The MEDITAGING study: protocol of a two-armed randomized controlled study to compare the effects of the mindfulness-based stress reduction program against a health promotion program in older migrants in Luxembourg.

BACKGROUND: Migration is a phenomenon worldwide, with older migrants, particularly those with fewer socioeconomic resources, having an increased risk of developing adverse cognitive and health outcomes and social isolation. Therefore, it is of utmost importance to validate interventions that promote healthy aging in this population. Previous studies have shown a positive impact of mindfulness based-stress reduction (MBSR) on outcomes such as cognition and sleep. However, only a few studies verified its potential in older adults, especially with vulnerable populations such as migrants. This article presents the protocol of the MEDITAGING study, which is the first to investigate the MBSR effects in migrants aged ≥55 in comparison to a health promotion program. METHODS: MEDITAGING is a two-arm randomized, double-blinded, controlled study, which will include older Portuguese-speaking migrants (n = 90). Participants are randomized to the MBSR or a health promotion program. Both interventions are conducted in groups over a total of 8 weeks, incorporating weekly meetings, an additional 4-hour class, and extra at-home tasks. The health promotion program has the same structure as the MBSR but comprises different activities related to dementia prevention, healthy habits, cognitive stimulation, sleeping, nutrition, watercolor painting, and physical activity. The assessment of executive functioning, physiological stress measures, self-reported questionnaires, and qualitative interviews are conducted at baseline, after 8 weeks (post-intervention), and at a follow-up session (from one to 3 months thereafter). Analyzes will be conducted using a modified intention-to-treat approach (all participants with at least 3 days of participation in the group-sessions and one post-intervention observation). DISCUSSION: This study will test effects of a mindfulness-based intervention against an active control condition in older adult migrants, which few studies have addressed. TRIAL REGISTRATION: ClinicalTrials.gov NCT05615337 (date of registration: 27 September 2022; date of record verification: 14 November 2022).

Quasi-experimental pilot study to improve mobility and balance in recurrently falling nursing home residents by voluntary non-targeted side-stepping exercise intervention.

BACKGROUND: Side-stepping is a potential exercise program to reduce fall risk in community-dwelling adults in their seventies, but it has never been tested in nursing home residents. This was a pilot quasi-experimental study to examine the feasibility and potential mobility and balance benefits of an intervention based on voluntary non-targeted side-stepping exercises in nursing home residents who fall recurrently. METHODS: Twenty-two participants were recruited and non-randomly assigned to an intervention group ([Formula: see text]11, side-stepping exercises, STEP) participating in an 8-week protocol and to a control group ([Formula: see text]11, usual physiotherapy care, CTRL). They were clinically assessed at 4-time points: baseline, after 4 and 8 weeks, and after a 4-week follow-up period (usual physiotherapy care). Statistical differences between time points were assessed with a Friedman repeated measures ANOVA on ranks or a one-way repeated measures ANOVA. RESULTS: Compared to baseline, significant benefits were observed in the STEP group at 8 weeks for the Timed Up and Go ([Formula: see text]0.020) and 6-minute walking test ([Formula: see text]0.001) as well as for the Berg Balance Scale ([Formula: see text]0.041) and Mini motor test ([Formula: see text]0.026). At follow-up, the Tinetti Performance Oriented Mobility Assessment and Berg Balance Scale significantly worsened in the STEP group ([Formula: see text]0.009 and [Formula: see text]0.001, respectively). No significant differences were found between the groups at the same time points. CONCLUSIONS: Our intervention was feasible and improved mobility and balance after almost 8 weeks. Studies with larger samples and randomized control trials are needed to consolidate our preliminary observations and confirm the deterioration of some tests when side-stepping exercises are discontinued. TRIAL REGISTRATION: Identifier: ISRCTN13584053. Retrospectively registered 01/09/2022.

Using social marketing for the promotion of cognitive health: a scoping review protocol.

