Document Type : Research Paper
Authors
Abstract
The purpose of this study was to evaluate the effectiveness of cognitive motor training on improvement of cognition, balance and gait which has already introduced as risk factors of falling. Three month motor cognitive intervention with two month follow up was applied on 40 elderly divided into two groups: elderly with dementia (20) and cognitively healthy elderly (20). Half of this sample were males and the other half were females. Evaluations included fall risk factors (gait, balance and cognitive state), as well as falling parameters and functional indexes. Subjects had significant improvement in different parameters of cognition, balance and gait after intervention which was maintained in 2 month follow up. These improvements was followed by decreased rate of fall, fear of fall and also enhanced performance in TUG and FR (P<0/05). There was also moderate correlation between a balance parameter (sway distance of COP in AP axis) and fall history in dementia group (r=0/75, p<0/05). Findings demonstrated significant decrease in fall risk among this vulnerable population due to improvement of fall risk factors after intervention. The improvements in these factors were along with less fall rates reported by both nurses and participants. This study can help to develop a new approach to prevention and coping with fall risk in elderly with cognitive impairment.
Keywords
Main Subjects
1. Huang H C, Gau M L, Lin W C, George K. Assessing risk of falling in older adults. Public Health Nursing. 2003; 20(5): 399-411.
2. Vazini Taher A, Khalil Ahmadi M, PakZamir F. Effects of multi-sensory stimulation on cognition function, depression, anxiety and quality of life in elderly persons with dementia. International Journal of Sport Studies. 2015; 5(3): 355-60.
3. Baars B J, Gage N M. Cognition, brain, and consciousness: Introduction to cognitive neuroscience. Academic Press; 2010. P. 128-31.
4. Aghdasi M T, Vazini Taher A, PakZamir F, Rahmani M. Improvement in the quality of life between older adult men with dementia through multi-sensory stimulation and group yoga exercise. Sport Psychology Researches. 2013; 2(4): 1-12.
5. Muir S W, Gopaul K, Odasso M M M. The role of cognitive impairment in fall risk among older adults: A systematic review and meta-analysis. Age Ageing. 2012; 41(3): 299-308.
6. Lamb S, Jorstad-Stein E, Hauer K, Becker C. Prevention of falls network Europe and outcomes consensus group. Development of a common outcome data set for fall injury prevention trials: The prevention of falls network Europe consensus. Journal of the American Geriatrics Society. 2005; 53(9): 1618-22.
7. Tinetti M E, Gordon C, Sogolow E, Lapin P, Bradley E H. Fall-risk evaluation and management: Challenges in adopting geriatric care practices. The Gerontologist. 2006; 46(6): 717-25.
8. Marigold D S, Patla A E. Age-related changes in gait for multi-surface terrain. Gait Posture. 2008; 27(4): 689-96.
9. Van Schoor N M, Smit J H, Pluijm S M, Jonker C, Lips P. Different cognitive functions in relation to falls among older persons: Immediate memory as an independent risk factor for falls. Journal of Clinical Epidemiology. 2002; 55(9):855-62.
10. Vassallo M, Mallela S K, Williams A, Kwan J, Allen S, Sharma J C. Fall risk factors in elderly patients with cognitive impairment on rehabilitation wards. Geriatrics & Gerontology International. 2009; 9(1): 41-6.
11. Mirelman A, Maidan I, Herman T, Deutsch J E, Giladi N, Hausdorff J M. Virtual reality for gait training: Can it induce motor learning to enhance complex walking and reduce fall risk in patients with Parkinson's disease? The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2011; 201.
12. Nagamatsu L S, Voss M, Neider M B, Gaspar J G, Handy T C, Kramer A F, et al. Increased cognitive load leads to impaired mobility decisions in seniors at risk for falls. Psychology and Aging. 2011; 26(2): 253.
13. Segev-Jacubovski O, Herman T, Yogev-Seligmann G, Mirelman A, Giladi N, Hausdorff J M. The interplay between gait, falls and cognition: can cognitive therapy reduce fall risk? Expert Review of Neurotherapeutics. 2011; 11(7): 1057–75.
14. Shaw F E, Bond J, Richardson D A, Dawson P, Steen I N, McKeith I G, et al. Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: Randomised controlled trial. British Medical Journal (BMJ). 2003; 326(7380): 73.
15. Theill N, Schumacher V, Adelsberger R, Martin M, Jäncke L. Effects of simultaneously performed cognitive and physical training in older adults. BMC Neuroscience. 2013; 14(1): 103.
16. Olazaran J, Muniz R, Reisberg B, Peña-Casanova J, Del Ser T, Cruz-Jentoft A, et al. Benefits of cognitive-motor intervention in MCI and mild to moderate Alzheimer disease. Neurology. 2004; 63(12): 2348-53.
17. Draganski B, Gaser C, Busch V, Schuierer G, Bogdahn U, May A. Neuroplasticity: Changes in grey matter induced by training. Nature. 2004; 427(6972): 311-2.
18. Michael Y L, Whitlock E P, Lin J S, Fu R, O’Connor E A, Gold R. Primary care-relevant interventions to prevent falling in older adults: A systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2010; 153: 815–25.
