Pre-frail older adults show improved cognition with StayFitLonger computerized home-based training: a randomized controlled trial

Sylvie Belleville, M Cuesta, M Bieler-Aeschlimann, K Giacomino, A Widmer, A G Mittaz Hager, D Perez-Marcos, S Cardin, B Boller, N Bier, M Aubertin-Leheudre, L Bherer, N Berryman, S Agrigoroaei, J F Demonet, Sylvie Belleville, M Cuesta, M Bieler-Aeschlimann, K Giacomino, A Widmer, A G Mittaz Hager, D Perez-Marcos, S Cardin, B Boller, N Bier, M Aubertin-Leheudre, L Bherer, N Berryman, S Agrigoroaei, J F Demonet

Abstract

Multidomain interventions have shown tremendous potential for improving cognition in older adults. It is unclear if multidomain interventions can be delivered remotely and whether remote intervention is beneficial for older adults who are vulnerable or at risk of cognitive decline. In a 26-week multi-site, home-based, double-blind, randomized controlled trial, 120 cognitively healthy older adults (75 robust, 45 pre-frail; age range = 60-94) recruited from Switzerland, Canada, and Belgium were randomized to receive either the StayFitLonger (SFL) computerized multidomain training program or an active control intervention. Delivered on tablets, the SFL intervention combined adapted physical exercises (strength, balance, and mobility), cognitive training (divided attention, problem solving, and memory), opportunities for social and contributive interactions, and psychoeducation. The active control intervention provided basic mobilization exercises and access to video games. Cognitive outcomes were global cognition (Z-scores of attention, verbal fluency, and episodic memory for nondemented older adults; ZAVEN), memory, executive function, and processing speed. Linear mixed model analyses indicated improved performance on the ZAVEN global cognition score in the SFL group but not in the active control group. Stratified analyses by frailty status revealed improved ZAVEN global cognition and processing speed scores following SFL in the pre-frail group but not in the robust group. Overall, the study indicates that a computerized program providing a multidomain intervention at home can improve cognition in older adults. Importantly, pre-frail individuals, who are at higher risk of cognitive decline, seem to benefit more from the intervention. Trial registration: ClinicalTrials.gov, NCT037519 Registered on January 22, 2020-Retrospectively registered, https://ichgcp.net/clinical-trials-registry/NCT04237519 .

Keywords: Cognitive prevention; Cognitive training; Frailty; Home-based computerized training; Physical training.

Conflict of interest statement

SB has been a consultant for research development on the prevention of Alzheimer’s disease for the Fondation IUGM (2016), Sojecci/Lucilab (2017 to current), and the development of a cognitive stimulation programme for the Centre de promotion de la Santé Avant Âge (2015). She has intellectual property rights on the “Programme de Stimulation pour une santé cognitive, Memoria, Batterie d’évaluation de la mémoire Côte-des-Neiges’ and ‘MEMO, Méthode d’Entrainement pour une Mémoire Optimale.” DPM and SC are employees of MindMaze SA. The remaining authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow diagram of participants’ progress in the efficacy study
Fig. 2
Fig. 2
Performance on global cognition (A), executive function (B), processing speed (C), and memory (D) composite scores (mean ± SEM) at PRE and POST training for the SFL (full line, circles) and active control (dashed line, squares) interventions for the total sample of participants. Post hoc test results are reported here when a significant intervention × time interaction (p < .05) was observed. ** p < .01, mean POST–PRE change score for SFL intervention. CS, composite score; POST, post-training assessment; PRE, pre-training assessment; SEM, standard error to the mean; SFL, StayFitLonger
Fig. 3
Fig. 3
Performance on global cognition (A), executive function (B), processing speed (C), and memory (D) composite scores (mean ± SEM) at PRE and POST training for the SFL (full line, circles) and active control (dashed line, squares) interventions for the pre-frail participants. Post-hoc test results are reported here when a significant Intervention x Time interaction (p < .05) was observed. * p < .05 and ** p < .01, mean POST–PRE change score for SFL intervention. CS, composite score; POST, post-training assessment; PRE, pre-training assessment; SEM, standard error to the mean; SFL, StayFitLonger
Fig. 4
Fig. 4
Performance on global cognition (A), executive function (B), processing speed (C), and memory (D) composite scores (mean ± SEM) at PRE and POST training for the SFL (full line, circles) and active control (dashed line, squares) interventions for the robust participants. CS, composite score; POST, post-training assessment; PRE, pre-training assessment; SEM, standard error to the mean; SFL, StayFitLonger