INTRODUCTION: The use of social marketing strategies to induce the promotion of cognitive health has received little attention in research. The objective of this scoping review is twofold: (i) to identify the social marketing strategies that have been used in recent years to initiate and maintain health-promoting behaviour; (ii) to advance research in this area to inform policy and practice on how to best make use of these strategies to promote cognitive health. METHODS AND ANALYSIS: We will use the five-stage methodological framework of Arksey and O'Malley. Articles in English published since 2010 will be searched in electronic databases (the Cochrane Library, DoPHER, the International Bibliography of the Social Sciences, PsycInfo, PubMed, ScienceDirect, Scopus). Quantitative and qualitative study designs as well as reviews will be considered. We will include those articles that report the design, implementation, outcomes and evaluation of programmes and interventions concerning social marketing and/or health promotion and/or promotion of cognitive health. Grey literature will not be searched. Two independent reviewers will assess in detail the abstracts and full text of selected citations against the inclusion criteria. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart for Scoping Reviews will be used to illustrate the process of article selection. We will use a data extraction form, present the results through narrative synthesis and discuss them in relation to the scoping review research questions. ETHICS AND DISSEMINATION: Ethics approval is not required for conducting this scoping review. The results of the review will be the first step to advance a conceptual framework, which contributes to the development of interventions targeting the promotion of cognitive health. The results will be published in a peer-reviewed scientific journal. They will also be disseminated to key stakeholders in the field of the promotion of cognitive health.

Spatiotemporal Gait Characteristics Associated with Cognitive Impairment: A Multicenter Cross-Sectional Study, the Intercontinental "Gait, cOgnitiOn & Decline" Initiative.

BACKGROUND: The study aims to determine the spatiotemporal gait parameters and/or their combination(s) that best differentiate between cognitively healthy individuals (CHI), patients with mild cognitive impairment (MCI) and those with mild and moderate dementia, regardless of the etiology of cognitive impairment. METHODS: A total of 2099 participants (1015 CHI, 478 patients with MCI, 331 patients with mild dementia and 275 with moderate dementia) were selected from the intercontinental "Gait, cOgnitiOn & Decline" (GOOD) initiative, which merged different databases from seven cross-sectional studies. Mean values and coefficients of variation (CoV) of spatiotemporal gait parameters were recorded during usual walking with the GAITRite® system. RESULTS: The severity of cognitive impairment was associated with worse performance on all gait parameters. Stride velocity had the strongest association with cognitive impairment, regardless of cognitive status. High mean value and CoV of stride length characterized moderate dementia, whereas increased CoV of stride time was specific to MCI status. CONCLUSION: The findings support the existence of specific cognitive impairment-related gait disturbances with differences related to stages of cognitive impairment, which may be used to screen individuals with cognitive impairment.

Guidelines for Assessment of Gait and Reference Values for Spatiotemporal Gait Parameters in Older Adults: The Biomathics and Canadian Gait Consortiums Initiative.

Background: Gait disorders, a highly prevalent condition in older adults, are associated with several adverse health consequences. Gait analysis allows qualitative and quantitative assessments of gait that improves the understanding of mechanisms of gait disorders and the choice of interventions. This manuscript aims (1) to give consensus guidance for clinical and spatiotemporal gait analysis based on the recorded footfalls in older adults aged 65 years and over, and (2) to provide reference values for spatiotemporal gait parameters based on the recorded footfalls in healthy older adults free of cognitive impairment and multi-morbidities. Methods: International experts working in a network of two different consortiums (i.e., Biomathics and Canadian Gait Consortium) participated in this initiative. First, they identified items of standardized information following the usual procedure of formulation of consensus findings. Second, they merged databases including spatiotemporal gait assessments with GAITRite® system and clinical information from the "Gait, cOgnitiOn & Decline" (GOOD) initiative and the Generation 100 (Gen 100) study. Only healthy-free of cognitive impairment and multi-morbidities (i.e., ≤ 3 therapeutics taken daily)-participants aged 65 and older were selected. Age, sex, body mass index, mean values, and coefficients of variation (CoV) of gait parameters were used for the analyses. Results: Standardized systematic assessment of three categories of items, which were demographics and clinical information, and gait characteristics (clinical and spatiotemporal gait analysis based on the recorded footfalls), were selected for the proposed guidelines. Two complementary sets of items were distinguished: a minimal data set and a full data set. In addition, a total of 954 participants (mean age 72.8 ± 4.8 years, 45.8% women) were recruited to establish the reference values. Performance of spatiotemporal gait parameters based on the recorded footfalls declined with increasing age (mean values and CoV) and demonstrated sex differences (mean values). Conclusions: Based on an international multicenter collaboration, we propose consensus guidelines for gait assessment and spatiotemporal gait analysis based on the recorded footfalls, and reference values for healthy older adults.