19. de Vries, Oscar J, Petra J M Elders, Majon Muller, Dirk L. Knol, Sven A. et.al. Multifactorial intervention to reduce falls in older people at high risk of recurrent falls: A randomized controlled trial. Archives of Internal Medicine. 2010; 170(13): 1110-17.
20. Pietrzak, Eva, Cristina Cotea, and Stephen Pullman. Using commercial video games for falls prevention in older adults: The way for the future? Journal of Geriatric Physical Therapy. 2014; 37(4): 166-77.
21. van Diest M, Lamoth C, Stegenga J, Verkerke G, Postema K. Exergaming for balance training of elderly: State of the art and future developments. Journal of NeuroEngineering and Rehabilitation. 2013; 10(1): 101.
22. Woollacott M, Shumway-Cook A. Attention and the control of posture and gait: A review of an emerging area of research. Gait Posture. 2002; 16: 1–14.
23. Bonaiuto S, Rocca W A, Lippi A, Luciani P, Giannandrea E, Cavarzeran F, et al. Study on the validity of the Hodkinson Abbreviated Mental Test Score (AMTS) in detecting dementia of elderly subjects in appignano (Macerata province), Italy. Archives of Gerontology and Geriatrics. 1992; 15: 75-85.
24. Sarasqueta C, Bergareche A, Arce A, Munain D, Lopez A, Poza J J, et al. The validity of Hodkinson’s Abbreviated Mental Test for dementia screening in Guipuzcoa, Spain. European Journal of Neurology. 2001; 8(5): 435-40.
25. Barnes R F, Raskind M A. DSM-III criteria and the clinical diagnosis of dementia: A nursing home study. Journal of Gerontology. 1981; 36(1): 20-7.
26. de Bruin E D, Reith A, Dörflinger M, Murer K. Feasibility of strength-balance training extended with computer game dancing in older people. Does it affect dual task costs of walking? Journal of Novel Physiotherapy and Physical Rehabilitation. 2011; 1: 104.
27. Zamanzadeh V, Rassouli M, Abbaszadeh A, Alavi-Majd H, Nikanfar A R, Ghahramanian A. Details of content validity and objectifying it in instrument development. Nursing Practice Today. 2014; 1(3): 163-71.
28. Schoene D, Lord S R, Delbaere K, Severino C, Davies T A, Smith S T. A randomized controlled pilot study of home-based step training in older people using videogame technology. PloS One. 2013; 8(3): 57734.
29. Bakhtiyari F, Foroughan M, Fakhrzadeh H, Nazari N, Najafi B, Alizadeh M, et al. Validation of the Persian version of Abbreviated Mental Test (AMT) in elderly residents of Kahrizak charity foundation. Iranian Journal of Diabetes and Metabolism. 2014; 13(6): 487-94.
30. Kempen G I, Todd C J, Van Haastregt J C, Rixt Zijlstra G A, Beyer N, Freiberger E, et al. Cross-cultural validation of the Falls Efficacy Scale International (FES-I) in older people: Results from Germany, the Netherlands and the UK were satisfactory. Disability and Rehabilitation. 2007; 29(2): 155-62.
31. Hauer K, Lamb S E, Jorstad E C, Todd C, Becker C. Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age and Ageing. 2006; 35(1): 5-10.
32. Eggermont L, Swaab D, Luiten P, Scherder E. Exercise, cognition and Alzheimer’s disease: More is not necessarily better. Neuroscience & Biobehavioral Reviews. 2006; 30(4): 652-75.
33. Cotman C W, Engesser-Cesar C. Exercise enhances and protects brain function. Exercise and Sport Sciences Reviews. 2002; 30(2): 75-9.
34. Netz Y, Wu M J, Becker B T, Tenenbaum G. Physical activity and psychological well- being in advanced age: A meta-analysis of interventions studies. Psychology and Aging. 2005; 20(2): 272-84.
35. Vance D, Wadley V, Ball K, Roenker D, Rizzo M. The effects of physical activity and sedentary behavior on cognitive health in older people. J Aging Phys Act. 2005; 13(3): 294-313.
36. Verghese J, Holtzer R, Lipton R B, Wang C. Quantitative gait markers and incident fall risk in older adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2009; 64(8): 896-901.
37. Marquis S, Moore M M, Howieson D B, Sexton G, Payami H, Kaye J A, et al. Independent predictors of cognitive decline in healthy elderly persons. Archives of Neurology. 2002; 59(4): 601-6.
38. Verghese J, Lipton R B, Hall C B, Kuslansky G, Katz M J, Buschke H. Abnormality of gait as a predictor of non-Alzheimer's dementia. New England Journal of Medicine. 2002; 347(22): 1761-8.
39. Tanaka A, Okuzumi H, Kobayashi I, Murai N, Meguro K, Nakamura T. Gait disturbance of patients with vascular and Alzheimer-type dementias. Percept Mot Skills. 1995; 80(3 Pt 1): 735-8.
40. Nutt J G, Marsden C D, Thompson P D. Human walking and higher-level gait disorders, particularly in the elderly. Neurology. 1993; 43(2): 268-79.
)