Web-Based Intervention Effects on Mild Cognitive Impairment Based on Apolipoprotein E Genotype: Quasi-Experimental Study.

BACKGROUND: Apolipoprotein E (APOE) ε4 allele is a major genetic risk factor for Alzheimer disease and mild cognitive impairment (MCI). Computer-based training programs can improve cognitive performance in elderly populations. However, the effects of computer-based interventions on MCI APOE ε4 carriers have never been studied before. OBJECTIVE: The effects of different web-based interventions and the APOE isoform-specific differences in training outcomes are investigated. METHODS: Using a quasi-experimental study design, 202 participants with MCI aged 60 years and older took part in three different intervention programs (physical and cognitive [Long-Lasting Memories, or LLM], cognitive [Active Control, or AC], or physical intervention [Physical Training Control, or PTC]) via an innovative information and communication technologies exergaming platform. Participants in each interventional group were subdivided into APOE ε4 carriers and non-APOE ε4 carriers. All participants underwent an extensive neuropsychological evaluation before and after the training, blood tests, and brain imaging. RESULTS: All interventions resulted in multiple statistically significant cognitive benefits after the intervention. Verbal learning (California Verbal Learning Test: immediate recall test score-LLM: P=.04; AC: P<.001), working memory (digit span forward and backward test scores-AC: P=.03; PTC: P=.02 and P=.006, respectively), and long-term memory (California Verbal Learning Test: delayed recall test score-LLM: P=.02; AC: P=.002; and PTC: P=.02) were improved. There was no statistically significant difference among the intervention effects. APOE ε4 presence moderates intervention effects as the LLM intervention improved only their task-switching processing speed (Trail Making Test, Part B: P=.03) and the PTC intervention improved only the working memory (digit span backward: P=.03). No significant performance alteration was noted for the APOE ε4+ cognitive AC training group. CONCLUSIONS: None of the applied interventions could be identified as the optimal one; it is suggested, however, that combined cognitive and physical training and physical training via exergaming may be more effective for the high-risk MCI ΑPOE ε4+ subgroup.

Creative Art Therapy as an Efficient Way to Improve the Well-Being of People Living with Dementia.

Dementia is characterized by a decline in cognition and loss of functional abilities. It is becoming more and more prevalent which places a tremendous strain on the health and social care systems, in parallel the caregivers are under a lot of stress. Engaging in creative activities such as painting, drawing, dance, music, and drama can help reduce stress, anxiety, and depression, and promote a sense of can be beneficial for patients with dementia as it can help them maintain their cognitive abilities. Educating people with dementia, their relatives, and professionals to improve their quality of life through innovative creative arts therapies such as music, dance, and drama supported by digital tools is an invaluable resource for people and organizations seeking to improve their wellness. Furthermore, it is highlighted the value of involving family members and caregivers in the therapeutic process, recognizing their critical role in supporting the well-being of people with dementia.

How Well Did the Healthcare System Respond to the Healthcare Needs of Older People with and without Dementia during the COVID-19 Pandemic? The Perception of Healthcare Providers and Older People from the SI4CARE Project in the ADRION Region.

One major challenge during the COVID-19 pandemic was the limited accessibility to healthcare facilities, especially for the older population. The aim of the current study was the exploration of the extent to which the healthcare systems responded to the healthcare needs of the older people with or without cognitive impairment and their caregivers in the Adrion/Ionian region. Data were collected through e-questionnaires regarding the adequacy of the healthcare system and were anonymously administered to older individuals and stakeholder providers in the following countries: Slovenia, Italy (Calabria), Croatia, Bosnia and Herzegovina, Greece, Montenegro, and Serbia. Overall, 722 older people and 267 healthcare stakeholders participated in the study. During the COVID-19 pandemic, both healthcare stakeholders and the older population claimed that the healthcare needs of the older people and their caregivers increased dramatically in all countries, especially in Italy (Calabria), Croatia and BiH. According to our results, countries from the Adrion/Ionian regions faced significant challenges to adjust to the special needs of the older people during the COVID-19 pandemic, which was possibly due to limited accessibility opportunities to healthcare facilities. These results highlight the need for the development of alternative ways of providing medical assistance and supervision when in-person care is not possible.

