Correlates of Adherence of Multimodal Non-pharmacological Interventions in Older Adults With Mild Cognitive Impairment: A Cross-Sectional Study.

Background: Non-pharmacological interventions are promising for delaying cognitive decline in older adults with mild cognitive impairment (MCI). Although some studies have demonstrated adherence rates and factors influencing participation in single modality non-pharmacological interventions, little is known about the level and correlates of adherence to multimodal non-pharmacological interventions (MNPIs) in older adults with MCI. Objective: This study aimed to explore the adherence level and the correlates of adherence to MNPIs in older adults with MCI. Methods: A cross-sectional design was employed. Community-dwelling older adults aged 60 years and over were recruited from senior community centers and healthcare centers in Huzhou from March 2019 to December 2020. Data were collected by a general information questionnaire and the adherence scale of cognitive dysfunction management (AS-CDM) in older adults with MCI. Hierarchical regression analyses were applied to explore the correlates of adherence to MNPIs. Results: A total of 216 completed questionnaires were finally analyzed. Of these, 68.52% were female, and 45.4% of the participants had no less than 6 years of education. The overall mean score for adherence was 117.58 (SD = 10.51) out of 160, equivalent to 73.49 in the hundred-mark system, indicating a medium-level adherence to MNPIs in older adults with MCI. Of the five dimensions of adherence (AS-CDM), self-efficacy scored the highest, and the lowest was perceived barriers. The univariate analysis showed that the factors associated with the adherence to MNPIs were: regular physical exercise, meat-vegetable balance, absence of multimorbidity, high level of education, living alone, and living in urban (p < 0.05). In the hierarchical regression analysis, the final model explained 18.8% of variance in overall adherence (p < 0.01), which high school (Beta = 0.161, p < 0.05), college and above more (Beta = 0.171, p < 0.05), meat-vegetarian balance (Beta = 0.228, p < 0.05), regular physical exercise (Beta = 0.234, p < 0.05), and presence of multimorbidity (Beta = -0.128, p < 0.05) significantly contributed to adherence. In addition, nearly 80% of older adults with MCI preferred MNPIs. Conclusion: Early assessment and management of adherence to MNPIs were essential in older adults with MCI. Furthermore, the findings shed light on several critical areas of intervention to improve adherence to MNPIs in older adults with MCI. Clinical Trial Registration: http://www.chictr.org.cn/showproj.aspx?proj=35363, ChiCTR1900020950 (Registered on January 23, 2019).

Modifiable facilitators and barriers to exercise adherence in older adults with MCI/dementia using the Theoretical Domains Framework: a systematic review protocol.

INTRODUCTION: Exercise has multiple benefits on maintaining or improving cognitive function for people with mild cognitive impairment (MCI)/dementia. However, many older adults with MCI/dementia are not sufficiently active to achieve these benefits. Allowing for the current studies on exercise adherence in older adults with MCI/dementia still have some deficiencies. This paper aims: (1) to identify the modifiable facilitators and barriers to exercise adherence for older adults with MCI/dementia in terms of the perspectives of patients, caregivers and healthcare professionals; (2) to organise the identified factors of exercise adherence based on the Theoretical Domains Framework (TDF) among included studies. METHODS AND ANALYSIS: A systematic computerised literature search will be performed in the following online databases: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure and Wan Fang Database, which published between January 1990 and June 2020. We will identify peer-reviewed publications which examined facilitators and barriers to exercise adherence. Searches will have no limitation in language publications using search terms related to exercise interventions, adherence and MCI/dementia. Two independent reviewers will screen titles, abstracts and full-text articles according to the predetermined inclusion and exclusion criteria. We will use the statistical software Nvivo V.12 to manage the information. Basing on the TDF, we will map identified modifiable facilitators and barriers of literature to the domains of TDF. ETHICS AND DISSEMINATION: This review will summarise modifiable facilitators and barriers to exercise adherence for older adults with MCI/dementia for the first time. Ethical approval is not required as no primary data are collected. We are going to disseminate our findings to the scientific and medical community in peer-reviewed journals. The review findings will facilitate adequate and accurate access to care and treatment to help older adults with MCI/dementia have a broader adoption to exercise. PROSPERO REGISTRATION NUMBER: CRD42019117725.

Effects and mediating mechanisms of a structured limbs-exercise program on general cognitive function in older adults with mild cognitive impairment: A randomized controlled trial.