Falls, Cognitive Impairment, and Gait Performance: Results From the GOOD Initiative.

OBJECTIVES: Falls are highly prevalent in individuals with cognitive decline. The complex relationship between falls and cognitive decline (including both subtype and severity of dementia) and the influence of gait disorders have not been studied. This study aimed to examine the association between the subtype (Alzheimer disease [AD] versus non-AD) and the severity (from preclinical to moderate dementia) of cognitive impairment and falls, and to establish an association between falls and gait parameters during the course of dementia. DESIGN: Multicenter cross-sectional study. SETTING: "Gait, cOgnitiOn & Decline" (GOOD) initiative. PARTICIPANTS: A total of 2496 older adults (76.6 ± 7.6 years; 55.0% women) were included in this study (1161 cognitively healthy individuals [CHI], 529 patients with mild cognitive impairment [MCI], 456 patients with mild dementia, and 350 with moderate dementia) from 7 countries. MEASUREMENTS: Falls history was collected retrospectively at baseline in each study. Gait speed and stride time variability were recorded at usual walking pace with the GAITRite system. RESULTS: The prevalence of individuals who fall was 50% in AD and 64% in non-AD; whereas it was 25% in CHIs. Only mild and moderate non-AD dementia were associated with an increased risk for falls in comparison with CHI. Higher stride time variability was associated with falls in older adults without dementia (CHI and each MCI subgroup) and mild non-AD dementia, whereas lower gait speed was associated with falls in all participant groups, except in mild AD dementia. When gait speed was adjusted for, higher stride time variability was associated with falls only in CHIs (odds ratio 1.14; P = .012), but not in MCI or in patients with dementia. CONCLUSIONS: These findings suggest that non-AD, but not AD dementia, is associated with increased falls in comparison with CHIs. The association between gait parameters and falls also differs across cognitive status, suggesting different mechanisms leading to falls in older individuals with dementia in comparison with CHIs who fall.

The relationship between emotion regulation capacity, heart rate variability, and quality of life in individuals with alcohol-related brain damage.

The reliable measurement of quality of life (QoL) presents a challenge in individuals with alcohol-related brain damage. This study investigated vagally mediated heart rate variability (vmHRV) as a physiological predictor of QoL. Self- and proxy ratings of QoL and dysexecutive symptoms were collected once, while vmHRV was repeatedly assessed over a 3-week period at weekly intervals in a sample of nine alcohol-related brain damaged patients. We provide robustness checks, bootstrapped correlations with confidence intervals, and standard errors for mean scores. We observed low to very low heart rate variability scores in our patients in comparison to norm values found in healthy populations. Proxy ratings of the QoL scale "subjective physical and mental performance" and everyday executive dysfunctions were strongly related to vmHRV. Better proxy-rated QoL and fewer dysexecutive symptoms were observed in those patients with higher vmHRV. Overall, patients showed low parasympathetic activation favoring the occurrence of dysfunctional emotion regulation strategies.

Poor Gait Performance and Prediction of Dementia: Results From a Meta-Analysis.