Digital Biomarkers for Well-being Through Exergame Interactions: Exploratory Study.

BACKGROUND: Ecologically valid evaluations of patient states or well-being by means of new technologies is a key issue in contemporary research in health and well-being of the aging population. The in-game metrics generated from the interaction of users with serious games (SG) can potentially be used to predict or characterize a user's state of health and well-being. There is currently an increasing body of research that investigates the use of measures of interaction with games as digital biomarkers for health and well-being. OBJECTIVE: The aim of this paper is to predict well-being digital biomarkers from data collected during interactions with SG, using the values of standard clinical assessment tests as ground truth. METHODS: The data set was gathered during the interaction with patients with Parkinson disease with the webFitForAll exergame platform, an SG engine designed to promote physical activity among older adults, patients, and vulnerable populations. The collected data, referred to as in-game metrics, represent the body movements captured by a 3D sensor camera and translated into game analytics. Standard clinical tests gathered before and after the long-term interaction with exergames (preintervention test vs postintervention test) were used to provide user baselines. RESULTS: Our results showed that in-game metrics can effectively categorize participants into groups of different cognitive and physical states. Different in-game metrics have higher descriptive values for specific tests and can be used to predict the value range for these tests. CONCLUSIONS: Our results provide encouraging evidence for the value of in-game metrics as digital biomarkers and can boost the analysis of improving in-game metrics to obtain more detailed results.

Health and Social Care During Coronavirus Outbreak: The Exploitation of Long Lasting Memories - LLM Care.

The Covid-19 pandemic has globally introduced a new crisis with severe consequences and led to a series of pandemic-related containment measures, including social distancing and self-isolation may cause significant impact on mental health. This study describes a social care initiative that was actualized during the Covid-19 outbreak with regard to the potential benefits in older adults' quality of life through the use of the Integrated Healthcare System Long Lasting Memories Care (LLM Care), and specifically the web-based cognitive training software. Online questionnaires, assessing various psychosocial and mental health domains, were distributed to 28 older adults before and after the interaction with the software aiming at evaluating the potential positive effect and usability of cognitive training software. Overall, the study demonstrates that the interaction with the web-based cognitive training software during the pandemic plays a significant role in maintaining mental health among older people, through improvements in well-being.

Technology Enhanced Health and Social Care for Vulnerable People During the COVID-19 Outbreak.

The COVID-19 pandemic has spread rapidly worldwide with critical consequences in health, as well as in social, economic, and particularly in psychological conditions of vulnerable people, especially older adults. Therefore, it is necessary the direct attention to their health care needs and related interventions. Information and Communication Technology (ICT) have direct impact on older adults' health and quality of life leading to decreased depression and loneliness, along with empowerment of independent life. Many studies involve cognitive training programs/software based on new technological systems that provide to vulnerable people access to gamified, attractive, cognitive exercises for overall functionality everywhere and at any time. Twenty-four participants (mean age 69.3 years) were assigned to this study. The cognitive training component of LLM Care was used as an interactive software to enhance participants' cognitive functions. The intervention lasted 12 weeks with the frequency of 2-4 times per week in sessions of at least 30 min. Participants used their personal devices (tablets/laptops) in their own residence, while technical and consulting guidance was provided by LLM Care certified trainers. They were informed about the purpose of the study, while consent forms along with psychological assessments were distributed every 2 weeks to periodically evaluate their psychosocial and mental health conditions. The assessments included the World Health Organization-Five Well-Being Index (WHO-5), the Short Anxiety Screening Test (SAST), the System Usability Scale (SUS) and the Impact Factor Event Scale (IES-R). According to the results, the participants with improved well-being tended to report decreased subjective distress caused by COVID-19, and their engagement with new technologies can potentially minimize the negative outcomes occurred by the current stressful situation, mitigating the effect of hyperarousal symptoms, while increasing their overall well-being. Well-being seems to remain relatively stable among older adults and decreases only when adversities occur, while the usability of the software was perceived as marginally acceptable by participants. The exploitation of the LLM Care contributes to the improvement of older adults' well-being and alleviates the negative experience caused by stressful situations like COVID-19.

