Thien Tuong Minh Vu

Benefits of Physical Exercise Training on Cognition and Quality of Life in Frail Older Adults

OBJECTIVES Frailty is a state of vulnerability associated with increased risks of fall, hospitalization, cognitive deficits, and psychological distress. Studies with healthy senior suggest that physical exercise can help improve cognition and quality of life. Whether frail older adults can show such benefits remains to be documented. METHOD A total of 83 participants aged 61-89 years were assigned to an exercise-training group (3 times a week for 12 weeks) or a control group (waiting list). Frailty was determined by a complete geriatric examination using specific criteria. Pre- and post-test measures assessed physical capacity, cognitive performance, and quality of life. RESULTS Compared with controls, the intervention group showed significant improvement in physical capacity (functional capacities and physical endurance), cognitive performance (executive functions, processing speed, and working memory), and quality of life (global quality of life, leisure activities, physical capacity, social/family relationships, and physical health). Benefits were overall equivalent between frail and nonfrail participants. DISCUSSION Physical exercise training leads to improved cognitive functioning and psychological well-being in frail older adults.

The multiple dimensions of frailty: physical capacity, cognition, and quality of life.

BACKGROUND Frailty is a complex health state of increased vulnerability associated with adverse outcomes such as disability, falls, hospitalization, and death. Along with physical impairments, cognition and quality of life may be affected in frail older adults. Yet, evidence is still lacking. The aim of this study was to compare frail and non-frail older adults on physical, cognitive, and psychological dimensions. METHODS Thirty-nine frail and 44 non-frail elders were compared on several measures of physical capacity, cognition, and quality of life. Frailty status was based on a geriatric examination and scored using the Modified Physical Performance Test. RESULTS After controlling for demographic and medical characteristics, physical capacity measures (i.e. functional capacities, physical endurance, gait speed, and mobility) were significantly lower in frail participants. Frail participants showed reduced performances in specific cognitive measures of executive functions and processing speed. On the quality of life dimension, frail elders reported poor self-perceptions of physical capacity, cognition, affectivity, housekeeping efficacy, and physical health. CONCLUSION In addition to the reduced physical capacity, frailty might affect selective components of cognition and quality of life. These dimensions should be investigated in intervention programs designed for frail older adults.

Effects of combined physical and cognitive training on fitness and neuropsychological outcomes in healthy older adults.

Purpose Physical exercise and cognitive training have been shown to enhance cognition among older adults. However, few studies have looked at the potential synergetic effects of combining physical and cognitive training in a single study. Prior trials on combined training have led to interesting yet equivocal results. The aim of this study was to examine the effects of combined physical and cognitive interventions on physical fitness and neuropsychological performance in healthy older adults. Methods Seventy-six participants were randomly assigned to one of four training combinations using a 2×2 factorial design. The physical intervention was a mixed aerobic and resistance training program, and the cognitive intervention was a dual-task (DT) training program. Stretching and toning exercises and computer lessons were used as active control conditions. Physical and cognitive measures were collected pre- and postintervention. Results All groups showed equivalent improvements in measures of functional mobility. The aerobic–strength condition led to larger effect size in lower body strength, independently of cognitive training. All groups showed improved speed of processing and inhibition abilities, but only participants who took part in the DT training, independently of physical training, showed increased task-switching abilities. The level of functional mobility after intervention was significantly associated with task-switching abilities. Conclusion Combined training did not yield synergetic effects. However, DT training did lead to transfer effects on executive performance in neuropsychological tests. Both aerobic-resistance training and stretching-toning exercises can improve functional mobility in older adults.

