Main Article Content
Background: Accumulating evidence suggests that older adults with mild cognitive impairment (MCI) not only had cognitive impairment but also fall risk. Cognitive training has been shown to either improve cognitive function or reduce fall risk among older adults with and without cognitive impairment. Only a limited number of studies have investigated the beneficial effects of cognitive training on both cognitive performance and fall risk in older adults with MCI and the findings have been inconclusive.
Objectives: To examine the effectiveness of cognitive training program on fall risk and cognitive performance in older adults with mild cognitive impairment.
Materials and methods: Forty older adults with MCI (mean age 68.91±4.25) were randomized into the intervention group (n=20) and control group (n=20). Participants in the intervention group underwent cognitive training program for 60-70 minutes per session, 3 times per week for 12 consecutive weeks. The control group received educational tutorial covering cognitive enhancement and fall prevention strategies. Outcome measures were fall risk including Timed Up and Go test (TUG) single and dual task, Physiological Profile Assessment (PPA), and cognitive performance including, Alzheimer’s disease Assessment Scale (ADAS-cog), Verbal Paired Associated (VPA)-immediate recall, and Trail Making Tests (TMT). All outcomes were assessed at baseline and the end of the 12-week training.
Results: At the end of 12-week training, participants in the intervention group had significantly better performance on ADAS-cog, VPA-immediate recall, and TUG dual task compared to the control group (p=0.007, p=0.033, and p=0.006 respectively). They also demonstrated significant improvement on TUG single and dual task, ADAS-cog, VPA-immediate recall, and TMT B-A from baseline (p=0.006, p=0.002, p=0.001, p=0.012, and p=0.019 respectively), whereas these improvements were not observed in the control group.
Conclusion: The 12-week cognitive training program has a beneficial effect in improving global cognitive function, memory, and decreasing fall risk while performing functional mobility in concurrent with cognitive task in older adults with MCI. The findings suggest that cognitive training should be considered when designing a fall prevention program for older adults with MCI.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Personal views expressed by the contributors in their articles are not necessarily those of the Journal of Associated Medical Sciences, Faculty of Associated Medical Sciences, Chiang Mai University.
 Petersen RC, Doody R, Kurz A, Mohs RC, Morris JC, Rabins PV, et al. Current concepts in mild cognitive impairment. Arch Neurol. 2001; 58: 1985-92.
 Campbell NL, Unverzagt F, LaMantia MA, Khan BA, Boustani MA. Risk factors for the progression of mild cognitive impairment to dementia. Clin Geriatr Med. 2013; 29: 873-93.
 Roberts RO, Knopman DS, Mielke MM, Cha RH, Pankratz VS, Christianson TJH, et al. Higher risk of progression to dementia in mild cognitive impairment cases who revert to normal. Neurology. 2014; 82: 317-25.
 Gauthier S, Reisberg B, Zaudig M, Petersen RC, Ritchie K, Broich K, et al. Mild cognitive impairment. Lancet. 2006; 367: 1262-70.
 Hulette CM, Welsh-Bohmer KA, Murray MG, Saunders AM, Mash DC, McIntyre LM. Neuropathological and neuropsychological changes in "normal" aging: evidence for preclinical Alzheimer disease in cognitively normal individuals. J Neuropathol Exp Neurol. 1998; 57: 1168-74.
 West RL. An application of prefrontal cortex function theory to cognitive aging. Psychol Bull. 1996; 120: 272-92.
 Rosano C, Studenski SA, Aizenstein HJ, Boudreau RM, Longstreth WT, Jr., Newman AB. Slower gait, slower information processing and smaller prefrontal area in older adults. Age Ageing. 2012; 41: 58-64.
 van Iersel MB, Kessels RP, Bloem BR, Verbeek AL, Olde Rikkert MG. Executive functions are associated with gait and balance in community-living elderly people. J Gerontol A Biol Sci Med Sci. 2008; 63: 1344-9.
