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Can leisure activities slow dementia progression in nursing home residents? A cluster-randomized controlled trial

Published online by Cambridge University Press:  10 January 2014

Sheung-Tak Cheng*
Affiliation:
Department of Psychological Studies, Hong Kong Institute of Education, Hong Kong Center for Psychosocial Health and Aging, Hong Kong Institute of Education, Hong Kong
Pizza K. Chow
Affiliation:
Department of Psychological Studies, Hong Kong Institute of Education, Hong Kong
You-Qiang Song
Affiliation:
Department of Biochemistry, University of Hong Kong, Hong Kong
Edwin C. S. Yu
Affiliation:
Department of Psychogeriatrics, Kwai Chung Hospital, Hong Kong
John H. M. Lam
Affiliation:
Department of Psychological Studies, Hong Kong Institute of Education, Hong Kong
*
Correspondence should be addressed to: Sheung-Tak Cheng, Department of Psychological Studies, Hong Kong Institute of Education, 10 Lo Ping Road, Tai Po, N.T., Hong Kong. Phone: +852 2948 6563; Fax: +852 2948 7702. Email: [email protected].

Abstract

Background:

To examine the effects of complex cognitive (mahjong) and physical (Tai Chi) activities on dementia severity in nursing home residents with dementia.

Methods:

Cluster-randomized open-label controlled design. 110 residents were randomized by nursing home into three conditions: mahjong, Tai Chi, and simple handicrafts (control). Activities were conducted three times a week for 12 weeks. Clinical Dementia Rating (CDR) was taken at 0 (baseline), 3 (post-treatment), 6, and 9 months. The outcome measure was CDR sum-of-box, which is a composite measure of both cognitive and functional deterioration in dementia.

Results:

Intent-to-treat analyses were performed using multilevel regression models. Apolipoprotein E ε4 allele and education were included as covariates. Neither treatments had effects on the cognitive and functional components of the CDR, but mahjong had a significant interaction with time on the CDR sum-of-box total, suggesting a slower rate of global deterioration in the mahjong group as compared with the control group.

Conclusions:

Mahjong led to a gradual improvement in global functioning and a slightly slower rate of dementia progression over time. The effect was generalized and was not specific to cognition or daily functioning.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

