Given increasing longevity worldwide, older adults and caregivers are seeking ways to curb cognitive decline especially for those with mild cognitive impairment (MCI, now mild neurocognitive disorder, mNCD, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-V). This quasi-experimental, within-subjects pilot clinical trial was designed to replicate and extend the study of cognitive benefits for MCI by improving upon our prior interactive Physical and Cognitive Exercise Study (iPACESTM v1.0) by increasing the usability of the neuro-exergame and exploring possible underlying neurobiological mechanisms. Older adults were enrolled in a three-month, in-home trial of a portable neuro-exergame (iPACES™ v2.0) where participants pedaled and steered along a virtual bike path (Memory Lane™). Neuropsychological function was assessed at baseline after component familiarization intervals (e.g., two weeks of exercise-only, game-only, etc.) and after three months of interactive neuro-exergame intervention. Fourteen participants were enrolled in the study and seven completed the final evaluation. Intent-to-treat analyses were conducted with imputed missing data (total n = 14). Significant improvement in executive function (Stroop) was found (d = 0.68, p = 0.02) only. Changes in salivary biomarkers (cortisol and insulin-like growth factor 1; IGF-1) were significantly associated with improved cognition. Further research is needed, but pilot data suggest that a portable in-home neuro-exergame may be an additional, practical tool to fight back against cognitive decline and dementia.
Dementia cases are on the rise among our aging global population, and thus there is increasing urgency to identify efficacious interventions for preserving or ameliorating cognitive decline. Physical exercise, cognitive training and combined physical and cognitive interventions have been found to slow the decline of cognitive abilities in those with mild cognitive impairment (MCI) but the biological mechanisms underlying these changes need further clarification. This quasi‐experimental within‐subjects design compared changes in biomarkers during two‐week exposures to components of the interactive physical and cognitive exercise system (iPACES™). Participants were evaluated over eight weeks at two‐week intervals. Biomarker levels of Cortisol, IGF1 and DHEAS were assessed at each evaluation through saliva (passive drool collection). Each saliva sample was analyzed using enzyme‐linked immunosorbent assays (ELISAs). Additionally, each sample was analyzed using bicinchoninic acid (BCA) protein assay to normalize protein concentration. Cognitive outcomes were also assessed, focusing on executive function via Stroop, Trails, and Flanker tests. This pilot study enrolled 14 older adults, 13 of which met criteria for MCI (MoCA<26), with ten study completers. Paired t‐tests revealed significant (ps<.05) cognitive improvements in Stroop and Flanker from baseline during all active component conditions (e.g., pedaler, game, and iPACES™), but not during placebo. Biomarkers did not change significantly during placebo or pedaler conditions, but during the game intervention, DHEAS declined significantly (p=.04), and during iPACES™ intervention, DHEAS declined further and IGF1 declined significantly (p=.05), consistent with prior research (McTiernan, et al., 2005; Yuichiro, et al., 2010). Furthermore, the changes (from baseline to the end of the 8‐week trial) for cognition were moderately correlated with biomarker changes (r's ranging from −.22 to −.48), suggesting a link between neurobiological mechanisms and cognitive outcomes. Further research is needed to replicate and extend this pilot research; in particular, it would be useful to compare such interventions in a randomized controlled trial.Support or Funding InformationNational Institute on Aging STTR Grant #R41AG053120 and Union College Undergraduate Research GrantThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
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