Can leisure activities slow dementia progression in nursing home residents? A cluster-randomized controlled trial.

BACKGROUND: To examine the effects of complex cognitive (mahjong) and physical (Tai Chi) activities on dementia severity in nursing home residents with dementia. METHODS: Cluster-randomized open-label controlled design. 110 residents were randomized by nursing home into three conditions: mahjong, Tai Chi, and simple handicrafts (control). Activities were conducted three times a week for 12 weeks. Clinical Dementia Rating (CDR) was taken at 0 (baseline), 3 (post-treatment), 6, and 9 months. The outcome measure was CDR sum-of-box, which is a composite measure of both cognitive and functional deterioration in dementia. RESULTS: Intent-to-treat analyses were performed using multilevel regression models. Apolipoprotein E ε4 allele and education were included as covariates. Neither treatments had effects on the cognitive and functional components of the CDR, but mahjong had a significant interaction with time on the CDR sum-of-box total, suggesting a slower rate of global deterioration in the mahjong group as compared with the control group. CONCLUSIONS: Mahjong led to a gradual improvement in global functioning and a slightly slower rate of dementia progression over time. The effect was generalized and was not specific to cognition or daily functioning.

Mental and physical activities delay cognitive decline in older persons with dementia.

OBJECTIVES: To examine the effects of cognitive stimulation (mahjong) and physical exercise (tai chi [TC]) on cognitive performance in persons with dementia. DESIGN: Cluster-randomized open-label controlled design. SETTING: Nursing homes. PARTICIPANTS: One hundred ten residents, most of whom were cholinesterase-inhibitor naive. Inclusion criteria were Mini-Mental State Examination (MMSE) = 10-24 and suffering from at least very mild dementia (Clinical Dementia Rating ≥ 0.5). Exclusion criteria were being bedbound, audio/visual impairment, regular activity participation before study, or contraindications for physical or group activities. INTERVENTIONS: Homes were randomized into three conditions (mahjong, TC, and simple handicrafts [control]). Activities were conducted three times weekly for 12 weeks. MEASUREMENTS: Primary outcome was MMSE. Secondary outcomes were immediate/delayed recall, categorical fluency, and digit span. Various biological risk factors, including apolipoprotein E ε4 allele, were included as covariates. Measures were collected at 0 (baseline), 3 (posttreatment), 6, and 9 months. RESULTS: Intent-to-treat analyses were performed using mixed-effects regression. Mahjong's effect varied by time for MMSE, delayed recall, and forward digit span. TC had similar effects but not for delayed recall. The typical pattern was that control participants deteriorated while mahjong and TC participants maintained their abilities over time, leading to enlarged treatment effects as time progressed. By 9 months, mahjong and TC differed from control by 4.5 points (95% confidence interval: 2.0-6.9; d = 0.48) and 3.7 points (95% confidence interval: 1.4-6.0; d = 0.40), respectively, on MMSE. No treatment effects were observed for immediate recall and backward digit span. CONCLUSIONS: Mahjong and TC can preserve functioning or delay decline in certain cognitive domains, even in those with significant cognitive impairment.

Evaluation of a computer-assisted errorless learning-based memory training program for patients with early Alzheimer's disease in Hong Kong: a pilot study.

BACKGROUND: Improving the situation in older adults with cognitive decline and evidence of cognitive rehabilitation is considered crucial in long-term care of the elderly. The objective of this study was to implement a computerized errorless learning-based memory training program (CELP) for persons with early Alzheimer's disease, and to compare the training outcomes of a CELP group with those of a therapist-led errorless learning program (TELP) group and a waiting-list control group. METHODS: A randomized controlled trial with a single-blind research design was used in the study. Chinese patients with early Alzheimer's disease screened by the Clinical Dementia Rating (score of 1) were recruited. The subjects were randomly assigned to CELP (n = 6), TELP (n = 6), and waiting-list control (n = 7) groups. Evaluation of subjects before and after testing, and at three-month follow-up was achieved using primary outcomes on the Chinese Mini-Mental State Examination, Chinese Dementia Rating Scale, Hong Kong List Learning Test, and the Brief Assessment of Prospective Memory-Short Form. Secondary outcomes were the Modified Barthel Index, Hong Kong Lawton Instrumental Activities of Daily Living Scale, and Geriatric Depression Scale-Short Form. The data were analyzed using Friedman's test for time effect and the Kruskal-Wallis test for treatment effect. RESULTS: Positive treatment effects on cognition were found in two errorless learning-based memory groups (ie, computer-assisted and therapist-led). Remarkable changes were shown in cognitive function for subjects receiving CELP and emotional/daily functions in those receiving TELP. CONCLUSION: Positive changes in the cognitive function of Chinese patients with early Alzheimer's disease were initially found after errorless training through CELP. Further enhancement of the training program is recommended.

