EFFECTIVENESS OF MENTAL IMAGERY ON QUALITY OF LIFE, MOTOR, COGNITIVE, EMOTIONAL STATUS OF OLDER PEOPLE WITH EARLY STAGE OF DEMENTIA

To assess the effects of MI on the quality of life, motor, cognitive and emotional status of older adults with early stage of dementia.

The present RCT consisted of 160 participants. The sample from Marousi Day Care Center Alzheimer Athens Association was randomized to: (a) MI and exercise group (intervention group-IG), (b) only exercise group (1^st control group) and (c) neither MI nor exercise group (2^nd control group). Participants received 24 physiotherapy sessions, lasting 45 minutes each, twice a week for 12 weeks. The exercises were selected from Otago Exercise Program. Three assessments were performed: (a) 1week prior to the program, (b) one and a half months and (c) after the program. The intervention group performed a 30-minute MI with exercise program content after the end of every physiotherapy exercise session. Multidirectional Reach Test (Reach in Four Directions Test), Five Times Sit-to-Stand Test (FTSST), Timed Up and Go test (TUG), Functional Gait Assessment (FGA), Walking While Talking Test (WWITT), Short-Form of Geriatric Depression Scale (SF-GDS), Short Anxiety Screening Test (SAST) and the Euro-Qol 5-Dimensions 5-Level of severity scale (Euro-Qol 5D-5L scale) were used to assess balance, functional status, cognitive status, emotional status and quality of life.

160 participants (43 men, 117 women, MMSE M=23.20, SD=0.15) had higher education (n=77) and had loss of memory as the 1^st symptom (n= 117). The participants were randomly divided into the intervention (n=55), the 1^st  group (n=52) and the 2^nd control group (n=53). One-way ANOVA showed the homogeneity of groups. Kolmogorov-Smirnov tests determined the non-parametric data for some variables and inverse transformation were performed. In the intention to treat analysis (18 participants were dropped out), the 3x3 repeated measures ANOVA indicated significant results between the 3 groups on (a) the TUG (F=3,06, df (2), p=0.04), (b) the FTSST (F=3.00, df (2), p=0.05), (c) the Multiforward direction test (F=4.14 df (2), p=0.02), the lateral right and the lateral left direction tests (F=3,90, df (2), p=0.02, and F=7.87, df (2), p=0.00), respectively, (d) the FGA (F=4.35, df (2), p=0.01). Friedman test showed significant results between the 3 groups on (a) BBT (X²=7.62, df=2, p=0.22), (b) quality of life (X²=11.87, df=2, p=0.00), (c) Depression (X²=6.54, df=2, p=0.38), (d) Anxiety (X²=39.90 df=2, p=0.00), (e) WWITTnumber mistakes (X²=14.94, df=2, p=0.00). Medium values of the effect size of partial η² coefficient for F-tests were found. Post-hoc comparisons using Bonferroni test and Wilcoxon test indicated that the mean scores for the IG and the 1^st control was significantly better from the 2^rd control group in many dependent variables.

The study showed a positive effect of MI on balance, functional and emotional status, cognitive ability and quality of life of older adults with early stage of dementia.

Examining the processes of MI in dementia may help physiotherapists to integrate MI into the rehabilitation program, contributing more to subjects’ mobility and cognitive status.