Posts Tagged dementia

[QUOTATION] Living with DEMENTIA

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[WEB SITE] Brains Tend to Work in Sync During Music Therapy, Study Suggests

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The brains of a patient and therapist become synchronized during a music therapy session, a breakthrough that could improve future interactions between patients and therapists, researchers suggest.

The research, published in the journal Frontiers in Psychology, was carried out by Professor Jorg Fachner and Dr Clemens Maidhof of Anglia Ruskin University (ARU).

In the study, they used a procedure called hyperscanning, which is designed to record activity in two brains at the same time, allowing them to better understand how people interact.

During the session documented in the study, classical music was played as the patient discussed a serious illness in her family. Both patient and therapist wore EEG (electroencephalogram) caps containing sensors, which capture electrical signals in the brain, and the session was recorded in sync with the EEG using video cameras, a media release from Anglia Ruskin University explains.

Music therapists work towards “moments of change,” where they make a meaningful connection with their patient. At one point during this study, the patient’s brain activity shifted suddenly from displaying deep negative feelings to a positive peak. Moments later, as the therapist realized the session was working, her scan displayed similar results. In subsequent interviews, both identified that as a moment when they felt the therapy was really working.

The researchers examined activity in the brain’s right and left frontal lobes where negative and positive emotions are processed, respectively. By analyzing hyperscanning data alongside video footage and a transcript of the session, the researchers were able to demonstrate that brain synchronization occurs, and also show what a patient-therapist “moment of change” looks like inside the brain.

“This study is a milestone in music therapy research,” says lead author Jorg Fachner, Professor of Music, Health and the Brain at Anglia Ruskin University (ARU), in the release.

“Music therapists report experiencing emotional changes and connections during therapy, and we’ve been able to confirm this using data from the brain.

“Music, used therapeutically, can improve well-being, and treat conditions including anxiety, depression, autism and dementia. Music therapists have had to rely on the patient’s response to judge whether this is working, but by using hyperscanning we can see exactly what is happening in the patient’s brain,” he continues.

“Hyperscanning can show the tiny, otherwise imperceptible, changes that take place during therapy. By highlighting the precise points where sessions have worked best, it could be particularly useful when treating patients for whom verbal communication is challenging. Our findings could also help to better understand emotional processing in other therapeutic interactions,” he concludes.

[Source(s): Anglia Ruskin University, Science Daily]

 

via Brains Tend to Work in Sync During Music Therapy, Study Suggests – Rehab Managment

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[BLOG POST] Mozart and epilepsy: the rhythm beats on

 

I can’t seem to get away from the theme of Mozart and epilepsy. When I first looked at this, in a blog post titled Mozart and seizures? The links between epilepsy and music, I took the topic rather lightly, more a subscript than a headline you may say. But I have since learnt to take the links between epilepsy and music more seriously.

By Barbara Krafft – The Bridgeman Art Library, Object 574471, Public Domain, Link

 

The major trigger for my ‘road to Damascus’ conversion is a 2018 paper titled Study of the Mozart effect in children with epileptic electroencephalograms, published in the journal Seizure. The paper was an eye-opener because it gave a very helpful comprehensive context to the broader beneficial effect of music…not just in epilepsy, but in other neurological disorders such as Parkinson’s diseasedementia and sleep disordersThe authors, Elyza Grylls and colleagues, started on the established premise that Mozart’s music has a beneficial effect on epilepsy. What they wanted to know was if other forms of music have a similar settling effect on epilepsy, or if only Mozart’s music carries the magic touch. The authors therefore played Mozart’s Sonata for two pianos in D major (K448) to 40 children with epilepsy who were undergoing an EEG (electroencephalogram, or electrical brain wave test). They then compared this with the effect of playing other types of music. Remarkably, they found that only Mozart’s Sonata led to a significant reduction in EEG epileptic discharges.

