A Comparison of the Efficacy of Different Rehabilitation Strategies in Mild Cognitive Impairment

Official title

Comparison of the Effectiveness of Dual-Task Training and Computer-Based Cognitive Rehabilitation in Older Adults With Mild Cognitive Impairment

Overview

The aim of this study is to conduct a comparative analysis of the effects of two different rehabilitation approaches on cognitive and functional outcomes in older adults diagnosed with mild cognitive impairment (MCI). The study compares two widely used approaches in the field of cognitive rehabilitation: Computer-Based Cognitive Rehabilitation (CBCR) and Dual-Task Training (DTT). The planned study will be conducted using a randomized controlled, parallel-group experimental design, in which individuals aged 65 and older diagnosed with MCI will be assigned to two intervention groups via computer-assisted randomization. Both groups will receive training for eight weeks, twice a week for 45 minutes each session, under the supervision of a specialist physical therapist. Pre- and post-intervention assessments will measure general cognitive function, executive function, fall risk, dual-task performance, functional independence, fear of falling, and physical activity level. This study is based on the assumption that cognitive decline is not limited to neuropsychological performance alone but is closely related to motor performance, safe mobility, and quality of life. The findings are expected to contribute to clinical decision-making processes by providing evidence-based data on which rehabilitation approach is more effective and feasible for older adults with HBB.

Detailed description

Mild cognitive impairment (MCI) is defined as mild cognitive decline that occurs as a natural consequence of aging. MCI generally represents a transitional stage between healthy aging and dementia. The recognition of MCI as a high-risk intermediate step leading to Alzheimer's disease and other forms of dementia makes early intervention approaches for MCI a priority. Preserving cognitive capacity encompasses not only mental functions but also areas that directly impact quality of life, such as fall risk, functional independence, and physical activity levels. The literature demonstrates that cognitive decline is associated with reduced walking speed, impaired balance control, and decreased ability to perform activities of daily living. Furthermore, a decline in cognitive performance increases the fear of falling, which in turn limits an individual's participation in physical activity and leads to a sedentary lifestyle. The literature indicates that physical activity levels decrease alongside cognitive decline in older adults. Low physical activity levels also increase the risk of falls and limit the ability to maintain independent living.Dual-task training and computer-based cognitive rehabilitation are two important intervention methods developed for cognitive impairments. Dual-task training aims to enhance cognitive-motor integration across multiple domains-including attention, executive functions, processing speed, spatial-visual perception, and postural control-by requiring the simultaneous performance of both cognitive and motor tasks. Dual-task training may also have positive effects on balance, fall risk, and gait in addition to cognitive functions. Computer-assisted cognitive rehabilitation programs, on the other hand, are digital intervention approaches that focus on cognitive domains such as memory, attention, processing speed, and problem-solving; they are individually adaptable and provide systematic progress. It has been reported that these programs have a direct effect on the improvement of cognitive functions.

Studies investigating the specific effects of both approaches are available in the literature; however, there are no studies in the literature comparing the effects of these two intervention methods on cognitive function, functional independence, fall risk, fear of falling, and physical activity levels. Therefore, a comparative evaluation of the effects of different intervention strategies not only on cognitive functions but also on quality-of-life parameters such as fall risk, fear of falling, physical activity level, and functional independence would make significant contributions to determining the approaches to be preferred in clinical practice.Therefore, a comparative evaluation of the effects of different intervention strategies not only on cognitive functions but also on quality-of-life parameters such as fall risk, fear of falling, physical activity level, and functional independence will make a significant contribution to determining the preferred approaches in clinical practice.

The aim of this study is to comparatively examine the effects of dual-task training and computer-based cognitive rehabilitation on cognitive functions, fall risk, functional independence, physical activity level, and fear of falling in older adults with mild cognitive impairment (MCI). By analyzing the effectiveness of both intervention methods on the relevant parameters based on quantitative data, the study aims to identify an effective and feasible intervention approach for preventing or slowing cognitive decline in older adults.

Interventions

• Other Dual Task Training
  Week Motor Task Cognitive Task Week 1 Straight walking Counting numbers Week 2 Straight walking Naming fruit images Week 3 Balancing Counting backward (feet together, tandem) Week 4 Throwing a ball Word generation (words starting with 'A') Week 5 Catching a ball Counting by 2s and 4s Week 6 Zigzag walking Reciting days of the week backward Week 7 Walking with obstacles Responding to non-animal words Week 8 Changing direction Verbal commands (e.g., "turn right if yellow, turn left if blue, or vic
• Other The computer-assisted cognitive rehabilitation
  The computer-assisted cognitive rehabilitation intervention will be conducted via the RehaCom (Hasomed, Germany) platform. The intervention program is designed to include combinations of modules targeting selective and divided attention, executive functions, processing speed, and visuospatial perception, with each session lasting 40 minutes. It will be implemented in a stepwise manner, with content and difficulty levels gradually increasing every two weeks.

