The Latest Articles on Rehabilitation in Dementia

Our staff editors continue to share exciting, interesting, and thought-provoking reading material in the recommended articles series.

This week, we would like to share several latest articles on Rehabilitation in Dementia.

Title: Family caregivers' satisfaction with telerehabilitation and follow-up intervention for older people with dementia: Randomized clinical trial
Authors: Renata Carolina Gerassi MS, Larissa Pires de Andrade Ph.D, Carolina Tsen Ph.D student, Ana Beatriz Simões Pereira bachelor in Gerontology, Graziele Norberto Pereira bachelor in Gerontology, Jéssica Bianca Aily Ph.D, Grace Angélica de Oliveira Gomes Ph.D, Juliana Hotta Ansai Ph.D
Type: Research Article
Abstract:

The present study aimed to assess caregiver satisfaction with a telerehabilitation program and remote monitoring for older adults with dementia and their caregivers during the COVID-19 pandemic, as well as to identify the factors influencing caregiver satisfaction. This study adopted a mixed-methods approach and was part of a randomized clinical trial, with blinded assessors, comprising two groups: the Intervention Group (IG) receiving a telerehabilitation program involving standardized physical exercises for older adults with dementia, along with caregiver guidelines for the caregiver; and the Control Group (CG) receiving remote monitoring. At baseline, factors related to older adults with dementia and their caregivers were measured. After 12 weeks, caregiver satisfaction with the interventions was assessed. The final sample consisted of 64 pairs of family caregivers and older people with dementia. Caregivers in the IG showed higher satisfaction levels with the intervention, Internet-based treatment, and healthcare received compared to caregivers in the CG. Both groups expressed positive views towards the treatment, with excellent ratings for audio and video quality, and a preference for Internet-based treatment over face-to-face. In the IG, only the amount of time dedicated to caregiving influenced satisfaction with the intervention, whereas in the CG, cognitive and functional performance of the older people influenced satisfaction with remote monitoring. Our findings suggest the potential of the program in providing effective care for older people with dementia and their caregivers.
Access this article: https://doi.org/10.1016/j.gerinurse.2023.08.011

Title: Balance-based exercise programs on balance in older adults with mild to moderate dementia: A critically appraised topic
Authors: Ella R. Lenox, Michael W. Jones
Type: Review
Abstract:

Objective
It is well established that exercise programs including balanced-based exercises are practical and beneficial for cognitively healthy older adults. However, there is limited evidence to determine if these types of training regimens are effective for individuals with dementia. We conducted a critical appraisal to determine if the addition of balance-based exercise programs, compared with usual care at residential homes, improved balance in adults diagnosed with mild to moderate dementia.

Materials and methods
Four databases were searched for randomized control trials implementing balanced-based exercise programs with individuals diagnosed with mild to moderate dementia. The articles were evaluated based on the Centre for Evidence Based Medicine level of evidence criteria and appraised using the PEDro scale.

Results
A comprehensive literature search revealed four studies relevant to the clinical question that fit the inclusion and exclusion criteria. All four studies indicated an improvement in balance following a weekly physical therapy program implementing balance-based exercises.

Conclusions
There is sufficient evidence to suggest that the use of physical therapy programs that include balance-based exercises, performed 1–2 times a week over the course of 12–25 weeks, improves balance in elderly adults with mild to moderate dementia.
Access this article: https://doi.org/10.1016/j.arr.2023.102073

Title: Experiences of Families, Staff, Volunteers, and Administrators With Namaste Care for Persons With Advanced Dementia in Canadian Long-Term Care Homes
Authors: Marie-Lee Yous PhD, Paulette V. Hunter PhD, Esther Coker PhD, Kathryn A. Fisher PhD, Maria Nicula MSc, Nadia Kazmie MSc, Vanina Dal Bello-Haas PhD, Thomas Hadjistavropoulos PhD, Carrie McAiney PhD, Genevieve Thompson PhD, Sharon Kaasalainen PhD
Type: Short communication
Abstract:

Objective
To explore the experiences of the Namaste Care intervention for persons with advanced dementia (ie, moderate and late-stage) in long-term care (LTC).