Public Domain, Link

The authors concluded that there was indeed an anti-epileptic effect of Mozart’s music, the so-called  ‘Mozart therapy’. But what is so special about K448? They speculate that it has to do with the structure of Mozart’s music, containing as it does, long periodicities. Interestingly, the music of Yanni, which is similarly structured, has somewhat a similar effect on brain wave activity. On the contrary, and sorry to Beethoven fans, Fur Elise doesn’t have this effect.

By W.J. Baker (held the expired copyright on the photograph) – Library of Congress[1]Contrairement à une erreur fréquemment répandue le buste a été réalisé par Hugo Hagen, non pas à partir du masque mortuaire mais, comme de nombreux autres, d’après le masque réalisé en 1812 par Franz Klein pour un buste qu’il devait réaliser ensuite., Public Domain, Link

So what does the structure of Mozart’s music do to the brain? One suggestion is that Mozart’s music enhances the body’s parasympathetic drive; this reduces the heart rate, and thereby inhibits the brain’s propensity to epileptic seizures. The suppression of this parasympathetic drive is of course the theory behind using vagus nerve stimulation (VNS) to treat drug-resistant epilepsy. For more on VNS, see my previous blog, Vagus nerve stimulation: from neurology and beyond!

By Bionerd – MRI at Charite Mitte, Berlin (used with permission), CC BY 3.0Link

You have surely wondered by now if K448 is the only one of Mozart’s compositions to have an anti-epileptic effect. It doesn’t matter if you have not, because the authors of another interesting paper did. They titled their study, published in 2018, Mozart’s music in children with drug-refractory epileptic encephalopathies: comparison of two protocols. Published in the journal Epilepsy and Behaviour, the authors, Giangennaro Coppola and colleagues, compared the effect of K448 with a set of his other compositions. Intriguingly they found that the composition set actually had a greater effect in epilepsy than K448…by a wide margin of 70% to 20%! Furthermore, the set was better tolerated by the children; they were less irritable and had a better nighttime sleep quality.   

https://www.publicdomainpictures.net/en/view-image.php?image=76907&picture=dog-amp-child-painting

It therefore appears as if it all rosy in the garden of music and the brain. But it is not! As every rose grows on a thorny tree, so do some forms of music trigger epileptic seizures. This so-called musicogenic epilepsy is well-recognised, and two recent culprits are the music of Sean Paul, discussed in the journal Scientific American , and the music of Ne Yo, explored by NME. Therefore you should craft your playlist wisely.

By CLASSICNEYO – Own workCC BY-SA 4.0Link

So, is it time for neurologists to start prescribing music?

Or is it too much of a double-edged sword?

Music is #SimplyIrresistible. Luca Florio on Flickr. https://www.flickr.com/photos/elle_florio/29516744480

via Mozart and epilepsy: the rhythm beats on – The Neurology Lounge

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[WEB SITE] How does music therapy work? Brain study sheds light

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Music therapy works, but no one is really sure how. Now, a novel type of brain scan may provide key insight.

man listening to music

Music is a powerful thing. In fact, it forms the basis of a type of therapy, the aptly named “music therapy.”

During sessions, a music therapist attempts to form a bond with their client in order to enhance well-being and improve confidence, communication skills, awareness, and attention.

There are several types of music therapy. Some involve simply listening to relaxing music while talking. Others involve making music with instruments, which can be particularly effective for those who struggle to communicate verbally.

One type, known as the Bonny Method of Guided Imagery and Music (GIM) aims to facilitate discussion. The therapist plays music and asks the client to describe the images that come to mind.

Trials have found benefits to music therapy, but how it works remains unclear.

Using GIM as their focus, a team led by two experts from Anglia Ruskin University, in the United Kingdom — Prof. Jörg Fachner and Clemens Maidhof, Ph.D. — set out to find the answer. Their findings appear in the journal Frontiers in Psychology.

Discovering important moments

The goal of a music therapist is to reach a “moment of change” in which they can strengthen their connection with their client. Therapists and clients often describe feeling in sync, and now there is evidence to prove it.

In the current study, the researchers used hyperscanning — a procedure that can simultaneously record two people’s brain activities — to study a music therapist’s session with a client.