References

    1. Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413–446. doi: 10.1016/S0140-6736(20)30367-6.
    1. Norton S, Matthews FE, Barnes DE, Yaffe K, Brayne C. Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data. Lancet Neurol. 2014 doi: 10.1016/S1474-4422(14)70136-X.
    1. Ngandu T, Lehtisalo J, Solomon A, Levalahti E, Ahtiluoto S, Antikainen R, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet. 2015 doi: 10.1016/S0140-6736(15)60461-5.
    1. Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, et al. Dementia prevention, intervention, and care. Lancet. 2017 doi: 10.1016/S0140-6736(17)31363-6.
    1. Whitfield T, McConnell B, Renouf P, Mansour H, Zabihi S, Aguirre E, et al. The effect of remotely delivered lifestyle interventions on cognition in older adults without dementia: a systematic review and meta-analysis. Ageing Res Rev. 2021 doi: 10.1016/j.arr.2021.101505.
    1. Lee KS, Lee Y, Back JH, Son SJ, Choi SH, Chung Y-K, et al. Effects of a multidomain lifestyle modification on cognitive function in older adults: an eighteen-month community-based cluster randomized controlled trial. Psychother Psychosom. 2014 doi: 10.1159/000360820.
    1. Richard E, van Charante EPM, Hoevenaar-Blom MP, Coley N, Barbera M, van der Groep A, et al. Healthy ageing through internet counselling in the elderly (HATICE): a multinational, randomised controlled trial. Lancet Digital Health. 2019 doi: 10.1016/S2589-7500(19)30153-0.
    1. Roh HW, Hong CH, Lim HK, Chang KJ, Kim H, Kim N-R, et al. A 12-week multidomain intervention for late-life depression: a community-based randomized controlled trial. J Affect Disord. 2020 doi: 10.1016/j.jad.2019.12.013.
    1. Vanoh D, Shahar S, Razali R, Ali NM, Manaf ZA, Mohd Noah SA, et al. The effectiveness of a web-based health education tool, WESIHAT 2.0, among older adults: a randomized controlled trial. J Alzheimers Dis. 2019;70(s1):S255–S70. doi: 10.3233/JAD-180464.
    1. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004 doi: 10.1093/gerona/59.3.M255.
    1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001 doi: 10.1093/gerona/56.3.M146.
    1. Borges MK, Canevelli M, Cesari M, Aprahamian I. Frailty as a predictor of cognitive disorders: a systematic review and meta-analysis. Front Med. 2019 doi: 10.3389/fmed.2019.00026.
    1. Willis SL, Belleville S. Cognitive training in later adulthood. Handbook of the psychology of aging. 8th ed. Academic Press; 2016. p. 219–43. 10.1016/B978-0-12-411469-2.00012-1.
    1. Lövdén M, Brehmer Y, Li S-C, Lindenberger U. Training-induced compensation versus magnification of individual differences in memory performance. Front Hum Neurosci. 2012 doi: 10.3389/fnhum.2012.00141.
    1. Boutron I, Altman DG, Moher D, Schulz KF, Ravaud P. CONSORT statement for randomized trials of nonpharmacologic treatments: a 2017 update and a CONSORT extension for nonpharmacologic trial abstracts. Ann Intern Med. 2017 doi: 10.7326/M17-0046.
    1. Witham MD, Stott DJ. Conducting and reporting trials for older people. Age Ageing. 2017 doi: 10.1093/ageing/afx153.
    1. Belleville S, Cuesta M, Bieler-Aeschlimann M, Giacomino K, Widmer A, Hager AM, et al. Rationale and protocol of the StayFitLonger study: a multicentre trial to measure efficacy and adherence of a home-based computerised multidomain intervention in healthy older adults. BMC Geriatr. 2020 doi: 10.1186/s12877-020-01709-2.
    1. Barberger-Gateau P, Fabrigoule C, Rouch I, Letenneur L, Dartigues JF. Neuropsychological correlates of self-reported performance in instrumental activities of daily living and prediction of dementia. J Gerontol B Psychol Sci Soc Sci. 1999 doi: 10.1093/geronb/54B.5.P293.
    1. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005 doi: 10.1111/j.1532-5415.2005.53221.x.
    1. Mittaz Hager AG, Mathieu N, Lenoble-Hoskovec C, Swanenburg J, de Bie R, Hilfiker R. Effects of three home-based exercise programmes regarding falls, quality of life and exercise-adherence in older adults at risk of falling: protocol for a randomized controlled trial. BMC Geriatr. 2019 doi: 10.1186/s12877-018-1021-y.
