Comparative Effects of Integrated Versus Sequential Approaches to Dual-Task Training in Elderly With Mild to Moderate Cognitive Impairment (nill)

实验性的：Integrated Dual-Task Training (Mild Cognitive Impairment)

Participants with mild cognitive impairment will receive integrated dual-task training, where motor and cognitive tasks are performed simultaneously. Training will be conducted for 8 weeks, 3 sessions per week, each lasting 45 minutes.

行为的：Integrated Dual-Task Training

Participants will perform motor and cognitive tasks simultaneously (integrated dual-task training). The intervention includes balance and gait exercises combined with cognitive activities such as counting, memory, and executive function tasks. Training will be conducted for 8 weeks, 3 sessions per week, with each session lasting 45 minutes.

实验性的：Integrated Dual-Task Training (Moderate Cognitive Impairment)

Participants with moderate cognitive impairment will receive integrated dual-task training combining simultaneous motor and cognitive tasks. The intervention will last 8 weeks, with 3 sessions per week of 45 minutes each.

行为的：Integrated Dual-Task Training

Participants will perform motor and cognitive tasks simultaneously (integrated dual-task training). The intervention includes balance and gait exercises combined with cognitive activities such as counting, memory, and executive function tasks. Training will be conducted for 8 weeks, 3 sessions per week, with each session lasting 45 minutes.

实验性的：Sequential Dual-Task Training (Mild Cognitive Impairment)

Participants with mild cognitive impairment will undergo sequential dual-task training, where motor and cognitive tasks are performed separately. Training will be conducted over 8 weeks, 3 sessions per week, 45 minutes per session.

行为的：Sequential Dual-Task Training

Participants will perform motor and cognitive tasks separately (sequential dual-task training). Motor exercises (balance, gait training) and cognitive tasks (memory, attention, executive function) will be administered in sequence. The intervention will last 8 weeks, with 3 sessions per week, each session lasting 45 minutes.

实验性的：Sequential Dual-Task Training (Moderate Cognitive Impairment)

Participants with moderate cognitive impairment will receive sequential dual-task training, involving separate motor and cognitive task performance. The program duration is 8 weeks, with 3 weekly sessions of 45 minutes each.

行为的：Sequential Dual-Task Training

Participants will perform motor and cognitive tasks separately (sequential dual-task training). Motor exercises (balance, gait training) and cognitive tasks (memory, attention, executive function) will be administered in sequence. The intervention will last 8 weeks, with 3 sessions per week, each session lasting 45 minutes.

Functional Mobility (Timed Up and Go Test) Change from Baseline in Timed Up and Go (TUG) Test Time at 8 Weeks

Functional mobility will be evaluated using the Timed Up and Go (TUG) test. It measures the time (in seconds) taken by a participant to stand up from a chair, walk 3 meters, turn, walk back, and sit down. Lower times indicate better mobility.

Functional mobility and balance will be assessed using the Timed Up and Go (TUG) test, a simple and widely used clinical measure of mobility and fall risk.

In this test, participants are required to stand up from a standard chair, walk a distance of 3 meters, turn around, walk back to the chair, and sit down. The total time taken to complete the task is recorded in seconds.

Shorter completion times indicate better functional mobility and balance, while longer times indicate impaired mobility and increased risk of falls. A time of less than 10 seconds is considered normal for healthy adults, 10-19 seconds indicates good mobility, 20-29 seconds suggests variable mobility, and 30 seconds or more indicates impaired mobility and a higher risk of falls

Executive Function (Trail Making Test) Change from Baseline in Trail Making Test (Part A and Part B) Completion Time at 8 Weeks

Executive function will be assessed using the Trail Making Test (TMT Parts A and B), which evaluates cognitive flexibility, processing speed, and task-switching ability. Performance is measured by completion time in seconds.

Cognitive function, specifically attention, processing speed, and executive function, will be assessed using the Trail Making Test (TMT). The test consists of two parts: Part A and Part B.