 Montero-Odasso M, Muir SW, Speechley M. Dual-task complexity affects gait in people with mild cognitive impairment: the interplay between gait variability, dual tasking, and risk of falls. Arch Phys Med Rehabil. 2012; 93: 293-9.
 Montero-Odasso M, Verghese J, Beauchet O, Hausdorff JM. Gait and cognition: a complementary approach to understanding brain function and the risk of falling. J Am Geriatr Soc. 2012; 60: 2127-36.
 Delbaere K, Kochan NA, Close JC, Menant JC, Sturnieks DL, Brodaty H, et al. Mild cognitive impairment as a predictor of falls in community-dwelling older people. Am J Geriatr Psychiatry. 2012; 20: 845-53.
 Liu-Ambrose T, Ashe MC, Graf P, Beattie BL, Khan KM. Mild cognitive impairment increases falls risk in older community-dwelling women. Phys Ther. 2008; 88: 1482-91.
 Borges AP, Carneiro JA, Zaia JE, Carneiro AA, Takayanagui OM. Evaluation of postural balance in mild cognitive impairment through a three-dimensional electromagnetic system. Braz J Otorhinolaryngol. 2016; 82: 433-41.
 Jean L, Bergeron ME, Thivierge S, Simard M. Cognitive intervention programs for individuals with mild cognitive impairment: systematic review of the literature. Am J Geriatr Psychiatry. 2010; 18: 281-96.
 Li H, Li J, Li N, Li B, Wang P, Zhou T. Cognitive intervention for persons with mild cognitive impairment: a meta-analysis. Ageing Res Rev. 2011; 10: 285-96.
 Li KZ, Roudaia E, Lussier M, Bherer L, Leroux A, McKinley PA. Benefits of cognitive dual-task training on balance performance in healthy older adults. J Gerontol A Biol Sci Med Sci. 2010; 65: 1344-52.
 Smith-Ray RL, Hughes SL, Prohaska TR, Little DM, Jurivich DA, Hedeker D. Impact of cognitive training on balance and gait in older adults. J Gerontol B Psychol Sci Soc Sci. 2015; 70: 357-66.
 Smith-Ray RL, Irmiter C, Boulter K. Cognitive training among cognitively impaired older adults: a feasibility study assessing the potential improvement in balance. Front Public Health. 2016; 4: 219.
 Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011; 7: 270-9.
 Dementia Association of Thailand Newletter: Mental State Examination T10 [Internet]. Bankok: the Dementia Association of Thailand; 2018 [cited 2020 Jun 12]. Available from: https://thaidementia.com/news/news_letter.html.
 Cecato JF, Martinelli JE, Izbicki R, Yassuda MS, Aprahamian I. A subtest analysis of the Montreal Cognitive Assessment (MoCA): which subtests can best discriminate between healthy controls, mild cognitive impairment and Alzheimer's disease? Int Psychogeriatr. 2016; 28: 825-32.
 Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012: Cd007146. doi: 10.1002/14651858.
 Boripuntakul S, Kothan S, Methapatara P, Munkhetvit P, Sungkarat S. Short-term effects of cognitive training program for individuals with amnestic mild cognitive impairment: a pilot study. Phys Occup Ther Geriatr. 2012; 30: 138-49.
 Valenzuela MJ, Jones M, Wen W, Rae C, Graham S, Shnier R, et al. Memory training alters hippocampal neurochemistry in healthy elderly. Neuroreport. 2003; 14: 1333-7.
 Department of Medical Service Ministry of Public Health. Cognitive stimulation in people with mild cognitive impairment. Bankok: Department of Medical Service Ministry of Public Health; 2018.
 Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go test. Phys Ther. 2000; 80: 896-903.