    1. Belleville S, Mellah S, de Boysson C, Demonet JF, Bier B. The pattern and loci of training-induced brain changes in healthy older adults are predicted by the nature of the intervention. PLoS ONE. 2014 doi: 10.1371/journal.pone.0102710.
    1. Warmington M, Hitch GJ. Enhancing the learning of new words using an errorless learning procedure: Evidence from typical adults. Memory. 2014 doi: 10.1080/09658211.2013.807841.
    1. Dresler M, Shirer WR, Konrad BN, Muller NCJ, Wagner IC, Fernandez G, et al. Mnemonic Training Reshapes Brain Networks to Support Superior Memory. Neuron. 2017 doi: 10.1016/j.neuron.2017.02.003.
    1. Hering A, Rendell PG, Rose NS, Schnitzspahn KM, Kliegel M. Prospective memory training in older adults and its relevance for successful aging. Psychol Res. 2014 doi: 10.1007/s00426-014-0566-4.
    1. Chesham A, Wyss P, Müri RM, Mosimann UP, Nef T. What older people like to play: genre preferences and acceptance of casual games. JMIR Serious Games. 2017;5(2):e8. doi: 10.2196/games.7025.
    1. Brooker H, Wesnes KA, Ballard C, Hampshire A, Aarsland D, Khan Z, et al. The relationship between the frequency of number-puzzle use and baseline cognitive function in a large online sample of adults aged 50 and over. Int J Geriatr Psychiatry. 2019 doi: 10.1002/gps.5085.
    1. Jin G, Li K, Qin Y, Zhong N, Zhou H, Wang Z, et al. fMRI study in posterior cingulate and adjacent precuneus cortex in healthy elderly adults using problem solving task. J Neurol Sci. 2012 doi: 10.1016/j.jns.2012.02.032.
    1. Ferreira N, Owen A, Mohan A, Corbett A, Ballard C. Associations between cognitively stimulating leisure activities, cognitive function and age-related cognitive decline. Int J Geriatr Psychiatry. 2015 doi: 10.1002/gps.4155.
    1. Murphy M, O’Sullivan K, Kelleher KG. Daily crosswords improve verbal fluency: a brief intervention study. Int J Geriatr Psychiatry. 2014 doi: 10.1002/gps.4079.
    1. Lim YY, Snyder PJ, Pietrzak RH, Ukiqi A, Villemagne VL, Ames D, et al. Sensitivity of composite scores to amyloid burden in preclinical Alzheimer’s disease: Introducing the Z-scores of Attention, Verbal fluency, and Episodic memory for Nondemented older adults composite score. Alzheimers Dement. 2016 doi: 10.1016/j.dadm.2015.11.003.
    1. Wechsler D. MEM-IV Echelle clinique de memoire de Wechsler. 4th ed. MN: Pearson; 2012. Available from: .
    1. Wechsler D. WAIS-IV Nouvelle version de lʼéchelle dʼintelligence de Wechsler pour adultes. 4th ed. MN: Pearson; 2011. Available from: .
    1. Cardebat D, Doyon B, Puel M, Goulet P, Joanette Y. Formal and semantic lexical evocation in normal subjects. Performance and dynamics of production as a function of sex, age and educational level. Acta Neurol Belg. 1990;90(4):207–17.
    1. Tombaugh TN. Trail Making Test A and B: normative data stratified by age and education. Arch Clin Neuropsychol. 2004 doi: 10.1016/S0887-6177(03)00039-8.
    1. Bayard S, Erkes J, Moroni C. Victoria Stroop Test: normative data in a sample group of older people and the study of their clinical applications in the assessment of inhibition in Alzheimerʼs disease. Arch Clin Neuropsychol. 2011 doi: 10.1093/arclin/acr053.
    1. Leclercq M, Zimmermann P, H. van Zomeren A. Applied neuropsychology of attention: theory, diagnosis and rehabilitation. Taylor & Francis ed. Edition s, editor. London: Psychology Press; 2002.
    1. Delis DC, Fine EM, Stricker JL, Houston WS, Wetter SR, Cobell K, et al. Comparison of the traditional recall-based versus a new list-based method for computing semantic clustering on the California Verbal Learning Test: evidence from Alzheimerʼs disease. Clin Neuropsychol. 2010 doi: 10.1080/13854040903002232.
    1. Poitrenaud J, Deweer B, Kalafat M, Van Der Linden M. CVLT Test dʼapprentissage et de mémoire verbale. MN: Pearson; 2017; Available from: .
    1. Moroni C, Bayard S. Inhibitory process: what evolution after the age of 50? Psychol Neuropsychiatr Vieil. 2009;7(2):121–129.
    1. Belleville S, Cloutier S, Mellah S, Willis S, Vellas B, Andrieu S, et al. Is more always better? Dose effect in a multidomain intervention in older adults at risk of dementia. Alzheimers Dement. 2022 doi: 10.1002/alz.12544.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa