CogniFit - Effect of Cognitive Remediation on Gait in Sedentary Seniors

Original Name: Effect of Cognitive Remediation on Gait in Sedentary Seniors.

Authors: Joe Verghese1, Jeannette Mahoney1,2, Anne F. Ambrose3, Cuiling Wang4 y Roee Holtzer1,2.

• 1. Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York.
• 2. Ferkauf School of Psychology, Yeshiva University, Bronx, New York.
• 3. Department of Rehabilitation Medicine, Mt. Sinai Medical Center, New York.
• 4. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York.

Journal: Journal of Gerontoly: MEDICAL SCIENCES (2010) 65A(12): 1338-1343.

References to this article (APA style):

• Verghese, J., Mahoney, J., Ambrose, AF., Wang, C., & Holtzer, R. (2010). Effect of cognitive remediation on gait in sedentary seniors. J Gerontol A Biol Sci Med Sci., 65(12), pp.1338-43.

Conclusion

CogniFit cognitive training has been able to improve mobility in sedentary elderly people through an 8-week intervention, 3 non-consecutive days per week, with two training sessions each day. Mobility during gait (change: 8.2 ± 11.4-1.3 ± 6.8 cm/s, p =. 10) and during gait while talking (change: 19.9 ± 14.9-2.5 ± 20.1 cm/s, p =. 05) compared to the control group.

Study summary

Mobility problems increase with age and adversely affect people's quality of life. Some cognitive skills such as attention and executive functions are very important in regulating mobility. In fact, a malfunction of these cognitive skills has been found to be closely related to slow walking and falls in older people. For this reason, it is proposed that cognitive training may improve walking speed and reduce falls in the elderly.

A blind randomized control design was applied to 24 sedentary elders . None of these people exercised more than once a week and walked at a rate of less than one metre per second (<1m/s). They were randomly assigned to the "waiting list" group or the eight-week CogniFit cognitive training program group. The results were divided intospeed during normal walking and in the condition of "walking and speaking simultaneously" . The proportion of people who had improved in each group was also compared. This improvement should consist of a speed change greater than or equal to four centimetres per second (≥4cm/s).

The results showed that cognitive training with CogniFit improves mobility in sedentary elders. This information demonstrates the usefulness of CogniFit's tool for strengthening and stimulating cognitive abilities related to gait.

Context

Mobility problems increase during aging. People with these difficulties tend to socialize for a shorter period of time, enjoy a lower quality of life, and have higher rates of morbidity and mortality. There is ample scientific evidence about the benefits of physical exercise, such as walking, to prevent mobility problems. Despite this, half of the seniors tend to drop out of physical exercise programs in the first three to six months. This explains the need to explore other approaches to improve the mobility of this population .

People's behavior, such as walking (gait), is regulated by a range of cognitive abilities, such as attention and executive functions. These allow us to adapt to changing situations, anticipate results and provide the resources to carry out more than one activity at the same time. All of this is necessary for a correct gait. In fact, attention problems and in executive functions are associated with falls and a slow gait.

Some studies have found that medication therapy for these cognitive abilities has a positive effect on gait. On the other hand, it has been shown that cognitive training programs can improve both attention and executive functions. Despite this, it has not been studied how cognitive training affects gait, which could be a good complement to prevent mobility problems.

CogniFit is an online tool of evaluation and cognitive training that has proven its validity to measure and stimulate different cognitive abilities, such as attention and executive functions. The simplicity of the design means that CogniFit can be used by young and old alike. For these reasons, it is the ideal tool to carry out this study.

Therefore, the objective of this study is to discover how CogniFit's computerized cognitive training can affect normal walking speed and the ability to walk and talk at the same time.

Methodology

Recruitment and design

To conduct the study, a randomized blind control design was chosen divided into two groups: the experimental "Cognitive Training" group and the "Waiting List" control group.

Letters were initially sent to people aged 70 or older explaining the purpose of the study. After this, potential participants were contacted by phone. Once verbal consent was given, a small interview was conducted to determine whether they met the inclusion criteria for the study. The 45 people who fit the study criteria were invited to the research center for more precise testing.

In-person testing consisted of a cognitive assessment with the MMSE (Mini-Mental State Examination) and a gait assessment. In this process, 21 participants were eliminated for failing to meet the inclusion criteria:

• Be 70 years of age or older.
• Availability and commitment to complete the study.
• Be sedentary (exercise once a week or less).
• Slow gait (<1.0m/s).
• Absence of dementia ( no clinical diagnosis of dementia, with a ≥5 score on phone screening and a ≥25 score on the MMSE).
• Ability to move independently (walk).
• Have not been hospitalized in the last three months for severe illness, surgery, and no history of serious neurological or psychiatric illness.
• Not participating in any other studies.

The 24 people meeting these criteria were divided equally into the two groups in a randomized fashion. All of them gave written consent. In addition, they did not receive any financial contribution but were provided with transportation to attend all sessions.

Experimental Group or Cognitive Training

In the experimental group, the first training session consisted of explaining to the participants the basics of how to use the computer, as only 2 out of 12 people used the computer regularly. The initial evaluation of CogniFit, which lasts approximately 45 minutes, was started. This evaluation allows the tool to adjust the difficulty of the tasks according to their weak or strong points. Computerized training sessions consisted of two CogniFit training cycles . Each training cycle lasted 15-20 minutes and consisted of three tasks. They did cognitive training for 45-60 minutes three times a week for 8 weeks (72 sessions in total) with at least one rest day between each session. Participants attended 99.2% of the sessions.

Control Group o Waiting List

Participants in the control group were told that they were on a waiting list for a future study, they were unaware of the experimental group's existence. They attended an initial health education session highlighting the benefits of physical exercise. To maintain interest and adherence to the experiment, they were contacted by phone and asked if they exercised, although they did not receive any treatment from home.

Variables measured:

The person who undertook the previous assessments and after eight weeks of cognitive intervention they did not know which group each participant belonged to. Their gait speed was measured using a computerized gateway (GAITRite). All participants were asked to take a walk on a carpet with comfortable shoes and in a quiet, well-lit corridor.

Other variables:

• At the end of the eight-week intervention, the MMSE was re-applied.
• In the experimental group, the processing speed was also measured in order to measure the learning effect and the transference of the cognitive processes trained.
• The participants' self-reports on the presence of relevant diseases were used to calculate a morbidity rate.
• Finally, all participants were given a physical activity quiz to quantify the amount of time they had spent on moderate exercise over the past week.

Analysis:

• All analyses were performed using SAS 9.1.
• To compare demographic characteristics and other baseline information between the two groups and within each group, descriptive statistics were used.
• The differences between the means of the gait speed before and after treatment, both in normal gait and in speech and walking simultaneously, were tested using mixed linear models.
• A mixed linear model was also used to compare changes in the processing speed of the experimental group after the intervention.
• All models were adjusted for age and sex.

Results and Conclusions

The study results indicated that the gait speed of experimental group participants (with cognitive training) in both conditions (normal walking and walking while talking) was greater after the intervention than in the initial assessment. In addition, the gait speed was higher in participants in the experimental group than in the control group.

Therefore, we can affirm that CogniFit cognitive training can improve mobility in sedentary elders . This opens a very important intervention door to reduce mobility problems in seniors. This type of intervention could help prevent mobility problems, avoiding deterioration in the quality of life of seniors who do not manage to carry out prevention programs through physical exercise.