A complex multimodal activity intervention to reduce the risk of dementia in mild cognitive impairment--ThinkingFit: pilot and feasibility study for a randomized controlled trial

Thomas M Dannhauser, Martin Cleverley, Tim J Whitfield, Ben C Fletcher, Tim Stevens, Zuzana Walker, Thomas M Dannhauser, Martin Cleverley, Tim J Whitfield, Ben C Fletcher, Tim Stevens, Zuzana Walker

Abstract

Background: Dementia affects 35 million people worldwide and is currently incurable. Many cases may be preventable because regular participation in physical, mental and social leisure activities during middle age is associated with up to 47% dementia risk reduction. However, the majority of middle-aged adults are not active enough. MCI is therefore a clear target for activity interventions aimed at reducing dementia risk. An active lifestyle during middle age reduces dementia risk but it remains to be determined if increased activity reduces dementia risk when MCI is already evident. Before this can be investigated conclusively, complex multimodal activity programmes are required that (1) combine multiple health promoting activities, (2) engage people with MCI, and (3) result in sufficient adherence rates.

Methods: We designed the ThinkingFit programme to engage people with MCI in a complex intervention comprised of three activity components: physical activity, group-based cognitive stimulation (GCST) and individual cognitive stimulation (ICST). Engagement and adherence was promoted by applying specific psychological techniques to enhance behavioural flexibility in an early pre-phase and during the course of the intervention. To pilot the intervention, participants served as their own controls during a 6- to 12-week run-in period, which was followed by 12 weeks of activity intervention.

Results: Out of 212 MCI patients screened, 163 were eligible, 70 consented and 67 completed the intervention (mean age 74 years). Activity adherence rates were high: physical activity = 71%; GCST = 83%; ICST = 67%. Significant treatment effects (p < .05) were evident on physical health outcomes (decreased BMI and systolic blood pressure, [pre/post values of 26.3/25.9 kg/m2 and 145/136 mmHg respectively]), fitness (decreased resting and recovery heart rate [68/65 bpm and 75/69 bpm]), and cognition (improved working memory [5.3/6.3 items]).

Conclusions: We found satisfactory recruitment, retention and engagement rates, coupled with significant treatment effects in elderly MCI patients. It appears feasible to conduct randomized controlled trials of the dementia prevention potential of complex multimodal activity programmes like ThinkingFit.

Trial registration: ClinicalTrials.gov registration nr: NCT01603862; date: 17/5/2012.

Figures

Figure 1
Figure 1
Study design.
Figure 2
Figure 2
Flowchart of screening and recruitment.