Design
A qualitative descriptive design was used. Staff Carers (eg, personal support worker, nurse, or activity aide) delivered Namaste Care with the support of volunteers in a small group. Activities provided during the Namaste Care sessions to enhance quality of life included massages, aromatherapy, music, and snacks/beverages.

Setting and Participants
Family carers of residents with advanced dementia, LTC staff, administrators, and volunteers from 2 Canadian LTC homes, located in a midsize metropolitan area, were included.

Methods
Experiences and acceptability of Namaste Care was assessed through semistructured interviews ranging from 30 to 60 minutes following the 6-month study duration period with family carers, LTC staff, administrators, and volunteers. Thematic analysis was used for interview transcripts.

Results
A total of 16 family carers and 21 LTC staff, administrators, and volunteers participated in the study. Namaste Care was found to be acceptable and successful in enhancing the quality of life of residents due to collaborative efforts of all group of participants. Families, volunteers, and staff noted positive responses in residents, such as smiling and laughing. The program environment supported the development of relationships within the LTC community, which included families, residents, staff, and volunteers.

Conclusions and Implications
Namaste Care was perceived by the LTC community as an acceptable intervention for persons with advanced dementia. It was perceived as offering multiple benefits for residents with advanced dementia such as improved communication and mood.
Access this article: https://doi.org/10.1016/j.jamda.2023.08.012

Title: Effects of Exercise Training Under Hypoxia versus Normoxia on Cognitive Function in Clinical and Non-Clinical Populations: A Systematic Review and Meta-analysis
Authors: Yanting Lin MS, Jiamin Yan MS, Xiaoqin Guo MS, Huawei Lin PhD, Chendong Ruan MS, Yaling Dai PhD, Sinuo Wang MS, Yajun Cao MS, Qing Xiang PhD, Minguang Yang PhD, Weilin Liu PhD, Lidian Chen MD, PhD
Type: Review
Abstract:

Objective
To compare the effects of exercise training under hypoxia versus normoxia on cognitive function in clinical and non-clinical populations.

Data Sources
From inception to June 13th, 2022, a systematic search was performed on PubMed, Web of Science, Embase, Scopus, and Cochrane Central Register of Controlled Trials.

Study Selection
Randomized controlled trials comparing the effects of exercise under hypoxic vs normoxic on cognition in clinical and non-clinical populations were included. The systematic search generated 14,894 relevant studies, of which 12 were finally included.

Data Extraction
Two reviewers independently extracted data from included studies. Results were expressed as standardized mean difference (SMD). Each included study was assessed using the Cochrane Risk of Bias 1.0 (RoB1.0) tool. Finally, the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to rate the certainty of evidence for each outcome.

Data Synthesis
Overall, 12 studies with a total of 338 participants met the inclusion criteria. The pooled results suggested that hypoxia exercise had a small but not statistically significant positive effect on overall cognitive function (SMD=0.064, 95% confidence interval (CI): -0.156-0.284, P=.567, very low-certainty evidence), when compared with normoxic exercise. Regarding the domain-specific cognitive functions, there was a medium and significant positive effect on memory (SMD=0.594, 95% CI: 0.068 to 1.120, P=.027, very low-certainty evidence), while effects on visuospatial function (SMD=0.490, 95% CI: -0.030 to 1.010, P=.065, very low-certainty evidence), attention (SMD=0.037, 95% CI: -0.340 to 0.414, P=.847, very low-certainty evidence), executive function (SMD=0.096, 95% CI: -0.268 to 0.460, P=.605, very low-certainty evidence), and processing speed (SMD=-0.145, 95% CI: -0.528 to 0.239, P=.459, very low-certainty evidence) were not statistically significant.

