The Effect of Dual task Program on Reducing the Risk of Dementia in older Adults

 

Soo-Hyun Park¹, Si-NaeAhn²*

¹Department of Occupational Therapy, Yeoju Institute of Technology, 12652, Korea

²Department of Occupational Therapy, Hyejeon College, Korea

 

ABSTRACT:

Background/Objectives: The purpose of this study was to assess the effect of a dual task program on prevention to dementia in old adult. Methods/Statistical analysis: Forty-four people were selected as subjects with a high risk of developing dementia.  Using a Korean version of the Montreal Cognitive Assessment, cognitive function was recorded; the Short Form of the Geriatric Depression Scale and the Korean version of the Quality of Life-Alzheimer’s Disease were administered pre- and post-evaluation to determine the changes in levels of depression and quality of life. Paired t tests were conducted using SPSS Version 12.0. Findings: The results indicated that the dual task program affected cognitive function and quality of life in older adults with a higher risk of developing dementia. The level of depression decreased after the intervention, but there was no statistically significant difference. In these studies, dual task programs included the synchronized use of both hands, integration of the bilateral side, and bimanual activity of inserting to facilitate cognitive function. Additionally, through the process of making procedures, the dual task program consisted of contents that enhance cognitive functions and motor functions. As a result, the dual task has been shown to be effective in preventing dementia. The dual task program was designed to improve cognitive functions and quality of life of those in an older population with a higher risk of developing dementia. Improvements/Applications: Applying the dual task program to elderly subjects at a high risk of developing dementia was confirmed to prevent dementia.

 

 

 

 

 

1. INTRODUCTION:

Dementia is one of the main diseases that develop in senescence along with heart disease, cancer, and stroke. It is known that new patient is diagnosed with dementia in every 3.2 second worldwide. In particular, occurrence rate of dementia doubles when age increases by 5.8 years. ¹

 

The disease has become a serious problem in aged society. Risk of dementia occurrence is related to developmental factors (low education level and occupation with low cognitive requirement)^2,3, psychological factors (depression and negativity)^4-6, life style (smoking, drinking, diet, and cognitive          stimulus)^7-11, and risk factors in cardiovascular system (diabetes, cholesterol, and obesity)^12,13 Hence, systematic approach to controllable factors among these risk factors is necessary. For this purpose, a lot of countries have established dementia management and prevention system and implemented diverse health management programs for the aged centered at local community. Physical activity and cognitive activity program is representative prevention programs. As people gets old, their overall physical and cognitive function diminished. Muscle strength and endurance decreases due to changes in musculoskeletal system. Vestibular function decreases causing diminished balancing ability. Fine coordination of hands also declines. From cognitive aspect, degeneration of divided attention is evident although simple attention is maintained.¹⁴ Divided attention refers to an ability to maintain concentration for a certain amount of time or simultaneously focus on two things¹⁵. In particular, divided attention is required when performing dual task is main index that indicates cognitive degeneration. It is one of the major early symptoms that patients with dementia experience.¹⁶

 

Dual task activity is function that is frequently used in daily activities such as talking to a person beside while walking or taking memos when talking on the phone. However, as a person has to perform activities that have high cognitive requirement and control body movement at the same time, dual task becomes very difficult to those with diminished cognitive function. In this case, power of executing functional activity and posture controllability decreases and risk of falling increases. Moreover, the consequent restriction in social participation decreases quality of life, in addition to damage on physical function.¹⁷

 

However, most of the dementia prevention programs are implemented by being divided into cognitive activity and physical activity. They mostly include learning activity centered at cognitive books that puts stress on cognitive functions such as memory, verbal ability, spatio-temporal perception, and computation and activities such as tangram, paper folding, and puzzle making.¹⁸ However, a recent study emphasized cognitive advantage of ‘multimodal intervention' over the simple table-top cognitive activity.¹⁹ Different from activities that only use limited cognitive elements, 'multimodal intervention' includes social factors and it includes activities such as video game that takes place in virtual reality and performance of problem-solving in social environment.^20,21

 