References

    1. Hamer M, Chida Y. Physical activity and risk of neurodegenerative disease: a systematic review of prospective evidence. Psychol Med. 2009;39(1):3–11. doi: 10.1017/S0033291708003681.
    1. Karp A, Paillard-Borg S, Wang HX, Silverstein M, Winblad B, Fratiglioni L. Mental, physical and social components in leisure activities equally contribute to decrease dementia risk. Dement Geriatr Cogn Disord. 2006;21(2):65–73. doi: 10.1159/000089919.
    1. Larson EB, Wang L, Bowen JD, McCormick WC, Teri L, Crane P, Kukull W. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann Intern Med. 2006;144(2):73–81. doi: 10.7326/0003-4819-144-2-200601170-00004.
    1. Barnes DE, Yaffe K. The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurol. 2011;10(9):819–828. doi: 10.1016/S1474-4422(11)70072-2.
    1. Craig R, Mindell J, Hirani V. Health Survey for England—2008. London: The Health and Social Care Information Centre; 2009.
    1. Petersen RC, Doody R, Kurz A, Mohs RC, Morris JC, Rabins PV, Ritchie K, Rossor M, Thal L, Winblad B. Current concepts in mild cognitive impairment. Arch Neurol. 2001;58(12):1985–1992. doi: 10.1001/archneur.58.12.1985.
    1. Mitchell AJ, Shiri-Feshki M. Rate of progression of mild cognitive impairment to dementia–meta-analysis of 41 robust inception cohort studies. Acta Psychiatr Scand. 2009;119(4):252–265. doi: 10.1111/j.1600-0447.2008.01326.x.
    1. Lautenschlager NT, Cox KL, Flicker L, Foster JK, van Bockxmeer FM, Xiao J, Greenop KR, Almeida OP. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA. 2008;300(9):1027–1037. doi: 10.1001/jama.300.9.1027.
    1. Suzuki T, Shimada H, Makizako H, Doi T, Yoshida D, Tsutsumimoto K, Anan Y, Uemura K, Lee S, Park H. Effects of multicomponent exercise on cognitive function in older adults with amnestic mild cognitive impairment: a randomized controlled trial. BMC Neurol. 2012;12:128. doi: 10.1186/1471-2377-12-128.
    1. van Uffelen JG, Chinapaw MJ, van Mechelen W, Hopman-Rock M. Walking or vitamin B for cognition in older adults with mild cognitive impairment? A randomised controlled trial. Br J Sports Med. 2008;42(5):344–351. doi: 10.1136/bjsm.2007.044735.
    1. Buschert VC, Friese U, Teipel SJ, Schneider P, Merensky W, Rujescu D, Moller HJ, Hampel H, Buerger K. Effects of a newly developed cognitive intervention in amnestic mild cognitive impairment and mild Alzheimer’s disease: a pilot study. J Alzheimers Dis. 2011;25(4):679–694.
    1. Sangster J, Furber S, Allman-Farinelli M, Haas M, Phongsavan P, Mark A, Bauman A. A population-based lifestyle intervention to promote healthy weight and physical activity in people with cardiac disease: the PANACHE (Physical Activity, Nutrition And Cardiac HEalth) study protocol. BMC Cardiovasc Disord. 2010;10:17. doi: 10.1186/1471-2261-10-17.
    1. Clare L, Hindle JV, Jones IR, Thom JM, Nelis SM, Hounsome B, Whitaker CJ. The AgeWell study of behavior change to promote health and wellbeing in later life: study protocol for a randomized controlled trial. Trials. 2012;13:115. doi: 10.1186/1745-6215-13-115.
    1. Hindin SB, Zelinski EM. Extended practice and aerobic exercise interventions benefit untrained cognitive outcomes in older adults: a meta-analysis. J Am Geriatr Soc. 2012;60(1):136–141. doi: 10.1111/j.1532-5415.2011.03761.x.
    1. Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci. 2003;14(2):125–130. doi: 10.1111/1467-9280.t01-1-01430.
    1. Bherer L, Erickson KI, Liu-Ambrose T. A review of the effects of physical activity and exercise on cognitive and brain functions in older adults. J Aging Res. 2013;2013:657508.
    1. Spirduso L, Poon L, Chodzo-Zajko W. In: Exercise and Its Mediating Effects on Cognition. Spirduso L, Poon L, Chodzo-Zajko W, editor. USA, Champaign, Ill: Human Kinetics; 2008. Using resources and reserves in an exercise-cognition model; pp. 3–11.
    1. Schooler C, Mulatu MS, Oates G. The continuing effects of substantively complex work on the intellectual functioning of older workers. Psychol Aging. 1999;14(3):483–506.
    1. Wilson RS, Mendes de Leon CF, Barnes LL, Schneider JA, Bienias JL, Evans DA, Bennett DA. Participation in cognitively stimulating activities and risk of incident Alzheimer disease. JAMA. 2002;287(6):742–748. doi: 10.1001/jama.287.6.742.
    1. Wilson RS, Scherr PA, Schneider JA, Tang Y, Bennett DA. Relation of cognitive activity to risk of developing Alzheimer disease. Neurology. 2007;69(20):1911–1920. doi: 10.1212/01.wnl.0000271087.67782.cb.
    1. Ybarra O, Burnstein E, Winkielman P, Keller MC, Manis M, Chan E, Rodriguez J. Mental exercising through simple socializing: social interaction promotes general cognitive functioning. Pers Soc Psychol Bull. 2008;34(2):248–259.
    1. Adolphs R. The social brain: neural basis of social knowledge. Annu Rev Psychol. 2009;60:693–716. doi: 10.1146/annurev.psych.60.110707.163514.
    1. Fratiglioni L, Paillard-Borg S, Winblad B. An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurol. 2004;3(6):343–353. doi: 10.1016/S1474-4422(04)00767-7.
    1. Fratiglioni L, Wang HX, Ericsson K, Maytan M, Winblad B. Influence of social network on occurrence of dementia: a community-based longitudinal study. Lancet. 2000;355(9212):1315–1319. doi: 10.1016/S0140-6736(00)02113-9.
    1. Knapp M, Prince M. Dementia UK–A report into the prevalence and cost of dementia prepared by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and the Institute of Psychiatry at King’s College London, for the Alzheimer’s Society: the full report. London: The London School of Economics and the Institute of Psychiatry at King’s College London; 2007.