The method, says lead author Prof. Fachner, “can show the tiny, otherwise imperceptible, changes that take place during therapy.”

The therapist and client wore EEG caps to record the electrical signaling in their brains, and the session was filmed. Ultimately, the researchers hoped to learn more about how the individuals interacted.

“Music, used therapeutically, can improve well-being and treat conditions including anxietydepressionautism, and dementia. Music therapists have had to rely on the patient’s response to judge whether this is working, but by using hyperscanning we can see exactly what is happening in the patient’s brain,” says Prof. Fachner.

Once the recordings were complete, the researchers asked the therapist, client, and two other GIM therapy experts to watch the video and each note down three moments of change, as well as one unimportant moment.

A clear connection

The team examined their answers for overlap to see whether any points were of interest to all four participants. A couple of moments fell into this category.

With that knowledge, Prof. Fachner and Maidhof examined the EEG readings from those moments. They paid particular attention to the areas of the brain that process positive and negative emotions.

Surprisingly, they came up with an image that illustrates a moment of change inside the brain.

When the client’s brain switched from negative emotions to positive ones, their EEG recording clearly showcased this. A few moments later, the therapist’s brain showed the exact same pattern.

Both the therapist and client later identified this moment as a point when they felt that the session was working. Not only were their thoughts in sync, but their brain activity, too.

The researchers also noted increased activity in both participants’ visual cortexes during these moments of change.

More effective therapy

It is unlikely that other case studies will provide the exact same results, due to the personalized nature of therapy. But more research will need to go into therapist-client relationships before the synchronicity can be confirmed.

Still, Prof. Fachner described the study as “a milestone in music therapy research.”

Music therapists report experiencing emotional changes and connections during therapy, and we’ve been able to confirm this using data from the brain.”

Prof. Jörg Fachner

He adds that the study has further implications than just proving a point. He explains, “By highlighting the precise points where sessions have worked best, it could be particularly useful when treating patients for whom verbal communication is challenging.”

The findings could also make music therapy more effective by exposing when and how a therapist should intervene for maximum efficacy.

And, as Prof. Fachner notes, studies such as this may “help [researchers] better understand emotional processing in other therapeutic interactions.”

 

via How does music therapy work? Brain study sheds light

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[WEB SITE] Antiepileptic drug use linked to increased risk of Alzheimer’s and dementia

The use of antiepileptic drugs is associated with an increased risk of Alzheimer’s disease and dementia, according to a new study from the University of Eastern Finland and the German Center for Neurodegenerative Diseases, DZNE. Continuous use of antiepileptic drugs for a period exceeding one year was associated with a 15 percent increased risk of Alzheimer’s disease in the Finnish dataset, and with a 30 percent increased risk of dementia in the German dataset.

Some antiepileptic drugs are known to impair cognitive function, which refers to all different aspects of information processing. When the researchers compared different antiepileptic drugs, they found that the risk of Alzheimer’s disease and dementia was specifically associated with drugs that impair cognitive function. These drugs were associated with a 20 percent increased risk of Alzheimer’s disease and with a 60 percent increased risk of dementia.

The researchers also found that the higher the dose of a drug that impairs cognitive function, the higher the risk of dementia. However, other antiepileptic drugs, i.e. those which do not impair cognitive processing, were not associated with the risk.

“More research should be conducted into the long-term cognitive effects of these drugs, especially among older people,” Senior Researcher Heidi Taipale from the University of Eastern Finland says.

Besides for epilepsy, antiepileptic drugs are used in the treatment of neuropathic pain, bipolar disorder and generalized anxiety disorder. This new study is the largest research on the topic so far, and the first to investigate the association in terms of regularity of use, dose and comparing the risk between antiepileptic drugs with and without cognitive-impairing effects. The results were published in the Journal of the American Geriatrics Society.

