title: A Combined Cognitive Stimulation and Physical Exercise Programme (MINDVital) in Early Dementia: Differential Effects on Single- and Dual-Task Gait Performance.
abstract: Gait disorders are common in early dementia, with particularly pronounced dual-task deficits, contributing to the increased fall risk and mobility decline associated with cognitive impairment.
  
  
  
  This study examines the effects of a combined cognitive stimulation and physical exercise programme (MINDVital) on gait performance under single- and dual-task conditions in older adults with mild dementia.
  
  
  
  Thirty-nine patients with early dementia participated in a multi-disciplinary rehabilitation programme comprising both physical exercise and cognitive stimulation. The programme was conducted in 8-week cycles with participants attending once weekly, and all participants completed 2 successive cycles. Cognitive, functional performance and behavioural symptoms were assessed at baseline and at the end of each 8-week cycle. Gait speed was examined under both single- (Timed Up and Go and 6-metre walk tests) and dual-task (animal category and serial counting) conditions. A random effects model was performed for the independent effect of MINDVital on the primary outcome variable of gait speed under dual-task conditions.
  
  
  
  The mean age of patients enroled in the rehabilitation programme was 79 ± 6.2 years; 25 (64.1%) had a diagnosis of Alzheimer's dementia, and 26 (66.7%) were receiving a cognitive enhancer therapy. There was a significant improvement in cognitive performance [random effects coefficient (standard error) = 0.90 (0.31), p = 0.003] and gait speed under both dual-task situations [animal category: random effects coefficient = 0.04 (0.02), p = 0.039; serial counting: random effects coefficient = 0.05 (0.02), p = 0.013], with reduced dual-task cost for gait speed [serial counting: random effects coefficient = -4.05 (2.35), p = 0.086] following successive MINDVital cycles. No significant improvement in single-task gait speed was observed. Improved cognitive performance over time was a significant determinant of changes in dual-task gait speed [random effects coefficients = 0.01 (0.005), p = 0.048, and 0.02 (0.005), p = 0.003 for category fluency and counting backwards, respectively].
  
  
  
  A combined physical and cognitive rehabilitation programme leads to significant improvements in dual-task walking in early dementia, which may be contributed by improvement in cognitive performance, as single-task gait performance remained stable.
authors.affiliation: Cognition and Memory Disorders Service, Department of Geriatric Medicine, Tan Tock Seng Hospital, and Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Laura
authors.initials: L
authors.lastname: Tay
authors.forename: Wee Shiong
authors.initials: WS
authors.lastname: Lim
authors.forename: Mark
authors.initials: M
authors.lastname: Chan
authors.forename: Noorhazlina
authors.initials: N
authors.lastname: Ali
authors.forename: Mei Sian
authors.initials: MS
authors.lastname: Chong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000503:physiopathology / Q000534:rehabilitation*; D001288:Attention / Q000502:physiology*; D003071:Cognition / Q000502:physiology*; D056344:Executive Function / Q000502:physiology*; D005684:Gait / Q000502:physiology*; D006801:Humans; D051346:Mobility Limitation; D013647:Task Performance and Analysis; D016138:Walking / Q000502:physiology; D000072797:Walking Speed / Q000502:physiology