Leisure activities alleviate depressive symptoms in nursing home residents with very mild or mild dementia.

OBJECTIVES: : To examine whether leisure activities can alleviate depressive symptoms among nursing home residents with very mild to mild dementia. METHODS: : A cluster-randomized open-label controlled design. Thirty-six residents with at least moderate depressive symptoms were randomized by home into three conditions-mahjong (a.k.a. mah-jongg), tai chi, and handicrafts (placebo). Activities were conducted three times weekly for 12 weeks. Outcome measure was Geriatric Depression Scale (GDS) administered at baseline, posttreatment, and at 6 months. RESULTS: : Repeated-measures analysis of variance showed a group by time interaction on the GDS. Unlike control and tai chi participants whose scores remained relatively unchanged, the mahjong group reported a drop of 3.25 points (95% confidence interval: 1.00-5.50) on the GDS at posttreatment but gained back 2.83 points (95% confidence interval: 1.95-5.47) at 6 months. Activity discontinuation might be the reason for depression to return to baseline. CONCLUSIONS: : Mahjong can lower depressive symptoms in those with mild dementia, but activity maintenance may be essential for long-term effects.

The geriatric depression scale as a screening tool for depression and suicide ideation: a replication and extention.

OBJECTIVES: To examine a) whether the Geriatric Depression Scale (GDS) can predict clinician-rated suicide ideation and depression, using the 15-, 5-, and 4-item versions, b) whether an additional suicide-ideation item would improve the performance, and c) whether the results vary by age groups. METHODS: First-time psychiatric outpatients responded to the GDS. They were subsequently assessed by psychiatrists blind to the GDS, who also indicated whether suicide ideation was present. The performance of the GDS scales was evaluated using receiver operating characteristic curves. Analyses were conducted separately for young-old (aged 60-74 years) and old-old (aged 75 years or older) adults. RESULTS: Areas under the curves showed that the different GDS versions were comparable in detecting depression and suicide ideation. For identifying depression, thresholds of 7, 2, and 2 for the 15-, 5-, and 4-item versions were optimal, respectively. In terms of detecting suicide ideation, all measures performed better in old-old than in young-old adults. A single, self-report suicide-ideation item performed better than all multiitem GDS measures. CONCLUSIONS: Both the 4- and the 5-item versions are excellent alternatives to the 15-item version, and all are reasonable tools for detecting the presence of suicide ideation also. However, to improve the effectiveness of screening, brief measures of suicide risk should also be included. Even a 1-item measure of suicide ideation can improve clinical decisions tremendously.

An exploratory study of the effect of mahjong on the cognitive functioning of persons with dementia.

OBJECTIVE: To explore the effect of an activity treatment-mahjong-on the cognitive functioning of persons with mild-to-moderate dementia. METHOD: Participants were 62 older persons (M(age) = 83.94, SD = 7.58) who met DSM-IV diagnosis of any dementia condition, had an initial Mini-Mental State Examination (MMSE) score < or = 24, and were able to play, yet not having played mahjong for the past six months. They were randomly assigned to play either twice (n = 33) or four times (n = 29) a week over a 16-week duration. Digit forward span, digit forward sequence, verbal memory and MMSE were measured at baseline, post-test and 1-month follow-up. RESULTS: Regardless of frequency of playing, mahjong produced consistent gains across all cognitive performance measures. It had large effect sizes on digit forward memory (1.0-1.4 for both span and sequence), moderate-to-large effect sizes on verbal memory (0.5-0.9), and a moderate effect size on MMSE (around 0.6). The effects lasted after mahjong had been withdrawn for a month, suggesting that constant practice is not necessary to achieve therapeutic effect once an initial threshold is attained. CONCLUSION: Mahjong is a viable treatment option for dementia. Because mahjong therapy basically does not require professional supervision and can be implemented as widely as space allows at a given time, the potential benefits of integrating mahjong into the daily routines of an institution are enormous vis-à-vis minimal, if any, cost to the institution.