The association of antiepileptic drug use with Alzheimer’s disease was assessed in Finnish persons diagnosed with Alzheimer’s disease and their controls without the disease. This study is part of the nationwide register-based MEDALZ study, which includes all 70,718 persons diagnosed with Alzheimer’s disease in Finland during 2005-2011 and their 282,862 controls. The association of antiepileptic drug use with dementia was investigated in a sample from a large German statutory health insurance provider, Allgemeine Ortskrankenkasse (AOK). The dataset includes 20,325 persons diagnosed with dementia in 2004-2011, and their 81,300 controls.

via Antiepileptic drug use linked to increased risk of Alzheimer’s and dementia

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[Abstract] The Impact of Traumatic Brain Injury on Later Life: Effects on Normal Aging and Neurodegenerative Diseases

ABSTRACT

The acute and chronic effects of traumatic brain injury (TBI) have been widely described; however, there is limited knowledge on how a TBI sustained during early adulthood or mid-adulthood will influence aging. Epidemiological studies have explored whether TBI poses a risk for dementia and other neurodegenerative diseases associated with aging. We will discuss the influence of TBI and resulting medical comorbidities such as endocrine, sleep, and inflammatory disturbances on age-related gray and white matter changes and cognitive decline. Post mortem studies examining amyloid, tau, and other proteins will be discussed within the context of neurodegenerative diseases and chronic traumatic encephalopathy. The data support the suggestion that pathological changes triggered by an earlier TBI will have an influence on normal aging processes and will interact with neurodegenerative disease processes rather than the development of a specific disease, such as Alzheimer’s or Parkinson’s. Chronic neurophysiologic change after TBI may have detrimental effects on neurodegenerative disease.

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via The Impact of Traumatic Brain Injury on Later Life: Effects on Normal Aging and Neurodegenerative Diseases | Abstract

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[WEB SITE] Hospital wins patent in VR treatment for cognitive disorders.

A local hospital is drawing attention by winning a patent in cognitive rehabilitation treatment using a 3D virtual reality (VR) technology.

The Gil Medical Center and Gachon University’s industry-university cooperation foundation said on Monday they registered the patent in “a method and system using 3D virtual reality for the treatment of cognitive impairment.” Professor Lee Ju-kang of Gachon University Gil Medical Center’s physical medicine and rehabilitation department had developed the system.

The invention allows doctors to treat a wide range of cognitive disorders, including dementia, with all the different kinds of virtual space. Physicians expect better treatment results with the new technology, which offers virtual areas such as homes that are more familiar to patients than hospital’s treatment rooms.

To build 3D background information, the user of the program should visit the patient’s home and scan it first. Then, the user can save it as a database.

“Existing dementia treatments are quite limited, as most of them focus on prevention of further progress rather than on cure. Thus, it is becoming more important to use rehabilitation treatment to prevent dementia-derived adjustment disorders or accidents in daily life,” the medical center stated in the patent explanation.

“Existing treatments include cognitive rehabilitation offered in a limited environment such as hospital’s treatment room and cognitive training through a few computer programs, which are far from real life,” it went on to say. “By generating 3D virtual reality, we have developed a system to give patients easier access to necessary environment and targets and treat their cognitive impairment.”

Earlier, the hospital unveiled a plan to open a “VR Life Center” next January to treat patients with post-traumatic stress disorder and panic disorder.

“If we combine VR technology with medical treatment software, we can reenact an environment, which is difficult to visit in reality and expect better treatment results,” the hospital said. “VR treatments have already been used as a psychological treatment for a phobia and an addiction and have proven effective.”

via Hospital wins patent in VR treatment for cognitive disorders – Korea Biomedical Review

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[BLOG POST] 20 Must-Know Facts To Harness Neuroplasticity And Improve Brain Health

2016-06-21-1466519690-6875968-holdingbrain.jpg

June is Alzheimer’s & Brain Awareness Month, so let me share these 20 Must-Know Facts to Harness Neuroplasticity & Improve Brain Health that come from the hundreds of scientific and medical studies we analyzed to prepare the book The SharpBrains Guide to Brain Fitness: How to Improve Brain Health and Performance at Any Age:

