Exercise intervention not effective in early dementia

Patients with early dementia or mild cognitive impairment did not benefit from an exercise and functional activity intervention in a recent trial.

Researchers in the United Kingdom randomly assigned patients with early dementia or mild cognitive impairment to the PrAISED (Promoting activity, Independence, and Stability in Early Dementia and mild cognitive impairment) intervention, a dementia-specific rehabilitation program focusing on strength, balance, physical activity, and activities of daily living, or to usual care plus a falls risk assessment. Those in the intervention group received up to 50 therapy sessions over 12 months. The primary outcome was score on a disability assessment for dementia scale 12 months after randomization, as reported by family or caregivers. Self-reported activities of daily living, physical activity, quality of life, balance, functional mobility, fear of falling, frailty, cognition, mood, caregiver strain, use of services at 12 months, and falls between months 4 and 15 were secondary outcomes. The results were published Aug. 29 by The BMJ.

Three hundred sixty-five patients were included in the trial, 183 assigned to the intervention group and 182 to the control group. Median age was 80 years (range, 65 to 95 years), median Montreal cognitive assessment score was 20 out of 30 (range, 13 to 26), 58% were men, and 98% were White. Overall, 19% had mild cognitive impairment, 39% had Alzheimer's dementia, 19% had vascular dementia, 16% had mixed dementia, and 7% had other or unknown conditions. Patients in the intervention group received a median of 31 therapy sessions (interquartile range, 22 to 40 sessions) and reported a mean of 121 minutes of PrAISED exercise each week. Sixty-eight percent of the sessions took place face-to-face, with some changes and accommodations necessary due to the COVID-19 pandemic. Data on the primary outcome were available for 149 patients in the intervention group and 141 in the control group. The groups did not differ in scores on the disability assessment for dementia scale (adjusted mean difference, −1.3; 95% CI, −5.2 to 2.6) or on most of the secondary outcomes. There were 375 falls in the intervention group and 421 in the control group, with 79 and 200, respectively, occurring between months 4 and 15 (adjusted incidence rate ratio, 0.78 [95% CI, 0.5 to 1.3]; P=0.3).

The researchers noted that the trial was not blinded and that the COVID-19 pandemic necessitated switching to remote delivery of the intervention, among other limitations. “We add to accumulating evidence that interventions to delay cognitive or functional decline in early dementia or mild cognitive impairment are ineffective,” they concluded. “So far, drug therapies, cognitive stimulation, exercise, and rehabilitation therapies have, at best, a small impact on functional activities and quality of life and do not appear to change the course of the disease.” They called for future interventions to focus on solving practical problems and crises, providing psychological and emotional support, and supporting family and other caregivers, among other factors.