Executive functions, physical fitness and mobility in well-functioning older adults

The objective of this study was to examine the relationships between executive functions, physical fitness and mobility in well-functioning older adults. Forty-eight well functioning older adults (70.5±5.3years old; 20 men, 28 women) were included in this study. Two median splits were conducted based on each individuals performance for the 10MWT and TUG. Comparisons between groups of slower and faster individuals were made with regard to executive functions and physical fitness parameters. A correlational approach was used to assess the association between variables. Between groups comparisons revealed that faster individuals in mobility tests demonstrate better performances in measures of cognitive flexibility (0.68<g<0.90). After including covariates from the medical/social domain, significant correlations were established between faster mobility tests and better cognitive flexibility (TUG: r=0.565; 10MWT: r=0.324). Between groups comparisons also revealed that faster individuals in mobility tests presented higher physical fitness levels (aerobic: 0.49<g<0.77, strength: 0.34<g<1.31). Significant correlations were found between better physical fitness and better cognitive flexibility (strength: r=-0.380; VO2 peak: r=-0.325) even after including age, education, fat-free mass and gender as covariates. These results suggest that the TUG and the 10MWT could potentially help distinguish individuals with poor neuromuscular, aerobic and cognitive flexibility performances.

Physical Functioning Is Associated With Processing Speed and Executive Functions in Community-Dwelling Older Adults

OBJECTIVES The aim of this study was to examine the association between physical functioning and cardiovascular burden on the cognitive performance of community-dwelling older adults. METHOD Ninety-three adults aged 60 and older completed a medical evaluation by a geriatrician, performance-based physical tests, and neuropsychological assessments. Cognitive composite scores (memory, speed, and executive) as well as a physical functioning score were created by averaging standardized z-scores of selected tests. A cardiovascular burden index was also computed by totalling the number of cardiovascular risk factors and diseases. RESULTS Multiple hierarchical regression analyses reveal that higher level of physical functioning was significantly associated with greater processing speed and better executive functions but was not associated with memory performance. These relations were independent of age, sex, and level of education. Cardiovascular burden was not significantly associated with any cognitive domain. DISCUSSION These results suggest that cognition is related to simple performance-based physical tests and highlight the importance of intervention studies aimed at enhancing cognitive and physical functioning in older adults.

Fitness level moderates executive control disruption during exercise regardless of age.

The purpose of this study was to assess the effects of exercise intensity, age, and fitness levels on executive and nonexecutive cognitive tasks during exercise. Participants completed a computerized modified-Stroop task (including denomination, inhibition, and switching conditions) while pedaling on a cycle ergometer at 40%, 60%, and 80% of peak power output (PPO). We showed that a bout of moderate-intensity (60% PPO) to high-intensity (80% PPO) exercise was associated with deleterious performance in the executive component of the computerized modified-Stroop task (i.e., switching condition), especially in lower-fit individuals (p < .01). Age did not have an effect on the relationship between acute cardiovascular exercise and cognition. Acute exercise can momentarily impair executive control equivalently in younger and older adults, but individuals fitness level moderates this relation.

Does Combined Physical and Cognitive Training Improve Dual-Task Balance and Gait Outcomes in Sedentary Older Adults?

Everyday activities like walking and talking can put an older adult at risk for a fall if they have difficulty dividing their attention between motor and cognitive tasks. Training studies have demonstrated that both cognitive and physical training regimens can improve motor and cognitive task performance. Few studies have examined the benefits of combined training (cognitive and physical) and whether or not this type of combined training would transfer to walking or balancing dual-tasks. This study examines the dual-task benefits of combined training in a sample of sedentary older adults. Seventy-two older adults (≥60 years) were randomly assigned to one of four training groups: Aerobic + Cognitive training (CT), Aerobic + Computer lessons (CL), Stretch + CT and Stretch + CL. It was expected that the Aerobic + CT group would demonstrate the largest benefits and that the active placebo control (Stretch + CL) would show the least benefits after training. Walking and standing balance were paired with an auditory n-back with two levels of difficulty (0- and 1-back). Dual-task walking and balance were assessed with: walk speed (m/s), cognitive accuracy (% correct) and several mediolateral sway measures for pre- to post-test improvements. All groups demonstrated improvements in walk speed from pre- (M = 1.33 m/s) to post-test (M = 1.42 m/s, p < 0.001) and in accuracy from pre- (M = 97.57%) to post-test (M = 98.57%, p = 0.005).They also increased their walk speed in the more difficult 1-back (M = 1.38 m/s) in comparison to the 0-back (M = 1.36 m/s, p < 0.001) but reduced their accuracy in the 1-back (M = 96.39%) in comparison to the 0-back (M = 99.92%, p < 0.001). Three out of the five mediolateral sway variables (Peak, SD, RMS) demonstrated significant reductions in sway from pre to post test (p-values < 0.05). With the exception of a group difference between Aerobic + CT and Stretch + CT in accuracy, there were no significant group differences after training. Results suggest that there can be dual-task benefits from training but that in this sedentary sample Aerobic + CT training was not more beneficial than other types of combined training.