  1. There is more than one “It” in “Use It or Lose It” — our performance depends on a variety of brain functions and cognitive skills, not just one (be it “attention” or “memory” or any other).
  2. Genes do not determine the fate of our brains. Thanks to lifelong neuroplasticity, our lifestyles are as important as our genes-if not more- in how our brains grow and our minds evolve.
  3. We need to pay more attention to Randomized Controlled Trials (RCTs) to verify whether any intervention causes an effect, and under what specific circumstances.
  4. The largest recent RCT (the ongoing FINGER study) and a 2010 systematic review of all relevant RCTs provide useful guidance: First, they report a protective effect of social and cognitive engagement, physical exercise, and the Mediterranean diet. Second, the average benefits at the population level appear quite limited, so we need to have realistic expectations.
  5. Physical exercise and increased fitness promote brain functioning through a variety of mechanisms, including increased brain volume, blood supply and growth hormone levels.
  6. Cardiovascular exercise that gets the heart beating – from walking to skiing, tennis and basketball – seems to bring the greatest brain benefits; thirty to sixty minutes per day, three days a week, seems to be the best regimen.
  7. Mental stimulation strengthens the connections between neurons (synapses), improving neuron survival and cognitive functioning. Mental stimulation also helps build cognitive reserve, helping the brain better cope with potential AD pathology.
  8. Routine activities do not challenge the brain. Keeping up the challenge requires going to the next level of difficulty, or trying something new.
  9. The only leisure activity that has been associated with reduced cognitive function is watching television.
  10. Brain training can work, putting the “cells that fire together wire together” to good use, but available RCTs suggest some key conditions must be met to transfer to real-life benefits.
  11. The brain needs a lot of energy: It extracts approximately 50% of the oxygen and 10% of the glucose from arterial blood.
  12. The Mediterranean Diet, supplemented with olive oil and nuts, is associated with decreased risk of cognitive decline.
  13. Moderate doses of caffeine increase alertness but there is no clear sustained lifetime health benefit (or harm).
  14. Light-to-moderate alcohol consumption seems to lower the risk of dementia.
  15. Taking “brain supplements” of any kind does not seem to boost cognitive function or reduce risks of cognitive decline or dementia, unless directed to address an identified deficiency.
  16. The larger and the more complex a person’s social network is, the bigger the amygdala (which plays a major role in our behavior and motivation). There is no clear evidence to date on whether “online” relationships are fundamentally different from “offline” ones in this regard.
  17. Chronic stress reduces and can even inhibit neurogenesis. Memory and general mental flexibility are impaired by chronic stress.
  18. There is increasing evidence that meditation and biofeedback can successfully teach users to self-regulate physiological stress responses.
  19. We will not have a Magic Pill or General Solution to solve all our cognitive challenges any time soon, so a holistic multi-pronged approach is recommended, centered around nutrition, stress management, and both physical and mental exercise.
  20. Having said that, no size fits all, so it’s critical to understand and address individual needs, priorities and starting points.

Now, remember that what counts in terms of brain health is not reading this article, or any other, but practicing some healthy behaviors every day until small steps become internalized habits.

Revisit the fact above that really grabbed your attention…and make a decision to try something new this summer.

Source: 20 Must-Know Facts To Harness Neuroplasticity And Improve Brain Health | HuffPost

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[ARTICLE] The effect of active video games on cognitive functioning in clinical and non-clinical populations: A meta-analysis of randomized controlled trials – Full Text

Abstract

Physically-active video games (‘exergames’) have recently gained popularity for leisure and entertainment purposes. Using exergames to combine physical activity and cognitively-demanding tasks may offer a novel strategy to improve cognitive functioning. Therefore, this systematic review and meta-analysis was performed to establish effects of exergames on overall cognition and specific cognitive domains in clinical and non-clinical populations. We identified 17 eligible RCTs with cognitive outcome data for 926 participants. Random-effects meta-analyses found exergames significantly improved global cognition (g = 0.436, 95% CI = 0.18–0.69, p = 0.001). Significant effects still existed when excluding waitlist-only controlled studies, and when comparing to physical activity interventions. Furthermore, benefits of exergames where observed for both healthy older adults and clinical populations with conditions associated with neurocognitive impairments (all p < 0.05). Domain-specific analyses found exergames improved executive functions, attentional processing and visuospatial skills. The findings present the first meta-analytic evidence for effects of exergames on cognition. Future research must establish which patient/treatment factors influence efficacy of exergames, and explore neurobiological mechanisms of action.

