Visual processing speed and its association with future dementia development in a population-based prospective cohort: EPIC-Norfolk.

Visual processing deficits have frequently been reported when studied in individuals with dementia, which suggests their potential utility in supporting dementia screening. The study uses EPIC-Norfolk Prospective Population Cohort Study data (n = 8623) to investigate the role of visual processing speed assessed by the Visual Sensitivity Test (VST) in identifying the risk of future dementia using Cox regression analyses. Individuals with lower scores on the simple and complex VST had a higher probability of a future dementia diagnosis HR1.39 (95% CI 1.12, 1.67, P < 0.01) and HR 1.56 (95% CI 1.27, 1.90, P < 0.01), respectively. Although other more commonly used cognitive dementia screening tests were better predictors of future dementia risk (HR 3.45 for HVLT and HR 2.66, for SF-EMSE), the complex VST showed greater sensitivity to variables frequently associated with dementia risk. Reduced complex visual processing speed is significantly associated with a high likelihood of a future dementia diagnosis and risk/protective factors in this cohort. Combining visual processing tests with other neuropsychological tests could improve the identification of future dementia risk.

The Effectiveness of Home-Based Exergames Training on Cognition and Balance in Older Adults: A Comparative Quasi-Randomized Study of Two Exergame Interventions.

Background and Objectives: The effectiveness of exergames on fall risk and related physical and cognitive function in older adults is still unclear, with conflicting findings. The discrepancy in these results could be due to the different components and task-specific demands of individual exergame interventions. This open-label quasi-randomized study aimed to compare the efficacy of 2 different home-based dual-task exergame treatments on cognition, mobility, and balance in older people. Research Design and Methods: Fifty older adults (65-85 years of age) were allocated to one of two 8-week exergame interventions: Cognitive-Intensive Exergame Training (CIT) or Physical-Intensive Exergame Training (PIT). Cognitive functions, balance, and mobility were assessed at baseline and after 8 weeks. Group × time interaction was measured by repeated-measure ANOVA, and both intention-to-treat (ITT) and per-protocol (PP) analyses were performed to assess the effectiveness of exergame interventions. Results: ITT analyses showed that improvement in visual processing speed and visuospatial working memory was greater in the CIT group, with a medium effect size (p = .04; η2 = 0.09 and p = .01; η2 = 0.12). The improvement in verbal memory and attention was significant within both groups (p < .05), but this improvement was not different between the groups (p > .05). A significant improvement in balance was also observed in the PIT group, with a medium effect size (p = .04; η2 = 0.09). Although mobility improved significantly in both groups (p < .01), there was no significant difference between groups (p = .08). These results were largely supported by the PP analysis. Discussion and Implications: Dual-task exergame training can improve mobility and cognition in older adults. However, the different cognitive and physical demands of these interventions may have varying impacts on fall risk and related physical or cognitive functions. Therefore, a training program that includes both cognitive and physical domains with appropriate intensity is essential for the development of tailored exergame interventions to reduce fall risk in older adults.

Does physical exercise improve the capacity for independent living in people with dementia or mild cognitive impairment: an overview of systematic reviews and meta-analyses.

OBJECTIVE: To summarise existing systematic reviews which assessed the effects of physical exercise on activities of daily living, walking, balance and visual processing in people with dementia or mild cognitive impairment. METHODS: In this overview of systematic reviews and meta-analyses, seven electronic databases were searched to identify eligible reviews published between January 2015 and April 2021. RESULTS: A total of 30 systematic reviews were identified and included in the overview. The most frequent type of exercise for the intervention group was multimodal exercises. Mind-body exercises, exergames, dance intervention and aerobic exercise were other exercise types. Most of the reviews reported that exercise is significantly effective for improving activities of daily living (SMD 95%CI, from 0.27 to 1.44), walking (SMD 95%CI, from 0.08 to 2.23), balance (SMD 95%CI, from 0.37 to 2.24) and visuospatial function (SMD 95%CI, from 0.16 to 0.51), which are among the most leading determinants of independent living in individuals with dementia or mild cognitive impairment. CONCLUSION: Evidence has shown that exercise (especially multicomponent exercise programmes including cognitive, physical and multitasking exercises) with sufficient intensity improves the activities of daily living skills. Exercise also improves walking, balance and visual processing, which can provide a more independent life for people with dementia and mild cognitive impairment. Cognitively impaired people should therefore be encouraged to exercise regularly in order to be more independent.Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2021.2019192.