Neurostimulation for cognitive enhancement in Alzheimer's disease (the NICE-AD study): a randomized clinical trial.

New therapies for symptoms in Alzheimer's disease (AD) are urgently needed. Prior studies suggest that transcranial direct current stimulation (tDCS), a noninvasive neuromodulatory method, may be a safe and potentially effective treatment, but conclusions have been limited by small-sample sizes and brief stimulation protocols. This double-blind randomized trial involving 100 older adults with mild-to-moderate AD examines effects of 6 months of at-home active tDCS or sham delivered over the dorsolateral prefrontal cortex. The primary outcome is global cognitive performance. Secondary outcomes include executive-control/spatial selective attention, functional neuroplasticity, depressive symptoms, quality of life and the durability of effects 3 months after the stimulation period. The results will provide evidence on the efficacy of multimonth at-home tDCS in the AD treatment. =Clinical trial identifier NCT04404153 (Clinicaltrials.gov).

Home-based exercise program for older adults with Motoric Cognitive Risk syndrome: feasibility study.

Aim: We developed a home-based goal-directed exercise program with telephonic coaching to overcome barriers to exercise participation in cognitively impaired older adults. Methods: Six patients with Motoric Cognitive Risk syndrome at high risk for dementia were enrolled, three assigned to goal-directed exercises and three to stretching exercises. All participants underwent an in-person training session followed by a session at home with a telephonic coach. Sessions were supervised by a physiatrist, and exercise programs were personalized. Results: In-person training and remote telephonic coaching support promoted adherence. There were no adverse effects and interventions were rated highly. Participant and logistical barriers were identified that can inform design of home-based clinical trials. Conclusion: Home-based exercises are safe and feasible in older adults with Motoric Cognitive Risk.

Lay abstract Motoric Cognitive Risk syndrome is characterized by presence of cognitive complaints and slow gait. Patients who are diagnosed with this syndrome are at high risk for developing dementia. Hence, it is important to develop safe and effective exercise programs to prevent cognitive decline in these patients. Our study shows that home-based exercises with telephonic coaching are both safe as well as feasible in patients with Motoric Cognitive Risk syndrome. Participants reported high satisfaction with the exercise intervention, and strong interest in participating in future studies. They found the individualized exercise program to be appropriate to their own level of fitness, and this provided them confidence to continue exercising at home.

The Effect of Personality Traits on Risk of Incident Pre-dementia Syndromes.

OBJECTIVES: Personality traits have been shown to be associated with the risk of dementia; less is known about their association with pre-dementia syndromes. The aim of the present study was to examine the role of personality traits as predictors of incident pre-dementia, motoric cognitive risk (MCR), and mild cognitive impairment (MCI) syndromes. DESIGN: We prospectively examined the association between five personality traits (neuroticism, extraversion, conscientiousness, agreeableness, and openness) and the risk of incident MCR or MCI. MCR builds on MCI operational definitions, substituting the cognitive impairment criterion with slow gait, and it is associated with increased risk for both Alzheimer's disease and vascular dementia. SETTING: Community based. PARTICIPANTS: Nondemented participants (n = 524; 62% women) aged 65 years and older. MEASUREMENTS: Cox proportional hazard analysis, adjusted for demographics and disease burden, was used to evaluate the risk of each pre-dementia syndrome based on baseline personality traits, measured using the Big Five Inventory. RESULTS: Over a median follow-up of 3 years, 38 participants developed incident MCR, and 69 developed incident MCI (41 non-amnestic and 28 amnestic subtypes). Openness was associated with a reduced risk of developing incident MCR (adjusted hazard ratio [aHR] = .94; 95% confidence interval [CI] = .89-.99), whereas neuroticism was associated with an increased risk of incident non-amnestic MCI (aHR = 1.06; 95% CI = 1.01-1.11). These associations remained significant even after considering the confounding effects of lifestyle or mood. None of the personality traits were associated with MCI overall or amnestic MCI. CONCLUSION: These findings provide evidence of a distinct relationship between personality traits and development of specific pre-dementia syndromes. J Am Geriatr Soc 68:1554-1559, 2020.

A comparison of turn and straight walking phases as predictors of incident falls.

BACKGROUND: While gait assessments are recommended to evaluate fall risk in older adults, these often involve walking in a straight line, even though one-third of steps taken throughout the day involve turning. Falls that occur during a turn tend to be more serious than falls that occur during a straight walk, but little is known about how gait variables collected during a turn can predict falls. RESEARCH QUESTION: How do gait characteristics collected from straight and turning walking phases predict falls in older adults? METHODS: We prospectively examined the association between six quantitative gait variables measured during normal walking turn and straight walking phases as predictors of incident falls in a community-based sample of older adults (N = 253; mean age 78.5; 51% women). Cox regressions adjusted for multiple potential confounders were used to examine the associations. RESULTS: Participants had significantly slower stride velocity (57.81 vs 83.26 cm/s), shorter stride length (74.76 vs 101.81 cm,), lower swing (30.1 vs 32.41%), higher double support (39.79 vs 35.19%), and more swing (30.09 vs 32.41%) and stride length variability (31.86 vs 6.35 %) during turns compared with straights. Higher swing percent in both turns (adjusted hazard ratio; HR 0.92, 95% CI 0.87, 0.97) and straights (HR 0.89, 95% CI 0.84, 0.96) was associated with reduced risk of falls. Higher double support percent during both turns (HR 1.04, 95% CI 1.01, 1.07) and straights (HR 1.06, 95% CI 1.02, 1.09) was associated with increased risk of falls. More swing variability during turns (HR 1.03, 95% CI 1.00, 1.06), but not straights, was associated with increased risk of falls. SIGNIFICANCE: Gait variables collected during turning and walking straight were similar in their predictions of future falls. In the future, clinical research that builds on these findings could improve identification and prevention of falls.