Longhurst JK1,2, Phan J3, Chen E3, Jackson S3, Landers MR3
1Cleveland Clinic Lou Ruvo Center for Brain Health, Neuro-Rehabilitation, Las Vegas, United States, 2University of Nevada Las Vegas, Interdisciplinary Health Science, Las Vegas, United States, 3University of Nevada Las Vegas, Physical Therapy, Las Vegas, United States
Background: Evidence suggests that individuals with cognitive impairment and dementia exhibit significant motor impairments such as decreased gait and balance function along with increased likelihood of falls; however, these motor impairments typically receive little treatment attention compared to the more prominent cognitive impairments. Moreover, despite substantial evidence in other populations, there is a lack of evidence about physiotherapy in older adults with cognitive impairment.
Purpose: The purpose of this study was to determine if one month of physiotherapy focused on addressing impairment and function is effective at improving gait and balance in individuals with Alzheimer's disease (AD), vascular dementia (VaD), dementia with Lewy bodies (DLB), and mild cognitive impairment (MCI).
Methods: Retrospective data of 173 patients with cognitive impairment conditions (67 with AD, 34 with VaD, 35 with DLB, and 37 with MCI) and an initial evaluation for physiotherapy at the Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA, were extracted from electronic records from January 2016 to December 2017.Physiotherapy consisted of aerobic activity (20-25 minutes), strengthening (15-20 minutes), and balance training (15-20 minutes). Cognitive and motor dual tasking and function training were incorporated into all three parts of the treatment program. Education to patient and caregiver and a simplified home exercise program were also addressed each treatment session. The following pre and 1 month post outcome data were extracted: Montreal Cognitive Assessment (MoCA), miniBESTest (MBT), 5 Times Sit-To-Stand (STS), Timed Up and Go (TUG), TUG cognitive, preferred gait speed (PGS), fast gait speed (FGS), 6 Minute Walk Test (6MWT), and the modified Fear of Falling Avoidance Behavior Questionnaire (FFABQm).
Results: After one month of physiotherapy (mean treatments = 3.4 ± 1.8), all four groups showed significant improvement in at least two of the gait outcome measures. Those with MCI improved statistically in every gait and balance outcome measure. Balance was significantly improved in each group of cognitive impairment with all groups improving in both MBT and STS, except VaD which only improved in MBT. Lastly, MoCA scores significantly improved in patients in the AD, VaD, and MCI groups. Only the AD group improved in the FFABQm.
Conclusion(s): Results of this retrospective study suggest that one month of physiotherapy addressing mobility impairment and function may be a viable intervention for patients with cognitive impairment. These results also suggest that treating mobility impairments may afford cognitive benefits, as all but the DLB group improved their MoCA scores. Future research using more rigorous designs is warranted.
Implications: These results, coupled with findings from other studies, suggest that physiotherapy may be beneficial for those with cognitive impairment.
Keywords: Dementia, Exercise, cognition
Funding acknowledgements: none
Purpose: The purpose of this study was to determine if one month of physiotherapy focused on addressing impairment and function is effective at improving gait and balance in individuals with Alzheimer's disease (AD), vascular dementia (VaD), dementia with Lewy bodies (DLB), and mild cognitive impairment (MCI).
Methods: Retrospective data of 173 patients with cognitive impairment conditions (67 with AD, 34 with VaD, 35 with DLB, and 37 with MCI) and an initial evaluation for physiotherapy at the Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA, were extracted from electronic records from January 2016 to December 2017.Physiotherapy consisted of aerobic activity (20-25 minutes), strengthening (15-20 minutes), and balance training (15-20 minutes). Cognitive and motor dual tasking and function training were incorporated into all three parts of the treatment program. Education to patient and caregiver and a simplified home exercise program were also addressed each treatment session. The following pre and 1 month post outcome data were extracted: Montreal Cognitive Assessment (MoCA), miniBESTest (MBT), 5 Times Sit-To-Stand (STS), Timed Up and Go (TUG), TUG cognitive, preferred gait speed (PGS), fast gait speed (FGS), 6 Minute Walk Test (6MWT), and the modified Fear of Falling Avoidance Behavior Questionnaire (FFABQm).
Results: After one month of physiotherapy (mean treatments = 3.4 ± 1.8), all four groups showed significant improvement in at least two of the gait outcome measures. Those with MCI improved statistically in every gait and balance outcome measure. Balance was significantly improved in each group of cognitive impairment with all groups improving in both MBT and STS, except VaD which only improved in MBT. Lastly, MoCA scores significantly improved in patients in the AD, VaD, and MCI groups. Only the AD group improved in the FFABQm.
Conclusion(s): Results of this retrospective study suggest that one month of physiotherapy addressing mobility impairment and function may be a viable intervention for patients with cognitive impairment. These results also suggest that treating mobility impairments may afford cognitive benefits, as all but the DLB group improved their MoCA scores. Future research using more rigorous designs is warranted.
Implications: These results, coupled with findings from other studies, suggest that physiotherapy may be beneficial for those with cognitive impairment.
Keywords: Dementia, Exercise, cognition
Funding acknowledgements: none
Topic: Neurology; Older people
Ethics approval required: Yes
Institution: Cleveland Clinic
Ethics committee: Institutional Review Board
Ethics number: 16-101
All authors, affiliations and abstracts have been published as submitted.
