Cognitive-Based Interventions to Improve Mobility: A Systematic Review and Meta-analysis

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Abstract

Objective: A strong relation between cognition and mobility has been identified in aging, supporting a role for enhancement mobility through cognitive-based interventions. However, a critical evaluation of the consistency of treatment effects of cognitive-based interventions is currently lacking. The objective of this study was 2-fold: (1) to review the existing literature on cognitive-based interventions aimed at improving mobility in older adults and (2) to assess the clinical effectiveness of cognitive interventions on gait performance. Design: A systematic review of randomized controlled trials (RCT) of cognitive training interventions for improving simple (normal walking) and complex (dual task walking) gait was conducted in February 2018. Setting and Participants: Older adults without major cognitive, psychiatric, neurologic, and/or sensory impairments were included. Measures: Random effect meta-analyses and a subsequent meta-regression were performed to generate overall cognitive intervention effects on single- and dual-task walking conditions. Results: Ten RCTs met inclusion criteria, with a total of 351 participants included in this meta-analysis. Cognitive training interventions revealed a small effect of intervention on complex gait [effect size (ES) = 0.47, 95% confidence interval (CI) 0.13 to 0.81, P =.007, I2 = 15.85%], but not simple gait (ES = 0.35, 95% CI –0.01 to 0.71, P =.057, I2 = 57.32%). Moreover, a meta-regression analysis revealed that intervention duration, training frequency, total number of sessions, and total minutes spent in intervention were not significant predictors of improvement in dual-task walking speed, though there was a suggestive trend toward a negative association between dual-task walking speed improvements and individual training session duration (P =.067). Conclusions/Implications: This meta-analysis provides support for the fact that cognitive training interventions can improve mobility-related outcomes, especially during challenging walking conditions requiring higher-order executive functions. Additional evidence from well-designed large-scale randomized clinical trials is warranted to confirm the observed effects.

Original languageEnglish (US)
JournalJournal of the American Medical Directors Association
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Gait
Walking
Meta-Analysis
Randomized Controlled Trials
Confidence Intervals
Executive Function
Cognition
Nervous System
Psychiatry
Regression Analysis
Walking Speed

Keywords

  • computerized cognitive training
  • elderly
  • fall risk
  • Gait control
  • neurophysiological plasticity

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy

Cite this

@article{99815fca95194a82aa949d890bea3b17,
title = "Cognitive-Based Interventions to Improve Mobility: A Systematic Review and Meta-analysis",
abstract = "Objective: A strong relation between cognition and mobility has been identified in aging, supporting a role for enhancement mobility through cognitive-based interventions. However, a critical evaluation of the consistency of treatment effects of cognitive-based interventions is currently lacking. The objective of this study was 2-fold: (1) to review the existing literature on cognitive-based interventions aimed at improving mobility in older adults and (2) to assess the clinical effectiveness of cognitive interventions on gait performance. Design: A systematic review of randomized controlled trials (RCT) of cognitive training interventions for improving simple (normal walking) and complex (dual task walking) gait was conducted in February 2018. Setting and Participants: Older adults without major cognitive, psychiatric, neurologic, and/or sensory impairments were included. Measures: Random effect meta-analyses and a subsequent meta-regression were performed to generate overall cognitive intervention effects on single- and dual-task walking conditions. Results: Ten RCTs met inclusion criteria, with a total of 351 participants included in this meta-analysis. Cognitive training interventions revealed a small effect of intervention on complex gait [effect size (ES) = 0.47, 95{\%} confidence interval (CI) 0.13 to 0.81, P =.007, I2 = 15.85{\%}], but not simple gait (ES = 0.35, 95{\%} CI –0.01 to 0.71, P =.057, I2 = 57.32{\%}). Moreover, a meta-regression analysis revealed that intervention duration, training frequency, total number of sessions, and total minutes spent in intervention were not significant predictors of improvement in dual-task walking speed, though there was a suggestive trend toward a negative association between dual-task walking speed improvements and individual training session duration (P =.067). Conclusions/Implications: This meta-analysis provides support for the fact that cognitive training interventions can improve mobility-related outcomes, especially during challenging walking conditions requiring higher-order executive functions. Additional evidence from well-designed large-scale randomized clinical trials is warranted to confirm the observed effects.",
keywords = "computerized cognitive training, elderly, fall risk, Gait control, neurophysiological plasticity",
author = "Uros Marusic and Joe Verghese and Mahoney, {Jeannette R.}",
year = "2018",
month = "1",
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doi = "10.1016/j.jamda.2018.02.002",
language = "English (US)",
journal = "Journal of the American Medical Directors Association",
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AU - Marusic, Uros

AU - Verghese, Joe

AU - Mahoney, Jeannette R.

