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FOTO Rehab Outcomes Blog

Motor-Cognitive Dual-Task Training in Patients with Dementia

If your patient happens to have mild to moderate dementia, is it possible to have an effect on the motor and cognitive functional ability?

motor-cognitive-dual-task-dementia

Clinically, I specialize in working with older adults. Quite a few of them have some level of dementia. I always wonder if there is a way to impact the dementia aspect because cognition is so important for safe function in daily life.

What I really need to truly address this study is full text access. How helpful is walking and counting with regard to transferability? Transfering to what? 

From my perspective, I like to incorporate dual task activities with a cognitive component because it challenges the motor performance. If the patient is thinking about X while doing Y and nailing Y with pretty good performance, then I know their body has learned the motor activity.

Other times, there seem to be patients who have little ability to perform a motor-cognitive dual task without totally falling apart with their motor performance. 

I thought this study could have some relevance to clinical practice. It seems that the majority of our treatments may be focused on impairments and not necessarily incorporating the level of complexity that a patient may need - especially if the patient exhibits a bit of dementia.

You'll find the abstract to the recent study below.

Transferability and Sustainability of Motor-Cognitive Dual-Task Training in Patients with Dementia: A Randomized Controlled Trial.

 

Abstract

BACKGROUND:

Specific dual-task (DT) training is effective to improve DT performance in trained tasks in patients with dementia (PwD). However, it remains an open research question whether successfully trained DTs show a transfer effect to untrained DT performances.

OBJECTIVE:

To examine transfer effects and the sustainability of a specific DT training in PwD.

METHODS:

One hundred and five patients with mild-to-moderate dementia (Mini-Mental State Examination: 21.9 ± 2.8 points) participated in a 10-week randomized, controlled trial. The intervention group (IG) underwent a specific DT training ("walking and counting"). The control group (CG) performed unspecific low-intensity exercise. DT performance was measured under three conditions: (1) "walking and counting" (trained); (2) "walking and verbal fluency" (semi-trained), and (3) "strength and verbal fluency" (untrained). Outcomes evaluated at baseline, after training, and 3 months after the intervention period included absolute values for the motor and cognitive performance under DT conditions, and relative DT costs (DTCs) in motor, cognitive and combined motor-cognitive performance.

RESULTS:

The IG significantly improved DT performances in the trained condition for absolute motor and cognitive performance and for motor, cognitive, and combined motor-cognitive DTCs compared to the CG (p ≤ 0.001-0.047; ηp2 = 0.044-0.249). Significant transfer effects were found in the semi-trained condition for absolute motor and partly cognitive performance, and for motor but not for cognitive DTCs, and only partly for combined DTCs (p ≤ 0.001-0.041; ηp2 = 0.049-0.150). No significant transfer effects were found in the untrained condition. Three months after training cessation, DT performance in the trained condition was still elevated for most of the outcomes (p ≤ 0.001-0.038; ηp2 = 0.058-0.187). Training gains in the DT performance in the semi-trained condition were, however, not sustained, and no significant group differences were found in the DT performance in the untrained condition after the follow-up.

CONCLUSION:

This study confirmed that specific DT training is effective in improving specifically trained DT performances in PwD and demonstrated sustainability of training-induced effects for at least 3 months. Effects were partially transferable to semi-trained DTs but not to untrained DTs. With increasing distance between trained and untrained DTs, transferability of training effects decreased.

 2018 Jul 24:1-16. doi: 10.1159/000490852. [Epub ahead of print


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