SAN DIEGO—A novel exercise program focused on movements required to perform functions of daily living may improve cognitive function, physical performance, and caregiver burden for patients with mild to moderate dementia, according to a small pilot study reported at the 65th Annual Meeting of the American Academy of Neurology.
“Currently available medications do not stop or slow progression of Alzheimer’s disease,” said Deborah E. Barnes, PhD, Associate Professor of Psychiatry at the University of California, San Francisco. “They are associated with small improvements in cognitive function, but they have minimal impact on physical function, quality of life, and caregiver burden.
“What if we had an overlooked drug that was clinically proven in randomized controlled trials to increase cognitive function and hippocampal volume in older adults, slow cognitive decline in individuals with mild cognitive impairment, enhance neurogenesis, and reduce beta-amyloid in animal models? That would be pretty amazing. What if this drug also had other health benefits throughout the body and had minimal side effects?”
This candidate “drug” is a program known as Preventing Loss of Independence Through Exercise (PLIÉ), which was developed by Dr. Barnes and her associates. The program combines elements of Eastern and Western exercise traditions and focuses on performing basic functional movements, increasing bodily awareness, and encouraging social engagement. “We met with experts in yoga, tai chi, Feldenkrais, physical therapy, occupational therapy, mindfulness, and dance movement therapy and had them talk about what they felt worked the best in people with dementia, and we tried to pull out the commonalities across the different traditions,” she explained.
A Pilot Trial of Adults With Dementia
In a pilot trial, the researchers studied 11 adults with mild to moderate dementia who attended an adult day care program in San Francisco. Participants were assigned to either the PLIÉ intervention group, which met two to three days per week for 18 weeks, or to a usual care group. Blinded assessors administered a battery of tests before and after the intervention to study participants and their caregivers. Tests included the Alzheimer’s Disease Assessment Scale–Cognitive subscale (ADAS–Cog) to measure cognitive function, the Quality of Life in Alzheimer’s Disease (QoL-AD) tool to measure quality of life, and the Short Physical Performance Battery (SPPB) to measure physical function.
Tests administered to caregivers included the Alzheimer’s Disease Cooperative Study–Activities of Daily Living Inventory (ADCS–ADL) to measure participant function, the QoL-AD to measure participant quality of life, the Neuropsychiatric Inventory Questionnaire to measure the frequency and severity of dementia-related symptoms (NPI-FS), as well as the NPI Caregiver Distress Scale (NPI-D). The researchers also administered the Caregiver Burden Inventory (CBI).
Of the 11 study participants, six were assigned to the intervention group and five to usual care. The average age of participants was 84, and most participants (82%) were female. The mean age of caregivers was 56. The majority (82%) were daughters who had been caring for their parent for three to four years.
Intervention Was Associated With Cognitive Improvement
After 18 weeks, the intervention group had a decline of 4.6 points on the ADAS–Cog, indicating improvement, while the usual care group had an increase of 2.4 points on the measure, for an effect size of 0.76. “This is a substantially higher treatment effect than what’s usually seen with dementia medications, which is usually around the order of 0.20,” noted Dr. Barnes.
In addition, scores on the QoL-AD improved by six points in the intervention group and 2.6 points in the usual care group, for an effect size of 0.83. Scores on the SPPB improved by one point in the intervention group and 0.2 points in the usual care group, for an effect size of 0.34. “Although these effect sizes were not statistically significant because of the small sample size, they were well within the clinically meaningful range,” she said.
There were no real differences for caregiver test measurements on participant function, as measured by the ADCS–ADL scale, but caregiver-reported participant quality of life as measured by the QoL-AD improved by 2.2 points in the intervention group, compared with 0 points in the usual care group, for an effect size of 0.33. For frequency and severity of the dementia-related symptoms on the NPI-FS, the intervention group declined 3.4 points, compared with three points for the usual care group, for an effect size of 0.02. Caregiver distress, as measured by the NPI-D, improved in the intervention group with a decline of 2.3 points, compared with an increase of 0.5 points in the usual care group, for an effect size of 0.28. There was an effect size of 0.49 for the PLIÉ intervention on the CBI, based on a decline of 5.5 points in the exercise group and an increase of 1.7 points in the usual care group.