Computerized physical and cognitive training improves the functional architecture of the brain in adults with Down syndrome: A network science EEG study.

Understanding the neuroplastic capacity of people with Down syndrome (PwDS) can potentially reveal the causal relationship between aberrant brain organization and phenotypic characteristics. We used resting-state EEG recordings to identify how a neuroplasticity-triggering training protocol relates to changes in the functional connectivity of the brain's intrinsic cortical networks. Brain activity of 12 PwDS before and after a 10-week protocol of combined physical and cognitive training was statistically compared to quantify changes in directed functional connectivity in conjunction with psychosomatometric assessments. PwDS showed increased connectivity within the left hemisphere and from left-to-right hemisphere, as well as increased physical and cognitive performance. Our findings reveal a strong adaptive neuroplastic reorganization as a result of the training that leads to a less-random network with a more pronounced hierarchical organization. Our results go beyond previous findings by indicating a transition to a healthier, more efficient, and flexible network architecture, with improved integration and segregation abilities in the brain of PwDS. Resting-state electrophysiological brain activity is used here for the first time to display meaningful relationships to underlying Down syndrome processes and outcomes of importance in a translational inquiry. This trial is registered with ClinicalTrials.gov Identifier NCT04390321.

Traditional Dance Improves the Physical Fitness and Well-Being of the Elderly.

Regular physical activity is considered one of the most important factors for lifestyle, for maintaining good health in older ages and increasing life expectancy. Dance is considered an activity that involves coordinating movements with music, as well as brain activation because it is constantly necessary to learn and remember new steps. Dance as a musical-kinetics skill, requires the coordination of body movements with rhythmic stimuli, developing the adaptability of the movement. One-hundred-thirty (130) elderly people aged 60 years and over (mean age 67 years old) with an average of 8 years of education, attended Greek traditional dance sessions for 32 weeks. The frequency was 2 times per week, for 75 min per session. Dances were selected from all over Greece with moderate intensity initially. During the program, they had the opportunity to try with greater intensity dances. At the beginning and after the end of intervention all the participants were evaluated by the Fullerton Senior Fitness Test for their physical fitness, the Single Leg Balance and the Handgrip Strength Test. The results showed a significant improvement in their physical fitness (Chair Stand: T = -5.459, p < 0.001; Arm Curl: T = -5.750, p < 0.001; Back Scratch: T = -4.648, p < 0.001; Sit and Reach: T = -4.759, p < 0.001; 2 min Step: T = -5.567, p < 0.001; Foot Up and Go: T = -8.599, p < 0.001) and at their static balance with eyes open (Balance 1 leg: T = -4.996, p < 0.001) and Handgrip Strength (Handgrip: T = -3.490, p < 0.001). Elderly seem to enjoy dancing as an activity while maintaining their functionality. Probably the elderly in traditional dance cause prosperity in their lives by promoting active aging.

Greek Traditional Dances: A Way to Support Intellectual, Psychological, and Motor Functions in Senior Citizens at Risk of Neurodegeneration.