BACKGROUND: Poor gait performance predicts risk of developing dementia. No structured critical evaluation has been conducted to study this association yet. The aim of this meta-analysis was to systematically examine the association of poor gait performance with incidence of dementia. METHODS: An English and French Medline search was conducted in June 2015, with no limit of date, using the medical subject headings terms "Gait" OR "Gait Disorders, Neurologic" OR "Gait Apraxia" OR "Gait Ataxia" AND "Dementia" OR "Frontotemporal Dementia" OR "Dementia, Multi-Infarct" OR "Dementia, Vascular" OR "Alzheimer Disease" OR "Lewy Body Disease" OR "Frontotemporal Dementia With Motor Neuron Disease" (Supplementary Concept). Poor gait performance was defined by standardized tests of walking, and dementia was diagnosed according to international consensus criteria. Four etiologies of dementia were identified: any dementia, Alzheimer disease (AD), vascular dementia (VaD), and non-AD (ie, pooling VaD, mixed dementias, and other dementias). Fixed effects meta-analyses were performed on the estimates in order to generate summary values. RESULTS: Of the 796 identified abstracts, 12 (1.5%) were included in this systematic review and meta-analysis. Poor gait performance predicted dementia [pooled hazard ratio (HR) combined with relative risk and odds ratio = 1.53 with P < .001 for any dementia, pooled HR = 1.79 with P < .001 for VaD, HR = 1.89 with P value < .001 for non-AD]. Findings were weaker for predicting AD (HR = 1.03 with P value = .004). CONCLUSIONS: This meta-analysis provides evidence that poor gait performance predicts dementia. This association depends on the type of dementia; poor gait performance is a stronger predictor of non-AD dementias than AD.

The effects of cognitive training on gait speed and stride variability in old adults: findings from a pilot study.

BACKGROUND: The interrelationship between gait performance and higher-order cognitive functions has been established through a number of different investigations. In turn, enabling gait by improving cognition is a new and emerging field of research. AIMS: Investigating if and to what extent a structured cognitive training program influences gait-related parameters in a sample of old and frail nursing home residents. METHODS: Twenty-one nursing home residents were quasi-randomized to an intervention group following a 6-week structured cognitive training program or a control group. Gait was investigated during normal pace and under two dual-task conditions (simple and complex dual-task walking conditions), using the GAITRite(®) system at three predefined time points (pre-intervention, post-intervention, 3-month follow-up). Outcome measures were gait speed and stride variabilities. RESULTS: Confirmation of the interrelationship between gait and cognition evidenced by decreased gait parameters during complex dual-task walking. Observation of clinical meaningful improvements in gait stability and gait speed after the training program under the complex dual-task situations, with only speed remaining stable over a period of 3 months. DISCUSSION: This study on the effects of cognitive training on gait is promising, with several results going in the expected direction. Our data corroborate previous findings and extend them to the group of frail old nursing home residents. CONCLUSIONS: The present pilot study's approach of improving gait under challenging walking situations by interventions designed to improve cognitions adds encouraging results to this emerging field of research, although restrictions in sample size and in the control group prevent us from drawing firm conclusions.

What about inhibition in the Wisconsin Card Sorting Test?

The commercially available Wisconsin Card Sorting Test (WCST) is one of the most commonly used tests for assessing executive functions within clinical settings. Importantly, however, it remains relatively unclear exactly what processes are assessed by the test. Conceptually, increased perseverative errors in sorting cards are usually related to deficient inhibition processes. Empirically, evidence supporting this conclusion is limited. In a sample of 38 healthy adults we addressed the question to what extent inhibition mechanisms assessed by the go/no-go and the stop-signal paradigm are related to WCST performances. Inhibition-related scores were found to predict non-perseverative errors better than perseverative errors. Consequently we conclude that the non-perseverative errors score reflects processes that are partly dependent on inhibition functions.

Incomplete psychometric equivalence of scores obtained on the manual and the computer version of the Wisconsin Card Sorting Test?

The Wisconsin Card Sorting Test (WCST) assesses executive and frontal lobe function and can be administered manually or by computer. Despite the widespread application of the 2 versions, the psychometric equivalence of their scores has rarely been evaluated and only a limited set of criteria has been considered. The present experimental study (N = 100 healthy adults) therefore examined the psychometric equivalence of 4 scores (i.e., Total Correct, Percentage of Errors, Perseverative Errors, and Failure-to-Maintain-Set) obtained on the 2 versions of the WCST in terms of 4 key criteria identified within the framework of classical test theory. The results showed considerable differences in variances, small to modest parallel-forms reliability coefficients, and small to modest temporal stability coefficients. Taken together, our results suggest that scores on the manual version and the computer version of the WCST show incomplete psychometric equivalence.