1. Introduction

Cognition can be broadly defined as the actions of the brain involved in understanding and functioning in our external environment (Hirschfeld and Gelman, 1994). As it is generally accepted that cognition requires multiple mental processes, this broader concept has been theoretically separated into multiple ‘cognitive domains’ (Hirschfeld and Gelman, 1994). Although definitions vary, and the boundaries between domains often overlap, examples of distinct areas of cognitive functioning include the processes for learning and remembering verbal and spatial information, attentional capacities, response speed, problem-solving and planning (Strauss et al., 2006).

Various neuropsychological tests have been developed as tools for assessing and quantifying an individual’s overall cognitive functioning (or ‘global cognition’) along with their performance within the separable domains of cognition (Strauss et al., 2006). Performance in these various cognitive tests has been found to be relatively stable over time in healthy adults, and moderately accurate predictors of real-world functioning and occupational performance (Chaytor and Schmitter-Edgecombe, 2003 ;  Hunter, 1986). Furthermore, neuropsychological tests can detect the deficits in cognitive functioning which arise as a consequence of various psychiatric and neurological diseases (Mathuranath et al., 2000 ;  Nuechterlein et al., 2004). For example, people with Parkinson’s disease show marked impairments in planning and memory tasks (Dubois and Pillon, 1996), whereas those with schizophrenia have cognitive pervasive deficits, 1–2 standard deviations below population norms, which also predict the severity of disability in this population (Green et al., 2000). Additionally, cognitive abilities decline naturally in almost all people during healthy ageing (Van Hooren et al., 2007). In an ageing population, the functional consequences of cognitive decline may ultimately have a severe social and economic impact. Thus, interventions which improve cognition hold promise for the treatment of psychiatric and neurological diseases, an have positive implications for population health.

Fortunately, interventions which stimulate the brain and/or body can improve cognition, or attenuate decline. For instance, physical exercise has been shown to significantly improve global cognition, along with working memory and attentional processes, in both clinical and healthy populations (Firth et al., 2016Smith et al., 2010 ;  Zheng et al., 2016). Interventions can also be designed to target cognition directly, as computerized training programs for memory and other functions have been found to provide significant cognitive benefits, at least in the short term (Hill et al., 2017 ;  Melby-Lervåg and Hulme, 2013). Furthermore, ‘gamification’ of cognitive training programs can maximize their clinical effectiveness, as more complex and interesting programs are capable of better engaging patients in cognitively-demanding tasks while also training multiple cognitive processes simultaneously (Anguera et al., 2013).

Previous studies have found that providing both aerobic exercise and cognitive training together may have additive effects, preventing ageing-related cognitive decline more effectively (Shatil, 2013). This may be due to aerobic and cognitive activity stimulating neurogenesis through independent but complementary pathways; as animal studies show that while exercise stimulates cell proliferation, learning tasks support the survival of these new cells (Kempermann et al., 2010), such that combining these two types of training results in 30% more new neurons than either task alone (Fabel et al., 2009).

Rather than delivering aerobic and cognitive training in separate training sessions, recent advances in technology has presented an opportunity for combining physical activity with cognitively-challenging tasks in a single session through ‘exergames’. Exergames are considered as interactive video-games which require the player to produce physical body movements in order to complete set tasks or actions, in response to visual cues (Oh and Yang, 2010). Common examples include the ‘Nintendo Wii’ (along with ‘Wii Fit’ or ‘Wii Sports software’) or the ‘Microsoft Xbox Kinect’. Additionally, virtual reality systems which use exercise bikes and/or treadmills as a medium for players to interact with three-dimensional worlds have also been developed to provide immersive training experiences (Sinclair et al., 2007).