In Part A, participants are required to connect numbered dots in sequential order as quickly as possible, assessing visual scanning and processing speed. In Part B, participants alternate between numbers and letters in sequence (e.g., 1-A-2-B), assessing executive function and task-switching ability.

The outcome is measured as the time (in seconds) taken to complete each part. Longer completion times indicate poorer cognitive performance, while shorter times indicate better cognitive performance.

The Trail Making Test will be administered at baseline and after completion of the

Global Cognitive Function (Montreal Cognitive Assessment) Change from Baseline in Montreal Cognitive Assessment (MoCA) Score at 8 Weeks

Global cognitive function will be assessed using the Montreal Cognitive Assessment (MoCA). It evaluates multiple cognitive domains including attention, memory, language, visuospatial ability, and executive function. Scores range from 0 to 30, with higher scores indicating better cognitive performance.

Cognitive function will be assessed using the Montreal Cognitive Assessment (MoCA), a standardized screening tool designed to detect mild cognitive impairment. The MoCA evaluates multiple cognitive domains including attention, executive function, memory, language, visuospatial skills, abstraction, calculation, and orientation.

The total score ranges from 0 to 30, with higher scores indicating better cognitive performance and lower scores indicating greater cognitive impairment. A score of 26 or above is generally considered normal cognitive function.

The MoCA will be administered at baseline and after completion of the intervention period to assess changes in cognitive function.

Balance Performance (Berg Balance Scale) Change from Baseline in Berg Balance Scale (BBS) Score at 8 Weeks

Balance will be assessed using the Berg Balance Scale (BBS), a 14-item objective measure designed to assess static and dynamic balance abilities in older adults. Scores range from 0 to 56, with higher scores indicating better balance performance.

Balance will be assessed using the Berg Balance Scale (BBS), a standardized clinical tool used to evaluate static and dynamic balance abilities. The BBS consists of 14 functional tasks, including sitting, standing, transferring, reaching, turning, and single-leg stance.

Each item is scored on a 5-point scale ranging from 0 to 4, with a maximum total score of 56. Higher scores indicate better balance performance, while lower scores indicate greater balance impairment and increased risk of falls.

A score of 41-56 indicates low fall risk, 21-40 indicates medium fall risk, and 0-20 indicates high fall risk.

The BBS will be administered at baseline and after completion of the intervention period to assess changes in balance performance.

Cognitive Function (Mini-Mental State Examination) Change from Baseline in Mini-Mental State Examination (MMSE) Score at 8 Weeks

Cognitive function will be assessed using the Mini-Mental State Examination (MMSE), a widely used screening tool for cognitive impairment. The MMSE evaluates domains including orientation, registration, attention and calculation, recall, and language. Scores range from 0 to 30, with higher scores indicating better cognitive function.

Cognitive function will be assessed using the Mini-Mental State Examination (MMSE), a widely used standardized tool for evaluating cognitive impairment. The MMSE assesses domains including orientation, registration, attention and calculation, recall, language, and visuospatial ability.

The total score ranges from 0 to 30, with higher scores indicating better cognitive function and lower scores indicating greater cognitive impairment. A score of 24-30 is generally considered normal cognition, 18-23 indicates mild cognitive impairment, and 0-17 indicates severe cognitive impairment.

MMSE will be administered at baseline and after completion

Quality of Life Change from Baseline in WHO Quality of Life-BREF (WHOQOL-BREF) Score at 6 Weeks

Quality of life will be measured using the WHOQOL-BREF questionnaire, which assesses physical health, psychological health, social relationships, and environmental domains. Higher scores indicate better quality of life.

Quality of life will be assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, a standardized instrument that evaluates individuals' perception of their position in life in the context of culture and value systems.

The WHOQOL-BREF consists of 26 items covering four domains: physical health, psychological health, social relationships, and environmental well-being. Each item is scored on a 5-point Likert scale, and domain scores are transformed to a scale of 0 to 100, with higher scores indicating better quality of life.

The WHOQOL-BREF will be administered at baseline and after completion of the intervention period to assess changes in quality of life.