Andel, R., Vigen, C., Mack, W. J., Clark, L. J. and Gatz, M. (2006). The effect of education and occupational complexity on rate of cognitive decline in Alzheimer's patients. Journal of the International Neuropsychological Society, 12, 147152. doi:10.1017/S1355617706060206.CrossRefGoogle ScholarPubMed
Berg, L. et al. (1988). Mild senile dementia of the Alzheimer type: 2. Longitudinal assessment. Annals of Neurology, 23, 477484.CrossRefGoogle ScholarPubMed
Bruandet, A. et al. (2008). Cognitive decline and survival in Alzheimer's disease according to education level. Dementia and Geriatric Cognitive Disorders, 25, 7480. doi:10.1159/000111693.CrossRefGoogle ScholarPubMed
Cedarbaum, J. M. et al. (2013). Rationale for use of the Clinical Dementia Rating Sum of Boxes as a primary outcome measure for Alzheimer's disease clinical trials. Alzheimer's & Dementia, 9, S4555. doi:10.1016/j.jalz.2011.11.002.CrossRefGoogle ScholarPubMed
Cheng, S. T. et al. (2014). Mental and physical activities delay cognitive decline in older persons with dementia. American Journal of Geriatric Psychiatry, 22, 6374. doi:10.1016/j.jagp.2013.01.060.CrossRefGoogle ScholarPubMed
Chung, J. C. C. (2004). Activity participation and well-being of people with dementia in long-term-care settings. OTJR: Occupation, Participation and Health, 24, 2231.Google Scholar
Coley, N., Andrieu, S., Jaros, M., Weiner, M., Cedarbaum, J. and Vellas, B. (2011). Suitability of the Clinical Dementia Rating-Sum of Boxes as a single primary endpoint for Alzheimer's disease trials. Alzheimer's & Dementia, 7, 602610. doi:10.1016/j.jalz.2011.01.005.CrossRefGoogle ScholarPubMed
Cummings, J. L. (1997). The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 48, S1016. doi:10.1016/S0140-6736(05)67889-0.CrossRefGoogle ScholarPubMed
Farina, N., Rusted, J. and Tabet, N. (2014). The effect of exercise interventions on cognitive outcome in Alzheimer's disease: a systematic review. International Psychogeriatrics, 26, 918.CrossRefGoogle ScholarPubMed
Fitzmaurice, G. M., Laird, N. M. and Ware, J. H. (2011). Applied Longitudinal Analysis. Hoboken, NJ: Wiley.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198. doi:10.1016/0022-3956(75)90026-6.CrossRefGoogle ScholarPubMed
Fratiglioni, L. and Wang, H. (2007). Brain reserve hypothesis in dementia. Journal of Alzheimer's Disease, 12, 1122.CrossRefGoogle ScholarPubMed
Heo, M. and Leon, A. C. (2009). Sample size requirements to detect an intervention by time interaction in longitudinal cluster randomized clinical trials. Statistics in Medicine, 28, 10171027.CrossRefGoogle ScholarPubMed
Hertzog, C., Kramer, A. F., Wilson, R. S. and Lindenberger, U. (2008). Enrichment effects on adult cognitive development: can the functional capacity of older adults be preserved and enhanced? Psychological Science in the Public Interest, 9, 165.CrossRefGoogle ScholarPubMed
Klusmann, V. et al. (2010). Complex mental and physical activity in older women and cognitive performance: a 6-month randomized controlled trial. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 65A, 680688. doi:10.1093/gerona/glq053.CrossRefGoogle Scholar
Kurz, A., Clare, L. and Lautenschlager, N. T. (2013). Add life to years: psychosocial interventions for people with cognitive disorders. International Psychogeriatrics, 25, 13891391. doi:10.1017/S1041610213000938.CrossRefGoogle ScholarPubMed
Lam, L. C. W. et al. (2011). Interim follow-up of a randomized controlled trial comparing Chinese style mind body (Tai Chi) and stretching exercises on cognitive function in subjects at risk of progressive cognitive decline. International Journal of Geriatric Psychiatry, 26, 733740. doi:10.1002/gps.2602.CrossRefGoogle ScholarPubMed
Lam, L. C. W. et al. (2012). A 1-year randomized controlled trial comparing mind body exercise (Tai Chi) with stretching and toning exercise on cognitive function in older Chinese adults at risk of cognitive decline. Journal of the American Medical Directors Association, 13, 568.e15–568.e20. doi:10.1016/j.jamda.2012.03.008.CrossRefGoogle ScholarPubMed
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 24122414.CrossRefGoogle ScholarPubMed
Murray, D. M., Blitstein, J. L., Hannan, P. J., Baker, W. L. and Lytle, L. A. (2007). Sizing a trial to alter the trajectory of health behaviours: methods, parameter estimates, and their application. Statistics in Medicine, 26, 22972316.CrossRefGoogle ScholarPubMed
O'Bryant, S. E. et al. (2010). Validation of the new interpretive guidelines for the Clinical Dementia Rating Scale Sum of Boxes score in the National Alzheimer's Coordinating Center database. Archives of Neurology, 67, 746749. doi:10.1001/archneurol.2010.115.Google ScholarPubMed
Rossetti, H. C., Cullum, C. M., Hynan, L. S. and Lacritz, L. H. (2010). The CERAD neuropsychiatric battery total score and the progression of Alzheimer disease. Alzheimer Disease and Associated Disorders, 24, 138142. doi:10.1097/WAD.0b013e3181b76415.CrossRefGoogle Scholar
Schreiner, A. S., Yamamoto, E. and Shiotani, H. (2005). Positive affect among nursing home residents with Alzheimer's dementia: the effect of recreational activity. Aging & Mental Health, 9, 129134.CrossRefGoogle ScholarPubMed
Seitz, D., Purandare, N. and Conn, D. (2010). Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review. International Psychogeriatrics, 22, 10251039. doi:10.1017/S1041610210000608.CrossRefGoogle ScholarPubMed
Volkers, K. M. and Scherder, E. J. A. (2011). Impoverished environment, cognition, aging and dementia. Reviews in the Neurosciences, 22, 259266. doi:10.1515/RNS.2011.026.CrossRefGoogle ScholarPubMed