Changes in Emergency Department Geriatric Services in Quebec and Correlates of These Changes

To describe changes in geriatric emergency department (ED) services from 2006 (T1) to 2013/14 (T2), associated factors, and outcomes.

Using the Bergman-Paris Question to screen seniors in the emergency department

OBJECTIVES In the fast pace of the Emergency Department (ED), clinicians are in need of tailored screening tools to detect seniors who are at risk of adverse outcomes. We aimed to explore the usefulness of the Bergman-Paris Question (BPQ) to expose potential undetected geriatric syndromes in community-living seniors presenting to the ED. METHODS This is a planned sub-study of the INDEED multicentre prospective cohort study, including independent or semi-independent seniors (≥65 years old) admitted to hospital after an ED stay ≥8 hours and who were not delirious. Patients were assessed using validated screening tests for 3 geriatric syndromes: cognitive and functional impairment, and frailty. The BPQ was asked upon availability of a relative at enrolment. BPQs sensitivity and specificity analyses were used to ascertain outcomes. RESULTS A response to the BPQ was available for 171 patients (47% of the main studys cohort). Of this number, 75.4% were positive (suggesting impairment), and 24.6% were negative. To detect one of the three geriatric syndromes, the BPQ had a sensitivity of 85.4% (95% CI [76.3, 92.0]) and a specificity of 35.4% (95% CI [25.1, 46.7]). Similar results were obtained for each separate outcome. Odds ratio demonstrated a higher risk of presence of geriatric syndromes. CONCLUSION The Bergman-Paris Question could be an ED screening tool for possible geriatric syndrome. A positive BPQ should prompt the need of further investigations and a negative BPQ possibly warrants no further action. More research is needed to validate the usefulness of the BPQ for day-to-day geriatric screening by ED professionals or geriatricians.

Incidence of delirium in the Canadian emergency department and its consequences on hospital length of stay: a prospective observational multicentre cohort study

Objective We aim to determine the incidence of delirium and describe its impacts on hospital length of stay (LOS) among non-delirious community-dwelling older adults with an 8-hour exposure to the emergency department (ED) environment. Design This is a prospective observational multicentre cohort study (March–July 2015). Patients were assessed two times per day during their entire ED stay and up to 24 hours on hospital ward. Setting The study took place in four Canadian EDs. Participants 338 included patients: (1) aged ≥65 years; (2) who had an ED stay ≥8 hours; (3) were admitted to hospital ward and (4) were independent/semi-independent. Main outcome(s) and measure(s) The primary outcomes of this study were incident delirium in the ED or within 24 hours of ward admission and ED and hospital LOS. Functional and cognitive status were assessed using validated Older Americans Resources and Services and the modified Telephone Interview for Cognitive Status tools. The Confusion Assessment Method was used to detect incident delirium. Univariate and multivariate analyses were conducted to evaluate outcomes. Results Mean age was 76.8 (±8.1), 17.7% were aged >85 years old and 48.8% were men. The mean incidence of delirium was 12.1% (n=41). Median IQR ED LOS was 32.4 (24.5–47.9) hours and hospital LOS was 146.6 (75.2–267.8) hours. Adjusted mean hospital LOS was increased by 105.4 hours (4.4 days) (95% CI 25.1 to 162.0, P<0.001) for patients who developed an episode of delirium compared with non-delirious patient. Conclusions An incident delirium was observed in one of eight independent/semi-independent older adults after an 8-hour ED exposure. An episode of delirium increases hospital LOS by 4 days and therefore has important implications for patients and could contribute to ED overcrowding through a deleterious feedback loop.