One of the major problems that elderly people are facing is dementia. For scientist's dementia is a medical, social and economic problem, as it has been characterized as the epidemic of the 21st century. Prevention and treatment in the initial stages of dementia are essential, and community awareness and specialization of health professionals are required, with the aim of early and valid diagnosis of the disease. Activities are recommended to the senior citizens to improve their physical and mental health. Dance has been suggested as an appropriate recreational activity for the elderly that brings functional adjustments to the various systems of the body, psychological benefits, and makes exercise to seem interesting and entertaining as it combines the performance of multiple animations with musical accompaniment. A Greek traditional dance program was performed where our sample consisted of 30 healthy elderly and 30 with Mild Cognitive Impairment - MCI. It lasted 24 weeks, two times a week for 60 min. Specific traditional dances from all over Greece were selected. The dances were of a moderate intensity at the beginning with a gradual increase in intensity, according to the age and physical abilities of the participants. The results showed a significant improvement in: attention (S4viac-Healthy: z = -3.085, p = 0.002; MCI: z = -3.695, p < 0.001, S4viti-Healthy: z = -2.800, p = 0.005; MCI: z = -3.538, p < 0.001), anxiety (Healthy: z = -2.042, p = 0.041; MCI: z = -2.168, p = 0.030), verbal fluency for MCI (Verflx: t = -2.396, df = 29, p = 0.023, Verfls: t = -3.619, df = 29, p = 0.001, Verfmo: t = -3.295, df = 29, p = 0.003) and in executive functions (FUCAS: z = -2.168, p = 0.030). Significant improvement also showed in physical condition (Arm curl- Healthy: z = -3.253, p = 0.001; MCI: z = -3.308, p = 0.001, Chair stand - Healthy: t = -3.232, df = 29, p = 0.003; MCI: t = -2.242, df = 29, p = 0.033, Back scratch- Healthy: z = -1.946, p = 0.052; MCI: z = -2.845, p = 0.004, 2 min step- Healthy: z = -2.325, p = 0.020; MCI: z = -2.625, p = 0.009, FootUpandGo- Healthy: z = -4.289, p < 0.001; MCI: z = -3.137, p = 0.002, Sit and Reach: z = -3.082, p = 0.002, Balance on One leg: z = -3.301, p = 0.001) and Quality of life (Healthy: z = -1.937, p = 0.053; MCI: z = -2.130, p = 0.033). This study proves that dancing not only improves the cognitive and physical condition of the elderly but also contributes to a better quality of life.

Co-Creation of an Innovative Vocational Training Platform to Improve Autonomy in the Context of Alzheimer's Disease.

Support of autonomy, at the onset and while Alzheimer's Disease progresses, is of utmost importance for both older adults and their caregivers. AD-Autonomy project aims at co-creating an innovative training platform with and for elderly people and their caregivers. Main aim of the project is to increase the competencies of older adults and their caregivers to cope with the disease effects, by leveraging existing ICT tools and applications, while transferring their applicability in real life contexts and activities. Initial anecdotal feedback is collected through a co-creation session, where all above themes were discussed and analyzed between seniors, family caregivers and professionals.

Unmet Needs of Persons with Down Syndrome: How Assistive Technology and Game-Based Training May Fill the Gap.

The use of new technology seems to be an important factor that contributes to the overall ability to adapt and achieve higher independence. Technologies using digital games have gained the great interest of the scientific community as there are many advantages for both effectiveness and benefits, physically and mentally, providing the opportunity for essential and enjoyable training. This study presents an important initial step utilizing the LLM Care service which focuses on the needs and challenges for the health and daily living of people with Down syndrome (DS) by applying new technology hardware and software. People with cognitive impairments, such as memory, attention and motivation problems may also benefit from this kind of cognitive support that assistive technology offers.

Functional Re-organization of Cortical Networks of Senior Citizens After a 24-Week Traditional Dance Program.

Neuroscience is developing rapidly by providing a variety of modern tools for analyzing the functional interactions of the brain and detection of pathological deviations due to neurodegeneration. The present study argues that the induction of neuroplasticity of the mature human brain leads to the prevention of dementia. Promising solution seems to be the dance programs because they combine cognitive and physical activity in a pleasant way. So, we investigated whether the traditional Greek dances can improve the cognitive, physical and functional status of the elderly always aiming at promoting active and healthy aging. Forty-four participants were randomly assigned equally to the training group and an active control group. The duration of the program was 6 months. Also, the participants were evaluated for their physical status and through an electroencephalographic (EEG) examination at rest (eyes-closed condition). The EEG testing was performed 1-14 days before (pre) and after (post) the training. Cortical network analysis was applied by modeling the cortex through a generic anatomical model of 20,000 fixed dipoles. These were grouped into 512 cortical regions of interest (ROIs). High quality, artifact-free data resulting from an elaborate pre-processing pipeline were segmented into multiple, 30 s of continuous epochs. Then, functional connectivity among those ROIs was performed for each epoch through the relative wavelet entropy (RWE). Synchronization matrices were computed and then thresholded in order to provide binary, directed cortical networks of various density ranges. The results showed that the dance training improved optimal network performance as estimated by the small-world property. Further analysis demonstrated that there were also local network changes resulting in better information flow and functional re-organization of the network nodes. These results indicate the application of the dance training as a possible non-pharmacological intervention for promoting mental and physical well-being of senior citizens. Our results were also compared with a combination of computerized cognitive and physical training, which has already been demonstrated to induce neuroplasticity (LLM Care).

