Transferability and Sustainability of Motor-Cognitive Dual-Task Training in Patients with Dementia: A Randomized Controlled Trial

Abstract

Background: Specific dual-task (DT) training is effective to improve DT performance in trained tasks in patients with dementia (PwD). However, it remains an open research question whether successfully trained DTs show a transfer effect to untrained DT performances. Objective: To examine transfer effects and the sustainability of a specific DT training in PwD. Methods: One hundred and five patients with mild-to-moderate dementia (Mini-Mental State Examination: 21.9 ± 2.8 points) participated in a 10-week randomized, controlled trial. The intervention group (IG) underwent a specific DT training (“walking and counting”). The control group (CG) performed unspecific low-intensity exercise. DT performance was measured under three conditions: (1) “walking and counting” (trained); (2) “walking and verbal fluency” (semi-trained), and (3) “strength and verbal fluency” (untrained). Outcomes evaluated at baseline, after training, and 3 months after the intervention period included absolute values for the motor and cognitive performance under DT conditions, and relative DT costs (DTCs) in motor, cognitive and combined motor-cognitive performance. Results: The IG significantly improved DT performances in the trained condition for absolute motor and cognitive performance and for motor, cognitive, and combined motor-cognitive DTCs compared to the CG (p ≤ 0.001–0.047; ηp² = 0.044–0.249). Significant transfer effects were found in the semi-trained condition for absolute motor and partly cognitive performance, and for motor but not for cognitive DTCs, and only partly for combined DTCs (p ≤ 0.001–0.041; ηp² = 0.049–0.150). No significant transfer effects were found in the untrained condition. Three months after training cessation, DT performance in the trained condition was still elevated for most of the outcomes (p ≤ 0.001–0.038; ηp² = 0.058–0.187). Training gains in the DT performance in the semi-trained condition were, however, not sustained, and no significant group differences were found in the DT performance in the untrained condition after the follow-up. Conclusion: This study confirmed that specific DT training is effective in improving specifically trained DT performances in PwD and demonstrated sustainability of training-induced effects for at least 3 months. Effects were partially transferable to semi-trained DTs but not to untrained DTs. With increasing distance between trained and untrained DTs, transferability of training effects decreased.

Dual-task exercises in older adults: A structured review of current literature

“…Most of the studies identified, quantified as outcome measures the gait performance of in DT [23][24][25][26][27][28] , and many in turn measured static and dynamic equilibrium with a variety of scales or measurements, including support on one foot 6,27,29 , Time Up and Go (TUG) 25,27,29,30 and the Berg Balance Scale (BBS), which was used by three studies 26,29,30 . Other scales, such as the Balance Evaluation System Test (BEST) 31 and the Tinetti scale 32 , were used to a lesser extent.…”

“…The interventions were developed in diverse settings, in community dwelling people 27,33 and people living in care homes 24,32 . Concerning age, only three studies accepted people of average adult age, all of them adults with neurological 23,31 and skeletal 29 pathologies, while the rest of the studies had only an older adult population.…”

“…Concerning age, only three studies accepted people of average adult age, all of them adults with neurological 23,31 and skeletal 29 pathologies, while the rest of the studies had only an older adult population. As regards sex, those studies that identified it had a predominance of females 19,24,25,29 (Table 3).…”

Investigation of the Relationship of Recommended Home Exercises with Dual-Task Training for the Elderly with Physical Activity Level, Life Quality and Kinesiophobia

“…More studies are needed on this subject. While only orthopedic and neurological problems were the majority in the studies, healthy elderly individuals were also included in our study (33). In our study, the agility and dynamic balance performances of the patients who received single and double task training showed an improvement compared to the TUGT.…”

“…There are some contradictions in evaluating the results obtained due to the sample size (n<30) in some studies showing a shortcoming of these studies. Therefore, the sample size was decided to be 60 to prevent these contradictions (33).…”