A number of studies proved positive effects of physical activity on brain health of elderly people and its dementia prevention effects.^22,23 In particular, aerobic exercise or cardiovascular fitness was proven to be effective in enhancing executive function and memory. Such change increased the size of hippocampus which is a structure of memory and learning and increased secretion of beta endorphin to induce psychological stability.²⁴ A recent study suggested necessity of combining physical and cognitive activity to maximize functional advantage. Kraft argued that environment that simultaneously simulates physical activity and challenging cognitive task is required for successful aging.²⁵ This is because such environment simultaneously simulates exercise and cognitive function of frontal lobe and activates parietal lobe for spatial perception.²⁶ However, most of the cognition and exercise combining activities that were implemented on patients with dementia or normal elderly people had a method where one session was divided into physical activity and cognitive activity to carry out the activities side by side. It is different from dual task activity. Moreover, whether dual task performance is more effective than individual cognitive or exercise activity for dementia prevention and whether there are synergic effects is still controversial.^{27, 28}

 

This study attempts to find out the effects of applying dual task that considers physical characteristics of elderly people to those who belong to high-risk elderly group. We hypothesized that dual task program is capable of improving cognitive and quality of life to prevent dementia in an older population.

 

2. MATERIALS AND METHODS:

2.1. Subjects:

In this study, 44 people were selected as the subjects at a higher risk of developing dementia from Alzheimer Center Chungcheongnam-do. They voluntarily agreed to participate in the study. Table 1 lists the demographic characteristics of the study subjects. Forty-four subjects were recruited in this study (5 males, 27 females). For the range of ages, 25 (56.8%) were from 65 to 74 years, 25 (36.4%) were from 75 to 84 years, and three (6.8%) were above 85 years.

 

Table 1: Characteristics of Subject (N=44)

 

2.2. Measurement:

Using a Korean version of the Montreal Cognitive Assessment (MoCA-K), cognitive function was recorded pre- and post-evaluation. A Short Form of the Geriatric Depression Scale (SGDS) and a Korean version of Quality of Life-Alzheimer’s Disease (KQOL-AD) were administered pre- and post-evaluation to determine the changes in the level of depression and quality of life.

 

2.2.1. Korean version of Montreal Cognitive Assessment (K-MoCA):

MoCA (Montreal Cognitive Assessment) is a tool that was developed to evaluate mild cognitive impairment. The tool evaluates cognitive functions including concentration, spatio-temporal perception, and power of execution, vocabulary, abstract thinking power, memory and orientation. K-MoCA is a Korean version of MoCA whose questions and forms were recomposed considering cultural and linguistic characteristics of Korea.²⁹ Total score is 30 and score higher than 23 is regarded as normal.

 

2.2.2. Korean version of short-form geriatric depression rating scale (SGDS-K):

Sheikh and Yesavage³⁰ recomposed the 30 items of geriatric depression scale developed by Yesavage et al. into 15 items, considering the concentration level of elderly people and the applicability.³¹ Geriatric Depression Scale-Korean (SGDS-K) is the Korean version that was standardized by Gi.³² SGDS-K is composed of ‘yes/no’ responses and score higher than 5 is determined as having depression symptom.

 

2.2.3. Korean version of Quality of Life-Alzheimer's Disease Scale (KQOL-AD):

QOL-AD is a measurement tool that Shin³³, standardized the evaluation tool of quality of life of patients with Alzheimer’s disease that was originally developed by Logsdon et al.³⁴. It is composed of 13 items, including physical health, energy, mood, living situation, memory, family, marriage, friends, self, ability to do chores around house, ability to do things for fun, and life as a whole. Each item is 4-score index from 1 (bad) to 4 (very good) and total score of 13 items becomes 52. Lower score means lower quality of life.

 

2.3. Dual Task Programs:

Dual task program was composed of activities where the subjects perform cognitive activity while moving body at the same time. As many subjects had arthritis in lower limb and difficulties in body movement, exercise activity was composed of coordination activities that require simultaneous movement of both upper limbs or accurate movement of upper limb. Cognitive activity was composed of simple calculation, naming animals/fruits, and memorizing the order of number/color. In case of cognitive activity, the level of difficulty of the activity was modified for each subject according to their activity concentration and education level. The program was composed of a total of 10 sessions and the order was determined such that the level of difficulty of the activity gradually increases as session progresses.

