title: Would older adults with mild cognitive impairment adhere to and benefit from a structured lifestyle activity intervention to enhance cognition?: a cluster randomized controlled trial.
abstract: BACKGROUND
  Epidemiologic evidence suggests that cognitive and physical activities are associated with better cognition in late life. The present study was conducted to examine the possible benefits of four structured lifestyle activity interventions and compare their effectiveness in optimizing cognition for older adults with mild cognitive impairment (MCI).
  
  
  RESULTS
  This was a 12-month cluster randomized controlled trial. 555 community-dwelling Chinese older adults with MCI (295 with multiple-domain deficits (mdMCI), 260 with single-domain deficit (sdMCI)) were recruited. Participants were randomized into physical exercise (P), cognitive activity (C), integrated cognitive and physical exercise (CP), and social activity (S, active control) groups. Interventions comprised of one-hour structured activities three times per week. Primary outcome was Clinical Dementia Rating sum of boxes (CDR-SOB) scores. Secondary outcomes included Chinese versions of Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog), delayed recall, Mini-Mental State Examination, Category Verbal Fluency Test (CVFT) and Disability Assessment for Dementia - Instrumental Activities of Daily Living (DAD-IADL). Percentage adherence to programs and factors affecting adherence were also examined. At 12th month, 423 (76.2%) completed final assessment. There was no change in CDR-SOB and DAD-IADL scores across time and intervention groups. Multilevel normal model and linear link function showed improvement in ADAS-Cog, delayed recall and CVFT with time (p<0.05). Post-hoc subgroup analyses showed that the CP group, compared with other intervention groups, had more significant improvements of ADAS-Cog, delayed recall and CVFT performance with sdMCI participants (p<0.05). Overall adherence rate was 73.3%. Improvements in ADAS-Cog and delayed recall scores were associated with adherence after controlling for age, education, and intervention groups (univariate analyses).
  
  
  CONCLUSIONS
  Structured lifestyle activity interventions were not associated with changes in everyday functioning, albeit with some improvements in cognitive scores across time. Higher adherence was associated with greater improvement in cognitive scores. Factors to enhance adherence should be specially considered in the design of psychosocial interventions for older adults with cognitive decline.
  
  
  BACKGROUND
  ClinicalTrials.gov ChiCTR-TRC-11001359.
authors.affiliation: Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Linda Chiu-Wa
authors.initials: LC
authors.lastname: Lam
authors.affiliation: Department of Psychiatry, The University of Hong Kong, Hong Kong.
authors.forename: Wai Chi
authors.initials: WC
authors.lastname: Chan
authors.affiliation: Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Tony
authors.initials: T
authors.lastname: Leung
authors.affiliation: Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Ada Wai-Tung
authors.initials: AW
authors.lastname: Fung
authors.affiliation: Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong.
authors.forename: Edward Man-Fuk
authors.initials: EM
authors.lastname: Leung
mesh_terms: D000203:Activities of Daily Living; D000339:Affect; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D060825:Cognitive Dysfunction / Q000523:psychology* / Q000534:rehabilitation*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D013997:Time Factors
references.citation: Stat Med. 2007 May 20;26(11):2297-316
references.pmid: 17044139
references.citation: Neurology. 2012 Apr 10;78(15):1123-9
references.pmid: 22491864
references.citation: Int J Geriatr Psychiatry. 2006 Oct;21(10):917-23
references.pmid: 16927409
references.citation: Psychosom Med. 2010 Apr;72(3):239-52
references.pmid: 20223924
references.citation: Ann Acad Med Singapore. 2000 Jul;29(4):474-85
references.pmid: 11056778
references.citation: J Am Med Dir Assoc. 2012 Jul;13(6):568.e15-20
references.pmid: 22579072
references.citation: Int Psychogeriatr. 1997;9 Suppl 1:173-6; discussion 177-8
references.pmid: 9447441
references.citation: BMC Neurol. 2012;12:128
references.pmid: 23113898
references.citation: JAMA Intern Med. 2013 May 13;173(9):797-804
references.pmid: 23545598
references.citation: Stat Med. 2009 Mar 15;28(6):1017-27
references.pmid: 19153969
references.citation: Dtsch Arztebl Int. 2011 Nov;108(44):743-50
references.pmid: 22163250
references.citation: Neurology. 2009 Aug 4;73(5):356-61
references.pmid: 19652139
references.citation: Biol Psychiatry. 2012 May 1;71(9):783-91
references.pmid: 22055015
references.citation: Alzheimers Dement. 2013 Jan;9(1):63-75.e2
references.pmid: 23305823
references.citation: BMJ. 2013;346:f576
references.pmid: 23457213
references.citation: East Asian Arch Psychiatry. 2011 Sep;21(3):123-7
references.pmid: 21921306
references.citation: J Aging Res. 2013;2013:861893
references.pmid: 23509628
references.citation: JAMA Intern Med. 2013 May 27;173(10):894-901
references.pmid: 23589097
references.citation: Neurology. 1998 Apr;50(4):1002-9
references.pmid: 9566386
references.citation: Dement Geriatr Cogn Disord. 2006;22(2):159-64
references.pmid: 16837791
references.citation: PLoS Med. 2007 Nov 27;4(11):e338
references.pmid: 18044984
references.citation: Epidemiol Rev. 2008;30:35-66
references.pmid: 18779228
references.citation: BMC Geriatr. 2011;11:27
references.pmid: 21615936
references.citation: J Am Geriatr Soc. 2009 Apr;57(4):594-603
references.pmid: 19220558
references.citation: Br J Psychiatry. 2013 Sep;203(3):255-64
references.pmid: 24085737
references.citation: Int J Geriatr Psychiatry. 2004 May;19(5):422-8
references.pmid: 15156543
references.citation: J Intern Med. 2004 Sep;256(3):240-6
references.pmid: 15324367
references.citation: Alzheimer Dis Assoc Disord. 2010 Oct-Dec;24(4):343-7
references.pmid: 20693868
references.citation: JAMA. 2008 Sep 3;300(9):1027-37
references.pmid: 18768414
references.citation: Dement Geriatr Cogn Disord. 2005;20(2-3):112-9
references.pmid: 15990425