Design, Implementation, and Wide Pilot Deployment of FitForAll: An Easy to use Exergaming Platform Improving Physical Fitness and Life Quality of Senior Citizens.

Many platforms have emerged as response to the call for technology supporting active and healthy aging. Key requirements for any such e-health systems and any subsequent business exploitation are tailor-made design and proper evaluation. This paper presents the design, implementation, wide deployment, and evaluation of the low cost, physical exercise, and gaming (exergaming) FitForAll (FFA) platform system usability, user adherence to exercise, and efficacy are explored. The design of FFA is tailored to elderly populations, distilling literature guidelines and recommendations. The FFA architecture introduces standard physical exercise protocols in exergaming software engineering, as well as, standard physical assessment tests for augmented adaptability through adjustable exercise intensity. This opens up the way to next generation exergaming software, which may be more automatically/smartly adaptive. 116 elderly users piloted FFA five times/week, during an eight-week controlled intervention. Usability evaluation was formally conducted (SUS, SUMI questionnaires). Control group consisted of a size-matched elderly group following cognitive training. Efficacy was assessed objectively through the senior fitness (Fullerton) test, and subjectively, through WHOQoL-BREF comparisons of pre-postintervention between groups. Adherence to schedule was measured by attendance logs. The global SUMI score was 68.33±5.85%, while SUS was 77.7. Good usability perception is reflected in relatively high adherence of 82% for a daily two months pilot schedule. Compared to control group, elderly using FFA improved significantly strength, flexibility, endurance, and balance while presenting a significant trend in quality of life improvements. This is the first elderly focused exergaming platform intensively evaluated with more than 100 participants. The use of formal tools makes the findings comparable to other studies and forms an elderly exergaming corpus.

Gains in cognition through combined cognitive and physical training: the role of training dosage and severity of neurocognitive disorder.

Physical as well as cognitive training interventions improve specific cognitive functions but effects barely generalize on global cognition. Combined physical and cognitive training may overcome this shortcoming as physical training may facilitate the neuroplastic potential which, in turn, may be guided by cognitive training. This study aimed at investigating the benefits of combined training on global cognition while assessing the effect of training dosage and exploring the role of several potential effect modifiers. In this multi-center study, 322 older adults with or without neurocognitive disorders (NCDs) were allocated to a computerized, game-based, combined physical and cognitive training group (n = 237) or a passive control group (n = 85). Training group participants were allocated to different training dosages ranging from 24 to 110 potential sessions. In a pre-post-test design, global cognition was assessed by averaging standardized performance in working memory, episodic memory and executive function tests. The intervention group increased in global cognition compared to the control group, p = 0.002, Cohen's d = 0.31. Exploratory analysis revealed a trend for less benefits in participants with more severe NCD, p = 0.08 (cognitively healthy: d = 0.54; mild cognitive impairment: d = 0.19; dementia: d = 0.04). In participants without dementia, we found a dose-response effect of the potential number and of the completed number of training sessions on global cognition, p = 0.008 and p = 0.04, respectively. The results indicate that combined physical and cognitive training improves global cognition in a dose-responsive manner but these benefits may be less pronounced in older adults with more severe NCD. The long-lasting impact of combined training on the incidence and trajectory of NCDs in relation to its severity should be assessed in future long-term trials.