 

Participants performed activity in a small group that includes 4 to 5 people and the level of group dynamic interaction was gradually increased as the session progressed. That is, early activity was implemented as individual activity within the small group and the level of interaction increased as the session progressed such that direct competition or cooperation can take place. One session was composed of approximately 50 minutes and two or three dual task programs were implemented in each session. Resting time was given every time when activity was changed to prevent concentration decline and fatigue.

 

The following dual task programs were applied to the subjects: carrying table tennis balls while counting numbers, beating balloons while naming animals, knocking while remembering the name of color/number, drawing figures with both hands, moving balloons with a cup while naming fruits, blue and white flag game (raise blue or white flag following instruction: for example, ‘raise blue flag’, ‘raise white flag’, or ‘raise white flag instead of blue flag’), receiving table tennis balls with a cup while adding two every time, and pushing coin with a finger by calculating money.

 

2.4. Study Process:

In this study, the subjects were recruited to 44 a higher risk of developing dementia, dual task programs were applied and pre - and post - evaluation were conducted (Figure 1).

 

Figure 1. Study process

 

2.5. Statistical analysis:

The collected data were analyzed based on the program PASW Statistics Version 12.0. Paired t tests were conducted to detect comparisons within the group concerning cognitive function, level of depression, and quality of life under baseline conditions. A statistically significant level was considered to be p<0.05.

 

3. RESULTS AND DISCUSSION:

The result of the comparisons showed that the dual task program affected cognitive functions in those at a higher risk of developing dementia (Table 2). The results showed that differences between pre- and post-test were found in the MOCA-K score. The items of delayed recall and total score in the MOCA-K were significantly improved in the post-test compared to the pre-test (p<.05). For the other items, there was no significant improvement (p>.05).

 

Table 2: Comparison of cognitive function according to intervention

K-MoCA: Korean version of Montreal Cognitive Assessment

 

 

The result was the depression and quality of life that applied dual task program in those at a higher risk of developing dementia (Table 3). The results showed that significant higher in post-test compared to the pre-test were found in the KQOL-AD score (p<.05). However, there was no significant improvement in the level of depression when assessing the SGDS (p>.05).

 

 

Table 3: Comparison of quality of life and depression according to intervention

Variable	Pre	Post	t	p
SGDS-K	3.84±4.00	3.14±3.67	1.470	.149
KQOL-AD	31.82±7.18	33.64±6.34	-2.200	.033

KQOL-AD: Korean version of Quality of Life-Alzheimer's Disease, SGDS-K: Korean version of Short-form Geriatric Depression Rating Scale

 

 

 

In this study, we aimed to assess the effect of a dual task program performed to prevent dementia in an older population. The results indicated that a dual task program affected the cognitive function and quality of life in older adults at a higher risk of developing dementia. The level of depression decreased after the intervention, but there was no statistically significant difference.

 

Previous studies have conducted a dual task program of motor and cognitive functions, which was also applied to a group at a higher risk of developing dementia.^35,36 In these studies, dual task programs included synchronized use of both hands, integration of bilateral side, and increasing bimanual activity to facilitate cognitive functions. Additionally, through the process of making procedures, dual task program consisted of contents that enhanced cognitive functions and motor functions. As a result, the dual task has been shown to be effective in preventing dementia.

 

Another study compared the effectiveness of a group with dual tasks, which included physical training, exercise, and cognitive tasks, to a group that conducted only physical training.  The dual task group was more effective in preventing dementia and improving cognitive function.³⁷Additionally, previous study reported that both physical and cognitive functions improved when they applied exercises that specialized in enhancing cognitive functions for patients with mild dementia.³⁸ this study found its results to be consistent with these studies.

 

In these studies, however, all the patients had dementia; in this study, the subjects were only at risk of developing dementia. In addition, it is meaningful that it was designed to promote motor and cognitive functions in the treatment of exercises—not only training exercises, but also encouraging cognitive functions and motor functions.

 

4. CONCLUSION:

This study identified a dual task program among older adults and confirmed that it was effective improving in cognitive abilities and quality of life. These results suggest that, in order to prevent dementia, there is a need for preventive programs beside cognitive functions and physical functions. Based on the results of this study, we consider that applying a dual task of interventions to dementia prevention and dual task programs can lead to better methods of dementia prevention.

 

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Accepted on 15.07.2017          © RJPT All right reserved