Primary outcome measures

• Mini Mental State Examination [Time frame: baseline and at the end of the 8-week intervention]
• The Trail Making Test [Time frame: baseline and at the end of the 8-week intervention]
• The Timed Up And Go Test [Time frame: baseline and at the end of the 8-week intervention]
• The Timed Up and Go dual-task Test [Time frame: baseline and at the end of the 8-week intervention]

Secondary outcome measures (3)

• Lawton Instrumental Activities of Daily Living Scale [Time frame: baseline and at the end of the 8-week intervention]
• The Falls Efficacy Scale-International [Time frame: baseline and at the end of the 8-week intervention]
• Physical Activity Level [Time frame: for 3 days before and at the end of the 8-week intervention]

Eligibility criteria

Inclusion criteria

• Have been diagnosed with mild cognitive impairment
• Be 65 years of age or older
• Agree to participate in the study
• Be literate in Turkish

Exclusion criteria

• Having been diagnosed with dementia or Alzheimer's disease
• Having an orthopedic condition that impairs mobility
• Having a rheumatological condition
• Having a neurological or psychiatric disorder
• Having a hearing or visual impairment,
• Having participated in a cognitive training program within the last 3 months

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Double blind

Primary purpose

Treatment

Study locations

Turkey (Türkiye) · 1 center

• Kartal Dr. Lütfi Kırdar Şehir Hastanesi — Istanbul

Publications

• Tam ACY, Chan AWY, Cheung DSK, Ho LYW, Tang ASK, Christensen M, Tse MMY, Kwan RYC. The effects of interventions to enhance cognitive and physical functions in older people with cognitive frailty: a systematic review and meta-analysis. Eur Rev Aging Phys Act. 2022 Aug 24;19(1):19. doi: 10.1186/s11556-022-00299-9. PMID 36002799
• Nousia A, Martzoukou M, Siokas V, Aretouli E, Aloizou AM, Folia V, Peristeri E, Messinis L, Nasios G, Dardiotis E. Beneficial effect of computer-based multidomain cognitive training in patients with mild cognitive impairment. Appl Neuropsychol Adult. 2021 Nov-Dec;28(6):717-726. doi: 10.1080/23279095.2019.1692842. Epub 2019 Dec 29. PMID 31885287
• Silsupadol P, Shumway-Cook A, Lugade V, van Donkelaar P, Chou LS, Mayr U, Woollacott MH. Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial. Arch Phys Med Rehabil. 2009 Mar;90(3):381-7. doi: 10.1016/j.apmr.2008.09.559. PMID 19254600
• Sherrington C, Fairhall N, Kwok W, Wallbank G, Tiedemann A, Michaleff ZA, Ng CACM, Bauman A. Evidence on physical activity and falls prevention for people aged 65+ years: systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. Int J Behav Nutr Phys Act. 2020 Nov 26;17(1):144. doi: 10.1186/s12966-020-01041-3. PMID 33239019
• Oliveira JJ, Ribeiro AGSV, de Oliveira Silva JA, Barbosa CGR, Silva ASE, Dos Santos GM, Verlengia R, Pertille A. Association between physical activity measured by accelerometry and cognitive function in older adults: a systematic review. Aging Ment Health. 2023 Nov-Dec;27(11):2089-2101. doi: 10.1080/13607863.2023.2248477. Epub 2023 Sep 5. PMID 37667883
• Montero-Odasso M, Verghese J, Beauchet O, Hausdorff JM. Gait and cognition: a complementary approach to understanding brain function and the risk of falling. J Am Geriatr Soc. 2012 Nov;60(11):2127-36. doi: 10.1111/j.1532-5415.2012.04209.x. Epub 2012 Oct 30. PMID 23110433
• Wang KN, Page AT, Etherton-Beer CD. Mild cognitive impairment: To diagnose or not to diagnose. Australas J Ageing. 2021 Jun;40(2):111-115. doi: 10.1111/ajag.12913. Epub 2021 Feb 18. PMID 33604998

Identifiers

NCT: NCT07547111 · Istanbul Üniversitesi Cerrahpa

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