BACKGROUND: Exercise is known to prevent cognitive decline. Sleep quality and depression symptoms, which are associated with processing speed, are considered as common mediators in the exercise-cognition putative model. However, these mediating mechanisms have not been empirically tested in an intervention study. OBJECTIVE: The aim of this study was to evaluate the effects of a structured limbs-exercise program on general cognitive function, and to test the mediating effects and mediating pathways of depressive symptoms, sleep quality and processing speed in the relationship of exercise-induced cognitive benefits. DESIGN: A two-arm and assessor-blinded randomized controlled trial. SETTINGS AND PARTICIPANTS: Community-dwelling older adults with mild cognitive impairment living in an urban area in Chifeng, China. METHODS: Participants (N=116) were randomly allocated to one of the two arms: (1) a 24-week structured limbs-exercise program (3 supervised limb exercise sessions /week, 60 min /session for the first 12 weeks and 3 unsupervised practice sessions /week, 60 min /session for the following 12 weeks) or (2) health promotion classes alone. Measures of depressive symptoms, sleep quality, processing speed, and general cognitive function were collected at baseline, 12-week, and 24-week. Multivariate analysis of variance and structural equation modeling was used to test the effectiveness and mechanisms of structured limbs-exercise-induced cognitive improvement respectively. RESULTS: The structured limbs-exercise program was beneficial for maintaining general cognitive function at 12 weeks (mean difference = 1.20, 95% CI [0.354, 2.054], p = 0.006) and at 24 weeks (mean difference = 1.59, 95% CI [0.722, 2.458], p = 0.001) in the intervention group. The results from the goodness-of-fit indices of structural equation modeling show as following: (1) The effect of structured limbs-exercise program on cognitive function was partially mediated by depressive symptoms, sleep quality, and processing speed, with 69.22% of joint mediation proportion; (2) Relative to the combined Z values of depressive symptoms and processing speed, sleep quality was more strongly related to cognitive function in the structured limbs-exercise program (Z= 9.294, p<0.01); (3) Processing speed was affected by depressive symptoms, sleep quality, and in turn, yielding a significant effect on cognitive function; and (4) Five potential mediating pathways for improvement in general cognitive function in the structured limbs-exercise intervention were identified. CONCLUSION: This study shows that this exercise program can maintain general cognitive function for older adults with mild cognitive impairment. Mediating variables include depressive symptoms, sleep quality and processing speed. Future research should continue to incorporate path-oriented intervention strategies in the exercise intervention to maximize improvements in cognitive function. Registration number: ChiCTR1800016299.

Effects of a Trans-Theoretical Model-Based Health Education Program on the Management of Cognitive Dysfunction in Older Adults With Mild Cognitive Impairment: Study Rationale and Protocol Design for a Randomized Controlled Trial.

Introduction: Recent studies have confirmed that the management of cognitive dysfunction produces considerable positive effects in individuals with mild cognitive impairment (MCI), however, compliance with participation in various cognitive dysfunction management strategies remains scant in older adults with MCI. Health education programs can improve the level of knowledge of the disease effectively, though it remains unclear as to whether health education programs are sufficient to promote behavior changes of older adults with MCI in the community. Objective: The study aims to provide insight into the effect of a trans-theoretical Model (TTM)-based health education program on increasing knowledge about mild cognitive impairment (MCI), compliance in cognitive dysfunction management, and other cognition-related health outcomes (general cognitive function, sleep quality, depression symptoms, apathy symptoms) for older adults with MCI. Methods: This study is a single-blinded, randomized, prospective clinical trial. We will recruit 132 participants with MCI who will be randomly assigned to a TTM-based health education group and a standard health education group in a ratio of 1:1. The intervention group will receive a TTM-based health education program (1 session/week, 4-560 min/session for 8 weeks), while the control group will receive standard health education. Assessors blinded to participant allocation will conduct baseline, post-intervention, and 3-month follow-up assessments. Statistical analyses will consist of the Wilcoxon test, the Chi-square test, the T-test, and 2 (group) × 3 (time) ANOVA with a 5% cut-off for significance. Discussion: Supposing the TTM-based health education program will provide validated community-based cognitive dysfunction management strategies for older adults with MCI, this would be a feasible approach to improve the compliance of participation in cognitive dysfunction management and the cognition-related health outcomes. Clinical Trial Registration: ChiCTR1900028351. Registered on December 19, 2019. http://www.chictr.org.cn/edit.aspx?pid=47223&htm=4.

Smartphone application training program improves smartphone usage competency and quality of life among the elderly in an elder university in China: A randomized controlled trial.

BACKGROUND: Given that China has free universities dedicated solely to the elderly, such universities may be the perfect place to provide large numbers of elderly with a systematic program of self-management. Yet, testing health applications in this location has not occurred, partly because time-consuming training is required before applications can be used. OBJECTIVE: This study aimed to develop and implement a smartphone training program for the elderly and to confirm the effects on smartphone competency and quality of life. METHODS: A randomized controlled trial was conducted. Participants were randomly assigned to either the intervention group or the wait-list control group. A smartphone operation manual was provided to all participants. The intervention group received the smartphone training program once a week for 20 weeks. After the study was finished, participants in the wait-list control group were permitted to undergo the smartphone training program. RESULTS: Of the 344 participants were randomized at the elder university in Huzhou. After 20 weeks of the intervention, the intervention group showed significant improvement in smartphone usage competency (except health applications) and quality of life relative to the wait-list control group (P < 0.05). CONCLUSION: This study confirmed the effectiveness of the smartphone training program in the elder university setting. However, further research is needed to strengthen the intervention in the area of health applications.

Risk factors for predicting progression from normal cognition to mild cognitive impairment: protocol for a systematic review and meta-analysis of cohort studies.

INTRODUCTION: Mild cognitive impairment (MCI) often represents the earliest stage of Alzheimer's disease. There has been considerable research investigating specific risk factors regarding the progression from normal cognition to MCI. However, different studies have come to different conclusions on the impact of particular risk factors. Therefore, it is necessary to conduct a meta-analysis of the risk factors that predict cognitive disruption in individuals based on associations with MCI. METHODS AND ANALYSIS: We will search seven electronic databases without time limit, including MEDLINE, EMBASE, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, the Wan Fang Database and China Biology Medicine. Two researchers will independently screen for eligibility and perform data extraction. Data were extracted from cohort studies meeting the inclusive criteria according to the Newcastle Ottawa Scale (NOS) methods. A third member of the research team will be contacted when a consensus cannot be reached. Any disagreement will be settled by consensus. The NOS will be used to assess the quality of the studies. All analyses were performed using Stata V.15.1. ETHICS AND DISSEMINATION: We will report this review in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. We will disseminate our findings through a publication in a peer-reviewed journal. This systematic review does not require ethical approval as no primary data are collected. PROSPERO REGISTRATION NUMBER: CRD42018109099.