Conclusions
The current pooled results revealed that hypoxic exercise was related to improved cognitive performance. Nevertheless, exercise under hypoxia did not have a significant advantage in cognitive promotion when compared with exercise under normoxia.
Access this article: https://doi.org/10.1016/j.apmr.2023.08.009

Title: Restless legs syndrome: From clinic to personalized medicine
Authors: S. Chenini, L. Barateau, Y. Dauvilliers
Type: Review

Abstract:

Restless legs syndrome (RLS) is a common neurological sensorimotor disorder that impairs sleep, mood and quality of life. RLS is defined by an urge to move the legs at rest that increases in the evening and at night, and is frequently associated with metabolic and cardiovascular diseases. Symptoms frequency, age at RLS onset, severity, familial history and consequences of RLS vary widely between patients. A genetic susceptibility, iron deficiency, dopamine deregulation, and possible hypo-adenosinergic state may play a role in the pathophysiology of RLS. Polysomnographic recordings found often periodic leg movements during sleep and wakefulness in patients with RLS. RLS can be classified as primary or comorbid with major diseases: iron deficiency, renal, neurological, rheumatological and lung diseases. First-line treatments are low-dose dopamine agonists, and alpha-2-delta ligands depending on the clinical context, and second/third line opiates for pharmacoresistant forms of RLS. Augmentation syndrome is a serious complication of dopamine agonists and should be prevented by using the recommended low dose. Despite an increase in knowledge, RLS is still underdiagnosed, poorly recognized, resulting in substantial individual health burden and socioeconomic coast, and education is urgently needed to increase awareness of this disabling disorder.

Title: Combined exercise and cognitive interventions for adults with mild cognitive impairment and dementia: A systematic review and network meta-analysis
Authors: Dandan Xue, Polly W.C. Li, Doris S.F. Yu, Rose S.Y. Lin
Type: Review
Abstract:

Backgrounde
Exercise and cognitive interventions are beneficial for adults with preclinical and clinical dementia, but it is unclear whether the combination of these two components could generate synergistic benefits and what intervention designs would optimize this effect.

Objectives
This review aims to compare the effects of combined exercise and cognitive interventions on cognitive, psychological, functional outcomes, and health-related quality of life with the corresponding single approach and control groups in adults with mild cognitive impairment and dementia. It also aims to identify the optimal intervention design and factors affecting treatment effects.

Methods
A comprehensive search was conducted in ten databases from inception to 23rd November 2022. The methodological quality of studies was evaluated by the Cochrane risk of bias tool. Pairwise meta-analyses were performed to assess the effects of combined interventions relative to the single type of intervention and control groups, with further subgroup analysis to explore the factors affecting treatment effects. Network meta-analyses were used to identify the optimal intervention components.

Results
Twenty-nine randomized controlled trials involving 2910 participants were included. The results of pairwise meta-analyses indicated that combined interventions were superior to exercise in improving response inhibition, working memory, and delayed recall, but were not superior to cognitive interventions in all outcomes. Combined interventions were superior to active/passive controls in improving global cognition, response inhibition, immediate recall, delayed recall, category fluency, processing speed, and visuospatial ability. Influences of the clinical severity of dementia (mild cognitive impairment vs dementia), combination format (sequential vs simultaneous combination), mode of delivery (group-based vs individual-based vs mixed), training duration (short: ≤ 12 weeks vs medium: 13–24 weeks vs long: > 24 weeks), and types of control (active vs passive control) were not detected. The network meta-analysis results indicated that the optimal intervention components varied across different outcomes, with multimodal exercise combining cognitive training demonstrated the greatest effects among all other combined or single component interventions in improving global cognition.

Conclusions
This review suggests the advantage of combined interventions over exercise with comparable effects when compared with cognitive interventions in the population with mild cognitive impairment and dementia. Full scale multi-arm randomized controlled trials to compare the effects of combined interventions with cognitive interventions are warranted.
Access this article: https://doi.org/10.1016/j.ijnurstu.2023.104592