence mainly comes from high-income countries and, as cognition and dementia have not been the primary outcomes of many trials, evaluation of cognitive changes have often been limited. As the cognitive aging process occurs over decades, it is unclear whether treatment during the late-life window is optimal for dementia prevention, yet older individuals have been the target of most trials thus far. Further, many trials have not been powered to explore interactions with modifiers such as age, race, and apolipoprotein E, even though sub-analyses from some trials indicate that the success of interventions differs depending on patient characteristics. Due to the complex multifactorial etiology of dementia, and variations in risk factors between individuals, multidomain interventions targeting several risk factors and mechanisms are likely to be needed and the long-term sustainability of preventive interventions will require personalized approaches that could be facilitated by digital health tools. This is especially relevant during the coronavirus disease 2019 (COVID-19) pandemic, where intervention strategies will need to be adapted to the new normal, when face-to-face engagement with participants is limited and public health measures may create changes in lifestyle that affect individuals’ vascular risk profiles and subsequent risk of cognitive decline.

The Effects of Cognitive-Based Interventions in Older Adults: A Systematic Review and Meta-Analysis

Background: Cognitive-based intervention is divided into three types: Cognitive Stimulation (CS), Cognitive Training (CT), and Cognitive Rehabilitation (CR). This study was conducted to identify systematically the effects of cognitive-based interventions in randomized controlled trials (RCTs) applied to older adults in the following three groups: cognitively healthy, mild cognitive impairment (MCI), and dementia. Methods: This search was carried out using the Ovid-MEDLINE, EMBASE, Cochrane library, CINAHL, ProQuest, and Korea databases. The effectiveness of the intervention was verified using the CMA 2.0 program. Results: A total of 54 RCTs were included in systematic reviews and 38 studies were analyzed by meta-analysis. Meta-analysis showed that cognitive-based interventions were effective in improving the cognitive function (SMD=0.39, 95% CI=0.32-0.44) of older adults. The subgroup analysis of cognitive function revealed that CT was the most effective in the cognitively healthy (SMD=0.40, 95% CI=0.33-0.46) and the MCI (SMD=0.45, 95% CI=0.27-0.63) groups, and CS was the most effective in the dementia group (SMD=0.57, 95% CI=0.43-0.70). Conclusion: In order to improve the cognitive function of older adults in each group, the most effective intervention type needs to be considered first. Evidence on the appropriate type of Cognitive-based intervention will be helpful in nursing practice.

Exercise Program: Tai Chi and Cognitive Stimulation to Improve Health Status of Elderly in Nursing Homes

The structure of the aging population reflects the higher average life expectancy, which possesses an impact on the emergence of degenerative non-communicable diseases. Promotive effort through an exercise program (tai-chi exercise and cognitive stimulation) is required for the elderly to enhance their physical and mental health. This study aims to determine an overview of the exercise program's effectiveness on the health status of the elderly in nursing homes. The research method administered Quasi experiment with a control group design. The sample was the elderly who live in nursing homes. This study employed simple random sampling with a total sample of 116 people in 2 provinces: DKI Jakarta and South Sumatra Province. The statistical test utilized a t-test and multiple linear regression test. The results revealed that there was a difference in the average value of the health status of the elderly before and after the exercise programs in the intervention group (p-value = 0.001), there was a difference in the average value of the health status of the elderly between the intervention group and the control group after the exercise intervention program (p-value = 0.001), there was a relationship between the length of stay in the orphanage on the health status of the elderly. Recommendation: the resulting exercise program can be employed as complementary therapies replicated more extensively in various health care settings.

ImproveCog, a cognitive stimulation program for people with mild cognitive impairment and dementia: First stage of development

Cognitive stimulation seems to be an important tool to slow the rate of cognitive decline due to dementia. This study describes the development of a cognitive stimulation program (ImproveCog) for people with Mild Cognitive Impairment, Alzheimer’s Disease, and behavioral variant Frontotemporal Dementia, within the Medical Research Council framework. Stage 1 established the theoretical and evidence basis of the program through a review of the existing cognitive stimulation programs as well as cognitive exercises and their efficacy (Pre-Clinical Phase) and includes qualitative testing through five focus group with eighteen health professionals and twelve individual interviews with people with cognitive impairment (Phase I - Modeling). An initial version of the program, which consisted of twelve 90-min weekly sessions and included a manual with cognitive stimulation exercises to be performed at home, was ready to be implemented in a pilot study to create a final version of ImproveCog.

Short-term memory, attention, and temporal orientation as predictors of the cognitive impairment in older adults: A cross-sectional observational study

Late-life cognitive decline ranges from the mildest cases of normal, age-related change to mild cognitive impairment to severe cases of dementia. Dementia is the largest global burden for the 21st century welfare and healthcare systems. The aim of this study was to analyze the neuropsychological constructs (temporal orientation (TO), spatial orientation (SO), fixation memory (FM), attention (A), calculation (C), short-term memory (STM), language (L), and praxis (P)), semantic fluency, level of functionality, and mood that reveal the greatest deficit in the different stages ranging from normal cognition (NC) to cognitive impairment in older adults in a primary healthcare setting. The study included 337 participants (102 men, 235 women), having a mean age of 74 ± 6 years. According to their scores on the Spanish version of the Mini-Mental State Examination (MEC-35), subjects were divided into 4 groups: no deterioration (ND) (score 32–35), subtle cognitive impairment (SCI) (score 28–31), level deterioration (LD) (score 24–27) and moderate deterioration (MD) (score 20–23). The ND group revealed significant differences in TO, STM, C, A, L, P, and S-T as compared to the other groups. The MD group (in all the neuropsychological constructs) and the ND and SCI groups showed significant differences on the Yesavage geriatric depression scale (GDS-15). All except the FM neuropsychological construct were part of the MEC-35 prediction model and all of the regression coefficients were significant for these variables in the model. Furthermore, the highest average percentage of relative deterioration occurs between LD and MD and the greatest deterioration is observed in the STM for all groups, including A and TO for the LD and MD groups. Based on our findings, community programs have been implemented that use cognitive stimulation to prevent cognitive decline and to maintain the neuropsychological constructs.