Exercise Combined With Cognitive Training Could Delay Dementia Onset
Aerobic-resistance exercise paired with computerized cognitive training could improve cognition in older adults with mild cognitive impairment (MCI) and delay dementia onset, according to a recent randomized clinical trial published in JAMA Network Open.
“The multidomain intervention effect was larger than the improvement from exercise alone,” said lead author Manuel Montero-Odasso, MD, PhD, Lawson Health Research Institute, London, Ontario, Canada, and co-authors. “Our findings suggest that this multidomain intervention could induce a clinically meaningful cognitive improvement in individuals with MCI, which may have important implications for their quality of life.”
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The study was a fractional factorial trial that took place at multiple sites. Participants between ages 65 and 84 with MCI were enrolled from September 2016 to April 2020, with data analyzed between February 2021 and December 2022. Participants were treated for 20 weeks in 1 of 5 randomized study arms:
1. Progressive aerobic-resistance exercise, sequential computerized cognitive training, and vitamin D (10,000 IU dose 3-times weekly)
2. Progressive aerobic-resistance exercise, sequential computerized cognitive training, and placebo vitamin D
3. Progressive aerobic-resistance exercise, “sham” cognitive training, and vitamin D (10,000 IU dose 3-times weekly)
4. Progressive aerobic-resistance exercise, sham cognitive training, and placebo vitamin D
5. Control group with balance-toning exercise, sham cognitive training, and placebo vitamin D
Researchers used the Alzheimer Disease Assessment Scale Cognitive 13 (ADAS-Cog-13) and Plus Variant to monitor cognition.
A total of 144 participants completed the intervention (49.1% women), and 133 completed the 12-month follow-up. At the 6-month mark, arms 1 through 4 had improved ADAS-Cog-13 scores compared to the control group (mean difference, −1.79 points; 95% CI, −3.27 to −0.31 points; P = .02; d = 0.64). Compared with exercise alone (arms 3 and 4), exercise and cognitive training (arms 1 and 2) improved the ADAS-Cog-13 scores (mean difference, −1.45 points; 95% CI, −2.70 to −0.21 points; P = .02; d = 0.39). Vitamin D showed no significant impact on patient cognition. The multidomain approach that combined exercise with the computerized program improved ADAS-Cog-13 scores significantly compared with the control group (mean difference, −2.64 points; 95% CI, −4.42 to −0.80 points; P = .005; d = 0.71).
Researchers noted that the COVID-19 pandemic limited study results because it forced participants to dropout and the study to end early. Authors also noted that most of the participants were vitamin D sufficient at the start of the study, which could have reduced “any potential effect of the vitamin D intervention.”
“A 2.64-point improvement in the ADAS-Cog-13 for the multidomain intervention is larger than changes seen in previous pharmaceutical trials among individuals with MCI or mild dementia, and approaches the 3 points considered clinically meaningful,” authors noted. “Together with the moderate-to-large effect size (0.71) found, our results support a beneficial cognitive effect from this multidomain intervention.”