 Cedervall Y, Stenberg AM, Åhman HB, Giedraitis V, Tinmark F, Berglund L, et al. Timed Up-and-Go dual-task testing in the assessment of cognitive function: a mixed methods observational study for development of the UDDGait Protocol. Int J Environ Res Public Health. 2020; 17: 1715.doi: 10.3390/ijerph17051715.
 Lord SR, Menz HB, Tiedemann A. A physiological profile approach to falls risk assessment and prevention. Phys Ther. 2003; 83: 237-52.
 Connor DJ, Sabbagh MN. Administration and scoring variance on the ADAS-cog. J Alzheimers Dis. 2008; 15: 461-4.
 Buschert VC, Friese U, Teipel SJ, Schneider P, Merensky W, Rujescu D, et al. Effects of a newly developed cognitive intervention in amnestic mild cognitive impairment and mild Alzheimer's disease: a pilot study. J Alzheimers Dis. 2011; 25: 679-94.
 Forster S, Buschert VC, Teipel SJ, Friese U, Buchholz HG, Drzezga A, et al. Effects of a 6-month cognitive intervention on brain metabolism in patients with amnestic MCI and mild Alzheimer's disease. J Alzheimers Dis. 2011; 26: 337-48.
 Wechler D. Wechsler Memory Scale-Third Edition (WMS-III) administration and scoring manual. San Antonio: TX: The Psychological Corporation; 1997.
 Kortte KB, Horner MD, Windham WK. The trail making test, part B: cognitive flexibility or ability to maintain set?. Appl Neuropsychol. 2002; 9: 106-9.
 Richardson JTE. Eta squared and partial eta squared as measures of effect size in educational research. Edu Res Rev. 2011; 6: 135-47.
 Barban F, Mancini M, Cercignani M, Adriano F, Perri R, Annicchiarico R, et al. A pilot study on brain plasticity of functional connectivity modulated by cognitive training in mild Alzheimer's disease and mild cognitive impairment. Brain sciences. 2017;7:50. doi: 10.3390/brainsci7050050.
 Moulin CJ, Perfect TJ, Jones RW. The effects of repetition on allocation of study time and judgements of learning in Alzheimer's disease. Neuropsychologia. 2000; 38: 748-56.
 Li B-Y, He N-Y, Qiao Y, Xu H-M, Lu Y-Z, Cui P-J, et al. Computerized cognitive training for Chinese mild cognitive impairment patients: a neuropsychological and fMRI study. NeuroImage Clinical. 2019; 22: 101691-. doi: 10.1016/j.nicl.2019.101691.
 Park DC, Bischof GN. The aging mind: neuroplasticity in response to cognitive training. Dialogues Clin Neurosci. 2013; 15: 109-19.
 Fiatarone Singh MA, Gates N, Saigal N, Wilson GC, Meiklejohn J, Brodaty H, et al. The Study of Mental and Resistance Training (SMART) study-resistance training and/or cognitive training in mild cognitive impairment: a randomized, double-blind, double-sham controlled trial. J Am Med Dir Assoc. 2014; 15: 873-80.
 Bahureksa L, Najafi B, Saleh A, Sabbagh M, Coon D, Mohler MJ, et al. The impact of mild cognitive impairment on gait and balance: a systematic review and meta-analysis of studies using instrumented assessment. Gerontology. 2017; 63: 67-83.
 Toots ATM, Taylor ME, Lord SR, Close JCT. Associations between gait speed and cognitive domains in older people with cognitive impairment. J Alzheimers Dis. 2019; 71: 15-21.
 Zimmerman ME, Lipton RB, Pan JW, Hetherington HP, Verghese J. MRI- and MRS-derived hippocampal correlates of quantitative locomotor function in older adults. Brain Res. 2009; 1291: 73-81.
 Smith-Ray RL, Makowski-Woidan B, Hughes SL. A randomized trial to measure the impact of a community-based cognitive training intervention on balance and gait in cognitively intact Black older adults. Health Educ Behav. 2014; 41: 62-9.