A Combined Cognitive Stimulation and Physical Exercise Programme (MINDVital) in Early Dementia: Differential Effects on Single- and Dual-Task Gait Performance

Abstract

Background: Gait disorders are common in early dementia, with particularly pronounced dual-task deficits, contributing to the increased fall risk and mobility decline associated with cognitive impairment. Objective: This study examines the effects of a combined cognitive stimulation and physical exercise programme (MINDVital) on gait performance under single- and dual-task conditions in older adults with mild dementia. Methods: Thirty-nine patients with early dementia participated in a multi-disciplinary rehabilitation programme comprising both physical exercise and cognitive stimulation. The programme was conducted in 8-week cycles with participants attending once weekly, and all participants completed 2 successive cycles. Cognitive, functional performance and behavioural symptoms were assessed at baseline and at the end of each 8-week cycle. Gait speed was examined under both single- (Timed Up and Go and 6-metre walk tests) and dual-task (animal category and serial counting) conditions. A random effects model was performed for the independent effect of MINDVital on the primary outcome variable of gait speed under dual-task conditions. Results: The mean age of patients enroled in the rehabilitation programme was 79 ± 6.2 years; 25 (64.1%) had a diagnosis of Alzheimer's dementia, and 26 (66.7%) were receiving a cognitive enhancer therapy. There was a significant improvement in cognitive performance [random effects coefficient (standard error) = 0.90 (0.31), p = 0.003] and gait speed under both dual-task situations [animal category: random effects coefficient = 0.04 (0.02), p = 0.039; serial counting: random effects coefficient = 0.05 (0.02), p = 0.013], with reduced dual-task cost for gait speed [serial counting: random effects coefficient = -4.05 (2.35), p = 0.086] following successive MINDVital cycles. No significant improvement in single-task gait speed was observed. Improved cognitive performance over time was a significant determinant of changes in dual-task gait speed [random effects coefficients = 0.01 (0.005), p = 0.048, and 0.02 (0.005), p = 0.003 for category fluency and counting backwards, respectively]. Conclusion: A combined physical and cognitive rehabilitation programme leads to significant improvements in dual-task walking in early dementia, which may be contributed by improvement in cognitive performance, as single-task gait performance remained stable.

Effects of a 16-week multimodal exercise program on gait performance in individuals with dementia: a multicenter randomized controlled trial

“…In contrast to previous studies, which predominantly reported positive effects for stride length and stride time in single and dual task conditions [ 39 – 46 ], our investigation did not confirm the effectiveness of an MEP for these spatiotemporal gait parameters. In accordance with 20 previous studies, we did not observe statistically significant effects on walking speed [ 24 – 38 , 42 , 44 , 47 , 48 ] and percent of double support [ 44 , 45 ], while twelve others did for single [ 17 – 23 , 40 , 41 , 43 , 46 ] and dual task conditions [ 28 ].…”

“…Most previous studies conducted multimodal physical activity interventions, including strength, balance, and aerobic exercises [ 17 – 21 , 23 – 25 , 28 , 30 – 36 , 39 – 45 , 47 ]. Given the relationship between motor, cognitive and gait performance, as well as the positive impacts of cognitive training programs [ 1 , 11 ], interventions combining physical and cognitive activity may be most promising for improving gait performance in IWD [ 15 ].…”

A mixed methods systematic review of multimodal non-pharmacological interventions to improve cognition for people with dementia

“…This is about collaborative engagement -co-ownership throughout the process. Another paper by Tay et al (2016) went into more depth about their goal-oriented approach (Chew, Chong, Fong, & Tay, 2015). Cognition goals as well as goals to improve engagement and socialization; reduce caregiver stress; and improve physical function, behaviour and mood were set and 61.8% of participants met them.…”

Dual-Task Gait and Alzheimer’s Disease Genetic Risk in Cognitively Normal Adults: A Pilot Study

“…Gait-cognition dual-task paradigms have demonstrated that dual-task interference is more pronounced in older compared to younger adults [10] and in those with neurological disorders including stroke [11], Parkinson’s disease [12], and AD [13]. Gait interference during dual-tasking is associated with risk of falls [14, 15] and is increasingly incorporated as an outcome in rehabilitation research [16, 17].…”