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N2 - Objective: A strong relation between cognition and mobility has been identified in aging, supporting a role for enhancement mobility through cognitive-based interventions. However, a critical evaluation of the consistency of treatment effects of cognitive-based interventions is currently lacking. The objective of this study was 2-fold: (1) to review the existing literature on cognitive-based interventions aimed at improving mobility in older adults and (2) to assess the clinical effectiveness of cognitive interventions on gait performance. Design: A systematic review of randomized controlled trials (RCT) of cognitive training interventions for improving simple (normal walking) and complex (dual task walking) gait was conducted in February 2018. Setting and Participants: Older adults without major cognitive, psychiatric, neurologic, and/or sensory impairments were included. Measures: Random effect meta-analyses and a subsequent meta-regression were performed to generate overall cognitive intervention effects on single- and dual-task walking conditions. Results: Ten RCTs met inclusion criteria, with a total of 351 participants included in this meta-analysis. Cognitive training interventions revealed a small effect of intervention on complex gait [effect size (ES) = 0.47, 95% confidence interval (CI) 0.13 to 0.81, P =.007, I2 = 15.85%], but not simple gait (ES = 0.35, 95% CI –0.01 to 0.71, P =.057, I2 = 57.32%). Moreover, a meta-regression analysis revealed that intervention duration, training frequency, total number of sessions, and total minutes spent in intervention were not significant predictors of improvement in dual-task walking speed, though there was a suggestive trend toward a negative association between dual-task walking speed improvements and individual training session duration (P =.067). Conclusions/Implications: This meta-analysis provides support for the fact that cognitive training interventions can improve mobility-related outcomes, especially during challenging walking conditions requiring higher-order executive functions. Additional evidence from well-designed large-scale randomized clinical trials is warranted to confirm the observed effects.

AB - Objective: A strong relation between cognition and mobility has been identified in aging, supporting a role for enhancement mobility through cognitive-based interventions. However, a critical evaluation of the consistency of treatment effects of cognitive-based interventions is currently lacking. The objective of this study was 2-fold: (1) to review the existing literature on cognitive-based interventions aimed at improving mobility in older adults and (2) to assess the clinical effectiveness of cognitive interventions on gait performance. Design: A systematic review of randomized controlled trials (RCT) of cognitive training interventions for improving simple (normal walking) and complex (dual task walking) gait was conducted in February 2018. Setting and Participants: Older adults without major cognitive, psychiatric, neurologic, and/or sensory impairments were included. Measures: Random effect meta-analyses and a subsequent meta-regression were performed to generate overall cognitive intervention effects on single- and dual-task walking conditions. Results: Ten RCTs met inclusion criteria, with a total of 351 participants included in this meta-analysis. Cognitive training interventions revealed a small effect of intervention on complex gait [effect size (ES) = 0.47, 95% confidence interval (CI) 0.13 to 0.81, P =.007, I2 = 15.85%], but not simple gait (ES = 0.35, 95% CI –0.01 to 0.71, P =.057, I2 = 57.32%). Moreover, a meta-regression analysis revealed that intervention duration, training frequency, total number of sessions, and total minutes spent in intervention were not significant predictors of improvement in dual-task walking speed, though there was a suggestive trend toward a negative association between dual-task walking speed improvements and individual training session duration (P =.067). Conclusions/Implications: This meta-analysis provides support for the fact that cognitive training interventions can improve mobility-related outcomes, especially during challenging walking conditions requiring higher-order executive functions. Additional evidence from well-designed large-scale randomized clinical trials is warranted to confirm the observed effects.

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