Along with their popular usage for leisure and entertainment, there is growing interest in the application of exergame systems to improve clinical outcomes. Recent systematic reviews and meta-analyses of this growing literature have provided preliminary evidence that exergames can improve various health-related outcomes, including reducing childhood obesity, improving balance and falls risk factors in elderly adults, facilitating functional rehabilitation in people with parkinson’s disease, and even reduce depression (Barry et al., 2014Li et al., 2016 ;  van’t Riet et al., 2014). However, the effects of exergames on cognitive functioning have not been systematically reviewed, despite many individual studies in this area.

Therefore, the aim of this study was to systematically review all existing trials of exergames for cognition, and apply meta-analytic techniques to establish the effects of exergames on global cognition along with individual cognitive domains. We also sought to (i) examine the effects of exergames on cognition in healthy and clinically-impaired populations, and (ii) investigate if the effects of exergames differed from those of aerobic exercise alone, by comparing exergames to traditional physical activity control conditions.

Fig. 1

Fig. 1. PRISMA flow diagram of systematic search and study selection.

Continue —> The effect of active video games on cognitive functioning in clinical and non-clinical populations: A meta-analysis of randomized controlled trials

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[ARTICLE] Effects of Virtual Reality Exercise Program on Balance, Emotion and Quality of Life in Patients with Cognitive Decline

Abstract

Purpose:

In this study, we investigated the effectiveness of a 12-week virtual reality exercise program using the Nintendo Wii console (Wii) in improving balance, emotion, and quality of life among patients with cognitive decline.

Methods:

The study included 30 patients with cognitive decline (12 female, 18 male) who were randomly assigned to an experimental (n=15) and control groups (n=15). All subjects performed a traditional cognitive rehabilitation program and the experimental group performed additional three 40-minute virtual reality based video game (Wii) sessions per week for 12 weeks. The berg balance scale (BBS) was used to assess balance abilities. The short form geriatric depression scale-Korean (GDS-K) and the Korean version of quality of life-Alzheimer’s disease (KQOL-AD) scale were both used to assess life quality in patients. Statistical significance was tested within and between groups before and after treatment, using Wilcoxon signed rank and Mann-Whitney u-tests.

Results:

After 36 training sessions, there were significant beneficial effects of the virtual reality game exercise on balance (BBS), GDS-K, and KQOL-AD in the experimental group when compared to the control group. No significant difference was observed within the control group.

Conclusion:

These findings demonstrate that a virtual reality-training program could improve the outcomes in terms of balance, depression, and quality of life in patients with cognitive decline. Long-term follow-ups and further studies of more efficient virtual reality training programs are needed.

