Rationale for Combined Exercise and Cognition-Focused Interventions to Improve Functional Independence in People with Dementia

Abstract

Evidence suggests that exercise and some cognition-focused intervention approaches can be used to elicit functional improvements in older people and, to some degree, those diagnosed with dementia. Independently, the two intervention types have been found to improve functional performance in people with dementia. The mechanisms underpinning these improvements come from comparable and diverse pathways. This suggests that it may be beneficial for the two intervention types to be coupled as part of regular care in individuals with a range of cognitive impairments. The aims of this review are threefold. The first aim is to present evidence to support the use for combining exercise and cognition-focused interventions. This will be achieved by reviewing the mechanisms of both approaches in improving functional performance in older people and in people with dementia and summarising recent progress. The increased risk of depression, falls and cardiovascular disease risk in people with dementia will also be highlighted. The second aim is to discuss the parameters of the two approaches that should be considered when combining them in terms of possible efficient models, especially in relation to exercise protocols as this is where the current literature shows the most promising outcomes. Maximisation of the efficacy of preventative and treatment interventions which focus on both cognitive functioning and physical health should lead to improving and extending functional independence. Key aspects of any combined intervention would involve the inclusion of both cardiovascular and other types of exercises, including falls reduction, and exercises addressing memory and executive function via goal setting in the real-life context. The third aim is to explore some of the issues that may arise when attempting to incorporate interventions into the regular treatment of people with dementia. Consideration must also be given to caregivers and the education of health professionals as well as to the mode of intervention itself. Further research is necessary in order to discern the most effective types of both intervention models. Provision of combined interventions might enhance the improvements in functional independence in people with dementia over and above the interventions being used separately.

Non-pharmacological intervention for memory decline

“…Overall, these findings showed that each learning method was effective and provided further evidence that learning is possible in AD and vascular dementia patients, which had been shown in previous studies (Camp et al, 1993;Bird and Kinsella, 1996). In addition, several other studies have investigated the usefulness of errorless learning for memory training in AD, which demonstrated improvements in memory for associations and compared the efficacy of different errorless learning methods (Clare and Wilson, 2004;Metzler-Baddeley and Snowden, 2005;Haslam et al, 2010;Laffan et al, 2010;Thom and Clare, 2011).…”

Independent and combined effects of cognitive and physical activity on incident MCI

“…Only one other observational study has directly examined the combined influence of CA and PA on risk for MCI, and they found decreased odds of having MCI for those engaging in both PA and computer use compared to neither activity [27]. There has been a recent push for combined intervention approaches [16, 17], although thus far, the results from trials have not been consistent. One combination intervention trial of cognitive training and PA reported that cognitive training to be the driving force behind the combined effects with aerobic activity [28], while another reported that combined mental and physical engagement did not improve cognitive performance more than the control conditions [29].…”

“…Observational studies suggest that engaging in activities requiring mental effort confers a reduced risk of both MCI [4, 5] and dementia [6–8], and more physically active older adults have a lower risk of MCI [9] and dementia [10–13] than those who are not as active. Because intervention studies have yielded mixed results when examining the separate effects of cognitive [14] and physical [15] activity, there is now growing interest in combined intervention strategies [16, 17]. …”

Methodological challenges in designing dementia prevention trials — The European Dementia Prevention Initiative (EDPI)

“…A combined programme of cognitive training and physical exercise might result in better effects on cognition and functional independence [61]. Experience from our own studies (FINGER and MAPT) shows that healthy elderly persons are eager to participate in physical and cognitive training programmes.…”