    1. Dishman RK. Motivating older adults to exercise. South Med J. 1994;87(5):S79–S82. doi: 10.1097/00007611-199405000-00014.
    1. Lawton BA, Rose SB, Elley CR, Dowell AC, Fenton A, Moyes SA. Exercise on prescription for women aged 40-74 recruited through primary care: two year randomised controlled trial. BMJ. 2008;337:a2509. doi: 10.1136/bmj.a2509.
    1. Pfister-Minogue K. Enhancing patient compliance: a guide for nurses: to increase their patients’ compliance with health recommendations, nurses need a framework. Geriatr Nurs. 1993;14(3):124–132. doi: 10.1016/S0197-4572(06)80128-X.
    1. Fletcher BC, Hanson J, Page N, Pine P. FIT–do something different a new behavioral program for sustained weight loss. Swiss J Psychol. 2011;70(1):25–34. doi: 10.1024/1421-0185/a000035.
    1. Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR. The Addenbrooke’s Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry. 2006;21(11):1078–1085. doi: 10.1002/gps.1610.
    1. Roth M, Tym E, Mountjoy CQ, Huppert FA, Hendrie H, Verma S, Goddard R. CAMDEX: a standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Br J Psychiatry. 1986;149:698–709. doi: 10.1192/bjp.149.6.698.
    1. Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004;256(3):183–194. doi: 10.1111/j.1365-2796.2004.01388.x.
    1. Thomas S, Reading J, Shephard RJ. Revision of the physical activity readiness questionnaire (PAR-Q) Can J Spt Sci. 1992;17(4):338–345.
    1. Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med. 1970;2(2):92–98.
    1. Tabet JY, Meurin P, Teboul F, Tartiere JM, Weber H, Renaud N, Massabie R, Driss AB. Determination of exercise training level in coronary artery disease patients on beta blockers. Eur J Cardiovasc Prev Rehabil. 2008;15(1):67–72. doi: 10.1097/HJR.0b013e3282eff61f.
    1. Finn M, McDonald S. Computerised cognitive training for older persons with mild cognitive impairment: a pilot study using a randomised controlled trial design. Brain Impairment. 2011;12:187–199. doi: 10.1375/brim.12.3.187.
    1. Iyengar SS, Lepper MR. When choice is demotivating: can one desire too much of a good thing? J Pers Soc Psychol. 2000;79(6):995–1006.
    1. BMI Healthy Weight Calculator. [ ]
    1. Siconolfi SF, Garber CE, Lasater TM, Carleton RA. A simple, valid step test for estimating maximal oxygen uptake in epidemiologic studies. Am J Epidemiol. 1985;121(3):382–390.
    1. Ashendorf L, Jefferson AL, O’Connor MK, Chaisson C, Green RC, Stern RA. Trail Making Test errors in normal aging, mild cognitive impairment, and dementia. Arch Clin Neuropsychol. 2008;23(2):129–137.
    1. Nutter-Upham KE, Saykin AJ, Rabin LA, Roth RM, Wishart HA, Pare N, Flashman LA. Verbal fluency performance in amnestic MCI and older adults with cognitive complaints. Arch Clin Neuropsychol. 2008;23(3):229–241. doi: 10.1016/j.acn.2008.01.005.
    1. Pedrosa H, De Sa A, Guerreiro M, Maroco J, Simoes MR, Galasko D, de Mendonca A. Functional evaluation distinguishes MCI patients from healthy elderly people–the ADCS/MCI/ADL scale. J Nutr Health Aging. 2010;14(8):703–709. doi: 10.1007/s12603-010-0102-1.
    1. Muangpaisan W, Intalapaporn S, Assantachai P. Digit span and verbal fluency tests in patients with mild cognitive impairment and normal subjects in Thai-community. J Med Assoc Thai. 2010;93(2):224–230.
    1. Galasko D, Bennett D, Sano M, Ernesto C, Thomas R, Grundman M, Ferris S. An inventory to assess activities of daily living for clinical trials in Alzheimer’s disease: the Alzheimer’s disease cooperative study. Alzheimer Dis Assoc Disord. 1997;11(Suppl 2):S33–S39.
    1. Barnes DE, Yaffe K, Belfor N, Jagust WJ, DeCarli C, Reed BR, Kramer JH. Computer-based cognitive training for mild cognitive impairment: results from a pilot randomized, controlled trial. Alzheimer Dis Assoc Disord. 2009;23(3):205–210. doi: 10.1097/WAD.0b013e31819c6137.
    1. Tak EC, van Uffelen JG, Paw MJ, van Mechelen W, Hopman-Rock M. Adherence to exercise programs and determinants of maintenance in older adults with mild cognitive impairment. J Aging Phys Act. 2012;20(1):32–46.
    1. Talbot LA, Musiol RJ, Witham EK, Metter EJ. Falls in young, middle-aged and older community dwelling adults: perceived cause, environmental factors and injury. BMC Public Health. 2005;5:86. doi: 10.1186/1471-2458-5-86.
    1. Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2009;2:CD007146.
    1. Abbott RD, White LR, Ross GW, Masaki KH, Curb JD, Petrovitch H. Walking and dementia in physically capable elderly men. JAMA. 2004;292(12):1447–1453. doi: 10.1001/jama.292.12.1447.
    1. Lytle ME, Vander BJ, Pandav RS, Dodge HH, Ganguli M. Exercise level and cognitive decline: the MoVIES project. Alzheimer Dis Assoc Disord. 2004;18(2):57–64. doi: 10.1097/01.wad.0000126614.87955.79.
    1. Rovio S, Kareholt I, Helkala EL, Viitanen M, Winblad B, Tuomilehto J, Soininen H, Nissinen A, Kivipelto M. Leisure-time physical activity at midlife and the risk of dementia and Alzheimer’s disease. Lancet Neurol. 2005;4(11):705–711. doi: 10.1016/S1474-4422(05)70198-8.
    1. Oswald WD, Gunzelmann T, Ackermann A. Effects of a multimodal activation program (SimA-P) in residents of nursing homes. Eur Rev Aging Phys Act. 2007;4(2):91–102. doi: 10.1007/s11556-007-0025-y.

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