INTRODUCTION

Dementia is a degenerative disease of the nervous system, which is prevalent in the elderly population. It involves deterioration in cognitive function and ability to perform everyday activities. As the early diagnosis and treatment of dementia is delayed, its economic costs and burden on families and society are gradually increasing and becoming a social problem.1 Older people with dementia have an increased risk of falls and lower levels of everyday activities being performed due to cognitive decline and decreased muscle mass. This is a result of reduced physical activity, which further deteriorates their quality of life.2 Therapeutic interventions to improve cognitive function and to increase activities of daily living (ADL) in patients with dementia are divided into pharmacological and non-pharmacological treatments. For pharmacological treatment, acetylcholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists are the most widely used in clinical practice.3 However, because pharmacological treatment alone cannot prevent the progression of cognitive decline and ADL deterioration in patients with dementia, various non-pharmacological treatments including cognitive therapy or physical exercise are used as additional treatments.4
Recent reports have stated that regular exercise was effective in delaying cognitive impairment in people with dementia.5 In a three-year follow-up study of healthy older people, a combination of cognitive activity and physical activity was found to be effective in reducing the risk for mild cognitive impairment.6 However, physical activity was found to be more important than cognitive activity in order to further reduce the risk for cognitive decline.6 When older people with dementia performed regular physical exercise, there was an improvement in the mini-mental state examination (MMSE) score.7 Physical exercise prevented the deterioration of ADL.8 The mechanism of the benefit of physical exercise on patients with dementia is thought to be that it can facilitate neuroplasticity, promote injury recovery mechanisms at a molecular level and facilitate self-healing of the brain through its neuroprotective effect.9
However, unless individuals perform exercise in the long run, such beneficial effects of exercise may wear off, leading to impaired brain function and worsened disease.10 Therefore, patients with dementia should continue exercise under the supervision of professional physical therapists in order to stop the progression of cognitive impairment for a long time. In order to achieve this, it is required to keep patients interested in the exercise therapy allowing them to maintain adherence. However, it is difficult to execute exercise treatment continuously in patients with dementia because of space, time, and cost issues in Korea. Patients get easily bored and tired of passive and simply repetitive forms of exercise treatment. In general, 20-50% of older people who start an exercise program will stop within six months.11 Patients with dementia are expected to be more likely to discontinue exercise program due to lowered levels of patience and self-regulation abilities. Therefore, exercise programs utilizing media, including games, attempt to keep patients interested in exercise programs and to improve therapeutic effects. With recent advances in scientific technologies and computer programs, exercise and rehabilitation interventions using virtual reality are being introduced in the medical field.12 Virtual reality refers to a computer-generated environment that allows users to have experiences similar to those in the real world. It is an interactive simulation characterized by technology that provides reality through various feedbacks.13 While performing predetermined tasks such as playing a game in virtual reality, users manipulate objects as if they were real and can control their movements by giving and receiving various feedbacks via numerous senses such as sight and hearing.14
The virtual reality-enhanced exercise consisting of exercise with computer-simulated environments and interactive videogame features allows patients to enjoy performing tasks, encourages competition, and creates motivation and interest in their treatment.15 Participation in a virtual reality-enhanced exercise was reported to lead to higher exercise frequency and intensity and enhanced health outcomes when compared with traditional exercise.16
However, despite these advantages, conventional virtual reality systems could not be widely available for patients in clinical settings due to several limitations including high costs and a large size.17 Therefore, it is necessary to develop virtual reality exercise programs that are easy to follow in hospitals and at home. As an alternative, the use of computer-based individual training programmes is becoming increasingly popular due to the low cost, independence and ease of use in the home. One such system that is increasing in popularity for use in exercise training is the Nintendo Wii (Wii; Nintendo Inc., Kyoto, Japan) personal game, which became commercially available. Wii is a video gaming console with a simple method, as its virtual reality system is implemented via a television monitor. It combine physical exercise with computer-simulated environments and interactive videogame features. Because the Wii console is inexpensive and small in size, it is easy to install or move it in hospitals or at home. This gaming console is designed to be controlled using a wireless controller, allowing user to interact with his/her own avatar, which is displayed on the screen through a movement sensing system. The controller is provided with an acceleration sensor that responds to acceleration changes recognizing direction and velocity changes.18 Wii-balance board is being used when playing a Wii Fit game. It is a force plate collecting movement information in the center of pressure of the standing user, enabling reflection of movements in a virtual environment on the monitor and thus constantly resending visual feedback to the user. Through this process, the user can adjust his/her postural responses. Studies have shown that the Wii balance board can be helpful in postural control training.19 Because Wii is a typical example of virtual reality applications and is simple, inexpensive, and easily accessible, Wii is expected to create interest among patients encouraging them to put more efforts in exercise via games and thus augmenting effects of the treatment.
Domestic studies on the use of Wii have reported its effects on the upper extremity function, visual perception and sense of balance in chronic stroke patients,20 spinal cord injury patients,21 Parkinson’s disease patients,22 and multiple sclerosis patients.23 However, there have been only a few controlled research studies about the effects of Wii on patients with cognitive decline. The present study aimed to analyze effects of virtual reality exercise program on balance function, emotions, and quality of life (QOL) in patients with cognitive decline.

Continue —> Effects of Virtual Reality Exercise Program on Balance, Emotion and Quality of Life in Patients with Cognitive Decline – ScienceCentral

 

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Figure 1 The level of satisfaction about Wii game for dementia patients (Number=%).

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